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Biomedical subjects

G D Hankins

Publications and source records attributed to G D Hankins.

At least 19 recordsLinked to original sources
PubMed1998

Prevalence and risk factors of chorioamnionitis among adolescents.

OBJECTIVE: To identify the prevalence of chorioaminionitis and unique risk factors for this disorder among adolescents under 18 years of age. METHODS: At their first prenatal visit we interviewed 352 adolescents who received prenatal care and delivered an infant at our institution between April 20, 1992, and November 10, 1994, to elicit information on demographic characteristics and behavioral risk factors. Retrospective chart review confirmed the presence of chorioamnionitis using accepted clinical criteria. We determined reproductive history, evidence of sexually transmitted disease, duration of labor, use of oxytocin, an internal uterine pressure monitor or conduction anesthesia, timing and duration of ruptured membranes, type of delivery, and infant birth weight from review of subjects' charts. Logistic regression analysis was used to develop adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors of chorioaminionitis. RESULTS: Ten percent (34 of 352) of adolescents met the clinical definition for chorioamnionitis. Alcohol and tobacco use during pregnancy (OR 7.6; 95% CI 2.3, 25.8) and being married or living with a partner (OR 2.7; 95% CI 1.1, 6.5) were significantly associated with chorioamnionitis, as was conduction anesthesia (OR 4.1; 95% CI 1.1, 15.4), a second stage labor longer than 2 hours (OR 3.5; 95% CI 1.4, 8.5), and rupture of the membranes longer than 18 hours (OR 6.9; 95% CI 2.5, 18.9). Parity or preterm delivery did not differ significantly between those with or without chorioamnionitis. CONCLUSION: These data suggest that in addition to risk factors observed in adults, adolescents who concurrently use tobacco and alcohol during pregnancy, are married or living with a male partner, and have conduction anesthesia are at increased risk for chorioamnionitis.

Adolescent↗
PubMed1998

Lower thoracic spinal cord injury--a severe complication of shoulder dystocia.

Fundal pressure as a maneuver for the relief of shoulder dystocia is associated with up to a 77% fetal injury rate. The usual injuries involve the brachial plexus or orthopedic injuries. We now report a severe lower thoracic spinal cord injury with permanent neurological injury when fundal pressure was applied in an attempt to relieve shoulder dystocia. Shoulder dystocia occurred in a 28-year-old nulliparous woman. A series of manual maneuvers to include episiotomy extension, McRoberts, suprapubic pressure, Woods screw, and extraction of the posterior arm all failed to achieve delivery. During these maneuvers, but not coordinated with them, fundal pressure was applied by multiple individuals. The Zavanelli maneuver and cesarean delivery ultimately allowed delivery. On Day 2 of life marked decrease in lower extremity motor function, over-flow urinary incontinence, and rectal incontinence led to imaging studies that revealed focal spinal cord injury at T-9 through T-12. Compressive forces applied to the fetal spine during fundal pressure is the likely cause of the lower thoracic spinal cord injury manifest by this newborn.

Adult↗
PubMed1998

Amniotic fluid embolism in progress: a management dilemma!

Amniotic fluid (AF) embolism is a rare but catastrophic complication of pregnancy. We present the first case where the debris was seen in the maternal uterine veins at the time of cesarean section. During a cesarean delivery performed for deteriorating fetal status and in conjunction with massive hydramnios; air bubbles and vernix were observed in the left uterine vein and in an area of Couvelaire appearance of the uterine fundus. As the patient was clinically stable and desired retained fertility, a decision was made to attempt to contain the debris in the uterine vasculature. The infundibulopelvic ligament and uterine arteries were ligated and the area of Couvelaire uterus was oversewn. With the exception of a mild laboratory coagulopathy, which required no specific treatment, the patient did well. The area of Couvelaire uterus is the likely portal for the debris seen in this patient's vasculature. Containment appears to have averted the AF embolism syndrome.

Adult↗
PubMed1998

Aeromedical transfer of preterm labor patients.

