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Biomedical subjects

Joseph R Wax

Publications and source records attributed to Joseph R Wax.

At least 19 recordsLinked to original sources
PubMed2006

Prevalence of new maternal alloantibodies after intrauterine transfusion for severe Rhesus disease.

Limited information is published on the frequency of new maternal alloantibodies found in patients treated for isoimmunization. The purpose of this study was to determine the prevalence of additional maternal red cell alloantibodies, found after the initiation of treatment for Rhesus (Rh) disease. A retrospective review of all patients treated for severe Rh disease was undertaken. Rh disease requiring intrauterine blood transfusion was defined as severe. Gravidas with alloantibodies in addition to Rh were included, but those without Rh antibodies were excluded. New alloantibodies were defined as antibodies absent in previous pregnancies and on initial pregnancy screening, and found after the onset of invasive treatment. There were a total of 84 intrauterine blood transfusions performed in 31 gravidas with severe Rh disease. Seven patients (23%) were found to develop additional red cell alloantibodies after treatment during the pregnancy. Induction of additional maternal red cell alloantibodies after treatment for severe Rh disease is relatively common. This may have significant implications for future pregnancies in this high-risk population.

Antibody Formation↗
PubMed2006

Maternal request cesarean versus planned spontaneous vaginal delivery: maternal morbidity and short term outcomes.

Since no randomized trial evaluates maternal morbidity from planned cesarean versus planned vaginal delivery, the issue must be addressed indirectly from retrospective cohort studies of vertex fetuses by actual or planned delivery route, and retrospective or randomized studies of breech fetuses by planned delivery route. The available data, although limited, suggest that term planned cesarean and planned vaginal delivery have similarly low rates of absolute and relative short-term maternal morbidity. Endometritis and cystitis are more frequent with cesarean, whereas hemorrhage is more frequent with planned vaginal delivery. Much of the morbidity of planned vaginal delivery is the morbidity of unplanned cesarean in labor and operative vaginal delivery, particularly forceps. Thus, the relative risk of short-term maternal morbidity of planned cesarean versus planned vaginal delivery will depend on the proportion of women in each group ultimately delivering in the planned manner and the frequency with which delivery occurs by an alternative unplanned method.

Cesarean Section↗
PubMed2006

Pain associated with transabdominal chorionic villus sampling--anticipated versus actual.

OBJECTIVE: To assess anticipated and perceived pain associated with transabdominal chorionic villus sampling (TA CVS). METHODS: Sixteen consecutive patients completed 0 (no pain) to 10 (excruciating pain) visual analog scales before and after TA CVS. RESULTS: Anticipated pain (5.1 +/- 2.9) and perceived pain (5.5 +/- 3.2) were similar (p = 0.42) and moderate. Actual pain was less in five (31%), the same in six (38%), and greater in five (31%) compared to anticipated pain. CONCLUSIONS: These baseline data are useful for patient counseling and designing interventional trials to decrease procedural pain. TA CVS is associated with moderate perceived pain.

Adult↗
PubMed2006

Cavernous transformation of the portal vein complicating pregnancy.

BACKGROUND: Cavernous transformation of the portal vein, associated with varices and thrombocytopenia, rarely complicates pregnancy. CASE: A 20-year-old primigravida with cavernous transformation of the portal vein underwent wireless video esophageal capsule endoscopy at 28 weeks of gestation, which ruled out esophageal and gastric varices and the need for prophylactic sclerotherapy. Magnetic resonance angiography at 32 weeks of gestation showed no abdominal wall varices or abnormally dilated lumbar or extradural veins, which ensured a safe surgical approach for cesarean and preserved the patient's ability to receive regional anesthesia. CONCLUSION: New noninvasive imaging modalities aided evaluation and management of the gravida with cavernous transformation of the portal vein.

Adult↗
PubMed2006

Nonmedical fetal ultrasound: knowledge and opinions of Maine obstetricians and radiologists.

