Search PubMed⌕ Search

Biomedical subjects

T J Garite

Publications and source records attributed to T J Garite.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1985

Prophylactic intrapartum amnioinfusion in patients with preterm premature rupture of membranes.

Patients with preterm premature rupture of the membranes are at increased risk to develop intrapartum variable decelerations and fetal distress. Short-term saline solution amnioinfusion may be of benefit in the treatment of variable or prolonged decelerations once they appear. In an effort to assess the benefit of prophylactic amnioinfusion, patients with preterm premature rupture of the membranes were studied during a 1-year period in a prospective randomized manner. Patients receiving prophylactic amnioinfusion had significantly decreased incidence and severity of variable decelerations in the first stage of labor (p less than 0.005). In the second stage of labor, the incidence of severe (p less than 0.005) and total (p less than 0.001) decelerations was also decreased in the treatment group. The umbilical arterial pH at delivery was significantly lower (p less than 0.001) as was the umbilical venous pH (p less than 0.005) in the newborn infants of control patients compared with those of patients receiving amnioinfusion. This suggests that prophylactic intrapartum amnioinfusion is of significant benefit in reducing the incidence of variable decelerations and improving the metabolic state in newborn infants born to women with preterm premature rupture of the membranes.

Adult↗
PubMed1985

Premature rupture of the membranes: the enigma of the obstetrician.

Decisions in regard to the management of patients with premature rupture of the membranes depend on the relative risks of prematurity, infection, and hypoxia for the fetus or neonate and infection and cesarean section for the mother. These risks vary primarily with gestational age. Because of the many variables and new technologies involved, the management of these patients is extremely controversial. In this article, the controversies are reviewed and management plans are presented for several different gestational age groups.

Abnormalities, Multiple↗
PubMed1985

The accuracy of estimated gestational age based on ultrasound measurement of biparietal diameter in preterm premature rupture of the membranes.

The management of patients with preterm premature rupture of the membranes is often influenced by the ultrasound measurement of biparietal diameter. The cephalic index has been used in pregnancies with intact membranes to predict the presence of an abnormal biparietal diameter that may be unreliable in estimating gestational age. This study analyzed 100 patients with rupture of the membranes between the beginning of gestation week 28 and the end of week 34. The cephalic index was found to be abnormal 45% of the time; all were in the brachiocephalic range. The biparietal diameter was affected by presentation and presence or absence of amniotic fluid (p less than 0.05). Use of the biparietal diameter was found to be unreliable in estimating gestational age with preterm premature rupture of the membranes. Use of the cephalic index did not enable prediction of which biparietal diameters would be abnormal; therefore use of the biparietal diameter or the cephalic index in preterm premature rupture of the membranes is not recommended. The use of the head circumference, abdominal circumference, and femur measurements may be a better way of predicting gestational age in this select population.

Amniotic Fluid↗
PubMed1985

The significance of a previous stillbirth.

Among 7052 patients studied between 1976 and 1982 in a collaborative project on antepartum fetal heart rate monitoring, 337 patients had a previous stillbirth as a reason for testing. Overall a previous stillbirth history significantly increased the risk of having a positive result on a contraction stress test, primarily among hypertensive patients. Patients with a previous stillbirth also had a significantly higher incidence of respiratory distress syndrome in their neonates attributable to premature intervention for maternal indications (primarily among hypertensive women and patients with clinical intrauterine growth retardation). Low Apgar scores were found to be significantly increased in diabetics with previous stillbirths primarily due to neonates with congenital malformations. Premature intervention by labor induction or cesarean section was more common among patients with a previous stillbirth for both maternal indications and abnormal antepartum fetal heart rate studies. Previous stillbirth would appear therefore to be a significant risk factor primarily when associated with a diagnosis of hypertension or clinical intrauterine growth retardation.

Apgar Score↗
PubMed1985

Fusobacterium: anaerobic occult amnionitis and premature labor.

Fusobacterium species are well established pathogens. Before the advent of effective anaerobic antimicrobial therapy, they were associated with prolonged, often fatal courses. Previously, fusobacterium had not been identified as a common perinatal pathogen. Three cases of occult amnionitis due to Fusobacterium are presented. Review of five series of occult amnionitis revealed 23 cases. In seven (30.4%), Fusobacterium was isolated. In 14 (60.8%), an anaerobic species was isolated. The average gestational age of patients from whom anaerobes were grown was 29.0 weeks. Of those that grew no anaerobes, the average gestational age was 32.3 weeks (P less than .05). The overall rate of maternal febrile morbidity was 35%. Fusobacterium accounted for 50% of the febrile cases while accounting for only 30.4% of the total cases.

