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P G Stubblefield

Publications and source records attributed to P G Stubblefield.

At least 19 recordsLinked to original sources
PubMed1992

Cigarettes, coffee, and preterm premature rupture of the membranes.

Premature (prior to 37 completed weeks of gestation) rupture of the membranes (preterm PROM) is one of the most common underlying causes of preterm delivery. However, there have been few epidemiologic studies of this obstetric complication. The authors studied the relation of maternal cigarette smoking and coffee consumption to both preterm PROM and spontaneous preterm labor not complicated by premature rupture of the membranes (preterm NONPROM) in a large cross-sectional data base. The 307 preterm PROM and 488 preterm NONPROM cases who delivered during 1977-1980 at the Boston Hospital for Women were compared with 2,252 randomly selected women who delivered at term at that institution. Multiple logistic regression techniques were used to derive maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals (CI). After confounders had been adjusted for, the relative risk of preterm PROM for women who reported ever having smoked during pregnancy, as compared with nonsmokers, was 1.6 (95% CI 1.1-2.4). However, no gradient between the number of cigarettes smoked per day and the risk of preterm PROM was observed. Similar results were observed for preterm NONPROM. Women who consumed three or more cups of coffee daily during the first trimester had a 2.2-fold greater risk of preterm PROM than did women who drank two or fewer cups (95% CI 1.5-3.3). Among coffee drinkers, there was some evidence of a linear trend in the risk of preterm PROM as coffee consumption increased. Consumption of three or more cups of coffee per day was less strongly associated with the occurrence of preterm NONPROM (adjusted OR = 1.4, 95% CI 1.0-1.9).

Adolescent↗
PubMed1991

Intraovarian abscess treated with laparoscopic aspiration and povidone-iodine lavage. A case report.

Intraovarian abscess is an unusual form of pelvic inflammatory disease usually managed with laparotomy. A patient with prolonged morbidity from an intraovarian abscess following pelvic inflammatory disease associated with an intrauterine contraceptive device was managed with laparoscopically guided needle aspiration of the abscess and povidone-iodine lavage. Laparoscopy should play a greater role in the management of pelvic inflammatory disease.

Abscess↗
PubMed1989

Control of pain for women undergoing abortion.

To reduce the anxiety and pain experienced by women undergoing abortion, pre-abortion psychological counseling should be given the first priority. Additional techniques for reducing pain are described, including the use of local anesthetic, sedatives, analgesics, and systemic anesthetic agents. Recommendations for practice include an improved technique for paracervical block, modified abortion technique to reduce painful stimulus, and safe use of low dose intravenous sedatives. General anesthesia should be avoided to improve abortion safety.

Abortion, Induced↗
PubMed1989

Cardiovascular effects of oral contraceptives: a review.

The evidence for and against the association of oral contraceptives (OCs) with vascular disease is reviewed, along with the possible pathophysiologic mechanisms for such an association, including effects on coagulation, circulating lipoproteins, and glucose metabolism. The new, low-dose estrogen OCs appear to affect coagulation minimally, and anticoagulant as well as procoagulant effects have been documented. Such concomitant factors as cigarette smoking, obesity, a family history of thrombosis, lack of physical activity, and blood type influence coagulation more strongly. Myocardial infarction and stroke are strongly correlated with the levels and pattern of circulating lipoproteins. The estrogen components of OCs have a favorable effect on lipids, while the effect of progestins, particularly potent androgenic progestins, is unfavorable and could be significant. OCs containing high-dose androgenic progestins can produce abnormal glucose tolerance resulting in increased cardiovascular risk. Low-dose OCs are associated with early, transient breakthrough bleeding. However, educating patients in the management of breakthrough bleeding can help reduce the number of women who must be switched to higher-dose OCs. Epidemiologic evidence confirms the safety of low-dose OCs. By selecting patients carefully, the risk of vascular disease from oral contraception can be reduced to very low levels.

Adult↗
PubMed1988

Ultrasound-guided intrauterine removal of intrauterine contraceptive devices in pregnancy.

The risk to the embryo and to the mother when pregnancy results with an intrauterine device (IUD) in the uterus is well documented. Current advice in such cases is to remove the IUD if the string is visible; proper management when the string is not accessible is controversial. In four such cases, we were able to remove the IUDs from inside the uterine cavity using a small alligator forceps guided by high-resolution ultrasound. All four pregnancies progressed successfully to term. Based on the literature and our own experience, we recommend removal of IUDs or therapeutic abortion when pregnancy occurs with an IUD in situ.

Adult↗
PubMed1986

Biological activity of oral contraceptives.

The synthetic steroid hormones used in oral contraceptives differ in their effects and potencies. Because all low-dose preparations currently sold in the United States contain the same estrogen, the differences among progestin components are of clinical significance. Synthetic progestins may have progestational, estrogenic, antiestrogenic, and androgenic effects; all have antiovulatory effects. Means for measuring the different effects of steroid hormones, ranging from animal assays to human studies, are reviewed. The problems of generalizing from effects of one steroid in an animal system to combination steroids in the human system are emphasized. Our evolving concept of desirable and undesirable effects of progestins is reviewed, the concept of minimal effective dose introduced, and a conclusion suggested from the limited human data available. A plan for the selection of contraceptive steroids for human use is proposed.

Animals↗
PubMed1986

Surgical techniques of uterine evacuation in first- and second-trimester abortion.

Induced abortion is an ancient procedure. Vacuum curettage is a recent innovation and is demonstrably superior to other methods for first-trimester abortions. Patient selection, patient preparation and the necessary instruments are described. The only absolute contraindications for local anaesthesia, vacuum curettage abortions are pregnancies too far advanced and allergy to local anaesthestics. The only mandatory laboratory tests are Rh blood group and cervical culture for gonorrhoea. Rh-negative patients must receive anti-D (Rh0) immunoglobulin. Perioperative antibiotics are of proven benefit. The technique of first-trimester vacuum curettage is described in detail here. The technique for very early abortion with the Karman cannula is also described. Fresh examination of tissue is critical after any abortion in order to rule out incomplete or missed abortion and to detect ectopic or molar pregnancy. Management of suspected perforation, haemorrhage, post-abortal syndrome and failed abortion are described. Dilation and evacuation (D&E) is the safest technique for mid-trimester abortion, especially when performed at 13-16 weeks. Some mid-trimester techniques are reviewed and the technique we follow is described in detail. Laminaria tents are left in place overnight, and the procedure is performed under paracervical block with intravenous sedation using low doses of diazepam and fentanyl. Evacuation is by means of large-bore vacuum cannula system and large ovum forceps. General anaesthesia is avoided because it increases the risk of perforation and haemorrhage. Adjuncts to D&E are described: intraoperative real-time ultrasound, intracervical vasopressin, two days' treatment with laminaria tents, and Hern's technique combining laminaria with intra-amniotic infusion of urea prior to D & E.

Abortion, Induced↗
PubMed1979

Anatomic and clinical correlates of uterine perforation.

We reviewed cases of uterine perforations which occurred at or were referred to the Boston Hospital for Women, Lying-In Division, over the 2 year period from mid-1975 to mid-1977. There were 25 uterine perforations; twenty patients were pregnant and five were not. In the pregnant patients, 16 perforations involved the cervix or the lower uterine segment, whereas only four were located in the uterine fundus; in the nonpregnant patients, all five were fundal perforations. In the pregnant patients, 12 required laparotomy, eight had serious lacerations of the uterine artery, and three had hysterectomy while none of the nonpregnant patients had lacerations or required subsequent procedures. Thus, there is a significant anatomic difference between those perforations which occurred in the pregnant patients and in the nonpregnant patients, the manner in which they presented clinically, and the need for intervention via laparotomy, subsequent morbidity, and outcome as reflected in future reproductive capability. Perforation at or near the cervix may be more common than previously assumed. Furthermore, two distinct clinical entities of cervical perforation exist in pregnant patients as based on the anatomic location of the defect. The anatomy of cervical perforations, their recognition, and their management are discussed.

Adolescent↗
PubMed1979

Evaluation of a balloon dilator before second-trimester abortion by vacuum curettage.

We evaluated the cervical dilator device (CDD), an expanding balloon, as a substitute for laminaria tents before abortion at 13 to 16 1/2 weeks by extraction and vacuum curettage. The CDD was found to be an effective dilator, although it did not appear to have any advantage over laminaria tents when placed overnight and was associated with significant pain upon insertion and an apparent increased risk of endometritis. The present CDD or a subsequent modification may offer advantages over laminaria tents for short-term placement.

Abortion, Induced↗
PubMed1979

Pain of first-trimester abortion: its quantification and relations with other variables.

Among 2,299 patients on whom first-trimester abortions were performed after administration of local anesthesia, 97 per cent reported experiencing some degree of pain. Independent ratings of the pain severity were obtained from the patients and also from the doctors and counselors who observed them. Although the rating procedures used by patients from those used by doctors and counselors, the three sources agreed significantly in evaluating pain levels of individual patients. Data from all three sources indicated that pain produced during the abortion procedure tended to be minor in severity. The ranking of relative painfulness of the eight stages of the aborton procedure based on average ratings obtained from doctors was nearly identical to that based on average ratings obtained from counselors. (Patients did not rate the separate stages.) On average, the patients rated the pain as being less than earache or toothache, but more than headache or bachache. The youngest patients experienced the most pain, and the oldest experienced the least. Both gestational age and cervical dilatation were related to pain in a curvilinear fashion, i.e., for both variables, patients in extreme categories experienced more pain than those in intermediate categories. Preprocedure fearfulness was positively related to intraoperative pain. No support was found for the expectation that oral administration of 5 mg. of diazepam reduces pain during this procedure.

Abortion, Induced↗
PubMed1979

Neonatal hypoglycemia after beta-sympathomimetic tocolytic therapy.

The effect of oral beta-sympathomimetic tocolytic therapy on neonatal serum glucose concentrations in the first several hours after delivery was examined in 12 babies. Hypoglycemia was noted in eight babies, and was sustained over at least a 30-minute period in five. The group with sustained hypoglycemia had a higher cord serum insulin concentration, a lower serum glucose nadir, and a more rapid initial rate of serum glucose disappearance than those babies with normoglycemia or transient hypoglycemia. Sustained hypoglycemia was observed in five of six babies delivered within two days of the termination of tocolytic therapy, but was not present in any of six babies delivered five or more days after the end of tocolytic therapy. Speculations as to the interaction between beta-sympathomimetic tocolytic drugs administered to the mother and fetal and neonatal glucose metabolism are made.

Ethanolamines↗
PubMed1978

Evaluation of a balloon dilator to augment midtrimester abortion.

A new balloon-type cervical dilating device (CDD) was inserted just after intra-amniotic infusion of a combination of prostaglandin F2alpha and hypertonic saline in an effort to shorten the interval from infusion to abortion. The CDD has both dilator and anchor balloons which are inflated with normal saline after insertion into the cervical canal. The infusion-to-abortion interval was shorter in patients with the CDD dilator inflated (14.6 +/- 2.1 hours) than in those with both dilating and anchor balloons inflated or in those aborting without the device in place at all (23.0 +/- 1.7 and 18.8 +/- 1.0 hours, respectively).

Abortion, Induced↗
PubMed1978

A randomized study of 12-mm and 15.9 mm cannulas in midtrimester abortion by laminaria and vacuum curettage.

We evaluated the adequacy of a new large-bore vacuum cannula system for midtrimester abortion by randomly allocating patients to be treated with a standard 12-mm vacuum system or the new 15.9-mm system. Cervical dilataion was accomplished by overnight placement of laminaria tents. Blood loss was similar for the two treatment groups and was significantly greater at gestational ages 17 to 18 weeks than for abortions at 16 weeks or less. Operating time was slightly less in the large-cannula group. When the 12-mm cannula was used beyond 13 weeks' gestation, forceps were usually needed to empty the uterus completely. The large-cannula system was able to empty the uterus through 16 weeks, but at 17 and 18 weeks it offered no advantage over the smaller system and forceps were always needed. Complications were minimal. We caution against forcible cervical dilatation to 16 mm and urge the use of laminaria instead. Our findings, together with published reports of the safety of late dilatations and evacuation, would appear to justify wider clinical trials by experienced investigators.

Abortion, Induced↗
PubMed1978

A controlled trial of antiemetics in abortion by PGF2alpha and laminaria.

Women undergoing abortion by intraamniotic prostaglandin F2alpha were randomized to receive either prochlorperazine edisylate 10mg, hydroxyzine hydrochloride 100mg, or a placebo every four hours by intramuscular injection in a double-blind fashion. Vomiting was significantly more frequent in the placebo-treated group [0.2 +/- 1.5 SD episodes per patient, n=21] than in the groups treated with prochlorperazine [1.2 +/- 0.5 episodes per patient, n=21] or hydroxyzine [0.3 +/- 0.8 episodes per patient, n=19]. The mean number of merperidine injections in the antiemetic-treated groups was lower than in the control group, but this effect was not statistically significant. There was no significant difference between the treated and the control groups in the interval from prostaglandin treatment to abortion.

Abortion, Induced↗