Jose L. Gonzalez

The Effects of Amnioinfused Solutions for Meconium-Stained Amniotic Fluid on Neonatal Plasma Electrolyte Concentrations and pH

OBJECTIVE: To determine if amnioinfused normal saline or lactated Ringers solution in cases of meconium-stained amniotic fluid is associated with significant changes on neonatal plasma electrolyte concentrations or pH.STUDY DESIGN: This was a prospective randomized study using normal saline or lactated Ringers solution for amnioinfusion in women with thick meconium in the amniotic fluid. The control group was composed of women with clear amniotic fluid not receiving amnioinfusion. Cord blood arterial sampling was analyzed for sodium, potassium, and chloride plasma concentrations and pH. The sample sizes allowed for an α of 0.05 and power of 0.80.RESULTS: We evaluated 61 cases (20 normal saline solution, 20 lactated Ringers solution, and 21 control). No significant differences in cord blood arterial plasma concentrations of sodium (p=0.43), potassium (p=0.21), chloride (p=0.68), and pH (p=0.11) were noted.CONCLUSION: Use of normal saline or lactated Ringers solution for amnioinfusion in meconium-stained amniotic fluid is not associated with changes on neonatal plasma electrolyte concentrations or pH.

Comparison of induced versus spontaneous labor in twins

Objective: To compare intrapartum outcomes of women with twin gestations undergoing an induction of labor versus spontaneous labor. Study design: This retrospective investigation included women with twin gestations undergoing a trial of labor between January 1995 and June 200. Only diamniotic twins with twin A presenting as a vertex at 24–40 weeks of gestation and women with an unscarred uterus were included. Statistical analysis was done using McNemar’s test, paired t test, and Wilcoxon signed rank test for paired samples. Results: A total of 121 patients underwent a trial of labor that was either induced (n = 40) or spontaneous (n = 81). No differences between groups were observed for maternal age, race, parity, and gestational age. Labor that was spontaneous eventually required augmentation in all cases. Labor that was induced, rather than spontaneous with augmentation, required a higher maximum dose (17.3 versus 7.3 mU/min, P <0.01) and a longer duration (688 versus 239 minutes, P <0.01) of oxytocin. Interruption of oxytocin infusion was uncommon when labor was either induced or later augmented (15% versus 13%). A greater need for cesarean delivery of twin A was found in the induced labor group (30.0% versus 9.8%, P <0.05). Conclusion: Labor in twin gestations that was induced, rather than spontaneous, required more time and was associated with a higher cesarean delivery rate.

Adverse drug events of an inpatient obstetrical service

Abstract Objective: To determine the rate and the drugs most frequently associated with adverse drug events (ADEs) in our inpatient obstetric service. We also compared our rate of ADEs with the reported national benchmark. Methods: We analyzed all reported ADEs occurring in labor and delivery and in the antepartum and postpartum wards from February 1994 to June 2000. Medication errors were classified into three classes depending on the severity of morbidity caused (eg, prolonged hospitalization, death). The medication error rate in our obstetric service was compared with the Mecon Peer-X Benchmark rate, derived from class two and class three errors compiled from academic institutions. Results: There were 255 ADEs reported: 228 class one errors, 27 class two errors, and no class three errors. The error rate at our center was significantly lower than the Mecon Peer-X Benchmark rate (0.00006 versus 0.0001). The majority of cases considered class two errors involved excessive dosing of magnesium sulfate and oxytocin. All cases were managed appropriately, with none resulting in permanent sequelae. Conclusions: A system to track medication errors is useful to establish reliable error rates for comparison between institutions. Magnesium sulfate and oxytocin were the drugs most commonly associated with class two errors at our center.