ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

To administer effective and safe pharmacotherapy, it is necessary to have precise knowledge of the kinetics of the drugs administered. The kinetics of absorption, distribution, and elumination are important for determining the dose schedule.The drugs investigated by the present authors' research group are shown in Table 1. The investigators focussed mainly on the course of drug concentrations in serum and in renal excretion. They compared the pharmacokinetics of pethidine, methaqualone, cefalotin, and ampicillin in healthy nonpregnant women with those of women in stage III of pregnancy and of women in labor. Women in labor were not included in the investigation of phenobarbital, sulfamerazine, chlorsulfamethin, or Berlocombin. The half-life of indocyanine green, aminophenazone, sodium salicylate, and noramidopyrine methane-sulfonate sodium was calculated by means of a FORTRAN program for linear regression analysis. Later, the investigators used a one-compartment or two-compartment model, according to the mode of application and the available values, to calculate the pharmacokinetic values. Table 1 contains only a few important pharmacokinetic measurements and accentuates the direction of changes in pregnancy during labor.In late gravidity, the Cp° value (fictitious initial concentration) is always diminished, and the volume of distribution is enlarged simultaneously. These changes are caused by an increase of the extracellular fluid and by inclusion of the fetoplacental unit in the distribution volume. The degree of diminution of Cp° and the extension of Vd55(volume of distribution in steady state) depend on the physiochemical characteristics of the drugs. The total clearance was nearly always raised. These findings indicate a tendency toward reduction of serum and tissue concentrations in pregnancy. The difference between pregnant and nonpregnant women was especially evident with sulfonamides and antibiotics. The authors conclude that, if pharmacotherapy becomes necessary in pregnancy, the dose should never be reduced and the administration interval should not be extended.

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Increasing attention is being given to the effects of maternal behavior during pregnancy on the course and outcome of the pregnancy and on the subsequent well-being of the newborn. Maternal adherence to prenatal care recommendations varies considerably and is frequently less than ideal. Many women fail to attend antenatal clinics until their pregnancies are well advanced, and a large proportion of those who attend continue to smoke and consume alcohol in spite of instructions to the contrary.The issues of fetal health and viability of the pregnancy may be considered behavioral problems on the part of the mother. Although low adherence to health care recommendations may have physiological implications, the origins of the problem are largely psychological. The present authors, in the course of studying the psychological effects of ultrasound in pregnancy, assessed health beliefs and behavior also. The results of these assessments, conducted at 16 weeks of gestation, are described herein.Real-time ultrasound examinations were performed at the first clinic visit. Women in the study were assigned at random to one of two conditions of real-time ultrasound: high feedback (N = 67), in which women were shown the monitor screen and were provided with specific verbal and visual feedback as to fetal size, shape, and movement; and low feedback (N = 62), in which the patients received a comparable examination and interview, with the sole exception that they were not able to see the monitor screen and so receive specific feedback. Women were assessed before and after the scan on a number of attitudinal and psychological measures.The biographical characteristics are presented in Table 1. Eighty per cent of the sample were still working at this time, and 24 per cent expressed the intention to resume work following delivery. All but three of the sample had been reading material related to health care during the pregnancy, and 95 per cent were taking dietary supplements (mainly iron) regularly. The majority (85 per cent) intended to attend prenatal classes, and 73 per cent expected their partners to accompany them.The women were required to report on behavioral change after the first prenatal clinic visit, and on their attitudes toward health care recommendations. Table 2 shows smoking behavior and attitudes. It can be seen that 40 of the sample admitted to smoking, with a mean number of 10.3 cigarettes per day. Among those not smoking, a near-significant association emerged with respect to quitting the practice following ultrasound.

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The management of pregnancies complicated by pregnancy-induced and/or chronic essential hypertension requires careful surveillance, rest, and perhaps drug therapy. Premature delivery may be necessary if the hypertension is severe or if the fetus is in jeopardy. Methods to assess fetoplacental integrity have included real-time ultrasonographic visualization, antepartum fetal heart rate testing, urine estriol/creatine determinations, and fetal activity monitoring. The perception of fetal activity by the compliant patient has been reported to be reliable and useful in following high-risk pregnancies. This prospective investigation attempts to determine whether fetal activity is altered in pregnancies complicated by hypertension and to assess whether this form of monitoring is useful in managing such pregnancies.Of the 124 pregnancies studied, 73 (59 per cent) had pregnancy-induced hypertension and 51 (41 per cent) had chronic hypertension, occurring either before conception or before the 20th gestational week. The number of perceived fetal movements per hour (24 ± 11) (mean ± SD) in the hypertensive pregnancies did not vary significantly from that of the normotensive group (28 ± 9). Evidence for fetal inactivity was infrequent in the hypertensive pregnancies (seven of 124 cases; 6 per cent) and did not differ significantly from that in the normotensive group.The fetal activity patterns and subsequent neonatal outcomes in pregnancies complicated by chronic or pregnancy-induced hypertension are compared in Table 1. Unfavorable outcomes occurred in six of seven pregnancies in which fetal inactivity became evident. All three instances of stillbirth occurred after fetal inactivity had been discerned, in spite of the presence of audible fetal heart tones. A prolonged fetal rest probably explains the only case involving an inactive fetus which had a successful outcome.A vigorous or active fetus was a reassuring sign in 111 (95 per cent) of the hypertensive pregnancies. Conditions associated with unfavorable outcomes in the remaining six cases were related to intrauterine growth retardation, placental abruption, umbilical cord accidents, and respiratory complications from prematurity.

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The management of pregnancies affected by rhesus hemolytic disease is helped by prediction of outcome, which is based conventionally on previous history and some measure of anti-D potency. The estimation and interpretation of anti-D potency have been facilitated by a British anti-D working standard, established in 1975. The present authors have examined the relation between maternal anti-D concentrations and outcome of rhesus-sensitized pregnancies. This is the first such study to report anti-D concentrations measured directly against the British standard.During the study (1977 to 1980), there were 109,000 births in the Oxford region. Seven babies died from hemolytic disease of the newborn (0.07/1000 births), and 380 women were found to have anti-D antibodies during pregnancy (3.5/1000 births). Of these 380 women, 260 were studied in detail. Five pregnancies were managed with intrauterine transfusion; two babies survived (initial anti-D concentrations of 7.9 and 28 III/ ml, respectively) and three died (initial concentrations of 45, 104, and 104 lU/ml, respectively).

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Surgical correction of tetralogy of Fallot has become a standard practice, and of those patients surviving corrective surgery, about 95 per cent are alive 5 to 10 years later. Survivors show loss of cyanosis and an improvement in effort tolerance.Uncorrected cyanotic heart disease carries a high risk in pregnancy for both mother and fetus. The high fetal mortality rate was caused by poor fetal growth, leading to a high incidence of abortion, prematurity, and small-for-dates babies. Pregnancy in patients with surgically corrected tetralogy of Fallot is increasing, but no large, detailed series of such pregnancies has been reported heretofore. The present report presents a study of 40 successful pregnancies in 27 patients with surgical correction.There were no serious cardiac complications in the 31 pregnancies about which detailed information was obtained. The only obstetrical complications were transient mild hypertension in six patients and mild edema in nine.The gestational age ranged from 35 to 42 weeks (mean, 39 weeks). Labor was induced in five patients, cardiac disease being given as the indication in only one. Of the 31 deliveries about which detailed information was available, 15 were spontaneous vaginal deliveries. There were 14 forceps deliveries, half of which were for cardiac disease. Two patients required cesarean section, one for cephalopelvic disproportion and the other for prolapse of the cord. The mean duration of the first stage was 6.8 hours (range, 1.5 to 17 hours) and of the second stage, 35 minutes (range, 5 to 130 minutes). Analgesia was achieved by epidural block in seven patients, by narcotics in 11, and by nitrous oxide with oxygen in three. Oral antibiotic prophylaxis against endocarditis was given in 24 of 28 patients where details were available. No puerperal problems were encountered.Of the 31 infants (18 boys, 13 girls) examined in this study, 30 were essentially normal (two had physiological jaundice and one had a mild intrauterine infection). One infant had pulmonary atresia and is under cardiological surveillance. The mean birth weight of the boys was 3.0 kg (range, 2.37 to 3.82 kg), whereas in the 13 girls, the mean weight was below 2.90 kg (range, 2.06 to 3.54 kg). Three of the boys (1 7 per cent) and three of the girls (23 per cent) were below the 10th centile for weight.The 27 patients who had been pregnant (group 1) were compared with 25 women with total correction of tetralogy of Fallot who had not been pregnant (group 2). Table 1 lists the features that were evaluated and gives the numbers and percentages of patients in each group in whom there was a positive finding for any given factor. Whether or not a patch was necessary, either to close the ventricular septal defect or to enlarge the right ventricular outflow tract, is an indirect indication of the complexity of the congenital defect. Previous surgery in all cases consisted of either a Blalock-Taussig shunt or a Brock procedure. Two of the women with residual ventricular septal defects required second operations after successful pregnancies. Obstruction of the right ventricular outflow tract or pulmonary regurgitation, or both, were fairly frequent residual findings but were of little hemodynamic importance. The documented arrhythmias consisted of isolated ventricular extrasystoles in six patients and supraventricular ectopics in one.

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Phenylketonuric women are at high risk for having children who are mentally retarded and microcephalic, have low birth weight, and may have congenital heart disease. Several studies suggest that low-phenylalanine dietary treatment during pregnancy, with control of the maternal biochemical abnormalities, prevents fetal damage and allows for the birth of normal offspring.One method of assessing the dietary treatment in maternal phenylketonuria is to compare nonphenylketonuric siblings from treated and untreated pregnancies. The present authors have studied the outcomes of three treated and three untreated pregnancies in one phenylketonuric mother.The mother is a 35-year-old woman in whom phenylketonuria was first diagnosed after her first delivery at the age of 21. At that time, one of her twin daughters was found to have an elevated blood phenylalanine concentration at 4 weeks of age (the other twin had a normal concentration). The mother had a markedly elevated blood phenylalanine concentration of 1650 μmol (27.2 mg/dl) and positive urinary phenylketones.During the first pregnancy, the mother was receiving a normal diet. This pregnancy was uncomplicated and resulted in female fraternal twins who had normal birth weights but were microcephalic.

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Reports on burns in pregnancy in the world literature are scarce. The present authors have collected details of 50 patients with burns in pregnancy of sufficient severity to warrant hospital admission. The results relevant to, and the implications for, obstetrical practice are presented and discussed in this paper.The 50 patients were divided into two groups. One group was composed of 23 women who were discharged from the hospital while still pregnant, and the second group comprised the other 27 women whose pregnancies ended during admission for primary burn care. Only three women discharged while still pregnant had severe burns (40 per cent or more), all occurring in the first trimester. Both fetus and mother survived in each of these cases, and it seems possible that the pregnancy is less vulnerable in the first trimester. Where the pregnancy ended prematurely, it is clear that a burn of 50 per cent forms the watershed of maternal survival (an important factor in management). Only two of the 13 patients with burns of less than 50 per cent died, both being near term in the third trimester and suffering irreversible cardiores-piratory arrests in the first 24 hours. Thus patients in the third trimester who may be approaching the physiological limits of cardiovascular homeostasis require particularly careful resuscitation.

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Christian Kielland (1916) designed his obstetrical forceps primarily for application to the nonengaged fetal head. But in modern obstetrical practice, high forceps delivery has been replaced by cesarean section. Kiel-land's forceps are now used in the mid-pelvis for rotation of the fetal head from a persistent occipito-posterior position or for rotation when the head has been arrested in a transverse position.Any delivery requiring rotation of the fetal head in mid-pelvis may be complicated and traumatic. At issue is whether delivery with Kielland's forceps is more dangerous than delivery by any other means in such a situation. There are few data on which to base an answer to this question. The only major recent study of the subject, in which Kielland's forceps rotation was associated with higher incidences of fetal damage than found in spontaneous vertex delivery, has been challenged.The aims of the present study were to examine the use of Kielland's forceps by: 1) analyzing all such deliveries at the authors' hospital over a 3-year period and tabulating fetal and maternal complications, and 2) comparing the results from the use of Kielland's forceps with that of other forceps for midcavity rotation and with manual rotation and forceps delivery.A total of 552 patients who were delivered with Kielland's forceps during the years 1977 to 1979 were included in the study, and their case histories were examined.

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Pregnancy in the diabetic patient is associated with increased hazard to mother and fetus. Cesarean section is frequently required in this high-risk group. The present authors, in a previous investigation, noticed lower umbilical pH values in infants of diabetic mothers having spinal anesthesia for cesarean section than in infants whose diabetic mothers received general anesthesia (7.20 vs. 7.28). The study reported here was designed to assess the effectiveness of the following measures in the administration of spinal anesthesia: 1) strict regulation of maternal blood glucose levels to maintain them between 80 and 90 mg/dl, 2) acute intravenous volume loading immediately before the induction of spinal anesthesia with a dextrose-free solution, and 3) avoidance of maternal hypotension during anesthesia. The purpose of such measures was to improve the neonatal acid-base values in this special group of patients.Twenty parturients scheduled for elective primary or repeat cesarean section at term were selected at random. Ten were controlled insulin-dependent diabetic mothers (mean preoperative fasting blood glucose level, 86 ± 4 mg/dl). The other 10 were healthy nondiabetic women who served as control patients.Two diabetic parturients were hospitalized three weeks before delivery for control of fasting blood glucose levels. Before surgery, however, fasting blood glucose levels were within normal limits (86 ± 4 mg/dl) in all the diabetic mothers.Comparison of the two groups of mothers revealed no significant differences in maternal age, height, or gestational age. Systolic blood pressure did not exceed 130 torr in any parturient within 24 hours of operation, and none of the mothers had systolic pressures of more than 30 torr from baseline levels during anesthesia. The total amount of ephedrine administered varied from 10 to 30 mg and was not significantly different between the two groups.There were no differences in the induction-delivery or uterine incision-delivery intervals between the two groups. The acid-base status of the mothers in both groups was normal at delivery. There were no significant differences in acid-base status or in blood-gas tensions between infants in the control and in the diabetic groups. Only one baby in the diabetic group had an Apgar score of less than 7 at one minute; the rest had Apgar scores greater than 7 at both one and five minutes.The authors observed that strict control of maternal diabetes, avoidance of dextrose-containing solutions for acute maternal volume expansion before anesthesia, and prompt treatment of any decrease of maternal blood pressure will maintain neonatal acid-base status at control levels during spinal anesthesia and avoid the development of acidemia.

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID