Biomedical subjects

M J Hughey

Publications and source records attributed to M J Hughey.

7 recordsLinked to original sources

PubMed1986

Routine prenatal and gynecologic care in prepaid group practice.

A survey of routine prenatal and gynecologic care provided by 26 prepaid medical groups to 1 673 895 members and 25 724 obstetrical deliveries per year showed that, in actual clinical practice, there is considerable disagreement over what should constitute routine care. The fact that many providers of care do not adhere to routines recommended by textbooks, professional groups, or legal precedent leads to diversity of routine care.

Diagnostic Tests, Routine↗

PubMed1978

Experience with modern inert IUDs to date: a review and comments.

A review of data from various large-scale studies reveals as much variation between studies as between devices. Many factors clearly unrelated to the IUD design undoubtedly influence their efficacy and continued use. Thus, the conclusions of the 1968 FDA report on effectiveness and utility still appear valid at this time. They are: A. "The Committee finds adequate scientific data attesting to the effectiveness and utility of the intrauterine devices." B. "The intrauterine devices are highly effective in preventing pregnancy, although they are not quite as reliable as the hormonal contraceptives if the latter are taken according to instructions." C. "The rate of continuation of use is similar to that of the oral contraceptives and is far higher than that of traditional methods, at least among the socially and economically deprived."

Animals↗

PubMed1978

Maternal and fetal outcome of Lamaze-prepared patients.

To determine whether Lamaze childbirth preparation is harmless, harmful, or beneficial, 500 consecutive Lamaze-prepared patients were compared to 500 hand-picked controls, matched for age, race, parity, and educational level. Lamaze preparation was found to have a significant beneficial effect in almost every obstetric preformance category. The Lamaze-oriented patients had one-fourth the number of cesarean sections and one-fifth the amount of fetal distress (P less than .005). Postpartum infection, measured both by maternal febrile morbidity and by the incidence of antibiotic use, was one-third that of the controls (P less than .005). Similarly, the "prepared" patients had fewer perineal lacerations and those that occurred were not as serious as those in the control patients (P less than .005). The control patients had three times as many cases of toxemia of pregnancy (P less than .005) and twice as many of prematurity (P less than .05).

Adult↗

PubMed1978

Forceps operations in perspective. I. Midforceps rotation operations.

Four hundred fifty-eight consecutive midforceps rotation operations were evaluated with a specially designed Perinatal Morbidity Index (PMI) and Maternal Morbidity Index (MMI). An unfavorable fetal outcome occurred in 30.8% of the midforceps rotation operations, and an unfavorable maternal outcome occurred in 13.5% of the cases. Twelve risk factors were found to be associated with suboptimal results. Among patients with no risk factors, an unfavorable fetal outcome occurred in 11% of the cases. Of the patients with three or more risk factors, in contrast, an unfavorable fetal outcome was found in 47% of the cases. A uniformly good fetal outcome was noted among patients selected as controls. Under ordinary circumstances, midforceps rotation operations should not be attempted in a patient already at significant risk. "Significant risk" is defined in the article.

Apgar Score↗

PubMed1978

Forceps operations in perspective. II. Failed operations.

Eighteen recent cases of failed forceps operations are reviewed. Although no maternal or fetal deaths occurred, low Apgar scores were found in more than half of those patients considered at significant risk with the use of the Perinatal Morbidity Index (PMI) and Maternal Morbidity Index (MMI) developed at our institution. Among low-risk patients more favorable results were found. Whenever difficulty in a forceps delivery is encountered because of misjudgement of pelvic capacity or fetal size, further attempts at vaginal delivery should cease and a cesarean section should be performed. This procedure will most likely lead to a favorable outcome for mother and child. A patient already at significant risk should, under ordinary circumstances, not be considered a candidate for a forceps trial. If the trial is successful, the infant has a nearly 50% chance of unfavorable outcome; if it is unsuccessful, the chance of an unfavorable outcome is 64%.

Adult↗

PubMed1977

The effect of fetal monitoring on the incidence of cesarean section.

To determine whether routine fetal monitoring inevitably increases the cesarean section rate, we studied the pertinent literature and analyzed the cesarean sections performed at Evanston Hospital during the last 8 years. Many authors have found a slight to moderate increase in cesarean section rates, whereas others have found no change or a decrease. At Evanston Hospital, the primary cesarean section rate has increased from 2.6% in 1968-1969 to 6.9% in 1974-1975. Only 19.2% of this increase is due to increased fetal distress; the magnitude of the increase is due to changes in other factors, notably, breech deliveries (29.5% of the increase) and "dystocia" (60.2% of the increase). The incidence of cesarean section is controlled by several complex variables, only one of which is fetal monitoring. To describe the fetal monitors as the cause of the increased cesarean section rate is to ignore these other equally profound changes in obstetric technic and philosophy.

Breech Presentation↗

PubMed1976

An evaluation of preinduction scoring systems.

A double-blind clinical study of five preinduction scoring systems was undertaken to determine the accuracy of clinical usefulness of each system as applied to a diverse group of patients. When strictly applied, all five systems were found to be as accurate and useful as it was originally claimed they were. However, when applied without regard to each author's prerequisites, none of the five scoring systems was found to be reliable. A series of preinduction score modifiers is presented which, when applied to any of the preinduction scoring systems, will reliably predict the outcome of induction of labor, with a 50% induction failure rate in patients with lower third scores, a 10% failure for middle third scores, and essentially a 0% failure in the upper third scores.

Apgar Score↗