摘要:

The quality and reliability of pulsed Doppler recordings from branches of the uterine artery were tested by studying 37 normotensive pregnancies and 14 complicated by pregnancy‐induced hypertension (PIH) lasting for several minutes. The coefficients of variation of mean velocity and A/B ratio (= peak systolic/end diastolic velocity) were 0.06 and 0.08, respectively. Thus, calculations of A/B ratio from a limited number of heart beats should be reliable. Calculations were then made from uterine artery Doppler recordings in 65 normotensive pregnancies and 32 with PIH. A significantly higher A/B ratio was found in the PIH group. Among the normotensives, no statistically significant difference in A/B ratio was found between those who gave birth to appropriate‐for‐gestational‐age (AGA) and small‐for‐gestational‐age (SGA:<10th centile) infants. In the PIH group a significant difference was found; A/B: 1.95 versus 1.78 in the SGA and AGA groups, respectively. The latter was still significantly higher than the normotensive (= 1.60/. Two PIH subgroups with equivalent blood pressures and proteinuria, but who gave birth to AGA or SGA infants, were compared. A/B ratio from the latter was significantly higher. These findings show that PIH is associated with increased uteroplacental vascular resistance; increased vascular pathology is associated with fetal growt

ISSN:0001-6349    

DOI:10.3109/00016348909021008

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Dihydralazine is frequently used in severe pregnancy induced hypertension (PIH). Little is known about its effect on the human uteroplacental circulation. In this study, Doppler ultrasound recordings were made from branches of the uterine artery in 5 women with PIH and blood pressure (BP) ≥ 150/100 who received either 7.5 or 10 mg dihydralazine, as repeated intravenous doses of 2.5 mg, before obtaining nearnormal/norrnal BP values. The measurements started 5–10 min prior to the injections and continued as undisrupted as possible during injections and the subsequent 30 min. When the reduction in BP was obtained, the median blood velocity was reduced by 23% (range 10–29%). A/B ratio was calculated at the same time as an indicator of peripheral vascular resistance. The ratio increased, compared with pre‐experiment values, in 3 subjects (5, 26 and 31%) but decreased in 2 (4 and 6%). Maternal tachycardia was noted in all but one woman. Continuous fetal heart rate (FHR) recording showed no signs of fetal distress. The uteroplacental circulation does not seem to benefit from the vasodilatory effects of dihydralazine, the response to the decreased perfusion pressure being a reduction in blood velocity and unchanged peripheral res

ISSN:0001-6349    

DOI:10.3109/00016348909021009

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Millar microtransducers were used in 7 patients to record contractile variations in the cervix and corpus during dilatation of the cervical canal by Laminaria tent preceding first‐trimester vacuum aspiration. The spontaneous contractile activity was registered in a control group of 5 patients without laminaria pretreatment. Two Millar catheters were used. The sensor tip of one Millar catheter was placed extra‐amniotically in the uterine cavity, and the other one in the mid‐cervical canal. Both sensor tips faced the wall of the cervix and corpus. The study showed that laminaria tents not only have a gentle dilatating effect on the cervix, but also induce painless uterine contractions, of amplitudes reaching 20 mmHg, and increased contractile activity in the cervix for the duration of dilat

ISSN:0001-6349    

DOI:10.3109/00016348909021010

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

In a prospective study, 519 women were randomly selected for cervical dilatation by laminaria tents or Hegar dilators before scheduled vacuum aspiration. In other 68 women randomly divided into a laminaria group and a control (Hegar) group, placenta, decidua and blood were separately aspirated from the uterine cavity before the vacuum aspiration and cultured for micro‐organisms. The rate of postabortal pelvic inflammatory disease (PID) was significantly lower after pretreatment with laminaria tent irrespective of patient's age and parity. However, a higher risk of postabortal PID was found in gestational age of 10–12 weeks than of 5–9 weeks. Previous PID and abortion did not increase the risk of postabortal PID. Vaginalkervical micro‐organisms were, irrespective of method for cervical dilatation, identified in two thirds of the p

ISSN:0001-6349    

DOI:10.3109/00016348909021011

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Neoplastic lesions of the vagina account for 1% of all gynecologic malignancies. The overall 5‐year survival rate for this disease is poor. This study comprised 58 patients with diagnosis of squamous cell carcinoma of the vagina treated between 1960 and 1984. Median age at diagnosis was 70 years. The lesions were staged according to FIGO. The numbers of patients in various stages were: I/13, II/24, III/12 and IV/9 and according to histologic differentiation: low grade/11, medium grade/17 and high grade/25; not recorded, 5. Twenty patients were treated with primary surgery and irradiation, 30 were treated with intracavitary and/or external irradiation only. The 5‐year corrected survival rates were: St I/50%, St II/30%, St III/17% and St IV/0%; grade 1/57%, grade 2/32% and grade 3/17%, younger than 70 years of age/43% and older than or 70 years of age/21%. The incidence of rectovaginal or vesicovaginal fistulas amounted to 17%. The treatment results of primary carcinoma of the vagina are poor. Prognostic factors for survival should be considered at treatment plann

