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Rodney K Edwards

Publications and source records attributed to Rodney K Edwards.

At least 19 recordsLinked to original sources
PubMed2006

Assessing the relationship between preterm delivery and various microorganisms recovered from the lower genital tract.

OBJECTIVE: To determine if the likelihood of preterm delivery is more dependent on the specific organisms present in the vagina than on the presence of bacterial vaginosis. METHODS: We evaluated the vaginal fluid of a prospective cohort of women at 23-32 weeks of gestation with signs and symptoms of preterm labor and intact membranes. Forward stepwise logistic regression models were used to evaluate the relationship between preterm delivery and the presence of anaerobic bacteria, Gardnerella, ureaplasmas and mycoplasmas, and sialidase. RESULTS: The cohort included 137 women, and complete delivery information was available for 134 of them. The rate of preterm delivery was 28% (37 of 134). Mycoplasma genitalium independently was associated with spontaneous preterm delivery (OR 3.48; 95% CI 1.41, 8.57). After controlling for this factor, none of the other variables were significantly prognostic for spontaneous preterm delivery (residual overall p = 0.19). CONCLUSION: The presence of Mycoplasma genitalium in the vagina of pregnant women is an independent risk factor for spontaneous preterm delivery.

Adult↗
PubMed2006

Preinduction cervical assessment.

The rate of labor induction is increasing in the United States. Methods for quantifying cervical factors have been developed to identify patients who may benefit from cervical ripening before induction. The first cervical scoring systems used digital examination. More recently, cervical ultrasound and testing for the presence of fetal fibronectin have been suggested to evaluate cervical readiness for labor induction, but neither of these methods provides a significant improvement over digital examination. The Bishop score, the most widely used digital examination scoring system, still is the most cost effective and accurate method of evaluating the cervix before labor induction.

Cervical Ripening↗
PubMed2006

Prediction of intrauterine pressure from electrohysterography using optimal linear filtering.

We propose a method of predicting intrauterine pressure (IUP) from external electrohysterograms (EHG) using a causal FIR Wiener filter. IUP and 8-channel EHG data were collected simultaneously from 14 laboring patients at term, and prediction models were trained and tested using 10-min windows for each patient and channel. RMS prediction error varied between 5-14 mmHg across all patients. We performed a 4-way analysis of variance on the RMS error, which varied across patients, channels, time (test window) and model (train window). The patient-channel interaction was the most significant factor while channel alone was not significant, indicating that different channels produced significantly different RMS errors depending on the patient. The channel-time factor was significant due to single-channel bursty noise, while time was a significant factor due to multichannel bursty noise. The time-model interaction was not significant, supporting the assumption that the random process generating the IUP and EHG signals was stationary. The results demonstrate the capabilities of optimal linear filter in predicting IUP from external EHG and offer insight into the factors that affect prediction error of IUP from multichannel EHG recordings.

Algorithms↗
PubMed2006

The interleukin-1 beta +3953 single nucleotide polymorphism: cervical protein concentration and preterm delivery risk.

PROBLEM: To determine the associations between preterm delivery <37 weeks (PTD), cervical fluid interleukin-1beta (IL-1beta) concentration, and its +3953 single nucleotide polymorphism (SNP). METHOD OF STUDY: Cervical fluid, peripheral blood, and cord blood samples were obtained from a cohort of women 23-32 weeks gestation with preterm labor symptoms and intact membranes. RESULTS: Increased cervical fluid concentrations of IL-1beta were associated with PTD (P = 0.017) and spontaneous PTD (P = 0.001). Maternal IL-1beta +3953 SNP genotype was associated neither with PTD (P = 0.43) nor with cervical fluid IL-1beta concentrations (P = 0.35). Neonatal IL-1beta +3953 SNP genotype was associated neither with PTD nor cervical IL-1beta concentrations. CONCLUSIONS: Cervical fluid concentrations of IL-1beta were elevated in symptomatic women destined to have a spontaneous PTD. The gene dosage of maternal IL-1beta +3953 allele 2 was associated neither with increased cervical fluid concentrations of IL-1beta nor with risk of PTD.

Adult↗
PubMed2005

Assessment of cervical antibody concentrations fails to enhance the value of cervical length as a predictor of preterm delivery.

OBJECTIVE: The purpose of this study was to determine if cervical fluid antibody concentrations can enhance the value of cervical length in predicting risk of preterm delivery. STUDY DESIGN: We obtained cervical fluid samples with preweighed cellulose wicks from a prospective cohort of women 23 to 32 weeks' gestation with signs and symptoms of preterm labor and intact membranes. Total immunoglobulin A and G (IgA and IgG) concentrations were determined by enzyme-linked immunosorbent assay. Bacterial vaginosis was diagnosed by Gram stain, and cervical length was measured with endovaginal ultrasound. RESULTS: For subjects with term (n = 77) and preterm (n = 24) deliveries, median IgA and IgG concentrations were 736 vs 643 microg/mL (P = .33) and 1528 vs 1769 microg/mL (P = .85). For subjects with normal flora (n = 71), intermediate flora (n = 14), and bacterial vaginosis (n = 16), median IgA and IgG concentrations were 717, 624, and 774 microg/mL (P = .90) and 1383, 1553, and 2731 microg/mL (P = .02). In a forward stepwise logistic regression model, cervical length was the only factor associated with preterm delivery (P < .001). CONCLUSION: Measuring the concentrations of IgA and IgG in cervical fluid does not enhance the value of cervical length in predicting risk of preterm delivery.

Adult↗
PubMed2005

The interleukin-6--174 single nucleotide polymorphism: cervical protein production and the risk of preterm delivery.

OBJECTIVE: The purpose of this study was to determine the associations between preterm delivery (PTD), cervical fluid interleukin-6 (IL-6) concentration, and the single nucleotide polymorphism at position -174 in the IL-6 gene. STUDY DESIGN: Cervical fluid samples were obtained from women 23 to 32 weeks' gestation with symptoms of preterm labor. Concentrations of IL-6 were determined by enzyme-linked immunosorbent assay (ELISA). IL-6 genotyping was performed using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. RESULTS: One hundred thirty-seven women were enrolled, and complete information was available for 126. Cervical fluid IL-6 concentrations were not elevated in women destined to have a spontaneous PTD ( P = .86). IL-6 -174 genotype was not associated with PTD ( P = .62) or cervical fluid IL-6 concentration ( P = .36). Neonatal IL-6-174 genotype was not associated with PTD or IL-6 concentration. CONCLUSION: Cervical fluid concentrations of IL-6 were not elevated in symptomatic women destined to have a spontaneous PTD. The presence of maternal IL-6 -174C was not associated with cervical fluid concentration of IL-6 or risk of PTD.

Adult↗
PubMed2005

Outcomes of second-trimester pregnancy terminations with misoprostol: comparing 2 regimens.

OBJECTIVE: The purpose of this study was compare outcomes of second-trimester pregnancy terminations with misoprostol between our previous low- (200 microg every 12 h) and present high-dose (400 microg every 6 h) regimens. STUDY DESIGN: This was an historic cohort study that was conducted from June 1996 to February 2004 on women undergoing medical termination of pregnancy at 13 to 27 weeks. Exclusion criteria were multiple gestation, placenta previa, and primary use of another medication. RESULTS: The cohort consisted of 147 women. For the low- (n = 100) and high-dose (n = 47) groups, respectively, median times to delivery were 22.5 vs 13.25 hours (P = .001). More patients in the high-dose group were delivered vaginally within 24 (81% vs 54%; P = .002) and 48 hours (98% vs 84%; P = .014). Fewer patients in the high-dose group required a second abortifacient (6% vs 27%; P = .004). Clinical chorioamnionitis was more common in the high-dose group (P = .03). One patient experienced a uterine rupture and is included in the analysis. Side effects were uncommon and did not differ between groups. CONCLUSION: Our present high-dose regimen for misoprostol terminations of pregnancy effects delivery more rapidly without an appreciable increase in side effects or complications.

Abortifacient Agents, Nonsteroidal↗
PubMed2005

Cardiac arrest during pregnancy.

This case involves cardiac arrest of a 29-week old pregnant African American woman, occurring 2 days after surgical correction of an incarcerated ventral hernia with small bowel obstruction. The patient could not be resuscitated from this arrest. Details of the case are presented, and diagnostic and unique management considerations for this uncommon occurrence are set forth.

Adult↗
PubMed2005

Chorioamnionitis and labor.

Chorioamnionitis is a puerperal infection that exists in histologic, clinical, and subclinical forms. This entity is believed to play a causative role in many cases of spontaneous preterm delivery. It also is associated with an increased risk of dysfunctional labor. This article focuses on the effects of chorioamnionitis on the progress of labor and the appropriate treatment of patients with clinical chorioamnionitis. The epidemiology, pathogenesis, and associated maternal and neonatal outcomes also are reviewed.

Chorioamnionitis↗
PubMed2004

Vaginal-perianal compared with vaginal-rectal cultures for identification of group B streptococci.

OBJECTIVE: To estimate whether the rates of recovery of group B streptococci from combined vaginal and perianal cultures and combined vaginal and rectal cultures are equivalent. METHODS: We performed a prospective cohort study of vaginal-perianal versus vaginal-rectal culture for group B streptococci. Two hundred pregnant women in the third trimester were enrolled. Three specimens were collected from each patient in the following order: lower third of the vagina, perianal skin, and rectum. Each specimen was cultured serially in selective broth media, then on sheep's blood agar. Suspicious colonies were confirmed by latex agglutination. Culture positivity rates from the combined sites of vagina and perianal skin were compared with vagina and rectum. Laboratory personnel were blinded to the collection site of each individual swab. RESULTS: Of the 200 subjects, 71 (36%) had a positive culture from at least 1 site. Vaginal culture was positive in 55 patients (28%), compared with 48 patients (24%) with positive perianal cultures and 50 patients (25%) with positive rectal cultures. Results of combined vaginal and perianal cultures were positive in 68 patients (34%); results of combined vaginal and rectal cultures were positive in 67 patients (34%) (P = 1.0). CONCLUSION: The group B streptococci detection rate from vaginal-perianal specimens is not significantly different from the detection rate from vaginal-rectal specimens. Therefore, pregnant women do not need to be subjected to the discomfort of collection of a rectal specimen. LEVEL OF EVIDENCE: II-2.

Adolescent↗
PubMed2003

Single additional dose postpartum therapy for women with chorioamnionitis.

OBJECTIVE: To determine whether a short course of antibiotics provides adequate treatment for chorioamnionitis. METHODS: Women received intravenous ampicillin, 2 g every 6 hours, and gentamicin, 1.5 mg/kg every 8 hours, when clinical chorioamnionitis was diagnosed. After delivery, subjects were randomized to continue this regimen until afebrile and asymptomatic for 24 hours (control group) or to receive only the next scheduled dose of each drug (study group). If delivered via cesarean, patients received clindamycin, 900 mg intravenously, at umbilical cord clamping. The control group continued receiving clindamycin every 8 hours until antibiotics were discontinued. The primary outcome was treatment failure, defined as a single temperature after the first postpartum dose of antibiotics of 39.0C or more, or two temperatures 38.4C or more at least 4 hours apart. To detect a 150% increase in rate of treatment failures from 8% in the control group to 20% in the study group, 292 subjects were needed (alpha = .05; 1 - beta = .80). RESULTS: From December 26, 1999, to March 18, 2003, a total of 292 women were enrolled in the study. In the intent-to-treat analysis, treatment failure rate did not differ between the control (n = 141) and study (n = 151) groups (3.5% versus 4.6%; P = .639). CONCLUSION: If treated promptly intrapartum, one additional dose of a broad-spectrum combination of antibiotics is sufficient postpartum therapy for immune-competent women with chorioamnionitis.

Adult↗
PubMed2003

Medical student self-assessment of performance on an obstetrics and gynecology clerkship.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of medical student self-assessment of performance on an obstetrics and gynecology clerkship and to assess the influence that demographic and temporal factors had on the accuracy of that assessment. STUDY DESIGN: From June 1990 to July 2000, 1152 students predicted examination and clerkship grades at the beginning and end of their obstetrics and gynecology clerkship. The effects of class rank, gender, rotation length, semester, prediction type, and timing on the accuracy of prediction were evaluated with logistic regression. RESULTS: Students more often correctly predicted clerkship than examination grades. Students with higher grades tended to underestimate their performance; the students who received lower grades tended to overestimate their performance. All factors had a significant effect on the outcome (all, P <.001). Odds ratios for the overestimation were greatest for the lower one third of the class compared with the upper one third of the class (odds ratio, 4.38) and for students who completed the 6-week clerkship compared with the 8-week clerkship (odds ratio, 3.61) CONCLUSION: Better performing medical students tend to underestimate their performance; poorer performing students tend to overestimate their performance. Below-average students have the potential to derive the most benefit from formal feedback.

Adult↗
PubMed2003

Deciding on route of delivery for obese women with a prior cesarean delivery.

OBJECTIVES: This study was undertaken to estimate the vaginal birth after cesarean (VBAC) success rate, compare rates of infections in women attempting VBAC and those undergoing planned repeat cesarean, and compare the cost of these two plans of care for obese women. STUDY DESIGN: We performed a historical cohort analysis of singleton deliveries at >/=36 weeks' gestation in women with a body mass index 40 or greater and one prior cesarean delivery. Outcomes included rates of VBAC success and puerperal infections and mean cost of care. RESULTS: The cohort consisted of 122 mother-infant pairs, 61 each in the VBAC and cesarean groups. In the VBAC group, 57% (95% CI 45-70) of women were delivered vaginally. The VBAC group had higher rates of chorioamnionitis (13.1% vs 1.6%, P=.02), endometritis (6.6% vs 0%, P=.06), and composite puerperal infection (24.6% vs 8.2%, P=.01). Mean cost of care was similar for mothers ($4439 vs $4427, P=.95), infants ($1241 vs $1422, P=.49), and mother-infant pairs ($5680 vs $5851, P=.64). CONCLUSION: Compared with planned cesarean delivery, VBAC trials in obese women are three times as likely to be complicated by infection and do not result in reduced costs.

Adult↗
PubMed2003

Is perioperative hypothermia a risk factor for post-Cesarean infection?

OBJECTIVE: To determine whether hypothermia during Cesarean delivery is a risk factor for postoperative infection. METHODS: An historical cohort investigation was conducted on all women delivered by Cesarean at our center during 2001. Initial recovery-room temperature, taken via the oral or axillary route, was used as a surrogate for intraoperative temperature. Adding 0.5 degrees C to axillary temperatures generated oral temperature equivalents. Women with chorioamnionitis were excluded, as were those with an initial recovery-room temperature that exceeded 37.9 degrees C or was recorded more than 20 minutes after the end of surgery. Prophylactic antibiotics (cefazolin, 1 g) were given during Cesarean delivery. RESULTS: A total of 42 women (7.6%) were diagnosed with postoperative infections. Infections included endometritis (n = 25), wound abscess (n = 7), wound cellulitis (n = 7) and urinary tract infection (UTI) (n = 4). No cases of septic pelvic thrombophlebitis or pelvic abscess occurred. One woman had both endometritis and a UTI. Mean temperatures were higher, rather than lower, for women who subsequently had postoperative infections compared with those who did not (36.4 +/- 0.8 degrees C vs. 35.9 +/- 0.7 degrees C; p < 0.001). Mean temperatures for the various postoperative infections were as follows: endometritis, 36.5 +/- 0.8 degrees C (p < 0.001 vs. uninfected group); wound abscess 36.0 +/- 0.8 degrees C (p = 0.63); wound cellulitis, 36.3 +/- 0.6 degrees C (p = 0.14); UTI, 36.7 +/- 0.9 degrees C (p = 0.04). CONCLUSIONS: Women who develop post-Cesarean infections have higher initial recovery-room temperatures than those who do not develop such infections. This suggests the presence of subclinical infection at the time of Cesarean. Evaluating whether intraoperative warming has any role during Cesarean delivery requires a randomized clinical trial.

Adult↗
PubMed2003

Intrapartum antibiotic prophylaxis and early-onset neonatal sepsis patterns.

OBJECTIVE: To compare the relative effects of intrapartum antibiotic prophylaxis regimens on patterns of early-onset neonatal sepsis. METHODS: We performed an historical cohort study of 17187 infants born at our center from September 1993 to February 2000. A risk-based strategy was employed prior to July 1996 and a screening-based strategy was utilized thereafter. Ampicillin was utilized prior to March 1995 and penicillin was used thereafter. RESULTS: There were 75 cases of neonatal sepsis, 34 (4. 10/1000) in the risk-based era and 41 (4.63/1000) in the screening-based era (p = 0.62). There were fewer ampicillin-resistant isolates during the risk-based than the screening-based era (32 versus 61%; p = 0.014). The only significant change in organism-specific sepsis rates was an increase in the rate of infection caused by coagulase-negative staphylococci in the screening-based era (0.36 versus 1.46/1000; p = 0.018), but 75% of infants infected with these organisms were not exposed to beta-lactam antibiotics within 72 h prior to delivery. For the risk- and screening-based eras, respectively, the rates of Gram-negative sepsis (1.21 versus 1.46/1000; p = 0.65) and the proportions of Gram-negative pathogens that were ampicillin-resistant (70 versus 77%; p = 1.0) were similar. The drug employed for prophylaxis did not appear to affect the pattern of sepsis cases. CONCLUSION: In our patient population, coagulase-negative staphylococci have become the most common cause of early-onset neonatal sepsis. The cause of this shift in pathogen prevalence is uncertain and seemingly unrelated to intrapartum antibiotic exposure.

Ampicillin↗
PubMed2002

Intrapartum antibiotic prophylaxis 1: relative effects of recommended antibiotics on gram-negative pathogens.

OBJECTIVE: To assess whether the antibiotic chosen for intrapartum antibiotic prophylaxis affects the subsequent exposure of the neonate to ampicillin-resistant gram-negative bacteria. METHODS: We performed a randomized clinical trial of ampicillin versus penicillin for intrapartum antibiotic prophylaxis. Genital tract cultures for Enterobacteriaceae were obtained at study entry and 8-36 hours postpartum. Organisms were isolated, identified, and tested for ampicillin susceptibility. RESULTS: The ampicillin (n = 175) and penicillin (n = 177) groups, respectively, did not differ in rates of ampicillin-resistant Escherichia coli at entry (25% versus 22%, P =.57) or postpartum (36% versus 38%, P =.64). Similarly, groups did not differ in rates of ampicillin-resistant Enterobacteriaceae at entry (38% versus 32%, P =.23) or postpartum (51% versus 55%, P =.46). However, postpartum culture rates of resistant Escherichia coli were higher than entry culture rates for both the ampicillin (36% versus 25%, P =.026) and penicillin (38% versus 22%, P <.001) groups. Postpartum culture rates of resistant Enterobacteriaceae were also higher than entry culture rates for both the ampicillin (51% versus 38%, P <.001) and penicillin (55% versus 32%, P <.001) groups. Results were similar when considering only women who received two or more doses and no additional antibiotics. CONCLUSION: Intrapartum antibiotic prophylaxis with either ampicillin or penicillin increases exposure of neonates to ampicillin-resistant Enterobacteriaceae.

Adolescent↗
PubMed2002

Intrapartum antibiotic prophylaxis 2: positive predictive value of antenatal group B streptococci cultures and antibiotic susceptibility of clinical isolates.

OBJECTIVE: To estimate the probability of positive intrapartum group B streptococcus cultures among women previously identified as carriers of this organism, and to estimate the susceptibility of group B streptococci to six commonly used antibiotics. METHODS: We performed a prospective cohort study of women identified as carriers of group B streptococci by current pregnancy genital tract (group 1) or urine cultures (group 2), or a positive culture in a prior pregnancy (group 3). Intrapartum culture specimens were obtained, and isolates were tested for susceptibility to six antibiotics using the agar disk diffusion technique. RESULTS: Intrapartum cultures were positive for 68% (62, 73), 61% (49, 72), and 48% (36, 60) of groups 1 (n = 249), 2 (n = 69), and 3 (n = 59), respectively. Cultures were positive in 67% (61, 73) of women in group 1 whose cultures were done 42 days or less before delivery (n = 218). The proportion of isolates (n = 239) susceptible to penicillin, ampicillin, cefazolin, and vancomycin was 100% (98, 100). The proportion susceptible to clindamycin and erythromycin was 91% (87, 94) and 79% (73, 84), respectively. CONCLUSION: The positive predictive value of antenatal group B streptococci cultures is lower than was previously reported. Clindamycin and erythromycin are not optimal agents for prophylaxis against early-onset neonatal group B streptococcal infection in patients who are allergic to penicillin.

Adolescent↗