Adult↗
PubMed1984

The risks of amniocentesis in the management of premature rupture of the membranes.

Amniocentesis has proved to be a useful tool in the management of preterm gestation with premature rupture of the membranes. Concern has been expressed, however, regarding possible risks of amniocentesis to mother or fetus. A retrospective review was made of 137 patients referred to us because of premature rupture of the membranes between 28 and 34 weeks of gestation. Amniocentesis was successfully performed in 91 patients. A statistical analysis of the time interval from amniocentesis to labor failed to show any evidence that amniocentesis might induce labor. In addition, no maternal or neonatal morbidity could be attributed to amniocentesis.

Amniocentesis↗
PubMed1984

Premature rupture of membranes before fetal viability.

The outcome of 53 cases expectantly managed with premature rupture of membranes (PROM) before fetal viability (16 to 25 weeks) was retrospectively reviewed. Forty-one percent of patients developed amnionitis, four had prolonged hospital stays (longer than seven days), and one each had sepsis and pelvic thrombophlebitis. Twenty-two mothers (41%) had no complications. No serious long-term maternal sequelae were noted. Eighteen patients were delivered after 26 weeks, and there were 13 surviving neonates with birth weights ranging from 740 to 2170 g.

Abortion, Spontaneous↗
PubMed1984

Late abruptio placenta in trauma patients: implications for monitoring.

A case report is presented in which abruptio placenta occurs five days after trauma. This is a very rare occurrence. The high incidence of abruption occurring after severe trauma is reviewed, and the importance of continuous fetal monitoring for at least 48 hours after admission to the hospital is stressed.

Abdominal Injuries↗
PubMed1984

Fetal heart rate patterns and fetal distress in patients with preterm premature rupture of membranes.

Two hundred sixty-seven consecutive patients with preterm premature rupture of membranes (PROM) and 130 consecutive patients with idiopathic premature labor and intact membranes between 28 and 35 weeks' gestation were compared. A significantly higher incidence of cesarean section for fetal distress was found in patients with PROM (7.9%) compared with patients with premature labor (1.5%) (P less than .05). Fetal distress occurred with similar frequency in patients with and without chorioamnionitis. Analysis of electronic fetal heart rate patterns in patients with fetal distress revealed that 16 of 21 patients (76%) with PROM had patterns consistent with umbilical cord compression. A significant difference was found in neonatal mortality rates between the PROM group (4.5%) and the premature labor group (0) (P less than .05). The neonatal death rate in patients with fetal distress (three of 12) was significantly higher than in patients without distress (nine of 385) (P less than .01). It is suggested that the increased incidence of fetal distress in patients with preterm PROM may represent the loss of the protection of the umbilical cord that amniotic fluid normally provides.

Female↗
PubMed1983

A new rapid slide agglutination test for amniotic fluid phosphatidylglycerol: laboratory and clinical correlation.

A new rapid slide agglutination test (Amniostat-FLM/AFLM) for amniotic fluid phosphatidylglycerol has been developed. One hundred ninety-three samples of amniotic fluid were tested for lecithin/sphingomyelin (L/S) ratio and phosphatidylglycerol by thin-layer chromatography and fluorescence polarization and compared with the AFLM. All four tests agreed in 123/193 cases. Phosphatidylglycerol and AFLM were concordant in 176/193 cases. From these samples, data were available on 105 neonates, of whom 74 were delivered within 72 hours of amniocentesis. All positive AFLM tests were associated with absence of hyaline membrane disease, of 22 negative tests, eight babies had hyaline membrane disease. Thus, preliminarily, it appears that this is a useful, rapid test for assessing fetal lung maturity, which like other tests is reliable when indicating maturity but has a high incidence of falsely immature results.

Agglutination Tests↗
PubMed1982

Chorioamnionitis in the preterm gestation.