ISSN:0001-6349    

DOI:10.3109/00016348909021012

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The obstetric service of Hutzel Hospital in Detroit, Michigan is responsible for approximately 7,300 deliveries annually. To monitor the quality and appropriateness of patient care, recognize and pursue opportunities for improving care, and resolve identified problems in the obstetric service as well as other clinical areas, the hospital developed a quality assurance (QA) program. The application of clinical indicators represents the principal method by which relevant QA information is obtained. These indicators are designed to identify problems in patient care. The obstetricigynecologic QA committee analyzes the results of this indicator‐based review process as well as other information (appropriateness of surgery, drug usage, transfusions, utilization of hospital resources, etc.) and reports its findings to the full staff of the Department on a monthly basis. If necessary, actions are taken to correct problems. They include lectures, individual counselling, development of guidelines, addition of personnel and/or equipment, and indicated disciplinary actions. These remedial measures have led to improvements in clinical care such as, for example, a more appropriate usage of antibiotics and oxytocin, and stricter adherence to guidelines. More important, however, are the intangible changes in practice patterns that have occurred in that physicians and other members of the health care team tend to render care with an added degree of diligence and circumspection because of their awareness that an effective monitoring process exist

ISSN:0001-6349    

DOI:10.3109/00016348909021013

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The relationship between life stress and hypertensive complications during pregnancy was studied in 345 women. A questionaire was answered in the first trimester. The questions concerned education, employment, social network, traumatic experiences, housing conditions and stress of work. In this way a total life stress score for each woman was obtained. Hypertensive disorders, including chronic hypertension, were found in 63 women (18.3%). No significant difference was evident between women with low and high life stress scores with regard to hypertensive disorders during pregnancy. Nor did pressure changes during pregnancy differ between these groups.

ISSN:0001-6349    

DOI:10.3109/00016348909021014

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

A subline predisposed to pulmonary metastasis was successfully derived by repeating in vivo selection of GCH‐1, a human gestational choriocarcinoma cell line, in nude mice. While the parent line GCH‐1, transplanted subcutaneously to nude mice, induced pulmonary metastasis in a few of the host animals, the newly established subline GCH‐l(m) successfully metastasized to the lungs in 100% of them. Compared with GCH‐1, GCH‐l(m) exhibited a higher degree of cell atypia, a lower capacity for cell growth and markedly higher productivity for human chorionic gonadotropin (hCG). Another characteristic of this subline was its enhanced growth after the addition of a pulmonary extract obtained from nude mice. The relationship of these findings to the mechanisms of metastasis of this cancer was

ISSN:0001-6349    

DOI:10.3109/00016348909021015

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

All second twins delivered by cesarean section (CS) after vaginal birth of the first twin (n = 38) and all breech‐extracted second twins (n = 282) in Sweden during 1973–81 were identified. Data from the medical records of all CS second twins were extracted and compared with breech‐extracted second twins from the same departments born within 2 years of the CS twin (n = 25). Second twins delivered after maternal general anesthesia had lower 5‐min Apgar scores, irrespective of mode of delivery. Maternal morbidity was substantial in the CS group. The results encourage the use of breech extraction under local anesthesia rather than CS when there is a need for a quick delivery of the second twin and when both alternatives are av

ISSN:0001-6349    

DOI:10.3109/00016348909021016

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

It seems to be a widely held notion that the uterine cavity is larger during a woman's later pregnancies than during her first pregnancy. The direct evidence for this is, however, scarce. The umbilical cord length at term is one measure of the fetal intra‐uterine mobility, and therefore indirectly of the space in which the fetus moves. If the uterine cavity is larger during later pregnancies, the cord length of the babies in these pregnancies should be longer. We have compared the cord lengths of 1839 babies, divided into three groups: babies born of primiparous, secundiparous and tertiparous women. The difference in mean cord length is statistically significant between the first and the third group. This supports the theory of a larger intra‐uterine space in later pregnancies. We also examined 159 mothers, measuring the umbilical cord length of their first and second babies. A significant positive correlation was found, in that the first baby tended to have the shorter cord. A control group with matching, but unrelated babies showed no such correlation. The results seem to us to support the stated theory furt

ISSN:0001-6349    

DOI:10.3109/00016348909021017

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY