Search PubMed⌕ Search

Biomedical subjects

S M Cox

Publications and source records attributed to S M Cox.

At least 19 recordsLinked to original sources
PubMed1999

Attachment behavior and its antecedents in offspring born to methadone-maintained women.

Videotaped 35 full-term, African American infants exposed in utero to methadone and 46 comparison infants at 12 months participating in a separation-reunion procedure to assess aspects of the infant's attachment relationship to the mother. Mothers in the two groups were comparable on education, age (18-35 years), socioeconomic status, parity, IQ and marital status. Offspring born to methadone-maintained women did not differ from comparison infants in indexes of proximity-seeking at reunion but did display higher scores on indexes of disorganized and avoidant behavior and lower scores on indexes of contact-maintaining behavior. Mothers' perceptions during pregnancy of their future infants' degree of bothersomeness were also related to higher scores on contact-maintaining behavior and lower scores on avoidant behavior. Finally, antecedents of attachment behavior within the opioid group alone were considered. The implications of using dimensional attachment ratings for uncovering more subtle attachment antecedents are discussed.

Adult↗
PubMed1998

Clinical chorioamnionitis and the prognosis for very low birth weight infants.

OBJECTIVE: To determine the effects of clinical chorioamnionitis on neonatal morbidity and mortality in very low birth weight infants. METHODS: This was an observational cohort analysis of all singleton live-born infants weighing 500-1500 g at 24 weeks' or greater gestational age and born between 1988 and 1996 at Parkland Memorial Hospital, Dallas, Texas. Chorioamnionitis was diagnosed on the basis of maternal fever of 38C with supporting clinical evidence, which included fetal tachycardia, uterine tenderness, and/or malodorous infant, and the absence of another source of infection. Multiple logistic regression analysis was used to adjust for outcomes of interest. RESULTS: Ninety-five of 1367 very low birth weight infants (7%) were exposed to chorioamnionitis. Neonatal sepsis, respiratory distress syndrome, seizure in the first 24 hours of life, intraventricular hemorrhage (grade 3 or 4), and periventricular leukomalacia were all significantly increased with chorioamnionitis, after adjusting for preterm ruptured membranes, pregnancy-associated hypertension, cesarean birth, gestational age, and birth weight. The odds ratios for intraventricular hemorrhage, periventricular leukomalacia, and seizures in the first 24 hours were 2.8 (95% confidence interval [CI] 1.6, 4.8), 3.4 (95% CI 1.6, 7.3), and 2.9 (95% CI 1.2, 6.8), respectively. CONCLUSION: Our results suggest a link between clinical chorioamnionitis and several indices of neonatal morbidity in the very low birth weight infant. Chorioamnionitis appears to make the very low birth weight infant particularly vulnerable to neurologic damage.

Cerebral Hemorrhage↗
PubMed1998

Syphilis.

Syphilis was first recognized as a distinct syndrome in Europe in the fifteenth century. Despite knowledge of congenital infection for more than 450 years and the existence of adequate therapy for 55 years, congenital infection remains a problem for the practicing clinician. Syphilis is caused by Treponema pallidum. Infection may be transmitted horizontally by sexual contact and vertically as a result of hematogenous dissemination across the placenta. Syphilis is classified as primary, secondary, latent, and tertiary. The diagnosis may be established by darkfield examination of clinical lesions and by serological assays. The drug of choice for syphilis is penicillin. This agent is the only antibiotic of proven value for the treatment of congenital syphilis. Accordingly, infected pregnant women who are allergic to beta-lactam antibiotics must be desensitized and then treated with penicillin.

Congenital Abnormalities↗
PubMed1997

The relationship of infection to method of delivery in twin pregnancy.

