PubMed Health⌕ Search

Biomedical subjects

L L Paine

Publications and source records attributed to L L Paine.

At least 19 recordsLinked to original sources
PubMed1992

Population differences of fetal biophysical and behavioral characteristics.

Population differences in nonstress test reactivity have been reported with a threefold increase in the likelihood of nonreactive nonstress tests observed in black fetuses as compared with white fetuses. We analyzed fetal behavioral states and fetal heart rates in 14 black and 15 white fetuses at term to explain this observed difference in nonstress test reactivity. Two-hour Doppler and real-time ultrasonographic examination of each patient revealed no differences in percent time spent in the four behavioral states between the two populations. A 9.5 beats/min difference between black and white fetuses was found. The higher baseline heart rate of the black fetuses persisted in each behavioral state and may affect nonstress test reactivity because of rate-dependent decreases in short-term variability and rate-dependent limitations of maximal acceleration amplitude.

Behavior↗
PubMed1992

Coupling of fetal movement and fetal heart rate accelerations as an indicator of fetal health.

OBJECTIVE: The purpose of this study was to determine the clinical value of identified coupling of fetal heart rate (FHR) accelerations (more than five beats per minute for any duration) with objectively detected fetal movements. METHODS: One hundred sixty-six patients underwent routine fetal testing using a Doppler device that recognized both FHR and fetal movements. The coupling index was determined to be the percentage of fetal movements associated with FHR accelerations, and various coupling indices were compared with nonstress test (NST) results. RESULTS: A coupling index above 25% and below 75% compared well with the traditional NST by standard epidemiologic criteria and by the kappa statistic. CONCLUSION: Coupling of even small FHR accelerations and fetal movements could substitute for or replace the NST in antenatal screening.

Female↗
PubMed1991

Fetal movement during labor.

The prognostic significance of antepartum fetal movement is well known; therefore it may be a variable in intrapartum fetal well-being. We report the simultaneous observation of fetal movement with fetal heart rate and uterine contractions by processed Doppler actograph signals during spontaneous labor of 22 normal women with normal fetal outcome. The mean percent incidence of fetal movement during labor was 17.3%. The percentage occurring during uterine contractions was 65.9%. Of all uterine contractions, 89.8% were associated with fetal movement. The proportion of time the fetus spent moving during uterine contractions (21.4%) was higher than between uterine contractions (12.9%). Uterine contractions associated with fetal movement were significantly longer than those not associated with fetal movement (p less than 0.0001). Mean percent incidence of fetal movement did not differ significantly between latent and active-phase labor. This study demonstrates a clear relationship between fetal movement and uterine contractions in labor.

Female↗
PubMed1991

Trends in selected obstetric complications from University Hospital, Kuala Lumpur, Malaysia.

Trends in selected pregnancy complications from 1969 to 1987 in a tertiary hospital in Malaysia are presented. Complications reviewed were abortion, ectopic pregnancy, anemia, hypertension, hyperemesis, antepartum and postpartum hemorrhage. Possible explanations for the observed trends were discussed, including the role of improved obstetric care and changes in the characteristics of the childbearing population. The data presented give some indication of maternal morbidity in the childbearing population served by this tertiary center and should lead to improvements in provision of services as well as in health data collection in the future.

Abortion, Spontaneous↗
PubMed1991

Population differences affect nonstress test reactivity.

The nonstress test (NST) is the most widely used test of fetal well-being. Recently it has been suggested that race may play a role in NST reactivity. The objective of this research was to explore population variables in addition to race that may influence NST reactivity. Study subjects were 1263 black and 658 white women who underwent NST in the week preceding delivery at a tertiary facility. Retrospective analysis of data from a comprehensive database was conducted. It was found that the percentage of black women with a nonreactive NST was more than three times the percentage of white women, and that from 35 weeks' to 42 weeks' gestation there were significantly fewer reactive NSTs for blacks than for whites (P less than .05). Racial differences in NST results persisted in a logistic regression analysis controlling for several population variables including pregnancy complications and demographic and behavioral factors (odds ratio 3.81; 95% CI 3.03 to 4.78). Regression analysis also confirmed that gestational age, maternal education, epilepsy, and smoking significantly influenced NST reactivity. These results indicate that population differences in NST reactivity exist at our facility. Further prospective study of population determinants of NST reactivity is needed to determine how race, test indication, and other clinical, demographic, and behavioral variables should be used in interpretation of tests of fetal well-being. Standard criteria for NST testing may not be useful in all obstetrical populations.