OBJECTIVE: The purpose of this study was to evaluate knowledge and opinions regarding nonmedical fetal ultrasound (NMFU) in obstetricians (OB) and radiologists (R). METHODS: A questionnaire was sent to all Maine fellows of the American College of Obstetricians and Gynecologists practicing obstetrics and members of the Maine Society of Radiology in April 2005. RESULTS: Among OB, 52 (81.2%), 24 (37.5%), 45 (75.0%), and 56 (87.5%) did not know whether the American College of Radiology, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, or US Food and Drug Administration held positions on NMFU. Among R, 11 (37.9%), 27 (93.1%), 19 (65.5%), and 24 (82.7%) did not know whether the organizations held positions. More R than OB agreed that women might forego medical ultrasound after NMFU (62.1% versus 49.2%; P = .05), whereas more OB than R believed fetal anomalies would go undetected during NMFU (79.4% versus 62.1%; P = .04). OB and R had concerns for false-positive NMFU diagnoses (41.9% and 31.0%), false reassurance by NMFU (76.2% and 62.1%), poor imaging causing anxiety (39.7% and 51.7%), and lack of physician availability to review suspected abnormalities on NMFU (73.0% and 65.5%). Sizable minorities of OB and R believed NMFU providers should be disciplined by licensing boards (33.9% and 44.8%), excluded from society memberships (22.9% and 37.9%), or reported to the Food and Drug Administration (21.3% and 31.0%). CONCLUSIONS: Most Maine OB and R are aware of their own but not each other's professional or regulatory NMFU positions yet practice within these guidelines. Most respondents do not favor sanctioning colleagues performing NMFU.

Attitude of Health Personnel↗
PubMed2006

Congenital jejunal and ileal atresia: natural prenatal sonographic history and association with neonatal outcome.

OBJECTIVE: The purpose of this study was to describe the prenatal sonographic features and natural course of congenital jejunal and ileal atresia and correlate the findings with neonatal outcomes. METHODS: We identified all neonates with surgically confirmed jejunal or ileal atresia that had prenatal sonography and neonatal surgery in our center from January 1, 1995, to April 1, 2005. Sonography reports and images were reviewed, without knowledge of neonatal outcomes, for features of intestinal obstruction. Obstetric and neonatal outcomes were evaluated. RESULTS: Fifteen (60%) of 25 offspring with atresias (10 jejunal, 4 ileal, and 1 jejunoileal) had sonography, of which 13 (86.6%) had features of atresia. Findings, number of affected fetuses, and gestational age at recognition included fetal echogenic bowel (n = 8), mean +/- SD, 21.3 +/- 3.8 weeks (range, 17.7-28.4 weeks); enlarged stomach (n = 5), 27.5 +/- 5.0 weeks (range, 22.0-34.3 weeks); dilated bowel (n = 13), 27.8 +/- 5.8 weeks (range, 18.3-35.9 weeks); and polyhydramnios (n = 6), 33.3 +/- 1.7 weeks (range, 31.0-35.6 weeks). No fetus with ileal atresia had an enlarged stomach or polyhydramnios. Delivery occurred at a mean of 34.7 +/- 3.6 weeks, with 9 (60%) cesarean deliveries. Neonatal outcomes of age at surgery, neonatal intensive care unit days, hospital days, total parenteral nutrition days, and death were similar whether or not fetal echogenic bowel, enlarged stomach, dilated bowel, or polyhydramnios was present. Likewise, these outcomes did not vary by type of atresia or time of diagnosis (prenatal or neonatal). CONCLUSIONS: Jejunal and ileal atresia have specific sonographic patterns allowing specific prenatal diagnoses in most affected fetuses. Prenatal sonographic findings and time of diagnosis did not affect neonatal outcome.

Adult↗
PubMed2005

Using fetal acoustic stimulation to shorten the biophysical profile.

PURPOSE: To determine whether fetal acoustic stimulation can decrease the time required to achieve a reassuring biophysical profile. METHODS: Patients scheduled for a biophysical profile were prospectively assigned to study and control groups. The study group received 3 seconds of acoustic stimulation if fetal breathing, tone, or movement were not present during the first 5 minutes of the study. The biophysical profile was completed in the standard fashion, for both groups. RESULTS: A total of 870 patients were enrolled (458 control, 412 with stimulation). The fetal acoustic stimulation group had decreased testing time (3 minutes) and fewer non-reassuring tests (5%). The fetal acoustic stimulation group had fewer studies without breathing, potentially reducing the need for further testing or intervention. CONCLUSIONS: Fetal acoustic stimulation can be used to decrease the biophysical profile testing time and to reduce the number of non-reassuring tests.

Acoustic Stimulation↗
PubMed2005

Efficacy of intramuscular penicillin in the eradication of group B streptococcal colonization at delivery.

OBJECTIVE: Due to rapid deliveries and human error, not all group B streptococcal positive mothers will receive adequate prophylactic antibiotic treatment in labor. We sought to determine if long acting intramuscular penicillin given after a positive culture result would be efficacious in eradicating group B streptococcal colonization at the time of delivery. METHODS: Patients positive for group B streptococci at 35-37 weeks were randomized to receive 2.4 million units of intramuscular benzathine penicillin G suspension (Bicillin L-A) versus no treatment. Study patients were recultured at the time of admission to labor and delivery prior to receiving prophylactic antibiotics according to CDC guidelines. RESULTS: A total of 53 patients were enrolled. A small but significant decrease in the rate of group B streptococcal colonization was observed in the treatment group (14/27, 52%) versus the control group (20/23, 87%), p=0.03. CONCLUSION: The large number of persistent carriers suggests that 2.4 million units of intramuscular benzathine penicillin G suspension (Bicillin L-A) is insufficient as sole therapy. However, the decline in group B streptococcal carriers might lessen the risk of failed or insufficient intrapartum treatment. Intramuscular benzathine penicillin G suspension (Bicillin L-A) may be useful as an adjunctive treatment for patients at risk for rapid delivery, before adequate intrapartum prophylaxis can be given.

Adult↗
PubMed2005

Reducing pain with genetic amniocentesis-A randomized trial of subfreezing versus room temperature needles.

OBJECTIVE: To determine whether pain associated with second trimester genetic amniocentesis is decreased by using subfreezing rather than room temperature needles. METHODS: Subjects were randomized to a -14 degrees C or room temperature (20-22 degrees C) 22-gauge spinal needle. Patients, blinded to allocation, recorded anticipated and actual pain before and after the procedure, respectively, using a 0-10 visual analog scale with 0 = no pain and 10 = excruciating pain. RESULTS: Thirty-three subjects were randomized to room temperature and 29 subjects to subfreezing needles. Anticipated pain was similar in room temperature, 5.1 +/- 1.7, and subfreezing groups, 4.9 +/- 2.0, respectively (p = 0.6). Actual pain was also similar in the room temperature, 3.6 +/- 2.0, and subfreezing groups, 2.8 +/- 2.0, respectively (p = 0.14). Similar numbers of subjects in the room temperature and subfreezing groups reported less actual pain (20 vs. 18), greater actual pain (4 vs. 4) or no difference in pain (9 vs. 5) than anticipated (p = 0.6). CONCLUSION: A subfreezing 22-gauge spinal needle does not decrease perceived pain associated with second trimester genetic amniocentesis.

Adult↗
PubMed2005

Patient choice cesarean--the Maine experience.

BACKGROUND: Patient choice cesarean refers to elective primary cesarean in the absence of a medical or obstetrical indication. The purpose of this study was to determine obstetricians' attitudes and practices with respect to patient choice cesarean in Maine, United States. METHODS: A questionnaire was sent to all Maine Fellows of the American College of Obstetricians and Gynecologists actively practicing obstetrics, after receiving institutional review exemption. Data were analyzed using descriptive statistics, Fisher exact, or chi-square tests. RESULTS: Seventy-eight of 110 (70.9%) obstetricians responded. Of these, 60 of 71 (84.5%) respondents performed or were willing to perform patient choice cesarean. However, 15 of 71 (21.1%) preferred a cesarean delivery for themselves (women) or partners (men). Indications included urinary continence (53.3%), adverse previous birth experience (41.7%), anal continence (35.0%), concern for fetal death or injury (33.3%), and fear of childbirth, preservation of sexual function, or pelvic organ prolapse (26.7% each). Less frequent were pain (11.7%), convenience (8.3%), and provider availability (10.0%). In addition, 82.1 percent believed medical evidence and 85.9 percent believed ethical issues sometimes or always supported patient choice cesarean. Responses were similar by gender, age, and time interval from training completion with two exceptions. Women under age 35 years were more likely to opt for a cesarean delivery themselves (p = 0.04), and 42.9 percent of respondents under age 35 years interpreted the medical literature as supporting cesarean in all cases versus 4.2 percent of older colleagues (p = 0.008). Sixty-four of 78 (82.1%) respondents would find a randomized trial of planned vaginal versus planned cesarean delivery helpful in addressing the issue of patient choice cesarean. CONCLUSIONS: Although Maine obstetricians were willing to perform patient choice cesarean, few preferred this delivery mode for themselves or their partners. A randomized trial of planned vaginal versus planned cesarean delivery is highly desired.

Adult↗
PubMed2005

Does the frequency of soft sonographic aneuploidy markers vary by fetal sex?

OBJECTIVE: To determine whether the frequency of soft sonographic aneuploidy markers varies by fetal sex. METHODS: We identified all singleton fetuses with known sex undergoing genetic sonography at 17 weeks' to 21 weeks 6 days' gestation in a single perinatal center from January 1, 2000, to December 31, 2003. Markers studied were biparietal diameter/femur length, transcerebellar diameter, ear length, echogenic bowel, femur length, humerus length, absent middle fifth phalanx, nuchal fold, renal pelvis dilatation, echogenic cardiac focus, and choroid plexus cysts. Additional information extracted from the prospectively ascertained database included maternal age, referral indications, and chromosomal analyses. Multiple gestations and fetuses with structural or chromosomal abnormalities were excluded. The study received exempt review status by the Institutional Review Board. Dichotomous variables were compared by the chi(2) or Fisher exact test; continuous variables were compared by the unpaired t test. RESULTS: In total, 4057 eligible fetuses, 2103 male and 1954 female, were examined at 18.9 +/- 0.9 weeks (mean +/- SD). Referral indications included maternal age of 35 years or older (n = 2983), abnormal second-trimester serum screen results (n = 610), soft marker on sonography (n = 583), prior aneuploid offspring (n = 24), and other (n = 125). More than 1 referral indication was possible for a given fetus. Overall, male fetuses exhibited echogenic fetal bowel (odds ratio, 1.76; 95% confidence interval [CI], 1.14-2.72; P = .009) and renal pelvis dilatation (odds ratio, 2.00; 95% CI, 1.30-3.09; P = .001) significantly more often than female fetuses. However, when fetuses were evaluated for single isolated markers, only male predominance of renal pelvis dilatation persisted (odds ratio, 2.32; 95% CI, 1.32-4.09; P = .003). No markers had increased frequency in female offspring. CONCLUSIONS: Male fetuses exhibit a significantly increased frequency of renal pelvis dilatation compared with female fetuses. Sex-specific adjustment of sonographically derived aneuploidy risk does not appear to be indicated. However, a larger series of fetuses with trisomy 21 and pyelectasis is required to assess sex-specific risk adjustment for this marker.

Adult↗
PubMed2004

Sinogenic brain abscess complicating pregnancy.

Cerebral abscess is an extremely rare complication of pregnancy. We report a case of a patient at 36 weeks of gestation presenting with severe headache, confusion, and seizures after starting treatment for sinusitis. Imaging revealed a left temporal lobe abscess, which was treated with broad-spectrum antibiotics. Neurologic deterioration in a gravida with sinusitis suggests secondary sinogenic intracranial suppurative complications.

Adult↗