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Biomedical subjects

T J Garite

Publications and source records attributed to T J Garite.

At least 37 records · Page 2Linked to original sources
PubMed1991

Management of preterm premature rupture of membranes.

The variables enumerated in the preceding paragraphs and the constantly changing and improving technology in neonatal care mean that the data on which to base the best management plans of PPROM are not yet available. Rather, we must be willing to revise our approach to the treatment of this entity constantly as new information is found. However, several important changes in the management of these patients over the last few years were implemented and have had a significant impact on the outcome of these neonates. The use of routine prophylactic intrapartum amnioinfusion is one of these. Although preliminary, the data on prophylactic antibiotic use are promising and have brought us closer to the concept of treating occult intraamniotic infections with antibiotics rather than immediate and indiscriminate delivery. The identification of several factors such as interleukin-1, neutrophil activating peptide-1/interleukin-8, and tumor necrosis factor (TNF) in patients with idiopathic preterm labor may allow us to determine the pathophysiologic mechanism by which preterm labor leading to PPROM is initiated and allow us to tailor treatment specifically. For instance, in such patients, uterine activity may respond to antibiotic therapy rather than the usual tocolytics. Unfortunately, measurements of such factors are not yet widely available and remain primarily research tools. However, these recent findings give us a glimpse of what lies ahead. It is entirely conceivable that a symposium on the management of PPROM eventually will have a section devoted to its prevention that is based on an understanding of its pathophysiology.

Amniotic Fluid↗
PubMed1990

Fetal gastroschisis and omphalocele: is cesarean section the best mode of delivery?

There has always been controversy regarding the mode of delivery of fetuses with abdominal wall defects. Prior studies may have been biased in this evaluation as a result of the effects of delay in repair, transport of the fetus to level III facilities, and antenatal diagnosis compared with an unsuspected diagnosis. The purpose of this study was to evaluate mode of delivery at level III institutions with access to complete care to determine if cesarean section improved outcome. One hundred eight infants were treated in the study period for abdominal wall defects. Fifty-six infants met all criteria for admission to the study. No difference in neonatal morbidity or mortality was identified. No difference was found in infants who were born by elective cesarean section compared with infants delivered after labor ensued. In conclusion, we found no evidence that cesarean section or avoidance of labor improved outcome in fetuses with uncomplicated abdominal wall defects.

Abdominal Muscles↗
PubMed1990

Gram stain results from amniocentesis in patients with preterm premature rupture of membranes--comparison of maternal and fetal characteristics.

A total of 108 patients with preterm premature rupture of membranes who had undergone amniocentesis were retrospectively analyzed. Seventy-seven patients had negative amniotic fluid Gram stains and were managed expectantly. Thirty-one patients had positive amniotic fluid Gram stains confirmed by subsequent cultures and were delivered of infants on that basis. A univariate comparison of various parameters revealed significant differences in maternal temperature, pulse, and white blood cell count. Patients with positive Gram stains had lower mean gestational age, higher baseline fetal heart rate, and nonreactive fetal heart rate tracings. On the basis of a multivariate stepwise discriminate analysis, fetal heart rate greater than 150 beats/min or nonreactive nonstress test were the best predictors of the Gram stain findings, with a sensitivity of 71%, specificity of 76%, and negative predictive value of 87%. These data suggest that in patients with preterm premature rupture of membranes and fetal tachycardia or nonreactive nonstress test, amniocentesis should be performed in the initial evaluation.

Adult↗
PubMed1990

Comparison of a rapid enzyme-linked immunosorbent assay test and the Gram stain for detection of group B streptococcus in high-risk antepartum patients.

Early-onset neonatal sepsis with group B streptococci is a major problem in the management of high-risk obstetrics. Intrapartum treatment of the colonized mother reduces neonatal acquisition; however, many high-risk patients are delivered before culture results are available. This study prospectively evaluated a new enzyme-linked immunosorbent assay and the Gram stain for their accuracy in rapid detection of group B streptococci in 131 high-risk patients. Twenty positive cultures for group B streptococci were identified in the study population and were used as the control for test comparisons. The enzyme-linked immunosorbent assay test was 60% sensitive, whereas the Gram stain was 45% sensitive. The enzyme-linked immunosorbent assay showed an increase in sensitivity as the colony count increased; however, two cases of severe neonatal sepsis occurred in patients with low colony counts and both had enzyme-linked immunosorbent assay negative results. In conclusion, the need for a rapid sensitive test for group B streptococci detection still exists.

