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Biomedical subjects

J M Barrett

Publications and source records attributed to J M Barrett.

At least 37 records · Page 2Linked to original sources
PubMed1983

The effect of type of delivery on neonatal outcome in singleton infants of birth weight of 1,000 g or less.

To evaluate the relationship between management of delivery and neonatal outcome in singleton neonates with birth weights between 501 and 1,000 g, a retrospective analysis was performed. In the 54-month period ending June 30, 1981, a total of 109 singleton neonates were born at Vanderbilt University Hospital, Nashville, Tenn, with birth weights between 501 and 1,000 g, 31 weighing 501 through 750 g, and 78 weighing 751 through 1,000 g. The overall neonatal survival rate was 60%, 39% in the group weighing 501 through 750 g and 69% in the group weighing 751 through 1,000 g. In terms of morbidity and mortality, there was no difference between neonates delivered by cesarean section compared with those delivered vaginally. The only significant factor found relating to neonatal mortality was the occurrence of labor. In the 17 newborns delivered without occurrence of labor, the frequency of neonatal death was significantly decreased, although this difference may be caused by differing risk factors in the infants delivered without occurrence of labor. When labor was present and the fetus had a cephalic presentation, cesarean section was not found to be superior to vaginal delivery in terms of neonatal morbidity or mortality for neonates of 1,000 g or less.

Cesarean Section↗
PubMed1983

Fetal heart rate responses to meperidine alone and in combination with propiomazine.

A study was performed to evaluate the effects of three regimens of intrapartum analgesia upon fetal heart rate characteristics. Either meperidine 50 mg (M50), meperidine 50 mg plus propiomazine 20 mg (M50/P20), or meperidine 25 mg plus propiomazine 10 mg (M25/P10) was given intravenously for intrapartum analgesia to 204 patients in the first stage of labor, and the effects were evaluated upon fetal heart rate variability (FHRV) and fetal heart rate reactivity (FHRR). M25/P10 was found to cause a decrease in FHRV in fewer patients than M50/P20 (13.6% vs 36.5%, P less than .005), while still providing adequate analgesia for most patients. Although M50 also caused a decrease in FHRV in fewer patients than M50/P20 (19.1% vs 36.5%, P less than .05), it produced emesis in 20% of patients. When FHRV was minimal or moderate before the analgesic was given, FHRV became absent in only eight of 222 doses (3.6%). FHRR was lost in fewer patients given M50 than in those given M50/P20 (45% vs 71%, P less than .01); there was no significant difference between M50 and M25/P10. We conclude that the effects of meperidine upon fetal heart rate characteristics are both potentiated by propiomazine, and, when meperidine is given with propiomazine, dose-related. We also conclude that absent FHRV is rarely caused by meperidine; when FHRV becomes absent after meperidine administration, the patient should be fully evaluated for the possibility of fetal distress before the absence of variability is attributed to analgesia.

Dose-Response Relationship, Drug↗
PubMed1982

Comparison of aggressive and conservative management of premature rupture of fetal membranes.

A 3-year prospective study was undertaken to compare two types of management of rupture of the fetal membranes between 26 and 34 weeks. Patients in whom amniotic fluid, obtained by amniocentesis, was shown to have no evidence of infection, and who had less than mature lecithin/sphingomyelin (L/S) ratios, were given steroids and, if needed, treated with tocolytic agents. Patients in whom no amniotic fluid could be obtained were not given steroids, but were managed expectantly. Only patients with rupture of membranes greater than or equal to 24 hours were included in the collection of data. Despite the aggressive treatment protocol of the steroid group, no significant difference was found between the two groups in the prevalence of respiratory distress, hyperbilirubinemia, patent ductus arteriosus, episodes of apnea and bradycardia, or necrotizing enterocolitis. Perinatal mortality rates were similar in the two groups, and no difference in the incidence of maternal or neonatal infectious complications was found.

Adolescent↗
PubMed1982

The effect of type of delivery upon neonatal outcome in premature twins.

