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H F Sandmire

Publications and source records attributed to H F Sandmire.

8 recordsLinked to original sources
PubMed1992

The Green Bay cesarean section study. II. The physician factor as a determinant of cesarean birth rates for failed labor.

OBJECTIVE: Our study was designed to develop a profile of specific labor management characteristics generally used by physicians with low versus those with high rates of cesarean sections in the care of nonprogressive labor in nulliparous patients. STUDY DESIGN: A 4-year retrospective data set was used to analyze all patients with nonprogressive labor cared for by 11 board-certified obstetricians and gynecologists practicing full-time at two Green Bay hospitals. Variations in labor management are analyzed and tested for their effect on the rate of cesarean section for failure of labor to progress. RESULTS: Cesarean section in nulliparous women for nonprogressive labor varied from 4.3% of all deliveries in the low group to 12.3% in the high group. Through multivariate analysis we developed a profile of specific labor management characteristics used by physicians with low versus those with high rates of cesarean section. CONCLUSION: These techniques can be used to definitively identify management strategies that result in a decrease in cesarean rates for nonprogressive labor.

Anthropometry↗
PubMed1990

The Green Bay cesarean section study. I. The physician factor as a determinant of cesarean birth rates.

This study was designed to identify the determinants of cesarean birth rates. The study population included all 1030 cesarean deliveries performed on singleton pregnancies by 11 obstetricians practicing at two Green Bay hospitals from 1986 through 1988; 1076 control patients with vaginal deliveries were selected for comparison purposes. The 1030 cesarean deliveries represented 14% of the 7335 singleton deliveries that occurred during the study period. Individual physician cesarean rates ranged from 5.6% to 19.7%. Cesarean rates for physician groups ranged from 9.8% to 18%. The variances in cesarean rates among individual and groups of physicians were not attributable to patient obstetric risk factors, socioeconomic status, service status, or duration of the physician's practice. Higher cesarean rates did not result in better neonatal outcome. Individual physician practice style was the only apparent determinant of cesarean rates for the 11 obstetricians. Current cesarean rates can be substantially reduced without sacrificing fetal and newborn safety.

Cesarean Section↗
PubMed1990

Whither electronic fetal monitoring?

Largely based on promising animal studies, continuous electronic fetal monitoring (EFM) was introduced into clinical practice in the early 1970s. After almost 20 years of experience, it is now apparent that the anticipated benefits of this technology have not materialized. Undesirable side effects of EFM include inappropriate operative intervention for some patients and increased liability for physicians and hospitals, resulting in an increase in the costs of obstetric services. After reviewing several research studies, The American College of Obstetricians and Gynecologists concluded that EFM and intermittent auscultation are equivalent methods for intrapartum assessment. We have developed a protocol for the performance of intermittent auscultation, including indicated responses to different levels of bradycardia. This protocol has allowed us to substitute auscultation for EFM in a high percentage of patients using existing nursing personnel. Laboring patients should, at a minimum, receive information on both intermittent auscultation and EFM to enable them to make an informed choice of method for intrapartum fetal assessment.

Bradycardia↗
PubMed1978

Minilaparotomy tubal sterilization.

Two hundred and twenty-six minilaparotomy Pomeroy tubal ligations performed between January, 1976, and July, 1977, are compared to 226 laparoscopic tubal sterilization operations. Operating time, length of hospital stay, and complications were similar for the two groups. Postoperative discomfort was greater in the minilaparotomy group but did not significantly increase the duration of hospitalization and was effectively relieved with oral administration of medication for pain. It is the author's belief that the minilaparotomy procedure provides the best current method of tubal sterilization in the patient who is not massively obese. The slight increase in postoperative discomfort is a small price to pay for freedom from the rare major complications of visceral, vascular, and thermal injuries. In addition the author recently has decreased the postoperative discomfort experienced by carefully expressing the room air from the peritoneal cavity just prior to tying the peritoneal suture.

Adult↗
PubMed1976

Carcinoma of the cervix in oral contraceptive steroid and IUD users and nonusers.

A total of 40,211 cytologic examinations and subsequent diagnostic procedures resulted in the diagnosis of carcinoma of the cervix in 76 patients. The 76 patients did not demonstrate any variations in use of oral contraceptive steroids or intrauterine devices when compared to 780 randomly selected control patients. This study is in agreement with our earlier report demonstrating no increased risk of carcinoma of the cervix in oral contraceptive steroid users compared to nonusers.

Carcinoma in Situ↗
PubMed1976

Experience with 40,000 Papanicolaou smears.

Forty thousand consecutive cytologic smears and subsequent diagnostic procedures resulted in the diagnosis of 41 carcinomas in situ, 35 microinvasive and invasive carcinomas, and 24 severe dysplasias for a yield of significant neoplasia of one lesion per 400 Papanicolaou smears. Twenty-five of the carcinomas in situ and microinvasive and invasive carcinomas were diagnosed in patients with atypical smears indicating that all patients with persistent atypical smears require evaluation by tissue examination. Seventy-eight percent of the 119 patients subjected to conization either had carcinoma in situ, microinvasive and invasive carcinoma, or significant cervical dysplasia. Post-operative complications following conization were negligible. In addition there were no postconization deleterious effects on three concurrent and nine subsequent pregnancies. A history of gonorrhea places a patient at a higher risk of developing cervical carcinoma. Annual performance of cytologic smear evaluation is indicated in all sexually active women and in all virginal women over 20 years of age.

Adenocarcinoma↗
PubMed1975

The Rh factor.

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Rh-Hr Blood-Group System↗