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Biomedical subjects

Everett F Magann

Publications and source records attributed to Everett F Magann.

18 recordsLinked to original sources
PubMed2003

Postpartum seizure prophylaxis: using maternal clinical parameters to guide therapy.

OBJECTIVE: To use individual patient clinical parameters to signal cessation of postpartum magnesium sulfate seizure prophylaxis for the spectrum of pregnancy-related hypertensive disorders. METHODS: This was a prospective study using clinical symptoms (absence of headache, visual changes, epigastric pain) and signs (sustained blood pressure less than 150/100 without need for acute antihypertensive therapy, spontaneous diuresis more than 100 mL per hour for no less than 2 hours) to signal cessation of intravenous magnesium sulfate postpartum in gravidas diagnosed with preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelets syndrome. Laboratory assessments (including proteinuria) were not used as criteria for drug discontinuation. RESULTS: Five hundred three patients were enrolled and classified according to American College of Obstetricians and Gynecologists criteria (mild preeclampsia, severe preeclampsia, chronic hypertension with superimposed preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelets syndrome). Maternal age, gestational age, and hours of magnesium therapy before delivery were not statistically different among groups. There was no significant difference in the duration of postpartum magnesium sulfate therapy among groups with the median duration of therapy 4 hours (range 2-77 hours). No eclamptic seizures occurred after magnesium discontinuation. Thirty-eight patients (7.6%) required reinstitution of magnesium therapy for 24 hours because of exacerbation of blood pressure (sustained blood pressure more than 160/110) associated with headache or visual changes. CONCLUSION: Clinical criteria, when compared with arbitrary protocols, can be used successfully to shorten the duration of postpartum magnesium sulfate administration for seizure prophylaxis in patients with pregnancy-related hypertensive disorders.

Adult↗
PubMed2003

Effect of maternal hydration on amniotic fluid volume.

OBJECTIVE: To estimate the effects of maternal intravenous hydration on amniotic fluid volume in normal pregnancies. METHODS: Women undergoing an amniocentesis for the evaluation of fetal lung maturity before an elective cesarean delivery were eligible to participate. An amniotic fluid index (AFI) was obtained before the amniocentesis, and at the time of the amniocentesis the amniotic fluid (AF) volume was determined by diazo-dye reaction with subsequent spectrophotometric analysis of AF samples. If the AF sample drawn for fetal maturity studies was mature, the patient was hydrated with 1000 mL of balanced salt solution 30 minutes before her cesarean delivery. Amniotic fluid volume was subsequently estimated after the hydration by a repeat AFI. Amniotic fluid volume was directly measured at cesarean delivery and compared with the dye-determined volume. The pre- and posthydration AFI were also compared. RESULTS: A total of 17 women participated in the study between January 2001 and June 2001. Statistically significant increases in the AF volume and AFI were found. The prehydration median AF volume was 450 mL (range 250-953), and the median increase in AF volume was 188 mL (95% confidence interval [CI] 60, 254 mL; P <.001). Median AFI was 8.6 (range 5.8-17.8) with a median change in AFI of 1.7 cm (95% CI 1.1, 3.0; P <.001). CONCLUSION: Maternal intravenous hydration appears to increase both the actual and ultrasound-estimated AF volumes in normal third-trimester pregnancies.

Adult↗
PubMed2003

Comparability of the amniotic fluid index and single deepest pocket measurements in clinical practice.

Two ultrasound techniques, the amniotic fluid index (AFI) and the single deepest pocket (SDP), are currently used to detect oligohydramnios, predict variable decelerations, risk of Caesarean delivery for fetal distress, Apgar scores, umbilical cord artery pH, perinatal mortality, and cerebral palsy. Both techniques poorly identify oligohydramnios. Both techniques identify pregnancies at risk for variable decelerations, low Apgar scores, and Caesarean delivery for fetal distress. Only the SDP is predictive of a compromised fetus-umbilical artery pH, as a stand-alone test, has been correlated with perinatal mortality, and as part of the biophysical profile has been linked to cerebral palsy. This brief communication reviews the comparability of these two techniques and which method, if either, is superior in the identification of oligohydramnios, the predictability of these techniques to identify an adverse pregnancy outcome, and the ability to predict cerebral palsy and perinatal mortality.

