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R P Lorenz

Publications and source records attributed to R P Lorenz.

At least 19 recordsLinked to original sources
PubMed2000

Need for urgent delivery after third-trimester amniocentesis.

OBJECTIVE: To estimate the risk of need for urgent delivery after third-trimester amniocentesis as currently done using ultrasound guidance to assess fetal lung maturity. METHODS: Ultrasound records of women scheduled for third-trimester amniocenteses to assess fetal lung maturity from February 1990 through October 1997 were reviewed for possible complications during or immediately after procedures. Collected data included gestational age, indication for the procedure, number of needle passes, transplacental passage, needle gauge, and fluid color. The primary outcome examined was procedure-related complications that required emergency delivery or the decision to deliver before completion of maturity studies. Infants who developed hyaline membrane disease leading to neonatal intensive care admission were also identified. RESULTS: During the 7 1/2-year study period, 962 amniocenteses were done to assess lung maturity. Complete data were not available for 49 cases. Of the remaining 913 procedures, 15 (1.6%) were unsuccessful (needle pass without collecting fluid). Forty-one infants were delivered spontaneously or by cesarean on the same day as the procedure. However, complications that required delivery were identified in only six cases, an incidence of 0.7% (95% confidence interval = 0.16, 1.24). Complications included fetal heart rate abnormalities (n = 3), placental bleeding (n = 1), abruptio placentae (n = 1), and uterine rupture (n = 1). Only one of six complications had a single needle pass with clear fluid collected. Hyaline membrane disease occurred in 14 neonates, including two with mature indices. CONCLUSION: Although complications that required urgent delivery after third-trimester amniocentesis are rare, the risks of the procedure should be carefully weighed against the benefits.

Amniocentesis↗
PubMed1997

Maternal diabetes mellitus: which views are essential for fetal echocardiography?

OBJECTIVE: To determine which fetal echocardiography views are essential to detect the majority of cardiac defects in fetuses of women with diabetes mellitus. METHODS: Fetal echocardiograms performed from February 1990 through May 1996 on insulin-requiring women with diabetes were reviewed. Individual component views of the examination were analyzed for the detection of fetal congenital heart defects. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Multiple gestations and patients with additional risk factors for congenital heart defects were excluded. RESULTS: A total of 223 patients were included in the study. There were 11 (4.9%) congenital heart defects, eight of which were conotruncal. When the four-chamber view and outflow tracts appeared normal, additional views such as the ductal and aortic arches did not detect a cardiac defect. The sensitivity of the four-chamber view for detecting an abnormal heart increased from 73% to 82% with the addition of the aortic outflow tract. There were two false-negative and no false-positive diagnoses. CONCLUSION: The four-chamber and outflow tracts are the essential views that will detect most cardiac defects in fetuses of women with insulin-requiring diabetes mellitus.

Echocardiography↗
PubMed1997

Gestational diabetes mellitus in women receiving beta-adrenergics and corticosteroids for threatened preterm delivery.

OBJECTIVE: To determine whether the incidence of gestational diabetes mellitus (GDM) is increased in patients receiving corticosteroids with or without beta-adrenergic agents for threatened preterm delivery. METHODS: We reviewed the laboratory records of 3396 patients undergoing screening (1-hour glucose) and diagnostic testing (3-hour glucose tolerance test [GTT]) for GDM over 2 years. Patients with antepartum admissions during which they received corticosteroids with or without beta-adrenergic agents for threatened preterm delivery were compared with a control group during the same period. Differences between the study and control groups were analyzed using chi 2, Student t test, or Fisher exact test where appropriate. P < .05 was considered significant. RESULTS: Fifty patients in the study group were compared with 1985 control patients. The remaining 1361 patients failed to meet inclusion criteria. The overall incidence of diagnosed GDM was significantly greater in the corticosteroid-beta-adrenergic agents study group, in which five (23.8%) of 21 patients screened had abnormal 3-hour GTT results, compared with 79 (4.0%) of 1985 controls (P = .001). One-hour glucose screening test results were abnormal in 60% of the study group compared with 25% of the controls (P < .001). CONCLUSION: Patients treated with beta-adrenergic agents and corticosteroids for threatened preterm delivery are at a significantly increased risk for developing GDM. The high rate of abnormal results in response to the 1-hour glucose screen suggests that this test is of limited value in patients exposed to these medications.

