R W Martin

Wright State University, Dayton, OH, United States

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Publications (93)297.24 Total impact

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    ABSTRACT: The objective of this study is to describe the incidence of transient hypertension and to evaluate if transient hypertension is associated with increased maternal or fetal morbidity as compared to other hypertensive disorders of pregnancy and normotensive controls. Data were collected from all deliveries at the University of Mississippi Medical Center from July 1, 1996 through January 1, 1997. Patients were grouped according to ACOG criteria for pregnancy induced hypertension. Specific maternal and fetal morbidities were compared among the groups and controls. There were 1489 deliveries during the study period. Nearly 30% of patients met the criteria for transient hypertension. There were no significant differences between patients with transient hypertension and controls in regard to maternal and fetal outcomes. Transient hypertension occurs more often than expected, however, it appears to be of limited clinical significance.
    American Journal of Perinatology 02/2001; 18(2):73-7. · 1.57 Impact Factor
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    ABSTRACT: Maternal obesity is a risk factor for severe preeclampsia. We sought to ascertain whether a similar relationship exists between maternal weight and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) as an atypical form of severe preeclampsia. In this retrospective investigation, 434 patients with HELLP syndrome were assigned to one of four study groups according to maternal weight and were analyzed in relation to selected maternal and perinatal data reflective of disease severity. We found no significant associations between maternal weight and parameters of HELLP syndrome severity, race, delivery mode, gestational age, or perinatal outcome. Significantly associated with increasing maternal weight were maternal age, parity, admission mean arterial pressure, peak peripartum systolic blood pressures, concurrent essential hypertension, and the interval between admission and delivery. Inversely associated were eclampsia and the interval between delivery and discharge. Severity and complications attendant with HELLP syndrome appear unrelated to maternal weight. Paradoxically, eclampsia occurs most commonly in the lighter gravida with HELLP syndrome.
    Southern Medical Journal 08/2000; 93(7):686-91. · 0.92 Impact Factor
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    ABSTRACT: To determine whether a urine collection of < 24 hours duration accurately assesses the level of proteinuria in inpatients being evaluated for preeclampsia. Patients admitted to the University of Mississippi between January and June of 1998 for evaluation of preeclampsia underwent two consecutive 12-hour urine collections. Each collection was analyzed for total protein, total calcium, total volume, and urine creatinine. A concurrent serum creatinine value was obtained. The protein:creatinine ratio, calcium: creatinine ratio, and creatinine clearance were calculated. Pearson's correlation, sensitivity, specificity, and positive and negative predictive values were assessed. A total of 25 patients (86%) were preeclamptic. Total protein, the protein: creatinine ratio, and serum creatinine were significantly correlated between the first and second urine collection. The sensitivity and specificity of the 12-hour urine collection was 96% and 100%, respectively. A 12-hour urine collection accurately depicts the amount of proteinuria in hospitalized gravidas being evaluated for preeclampsia.
    Journal of Perinatology 01/2000; 19(8 Pt 1):556-8. · 2.25 Impact Factor
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    ABSTRACT: The aim of this study was to determine factors contributing to deaths among women with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Information from multiple sources was scrutinized to distinguish and profile maternal deaths associated with HELLP syndrome. Information was available regarding 54 maternal deaths. According to HELLP syndrome classification 60.0% had class 1 disease, 35.6% had class 2 disease, and 4.4% had class 3 disease. Events associated with maternal deaths included cerebral hemorrhage (45%), cardiopulmonary arrest (40%), disseminated intravascular coagulopathy (39%), adult respiratory distress syndrome (28%), renal failure (28%), sepsis (23%), hepatic hemorrhage (20%), and hypoxic ischemic encephalopathy (16%). Delay in diagnosis of HELLP syndrome was implicated in 22 of 43 patients' deaths (51.1%). It appears that (1) most maternal deaths occurred among women with class 1 HELLP syndrome, (2) delay in diagnosis was associated with mortal consequences, and (3) hemorrhage in the hepatic or central nervous system or vascular insult to the cardiopulmonary or renal system were associated with increased mortality risk.
    American Journal of Obstetrics and Gynecology 11/1999; 181(4):924-8. · 3.88 Impact Factor
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    ABSTRACT: Our purpose was to compare the efficacy, safety, and adverse effects of intra-amniotically administered (15S)-15-methyl-prostaglandin F(2alpha) and intravaginally administered misoprostol for second-trimester uterine evacuation. Fifty-one patients were randomly assigned to receive either a single 2.5-mg intra-amniotic injection of (15S)-15-methyl-prostaglandin F(2)(alpha) (n = 26) or two 200-microg intravaginal doses of misoprostol (n = 25) at 12-hour intervals. The primary outcome measured was evacuation of the uterus within 24 hours. The mean time from initiation of termination to uterine evacuation was less in the prostaglandin group than in the misoprostol group (17.5 +/- 8.6 hours vs 22.3 +/- 12.5 hours), but this was not statistically significant (P >.05). The rate of successful fetal evacuation at 24 hours was significantly higher in the prostaglandin group than in the misoprostol group (88% vs 60%, P =.02). The complete-abortion rate and the incidence of adverse effects were similar in both groups. The use of an intra-amniotic injection of (15S)-15-methyl-prostaglandin F(2alpha) for midtrimester pregnancy termination is safe and is associated with a greater number of successful uterine evacuations within 24 hours, without an increase in adverse effects, than intravaginal administration of misoprostol.
    American Journal of Obstetrics and Gynecology 11/1999; 181(5 Pt 1):1057-61. · 3.88 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate our institutional experience with planned cesarean hysterectomy. In this retrospective case-control investigation of a 16-year experience, 100 pregnant women who underwent planned cesarean hysterectomy were compared with 37 patients who underwent cesarean delivery followed by a hysterectomy performed within 6 months. Women undergoing planned cesarean hysterectomy did not have any demonstrable increase in intraoperative or postoperative complications when compared with the cesarean delivery plus later hysterectomy group. Primarily as a result of significantly reduced hospital stay and shorter total operative time, there was a significant financial advantage associated with a single planned cesarean hysterectomy with respect to separate operations. A policy to undertake planned cesarean hysterectomy for carefully selected patients appeared to produce advantages without increasing risks for these patients. Secondarily, it provided resident physicians the opportunity to learn the operation with supervision and under controlled circumstances.
    American Journal of Obstetrics and Gynecology 07/1999; 180(6 Pt 1):1385-93. · 3.88 Impact Factor
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    ABSTRACT: This article is a critical review of the obstetric literature concerning preeclampsia-associated hepatic hemorrhage to develop guidelines conducive to optimal maternal and perinatal outcomes. An English literature search was performed for reports of hepatic hemorrhage or hepatic rupture in pregnancy during 1960 to 1997. Data were analyzed by Statmost packages using ANOVA, Chi-square, and Fisher's exact tests. One hundred forty-one patients with hepatic rupture/hemorrhage were reported. The three most common presenting findings were epigastric pain, hypertension, and shock. With rare exception, patients had evidence of preeclampsia. Diagnosis was elusive and most frequently accomplished at laparotomy. When utilized, ultrasound and computed tomography (CT) were helpful diagnostic modalities. Maternal survival was highest in the arterial embolization treatment group. Maternal and perinatal survival improved considerably during the study interval. Route of delivery did not seem to impact survival rates. It was concluded that the application of ultrasound and CT for diagnosis and the use of hepatic artery embolization for treatment of hepatic hemorrhage/rupture seem to be beneficial management options for this rare event.
    Obstetrical and Gynecological Survey 04/1999; 54(3):196-202. · 2.51 Impact Factor
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    ABSTRACT: The purpose of this study was to investigate the safety of treating pre-eclampsia with magnesium sulfate, with clinical determinants used for drug discontinuation. One hundred sixty-eight patients were enrolled. After delivery, women with mild pre-eclampsia received a minimum of 6 hours of intravenous magnesium sulfate, whereas women with severe pre-eclampsia received a minimum of 12 hours. Magnesium sulfate was discontinued in the absence of clinical symptoms associated with spontaneous diuresis, minimal protein by urinary dipstick, and satisfaction of predetermined blood pressure criteria. Patients with mild pre-eclampsia required significantly less magnesium sulfate (mean 9.5 +/- 4.2 hours) than did those with severe pre-eclampsia alone (mean 16 +/- 5.9 hours); pre-eclampsia superimposed on chronic hypertension (mean 16 +/- 5.8 hours); or hemolysis, elevated liver enzyme, and low platelet count syndrome (mean 20 +/- 6.7 hours). With this protocol there was no eclampsia, and recovery room time was reduced by 50%. Individual determination of postpartum magnesium sulfate therapy for pre-eclampsia appears to be a safe approach that carries minimal risk of eclampsia.
    American Journal of Obstetrics and Gynecology 11/1998; 179(4):952-6. · 3.88 Impact Factor
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    ABSTRACT: Pregnancy-related adult respiratory distress syndrome (ARDS) can lead to maternal mortality and morbidity. Records of all pregnant patients diagnosed with ARDS over a 14-year period were reviewed and the cases were stratified into survivors and nonsurvivors. Forty-one cases were identified and 31 survived (maternal mortality rate of 24.4%). Adult respiratory distress syndrome was diagnosed in the antepartum period in 23 (56.1%) of the patients and the majority of these cases occurred in the third trimester (73.9%). There was no statistically significant difference in demographic characteristics, preexisting diseases, or probable precipitating cause for the development of ARDS between the two groups. The cause of death among the nonsurvivors included multisystem organ failure, sepsis, cardiac arrest, and disseminated intravascular coagulopathy. Pregnancy-related ARDS continues to be associated with a high maternal mortality rate (25%). Unfortunately, the etiology for ARDS during pregnancy is not predictive of maternal outcome.
    Southern Medical Journal 06/1998; 91(5):441-4. · 0.92 Impact Factor
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    ABSTRACT: Following parenteral magnesium tocolysis for patients in preterm labor. The choice of oral tocolytic medications is controversial. Over a six-month period, 47 patients who were inpreterm labor were randomized after parenteral magnesium tocolysis to receive magnesium gluconate ([Mg-g] 648 mg elemental magnesium/day) or magnesium chloride ([Mg-c] 640 mg elemental magnesium/ day). A serum magnesium was obtained 24 hours after the initiation of oral therapy. In the 25 patients were treated with Mg-g and 22 with Mg-c there were no differences in patient demographics, initial cervical dilatation hours on parenteral magnesium sulfate, recurrent contractions, or side effects between the two groups. The cost was also similar (Mg-c, $1.40/d; Mg-g, $2.11/d). The serum magnesium levels were higher in the Mg-c group (1.80 +/- 0.28 mg/dl) compared to the Mg-g group (1.63 +/- 0.30 mg/dl) but the difference was not significant. These two preparations of magnesium are similar in their effects on uterine activity and serum levels when used at these dosages.
    Journal of the Mississippi State Medical Association 06/1998; 39(5):180-2.
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    ABSTRACT: Our purpose was to compare the efficacy of intravaginal misoprostol and intracervical Foley catheter/intravaginal dinoprostone for cervical ripening. Patients admitted for induction of labor were randomized to receive intravaginal misoprostol 25 microg every 4 hours or intracervical Foley catheter/intravaginal dinoprostone 4 mg every 4 hours. Patients not entering active labor and having ruptured membranes or arrest of dilatation received intravenous oxytocin. Sixty-five patients received Foley catheter/dinoprostone gel and 62 patients received misoprostol. The mean time until cervical ripening was less in the catheter/gel group (7.5 +/- 3.4 vs 12.0 +/- 5.9 hours, p < 0.01). The mean time until vaginal delivery was less in the catheter/gel group (17.4 +/- 6.9 vs 21.2 +/- 7.5 hours, p = 0.004). Among vaginal deliveries, more patients in the catheter/gel group delivered within 24 hours (90% vs 69%, p = 0.013). Intracervical Foley catheter/intravaginal dinoprostone was associated with more rapid cervical ripening, shorter induction to vaginal delivery interval, and greater number of vaginal deliveries within 24 hours.
    American Journal of Obstetrics and Gynecology 06/1998; 178(6):1333-40. · 3.88 Impact Factor
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    ABSTRACT: Our purpose was to compare induction of labor with preterm rupture of membranes between 34 and 37 weeks' gestation with expectant management. In this prospective investigation 120 gravid women at > or = 34 weeks 0 days and < 36 weeks 6 days of gestation were randomized to receive oxytocin induction (n = 57) or observation (n = 63). Estimated gestational age at rupture of membranes (34.3 +/- 1.4 weeks vs 34.5 +/- 1.4 weeks) and ultrasonographically estimated fetal weight (2230 +/- 321 gm vs 2297 +/- 365 gm) were equivalent between groups (not significant). Chorioamnionitis occurred more often (16% vs 2%, p = 0.007), and maternal hospital stay (5.2 +/- 6.8 days vs 2.6 +/- 1.6 days, p = 0.006) was significantly longer in the control group. Neonatal sepsis was also more common in the observation group (n = 3) than among induction patients (n = 0), but the difference was not statistically significant. Aggressive management of preterm premature rupture of the membranes at > or = 34 weeks 0 days of gestation by induction of labor is safe for the infant in our population and avoids maternal-neonatal infectious complications.
