Maurice K. Eggleston

Use of surgical pass trays to reduce intraoperative glove perforations

This randomized prospective study evaluated the surgical pass tray to reduce intraoperative glove perforation during cesarean delivery. Surgical team members were assigned to employ normal instrument pass techniques or surgical pass tray during all cesarean deliveries. Surgical team members were asked to record their surgical role and level of training. Gloves were collected and tested using standard hydrosufflation techniques. Additional variables studied were patient weight, surgical indication, estimated blood loss, and length of surgery. A total of 192 cesarean sections were performed during the study period, for which 165 were studied. Data collection was considered adequate in 156 cases. Four hundred forty-four pairs of gloves were collected and tested, including 38 double glove sets. Seventy-eight perforations were noted in 444 pairs of gloves, including 11 in the double glove sets. Among surgeries assigned to use pass trays, 221 pairs of gloves were obtained with 42 (19.0%) perforations noted. Surgeries assigned to the control group contributed 223 glove sets of which 36 (16.1%) perforations were noted (P = .5). There were no complete perforations noted in the total of double glove sets. The frequency of glove perforations is not reduced by using surgical pass trays. While there is no demonstrated benefit in using pass trays there appears to be little adverse impact.

Streptococcus Viridans Intra-amniotic Infection Associated with Antecedent Cunnilingus

Introduction of bacteria into the amniotic cavity has been associated with oral sex through an ascending infectious route. Previous reports have implicated both Capnocytophaga and Fusobacterium nucleatum via this process. We report a case of Streptococcus viridans intra‐amniotic infection occurring at 25 weeks’gestation. Patient questioning revealed a close temporal relationship between the onset of symptoms and previous episodes of cunnilingus. The diagnosis of subclinical bacterial colonization of the amniotic fluid should be considered in patients presenting with preterm labour and no apparent aetiology. A history of recent cunnilingus may be associated with the presence of Streptococcus viridans in the amniotic fluid.

Pregnancy complicated by multiple endocrine neoplasia type IIA (Sipple's syndrome)

A patient with preexisting multiple endocrine neoplasia type IIA had normal 24-hour urinary metanephrine and vanillylmandelic acid excretions before and during pregnancy. After a benign prenatal course, the patient had a term spontaneous vaginal delivery. Multiple endocrine neoplasia type IIA antedating pregnancy may be associated with a normal obstetric outcome in the absence of a phenochromocytoma.

Adjunctive color Doppler ultrasonography in second-trimester transabdominal amnioinfusion

Transabdominal amnioinfusion improves the diagnostic accuracy of ultrasonography in pregnancies complicated by second-trimester oligohydramnios. Needle localization may be difficult because of patient obesity or the absence of an acoustic window. The two cases presented demonstrate that color Doppler imaging facilitates amnioinfusion by visualizing the injection jet of free-flowing infusate, confirming intraamniotic needle placement.

Prenatal ultrasonographic findings associated with Jacobsen syndrome

Jacobsen syndrome results from deletion of the distal long arm of chromosome 11.1 Reported cases have been identified after chromosomal analysis of dysmorphic or mentally retarded persons.U We report the sonographic features of an affected fetus that led to prenatal cytogenetic diagnosis. One parent was newly identified as a carrier of a balanced translocation and the source of the aberrant chromosome.

Intrapartum fetal atrial bigeminy--diagnostic and therapeutic role of the fetal scalp stimulation test.

Concern for fetal hypoxia often leads to cesarean delivery when persistent fetal bradycardia is identified. A fetus with premature atrial contractions had a prolonged second-stage heart rate of 80 beats/min. Intrapartum echocardiography and electronic fetal heart rate monitoring distinguished bradycardia caused by blocked atrial bigeminy from hypoxic bradycardia. The fetal scalp stimulation test documented normal acid-base balance and normalized the ventricular rate, avoiding cesarean delivery. (AM J OBSTET GYNECOL 1996;174:1649-50.).