Amniotic Fluid↗
PubMed2003

Predictability of intrapartum and neonatal outcomes with the amniotic fluid volume distribution: a reassessment using the amniotic fluid index, single deepest pocket, and a dye-determined amniotic fluid volume.

OBJECTIVE: The purpose of this study was to establish whether ultrasound-estimated or dye-determined amniotic fluid distribution (upper compared with lower quadrant) is predictive of perinatal outcome. STUDY DESIGN: Amniotic fluid distribution as measured by the amniotic fluid index, single deepest pocket, and dye-determined volumes was ascertained and correlated with intrapartum and neonatal outcomes. RESULTS: Between January 1997 and January 2001, 135 women (70 upper-greater and 65 lower-greater) participated in this prospective observational study. The sum of the amniotic fluid index (P =.309), single deepest pocket (P =.168), and dye-determined amniotic fluid volume (P =.368) for the upper-greater compared with the lower-greater groups were similar. Decelerations in labor (P =.597), late decelerations (P =.999), cesarean deliveries for fetal distress (P =.413), and umbilical cord pH < 7.2 were similar (P =.647) CONCLUSION: Ultrasound-estimated and dye-determined amniotic fluid volumes are similar between upper-greater and lower-greater groups, and intrapartum/neonatal outcomes are not affected by the amniotic fluid distribution.

Adult↗
PubMed2003

Continuous subcutaneous terbutaline administration prolongs pregnancy after recurrent preterm labor.

OBJECTIVE: This study was undertaken to study the effectiveness of continuous subcutaneous terbutaline (SQT) in the home after recurrent preterm labor (RPTL). STUDY DESIGN: Women with RPTL at less than 32 weeks' gestation were treated with continuous SQT administered in the home compared with matched control patients. RESULTS: Fifteen SQT patients were compared with 45 women (3:1) treated with no tocolytic therapy after hospitalization. Gestational age at delivery more than 37 weeks (53% vs 4%), percentage delivered at less than 32 weeks (0% vs 47%), overall and pregnancy prolongation (49.8 +/- 19.2 days vs 24.5 +/- 12.8 days) were all significantly better in the study group (P <.001). The total number of maternal hospital days (9.8 +/- 2.1 vs 15.9 +/- 7.4, P <.0001), duration of NICU stay (1.9 +/- 4.9 vs 19.8 +/- 29.3 days, P <.001), and total cost for newborn care (6,995 +/- 14,822 US dollars vs 62,033 +/- 89,978 US dollars, P <.002) favored the study patients. For every dollar spent on SQT, there was a savings of 4.67 US dollars in newborn hospital costs for control patients. CONCLUSION: In this small study, the use of SQT significantly prolongs pregnancy, decreases serious neonatal complications, and reduces the duration of hospitalization for both mother and infant, as well as neonatal costs.

Adult↗
PubMed2003

Vaginal birth after cesarean section versus elective repeat cesarean delivery: Weight-based outcomes.

OBJECTIVE: The study was undertaken to compare infectious morbidity and trial of labor (TOL) success stratified by weight in women. STUDY DESIGN: Vaginal birth after cesarean section (VBAC) candidates were divided into groups based on prepregnancy weight: group I, 70 (<200 pounds); group II, 70 (200-300 pounds); and group III, 69 (>300 pounds). RESULTS: The TOL success rate was 81.8% in group I compared with 57.1% in group II and 13.3% in group III (P =.001). The overall infectious morbidity was significantly greater in the obese women 39% (P =.001) compared with the average women at 11.4% and the lean women at 5.7%. CONCLUSION: Infectious morbidity is increased and VBAC success is reduced in patients who weigh more than 300 pounds.

Adult↗
PubMed2003

Cesarean delivery for fetal distress: rate and risk factors.

UNLABELLED: The objective of this article was to review the recent English language literature on cesarean delivery for fetal distress to determine its incidence, diagnostic tests, and the contributing factors to this obstetric complications. A PubMed search (1990-2000) with items of "cesarean, fetal distress," "cesarean, non-reassuring fetal heart rate," "cesarean, neonatal acidosis," and "cesarean, umbilical arterial pH," was undertaken. Reports, letters to the editor, focus on anomalous fetuses, and papers not specifically focused on this topic were excluded. Of the 392 articles that the search yielded, 169 met the inclusion criteria. Based on 37 reports with more than 1,000 patients each, the overall risk of prompt cesarean delivery for fetal concern was 3.1% (43,340 of 13,989,74). The risk exceeded 20% in patients with moderate/severe asthma, severe hypothyroidism, severe preeclampsia, and postterm or fetal growth restricted fetuses with abnormal Doppler studies. Use of likelihood ratios suggests that Doppler of the umbilical artery is a superior diagnostic test to amniotic fluid index in identifying parturients at risk for cesarean for non-reassuring fetal heart rate tracing. Although several risk factors increase the need for cesarean delivery for fetal distress, in general, most are unpreventable. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to estimate the incidence of cesarean delivery for non-reassuring fetal heart rate tracing, outline potential diagnostic tests that are useful for the detection of fetal distress, and summarize medical and obstetric conditions that place patients at risk for cesarean delivery for fetal distress.

Adult↗
PubMed2003

Clinical and sonographic estimations of uterine weight.

Over a 36 month period, all hysterectomies with clinical assessment, sonographic measurement of uterine length and estimated uterine weight were reviewed. Accuracy of these methods was ascertained by: 1) mean error, 2) mean standardized error, and 3) percentage of estimates within 10% of the actual weight. Among 210 hysterectomies, the mean (+/- standard deviation) of uterine weight was 514.9 gm +/- 647.0 gm (range 54-6700 gm) with 135 specimens (64.3%) being 500 gm and 75 > 500 gm. The receiver-operating curves for clinical assessment (0.82 +/- 0.03), uterine length (0.87 +/- 0.03) and Linear Regression Equation (0.82 +/- 0.04) are not significantly different (P > 0.05), having similar abilities to differentiate uterine weight. The clinical estimate of uterine weight is as accurate as ultrasound in determining a uterus weighing > 500 gm but all three methods poorly predict actual uterine weight.

Adult↗
PubMed2003

Detecting fetal macrosomia with abdominal circumference alone.

OBJECTIVE: To determine if abdominal circumference (AC) can identify macrosomia (> or = 4,000 g) at or beyond 37 weeks. STUDY DESIGN: Prospectively, parturients at term admitted for delivery underwent sonographic mensuration of AC. A receiver-operating characteristic (ROC) curve was constructed to determine if AC can differentiate between normal (birth weight < 3,999 g) and macrosomia. A likelihood ratio was calculated. P < .05 was considered significant. RESULTS: The mean gestational age of the 256 subjects was 39.1 +/- 1.5 weeks, and the prevalence of macrosomia was 8.2% (21/256). Inspection of the ROC curve indicated that AC > or = 350 mm can identify macrosomic fetuses. The area under the ROC curve (0.79 +/- 0.04 for macrosomia) was significantly different than the area under the nondiagnostic line (P < .005). The likelihood ratio for AC to detect macrosomia was 2.9 (95% confidence interval, 2.1-4.0). Based on the proportion of macrosomia in our population, we would require over 1,000,000 newborns for a macrosomia analysis to obtain narrow confidence intervals around a clinically useful likelihood ratio. CONCLUSION: Using the guidelines proposed by the Evidence-Based Medicine Working Group, AC is slightly useful in detecting macrosomia among term parturients.

Abdomen↗
PubMed2002

Antepartum, intrapartum, and neonatal significance of exercise on healthy low-risk pregnant working women.

OBJECTIVE: To evaluate the influence of exercise on maternal and perinatal outcome in a low-risk healthy obstetric population. METHODS: We conducted a prospective observational study of low-risk healthy women exercising during their pregnancy. An extensive questionnaire collected antepartum, intrapartum, and postpartum patient information on 750 women. The women were divided into four groups based on exercise level during pregnancy. RESULTS: There were no differences among groups for maternal demographic characteristics, antenatal illnesses, stress, social support, or smoking. Heavily exercising women were older (P =.042), had higher incomes (P =.001), and were exercising more at conception (P =.001). Women who did more exercise were more likely to need an induction of labor (P =.033, relative risk 1.84, 95% confidence interval 1.05, 3.20), induction or augmentation with oxytocin (P =.015, relative risk 1.53, 95% confidence interval 1.19, 1.97), and had longer first-stage labors (P =.032) resulting in longer total labors (P =.011). The difference in the length of first-stage labor was even greater if the no-exercise group was compared with the strongly exercising group (P =.009, relative risk 1.38, 95% confidence interval 0.16, 2.60). Fewer umbilical cord abnormalities (P =.034) were observed with exercise, but exercising women had more colds and flu (P =.008). Heavily exercising women had smaller infants (mean difference 86.5 g) compared with sedentary women. CONCLUSION: Exercise in working women is associated with smaller babies, increased number of inductions and augmentations of labor, and longer labors. Colds and flu are more frequent in exercising women.

Adult↗
PubMed2002

Markedly elevated beta-hCG levels in a normal singleton gestation with hyperreactio luteinalis.

BACKGROUND: Human chorionic gonadotropin (hCG) is produced by the trophoblast early in pregnancy and peaks at a level of approximately 100,000 IU/liter around the ninth week of gestation. Abnormally high levels are usually noted in association with multiple gestation, molar gestation, and specific ovarian or gestational malignancies. CASES: A multiparous patient in the second trimester was referred for evaluation after a maternal triple marker screen was incalculable due to a beta-hCG level of 2.1 million IU/L. Targeted sonography revealed bilateral complex adnexal masses with a solid component of the left ovary, a normal fetus, and normal placenta. The patient underwent an exploratory laparotomy at 18 weeks' gestational age. A left oophorectomy was performed. Pathology confirmed hyperreactio luteinalis. The remainder of the pregnancy was remarkable for preterm labor and delivery at 35 weeks' gestational age. At delivery, the hCG level was noted to be 24,210 IU/L, and the fetus and placenta were normal. CONCLUSION: Markedly elevated hCG levels rarely occur in normal singleton pregnancy and can be associated with hyperreactio luteinalis. When noted, a work-up to evaluate possible malignancy, molar gestation, and multiple gestation should be pursued.

Adult↗
PubMed2002

Pregnancy after classic cesarean delivery.

OBJECTIVE: To describe maternal and perinatal outcomes after a prior classic cesarean delivery. METHODS: A retrospective review was performed including all patients from 1990-2000 whose most recent pregnancy was preceded by classic cesarean delivery. RESULTS: During the 11-year period, there were 37,863 deliveries and 157 patients (0.4%) underwent classic cesarean operations. In the next pregnancy, one case of uterine rupture (0.6%, 95% confidence interval 0.1, 3.5) occurred at 29 weeks without preterm labor and resulted in fetal death. The prevalence of asymptomatic dehiscence was 9% (95% confidence interval 5, 15). There was no significant difference between patients with uterine dehiscence (n = 15) and patients with intact uteri (n = 141) with regard to maternal demographics, duration of labor, cervical dilatation at time of surgery, transfusion of packed red cells, bowel injury, postpartum endometritis, wound breakdown, thrombophlebitis, or umbilical arterial pH less than 7.00 (P >.05). Duration of labor, cervical dilatation, and gestational age at repeat cesarean delivery were poor predictors for uterine rupture or dehiscence. CONCLUSION: Among patients with prior classic cesarean delivery, uterine rupture and dehiscence are neither predictable nor preventable. One in four patients will experience some form of maternal morbidity. Uterine rupture, although infrequent, can be fatal to the fetus. Uterine dehiscence, however, does not increase neonatal or peripartum maternal morbidity.

Cesarean Section↗
PubMed2002

Cervical ripening and induction of labor with misoprostol, dinoprostone gel, and a Foley catheter: a randomized trial of 3 techniques.

OBJECTIVE: The purpose of this study was to compare the efficacy of 3 different techniques of cervical ripening and induction. STUDY DESIGN: Patients who required cervical ripening and induction were randomized to one of 3 groups: (1) supracervical Foley catheter and intravaginal dinoprostone gel, (2) supracervical Foley catheter and 100 microg oral doses of misoprostol, or (3) serial 100-microg oral doses of misoprostol. Intravenous oxytocin was administered when a protraction disorder of labor was identified. RESULTS: There were 339 women randomized. There was no significant difference in the time from first intervention to delivery in the 3 groups (P =.546). In each group, a similar percentage of women required oxytocin (P =.103). The rates of cesarean delivery were equivalent among the groups (P =.722). Rates of tachysystole were high but statistically equivalent among the 3 groups. There were no significant differences in Apgar scores or umbilical artery pH. CONCLUSION: Oral 100 microg serial doses of misoprostol, with or without the use of a supracervical Foley catheter, were equivalent to the use of a supracervical Foley catheter and serial 4-mg doses of dinoprostone gel for cervical ripening and the induction of labor.