    American Journal of Obstetrics and Gynecology 01/1998; 178(1 Pt 1):126-30. · 3.88 Impact Factor
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    ABSTRACT: Our objective was to determine the best treatment for parturients at term with an unfavorable cervix and premature rupture of membranes (PROM). In this prospective study, 96 women with PROM and an unfavorable cervix were randomized into one of three treatment groups: oxytocin induction, vaginal prostaglandin E2 gel followed by oxytocin, or expectant management. Length of labor, cesarean section rate, and maternal/neonatal morbidity were not significantly different. In contrast, the interval from PROM until delivery and length of hospital stay were significantly longer in the expectantly managed group than in the other groups. Four of the patients who received expectant management required delivery because of nonreassuring fetal assessments. Expectant management of PROM at term significantly prolongs hospital stay without decreasing the incidence of abdominal delivery or infectious morbidity. There appears to be potential for cord compression in patients managed expectantly without continuous electronic fetal surveillance.
    Southern Medical Journal 01/1998; 90(12):1229-33. · 0.92 Impact Factor
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    ABSTRACT: Our purpose was to examine the effect of epidural analgesia on dystocia-related cesarean delivery in actively laboring nulliparous women. Active labor was confirmed in nulliparous women by uterine contractions, cervical dilatation of 4 cm, effacement of 80%, and fetopelvic engagement. Patients were randomized to one of two groups: epidural analgesia or narcotics. A strict protocol for labor management was in place. Patients recorded the level of pain at randomization and at hourly intervals on a visual analog scale. Elective outlet operative vaginal delivery was permitted. One hundred women were randomized. No difference in the rate of cesarean delivery for dystocia was noted between the groups (epidural 8%, narcotic 6%; p = 0.71). No significant differences were noted in the lengths of the first (p = 0.54) or second (p = 0.55) stages of labor or in any other time variable. Women with epidural analgesia underwent operative vaginal delivery more frequently (p = 0.004). Pain scores were equivalent at randomization, but large differences existed at each hour thereafter. The number of patients randomized did not achieve prestudy estimates. A planned interim analysis of the results demonstrated that we were unlikely to find a statistically significant difference in cesarean delivery rates in a trial of reasonable duration. With strict criteria for the diagnosis of labor and with use of a rigid protocol for labor management, there was no increase in dystocia-related cesarean delivery with epidural analgesia.
    American Journal of Obstetrics and Gynecology 01/1998; 177(6):1465-70. · 3.88 Impact Factor
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    ABSTRACT: To compare the efficacy, safety, and side effects of intra-amniotic (15S)-15-methyl prostaglandin F2 alpha (15-M-PGF2 alpha) and intravaginal prostaglandin E2 (PGE2) for midtrimester uterine evacuation. Ninety-three patients underwent therapeutic midtrimester pregnancy termination by the use of laminaria placement and intra-amniotic injection of 15-M-PGF2 alpha. A matched control group underwent uterine evacuation by laminaria placement and insertion of PGE2 intravaginal suppositories. The main outcomes studied were time to delivery, side effects, and complications. The 15-M-PGF2 alpha group had a shorter time to delivery (12.3 +/- 6.4 hours) compared with the PGE2 group (16.2 +/- 6.6 hours, p < 0.0001). The evacuation rate over time was significantly greater in the 15-M-PGF2 alpha group (p = 0.001). The PGE2 group had a significantly higher incidence of side effects. The use of intra-amniotic 15-M-PGF2 alpha for therapeutic second-trimester pregnancy termination is safe and is associated with a more rapid evacuation of the uterus and fewer side effects than intravaginal PGF2 suppositories.
    Journal of Perinatology 01/1998; 18(1):24-7. · 2.25 Impact Factor
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    ABSTRACT: The objective of this study was to compare 2-hour postprandial glucose measurements with the standard 1-hour, 50 gm glucola screen as a predictor of gestational diabetes. In this prospective study, 448 patients were screened for gestational diabetes mellitus after 20 weeks' gestation. Each patient was instructed to ingest a meal containing at least 100 gm of carbohydrate, and 2 hours later a plasma glucose level was obtained. Shortly after, each patient was given 50 gm glucola followed by a 1-hour glucose measurement. If either screen showed a result of 140 mg/dl or more, a formal 3-hour glucose tolerance test was done. Data were analyzed with use of the receiver operating characteristic curve. Of the 448 patients screened, 39 (8.7%) had a screening result of 140 mg/dl or greater and 16 (3.6%) of these had gestational diabetes mellitus. The receiver operating characteristic curve showed that the 1-hour glucose screen was more predictive of gestational diabetes than the postmeal assessment. The area under the receiver operating characteristic curve (plus or minus the SEM) for the 1-hour glucose test was 0.746 +/- 0.086 (p < 0.005) whereas the 2-hour postprandial test produced an area of 0.524 +/- 0.097 (p = NS). The range of optimal 1-hour glucola discriminatory values was 182 to 190 mg/dl. Thus the critical cutoff value of the 1-hour glucola test that minimizes false-positive results and maximizes true-positive screening for gestational diabetes is 182 mg/dl or greater. The 1-hour glucola test is a reliable screening test for gestational diabetes mellitus whereas the 2-hour post-prandial test is not.
    Journal of Perinatology 01/1998; 18(1):49-54. · 2.25 Impact Factor
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    ABSTRACT: Our purpose was to determine whether intrapartum obstetric interventions are associated with umbilical cord prolapse. A computer search identified patients who had intrapartum umbilical cord prolapse. Thirty-seven cases were identified between 1990 and 1994 (incidence of 1.85 per 1000). These women were randomly matched to control patients with intact membranes. Patients with umbilical cord prolapse were delivered earlier (34.8 vs 37.1 weeks, p = 0.05). Otherwise, there were no differences between groups regarding the use of cervical ripening, incidence of labor induction, or the use of amnioinfusion and amniotomy. Although cervical dilatation and station were similar between groups at the time of admission, women with umbilical cord prolapse did not have as much descent of the presenting part associated with cervical dilatation and progressive labor compared with control patients. By themselves, obstetric interventions of cervical ripening, labor induction, amnioinfusion, and amniotomy do not increase the likelihood that a patient will have umbilical cord prolapse.
    American Journal of Obstetrics and Gynecology 07/1997; 176(6):1181-3; discussion 1183-5. · 3.88 Impact Factor
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    ABSTRACT: To assess the effect of home uterine contraction assessment (HUCA) in twin pregnancies with preterm labor (PTL) at < 24 weeks' gestation. In this retrospective, analytic study, patients were stratified by whether HUCA had been prescribed before or after diagnosis of PTL. The main outcomes studied were time of PTL diagnosis and delivery as well as birth weight and need for neonatal intensive care unit (NICU) admission. In 63 patients, 32 were prescribed HUCA after PTL had been arrested at < 24 weeks (group I). Thirty-one women had HUCA prescribed at 20 weeks' gestational age and then developed PTL at < 24 weeks (group II). Labor was diagnosed at similar times in both groups (22.8 vs 23.4 weeks), but delivery was earlier in group I (27.6 weeks vs. 34.7 weeks) than in group II. The birth weight in group I was less (918 +/- 255 g), and of the 64 infants, 55 required NICU admission as compared to 2,340 +/- 525 g and 11 of 62 infants (P < .0001, .0001) in group II, respectively. Women with twin gestations and the diagnosis of PTL prior to 24 weeks deliver later in gestation, and their infants weigh more and have fewer NICU admissions if intensive prenatal surveillance is prescribed prior to the onset of labor.
    The Journal of reproductive medicine 04/1997; 42(4):229-34. · 0.75 Impact Factor
  • American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/1997; 176(1).
  • American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/1997; 176(1).

Publication Stats

1k Citations
297.24 Total Impact Points

Institutions

  • 1998
    • Wright State University
      • Department of Obstetrics and Gynecology
      Dayton, OH, United States
  • 1988–1998
    • University of Mississippi Medical Center
      • Department of Obstetrics and Gynecology
      Jackson, MS, United States
  • 1990
    • University of South Florida
      • Department of Obstetrics and Gynecology
      Tampa, FL, United States
    • Rush Medical College
      Chicago, Illinois, United States