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Biomedical subjects

W M Hern

Publications and source records attributed to W M Hern.

At least 19 recordsLinked to original sources
PubMed2001

Laminaria, induced fetal demise and misoprostol in late abortion.

OBJECTIVES: To analyze and determine the safety and effectiveness of induced fetal demise as an adjunctive method in outpatient abortion for patients with advanced pregnancies and to evaluate the independent effect of intrauterine misoprostol administered after amniotomy in late abortion. METHODS: During a 9-year period, 1677 abortions were performed for patients whose pregnancies ranged from 18 through 34 menstrual weeks in an outpatient facility. Of these, 832 were performed by one physician. Techniques for performing all the abortions included induction of fetal demise by intrauterine fetal injection of digoxin and/or hyperosmolar urea, serial multiple laminaria treatment of the cervix, amniotomy, oxytocin induction of labor, and assisted delivery or surgical evacuation of the fetus and placenta. In the last 411 of the 832 patients whose abortions were performed by one physician, misoprostol was placed in the lower uterine segment following amniotomy in order to enhance labor induction, cervical ripening, and fetal expulsion. RESULTS: Of the entire group of 1677 cases, the median gestational age was 22 menstrual weeks. The median procedure time for all cases was 10 min. Measured median blood loss was 125 ml. Blood loss and procedure time increased with length of gestation, but these were not affected by misoprostol. There were three major complications (0.2%) in the overall series. Among patients seen by one physician (N=832), amniotomy-to-procedure time was shorter by 26 min for patients receiving misoprostol, and there was 27% more variability in amniotomy-to-procedure time among patients not receiving misoprostol. Complication rates for patients receiving misoprostol were the same as for those not receiving misoprostol. There were no major complications in the 832 patients seen by one physician, no uterine rupture or perforations, and no cervical lacerations. CONCLUSIONS: Outpatient abortion may be performed safely from 18 through 34 menstrual weeks using combined surgical and medical procedures. Use of intrauterine post-amniotomy misoprostol was associated with reduced amniotomy-to-procedure time and reduced variability in the amniotomy-to-procedure time.

Abortifacient Agents, Nonsteroidal↗
PubMed1994

Laminaria versus Dilapan osmotic cervical dilators for outpatient dilation and evacuation abortion: randomized cohort comparison of 1001 patients.

OBJECTIVE: Our purpose was to compare the clinical experience in using Dilapan osmotic dilator and Laminaria japonicum as overnight osmotic cervical dilators in second-trimester dilation and evacuation abortion with respect to measurable outcome variables, including complication rates. STUDY DESIGN: A cohort comparison was performed of 1001 patients receiving alternate preoperative treatment with either osmotic dilator after initial randomization until this number had been reached in the series. RESULTS: Few significant differences were found in the two cohorts with respect to blood loss, procedure times, and overall complication rates. However, patients receiving the Dilapan dilator were at least twice as likely to experience problems in cervical dilation or problems resulting from poor dilation or disintegration of the device than were patients receiving Laminaria japonicum. Although more patients receiving laminaria experienced amniotic fluid embolism or disseminated intravascular coagulation syndrome, these problems could not be attributed to the type of osmotic dilator used. CONCLUSION: Both osmotic dilators are acceptable for use in overnight dilation in this procedure, but the Dilapan dilator is more likely to disintegrate, retract, or present minor problems associated with poor dilation.

Abortifacient Agents↗
PubMed1993

Has the human species become a cancer on the planet? A theoretical view of population growth as a sign of pathology.

The author describes current global population trends as being similar to the development of a cancer in the living body. "The human species, through the instrument of culture, has become the dominant force of planetary ecological change. Our adaptations have become maladaptive. Moreover, the human species as a whole now displays all four major characteristics of a malignant process: rapid, uncontrolled growth; invasion and destruction of adjacent normal tissues (ecosystems); metastasis (distant colonization); and dedifferentiation (loss of distinctiveness in individual components). We have become a malignant ecopathologic process. If this diagnosis is true, what is the prognosis? The difference between us and most forms of cancer is that we can think, and we can decide not to be a cancer."

Demography↗
PubMed1993

Outpatient abortion for fetal anomaly and fetal death from 15-34 menstrual weeks' gestation: techniques and clinical management.

OBJECTIVE: To determine the safety of providing outpatient abortion services for women with complicated advanced pregnancies. METHODS: During a 10-year period, 124 abortions were performed after 14 menstrual weeks' gestation at an outpatient abortion facility for indications of fetal anomaly, diagnosed genetic disorder, or fetal death. Gestational lengths ranged from 15-34 menstrual weeks. Fetal diagnoses included a variety of chromosomal abnormalities, malformations, and death. Techniques for performing the late abortions included a serial multiple laminaria method of cervical dilation. Abortions performed after 20 menstrual weeks were effected by instillation of intra-amniotic hyperosmolar urea or induction of fetal death by injection of digoxin and/or hyperosmolar urea into the fetus, followed by artificial rupture of membranes, induction of labor, and assisted expulsion or instrumental extraction of the fetus. At less than 20 weeks, dilation and evacuation following serial multiple laminaria treatment of the cervix was the method of choice. RESULTS: The median gestational age was 23 menstrual weeks. The median procedure time for all cases was 12 minutes and median blood loss was 125 mL. Procedure time increased with length of gestation (P = .00). Blood loss was only slightly increased by gestation length (P = .154) and not by procedure time (P = .299). Complication rates were not significantly related to gestation length (P = .895). There was one major complication in this series. There were no uterine perforations and one cervical laceration. CONCLUSION: Outpatient abortion may be performed safely in most cases of fetal disorder, including death, through 34 menstrual weeks under proper conditions.

Abortion, Eugenic↗
PubMed1984

Correlation of fetal age and measurements between 10 and 26 weeks of gestation.

Fetal measurements, especially fetal foot length, were correlated with fetal age--as measured by last menstrual dates--for 1800 tissue specimens obtained after dilatation and evacuation abortion. These observations were compared with Streeter's results from 1920. Fetal ages ranged from ten through 26 completed menstrual weeks. Fetal measurements including weight, knee-to-heel length, biparietal diameter, placental weight, and amniotic fluid volume were correlated with foot length. Sonographic biparietal diameter obtained by real-time imaging was correlated with tissue measurement of biparietal diameter for various fetal ages. The difficulties of establishing valid correlations are discussed, and a table of recommended values for fetal measurements by week of fetal age is provided.

Abortion, Induced↗
PubMed1984

Serial multiple laminaria and adjunctive urea in late outpatient dilatation and evacuation abortion.

The safety and clinical approach in late second-trimester outpatient dilatation and evacuation abortion is controversial. In this series, 1000 dilatation and evacuation abortions were performed on patients from 17 through 25 menstrual weeks' gestation in a private office outpatient facility. Each patient experienced serial multiple laminaria treatment over two days before abortion. Patients at 20 weeks' gestation or more also received adjunctive urea amnioinfusion on the day of the procedure. Three patients (0.3%) experienced major complications. Although a wide variety of clinical problems was encountered, procedure times were short, blood loss was generally low, and other complication rates were low. Recommendations for staffing and the prevention of complications are discussed.

Abortion, Induced↗