Biomedical subjects

E F Magann

Publications and source records attributed to E F Magann.

125 records · Page 7Linked to original sources

PubMed1992

Measurement of amniotic fluid volume: accuracy of ultrasonography techniques.

OBJECTIVE: Our purpose was to determine amniotic fluid volume by the dye-dilution technique and compare it with the amniotic fluid index, largest vertical pocket, and two-diameter pocket (defined as vertical x horizontal of the largest vertical pocket). STUDY DESIGN: This prospective study involved 40 women undergoing amniocentesis in late pregnancy to detect fetal lung maturity or evidence of chorioamnionitis. The amniotic fluid volume was quantified ultrasonographically by means of the amniotic fluid index, largest vertical pocket, and two-diameter pocket. During amniocentesis the fluid volume was calculated by the dye-dilution technique of Charles and Jacoby. RESULTS: Ultrasonographic measurements by amniotic fluid index, largest vertical pocket, and two-diameter pocket correctly predicted normal amniotic fluid and hydramnios (74%). A new measurement, two-diameter pocket, gave a significantly more accurate estimate of oligohydramnios than did amniotic fluid index (p < 0.002) or largest vertical pocket (p < 0.0003). CONCLUSION: All three indices are moderately accurate in identifying normal amniotic fluid volume and hydramnios. Two-diameter pocket is the most accurate test to predict oligohydramnios.

Adolescent↗

PubMed1992

The effect of placental management at cesarean delivery on operative blood loss.

OBJECTIVES: The effect of alternative methods of placental delivery at cesarean section on blood loss has not been reported. The hypothesis of this study was that spontaneous expulsion of the placenta would reduce operative blood loss, compared with that of manual extraction during cesarean delivery. STUDY DESIGN: We prospectively randomized and compared outcomes of 62 gravid women with manual (n = 31) or spontaneous (n = 31) placental delivery at cesarean section. Operative blood loss was measured directly. RESULTS: Blood loss measured at cesarean delivery was greater in the manually delivered group (967 +/- 248 ml) than in the spontaneously delivered group (666 +/- 271 ml, p < 0.0001). The incidence of postpartum endometritis was sevenfold greater in the manual than the spontaneous group (23% vs 3%, respectively; p < 0.05). CONCLUSIONS: We conclude that spontaneous expulsion of the placenta at cesarean delivery results in less operative blood loss and a lower incidence of postoperative endometritis.

Adult↗

PubMed1992

The diagnosis and management of dystocia of the shoulder.

Dystocia of the shoulder is an unpredictable obstetric emergency that may result in injury to the mother or fetus. In an effort to reduce such risks, attempts have been made to identify patients having a fetus who may subsequently develop shoulder dystocia. The literature, however, clearly reflects that even the combination of prenatal historic facts, estimated fetal weight and sequence of intrapartum events is ineffective in prospectively identifying infants whose births are complicated by shoulder dystocia. During a ten year period at the University of Mississippi Medical Center, the incidence of macrosomia, shoulder dystocia and subsequent brachial plexus injury was reviewed. The majority of instances (89 percent) of shoulder dystocia occurred in patients weighing less than 8 pounds 13 ounces at birth. In the current retrospective review, only 11 percent of the women had risk factors for macrosomia or shoulder dystocia and among these, none were identified prospectively. Additionally, 91 percent of patients with brachial plexus injury recovered with no sequelae. One instance of brachial plexus injury occurred at the time of cesarean section. These data reveal that macrosomia and subsequent shoulder dystocia cannot be predicted. Therefore, it is not feasible to prevent brachial plexus injury prospectively by prophylactic cesarean section. Great clinical acumen and technical expertise by the obstetrician using a variety of methods may be useful in avoiding, as much as possible, injury to the mother and fetus when shoulder dystocia does occur.

Birth Weight↗

PubMed1992

A randomized comparison of secondary closure and secondary intention in patients with superficial wound dehiscence.

