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Biomedical subjects

S S Entman

Publications and source records attributed to S S Entman.

At least 19 recordsLinked to original sources
PubMed1999

Serious maternal morbidity after childbirth: prolonged hospital stays and readmissions.

OBJECTIVE: To determine the frequency of and risk factors for serious morbidity resulting in a prolonged hospital stay or readmission among women enrolled in Tennessee's Medicaid program who delivered live or dead infants in 1991. METHODS: This retrospective cohort study included 33,251 women of white or black ethnicity. Main outcome measures included childbirth-related medical conditions serious enough to result in death, prolonged delivery hospitalization, or readmission within 60 days of delivery. RESULTS: Among 25,810 women with vaginal (78%) and 7441 (22%) women with cesarean deliveries, 2.6% and 8.9%, respectively, had at least one childbirth-related medical condition requiring prolonged delivery hospitalization or readmission, including infection (1.8% and 7.9%), hypertension-related complications (0.7% and 2.0%), or hemorrhage (0.5% and 2.4%). After controlling for other risk factors, maternal age over 32 years was independently associated with increased rate of serious morbidity among women who had vaginal (relative risk [RR] 1.9, 95% confidence interval [CI] 1.4, 2.7) or cesarean deliveries (RR 1.6, 95% CI 1.1, 2.2). Black women had approximately twice the rate of maternal morbidity with vaginal (RR 1.9, 95% CI 1.5, 2.4) or cesarean deliveries (RR 2.3, 95% CI 1.9, 2.9). Primiparous women who had vaginal or cesarean deliveries had a 60% (RR 1.6, 95% CI 1.3, 2.0) and 70% (RR 1.7, 95% CI 1.4, 2.0), respectively, greater risk of serious maternal morbidity than women with 1-3 prior births. CONCLUSION: Predictors of serious maternal morbidity included age over 32 years, black ethnicity, and primiparity.

Adolescent↗
PubMed1998

Satisfaction with obstetric care: relation to neonatal intensive care.

OBJECTIVE: To examine the relationship between admitting children to a neonatal intensive care unit (NICU) and mothers' satisfaction with obstetric care. METHODS: Mothers of live-born infants who are now normal were interviewed about their perceptions of the interpersonal, organizational, and technical care they and their babies received during pregnancy, delivery, and the neonatal period, and their and their infants' health. Comparisons between the responses of mothers whose babies were admitted to the normal nursery (n = 595) and those whose babies were sent to an NICU (n = 72) were made by chi2 analysis (1 df) and Wilcoxon rank sum tests. RESULTS: Mothers whose babies were admitted to an NICU were more likely to complain that their obstetricians did not explain things in terms they could understand (P < .05); did not give them the right amount of information about what to expect during pregnancy (P < .05); hid something from them before delivery (P < .001); did not explain the reasons for tests performed during delivery (P < .05); misled them about their child's prognosis (P < .001); failed to treat properly a problem during delivery (P < .05); and did not know the latest medical developments (P < .05). CONCLUSION: Even when children do well, admission of newborns to an NICU is associated with greater maternal dissatisfaction with obstetric care.

Adult↗
PubMed1998

No-fault system of compensation for obstetric injury: winners and losers.

OBJECTIVE: To determine whether Florida's implementation of a no-fault system for birth-related neurologic injuries reduced lawsuits and total spending associated with such injuries, and whether no-fault was more efficient than tort in distributing compensation. METHODS: We compared claims and payments before and after implementation of a no-fault system in 1989. Data came from the Department of Insurance's medical malpractice closed claim files and no-fault records. Descriptive statistics were compiled for tort claims before 1989 and for tort and no-fault claims for 1989-1991. We developed two projection approaches to estimate claims and payments after 1989, with and without no-fault. We assessed the program's performance on the basis of comparisons of actual and projected values for 1989-1991. RESULTS: The number of tort claims for permanent labor-delivery injury and death fell 16-32%. However, when no-fault claims were added to tort claims, total claims frequency rose by 11-38%. Annually, an estimated 479 children suffered birth-related injuries; however, only 13 were compensated under no-fault. Total combined payments to patients and all lawyers did not decrease, but of the total, a much larger portion went to patients. Compensation of patients after plaintiff lawyers' fees rose 4% or 44%, depending on the projection method used. Less than 3% of total payments went to lawyers under no-fault versus 39% under tort. CONCLUSION: Some claimants with birth-related injuries were winners, taking home a larger percentage of their awards than their tort counterparts. Lawyers clearly lost under no-fault. Because of the narrow statutory definition, many children with birth-related neurologic injuries did not qualify for coverage.

Birth Injuries↗
PubMed1998

Postdelivery mortality in Tennessee, 1989-1991.

OBJECTIVE: To describe postdelivery mortality rates among residents of Tennessee from 1989 through 1991 and to compare these rates with those of women who had not delivered a live or stillborn infant in the previous year. METHODS: Postdelivery deaths (those occurring within a year of delivery of a live or stillborn infant) were identified using a computerized linkage of birth and fetal death certificates to death certificates of female decedents aged 15-44 years. Each identified postdelivery death was reviewed and categorized as either pregnancy-related (temporally and causally related to pregnancy) or pregnancy-associated-but-not-related (temporally but not causally related to pregnancy). Cause-specific mortality rates were compared for women who died postdelivery with women who died but had not delivered in the previous year. RESULTS: We identified 129 postdelivery deaths, one quarter of which were classified as pregnancy-related. The rates of postdelivery pregnancy-related and of pregnancy-associated-but-not-related death were 14.6 and 58.7, respectively, per 100,000 women who had delivered. Nonwhite women were 6.9 times more likely to experience postdelivery pregnancy-related death and 2.0 times more likely to experience postdelivery pregnancy-associated-but-not-related death than were white women. The leading cause of death among both women who had delivered and women who had not delivered a live or stillborn infant in the previous year was injury, although the risk of death the year after delivery was lower than for women who had delivered. CONCLUSION: Women were less likely to die in the year after delivery than were women who had not delivered a live or stillborn infant in the previous year. However, regardless of their delivery status, injuries were the leading cause of death among women. Postdelivery mortality was statistically significantly higher in nonwhite than white women, especially for pregnancy-related deaths.

Adolescent↗
PubMed1995

Universal screening for group B streptococcus: recommendations and obstetricians' practice decisions.

OBJECTIVE: To determine how obstetricians' opinions regarding universal screening of pregnant women for group B streptococcus (GBS) and their responses to positive culture results vary from American Academy of Pediatrics recommendations, and to determine the physician characteristics that predict divergent opinions. METHODS: One hundred ninety-four practicing obstetricians in the middle Tennessee region were queried by a mail survey. They were asked if they agreed with universal screening for GBS and to indicate whether they would prescribe antibiotics for women in labor, represented by six scenarios that differed with respect to presence or absence of preterm labor, premature rupture of membranes (ROM), prolonged ROM, and a positive GBS cervical culture. They were also asked to describe their practice and personality characteristics. RESULTS: Completed surveys were returned by 135 of 194 obstetricians (70%). Although only 28% of the respondents agreed with routine prenatal screening for GBS, most (74%) said they would treat a patient on the basis of a positive culture alone. Other risk factors, when added to a positive culture, slightly increased the decision to treat (from 74 to 88%). Multiple logistic regression, used to assess the relative effect of clinical and physician characteristics on treatment decisions, revealed that chemoprophylaxis for GBS was predicted most strongly by a positive culture at 28 weeks' gestation followed by prolonged ROM and preterm labor. Practicing in an urban location and seeing fewer than 20 patients per day also influenced the decision to treat. CONCLUSION: Although most obstetricians in the middle Tennessee region do not believe in universal screening, most will prescribe intrapartum antibiotics on the basis of a positive screening culture. However, other clinical risk factors and physician characteristics significantly and independently affect the decision to treat as well.

Adult↗
PubMed1995

Pelvic organ prolapse and stress urinary incontinence.

Pelvic organ prolapse presents a wide array of distressing symptoms to the female patient. Stress urinary incontinence is often considered a normal phenomenon of aging and tolerated for years before seeking medical attention. A detailed history outlining specific complaints and a targeted pelvic examination can usually elucidate the anatomic problems responsible for producing symptoms. Nonsurgical therapy can be initiated, often with great improvement in symptoms. If the results are not satisfactory, the patient can be referred for further evaluation and possible surgical intervention.

Female↗
PubMed1995

Effects of the threat of medical malpractice litigation and other factors on birth outcomes.

Most major health reform proposals include reform of medical malpractice. A major objective of the current medical malpractice system is to improve quality of care. The authors examine the effect of variations in the threat of medical malpractice, measured by claims frequency and payments per exposure year, on various indicators of birth outcomes, fetal deaths, low Apgar score, death within 5 days of birth, infant death, and death or permanent impairment at 5 years of age. Data came from 2 sources: a Survey of Obstetrical Care of 963 women in Florida in 1992 who delivered 5 years previously; and a fetal death and a linked birth-death file obtained from Florida Vital Statistics for 1987. Among the outcomes considered, only fetal deaths decreased in response to an increased threat of being sued, and this relationship was only obtained from one of the data sets. Overall, no systematic improvement in birth outcomes in response to an increased threat of medical malpractice litigation was obtained.

Adult↗
PubMed1993

A multicenter study of preterm birth weight and gestational age-specific neonatal mortality.

OBJECTIVE: This analysis was performed to present updated neonatal mortality data by age and birth weight for preterm newborns and to demonstrate the influence of plurality, ethnicity, and infant sex on mortality. STUDY DESIGN: Preterm birth weight and gestational age-specific mortality rates were compiled from the five centers that participated in the March of Dimes Multicenter Preterm Birth Prevention Project. In each center gestational age was assessed by standardized methods. A birth weight and gestational age-specific mortality chart for preterm births was created with live-birth data. RESULTS: In each birth weight group mortality decreased as the gestational age advanced; for each gestational age group heavier infants had less mortality. Female infants < 29 weeks survived better than male infants, and singletons < 29 weeks survived better than twins. Survival for black preterm newborns was better than that of whites but differences were not significant. Mortality for black term infants was significantly higher. The largest improvement in survival occurred between 25 and 26 weeks. At 30 weeks survival was > 90% and improved < 1% per week thereafter. CONCLUSIONS: When compared with rates in previous reports, mortality rates appear to have improved, especially at gestational ages < 29 weeks. These data may be useful in decision-making and in counseling patients at risk for preterm delivery.

Black or African American↗
PubMed1993

Maternal recall and medical records: an examination of events during pregnancy, childbirth, and early infancy.

It is not currently known whether sufficiently precise data on a previous pregnancy, labor and delivery, and early infancy can be obtained retrospectively. We conducted a telephone survey in 1991 of women who delivered babies between 1984 and 1986 at two teaching hospitals in Nashville, Tennessee, to assess how well mothers recall information on factors predictive of an adverse birth outcome. The survey yielded 102 usable responses that were compared with hospital records for mothers and infants. Overall, 89 percent agreement was found between women's responses and their charts. Respondents were not reluctant to answer potentially sensitive questions, and their technical knowledge was typically better for their own health than about some prenatal diagnostic procedures and their infants' health. We found no difference in recall accuracy according to whether mothers experienced some adversity with the index pregnancy. Accurate perinatal information can generally be obtained with a recall period as high as four to six years.

Data Collection↗
PubMed1993

Antenatal care and intrapartum management.

Cost-effective care is an increasingly important issue in medicine. This will necessitate re-evaluating many aspects of antenatal and intrapartum care, including health-care delivery systems and routine surveillance techniques for uncommon events such as Down syndrome. It will demand justification for broadening indications for cesarean section by including fetal macrosomia and intensify the search for the causes of preterm labor. As new techniques are developed for intrapartum monitoring, such as fetal electrocardiography, fetal lactic acid levels, and near-infrared spectroscopy, they, too, will have to be determined to be cost-effective before attaining a role in clinical management.

Cesarean Section↗
PubMed1991

Gonococcal peritonitis after tubal ligation. A case report.

Gonococcal peritonitis occurred after a tubal ligation. Falk's postulated benefit of cornual resection as a preventive measure for recurrent infection does not extend to isthmic interruption. Pelvic inflammatory disease should be considered when a sterilized woman presents with an acute abdomen.

Adult↗
PubMed1990

Transvaginal scanning of the endometrium.

Transvaginal sonography (TVS) can accurately depict the anteroposterior, width, and long axis of the endometrium. This article describes and illustrates normal and abnormal endometria as depicted by TVS.

Decidua↗
PubMed1990

Transvaginal sonography (TVS) of the endometrium: current and potential clinical applications.

This review has discussed and illustrated the numerous applications of TVS for the sonographic detection of the endometrium. Its major applications are in early pregnancy evaluation and in evaluation of patients with endometrial carcinoma. As more clinical experience with this technique is gained, more extensive application of this technique will undoubtedly come about.

Endometrium↗
PubMed1990

Sonographic evaluation of maternal disorders during pregnancy.

This article has reviewed and illustrated the sonographic features of the most common pelvic masses that can be encountered in pregnant patients. Sonographic evaluation allows delineation of the size, consistency, and location of pelvic masses occurring during pregnancy. It has an important role in establishing the enlargement or regression of pelvic masses that occur during pregnancy. Sonography also has an important role in the diagnosis of cholecystitis and upper urinary tract obstruction and/or infections in the pregnant patient.

Cholelithiasis↗
PubMed1989

Effect of maternal heme degradation on fetal carboxyhemoglobin concentration in pregnancy-induced hypertension.

Increased red cell destruction with consequent heme catabolism results in accumulation in carboxyhemoglobin in women with pregnancy-induced hypertension. Temporally associated with this is a significant shift in the oxyhemoglobin dissociation curve to the left. In this study we assessed the relationship between carboxyhemoglobin concentration and oxyhemoglobin dissociation curve in simultaneously obtained maternal and fetal venous blood in which patients with pregnancy-induced hypertension were compared with normotensive patients. Maternal and fetal carboxyhemoglobins were significantly higher in patients with pregnancy-induced hypertension than in control subjects. Fetal carboxyhemoglobin was significantly higher than maternal carboxyhemoglobin in both clinical groups. Furthermore, maternal and fetal oxyhemoglobin dissociation curves were significantly shifted to the left in patients with pregnancy-induced hypertension compared with controls. The fetal-maternal gradient of carboxyhemoglobin was similar in both groups. The maternal-fetal gradient of oxyhemoglobin dissociation curve position was significantly reduced in pregnancy-induced hypertension. The concentrations of carboxyhemoglobin measured do not fully explain the magnitude of the shift in oxyhemoglobin dissociation curve, but the data suggest a potential impact on fetal oxygenation in pregnancy-induced hypertension.

Carboxyhemoglobin↗
PubMed1989

Transabdominal and transvaginal sonography of pelvic masses.

Determination of the type of pelvic mass by pelvic sonography was improved significantly when a transvaginal study was performed after transabdominal sonography. Of 34 patients who underwent both studies, transvaginal sonography (TVS) was considered to add diagnostic information in 24 (70%); transabdominal sonography (TAS) was better than TVS in 4 (12%); TVS was equivalent to TAS in 5 (15%), and neither were accurate in 1 (3%). It is concluded that the use of transvaginal sonography as an adjunct to TAS is warranted for evaluating most pelvic masses; especially those confined to the true pelvis.

Adnexal Diseases↗
PubMed1989

Localization of transferrin and its receptor in ovarian follicular cells: morphologic studies in relation to follicular development.

Granulosa cells perform an essential role in ovarian follicle and ovum development. Proliferating cells have an absolute requirement for iron, which is delivered by transferrin with subsequent intracellular transport via the transferrin receptor. Because iron and transferrin concentration increase in follicular fluid with advancing follicular maturation, the authors studied the distribution of transferrin and its receptor in rat and human granulosa cells with light and electron microscopic immunohistochemistry. Intense cytoplasmic staining was found in granulosa cells, with immunostaining enhancement occurring with advanced follicle maturation, including the periovulatory period. Immunoelectron microscopy showed transferrin throughout the cytoplasm, often in proximity to polyribosomes and vesicular structures. When transferrin was absent in the culture medium used to maintain granulosa cells, diminished transferrin immunostaining was seen. Based on these findings, the authors conclude that follicular maturation is closely related to high levels of cellular transferrin and transferrin receptor. Acquisition of transferrin occurs primarily by either ultrafiltration or facilitated diffusion, whereas de novo local synthesis does not have a major role.

Animals↗