Biomedical subjects
M A Stenchever
Publications and source records attributed to M A Stenchever.
Abuse of women: an overview.
Abuse of women, particularly in ongoing relationships, is very common. The risks to these women and their children for both bodily harm and death are great. The risk to the batterer as the woman tries to defend herself is also significant. Physicians and other health care workers should evaluate patients for the possibility that they are victims of violence and, when this is discovered, should offer viable options to that of remaining in a violent relationship.
Too much informed consent?
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Effects of electronic fetal-heart-rate monitoring, as compared with periodic auscultation, on the neurologic development of premature infants.
In a multicenter, randomized clinical trial, we assessed the early neurologic development of 93 children born prematurely whose heart rates were monitored electronically during delivery and compared it with that of 96 children born prematurely whose heart rates were periodically monitored by auscultation. All the children were singletons with cephalic presentation, and all weighed less than or equal to 1750 g at birth. The mental and psychomotor indexes of the Bayley Scales of Infant Development (standardized mean score +/- SD, 100 +/- 16) and a formal neurologic examination were administered at three follow-up visits (at 4, 8, and 18 months of age, corrected for gestational age). At 18 months, the mean mental-development scores in the groups receiving electronic fetal monitoring and periodic auscultation were 100.5 +/- 2.4 and 104.9 +/- 1.8, respectively (P greater than 0.1). The mean psychomotor-development scores in the two groups at 18 months were 94.0 +/- 2.4 and 98.3 +/- 1.8, respectively (P greater than 0.1). The incidence of cerebral palsy was higher in the electronically monitored group--20 percent as compared with 8 percent in the group that was monitored by auscultation (P less than 0.03). In the electronic-fetal-monitoring group (but not in the periodic-auscultation group), the risk of cerebral palsy increased with the duration of abnormal fetal-heart-rate patterns, as assessed by retrospective review (chi 2 trend = 12.71, P less than 0.001). The median time to delivery after the diagnosis of abnormal fetal-heart-rate patterns was 104 minutes with electronic fetal monitoring, as compared with 60 minutes with periodic auscultation. We conclude that as compared with a structured program of periodic auscultation, electronic fetal monitoring does not result in improved neurologic development in children born prematurely.
Symptomatic retrodisplacement, pelvic congestion, universal joint, and peritoneal defects: fact or fiction?
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Relationship of bacteriologic characteristics to semen indices in men attending an infertility clinic.
Bacteria can be isolated from most seminal fluid samples, but the significance of these microorganisms is uncertain because most men lack symptoms associated with bacterial infection of the reproductive tract. We obtained semen samples from 37 men attending a Special Infertility Clinic and assessed the relationship between seminal fluid microorganisms and seminal fluid analysis including sperm motility, morphology, and concentration; the numbers of polymorphonuclear leukocytes and other white blood cells; and the hamster zona-free oocyte sperm penetration assay. Aerobic and/or anaerobic bacteria were recovered from 36 of the 37 samples. One hundred eighty-eight isolates (113 aerobes, 74 anaerobes, and one yeast) were recovered, with a mean of 5.2 isolates per semen specimen. The microorganisms recovered from the samples included: coagulase-negative staphylococci (89%), viridans streptococci (65%), diphtheroids (86%), Peptostreptococcus sp (62%), Bacteroides sp (27%), Gardnerella vaginalis (19%), Lactobacillus sp (16%), Actinomyces sp (16%), Enterococcus (11%), and Veillonella (11%). Other microorganisms including group B streptococcus, Hemophilus, Escherichia coli, Mobiluncus, and Clostridium were each recovered from fewer than 10% of the specimens. When the microbiology of seminal fluid specimens with or without polymorphonuclear leukocytes was compared, the presence of polymorphonuclear leukocytes in the semen was not associated with the isolation of staphylococci (33 versus 25%), viridans streptococci (33 versus 28%), Bacteroides sp (17 versus 37%), or Peptostreptococcus (31 versus 33%) (P greater than .05 for each comparison). The proportion of semen samples yielding bacterial isolates was similar after categorization by normal motility (more than 60%), pyospermia (six or more leukocytes per 100 sperm), sperm concentration, morphology, and a normal sperm penetration assay (11% or more).(ABSTRACT TRUNCATED AT 250 WORDS)
Cavernous lymphangioma of the vulva.
Lymphangiomas are rare benign proliferations of the lymphatic system. Three types are generally acknowledged: circumscriptum (or capillary), cavernous, and cystic. The management of these lesions depends on type, size, and anatomical location. We present a case of cavernous lymphangioma of the right labium majus in a young woman with no history of radiation therapy or other pathology, which was treated by wide resection.
Sperm penetration assay and subsequent pregnancy: a prospective study of 74 infertile men.
Seventy-four men of infertile couples, for whom a female infertility factor had been excluded, were followed for up to three years after semen analyses that included the sperm penetration assay, an in vitro test of sperm function. At 156 weeks after a normal sperm penetration assay, the cumulative pregnancy rate was 68%, versus only 27% when an abnormal assay was noted. Cumulative pregnancy percents at one year varied significantly (P less than .02) according to the magnitude of the assay result (0%, 1-10%, 11-15%, 16% or greater). However, differences between 0% versus 1-10%, and 11-15% versus 16% or greater, were not statistically significant. Only one of 14 men effected conception after an assay result of 0%. These findings were little altered when analysis of the sperm penetration assay was restricted to men with normal sperm concentration (20 X 10(6) sperm mL-1 or greater) and motility (60% or greater). The presence of pyospermia (six or more white blood cells per 100 spermatozoa) was associated with continued infertility, but neither abnormal sperm concentration nor motility were associated significantly with lower cumulative pregnancy percents. When performed for infertile men according to standard protocol, the sperm penetration assay enhances prediction of future pregnancy.
