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Biomedical subjects

T J Garite

Publications and source records attributed to T J Garite.

At least 19 recordsLinked to original sources
PubMed1995

The impact of amniotic fluid volume assessed intrapartum on perinatal outcome.

OBJECTIVE: Our purpose was to determine the value of routine intrapartum amniotic fluid volume assessment on perinatal outcome. STUDY DESIGN: Patients admitted for labor and delivery who were ultimately delivered between January 1988 and June 1989 with a gestational age > or = 26 weeks and who had an intrapartum amniotic fluid index composed the study group. The amniotic fluid index was determined by the four-quadrant technique on admission to labor and delivery. Oligohydramnios was defined as an amniotic fluid index < or = 5 cm (n = 170), borderline oligohydramnios as an amniotic fluid index 5.1 to 8.0 cm (n = 261), and normal amniotic fluid volume as an amniotic fluid index 8.1 to 20 cm (n = 336). Nine patients with an amniotic fluid index > 20 cm were excluded from data analysis. The oligohydramnios and borderline oligohydramnios groups were compared with the normal group with regard to antenatal, intrapartum, and postpartum variables. RESULTS: The groups had similar maternal age, parity, gestational age at delivery, and antenatal complications. Meconium-stained amniotic fluid occurred significantly less often in the oligohydramnios group compared with the normal group (relative risk 0.67, 95% confidence interval 0.49 to 0.92). However, variable decelerations occurred significantly more often in the oligohydramnios group compared with the normal group (relative risk 1.44, 95% confidence interval 1.12 to 1.87), and cesarean delivery for fetal distress also occurred significantly more often (relative risk 6.83, 95% confidence interval 1.55 to 30.4). There was no difference in Apgar scores or neonatal complications between groups. The efficacy of intrapartum-determined oligohydramnios predicting cesarean delivery for fetal distress gave a sensitivity of 78%, a specificity of 74%, a positive predictive value of 33%, and a negative predictive value of 95%. CONCLUSION: The amniotic fluid index for detecting intrapartum oligohydramnios is a valuable screening test for subsequent fetal distress requiring cesarean delivery.

Amniotic Fluid↗
PubMed1995

Development and experience of a university-based, freestanding birthing center.

OBJECTIVE: To describe our experience with a freestanding birthing center established in conjunction with a university medical center, and to determine the safety and effectiveness of such a program. METHODS: The University of California Irvine Medical Center opened a freestanding birthing center 2 miles from the hospital. The unit provides prenatal, labor, delivery, postpartum and well-baby care 24 hours/day. All direct patient care is provided by certified nurse-midwives. Data were collected prospectively to provide a descriptive account and to evaluate maternal and perinatal morbidity and mortality to determine the safety and efficacy of this approach. RESULTS: During the first 20 months of operation, the University of California Irvine Birthing Center cared for 1830 patients. Approximately 90% were indigent, 85% were Hispanic, and 35% were nulliparas. Of the total patients, 12% were transferred antenatally for high-risk conditions and 19% were transferred intrapartum. The cesarean rate for all patients was 10% (6.5% for those whose intrapartum care began at the birthing center). The perinatal mortality rate was six per 1000. Neonatal morbidity rates, neonatal intensive care unit admissions, and maternal complications were not greater than expected. CONCLUSION: The first 20 months of experience with a university-based, freestanding birthing center suggests that this alternative is safe for delivering obstetric and newborn care to low-risk patients.

Adolescent↗
PubMed1995

Third trimester POMC disregulation predicts use of anesthesia at vaginal delivery.

In a prospective study, third trimester plasma levels of BE and ACTH were determined in 58 women who delivered vaginally. Peptide regulation was compared between subjects who used conduction anesthesia at delivery and subjects who did not. Third trimester levels of maternal BE and ACTH were significantly related; however, the relationship was significant only in subjects who did not receive conduction anesthesia (n = 24) at delivery. The normal co-release pattern between BE and ACTH in subjects receiving conduction anesthesia (n = 34) during birth was uncoupled. The use of conduction analgesia during vaginal delivery was significantly related to a disregulation index created to quantify the BE-ACTH release pattern. Uncoupled ACTH and BE patterns may result from modified control of pro-opiomelanocortin (POMC) expression during pregnancy or unique proteolytic processing of POMC, and may alter pain tolerance during delivery.

Adolescent↗
PubMed1995

Evaluation of the nonreactive positive contraction stress test prior to 32 weeks: the role of the biophysical profile.

A nonreactive positive contraction stress test in a pregnancy near term is an indication for delivery. Such nonreassuring antepartum testing combined with severe prematurity presents a management dilemma. Ideally, prolongation of selected pregnancies would allow time for corticosteroid therapy and fetal maturation. Prior to 32 weeks' gestation, we utilized the biophysical profile to select patients for continued intrauterine management as an alternative to immediate delivery. Continued surveillance was undertaken if the fetus had a reassuring biophysical profile score; immediate delivery by cesarean section was undertaken if the biophysical profile score was nonreassuring. This approach allowed a mean gain of 13 days in utero for the continued surveillance group. There was no evidence of further fetal compromise in this group based on umbilical cord pH or 5-minute Apgar scores. These data suggest that the biophysical profile can be safely used to prolong selected preterm pregnancies with nonreactive positive contraction stress tests without adversely affecting the initial neonatal metabolic status.

Adult↗
PubMed1994

Tocolysis with indomethacin increases the incidence of necrotizing enterocolitis in the low-birth-weight neonate.

OBJECTIVE: The null hypothesis states that prolonged antenatal indomethacin exposure within 24 hours of delivery does not increase the incidence of necrotizing enterocolitis in the low-birth-weight neonate. STUDY DESIGN: The neonates of patients receiving indomethacin tocolysis admitted in preterm labor (N = 56) were compared with the neonates of preterm labor patients who received no indomethacin tocolysis (N = 703). These neonatal groups were then compared with regard to gestational age at delivery, birth weight, mode of delivery, antenatal magnesium and steroid exposure, incidence of respiratory distress syndrome, perinatal depression, sepsis, umbilical catheterization, and feeding rates and volumes. The overall incidence of necrotizing enterocolitis, mortality secondary to necrotizing enterocolitis, and the intervals from delivery and feeding to necrotizing enterocolitis diagnosis were also compared. The association between necrotizing enterocolitis and the duration of indomethacin exposure and the interval from exposure to delivery for both the indomethacin and control groups was determined. RESULTS: The incidence of necrotizing enterocolitis in neonates who were delivered within 24 hours of maternal indomethacin therapy was 20% compared with 9% in the control group (p = 0.005). The incidence of necrotizing enterocolitis in neonates with > 48 hours of antenatal indomethacin exposure was 26.4% compared with 4.1% in those with < 48 hours exposure (p = 0.042). The interval from first feeding to necrotizing enterocolitis development was significantly shorter in the indomethacin group versus the control group (2.1 +/- 3.0 vs 6.8 +/- 6.3 days) (p = 0.001), as was the mean interval from delivery to development of necrotizing enterocolitis (10.2 +/- 3.7 vs 15.2 +/- 3.8 days) (p = 0.019). CONCLUSIONS: Antenatal indomethacin exposure occurring within < or = 24 hours of delivery and of at least 48 hours' duration is associated with a significant increase in the incidence of necrotizing enterocolitis in the low-birth-weight neonate.

Birth Weight↗
PubMed1993

The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation.

OBJECTIVE: The aim was to test a model of the influence of maternal prenatal psychosocial stress on birth outcomes after controlling for biomedical risk. STUDY DESIGN: In a prospective study a sociodemographically homogeneous sample of 90 women was assessed during the third trimester with standard, reliable questionnaires that measured episodic and chronic stress, strain (response to stress), and pregnancy-related anxiety. Birth outcomes included infant birth weight, gestational age at birth, and intrapartum complications. Parity and biomedical (antepartum) risk was also coded. Bivariate and multivariate analyses were performed after controlling for the effects of biomedical risk factors. RESULTS: Independent of biomedical risk, each unit increase of prenatal life event stress (from a possible sample range of 14.7 units) was associated with a 55.03 gm decrease in infant birth weight and with a significant increase in the likelihood of low birth weight (odds ratio 1.32), and each unit increase of prenatal pregnancy anxiety (from a possible sample range of 5 units) was associated with a 3-day decrease in gestational age at birth. CONCLUSION: Independent of biomedical risk, maternal prenatal stress factors are significantly associated with infant birth weight and with gestational age at birth.

Adult↗
PubMed1993

Use of Amniostat-FLM in detecting the presence of phosphatidylglycerol in vaginal pool samples in preterm premature rupture of membranes.

OBJECTIVE: The presence of phosphatidylglycerol in amniotic fluid from the vaginal pool has been established as a reliable marker of pulmonary maturity in pregnancies complicated by preterm premature rupture of membranes because its presence is not affected by contaminants. This study was undertaken to determine the distribution of positive phosphatidylglycerol relative to gestational age from vaginal pool amniotic fluid samples and to assess the efficacy and accuracy of the Amniostat-FLM (Hana Biologics; Irvine Scientific after Sept. 14, 1989), an antibody agglutination method for rapidly detecting phosphatidylglycerol. STUDY DESIGN: All singleton nondiabetic pregnancies between 26 and 36 weeks with premature rupture of membranes from whom a vaginal pool sample was obtained were studied. The percent positive by gestational age was analyzed. The neonates that were delivered with a positive phosphatidylglycerol were evaluated for the presence of hyaline membrane disease and other immediate sequelae of prematurity. RESULTS: Of the 201 vaginal pool amniotic fluid samples assayed for phosphatidylglycerol with the Amniostat-FLM procedure, 18% (36/201) were positive for phosphatidylglycerol and none of the delivered infants developed hyaline membrane disease. CONCLUSION: The Amniostat-FLM seems to be accurate in predicting pulmonary maturity from vaginal pool samples.

Agglutination Tests↗
PubMed1993

The influence of elective amniotomy on fetal heart rate patterns and the course of labor in term patients: a randomized study.

OBJECTIVES: Our study was designed to evaluate the effects of routine elective amniotomy on the frequency and severity of abnormal fetal heart rate patterns and on the course of labor and the need for oxytocin augmentation. STUDY DESIGN: A randomized, controlled trial was conducted at term in patients in active labor who were randomly selected to undergo elective amniotomy (amniotomy group) or left intact with amniotomy reserved for specific indications (intact group). RESULTS: Four hundred fifty-nine patients were studied (235 in the amniotomy group vs 224 in the intact group). Average cervical dilatation at rupture was 5.5 cm in the amniotomy group and 8.1 cm in the intact group. Analysis of fetal heart rate revealed more mild and moderate variable decelerations in the active phase of labor in the amniotomy group but no difference in the frequency of more severe decelerations or operative deliveries. In the intact group the need for oxytocin was twice as common (76 in the intact group vs 36 in the amniotomy group, p = 0.000005), and the active phase of labor was considerably longer (5 hours 56 minutes in the intact group vs 4 hours 35 minutes in the amniotomy group). Neonatal outcome was similar in the two groups. CONCLUSIONS: Elective amniotomy appears to increase the likelihood of umbilical cord compression in the active phase of labor and results in more mild and moderate variable decelerations, but it does not result in more severe abnormal fetal heart rate patterns or more operative intervention. Elective amniotomy does, however, shorten the active phase of labor and decreases the need for oxytocin augmentation.

Amnion↗
PubMed1993

Cocaine intoxication presenting as preeclampsia and eclampsia.

OBJECTIVE: To relate the clinical presentation of acute cocaine intoxication in the third trimester to preeclampsia and eclampsia. METHODS: Eleven women presented to Long Beach Memorial Women's Hospital and the University of California, Irvine Medical Center with hypertension and clinical symptoms of headache, blurred vision, abdominal pain, or seizures in the third trimester of pregnancy. Each had a positive urine drug screen for cocaine. The laboratory evaluation for preeclampsia included a complete blood count, platelet count, uric acid, aspartate aminotransferase, alanine aminotransferase, creatinine, and urine for protein content. RESULTS: All women had a diastolic blood pressure of at least 90 mmHg, which returned to the normal range 45-90 minutes after admission. Each presented with one or more symptoms associated with preeclampsia, which ultimately improved as the drug wore off. In addition, all laboratory evaluations for preeclampsia were negative. CONCLUSION: If a patient presents in the third trimester with hypertension and clinical symptoms of preeclampsia that rapidly improve shortly after admission, cocaine intoxication should be considered as the possible source.

Cocaine↗
PubMed1992

Prostaglandin E2 for induction of labor in patients with premature rupture of membranes at term.

OBJECTIVE: A prospective study comparing three management schemes for patients at term with premature rupture of membranes was performed. STUDY DESIGN: One hundred forty patients were randomized to one of three study groups: prostaglandin E2, placebo, or oxytocin. Patients randomized to prostaglandin E2 and placebo received vaginal suppositories containing 3 mg prostaglandin E2 or glycerin only, respectively; suppositories were administered in a double-blind fashion, on one or two occasions, 6 hours apart. Oxytocin was given only if labor was not established after 12 hours or to augment inadequate labor. In patients randomized to oxytocin labor was induced with intravenous oxytocin. The time interval to delivery, delivery outcome, and complications were analyzed. RESULTS: Patients receiving prostaglandin E2 were more likely to be in labor after one suppository and to be delivered without the addition of oxytocin when compared with placebo. The time interval to delivery was shorter with prostaglandin E2 and oxytocin induction versus placebo ("expectant management"). The incidence of maternal infection was lowest in patients with labor induced by prostaglandin E2. Although the overall cesarean section rate was low, there was a trend toward a lower rate with prostaglandin E2 induction. No adverse effects were observed with prostaglandin E2. CONCLUSION: Prostaglandin E2 can be used successfully to induce labor after premature rupture of membranes at term with greater ease of administration when compared with oxytocin.

Cesarean Section↗
PubMed1992

A randomized, placebo-controlled trial of betamethasone for the prevention of respiratory distress syndrome at 24 to 28 weeks' gestation.

Previous randomized controlled studies of corticosteroids for the reduction of respiratory distress syndrome have failed to demonstrate benefit in very early premature gestational age groups. A randomized, double-blind, placebo-controlled clinical trial of betamethasone given to mothers with intact membranes and threatened premature delivery between 24 and 28 weeks of pregnancy was conducted. Thirty-six patients were randomized to receive betamethasone, two doses of 12 mg, 24 hours apart, and 41 received placebo. No difference was found in the overall incidence of respiratory distress syndrome between the two groups (betamethasone vs placebo 0.55 vs 0.66) or in the incidence of respiratory distress syndrome in babies delivered between 1 and 7 days after the first dose of drug (betamethasone vs placebo 0.78 vs 0.88). Nor were there any differences observed in any measure of severity of respiratory distress syndrome between the groups. The neonatal death rates were also similar (betamethasone vs placebo 0.25 vs 0.24). The only difference seen was an unexpected reduction in the betamethasone group in the incidence of grades 3 and 4 intraventricular hemorrhage (betamethasone vs placebo 1/31 vs 9/36, p = 0.01). Therefore this study was unable to demonstrate any beneficial effect of corticosteroids in reducing respiratory distress syndrome at less than 28 weeks' gestation in spite of a sample size that had an 80% likelihood of detecting a 50% reduction in the incidence of respiratory distress syndrome with p = 0.05, which is the minimum reduction seen in virtually all randomized trials in other gestational age groups.

Adult↗
PubMed1992

Effects of digital vaginal examinations on latency period in preterm premature rupture of membranes.

OBJECTIVE: To compare the clinical outcome in patients with preterm premature rupture of membranes (PROM) who had a sterile speculum examination with those having a digital vaginal examination. METHODS: We studied 271 singleton pregnancies complicated by preterm PROM from the Memorial Medical Center of Long Beach Perinatal Outreach program that met the criteria for expectant treatment from January 1986 to April 1990. Patients were not included in the study if they had multiple gestations, cerclage, advanced labor, or any indication for delivery on admission (eg, mature lung profile, chorioamnionitis). All subjects were maternal transports to our tertiary care facility and were managed similarly by our perinatal group. The women were questioned as to whether a digital vaginal examination had been performed before transport. Latency period and other obstetric characteristics were then compared. The latency period, defined as days from rupture of membranes until active intervention was initiated or labor began spontaneously, was also stratified by gestational age. RESULTS: One hundred twenty-seven subjects had a digital vaginal examination and 144 had a sterile speculum examination. A significantly (P less than .0001) shorter mean latency period (2.1 +/- 4.0 versus 11.3 +/- 13.4 days) was found in those who had a digital vaginal examination. In addition, a shorter latency period was noted for each gestational age. No difference in uterine activity or cervical dilatation and effacement was noted between the groups on admission. CONCLUSION: Digital vaginal examinations performed on patients whose pregnancies are complicated by preterm PROM appear to shorten significantly the latency period.

Chorioamnionitis↗
PubMed1992

Fetal fibronectin: a method for detecting the presence of amniotic fluid.

OBJECTIVE: To determine whether fetal fibronectin is a sensitive test for the detection of amniotic fluid (AF) in women with rupture of the membranes. METHODS: In a multicenter clinical trial, pooling, ferning, and nitrazine tests were compared with fetal fibronectin in 339 women at term (study group) with a clinical history of rupture of the membranes and in 67 women at term receiving routine prenatal care (controls). Ruptured membranes was diagnosed if any two of the standard tests were positive. Fetal fibronectin in the cervicovaginal secretions was determined using a qualitative enzyme-linked immunosorbent assay test. Fetal fibronectin was considered positive at 50 ng/mL. RESULTS: The sensitivity of fetal fibronectin in the women with ruptured membranes was 98.2%. No controls had ruptured membranes based on standard test results, but 13 women had fetal fibronectin present. The mean (+/- standard error) interval between sampling and delivery was significantly less in the women positive for fetal fibronectin (169.3 +/- 45.8 hours) than in those with no detectable fetal fibronectin (333.4 +/- 29.0 hours). CONCLUSION: Fetal fibronectin is a sensitive test for detection of AF in the vagina and compares favorably to standard tests. Its low specificity suggests that the assay may detect an alteration in membrane integrity. In addition, in patients without rupture of the membranes, the interval between sampling and delivery is significantly shorter if fetal fibronectin is present. We speculate that the presence of fetal fibronectin in cervicovaginal secretions may be a marker for impending labor in gravidas without gross rupture of the membranes.

Adult↗
PubMed1991

Fetal fibronectin in cervical and vaginal secretions as a predictor of preterm delivery.

BACKGROUND: Preterm delivery is the leading cause of neonatal mortality in the United States, but efforts to address the problem are hampered by the inability to predict accurately which pregnancies are at risk. We postulated that damage to the fetal membranes may release fetal fibronectin into the cervix and vagina, giving rise to a biochemical marker for preterm delivery. METHODS: We measured fetal-fibronectin concentrations in cervical and vaginal secretions, amniotic fluid, and maternal plasma with a sensitive immunoassay using the monoclonal antibody FDC-6. Immunohistochemical studies were used to determine the distribution of fetal fibronectin in the placenta and amniochorionic membranes and to ascertain its cell of origin. RESULTS: Women with uncomplicated pregnancies (n = 163) who delivered at term rarely had cervicovaginal fetal-fibronectin concentrations above 0.05 micrograms per milliliter between 21 and 37 weeks of gestation (11 of 267 cervical samples [4 percent] and 9 of 267 vaginal samples [3 percent]. High levels of fetal fibronectin were detected in amniotic fluid and in the cervical or vaginal secretions of 93.8 percent of the women with preterm rupture of membranes (n = 65). Cervical or vaginal fetal fibronectin was also present in 50.4 percent of the women with preterm uterine contractions and intact membranes (n = 117), and its presence identified the women who delivered before term (n = 60) with a sensitivity of 81.7 percent and a specificity of 82.5 percent. In the placenta and membranes, fetal fibronectin was found at points of contact with the uterine wall. CONCLUSIONS: The presence of cervicovaginal fetal fibronectin in the second and third trimesters of pregnancy identifies a subgroup of women who are at high risk for preterm delivery. This phenomenon may reflect the separation of the chorion from the decidual layer of the uterus, with the release of intact or degraded chorionic components of the extracellular matrix into the cervical and vaginal secretions.

