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:

Terbutaline, a β-mimetic agent, is known as one of the most selective β-receptor stimulators. The results of a double-blind, placebo-controlled study suggest that the drug is a safe, potent, and well-tolerated inhibitor of premature labor. This treatment, however, influences the mother's cardiovascular system. The side effects of terbutaline are said to be mild, consisting of a slight increase in systolic pressure and a slight decrease in diastolic pressure and, consequently, an increase in pulse pressure. A moderate increase in maternal heart rate occurred in all the patients in the aforementioned study. No serious side effects were observed. It is only during intensive infusion therapy that palpitations and flush appear, and they seldom cause any discomfort.With the exception of blood pressure and heart rate, no details of the hemodynamic situation of the mother influenced by terbutaline are available. There has been no basic investigation of the circulatory effects of terbutaline on the most important factor in the cardiovascular system, namely, the cardiac output and total peripheral resistance. The aim of the present study was to elucidate these effects.The authors examined 10 normotensive women between the 20th and 34th weeks of gestation with the noninvasive. method of quantitative sphygmometry. All patients were subject to incipient premature labor. Their ages ranged from 20 to 29 years, with a mean of 23.2 years. They weighed from 50.6 to 68.3 kg (mean, 63.5 kg), and their sizes varied from 152 to 172 cm (mean, 161.8 cm). The patients examined were on a regular diet. Drug intake was excluded.The results are demonstrated graphically in Figure 1. The relative changes in the components of the cardiovascular system are important for clinical use. Absolute values and their statistical significance are shown in Table 1. At the end of the terbutaline infusion period, systolic blood pressure had risen by 6 per cent, and diastolic blood pressure had fallen by 8 per cent. There was no significant change in the mean arterial pressure. Heart rate increased by 28 per cent, stroke volume showed only moderate fluctuations, cardiac output rose enormously (by 52 per cent), and total peripheral resistance decreased significantly at the same time by 33 per cent. These changes must be interpreted in such a way that, in comparison with the nonpregnant status, cardiac output is elevated by 30.

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

During pregnancy, progressive maternal adaptations occur, and many biochemical measurements deviate from the normal range for males and nonpregnant females. Laboratory ranges specific to pregnancy need to be defined. Ideally, they would be determined in healthy women having uncomplicated pregnancies resulting in the birth of live, healthy children, but such data are scarce.The present paper describes the changes in serum uric acid concentrations throughout normal pregnancy and reports two clinically important aspects. First, the values decrease significantly below nonpregnant levels by 8 weeks of gestation. Second, uric acid concentrations in serum are not only increased above nonpregnant values by term in many women, but they remain elevated for as long as 12 weeks after delivery. Such postpartum values, therefore, should not be used as representative of nonpregnant concentrations.Thirty-one healthy women, with a mean age of 28 years (range, 23–37 years), were included in the study. Blood samples were taken at approximately 4, 8, 12, 16, 24, 32, 36, and 38 weeks of gestation and 12 weeks postpartum.There was a wide range of uric acid concentrations before, during, and after pregnancy. Two general points emerged: 1) the mean values decreased during the first trimester, remained at this lower level until about 24 weeks of gestation, and increased thereafter; 2) the mean concentration 12 weeks after delivery was higher than that before conception. This pattern was followed closely by individuals. There was also a clear tendency for subjects to retain their positions in the spectrum of uric acid values throughout pregnancy, which indicates that women who had high concentrations before pregnancy tended to remain in the upper range of values through pregnancy. Those with lower values before pregnancy tended to remain in that category. It appeared that before conception the wide range of observed concentrations resulted more from genuine differences among patients than from variations in uric acid values within patients from occasion to occasion.In those patients in whom 24-hour creatinine clearances were being determined, the reabsorption of uric acid was measured also. The amount reabsorbed decreased by 8 weeks of gestation, remained at the reduced level until about 24 weeks, and increased thereafter to such an extent that, by term, the amount reabsorbed was not significantly different from the prepregnancy value. This increase persisted, however, and by 12 weeks postpartum, the amounts reabsorbed were significantly greater than those before conception. The general trend throughout pregnancy, therefore, was similar to that followed by maternal serum uric acid concentrations.

