PubMed Health⌕ Search

Biomedical subjects

F H Boehm

Publications and source records attributed to F H Boehm.

At least 73 records · Page 4Linked to original sources
PubMed1982

The effect of type of delivery upon neonatal outcome in premature twins.

A retrospective study from January 1, 1976, through July 31, 1981, was performed to evaluate the relationship between type of delivery and perinatal morbidity and mortality in twins of birth weight less than 2,000 gm. Vaginally delivered second twins who weighed 601 to 999 gm had increased risk of neonatal mortality when compared to their siblings. Among twins who weighed 1,000 to 1,499 gm, vaginally delivered second twins had significantly lower Apgar score and increased risks of neonatal morbidity in comparison to their siblings, whereas second twins who were delivered by cesarean section had no difference in Apgar score or neonatal morbidity from those of their siblings. In twins who weighed 1,500 to 1,999 gm, a significant increase in neonatal complications in vaginally delivered second twins was not found, although the majority of neonatal complications did occur in vaginally delivered second twins. Cesarean section is proposed as the optimal route of delivery for all twins expected to have a birth weight less than 1,500 gm.

Apgar Score↗
PubMed1982

Pregnancy-related rupture of arterial aneurysms.

Over 50 per cent of ruptured arterial aneurysms in women under the age of 40 are pregnancy-related. The hemodynamic and endocrine changes of pregnancy appear to be the cause of arterial alterations which may lead to new aneurysm formation and/or weakening of preexisting aneurysms. The most commonly reported arteries to have aneurysms rupture during pregnancy are the aorta, cerebral arteries, splenic artery, renal artery, coronary artery, and ovarian artery. In many instances, the rupture of an arterial aneurysm will initially simulate other less serious disease processes, thus delaying the correct diagnosis until a catastrophic event occurs. Early diagnosis and treatment of a ruptured arterial aneurysm are imperative in order to give optimal chances of survival to the mother and fetus.

Adult↗
PubMed1982

Sonographic placental localization in the determination of the site of uterine incision for placenta previa.

The presence of a placenta previa is associated with increased maternal and fetal morbidity. Hemorrhage is considered the primary underlying factor contributing to this increased morbidity. Patients who have a placenta previa are often hypovolemic and are therefore at high risk for hemorrhagic shock if intraoperative blood loss during cesarean section is not minimized. The authors reviewed sonographic localization of the placenta prior to cesarean section for placenta previa, in order to facilitate proper selection of uterine incision based on placental site and so reduce intraoperative blood loss. Nineteen cases of placenta previa were reviewed. Seventeen patients underwent a conventional low cervical or classic incision, whereas two underwent paramedian uterine incision. Data from these cases suggest that in patients who wish to be sterilized and in whom the site of placental implantation is directly beneath the lower uterine segment, as well as extending to an area in which a traditional classic cesarean section would be made, a paramedian incisional technique is of value.

Adult↗
PubMed1982

The clinical significance of a sinusoidal fetal heart rate pattern associated with alphaprodine administration.

A prospective analysis of 34 patients in active labor who were given alphaprodine for analgesia revealed a 32% incidence of sinusoidal fetal heart rate patterns (SFHRP). In a control group of 27 patients who did not receive narcotic analgesia, 1 patient (3.7%) showed a sinusoidal pattern. All study infants, with one exception, who developed SFHRP had a one-minute Apgar score of 7 or greater. Alphaprodine is believed to affect the fetal cardioregulatory center in such a manner as to cause the SFHRP but seems to cause no increase in perinatal morbidity or mortality when given in nontoxic doses.

Alphaprodine↗
PubMed1981

Management of genital herpes simplex virus infection occurring during pregnancy.

Genital herpes simplex virus (HSV) infection during pregnancy has caused considerable concern among lay and professional personnel in the past 10 years. Knowledge concerning the potential hazards of HSV to the newborn infant has increased the use of cesarean section for women who have or are suspected of having genital HSV infection near or at the time of labor. Because of this, a 57-month prospective study was begun at Vanderbilt University Hospital and its affiliate, Nashville General Hospital, January 1, 1976, and involved HSV culturing of all suspected genital herpes lesions during pregnancy. Those patients with positive HSV cultures prior to labor and without a subsequent negative culture underwent cesarean section. Those patients whose cultures reverted to negative were considered candidates for vaginal delivery. During the study period, there were 16,381 deliveries at the two institutions. One hundred twenty pregnant women were cultured, with 80 being HSV culture negative and 40 culture positive. The outcome of these pregnancies as well as a review of the experience with neonatal HSV infection in Middle Tennessee is presented. It is concluded that by utilizing HSV cultures of genital lesions as a guide to determining the route of delivery, the incidence of cesarean sections and neonatal HSV infection can be kept to a minimum.

Cesarean Section↗
PubMed1981

Induced abortion: a risk factor for placenta previa.

A threefold increase in the incidence of placenta previa, from one in 318 deliveries (0.3%) in 1972-1974 to one in 109 deliveries (0.9%) in the twelve-month period ending June 30, 1980, was noted at Vanderbilt University Hospital. Two large groups of patients not present in 1972-1974 were found to be responsible for this increased incidence of placenta previa: one-way maternal transports and women who had had induced first trimester abortions. The frequency of maternal transports having placenta previa was 3.3% (p less than 0.0001), and the frequency of placenta previa in women after an induced first trimester abortion was 3.8% (p less than 0.0001). When correction for maternal transports was made, the endogenous induced first trimester abortion population had a frequency of placenta previa of 2.1% (p less than 0.004), whereas the remainder of the endogenous population had an incidence of placenta previa similar to that found in the years 1972-1974. Induced first trimester abortion is seen as a significant factor predisposing to placenta previa.

