Norman Meyer

Urinary dipstick protein: A poor predictor of absent or severe proteinuria☆☆☆*

OBJECTIVE Our purpose was to compare urinary protein dipstick values with standard 24-hour urinary protein excretion in women with hypertension in pregnancy. STUDY DESIGN Urinary protein dipstick determinations and concurrent 24-hour urinary protein excretion measurements were compared by review of 300 urine samples obtained from women with hypertension in pregnancy. RESULTS One hundred twenty-three samples had negative to trace protein on dipstick on two occasions at least 6 hours apart. Eight-one (66%) of these patients had significant proteinuria (> or = 300 mg per 24 hours). Seventy-six samples revealed 3+ to 4+ protein on dipstick in at least two samples. Of these, 27 (36%) had heavy proteinuria (> or = 5 gm per 24 hours), and 42 (55%) had nephrotic range proteinuria of > or = 3.5 gm per 24 hours. One hundred one patients had urine dipstick values of 1+ to 2+, of whom 89 (88%) had significant proteinuria. CONCLUSION Urinary protein dipstick values > or = 1+ have a positive predictive value of 92% (162/177) for predicting > or = 300 mg per 24 hours. In contrast, a dipstick of negative to trace should not be used to rule out significant proteinuria because its negative predictive value is only 34% (42/123) in hypertensive patients. Moreover, urine dipstick values of 3+ to 4+ should not be used to diagnose severe preeclampsia because their positive predictive value is only 36% (27/76).

A randomized trial of postoperative wound irrigation with local anesthetic for pain after cesarean delivery

OBJECTIVE The purpose of this study was to investigate the efficacy of continuous local anesthetic infusion system for pain control after cesarean delivery. STUDY DESIGN This was a randomized prospective double-blind study. Patients who underwent cesarean delivery had a pain system implanted subcutaneously after closure of the fascia. Patients were randomized to receive an infusion of either 0.25% bupivacaine (n = 20) or normal saline solution (n = 16) into the wound for 48 hours. Postoperative pain (determined with a visual analog scale) and postoperative morphine use were assessed at 12, 24, and 48 hours. RESULTS There were no significant differences in patient demographics or visual analog pain scores at any time interval between the bupivacaine versus the placebo group. However, narcotic requirements to produce this amount of pain relief were significantly less in patients who received bupivacaine infusion rather than normal saline solution at all time intervals. CONCLUSION The continuous local anesthetic infusion system appears to be effective in reducing postoperative morphine use after cesarean delivery.

Cefazolin versus cefazolin plus metronidazole for Antibiotic prophylaxis at cesarean section

Background Although prophylactic antibiotic medications have been shown to reduce the incidence of postoperative infectious morbidity after cesarean delivery, the most effective regimens have not been established. The purpose of this investigation was to compare the efficacy and costs of prophylaxis with cefazolin alone with cefazolin plus metronidazole. Methods Women undergoing cesarean delivery were randomized to prophylaxis with 2 g cefazolin (n = 81) or 1 g cefazolin plus 500 mg metronidazole (n = 79). Postoperative infectious morbidity and the duration of hospitalization in the two groups were compared. Results Thirty-seven (23%) of 160 patients developed endomyometritis. There was a significant reduction in the number of postoperative infections (14 versus 32%) and hospital days (3.12 versus 4.46) with cefazolin and metronidazole prophylaxis (P = 0.0064 versus P = 0.014) compared with cefazolin alone. The estimated antibiotic prophylaxis cost per person was less with cefazolin and metronidazole than with cefazolin alone (

Adhesion formation associated with the use of absorbable staples in comparison to other types of peritoneal injury

9.12 versus

Yolk sac on transvaginal ultrasound as a prognostic indicator in the treatment of ectopic pregnancy with single-dose methotrexate

26.73). Conclusion Antibiotic prophylaxis with metronidazole and cefazolin results in fewer postoperative infections, decreased duration of hospitalization, and lower medication cost than cefazolin alone.

Positive serum screening for fetal Down syndrome does not predict adverse pregnancy outcome in absence of fetal aneuploidy.

Adhesion formation was assessed after inducing peritoneal injury with absorbable staples, absorbable suture, surgical excision or thermal injury. In addition, adhesion formation was assessed in the presence of Hyskon. Absorbable staples were associated with increased adhesion formation when compared to the other methods of injury. Hyskon appears to significantly reduce the formation of peritoneal adhesions at sites of peritoneal suturing, excision, and thermal injury, but did not reduce adhesion formation in the area of stapling.

Pregnancy Complicated by Cardiac Disease: Maternal and Perinatal Outcome

OBJECTIVE To determine whether yolk sac on transvaginal ultrasound was an independent predictor for single-dose methotrexate failure for tubal ectopic pregnancies. STUDY DESIGN Seven hundred sixty-six consecutive methotrexate-treated ectopic pregnancy patients were reviewed. After excluding 25 oral and 97 multidose methotrexate patients, 18 cornual, 4 cervical pregnancies, and 63 patients with ectopic cardiac activity, 559 study patients remained. Variables studied included age, gravidity, parity, previous ectopic pregnancy, serum human chorionic gonadotropin and progesterone levels, ectopic size, ectopic volume, body surface area, and yolk sac presence. RESULTS Sixteen of 73 (21.9%) patients with yolk sac failed treatment vs 36 of 486 (7.4%) patients without yolk sac (P = .0003). Other significant variables on single factor analysis were previous ectopic (P = .0005), human chorionic gonadotropin (P < .0001), and progesterone (P = .003). Only previous ectopic and human chorionic gonadotropin remained significant on logistic regression analysis. CONCLUSION The presence of a yolk sac, although a risk factor for failure of single-dose methotrexate in treatment of tubal ectopic pregnancy, is not an independent predictor.

Cefazolin versus cefazolin/ metronidazole for antibiotic prophylaxis at cesarean delivery

OBJECTIVE: The purpose of this study was to determine whether false-positive maternal serum screening for fetal Down syndrome is predictive of poor pregnancy outcome. METHODS: The pregnancy outcomes of 99 women having positive serum screening for fetal Down syndrome (study group)—based upon maternal serum alpha-fetoprotein (MSAFP), un conjugated estriol (uE3), hCG, and maternal age—were compared to the outcomes of matched control patients having negative serum screening results (control group). The outcome indices analyzed were fetal death, intrauterine growth retardation (IUGR), preeclampsia, and fetal anomalies. RESULTS: Between the study group and the control group, there were no statistically significant differences in pregnancy outcome with respect to fetal death, IUGR, preeclampsia, or fetal anom alies. CONCLUSIONS: Our findings demonstrate no apparent increase in the adverse perinatal out comes analyzed in women having unexplained positive serum screening for fetal Down syndrome. Although further investigation is needed, these results provide no evidence to support increased antepartum surveillance in such patients. (J Soc Gynecol Invest 1994;1:55-8)

A histologic evaluation of peritoneal injury and repair: Implications for adhesion formation

We report maternal and perinatal outcome in pregnancies complicated by maternal cardiac disease. A retrospective review of 54 women with cardiac disease, managed through 71 pregnancies from February 1981, through July 1991, was conducted. Tricuspid atresia and pulmonary hypertension were associated with a 50% maternal mortality rate and a 67% incidence of intrauterine growth retardation. Cardiomyopathy was associated with prematurity and low birthweight. Atrial or ventricular septal defects and stenotic lesions of the outflow tracts were generally not associated with adverse maternal or perinatal outcome. Women with previous myocardial infarction, corrected tetralogy of Fallot, aortic or mitral insufficiency, and mitral valve prolapse generally tolerated pergnancy, labor, and delivery without adverse sequelae in this review. Although peripartum cardiomyopathy was associated with low birthweight, pregnancies were successfully managed with intensive monitoring. Tricuspid atresia and pulmonary hypertension r...

Comparison of multidose and single-dose methotrexate protocols for the treatment of ectopic pregnancy

Abstract Objective: To evaluate the efficacy and costs of cefazolin, compared with the broader spectrum and less expensive regimen of cefazolin plus metronidazole when used for prophylaxis at cesarean delivery. Methods: Women undergoing cesarean delivery who did not demonstrate exclusion criteria were randomly selected to receive either cefazolin, 2 g, (average wholesale price