PubMed Health⌕ Search

Biomedical subjects

J A Read

Publications and source records attributed to J A Read.

52 records · Page 3Linked to original sources
PubMed1982

The effect of hydrostatic pressure on the interpretation of the supine pressor test.

To assess the effects of hydrostatic pressure on the interpretation of the supine pressor test (SPT), blood pressure (BP) measurements were made with a mercury sphygmomanometer in 35 normotensive primigravid patients between 28 and 32 weeks' gestation. BP was recorded in both left lateral recumbent and supine positions. Blood pressure was also recorded in both arms simultaneously by separate observers. A positive supine pressor test was defined as a diastolic BP rise of 20 mm Hg. There were no positive SPTs when BP was recorded in the lower arm despite the development of preeclampsia in eight patients. When BP was corrected for the hydrostatic effect of position, no correlation was seen between position change and blood pressure (p greater than 0.05). Diastolic BP was significantly higher (p less than 0.01) in patients who later developed preeclampsia than in patients who remained normotensive.

Blood Pressure↗
PubMed1982

Management of post-term pregnancy in a large obstetric population.

A practical management protocol to handle the large volume of post-term gestations at the Los Angeles County/University of Southern California Medical Center was introduced and evaluated in 880 patients seen between March 1, 1979, and February 29, 1980. The protocol divided patients into 2 groups based on substantiated "good" or unsubstantiated "poor" obstetric dates. After clinical examinations, the primary screening test used was twice weekly plasma unconjugated estriol (E3) determinations. Antepartum fetal heart rate testing, in the form of nonstress tests, was used initially in the good obstetric dates group, and then done twice weekly only if the E3 value was abnormal (less than 18 ng/ml with good obstetric dates and less than 12 ng/ml with poor obstetric dates). Patients with good obstetric dates were delivered electively at more than 42 weeks' gestation if the cervix was favorable (Bishop score 9 or greater); otherwise, intervention occurred only with abnormal tests and a positive or suspicious contraction stress test, or with other medical indications. Only 8 perinatal losses (3 neonatal deaths and 5 stillbirths) occurred in 880 patients. Each of these patients received a follow-up evaluation: 3 had severe congenital anomalies, and 5 deaths occurred in patients who did not comply with the protocol. The cesarean section rate was 15.8%.

Academic Medical Centers↗
PubMed1982

Effect of maternal weight gain on fetal, infant, and childhood death and on cognitive development.

The effect of maternal weight gain during pregnancy on fetal, infant, and childhood death and on cognitive development was analyzed by examining the conception products of 2590 women who participated in the Child Health and Development Studies of the School of Public Health, University of California, Berkeley. Although there was a strong inverse association between maternal weight gain and fetal and neonatal death, the implications of this are uncertain and are herein discussed. When the analysis was confined to pregnancies with gestational periods greater than 35 weeks, there was no effect of maternal weight gain on fetal, neonatal, infant, or childhood death. Children whose mothers gained between 5 and 29 lb during their pregnancy scored higher on the Raven Coloured Progressive Matrices test at age 5 than did those whose mothers gained less than 5 or more than 29 lb. Within the 5- to 29-lb group there were no significant differences in test scores among the different categories of maternal weight gain.

Body Weight↗
PubMed1981

Intrapartum assessment of the postdate fetus.

Continuous monitoring of fetal heart rate (FHR) and routine sampling of fetal scalp blood were utilized to evaluate the intrapartum performance of 82 fetuses of postdates pregnancies. A comparison was made between this group and 260 term pregnancies. The incidences of abnormal FHR patterns were not different between the postdates group and the control group. All of the postdates neonates with low 5 minute Apgar scores had passed meconium. The mean pH values of the postdates fetuses with meconium were significantly lower than those of the control group at each sampling interval (i.e., early labor, late labor, and umbilical artery). Those fetuses with thick meconium had significantly lower pH values in late labor than did those with thin meconium. Continuous electronic FHR monitoring is recommended for intrapartum surveillance of all postdates patients. Because of the increased incidence of fetal acidosis in the presence of thick meconium, sampling of fetal scalp blood is not unreasonable even with a normal FHR pattern.

Adolescent↗
PubMed1981

Randomized trial of ambulation versus oxytocin for labor enhancement: a preliminary report.