Adrenergic beta-Agonists↗
PubMed1995

Pregnancy outcome in nulliparous women 35 years and older.

OBJECTIVE: To compare pregnancy and delivery complications of first births in women 35 years and older with women 25-29 years old. METHODS: Maternal and newborn records for first births at three suburban hospitals from July 1, 1986 to June 30, 1990 were studied retrospectively. RESULTS: The older women differed significantly in: 1) antepartum factors (type of insurance, marital status, prior pregnancy experience, weight gain, obesity, chronic and pregnancy-induced hypertension, gestational diabetes [without insulin], asthma, leiomyomas; and third-trimester bleeding), 2) intrapartum factors (anesthesia for vaginal delivery, gestational age at delivery, preterm labor, spontaneous labor, oxytocin use, malpresentation, cesarean births, and postpartum hemorrhage), and 3) neonatal outcomes (gestational age, birth weight, preterm births, abnormal karyotypes, neonatal intensive care unit admissions, low birth weight, and small for gestational age infants). Logistic regression determined that risk factors significantly predicting perinatal mortality were leiomyomas (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.3-5.0), preterm birth (OR 4.9, 95% CI 3.1-7.7), and chorioamnionitis (OR 5.9, 95% CI 3.1-11.4), but not age. CONCLUSION: Nulliparous women 35 years and older had higher rates of antepartum, intrapartum, and newborn complications than nulliparas between the ages of 25-29 years, but not an increased perinatal mortality rate. Despite the increased risk of complications, maternal and perinatal outcomes were good.

Adult↗
PubMed1995

Reduction in the rate of cesarean birth with active management of labor and intermediate-dose oxytocin.

Active management of labor (AML) was introduced to lower the cesarean birth rate in nulliparas by using oxytocin at a dose higher than commonly used in this country but less than that used in other AML studies. Cesarean birth rates among nulliparas were compared before and after introduction of AML. When indicated, oxytocin was begun at 2 mIU/min rather than 6 mIU/min, as used in other, similar studies. Three-hundred fifty-two historical control and 160 AML study patients in labor were compared. Analysis utilized chi 2 and Student's t test. AML patients had a lower rate of cesarean birth, 6.3%, than did control patients in spontaneous labor, 13.1% (P = .03). The overall cesarean birth rate for all nulliparas (including inductions and cesarean sections prior to labor) fell from 23% to 16% (P = .04). The introduction of an AML program using intermediate-dose oxytocin into the clinic service at a large, private teaching hospital has safely reduced the rate of cesarean births among nulliparas.

Adult↗
PubMed1994

Survival and short-term outcome in newborns of 23 to 25 weeks' gestation.

OBJECTIVES: We determined which factors are associated with survival and good short-term neurologic outcome in newborns of 23 to 25 weeks' gestation. STUDY DESIGN: We retrospectively reviewed the charts of all (n = 82) infants born alive at our hospital at 23 to 25 weeks' gestation from 1988 through 1991. We used univariate and multiple logistic regression analysis to compare survivors at hospital discharge with nonsurvivors and those with and without good short-term neurologic outcome. RESULTS: Survival rates were 19%, 59%, and 65% at 23, 24, and 25 weeks' gestation, respectively. A total of 90% of survivors had good short-term neurologic outcome. On multiple logistic regression analysis, female sex (odds ratio 8.7, 95% confidence limits 2.2 and 34), larger birth weight (odds ratio 2.5 per 100 gm increment, 95% confidence limits 1.3 and 4.9), and more advanced gestational age (odds ratio 5.3, 95% confidence limits 1.2 and 22 for 24 weeks; odds ratio 3.8, 95% confidence limits 0.6 and 22 for 25 weeks) were associated with survival. Female sex, more advanced gestational age, and larger birth weight were also associated with good short-term neurologic outcome. CONCLUSIONS: Good short-term neurologic outcome is possible in many survivors in this gestational age range. Factors other than gestational age may be considered when intervention in these pregnancies is contemplated.

Birth Weight↗
PubMed1991

Importance of locally derived birth weight nomograms.

Significant differences exist between the published nomograms of birth weight for gestational age. Differences in demographics, altitude above sea level and study methodology have all been implicated. A three-year experience of uncomplicated singleton gestations (N = 14,766) was analyzed for birth weight and gestational age. The mean, 10th percentile and their 95% confidence intervals were compared to Brenner's data and a pooled sample from other studies in this country. The mean birth weights were significantly higher than Brenner's after 32 weeks' gestation and higher than the pooled mean after 35. The 10th percentiles were significantly greater than Brenner's after 36 weeks' gestation. Approximately 66% of neonates at risk, below our 10th percentile, would not be identified with Brenner's criteria. We agree with Goldenberg that uniform criteria for the definition of the normal population are important in identifying aberrant growth. However, birth weight standards should be developed for the specific population in question.

Altitude↗
PubMed1990

A prospective controlled study of outcome after trauma during pregnancy.

In a prospective cohort study, 85 women who suffered varying degrees of trauma during pregnancy (12 to 41 weeks) were compared with a control group of pregnant women matched for gestational age. Fetomaternal transfusion occurred significantly more frequently in the study group (30.6% vs 8.2%, p less than 0.05). Study subjects whose placentas were anteriorly placed were at increased risk for fetomaternal transfusion on comparison with other placental positions (47% vs 23.5%, p less than 0.05). Immediate adverse outcomes including abruptio placentae occurred frequently in the study group (9.4%) and were not predictable on the basis of injury severity. When immediate adverse outcomes were excluded, there was no difference in pregnancy outcome. Four hours of cardiotocographic monitoring used as a screening tool was found to be an extremely sensitive but nonspecific indicator of immediate adverse outcomes. On the basis of these findings, it is recommended that routine screening for fetomaternal transfusion occur in all pregnant women who suffer trauma during pregnancy beyond 11 weeks' gestation and that a minimum of 4 hours of cardiotocographic monitoring occur in women greater than 20 weeks' gestation.

Abruptio Placentae↗
PubMed1990

Randomized prospective trial comparing ultrasonography and pelvic examination for preterm labor surveillance.

This study was designed to compare the effectiveness of cervical assessment by either ultrasonography or bimanual pelvic examination in a program for preterm labor surveillance. Patients (n = 57) at risk for preterm birth were seen once a week for patient education, review of symptoms, and cervical evaluation. Cervical evaluation was assigned randomly to either ultrasonographic evaluation or pelvic examination. The groups did not differ in demographic or obstetric factors. The overall rate of prematurity was 18%. Preterm labor was more frequent with ultrasonographic evaluation (52%) than with pelvic examination (25%) (p less than 0.05). The group evaluated by ultrasonography received oral tocolytic agents (55%) more than the group that had pelvic examinations (21%) (p less than 0.02). The groups did not differ in infant birth weights, length of gestation, or neonatal mortality or morbidity. In this prospective randomized study of patients at risk for preterm birth, patients under surveillance by ultrasonographic assessment of the cervix did not fare better than those assigned to bimanual examination.

Adult↗
PubMed1989

Multidisciplinary team counseling for fetal anomalies.

Prenatal management of fetal anomalies requires a cooperative effort of the family, obstetrician, ultrasonographer, neonatologist, pediatric subspecialists, nursing staff, geneticists, and social workers. Our approach to these patients is to convene all team members and the family shortly after an anomaly is identified to review the diagnosis, prognosis, plans, and alternatives. Team counseling offers a clear definition of the problem, avoids unnecessary confusion and anxiety for the family, and provides a supportive environment during this family crisis. Our experience with 28 families has been favorable and is described herein.

Congenital Abnormalities↗
PubMed1989

Acute neurohumoral response to electroconvulsive therapy during pregnancy. A case report.

The neurohumoral changes induced by electroconvulsive therapy (ECT) in pregnancy have not been described previously. In the nonpregnant adult, ECT causes an acute rise in prolactin, adrenocorticotropic hormone (ACTH), cortisol, norepinephrine, epinephrine and beta-endorphin. Because pregnancy alters the production and release of these hormones, consideration should be given to how ECT may further alter the neuroendocrine response, with possible implications for the success of treatment and the fetal response. A 30-year-old woman with a major affective disorder underwent a course of ECT beginning at 23 weeks' gestation. Serial hormonal assays of peripheral venous samples from -30 to +240 minutes were obtained during her first treatment. The prolactin, ACTH, norepinephrine, epinephrine, beta-endorphin, dopamine and oxytocin levels rose acutely and returned to baseline during observation. The maternal vital signs were stable. No increase in uterine activity or fetal heart rate abnormalities were observed during any treatment. A healthy infant weighing 2,900 g was delivered at term, with Apgar scores of 9 and 9 and no problems. We conclude that there are acute neurohumoral changes in specific hormones with ECT in pregnancy, but none of these changes appeared to adversely affect the fetus in our case.

Adult↗
PubMed1989

Survey of maternal-fetal medicine subspecialists: professional activities, job setting, and satisfaction.

We analyzed the job setting, professional activities, and satisfaction of subspecialists in maternal-fetal medicine. A two-page questionnaire was mailed to all members of the Society of Perinatal Obstetricians. The results were analyzed by multiple regression and multivariate analysis. Of 603 questionnaires mailed, 496 (80%) were returned; 70% of all certified maternal-fetal medicine subspecialists responded. The job setting of respondents was university hospital-based faculty in 66%, community hospital-based salaried in 15%, private practice in 10%, and other in 9%. The average percent of professional time devoted to each area was as follows: clinical work, 57% of all professional time; research, 18%; administrative, 15%; and educational, 11%. Time distribution, volume of hysterectomies, and number of peer-review publications were the only significant differences among job settings. For university hospital-based faculty, the time distribution was 50% clinical, 23% research, 16% administrative, and 11% educational. For community hospital-based salaried physicians, it was 63% clinical, 10% research, 16% administrative, and 11% educational; for private practice, it was 84% clinical, 7% research, 5% administrative, and 6% educational. Types of activities of maternal-fetal medicine subspecialists included ultrasound (75% of respondents, mean 436 studies per year), gynecologic procedures (71% of subspecialists, volume of 8.7 hysterectomies per year), genetic procedures (83%; 125 procedures per year), research (87%), recent peer-review publications (80%), grants (40%), and medicolegal reviews (64%). Ninety-five percent had a medical-school faculty appointment.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1988

Skin preparation methods before cesarean section. A comparative study.

Preoperative skin preparation before cesarean section using a one-minute alcohol wash followed by application of an iodophor-impregnated adhesive film was evaluated in a prospective, randomized, controlled study of 79 patients. The iodophor film was as effective as the five-minute iodophor scrub followed by an iodophor wash, as determined by a reduction in skin bacterial counts. Clinical infectious morbidity was no different between the treatment and control groups, although the study was too small to draw statistically significant conclusions in this respect. This study demonstrated the antimicrobial effectiveness of a new, more rapid method of pre-operative skin preparation before cesarean section as compared to a longer, traditional method. This new, rapid method offers advantages for many patients undergoing abdominal delivery.

Adhesives↗