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Biomedical subjects

L W Hess

Publications and source records attributed to L W Hess.

36 records · Page 2Linked to original sources
PubMed1990

Correlation of uterine activity using the Term Guard monitor versus standard external tocodynamometry compared with the intrauterine pressure catheter.

Uterine activity monitoring to detect preterm contractions and thus to manage patients in active labor is valuable to the clinician. Uterine activity measured by external devices using the guard ring principle or by standard tocodynamometers has been shown to be accurate concerning the frequency of uterine activity as compared with intrauterine pressure catheter-derived data in the third trimester. In this study, 26 women from 19-34 weeks in documented preterm labor had their uterine activity measured by a standard in-hospital monitor and a Term Guard tocodynamometer simultaneously. The standard monitor reflected 16-91% of the frequency of contractions noted by the Term Guard device, with a reduction in the correlation at gestational ages under 30 weeks. In another 20 patients between 17-36 weeks' gestation, these two methods of external tocodynamometry were compared with a transcervical catheter which measured actual intrauterine pressure and frequency of contractions. There was a good correlation between the Term Guard device and transcervically measured contractions (94.6%). At gestational ages of 28 weeks or less, there was poor performance from standard devices (less than 38% correlation with the intrauterine pressure catheter). These data have important implications for clinicians who monitor preterm patients on an ambulatory basis for early detection of preterm labor and also have clinical impact for the management of patients at early gestational ages in active labor.

Cardiotocography↗
PubMed1990

Characteristics of uterine activity in gestations less than 20 weeks.

Ambulatory tocodynamometry has been used for some time to record uterine activity during pregnancy. Most studies, however, have been performed in the third trimester (more than 24 weeks). The current study was initiated to assess uterine activity at earlier gestational ages. One hundred thirty-seven patients were studied between 14-19 weeks' gestation (inclusive). Seven patients who were being monitored were noted to have preterm labor, and six of these seven were found to have increased uterine activity before the diagnosis of preterm labor. There was no difficulty encountered in the vast majority of cases in recording objective, accurate uterine activity information even at these early gestational ages. There was an increase in the uterine activity (during the 18th and 19th weeks) in patients destined to develop preterm labor later in gestation as compared with the contraction pattern of those who labored at term. This study demonstrates that accurate uterine activity information can be gained at these early gestational ages and that when increased contraction frequency is present, it is related to preterm labor.

Adult↗
PubMed1989

Cost effectiveness of ambulatory uterine activity monitoring.

A cost analysis is presented comparing 34 patients who received uterine activity monitoring versus 33 patients who attempted to detect uterine activity by palpation. All patients were at high risk for preterm delivery and were given the same educational information and prenatal care regarding signs and symptoms of preterm labor. The results revealed an increase in newborn days (640) and cost to those patients who were in the self-palpation group ($13,364) compared to monitored parturients (268 days and $8,633). The difference was attributed to neonatal morbidity from an increased number of preterm deliveries greater than 26 weeks but less than 37 weeks (P = 0.04). The increase in NICU days was significant (P = 0.03). No difference in normal newborn costs for infants delivered after greater than 33 weeks could be detected between the two groups, but morbidity was increased among control infants delivering between 34 and 36 weeks. Uterine activity monitoring to prevent preterm birth appears to be medically effective and reduces cost.

Cost-Benefit Analysis↗
PubMed1989

Incarceration of the retroverted gravid uterus: report of four patients managed with uterine reduction.

Incarceration of the retroverted gravid uterus may have an adverse effect on pregnancy. To evaluate these effects, we reviewed obstetric records to identify parturients with the diagnosis of incarceration of the retroverted uterus during the years 1977 to 1987. Four such patients were identified by this retrospective review, for a calculated incidence in our primary population (patients not referred for evaluation who also received prenatal care at only one hospital) of one case per 10,384 live births. The incarceration was successfully reduced in all four patients without surgical intervention, and all had a normal infant of appropriate weight at term.

Diagnosis, Differential↗
PubMed1989

Cervical pregnancy managed without hysterectomy. A case report.

A woman with a cervical pregnancy was treated without a hysterectomy. Hemorrhage from the implantation site was controlled by placement of a Foley catheter balloon in the cervix. Placement and inflation of a Foley catheter balloon in the cervix after cervical dilation and curettage appears to be a simple and effective means of managing postoperative hemorrhage secondary to cervical pregnancy.

Adult↗
PubMed1989

Group B streptococcal sepsis and death in utero following funipuncture.

The technique of umbilical cord puncture for diagnosis and therapy, which has been shown to be feasible and relatively safe for both mother and fetus, is being used increasingly. The fetal loss rate with this technique has been estimated to be approximately 1%. A case is presented of fetal death from group B beta-streptococcal sepsis after funipuncture, the first report of this complication.

Adult↗
PubMed1988

Adnexal mass occurring with intrauterine pregnancy: report of fifty-four patients requiring laparotomy for definitive management.

Fifty-four cases in which surgical intervention during pregnancy was required for definitive therapy of adnexal masses were reviewed. The calculated incidence of adnexal masses that required surgical intervention during pregnancy in our primary population (patients who were not referred for evaluation of an already identified mass) was one case per 1300 live births. A malignant tumor was found in 5.9% of the pregnant patients who underwent exploratory celiotomy for therapy of an adnexal mass. Those pregnant women who underwent emergency celiotomy because of hemorrhage or torsion as a complication of an adnexal mass spontaneously aborted or underwent premature delivery more frequently than those patients who underwent elective celiotomy for removal of the mass (p less than 0.001). On the basis of this review, we recommend that pregnant women with persistent adnexal masses undergo elective extirpation of the mass in the second trimester of pregnancy.

Adnexal Diseases↗
PubMed1988

Severe medical illness complicating cesarean section.

The care of the perioperative cesarean birth patient who has serious medical illnesses has changed in the past decade. The increasing sophistication of monitoring has allowed the obstetrician and anesthesiologist better to modify certain physiologic parameters that are important in the care of the patient whose physiology has been altered by surgery or disease. As an increasing segment of the obstetric population becomes older, and with better survival of medical diseases, the profession as a whole will be challenged by these patients. It will become more important that a certain subset of physicians develop the skills necessary to undertake the care of these patients and that the special needs of these patients be recognized.

Acute Kidney Injury↗
PubMed1988

A program of uterine activity monitoring and its effect on neonatal morbidity.

In a recent study 34 patients at high risk for preterm delivery who received uterine activity monitoring were compared with 33 similar patients who attempted to detect contractions by palpation. The incidence of preterm delivery was significantly reduced among those using the uterine activity detection device, although all patients in both groups had the same prenatal care and educational intervention. When short-term neonatal morbidity associated with preterm delivery was compared between the two groups, adverse effects decreased significantly among those in the monitored group (p = 0.001). The majority of short-term morbidity in both groups was noted in those delivering preterm and thus was gestational age related. No significant difference was found in neonatal morbidity between the groups when the infants were delivered at less than 37 weeks' gestation. Uterine activity monitoring, which is effective in preventing preterm birth, is also efficacious in decreasing short-term neonatal morbidity.

Female↗
PubMed1988

Meperidine and normeperidine distribution in the rhesus monkey.

Previous work has shown that both meperidine and normeperidine are transferred across the placenta to the fetus. Little is known in primates, however, about the tissue deposition of these compounds. Four pregnant, dated rhesus monkeys within one week of term were anesthetized for cesarean delivery. An equal mixture of meperidine and normeperidine was administered as an intravenous bolus 10 minutes before delivery (1.25 mg/kg). The infants were then sacrificed at 20 minutes after birth and the concentration of the compounds in various organ systems were analyzed by gas-liquid chromatography and mass spectroscopy (GLC-MS). The infant serum 20 minutes after delivery revealed a meperidine concentration of 2.23 micrograms/ml and a normeperidine level of 0.67 micrograms/ml (3:1). In contrast, the tissues analyzed showed a much higher concentration of the metabolite in the liver (1:7), gallbladder (1:3), and brain (1:2). Other tissues, such as muscle and kidney, demonstrated equal levels of the two compounds. The authors conclude that normeperidine is quickly transferred to fetal tissues and to a greater degree than the parent compound in certain organs. The increased distribution, particularly in the brain, could account for the toxic actions in the cerebrum of the derivatives of meperidine.

Animals↗
PubMed1987

TC-83 Venezuelan equine encephalitis vaccine exposure during pregnancy.

A human pregnancy exposed to TC-83 live attenuated Venezuelan equine encephalitis (VEE) virus vaccine resulted in hydrops fetalis and fetal demise. Maternal seroconversion and the finding of a diffuse mononuclear cell infiltrate on postmortem examination are suggestive of a causative role for TC-83 vaccine.

Adult↗
PubMed1987

Prepartum diagnosis of limb-shortening defects with associated hydramnios.

Two cases of skeletal dysplasia with limb-shortening abnormalities are presented. In association with the skeletal abnormalities, gross hydramnios was noted. A review of the existing literature reveals that coexistent fetal skeletal dysplasia and hydramnios have an extremely poor prognosis, especially in the nonachondroplastic patient with singleton fetus. The two cases presented here and the accompanying review emphasize the importance of recognizing this association in providing appropriate counseling to parents.

Adult↗
PubMed1986

Plasma and amniotic fluid concentrations of fibronectin during normal pregnancy.

To ascertain the influence of pregnancy on plasma concentrations of fibronectin, we quantified plasma concentrations of fibronectin in 22 normal, pregnant women during the first, second, and third trimesters; at the time of delivery; and at six weeks and eight months postpartum, using a rapid, immunoturbidimetric procedure. Mean plasma concentrations of fibronectin rose significantly throughout pregnancy, and were significantly greater than umbilical cord plasma concentrations. Maternal plasma concentrations of fibronectin at six weeks postpartum were similar to those observed at the time of delivery, but returned to concentrations observed in nonpregnant women by eight months postpartum. No significant differences between concentrations of fibronectin in amniotic fluid obtained during the second and third trimesters of pregnancy were observed. Six-week postpartum values appeared to depend upon the type of infant feeding as values rose in bottle feeding but fell in breast-feeding mothers.

Adolescent↗
PubMed1986

Significance of opaque discolored amniotic fluid at second-trimester amniocentesis.

From June 1978 to December 1983, 100 patients with viable pregnancies involving opaque, discolored, second-trimester amniotic fluid were identified. During this period 7018 genetic amniocenteses were performed for an incidence of discolored fluid of 1.4%. Compared with case matched control subjects there were no statistically significant differences in the incidence of elevated amniotic fluid alpha-fetoprotein, preterm labor, fetal distress during labor, intrauterine growth retardation, or stillbirth. The rate of spontaneous abortion (7 versus 0%; P less than .05) was increased in the discolored fluid group. The patients with discolored fluid also had an increased incidence of prior vaginal bleeding (P less than .001).

Amniocentesis↗
PubMed1985

Leukocyte esterase activity in the rapid detection of urinary tract and lower genital tract infections in obstetric patients.

Infections of the vagina and urinary tract are important problems for the obstetrician. Examination of the vaginal discharge and urine for the presence of leukocytes is an important part of the evaluation for vaginitis and urinary tract infections. Neutrophils contain several esterases that are not present in serum, urine, or vaginal secretions. These esterases are not influenced by bacteria, commonly used drugs, or variable compositions of urine or vaginal secretions. A prospective study was performed to assess the sensitivity and specificity of leukocyte esterase activity as measured by dipstick (Chemstrip 9, Biodynamics) for the prediction of vaginitis and urinary tract infections during pregnancy. Results were compared with those obtained from potassium hydroxide smears, wet preps, and urine cultures. The vaginal discharge and urine of 65 patients was tested for leukocyte esterase activity on their initial OB visit. Leukocyte esterase was 100% sensitive and 100% specific for detecting urinary tract infections. It was 100% sensitive and 90% specific for predicting vaginal infections. Trichomonas infections accounted for the positive leukocyte esterase results when the urine culture was negative. On the basis of this study we believe that leukocyte esterase activity is sufficiently sensitive and specific to permit use of this test as a rapid and inexpensive screening procedure for vaginitis and urinary tract infections.

Chlamydia Infections↗
PubMed1985

Rapid in vitro replication of group B streptococcus in term human amniotic fluid.

4-hour in vitro growth curves of a type III group B streptococcus (GBS) and Escherichia coli were examined in sterile term human amniotic fluid specimens. Both bacterial strains proliferated despite ratios of phosphate to elemental zinc in the range reportedly inhibitory for E. coli. After 4 h of incubation, despite comparable inocula, GBS numbers exceeded those of E. coli by 10-fold. The strikingly rapid growth of some GBS strains in amniotic fluid may represent yet another factor responsible for perinatal GBS infection of the human neonate.

Amniotic Fluid↗