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Biomedical subjects

K G Perry

Publications and source records attributed to K G Perry.

At least 37 records · Page 2Linked to original sources
PubMed1997

Are obstetric interventions such as cervical ripening, induction of labor, amnioinfusion, or amniotomy associated with umbilical cord prolapse?

OBJECTIVE: Our purpose was to determine whether intrapartum obstetric interventions are associated with umbilical cord prolapse. STUDY DESIGN: A computer search identified patients who had intrapartum umbilical cord prolapse. Thirty-seven cases were identified between 1990 and 1994 (incidence of 1.85 per 1000). These women were randomly matched to control patients with intact membranes. RESULTS: Patients with umbilical cord prolapse were delivered earlier (34.8 vs 37.1 weeks, p = 0.05). Otherwise, there were no differences between groups regarding the use of cervical ripening, incidence of labor induction, or the use of amnioinfusion and amniotomy. Although cervical dilatation and station were similar between groups at the time of admission, women with umbilical cord prolapse did not have as much descent of the presenting part associated with cervical dilatation and progressive labor compared with control patients. CONCLUSION: By themselves, obstetric interventions of cervical ripening, labor induction, amnioinfusion, and amniotomy do not increase the likelihood that a patient will have umbilical cord prolapse.

Adolescent↗
PubMed1997

The case for trial of labor in the patient with a prior low-segment vertical cesarean incision.

OBJECTIVE: Our purpose was to review recent obstetric literature detailing the subsequent delivery experience of patients with a prior low-segment vertical cesarean incision and to derive recommendations for practice on the basis of this information. STUDY DESIGN: Ten studies that included information about pregnancy outcome in patients with prior low-segment vertical cesarean operations were retrieved and reviewed from the American obstetric literature since 1981 and from a review of all abstracts presented annually since 1981 to the Society of Perinatal Obstetricians. RESULTS: Altogether, information about subsequent pregnancy outcome for 382 patients with prior low-segment vertical cesarean delivery was available for analysis. Among the 372 patients with complete patient population information, vaginal delivery was safely accomplished in 306 (82%). Four uterine ruptures (1.05%) have been reported, only one of which occurred after a single prior unextended low-segment vertical cesarean incision. Two ruptures occurred elsewhere on the lateral or posterior aspect of the uterus in subsequent pregnancies, and the fourth rupture occurred at the juncture of prior low vertical and transverse incisions. No perinatal mortality or permanent perinatal morbidity was encountered with these pregnancies. CONCLUSIONS: In the otherwise uncomplicated pregnancy the patient with one previous nonextended low-segment vertical cesarean incision should be considered to have a prior low-segment scar and as such be a candidate for trial of labor in her current singleton pregnancy. The same care, counseling, and caution should be exercised for this patient as for one with a prior low-segment transverse incision.

Birth Weight↗
PubMed1997

Premature rupture of membranes at term with an unfavorable cervix: comparison of expectant management, vaginal prostaglandin, and oxytocin induction.

BACKGROUND: Our objective was to determine the best treatment for parturients at term with an unfavorable cervix and premature rupture of membranes (PROM). METHODS: In this prospective study, 96 women with PROM and an unfavorable cervix were randomized into one of three treatment groups: oxytocin induction, vaginal prostaglandin E2 gel followed by oxytocin, or expectant management. RESULTS: Length of labor, cesarean section rate, and maternal/neonatal morbidity were not significantly different. In contrast, the interval from PROM until delivery and length of hospital stay were significantly longer in the expectantly managed group than in the other groups. Four of the patients who received expectant management required delivery because of nonreassuring fetal assessments. CONCLUSIONS: Expectant management of PROM at term significantly prolongs hospital stay without decreasing the incidence of abdominal delivery or infectious morbidity. There appears to be potential for cord compression in patients managed expectantly without continuous electronic fetal surveillance.

Cesarean Section↗
PubMed1997

Twins and preterm labor.