Published reports imply that intrapartum ambulation may improve labor. This suggests the possible efficacy of ambulation in labors requiring augmentation, provided that adequate monitoring surveillance is maintained. Fourteen patients who failed to progress in active-phase labor, and who required augmentation for "inadequate" contractions were randomized into ambulation (eight) and oxytocin (six) groups. Internal fetal monitoring was used in all patients for 30 minute baseline and 2 hour study periods, with two-channel telemetry used in ambulating patients. Oxytocin was administered by infusion pump. Study parameters included changes in cervical dilation and station, contraction frequency, intensity and baseline tonus, and uterine activity. Labor progress was slightly but not significantly better in the ambulatory group. A mean increase in uterine activity units (UAU) in the ambulatory group was immediate to ranges not reached in the oxytocin group for 2 hours. Increase in Montevideo units was slightly greater in the ambulatory group during the first hour, but was exceeded by the oxytocin group during the second hour. These initial observations seem to indicate that, in terms of labor progress and initial effects on uterine activity, ambulation is as effective as oxytocin for the enhancement of labor and warrants further investigation.

Cervix Uteri↗
PubMed1980

Hemodynamic observations in evacuation of molar pregnancy.

The high incidence of pulmonary complications following evacuation of molar gestation at 16 weeks' size of greater (27%) prompted us to institute hemodynamic monitoring in seven of these patients in an effort to determine etiologies and possible modes of therapy for this potentially life-threatening complication. Our data indicate that following suction curettage with general anesthesia there appears to be impairment of ventricular performance of a transient nature as manifested by increases in central venous pressure, mean pulmonary artery pressure, and pulmonary capillary wedge pressure, despite a slight elevation in cardiac index and a decrease in systemic vascular resistance. The possible role of general anesthesia in the development of these changes, as well as the role of the colloid osmotic pressure to wedge gradient in the development of pulmonary complications, is discussed.

Adolescent↗
PubMed1980

The conservative aggressive management of placenta previa.

One hundred and seventy-three cases of placenta previa managed at the Women's Hospital of Los Angeles County-University of Southern California Medical Center from July, 1975, through June, 1978, were reviewed and compared to a similar series of cases studied in the same institution in 1969. The perinatal mortality of 12.6% was roughly one half of that in the earlier study. The fetal death rate did not change significantly, but the neonatal mortality was markedly less, especially in the 27-to-32-week range. Expectant management was employed in 65.8% of patients, as compared to 42.6% in 1969. The higher rate of expectant management was characterized by the aggressive use of antepartum transfusions in the face of moderate-to-severe bleeding in lieu of delivery, as well as the occasional use of tocolytic agents for inhibition of premature labor in the presence of vaginal bleeding. Elective termination of pregnancy utilizing the lecithin/sphingomyelin (L/S) ratio for determination of pulmonary maturation also resulted in significantly less overall neonatal morbidity and mortality. These multiple factors appear to have contributed to a dramatic reduction in the perinatal mortality associated with placenta previa.

Adolescent↗
PubMed1980

Placenta accreta: changing clinical aspects and outcome.

In an effort to determine if a changing clinical picture for placenta accreta exists in the late 1970s, 22 cases from January 1, 1975, to May 30, 1979, at Los Angeles County/University of Southern California (LAC/USC) Medical Center were reviewed. An incidence of clinically diagnosed placenta accreta of 1 per 2562 deliveries for all cases and 1 per 4027 for pathologically confirmed cases (ie, hysterectomy specimens) was found. Mean age of the patients was 29.5 years, and mean gravidity, parity, and abortion were 3.4, 2, and 0.27, respectively. Placenta previa was found in 14 patients (63.6%), 6 of whom had previously undergone cesarean section. No obvious etiology was found in 1 patient. Sixteen patients underwent cesarean section. Hysterectomy was performed on 14 patients, and conservative measures were employed in 8 patients. One maternal death (4.5%) occurred, but there was no perinatal mortality. The clinical picture of placenta accreta today is one of higher reported incidence, lower parity, greater incidence of associated placenta previa, individualized management, and decreasing maternal and perinatal mortality.

Adolescent↗
PubMed1980

Urinary bladder distention: effect on labor and uterine activity.

