Michael C Gordon

University of Utah, Salt Lake City, UT, United States

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Publications (6)19.19 Total impact

  • Source
    Bradley A Yoder, Michael C Gordon, William H Barth
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    ABSTRACT: To analyze the effect of gestational age, delivery mode, and maternal-fetal risk factors on rates of respiratory problems among infants born 34 or more weeks of gestation over a 9-year period. Retrospective analysis of prospectively collected maternal and neonatal data on all inborn births at 34 or more weeks of gestation at a single tertiary care center for the years 1990-1998. Specific diagnostic criteria were concurrently applied by a single investigator. Over the 9-year period, late-preterm births increased by 37%, whereas births at more than 40 weeks decreased by 39%, resulting in a decrease in median age at delivery from 40 weeks to 39 weeks (P<.001). Respiratory problems occurred in 705 term or late-preterm infants (4.9%), with clinically significant morbidity (respiratory distress syndrome, meconium aspiration syndrome, or pneumonia) least common at 39-40 weeks of gestation. Respiratory morbidity was greater among infants born by cesarean delivery or complicated vaginal delivery compared with uncomplicated cephalic vaginal delivery. The rate of respiratory morbidity did not change over time (1990-1992 1.3%, 1993-1995 1.5%, 1996-1998 1.4%, P=.746). The etiologic fraction for respiratory morbidity did not change over time for infants 34-36 weeks but decreased twofold for infants born after 40 weeks. Over the 9-year study period, reduced respiratory morbidity associated with decreased births after 40 weeks were offset by the adverse respiratory effect of increased cesarean delivery rates and increased late-preterm birth rates.
    Obstetrics and Gynecology 05/2008; 111(4):814-22. · 4.80 Impact Factor
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    ABSTRACT: To describe changes in neonatal and obstetric practices that may have contributed to the decreasing incidence of meconium aspiration syndrome in our population during this time. We compared neonatal and obstetric characteristics of 61 infants diagnosed with meconium aspiration syndrome with 1365 infants born through moderate or thick meconium-stained amniotic fluid at more than 37 weeks' completed gestation. Data were prospectively collected, and all respiratory diagnoses were concurrently made. Three distinct birth year groups were analyzed based on changing obstetric practice paradigms. Meconium aspiration syndrome decreased nearly four-fold from 1990-1992 to 1997-1998 (5.8% to 1.5% of meconium-stained infants more than 37 weeks; P <.003). The only change in neonatal characteristics was a 33% decrease in births more than 41 weeks with a reciprocal 33% increase in births 38-39 weeks during 1997-1998. Significant changes in obstetric practice included more frequent diagnosis of nonreassuring fetal heart rate patterns, greater use of amnioinfusion, and increased cesarean delivery rate in 1997-1998. By logistic regression analysis, the only consistent risk factor for meconium aspiration syndrome across all three epochs was the presence of tracheal meconium. Reduction in post-term delivery was the most important factor in reducing meconium aspiration syndrome.
    Obstetrics and Gynecology 05/2002; 99(5 Pt 1):731-9. · 4.80 Impact Factor
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    ABSTRACT: The objective of the study was to estimate the risks of third-trimester amniocentesis with continuous ultrasound guidance. Cohort study. We reviewed the medical records of women who had an amniocentesis with continuous ultrasound guidance after 30 weeks' gestation at a single institution from January 1991 through December 1994. For procedures performed from January 1991 to February 1994, we obtained information from a chart review. From March 1994 to December 1994, we collected data prospectively. The primary outcome was whether or not there were any complications within 48 hours of the procedure. We also sought to determine any risk factors associated with complications. Complete records and data were available for 562 amniocenteses during the study period. The mean gestational age at the time of amniocentesis was 34.9 weeks. Of the 562 procedures, five (0.8%) were unsuccessful and 50 (9%) required more than one needle stick. The complication rate was 0.7% (95% confidence level (CI) = 0.02%, 1.9%). These included spontaneous labor in a preterm gestation (1), premature rupture of the membranes (1), placental abruption (1), and fetal-maternal hemorrhage (1). No patient required an emergency cesarean delivery and none suffered a perinatal death (95% CI 0, 0.8%). Complications were not associated with the number of needle sticks, the presence of bloody amniotic fluid, or the level of operator experience. Third-trimester amniocentesis performed with continuous ultrasound guidance has a high success rate and low risk for complications.
    Obstetrics and Gynecology 03/2002; 99(2):255-9. · 4.80 Impact Factor