OBJECTIVE: Our purpose was to determine whether manipulation of the second twin increases the risk of postpartum infection. STUDY DESIGN: Medical records of all twin deliveries between January 1991 and December 1994 were reviewed. The route of delivery (vaginal vs cesarean section) was examined. The vaginal group was further divided into those delivered in the vertex/vertex position (i.e., no uterine manipulation) versus those delivered vertex/breech extraction (i.e., manipulation). The chi 2 and Student t test were used where appropriate. RESULTS: A total of 718 twins were identified, and maternal age, parity, gestational age at delivery (36 weeks), and birth weight (2278 gm) were similar among groups. The metritis rate was higher in the cesarean group (74/447 or 18%) than in the vaginal group (17/299 or 5.7%, p < 0.001). In comparing the vaginal group delivered without uterine manipulation with the vaginal group delivered with manipulation (i.e., breech extraction), there was no difference in the incidence of metritis (10/147 or 6.8% vs 7/152 or 4.6%, not significant). The length of time between delivery of twin A and twin B did not affect the metritis rate. Neonatal outcomes including sepsis, neonatal death, and length of hospitalization were similar among groups (not significant). CONCLUSION: Uterine manipulation of the second twin does not increase the risk of postpartum metritis or neonatal sepsis. In addition, the time interval between delivery of twins A and B has no effect on the rate of metritis. Although the rate of endometritis has been reported to be higher with twins delivered by cesarean section compared to singletons, the 18% rate of endometritis in twins delivered by cesarean section in this study is slightly lower than in our general population of cesarean deliveries (22%).

Adult↗
PubMed1997

Outcome of twin gestations with a single anomalous fetus.

OBJECTIVE: Our goal was to determine whether the presence of one anomalous fetus in a twin gestation affects pregnancy outcome when compared with twin pregnancies without fetal anomalies. STUDY DESIGN: Maternal and neonatal data from 970 twin pregnancies delivered from 1988 to 1995 were collected. Three groups of twin gestations were identified: one fetus with a major anomaly (n = 18), one fetus with a minor anomaly (n = 38), and both fetuses without anomalies (n = 914). RESULTS: Maternal demographic characteristics (age, race, and antepartum complications) were similar among the groups. There was no difference in neonatal outcome (gestational age at delivery, birth weight, cord pH, sepsis, and death) in the minor anomaly and no anomaly groups. There were significant differences between the major anomaly group and the no anomaly group in gestational age at delivery (32.9 vs 35.6 weeks, p < 0.05), birth weight at delivery (1759 vs 2291 gm, p < 0.05), hospital days (41 vs 13 days, p < 0.05), and perinatal death of the anomalous fetus (278/1000 vs 10/1000). Except for total days in the hospital, there was no difference in neonatal morbidity or mortality for the normal fetus when compared with the minor group or the no anomaly group. CONCLUSION: The presence of a fetus with a major anomaly in a twin gestation increases the risk of preterm delivery. The neonatal outcome of the nonanomalous fetus does not appear to be affected by the anomalous fetus.

Cesarean Section↗
PubMed1997

Urinary tract infections complicating pregnancy.

Urinary tract infections (asymptomatic bacteriuria, cystitis, and pyelonephritis) are frequently encountered medical complications of pregnancy. The majority of infections in pregnancy are asymptomatic; however, even covert bacteriuria places the mother at risk for low birth weight and preterm birth. Pyelonephritis can result in significant maternal and fetal morbidity and mortality. Therefore, all pregnant women should be screened for asymptomatic bacteriuria, and urinary tract infections should be promptly treated to prevent adverse pregnancy outcome. This article reviews the diagnosis, etiology, treatment, and complications associated with urinary tract infections in pregnancy.

Cystitis↗
PubMed1997

Chorioamnionitis and endometritis.

Chorioamnionitis complicates 1% to 2% of all pregnancies and may affect 10% of women with certain risk factors. Intraamnionic infection may result in devastating morbidity for both the fetus and the mother. Also, chorioamnionitis is associated with higher cesarean section rates. As demonstrated earlier, endometritis is a common complication of cesarean delivery alone. Nevertheless, antibiotic prophylaxis has been shown to reduce postpartum morbidity. In the face of chorioamnionitis and a cesarean delivery, the risk of developing endometritis increases exponentially. However, if appropriate antibiotic therapy is instituted at the time of diagnosis, fetal and maternal outcomes improve dramatically. Similar to chorioamnionitis, endometritis is usually polymicrobial in nature. The preponderance of the organisms isolated are anaerobic. Established risk factors include operative delivery, prolonged ruptured fetal membranes, and prolonged labor. The diagnosis is based primarily on clinical examination with fever and the exclusion of other sources of extrapelvic infection. Once the diagnosis is established, appropriate empiric antibiotics are instituted. Antibiotic therapy should be continued until the patient is afebrile and asymptomatic for 24 to 36 hours. Over the past 20 years, the use of single-agent therapy in these serious infections has been shown to be safe as well as effective. Once successful therapy is completed, the patient is discharged home with no oral antibiotics.

Chorioamnionitis↗
PubMed1997

Postcesarean analgesia with both epidural morphine and intravenous patient-controlled analgesia: neurobehavioral outcomes among nursing neonates.

UNLABELLED: Among nursing parturients after cesarean delivery, intravenous patient-controlled analgesia (PCA) with meperidine is associated with significantly more neonatal neurobehavioral depression than PCA with morphine. A single dose of epidural morphine (4 mg) decreases postcesarean opioid analgesic requirements and may reduce or prevent neonatal neurobehavioral depression associated with PCA meperidine. Prospectively, 102 term parturients underwent cesarean delivery with epidural anesthesia, 2% lidocaine and epinephrine 1:200,000. After umbilical cord clamping, each patient received epidural morphine 4 mg and was randomly allocated to receive either PCA meperidine or PCA morphine. Initial neonatal characteristics, included gestational age, Apgar scores, weight, and umbilical cord gas partial pressures. Brazelton Neonatal Behavioral Assessment Scale (NBAS) examinations were performed on each of the first 4 days of life. Nursing infants (n = 47) were grouped according to maternal PCA opioid in breast milk (meperidine [n = 24] or morphine [n = 23]); bottle-fed infants (n = 56) served as the control group. The three infant groups were equivalent with respect to initial characteristics and NBAS scores on the first 2 days of life. On the third day of life, infants in the morphine group were significantly more alert and oriented to animate human cues compared with infants in the meperidine or control group. On the fourth day of life, infants in the morphine group remained significantly more alert and oriented to animate human auditory cues than infants in the meperidine group. Average PCA opioid consumption through 48 h postpartum was equivalent (0.54 mg/kg morphine and 4.7 mg/kg meperidine); however, even with these small doses, meperidine was associated with significantly poorer neonatal alertness and orientation than morphine. Morphine is the PCA opioid of choice for postcesarean analgesia among nursing parturients. IMPLICATIONS: Among nursing parturients after cesarean delivery, intravenous patient-controlled analgesia with meperidine is associated with more neonatal neurobehavioral depression than patient-controlled analgesia with morphine. In this study, we found that nursing infants exposed to morphine were more alert and oriented to animate human cues than those exposed to meperidine.

Adult↗
PubMed1996

Randomized investigation of antimicrobials for the prevention of preterm birth.

OBJECTIVE: Occult amniotic fluid infection has emerged as a possible cause of many heretofore unexplained preterm births. We sought to determine whether antimicrobial therapy is effective in preventing preterm delivery. STUDY DESIGN: A double-blind, placebo-controlled, randomized trial was conducted to study the efficacy of ampicillin-sulbactam and amoxicillin-clavulanic acid in women hospitalized for preterm labor between 24 and 34 weeks' gestation. During this investigation no tocolytics or steroids were used. RESULTS: Thirty-nine women with preterm labor received antimicrobial therapy and 39 received placebos. The mean gestational ages at study entry were 29.8 +/- 0.4 weeks (SEM) and 30.6 +/- 0.3 weeks in the antimicrobial and placebo groups, respectively (not significant). Similarly, the mean gestational ages at delivery were 34.2 +/- 0.7 and 34.1 +/- 0.6 weeks, respectively (not significant). Other index values of pregnancy outcome, for example, birth weight, neonatal morbidity, and prenatal death, were not significantly improved by antimicrobial therapy given to the mother in preterm labor. CONCLUSION: We find that antimicrobial therapy given to women in preterm labor is ineffective in the prevention of preterm birth.