A randomized trial of electronic fetal monitoring in preterm labor.
Intrapartum electronic fetal heart rate (FHR) monitoring and fetal blood gas sampling were compared with periodic auscultation of FHR in a multicentered randomized trial of preterm singleton pregnancies with fetal weights of 700-1750 g. Two hundred forty-six pregnancies were studied (electronic FHR monitoring N = 122, auscultation N = 124). Perinatal or infant death was associated with 14% of pregnancies with electronic FHR monitoring and 15% with auscultation. No significant differences were noted in the prevalence of low five-minute Apgar scores, intrapartum acidosis, intracranial hemorrhage, or frequency of cesarean section (P greater than .10). Compared with electronic FHR monitoring, intrapartum auscultation as done in this study is unlikely to be associated with detectable differences in perinatal outcomes within the high-risk setting of preterm labor.
Diagnosis and management of urinary incontinence.
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Relationship of hamster ovum sperm penetration assay to seminal fluid analyses in the evaluation of infertile couples.
The males of 279 infertile couples were evaluated with hamster ovum sperm penetration assay (SPA) and seminal fluid analysis. The mean SPA score for the total population was 23.0% penetration with a range of 0-97%. Twenty five percent of the patients demonstrated scores within the abnormal range (0-10%), and 15% were in the "equivocal" range (11-14%). Comparing each individual with the total population using linear regression analysis, it was noted that sperm concentration, percent motility, and percent oval forms varied directly with the SPA, and the slopes of the relationships are positive and statistically significant (p less than 0.0001, 0.002, and 0.0001, respectively). The relationship between SPA and volume is not statistically significant (p greater than or equal to 0.354). To determine whether the SPA could be utilized to establish appropriate normal parameters for various components of SFA, these were analyzed in 169 men who had SPAs of greater than or equal to 15%. Although most SFA values fell within the normal range for this group, there were several exceptions, particularly with respect to percent motility and the presence of leukocytes in the semen. Comparing the percentage of males with abnormal SPA in groups of couples with or without a demonstrable abnormality affecting fertility in the wife, no statistically significant differences could be found. The value of the SPA and SFA in investigating males of infertile couples is discussed.
Genetic amniocentesis: significance of intraamniotic bleeding and placental location.
Simultaneous ultrasound was used to determine if there was a correlation between visualized intraamniotic bleeding, placental location, and fetal-maternal hemorrhage. It was hoped to then determine which Rh-negative patients should receive Rh immunoglobulin. Visualized intraamniotic bleeding showed no correlation to fetal-maternal hemorrhage. Intraamniotic bleeding was commonly associated with needle insertion through an anterior placenta, but also occurred regardless of placental location and in the absence of placental needle traversal. No correlation was found between placental location and fetal-maternal hemorrhage as evidenced by evaluation of maternal serum alpha-fetoprotein. The Kleihauer test was not as sensitive as alpha-fetoprotein.
Longitudinal analysis of a multisite clerkship.
Monitoring the quality of well-established multisite clerkships can be aided by the use of trend analysis and graphic-oriented presentations. Five years of data on student performance, experience, and perceptions are reported for an obstetrics and gynecology clerkship offered at eight geographically dispersed sites. Of the five measures of student performance, two (final written and oral examinations) showed major changes. Trends also appeared in student participation in deliveries and student ratings of teaching over time. The results of these analyses were communicated to faculty at each site and used to make improvements in the clerkship. The implications and use of these longitudinal evaluation procedures are discussed.
Evaluating student performance in an obstetrics and gynecology clerkship.
The development of a comprehensive evaluation system for an obstetrics and gynecology clerkship at the Unviersity of Utah is described and the results of two years experience using it are presented. Seven different measurement procedures were developed and used with 111 junior medical students including pre- and post-tests, oral examination, clinical performance ratings by residents, and ratings by faculty on oral and written presentations and participation in tutorial sessions. Learning gains as measured by pre-post test scores were significant at the 0.001 level. Only six of 37 correlations among the evaluation measures were significantly related at the 0.01 level; furthermore, little relationship could be found between measures of student achievement in cognitive as compared to clinical skill areas. The need for multiple sources of information on student performance in clerkships is discussed.
A national survey of undergraduate teaching in obstetrics and gynecology.
Representatives of 114 academic departments of obstetrics and gynecology in North America completed a written questionnaire in 1977 designed to assess undergraduate educational programs. Respondents reported increases in numbers of departments and faculty per department and decreases in the length and number of students per clerkship in comparison with a 1968 survey. Small-group discussion, lecture, and professional patients were preferred instructional modalities of faculty and students. Evaluation procedures and faculty development activities are reported and discussed in relation to prior surveys of departments of obstetrics and gynecology.
Infectious mononucleosis and congenital anomalies.
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Promethazine hydrochloride: use in patients with Rh isoimmunization.
Twenty-two babies born to 21 mothers were treated prenatally for varying periods of time with promethazine hydrochloride in doses of 150 mg. per day. Seven of the 22 babies required intrauterine transfusions. With the exception of positive clinical impressions in some cases, specific ameliorating effects of the drug in this group could not be demonstrated.
Pelvic exam instruction.
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