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    ABSTRACT: OBJECTIVE:The objective of the study was to estimate the risks of third-trimester amniocentesis with continuous ultrasound guidance.METHODS:Cohort study. We reviewed the medical records of women who had an amniocentesis with continuous ultrasound guidance after 30 weeks’ gestation at a single institution from January 1991 through December 1994. For procedures performed from January 1991 to February 1994, we obtained information from a chart review. From March 1994 to December 1994, we collected data prospectively. The primary outcome was whether or not there were any complications within 48 hours of the procedure. We also sought to determine any risk factors associated with complications.RESULTS:Complete records and data were available for 562 amniocenteses during the study period. The mean gestational age at the time of amniocentesis was 34.9 weeks. Of the 562 procedures, five (0.8%) were unsuccessful and 50 (9%) required more than one needle stick. The complication rate was 0.7% (95% confidence level (CI) = 0.02%, 1.9%). These included spontaneous labor in a preterm gestation (1), premature rupture of the membranes (1), placental abruption (1), and fetal-maternal hemorrhage (1). No patient required an emergency cesarean delivery and none suffered a perinatal death (95% CI 0, 0.8%). Complications were not associated with the number of needle sticks, the presence of bloody amniotic fluid, or the level of operator experience.CONCLUSIONS:Third-trimester amniocentesis performed with continuous ultrasound guidance has a high success rate and low risk for complications.
    Obstetrics and Gynecology 01/2002; 99(2):255-259. · 4.80 Impact Factor
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    ABSTRACT: OBJECTIVE:To describe changes in neonatal and obstetric practices that may have contributed to the decreasing incidence of meconium aspiration syndrome in our population during this time.METHODS:We compared neonatal and obstetric characteristics of 61 infants diagnosed with meconium aspiration syndrome with 1365 infants born through moderate or thick meconium-stained amniotic fluid at more than 37 weeks’ completed gestation. Data were prospectively collected, and all respiratory diagnoses were concurrently made. Three distinct birth year groups were analyzed based on changing obstetric practice paradigms.RESULTS:Meconium aspiration syndrome decreased nearly four-fold from 1990–1992 to 1997–1998 (5.8% to 1.5% of meconium-stained infants more than 37 weeks; P < .003). The only change in neonatal characteristics was a 33% decrease in births more than 41 weeks with a reciprocal 33% increase in births 38–39 weeks during 1997–1998. Significant changes in obstetric practice included more frequent diagnosis of nonreassuring fetal heart rate patterns, greater use of amnioinfusion, and increased cesarean delivery rate in 1997–1998. By logistic regression analysis, the only consistent risk factor for meconium aspiration syndrome across all three epochs was the presence of tracheal meconium.CONCLUSION:Reduction in post-term delivery was the most important factor in reducing meconium aspiration syndrome.
    Obstetrics and Gynecology - OBSTET GYNECOL. 01/2002; 99(5):731-739.
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    ABSTRACT: Objective: To determine whether betamethasone administered to women at risk of preterm delivery causes adrenal suppression.Methods: Ten women at risk of preterm delivery had three weekly low-dose (1 μg) ACTH stimulation tests with the first one between 24 and 25 weeks’ gestation. Immediately after the first and second ACTH stimulation tests, we gave each woman a 12-mg betamethasone dose intramuscularly and repeated it 24 hours later. The third ACTH stimulation test was 1 week after the second course of betamethasone. Serum cortisol levels were measured before (baseline) and 30 minutes after ACTH administration.Results: All subjects had normal baseline and stimulated cortisol levels for the first ACTH stimulation test. Mean baseline serum cortisol levels decreased with each ACTH stimulation test, from 25.4 ± 4.8 μg/dL (before betamethasone) to 4.3 ± 4.0 μg/dL (1 week after the second course of betamethasone) (P < .001). The mean stimulated cortisol levels also decreased from 33.0 ± 4.3 μg/dL (before betamethasone) to 11.8 ± 6.4 μg/dL (1 week after the second course of betamethasone) (P < .001). Compared with initial ACTH stimulation tests, laboratory evidence of adrenal suppression occurred in four patients 1 week after the first course of betamethasone and in seven patients after the second course. No signs or symptoms of Addisonian crisis occurred antepartum or intrapartum.Conclusion: Antenatal administration of betamethasone produced measurable adrenal suppression in women at risk of preterm delivery. The number of women with adrenal suppression increased each week that antenatal betamethasone was repeated. (Obstet Gynecol 2000;96:287–90.)
    Obstetrics and Gynecology - OBSTET GYNECOL. 01/2000; 96(2):287-290.

Publication Stats

89 Citations
19.19 Total Impact Points

Top Journals

Institutions

  • 2008
    • University of Utah
      • Department of Obstetrics and Gynecology
      Salt Lake City, UT, United States
  • 2002
    • Wilford Hall Ambulatory Surgery Center
      Lackland Air Force Base, Texas, United States