OBJECTIVE: To determine whether secondary closure or secondary intention results differ with respect to time for complete healing and number of postoperative visits in patients with superficial wound dehiscence. METHODS: A randomized trial involved 33 obstetric and gynecologic patients at the University of Mississippi Medical Center who experienced superficial wound dehiscence. Subjects were assigned to secondary-closure or secondary-intention groups. The two groups were similar in age, absolute body weight, percent ideal body weight, length of the primary surgical procedure, estimated blood loss at the primary surgical procedure, portion of the would that opened, preoperative hemoglobin concentration, and preoperative hematocrit. RESULTS: Patients randomized to secondary closure required a mean (+/- standard deviation) of 17.6 +/- 7.2 days from dehiscence to complete healing, whereas those assigned to secondary intention required 61.2 +/- 35.8 days (P less than .001). The secondary-closure group required a mean of 2.0 +/- 0.7 postoperative visits, compared with 8.4 +/- 6.2 visits in the secondary-intention group (P less than .001). CONCLUSION: Secondary closure of superficial wound dehiscence is superior to healing by secondary intention.

Adult↗

PubMed1992

Ascites: a portent of cardiopulmonary complications in the preeclamptic patient with the syndrome of hemolysis, elevated liver enzymes, and low platelets.

OBJECTIVE: Maternal ascites is frequently found at cesarean delivery in patients with severe preeclampsia or eclampsia expressed as hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). We attempted to determine whether large-volume maternal ascites present at cesarean delivery in HELLP syndrome patients is correlated with disease severity or with any specific form of increased maternal morbidity. METHODS: For this retrospective case series, we reviewed the medical records of 190 patients and noted the presence or absence of large-volume maternal ascites, peripartum complications, laboratory data, and specific operative techniques. RESULTS: The incidence of large-volume ascites in patients with HELLP syndrome who underwent abdominal delivery was approximately 10% in classes 1, 2, and 3. Compared with HELLP syndrome patients without ascites, those with HELLP-associated ascites at surgery had a significant sixfold increase in the incidence of congestive heart failure and a ninefold increase in the incidence of adult respiratory distress syndrome, both of which usually became clinically apparent within 24 hours postpartum. Those HELLP syndrome patients without ascites at surgery developed congestive heart failure or adult respiratory distress syndrome infrequently, and more than 24 hours postoperatively. CONCLUSION: Cautious fluid administration and observation for cardiopulmonary deterioration are crucial in management of the critically ill, high-risk group of HELLP syndrome patients with large-volume ascites.

Adult↗

PubMed1991

Pregnancy outcome in an active-duty population.

The number of women in the military has grown since the initiation of the all-volunteer force. Pregnancy is no longer a justification for discharge from active service. Previously published reports have shown that active military service is associated with poor pregnancy outcomes. We compared a group of active-duty pregnant women (N = 331) matched for age and gravidity with a control group of dependent wives of active-duty personnel (N = 1218). Study variables examined were the incidences of cesarean and operative vaginal delivery, Apgar scores of less than 7 at 5 minutes, preterm complications (preterm labor and premature rupture of membranes) requiring transfer to a tertiary care center, pregnancy-induced hypertensive syndromes, intrauterine growth retardation (IUGR) (infant weight less than 2500 g), and pregnancy-related complications. In the active-duty group, the rates of primary cesarean (P less than .001), transfer for preterm complications (P less than .0001), pregnancy-induced hypertensive syndromes (P less than .01), and IUGR (P less than .05) were greater than in the control group. Active-duty servicewomen, despite defined limitations of work and ready access to health care, continue to represent a high-risk population.

Adult↗

PubMedDate not supplied

Ultrasonic assessment of the amniotic fluid volume in diamniotic twins.