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Asymptomatic urinary tract infection occurs in approximately 5 per cent of pregnant women. If bacteriuria is detected in the first trimester and is not eradicated, about 25 per cent of these women will develop acute pyelonephritis during the third trimester or the puerperium. Several reports indicate that single-dose antibacterial therapy, applied at the asymptomatic stage, may be effective in such cases.Two investigators used single-dose combination therapy in four different regimens for treating women with bacteriuria of pregnancy. The most successful of these was a single dose of streptomycin and sulfametopyrazine, which resulted in a 77 per cent cure rate among the 47 women treated. Both drugs, however, are considered hazardous to mother and infant.Another team treated 25 pregnant women with a single intramuscular dose of cephaloridine (2 gm) and cured 13 (52 per cent) of the patients. The sole criterion for cure was the eradication of the original infecting organism. Involvement of the renal parenchyma was detected by measuring strength of the antibody directed against the O-antigen of the infecting organism. If there was involvement of the parenchyma, the strength was usually 1:320 or greater, whereas a strength of 1:160 or less suggested the absence of renal involvement. This test was undertaken in 19 of the 25 pregnant women. Of those with an antibody strength suggesting kidney involvement, only 1 of 10 was cured, as compared with 8 of the 9 in whom the antibody strength indicated that the infection was confined to the bladder. The investigators concluded that the response to a single dose of cephaloridine appeared to be a good indicator of whether the infection involved the kidney. They suggested that, although cephaloridine was known to be bactericidal, this effect was not as rapid as that obtained with some other antibiotics, such as the aminoglycosides. Furthermore, complete sterilization of the bacterial population does not occur, and a few “persisters” remain. Improved results might have been obtained if the patients had been instructed to increase their fluid intake and empty their bladders at frequent intervals in order to wash out the bacteria. A second dose of cephaloridine on the following day might also have produced better results.The present author and his co-workers studied the effects of treating 12 pregnant women with asymptomatic bacteriuria with a single 100-mg oral dose of nitrofurantoin. Six of the 12 patients were cured (sterile urine 7 days after cessation of treatment). The six women were shown subsequently to have radiologically normal urinary tracts. Of the six patients who remained infected, three had radiological defects, namely, renal calculus, pelviureteric obstruction, or unilateral reflux nephropathy.

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 maternal carriage of group B streptococci is a major threat to newborn infants. Chemoprophylactic strategies that use maternal prenatal, maternal intrapartum, and neonatal postpartum antibiotic administration have been proposed as treatment. Two key epidemiological issues are important in regard to intrapartum and postnatal prophylaxis. The first is whether most cases of group B streptococcal early-onset disease are acquired during the first stage of labor or during delivery and the subsequent postnatal period. If the latter is true, then postnatal prophylaxis of infants should be effective; if the former is true, then an intrapartum strategy aimed at parturient women would seem to be preferable. The second issue concerns the possibility of identifying parturient women whose newborn infants are particularly susceptible to early infection. The present authors have studied these two issues through a prospective epidemiological analysis of all cases of group B streptococcal early-onset disease in infants born in their institution over a 9-year period (1973–1981).Of 32,384 live births during the period of study, 61 infants developed group B streptococcal early-onset disease, an overall attack rate of 1.9 per 1000 live births. Fifty-nine of the infants had appropriate weights for their gestational ages. Sixteen (26 per cent) of the affected infants died, giving an overall mortality rate of 0.5 per 1000.Forty-one (67 per cent) of the 61 affected infants were bacteremic either at birth or at less than 1 hour of age. Most had neonatal asphyxia or respiratory distress. The remaining 20 infants developed illness after a symptom-free interval ranging from 1.5 to 180 hours. Four (17 per cent) of the 24 infants who were ill at birth and had lumbar puncture before therapy, had positive cerebrospinal fluid cultures, as compared to 7 (47 per cent) of the 15 with lumbar puncture who became ill after a symptom-free interval (P = 0.07). Fifteen of the 41 infants with illness at birth died, giving a case-fatality rate of 37 per cent. Of the 20 infants who became ill after a symptom-free interval, only 1 died (a case-fatality rate of 5.0 per cent; P = 0.012).Maternal age, race, and financial status did not affect attack rates significantly. On the other hand, attack rates showed striking relationships to perinatal risk factors identifiable during labor. As birth weights decreased, attack rates increased from 1.1 per 1000 in infants who weighed more than 2500 gm to 26.2 per 1000 in infants who weighed 1000 gm or less. The relative risk of developing group B streptococcal early-onset disease for infants with birth weights of 2500 gm or less was 7.3-fold higher than that for infants with birth weights of more than 2500 gm (P < 0.001). As the duration of amniotic membrane rupture increased, attack rates showed stepwise increases ranging from 0.8 per 1000 in those with membrane rupture of 6 hours or less to 10.8 per 1000 in those with membrane rupture of 48 hours or more in duration. The relative risk of developing group B streptococcal early-onset disease for infants with membrane rupture of more than 18 hours was 7.2 times higher than that for infants with membrane rupture of 18 hours or less.Attack rates were increased to 6.5 per 1000 in infants bom to mothers with intrapartum fever (relative risk, 4.0; P < 0.001). Overall, 45 (74 per cent) of the 61 affected infants had birth weights of 2500 gm, membrane rupture duration of more than 18 hours, or maternal intrapartum fever. These perinatal risk factors were present in 85 per cent of affected infants who were ill at birth and in 50 per cent of those whose onsets followed symptom-free intervals. Infants with one or more risk factors had an attack rate of 7.6 per 1000, with a relative risk of developing group B streptococcal early-onset disease of 12.5 (P < 0.001).In an earlier study of vaginal colonization with group B streptococci in high-risk parturients, the authors found an overall carriage rate of 16.7 per cent. According to the assumption that affected infants are born only to mothers with intrapartum colonization, adjustment of the attack rate of early-onset disease in infants with perinatal risk factors (7.6 per 1000) by the 16.7 per cent overall prevalence of maternal vaginal colonization yields an estimated attack rate of 45.5 per 1000 (7.6 per 167) for infants born to colonized high-risk parturients with intrapartum colonization.