OBJECTIVE: To assess the effect of home uterine contraction assessment (HUCA) in twin pregnancies with preterm labor (PTL) at < 24 weeks' gestation. STUDY DESIGN: In this retrospective, analytic study, patients were stratified by whether HUCA had been prescribed before or after diagnosis of PTL. The main outcomes studied were time of PTL diagnosis and delivery as well as birth weight and need for neonatal intensive care unit (NICU) admission. In 63 patients, 32 were prescribed HUCA after PTL had been arrested at < 24 weeks (group I). Thirty-one women had HUCA prescribed at 20 weeks' gestational age and then developed PTL at < 24 weeks (group II). RESULTS: Labor was diagnosed at similar times in both groups (22.8 vs 23.4 weeks), but delivery was earlier in group I (27.6 weeks vs. 34.7 weeks) than in group II. The birth weight in group I was less (918 +/- 255 g), and of the 64 infants, 55 required NICU admission as compared to 2,340 +/- 525 g and 11 of 62 infants (P < .0001, .0001) in group II, respectively. CONCLUSION: Women with twin gestations and the diagnosis of PTL prior to 24 weeks deliver later in gestation, and their infants weigh more and have fewer NICU admissions if intensive prenatal surveillance is prescribed prior to the onset of labor.

Adult↗
PubMed1996

Forceps and vacuum delivery: a survey of North American residency programs.

OBJECTIVE: To document resident instruction in operative vaginal delivery by forceps and vacuum. METHODS: A survey was sent to all 291 obstetrics-gynecology training programs in the United States and Canada. RESULTS: The overall response rate was 72% (210 of 291). Most programs (60%) have an operative vaginal delivery rate of 10% or less. Nearly all of the responding programs (199 of 209, 95%) teach operative vaginal delivery via the vacuum route; metallic cups are used in only 14% of centers. Forceps are the primary instrument in most programs (68%), but nearly one-third of responding centers use the vacuum method more often than forceps. Instruction in midpelvic operative vaginal delivery is offered in 64% of the programs, with forceps being more common by nearly a two-to-one ratio. Deep transverse arrest is handled initially by forceps by half of the respondents, whereas 28 and 22% would proceed with cesarean or attempt a vacuum extraction, respectively. CONCLUSION: Instruction in both types of operative vaginal delivery is found in most programs. The forceps are used more commonly, but vacuum is the preferred instrument in about one-third of training programs. Instruction in midpelvic delivery is offered in 64% of programs, but we noted a declining trend.

Canada↗
PubMed1996

Trauma in pregnancy: the role of interpersonal violence.

OBJECTIVE: Our purpose was to determine what role interpersonal violence as intentional injury plays in the pregnant trauma victim. STUDY DESIGN: We performed a retrospective review of medical records. RESULTS: During a 9-year period in a single university medical and trauma center, 203 pregnant women were treated for a physically traumatic event. Sixty-four women (31.5%) were victims of intentional injury, in most cases by the husband or boyfriend. Although the mean Injury Severity Score was higher in women with fetal death than in women with successful pregnancy outcomes (7.25 vs 1.74, respectively; p < 0.01), 5 of the 8 women with fetal losses incurred these despite an apparent absence of physical injury (maternal Injury Severity Score = 0). CONCLUSIONS: Interpersonal violence during pregnancy is a frequent and increasingly common cause of maternal injury. The inconsistent relationship between Injury Severity Score and serious fetal injury or death is underscored by the loss of 5 fetuses despite an Injury Severity Score of 0.

Accidents, Traffic↗
PubMed1996

Operative vaginal delivery: a survey of fellows of ACOG.

OBJECTIVE: To document operative vaginal delivery rates of ACOG Fellows and to stratify practice patterns with regard to mid-pelvic delivery and deep transverse arrest by the time elapsed since residency. METHODS: A survey was mailed to a random sample of 1600 ACOG Fellows. Of the 597 respondents (37%), 558 who still practice obstetrics formed the study group. Selection bias regarding recipients of the survey was reduced by randomization by an uninvolved third party. The length of time since residency was categorized as 10 years or fewer ("recent," 31%), 11-20 years ("intermediate," 43%), and more than 20 years ("remote," 26%). RESULTS: The majority of respondents (338 of 558, 61%) reported an operative vaginal delivery rate of 15% or less. One hundred forty-two (25%) use only forceps, whereas 78 (14%) use vacuum extraction exclusively. More than half have abandoned mid-pelvic operative vaginal deliveries, and of the 41% who still perform these operations, about half use forceps. In cases of deep transverse arrest, about 25% perform cesarean delivery, whereas 26% and 42% use forceps or vacuum, respectively. Resident training and practice in vacuum delivery were more common in the recently trained groups (recent > intermediate > remote; P < .001). There were no differences among the groups with respect to attempting mid-pelvic operative vaginal delivery (P = .29), but the remote group was more likely to use forceps, whereas the recent group was more likely to use vacuum (P = .039). A large disparity existed among the groups regarding the management of deep transverse arrest, with vacuum use associated with group assignment (P < .001). CONCLUSIONS: The majority of respondents have an operative vaginal delivery rate of no more than 15%. Most respondents have abandoned mid-pelvic operative vaginal delivery. Practice patterns reflect differences in residency training; the more recently trained Fellows more often were taught and use vacuum for delivery.

