A 31-year-old primigravida had a combined pregnancy consisting of intrauterine twins and an inter... more A 31-year-old primigravida had a combined pregnancy consisting of intrauterine twins and an interstitial ectopic after in vitro fertilization/embryo transfer. The patient underwent repair of the ectopic pregnancy at 15 weeks of gestation, with subsequent delivery of mature twins close to term.
Objective The percentage of operative vaginal deliveries (OVDs) in the United States has sharply ... more Objective The percentage of operative vaginal deliveries (OVDs) in the United States has sharply declined. In May 2016, our institution's obstetrics and gynecology (OB/GYN) residency program implemented a twice-yearly OVD curriculum consisting of didactics and simulation. We sought to evaluate the impact of this curriculum. Study Design We performed a retrospective cohort study of all deliveries at our institution from July 2011 to May 2018. Deliveries were evaluated quarterly for the pre- (July 2011–April 2016) and postcurriculum (July 2016–May 2018) periods. Forceps-assisted vaginal delivery (FAVD), vacuum-assisted vaginal delivery (VAVD), and total OVD percentages, and the ratio of forceps to vacuums were calculated. Pre- and postcurriculum percentages were compared using Wilcoxon's rank-sum test. Cubic regression curves were fit to quarterly percentages to illustrate trends over time. Results The quarterly OVD percentage was unchanged following curriculum implementation (mean 3.2% [Q1–Q3: 2.6–3.5%] pre- vs. 3.1% [2.5–3.8%] post-, p > 0.99). The FAVD percentage was increased (1.2% [0.8–1.5%] vs. 2.0% [1.4–2.6%], p = 0.027) and the VAVD percentage was decreased (2.0% [1.6–2.2%] vs. 1.2% [0.9–1.3%], p
The objective of this study was to determine if an ultra-sound examination, when performed in the... more The objective of this study was to determine if an ultra-sound examination, when performed in the third trimester immediately preceding delivery, is useful in predicting outcome in infants with a myelomeningocele. A retrospective review was undertaken of prenatal ultrasound records and pediatric outcome data on fetuses with isolated myelomeningocele referred to our institution after 28 weeks' gestation during a three-year period. Macrocephaly proved to be the one antenatal ultrasound finding that most correlated with later poor outcomes in infants with myelomeningocele. Macrocephalic fetuses had a longer mean hospital stay after birth and were more likely to have significant respiratory and feeding difficulties. No fetus with macrocephaly had a normal mental score, and all had severe motor deficits on later follow-up testing. The ultrasound diagnosis of macrocephaly identified a group of fetuses with myelomeningocele, who were at highest risk of neonatal problems and development...
American Journal of Obstetrics and Gynecology, 1997
Ultrasound measurements of 15 fetuses with trisomy 21 detected during the 17th week of gestation ... more Ultrasound measurements of 15 fetuses with trisomy 21 detected during the 17th week of gestation were matched retrospectively to those of 45 normal controls. We compared nine standard ultrasound measurements of the fetal head, abdomen, and femur in these two groups. The fetuses with trisomy 21 had significantly shorter mean femur lengths, narrower occipitofrontal diameters, and increased biparietal diameter (BPD)/femur length and abdominal circumference/femur length ratios. An increased BPD/femur length ratio was the ultrasound finding that best predicted a fetus with Down syndrome. A BPD/femur length ratio of 1.80 or higher was 40% sensitive and 97.8% specific in predicting Down syndrome, and had a false-positive rate of only 2.2%. An increased second-trimester BPD/femur length ratio measured by ultrasound may prove beneficial as an additional screening test for Down syndrome.
Journal of Maternal-fetal & Neonatal Medicine, Aug 1, 2001
To determine how changes in eligibility criteria for early discharge affected quality and costs o... more To determine how changes in eligibility criteria for early discharge affected quality and costs of home nursing follow-up care for Medicaid patients. A nurse screened women delivering vaginally to determine eligibility for discharge at 24-47 h. Maternal criteria were a vaginal delivery, no serious medical problems, > or = 8 h after bilateral tubal ligation and, if 24 h postpartum, by 21.00 on day of discharge. Newborn criteria were 36 weeks' gestation or more, 2000 g or greater and a normal examination at 24 h of age. By 48 h after discharge, a nursing visit was ordered for each mother and newborn. Nursing consultations were tracked and later entered into a database linked to hospital financial data. Of 3133 vaginal deliveries occurring from 1 August 1997 to 31 January 1999, eligibility criteria allowed 1799 mothers (58%) and 1587 newborns (51%) to be discharged early. Medical problems were rarely detected at follow-up (1% mothers, 2% newborns). To perform the increased number of visits, more personnel were hired and home nursing costs rose 150%. Despite the increased staff and costs, 19 mothers (1%) and ten newborns (0.6%) were lost to follow-up and 25 mothers (1%) and 20 newborns (1%) were visited beyond 72 h after discharge. Liberal changes in maternal and newborn eligibility criteria did not adversely affect the quality of home nursing follow-up care following early discharge. For hospitals performing a large number of early discharges, follow-up care using only a home nursing visit may be too expensive and difficult to organize. Alternative follow-up plans, such as clinic visits or phone calls, may also need to be utilized.
American Journal of Obstetrics and Gynecology, 1991
The degree of umbilical arterial acidemia associated with immediate newborn morbidity has not bee... more The degree of umbilical arterial acidemia associated with immediate newborn morbidity has not been determined. Therefore we compared 358 term infants with umbilical artery acidemia (pH less than 7.20) with 358 term, nonacidotic matched control infants, to evaluate immediate neonatal complications in both groups. Nonacidotic was defined as an umbilical artery pH greater than or equal to 7.20. Complications included seizures, persistent hypotonia, and/or signs of end-organ damage such as renal or cardiac dysfunction. None of the 693 newborns with an umbilical artery pH greater than or equal to 7.00 had such complications. Two of 23 infants with an umbilical artery pH less than 7.00 had sequelae related to intrapartum asphyxia. In these two infants the umbilical artery pH was less than 7.00, the 1-minute and 5-minute Apgar scores were less than or equal to 3 and the acidemia was metabolic in nature.
American Journal of Obstetrics and Gynecology, 1989
Perinatal outcomes were analyzed in 848 high-risk pregnancies managed with a prospective weekly c... more Perinatal outcomes were analyzed in 848 high-risk pregnancies managed with a prospective weekly contraction stress testing protocol. In 615 patients the last test was performed by a nipple stimulation protocol whereas 233 patients had sufficient spontaneous contractions for performance of the test. All patients were either delivered of their infants or admitted for delivery within 7 days of the last test. The results of the last test were compared to various perinatal outcome parameters. There was no significant difference in perinatal outcomes between the two groups.
... Invasive Techniques for Fetal Evaluation and Treatment CYNTHIA G. BRUMFIELD, MD, and M. WENDY... more ... Invasive Techniques for Fetal Evaluation and Treatment CYNTHIA G. BRUMFIELD, MD, and M. WENDY ATKINSON, MD University of Alabama School of Medicine Birmingham, Alabama The trend ¡n the 1990s has been to use in-vasive techniques that allow prenatal di ...
... Invasive Techniques for Fetal Evaluation and Treatment CYNTHIA G. BRUMFIELD, MD, and M. WENDY... more ... Invasive Techniques for Fetal Evaluation and Treatment CYNTHIA G. BRUMFIELD, MD, and M. WENDY ATKINSON, MD University of Alabama School of Medicine Birmingham, Alabama The trend ¡n the 1990s has been to use in-vasive techniques that allow prenatal di ...
A 31-year-old primigravida had a combined pregnancy consisting of intrauterine twins and an inter... more A 31-year-old primigravida had a combined pregnancy consisting of intrauterine twins and an interstitial ectopic after in vitro fertilization/embryo transfer. The patient underwent repair of the ectopic pregnancy at 15 weeks of gestation, with subsequent delivery of mature twins close to term.
Objective The percentage of operative vaginal deliveries (OVDs) in the United States has sharply ... more Objective The percentage of operative vaginal deliveries (OVDs) in the United States has sharply declined. In May 2016, our institution's obstetrics and gynecology (OB/GYN) residency program implemented a twice-yearly OVD curriculum consisting of didactics and simulation. We sought to evaluate the impact of this curriculum. Study Design We performed a retrospective cohort study of all deliveries at our institution from July 2011 to May 2018. Deliveries were evaluated quarterly for the pre- (July 2011–April 2016) and postcurriculum (July 2016–May 2018) periods. Forceps-assisted vaginal delivery (FAVD), vacuum-assisted vaginal delivery (VAVD), and total OVD percentages, and the ratio of forceps to vacuums were calculated. Pre- and postcurriculum percentages were compared using Wilcoxon's rank-sum test. Cubic regression curves were fit to quarterly percentages to illustrate trends over time. Results The quarterly OVD percentage was unchanged following curriculum implementation (mean 3.2% [Q1–Q3: 2.6–3.5%] pre- vs. 3.1% [2.5–3.8%] post-, p > 0.99). The FAVD percentage was increased (1.2% [0.8–1.5%] vs. 2.0% [1.4–2.6%], p = 0.027) and the VAVD percentage was decreased (2.0% [1.6–2.2%] vs. 1.2% [0.9–1.3%], p
The objective of this study was to determine if an ultra-sound examination, when performed in the... more The objective of this study was to determine if an ultra-sound examination, when performed in the third trimester immediately preceding delivery, is useful in predicting outcome in infants with a myelomeningocele. A retrospective review was undertaken of prenatal ultrasound records and pediatric outcome data on fetuses with isolated myelomeningocele referred to our institution after 28 weeks' gestation during a three-year period. Macrocephaly proved to be the one antenatal ultrasound finding that most correlated with later poor outcomes in infants with myelomeningocele. Macrocephalic fetuses had a longer mean hospital stay after birth and were more likely to have significant respiratory and feeding difficulties. No fetus with macrocephaly had a normal mental score, and all had severe motor deficits on later follow-up testing. The ultrasound diagnosis of macrocephaly identified a group of fetuses with myelomeningocele, who were at highest risk of neonatal problems and development...
American Journal of Obstetrics and Gynecology, 1997
Ultrasound measurements of 15 fetuses with trisomy 21 detected during the 17th week of gestation ... more Ultrasound measurements of 15 fetuses with trisomy 21 detected during the 17th week of gestation were matched retrospectively to those of 45 normal controls. We compared nine standard ultrasound measurements of the fetal head, abdomen, and femur in these two groups. The fetuses with trisomy 21 had significantly shorter mean femur lengths, narrower occipitofrontal diameters, and increased biparietal diameter (BPD)/femur length and abdominal circumference/femur length ratios. An increased BPD/femur length ratio was the ultrasound finding that best predicted a fetus with Down syndrome. A BPD/femur length ratio of 1.80 or higher was 40% sensitive and 97.8% specific in predicting Down syndrome, and had a false-positive rate of only 2.2%. An increased second-trimester BPD/femur length ratio measured by ultrasound may prove beneficial as an additional screening test for Down syndrome.
Journal of Maternal-fetal & Neonatal Medicine, Aug 1, 2001
To determine how changes in eligibility criteria for early discharge affected quality and costs o... more To determine how changes in eligibility criteria for early discharge affected quality and costs of home nursing follow-up care for Medicaid patients. A nurse screened women delivering vaginally to determine eligibility for discharge at 24-47 h. Maternal criteria were a vaginal delivery, no serious medical problems, > or = 8 h after bilateral tubal ligation and, if 24 h postpartum, by 21.00 on day of discharge. Newborn criteria were 36 weeks' gestation or more, 2000 g or greater and a normal examination at 24 h of age. By 48 h after discharge, a nursing visit was ordered for each mother and newborn. Nursing consultations were tracked and later entered into a database linked to hospital financial data. Of 3133 vaginal deliveries occurring from 1 August 1997 to 31 January 1999, eligibility criteria allowed 1799 mothers (58%) and 1587 newborns (51%) to be discharged early. Medical problems were rarely detected at follow-up (1% mothers, 2% newborns). To perform the increased number of visits, more personnel were hired and home nursing costs rose 150%. Despite the increased staff and costs, 19 mothers (1%) and ten newborns (0.6%) were lost to follow-up and 25 mothers (1%) and 20 newborns (1%) were visited beyond 72 h after discharge. Liberal changes in maternal and newborn eligibility criteria did not adversely affect the quality of home nursing follow-up care following early discharge. For hospitals performing a large number of early discharges, follow-up care using only a home nursing visit may be too expensive and difficult to organize. Alternative follow-up plans, such as clinic visits or phone calls, may also need to be utilized.
American Journal of Obstetrics and Gynecology, 1991
The degree of umbilical arterial acidemia associated with immediate newborn morbidity has not bee... more The degree of umbilical arterial acidemia associated with immediate newborn morbidity has not been determined. Therefore we compared 358 term infants with umbilical artery acidemia (pH less than 7.20) with 358 term, nonacidotic matched control infants, to evaluate immediate neonatal complications in both groups. Nonacidotic was defined as an umbilical artery pH greater than or equal to 7.20. Complications included seizures, persistent hypotonia, and/or signs of end-organ damage such as renal or cardiac dysfunction. None of the 693 newborns with an umbilical artery pH greater than or equal to 7.00 had such complications. Two of 23 infants with an umbilical artery pH less than 7.00 had sequelae related to intrapartum asphyxia. In these two infants the umbilical artery pH was less than 7.00, the 1-minute and 5-minute Apgar scores were less than or equal to 3 and the acidemia was metabolic in nature.
American Journal of Obstetrics and Gynecology, 1989
Perinatal outcomes were analyzed in 848 high-risk pregnancies managed with a prospective weekly c... more Perinatal outcomes were analyzed in 848 high-risk pregnancies managed with a prospective weekly contraction stress testing protocol. In 615 patients the last test was performed by a nipple stimulation protocol whereas 233 patients had sufficient spontaneous contractions for performance of the test. All patients were either delivered of their infants or admitted for delivery within 7 days of the last test. The results of the last test were compared to various perinatal outcome parameters. There was no significant difference in perinatal outcomes between the two groups.
... Invasive Techniques for Fetal Evaluation and Treatment CYNTHIA G. BRUMFIELD, MD, and M. WENDY... more ... Invasive Techniques for Fetal Evaluation and Treatment CYNTHIA G. BRUMFIELD, MD, and M. WENDY ATKINSON, MD University of Alabama School of Medicine Birmingham, Alabama The trend ¡n the 1990s has been to use in-vasive techniques that allow prenatal di ...
... Invasive Techniques for Fetal Evaluation and Treatment CYNTHIA G. BRUMFIELD, MD, and M. WENDY... more ... Invasive Techniques for Fetal Evaluation and Treatment CYNTHIA G. BRUMFIELD, MD, and M. WENDY ATKINSON, MD University of Alabama School of Medicine Birmingham, Alabama The trend ¡n the 1990s has been to use in-vasive techniques that allow prenatal di ...
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