Black People↗
PubMed1990

Doppler recordings of fetal movement: II. Comparison with maternal perception.

Twenty-seven women were studied to assess the relationship between maternally perceived fetal movement and that recorded by a Doppler device. Eighty-eight percent (433 of 492) of maternally perceived movements were detected by Doppler, but only 16% of movements detected by Doppler were maternally perceived (433 of 2196). When complex movements were classified by duration, those movements lasting between 20-60 seconds were most likely (correlation greater than 0.9) to be perceived by the mother. This Doppler method has the potential to replace maternal event marking and other techniques in the recording of fetal movement.

Adult↗
PubMed1990

A prospective comparison of hourly and quarter-hourly oxytocin dose increase intervals for the induction of labor at term.

Fifty-two women undergoing labor induction and vaginal delivery at term were randomized between two oxytocin infusion protocols, involving hourly versus quarter-hourly increases in dose. Potential differences were sought of duration of labor, amount of uterine activity generated, and amount of oxytocin required. Starting at 0.5 mU/minute, oxytocin infusion was increased regularly in small increments every hour or every 15 minutes, according to group assignment. No differences were observed in potentially confounding clinical and demographic factors between the groups, including time to ruptured membranes. There were no clinically or statistically significant differences found for the duration of any phase or stage of labor, quantitative assessment of uterine activity, incidence of hyperstimulation, or neonatal outcome. The average dose of oxytocin used was lower in the hourly than in the quarter-hourly, protocol (4.4 versus 6.7 mU/minute; P less than .005). Significantly fewer patients on the hourly protocol required a maximum infusion rate exceeding 8 mU/minute (P less than .05). More patients on the hourly protocol either had oxytocin discontinued completely or were maintained at 4 mU/minute or less during the active phase of labor (P less than .05 and P less than .001, respectively). We conclude that a slower rate of increase in oxytocin administration via continuous infusion results in no prolongation of any phase of induced labor, while permitting lower infusion rates of the drug.

Drug Administration Schedule↗
PubMed1988

Auscultated fetal heart rate accelerations. III. Use of vibratory acoustic stimulation.

The auscultated acceleration test has been proposed as a simple, inexpensive screening test for fetal health; previous studies of the auscultated acceleration test used external stimulation to elicit fetal movement. This study was conducted to explore the ability of the auscultated acceleration test to predict nonstress test results when vibratory acoustic stimulation is used to elicit fetal reactivity. After antepartum nonstress testing on 100 gravid women between 28 and 43 weeks' gestation, a 6-minute auscultated acceleration test protocol was performed with two vibratory acoustic stimulations to the maternal abdomen if no spontaneous fetal heart rate acceleration occurred. The ability of the auscultated acceleration test to predict nonstress test results after selected variables were controlled for was as follows: sensitivity, 75%; specificity, 97.6%; false-positive results, 14.3%; and false-negative results, 4.7%. Logistic regression analysis indicated that, in addition to the auscultated acceleration test, gestational age and race contributed significantly to the prediction of nonstress test results. Although specificity and the false-positive rate were improved, the use of vibratory acoustic stimulations to elicit fetal movement did not improve the validity of the auscultated acceleration test in terms of sensitivity and false-negative results over previous studies. However, the auscultated acceleration test continues to show potential as an initial screening test for fetal assessment. In addition to recommendations for further research, methodologic issues related to sampling techniques are identified.

Acoustic Stimulation↗
PubMedDate not supplied

Nurse-midwives speak out on research. Results of the 1987-88 needs assessment survey, Part 2.

