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J Christopher Glantz

Publications and source records attributed to J Christopher Glantz.

7 recordsLinked to original sources
PubMed2006

Obstetric outcomes in overweight and obese adolescents.

OBJECTIVE: Obese adult pregnant women have increased rates of maternal and neonatal complications. Our objective was to examine adverse obstetric outcomes in overweight adolescent women. STUDY DESIGN: In a retrospective case-control study of 4822 women who were < 19 years old, 3324 appropriate-weight subjects (body mass index, 18.5-24.9 kg/m2) and 1498 overweight subjects (body mass index, > or = 25 kg/m2) were compared. Frequencies and odds ratios for adverse maternal or neonatal events were computed. RESULTS: Compared with appropriate-weight adolescents, primary cesarean delivery (odds ratio, 1.6; 95% CI, 1.4-1.9), failure to progress/cephalopelvic disproportion (odds ratio 1.6; 95% CI, 1.3-1.9), labor induction (odds ratio, 1.4; 95% CI, 1.3-1.7), pregnancy-induced hypertension (odds ratio, 1.8; 95% CI, 1.4-2.3), preeclampsia (odds ratio, 1.7; 95% CI, 1.2-2.4), and gestational diabetes mellitus (odds ratio, 3.0, 95% CI, 1.6-5.4) were significantly more common in overweight adolescents. Significant neonatal findings included an increased incidence of macrosomia (odds ratio, 1.6; 95% CI, 1.2-2.0) and a decreased incidence of low birth weight infants (odds ratio, 0.6; 95% CI, 0.4-0.8) and small for gestational age infants (odds ratio, 0.8; 95% CI, 0.7-1.0). CONCLUSION: Overweight adolescent women are at increased risk for adverse neonatal and perinatal outcomes. With rates of overweight increasing overall, overweight in the gravid adolescent is a pressing perinatal and public health concern.

Adolescent↗
PubMed2005

Local anesthesia with sedation for vaginal reconstructive surgery.

To evaluate local anesthesia with sedation for vaginal reconstructive surgery. All cases of vaginal surgery performed by the primary author for correction of pelvic organ prolapse with and without urinary incontinence between February 2000 and October 2004 were identified. From the medical record, data on age, duration of surgery, amount of local anesthetic used, estimated blood loss, hospital stay, urinary retention, and need for conversion to general anesthesia were recorded. Among 127 potential candidates, 98 (77.2%) opted for local with sedation. These cases included 18 anterior colporrhaphies, 47 posterior colporrhaphies with perineoplasties, 9 enterocele repairs, 32 total colpocleises, and 9 LeFort procedures. Tension-free vaginal tape (TVT) were concomitantly placed in 37 of the cases; 121 TVT-only cases done under local were not included. No cases were converted to general anesthesia. Surgical time ranged from 20 to 195 min (mean 99 min). Most patients were discharged within 24 h of surgery. Traditionally, local anesthesia with sedation has been reserved for superficial vaginal procedures. However, it can be successfully employed for more invasive vaginal reconstructive surgeries. Duration of surgery and patient acceptance have not been limiting factors. The advantages of local anesthesia include minimal interference with homeostasis and rapid recovery with patients often bypassing the recovery unit.

Adult↗
PubMed2005

Elective induction vs. spontaneous labor associations and outcomes.

OBJECTIVE: To determine factors and outcomes associated with elective medical induction of labor as compared with spontaneous labor in low-risk women. STUDY DESIGN: Using a birth certificate database including 11,849 low-risk, laboring women, univariate and multiple logistic regression was used to evaluate demographic and obstetric factors associated with elective labor induction. Low risk was defined as singleton, vertex, 37-41 weeks' gestation, no prior cesarean section, and no presenting medical/obstetric diagnoses considered indications for cesarean or induction. Adverse neonatal outcome was defined as 1- or 5-minute Apgar score < 7, neonatal intensive care unit admission or respiratory distress. Spontaneously laboring women (n = 10,608) were compared with women who underwent induced labor for no apparent medical/obstetric reason (n = 1,241). Interventions and outcomes during and after labor induction were adjusted for relevant associated variables. RESULTS: Odds ratios for epidural anesthesia, cesarean delivery and diagnoses of nonreassuring fetal heart rate patterns were independently increased following elective induction; odds ratios for cephalopelvic disproportion, instrumental delivery and adverse neonatal outcome were not. Maternal length of stay was 0.34 days longer with induction than with spontaneous labor (p < 0.0001). Slightly more induced labors ended before midnight. CONCLUSION: As compared with spontaneous labor, elective labor induction is independently associated with more intrapartum interventions, more cesarean deliveries and longer maternal length of stay. Neonatal outcome is unaffected.