Obstetric patients are transported by air quite frequently. We evaluated transport times, obstetric outcomes, air-versus-ground transport costs, and related data on 22 helicopter aeromedical transports of pregnant patients with preterm labor. We found no significant differences between patients who delivered and those who did not when comparing transport time (167.1 +/- 41.9 minutes versus 177.1 +/- 56.2 minutes), air distance of transport (122.9 +/- 44.8 miles versus 143.6 +/- 23.8 miles), and other outcome measures. No deliveries occurred in flight. Air transport costs were significantly greater than estimated ground transfer ($4613.64 +/- $581.12 versus $604.02 +/- $306.38; P < .01). Two-way air transfer of preterm labor patients over moderate distances is more costly than contracted ground transfer costs at our institution.

Air Ambulances↗
PubMed1997

Prolonged fetal bradycardia secondary to maternal hypothermia in response to urosepsis.

Fetal bradycardia is a well-known response to maternal hypothermia, as induced at open-heart surgery, but heretofore has not been reported in conjunction with hypothermia from urosepsis. A 24-year-old Vietnamese woman admitted at 33 weeks estimated gestational age with pyelonephritis secondary to Escherichia coli developed several episodes of maternal hypothermia to 35-36 degrees C. During each episode of maternal hypothermia, the baseline fetal heart rate fell to 90-100 bpm, but with retained reactivity. During each episode, maternal vital signs were otherwise stable and oxygen saturation was normal as measured by pulse oximetry. Interpretation of fetal bradycardia during episodes of maternal urosepsis is complex. If seen in conjunction with maternal hypothermia, and in the presence of normal maternal cardiac and respiratory function, bradycardia is unlikely to represent fetal distress.

Adult↗
PubMed1996

Third-trimester arterial blood gas and acid base values in normal pregnancy at moderate altitude.

OBJECTIVE: To report arterial blood gas and acid base values of normal nulliparous patients at moderate altitude for commonly used maternal positions. METHODS: Ten normotensive nulliparous women between 36 and 38 weeks' gestation volunteered to undergo radial and pulmonary artery cannulation as part of a larger study. Following instrumentation, baseline assessments were made in the left lateral recumbent position after a 30-minute stabilization period. Sequential measurements were then obtained in the left lateral, right lateral, supine, knee-chest, sitting, and standing positions. Blood samples were analyzed in duplicate for oxygen content on a blood gas analyzer. Statistical analysis was performed by analysis of variance of repeated measures with significance defined at P < or = .05. RESULTS: There was no significant difference in arterial blood gas or acid base values between any positions in this antepartum population of term healthy women. The composite mean values were as follows: pH 7.46, arterial carbon dioxide pressure (PaCO2) 26.6 mmHg, arterial oxygen pressure 88.3 mmHg, bicarbonate 18.2 mEq/L, saturated arterial hemoglobin level 0.96. CONCLUSION: Arterial blood gas and acid base values are not altered by maternal position in the late third trimester of pregnancy. The PaO2 in these women studied at moderate altitude was lower than previously reported for healthy pregnant women studied at sea level. Appropriate interpretation of arterial blood specimens of pregnant women should take into account both the pregnancy and altitude at which the women reside.

Acid-Base Equilibrium↗
PubMed1996

The effects of maternal position and cardiac output on intrapulmonary shunt in normal third-trimester pregnancy.

