Patti Jayne Ross

Leukocyte function in healthy neonates following vaginal and cesarean section deliveries.

Oxidative metabolic activities of polymorphonuclear leukocytes from cord blood of 15 full-term infants delivered by cesarean section without labor, five infants delivered by cesarean section with labor, and 15 infants delivered vaginally, as well as 35 healthy adult control subjects, were evaluated. The absolute polymorphonuclear leukocyte counts of cord blood from infants delivered vaginally and by cesarean section with labor were significantly higher when compared to cord blood APCs from infants delivered by cesarean section without labor and healthy adult control APCs. Zymosan-stimulated oxygen consumption, hexose monophosphate shunt activity, and quantitative nitroblue tetrazolium dye reduction were significantly lower in cord blood PMNLs from infants delivered vaginally and by cesarean section with labor than in cord blood PMNLs from infants delivered vaginally and by cesarean section with labor than in cord blood PMNLs from infants delivered by cesarean section without labor or control PMNLs. Metabolic activity of PMNLs from healthy adults and infants born by cesarean section without labor did not differ significantly. This study indicates that the function of PMNLs isolated from cord blood varies with the method of delivery. These observations may explain previous discrepancies in the literature as well as the propensity of certain neonates to infection.

Premature termination of nursing secondary to Serratia marcescens breast pump contamination.

BACKGROUND: Serratia marcescens, a known pathogen associated with postpartum mastitis, may be identified by its characteristic pigmentation. CASE: A 36-year-old P0102 woman presented postpartum and said that her breast pump tubing had turned bright pink. S marcescens was isolated, indicating colonization. She was started on antibiotics. After viewing an Internet report in which a patient nearly died from a Serratia infection, she immediately stopped breastfeeding. CONCLUSION: Serratia colonization may be noted before the development of overt infection. Because this pathogen can be associated with mastitis, physicians should be ready to treat and should encourage patients to continue nursing after clearance of the organism. Exposure to sensational Internet reports may make treatment recommendations difficult.

Autologous Transfusion in Obstetrics and Gynecology

Two cases are presented which illustrate the use of autologous blood transfusion for elective surgery in obstetrics and gynecology. The advantages and disadvantages are described and review of the pertinent literature over the past century is summarized.

Diagnosis and Management of Unilateral Third-Trimester Hydrocephalus: A Multidisciplinary Approach

Hydrocephalus is a pathological increase in cerebrospinal fluid. This condition may occur when production exceeds absorption. Prior reports describe prenatally diagnosed unilateral hydrocephalus with varying outcomes depending on underlying brain abnormalities, karyotypic abnormalities, and infection. Prenatal ultrasound is a valuable diagnostic tool in the identification of hydrocephalus. Obstacles such as near-field artifact, additional intracranial abnormalities, fetal positioning, and maternal habitus often make the diagnosis difficult. Antenatal diagnosis is important for emotional preparation and for transfer to a tertiary center where appropriate facilities and subspecialists are available. We present a case of right-sided hydrocephalus and mild left-sided ventriculomegaly diagnosed in the third trimester. Fetal brain magnetic resonance imaging confirmed the sonographic diagnosis, which allowed the multidisciplinary fetal team to meet with the patient and formulate a management plan prior to delivery.

The effect of a clinical problem-solving curriculum on medical student examination performance

Abstract The objective of this study was to determine whether a clinical problem-solving curriculum during the third-year obstetrics/gynecology clerkship would affect National Board Medical Examiners (NBME) subject test performance. During the 1999–2000 academic year, 184 third-year medical students rotated through the obstetrics/gynecology clerkship. They were assigned to one of three clinical training sites. Thirty-six students were assigned to a community hospital, whereas the remaining 148 students were assigned to either a private university hospital or a county hospital. In July 1, 1999, the community hospital adopted a problem-solving curriculum designed to stimulate a better understanding of underlying mechanisms of disease rather than the memorization of facts. Each morning, an attending physician spent 20 minutes on interactive conferences. At the end of the clerkship, each student took the NBME subject test for obstetrics and gynecology. A test score of 80 was chosen as the honors level. Students who participated in the problem-solving curriculum scored significantly higher than did those taught by the traditional program, based on median NBME subject test scores, 79.0 (interquartile range, 74.0–82.0) versus 71.0 (interquartile range, 65.0–76.5), P

Utilization of fetal scalp pH and direct fetal electrocardiogram in the intrapartum management of congenital complete heart block in an adolescent primigravida

This case report documents the antepartum detection of congenital complete heart block in the fetus of an adolescent primigravida. Management utilizing direct fetal electrocardiogram and fetal scalp sampling is discussed. The report illustrates the appropriate management of a fetus in utero with congenital complete heart block and suggests procedures to be taken prior to delivery in the expectant management of a neonate with a congenital conduction defect.