Amoxicillin↗
PubMed1996

Ampicillin for neonatal group B streptococcal prophylaxis: how rapidly can bactericidal concentrations be achieved?

OBJECTIVE: Our purpose was to determine how rapidly bactericidal concentrations of ampicillin against group B streptococci are achieved in amniotic fluid and cord blood after a 2 gm maternal infusion. STUDY DESIGN: Ampicillin was administered at varying time intervals between 3 and 67 minutes before elective cesarean delivery in 40 women. Samples of amniotic fluid were obtained by amniocentesis just before the uterine incision was made. Umbilical and maternal blood were obtained at the time of delivery. Ampicillin concentrations were measured by high-pressure liquid chromatography. RESULTS: The mean concentrations of ampicillin measured in maternal and umbilical cord sera all exceeded the minimum bactericidal concentrations reported for group B streptococci (0.25 to 2.0 micrograms/ml) and were achieved as soon as 5 minutes after ampicillin infusion. Similarly, bactericidal levels of ampicillin in the amniotic fluid could be detected as early as 5 minutes. However, such concentrations of ampicillin in the amniotic fluid were achieved in only 85% of the pregnancies studied. CONCLUSIONS: Bactericidal levels of ampicillin against group B streptococci can usually be achieved rapidly in both fetal blood and amniotic fluid after a standard 2 gm intravenous dose given to the mother for neonatal prophylaxis.

Amniotic Fluid↗
PubMed1996

Clinical course of premature rupture of the membranes.

Premature rupture of the membranes (PROM), defined as rupture of the membranes before the onset of labor, is a common obstetric event occurring in 10% of pregnancies. Most of the time this occurs at or beyond 37 weeks' gestation with only 10% of PROM occurring at less than 37 weeks' gestation. The natural course of PROM is labor, and at term this is associated with a low rate of complications for the mother and the fetus. At less than 37 weeks' gestation PROM places the mother and the fetus at increased risk of short-term and long-term morbidity and mortality. Several factors related to preterm premature rupture of the membranes (PROM) add risk to the pregnancy and include premature delivery, infection in the mother and the fetus, effects of prolonged oligohydramnios on fetal development, abruptio placenta, prolapsed cord, and fetal malposition. Since the 1970s expectant management has been the standard treatment for PROM; however, in the majority of patients, this strategy results in the delivery of a preterm infant. In addition, controversy exists over the gestational age at which expectant management should be abandoned and active interventions to effect delivery pursued. This article discusses the natural history of PROM, the outcome of expectant management in PROM, and maternal and fetal outcomes in these patients. The emphasis of this discussion is on the preterm fetus.

Female↗
PubMed1995

Coarctation of the abdominal aorta in pregnancy: diagnosis by magnetic resonance imaging.

BACKGROUND: Coarctation of the aorta is rare, affecting one per 2000-3000 women. Abdominal coarctation is more commonly identified in women than in men, but only two cases have been reported in pregnancy. CASE: A 26-year-old woman was diagnosed with hypertension at 15 years of age. Her blood pressure was controlled adequately with beta-blockers. During her pregnancy, she was found to have coarctation of the abdominal aorta by magnetic resonance imaging. CONCLUSION: Magnetic resonance imaging is a safe, reliable means by which to confirm clinically suspected coarctation of the aorta during pregnancy.

Adrenergic beta-Antagonists↗
PubMed1995

Genital herpes during pregnancy: no lesions, no cesarean.

