ABSTRACT
A national survey was conducted to examine the American obstetricians' approach to management of preterm labor. Multiple-choice questionnaires were mailed to all current members of the Society of Perinatal Obstetricians and 750 randomly selected diplomates of the American College of Obstetricians and Gynecologists. Respondents included 249 members of the Society of Perinatal Obstetricians and 441 fellows of the American College of Obstetricians and Gynecologists. Analysis of the replies reflects wide variations among American obstetricians' criteria to diagnose preterm labor, choice of tocolytic agent, use of amniocentesis, and use of corticosteroids. Significant differences were found between the two groups in many aspects of diagnosis and management of preterm labor. However, the replies reflect a high degree of awareness of and many instances of first hand experience with severe beta-adrenergic therapy complications, including maternal death. These findings emphasize the need for caution in selection of patients for beta-adrenergic tocolytic therapy and judicious use of these agents.
Subject(s)
Attitude of Health Personnel , Obstetric Labor, Premature/prevention & control , Obstetrics , Perinatology , Tocolytic Agents/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Adrenergic beta-Agonists/adverse effects , Adrenergic beta-Agonists/therapeutic use , Adult , Amniocentesis , Delivery, Obstetric , Female , Fetal Membranes, Premature Rupture , Gestational Age , Humans , Infant, Newborn , Magnesium Sulfate/therapeutic use , Obstetric Labor, Premature/diagnosis , Obstetric Labor, Premature/drug therapy , Pregnancy , Respiratory Distress Syndrome, Newborn/prevention & control , Ritodrine/therapeutic use , Surveys and Questionnaires , Terbutaline/therapeutic use , Tocolytic Agents/adverse effects , United StatesSubject(s)
Abortion, Incomplete/etiology , Caffeine/administration & dosage , Female , Humans , Pregnancy , Risk , Time FactorsABSTRACT
Amniocentesis was performed in 25 patients being treated with tocolytic therapy for premature labor, in an effort to determine the incidence of patients with mature lecithin/sphingomyelin (L/S) ratios and to discover a possible effect of tocolytic therapy on pulmonary maturity studies. Optical density measurements at 650 nm (OD650) and L/S ratio determinations were performed on the amniotic fluid. Repeat amniocentesis was performed in eight patients from 48 hours to 7 days after initiation of tocolytic therapy. There was a poor correlation between OD650 values of 0.150 or greater and L/S ratios of 2 : 1 or greater (64.3% false positives); and in the eight patients who underwent repeat amniocentesis, there was no significant change in the L/S ratio.
Subject(s)
Amniotic Fluid/analysis , Fetal Organ Maturity , Lung/metabolism , Phosphatidylcholines/analysis , Sphingomyelins/analysis , Amniocentesis , Densitometry , Female , Fetal Organ Maturity/drug effects , Humans , Infant, Newborn , Obstetric Labor, Premature/drug therapy , Pregnancy , Prospective Studies , Terbutaline/administration & dosageABSTRACT
Amniocentesis was performed to obtain amniotic fluid for culture in 25 patients undergoing tocolytic therapy for premature labor, all of whom had intact membranes. Three specimens yielded positive cultures, 2 of which were considered contaminants. The only patient with significant bacterial growth in the amniotic fluid also had clinical signs and symptoms suggestive of amnionitis. Five of the 25 patients (20%) experienced spontaneous rupture of membranes after amniocentesis. Based on the results of this study, amniocentesis solely for the confirmation of asymptomatic amnionitis in the patient in premature labor seems to be of questionable value.
Subject(s)
Amniocentesis , Amniotic Fluid/microbiology , Obstetric Labor, Premature/diagnosis , Amnion , Bacteria/growth & development , Bacterial Infections/microbiology , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/microbiologySubject(s)
Abortion, Induced , Curettage , Extraction, Obstetrical , Pregnancy Trimester, First , Vacuum Extraction, Obstetrical , Anesthesia, Obstetrical , Autonomic Nerve Block , Cervix Uteri , Curettage/methods , Dilatation , Female , Humans , Pregnancy , Time Factors , Uterine Hemorrhage , WaterABSTRACT
PIP: At Tripler Army Medical Center in Honolulu abortion patients underwent suction curettage using either an electric pump unit (21, group A) or a simple water vacuum pump (WVSC) (28, group B). In both groups the use of the flexible 6 mm uterine curette and method of curettage were the same. For groups A and B the average blood losses were 40 ml and 39 ml. Average tissue volumes removed were 26 ml and 39 ml (greater yield reflects more patients at gestation of 9-10 weeks). From September 1971 to August 1972 400 patients of gestation of 10 weeks or less were curettaged using WVSC. Most of the operations were performed by first-year residents. Complications requiring readmission were not skewed towards largest gestations but distributed throughout the groups suggesting importance of individual technique in equipment use. The complications included retained products of conception (6), endometritis (2), endometritis with retained products of conception (3), and hermorrhage (1). Advantages of the WVSC unit are 1) quiet sound of running water rather than harsh sound of electric pump, 2) requirement of only a standard waterhead making method available to impoverished areas where electricity may be precious, 3) failsafe, unidirectional suction, 4) easy storage, transport, and assemblage, and 5) lack of need for safety pop-off valve because of intrinsic lag time from close of system to development of maximum suction. With its simplicity, safety, and flexibility WVSC is best suited for outpatients.^ieng