Adult↗
PubMed2002

Subcutaneous stitch closure versus subcutaneous drain to prevent wound disruption after cesarean delivery: a randomized clinical trial.

OBJECTIVE: The purpose of this study was to compare a subcutaneous stitch closure and subcutaneous drain placement for the risk of wound disruption after cesarean delivery. STUDY DESIGN: This was a prospective randomized clinical trial that evaluated subcutaneous stitch closure, placement of a subcutaneous drain, or no closure for subsequent wound disruption risk in women with subcutaneous depth at >or=2 cm. RESULTS: The maternal demographics and intrapartum risk factors for postoperative wound disruptions were similar among the 964 study subjects, who were divided into 3 groups. Wound disruptions that required opening of the wound, irrigation, debridement, packing, and/or secondary delayed closure occurred in 9.7% of the women with no closure, 10.4% of the women in the stitch closure group, and 10.3% of the women in the closed drain group (P =.834). CONCLUSION: There appears to be no difference in the subsequent risk of wound complications when no closure of the subcutaneous tissue layers occurs versus suture closure or a closed drainage system.

Adult↗
PubMed2002

Intra-operative haemorrhage by blunt versus sharp expansion of the uterine incision at caesarean delivery: a randomised clinical trial.

OBJECTIVE: To determine whether the method used to expand the uterine incision for caesarean delivery affects the incidence of intra-operative haemorrhage. DESIGN: A prospective randomised study of women undergoing a low segment transverse caesarean delivery. Participants were assigned to have their uterine incision either sharply or bluntly expanded. PARTICIPANTS: Between June 1998 and June 2000, 470 women drew assignments to the sharp expansion group and 475 to the blunt group. RESULTS: The maternal demographics of age, race, nulliparity, and body mass index as well as pre-operative haematocrit were similar between groups. Compared with the blunt group, the estimated blood loss (886 versus 843mL, P = 0.001), change in the mean haematocrit (6.1% versus 5.5%, P = 0.003), incidence of postpartum haemorrhage (13% versus 9%; relative risk = 1.23, 95% CI 1.03, 1.46) and need for a transfusion (2% versus 0.4%; relative risk = 1.65, 95% CI 1.25, 2.21) were significantly greater in the sharp group. CONCLUSION: In caesarean delivery, sharply expanding the uterine incision significantly increases intra-operative blood loss and the need for subsequent transfusion.

Adult↗
PubMed2002

Dominant maternal sleep position influences site of placental implantation.

The objective of this study was to determine if maternal sleeping position around the time of implantation influences eventual placental implantation site. Between November 1997 and April 1999, women with singleton pregnancies between gestational ages of 15 and 20 weeks presenting for ultrasound examinations were prospectively queried regarding their usual position of sleep during early gestation. Dominant position of sleep was noted as prone, supine, right side, or left side. At ultrasound examination, placental location was categorized as (1) fundal, (2) left high, (3) right high, (4) anterior high, (5) posterior high, (6) anterior low, (7) posterior low, (8) right low, (9) left low, or (10) central low. During the 18 months of this study, data were obtained from 1,500 patients. At the time of conception, front or prone sleeping was the most common (497 of 1,500, 33.1%), followed by right side (439 of 1,500, 29.3%) and left side (360 of 1,500, 24%), with the back being the least frequent position of sleep (204 of 1,500, 13.6%). Women who usually slept supine at the time of conception and implantation were significantly more likely to have a high or fundal placental location compared with those who usually slept in the prone position (p = 0.041). In addition, women who slept exclusively on their right side early in pregnancy were significantly more likely to have a right-sided placental location compared with women who slept exclusively on their left side (p = 0.025). The data from this investigation indicate that sleeping position early in gestation may influence the ultimate placental implantation site.

Adolescent↗
PubMed2002

HELLP syndrome leading to a diagnosis of pregnancy.

HELLP syndrome (an acronym for hemolysis, elevated liver enzymes, and low platelets) is a life-threatening complication of pregnancy seen in association with either preeclampsia or eclampsia. HELLP syndrome is rarely diagnosed before 24 weeks of gestation. This atypical form of severe preeclampsia is associated with significant fetal and maternal mortality. The only effective treatment is delivery. We report a case of HELLP syndrome that proved to be a diagnostic clue to an early pregnancy.

Abortion, Therapeutic↗