Adult↗
PubMed2004

Can differences in labor induction rates be explained by case mix?

OBJECTIVE: To determine whether differences in case mix account for variations in labor induction rates between hospitals and whether case mix adjustment is helpful in evaluating hospital induction rates. STUDY DESIGN: Using a New York State birth certificate database, factors associated with induction of labor were entered into a logistic regression to calculate labor induction probabilities. The probabilities were used to calculate expected induction rates at each of 16 regional hospitals. Each hospital's observed and expected induction rates were compared to determine the degree of residual variation. RESULTS: Excluding women who delivered by cesarean section without labor, the regional labor induction rate was 20.8%, with a 3.9-fold difference between the highest and lowest hospital rates (P < .0001). Adjusting for risk factors explained only 12.6% of the variation in induction rates. Risk adjustment to compare labor induction rates had a minimal effect on rank ordering of rates but made clearer some hospitals' rates. CONCLUSION: Differences in case mix do not explain labor induction rate variation, but adjustment for case mix may aid in interpreting rates at individual hospitals.

Adult↗
PubMed2003

Vertical skin incisions and wound complications in the obese parturient.

OBJECTIVE: To examine the relationship between the type of skin incision and postoperative wound complications in an obese population. METHODS: A hospital-based perinatal database was used to identify women with a body mass index (BMI) of greater than 35 undergoing their first cesarean delivery. Hospital and outpatient medical records were reviewed for the following variables: age, insurance status, BMI, gestational age at delivery, birth weight, smoking history, prior abdominal surgery, existing comorbidities, preoperative hematocrit, chorioamnionitis, duration of labor and membrane rupture, dilation at time of cesarean delivery, type of skin and uterine incision, estimated blood loss, operative time, antibiotic prophylaxis, use of subcutaneous drains or sutures, endometritis, and length of stay. The primary outcome variable was any wound complication requiring opening the incision. Multiple logistic regression analysis was completed to determine which of these factors contributed to the incidence of wound complications. RESULTS: From 1994 to 2000, 239 women with a BMI greater than 35 undergoing a primary cesarean delivery were identified. The overall incidence of wound complications in this group of severely obese patients was 12.1%. Factors associated with wound complications included vertical skin incisions (odds ratio [OR] 12.4, P < .001) and endometritis (OR 3.4, P = .03). A high preoperative hematocrit was protective (OR .87, P = .03). No other factors were found to impact wound complications. CONCLUSION: Primary cesarean delivery in the severely obese parturient has a high incidence of wound complications. Our data indicate that a vertical skin incision is associated with a higher rate of wound complications than a transverse incision.

Adult↗
PubMed2003

Labor induction rate variation in upstate New York: what is the difference?

BACKGROUND: Labor induction rates in the United States rose from 9.0 percent in 1989 to 20.5 percent in 2001, but reasons for the increase are poorly defined. A birth database from a region of upstate New York, including 31,352 deliveries from 1998 through 1999, was used to determine the degree of variation of labor induction rates among hospitals and practitioners. METHODS: Total and elective labor induction rates were calculated for 16 hospitals and individual staff, and then evaluated using chi-square testing and regression. RESULTS: Using all laboring women as the denominator, the regional labor induction rate was 20.8 percent; of these inductions, 25 percent had no apparent medical indication. Total induction rates and percent of elective inductions that were elective varied significantly among hospitals (10%-39% and 12%-55%, respectively, p<0.0001) and among practitioners within hospitals (7%-48% and 3%-76%, respectively, p<0.0001). Hospitals varied in size, risk status, and cesarean section rates, but these factors did not correlate with induction rates. CONCLUSIONS: Labor induction rates are highly variable among and within hospitals. Delivery volume, population risk status, and differences in cesarean section rates did not explain this variation.

Adult↗