Biomedical subjects

Jay M Bolnick

Publications and source records attributed to Jay M Bolnick.

5 recordsLinked to original sources

PubMed2006

Cross-over trial of fetal heart rate response to halogen light and vibroacoustic stimulation.

OBJECTIVE: The purpose of this study was to compare the effect of halogen light and vibroacoustic stimulation on fetal heart rate (FHR) responsiveness and on nonstress test (NST) results. METHODS: Sixty consecutively-chosen patients between 33 and 39 weeks of gestation underwent an NST on at least three weekly occasions. Each received halogen light (Vector Compact Sport Spot, Ft Lauderdale, FL, USA), vibroacoustic (SolaTone Artificial Larynx, Temecula, CA, USA), and no stimulation in a randomized order. The transabdominal light or vibroacoustic stimulation lasted for 10 seconds. If no initial FHR acceleration occurred, then the stimulus was repeated 10 minutes later up to a maximum of three times. The investigators who interpreted the FHR patterns were blinded as to the type of stimulus used. RESULTS: Reactive results were present in 171 tests (vibroacoustic: 98.3%; light: 96.6%; none: 93.3%). Compared with no stimulation, the mean difference in time from the onset of recorded "stimulation" to the first FHR acceleration was shorter (p < 0.01) with either light (2.7 minutes, 95% confidence interval (CI) 0.9-4.5 minutes) or vibroacoustic stimulation (2.6 minutes, 95% CI 0.8-4.4 minutes). The mean time difference until a reactive result was also shorter (p < 0.05) with either light (2.7 minutes, 95% CI 0.1-4.9 minutes) or vibroacoustic stimulation (2.4 minutes, 95% CI 0.1-4.7 minutes) than with no stimulation. The need for repeated stimulation during each test was infrequent (light: 5.0%; vibroacoustic: 3.3%). No adverse effect from external stimulation was noted on the FHR tracing. CONCLUSION: Halogen light stimulation is an acceptable alternative to vibroacoustic stimulation in provoking a more rapid fetal heart rate response and in shortening the time before a reactive nonstress test result.

Acoustic Stimulation↗

PubMed2004

Effect of halogen light stimulation on nonstress testing.

OBJECTIVE: This study was undertaken to determine whether external stimulation using a halogen light source influences fetal heart rate (FHR) responsiveness and nonstress test results. STUDY DESIGN: A total of 107 patients at 32 to 42 weeks' gestation undergoing a nonstress test were randomly assigned to have either transabdominal light stimulation or no light stimulation. The light (Vector Compact Sport Spot, Ft Lauderdale, Fla) was turned on for 10 seconds. If no qualifying FHR acceleration was observed, then the stimulus was repeated at 10-minute intervals for a maximum of 3 times. The investigators were blinded as to light stimulation for FHR interpretation. RESULTS: Reactive results were present in 52 cases in each group. Light stimulation led to a significantly shorter time (P <.02) until the first FHR acceleration (difference: 2.1 minutes; 95% CI 0.4-3.8 minutes). The height and width of the first acceleration were indistinguishable between groups. The time until a reactive result was significantly shorter after light stimulation (difference: 4.2 minutes; 95% CI 2.0-6.4 minutes). CONCLUSION: The earlier onset of FHR accelerations after halogen light stimulation prompted a more rapid reactive nonstress test result.

Confidence Intervals↗

PubMed2004

Randomized trial between two active labor management protocols in the presence of an unfavorable cervix.

OBJECTIVE: The purpose of this study was to compare the efficacy of two protocols for active management of labor at term in the presence of an unfavorable cervix. STUDY DESIGN: Pregnancies that underwent labor induction at > or =37 weeks of gestation with an unfavorable cervix (Bishop score, < or =6) were randomly assigned to receive vaginally either a single dose of sustained-release dinoprostone (Cervidil) with concurrent low-dose oxytocin or multidosing of misoprostol (25 microg every 4 hours) followed by high-dose oxytocin. The primary outcome was the time interval from induction to vaginal delivery. Other parameters included excess uterine activity and cesarean delivery rates. RESULTS: A total of 151 patients (dinoprostone, 74 patients; misoprostol, 77 patients) were enrolled. The mean time from the initiation of induction to vaginal delivery was the same in the dinoprostone and misoprostol groups (15.7 hours; 95% CI, 13.7-17.7 hours vs 16.0 hours; 95% CI, 14.1-17.8 hours; P=.34), regardless of parity. The dinoprostone and misoprostol groups did not differ statistically in the percent of patients who were delivered vaginally by 12 hours (36.2% vs 29.7%), 18 hours (63.8% vs 56.3%), and 24 hours (81.0% vs 81.3%). Excess uterine activity was not more common in either group, and hyperstimulation syndrome was absent in all cases. Primary cesarean delivery rates were similar (dinoprostone, 21.6%; misoprostol, 16.9%; relative risk, 1.3; 95% CI, 0.7-2.5), with a failed induction that occurred in one case in each group. CONCLUSION: Sustained-release dinoprostone with concurrent low-dose oxytocin and intermittent misoprostol with delayed high-dose oxytocin are effective alternatives for active management of labor with an unfavorable cervix.

Cervical Ripening↗

PubMed2004

Selecting an external light source for fetal biophysical testing.

OBJECTIVE: To select the most intense light source that penetrates tissues and is safe for fetal biophysical testing STUDY DESIGN: A 3-step series of experiments was undertaken using a digital light meter (Extech Light Probe Meter, Extech Instruments, Waltham, Massachusetts). First, the density of light through a light filter was compared between the sun and 4 commercially available light sources. Second, penetration of light through the abdominal subcutaneous tissue (3-4 cm thick) of 6 pigs was compared between these light sources. Last, the skin reaction to the preferred light source and the distance in penetrating the uterine cavity were assessed in 50 pregnant women. RESULTS: Light emitted from a halogen bulb was significantly more intense than from a photographic flash, krypton bulb or penlight. Maximal intensity was gained with the light source placed against the skin. The halogen bulb penetrated a pig's abdominal wall more than the photographic flash or krypton bulb. The thickness of a pig's abdominal wall is similar to the distance in pregnant humans near term from the skin to the uterine cavity. No thermal injury or discomfort to the skin was observed for exposures <10 seconds. CONCLUSION: The halogen bulb was safe, penetrated tissues most effectively and was the best light source for fetal biophysical testing.

Abdomen↗

PubMed2003

Substance use disorders in women: special considerations during pregnancy.

Care of substance-using pregnant women is complex, difficult, and often demanding. Women's care providers must be aware of these women's unique psychologic and social needs and the related legal and ethical ramifications surrounding pregnancy. In addition, relating specific substances to perinatal outcome is difficult, because concurrent use of multiple substances is frequent and many pregnant abusers are members of economically disadvantaged segments of society in which unfavorable perinatal outcomes are more common. It is also difficult to follow up outcomes in such pregnancies prospectively and to analyze research data. This article discusses various issues related to pregnancies complicated by substance use, including perinatal pharmacology and teratogenic risks, identification of substance abuse, treatment approaches, and comprehensive perinatal management.

Adolescent↗