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Biomedical subjects

A W Robertson

Publications and source records attributed to A W Robertson.

7 recordsLinked to original sources
PubMed1991

A case report of massive vulvar edema during tocolysis of preterm labor.

Bilateral vulvar edema that is not associated with preeclampsia has been reported only rarely during pregnancy or the puerperium. A primiparous patient in premature labor at 34 weeks' gestation with no history of lymphatic or venous obstruction underwent combination tocolysis with intravenous ritodrine and magnesium sulfate. On the fifth day of tocolysis, edema developed in the right labium majus pudendi and gradually spread to the left labia during the ensuing 24 hours. The patient remained afebrile, normotensive, and without signs of localized infection or anasarca. A trial of triple intravenous antibiotics and local skin care proved ineffective. By the ninth hospital day, the edema and discomfort had progressed, thereby precluding vaginal examination without sedation. In spite of progressive cervical dilatation with tocolysis, cesarean delivery was performed. With no further treatment, the vulvar edema gradually resolved during the next week.

Adult↗
PubMed1988

The nitrite and leukocyte esterase tests for the evaluation of asymptomatic bacteriuria in obstetric patients.

The purpose of this investigation was to compare the reliability of a urine dipstick evaluation for nitrites and leukocyte esterase activity with that of a urine culture in diagnosing asymptomatic bacteriuria in obstetric patients. A clean-catch midstream urine specimen was obtained from 750 consecutive obstetric patients presenting for initial evaluation. One portion of the specimen was tested for nitrites and leukocyte esterase activity with Chemstrip LN dipsticks. A second aliquot of urine was plated on blood and MacConkey agar and incubated aerobically. The cost of the nitrite and leukocyte esterase test was $0.35. The per patient charge for the urine cultures would have been $28. Sixty-two women (8.3%) had urine cultures of 100,000 or more colony-forming units of a uropathogen per milliliter. The sensitivities of the nitrite and leukocyte esterase test in identifying patients with positive cultures were 43 and 77%, respectively, and the specificities were 99 and 96%, respectively. The sensitivity and specificity for the two tests combined (either test abnormal) were 92 and 95%, respectively. Five patients had negative screening tests but positive urine cultures; all five isolates were gram-positive organisms, three group B streptococci and two enterococci. We conclude that neither the nitrite test nor the leukocyte esterase test alone is a sensitive enough screening test to detect asymptomatic bacteriuria in obstetric patients. The combination of the two tests, however, may provide an acceptable cost-effective alternative to screening all asymptomatic obstetric patients with urine cultures.

Bacteriuria↗
PubMed1987

Single-dose cefazolin versus cefonicid for antibiotic prophylaxis in cesarean delivery.

The purpose of this prospective investigation was to compare a single intravenous dose of cefazolin to a single dose of cefonicid as prophylaxis for women having unscheduled cesarean delivery. In a double-blind, randomized design, 96 patients were assigned to receive a 1-g dose of cefazolin and 103 patients were designated to receive a 1-g dose of cefonicid. The antibiotics were administered after delivery of the infant. The two groups were comparable with respect to recognized risk factors for postcesarean infection. There were no statistically significant differences between the groups in the incidence of standard febrile morbidity, endomyometritis, urinary tract infection, wound infection, and bacteremia. There were also no significant differences between the groups in the fever index or the duration of hospitalization. We conclude that cefazolin and cefonicid provide a similar degree of prophylaxis against infection in patients having unscheduled cesarean delivery.

Bacterial Infections↗
PubMed1987

External cephalic version at term: is a tocolytic necessary?

This prospective investigation evaluates the benefit of a beta-mimetic tocolytic for external cephalic version. From July 1, 1984 to May 15, 1987, 58 patients who had breech presentations between 37-41 weeks' gestation were considered for external cephalic version. The patients were randomly assigned to one of two groups: tocolytic or no tocolytic. An ultrasound examination, serum alpha-fetoprotein (AFP), Kleihauer-Betke test, and nonstress test (NST) were performed before and after the attempt at version. A version was not attempted if there was evidence of intrauterine growth retardation (IUGR), oligohydramnios, or a nonreactive NST. Patients in the tocolytic group received 200 micrograms/minute of ritodrine hydrochloride for 20 minutes via continuous intravenous infusion before a version was attempted. Twenty of the 30 patients (66.7%) in the tocolytic group and 19 of the 28 patients (67.8%) in the no-tocolytic group had successful versions, a nonsignificant difference. The nine patients with unsuccessful version attempts in the group without a tocolytic then received intravenous ritodrine and underwent a second attempt. Only one of these nine attempts was successful. There were no serious maternal or fetal complications associated with the attempts at version. In our patient population, use of a tocolytic did not significantly increase the probability of a successful version.

Adult↗