The use of prophylactic antibiotics in obstetrics and gynecology. A review.
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Abortion, Legal↗
Biomedical subjects
S S Entman
Publications and source records attributed to S S Entman.
Anaphylaxis in pregnancy.
The intrauterine anoxic insult to the fetus of a woman who suffered anaphylactic shock raises concern about supporting uteroplacental perfusion during maternal therapy. We propose ephedrine as an appropriate first-line medication.
Anaphylaxis↗
Continuing neonatal morbidity in infants of women with class A diabetes.
Despite having implemented rigorous glucose control for women with gestational diabetes early in the third trimester, we found excessive morbidity among the neonates of these women. To accurately assess the risk of newborn complications, we did a five-year review (1977 to 1981) of infants of class A diabetic mothers to determine the incidence and scope of morbidity in these infants. Fifty-one infants of class A mothers were identified (group 1) and randomly matched with 102 infants of nondiabetic mothers (group 2). The distribution of morbidity between the two groups was as follows: hypoglycemia 9/51 (18%) vs 0/102 (P less than .001); birth injuries 4/51 (8%) vs 1/102 (2%) (P less than .05); pulmonary edema 3/51 (6%) vs 0/102 (P less than .05); respiratory distress 4/51 (8%) vs 7/102 (7%) (NS); macrosomia 18/51 (35%) vs 23/102 (23%) (NS); and hyperbilirubinemia 3/51 (6%) vs 8/102 (8%) (NS). There were two fetal deaths and three infants with major congenital anomalies among the diabetic pregnancies compared to none from the nondiabetic pregnancies. Compared to insulin-dependent diabetes, class A diabetes is accompanied by relatively mild metabolic disturbances in the mother. On the other hand, the infant of a mother with class A diabetes appears to be at risk for serious and life-threatening complications, both before and after birth. These results raise the question of whether earlier identification, subsequent meticulous diabetic management, and altered timing of delivery might reduce the complications experienced by these infants.
Abnormalities, Multiple↗
Clinical applications of the altered iron kinetics of toxemia of pregnancy.
The previously reported elevation of serum iron in association with toxemia of pregnancy was evaluated to determine if this chemical test could be clinically useful. When patients with toxemia and pregnant women with chronic hypertension were compared, a serum iron value greater than 100 micrograms/dl or an increase greater than 70% above baseline was a sensitive and specific indicator of toxemia. The predictive value is high and exceeds that of other commonly available tests. The clinical value of this model is discussed.
Female↗
The importance of the scan plane in fetal ventricular size assessment.
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Adult↗
Correlation of the one-minute Apgar score and the pH value of umbilical arterial blood.
The one-minute Apgar score, proven useful for rapid assessment of the neonate, is often poorly correlated with other indicators of intrauterine well-being. Fetal asphyxia is directly associated with neonatal acidosis. A low Apgar score in the face of normal pH and base deficit does not, therefore, indicate an asphyxiated infant. We performed a study at Vanderbilt University Hospital to ascertain the feasibility of combining the pH value of umbilical arterial blood with the one-minute Apgar score for neonatal assessment. The pH values and Apgar scores were obtained on 172 singleton neonates. When the Apgar score was less than 7, over one half (56%) of the neonates had a normal pH value. Of this group 46% had undergone intubation and nasopharyngeal suctioning, procedures known to be associated with lowered Apgar scores. We recommend, therefore, that neonates with a one-minute Apgar score of less than 7 be further evaluated with umbilical arterial blood gas studies to ascertain the presence of acidosis and to differentiate between metabolic and respiratory acidosis. More precise confirmation of the diagnosis of fetal distress and neonatal asphyxia, for both treatment and medicolegal purposes, is possible with this information.
Apgar Score↗
Altered ferrokinetics in toxemia of pregnancy: a possible indicator of decreased red cell survival.
Serum iron concentration was increased in women with toxemia of pregnancy (mean 135 mcg/dl) compared to normotensive parturients (62 mcg/dl) and chronic hypertensive parturients (72 mcg/dl). Mean iron for eclamptics was 203 mcg/dl; for severe preeclamptics, 137 mcg/dl, independent of hepatic or renal function. Recovery to normal postpartum levels occurred in 1-3 days. Concomitant increase in serum ferritin (mean: 59 ng/ml vs. 19 ng/ml for normals) persisted longer. When hepatocellular injury occurred, mean ferritin increased to 421 ng/ml. Increased iron was independent of transferrin concentration. Serum hemoglobin was detectable in 15 of 25 toxemic patients who had elevated serum iron; only 3 of these patients had clinically significant levels. Serum haptoglobin was significantly decreased in 4 of 25 patients. Reticulocyte count averaged 2.5%, with an average hematocrit of 38%. It is hypothesized that serum iron and ferritin increase in response to catabolism of released hemoglobin. The magnitude of iron increase is greater than could be derived from intravascular hemolysis and suggests an extravascular locus.
Blood Cell Count↗
Elevated serum ferritin in the altered ferrokinetics of toxemia of pregnancy.
The serum concentration of ferritin in 11 patients with toxemia of pregnancy was compared to that of normal women in the early third trimester of pregnancy and in labor at term. The mean concentration of ferritin for toxemic patients was 91.8 ng/ml compared to 18.4 ng/ml and 19.4 ng/ml for the two control groups, respectively. The biochemical and physiologic features of ferritin are reviewed, and the relationship between iron and ferritin is discussed. Despite elevated serum levels of ferritin in toxemia, it is noted to be less reflective of the clinical course of the syndrome than serum ion.
Aspartate Aminotransferases↗
Elevated serum iron in toxemia of pregnancy.
The records of 144 women with toxemia of pregnancy were evaluated retrospectively for clinical course and clinical laboratory parameters. A striking elevation of serum iron was noted when patients were most seriously ill. There was a prompt return to normal iron values with improved clinical status. The toxemia-associated rise in iron is out of proportion to the increase in other parameters, such as uric acid, blood urea nitrogen, and hematocrit. Possible explanations for this phenomenon are offered.
Adolescent↗
Conservative coloprotectomy for the sexually active woman.
The procedure described herein, capitalizes on a knowledge of the relationships between the pelvic viscera, its autonomic innervation and its tissue support. Operative time is shorter, not only because of the presence of a simultaneous second surgical team, but also because the improved exposure and use of bloodless planes facilitates dissection and reduces blood loss. The careful treatment of the cul-de-sac peritoneum helps protect the autonomic innervation of the pelvis, preserving the function of the bladder and sexual response. Preserving the perineal body and obliterating the dead space behind the posterior vaginal wall with the levator ani muscle provides a muscular cushion for the vagina, preserving maximum coital function. For the woman who is sexually active, these are important goals. Her improved sense of well-being following successful surgical therapy of the disease will result in increasing libido, and her successful adaptation to her new condition will be influenced favorably by her ability to function sexually.
Coitus↗
Obstetrical considerations for the working woman.
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Female↗
Monitoring maternal mortality using vital records linkage.
We developed a method to identify maternal deaths (deaths to women within 365 days of delivery) by linking Tennessee vital records. A computerized algorithm compared personal identifiers from the death certificates of reproductive-aged women to maternal identifiers on birth and fetal death certificates. For each decedent record which met the study criteria, the algorithm calculated a "match score" by comparing common elements in both files. The algorithm awarded full credit for data elements that agree exactly, partial credit for elements in partial agreement, and subtracted credit for information that mismatched. Match scores ranged from 0 to 35 for the 9,009 deaths in women 10-55 years of age during the three study years, with the majority of scores (96.3%) being 0 for "no match." Match scores of 1 to 8 were obtained by 153 (1.7%) of decedent records, while scores greater than 9 were obtained by 184 (2.0%) of decedent records. We used nurse-abstracted hospital, autopsy, and coroner records as our standard to verify the linkages. Manual review of personal identifiers showed that scores of 12 or less were not a match while scores of 13 or more indicated "true" matches. Based on this cutoff, the linkage algorithm yielded 130 maternal deaths. Of these, 32 (25%) were classified as truly pregnancy-related upon medical record review by an obstetrician. The remaining 98 deaths were associated only temporally with pregnancy. During the same time period, 16 individuals were identified to the State Health Department on their death certificates as dying from pregnancy-related causes, including one not identified by the linkage process.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Obstetricians' prior malpractice experience and patients' satisfaction with care.
OBJECTIVE: To examine the relationship between prior physician malpractice experience and patients' satisfaction with care. DESIGN: Women were interviewed using a questionnaire that contained structured and open-ended questions. PARTICIPANTS: Mothers of all stillborn infants, infant deaths, and a random sampling of viable infants drawn from 1987 Florida Vital Statistics were sorted into four groups based on the malpractice claims experience of their obstetricians between 1983 and 1986. Interviews were completed with 963 of 1536 women, most by telephone, 53 by in-person interview. MAIN OUTCOME MEASURES: Mothers' responses to closed-ended and open-ended questions about their perceptions of the care they received during their pregnancy, labor, and delivery. RESULTS: Even though none of the women actually filed a claim, a consistent pattern of differences emerged when comparing women's perceptions of care received. Patients seeing physicians with the most frequent numbers of claims but without high payments were significantly more likely to complain that they felt rushed, never received explanations for tests, and were ignored. In response to the open-ended question, "What part of your care were you least satisfied with?" women seeing physicians in the High Frequency malpractice risk group offered twice as many complaints as those seeing physicians who had never been sued. Problems with physician-patient communication were the most commonly offered complaints. CONCLUSION: Physicians who have been sued frequently are more often the objects of complaints about the interpersonal care they provide even by their patients who do not sue.
Female↗
The relationship between malpractice claims history and subsequent obstetric care.
OBJECTIVE: To determine the relationship between prior malpractice claims experience and the quality of clinical obstetric care. DESIGN: Historical cohort study of obstetricians, classified by their prior malpractice claims experience, with blinded review of medical records from their practices 5 to 10 years later. SETTING: Florida obstetricians who lost, settled, or defended malpractice claims between 1977 and 1983 and who were still practicing obstetrics in 1987. MAIN OUTCOME MEASURES: Objective and subjective assessment of quality of clinical care of patients attended by obstetricians with different histories of malpractice claims. RESULTS: No differences were found in any of the objective or subjective measures of the quality of clinical care provided to patients of obstetricians who were classified into one of four groups according to their prior claims history. CONCLUSIONS: No relationship was found between prior malpractice claims experience and the technical quality of practice by Florida obstetricians. Strategies that attempt to identify physicians at risk for future clinical errors by using data on prior malpractice claims (such as the National Practitioner Data Bank) may be misjudging the likelihood that substandard clinical care will be provided by physicians with prior claims.
Cohort Studies↗