Initiation of antepartum testing in the hypertensive gravid woman.
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Female↗
Biomedical subjects
W N Herbert
Publications and source records attributed to W N Herbert.
Glycosylated hemoglobin and fructosamine. Indicators of glycemic control in pregnancies complicated by diabetes mellitus.
In 50 gravidas with insulin-dependent diabetes mellitus, mean preprandial whole blood glucose levels over a two-week period were compared with serum glycosylated hemoglobin (HbA1c) and fructosamine values. Although there was a statistically significant correlation between mean glucose levels and both HbA1c (r = .44, P less than .01) and fructosamine (r = .37, P less than .01), the wide range of HbA1c and fructosamine observed at all levels of mean blood glucose limited the usefulness of those assays in the management of pregnant diabetics.
Blood Glucose↗
Evaluation of the PG-Numeric assay for semi-automated analysis for phosphatidylglycerol in amniotic fluid.
We evaluated the performance of the PG-Numeric (PGN; Isolab, Inc.) enzymatic assay for phosphatidylglycerol (PG) adapted for semi-automated analysis on the Cobas-Bio (Roche) centrifugal analyzer. We evaluated precision, linearity, and potential interference from endogenous glycerol. In addition, we compared the results of the PGN assay with those for two other PG assays. Amniostat-FLM (AFLM; Hana Biologics) and phosphatidylglycerol/sphingomyelin ratio (PG/S), on amniotic fluid samples from 51 patients. Within-run and total CVs for the PGN test (n = 80) were respectively 8.6% and 11.4% for PG at 2.6 mumol/L, and 4.5% and 6.2% at 7.3 mumol/L. The PGN test exhibited no significant deviation from linearity between PG concentrations of 0.4 and 15 mumol/L. Endogenous glycerol up to 500 mumol/L did not affect PGN results significantly. Results of the PGN assay compared favorably with those of the other PG assays for tests of fetal lung maturation. The Cobas-Bio adaptation of the PGN test performed well analytically and clinically, and allowed the determination of PG in less than 1 h.
Amniotic Fluid↗
Profile of student clerkship administration in obstetrics and gynecology.
To determine a current profile of clerkships in obstetrics and gynecology, a national survey was conducted. The average clerkship director is 48 years old and has held that post for 6 years. Board certification has been accomplished by 91%, of whom 23% are also certified in a subspecialty. An advanced degree in education is held by 14%. Of full-time faculty, 81% are actively involved with medical student teaching; of part-time faculty, 62% teach students. The average number of 16 students completing the clerkship each 7 weeks is similar to that in previous reports. Evaluation of student performance varies but generally involves assessment of clinical activities (98% of programs), a written examination (96%), and an oral examination (54%). Clerkship directors find the responsibility of coordinating undergraduate education an important task from which they derive personal satisfaction.
Clinical Clerkship↗
Student evaluation in obstetrics and gynecology: self- versus departmental assessment.
Self-assessment of clerkship performance in obstetrics and gynecology was completed by 142 medical students and compared with departmental evaluations. Significant positive correlations existed between self- and departmental assessments for each of seven parameters in three categories of evaluation (clinical activities, written examination, and oral examinations). Students graded themselves lower than the actual faculty ratings and higher than the actual resident ratings. There was no difference in self- or departmental evaluations in regard to student gender. The amount of previous clerkship experience did not correlate with either the actual or perceived grades. Overall, self-assessments are consistent with those rendered by the department.
Educational Measurement↗
Opinions and approaches to continuing education among obstetrician/gynecologists.
This national survey of Fellows of The American College of Obstetricians and Gynecologists found that obstetrician/gynecologists are actively involved in continuing medical education activities and appear satisfied with the resources available, yet desire additional opportunities for lifelong learning. Traditional resources (eg, journals, seminars) are used much more extensively than newer, electronic resources (eg, video cassettes, cable television), probably as a result of unfamiliarity with these latter methods and limited access to them. However, the majority of Fellows want increased exposure to these newer educational programs. Relevance of content, caliber of faculty, and potential for professional growth were important factors in choosing continuing medical education programs. Strong interest was expressed in individualized learning programs designed in collaboration with university faculty. These findings are of value in producing future educational programs for practitioners in obstetrics and gynecology.
Attitude of Health Personnel↗
2001: the challenge in education in obstetrics and gynecology.
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Curriculum↗
Leukocyte esterase: a simple bedside test for the detection of bacterial colonization of amniotic fluid.
Chorioamnionitis is a major cause of neonatal mortality, neonatal morbidity, and maternal morbidity. Clinical signs of acute chorioamnionitis occur relatively late, and laboratory tests for acute chorioamnionitis lack the desired sensitivity and specificity. Early antibiotic treatment may have important neonatal implications. The leukocyte esterase test is both rapid and simple. Because of the specificity (100%) and sensitivity (81%) of the test in predicting bacterial colonization of the amniotic fluid, we conclude that it has the potential to become an invaluable tool in assessing the intrauterine environment.
Amniotic Fluid↗
On improving the lecture.
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Audiovisual Aids↗
Maternal cardiovascular effects of drugs that alter uterine activity.
All drugs that modify uterine activity have cardiovascular effects. These changes, which include alterations in blood pressure, heart rate, cardiac output, the peripheral vascular resistance, can have significant impact on both mother and fetus. The intensity of these effects is dependent on the concentration of the agent, its infusion rate, and the additive effects of other drugs administered concomitantly. A knowledge of these potentially adverse cardiovascular properties of medications that alter uterine activity is required for competent management of preterm and term labor and delivery.
Cardiovascular System↗
Autologous blood storage in obstetrics.
Autologous transfusion, storage of one's own blood for subsequent infusion if needed, is safe and effective in a variety of scheduled operative procedures. Obstetric involvement in such programs is very limited, however. Thirty pregnant women with placenta previa or other potential complications underwent 55 phlebotomies in an autologous transfusion program. Phlebotomies were performed at an average gestational age of 32.4 weeks (range 13-40). Changes in mean diastolic blood pressure and pulse were minimal. Electronic fetal monitoring tracings were normal during the 34 procedures in which it was used. The frequency of mild donor reactions (4%) was consistent with that in nonpregnant donors. After entry into this program, 15 patients received a total of 29 U of packed red blood cells (23 autologous; six homologous). Homologous transfusion was avoided in 86.7% of patients receiving blood. Selected pregnant women can participate safely in autologous blood collection programs, minimizing the need, and therefore the risks, of homologous transfusion.
Blood Preservation↗
Prenatal sonographic diagnosis and management of a twin pregnancy with placenta previa and hemicardia.
The sonographic diagnosis of a twin pregnancy complicated by acardius anceps of one fetus, total placenta previa, uterine overdistension, and preterm labor is presented and management is discussed. Attempted selective fetocide is described, but was not successful. Clinical management of severe discordant sonographic dysmorphology is discussed, and diagnostic criteria for sonographic diagnosis of acardia are presented.
Abnormalities, Severe Teratoid↗
Clinical aspects of fetal heart auscultation.
The widespread belief that fetal heart tones are first detected with an unamplified fetoscope at about 20 weeks' gestation has been studied prospectively only twice. Using data collection prospectively from 352 visits of 77 patients between 15 and 23 weeks' pregnancy, we studied various clinical aspects of fetal heart tone detection. We determined the gestational age at the time of initial auscultation of fetal heart tones with an ordinary fetoscope, and its relationship to quickening, parity, and placenta location. Fetal heart tones were first identified by auscultation at a mean gestational age of 19.4 weeks (range 17-22 weeks). Detection was possible in 81% of patients examined at 20 weeks and in virtually all patients examined at 21 weeks or later. Once heard, fetal heart tones were identified in every subsequent visit for all patients. Parity and placenta location were significant factors influencing initial fetal heart tone detection. Auscultation preceded quickening in only 12% of patients. Recommendations for using initial fetal heart tone detection in clinical practice are given.
Female↗
Clinical and economic considerations associated with testing for fetal lung maturity.
Performing multiple tests of fetal lung maturity on amniotic fluid samples may not use the individual test results and laboratory personnel most effectively. To determine the best strategy for fetal lung maturity testing, we analyzed our experience with use of a variety of procedures. Clinical usefulness was assessed according to sensitivity, specificity, predictive values, and efficiency. Economic and technical aspects analyzed included time and personnel requirements, availability of tests, and expense of each procedure. Several testing sequence approaches were compared for efficiency and cost. In our laboratory the foam stability index proved to be the most useful initial test of fetal lung maturity, reserving more expensive and time-consuming tests for instances in which the foam stability index is immature. Routine multiple testing did not enhance clinical usefulness and greatly increased costs. Development of a testing strategy using a rapid, inexpensive, and widely available test such as the foam stability index would promote clinical and economic efficiency.
Amniotic Fluid↗
Fetal growth response to total parenteral nutrition in pregnancy. A case report.
Although clinical experience with total parenteral nutrition (TPN) in pregnancy is accumulating, assessment of the fetal growth response to this therapy has been limited primarily to birth weight. We performed serial ultrasonographic measurements of the fetal biparietal diameter (BPD), femur length (FL) and abdominal circumference (AC) in a patient who received TPN because of chronic malnutrition. BPD and FL were within normal limits before and after TPN. Consistent with asymmetric growth retardation, the AC was low prior to TPN and increased significantly after TPN was administered. Estimated fetal weight increased accordingly. These data suggest that TPN can reverse subnormal fetal growth secondary to maternal nutritional deprivation.
Adult↗
A little bit of obstetrics for all of us.
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Congenital Abnormalities↗
Fetal lung maturation: human amniotic fluid phosphatidate phosphohydrolase activity through normal gestation and its relation to the lecithin/sphingomyelin ratio.
In order to evaluate the relationship between the increase in amniotic fluid phosphatidate phosphohydrolase (PAPase) specific activity and the increase in the lecithin/sphingomyelin (L/S) ratio during normal human pregnancy, PAPase specific activity and the L/S ratio were measured in 171 amniotic fluid samples obtained from 164 women who were at 17 to 42 weeks' gestation. The increase in PAPase specific activity in amniotic fluid is parallel to the increase in the L/S ratio. The correlation between PAPase specific activity and the L/S ratio in amniotic fluid from all gestational ages is highly significant. The relationship of PAPase specific activity in amniotic fluid to PAPase specific activity in gastric fluid was investigated in a study of 97 newborn infants. A highly significant correlation was found between these two values. To ascertain if a relationship exists between the specific activity of PAPase in amniotic fluid and the subsequent development of hyaline membrane disease (HMD), 223 neonates who were delivered within 72 hours of amniotic fluid collection were studied. Only one infant developed HMD out of 170 with amniotic fluid PAPase specific activity equal to or greater than 50 nmoles of orthophosphate released X mg.-1 of protein X hr.-1. On the other hand, the finding of an amniotic fluid PAPase specific activity of less than 50 nmoles was of little value in predicting lung immaturity. We believe that these findings are also supportive of the view that PAPase and surfactant are released from the type II pneumocyte as a closely related structural unit, viz., the lamellar body.
Amniotic Fluid↗