Obstetrics and gynecology
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Obstetrics and gynecology · Apr 1988
Outpatient treatment of pelvic inflammatory disease with cefoxitin and doxycycline.
Sixty-three women with abdominal pain and adnexal tenderness were enrolled in a study of ambulatory treatment of acute pelvic inflammatory disease. Treatment consisted of 2 g of cefoxitin intramuscularly and 1 g of probenecid orally, followed by doxycycline, 100 mg by mouth twice daily for 14 days. Patients were stratified into groups indicating whether pelvic inflammatory disease was probable, possible, or unlikely, based upon endometrial biopsy and clinical criteria. ⋯ Of 22 patients initially infected with C trachomatis and/or N gonorrhoeae, 20 were culture-negative for both organisms after therapy. Both microbiologic failures had been reexposed. This study suggests that the combination of cefoxitin and doxycycline is effective for ambulatory treatment of pelvic inflammatory disease.
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Obstetrics and gynecology · Apr 1988
The natural history of preterm ruptured membranes: what to expect of expectant management.
We asked the question: What can be expected of expectant management in preterm ruptured membranes? Our findings showed that ruptured membranes during the first half of the third trimester occurred in only 1.7% (N = 298) of 17,877 pregnancies delivered at our institution, yet accounted for 20% of the total perinatal deaths during the study period. Expectant management was seldom successful; only 20 (7%) of pregnancies with preterm ruptured membranes did not begin labor within 48 hours. The condition of preterm ruptured membranes was also frequently associated with other obstetric complications such as twins, breech presentation, chorioamnionitis, and fetal heart rate decelerations in labor. We conclude that preterm ruptured membranes is an uncommon but complex obstetric problem that remains largely unsolved.
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To determine the impact of routine naso-oropharyngeal DeLee and tracheal suction on the prevention of meconium aspiration syndrome, we compared 755 infants with meconium-stained fluid, born during a 12-month period (1983), with a similar group of 742 infants born in a previous year (1975) when these suctioning techniques were not routinely used. Morbidity and mortality data from meconium aspiration syndrome in 103 infants, using combined DeLee and tracheal suction during a five-year period (1979-1983), were also analyzed retrospectively. ⋯ Even though significant morbidity remained associated with meconium aspiration in both periods studied, a drastic reduction occurred in neonatal mortality, from 46%, in 1975 to 12.5% in 1983, which was probably aided by major advances in perinatal care and supports routine prophylactic suctioning of meconium at birth. From these findings, we suggest that meconium aspiration syndrome is predominantly an intrauterine event secondary to fetal distress, and that DeLee and tracheal suctioning reduce only its severity.
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Obstetrics and gynecology · Mar 1988
Case ReportsThe benefit of cesarean section in acute myocardial infarction complicated by premature labor.
A 42-year-old woman with no known risk factors had an acute myocardial infarction at 32 weeks' gestation and went into premature labor. She required invasive hemodynamic monitoring and inotropic support. ⋯ The concept of the stunned myocardium is used to explain this finding and to justify early cesarean section. Another complication of her infarction, left ventricular thrombosis, has not previously been described in pregnancy.
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Anaphylaxis is a relatively uncommon event in pregnancy that can have serious implications for both mother and fetus. A case is presented of anaphylaxis to intravenous (IV) ampicillin given during labor, and the pertinent literature is reviewed. ⋯ Fetal outcome was good, presumably as a result of prompt delivery near term. The management of anaphylaxis in pregnancy is reviewed.