Two hundred fifty-one patients with premature rupture of membranes between 28 and 34 weeks' gestation were followed prospectively to evaluate the maternal and neonatal effects of chorioamnionitis. Forty-seven (19%) developed intrauterine infection prior to delivery. Fetal tachycardia, maternal leukocytosis, and uterine contractions were not predictive of intrauterine infection in afebrile patients. In afebrile patients, however, amniocenteses positive for bacteria on Gram stains and/or with subsequent positive culture correlated with subsequent development of antenatal maternal fever. Other than an increased rate of postpartum endometritis no serious maternal complications were seen in patients with chorioamnionitis. Neonatal outcome, however, was significantly adversely affected with respect to increase in perinatal mortality, overall neonatal infection rate, and respiratory distress syndrome (RDS) in patients with maternal infection. Neither trial of labor nor duration of labor in patients with chorioamnionitis correlated with adverse neonatal outcome. However, the appearance of maternal fever prior to the onset of labor correlated more significantly with neonatal death and RDS in the newborn that did the development of maternal fever in the intrapartum period.

Amniotic Fluid↗
PubMed1982

Ultrasonic prediction of fetal macrosomia in diabetic patients.

Traumatic morbidity in the newborn of a diabetic mother occurs in 3 to 9% of vaginal deliveries in diabetic pregnancies. Prediction of diabetic macrosomia by ultrasound measurement of chest diameter and biparietal diameter is evaluated in this study. A macrosomia index was calculated for 70 diabetic pregnancies by subtracting the biparietal diameter from the chest diameter (chest - biparietal diameter). Twenty-three macrosomic infants (weight greater than 4000 g) were delivered. In this study 20/23 (87%) of the infants weighing greater than 4000 g had a chest - biparietal diameter of 1.4 cm or greater. There were 4 cases of shoulder dystocia in 15 patients delivered vaginally. In this study, cesarean section for all fetuses with a chest - biparietal diameter of 1.4 cm or greater would reduce the incidence of traumatic morbidity from 27% to 9%.

Body Weight↗
PubMed1981

Prospective randomized study of corticosteroids in the management of premature rupture of the membranes and the premature gestation.

A prospective randomized study involving patients with premature rupture of the membranes between the twenty-eighth week and the thirty-fourth week of pregnancy was conducted. Patients with chorioamnionitis, advanced labor, and fetal distress, as well as those with mature lecithin/sphingomyelin ratios and/or Gram stains positive for bacteria, were delivered immediately. The remaining patients were randomized. One group received betamethasone. Tocolytic agents were used in this group when necessary. After 48 hours all patients given corticosteroids (CS group) were delivered). The second group was managed expectantly (EM group) and were delivered only when spontaneous labor or infection occurred. A total of 160 patients were randomized, 80 in each group. Maternal outcome, including chorioamnionitis and cesarean section rates, was not different; however, the endometritis rate was significantly higher in the CS group (p less than 0.05). Neonatal outcome did not differ in mean birth weights, perinatal death rates, neonatal infections, or incidences of respiratory distress. The frequency of prolonged hospital stay (greater than 4 weeks) was higher in the neonates in the CS group (p less than 0.01). The conclusion is that corticosteroids and active management in patients with premature rupture of the membranes and premature gestations do not decrease the incidence of respiratory distress syndrome or perinatal mortality and may aggravate certain infectious complications.

Adolescent↗
PubMed1981

Incidence of premature delivery following the oxytocin challenge test.

The oxytocin challenge test (OCT) has been used to identify and follow the fetus at risk for uteroplacental insufficiency. Of 389 patients who had at least one OCT prior to 38 weeks' gestation, 26 (6.7%) underwent delivery after spontaneous onset of premature labor within 5 days of an OCT. This compares to a 7.5% incidence of spontaneous delivery prior to 38 wk at the University of California Irvine Hospital, and to a 7.6% rate of premature delivery after spontaneous onset of labor in those patients followed with nonstress tests only.

Delivery, Obstetric↗
PubMed1981

Postdate pregnancy: utilization of contraction stress testing for primary fetal surveillance.

Six hundred seventy-nine postdate study patients surveyed with a contraction stress test (CST) protocol had no perinatal deaths and no greater morbidity than that found in a 500-patient normal term control population. However, the postdate study did have a significantly increased risk of intrapartum fetal distress, meconium-stained amniotic fluid, macrosomia, and cesarean section for both failed progress of labor and fetal distress. Among the postdate study group there was a high incidence of patients with abnormal CST results (39%); these patients with abnormal CST results were at increased risk for subsequent intrapartum fetal distress. Seventy-five percent of the postdate study patients entered labor spontaneously and delivery was elected because of abnormal CST results in only 5.4%. The data presented here support the use of contraction stress testing for primary surveillance of the prolonged pregnancy and they suggest that only one in 20 patients past 42 weeks' gestation will require intervention for fetal indications with this approach.

Cesarean Section↗