Biomedical subjects
Publications and source records attributed to M R Sachtleben.
One thousand consecutive women presenting for first-trimester abortion at a free-standing clinic were interviewed with respect to contraceptive education and use. The vast majority had had some exposure to contraceptive information, yet more than half had not been using any form of contraception when conception occurred. More energy should be given to increasing women's motivation for using contraception.
A matched control study was undertaken in which 156 children were examined between ages 23 and 62 months after births associated with spontaneous labor, oxytocin-induced labor, or prostaglandin E2 (PGE2)--induced labor. Physical development was not adversely affected by labor induction based on height and weight percentiles. The frequency of neurologic or developmental abnormalities not attributable to postdelivery events was the same overall in induced and spontaneous labors (19.2 per 1,000), but those abnormalities occurring after labor induction all followed use of oxytocin. None followed PGE2 despite case-selection criteria which specifically chose PGE2 cases from among those with documented adverse drug-related reactions.
The differential characteristics of 697 women desiring induced abortion were studied according to when in pregnancy they presented. Age, marriage, and level of formal education were inversely related, those with greatest delay tending to be young, unmarried, and minimally educated. Religion was relevant, but generally was not. Nulliparity was only a weak correlate of delay. Contributory factors of denial, ambivalence, fear, and preceding menstrual irregularity accounted for two thirds of cases; they were uniformly distributed over the range of gestational age, but constituted the greatest proportion of reasons among those delaying decision longest. Physician delay and laboratory error accounted for all but one tenth of the remainder; they were concentrated particularly among gravidas presenting for care in the early part of the midtrimester. Fear characterized the young, poorly informed noncontraceptors, and had the greatest relative impact in protracted delays; denial was more likely to be found among older and ostensibly better informed women.
The incidnce of uterine contractility and of abnormalities of fetal heart rate (FHR) pattern was determined in a series of 2,834 monitored gravid women with singleton pregnancies producing mature infants in vertex presentation. Those subjected to uterotonic agents for induction or augmentation of lbaor had significantly more tetanic contractions, baseline hypertonus, and coupling of contractions. Similarly, significantly more variable and late FHR decelerations occurred in stimulated labors, and these were concentrated primarily in those receiving oxytocin. The overall incidence of FHR decelerations associated with the use of prostaglandin E2 (PGE2) was comparable to that encountered in unstimulated labor. The similarity between the contractions of spontaineous labor and those labors produced by PGE2 is noted.
Developmental studies were done at 3 and 4 years of age in a series of 656 children and the results were correlated with the preceding labor pattern and the type of delivery. It was determined that there were significant adverse effects among offspring delivered by midforceps procedures or born following labors characterized by prolonged deceleration, secondary arrest of dilatation, or arrest of descent.
In a series of 182 twin gestations second-born twins were more often heavier than first-born twins (55%), but overall they weighed less by an average of 21 g. This paradox was shown to be due to the skewed distribution of weight differences favoring the first-born twin, most apparent among pairs in which one or both weighed at least 3000 g. The larger the difference between birthweights, the greater the likelihood that the heavier twin would be delivered first.
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The specific labor aberration of arrest of descent was investigated in 253 nulliparas. It was found to be associated with fetopelvic disproportion in 52%. Delivery outcome was adversely affected by such factors as high fetal station at time of arrest and long duration of arrest. Arrest of descent occurring during the administration of oxytocin infusion was particularly ominous, no patient subsequently delivering vaginally. The best delivery prognosis was seen in those cases in which apparently causative inhibitory agents, including peridural anesthesia and sedation, were allowed to abate expectantly. Neither immediate operative delivery nor expectancy (other than in the specific abatement cases) was determined to be an appropriate approach to resolving this problem. Postarrest progression, especially if at a rate that was the same as or greater than prearrest descent, proved to be a favorable sign for delivery outcome. Neonatal depression and birth trauma were closely correlated with midforceps procedures, especially when done in conjunction with forceps rotation. Cephalopelvic disproportion yielded poor perinatal results, particularly among those delivered vaginally by instrumental means. Uterotonic stimulation of labor to correct the arrest problem therapeutically also had an adverse effect on the fetus when followed by operative delivery. Based on these observations a program of management was evolved for treating patients with arrest of descent.
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Prostaglandin E2 was administered orally for induction of labor in 100 normal term gravidas with two dosage regimens. The data derived were compared with comparable data from gravidas matched with study patients according to prelabor cervical preparation and other relevant obstetric and actuarial features. Analysis of patterns of cervical dilatation and station vs. time was carried out. A dose of 0.5 mg. hourly was found to be effective in inducing labor of good quality with minimal side effects, providing a better balance between efficacy and adverse reactions than the higher dosage level.
A double-blind study was undertaken to determine the effectiveness of prostaglandin E2 as a means for improving the prelabor pelvic conditions preparatory to induction of labor at term in 30 patients with unfavorable Bishop scores of less than 6. An interval of priming was followed after 8 to 12 hours by induction with oxytocin infusion. No meaningful differences were found in index cases as compared with controls to verify that PGE2 has any priming or enhancing effect under the conditions of the investigation.
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Explore the source record for details and available documents.