Biomedical subjects
H F Andersen
Publications and source records attributed to H F Andersen.
Transvaginal and transabdominal ultrasonography of the uterine cervix during pregnancy.
Transvaginal and transabdominal ultrasound evaluation of the uterine cervix were compared in a study of 186 pregnant women. An empty bladder made transabdominal ultrasound measurement of the cervix more difficult, while bladder filling resulted in significant lengthening of the transabdominal cervical measurement. In contrast, transvaginal ultrasound cervical measurement was possible in all but 1 patient. Normal transvaginal ultrasound cervical measurements were significantly shorter on average than transabdominal cervical measurements, but compared closely with prior transabdominal ultrasound studies in which bladder filling was carefully controlled. Significant cervical shortening was not noted in most patients with a clinical diagnosis of incompetent cervix.
Outpatient sedation: an essential addition to gynecologic care for persons with mental retardation.
Routine gynecologic care for persons with mental retardation may be difficult to provide, especially to those women who do not allow a pelvic examination to be performed. Of 275 women referred to a multidisciplinary clinic addressing the reproductive health concerns of mentally retarded women, 61 patients (22%) did not allow a gynecologic examination to be performed. The administration of ketamine alone, midazolam alone, or a combination of midazolam and ketamine allowed for the successful performance of a gynecologic examination in 81% of previously uncooperative women. No adverse effects of the medications were noted. We conclude that sedation of difficult-to-examine, mentally handicapped women can be safely performed in the outpatient setting, thus avoiding the need for general anesthesia and its inherent risks.
Webster should not affect prenatal diagnosis.
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Pre- to postnatal reduction in ultrasound attenuation coefficient of the liver.
A recent study showed the ultrasound attenuation coefficient of fetal liver between 26 and 40 weeks of gestation to be 26% higher than after birth. To test the hypothesis that ultrasound attenuation is sensitive to fetal liver glycogen concentration, the livers of 24 fetuses were examined at 5 MHz just prior to and just after birth. The mean pre- to post-delivery reduction in attenuation coefficient was 0.08 dB cm-1 MHz-1 +/- 0.02 (SEM), or 17% of the post-delivery mean. This is consistent with the increase in attenuation measured by others in liver homogenate when glycogen was added. An increase in measurement accuracy, correlation with glycogen content, and, possibly, control for biological variability will be required to make predictions in individual cases, as opposed to these averages. A simple test of glycogen content would be of value scientifically and in prenatal and postnatal management.
Ultrasound: a new approach to the evaluation of cervical ripening.
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Vaginal laceration following a jet-ski accident.
A 17-year-old woman riding as a passenger on a jet-ski fell behind the jet nozzle while jumping waves. A vaginal laceration with intra-abdominal extension occurred as a result of the accident. Hypogastric artery ligation controlled the hemorrhage and avoided more extensive surgery. The case represents an unusual injury from this type of watercraft and illustrates important points in the management of genital tract trauma.
An analysis of the ACOG and AAP ethics statements on conflicts in maternal-fetal care.
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Histidine-rich glycoprotein inhibits contact activation of blood coagulation.
Histidine-rich glycoprotein has been purified from bovine plasma employing two different purification procedures. The first procedure was one-step ion-exchange chromatography using phosphocellulose, while the second procedure involved fractionation using polyethyleneglycol 6000 followed by column chromatography employing CM-Sepharose and heparin-Sepharose. The effect of purified bovine histidine-rich glycoprotein on the contact activation of blood coagulation was studied in human plasma by using as activating surface either an ellagic acid-phospholipid suspension (Cephotest) or sulfatide. Contact activation was monitored by the generation of amidolytic activity towards a synthetic chromogenic substrate (S-2302) for factor XIIa and plasma kallikrein. Bovine histidine-rich glycoprotein inhibits the contact activation induced by both of these activating surfaces.
Prediction of risk for preterm delivery by ultrasonographic measurement of cervical length.
Risk assessment for preterm delivery remains difficult, particularly among women with no prior history of preterm birth. We hypothesized that accurate assessment of cervical length by endovaginal ultrasonography could predict preterm delivery risk. A total of 178 patients with singleton gestations and without cervical incompetence were studied with transabdominal ultrasonography and endovaginal ultrasonographic cervical length measurement and manual vaginal examination of cervical length. A total of 113 patients who were evaluated by 30 weeks' gestation (excluding four induced preterm deliveries) were analyzed. Preterm delivery risk was compared between women with cervical lengths equal to or greater than the median and those with cervical lengths less than the median. An endovaginal ultrasonographic cervical measurement less than 39 mm was associated with a significantly increased risk of preterm delivery (25.0% versus 6.7%) and detected 76% of preterm births. Manual examination of cervical effacement detected 71% of preterm births, but transabdominal ultrasonographic measurement of cervical length was not preditive. Endovaginal ultrasonographic cervical measurement predicted increased preterm delivery risk regardless of parity or obstetric history. Endovaginal ultrasonography is a promising method for the prediction of risk of preterm birth. Because it has the potential to be an objective measure of cervical length, endovaginal ultrasonography may be superior to manual digital examination for preterm delivery risk assessment.
Lifestyle modification as an intervention for inner city women at high risk for preterm birth.
This study details a programme which emphasized nursing interventions for women at high risk for preterm birth. Preterm birth continues to be a major health problem, with ongoing research being conducted both in the United States and internationally in an effort to find causative factors. Programmes designed to prevent preterm birth have been described often in the literature, with lifestyle factors being implicated in the incidence of preterm birth by many researchers. The purpose of this study was to determine the lifestyle factors most often associated with preterm birth in a high risk population of inner city women, and to examine the effect of change in lifestyle when change was possible. Women at high risk for preterm birth were interviewed extensively for prevalence of 12 lifestyle factors most often cited in the literature as being associated with preterm birth. Counselling and education were offered to each woman, with emphasis on symptom recognition and modification of lifestyle activities. Comprehensive prenatal care was administered by programme personnel. A profile of the women's reported lifestyle activities and stress factors is presented along with the relationship to outcome. The data suggested that, when change in lifestyle activity or stress was possible, women who decreased the activity or stressor were more likely to deliver at term. This study represents one of the first efforts in the United States to produce a prospective database to quantify risk and analyse the impact of change in activities associated with symptoms of preterm labour in high risk women.(ABSTRACT TRUNCATED AT 250 WORDS)
Maternal-fetal conflict: a study of physician concerns in court-ordered cesarean sections.
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A "PROPP" for the Bronx: preterm birth prevention education in the inner city.
As one component of the multifaceted community-wide preterm prevention program known as "A PROPP for the Bronx" (Program to Reduce Obstetric Problems and Prematurity), a prenatal education videotape in both English and Spanish was developed. Its impact was evaluated in 615 high-risk patients at the Bronx Municipal Hospital Center. The 12-minute videotape focused on the implications of preterm birth, the signs and symptoms of preterm labor, and behavioral modification to reduce life-style risk factors. An instrument was constructed to examine baseline knowledge, information transfer, and knowledge retention, and was validated and tested for reliability (r = 0.95). The results demonstrated a statistically significant knowledge transfer for patients viewing the videotape (P less than .0001) and significant knowledge retention through the postpartum period (P less than .0001) for Spanish-speaking as well as English-speaking parturients. These data emphasize the importance of the educational component of a preterm prevention program in an impoverished population at risk for early delivery.
Court-ordered cesarean section: an analysis of ethical concerns in compelling cases.
Two previously unreported cases are presented in which court-ordered cesarean sections were considered appropriate by physicians. An analysis of the factors that compel physicians to deem court-ordered intervention appropriate is presented. When the significance of a third-trimester fetal death or a lifetime physical or mental disability is balanced against the demand to uphold maternal autonomy at all costs, the recognized ethical principles of beneficence, nonmaleficence, justice, obstetric contract keeping, and acting in the patients' best interests combine, in rare situations, to override concerns for individual maternal autonomy and justify court-ordered intervention.
Effectiveness of patient education to reduce preterm delivery among ordinary risk patients.
Patient education is an important component of all preterm birth prevention programs, but studies of these programs have not examined the independent contribution of patient education to preterm birth prevention. The Program to Reduce Obstetrical Problems and Prematurity in the Bronx, New York, is a multifaceted preterm birth prevention program that includes a half hour combined videotape and nurse discussion session, which was offered to all patients. In evaluating the outcome of pregnancies in patients not at high risk for preterm delivery (ordinary risk patients) we found that patients who received instruction to recognize early signs of preterm labor had babies with a higher birthweight (3255 +/- 548 gm) than patients who were not so instructed (3200 +/- 599 gm, p = 0.03). Average length of gestation in the instructed and noninstructed patients was 276 +/- 15 days and 275 +/- 18 days (p = 0.12), respectively. The preterm delivery rate among patients receiving the instruction was 9.5% compared with 11.5% among those who did not receive it. We conclude that specific prenatal education about early warning signs of preterm labor is an important component of preterm birth prevention programs that can be demonstrated to have an independent contribution to prenatal care.
Utility of a sensitive bedside serum pregnancy test.
We compared the performance characteristics of a rapid qualitative serum pregnancy test with a standardized quantitative assay for human chorionic gonadotropin in the evaluation of women with suspected ectopic pregnancy. At a threshold value of 25 mIU/mL, the rapid assay demonstrated a sensitivity of 100% and a specificity of 96%.
Neonatal status in relation to incision intervals, obstetric factors, and anesthesia at cesarean delivery.
Uterine incision to delivery interval has been suggested as a critical determinant of neonatal outcome; however, studies of skin incision and uterine incision to delivery intervals have usually not analyzed the contribution of obstetric factors relative to time factors in determining outcome. A group of 204 patients undergoing cesarean delivery were studied. Stepwise multivariate regression was used to examine the relative contribution of obstetric and anesthetic factors to Apgar scores and umbilical cord blood gases. Apgar scores and umbilical cord blood gases were significantly influenced by labor complications (fetal distress, meconium, and pre-eclampsia), infant weight, type of cesarean delivery (primary vs. repeat), and type of anesthesia. Skin incision and uterine incision to delivery intervals did not significantly contribute to Apgar scores nor umbilical cord blood gases when corrected for these factors. We conclude that careful attention to maternal status prior to cesarean delivery and optimal anesthetic management appear to be the most important factors for good neonatal outcome. Surgical techniques should be directed at gentle, atraumatic delivery of the fetus for the good of the fetus and the mother.
Disseminated herpes simplex infection in an immunocompromised pregnancy: treatment with intravenous acyclovir.
In this article, we report a case of third-trimester disseminated herpes simplex virus (HSV) infection in an immunocompromised gravida who was treated with parenteral acyclovir. Rapid resolution of lesions occurred, and the fetus was delivered at term without evident abnormalities. Of the four previous reports on this therapy, there has been one maternal death and survival of all neonates. Acyclovir should be considered in the treatment of disseminated HSV infection in pregnancy.