Biomedical subjects
Publications and source records attributed to M W Varner.
In summary, we report a case of secondary infertility attributed to pseudomyxoma peritonei caused by ruptured appendiceal mucocele. Resection of the tumor and visible mucinous ascites resulted in spontaneous conception. We hypothesize secondary infertility was caused by significant peritoneal inflammation and inhibition of sperm-oocyte interaction from the ascites.
Demographic, psychiatric, social, cognitive, and life stress variables were used to determine the etiology of depression in childbearing (CB; n = 182) and nonchildbearing (NCB; n = 179) women. Hormonal variables in postpartum depression were also evaluated. In the CB group predictors of depression diagnosis were previous depression, depression during pregnancy, and a Vulnerability (V) x Life Stress (LS) interaction; predictors of depressive symptomatology were previous depression, depressive symptoms during pregnancy, life events, and V x LS. Only estradiol was associated with postpartum depression diagnosis. In the NCB group V X LS was the only predictor of depression diagnosis; depressive symptoms during pregnancy and life events were predictors of depressive symptomatology. Previous findings about depression vulnerability were replicated. The significant V x LS interactions support the vulnerability-stress model of postpartum depression.
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Vaginal bleeding during the second trimester has historically been associated with high perinatal mortality rates (33 to 82 per cent). Because this topic has not been specifically studied since the advent of obstetric ultrasound and electronic fetal heart rate monitoring, we reviewed the experience at the University of Utah with second trimester vaginal bleeding from 1 January 1983 through 15 June 1989. The cause of the bleeding was found to fit into four general categories. These are placenta previa, abruption, both previa and abruption, and other or unknown. Midtrimester bleeding is still associated with a high perinatal mortality rate (22.3 per cent), being highest when associated with placental abruption (36.6 per cent) and lowest with placenta previa (7.4 per cent). For the entire series, pregnancies maintained into the third trimester were associated with a much lower perinatal mortality rate than those in which delivery occurred during the second trimester (7.1 versus 54.5 per cent). These relatively improved outcomes suggest that aggressive obstetric management is warranted in most instances.
This study was conducted to test the hypothesis that nonclosure of the visceral and parietal peritoneum during low transverse cervical cesarean delivery is not associated with increased intraoperative or immediate postoperative complications. One hundred thirteen patients scheduled for low transverse cervical cesarean were randomized to either closure of both the visceral and parietal peritoneum with absorbable suture (N = 59) or no peritoneal closure (N = 54). Patients were cared for in the usual postoperative manner without reference to treatment group. There were no demographic differences between the groups and no differences in method(s) of anesthesia, operative indication(s), or use of peripartum epidural narcotics. The incidence of fever, endometritis, or wound infection was similar between groups. There were no differences in the number of patients requiring parenteral narcotic analgesia or in the number of doses per patient. The number of oral analgesic doses was significantly greater with closure than without (P = .014). The frequency with which postoperative ileus was diagnosed in each group was similar, and there was no difference regarding the day on which patients were advanced to liquid or select diets. Bowel stimulants were administered more frequently to the closure than to non-closure patients (P = .03). The average operating time was shorter for the open group than for the closure group (P less than .005). We conclude that non-closure of the visceral and parietal peritoneum at low transverse cervical cesarean delivery appears to have no adverse effect on immediate postoperative recovery, may decrease postoperative narcotic requirements, allows less complicated return of bowel function, and provides a simplified and shorter surgical procedure.
To test the hypothesis that visual disturbances are more common during intravenous magnesium sulfate administration than at 1 to 4 days after discontinuation of the drug, 13 women underwent bedside neuroophthalmologic examinations during intravenous magnesium sulfate tocolysis at 2.0 to 3.0 gm hr and again at 1 to 4 days after cessation of therapy. Visual symptoms were common during intravenous magnesium sulfate administration. Blurred vision was present in 12 of 13 patients and diplopia was present in 10 of 13 patients. Abnormal findings during neuroophthalmologic examination occurred in all patients during intravenous magnesium sulfate administration. Findings included ptosis, accommodative and convergence insufficiency, and abnormal pupillary responsiveness to light and near. All patients were symptom-free and had normal examinations after magnesium sulfate was discontinued. These findings suggest that visual disturbances with therapeutic magnesium sulfate are common.
In more than 50% of amaurosis fugax patients under 45 years of age no cause for the episodes of visual loss is identifiable. We have encountered 6 young adults (4 women and 2 men) with episodes of amaurosis fugax associated with elevated levels of antiphospholipid antibodies. Splinter hemorrhages of the nail beds were present in most patients. Treatment with antiplatelet medications and anticoagulants appeared to reduce the frequency of episodes and might prevent central retinal artery occlusions or stroke.
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While false labor is a common clinical problem, little information exists for correlating hospital visits (for false labor) with the subsequent labor course or perinatal outcome. We evaluated the obstetric and perinatal outcomes in 112 consecutive patients with one or more hospital visits for false labor and compared them with those in matched controls. The only statistically significant difference was the incidence of oxytocin induction following premature rupture of the membranes in the false-labor group (16 vs. 6, chi 2 = 5.05, P less than .05). This study suggests that a previous false-labor admission does not increase the risk of a labor abnormality or suboptimum perinatal outcome.
The frequency of maternal death is decreasing in Iowa, particularly in the category of direct obstetric causes, such as hemorrhage, infection, pre-eclampsia and eclampsia. Unfortunately, concurrent linkage of vital statistics records was not performed during the study period, precluding any certain conclusion that all maternal deaths were actually identified (29). In addition, there has been, at best, only a modest decrease in the proportion of direct obstetric deaths that are preventable, suggesting that the educational goals of the maternal mortality review process are as yet far from fulfilled. In particular, the number of embolic deaths, both from pulmonary emboli and amniotic fluid emboli, has remained constant. We now appreciate many predisposing risk factors for pulmonary embolization and must seriously consider prophylactic anticoagulation in pregnant or puerperal women at increased risk. We also need further studies in the pathogenesis, treatment and prevention of amniotic fluid emboli. Although associated with lower proportions of preventability than with direct causes of obstetric deaths, the indirect and nonobstetric categories of maternal deaths have also been associated with a less dramatic decline in numbers. In particular, trauma remains a persistent cause of preventable maternal death. Continued public education as well as legislation for mandatory safety restraints in automobiles may reverse this trend. This suggests that considerable room for improvement exists in the field of education of patients and of health care professionals who routinely care for patients with complicated obstetric problems.
Serial human placental lactogen (hPL) determinations were performed on 806 women with normal and abnormal pregnancies late in the pregnancy. These results were not reported to the clinicians involved. For the study population as a whole, low hPL levels did not effectively predict those adverse perinatal outcome variables evaluated. Further analysis revealed that this was true both for the normal and abnormal pregnancy groups. Our data do not support the routine use of antepartum hPL screening, as advocated by others, as a means of improving perinatal outcome. In certain at-risk patients, there was an association between low hPL values and the presence of 1 or more of the adverse outcome variables. However, these patients had been recognized clinically as having fetuses in jeopardy.
Serum human placental lactogen (hPL) levels were studied in 806 women in late pregnancy. The hPL levels were positively correlated with birth weight but were unrelated to maternal age, parity, socioeconomic status, or the sex of the newborn. The hPL levels peaked at 37 weeks' gestation and then declined moderately. An individual's hPL levels in late pregnancy are quite constant week to week. Patients with severe chronic hypertension have low hPL values; those carrying twins have high values.