ISSN:0001-6349    

DOI:10.3109/00016349409015762

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0001-6349    

DOI:10.3109/00016349409015763

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Several data emphasize the neuroendocrine aspects of human placenta. Classical hypophyseo‐tropic neurohormones are produced and secreted by the human placenta. Indeed, in contrast with non pregnant subjects, gonadotropin‐releasing hormone (GnRH) and corticotropin‐releasing factor (CRF) are measurable in maternal plasma during pregnancy. The aim of the present study was to investigate the characteristics of the secretory pattern of maternal plasma GnRH and CRF levels. A total of 25 healthy pregnant women participated in the present cross‐sectional study. Plasma levels of the two neurohormones were measured according to three different time‐intervals: 1) every five minutes for eight hours (n=4), 2) every ten minutes for four hours (n= 15), 3) every four hours for 24 hours (n=7). Following an acidic extraction plasma GnRH and CRF levels were measured by specific radioimmunoassay. Using two different algorithms (Detect and Cluster) a pulsatile pattern for both plasma GnRH and CRF levels was observed. Specific pulse frequency, amplitude, and duration were found. In the groups of women studied with a longer sampling interval, pulse frequency of GnRH or CRF levels did not differ between first and third trimester of gestation. However, amplitude of CRF pulses were significantly higher at term than at early stages of pregnancy (p≤0.01), while GnRH pulse amplitude was highest in women at first trimester of gestation. Evaluating the degree of concordance in all subjects, GnRH pulses significantly correlated with CRF pulses at 30 min. lag (p≤0.01). No significant circadian changes were found for any circulating neurohormone measured. The present study showed that maternal circulating neurohormone levels change according to a pulsatile pattern, probably reflecting the placental sec

ISSN:0001-6349    

DOI:10.3109/00016349409015764

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective.To determine when fetal urinary tract anomalies were detected by ultrasound screening during pregnancy and to discuss the possible consequences if only one early ultrasound examination is performed.Design.A retrospective study of 47 cases where fetal urinary tract malformations were diagnosed in a two‐stage screening program (17th and 32nd week of gestation) covering 22,310 women over ten years, 1982‐91.Setting.Ullevål University Hospital in Oslo which serves as a referral center for obstetric and neonatal diseases.Results.Urinary tract anomalies were diagnosed in 0.18% of the pregnancies. Of these, 61.7% were found at the second routine ultrasound screening. The most difficult differential diagnoses were those of hydronephrosis without megaureter and a multicystic kidney. Hydronephrosis was found in 51% and a multicystic kidney in 21% of the cases. The tentative prenatal diagnoses were confirmed postnatally in 83% of the cases.Six of the fetuses had anomalies regarded as incompatible with postnatal life. These pregnancies were terminated, and the diagnoses verified by autopsy. Two other infants died perinatally, one of them as a result of the urinary tract anomalies.Conclusion.If only one ultrasound scanning had been performed in the 17th week, approximately two‐thirds of the cases would not have been detected. Early intervention and follow‐up after delivery would only have been performed if the infants had developed symptoms or complications related to the urinary tract a

ISSN:0001-6349    

DOI:10.3109/00016349409015765

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective.To compare normal pregnancy with pregnancy‐induced hypertension (PIH)/preec‐lampsia with respect to the effects of acute volume expansion on plasma atrial natriuretic peptide (ANP), cyclic guanosine monophosphate (cGMP) and fetal‐maternal circulation.Design.Observational study.Setting.University hospital.Subjects.Fifteen women with PIH/ preeclampsia and 15 healthy pregnant controls.Interventions.Before and after 30 minutes' infusion of a crystalloid solution (15 ml/kg), maternal venous blood was sampled for ANP and cGMP analysis and echocardiography and Doppler investigations were performed.Results.Basal median (range) ANP and cGMP levels were significantly higher in the PIH/ preeclampsia group compared to the controls: 6.5 (3.8‐30.4) compared to 3.9 (2.0‐6.7) pmol/1,p≤0.01 and 5.8 (2.4‐11.6) compared to 4.0 (2.3‐10.8) nmol/1,p≤0.05. The response to volume load was enhanced: 4.6 (‐4.5‐21.8) compared to 0.7 (‐4.1‐8.8), p≤0.05 and 2.9 (0.1‐10.9) compared to 1.2 (‐ 5.0‐6.0),p≤0.05, respectively. Systemic vascular resistance was initially higher in the patient group, 22.3 (14.1‐36.7) compared to 15.6 (10.0‐25.5) peripheral resistance units,p≤ 0.01 but the response to volume load was similar in both groups (12‐13% decrease). The pulsatility index of the uterine artery, 0.85 (0.46‐1.38) compared to 0.72 (0.49‐1.26) and umbilical artery 0.89 (0.66‐1.57) compared to 0.97 (0.74‐1.31) did not differ between the groups. Volume expansion did not affect any of these variables.Conclusions.The pulsatility index of the uterine artery remained unaffected in both preeclamptic patients and healthy controls despite an increase of ANP and cGMP concentration and a systemic vasodilatation during acute volume expansion. This finding may indicate the absence of

ISSN:0001-6349    

DOI:10.3109/00016349409015766

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

During the time period 1983‐90, 91,300 consecutive pregnancies were monitored for red cell alloimmunization. Once revealed, the immunizations were followed by means of repeated maternal antibody titers, maternal anti‐D quantitation in D‐immunized women, amniotic fluid bilirubin levels and fetal hemoglobin concentrations. High dose intravenous immunoglobulin and/or intrauterine intravascular transfusion was given to prevent or treat fetal anemia. Delivery was induced for all before term when antibody titers were ≥16. Nevertheless, exchange transfusions were performed in 41 newborns with mothers alloimmunized to Rh(D), Rh(c), Rh(E) and Kell antigens. Eight of the mothers were Rh(D) positive. Phototherapy alone was given to 35 newborns. Both maternal antibody titers and amniotic fluid bilirubin levels were found to be unreliable to predict the need of exchange transfusions in the newborns. Quantitation of maternal anti‐D concentration was found to be significantly better predicting 62% at a cut‐off level of 0.7 μg/mL. Analysis of fetal hemoglobin concentration by cordocentesis is the only direct method to evaluate the degree of fetal affection, and should probably be performed when maternal antibody titers are ≥64, anti‐D concentration is ≥0,7 μg/mL and data indicate an aggravation

ISSN:0001-6349    

DOI:10.3109/00016349409015767

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective.To evaluate risk factors associated with occurrence of abruptio placentae in preterm deliveries.Methods.Risk factors were evaluated in 55 consecutive index cases of abruptio placentae and 726 control patients delivered between 24‐36 weeks' gestation.Results.In logistic regression analysis abruptio placentae was associated with a low number of antenatal visits, smoking in pregnancy, hypertension, intravenous drug abuse and a history of recent abdominal trauma. Among hypertensive disorders of pregnancy, preeclampsia superimposed on chronic hypertension was associated with the highest risk of premature placental separation. Finally, there was a significant trend relating duration of premature rupture of membranes with abruptio placentae (chi‐square for trend =3.93,p=0.047).Conclusions. Several risk factors seem strongly associated with abruptio placentae in preterm deliveries; the presence of these risk factors should dictate intensive surveilla

ISSN:0001-6349    

DOI:10.3109/00016349409015768

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The infectious complications of 122 consecutive abdominal twin deliveries over the period 1984‐1989 were analyzed in a prospective clinical study, comparing them with 761 singleton abdominal deliveries over the period 1984‐1986. The incidence of endometritis was nearly three‐fold after twin deliveries and the incidence of abdominal wound infections nearly twofold compared with singleton abdominal pregnancies (13.1/4.7% and 5.6/3.0%). The risk of amnionitis was increased ten‐fold, 6 hours after rupture of the membranes in abdominal twin delivery, but no connection was found between amnionitis and endometritis, as in singleton abdominal deliveries. Multiple regression analysis indicated only two risk factors as regards puerperal endometritis after abdominal twin delivery: age under 25 years (odds ratio 6.9, 95% confidence limits 1.9‐24.8), an association also seen in singleton abdominal deliveries, and a period of more than 6 hours from rupture of membranes to delivery (odds ratio 7.8, 95% confidence limits 2.1‐28.5). Multiple pregnancy appears to be associated with an increased risk of endometritis. The etiological factors remain unknown, but a large placental bed and/or immunological factors may be

ISSN:0001-6349    

DOI:10.3109/00016349409015769

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The aim of this open prospective randomized study was to compare two non‐invasive methods for second trimester abortion using gemeprost pessaries (Cervagem®) and dinoproston gel (Cerviprost®) concerning effectiveness, time for abortion, consumption of analgesics, infection‐rate and side‐effects.Forty women admitted for second trimester legal abortion were allocated to treatment with either gemeprost (20) intravaginally or dinoproston (20) intracervically. All patients were pre‐treated with a 3 mm in diameter Lamicel® tent applied intracervically for about four hours. The success‐rate was 95% for gemeprost and 75% for dinoproston within approximately 48 hours. The median abortion time calculated from the insertion of the Lamicel® tent for the successful cases was 22 h 0 min for gemeprost and 24 h 5min for dinoproston (not significant). The shortest abortion time was found among parous women in the Cervagem® group. The difference between Cerviprost® and Cervagem® in parous women was statistically significant. For nonparous women there were no significant differences in abortion time between the two regimes.No significant difference was found in the demand of Pethidin® and the infection‐rate between the two groups. No major side effects of the treatment were found.Even if no significant difference in successful abortions was found, probably due to the small patient material, Cervagem® seems to be the most appropriate of the two non‐invasive methods, because of a 95 per cent success‐rate within 48 hours, but also due to

ISSN:0001-6349    

DOI:10.3109/00016349409015770

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

One hundred infertility patients were investigated by Doppler ultrasound and 17 were found to have a short luteal phase (<10 days) (SLP), which is regarded a subgroup of luteal insufficency (LPD). The vascularisation within the corpus luteum (CL) was investigated using vaginal Doppler ultrasound. The values were compared with those of a control material. In both groups the resistance to blood flow was lowest on the fifth postovulatory day and grew from the ninth postovulatory day towards the end of the luteal phase. The results in these groups did not differ significantly. In both groups serum progesterone values had a slight negative correlation with pulsatility index (PI) and resistance index (RI) measured within the CL. The defect in vascularisation of the CL is not a reason for SLP, and Doppler ultrasound measurements from the CL do not help in the diagnosis of SLP.

ISSN:0001-6349    

DOI:10.3109/00016349409015771

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY