ISSN:0029-7828    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

In one retrospective study, mothers in labor who were given intravenous infusions of glucose delivered newborns with lower average blood glucose levels than did mothers who were not given intravenous glucose. In a further investigation of the subject, the authors conducted a prospective study to determine the relationships between maternal glucose infusion and fetal and neonatal insulin and blood glucose levels. In addition, they studied the subsequent neonatal neuro behavior in an otherwise healthy and normal population.Fifty-six mother-newborn pairs were studied. All mothers received intravenous glucose before delivery in accordance with standard practice. The total glucose load and the rate of glucose infusion were determined, and venous blood was obtained from the mother at the time of delivery. Umbilical venous blood glucose and insulin levels and neonatal blood glucose levels were measured.The total amount of maternal glucose administered ranged from 3.5 to 82.5 g (median, 32.5 g). The rate of glucose infusion ranged from 35 to 57 g/h (median, 8 g/h). The median time interval between the start of glucose infusion and delivery was 4.1 hours (range, 0.7 to 1 7 h). Maternal blood glucose levels at delivery had a median of 110 mg/dl (range, 65 to 230 mg/dl). The total amount of glucose infused correlated significantly (P < 0.01) with maternal blood glucose levels.The median umbilical vein glucose level was 104 mg/ dl (range, 73 to 215 mg/dl). The correlation coefficient between maternal and umbilical vein glucose levels was r = 0.94 (P < 0.001). Umbilical vein insulin concentrations ranged from 3.1 to 202 μU/ml. The umbilical vein glucose levels correlated significantly (P < 0.001) with the total glucose load and the glucose infusion rate. The umbilical vein glucose also correlated significantly with the maternal blood glucose concentration (P < 0.001). The umbilical vein insulin level was significantly related to the rate of glucose infusion in the mother (P < 0.001), as well as to maternal blood glucose and to umbilical vein glucose (P < 0.01).Six of the 56 babies (11 per cent) had hypoglycemia at 1 hour of age. The presence of low blood glucose in the newborn significantly correlated (P < 0.05) with a maternal blood glucose level of 120 mg/dl or greater. Furthermore, low neonatal glucose levels correlated (P < 0.05) with a maternal glucose infusion rate of 20 g/h or greater. Neonatal hypoglycemia also correlated significantly (P < 0.01) with umbilical vein insulin levels greater than 40 μU/ml. Hypoglycemia in all babies promptly responded to appropriate therapy.Adjustment to auditory stimulus was significantly better (P < 0.01) in hypoglycemic neonates than in the nonhy-poglycemic neonates at 4 hours of age. There were no other significant differences associated with neonatal blood glucose levels, although in hypoglycemic infants there was a tendency to diminish Moro's response and to have poorer rooting at age 4 hours. There were no differences for any neurobehavioral measure at 24 hours of age.It is recommended that the normal parturient be given less than 20 g/h of intravenous glucose before delivery and have a blood glucose level less than 120 mg/dl at the time of delivery. Newborns delivered to mothers with hyperglycemia or excessive glucose infusion should be tested for hypoglycemia at 1 and 2 hours of age.

ISSN:0029-7828    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Little research has been devoted to the pain and discomfort resulting from episiotomy during the puerperium. In this study, the authors have attempted to document the nature of postepisiotomy pain and its severity, incidence, and modulating factors. A second objective was to study the process of recovery, to identify factors associated with healing, and to reassess the attitudes toward the care received.