OBJECTIVE: We sought to determine amniotic fluid (AF) volume in diamniotic twin gestations and to relate these findings to estimates using standard ultrasonic techniques. METHODS: In this prospective study, AF volume in 45 diamniotic twin gestations at 27-38 weeks was assessed by sonography using the largest vertical pocket technique, the AF index, and the two-diameter pocket method. After the three different sonographic estimations of AF volume, the true amount of AF was determined using amniocentesis and a dye-dilution technique. RESULTS: The individual sac AF volume was less than 500 mL in 35 amniotic cavities, 500-2000 mL in 48 sacs, and greater than 2000 mL in seven. Individual AF volume between 500 and 2000 mL was correctly predicted by sonographic use of the largest vertical pocket in 47 of 48 patients (98%), the AF index in 47 of 48 (98%), and the two-diameter pocket method in 39 of 48 (81%). Estimation of AF volume less than 500 mL was significantly more accurate using the two-diameter pocket method compared with either the AF index (P = .015) or the largest vertical pocket technique (P < .0001). CONCLUSIONS: Currently available ultrasonic techniques to assess mid-range AF volume (500-2000 mL) in twin pregnancy are very accurate (81-98%). Oligohydramnios (less than 500 mL) is poorly identified by any sonographic method.

Adult↗

PubMedDate not supplied

Neonatal salvage by week's gestation in pregnancies complicated by HELLP syndrome.

OBJECTIVE: For clinical management and counseling purposes, we determined the neonatal salvage by weeks' gestation and birth weight of pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). METHODS: All patients who delivered with a diagnosis of HELLP syndrome between January 1, 1980 and December 31, 1991 at a single tertiary care medical center were evaluated for neonatal outcome and survival. The syndrome was diagnosed in the presence of severe preeclampsia/eclampsia accompanied by laboratory evidence of hemolysis, hepatic dysfunction, and thrombocytopenia. RESULTS: During the study interval, 58,670 live-born deliveries occurred, of which 527 (0.11%) had HELLP syndrome. In this population, 143 patients delivered fetuses at less than 30 weeks' gestational age. Based upon gestational age intervals, neonatal salvage was 0% at 23 weeks in 13 deliveries, 17% (intact salvage 8.5%) at 24 weeks, 31% (intact salvage 15%) at 25 weeks, 75% (intact salvage 65%) at 26 weeks, 80% (intact salvage 70%) at 27 weeks, and 83% at 28 and 29 weeks (intact salvage 70 and 76%). Based on birth weight intervals, neonatal salvage was 0% at less than 600 g, 34% at 600-700 g (intact salvage 17%), 69% at 700-800 g (intact salvage 53%), and 84% or more at greater than 800 g. These pregnancy outcomes are similar to those in this institution in patients without HELLP syndrome. Disease severity was distributed evenly among the 143 patients at less than 30 weeks' gestation. Apart from gestational age, there was no significant relation between the severity of the HELLP disease process and ultimate neonatal salvage. CONCLUSIONS: Intact neonatal salvage in pregnancies complicated by HELLP syndrome is poor at weights less than 700 g and gestation of 25 weeks or less, but is more optimistic in pregnancies of greater than 700 g and 26 weeks' gestation or later. Aggressive efforts to enhance perinatal outcome, by operative delivery if indicated for fetal compromise, appear especially appropriate in gestations of greater than 700 g and 26 weeks' gestation or later, provided that adequate intensive care nursery facilities and neonatal expertise are available.

Birth Weight↗

PubMedDate not supplied

Accelerated recovery from severe preeclampsia: uterine curettage versus nifedipine.

OBJECTIVE: We investigated the ability of uterine curettage and nifedipine to accelerate postpartum recovery from severe preeclampsia. METHODS: Forty-five parturients with severe preeclampsia were randomly assigned to one of three groups following delivery. Patients in group 1 were managed with intravenous magnesium sulfate (2 g/hour) and observed in the obstetric recovery room until blood pressure had stabilized (systolic blood pressure less than 150 mmHg and diastolic blood pressure less than 100 mmHg) and adequate diuresis was noted. Group 2 was treated in a similar manner but with the addition of oral nifedipine, 10 mg every 4 hours postpartum for 48 hours. Group 3 underwent an ultrasound-directed curettage immediately following delivery in the delivery/operating room and was then treated as in group 1. All three groups were assessed postpartum for mean arterial pressure (MAP) and urine output (UO) every 2 hours, hematocrit and platelet count every 6 hours, and lactic dehydrogenase/aspartate aminotransferase every 12 hours for 48 hours postpartum. RESULTS: Fifteen women were assigned to each of the three treatment groups. The MAP decreased significantly (P < .0001) in all three groups during the first 48 hours postpartum. Treatment interaction indicated specific differences among the groups. Standard therapy (group 1) was significantly inferior to nifedipine (group 2) and curettage (group 3) in regard to MAP decrease (P = .0017) and UO increase (P = .0137). No statistical differences existed between nifedipine and curettage. The rise in the platelet count following delivery was significantly different among the three groups (P = .033), with a much more rapid recovery in the curettage group (12-18 hours) than in the other groups (P = .0106). CONCLUSIONS: Nifedipine and uterine curettage both appear to accelerate recovery from severe preeclampsia, as measured by MAP and UO. Uterine curettage appears the most effective in rapidly resolving the thrombocytopenia associated with severe preeclampsia.

Adult↗

PubMedDate not supplied

Amniotic fluid interleukin-6 and interleukin-8 levels predict the success of tocolysis in patients with preterm labor.

OBJECTIVE: To determine whether the levels of the cytokines interleukin-6 (IL-6) and IL-8 in amniotic fluid identify patients with preterm labor who are resistant to tocolysis. METHODS: Amniocenteses were performed in 23 women with documented preterm labor at 20-32 weeks' gestational age who were treated subsequently with tocolytics. The concentrations of IL-6 and IL-8 in amniotic fluid were determined by double-antibody radioimmunoassay methods using recombinant human IL standards. RESULTS: Of the 23 patients, five failed to respond to tocolysis (four delivered within 48 hours), and of the remaining 18, all delivered more than 9 days after tocolysis was initiated (mean 31 +/- 10 days; range 9-61). In women who had failed tocolysis, discriminatory concentrations of IL-6 and IL-8 were 20 and 15 ng/mL, respectively. Of the patients who had amniotic fluid concentrations higher than these thresholds, all failed tocolysis (100% positive predictive value) and delivered within 6 days. The patients with levels below these discriminatory concentrations had successful tocolysis, and 17 of 18 delivered more than 2 weeks after treatment (95% negative predictive value). CONCLUSION: The success of tocolysis and thus delivery remote from an episode of preterm labor is associated with discriminatory amniotic fluid IL-6 and IL-8 levels of less than 20 and less than 15 ng/mL, respectively. If the immunologic response that causes the release of IL-6 and IL-8 has not occurred, the likelihood of successful tocolysis is extremely high. However, if both IL-6 and IL-8 are elevated, tocolysis is likely to fail and delivery may occur within 48 hours.

Adult↗

PubMedDate not supplied

Hemorrhage associated with cesarean delivery: when is transfusion needed?

Our objective was to determine the incidence of blood administration after cesarean delivery and whether such transfusions are always beneficial. In this retrospective study 1610 women underwent cesarean delivery during a 2-year period and 127 of these patients had hemorrhage during or after operation. Of these subjects 103 received blood because of intraoperative hemorrhage, a reduction in the hematocrit of more than 10 points, or because the postoperative hematocrit was < 24%. These subjects were compared with the remaining women (n = 24) who met the same criteria for hemorrhage but did not receive transfusion. The maternal age, race, and parity were similar in both groups. The estimated blood loss (873 +/- 484 ml) and the preoperative hematocrit (33.4% +/- 6.4%) in the women who did not receive transfusion were not significantly different from those of patients who received packed red blood cells (854 +/- 576 ml and 30.0% +/- 5.4%, respectively). The postdelivery hematocrit was similar in both groups: 25.9% +/- 4.3% in the nontransfused group and 24.5% +/- 5.6% in the transfused group. Patients in the transfused group received a mean of 3.8 +/- 4.9 units of packed red blood cells, with a range of 1 to 40 units. The mean equilibrated (stable) hematocrit after transfusion was 28.4% +/- 5.4%, which was significantly greater than the mean equilibrated postoperative hematocrit of 22.7% +/- 4.6% in patients who did not receive transfusion (p < 0.0001). Nonetheless, the hospital stay, incidence of postoperative infection, and incidence of wound complications were similar in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Parous patients' estimate of birth weight in postterm pregnancy.

Our objective was to determine among postterm gestations (gestational age > or = 41 weeks) the accuracy of a parous patient's (n = 70) estimate of her newborn's birth weight and to compare the accuracy of clinical prediction with the assessment by the parturient (n = 40). During early labor 70 postterm parous subjects were asked to predict the birth weight of their neonate on the basis of their prior obstetric experiences. For comparison, a concurrent clinical estimate of the birth weight by the provider was also obtained in 40 of these patients. The incidence of macrosomia (birth weight > or = 4000 gm) among postterm parous mothers was 25.7%. The mean standardized error of the maternal estimate of birth weight was 85 +/- 76 gm/kg and 71.4% of their estimates were within +/- 10% of actual birth weight. Maternal estimate of birth weight > or = 4000 gm had a 94% specificity and 77% positive predictive value for a macrosomic fetus. Among 40 postterm parous women the clinical estimate had a mean standardized error (75 +/- 71 gm/kg) comparable to that of the maternal prediction (92 +/- 81 gm/kg) of birth weight (p = not significant). The mean standardized error among estimates for 11 macrosomic newborn infants who underwent both methods of estimation of birth weight was not significantly different. In conclusion, postterm parous women are at risk for delivery of a macrosomic fetus. Among these parturients, an estimate of birth weight by parous women is comparable to the clinical prediction of newborn weight by their providers.

Adult↗

PubMedDate not supplied

Obstetric challenges of massive obesity complicating pregnancy.

This study examined the effects of massive maternal obesity on medical complications, mode of delivery, postpartum complications, and hospital confinement. In this retrospective case control study, women weighing > 300 pounds delivering from January 1, 1986, to November 1, 1991, were matched for age, race, parity, and height with lean parturient women (mean weight 160 +/- 21 pounds). Among massively obese women there was a greater incidence of chronic hypertension (p < 0.05) and diabetes (p < 0.05) than in the control group. Primary cesarean section was more frequent (p < 0.05), as was the postoperative complication of endometritis when obese patients were compared with lean women (p < 0.05). Cephalopelvic disproportion was the only indication for primary cesarean section, which occurred with greater frequency in the obese group. The postpartum hospital confinement was also significantly longer in the obese study group (p < 0.05). The gestation of a massively obese parturient woman is more frequently complicated by chronic hypertension and diabetes. Abdominal delivery for cephalopelvic disproportion is more likely, and this mode of birth is more often followed by endometritis, which results in longer hospital stays.

Adult↗

PubMedDate not supplied

Martial status and military occupational specialty: neither factor has a selective adverse effect on pregnancy outcome.

This investigation was undertaken to determine whether there is a relationship between martial status or military occupational specialty (MOS) and pregnancy outcome in and active-duty population. In this prospective, descriptive study 312 active-duty women were identified as married or single and stratified into four groups on the basis of MOS: group I (n = 144), mild to moderate mental stress; group II (n = 43), intensive mental stress; group III (n = 72), exposure to hazardous material; and group IV (n = 53), physical stress. Each patient group was evaluated to determine the incidence of medical complications. One hundred ninety-three of the service women were married and 70 were single. There was no significant difference between pregnancy complications and martial status. In spite of considerable stress and hazardous exposure the incidence of medical complications of pregnancy observed among groups (group I = 67%, group II = 58%, group III = 48% and group IV = 53%) was not significantly different. On the basis of the findings of this study we conclude that martial status and MOS did not significantly influence military pregnancy outcome.

Female↗

PubMedDate not supplied

Intrapartum amniotic fluid index and two-diameter pocket are poor predictors of adverse neonatal outcome.

