(American College of Cardiology) Timely application of ABC (aspirin, beta blocker, clot buster [or thrombolytic] therapy) reduces mortality in elderly patients who present to the emergency department with myocardial infarction, according to an evaluat
(71st American Heart Association Scientific Sessions) Electronic beam computed tomography (EBCT) performed before menopause is effective in predicting development of disease in the coronary arteries and aorta after menopause, according to a 15-year st
(62nd National Scientific Meeting of the American College of Rheumatology) A randomized, double-blind study of 672 patients with osteoarthritis of the hip or knee has shown that rofecoxib (Vioxx), one of a new class of treatments for arthritis called
(Fifth International Congress of Parkinson's Disease and Movement Disorders) Postmenopausal women receiving hormone replacement therapy (HRT) may be less likely to develop Parkinson's disease than those who do not receive HRT, according to a study of
Medical Genetics Recommended core educational guidelines for family practice residents This document has been endorsed by the American Academy of Family Physicians and was developed in cooperation with the American College of Medical Genetics,
Monday CAG received an excellent suggestion from our nurse practitioner, Lori White, for giving eye drops to children and adults. The patient lies supine with the eyes closed, and another person places two drops in the medial canthus of each e
(Australia-Australian Family Physician, March 1999, p. 223.) Postnasal drip refers to the accumulation of mucus in the postnasal space, caused by hypersecretion from the paranasal sinuses or a disturbance of normal drainage. In addition to "congestion
(Great Britain-The Practitioner, February 1999, p. 118) Advanced Cushing's syndrome usually is easily diagnosed, but mild or early cases can be overlooked. Most cases are iatrogenic, resulting from daily corticosteroid intakes equivalent to or greater
(Australia-Australian Family Physician, March 1999, p. 209.) The larynx is the second most common site of head and neck cancers, exceeded in frequency only by cancers of the oral cavity. Most laryngeal cancers are squamous cell carcinomas, and the mos
(Great Britain-The Practitioner, February 1999, p. 110) In a population of 1 million, 60 to 70 adults have acromegaly, and about three new cases are detected each year. The diagnosis of this rare disease may be delayed because the symptoms develop slo
Date: March, 1994
The Muller-Hillis maneuver has traditionally been used to screen for dystocia during labor. As first described by Muller in 1886, the method requires an examiner to determine descent of the presenting part while an assistant applies fundal pressure. In the contemporary version, modified by Hillis in 1930, only one operator is needed to apply the fundal pressure and assess the pelvic station achieved on descent. Although the maneuver is widely used in clinical practice, it has not been prospectively studied. Thorp and colleagues examined the value of the maneuver in predicting dystocia during labor.
Muller-Hillis maneuvers were performed on 106 patients in active labor by a single perinatologist at a university medical center. Patient selection was based on availability of the physician. Labor was defined as cervical effacement of at least 90 percent and regular uterine contractions. Only women with singleton pregnancies in cephalic presentations with no known medical or obstetric complications were assessed. Staff members were unaware of the results of the assessment. Following delivery, an independent evaluator correlated the predictions made by the maneuver with the actual delivery outcomes.
Of the 106 patients, 25 (23.6 percent) were assessed as having no descent (positive test result) during the Muller-Hillis maneuver. No significant differences existed between patients with no descent and those with descent in terms of outcome of labor or demographic or obstetric variables such as age, race, maternal weight, gestational age or parity. Even when parity was considered in the analysis, lack of descent failed to predict an increased risk of abdominal delivery, use of forceps or vacuum extractor, prolonged second stage, need for oxytocin or abnormal progress during labor.
Although it is difficult to accurately assess a maneuver that depends on subjective assessment made by a single clinician during labor, the authors believe this study provides evidence that the Muller-Hillis maneuver does not predict dystocia. The authors seriously challenge the use of this maneuver in clinical practice and call for its use to be discontinued. (Obstetrics and Gynecology, October 1993, vol. 82, p. 519.)
EDITOR'S NOTE: With increasing emphasis on effective and efficient clinical practice, many established protocols and practices are being challenged. Objective studies of utility such as this one may be difficult to carry out but are essential. As a result of this study, clinical judgments based on the Muller-Hillis maneuver must be regarded as unreliable. - Anne D. Walling, M.D.
COPYRIGHT 1994 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group