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Biomedical subjects

P Duff

Publications and source records attributed to P Duff.

At least 19 recordsLinked to original sources
PubMed1992

Management of term patients with premature rupture of membranes and an unfavorable cervix.

The purpose of this prospective investigation was to evaluate a protocol for management of term patients with premature rupture of membranes (PROM) and a cervix unfavorable for induction of labor (Bishop score 4 or less). Patients initially were observed for 24 to 36 hours for the spontaneous onset of labor. If spontaneous contractions did not commence, labor was induced with oxytocin. Patients subsequently were divided into three groups: 44 who had spontaneous labor, 29 who had spontaneous labor but required oxytocin augmentation, and 39 women who had oxytocin induction. Patients who entered labor spontaneously had a significantly shorter mean latent period between rupture of membranes and onset of labor (16.0 versus 26.8 and 40.7 hours), shorter mean duration of labor (7.6 versus 12.1 and 13.1 hours), and shorter mean duration of rupture of membranes (23.6 versus 39.0 and 53.8 hours). These women also had a significant decrease in the frequency of chorioamnionitis (7 versus 14 and 33%), and their infants had fewer evaluations for sepsis (25.0 versus 34.5 and 53.8%). We conclude that term patients with PROM and an unfavorable cervix who require oxytocin augmentation or induction of labor are at increased risk for intrapartum and neonatal infection compared with those who progress through labor spontaneously.

Cervix Uteri↗
PubMed1992

Assessment of a rapid latex agglutination test for group B streptococcal colonization of the genital tract.

OBJECTIVE: The purpose of this study was to determine the reliability of a rapid enzyme extraction-latex agglutination test in detecting intrapartum colonization of the maternal genital tract by group B streptococci. METHODS: Swabs of vaginal secretions were obtained from 314 patients in labor with either ruptured or intact membranes. Four tests were performed on each specimen: 1) qualitative culture on blood agar, 2) semiquantitative culture on blood agar, 3) culture in selective Todd-Hewitt broth, and 4) latex agglutination preceded by enzyme extraction. RESULTS: The prevalence of positive cultures was 29%. When compared with culture in Todd-Hewitt broth, the latex agglutination test had a sensitivity of 30%, specificity 93%, positive predictive value 64%, and negative predictive value 76%. In patients with heavy colonization the test had a sensitivity of 76%, compared with 17% in patients with light growth (P less than .001). The lower limit of sensitivity of the test was 4 x 10(5) cfu/mL. The performance of the test was not affected by rupture of the membranes. CONCLUSION: Although the latex agglutination test is reasonably sensitive in detecting heavy colonization, low overall performance combined with technical difficulties in assessment of particle agglutination make the test unsuitable for general screening.

Evaluation Studies as Topic↗
PubMed1992

The aminoglycosides.

The three most commonly used aminoglycosides in obstetrics and gynecology are gentamicin, tobramycin, and amikacin. These drugs bind to subunits of the ribosome and inhibit bacterial protein synthesis. They are primarily active against aerobic gram-negative bacilli. Their principal adverse effects are nephrotoxicity, ototoxicity, and neuromuscular blockage. They may be administered intramuscularly or intravenously and usually are used in combination with other drugs for treatment of disorders such as pyelonephritis, chorioamnionitis, puerperal endometritis, and pelvic inflammatory disease.

Aminoglycosides↗
PubMed1992

The quinolone antibiotics.

The fluorinated quinolones are synthetic derivatives of nalidixic acid. They are well absorbed when administered orally and have an extended duration of action. They are of primary value in treating gonorrhea and complicated urinary tract infections in nonpregnant women.

4-Quinolones↗
PubMed1992

Assessment of rapid identification tests for genital carriage of group B streptococci.

OBJECTIVE: The purpose of this study was to assess the relative value of reported methods for rapid identification of group B streptococcal colonization of the female genital tract. DATA SOURCES: Trials of group B streptococcal identification techniques published in peer-reviewed journals were located using a computerized literature search and cited references from relevant articles or text chapters. METHODS OF STUDY SELECTION: Reports were included in the analysis if the methodology fulfilled the following criteria: 1) A reference culture method was used for comparison; 2) performance characteristics were presented or could be calculated; 3) the method could be performed in a standard laboratory on a 24-hour-a-day basis; and 4) results could be routinely available within 12 hours. DATA EXTRACTION AND SYNTHESIS: Performance characteristics such as sensitivity, specificity, and predictive values for the various methods were evaluated and compared. Factors such as colonization rates and methods for identifying carriers were included in the overall assessment of test performance. CONCLUSIONS: The overall sensitivity of current methods for the rapid detection of group B streptococcal colonization is low. However, some rapid antigen detection tests are highly sensitive in identifying heavily colonized patients, and therefore may be useful for selecting high-risk patients for intrapartum antibiotic prophylaxis.

Cervix Uteri↗
PubMed1992

The perinatal management of severe laryngeal stenosis.

BACKGROUND: Conditions that completely occlude the fetal larynx are rare. We describe the perinatal course of an infant with severe congenital subglottic stenosis, for whom the prenatal recognition of airway occlusion led to enhanced neonatal management. CASE: Serial ultrasound examinations from 23-37 weeks' gestation led to the diagnosis of upper airway obstruction in the fetus of a 29-year-old woman. Significant findings included fetal ascites, echogenic enlarged lungs, and a dilated fluid-filled trachea. The infant was delivered in a level III hospital with a neonatologist and anesthesiologist in attendance. The cord was not clamped until a tracheostomy was secured. CONCLUSION: Upper-airway obstruction can be diagnosed prenatally by the presence of secondary manifestations. Infant survival may depend on foreknowledge of the pathology and prompt, directed efforts at bypassing the airway obstruction.

Adult↗
PubMed1991

Progress in pathogenesis and management of clinical intraamniotic infection.

In the past decade, gratifying progress has been achieved in our understanding of clinical intraamniotic infection. With a usual incidence of 1% to 4%, clinical intraamniotic infection mainly develops as an ascending process after prolonged rupture of the membranes and labor, but other cases may be hematogenous in origin whereas still others complicate intrauterine procedures. The most common organisms isolated in amniotic fluid of cases of intraamniotic infections are anaerobes, genital mycoplasmas, group B streptococci, and Escherichia coli. The latter two are found most commonly in maternal or neonatal bacteremia complicating intraamniotic infection. Although the diagnosis remains largely a clinical one, laboratory tests have been suggested to confirm the diagnosis in women with symptoms. These include amniotic fluid Gram stain, gas-liquid chromatography, and leukocyte esterase measurement. Maternal treatment consists of antibiotic therapy and delivery. Studies to date have used a penicillin plus an aminoglycoside, with some authors advocating the addition of clindamycin after cesarean delivery. Other broad-spectrum regimens may be equally effective. Complications of clinical intraamniotic infections include an increase in cesarean section rate and in maternal and neonatal bacteremia. Poor neonatal outcomes in intraamniotic infection are more likely in the following cases: (1) when E. coli or group B streptococci are present in the amniotic fluid; (2) when the infant has a low birth weight; (3) when maternal antibiotic therapy is delayed until after delivery.

Amniotic Fluid↗
PubMed1991

Role of amniotic fluid cytogenetic analysis in the evaluation of recent fetal death.

Chromosome abnormalities may be present in approximately 10% of cases of fetal death. Because of cell maceration and autolysis, the likelihood of successful karyotype analysis of fetal tissue varies inversely with the time between fetal death and delivery. In an attempt to reduce the influence of these postmortem changes, we obtained amniotic fluid cells for cytogenetic studies from 12 fetuses as soon as possible after the diagnosis of fetal death was confirmed. We also obtained fetal tissue for cell culture in ten of the cases immediately following evacuation of the uterus. Cell culture was successful in 11 of 12 amniotic fluid specimens and in only one of ten fetal tissue specimens (p less than 0.001). Since the results of cytogenetic studies are of such importance in counseling patients regarding recurrence risk for fetal death, we recommend that amniotic fluid cells be obtained for karyotype analysis at the time of diagnosis of fetal death rather than awaiting delivery of a potentially macerated and autolyzed fetus.

Amniotic Fluid↗
PubMed1991

Intraamniotic infection in patients with intact membranes and preterm labor.

The purpose of this review was to determine the frequency of intraamniotic infection in women with preterm labor and intact membranes and to assess the need for amniocentesis in these patients. We reviewed reports in the English language literature from the past 10 years in which the frequency of intraamniotic infection was determined by transabdominal amniocentesis. The 16 studies reviewed demonstrated frequencies of positive cultures that varied from 0 to 61 per cent. This extreme variability seems to be the result of diverse patient populations, dissimilar microbiologic techniques, and different definitions of preterm labor. Advanced cervical dilation and poor response to tocolytic agents were two factors associated with a higher frequency of intraamniotic infection. We conclude that each institution must determine the frequency of intraamniotic infection associated with preterm labor in their patient population. In populations with a high frequency of infection, amniocentesis for microbiologic evaluation is recommended for management of preterm labor, especially in patients who have advanced cervical dilatation or who are unresponsive to tocolytic therapy.

Amniocentesis↗
PubMed1991

The effect of double gloving on frequency of glove perforations.

OBJECTIVE: The purposes of this prospective investigation were to determine the frequency of glove perforation during obstetric and gynecologic procedures and to assess the value of double gloving in preventing damage to the inner glove. METHODS: During a 2-month period, surgeons in the Department of Obstetrics and Gynecology were asked to double glove during all operative procedures. At the conclusion of surgery, the gloves were collected and the surgeons noted the type of procedure and their role as primary surgeon or first assistant. They also indicated whether a perforation was recognized intraoperatively. The gloves were tested for damage by first filling them with air and immersing them in water and then by directly filling them with water. RESULTS: Four hundred forty-one sets of double gloves were evaluated. Of these, 61 sets (14%, 95% confidence interval 10.8-17.2%) had holes in at least one of the four gloves and six sets had more than one perforation, for a total of 67 holes. Fifty-two holes (78%) penetrated only the outer glove and nine (13%) were only in the inner glove. Penetration of both gloves at identical sites occurred in only six of the total glove sets (1.4%, 95% confidence interval 0.3-2.5%). The two most common sites of perforation were the thumb and index finger of the nondominant hand. Glove perforation occurred in 15% of cesarean deliveries and 11% of vaginal deliveries, a nonsignificant difference. In contrast, penetration occurred in 28% of major gynecologic procedures (P less than .05 compared with cesarean or vaginal delivery). Chief and third-year residents were significantly more likely to sustain perforation than were attending physicians or junior residents (P less than .01). Perforation to the gloves of chief residents typically occurred while they were serving as assistants for first- and second-year residents. Third-year residents usually sustained perforations while functioning as primary surgeons. CONCLUSIONS: Glove perforations occur with relatively high frequency during pelvic surgery, particularly abdominal procedures. Double gloving offers a measure of protection against damage to the inner glove and may prevent subsequent exposure of the surgeon to blood and other body fluids.

Gloves, Surgical↗
PubMed1991

Amoxicillin treatment of bacterial vaginosis during pregnancy.

The purpose of this investigation was to evaluate the efficacy of amoxicillin for treatment of bacterial vaginosis during pregnancy. The diagnosis of bacterial vaginosis was established by clinical examination and microscopic examination of a Gram stain and saline preparation of vaginal secretions. In a double-blind, randomized manner, 108 patients at 15-25 weeks' gestation were assigned to treatment with oral amoxicillin, 500 mg three times daily for 14 days, or placebo. Patients were evaluated 2 weeks after treatment, at 34-36 weeks' gestation, and at delivery. There were no significant differences between the two groups with respect to any clinical or microbiologic measure of treatment outcome. There were also no significant differences in the frequency of obstetric complications. We conclude that amoxicillin is not effective therapy for bacterial vaginosis in pregnant women.

Amoxicillin↗
PubMed1991

Pulmonary function of preeclamptic women receiving intravenous magnesium sulfate seizure prophylaxis.

Pulmonary function was studied in ten preeclamptic women in labor (mean gestational age 38.1 +/- 0.9 weeks measured from the last menstrual period) receiving continuous intravenous (IV) infusions of magnesium sulfate. Baseline maximal inspiratory pressure, maximal expiratory pressure, functional vital capacity, and forced expiratory volume at 1 second were measured immediately before a 6-g IV loading dose of magnesium sulfate and 2 hours after the initiation of a continuous 2-g/hour infusion of magnesium sulfate. Serum magnesium levels were measured at the same time pulmonary function tests were performed. All values are reported as the mean +/- standard deviation. The maximal inspiratory pressure, an indicator of generalized respiratory muscle weakness, decreased from a baseline value of 26.2 +/- 7.7 to 19.4 +/- 6.3 cm H2O (P less than .05). The maximal expiratory pressure, an indicator of expiratory muscle strength, decreased from a baseline value of 30.6 +/- 9.2 to 25.2 +/- 7.1 cm H2O (P less than .005). The functional vital capacity decreased from a baseline value of 3.37 +/- 0.49 to 3.19 +/- 0.73 L, and the forced expiratory volume at 1 second decreased from a baseline value of 2.61 +/- 0.58 to 2.36 +/- 0.68 L at 2 hours (P less than .05). The mean serum magnesium level was 1.7 +/- 0.2 mg/dL before the administration of the IV loading dose and 4.51 +/- 0.67 mg/dL 2 hours after initiation of the continuous infusion. Our results demonstrate a significant decrease in pulmonary function tests in term preeclamptic patients receiving magnesium sulfate for seizure prophylaxis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Microbiology of the lower genital tract and amniotic fluid in asymptomatic preterm patients with intact membranes and moderate to advanced degrees of cervical effacement and dilation.

The purpose of this prospective investigation was to evaluate the microbiology of the lower genital tract and amniotic fluid in asymptomatic women with preterm labor. We limited inclusion in the study to patients at 20 to 36 weeks' gestation whose membranes were intact and whose cervix was at least 50% effaced and 2 cm dilated. At the time of admission, we obtained an endocervical specimen for culture for Neisseria gonorrhoeae and for enzyme-linked immunoabsorbent assay for Chlamydia trachomatis and a vaginal specimen for culture for group B streptococci (GBS). We also performed transabdominal amniocentesis to collect amniotic fluid for Gram's stain, latex fixation test for GBS, and aerobic and anaerobic cultures. All patients received parenteral tocolytics. Women who had an immature lecithin to sphingomyelin ratio also received betamethasone. Only 1 of 72 women (1.4%, 95% confidence interval 0 to 4.1%) had a positive amniotic fluid culture. One patient (1.4%) had a positive Gram's stain, and two (2.8%) had positive latex fixation tests. None of these individuals subsequently had a positive culture. Eight women (11.1%) had positive tests for chlamydia, and four (5.5%) had positive vaginal cultures for GBS. None of the patients developed clinical evidence of chorioamnionitis, and only one had puerperal endometritis. None of the neonates had any complications due to infection. We conclude that, in our population, intra-amniotic infection is not a common cause of preterm labor in asymptomatic patients with intact membranes and that amniocentesis should not be performed routinely to assess the bacteriology of the amniotic fluid.

Amniocentesis↗
PubMed1990

The evaluation of urine pH in screening for asymptomatic bacteriuria in pregnancy.

The purpose of this prospective investigation was to determine whether an alteration in urine pH, either by itself or in combination with other rapid screening tests, could be used to identify asymptomatic bacteriuria in pregnant women. Clean catch urine specimen was used to evaluate 510 asymptomatic obstetric patients. Urine specimens were tested for pH, leukocyte esterase activity, and the presence of nitrites. The pH, leukocyte esterase activity, and nitrite reaction were evaluated singly and in combination to determine if these variables could be used to predict significant bacteriuria. Twenty-four (4.8%) patients had positive cultures for E. coli. The mean pH of the infected population was not significantly different from that of the uninfected population. The performance parameters of pH, singly and in combination with the leukocyte esteras and nitrite status, were poor. We concluded that the identification of urine pH is not of value in detecting asymptomatic bacteriuria.

Bacteriuria↗
PubMed1990

Antibiotic prophylaxis for cesarean delivery: is an extended-spectrum agent necessary?

The purpose of this investigation was to determine whether an extended-spectrum antibiotic with a long duration of action was more effective for prophylaxis for cesarean delivery than a limited-spectrum agent with a shorter duration of action. Patients were eligible for the study if they were in labor or had ruptured membranes at the time of surgery. In a randomized, double-blind manner, 377 women were assigned to receive 2 g of cefazolin (192) or 2 g of cefotetan (185) intravenously immediately after the infant's umbilical cord was clamped. There were no significant differences between groups with respect to the frequency of febrile morbidity (22.4 versus 21.6%), the mean fever index (15.8 versus 14.9 degree-hours), the frequency of endometritis (19.3 versus 21.1%), or the mean duration of postoperative hospitalization (3.8 versus 3.9 days). Among patients who became infected despite prophylaxis, enterococcus was isolated with disproportionate frequency. This organism was responsible for 89% of the postoperative urinary tract infections and all three cases of bacteremia. It was also the second most common isolate in women with endometritis. A single dose of cefazolin is comparable in effectiveness to cefotetan. In view of the cost difference between the two antibiotics, there is no justification for use of the more expensive, extended-spectrum agent.

Cefazolin↗