Amniotic Fluid↗
PubMed1991

Does amniotic fluid index affect the accuracy of estimated fetal weight in preterm premature rupture of membranes?

Estimated fetal weights play a critical role in the management scheme of patients with preterm premature rupture of membranes but are often technically difficult to obtain in these patients because of low amniotic fluid volume. Previous studies have had conflicting data as to the accuracy of estimated fetal weights in preterm premature rupture of membranes. This study was undertaken to evaluate the effect of amniotic fluid index on the accuracy of estimated fetal weights in pregnancies complicated by preterm premature rupture of membranes. Over a 2-year period at Long Beach Memorial Medical Center, 98 patients with preterm premature rupture of membranes who had an ultrasonographic examination with estimated fetal weights and amniotic fluid index performed within 48 hours of delivery were identified and compared with a control group of 55 patients in preterm labor with normal amniotic fluid index for gestational age, also obtained within 48 hours of delivery. Shepard and Hadlock formulas were used to estimate fetal weight. Results were measured in percent error from the actual birth weight. All birth weights were less than 2000 gm. No statistical differences were identified. The value of amniotic fluid index did not affect the accuracy of predicted estimated fetal weight in preterm premature rupture of membranes. Predicted estimated fetal weight of patients with preterm premature rupture of membranes appears to be as accurate as predicted estimated fetal weight in pregnancies with normal amniotic fluid volumes.

Amniotic Fluid↗
PubMed1991

Rate of recurrence of preterm premature rupture of membranes in consecutive pregnancies.

The reported incidence of preterm premature rupture of membranes ranges between 1% and 2% of all pregnancies. The rate of recurrence is poorly defined. The goal of this study was to establish the frequency of recurrence in a high-risk referral practice. Over a 5-year period we identified 121 patients with preterm premature rupture of membranes who had a minimum of two consecutive pregnancies under our care, resulting in a total of 255 pregnancies for analysis. Recurrent preterm premature rupture of membranes occurred in 39 of 121 patients, for a rate of 32.2% (95% confidence interval, 23.9 +/- 40.5). We were unable to demonstrate an association between the estimated gestational age at the time of rupture in the index pregnancy, latency period, interval between pregnancies, and the probability of repeat preterm premature rupture of membranes in the next pregnancy. We conclude that patients with preterm premature rupture of membranes should be counseled regarding the significant risk of recurrence and need to have close follow-up in their subsequent pregnancies.

Adult↗
PubMed1991

Pulmonary injury associated with antepartum pyelonephritis: can patients at risk be identified?

The development of pulmonary injury in cases of antepartum pyelonephritis is rare but serious. To date, factors that might identify patients at risk have not been determined. We compared 11 patients with pyelonephritis and pulmonary injury with 119 patients with pyelonephritis only. Pulmonary injury was more likely to occur in the more severe cases; however, the presence of a maternal heart rate greater than 110 beats/min and a fever to 103 degrees F 12 to 24 hours before the occurrence of respiratory symptoms in a gestation greater than 20 weeks was highly predictive of pulmonary injury. The most significant predictive factors associated with pulmonary injury were elements of treatment such as fluid overload, use of tocolytic agents, and, to a lesser extent, choice of antibiotic. Therefore, if tocolytic agents are considered at all in the management of acute pyelonephritis in pregnancy, they should be used only in patients with documented cervical change. In addition, urinary output should be monitored very closely. These data also may suggest a cause of the pulmonary edema that is occasionally seen in the management of premature labor with the use of tocolytic agents and fluids in the presence of a possible occult infection.

Anti-Bacterial Agents↗