A retrospective study from January 1, 1976, through July 31, 1981, was performed to evaluate the relationship between type of delivery and perinatal morbidity and mortality in twins of birth weight less than 2,000 gm. Vaginally delivered second twins who weighed 601 to 999 gm had increased risk of neonatal mortality when compared to their siblings. Among twins who weighed 1,000 to 1,499 gm, vaginally delivered second twins had significantly lower Apgar score and increased risks of neonatal morbidity in comparison to their siblings, whereas second twins who were delivered by cesarean section had no difference in Apgar score or neonatal morbidity from those of their siblings. In twins who weighed 1,500 to 1,999 gm, a significant increase in neonatal complications in vaginally delivered second twins was not found, although the majority of neonatal complications did occur in vaginally delivered second twins. Cesarean section is proposed as the optimal route of delivery for all twins expected to have a birth weight less than 1,500 gm.

Apgar Score↗
PubMed1982

Pregnancy-related rupture of arterial aneurysms.

Over 50 per cent of ruptured arterial aneurysms in women under the age of 40 are pregnancy-related. The hemodynamic and endocrine changes of pregnancy appear to be the cause of arterial alterations which may lead to new aneurysm formation and/or weakening of preexisting aneurysms. The most commonly reported arteries to have aneurysms rupture during pregnancy are the aorta, cerebral arteries, splenic artery, renal artery, coronary artery, and ovarian artery. In many instances, the rupture of an arterial aneurysm will initially simulate other less serious disease processes, thus delaying the correct diagnosis until a catastrophic event occurs. Early diagnosis and treatment of a ruptured arterial aneurysm are imperative in order to give optimal chances of survival to the mother and fetus.

Adult↗
PubMed1982

Sonographic placental localization in the determination of the site of uterine incision for placenta previa.

The presence of a placenta previa is associated with increased maternal and fetal morbidity. Hemorrhage is considered the primary underlying factor contributing to this increased morbidity. Patients who have a placenta previa are often hypovolemic and are therefore at high risk for hemorrhagic shock if intraoperative blood loss during cesarean section is not minimized. The authors reviewed sonographic localization of the placenta prior to cesarean section for placenta previa, in order to facilitate proper selection of uterine incision based on placental site and so reduce intraoperative blood loss. Nineteen cases of placenta previa were reviewed. Seventeen patients underwent a conventional low cervical or classic incision, whereas two underwent paramedian uterine incision. Data from these cases suggest that in patients who wish to be sterilized and in whom the site of placental implantation is directly beneath the lower uterine segment, as well as extending to an area in which a traditional classic cesarean section would be made, a paramedian incisional technique is of value.

Adult↗
PubMed1981

Induced abortion: a risk factor for placenta previa.

A threefold increase in the incidence of placenta previa, from one in 318 deliveries (0.3%) in 1972-1974 to one in 109 deliveries (0.9%) in the twelve-month period ending June 30, 1980, was noted at Vanderbilt University Hospital. Two large groups of patients not present in 1972-1974 were found to be responsible for this increased incidence of placenta previa: one-way maternal transports and women who had had induced first trimester abortions. The frequency of maternal transports having placenta previa was 3.3% (p less than 0.0001), and the frequency of placenta previa in women after an induced first trimester abortion was 3.8% (p less than 0.0001). When correction for maternal transports was made, the endogenous induced first trimester abortion population had a frequency of placenta previa of 2.1% (p less than 0.004), whereas the remainder of the endogenous population had an incidence of placenta previa similar to that found in the years 1972-1974. Induced first trimester abortion is seen as a significant factor predisposing to placenta previa.

Abortion, Induced↗
PubMed1981

The nonstress test: an evaluation of 1,000 patients.

In November, 1978, the fetal heart rate nonstress test (NST) was instituted as the primary screening procedure for the evaluation of fetal well-being at Vanderbilt University Hospital. The results of the first 1,000 patients tested are presented. The stillborn rate within 8 days of a reactive NST was 6.4 per 1,000, with the stillbiths occurring either in patients with diabetes mellitus or with intrauterine growth retardation (IUGR). A review of other series in which both the total indications for nonstressed testing and the risk groups in which stillbirths occurred within 7 days of an NST reveals that patients with diabetes mellitus (p less than 0.025) and patients with IUGR (p less than 0.01) are at greater risk for stillbirth within 7 days of an NST. Weekly nonstress testing, effective in preventing stillbirths in most risk groups, is not adequate in patients with diabetes mellitus or IUGR.

Female↗
PubMed1981

The effect of electronic fetal monitoring on the incidence of cesarean section.

In an attempt to elucidate the effect of electronic fetal monitoring on cesarean section rates, a review was made of the experience before and that during the 7 years after the initiation of fetal monitoring at Vanderbilt University Hospital. When a comparison was made of the cesarean section rates in the 3 years prior to fetal monitoring with those over the subsequent 2 years, no change was observed, thus indicating that, in experienced hands, a liberal use of fetal monitoring in low-risk and high-risk patients does not necessarily cause a rise in the overall incidence of cesarean sections. During this time, the neonatal mortality rate fell approximately fourfold. On the basis of this study, the belief is that a liberal attitude toward delivery by cesarean section for patients with breech presentations and other high-risk conditions contributed more to the rise in cesarean sections at Vanderbilt University Hospital than did electronic fetal monitoring. With proper education of the clinician and correct interpretation of the findings, electronic fetal monitoring need not increase cesarean section rates, but rather should allow for a more accurate description of intrapartum life.

Cesarean Section↗
PubMed1981

Hydrops fetalis: sonographic evaluation and clinical implications.

A systematic sonographic evaluation of hydropic fetus is presented, based on 21 cases and a literature review. The clinical implications of fetal ascites with or without anasarca, maternal hydramnios, maternal oligohydramnios, or an abnormally thick placenta are discussed as they relate to fetal outcome. It is concluded that sonography could play a major role in determining the optimal approach to perinatal management of the fetus in hydrops fetalis, and thus contribute to a reduction in the perinatal mortality and morbidity associated with this disorder.

Edema↗
PubMed1981

Acute effect of cigarette smoking on the fetal heart nonstress test.

A major limitation in the use of the nonstress test (NST) has been the high frequency of nonreactive NSTs in the absence of fetal distress. Exogenous factors causing loss of fetal heart rate reactivity (FHRR) have not been fully evaluated, although it has previously been shown that chronic smokers have an increased incidence of nonreactive NSTs in the absence of fetal distress. A group of chronically smoking high-risk pregnant women at 31 to 44 weeks' gestation was studied to determine if the acute effects of smoking caused the NST to become nonreactive. After a reactive NST was obtained, each patient smoked 1 cigarette and the effects of the fetus were observed. Twenty-six studies were performed on 25 patients. A transient mild elevation of baseline fetal heart rate was noted after smoking in several studies; however, no significant change was found in FHRR, indicating that the acute effects of smoking a single cigarette are not responsible for the increased incidence of nonreactive NSTs in smokers.

Adolescent↗
PubMed1981

Association of portal hypertension and ruptured splenic artery aneurysm in pregnancy.

Spontaneous rupture of a splenic artery aneurysm is a rare, usually catastrophic event complicating pregnancy. Among risk factors for splenic artery aneurysm in nonpregnant patients is portal hypertension. The third case of rupture of splenic artery aneurysm in a patient with portal hypertension is reported, and previous reports are reviewed. In each of these cases the portal hypertension was due to hepatic cirrhosis. A previously unreported association between portal hypertension in pregnancy and rupture of a splenic artery aneurysm is presented.

Adult↗
PubMed1980

Bleomycin, vinblastine, and cis-platinum in the treatment of advanced endodermal sinus tumor.

The endodermal sinus tumor has traditionally been associated with an exceedingly poor prognosis. Three women with advanced pure endodermal sinus tumors were treated with a combination of bleomycin, vinblastine, and cis-platinum (VBC). Serum alpha-fetoprotein levels were monitored for all patients during and after therapy, and in each case the alpha-fetoprotein returned to normal range, correlating with complete clinical remission. Second-look laparotomy was negative for tumor in each case. Two patients have had no overt sign of recurrence 12 months after cessation of therapy. The third patient had post-treatment elevation of alpha-fetoprotein levels, and eventually was found to have recurrent tumor 6 months after chemotherapy was stopped. The VBC combination, previously found effective in testicular germ cell tumors, is also effective in ovarian germ cell tumors.

Adolescent↗