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Biomedical subjects

B L Flamm

Publications and source records attributed to B L Flamm.

12 recordsLinked to original sources
PubMed1991

External cephalic version after previous cesarean section.

Approximately 100,000 cesarean sections are performed each year in the United States because of breech presentation. Numerous studies have shown that external cephalic version can eliminate the need for many of these operations. However, because of the fear of uterine rupture, these studies have generally excluded patients who have undergone previous cesarean section. To evaluate the validity of this exclusion policy, we studied patients with one or more previous cesarean sections and breach presentations near term. Version attempts were successful in 82% of 56 patients who had undergone a previous cesarean section. Sixty-five percent of the successful version patients went on to have vaginal birth after cesarean section. There were no serious maternal or fetal complications associated with the version attempts. We conclude that external cephalic version is a reasonable option in patients with prior low transverse cesarean section.

Breech Presentation↗
PubMed1990

Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study.

Cesarean delivery has become the most frequently performed major operation in the United States. Widespread use of vaginal birth after previous cesarean delivery could potentially eliminate up to one-third of cesareans. However, many physicians have been reluctant to adopt this policy without large studies conclusively demonstrating its safety. This study evaluated the maternal and perinatal outcomes of over 5000 cases of labor after previous cesarean delivery. This multicenter study began in 1984 and initially included nine California hospitals. During the first 2 years, there were 1776 trials of labor resulting in 1314 vaginal births. In January 1986 two additional hospitals joined the collaborative project. Over the next 3 years, there were 3957 trials of labor resulting in 2977 vaginal births at the 11 participating hospitals. During the entire study period, 5733 patients opted for a trial of labor and 4291 (75%) delivered vaginally. There were no maternal deaths in the trial-of-labor group, and perinatal mortality was not significantly different from that of the general obstetric population. These results support the findings of numerous smaller studies that have concluded that the policy of routine repeat cesarean delivery should be abandoned.

California↗
PubMed1989

Vaginal birth after cesarean section: is suspected fetal macrosomia a contraindication?

The American College of Obstetricians and Gynecologists' "Guidelines for vaginal delivery after a previous cesarean birth" include a precautionary statement regarding estimated fetal weight of more than 4000 g. To evaluate the validity of this restriction, we conducted an analysis of the outcomes of 301 trials of labor with birth weights equal to or greater than 4000 g. In the birth-weight range of 4000-4499 g, 139 of 240 patients (58%) delivered vaginally. In the group with birth weights exceeding 4500 g, 26 of 61 patients (43%) delivered vaginally. When compared with 1475 trials of labor with birth weights under 4000 g, no significant differences in perinatal or maternal morbidity were found. Comparison with a control group of 301 women with no previous uterine surgery who delivered macrosomic infants also demonstrated no significant differences in perinatal or maternal morbidity. The medical literature does not support elective cesarean section for suspected fetal macrosomia in nondiabetic women, and based on our experience, there appears to be no reason for treating previous-cesarean mothers differently.

Birth Weight↗
PubMed1988

Vaginal birth after cesarean section: results of a multicenter study.

Cesarean section is now the most frequently performed major operation in the United States. Nearly one out of every four American babies is delivered by this operation. "Elective repeat" has become the most common indication for cesarean section. Although the safety of vaginal birth after cesarean section has been documented in several recent publications, automatic repeat cesarean section remains the rule in this country. We present one of the largest series of trial of labor ever reported. Of 57,553 live births, 4929 (8.6%) were of women with prior cesarean sections. Among 1776 patients who underwent a trial of labor, 1314 (74%) delivered vaginally. There was no maternal or perinatal mortality related to uterine scar rupture. Thus during the study period 1314 major operations were avoided. We conclude that, for the vast majority of women, allowing a trial of labor is a safe alternative to automatic elective repeat cesarean section.

Adult↗
PubMed1987

Oxytocin during labor after previous cesarean section: results of a multicenter study.

The use of oxytocin for labor induction or augmentation in patients with previous cesarean delivery is controversial. This paper presents a series of 1776 patients allowed to labor after a previous cesarean section, of whom 485 (27%) were treated with oxytocin. When the patients who received oxytocin were compared with those who did not, no significant differences were found with respect to uterine rupture, maternal morbidity, fetal morbidity, or fetal mortality. We conclude that the judicious use of oxytocin is safe in the patient with a previous low transverse cesarean section.

Cesarean Section↗
PubMed1984

Vaginal delivery following cesarean section: use of oxytocin augmentation and epidural anesthesia with internal tocodynamic and internal fetal monitoring.

The cesarean section rate continues to rise, and, as new indications for the operation continue to be proposed, a method for safely decreasing the rate is truly needed. Less than 1% of patients in the United States are allowed a trial of labor after a cesarean section, in spite of the thousands of (safe) vaginal deliveries after cesarean section now reported in the literature. Few reports in the literature mention the use of oxytocin or regional anesthesia in these patients. We present our experience with 230 trials of labor after primary low transverse cesarean section. One hundred eighty-one patients (79%) were delivered vaginally, 73 patients (32%) received epidural anesthesia, and 94 patients (41%) received oxytocin augmentation of labor. Internal tocodynamic and fetal heart monitoring was used in all patients. Our rationale for this controversial management is discussed.

Anesthesia, Epidural↗
PubMed1977

Pharmacokinetics of methylphenidate in the rat using single-ion monitoring GLC-mass spectrometry.

A GLC-mass spectrometric assay for methylphenidate in biological fluids was developed using the ethyl ester homolog of the drug as the internal standard. The procedure has a lower level of sensitivity of 1.2 ng/ml and is based on GLC-mass spectrometic monitoring of the m/e 180 ion common to the mass spectra of the N-trifluoroacetyl derivatives of the drug and internal standard. The brain and plasma levels of methylphenidate in rats were determined after intravenous administration of 0.5 mg/kg of the drug. The two-compartment open pharmacokinetic model fit the data.

Animals↗