Part 1 of this 2 part article appeared in the preceding (January/February) issue of this journal. Results from the 1987-88 ACNM Needs Assessment Survey pertaining to research are presented. As with other topics addressed in Part 1 of the Needs Assessment Survey, subgroup analysis was conducted to determine if certain groups of CNMs had differing views and perceived needs regarding research. Survey responses were categorized to include: 1) CNM attitudes about research, 2) importance of ACNM research related services and activities, 3) use of a uniform data collection instrument, 4) CNM access to research resources, and 5) views on funding for ACNM research activities. Discussion of the implications of the results as they relate to development of the goals and objectives of the newly formed ACNM Division of Research is included.

Attitude of Health Personnel↗
PubMedDate not supplied

Nurse-midwives speak out on the ACNM. Results of the 1987-88 Needs Assessment Survey, Part 1.

This article presents the purposes and methods of the first Needs Assessment Survey of all nurse-midwives who have been certified by the ACNM. A detailed summary of the general results of the survey is provided, and includes the perceptions of respondents about the ACNM organizational structure, goals, leadership, and services. Analyses of differences in response based on such variables as membership status, minority status, years since certification, level of educational preparation, work setting, and region of residence are also presented. The article concludes with a discussion of the implications for the nurse-midwifery profession. Part 2 will appear in JNM 34:2.

Certification↗
PubMedDate not supplied

Investigation of institutional differences in primary cesarean birth rates.

Differences in primary cesarean birth rates between a maternity center staffed by certified nurse-midwives (CNM) with physician backup on the premises and a university teaching hospital staffed by resident and attending physicians were studied. The study sample included 796 and 804 women, similar in demographics, who received their prenatal and intrapartum care in the respective sites in 1977 and 1978. Study results indicate a significantly lower rate of primary cesarean birth at the maternity center than at the university hospital that was independent of institutional differences in the indications for abdominal delivery. Although cesarean birth was related to contracted pelvis (at labor), fetal malpresentation, and placental bleeding at both institutions, it was significantly associated with preeclampsia, primiparity, fetal distress, and maternal age only at the university hospital. There were no noteworthy differences in pregnancy outcomes for women delivered vaginally or by cesarean, except for more newborns with low Apgar scores among primary cesarean births at the university hospital. A likely explanation for these findings is differing labor and delivery management styles between the providers of care at the two institutions.

Adolescent↗
PubMedDate not supplied

Trends in nurse-midwifery. Results of the 1988 ACNM Division of Research Mini-Survey.

The purpose of the 1988 Mini-Survey was the collection of up-to-date data from the ACNM membership, focusing on nurse-midwifery income. These were the last data collected about CNMs for the 1980 decade. The final survey sample included 1,735 CNMs and 67 SNMs; 70.6% of the CNMs were in clinical practice. The demographic, employment, and income findings are presented for all CNM respondents by ACNM region of residence and for CNMs in full-scope clinical nurse-midwifery practice. Additional income findings for CNMs working full time and part time are also presented by ACNM region of residence, as well as by selected individual states. Nurse-midwifery income is compared with nursing income during the same time period. Demographic and/or employment characteristics are presented for CNMs doing home births, for student nurse-midwives, for nurse-midwifery faculty, and for nurse-midwives with doctorates. In surveys done from 1984 to 1988, the mean full-time CNM annual income increased by +10,000. The 1988 Survey data are now approximately two years old and the impact of the recent nursing shortage on both nursing and nurse-midwifery salaries was not necessarily reflected in these data.

Certification↗
PubMedDate not supplied

Antepartum fetal assessment. A nurse-midwifery perspective.

This article provides an in-depth review of the most current antepartum fetal assessment techniques. Included in this review are both low- and high-technology methods, such as fetal movement counting, nonstress tests, vibroacoustic stimulation, auscultated acceleration tests, contraction stress tests, amniotic fluid index, biophysical profiles, and Doppler velocimetry. The interpretation of antepartum testing using screening test validity concepts is addressed, as is the current and emerging role of the nurse-midwife in fetal assessment. By integrating content on maternal and fetal physiology, including a critical review of current literature, together with relevant clinical information, including protocols, this article provides a useful guide to fetal assessment for nurse-midwives.

Embryonic and Fetal Development↗