摘要:

Acute leukemia is a rare complication of pregnancy. Previous reviews that covered cases reported before the introduction of effective combination chemotherapy found fewer than 300 reported pregnancies, with a 36–69 per cent perinatal mortality and median maternal survival, from diagnosis, of less than 6 months. Advances in the fields of hematology-oncology, maternal-fetal medicine, and neonatology have resulted in a marked improvement in both perinatal survival statistics, and median maternal survival. Since 1972, there have been 14 pregnancies reported in patients cured of acute lymphocytic leukemia, with 1 early spontaneous abortion and 13 term infants. All mothers survived. There have been 47 reports of pregnancy in association with acute leukemia. In 40 pregnancies in which acute leukemia was treated, there were 5 abortions, 3 perinatal demises, 1 infant “liveborn in grave condition,” and 31 surviving infants. Median maternal survival was at least 6, and possibly more than 12 months from delivery. In seven cases in which leukemia was untreated, there were one abortion, two perinatal demises, and four living infants; only one of six mothers survived beyond 6 months. Here, a case of pregnancy complicated by acute promyelocytic leukemia is presented. The mother was aggressively treated with combination chemotherapy. The fetus was closely monitored and delivered following a course of betamethasone at 34 weeks' gestation, and had no neonatal problems. The mother expired 13 months status-post bone marrow transplantation, 16 months after delivery.Cases of pregnancy complicated by acute leukemia reported in the period 1972–1982 are reviewed, and management is discussed in detail. Aggressive hematologic and obstetric management is advocated, and should result in further improvements in fetal and maternal outcome.

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Physical effort in pregnancy may result in premature birth. In the case of working mothers, therefore, it is important to know what kinds of exertion are harmful. The aim of this study was to determine the elements of a given occupation which might constitute possible risk factors in the course of a pregnancy, especially with regard to premature birth.The authors made a survey of 3437 women whose infants were delivered at two maternity hospitals, one in Lyon (a large city) and the other in Haguenau (a small town). Towns of different size were chosen in order to obtain a wider sample of living conditions. Of the 3437 women, 1928 had paid occupations. An analytical breakdown of each job into its diverse components revealed five sources of occupational fatigue: posture, work on industrial machines, physical exertion, mental stress, and environment. The authors constructed an index based on these sources, defining the index scores as ordered variables which could take increasing values as the job became more strenuous with respect to the fatigue source.Premature deliveries occurred in 221 of the total sample of 3437 women (prematurity rate, 6.4 per cent), in 112 of the 1928 working women (prematurity rate, 5.8 per cent), and in 109 of 1509 housewives (prematurity rate, 7.2 per cent). There is no significant difference among these rates, although they may reflect the different sociological profiles of the groups. Since there was no significant difference between the prematurity rates of the two hospitals, the results from both were combined.The occupational category, the weekly working hours, and the daily working timetable were analyzed with regard to prematurity risk. Approximately half of the women had jobs that could be associated with a high prematurity rate. The rate averaged 8.3 per cent among shop staff and

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

In the past, the lack of sensitive noninvasive methods has prevented direct examination of human fetal hemody-namics under clinical conditions. The introduction of ultrasonic methods based on a combination of B-mode or realtime and Doppler equipment has allowed the measurement of fetal blood flow in the umbilical vein and the descending aorta. Recent results show that this new technique can indicate the degree of fetal anemia in rhesus isoimmunization. The purpose of this study was to demonstrate the applicability of the method to cases of moderate to severe chronic fetal distress.There were 11 patients (Table 1) who showed the following evidence of fetal compromise: weight of newborn less than the 10th centile for normal Finnish infants; Apgar scores of 7 or less at 1 and 5 minutes; and pathological findings (repeated late decelerations and/or loss of beat-to-beat variability and/or pathological oxytocin challenge test) during the last cardiotocogram before delivery. No persistent bradycardia was noted during the flow measurement.Umbilical vein blood flow at the last measurement before delivery was less than the 10th centile for the normal flow range in all patients (Fig. 1), and the earlier flow values were pathologically low in all except one patient. In 4 of

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The oxytocin challenge test is potentially dangerous to the fetus in that it may cause hyperstimulation of the uterus. This is caused by a reaction of the myometrium to exogenous oxytocin. As an alternative, some investigators have recommended nipple stimulation, which releases endogenous oxytocin. There are, however, disadvantages to this method also. The present authors report three patients in whom nipple stimulation induced marked uterine hypertonus, resulting in profound bradycardia in fetuses otherwise demonstrating reactive heart rate patterns.Patient 1, a 35-year-old Filipino woman, was seen in the 41st week of an otherwise normal third pregnancy. An antepartum cardiotocogram was performed because of recent weight loss. Nipple stimulation during the fetal heart rate recording resulted in uterine hypertonus and a change in fetal heart response from a reactive pattern to profound bradycardia (Fig. 1a). Immediate cesarean section resulted in the birth of a normal male, weighing 3200 gm with Apgar scores of 9 and 10 at 1 and 5 minutes, respectively. AmnJotic fluid was clear, and there were no placental or

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Amniotic rupture is a rare condition observed thus far only in cases of extra-amniotic pregnancy. In examples previously reported, the ruptured membranes were small, and the diagnosis was unequivocal in each instance. When the membrane is large, the placental changes can be overlooked, especially when the infant does not have the amniotic band syndrome. The present authors have observed two such placentas from otherwise normal pregnancies. The presence of vernix granulomata in the denuded chorionic mesenchyme of both placentas confirmed the diagnosis of antepartum amniotic rupture.Case 1. A 25-year-old woman, gravida 2, para 1, delivered a set of fraternal twins after 31.5 weeks of gestation. The course of pregnancy was uneventful, and she denied taking any medication. There was no documented history of trauma or premature rupture of membranes. Labor commenced spontaneously and lasted 51/2hours before the first twin, a 1740-gm male, was delivered vaginally after rupture of the bulging amniotic sac. No oligohydramnios was noted. The second amniotic sac ruptured 15 minutes later, and a 1810-gm female was delivered. Both twins were free of malformations, including those of the amniotic band syndrome. The first twin developed hyper-bilirubinemia and was found later to have hyperthyroidism; the second developed hyaline membrane disease and hyperbilirubinemia. Both infants were treated successfully and discharged in satisfactory condition at age 23 days.

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The authors of this report describe a case of intracranial bleeding associated with an aneurysm in a patient whose near-term pregnancy was complicated by systemic arterial hypertension. They point out several factors which are important to the survival of both mother and child in such cases.A 35-year-old woman (gravida 2, para 1) had an intrauterine pregnancy at 32 weeks of gestation, complicated by mild pregnancy-associated hypertension. An intracranial aneurysm was suspected after the acute onset of occipital cephalgia, and a lumbar puncture revealed bloody cerebrospinal fluid. A 2-cm aneurysm at the junction of the right basilar and posterior cerebral arteries was delineated by both computer tomography and selective cerebral angiography. The size, location, and angiographic appearance of the aneurysm suggested an urgent need for surgical repair. Sedation, used to prevent further bleeding, included phenobarbrtal, diazepam, and codeine. The patient's medical history included a previous hypertensive pregnancy, with cesarean delivery because of cephatopelvic disproportion. She was scheduled for a cesarean section which was to be followed by a right frontal craniotomy. The patient was in moderate distress caused by her cephalgia. Arterial blood pressure range was 90–135/60–85 mm Hg, with a heart rate of 60–80 beats/min. She was intelligent and composed, and consented to the planned procedures. The next morning, incremental doses of morphine sulfate (total, 8 mg) were injected intravenously while she was in her room for sedation. In the operating room, a quiet, calm atmosphere was maintained. Intravenous and arterial cannulae were inserted after infiltration with lidocaine. The fetal heart tones were stable at 150 beats/ min. Propranolol was given intravenously in 0.5-mg increments to a total of 3 mg (until the heart rate decreased approximately 10 beats/min). Anesthesia was induced with thiopental (150 mg intravenously), and 8 mg of pancuronium provided skeletal muscle relaxation. Ventilation was controlled by inhalation of 1 per cent halothane in oxygen. One minute preceding intubation of the trachea, 100 mg of lidocaine was given intravenously. With the abolition of

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

There has been much uncertainty with regard to fetal outcome in pemphigoid gestationis (formerly called herpes gestationis). The present authors have studied the infants from 50 pregnancies which were affected by the disease. They were able to estimate the fetal risk in pemphigotd gestationis by considering birth weights, gestational ages, and the incidence of small-for-gestational age infants in the study population.Ten infants (20 per cent) were delivered by cesarean section, the indications being fetal distress (5), preeclampsia (1), cord prolapse (1), placenta previa (1), and previous cesarean section (1). The indication was not clear in one patient. In the cases with fetal distress, cesarean sections were performed at 32, 34, 36, 36, and 40 weeks, respectively. Sixteen infants (32 per cent) required admission to a special care baby unit. Details of their sex, birth weights, and gestational ages are listed in Table 1. There was a significant increase in the frequency of low birth weight and small-for-gestational age infants. The deliveries were

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID