摘要:

A risk factor is any ascertainable characteristic or circumstance of a person or group of persons that is known to be associated with an abnormal risk of having, developing, or being especially adversely affected by a morbid process (1). Risk factors may be causally or indirectly connected with the unwanted outcome, but any strategy for a counterattack must start with the identification and ranking of such factors. For perinatal death the analysis must consider the child itself, its mother, circumstances around the pregnancy and birth, and more remotely but increasingly important, social and economic conditions.

ISSN:0001-6349    

DOI:10.3109/00016348909006137

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

This paper analyses data from the Israeli nationwide perinatal census, with the aim of revealing the possible causes of perinatal death, and to assess the effects of risk factors, using a logistic regression analysis. The analysis provided an estimate of the net effect of each characteristic independently, thus identifying high‐risk pregnancies that should be monitored with greater intensity. Five variables were found to have a significant effect on perinatal death. Among these, in order of decreasing risk: fetal presentation, maternal diseases complicating pregnancy, number of fetuses, ethnic origin, and maternal age. Other variables such as parity, standard of hospital, the mother's country of birth and domiciliary circumstances, did not significantly affect perinatal mortalit

ISSN:0001-6349    

DOI:10.3109/00016348909006138

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

ObjecfiveTo determine the proper management of pregnancy in uncomplicated cases going beyond 42 weeks.DesignRandomized controlled trial of induction of labor at or shortly after the 42‐week limit, versus close monitoring without induction except when indicated for medical reasons.SettingHospital's obstetrical departmentStudy population: 188 pregnant women, randomly allocated to two groups with 94 in each.InterventionsInduction of labor by stripping of membranes and i.v. oxytocin infusion, with artificial rupture of membranes when the cervical opening was 3 cm or more in diameter. The control group was followed with clinical, biochemical and electronic tests, intervention being applied according to needs.End pointsFrequency and modes of operative delivery, maternal and perinatal rnorbidity and mortality.Main resultsThe distribution of gestational age (in weeks) at birth was almost identical in the two groups, but there were more operative deliveries in the control group than in the induction group (64 versus 48, p<0.05). Maternal complications and perinatal morbidity rates were equally distributed between the groups. There was one perinatal death in the induction group and two deaths among the controls.ConclusionWith due reservation for small numbers, routine induction after term may result in fewer operative deliveries. No other advantage has been demonstrated when compared with close monitoring and intervention when medically indicate

ISSN:0001-6349    

DOI:10.3109/00016348909006139

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The influence of fetal sex on human chorionic gonadotropin IhCG) in cord and peripheral maternal blood was studied at delivery in 57 twin and 66 singleton uncomplicated pregnancies. In twin pregnancies the hCG levels were about twice as high in female‐female and in female‐male vis‐à‐vis male‐male combinations in both maternal and cord blood. In singleton pregnancies the hCG levels were significantly higher in maternal and in cord blood in cases of female vis‐his male infants. The ratio of maternal hCG/placental weight was also highest in the twin pregnancies when one or both infants were female. This suggests a “female effect”, possibly g

ISSN:0001-6349    

DOI:10.3109/00016348909006140

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Identification of poor fetal growth is an important objective of antenatal care. We evaluated the validity of the Wennergren score to predict small for gestational age and/or underweight for length infants (low ponderal index). To 405 randomly chosen pregnant women from our university hospital population, this numerical scoring system was applied at 28 and 34 weeks of gestation. Birthweights below the 2.3rd and 10th centile and ponderal indexes below the 3rd and 10th centile were used as outcome standards. The sensitivity of predicting SGA infants ranged from 28.4% for infants below the 10th birthweight centile at 28 weeks, to 66.7% for infants below the 2.3rd centile at 34 weeks. Figures for low ponderal indices ranged from 25.0% to 50.0%.In contrast to the promising performance of the Wennergren score as described in the Scandinavian literature, this score was not useful as a screening test for SGA or underweight for length infants in a Dutch hospital population.

ISSN:0001-6349    

DOI:10.3109/00016348909006141

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Among the 56 risk factors (RF) in pregnant women, used by the Danish National Board of Health, those that can predict complicated delivery (CD) were identified. The significance of parity, maternal age, social class and civil status was also analysed. The material comprises a Danish county cohort of 4,102 deliveries. The 56 original RFs affected 56% of the population. Women (8.8%) with twin pregnancy, fetus in breech, footling and transverse lie, or having an elective cesarean section were analysed separately. The incidence of CD was otherwise 39%. Of all the women, 8.7% had only prepregnancy RFs with a CD rate of 52%; 19.2% had only pregnancy RFs other than special conditions mentioned with a CD rate of 52%; 3.6% had both prepregnancy and pregnancy RFs with a CD rate of 62%. When the special conditions separately analysed were included, 14 RFs of the original 56 were found to predict complicated delivery. These affected 40% of the population. Primiparity was also a RF. The conceptional age of a primipara raised the odds in favor of CD by a factor 1.09 for each year. Social class and civil status were of no significance for CD.

ISSN:0001-6349    

DOI:10.3109/00016348909006142

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

In this study, antenatal risk factors (RF) predicting perinatal morbidity and mortality (PMMI were identified among 56 RFs defined by the Danish National Board of Health. The association with parity, age, social class, civil status, complicated delivery was also analysed. The RFs predicting complicated delivery have been described in Part I (1). All events, both prenatal and during the perinatal period, in 4,138 infants borne by 4,102 women in an entire Danish district were analysed. The frequency of perinatal mortality was 0.8% and of perinatal morbidity, 12.7%. The original 56 RFs affected 56% of the population. Fourteen ‘new’ RFs among the original 56 RFs predicted PMM and affected 27% of the population. The prepregnancy RFs affected 4.5% of all women with singleton pregnancies and their infants had a PMM rate of 21%; the pregnancy RFs affected 18.1%, the PMM rate being 25%; 3.4% had both prepregnancy and pregnancy RFs, their PMM rate was 41%. Twin pregnancies occurred in 0.996, with a PMM rate of 47%. Apart from these groups, the PMM rate was only 8%. Parity, social class and civil status were of no significance for PMM. Some delivery complications, termed labor RFs, raised the odds of PMM by a factor of 1

ISSN:0001-6349    

DOI:10.3109/00016348909006143

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

In 228 patients, fetal blood pH, pCO2and lactic acid were measured in two distinguishable parts of the second stage of labor. The ‘first’ part begins at full cervical dilatation and ends when the mother starts her first voluntary bearing down efforts. In our study, the fetal acid‐base status did not change in this part, regardless of a late developing hypoxia. In contrast, higher levels of lactic acid and pCOz and lower pH values were observed in the ‘final’ part of the second stage, indicating increasing acidosis. In this ‘final’ part, the fetuses with clinical signs of distress, as defined by an ominous Apgar score at birth, showed quicker and larger acid‐base shifts than did the normal fetuses. Thus the two parts of the second stage of labor actually differ in their potential to stimulate fetal acidosis. Since such fetal acidosis may develop especially during the ‘final’ part of labor, we have concluded that special particular attention should be d

ISSN:0001-6349    

DOI:10.3109/00016348909006144

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The study material comprised 213 newborns with a birth weight above 2000 g, and their mothers. At delivery, blood samples were obtained from the umbilical cord and the mother's cubital vein for determination of the transplacental bilirubin gradient and assessment of placental function by means of the HPL concentration in the rnaternal blood. The HPL concentration showed no relation to the transplacental bilirubin gradient or the umbilical cord bilirubin concentration. Therefore, to the extent that the the HPL concentration reflects the rate constants for bilirubin transfer, an increased transplacental bilirubin gradient or an increased cord bilirubin concentration could not be explained by an impaired ability of the placenta to transfer bilirubin. When the infants who became jaundiced were compared with the non‐jaundiced, significantly higher transplacental bilirubin gradient (p<0.00001), cord bilirubin (p<0.00001) and maternal bilirubin values at the time of delivery (p<0.03) were found among the jaundiced infants. On the basis of the results it was possible to define subgroups of infants with significantly higherllower risk of subsequent jaundic

ISSN:0001-6349    

DOI:10.3109/00016348909006145

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The effects of a new calcium antagonist, isradipine (PN 200–110) on postpartum uterine activity and the maternal cardiovascular system were investigated. Uterine activity was recorded by a microtip transducer catheter inserted transcer‐vically within 45 min of normal vaginal delivery. 0.5 mg of isradipine was given as a bolus injection during 5 min to 7 women with spontaneous uterine activity and 1 mg was given during a 15‐min period to another 8 women with oxytocin‐stimulated uterine activity. Matched controls with similar pre‐injection activity (±5%) but not given the drug were selected for comparison. The effects of the drug in 3 women (given 1 mg of isradipine) were compared with those in matched controls and in women given 0.25 mg of terbutalin i.v. as a bolus injection. lsradipine had a marked inhibitory effect on both spontaneous and oxytocin‐stimulated uterine activity. The inhibitory effect of 1 mg of isradipine seemed comparable to that of 0.25 mg of terbutalin. The inhibition occurred within 1–2 min after the injection and was sustained throughout the study period (2 h). A transient reduction of the systolic (mean maximum decrease 10–15%) and diastolic blood pressure (mean maximum decrease 15–2096) was seen, particularly during the injection period. Hypotension (systolic blood pressure<80 mmHg) was not recorded. A moderate increase in pulse rate (mean maximum increase 22–27%) was seen in all cases. The results show that isradipine given as a bolus injection can inhibit early postpartum uterine activity, with

ISSN:0001-6349    

DOI:10.3109/00016348909006146

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY