Journal of perinatology : official journal of the California Perinatal Association
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Patients with multiple gestations or recalcitrant preterm labor are at very high risk for preterm birth in spite of adequate tocolysis. Subcutaneous infusion of tocolytic medications on an ambulatory basis has been used in several small series and has effectively prolonged gestation. This retrospective analysis presents data from 992 patients at very high risk for preterm delivery who were prescribed this therapy. ⋯ The therapy extended the gestation a mean of 38 +/- 23 days and average gestational age at delivery was 36.3 +/- 2.6 weeks with a mean birthweight of 2759 +/- 681 g. This study, utilizing a large number of patients, confirms earlier reports that for women at very high risk for preterm delivery subcutaneous tocolytic infusion therapy is beneficial. Prospective studies evaluating such treatment on a randomized basis are indicated.
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Manual ventilation of neonates suffering from respiratory distress is frequently performed in the hospital setting. The authors hypothesized that without manometer feedback present, experienced neonatal intensive care therapists cannot accurately estimate ventilating pressures. We also speculated that with rate feedback present, this same group could match a given ventilatory rate. ⋯ Rate accuracy was good with the higher rate, but there was some statistical deviation from the given lower rate for both models. We conclude that in the presence of a cycling ventilator set at the desired rate, this group of therapists could replicate the cycling rate. However, without a means for feedback of ventilating pressures, dictated pressures could not be matched.
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To evaluate the effect of body position on oxygenation and ventilation in neonates over a prolonged period, infants with respiratory disease were followed by transcutaneous (tc) monitoring for alterations in tcPO2 and tcPCO2 with position changes. In 14 studies of seven patients, prone positioning was compared with supine positioning over a 6-hour interval. All patients were premature, were receiving supplemental oxygen, and had respiratory disease secondary to prematurity. ⋯ No significant change in tcPCO2 was detected. Infants were also found to spend a greater proportion of time sleeping when prone (75% +/- 13% vs 33% +/- 14%; P less than .05). These finding suggest that improvement in oxygenation with the prone position is stable over an extended period in the sick preterm infant.
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A retrospective review of 33 patients who underwent transvaginal cervical cerclage for the treatment of an incompetent cervix from June 1984 through July 1987 was conducted. A total of 38 transvaginal cerclages were placed. For the purposes of comparison, the patients were divided into three groups according to gestational age at the time of cerclage: group 1 less than or equal to 13 weeks; group 2 greater than 13 weeks, but less than 18 weeks; group 3 greater than or equal to 18 weeks. ⋯ None of these, however, reached the level of statistical significance. Estimated blood loss, obstetric complications, mean birthweight, and mean gestational age at delivery were not statistically different for the three study groups. The above data are discussed and support given for the safety and efficacy of cervical cerclage placement in early pregnancy when compared with the more standard recommendations of placement at from 14 to 17 weeks' gestational age.
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Comparative Study Clinical Trial Controlled Clinical Trial
Pain control after cesarean birth. Efficacy of patient-controlled analgesia vs traditional therapy (IM morphine).
A clinical trial compared the efficacy of a mechanical device to deliver patient-controlled analgesia (PCA) (n = 25) with intramuscularly administered morphine (n = 17) for postcesarean pain management. Hypotheses were: (1) patient-controlled administration of narcotics will be superior (increased satisfaction, reduced pain, decreased sedation, increased ambulation, decreased length of stay), and (2) functional vital capacity will increase post-operatively with PCA. No differences in demographic variables were identified (P = less than or equal to .001). ⋯ No differences in vital capacity were identified. The hypothesis related to the superiority of PCA was accepted, while the association between PCA and increased vital capacity was not supported. The use of mechanical PCA devices provides an effective and safe means of managing postcesarean pain.