Cessation of drug use and infant birth weight.
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Adult↗
Biomedical subjects
D B Acker
Publications and source records attributed to D B Acker.
A shoulder dystocia intervention form.
The absence of a detailed note describing the maneuvers used to resolve shoulder dystocia often results in an inconsistent and counterproductive representation of the facts. Such a note should include exact times of events, a description of the maneuvers used, and an estimation of the traction forces exerted.
Dystocia↗
The nonstress test. Transmission from the home.
The Genesis Fetal Monitor System, which includes a recorder, a communication module and a receiver system, accurately and rapidly transmits a complete antenatal fetal monitor tracing over standard telephone lines and duplicates the original tracing at the receiver center. Transmission time for a 20-minute nonstress test is less than 2 minutes. The time required to generate a duplicate strip is less than 30 seconds. In all cases in this study the original and generated tracings were superimposable. No significant technical problems were encountered. Bioelectronic fetal assessment can be performed from a nonhospital setting, including the patient's home, with immediate interpretation of the tracing by skilled consultants.
Female↗
Cesarean birth rate: small-geographic-area analysis.
Population-based analysis of cesarean section rates within 172 geographic areas in the Commonwealth of Massachusetts during fiscal year 1985 revealed a nearly normal distribution of observed-to-expected rates, implying that the forces that compel obstetricians to perform this surgical procedure are pervasive. However, a small number of areas were identified in which the number of procedures performed was significantly different from the state mean. During fiscal years 1982 to 1985, certain geographic subgroups consistently demonstrated incidence rates significantly greater than the state mean. Although variation (either overutilization or underutilization) from the state rate is not synonymous with inappropriate care, those physicians within the identified geographic areas must take responsibility for ascertaining the explanation for the variance.
Cesarean Section↗
Ultrasonographic diagnosis of incompetent cervix. A case report.
The ultrasonographic findings of an incompetent cervix, the protrusion of the lower pole of the fetal membranes through the dilated internal os, may precede physical changes in the cervix. The symptoms at that time may be nonspecific. As this case report indicates, we believe that action--either close observation, conservative treatment or surgical intervention--should follow the detection of this condition.
Adult↗
Risk factors for Erb-Duchenne palsy.
The risk factors associated with the occurrence of Erb-Duchenne palsy were examined. Of 22 palsies, 18 were noted among 32,088 nondiabetic gravidas (0.56 per 1000) compared with four among 380 diabetic gravidas (10.5 per 1000), a statistically significant difference. One in six infants of diabetic gravidas who sustained shoulder dystocia experienced an Erb-Duchenne palsy. The incidence of precipitate second-stage labors was high (31.8%) among those infants who experienced the neurologic complication. This labor abnormality is not preventable and may contribute, in many ways, to the neurologic complication. Although recently graduated (less than four years' postresidency training) obstetricians, especially if placed in a high-volume practice, were more likely to experience this adverse outcome than more experienced physicians, even the most senior clinicians delivered infants who were affected.
Dystocia↗
Use of midforceps and associated risk.
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Birth Injuries↗
The normal parturient's admission temperature.
The relationship between oral temperature taken at the time of admission and the duration of elapsed labor was evaluated. Onset of labor data revealed a diurnal distribution with an apogee at midnight to 2 AM and a nadir at 11 AM to noon. Temperature data ranged from 94.3 degrees to 99.7 degrees F (34.6 degrees to 37.6 degrees C). The mean temperature of 97.8 degrees +/- 0.8 degrees F (36.6 degrees +/- 0.44 degrees C) is significantly lower (p less than 0.001) than the clinical reference temperature of 98.6 degrees F (37.0 degrees C). A likely explanation is the coincidental admission time (early to late morning) and the nadir of the diurnal variation in temperature. Linear regression fitted to the data (after deletion of six hypothermic outliers) yielded the relationship: temperature = 97.8 degrees F + 0.0115 X duration of elapsed labor (temperature = 36.6 degrees C + 0.0064 X duration of elapsed labor) for which the correlation coefficient is not statistically significant.
Body Temperature↗
Ultrasonography for fetal weight estimation: the Birnholz equation.
In the population of 563 normal live births, subject to the selection criteria of this study, the mean ultrasonographically-estimated fetal weight calculated using the Birnholz equation accurately predicts the mean true birth weight with less than 1 percent error. However, on a pairwise basis, the error was found to be systematic (rather than random) with a large standard error of the estimate (+/- 300 g). The equation consistently underestimated the mean birth weight between 1500-3750 g and consistently overestimated it thereafter.
Birth Weight↗
What my residents taught me.
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Communication↗
Risk factors for shoulder dystocia in the average-weight infant.
Almost half (47.6%) of all deliveries with shoulder dystocia occurred in association with the delivery of an average-weight infant (under 4000 g). Of 4294 nondiabetic gravidas delivering infants of birth weight 3500 to 3999 g, 94 (2.2%) experienced a shoulder dystocia. Protraction and arrest disorders were associated with a statistically significant increase in the incidence of shoulder dystocia, and this effect was further augmented by low forceps delivery. Among 6252 infants weighing 3000 to 3499 g, there were 40 instances of shoulder dystocia (0.6%). Only arrest disorders were associated with an increased rate.
Apgar Score↗
The leukocyte count in labor.
The leukocyte count was evaluated in 479 laboring gravida women. Increasing leukocyte counts appeared to be linearly related to the duration of elapsed labor (y = 0.2174x + 10.31; p less than 0.001; 95% confidence interval of the slope = 0.1414 to 0.2934). Isolated mild elevations and mild increases of leukocyte count in labor may be managed expectantly. Elevations greater than 2 SD are unlikely to represent normal variation; a diligent search for unapparent infection is warranted.
Chorioamnionitis↗
Risk factors for shoulder dystocia.
The risk factors associated with the occurrence of shoulder dystocia were examined in the general obstetrical population of women delivering vaginally. An increasing incidence of shoulder dystocia was found as infant birth weight increased. Although one-third of shoulder dystocia occurred in pregnancies at 42 + weeks, except for those resulting in infants weighing 4500 + g, the vast majority was unaffected by shoulder dystocia. The incidence of shoulder dystocia in nondiabetic gravidas delivering an infant weighing 4000 to 4499 and 4500 + g vaginally was 10.0 and 22.6%, respectively. Within the 4000- to 4499-g group, no labor abnormality was clearly predictive; however, in the heaviest birth weight group, an arrest disorder heralded a shoulder dystocia in 55.0% of cases. Diabetics experienced more shoulder dystocia than nondiabetics. Among them, 31% of vaginally delivered neonates weighing 4000 + g experienced shoulder dystocia. Nevertheless, the risk factors of diabetes and large fetus (4000 + g) could predict 73% of shoulder dystocia among diabetics; large fetus along flagged 52% of shoulder dystocia in nondiabetics. Cesarean section is recommended as the delivery method for diabetic gravidas whose estimated fetal weight is 4000 + g. If others confirm the risk, the authors advise serious consideration of cesarean section for gravidas who are carrying fetuses estimated to be 4500 + g and who experience an abnormal labor.
Apgar Score↗