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Biomedical subjects

D M Sherline

Publications and source records attributed to D M Sherline.

At least 19 recordsLinked to original sources
PubMed1998

Unengaged vertex in nulliparous women in active labor. A risk factor for cesarean delivery.

OBJECTIVE: To compare the route of delivery among nulliparous parturients with and without an engaged vertex in the early, active phase of labor. METHODS: Prospectively, the position of the fetal head was ascertained among nulliparous women at 37 weeks' gestation or more in early, active labor (cervical dilation > or = 4 cm with adequate contractions). Sixteen variables, including maternal demographics, obstetric complications and intrapartum course, were examined using chi 2 and logistic regression analysis. RESULTS: Among the 77 patients, 33 (42.8%) had an unengaged vertex and 44 (57.2%) had an engaged vertex in active labor. Of the 22 cesarean deliveries for arrest disorder, 2 were in the engaged and 20 in the unengaged group (P < .001). The mean birth weight was similar among those who had vaginal (3,211 +/- 416 g) and cesarean delivery (3,400 +/- 489 g, P = .08). Univariate analysis indicated that chorioamnionitis (relative risk [RR] 2.6, 95% confidence interval [CI] 1.4-4.9) and unengaged vertex (RR 13.3, CI 3.3-53.0) were associated with cesarean delivery for arrest disorders. When entered into a multiple logistic model, only unengagement was a risk factor for cesarean delivery. The following were not associated with cesarean delivery: maternal demographics, gestational age, estimate of fetal weight, presence or absence of meconium, preeclampsia, diabetes mellitus, private obstetric care or use of epidural anesthesia. CONCLUSION: Among nulliparous parturients, an unengaged vertex is a significant risk factor for cesarean delivery for arrest disorders.

Adolescent↗
PubMed1991

Thrombotic thrombocytopenic purpura first seen as massive vaginal necrosis.

Thrombotic thrombocytopenic purpura is a hematologic disorder that affects the microcirculation. A 38-year-old woman was first seen with fever, thrombocytopenia, and vaginal bleeding. Pelvic examination revealed massive vaginal necrosis. Hematology consultation resulted in agreement with the diagnosis of thrombotic thrombocytopenic purpura. This is the first reported case of thrombotic thrombocytopenic purpura first seen as vaginal necrosis of which we are aware.

Adult↗
PubMed1991

The effects of epidural anesthesia on the Doppler velocimetry of umbilical and uterine arteries in normal and hypertensive patients during active term labor.

To study the effects of epidural anesthesia on uterine and umbilical artery blood flow in preeclampsia, we observed 25 patients in active labor at 36 or more weeks' gestation. Seven had preeclampsia, eight had chronic hypertension, and ten had no complications. Doppler velocimetry of the uterine and umbilical arteries was performed before and after intravenous fluid loading and at 30 and 60 minutes after epidural blockade. Maternal vital signs and fetal heart rate were monitored continuously. After epidural block, mean maternal blood pressure fell significantly in all groups, but no maternal hypotension was observed. Mean maternal and fetal heart rates were unchanged. After epidural block, mean uterine artery systolic-diastolic (S-D) ratios did not change in the chronic-hypertension and normal groups, but fell significantly in the preeclamptic group to values similar to those of the normal group. Umbilical artery S-D ratios did not change in any group. In preeclamptic pregnancy, epidural anesthesia may help to reduce uterine artery vasospasm and may benefit intrapartum fetal well-being.

Adult↗
PubMed1988

The resident and fellow relationship in obstetrics and gynecology.

In a nationwide survey, chief administrative residents reported their views on how subspecialty fellowships affect their residency training in obstetrics and gynecology. The residents felt that fellows improve the quality of their training, depending on the degree they consider fellows as junior faculty involved in teaching and modeling patient care. Competition for surgical cases, and the surgical priority fellows have over residents in the new technology and nonroutine cases, potentially detract from the resident-fellow training relationship. These factors varied by subspecialty and the particular content areas of the fellowship. The residents' comments highlight the positive and negative components of each fellowship and identify the features of their relationship with the fellows. The implications of these findings for enhancing this relationship are presented.

Attitude↗
PubMed1988

A comparison of resident and program director views on the effects of subspecialty fellowships on residency training in obstetrics and gynecology.