OBJECTIVE: To assess the effect of pregnancy, maternal position, and cardiac output on intrapulmonary shunting (Qs/Qt) in normotensive nulliparous women near term. METHODS: Ten normotensive nulliparas between 36 and 38 weeks' gestation underwent pulmonary artery catheterization (via the subclavian route) and radial artery canalization. Baseline assessments were made with subjects in the left lateral recumbent position after a 30-minute stabilization period. Measurements were obtained sequentially in the left lateral, right lateral, supine, knee-chest, sitting, and standing positions. Each position change was followed by a 10-minute pre-measurement stabilization period. Cardiac output was measured via the thermodilution technique. Blood samples were obtained simultaneously from the pulmonary and radial arteries and analyzed in duplicate for oxygen content with a blood gas analyzer. Qs/Qt was calculated using the classic shunt equation. Statistical analysis was performed by analysis of variance of repeated measures of Qs/Qt and maternal position. The relationship of Qs/Qt to maternal cardiac output was evaluated by the correlation coefficient. Significance was defined as P < .05. RESULTS: Directly measured Qs/Qt averaged 15.3% in left lateral, 15.2% in right lateral, 13.9% in supine, 12.8% in knee-chest, 13.8% in sitting, and 13.0% in standing positions. There was no statistically significant correlation between Qs/Qt and cardiac output (R2 = 0.11, not significant). CONCLUSION: This is the first report of directly measured Qs/Qt in normal pregnant women in the third trimester. Qs/Qt values reported in pregnancy are higher than those reported in nonpregnant individuals.

Adult↗
PubMed1996

Operative vaginal delivery--year 2000.

Literature review was performed to analyze and define the current state of operative vaginal delivery. On the basis of published data, it is concluded that outlet and low forceps deliveries with < or = 45 degrees of rotation are effective and safe for both mother and baby. The greatest risk to mother or fetus occurs with operations performed at the 0 or +1 station or those involving rotations > 45 degrees. It is likely that operative deliveries involving > 45 degrees of rotation will be abandoned in the future. It is further recommended that The American College of Obstetricians and Gynecologists 1988 forceps classification system be adopted for deliveries by vacuum extractors.

Delivery, Obstetric↗
PubMed1996

The pharmacokinetics of oxytocin as they apply to labor induction.

OBJECTIVE: Our purpose was to determine the relationship among plasma oxytocin levels, metabolic clearance rate of oxytocin, and uterine activity in gravid women undergoing labor induction. STUDY DESIGN: Ten women receiving oxytocin for labor induction and agreeing to participate had blood sampled before initiation of oxytocin and at different levels of uterine pressure. Samples were analyzed with 200 microliter extracts from 1 ml of plasma with an oxytocin radioimmunoassay. The intraassay coefficient of variation was < 3%. Sensitivity of the assay was 1.5 pg/ml. Pharmacokinetic parameters including plasma levels and metabolic clearance rates were calculated. Data were analyzed with the paired t test and linear and logistic regression. RESULTS: Mean oxytocin levels and metabolic clearance rates were 26.6 pg/ml and 7.97 ml/min. There was no correlation between changes in oxytocin level and metabolic clearance rate. Increases in infusion rates were correlated with increases in oxytocin levels (r = 0.71, p < 0.001). Cervical dilatation and uterine contraction pressures did not correlate with oxytocin levels. CONCLUSION: Peripheral plasma levels of oxytocin may not accurately reflect uterine activity or progress in labor. Plasma levels of oxytocin may merely reflect the rate of oxytocin infusion.

Adult↗
PubMed1996

Patient satisfaction with collaborative practice.

OBJECTIVE: To gather information on women's perceptions of the services delivered in collaborative obstetrics and gynecology practices and to determine whether patients perceive a difference in the delivery of services in a variety of practice settings. METHODS: A cross-sectional patient satisfaction survey was developed by the Collaborative Practice Advisory Group of ACOG. Ten collaborative practices were selected to participate: five in private offices, two in clinics, two in health maintenance organizations, and one in the military. Between April 15 and May 15, 1994, 3257 completed surveys were obtained for analysis. RESULTS: Between 71% and 92% of women, depending upon the practice setting, agreed with statements regarding the possible benefits from being cared for in a collaborative practice. The majority (75-92%) expected services provided in a collaborative practice to differ from those provided in a noncollaborative practice. Women making their first visit to a collaborative practice expected quicker appointments, more time with the provider, more health information, and more specific diet information than did women who had previously been seen in such a practice. There were minimal differences in comfort levels when discussing issues of sexuality and physical and sexual abuse in either public or private settings with physicians or non-physicians. CONCLUSIONS: Patients in this survey were accepting of the concept of collaborative practice and felt that it offered quicker appointments, more time with the provider, more health information, and more specific diet information than did physician-only practices.