To study quantitatively the effect of urinary bladder distention on labor and uterine activity, 68 patients requiring catheterization were studied. All patients were in the active phase of labor and had transcervical intrauterine pressure monitoring. Patients were studied in the same lateral position for 30 minutes before and after a catheterization interval, during which time uterine activity units were quantitated on line and changes were noted in cervical dilation and station and contraction frequency and tonus. Results were analyzed for the entire study group, for individual patients, and by urine volumes (10 to 550 ml) obtained at catheterization. Total uterine activity units increased in 43 patients and decreased in 25 after catheterization, but when compared with expected increases calculated from the slopes of the precatheterization interval in individual patients, there were 36 increases and 32 decreases. Individual slopes of uterine activity increased in 36 and decreased in 31 cases. There were no differences when the data were analyzed by urine volume, parity, or bith weight except possibly at large volumes. Changes in rates of cervical dilation and descent of the presenting part conform to the expected normal labor pattern. Within the limits of this study, emptying the urinary bladder has no effect on the course of labor or uterine activity based on the dynamic model of labor.

Adolescent↗
PubMed1979

The bupivacaine paracervical block in labor and its effect on quantitative uterine activity.

This study utilized internal fetal monitoring and an on-line voltage control oscillator for measurement of uterine activity unit (UAU) determination in patients who received a paracervical block (PCB) with the use of bupivacaine hydrochloride (Marcaine). The total dose of 25 mg (5 cc/side) of 0.25% bupivacaine used for PCB in 32 patients produced no ill effects to the fetus, as reflected by baseline fetal heart rate (FHR), beat-to-beat variablity, or Apgar scores. No adverse maternal effects were noted, and anesthesia was rated good or excellent in 81% of patients. Rate of cervical dilation remained the same or increased in 29 of 32 patients. Quantitative UAUs showed a significant decrease in the third 10-minute interval after block in primiparas, but no significant change in multiparas or in the group taken as a whole. Total UAUs before versus after PCB for either group or taken together were not statistically different. A decreasing trend in UAUs after PCB versus a positive regression line from activity prior to the block was noted.

Anesthesia, Local↗
PubMed1978

A rapid method for the presurgical cleansing of hands.

A new rapid method of presurgical cleansing of the hands has been evaluated in a clinical setting. The effectiveness of a 90 second jet wash has been compared with a standard 10-minute presurgical scrub. Bacteriologic cultures were obtained from the fingertips of interns, residents, and staff of the Department of Obstetrics and Gynecology of the Walter Reed Army Medical Center before and after 90-second jet washings and 10-minute conventional scrubs. The results showed that the 90-second jet wash was more effective in degerming the hands than the 10-minute standard brush scrub. Other advantages of the new method, such as the amount of time saved, the standardization of cleansing, and reduced skin irritation are discussed.

Antisepsis↗
PubMed1977

Fetal heart rate acceleration in response to acoustic stimulation as a measure of fetal well-being.

The search for better means of testing for antepartum fetal well-being is a major objective of perinatal medicine. This preliminary report explores the use of a 2,000 c.p.s. pure-tone auditory stimulus for "nonstress" testing, a comparison with the oxytocin challenge test (OCT), and a correlation with fetal outcome. Instead of waiting, when the fetus may be inactive or "sleeping," for a positive fetal heart (FHR) response following a fetal kick or movement, a rapid "nonstress" test may be performed by evoking an FHR acceleration after the application of a five-second auditory stimulation at 105 to 120 db. When FHR acceleration evoked exceeded 15 b.p.m., the subsequent OCT was always negative. Suspicious or positive OCT's were frequently obtained when no response to auditory stimuli occurred. Subsequent outcomes as well as safety and potential applications of this rapid test which may eliminate the need for many OCT's are discussed.

Acoustic Stimulation↗
PubMed1977

Amniotic fluid neutrophils prior to Cesarean section and intrauterine infection.

Amniotic fluid from 35 patients delivered by cesarean section was examined by Wright's stain. Of the patients in labor and with rupture of the membranes, 32% had more than 1 polymorphonuclear neutrophil per oil field (PMN/OF) while 68% had less than 1 PMN/OF. In both groups, endometritis occurred frequently, and fever indexes were similar. With ruptured membranes prior to cesarean section, observing greater than 1 PMN/OF of amniotic fluid did not discriminate groups at high and low risk for intrauterine infection.

Amniotic Fluid↗
PubMed1976

The effect of internal fetal monitoring on maternal infection following cesarean section.

A retrospective review of 300 cesarean sections was performed. Patients with internal fetal monitoring were at no greater risk for infection than were those patients with labor and rupture of membranes but without internal monitoring. However, the combination of rupture of membranes and labor was a major risk factor for both the frequency and severity of maternal infection after cesarean section. Once membranes are ruptured, we find no contraindication to the use of internal monitoring.

Adult↗