Anticoagulation in pregnancy.
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Anticoagulants↗
Biomedical subjects
T J Garite
Publications and source records attributed to T J Garite.
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↗
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↗
Sinusoidal fetal heart rate pattern.
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Fetal Heart↗
Fetal heart rate patterns and fetal distress in fetuses with congenital anomalies.
Over a 3-year period at the Long Beach Women's Hospital, where electronic FHR (fetal heart rate) monitoring was routine, there were 8622 live births, including 41 infants born with major congenital malformations. The neonatal death rate in these malformed infants was 44%; 17 were delivered by cesarean section, 11 of which were performed because of fetal distress. There were no characteristic FHR patterns that would specifically identify major congenital malformations. There was a significantly increased incidence of prematurity, breech presentation, and cesarean section delivery in the congenital malformation group as compared to the overall population delivering at the Women's Hospital. The clinical implications of these observations are discussed.
Adult↗
The use of amniocentesis in patients with premature rupture of membranes.
A prospective study was conducted to evaluate the usefulness of amniocentesis in patients with premature rupture of membranes (PROM) for the prediction of occult or impending intrauterine infection and the assessment of fetal maturity. Fifty-nine patients with PROM between 28 and 35 weeks' gestation, without apparent infection, were evaluated sonographically for possible amniocentesis. Thirty patients had successful amniocenteses for a success rate of 51%. Fifteen patients had a mature lecithin/sphingomyelin (L/S) ratio and were delivered immediately without respiratory distress syndrome (RDS) or other neonatal complications. All amniotic fluids were evaluated by Gram stains and cultures. Nine of the 30 patients had positive cultures, with a high incidence of subsequent development of amnionitis and other infectious morbidity. In the 21 patients with negative cultures, there were 19 without any infectious morbidity. Amniocentesis appears in this study to be a useful method for selecting the patients who have mature fetuses and/or who are more likely to develop amnionitis.
Amniocentesis↗
Antepartum stress test monitoring.
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Female↗
Oxytocin challenge test: achieving the desired goals.
The desired goals of the oxytocin challenge test (OCT) are preventing stillbirth and avoiding unnecessary premature intervention. To effectively reduce stillbirth the test should be done on a significant proportion of those fetuses who would subsequently succumb in utero. To analyze whether or not the OCT is achieving these goals. 5351 deliveries over a 2-year period at the University of California, Irvine, Medical Center were studied retrospectively. Four hundred and thirty of these patients had 823 OCTs performed. There were ten positive and 19 suspicious tests, and five neonatal deaths in these two groups. In patients who were studied with OCTs only one stillbirth occurred (in a patient who was noncompliant). During the same period, all stillbirths were reviewed. In the group in which stillbirth occurred, it was determined that 11 or 35% of the patients had indications for antepartum testing but were not tested. All 11 of these patients were transferred to the University hospital or had no prenatal care. It is suggested that these stillbirths may have been prevented had appropriate prenatal care allowed identification of patients for antepartum testing.
False Positive Reactions↗
An evaluation of cytologic sampling techniques. A comparative study.
False negative cervical cytology is primarily due to errors in sampling. It has been demonstrated that combined ectocervical and endocervical sampling techniques will improve the yield. A prospective study was done to compare ectocervical and combined sampling with a selective technique in which the examiner determines the location of the squamocolumnar junction and chooses the appropriate method. The results demonstrate that combined ectocervical and endocervical sampling significantly increases the number of positive Papanicolaou smears. Selecting which cervices should be samples ectocervically and which need combined sampling does not significantly improve the yield over ectocervical sampling alone. It is the conclusion of this study that both ectocervical and endocervical sampling should routinely be used.
Diagnosis, Differential↗