Adult↗
PubMed1996

Physical and sexual abuse in a middle-class obstetric population.

To evaluate the prevalence of a history of physical and sexual abuse in pregnant, economically stable, middle-class women with access to comprehensive health care, we issued self-report questionnaires to prenatal orientation classes at Wilford Hall Medical Center from October 19, 1992, to March 15, 1993. After identifying women who had been physically or sexually abused, we identified the assailant, the number of occurrences, and injuries resulting from the abuse. Of the 563 women who responded, 100 (18%) reported previous physical or sexual abuse. Seven women (1%) stated that they were physically abused during the pregnancy. Women were more likely to be physically than sexually abused by a spouse or lover (46% versus 13%). To identify women who have a history of abuse and to address their needs, practitioners should incorporate taking a history of physical and sexual abuse during the routine new obstetric visit.

Adult↗
PubMed1996

Vulvovaginal hematomas complicating delivery. Rationale for drainage of the hematoma cavity.

OBJECTIVE: To review the management of puerperal vulvovaginal hematomas and report on the use of closed system drainage in cases in which operative intervention was used. STUDY DESIGN: A retrospective review of medical records for a five-year period was conducted. The charts of all patients in whom puerperal vulvovaginal hematomas occurred were reviewed and data extracted regarding possible etiologic factors, details of delivery, characterization of the hematoma, surgical intervention and type of drain used. Also recorded was length of stay and postoperative complications. RESULTS: Eleven patients with hematomas were identified, for an incidence of 1/526. All patients received antibiotics; transfusion was required in eight patients. Drains were used in nine patients: Penrose in four and closed system drainage in five. All drains were brought through a separate site distant from the repair. There was one postoperative abscess, which resolved with wound care, resulting in no long-term morbidity. CONCLUSION: Puerperal vulvovaginal hematomas may be a life-threatening event. Review of the literature and our experience suggests that aggressive operative management and the use of drains are beneficial in the management of these patients. Closed system drainage may be an effective adjunct in the management of vulvovaginal hematomas.

Adolescent↗
PubMed1995

Amniotic fluid embolism: analysis of the national registry.

OBJECTIVE: We analyzed the clinical course and investigated possible pathophysiologic mechanisms of amniotic fluid embolism. STUDY DESIGN: We carried out a retrospective review of medical records. Forty-six charts were analyzed for 121 separate clinical variables. RESULTS: Amniotic fluid embolism occurred during labor in 70% of the women, after vaginal delivery in 11%, and during cesarean section after delivery of the infant in 19%. No correlation was seen with prolonged labor or oxytocin use. A significant relation was seen between amniotic fluid embolism and male fetal sex. Forty-one percent of patients gave a history of allergy or atopy. Maternal mortality was 61%, with neurologically intact survival seen in 15% of women. Of fetuses in utero at the time of the event, only 39% survived. Clinical and hemodynamic manifestations were similar to those manifest in anaphylaxis and septic shock. CONCLUSIONS: Intact maternal or fetal survival with amniotic fluid embolism is rare. The striking similarities between clinical and hemodynamic findings in amniotic fluid embolism and both anaphylaxis and septic shock suggest a common pathophysiologic mechanism for all these conditions. Thus the term amniotic fluid embolism appears to be a misnomer.

Adolescent↗
PubMed1995

Brachial plexus palsy involving the posterior shoulder at spontaneous vaginal delivery.

Brachial plexus injuries sustained at birth have most often been attributed to the maneuvers performed when attempting to relieve a shoulder dystocia or to deliver a breech vaginally. In the case now reported, the brachial plexus injury involved the posterior shoulder. As the delivery was spontaneous and without forceps or manual rotation, with delivery effected using only the McRobert's maneuver, it is hypothesized that maternal expulsive forces in conjunction with lodging of the posterior shoulder on the sacral promontory resulted in the injury.