ISSN:0029-7828    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

This study was conducted during the period June 1976 to September 1980 to evaluate the effect of prophylactic and therapeutic heparin treatment during pregnancy in 35 women (37 pregnancies) with acute or previous thromboembolic complications (TE). Therapeutic anticoagulant therapy (group T) was instituted in 18 women with acute deep venous thrombosis and in four with transitory ischemic attacks. Antithrombotic prophylaxis was given to 13 women (group P) with previous thrombo-embolism; of these 12 had suffered earlier complications when the level of estrogens was elevated (i.e., seven during pregnancy and five during treatment with combined oral contraceptives). Their previous complications were pulmonary emboli (4 women), iliofemoral thrombi (4), tibial/fibular thrombi (4), retinal vein thrombosis (1), and mechanical occlusion of the right iliac artery and vein during the third trimester (1).Twenty-five of the 37 pregnancies developed normally. One case of pregnancy-induced hypertension was observed. In a previous pregnancy, this patient had developed eclampsia. Fetal growth retardation was seen in one patient with minor vaginal bleeding in early pregnancy during heparin treatment. The bleeding complications vanished during reduction of heparin and, later on, the dosage could be increased without any difficulties. This woman had also been treated with warfarin before the pregnancy was confirmed.Eight women displayed cervical insufficiency, and incipient premature labor was noted in seven pregnancies in the third trimester. Three of these were twin pregnancies. One pregnancy was complicated by ablatio placentae and one by diabetes mellitus and goiter. One spontaneous abortion occurred in a woman with factor XIII deficiency. Only one termination of pregnancy by cesarean section was due to thromboembolism.The antithrombin III level, measured with the chromogenic substrate S-2238, and platelet counts were analyzed in 16 women. Liver function was studied in 13 of them. A significant decrease in antithrombin III occurred initially in both groups and became normal during long-term heparin treatment. Platelet counts and liver function tests were mainly unchanged.The incidence of thromboembolic complications varies between 1 in 300 and 1 in 5000 deliveries, and thrombosis and pulmonary embolism have most often been reported to occur in late pregnancy and in the puerperium. After traumatic vaginal deliveries and cesarean sections, the frequency of thromboembolism is increased several times. The best drug for anticoagulant therapy in pregnant women seems to be heparin. The main side effects in the mothers are bleeding, osteopororis, and thrombocytopenia. The frequency of these complications is unknown. No definite proof of any complications in the fetus caused by heparin alone has been presented.

ISSN:0029-7828    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Pregnancy in women with a history of immune thrombocytopenic purpura may be complicated by the development of neonatal thrombocytopenia. The factors responsible were investigated in a prospective study of 23 pregnant women with either a history of immune thrombocytopenic purpura or clinically active immune thrombocytopenic purpura.

ISSN:0029-7828    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Although many studies describe morphological and chromosomal findings in embryos and fetuses of spontaneous abortions, reports of placental morphology are less common. The present investigation describes placental findings in 360 spontaneous abortions and stillbirths occurring in Jerusalem in 1973–1976, and compares these findings to the morphology and chromosome constitution of the fetuses. Placentae from 100 elective abortions of 2–5 months of gestation served as controls.

ISSN:0029-7828    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Intraperitoneal transfusion of unborn infants with severe rhesus hemolytic disease gives poor results when the fetus is of low gestational age and has hydrops. Direct intravascular transfusion of fetuses under feto-scopic control at 23 to 26 weeks of gestation is more efficient, but it cannot be used beyond that age because of fetoscopic limitations. The authors have therefore tried direct intravenous transfusion of fetuses through the hepatic part of the umbilical vein using a thin needle guided by ultrasound. The procedures conformed with the Declaration of Helsinki of 1975. Results in two cases are described.Case 1, a 33-year-old woman (blood group O, rhesus-negative) was in her fifth pregnancy. Ultrasonic assessment showed a fetus of normal size for 29 weeks. Fetal ascites was present, and the amniotic fluid bilirubin concentration was 14 μmol/liter(0.8 mg/100 ml), which was in the “severely affected” zone of the prognostic chart. The patient was treated with betamethazone (12 mg daily for 2 days), ritodrine (10 mg four times daily), and phe-nobarbitone (100 mg daily).An intraperitoneal transfusion was planned, with 50 ml of group O, rhesus-negative (cde/cde) erythrocytes suspended in sterile isotonic sodium chloride (packed cell volume, 0.60 (60 per cent)). To prevent immunological complications, the cell suspension was irradiated with 2160 rad for 4 minutes before use. During the transfusion, the authors observed a dilated umbilical vein and gave a further 10 ml of blood into the hepatic part of the vein. A fetal blood sample, which looked like reddish serum, showed the fetus to be group A, rhesus-positive, and gave a strongly positive reaction to a direct Coombs test.A second intravenous transfusion of 25 ml was given a week later. A fetal blood sample before the second transfusion showed a ratio of fetal to adult erythrocytes of 37:63.At 32 weeks, a girl of 1 700 g was delivered by cesar-ean section. The Apgar score was 3 at 1 minute and 10 at 5 minutes. The umbilical cord hemoglobin concentration was 6.4 g/dl and the bilirubin concentration 144 μmol/liter (8.4 mg/100 ml). The ratio of fetal to adult erythrocytes was 22:78. The infant had a slight bluish discoloration around the umbilicus, possibly a slight he-matoma. During the next 2 days, five exchange transfusions were given because of high and rising serum bilirubin concentrations, the highest being 393 μmol/liter (22.9 mg/100 ml). There were no further complications.Case 2, a 25-year-old woman in the 23rd week of pregnancy, was admitted for termination of pregnancy after a prenatal diagnosis of genetic disease (chromosomal abnormality). There was no evidence of rhesus isoimmunization. Ultrasound-guided puncture for fetal blood sampling was performed. Biparietal diameter was compatible with the age of gestation. Puncture of the hepatic part of the umbilical vein was performed under epidural anesthesia. The tip of the needle was visualized on the oscilloscope in the lumen of the vein and 0.5 ml of blood was withdrawn. Analysis on a Coulter counter showed 100 per cent fetal blood. Subsequently, 40 mg of dinoprost trometamol (Amoglandin) were instilled into the amniotic cavity for termination.Knowledge of various factors—for example, the size of transfusion, the cardiovascular effects of transfusion, the importance of different blood variables in fetal blood—should be established, but it is hoped that direct intravenous fetal tranfusion will improve the prognosis of high risk, rhesus-sensitized fetuses that cannot be saved by traditional methods.

ISSN:0029-7828    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

It has been widely believed that local anesthetics injected into the epidural space during uterine contractions may produce a high level of anesthesia. The purpose of this study was to test the validity of this clinical impression.Thirty-four full-term, healthy primiparous patients scheduled for epidural labor analgesia were studied. The patients were divided into two equal groups, A and B. In group A the inducing dose of 8 ml of 2 per cent chloro-procaine was injected at a rate of 1 ml/second during a uterine contraction. After the block had worn off (75 ± 3 minutes), a second dose was injected during the interval between uterine contractions. The protocol in group B was similar to that in group A except that the first injection was made during the interval between two uterine contractions and the second during a uterine contraction. The interval between the injections was 77 ± 7 minutes. The progression of labor and the descent of the presenting part during the two injections were similar to those in group A. The total number of segments blocked and changes in maternal blood pressure and heart rate obtained after the first injection were compared with those obtained after the second in each group by the f-test at levels of significance of P < 0.05.In group A, the first injection (during contraction) blocked 16.7 ± 0.44 (± 1 SE) segments and decreased mean blood pressure by 4 ± 2 torr and HR by 2 ± 2.5 beats per minute. The second dose (between contractions) blocked 16.6 ± 0.46 segments and decreased blood pressure by 5 ± 2 torr and heart rate by 3 ± 2 beats per minute. In group B (reversed injection sequence), the first injection blocked 16.2 ± 0.44 segments and reduced blood pressure and heart rate by 4 ± 1 torr and 1 ± 2 beats per minute, respectively. There was no statistically significant difference in any of the measurements between the two injections in either group.Results of this study indicate that uterine contractions do not affect the spread of local anesthetic solution in the epidural space.

ISSN:0029-7828    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1982

数据来源: OVID