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Biomedical subjects

T W McElin

Publications and source records attributed to T W McElin.

At least 19 recordsLinked to original sources
PubMed1978

Maternal and fetal outcome of Lamaze-prepared patients.

To determine whether Lamaze childbirth preparation is harmless, harmful, or beneficial, 500 consecutive Lamaze-prepared patients were compared to 500 hand-picked controls, matched for age, race, parity, and educational level. Lamaze preparation was found to have a significant beneficial effect in almost every obstetric preformance category. The Lamaze-oriented patients had one-fourth the number of cesarean sections and one-fifth the amount of fetal distress (P less than .005). Postpartum infection, measured both by maternal febrile morbidity and by the incidence of antibiotic use, was one-third that of the controls (P less than .005). Similarly, the "prepared" patients had fewer perineal lacerations and those that occurred were not as serious as those in the control patients (P less than .005). The control patients had three times as many cases of toxemia of pregnancy (P less than .005) and twice as many of prematurity (P less than .05).

Adult↗
PubMed1978

Forceps operations in perspective. I. Midforceps rotation operations.

Four hundred fifty-eight consecutive midforceps rotation operations were evaluated with a specially designed Perinatal Morbidity Index (PMI) and Maternal Morbidity Index (MMI). An unfavorable fetal outcome occurred in 30.8% of the midforceps rotation operations, and an unfavorable maternal outcome occurred in 13.5% of the cases. Twelve risk factors were found to be associated with suboptimal results. Among patients with no risk factors, an unfavorable fetal outcome occurred in 11% of the cases. Of the patients with three or more risk factors, in contrast, an unfavorable fetal outcome was found in 47% of the cases. A uniformly good fetal outcome was noted among patients selected as controls. Under ordinary circumstances, midforceps rotation operations should not be attempted in a patient already at significant risk. "Significant risk" is defined in the article.

Apgar Score↗
PubMed1978

Forceps operations in perspective. II. Failed operations.

Eighteen recent cases of failed forceps operations are reviewed. Although no maternal or fetal deaths occurred, low Apgar scores were found in more than half of those patients considered at significant risk with the use of the Perinatal Morbidity Index (PMI) and Maternal Morbidity Index (MMI) developed at our institution. Among low-risk patients more favorable results were found. Whenever difficulty in a forceps delivery is encountered because of misjudgement of pelvic capacity or fetal size, further attempts at vaginal delivery should cease and a cesarean section should be performed. This procedure will most likely lead to a favorable outcome for mother and child. A patient already at significant risk should, under ordinary circumstances, not be considered a candidate for a forceps trial. If the trial is successful, the infant has a nearly 50% chance of unfavorable outcome; if it is unsuccessful, the chance of an unfavorable outcome is 64%.

Adult↗
PubMed1977

The effect of fetal monitoring on the incidence of cesarean section.

To determine whether routine fetal monitoring inevitably increases the cesarean section rate, we studied the pertinent literature and analyzed the cesarean sections performed at Evanston Hospital during the last 8 years. Many authors have found a slight to moderate increase in cesarean section rates, whereas others have found no change or a decrease. At Evanston Hospital, the primary cesarean section rate has increased from 2.6% in 1968-1969 to 6.9% in 1974-1975. Only 19.2% of this increase is due to increased fetal distress; the magnitude of the increase is due to changes in other factors, notably, breech deliveries (29.5% of the increase) and "dystocia" (60.2% of the increase). The incidence of cesarean section is controlled by several complex variables, only one of which is fetal monitoring. To describe the fetal monitors as the cause of the increased cesarean section rate is to ignore these other equally profound changes in obstetric technic and philosophy.

Breech Presentation↗
PubMed1976

An evaluation of preinduction scoring systems.

A double-blind clinical study of five preinduction scoring systems was undertaken to determine the accuracy of clinical usefulness of each system as applied to a diverse group of patients. When strictly applied, all five systems were found to be as accurate and useful as it was originally claimed they were. However, when applied without regard to each author's prerequisites, none of the five scoring systems was found to be reliable. A series of preinduction score modifiers is presented which, when applied to any of the preinduction scoring systems, will reliably predict the outcome of induction of labor, with a 50% induction failure rate in patients with lower third scores, a 10% failure for middle third scores, and essentially a 0% failure in the upper third scores.

Apgar Score↗
PubMed1975

A six-year prospective study of term breech deliveries utilizing the Zatuchni-Andros Prognostic Scoring Index.

Utilizing the Zatuchni-Andros Breech Scoring Index a prospective study of 290 consecutive term breech deliveries occurring at Evanston Hospital from Jan. 1, 1968, to Jan. 1, 1974, is reported. This paper represents a direct continuation of a retrospective study of 500 consecutive term breech deliveries reported by the authorsin 1970. The results indicate that this breech assessment method is a valid method and it is recommended that patients whose breech score is 3 or less be submitted to immediate cesarean section and, conversely, those with a breech score of 4 or more be allowed to labor with meticulous observation with a high confidence level that successful vaginal delivery will result. Also, cautious stimulation with intravenous oxytocin can be safely undertaken when necessary in patients with a breech score of 4 or more. By employment of the Zatuchni-Andros Breech Scoring Index, the authors submit, fetal mortality and morbidity rates are markedly diminished.

Adolescent↗