In separate nationwide surveys, chief administrative residents and residency program directors reported their views on the impact of subspecialty fellowships on residency training. The residents expressed a less positive view of the fellowships, but like the directors, considered them beneficial to their training. The directors underestimated the degree residents regret the loss of operative experiences to the fellows, particularly in laser surgery, infertility surgery, and radical pelvic surgery. Within a given residency program, resident and program director opinions of the fellowships appear unrelated or contradictory. The implications of these findings for a discussion between residents and program directors are presented.

Administrative Personnel↗
PubMed1987

The effects of fellowships on residency training in obstetrics and gynecology.

The impact of subspecialty fellowships on resident training deserves examination. Program directors responded to a nationwide survey assessing their opinions, their residents' views, and the Residency Review Committee's comments about fellowship effects on the residency. The directors agreed that the fellows' teaching and research contact enhances training. Competition between fellows and residents for scarce, nonroutine surgical cases detracts from this relationship. Residents reportedly benefit from fellows, yet they resent deferring select surgical experiences to them, such as microsurgery and radical pelvic surgery. The majority of the programs the Residency Review Committee reviewed received positive or neutral comments. Programs that grant their fellows junior faculty status and emphasize research over clinical duties recognize the full benefits of a combined residency-fellowship program.

Fellowships and Scholarships↗
PubMed1987

Obstetric-gynecologic academic manpower--1986.

Full-time faculty numbers in academic departments of obstetrics-gynecology have resumed growth in the last three years, and now average 18.3 per department. Women are represented in a larger proportion than among practicing specialists. Faculty subspecialists are increasing in numbers, but their trend is toward practice rather than academic positions. Research involves 61% of the MD faculty. Chairmen predict major growth in faculty positions and in research over the next five years.

Canada↗
PubMed1987

Comparison of uterine activity induced by nipple stimulation and oxytocin.

Intermittent nipple stimulation has been proposed as a substitute for exogenous oxytocin infusion in the performance of contraction stress tests. To compare the uterine activity produced by these two methods, we studied a group of 45 term pregnant women undergoing indicated inductions of labor. Twenty-five patients had nipple stimulation and 20 patients received oxytocin infusions according to a study protocol. The two groups were similar in all obstetric parameters. Pre- and posttest uterine activity was measured by internal tocodynamometry and quantified in Montevideo units. A significant increase in uterine activity occurred in both groups (P less than .01). Regular uterine activity (three contractions in ten minutes) was achieved more rapidly (P less than .005), but at a lower level (P less than .001) in the nipple stimulation group. Pre- and posttest tonus did not change significantly in either group. In the nipple stimulation group, five patients (20%) did not achieve adequate contraction patterns after 15 stimulation-rest cycles (a total of 110 minutes) and three subjects (12%) experienced uterine hyperstimulation. These observations suggest that exogenous oxytocin and intermittent nipple stimulation may not have equivalent effects on uterine contractility. Therefore, it may not be justified to substitute one technique for the other or to use the same criteria for interpretation of contraction stress tests produced by both techniques.

Adult↗
PubMed1985

Computer-assisted assessment of the fetal biophysical profile.

The biophysical profile assesses fetal heart rate, breathing movements, fetal body movements, amniotic fluid volume, and fetal tone. In the past, these data have been scored by an arbitrary, unweighted system. While this approach is useful in detecting major anomalies and oligohydramnios, both static observations, the dynamic variables (fetal heart rate, fetal breathing movements, and fetal body movements) have added little information beyond that of an extended nonstress test alone. We have evaluated an alternative biophysical assessment system, modeled after extended physiologic studies, which not only acquires dynamic fetal variables simultaneously but, with computer assistance, quantifies the biophysical information. With an ADR 4000/L scanner, a Hewlett-Packard 8040 A monitor, and a specially programmed IBM microcomputer, we studied 100 normal term fetuses during 60-minute epochs. Each gestation had normal amniotic fluid volume and fetal tone. Normative values for the dynamic variables, expressed as means +/- SD were: fetal heart rate, 137 +/- 6.3 bpm; incidence of fetal breathing movements, 25.0% +/- 17.3%; rate of fetal breathing movements, 46.0 +/- 9.4 breaths/min; total fetal breathing movements, 823 +/- 61; incidence of fetal body movements, 8.5% +/- 3.9%; accelerations (greater than 15 bpm, 15 seconds), 14.1 +/- 6.3. We conclude that this approach is practicable, respects the biologic cycles of fetal behavior, and provides a basis for population standards and sequential study of the same fetus.

Amniotic Fluid↗
PubMed1985

The nonstress test as a diagnostic test: a critical reappraisal.