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Cytotoxic chemotherapy is a potential cause of sterility in young women and of malformations in the offspring of patients who conceive after treatment. The present authors, with the aim of identifying drug regimens that are compatible with fertility and not teratogenic, studied the obstetrical histories of women who entered remission after receiving cytotoxic chemotherapy for gestational trophoblastic tumors.Up-to-date obstetrical records on 445 women were available. Of the 217 who wished to conceive, 187 (86 per cent) succeeded in having at least one live birth each. Twenty-three (11 per cent) conceived but did not achieve a live birth, and seven (3 per cent) failed to conceive.The mean duration of chemotherapy was 4 months. The average age on completion of treatment was 24.9 years for those who had live births, 24.4 years for those who conceived but had no live birth, and 24.4 years for those who did not conceive at all. The average age of the women who did not want a pregnancy was 31.5 years.For each of the four groups of women, Table 1 shows the mean and maximum amounts of cytotoxic drug received. Methotrexate was given to all but two patients, neither of whom had tried to conceive. Analysis of each drug individually showed no significant difference between the mean amounts given to the women who achieved live births and those who did not. Live births occurred after all of the agents used, apart from cisplatin and etoposide. There was little difference, in the maximum doses given, between the group who had live births and the groups who had none.Combination chemotherapy was given to 43 per cent of the women who had live births, to 57 per cent of those who conceived but had no live births, and to 71 per cent of those who failed to conceive. These differences were not significant, but there was a distinct difference when the number of drugs received was considered. Women who were given three or more drugs in combination were less likely to have live births or to conceive at all than those given methotrexate alone or in combination with only one other drug (P < 0.001).Those who received actinomycin D or vincristine were less likely to have live births than the women who did not receive either drug (P < 0.01 and P < 0.05, respectively). None of the other drugs used in combination showed this significance, and none, including actinomycin and vincristine, showed any dose-response relation.

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:

Neonatal outcome after cesarean section under general anesthesia may be influenced by several factors. Two of these are the interval between anesthesia induction and delivery and the interval between uterine incision and delivery. The present authors evaluated the relationship between both factors and the Apgar scores of newborn infants delivered by cesarean section at various gestational ages. The study comprised 568 cesarean deliveries that were performed and under general anesthesia without any sign of fetal distress before operation.Of the 568 women, 216 had elective operations, and 352 had nonelective cesarean deliveries.

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID