R W Martin

University of Mississippi, Mississippi, United States

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Publications (62)217.26 Total impact


  • No preview · Article · Dec 2011 · Obstetric Anesthesia Digest
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    ABSTRACT: Atrial natriuretic polypeptide (ANP) comprises a group of potent diuretic and vasorelaxant substances synthesized and released by mammalian atrial cardiocytes. In late pregnancy, plasma ANP concentrations appear to be increased in gravidas with severe pregnancy-induced hypertension (PIH) versus normotensive parturients. Earlier gestational assessments of ANP in plasma and other fluid compartments are needed at various stages of gestation in gravidas who remain normotensive and those who become hypertensive. The present retrospective study was undertaken to determine if midgestational amniotic fluid concentrations of ANP in healthy controls and in gravidas destined to develop PIH would be significantly different and possibly predictive of later hypertensive disease. The findings in 14 gravidas who underwent midtrimester genetic amniocentesis and later developed PIH were compared with 44 matched control patients. Midgestational amniotic fluid ANP concentrations were determined to not be significantly different between the two groups of patients. Thus, it appears that this determination at the time of midtrimester genetic amniocentesis does not identify gravidas at risk for the later development of PIH
    No preview · Article · Jul 2009 · Hypertension in Pregnancy
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    J N Martin · W L May · B K Rinehart · R W Martin · E F Magann
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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.
    Full-text · Article · Aug 2000 · Southern Medical Journal
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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.
    No preview · Article · Jan 2000 · Journal of Perinatology
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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.
    No preview · Article · Jun 1998 · Journal of the Mississippi State Medical Association
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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.
    No preview · Article · Jan 1998 · Journal of Perinatology
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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.
    No preview · Article · Jan 1998 · Southern Medical Journal
  • O Rust · J A Bofill · S C Carroll · B D Cowan · R W Martin · J C Morrison
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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.
    No preview · Article · Jan 1998 · Journal of Perinatology
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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.
    No preview · Article · Apr 1997 · The Journal of reproductive medicine
  • R. W. Martin · P. G. Blake · L. Robinette · A. Moore · J. N. Martin

    No preview · Article · Jan 1997 · American Journal of Obstetrics and Gynecology
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    ABSTRACT: OBJECTIVE: After demonstrating maternal-fetal benefit with antepartum or postpartum dexamethasone (DEX) administration for HELLP syndrome pregnancies treated during 1992-1993, routine utilization of either betamethasone (BMZ) for fetal lung maturation (FLM) and/or DEX for HELLP syndrome antepartum and/or postpartum was encouraged during 1994 and 1995. We postulate that aggressive steroid utilization considerably improved maternal and perinatal outcomes compared to 1988-1991 when corticosteroids were used sparingly. STUDY DESIGN: All pregnancies with Class 1 and 2 HELLP syndrome managed during 1988-1991 (Group l, n -169) were compared to those managed during 1994-1995 (Group 2, n = 64). Subgroups include use of DEX or BMZ for FLM or DEX for HELLP syndrome before (ANTE-DEX), after (POST-DEX), or around (BOTH-DEX) delivery: Group 1 (1988-1991) (sroup 2 (1994-1995) DEX for FLM 23 (14%) 0 BMZ for FLM 7 (4%) 11 (17%) ANTE-DEX 0 11 (17%) POST-DEX 0 49 (77%) BOTH-DEX 0 15 (22%) RESULTS: Overall steroid utilization increased from 18% in Group 1 to 85% in Group 2 (p < .001) while maternal disease severity was reduced as reflected by platelet nadir (X, 67,000/|ol, vs 57,000/u.L; p = .011). Fewer patients deteriorated to Class 1 HELLP (platelets <50,000/|j.L: 30% in Group 2 vs 44% in Group 1; p = .07). Significantly fewer patients in Group 2 received blood products (only 5 patients) vs 56 in Group 1 (p < .05). Maternal respirator)' support measures, infectious/wound morbidity (19% vs 46%; p < .05). bleeding (3% vs 11%; p < .05) and hyaline membrane disease declined (28% vs 48%; p < .05) significantly. CONCLUSIONS: Expanded, aggressive corticosteroid utilization in HELLP syndrome pregnancies was associated with significantly improved maternal-perinatal outcomes.
    No preview · Article · Jan 1997 · American Journal of Obstetrics and Gynecology
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    ABSTRACT: OBJECTIVE: To determine if the routine initiation of dexamethasone (DEX) in patients with postpartum Class 1 or 2 HELLP syndrome produces specific and general therapeutic benefits. STUDY DESIGN: The puerperal courses of 43 mothers who initially received DEX after delivery were compared to 240 other patients with Class 1 or 2 HELLP syndrome who received no corticosteroids whatsoever during the peripartum course. Treated patients received DEX 10 mg IV at 12-hour intervals until disease remission was noted at which time up to two additional 5-mg IV doses at 12-hour intervals were given. RESULTS: The two patient groups were similar in regard to mode of delivery, gestational age, HELLP severity, parity, and frequency of eclampsia. Compared to controls, postpartum DEX-treated patients had significantly higher (p < 0.05) admission mean arterial blood pressure, serum uric acid, and 3-4 + proteinuria. Yet DEX was associated with a more rapid normalization of platelets and LDH by postpartum day 2, the need for transfusion and respiratory therapy was reduced, infectious/bleeding morbidity was lessened, and hospitalization was shortened. PPDEX No DEX (n = 43) (n = 240) p PP day 1 platelets 86,000 ±30,000 84,000 ±38,000 NS PP day 2 platelets 98,000 ±34,000 83,000 ±37,000 .016 Transfused blood 2 (4.7%) 73 (30.5%) <.001 Transfused plasma 0 26 (10.8%) .024 Respiratory therapy 1 (2.3%) 13 (5.4%) <.05 Infection/bleeding 6 (14%) 113 (47%) <.05 Delivery-discharge (d) 4.3 ±1.6 6 ±3.4 .002 PP, postpartum; d, days CONCLUSIONS: DEX for the patient with postpartum HELLP syndrome shortens the disease course, accelerates recovery, minimizes morbidity, and significantly decreases the need for other interventive therapy.
    No preview · Article · Jan 1997 · American Journal of Obstetrics and Gynecology

  • No preview · Article · Jan 1997 · American Journal of Obstetrics and Gynecology
  • JA Bofill · OA Rust · K G Perry · W E Roberts · R W Martin · J C Morrison
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    ABSTRACT: To document operative vaginal delivery rates of ACOG Fellows and to stratify practice patterns with regard to mid-pelvic delivery and deep transverse arrest by the time elapsed since residency. A survey was mailed to a random sample of 1600 ACOG Fellows. Of the 597 respondents (37%), 558 who still practice obstetrics formed the study group. Selection bias regarding recipients of the survey was reduced by randomization by an uninvolved third party. The length of time since residency was categorized as 10 years or fewer ("recent," 31%), 11-20 years ("intermediate," 43%), and more than 20 years ("remote," 26%). The majority of respondents (338 of 558, 61%) reported an operative vaginal delivery rate of 15% or less. One hundred forty-two (25%) use only forceps, whereas 78 (14%) use vacuum extraction exclusively. More than half have abandoned mid-pelvic operative vaginal deliveries, and of the 41% who still perform these operations, about half use forceps. In cases of deep transverse arrest, about 25% perform cesarean delivery, whereas 26% and 42% use forceps or vacuum, respectively. Resident training and practice in vacuum delivery were more common in the recently trained groups (recent > intermediate > remote; P < .001). There were no differences among the groups with respect to attempting mid-pelvic operative vaginal delivery (P = .29), but the remote group was more likely to use forceps, whereas the recent group was more likely to use vacuum (P = .039). A large disparity existed among the groups regarding the management of deep transverse arrest, with vacuum use associated with group assignment (P < .001). The majority of respondents have an operative vaginal delivery rate of no more than 15%. Most respondents have abandoned mid-pelvic operative vaginal delivery. Practice patterns reflect differences in residency training; the more recently trained Fellows more often were taught and use vacuum for delivery.
    No preview · Article · Dec 1996 · Obstetrics and Gynecology
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    ABSTRACT: To determine if combining two commonly used methods or cervical ripening (intracervical prostaglandin E2 [Pge2] gel and Foley balloon catheter) would result in a higher number of successful inductions and fewer cesarean sections when compared to PGE2 gel alone. Seventy-eight patients with unfavorable cervixes eligible for induction of labor were prospectively randomized to receive either one dose (0.5 mg) of PGE2 gel followed by insertion of a 24-French Foley catheter (group 1, 41 patients) or two doses of 0.5 mg of intracervical gel (group 2, 37 patients). Outcome parameters included change in Bishop score, number of failed inductions, rate of cesarean section, rate of uterine hyperstimulation and postpartum infection. Patients in group 1 had a significant increase in posttreatment Bishop scores (7.26 +/- 2.0 SD vs. 4.82 +/- 1.8 P = .0001) and fewer failed inductions (0 vs. 6, P = .009) when compared to patients in group 2. Abdominal delivery rates, uterine hyperstimulation and infections complications were not different between the two groups. The combination of the Foley balloon and prostaglandin gel significantly improved the Bishop score and led to fewer failed inductions, although it did not increase the vaginal delivery rate.
    No preview · Article · Dec 1996 · The Journal of reproductive medicine
  • R D Vincent · R W Martin
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    ABSTRACT: To determine the anesthetic and surgical morbidity associated with postpartum tubal ligation after pregnancy complicated by pregnancy-induced hypertension. Preoperative hemodynamic measurements, laboratory results, choice of anesthetic technique, intraoperative hemodynamic changes, and postoperative morbidity were compared in 53 women with pregnancy-induced hypertension (hypertensive group) and 53 controls who underwent postpartum tubal ligation between October 1992 and November 1995. We used a retrospective case-control design. Preoperative mean blood pressure (BP) measurements ( +/- standard deviation) were greater in hypertensive women than in controls (158 +/- 22/91 +/- 12 versus 126 +/- 13/71 +/- 10 mmHg; P < .001). Among women given spinal anesthetics for tubal ligation, the minimum intraoperative systolic BP was significantly lower in controls than in hypertensive women (P < .05). However, the maximum percentage decrease in systolic BP was greater in hypertensive women than in controls (33 +/- 14 versus 22 +/- 10%; P < .05). Only one patient in each group developed intraoperative hypertension. The percentage of patients discharged later than the first postoperative day was greater in hypertensive women than in controls (23 versus 8%; P < .05). The lack of profound hemodynamic responses during spinal or general anesthesia for postpartum tubal ligation supports the continued use of this procedure in selected women with pregnancy-induced hypertension.
    No preview · Article · Aug 1996 · Obstetrics and Gynecology
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    ABSTRACT: Our objective was to determine the incidence of blood administration after cesarean delivery and whether such transfusions are always beneficial. In this retrospective study 1610 women underwent cesarean delivery during a 2-year period and 127 of these patients had hemorrhage during or after operation. Of these subjects 103 received blood because of intraoperative hemorrhage, a reduction in the hematocrit of more than 10 points, or because the postoperative hematocrit was < 24%. These subjects were compared with the remaining women (n = 24) who met the same criteria for hemorrhage but did not receive transfusion. The maternal age, race, and parity were similar in both groups. The estimated blood loss (873 +/- 484 ml) and the preoperative hematocrit (33.4% +/- 6.4%) in the women who did not receive transfusion were not significantly different from those of patients who received packed red blood cells (854 +/- 576 ml and 30.0% +/- 5.4%, respectively). The postdelivery hematocrit was similar in both groups: 25.9% +/- 4.3% in the nontransfused group and 24.5% +/- 5.6% in the transfused group. Patients in the transfused group received a mean of 3.8 +/- 4.9 units of packed red blood cells, with a range of 1 to 40 units. The mean equilibrated (stable) hematocrit after transfusion was 28.4% +/- 5.4%, which was significantly greater than the mean equilibrated postoperative hematocrit of 22.7% +/- 4.6% in patients who did not receive transfusion (p < 0.0001). Nonetheless, the hospital stay, incidence of postoperative infection, and incidence of wound complications were similar in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
    No preview · Article · Jan 1995 · Journal of Perinatology
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    ABSTRACT: Objective: To compare nifedipine and magnesium as initial and long-term tocolytic agents. Methods: In this prospective study, 90 patients with documented preterm labor over an 18-month period were randomized to receive oral nifedipine (n = 50) vs parenteral magnesium (n = 40). If tocolysis was successful, oral therapy using nifedipine or magnesium (gluconate) was continued. Results: Both groups demonstrated clinically significant prolongation of pregnancy from the time of initiation of therapy (magnesium = 43 ± 34 day; nifedipine = 37 ± 26 day). There was no difference in the preterm birth (n = 18 in both groups) or low birth weight (< 2500 g, magnesium = 19, nifedipine = 15). There were no hypotensive side effects or fetal complications of nifedipine therapy, and no patient was removed from long-term therapy for side effects. Gastrointestinal side effects were responsible for discontinuing oral magnesium therapy in three women. Conclusions: These data show that both nifedipine and magnesium are effective as a first-line tocolytic therapy. No evidence of fetal, neonatal, or maternal compromise was noted in either group.
    No preview · Article · Jan 1995
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    ABSTRACT: This study attempted to determine the best method of treatment for patients with recurrent preterm labor: administration of terbutaline via an automated, programmable, subcutaneous infusion pump or oral terbutaline. In this retrospective, controlled study, 32 patients diagnosed with recurrent preterm labor, as determined by persistent uterine contractions with cervical change, were treated with a programmable infusion pump adjusted to control uterine contraction frequency to < or = 4 contractions per hour. Patients in this group were matched for age, race, parity, gestational age and cervical dilation at diagnosis of recurrent preterm labor in subjects taking oral terbutaline. The patients receiving oral terbutaline were given an average of 6.5 mg every four to six hours to maintain uterine quiescence, while those in the pump group were given basal rates of terbutaline and in addition received four to six boluses per day (< 3 mg/d total dose) to achieve this outcome. Patients using the pump were more likely to reach term and less likely to fail tocolytic therapy than were those taking oral terbutaline. The terbutaline pump appeared to be more successful in prolonging pregnancies to term after the diagnosis of recurrent preterm labor than did oral terbutaline.
    No preview · Article · Sep 1994 · The Journal of reproductive medicine
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    ABSTRACT: The objective of this study was to determine the risk of significant neonatal morbidity in women with preterm labor who deliver between 34 and 37 weeks' gestation. A total of 101 women between 34 and 37 weeks' gestation with documented preterm labor met inclusion and exclusion criteria; 90 gave informed consent and were randomly assigned to receive either intravenous magnesium tocolysis (treatment group) or conservative management with hydration, sedation, and observation (control group). Of the 90 women entering the study (45 in the treatment group and 45 in the control group), 2 discontinued tocolytic therapy because of gastrointestinal side effects. The gestational age on admission, cervical dilatation at diagnosis of preterm labor, interval to delivery, and birth weight were not significantly different between the treatment and control groups. There were no serious neonatal complications. In each group, three women had transient tachypnea and one had respiratory distress syndrome. We conclude that neonatal morbidity after delivery between 34 and 37 weeks' gestation is unchanged whether or not attempts to arrest labor are unsuccessful. The extra expense and maternal risk of tocolysis are not justified by beneficial results in the infant.
    No preview · Article · Apr 1994 · Journal of Perinatology

Publication Stats

969 Citations
217.26 Total Impact Points

Institutions

  • 1987-2009
    • University of Mississippi
      Mississippi, United States
  • 1988-2000
    • University of Mississippi Medical Center
      • Department of Obstetrics and Gynecology
      Jackson, Mississippi, United States
  • 1997
    • Jackson State University
      Jackson, Mississippi, United States
  • 1990
    • Creighton University
      • Department of Obstetrics and Gynecology
      Omaha, Nebraska, United States
  • 1989
    • Society for Maternal-Fetal Medicine
      Jackson, Mississippi, United States