Leukocyte function in healthy neonates following vaginal and cesarean section deliveries

Abstracts Impaired neonatal leukocyte function has been demonstrated by several investigators. Previous studies have reported abnormal oxidative metabolic and functional activities of polymorphonuclear leukocytes from infected neonates, as well as from healthy newborn infants. The results of these studies are discordant, and the potential role of the method of delivery on neutrophil function of healthy, uninfected newborn infants has not been studied. The present study was designed to evaluate the effect of various methods of delivery on neutrophil function of the newborn. Thirty-five newborn infants were included in the study. Cord blood was obtained from 15 (38 to 43 weeks of gestation) delivered vaginally after 11 hours of labor, from 5 (40 to 43 weeks of gestation) delivered by cesarean section after 10 to 14 hours of labor, and from 15 (38 to 41 weeks of gestation) delivered by cesarean section without labor. Sixty milliliters of blood were obtained also from 12 postpartum women one hour after delivery to assess the effect of delivery method on maternal cell function. Each time neonatal cord blood or maternal blood was obtained, leukocytes were isolated from 80 ml of venous blood from each of 35 healthy adult volunteers who were used as control subjects. There were no significant differences in maternal age or duration of gestation among the three groups. The mean duration of labor was 7.5 hours in the vaginal group and 12 hours in the cesarean section group with labor. White blood cell function was assessed immediately after blood was obtained and the polymorphonuclear leukocytes were separated. The cell counts x 103 per mm3 of neonates delivered by cesarean section without labor (8.6 ± 1.0) and of adult control subjects (7.0 ± 0.4) were significantly (P < 0.01) lower than those of neonates delivered by cesarean section with labor (14.8 ± 0.9) or vaginally (14.2 ± 1.0) (Fig. 1). The absolute polymorphonuclear leukocyte counts of neonates delivered by cesar ean section without labor (3.5 ± 0.8) and of adult control subjects (4.0 ± 0.4) were significantly (P < 0.001) lower than those of neonates delivered vaginally (7.2 ± 0.6) or by cesarean section with labor (7.4 ± 0.5). The resting oxygen consumption of polymorphonuclear leukocytes isolated from neonates delivered vaginally or by cesarean section with labor was lower than that of polymorphonuclear leukocytes from neonates delivered by cesarean section without labor or from adult control subjects. The mean stimulated oxygen consumption of polymorphonuclear leukocytes from neonates delivered by cesarean section with labor (7.2 ± 0.9) or vaginally (7.6 ± 1.1) was significantly (P < 0.005 and P < 0.001, respectively) lower than that from neonates delivered by cesarean section without labor (16.5 ± 1.6) and from adult control subjects (15.2 ± 1.0). In the resting state, hexose monophosphate shunt levels of the polymorphonuclear leukocytes from neonates delivered vaginally or by cesarean section with labor were not significantly different from levels of neonates delivered by cesarean section without labor or from those of control subjects. The unstimulated dye reduction levels were similar in all groups. The reduction of nitroblue tetrazolium dye by zymosan-stimulated polymorphonuclear leukocytes isolated from neonates delivered by cesarean section with labor (0.353 ± 0.03) or vaginally was significantly (P <0.05) lower than levels of polymorphonuclear leukocytes isolated from cord blood of neonates delivered by cesarean section without labor (0.416 ± 0.01) and from those of control subjects (0.417 ±0.01). There were no significant differences among the groups of postpartum women with regard to zymosan-stimulated or resting hexose monophosphate shunt activity, nitroblue tetrozolium dye reduction, or oxygen consumption when compared to adult control subjects.

914 COMPARISON OF HUMAN NEONATAL POLYMORPHO-NUCLEAR LEUKOCYTE (PMNL) AND MONOCYTE (MN) ACTIVITY FOLLOWING VAGINAL (V) AND C-SECTION (C-S) DELIVERIES

Oxidative metabolic and functional activities of Ficoll-Hypaque separated PMNL and MN from 35 cord blood specimens were evaluated: 15 term infants delivered by C-S without labor, 5 C-S with labor and 15 V. Healthy adults were controls. Absolute PMNL counts (× 103/mm3) of V and C-S with labor cord bloods were significantly higher (7.1±0.9) when compared to C-S without labor cord bloods (3.5±0.4, p<0.01) and controls (4.0 ±0.3, p<0.001). Stimulated 02 consumption (μ1 02/5 × 106 PMNL/15 min) was significantly lower in V and C-S with labor cord PMNL (7.6±1.1) than in the C-S without labor cord PMNL (16.5±1.6, p<0.005) or control PMNL (15.2±1.0, p<0.001). Zymosan stimulated HMPS activity (CPM/106 PMNL) was significantly lower in V and C-S with labor cord PMNL (1,631±171) than in the C-S without labor cord PMNL (2,613±131, p<.05) and control PMNL (2,254±132, p<0.05). Quantitative NBT dye reduction (OD 515 nm/15 min/2.5 × 106 PMNL) was lower in V and C-S with labor cord PMNL (.358 ±.04) when compared to C-S without labor cord PMNL (.416±.05) or control (.417±.05). Metabolic activity of PMNL did not differ significantly between controls and C-S without labor. Using 3H methyl thymidine labeled S. aureus as the test organism, bacteria were more sluggishly internalized by V or C-S than control PMNL. Stimulated HMPS activity was lower in V cord MN (832±84) compared to C-S without labor cord MN (1291±31) or control (1053±51). These studies indicated that oxidative metabolic and functional activities of neonatal PMNL differ significantly between V, C-S with labor and C-S without labor.