Using health status surveys in medical consultations.

The goal of this research was to identify patients' preferences for physician inquiry into various aspects of health status and to examine whether the preconsultation availability of health status data (collected from the SF-36 Health Status Questionnaire) influenced the physician's conduct during the consultation. Results from 58 prenatal patient visits yielded the following findings. First, patients expressed strong preferences for physicians to ask about the patient's perceptions of health in general and about physical dimensions of health status such as pain, vitality, and role limitations due to physical functioning. Patients also were more satisfied when doctors were perceived as having asked about these issues. Second, patients varied considerably in their preferences for physician inquiries into psychosocial issues such as social functioning, mental health, and role limitations due to emotional problems. Approximately half the patients wanted these matters discussed, whereas the remainder either did not care or preferred that doctors not ask about these topics. Third, the preconsultation availability of health status information had little effect on the degree to which physicians asked about the patient's health-related quality of life. Clinical implications are discussed.

Magnesium sulfate versus phenytoin for seizure prophylaxis in pregnancy-induced hypertension.

Seizure prophylaxis is standard intrapartum therapy for patients with pregnancy-induced hypertension. Magnesium sulfate is used in the United States in spite of limited literature comparing its efficacy with other anticonvulsants. Fifty patients with pregnancy-induced hypertension were prospectively randomized to receive magnesium sulfate or phenytoin for seizure prophylaxis. Patients were observed for toxicity, side effects, and labor outcomes, and the neonates were evaluated for side effects of the therapy. Three patients were excluded with adverse reactions to medications (one in magnesium sulfate group, two in phenytoin group). No differences were found in patient tolerance, adverse reactions, or neonatal outcomes between groups. Maternal free phenytoin levels were 13.0% +/- 0.4% of total phenytoin (serum albumin, 2.5 to 3.5 gm/dl), significantly higher than in nonpregnant patients. Neither free phenytoin levels nor percentage of total phenytoin that was free correlated significantly with maternal albumin levels. The pharmacokinetics of phenytoin loading in the massively obese pregnant patient may differ and require further evaluation. Phenytoin is a well-tolerated alternative to magnesium sulfate for seizure prophylaxis in the patient with mild pregnancy-induced hypertension.

Prenatal diagnosis of fetal diastematomyelia in a pregnancy exposed to acyclovir.

A rare form of spinal dysraphism, diastematomyelia, was diagnosed in a pregnancy exposed to acyclovir at the time of implantation. The prenatal diagnosis was based on the ultrasound examination of the fetus. Pathologic evaluation of the postabortion fetus confirmed the diagnosis. The use of acyclovir in pregnancy and associated anomalies are reviewed.

Oral desensitization in Rh disease.

Four pregnancies managed with erythrocyte membrane oral therapy because of severe Rh disease are presented. Reduction in anti-(D) production was the goal of the study. A patient was classified as having severe Rh immunization if there was a history of fetal loss due to erythroblastosis fetalis prior to 26 weeks.