Data Collection↗
PubMed1996

Order of rotation in third-year clerkships. Influence on academic performance.

OBJECTIVE: To determine if student performance during the third-year clerkship is influenced by the order of departmental rotation. STUDY DESIGN: In this retrospective, descriptive study, the National Board of Medical Examiners (NBME) scores, departmental examination grade (DE) and final block grade (FG) were stratified into six segments based on the order of block time in obstetrics-gynecology, pediatrics, psychiatry, internal medicine, surgery and family medicine. Consistency was validated by comparing these performance criteria from 1988 to 1992. RESULTS: When all six clerkships were assessed by year, there was no uniform trend of improved performance over time. In the obstetrics-gynecology block, however, NBME scores and FGs were highest for students assigned to the fifth and sixth rotation as compared to the first two groups (P < .02). No such trend was noted with the departmental written examination. In surgery, DE and FG were always lower in the first rotation (P = .0001). Psychiatry DE scores were significantly higher on the second or third blocks as compared to the fifth and sixth rotation positions (P < .001). Students had a higher FG in pediatrics when the sixth position was compared to the second block (P = .02), but the DE grades and NBME scores were not altered by rotational schema. In family medicine and internal medicine, no effect of rotation was noted. CONCLUSION: Third-year clerks tended to have higher NBME scores and FGs in obstetrics-gynecology if they selected this rotation later in the academic year. Surgery DEs and FGs were lowest if selected first in the academic year. There was no similar trend in other nonsurgical specialties. These data suggest that prior clinical rotations positively influence student performance in obstetrics-gynecology.

Clinical Clerkship↗
PubMed1995

The irritable uterus: a risk factor for preterm birth?

OBJECTIVE: Our aim was to determine the incidence and preterm delivery rate along with the indication for delivery in patients with uterine irritability. STUDY POPULATION: In this retrospective, descriptive study, 17,186 patients with well-defined high-risk factors were compared with 2637 women with uterine irritability. RESULTS: The incidence of preterm labor in patients with uterine irritability was 18.7%, significantly less than in those with other high-risk factors (odds ratio 0.35, 0.31 < odds ratio < 0.38). However, women with uterine irritability who experience preterm labor, compared with other high-risk factors, are much more likely to deliver before 34 weeks' gestation (odds ratio 2.50, 2.07 < odds ratio < 3.03) and more than twice as likely to deliver as a result of advanced preterm labor or membrane rupture (odds ratio 2.20, 1.75 < odds ratio < 2.78). CONCLUSIONS: The incidence of preterm labor in women with uterine irritability is not as frequent as in patients with other high-risk factors. However, preterm labor does occur in patients with uterine irritability at a rate higher than that in the general obstetric population (18.7% vs 11.0%). Because it appears that women with uterine irritability have more resistance to conventional tocolytic therapy, this condition should prompt the physician to use more aggressive perinatal assessment.

Adult↗
PubMed1995

Climatic factors and preeclampsia-related hypertensive disorders of pregnancy.

Seasonal variations of temperature and humidity are said to influence the incidence of hypertensive disorders of pregnancy. Pregnant women with hypertensive disorders of pregnancy were assessed on the basis of temperature and relative humidity at diagnosis. Temperature variations with constant high humidity do not influence the incidence of preeclampsia-eclampsia-related hypertensive disorders of pregnancy.

Eclampsia↗
PubMed1995

Incidence of adverse cardiopulmonary effects with low-dose continuous terbutaline infusion.

OBJECTIVE: Our purpose was to determine the incidence of adverse cardiovascular effects of terbutaline sulfate when administered as a continuous subcutaneous infusion in women with arrested preterm labor. STUDY DESIGN: Over a 6-year period records from 8709 women prescribed this therapy for preterm labor that had previously been arrested with other intravenous tocolytics were reviewed. These women were assessed daily for cardiovascular complaints and tolerance of the medication, while either in the hospital or at the home (by telephone). The main outcomes studied were the occurrence of pulmonary edema, sustained cardiac arrhythmias, chest pain, or myocardial ischemia. Any maternal death regardless of cause was also reviewed. RESULTS: Of the 8709 subjects, 47 (0.54%) had one or more cardiopulmonary problems. Pulmonary edema developed in 28 patients (0.32%) while receiving continuous subcutaneous infusion of terbutaline, 5 at home and 23 in the hospital. Of the total, 17 women were being treated concurrently with large amounts of intravenous fluids and one to three other tocolytic agents. In the 11 remaining subjects, 4 were diagnosed with pregnancy-induced hypertension and/or multiple gestation. Nineteen patients experienced other adverse cardiovascular effects, including electrocardiogram changes, irregular heart rate, chest pain, or shortness of breath. CONCLUSIONS: Continuous terbutaline infusion for women with stabilized preterm labor is associated with much fewer adverse effects than previous literature regarding intravenous beta-adrenergic agonist therapy would suggest.

Adrenergic beta-Agonists↗
PubMed1995

Cervical ripening before medical induction of labor: a comparison of prostaglandin E2, estradiol, and oxytocin.

OBJECTIVE: Our purpose was to evaluate the effectiveness of oxytocin, prostaglandin E2 intracervical gel, and estradiol cream for ripening the very unfavorable cervix in patients requiring induction of labor at term. STUDY DESIGN: This prospective, randomized study was conducted in a population of women with a very unfavorable cervix (Bishop score < 4) requiring induction of labor. The patients received prostaglandin E2 gel (0.5 mg) intracervically (three doses 6 hours apart), 4 mg estradiol cream in the anterior fornix of the vagina (three doses 6 hours apart), or oxytocin at induction per protocol with an infusion pump. RESULTS: Ninety-nine women were recruited into this trial and evenly distributed among the three groups. The demographics of maternal age, race, parity, gestational age, initial Bishop score, and indication for induction were similar among the groups. The incidence of cesarean deliveries was similar in the three groups with approximately 59% of pregnancies delivered abdominally. For patients undergoing abdominal delivery the maximum cervical dilatation among the oxytocin, estradiol, and prostaglandin E2 groups was similar (3.90 +/- 3.02 cm, 3.63 +/- 2.79 cm, and 4.65 +/- 2.78 cm, respectively; p > 0.05). For all patients birth weight and Apgar scores at 1 and 5 minutes were comparable across all regimens (p > 0.05). In the subset of patients delivered vaginally patients receiving oxytocin for cervical ripening had the greatest improvement in Bishop score over baseline (p = 0.023) with an improvement of 7.08 +/- 2.42. CONCLUSION: No differences were detected among prostaglandin E2 gel, estrogen, and oxytocin in relation to cervical ripening in patients with an unfavorable cervix at term who require an induction of labor. Patients with a very unfavorable cervix at term who require delivery may benefit from serial ripening and inductions.

Adult↗
PubMed1995

Postpartum plasma exchange for atypical preeclampsia-eclampsia as HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

OBJECTIVE: Our purpose was to investigate the postpartum use of plasma exchange in patients considered to have atypical preeclampsia-eclampsia manifested as persistent HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome with or without evidence of other organ injury. STUDY DESIGN: During a 10-year period, 18 patients with HELLP syndrome were treated post partum with single or multiple plasma exchange with fresh-frozen plasma. Each patient was entered into the clinical trial either because of persistent evidence of atypical preeclampsia-eclampsia as HELLP syndrome > 72 hours after delivery (group 1) or with evidence of worsening HELLP syndrome at any time post partum in association with single- or multiple-organ injury (group 2). All procedures were performed with the IBM 2997 Cell Separator (IBM, Cobe Laboratories, Inc., Lakewood, Colo.) system. Maternal and perinatal outcomes were the main outcomes studied. RESULTS: In the absence of other disease conditions, the 9 patients in group 1 with persistent postpartum HELLP syndrome complicated only by severe clinical expressions of preeclampsia-eclampsia responded rapidly to one or two plasma exchange procedures with few complications and no maternal deaths. In contrast, in the 9 patients of group 2 with HELLP syndrome presentations complicated by other organ disease, the response to plasma exchange was variable and there were two deaths in this group. CONCLUSION: The current series of patients details the successful postpartum application of plasma exchange therapy for unremitting HELLP syndrome but reveals that a uniformly positive response to this therapy will not always be observed when there is additional single or multiple organ injury.