In the past decade the nonstress test has become a major method of assessing high-risk pregnancy. Although many studies have been published, there has been a lack of rigorous adherence to the standard criteria for diagnostic testing, that is, presentation of test specificity, sensitivity, predictive value, and the prevalence of abnormal outcomes in the populations studied. Furthermore, the populations studied vary widely in composition, testing conditions, methods of test interpretation, and clinical management. The authors undertake a review of these studies, with a focus on these issues, in an attempt to indicate potential problems involved in current test usage and to suggest avenues for needed clinical investigation.

Evaluation Studies as Topic↗
PubMed1985

Clinical sequelae of the extended nonstress test.

Two hundred eighty-one high-risk gravida women undergoing a collective total of 661 nonstress tests entered a protocol to determine whether extending initially nonreactive tests improved the positive predictive value of this test modality. Reactivity required the occurrence of at least three fetal heart rate accelerations (15 bpm, 15 seconds' duration), associated with fetal movement during a 30-minute episode. Tests failing these criteria were extended by sequential 30-minute increments until a reactive 30-minute window appeared or 90 minutes had elapsed. After 90 minutes, a nonreactive test was followed by a contraction stress test. Reactive tracings occurred in 266 patients (95%) and in all cases were evident by the end of 70 minutes. Corrected perinatal mortality and morbidity in this group were 0% and 5.6%, respectively. Nonreactive fetuses not only produced abnormal (positive or persistently equivocal) contraction stress tests in nearly all cases (93.3%) but had mortality and morbidity rates of 6.7% and 93.3%, respectively. Furthermore, in five of 15 instances, the contraction stress test was associated with profound fetal heart rate decelerations necessitating emergency delivery. We conclude that prolonged nonreactivity, in the absence of significant immaturity, congenital abnormalities, or pharmacologic agents, identifies significant fetal jeopardy. Expeditious termination of pregnancy should be considered and, under these circumstances, a subsequent contraction stress test may be relatively contraindicated.

Congenital Abnormalities↗
PubMed1985

Nonstress test: dimensions of normal reactivity.

Despite the widespread use of the nonstress test, there has been no consensus on the criteria for normal reactivity. The authors studied 495 nonstress tests of 230 normal term fetuses, using a standardized protocol. The frequency distribution of movement-associated fetal heart rate (FHR) accelerations exceeding 15 beats per minute and 15 seconds' duration was examined in windows, ranging from ten to 40 minutes. Mean, median, and modal frequencies of movement-associated FHR accelerations were determined in 1910, 1418, 895, and 473 windows of ten, 20, 30, and 40 minutes, respectively. No significant difference in movement-associated FHR acceleration frequency was observed for any sequential ten-minute window, but movement-associated FHR accelerations were absent in 19.5, 8.8, 5.2, and 5.0% of 10-, 20-, 30-, and 40-minute windows, respectively. The broad frequency distributions of movement-associated FHR accelerations, produced by normal fetuses, precludes discrete diagnostic cutoffs in short time windows, unless one is willing to accept significant negative predictive errors.

Female↗
PubMed1983

Picenadol (LY 150720) compared with meperidine and placebo for relief of post-cesarean section pain: a randomized double-blind study.

Picenadol (LY 150720) is a racemic mixture of an N-methyl-4-phenylpiperidine derivative, with agonist-antagonist opiate properties. Preclinical animal pharmacology and toxicology studies demonstrated analgesic activity and a low order of toxicity. Clinical pharmacology studies have demonstrated its safety in man. Hospitalized post-cesarean section patients with postoperative pain were blindly given an intramuscular dose of picenadol, 25 mg, meperidine, 100 mg, or placebo. Analgesia and side effects of picenadol and meperidine were similar.

Adolescent↗
PubMed1978

Adolescent pregnancy: the Jackson, Mississippi, experience.

An adolescent pregnancy center combining the educational, medical, and social needs was operational in Jackson, Mississippi, from September, 1971, to July 1976. Administrative responsibilities were shared by the University of Mississippi and the Jackson Separate School District. From 1971 to 1975, 763 students were enrolled. The mean age was 16 and ages ranged from 11 to 18 years. Ninety-nine per cent were black and a majority were poor and from a single-parent home. There was a 78 per cent school retention rate, but the center did not reduce dependence upon welfare assistance. When center, noncenter, faculty, and unregistered patients were compared, no difference could be detected in the incidence of medical complications, low birth weight, hypertension, and hematocrit. When compared for age only hypertension and difficult deliveries appeared to be age related.

Adolescent↗