Enzyme-Linked Immunosorbent Assay↗
PubMed1990

Diagnosis of preterm rupture of membranes: is testing for alpha-fetoprotein better than ferning or nitrazine?

This article evaluates the role of alpha-fetoprotein (AFP) testing in the diagnosis of ruptured membranes in the preterm patient. AFP is normally found in amniotic fluid and is not present in vaginal secretions. Testing for AFP in vaginal fluid was compared with nitrazine evaluation and ferning in two groups of preterm patients, those with intact membranes and those with ruptured membranes. There was no difference in the sensitivities of AFP, nitrazine, or ferning in diagnosing ruptured membranes. The specificities of AFP and ferning were similar and both were significantly better than nitrazine. Duration of membrane rupture for greater than 24 hours negatively affected the accuracy of all three tests. Blood-tinged amniotic fluid interfered with AFP and nitrazine evaluation. AFP does not appear to offer a significant advantage over nitrazine testing and ferning in the evaluation of patients with possible ruptured membranes.

Azo Compounds↗
PubMed1990

Uterine activity characteristics in multiple gestations.

The frequency of uterine contractions has been shown to be increased during the 24-48 hours before the diagnosis of preterm labor in singleton gestations. Experience has indicated that there is also an increase in baseline uterine activity in twin gestations beyond that seen in women with singleton pregnancies. In this study, patients with twin gestations (39), triplet pregnancies (20), and quadruplets (ten) were monitored in the home daily for uterine activity. The results indicate that uterine activity was increased slightly within 48 hours of the onset of their initial preterm labor episode and significantly increased over baseline during the 24 hours preceding the diagnosis of preterm labor. This uterine activity led to evaluation for preterm labor before advanced dilatation occurred so that the majority of patients continued their pregnancy for more than 48 hours after diagnosis. Tocolytics did not have an effect on the crescendo of uterine activity preceding preterm labor. In this study, the crescendo of uterine activity occurred in multifetal gestations within 24 hours of preterm labor, as has been described for singleton pregnancies.

Female↗
PubMed1990

Intracervical prostaglandin in postdate pregnancy. A randomized trial.

A study was designed to see if incorporating intracervical administration of prostaglandin could affect the outcome of postdate pregnancies. All patients with verified dates, at least 41 6/7 weeks pregnant and enrolled in an antepartum testing schedule were randomized in a double-blind fashion to receive either 0.5 mg of prostaglandin E2 (PGE2) suspended in methylcellulose or a placebo of the gel alone. The gel was inserted directly into the cervical canal after the patient had a reactive/negative contraction stress test. The patient was then observed on an external fetal monitor for an hour before going home. A total of 23 patients received PGE2, and 20 received the placebo. Results were analyzed for the following: change in the Bishop score, lag time from dosage to delivery, spontaneous versus induced labor, cesarean section rate, length of labor and neonatal outcome. There were no significant differences between the groups except in the incidence of patients going into labor within 72 hours. The results indicate that, in general, 0.5 mg of intracervical PGE administered at greater than or equal to 41 6/7 weeks without subsequent oxytocin induction of labor did not appear to significantly alter the obstetric outcome.

Cervix Uteri↗
PubMed1989

Maternal serum alpha-fetoprotein and fetal triploidy.

Fetal triploidy is commonly found in early pregnancy. The majority of these pregnancies spontaneously abort in the first trimester. Occasionally, the pregnancy progresses to the second and third trimesters. We reviewed the maternal serum alpha-fetoprotein (MSAFP), amniotic fluid alpha-fetoprotein (AFP), amniotic fluid acetylcholinesterase (ACHE), fetal pathology, and placental pathology in sex second-trimester pregnancies complicated by fetal triploidy. Four of these patients had MSAFP values greater than 7.5 multiples of the median (MoM). Five of six pregnancies had MSAFP values greater than 2.25 MoM. All five of these patients had a partial mole. Four patients had amniotic fluid AFP values greater than 2.0 MoM. Two fetuses had associated neural tube defects. These were the only patients with positive amniotic fluid ACHE. None of the other patients had fetuses with anomalies that are known to be associated with an elevated MSAFP. The elevated MSAFP appeared to be related to the presence of a partial mole. Two of the five cases with an MSAFP greater than 2.25 MoM did not have sonographic evidence of a significant anomaly. Therefore, karyotyping can be of benefit in evaluating patients with elevated MSAFP.

