Publications by authors named "Howard K Kaufman"

2 Publications

  • Page 1 of 1

Nasopharyngeal carriage of methicillin-resistant Staphylococcus aureus: incidence and outcomes in pregnant women.

J Am Osteopath Assoc 2011 Jun;111(6):389-95

St Alexius Medical Center in Hoffman Estates, Illinois, USA.

Context: Infections due to methicillin-resistant Staphylococcus aureus (MRSA), especially community-acquired MRSA, have increased substantially during the past decade. The optimal protocols for screening patients, particularly during pregnancy, have not been determined.

Objectives: To determine the incidence of nasopharyngeal carriage of MRSA in pregnancy as well as whether there was a correlation between positive maternal screening test results and an increased risk of adverse maternal or neonatal outcomes, including neonatal carriage of MRSA.

Methods: The authors conducted a retrospective review of medical records from Rockford Memorial Hospital in Illinois between December 14, 2007, and July 14, 2008. All patients, who were pregnant women admitted to the hospital, and their newborns had nasopharyngeal swabs collected for MRSA detection. Numbers of neonatal intensive care unit admissions and results of neonatal sepsis evaluations were noted. Maternal postoperative infections and anesthesia-related complications were noted and compared to those of control patients. Apgar scores at birth were compared with those of a control group.

Results: Of 1,045 patients who were tested, 31 patients (2.9%) had positive results for MRSA. By comparison, the hospital-wide MRSA prevalence for this period was 7.9% (569 positive results of 7,206 patients tested). This prevalence was substantially higher than that noted for the study population. Twenty-three of the 31 patients (74%) delivered at our institution and thus comprised the study group. A control group comprised 46 patients with negative results of MRSA screening. No positive results of neonatal MRSA screening tests were noted in either group, and no statistically significant difference between the 2 groups existed in 5-minute Apgar scores, neonatal intensive care unit admissions, or neonatal sepsis evaluations. Positive MRSA-screening test results were associated with a statistically significant decrease in the provision of regional anesthesia to the pregnant women (P=.05).

Conclusion: Maternal nasopharyngeal carriage of MRSA was not associated with adverse maternal or neonatal outcomes, including neonatal MRSA carriage. Regional anesthesia was provided less frequently to MRSA-positive individuals. Further studies in larger groups of patients are needed to help determine the optimal management of MRSA-positive patients during pregnancy.
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June 2011

Natural history of twin gestation complicated by in utero fetal demise: associations of chorionicity, prematurity, and maternal morbidity.

Fetal Diagn Ther 2003 Nov-Dec;18(6):442-6

Maternal-Fetal Medicine, Rockford Memorial Hospital, Rockford, IL 61103, USA.

Objectives: To evaluate the pathophysiology by which the in utero death of 1 twin might increase morbidity to its co-twin survivor and its mother. To assess previously reported risks for maternal disseminated intravascular coagulopathy, peripartal hemorrhage, retained placenta and infection, as well as the fetal risk of prematurity.

Material And Methods: A retrospective analysis of the natural history of twin pregnancies from three institutions was performed. A total of 1,989 cases of twin pregnancy were identified, Wayne State University included 1,266 cases from 1984 to 1993; Madigan Army Medical Center 136 cases, 1995-2000, and Rockford Regional Perinatal Center, 587 cases, 1990-2000. The findings were classified by the presence or absence of fetal death in utero (IUFD) as follows: both IUFD (0/0); 1 IUFD (0/+), and both live born (+/+). A case-control study was performed on the subgroup of patients for whom complete records as to chorionicity, etc., were available.

Results: Of the 1,989 cases reviewed there were 49 both IUFD (0/0), 61 complicated by 1 IUFD (0/+), and 1,879 with both live born (+/+). The overall fetal death rate for this twin cohort was 55/1,000. IUFD of 1 or both twins was related to an increased risk of previable delivery 55% in 0/0, and 28% in 0/+ versus 4% for +/+ with p<0.001. IUFD also was associated with early preterm delivery (mean gestational age at delivery of 23 (0/0) and 30 (0/+) versus 35 (+/+) weeks). Chorionicity as well as maternal risks were examined in the case-control study (24 (0/0), 43 (0/+), 134 (+/+)) with the following results: monochorionic placentation was more likely in pregnancies complicated by IUFD (54% (0/0), 51% (0/+) versus 14% (+/+); p<0.001). Retained placenta, requiring dilation and curettage, occurred more frequently when both twins died in utero, but may be related to the earlier gestational age at delivery.

Discussion: Independent of retained placenta, there is no difference in the maternal risks for hemorrhage, abruption, coagulopathy or infection between groups. Immaturity at delivery and monochorionicity are more common in pregnancies complicated by fetal demise. Neonatal morbidity and developmental outcome will be the focus of a longitudinal study comparing cotwin survivors to twins matched for chorionicity and gestational age at delivery.
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http://dx.doi.org/10.1159/000073140DOI Listing
June 2004