Abortion, Induced↗
PubMed1981

The nonstress test: an evaluation of 1,000 patients.

In November, 1978, the fetal heart rate nonstress test (NST) was instituted as the primary screening procedure for the evaluation of fetal well-being at Vanderbilt University Hospital. The results of the first 1,000 patients tested are presented. The stillborn rate within 8 days of a reactive NST was 6.4 per 1,000, with the stillbiths occurring either in patients with diabetes mellitus or with intrauterine growth retardation (IUGR). A review of other series in which both the total indications for nonstressed testing and the risk groups in which stillbirths occurred within 7 days of an NST reveals that patients with diabetes mellitus (p less than 0.025) and patients with IUGR (p less than 0.01) are at greater risk for stillbirth within 7 days of an NST. Weekly nonstress testing, effective in preventing stillbirths in most risk groups, is not adequate in patients with diabetes mellitus or IUGR.

Female↗
PubMed1981

The effect of electronic fetal monitoring on the incidence of cesarean section.

In an attempt to elucidate the effect of electronic fetal monitoring on cesarean section rates, a review was made of the experience before and that during the 7 years after the initiation of fetal monitoring at Vanderbilt University Hospital. When a comparison was made of the cesarean section rates in the 3 years prior to fetal monitoring with those over the subsequent 2 years, no change was observed, thus indicating that, in experienced hands, a liberal use of fetal monitoring in low-risk and high-risk patients does not necessarily cause a rise in the overall incidence of cesarean sections. During this time, the neonatal mortality rate fell approximately fourfold. On the basis of this study, the belief is that a liberal attitude toward delivery by cesarean section for patients with breech presentations and other high-risk conditions contributed more to the rise in cesarean sections at Vanderbilt University Hospital than did electronic fetal monitoring. With proper education of the clinician and correct interpretation of the findings, electronic fetal monitoring need not increase cesarean section rates, but rather should allow for a more accurate description of intrapartum life.

Cesarean Section↗
PubMed1981

Hydrops fetalis: sonographic evaluation and clinical implications.

A systematic sonographic evaluation of hydropic fetus is presented, based on 21 cases and a literature review. The clinical implications of fetal ascites with or without anasarca, maternal hydramnios, maternal oligohydramnios, or an abnormally thick placenta are discussed as they relate to fetal outcome. It is concluded that sonography could play a major role in determining the optimal approach to perinatal management of the fetus in hydrops fetalis, and thus contribute to a reduction in the perinatal mortality and morbidity associated with this disorder.

Edema↗
PubMed1981

Prolonged end-stage fetal heart rate deceleration: a reanalysis.

In an earlier publication we reported on 18 patients who had what was described as prolonged fetal heart rate (FHR) deceleration in the second stage of labor and who had uniformly good outcome. It was believed that the reason for the good outcome was early diagnosis and rapid delivery when the FHR deceleration did not improve by the time the patient entered the delivery room. We have continued to handle this type of deceleration pattern in a similar fashion with good results, but 18 additional cases of prolonged end-stage FHR deceleration associated with a poor outcome are reported along with 1 case of intrauterine demise. Physicians who use the fetal monitor need to be aware of this potentially ominous FHR pattern.

Apgar Score↗
PubMed1981

Acute effect of cigarette smoking on the fetal heart nonstress test.

A major limitation in the use of the nonstress test (NST) has been the high frequency of nonreactive NSTs in the absence of fetal distress. Exogenous factors causing loss of fetal heart rate reactivity (FHRR) have not been fully evaluated, although it has previously been shown that chronic smokers have an increased incidence of nonreactive NSTs in the absence of fetal distress. A group of chronically smoking high-risk pregnant women at 31 to 44 weeks' gestation was studied to determine if the acute effects of smoking caused the NST to become nonreactive. After a reactive NST was obtained, each patient smoked 1 cigarette and the effects of the fetus were observed. Twenty-six studies were performed on 25 patients. A transient mild elevation of baseline fetal heart rate was noted after smoking in several studies; however, no significant change was found in FHRR, indicating that the acute effects of smoking a single cigarette are not responsible for the increased incidence of nonreactive NSTs in smokers.

Adolescent↗
PubMed1980

Prostaglandin E2 vaginal suppositories in pregnancy with an anencephalic fetus.

Three patients with anencephalic fetuses were delivered vaginally following use of prostaglandin E2 (PGE2) vaginal suppositories with minimal side effects and minimal delay until delivery, even though the cervix was unfavorable. One patient had laminaria inserted 12 hours prior to a single PGE2 suppository. The fetuses were stillborn, although all had had fetal heart tones when the first suppository was inserted. The observed uterine tachysystole and hypertonus under these circumstances may be advantageous if they prevent the additional emotional stress involved with the birth of a "live" anencephalic infant.

Abortion, Induced↗
PubMed1979

One-way maternal transport: an evolving concept. Inpatient services.

Transporting the high-risk pregnant woman to a tertiary center prior to labor or delivery, in an attempt to offer more intensive care to the patient and her infant, has gained increasing support from medical communities over the past few years. Because of this concept, tertiary centers need to be actively involved in the organization of these transport systems and to be certain that all members of the perinatal team at the referring as well as the receiving center are kept informed of events. This paper describes how Vanderbilt University Hospital initiated an acitive one-way maternal transport system and how that system is maintained and reviews the first 176 patients treated under that system. Establishing direct lines of communication between the practicing physician and the tertiary center and emphasizing continuing education at all levels seem to be important aspects in the development and maintenance of such a referral system.

Education, Continuing↗