Adult↗
PubMed1995

Trial of labor: a disciplined approach to labor management resulting in a high rate of vaginal delivery.

A disciplined approach to labor management has resulted in a low cesarean rate (9%) in our population. We wondered if this management scheme was applicable and safe applied to women with previous cesareans. Women with a previous cesarean delivering in a 5-year period were included. Labor management included encouragement of trial of labor, labor stimulation with oxytocin when indicated, epidural analgesia only after entering the active phase, and continuous monitoring. Demographic, labor and delivery, and neonatal data were electronically stored and analysis performed using SPSS release 4.1 for VAX/VMS. Statistical analysis was performed using chi-square and Fisher's exact test where appropriate. Multiple logistic regression was performed to control for potentially confounding variables. A previous cesarean had been performed in 713 (11%) gravidas who met the inclusion criteria. Vaginal delivery was attempted in 588 (82%) and 517 (88%) achieved vaginal birth. Older women (14 versus 1 versus 8%, p = 0.04), of higher parity (63 versus 35 versus 17%, p = 0.0001), requiring preterm delivery (14 versus 8 versus 4%) were more likely to have an elective repeat cesarean than a successful or failed trial of labor. Pregnancies requiring oxytocin (90 versus 53%, p = 0.02), receiving epidural analgesia (62 versus 49%, p = 0.05), developing chorioamnionitis (20 versus 4%, p < 0.0001) were more likely to fail a trial of labor. Four uterine ruptures occurred and only one patient was receiving oxytocin. There were no differences in umbilical artery blood acidemia among elective repeat cesarean sections and successful or failed trial of labor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Physical and sexual abuse. A middle-class concern?

This study evaluated the prevalence of physical and/or sexual abuse in a population of employed, middle-class women who all have access to health care. Questionnaires were given to all patients who came to the ambulatory gynecology clinic at Wilford Hall Medical Center from October 19, 1992, to November 13, 1992. Questions were asked to ascertain the number of women who had experienced at least one episode of forced sexual contact or physical abuse. Other questions allowed identification of the relationship of the assailant to the respondent, number of occurrences and injuries resulting from the abuse. Of the 531 women who responded, 72 reported a history of only physical abuse, and 37 reported a history of only sexual abuse. Forty women reported that they were both physically and sexually abused. The typical victim of abuse was younger (32.6 vs. 39.8 years old, P < .001) and was more likely to work outside the home (63.1% vs. 47.9%, P < .005). Women were significantly more likely to be battered by a husband or lover than to be sexually assaulted by an intimate partner (75% vs. 16%, P < .001). Women who were both physically and sexually abused were injured more often than women who were only physically or sexually abused (60% vs. 28%, P < .01, and 60% vs. 24%, P < .01, respectively). Victims abused by an intimate partner were more likely to be abused on more than one occasion. All women should be asked about a recent history of abuse so that individuals identified can be counseled appropriately and attempts can be made to intervene to prevent further episodes of abuse.

Adult↗
PubMed1995

Measuring quantitative serum human chorionic gonadotropin. Variations in levels between kits.

Human chorionic gonadotropin (hCG) may be used in the monitoring of early pregnancy. It may also be used as a tumor marker in the diagnosis and follow-up of gestational trophoblastic disease, choriocarcinoma and testicular carcinoma. The combination of maternal serum unconjugated estriol, alpha-fetoprotein and quantitative hCG has shown promise as an antepartum screen for Down syndrome. In the quantitative assessment of hCG, the calibrators used by various kits are standardized to one of two different standards, either the Second International Standard or the First International Reference Preparation (IRP), established by the World Health Organization in 1968 and 1975, respectively. The IRP is now considered the Third International Standard, and both terms may be used interchangeably. Confusion may exist in clinical situations if quantitative hCG levels determined by assays in different laboratories using different standards are compared or used simultaneously. Practitioners are advised to be aware of which calibration standard is utilized in their laboratory and to interpret the results accordingly.

Chorionic Gonadotropin↗