Acetylcholinesterase↗
PubMed1989

Evaluation of the new amniostat-FLM test for the detection of phosphatidylglycerol in contaminated fluids.

The Amniostat-FLM rapid slide test (Hana Biologics, Inc., Alameda, Calif.) for detection of phosphatidylglycerol has previously been evaluated and has shown good correlation with the more sophisticated two-dimensional thin-layer chromatographic method. A new, ultrasensitive kit has now been released with a lower level of detection of 0.5 microgram of phosphatidylglycerol per milliliter of fluid. This is the first report of this new kit, which we used with vaginal pool samples and with contaminated amniocentesis samples. We evaluated this kit for concordance with thin-layer chromatography results as well as fetal outcome. Of 48 vaginal pool samples, 41 (85%) showed concordance, whereas 39 of 42 (93%) contaminated amniocentesis samples were concordant, for an overall concordance of 89% (80 of 90 samples). Sixty-seven infants were delivered within 72 hours of the test and there were no cases of hyaline membrane disease in the presence of a positive test result. We conclude that this new, ultrasensitive kit is a good, time-saving, and reliable test for the detection of phosphatidylglycerol without the development of false-positive results even when tested on the worst possible fluid samples. A review of clinical studies involving the Amniostat-FLM is also presented.

Amniocentesis↗
PubMed1988

The lambda fetal heart rate pattern: an assessment of its significance in the intrapartum period.

The "lambda" fetal heart rate (FHR) pattern was first described in 1977 as a pattern involving an acceleration followed immediately by a deceleration. However, its clinical significance has not been elucidated. During 6 months, 56 patients with this pattern were identified, representing 4% of all deliveries during this period. These were compared with a control group of 500 consecutive low-risk term patients who had been monitored electronically. The lambda pattern generally appeared early in labor and lasted for a variable period of time, but rarely persisted throughout labor. The relative rates of low Apgar scores, cesarean sections, and associated nonreassuring FHR patterns were similar between the two groups. The timing or depth of the decelerative portion of the pattern did not appear to correlate with any adverse outcome. Therefore, it does not appear that the lambda pattern is associated with any adverse outcome, nor does it predict the development of other concerning FHR patterns.

Apgar Score↗
PubMed1987

A randomized trial of ritodrine tocolysis versus expectant management in patients with premature rupture of membranes at 25 to 30 weeks of gestation.

Expectant management was compared with similar management plus ritodrine tocolysis in a randomized controlled trial in patients with premature rupture of membranes at 25 to 30 weeks of gestation. In the tocolysis group intravenously administered ritodrine was instituted at the onset of labor and then changed to the oral form if successful. Tocolysis was discontinued or not instituted after 31 weeks of gestation. Seventy-nine patients were randomized over a 4-year period, 39 in the tocolysis group and 40 in the expectant group. Twenty-three patients in the tocolysis group actually received ritodrine. No difference between the two groups was demonstrated in the interval between premature rupture of membranes and delivery or in reaching 32 weeks of gestation. No statistical difference was seen in maternal morbidity. Birth weights and gestational ages at delivery were similar between the two groups as were the incidences of neonatal morbidities caused by prematurity and infection and in the duration of neonatal hospital stays. Despite being conducted in those gestational ages in which prolongation of pregnancy might be expected to be of most benefit, no difference could be demonstrated with the addition of tocolytic therapy over expectant management alone.

Adult↗
PubMed1987

Placenta accreta: a problem of increasing clinical significance.

Placenta accreta in association with placenta previa and previous cesarean delivery is a condition of increasing clinical significance. A case report of a woman with placenta percreta is presented. Risk factors, incidence, and management are discussed. Recommendations for preoperative and intraoperative management are presented.

