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Biomedical subjects

L B Spaulding

Publications and source records attributed to L B Spaulding.

6 recordsLinked to original sources
PubMed1994

Endometrial ablation for refractory postmenopausal bleeding with continuous hormone replacement therapy.

OBJECTIVE: To determine the role of endometrial ablation and benign uterine pathology in menopausal women with refractory bleeding who were treated with continuous hormone replacement therapy (HRT). DESIGN: Prospective. SETTING: Health maintenance organization. PATIENTS: One hundred seventy-one menopausal women with an average age of 55 were enrolled in an algorithm of continuous HRT, endometrial biopsy for bleeding with initial therapy, doubling of the progestin dose, hysteroscopy, and endometrial resection-ablation for continued refractory bleeding. INTERVENTION: Endometrial biopsy, hormone manipulation, office hysteroscopy, and hysteroscopic resection-ablation. MAIN OUTCOME MEASURES: Refractory menopausal bleeding and benign uterine pathology. RESULTS: One hundred sixty-two women completed the study. One hundred six (65.4%) remained free of bleeding at the end of the initial 3 months of hormone therapy. Fifty-six (34.6%) had one or more bleeding episodes and required office biopsy and an increase in dosage of progestin. Bleeding ceased in an additional 35 (87%) while 21 (13%) continued to bleed. Those patients underwent endometrial resection-ablation. Surgical specimen demonstrated endometrial polyps, submucous leiomyomas, and adenomyosis in 85.7% of the cases. All patients are now free of bleeding. CONCLUSION: Many women became amenorrheic on the initial dose of continuous HRT; however, if bleeding continues, most stop when the dosage of progestin is doubled. Benign uterine pathology may cause refractory bleeding in a small group of patients but may be eliminated with endometrial resection-ablation.

Adult↗
PubMed1992

Delivery through the maternal bladder during trial of labor.

BACKGROUND: The safety of trial of labor after cesarean has been documented by numerous studies. Large series have demonstrated that in a properly chosen setting, 75% of women can achieve vaginal delivery without undue risk to the mother or fetus. In a small percentage of cases, trial of labor deviates from the expected outcome. CASES: Two infants were delivered through the maternal bladder, one after uterine dehiscence and the other after vaginal rupture at trial of labor. CONCLUSION: Standard and unique complications are reported with trial of labor. Because these complications occur infrequently, they should not discourage an attempt at vaginal delivery after cesarean.

Adult↗
PubMed1979

The role of ultrasonography in the management of endometritis/salpingitis/peritonitis.

Ultrasonography has been used as an adjunct in managing pelvic infections when culdocentesis is contraindicated. Twenty-three of 42 women presenting with endometritis/salpingitis/peritonitis (ESP) had ultrasonographic masses. The erythrocyte sedimentation rate (ESR), white blood cell count (WBC), and the highest temperature in the first 24 hours failed to distinguish those with sonographic masses from 19 patients without pelvic masses. The clinical parameter that tended to distinguish patients with masses versus no masses occurred in individuals who had an IUD at the time of admission. If a patient had an ESR greater than 65 mm/hr and an IUD, sonography demonstrated a mass in 71.4% of the cases. The clinical response to multidrug therapy (bactericidal-bacteriostatic, bactericidal-bactericidal, and triple-drug therapy) were comparable in the patient populations with or without a sonographic mass. Sonography is of little use in the acute phase of ESP. It is best reserved for those patients who do not respond to adequate antibiotic therapy and for the serial evaluation of a large tubo-ovarian complex when conservative management is indicated.

Anti-Bacterial Agents↗
PubMed1979

Current concepts of management of rupture of the gravid uterus.

Fifteen cases are reported of spontaneous rupture of the gravid uterus occurring at the Naval Regional Medical Center (NRMC), Portsmouth, Virginia, over a 21-year period. Forty-seven percent of the patients had previously undergone a cesarean section. Thirteen percent of the patients had received oxytocin prior to the rupture. Fetal mortality associated with these ruptures was 13%. No maternal deaths occurred. Forty percent of the patients had repair of the defect, with 60% undergoing some type of hysterectomy. Preventive measures, early diagnosis, and prompt treatment are emphasized.

Adult↗