Adolescent↗
PubMed1995

A randomized study to assess the efficacy of the amniotic fluid index as a fetal admission test.

OBJECTIVE: To determine whether there is a difference in the incidence of abdominal delivery for presumed fetal distress in women who have an intrapartum fluid index assessment and those who do not. METHODS: Over a 7-month period, parturients at 26-42 weeks' gestation and in early labor were randomized to the study (measured amniotic fluid index [AFI] on admission) or a control group (no sonographic assessment of amniotic fluid [AF] volume). The labor and delivery staff were aware of the AFI results of the study subjects. All patients had continuous electronic fetal monitoring, and none had an abnormal tracing on admission. Student t test or chi 2 was used for statistical analysis. P < .05 was considered significant. RESULTS: The study (N = 447) and control groups (N = 436) had similar maternal demographics as well as medical and obstetric complications. In the study group, the incidence of abdominal delivery for fetal distress (29 of 447) was significantly higher than among controls (14 of 436) (P = .02; relative risk 1.3, 95% confidence interval 1.1-1.7). Among parturients who had abdominal delivery for fetal distress, the decision-to-incision times (mean +/- standard deviation) were similar for parturients who had undergone assessment of AFI and those who had not (38.5 +/- 14.7 versus 32.5 +/- 14.7 minutes, respectively; P = .47). Mean birth weight, incidence of low birth weight, macrosomia, Apgar scores less than 7, and the number of admissions to the neonatal intensive care unit were not significantly different in the two groups. CONCLUSIONS: Patients having an intrapartum assessment of AFI as a fetal admission test are significantly more likely to have abdominal delivery for presumed fetal distress. However, the decision-to-incision time is not decreased and the perinatal outcome is not improved if the status of AF volume is known for patients in early labor.

Adult↗
PubMed1995

Pregnancy complicated by sickle hemoglobinopathy.

During the last decade it has been shown that patients with major sickle hemoglobinopathies can experience a normal reproductive outcome. This has been accomplished with early aggressive prenatal care, effective counseling, and appropriate intervention by providers with a high index of suspicion for factors that lead to untoward outcomes in such women. Because controversy surrounds the use of transfusion therapy for pregnant patients with sickle cell disease, individualization should depend on patient circumstances and provider experience because this is a key factor in the management of these women. New therapies for those with major sickle hemoglobinopathy are on the horizon, but their use in pregnancy awaits further evaluation.

Anemia, Sickle Cell↗
PubMed1995

Accuracy of ultrasonography in evaluating amniotic fluid volume at less than 24 weeks' gestation.

The purpose of this investigation was to evaluate the accuracy of common sonographic techniques in assessing the amniotic fluid volume in pregnancies of less than 24 weeks' gestation. Patients at less than 24 weeks' gestation undergoing an amniocentesis for the placement of prostaglandin F2 alpha for termination (because of genetic or fetal anomalies, or both) were assessed for amniotic fluid volume. All fetuses were alive at the time of prostaglandin instillation. The amniotic fluid index and two-diameter pocket were used to determine the amniotic fluid volume. Prior to the prostaglandin instillation, the amniotic fluid volume was determined with para-aminohippurate using a diazo dye reaction with spectrophotometric analysis. The amniotic fluid volume was determined in 21 pregnancies between 15 and 24 weeks' gestation, yielding volumes ranging from 189 to 1840 ml. Using published standards for amniotic fluid volume in singleton pregnancies, oligohydramnios was present in three gestations, the volume was found to be normal in 15, and hydramnios complicated three pregnancies. The two-diameter pocket identified the amniotic fluid volumes correctly more often (18 of 21 [85.7%]) than the amniotic fluid index (10 of 21 [47.6%]) (P = 0.02). Normal amniotic fluid volume was identified in nine of 15 (60%) pregnancies by the amniotic fluid index and in 14 of 15 (93.3%) by the two-diameter pocket (P = not significant). Abnormal amniotic fluid volumes, oligohydramnios, and hydramnios were recognized more often by the two-diameter pocket (66.7%) than by the amniotic fluid index (1 of 6 [16.7%], P = not significant).

Abortion, Induced↗