OBJECTIVE: The objective of this study was to determine whether amniotic fluid index < or = 5.0 cm or two-diameter pocket volume < or = 15 cm2 is a predictor of abdominal delivery because of fetal distress or of Apgar score < 7 at 1 or 5 minutes. STUDY DESIGN: The study was prospective and involved 209 parturients in early labor who had ultrasonographic assessment of amniotic fluid volume by both methods. RESULTS: The incidences of cesarean delivery because of fetal distress and of Apgar scores < 7 at 1 and 5 minutes were 8.1%, 9.0%, and 1.9%, respectively. Only Apgar scores < 7 at 1 minute were significantly higher among patients with a two-diameter pocket < 15 cm2 (16/114) as compared with > 15(2) (3/95, p = 0.007). Oligohydramnios by either method was a poor predictor of adverse outcomes (p values ranging from 0.06 to 0.21). Receiver-operating characteristic curves generated for the amniotic fluid index or two-diameter pocket to predict abdominal delivery because of fetal distress or Apgar scores < 7 at 1 minute indicate that both methods are poor diagnostic tests to predict these complications. CONCLUSION: Intrapartum assessment of amniotic fluid volume, by amniotic fluid index or the two-diameter pocket technique, is a poor predictor of adverse neonatal outcome.

Amniotic Fluid↗

PubMedDate not supplied

Comparison of intra-amniotic (15S)-15-methyl-PGF2 alpha and intravaginal prostaglandin E2 for second-trimester uterine evacuation.

OBJECTIVE: To compare the efficacy, safety, and side effects of intra-amniotic (15S)-15-methyl prostaglandin F2 alpha (15-M-PGF2 alpha) and intravaginal prostaglandin E2 (PGE2) for midtrimester uterine evacuation. STUDY DESIGN: Ninety-three patients underwent therapeutic midtrimester pregnancy termination by the use of laminaria placement and intra-amniotic injection of 15-M-PGF2 alpha. A matched control group underwent uterine evacuation by laminaria placement and insertion of PGE2 intravaginal suppositories. The main outcomes studied were time to delivery, side effects, and complications. RESULTS: The 15-M-PGF2 alpha group had a shorter time to delivery (12.3 +/- 6.4 hours) compared with the PGE2 group (16.2 +/- 6.6 hours, p < 0.0001). The evacuation rate over time was significantly greater in the 15-M-PGF2 alpha group (p = 0.001). The PGE2 group had a significantly higher incidence of side effects. CONCLUSIONS: The use of intra-amniotic 15-M-PGF2 alpha for therapeutic second-trimester pregnancy termination is safe and is associated with a more rapid evacuation of the uterus and fewer side effects than intravaginal PGF2 suppositories.

Abortifacient Agents, Nonsteroidal↗

PubMedDate not supplied

Home blood pressure monitoring for pregnant patients with hypertension.

OBJECTIVE: To determine whether automated measurement of blood pressure and pulse in a home setting can be easily accomplished by pregnant women with chronic hypertension. STUDY DESIGN: In this prospective investigation, seven women with chronic hypertension complicating pregnancy recorded their blood pressure at home twice a day. These data were offloaded once daily into a computer at a remote site, and a computerized printout of these data was received by the physician. RESULTS: The patients participated in the study for 12.2 +/- 5.8 weeks (range 4 to 18 weeks) and were between 23 and 42 weeks' gestation. Average mean arterial pressure in the home was 102 +/- 10 mm Hg, and average pulse was 81 +/- 11 beats per minute. In the clinic, the values were 112 +/- 13 mm Hg and 90 +/- 30 beats per minute (p < 0.05). Each patient was easily taught how to use the machine. CONCLUSIONS: The home blood pressure monitoring device was easy to use and correlated well with values recorded by health professionals for this limited number of subjects. It was particularly helpful to patients (n = 5) who lived long distances (more than 60 miles) from the clinic and to women who needed adjustments of antihypertensive medication.

Blood Pressure↗