OBJECTIVE: To determine the effects at our hospital of adoption of the 1988 guidelines recommended by ACOG for management of genital herpes infections during pregnancy. METHODS: Between 1984-1986, 96 pregnancies complicated by active genital herpes were delivered at Parkland Hospital. The outcome of these pregnancies were compared with 217 similar pregnancies managed after implementation of the 1988 ACOG herpes guidelines. RESULTS: Adoption of the 1988 ACOG herpes guidelines resulted in a 37% decrease in the use of cesarean delivery for women with genital herpes infections at our hospital. Most of this decrease was because the new guidelines eliminated the need for a confirmatory negative herpes culture before permitting vaginal delivery. No neonatal herpes infections occurred as a result of implementing the ACOG recommendations. CONCLUSION: The rate of cesarean delivery for women with genital herpes infections during pregnancy declined significantly at our hospital as a result of the adoption of ACOG herpes guidelines, and there were no neonatal consequences, such as increased incidence of neonatal herpes simplex virus infection.

Cesarean Section↗
PubMed1995

The correlation between transperineal sonography and digital examination in the evaluation of the third-trimester cervix.

OBJECTIVE: To determine the correlation between transperineal or translabial ultrasound and digital examination of the cervix in the third trimester in women presenting to the obstetrical triage area complaining of uterine contractions and/or rupture of membranes. METHOD: One hundred women were evaluated initially with an ultrasound unit using a 5-MHz glove-covered curvilinear transducer applied to the perineum in the sagittal plane. Immediately after the ultrasound evaluation, another examiner assessed the cervix digitally, blinded to the sonographic results. Cervical dilatation, length, and station were assessed. RESULTS: Transperineal ultrasound correlated (P < .001) with digital cervical examination in the assessment of dilatation (Pearson correlation coefficient 0.87), length (Pearson correlation coefficient 0.80), and corrected station (Pearson correlation coefficient 0.69). CONCLUSION: There is a statistically significant correlation between the digital cervical examination and the sonographic assessment of cervical dilatation, length, and station by the transperineal approach.

Adult↗
PubMed1995

Intentional delivery versus expectant management with preterm ruptured membranes at 30-34 weeks' gestation.

OBJECTIVE: To determine maternal and neonatal outcomes in pregnancies complicated by preterm rupture of membranes (PROM) at 30-34 weeks' gestation. METHODS: A randomized controlled trial was conducted to study the benefits of expectant management in women hospitalized for PROM at 30-34 weeks' gestation. During this investigation, no tocolytics, corticosteroids, or prophylactic antibiotics were used. RESULTS: Sixty-eight women with PROM were managed expectantly and 61 were delivered intentionally. The mean gestational age at study entry was 31.7 weeks in both the expectant management and intentional delivery groups (P > .05). The mean gestational ages at delivery were similar (32.0 and 31.7 weeks, respectively). Other indices of pregnancy outcome (ie, birth weight, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, respiratory distress syndrome, and perinatal death) were not significantly improved by expectant management. However, there was a significant increase in the incidence of chorioamnionitis and antepartum hospitalization in the women managed expectantly. CONCLUSION: There were no clinically significant neonatal advantages to expectant management of ruptured membranes at 30-34 weeks. Antepartum hospitalization was decreased by 2.5 days in those women randomized to intentional delivery.

Adult↗
PubMed1995

Emergent obstetric management of uterine inversion.

Puerperal inversion of the uterus is an unusual and potentially life-threatening event occurring in the third stage of labor, but when managed promptly and aggressively inversion can result in minimal maternal morbidity and mortality. Once the diagnosis of inversion is made, measures should be undertaken to manage and correct acute blood loss and potential shock. In conjunction with anesthesia personnel, immediate uterine replacement should be considered. Uterine relaxants (MgSO4, terbutaline, or halothane) can be used if initial attempts fail; however, in the majority of patients successful immediate replacement without use of uterine relaxants is possible. The choice of anesthetic agent and uterine relaxants should be individualized based on the clinical scenario. Following manual replacement, massage and ecbolic agent(s) should be instituted immediately to prevent reinversion. Surgical repositioning via an abdominal or vaginal approach may be necessary in subacute or chronic inversions.

Anesthesia, Obstetrical↗