ISSN:0001-6349    

DOI:10.3109/00016349509013466

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective. To evaluate the accuracy of diagnosing gestational diabetes mellitus (GDM) by a 2‐h blood glucose value ≥9.0 mmol/l in the 75 g oral glucose tolerance test (OGTT). The maternal and neonatal outcome in women with a 2‐h blood glucose value just below this limit, 8.0–8.9 mmol/l, is analyzed. The outcome is compared to a randomly selected control group.Design. A comparative study.Subjects. There were 223 women in the group with a 2‐h value of 8.0 to 8.9 mmol/l in the OGTT. This group was compared to a randomly selected control group of 391 women. Main outcome measures. Fetal outcome: perinatal mortality, birth weight, respiratory disturbances, symptomatic hypoglycemia, polycythemia, hyperbilirubinemia and traumatic deliveries. Maternal age, body mass index (BMI), pregnancy‐induced hypertension (PIH) or preeclampsia and route of delivery.Results. The women in the group with a 2‐h glucose value of 8.0–8.9 mmol/l were, compared to the control group, significantly older, heavier, had a higher BMI, gave birth to heavier children and a significantly increased number of large‐for‐date infants, while there were no differences in neonatal mortality, morbidity or birth trauma.Conclusions. This study shows that using the 75 g 2‐h OGTT with a B‐glucose limit of ≥9.0 mmol/l instead of ≥8.0 mmol/l to diagnose GDM during pregnancy has no major adverse effects concerning maternal and neonatal outcome in the borderline in

ISSN:0001-6349    

DOI:10.3109/00016349509013467

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Background. Assessing the relationship between fatty fish intake, the main source of N‐3 polyunsaturated fatty acids and maternal and fetal levels in erythrocytes at labor.Methods. The fatty acid composition was studied in 64 mother‐newborn infant pairs by means of capillar gas chromatography. Following a nutritional inquiry our population was classified as follows: superior intake group (SIG) (>4 times fatty fish per month; 54.4±20.5 g/day), medium intake group (MIG) (2–4 per month; 16.5±4 g/day) and inferior intake group (IIG) (<2 times per month; 4.3±4 g/day).Results. In erythrocyte phospholipids higher levels were observed in SIG in relation to IIG in mothers regarding eicosapentaenoic (0.56±0.3% and 0.39±0.2%; p=0.02) and docosahexaenoic acids (6.14±1.16% and 5.4±0.98%; p=0.02) and in newborn infants regarding eicosapentaenoic acid (0.32±0.24% and 0.17±0.09%; p<0.01). On the other hand, SIG had lower values of arachidonic acid than IIG in mother (11.15±1.61% vs 12.83±1.86%; p<0.01) and newborn infants (16.08 ± 3.42% vs 17.89±2.57%; p=0.05).Conclusions. From a biochemical point of view, and taking into account the pre‐existing literature, it is suggested that a minimum fatty fish intake of twice per month should be recommended (edible portion 85 g.) in order to reach the N‐6/N‐3 q

ISSN:0001-6349    

DOI:10.3109/00016349509013468

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective. In view of the increased risk of obstetric and perinatal complications in post‐term pregnancy, and the lack of consensus regarding clinical routines for fetal surveillance and labor induction, the aim of this prospective controlled study was to compare obstetric and perinatal outcome after serial monitoring until 43 weeks of gestation with that after labor induction at 42 gestational weeks.Materials and methods. A study group of 193 gravidae scheduled for serial monitoring until 43 weeks of gestation was compared with a control group of 205 gravidae admitted for induction of labor at 42 weeks. A third, high‐risk, group comprised gravidae (from either of the foregoing groups) who had to be admitted for emergency induction of labor owing to increased fetal risk (i.e., the presence of oligohydramnios or a small‐for‐gestational‐age fetus).Results. The frequency of labor induction was significantly lower in the study group than among controls (p<0.001), but the two groups did not differ in obstetric or perinatal outcome. As compared with these two low‐risk groups, the high‐risk group was characterized by significantly higher frequencies of instrumental delivery (p<0.01), operative delivery for fetal distress (p<0.001) and infants requiring neonatal intensive care (p<0.001).Conclusion. As the wait‐and‐see policy with serial monitoring resulted in a lower rate of labor induction, but not in a lower rate of instrumental delivery or perinatal complication, medically the two routines would appear to be comparable. However, an individual approach with intensified fetal surveillance is to be recommended, as it is vital to identify post‐term pregnancies where the fetus is at increased risk. The use of such new techniques as umbilical artery flow velocimetry would no doubt improve the management of high‐risk

ISSN:0001-6349    

DOI:10.3109/00016349509013469

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Background. To determine the leading causes of maternal mortality in a large maternity hospital and to define priorities regarding this subject throughout Turkey.Methods. Retrospective, institutional study among 100,531 live births between 1983 and 1992.Results. Seventeen maternal deaths took place in this institution. Thus, the overall maternal mortality ratio was 16.9 per 100,000. The leading causes of maternal mortality were hemorrhage in seven (41.2%) and pulmonary embolism in six (35.3%) patients. The majority of deaths were observed in the 25–29 and 30–34 age groups and in patients with parity more than two.Conclusion. The relatively low figure of 16.9/100,000 for maternal mortality may be seen as a promising health index. However, obstetric hemorrhage is still the leading cause of this series. Pregnant women less than 20 years old and greater than 35 years old, and grand multiparous women as well as women with hypertension and heart disease are at high mortality risk. The observation of such cases demands further efforts for improved obstetric care in the hospital and throughout Tur

ISSN:0001-6349    

DOI:10.3109/00016349509013470

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Background. Discuss the course of acute pancreatitis in pregnant patients and demonstrate that most attacks of pancreatitis in pregnancy are mild.Methods. This article is a retrospective case series study. Eight patients with acute pancreatitis during pregnancy were seen in referral‐based obstetric practice at our department in the last 5 years. Five of them had either gallstones or hyperlipidemia. Two patients had both gallstones and hyperlipidemia. One patient was lost to follow‐up at 33 weeks gestation. The others were followed at least one month post‐partum. Conservative treatment was instituted for pancreatitis and a fat‐restricted diet was instituted for hyperlipidemia.Results. There was no maternal mortality and only one fetal death. Acute pancreatitis occurred in both primipara and multipara patients. Preterm labor or preeclampsia may occur in pregnancy complicated by acute pancreatitis. Most patients experience relief from the pancreatitis soon after delivery. Two patients underwent cesarean section, one was due to fetal distress and the other was elective.Conclusions. Early diagnosis and treatment is of utmost importance. Gallstones and/or hyperlipidemia seems to have a specific link with acute pancreatitis in pregnancy. Although acute pancreatitis is a rare complication of pregnancy, we present evidence that both maternal and fetal mortality can be minimized if appropriately

ISSN:0001-6349    

DOI:10.3109/00016349509013471

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Background. The study aims at confirming or rejecting the hypothesis of an association between birthweight and post partum uterine infection.Methods. A case‐referent study was performed on 51 puerperal women with clinical signs of endometritis‐myometritis. To each case an otherwise healthy puerperal woman was recruited and matched for age, parity and days after delivery.Results. The proportion of women having had newborns with birthweight<2500 g was 20/49 among cases and 2/50 among referents (odds ratio 16.6; 95% CI 3.5–152.3). Preterm births were registered in 15/50 cases and 2/49 referents (odds ratio 10.1; 95% CI 2.1–94.5). The average gestational age at delivery was approximately 2 weeks shorter among cases than among referents (37.5 versus 39.5 weeks).Conclusions. Low birth weight was ten times more prevalent among women with puerperal infection than among healthy puerperal women. The findings indicate that giving birth to a low birth weight baby is strongly associated with ensuing puerperal infection, possibly by a subclinical antenatal intrauterine infection, predisposing to both adverse fetal and maternal outcomes of pr

ISSN:0001-6349    

DOI:10.3109/00016349509013472

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objectives. The increasing use of drugs for ovarian stimulation and the possibility of long‐term risks has actualized a quantitative assessment of the use of such therapy. The aim of the study was to analyze the development in the sale of different types of drugs used for ovarian stimulation in Denmark during the last two decades.Material. Sale statistics of clomiphene citrate, cyclophenile, human menopausal gonadotropin (hMG), mare menopausal gonadotropin (mMG) and human chorionic gonadotropin (hCG) in Denmark 1973–1993.Methods. The number of defined daily doses (DDD) was calculated for each product group. On given assumptions the number of cycles of different treatment regimens and the number of treated women was calculated.Results. The sale has increased almost exponentially throughout the last two decades: Clomiphene citrate 11 fold, hMG 30 fold, and hCG 5 fold. Today, among women 15–44 years old, the estimated incidence rate of women treated with clomiphene alone is about 2.7/1,000/year, and the incidence rate of women treated with clomiphene/hCG and hMG/hCG account for about 3.1/1,000/year and 1.9/1,000/year, respectively.Conclusion. Any study concerning short‐and long‐term effects of ovarian stimulation have to consider this secu

ISSN:0001-6349    

DOI:10.3109/00016349509013473

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective. To assess the effectiveness of laser endometrial ablation in women with dysfunctional bleeding.Design. A retrospective analysis of 90 patients.Setting. Department of Gynaecology, King George Hospital, Barley Lane, Goodmayes, Essex IG3 8YB, U.K.Subjects. Ninety patients with dysfunctional uterine bleeding who were hysteroscopically suitable for laser endometrial ablation.Interventions. Endometrial laser ablations using the neodynium‐yttrium‐garnet laser at 70 watts power output.Main outcome measures. Patient satisfaction/dissatisfaction at 6 months follow‐up and response to repeat ablation.Results. A total of 117 procedures were carried out on the 90 patients. There was one suspected perforation which was not confirmed at subsequent hysterectomy and one primary hemorrhage which required tamponade with Foley catheter. There were three cases of fluid overload with no clinical evidence of fluid over‐load syndrome. All five major complications occurred in the first six months or ‘learning phase’ of the study. During this period, there were proportionately more treatment failures after one attempt (52.8% versus 42.6%) than the second six months of the study. Overall. 53.3% of the patients were satisfied with the initial ablation and 73.3% were satisfied after repeat ablations.Conclusion. Endometrial laser ablation is a major advance in the management of dysfunctional uterine bleeding, especially in patients who would otherwise have had a h

ISSN:0001-6349    

DOI:10.3109/00016349509013474

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective. To examine the associations between potential risk factors and fractures in perimenopausal women.Subjects. A total of 3140 women (mean age 53.4±2.8 (s.d.) years) were followed‐up for 2.4 years after axial bone densitometry (lumbar spine and femoral neck) with regard to the occurrence of fractures.Results. In all, 5.6% of the women sustained a fracture. There were 169 low energy fractures (falling on a level surface) in 157 women after the exclusion of 18 fractures caused by a high energy trauma. The wrist was the most frequent site of fracture (n=46). Lumbar bone mineral density was 5.8% lower and femoral bone mineral density 4.6% lower among fracture cases compared with non‐fracture cases (p<0.0001). History of a fracture during 1980–1989 elevated the risk of all fractures 2.83‐fold (95% confidence interval (CI) 1.95–4.10) and the risk of a first wrist fracture 2.25‐fold (95% CI 1.10–4.62). The amount of weekly alcohol intake was higher among fracture cases than among non‐fracture cases yielding an age‐adjusted odds ratio (OR) of 1.45 (95% CI 1.05–2.02). Past or present use of hormone replacement therapy was protective against fractures (age‐adjusted OR 0.70, 95% CI 0.50–0.96). If bilateral oophorectomy had been carried out under the age of 45 years, the risk of fracture was 3.64‐fold (95% CI 1.01–13.04) compared with women operated upon after the age of 45 years. Age at menarche, parity, lactation and smoking history did not differ between the fracture and non‐fracture groups.Conclusions. A former history of fractures, low baseline bone mineral density (BMD) and use of alcohol are predisposing factors associated with perimenopausal fractures, while hormone replacement therapy

ISSN:0001-6349    

DOI:10.3109/00016349509013475

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY