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Biomedical subjects

E F Magann

Publications and source records attributed to E F Magann.

At least 91 records · Page 5Linked to original sources
PubMed1996

Neonatal electrolyte response to amnioinfusion with lactated Ringer's solution vs. normal saline. A prospective study.

OBJECTIVE: To determine if amnioinfusion with normal saline vs. lactated Ringer's solution crystalloids causes electrolyte imbalance in the human neonate. STUDY DESIGN: Over two months, all parturients undergoing amnioinfusion in the active phase of labor were prospectively randomized to receive either normal saline (n = 37) or lactated Ringer's solution (n = 30). Maternal electrolytes were obtained prior to amnioinfusion, and neonatal electrolytes were obtained from cord blood samples at the time of delivery. RESULTS: Our results showed the two groups were similar in maternal age, ethnicity, gravidity, parity, gestational age, maternal electrolyte levels prior to amnioinfusion, amount of solution amnioinfused, duration of labor after amnioinfusion, mode of delivery and mean birth weight. The chloride concentrations were nearly identical among neonates who had received normal saline and those who had received lactated Ringer's solution (102 +/- 2.1 SD and 104 +/- 2.4 mmol/L, respectively; P = 1.0). Other electrolytes were likewise not significantly different regardless of the crystalloid infused. CONCLUSION: Unlike the fetal sheep model, amnioinfusion with normal saline is not associated with hyperchloremia in the human neonate.

Adolescent↗
PubMed1996

Intrapartum amniotic fluid index. A poor diagnostic test for adverse perinatal outcome.

OBJECTIVE: To determine if an intrapartum amniotic fluid index (IAFI) < or = 5.0 cm, or any other level, is associated with abdominal delivery for fetal intolerance to labor or Apgar scores < 7 at one and five minutes. STUDY DESIGN: Prospectively IAFI was obtained in the latent phase of labor in 1,000 parturients at > 26 weeks. Receiver operating characteristic curves were utilized to determine if any IAFI could be utilized to predict adverse outcome among (1) the entire population, (2) complicated pregnancies, (3) uncomplicated pregnancies, (4) term, or (5) preterm gestation. RESULTS: The frequencies of abdominal delivery for suspected fetal intolerance and low Apgar scores were similar among patients with IAFI < or = 5.0 cm (n = 288) versus those with IAFI > 5.0 cm. All five receiver operating characteristic curves indicated that IAFI is a poor predictor of adverse outcomes. At all the discriminatory IAFIs (0-20 cm), the false positive rate was virtually identical to the true positive rate. CONCLUSION: IAFI appears to be a poor screening test for identifying those at risk for abdominal delivery for presumed fetal distress or for birth of an infant with low Apgar scores.

Amniotic Fluid↗
PubMed1995

Climatic factors and preeclampsia-related hypertensive disorders of pregnancy.

Seasonal variations of temperature and humidity are said to influence the incidence of hypertensive disorders of pregnancy. Pregnant women with hypertensive disorders of pregnancy were assessed on the basis of temperature and relative humidity at diagnosis. Temperature variations with constant high humidity do not influence the incidence of preeclampsia-eclampsia-related hypertensive disorders of pregnancy.

Eclampsia↗
PubMed1995

Massive congenital intracranial teratoma with skull rupture at delivery.

The majority of case reports concerning intracerebral tumors are almost equally divided between teratomas and gliomas. We report a case of congenital intracranial teratoma with suggested management. An 18-year-old woman at 30 weeks' gestation in active labor because of severe fetal hydrocephalus and polyhydramnios was delivered by cesarean section. Spontaneous rupture of the neonatal skull led to delivery of a stillborn infant; a congenital teratoma was found. Although intracranial teratoma is a well-recognized entity in the differential diagnosis of pediatric brain tumors, massive congenital teratoma replacing cerebral hemispheres of a fetus has been seldom reported. Antenatal diagnosis of the neoplasm and abdominal delivery may not improve outcome.

Adolescent↗
PubMed1995

Cervical ripening before medical induction of labor: a comparison of prostaglandin E2, estradiol, and oxytocin.

OBJECTIVE: Our purpose was to evaluate the effectiveness of oxytocin, prostaglandin E2 intracervical gel, and estradiol cream for ripening the very unfavorable cervix in patients requiring induction of labor at term. STUDY DESIGN: This prospective, randomized study was conducted in a population of women with a very unfavorable cervix (Bishop score < 4) requiring induction of labor. The patients received prostaglandin E2 gel (0.5 mg) intracervically (three doses 6 hours apart), 4 mg estradiol cream in the anterior fornix of the vagina (three doses 6 hours apart), or oxytocin at induction per protocol with an infusion pump. RESULTS: Ninety-nine women were recruited into this trial and evenly distributed among the three groups. The demographics of maternal age, race, parity, gestational age, initial Bishop score, and indication for induction were similar among the groups. The incidence of cesarean deliveries was similar in the three groups with approximately 59% of pregnancies delivered abdominally. For patients undergoing abdominal delivery the maximum cervical dilatation among the oxytocin, estradiol, and prostaglandin E2 groups was similar (3.90 +/- 3.02 cm, 3.63 +/- 2.79 cm, and 4.65 +/- 2.78 cm, respectively; p > 0.05). For all patients birth weight and Apgar scores at 1 and 5 minutes were comparable across all regimens (p > 0.05). In the subset of patients delivered vaginally patients receiving oxytocin for cervical ripening had the greatest improvement in Bishop score over baseline (p = 0.023) with an improvement of 7.08 +/- 2.42. CONCLUSION: No differences were detected among prostaglandin E2 gel, estrogen, and oxytocin in relation to cervical ripening in patients with an unfavorable cervix at term who require an induction of labor. Patients with a very unfavorable cervix at term who require delivery may benefit from serial ripening and inductions.

Adult↗
PubMed1995

Corticosteroid-induced arrest of HELLP syndrome progression in a marginally-viable pregnancy.

Corticosteroid therapy in preterm pregnancy complicated by severe pre-eclampsia as HELLP syndrome temporarily stabilizes the HELLP syndrome. One such patient complicated by extreme prematurity was treated with long-term high-dose corticosteroid therapy. The HELLP syndrome was temporarily stabilized and additional in utero fetal maturation was gained.

Adrenal Cortex Hormones↗
PubMed1995

Amniotic fluid volume of third-trimester diamniotic twin pregnancies.

OBJECTIVE: To define the normal range of amniotic fluid (AF) volume in third-trimester diamniotic twin gestations. METHODS: The AF volume of third-trimester diamniotic twin pregnancies was measured prospectively. An AF sample was drawn from both amniotic cavities of diamniotic twins either for diagnosis of subclinical chorioamnionitis with preterm labor and/or assessment of fetal lung maturity. Actual AF volume was determined in each amniotic cavity by a dye-dilution technique. RESULTS: The AF volume of 45 diamniotic twin pregnancies of 27-38 weeks' gestation was assessed. The AF volume per amniotic sac ranged from 155-5430 mL, with a mean (+/- standard deviation) of 877 +/- 860 mL. The AF volume in individual amniotic cavities and the total of both cavities in a diamniotic twin pregnancy were unchanged across the entire gestational age range (27-38 weeks). Neither fetal positioning within the uterus (lower twin versus upper twin) nor fetal weight were determining factors in the AF volume variability (P = .846 and P = .726, respectively). Based on absolute volumetric differences between the larger- and smaller-sac AF volume, we observed that as the AF volume of the larger sacs increased proportionately (P < .001), the AF volume of the smaller sacs remained relatively constant across the entire range of differences (P = .687) between 27-38 weeks. CONCLUSIONS: The average AF volume of 877 mL for each diamniotic twin is similar to the AF volume reported for third-trimester singletons. The AF volumes of diamniotic twin gestations relate neither to fetal position nor fetal weight, but instead develop independently without relation to the other amniotic cavity. Ninety percent of the AF volumes were 215-2500 mL.

Adolescent↗
PubMed1995

A randomized study to assess the efficacy of the amniotic fluid index as a fetal admission test.

OBJECTIVE: To determine whether there is a difference in the incidence of abdominal delivery for presumed fetal distress in women who have an intrapartum fluid index assessment and those who do not. METHODS: Over a 7-month period, parturients at 26-42 weeks' gestation and in early labor were randomized to the study (measured amniotic fluid index [AFI] on admission) or a control group (no sonographic assessment of amniotic fluid [AF] volume). The labor and delivery staff were aware of the AFI results of the study subjects. All patients had continuous electronic fetal monitoring, and none had an abnormal tracing on admission. Student t test or chi 2 was used for statistical analysis. P < .05 was considered significant. RESULTS: The study (N = 447) and control groups (N = 436) had similar maternal demographics as well as medical and obstetric complications. In the study group, the incidence of abdominal delivery for fetal distress (29 of 447) was significantly higher than among controls (14 of 436) (P = .02; relative risk 1.3, 95% confidence interval 1.1-1.7). Among parturients who had abdominal delivery for fetal distress, the decision-to-incision times (mean +/- standard deviation) were similar for parturients who had undergone assessment of AFI and those who had not (38.5 +/- 14.7 versus 32.5 +/- 14.7 minutes, respectively; P = .47). Mean birth weight, incidence of low birth weight, macrosomia, Apgar scores less than 7, and the number of admissions to the neonatal intensive care unit were not significantly different in the two groups. CONCLUSIONS: Patients having an intrapartum assessment of AFI as a fetal admission test are significantly more likely to have abdominal delivery for presumed fetal distress. However, the decision-to-incision time is not decreased and the perinatal outcome is not improved if the status of AF volume is known for patients in early labor.

Adult↗
PubMed1995

Acute tocolysis for suspected intrapartum fetal distress: maternal effects of terbutaline versus magnesium sulfate.

This study was undertaken to determine the maternal hemodynamic impact of terbutaline versus magnesium sulfate in the acute treatment of fetal distress prior to cesarean delivery. Forty-six women were prospectively randomized to receive 0.25 mg subcutaneous terbutaline or 4.0 g intravenous magnesium sulfate for in utero fetal resuscitation before cesarean delivery. There were no significant differences between groups in baseline mean arterial pressure, arterial pressure before and after induction of anesthesia, maternal heart rate, maternal oxygen saturation, estimated blood loss, and pre- and postoperative hematocrits. Magnesium sulfate-treated women received significantly more intraoperative intravenous fluids (2365 +/- 877 ml) than the terbutaline group (1624 +/- 564 ml; P < 0.001). However, mean urine output was significantly greater in the terbutaline group (88 +/- 42 ml/h) than in those treated with magnesium sulfate (61 +/- 26 ml/h; P < 0.03). Terbutaline, the superior agent for acute tocolysis, is not associated with an increase in maternal cardiovascular side effects during anesthesia.

Journal Article↗
PubMed1995

Sonographic assessment of birth weight among breech presentations.

The objective in this study was to determine whether there was a difference in the accuracy of sonographically determined birth weight estimate in fetuses presenting by the breech as compared to the vertex. Prospectively, 104 consecutive singleton fetuses presented by the breech presentation were identified who also had a sonographic estimate of birth weight within 72 h of delivery. The control group (n = 104) consisted of fetuses presenting by the vertex of women who had the following hospital number and who were of similar demographic characteristics; the birth weight estimate in the control group had to be within 100 g of that of the women with the breech fetus. The estimate of the birth weight was derived for both groups using seven published models. Prediction limits were calculated for an estimated vs. actual birth weight for parturients with breech presentation. Among the study group, the mean standardized absolute error was similar for the seven models (range 120 +/- 104 to 138 +/- 118 g/kg; p = 0.08). For six of the models, the mean standardized absolute error was significantly higher for fetuses in the breech presentation than for fetuses in vertex presentation (range 80 +/- 63 to 112 +/- 95 g/kg; p = 0.02 to < 0.0001). Prediction limit calculations indicate that 99% of the time the actual birth weight was between 1500 and 3999 g if the estimate of birth weight was 2400-2900 g. We conclude that, for fetuses in a breech presentation, the error with most models is significantly higher than for a singleton in the vertex position.

Abdomen↗
PubMed1995

Factors adversely affecting pregnancy outcome in the military.

This prospective study was undertaken to identify the significant risk factors associated with adverse pregnancy outcome in active-duty women. The deliveries of 300 consecutive pregnancies of active-duty women were assessed for maternal-fetal outcome. The risk factors evaluated were: marital status, parity, race, smoking and alcohol consumption while pregnant, maternal weight gain during pregnancy, maternal height, and educational level. Two-thirds of these women were junior enlisted personnel (rank E-4 or below) and worked under demanding job conditions over which they had little control. Increased age as a risk factor was associated with a significant increase in pregnancy-associated complications of cesarean birth, operative vaginal delivery, pregnancy-induced hypertension, preterm labor, maternal transport for fetal indications, intrauterine growth restriction, intrauterine fetal death, postpartum hemorrhage, placenta previa, and 5-minute Apgar scores < 7 (p = 0.039). In gravidas more than 65 inches in height with a weight gain more than 42 pounds, there was a significant increase in the complications of pregnancy (p = 0.022). Interactions of these risk factors yielded a significant age (p = 0.025), maternal height (p = 0.007), and height times weight gain interaction (p = 0.006) association with pregnancy complications. The risk factors of advancing maternal age and tall stature with a maternal weight gain of more than 42 pounds are associated with increased pregnancy complications of active-duty women.

Adult↗
PubMed1995

The laboratory evaluation of hypertensive gravidas.

A number of laboratory tests are available for the evaluation of the hypertensive gravida. These tests can be used to either predict and/or prognosticate between preeclampsia and other hypertensive disorders of pregnancy. These laboratory tests were evaluated based on published experience with special attention to its ability to facilitate identification of the patient with preeclampsia apart from other hypertensive disorders that co-exist with and occur as a complication of pregnancy. Hypocalciuria and increased cellular plasma fibronectin seem to be good tests to differentiate preeclampsia from chronic hypertension. The management of preeclampsia with its increased risk of perinatal morbidity and mortality renders this differentiation clinically very important. Hyperuricemia, proteinuria, increased serum beta-thromboglobulin concentration, abnormal red blood cell morphology with increased hemoglobin/hematocrit, and increased serum iron individually and collectively reflect the severity of preeclampsia. Platelets and total serum lactate dehydrogenase are the best tests to reflect the severity of HELLP syndrome. Circulating hCG and serum thromboglobulin seem to be the most promising future predictors for preeclampsia.

Diagnosis, Differential↗
PubMed1995

Intrapartum detection of a macrosomic fetus: clinical versus 8 sonographic models.

The purpose of this study was to determine whether clinical or sonographic models have 1) the highest accuracy in differentiating newborns with birth-weights > or = 4,000 g (macrosomia) versus < or = 3,999 g, and 2) among macrosomics which method of predicting birth-weight has the lowest percentage error. Prospectively, 602 consecutive parturients at term had a clinical estimate of birth-weight followed by sonographic measurement of fetal parts. The sonographic prediction of birth-weight was derived using 8 different models that utilize either 1 measurement or a combination of 2 to 4 parameters. The incidence of macrosomia was 11.1% (67 of 602). Analysis of ROC curves indicated that clinical predictions (w = 0.85) were significantly better than 4 of the 8 sonographic models. The mean standardized absolute error among macrosomic newborns is significantly lower when predictions are derived clinically (99 +/- 70 g/kg) than using 1 or 2 fetal parts. Sonographic assessment of birth-weight is not significantly more accurate in the detection of a macrosomic fetus than clinical predictions.

Adult↗
PubMed1995

Accuracy of ultrasonography in evaluating amniotic fluid volume at less than 24 weeks' gestation.

The purpose of this investigation was to evaluate the accuracy of common sonographic techniques in assessing the amniotic fluid volume in pregnancies of less than 24 weeks' gestation. Patients at less than 24 weeks' gestation undergoing an amniocentesis for the placement of prostaglandin F2 alpha for termination (because of genetic or fetal anomalies, or both) were assessed for amniotic fluid volume. All fetuses were alive at the time of prostaglandin instillation. The amniotic fluid index and two-diameter pocket were used to determine the amniotic fluid volume. Prior to the prostaglandin instillation, the amniotic fluid volume was determined with para-aminohippurate using a diazo dye reaction with spectrophotometric analysis. The amniotic fluid volume was determined in 21 pregnancies between 15 and 24 weeks' gestation, yielding volumes ranging from 189 to 1840 ml. Using published standards for amniotic fluid volume in singleton pregnancies, oligohydramnios was present in three gestations, the volume was found to be normal in 15, and hydramnios complicated three pregnancies. The two-diameter pocket identified the amniotic fluid volumes correctly more often (18 of 21 [85.7%]) than the amniotic fluid index (10 of 21 [47.6%]) (P = 0.02). Normal amniotic fluid volume was identified in nine of 15 (60%) pregnancies by the amniotic fluid index and in 14 of 15 (93.3%) by the two-diameter pocket (P = not significant). Abnormal amniotic fluid volumes, oligohydramnios, and hydramnios were recognized more often by the two-diameter pocket (66.7%) than by the amniotic fluid index (1 of 6 [16.7%], P = not significant).

Abortion, Induced↗
PubMed1995

Infectious morbidity, operative blood loss, and length of the operative procedure after cesarean delivery by method of placental removal and site of uterine repair.

OBJECTIVE: This study was done to determine the impact of the method of placental removal and the site of uterine repair on postcesarean infectious morbidity rates in women receiving prophylactic antibiotics at cesarean delivery. STUDY DESIGN: This prospective study included 284 women who underwent cesarean delivery and who were randomly assigned to four groups based on the method of placental removal and the site of uterine repair: group 1, spontaneous placental removal and in situ uterine repair; group 2, spontaneous placental removal and exteriorized uterine repair; group 3, manual placental removal and in situ uterine repair; and group 4, manual placental removal with exteriorized uterine repair. Exclusion criteria were repeat cesarean deliveries without labor, active infection at the time of cesarean delivery, and patient refusal to participate. RESULTS: There was no significant difference among the groups in maternal age, race, parity, weight, the length of time from rupture of membranes (ROM) or the number of vaginal examinations from ROM to cesarean delivery, or preoperative hematocrit. Intraoperatively, the type of uterine incision, anesthesia administered, incidence of meconium-stained amniotic fluid, Apgar scores, and cord gases were similar between groups. The incidence of postcesarean endometritis was greater in group 4 (32 [45 percent] of 71, p = 0.003) compared with group 1 (17 [24 percent] of 71), group 2 (12 [30 percent] of 71); and group 3 (13 [18 percent] of 71). CONCLUSIONS: Manual placental removal and exteriorization of the uterus for repair of the surgical incision increases the infectious morbidity rate in women receiving prophylactic antibiotics at the time of cesarean delivery and increases the length of hospitalization.

Adult↗
PubMed1995

Complicated postpartum preeclampsia-eclampsia.

Infrequently, severe preeclampsia-eclampsia with or without HELLP syndrome persists more than 24 to 48 hours into the postpartum period. Maternal morbidity and mortality is increased in these women who persist in their disease and do not rapidly resolve their hypertension, decreased urinary output, depressed platelet count, and other related abnormalities within 72 to 96 hours postpartum. When these worsen to include multiple system organ failure, infection, and fibrin consumption coagulation disorders, emergent and aggressive intervention is needed. Prophylactic treatment options to accelerate postpartum recovery include ultrasound-directed postpartum curettage and oral nifedipine therapy. In pregnancies complicated by HELLP syndrome, postpartum corticosteroids can be used to hasten the recovery from this disease. Delayed ultrasound-directed curettage and exchange plasmapheresis with fresh-frozen plasma can be used in pregnancies when evidence of recovery is absent or further deterioration is evident by 96 hours postpartum. Other specific system involvement, such as central nervous system or renal system, requires directed therapy unique to the individual condition and patient that is undertaken in association with consultants.

Female↗
PubMed1995

New-onset hypertension in the pregnant patient.

The new onset of hypertension in pregnancy most often reflects preeclampsia, underlying chronic hypertension, chronic hypertension with superimposed preeclampsia, or gestational hypertension, and less commonly is due to substance abuse or any of several rare conditions. The term "pregnancy-induced hypertension" applies to all of these categories, but because it does not adequately and specifically define the patient's condition, its use therefore is discouraged. Attention to accurate identification of the specific type of "pregnancy-induced hypertension" is important since treatment varies depending on the diagnosis and the stage of pregnancy from observation with gestational hypertension to active intervention in the patient with chronic hypertension and superimposed preeclampsia. Both perinatal and maternal outcomes are dependent also on the categorization of the hypertensive disorders of pregnancy. Efforts to selectively identify, correctly diagnose, and optimally treat each hypertensive mother should help to achieve the best possible outcome with the least maternal risk.

Chronic Disease↗