Adult↗
PubMed1986

Candida chorioamnionitis diagnosed by amniocentesis with subsequent fetal infection.

Isolation of Candida albicans from the vaginal secretions of pregnant women occurs with an incidence of 5-23%. Intrauterine infection caused by Candida during pregnancy is relatively rare; only 81 cases, all diagnosed after delivery, have been reported. We report six cases of candidal chorioamnionitis diagnosed by amniocentesis and confirmed by histologic studies, associated with preterm labor and delivery of five viable infants. Three of the six maternal patients had intrauterine contraceptive devices in situ. Three infants had a diagnosis of congenital cutaneous candidiasis and two had congenital systemic candidiasis, one with monilial pneumonia, and one with meningitis and septicemia. All viable neonates were treated successfully. The sixth, a very immature infant, died soon after delivery. Torulopsis (Candida) glabrata was isolated from this amniotic fluid. C. Albicans is a pathogen that potentially may cause chorioamnionitis and has been associated with high mortality (94%) in infants weighing less than 1500 gm. Use of amniocentesis in patients with preterm labor may allow early detection of subclinical candidal chorioamnionitis, thus guiding appropriate perinatal management.

Adolescent↗
PubMed1986

The use of 15 methyl F2 alpha prostaglandin (Prostin 15M) for the control of postpartum hemorrhage.

Postpartum hemorrhage is a potentially life-threatening obstetric complication. A 22-month experience treating postpartum hemorrhage with Prostin 15M patients who had not responded to conventional therapy is presented. A total of 26 patients were treated. There were 22 successes and 4 failures (84.6% success rate). Two failures were documented placenta accreta. Side effects occurred in 13 of the 26 patients and were generally mild. This group of patients is at risk for significant blood loss as well as blood replacement. The treatment of postpartum hemorrhage with intramuscular Prostin 15M was found to be safe and effective.

Adult↗
PubMed1986

Fetal maturity cascade: a rapid and cost-effective method for fetal lung maturity testing.

One hundred ninety-three amniotic fluid samples were tested for fetal lung maturity using a maturity cascade scheme involving the sequential use of, in order, the shake test, fluorescence polarimetry, and lecithin: sphingomyelin (L:S) ratio. If any of these tests indicated maturity, the sequence was terminated and no further test was performed, and the fetus was considered mature. Seventy percent of the tests yielded mature values and of these, 85 (63%) required a shake test only, 37 (27%) had a shake test and a fluorescence polarimetry, and only 14 (10%) required all three tests. From these 193 amniocenteses, 111 patients delivered within 72 hours of the procedure. One of 94 infants had respiratory distress syndrome after a mature test (1% false maturity) and ten of 17 had respiratory distress syndrome after an immature cascade (41% falsely immature). This approach saves time and cost and by confirming immaturity with multiple tests only when necessary and may improve predictability of neonatal respiratory distress syndrome.

Amniocentesis↗
PubMed1986

Amniocentesis and the management of premature labor.

Two applications of amniocentesis for the evaluation of the patient in idiopathic premature labor, fetal lung maturity testing, and detection of occult intraamniotic infection were evaluated in a review of 59 cases. Seven patients (12%) had positive amniotic fluid cultures despite the absence of clinical signs of infection. This group presented at earlier gestational ages (29 + 2.3 versus 32 + 2.0 weeks, P less than .005) and were more likely to rupture membranes while on tocolytic therapy (four of seven versus two of 52, P less than .001) than patients whose cultures were negative. All seven patients with a positive culture delivered within 48 hours of admission, whereas 44 of 52 patients with negative cultures delivered after 48 hours (P less than .001). Increase in maternal and neonatal morbidity seemed to be related primarily to a higher cesarean section rate and earlier gestational ages at delivery in this group. Lecithin/sphingomyelin ratio was predictive of fetal lung maturity as expected. More than one-half of patients greater than 33 weeks and one-third of patients at 31 to 32 weeks demonstrated fetal lung maturity. The authors conclude that amniocentesis is an important tool in evaluating patients in preterm labor, especially with respect to making appropriate management decisions regarding tocolytic and/or corticosteroid therapy.

Adrenal Cortex Hormones↗