ISSN:0001-6349    

DOI:10.3109/00016349609033346

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective. To study the role of decidual monoamine oxidase (MAO) ‐A and ‐B activities before delivery, the relationship between MAO activity in fetal membranes and catecholamine (CA) concentration in amniotic fluid (AF) was determined.Methods. Fetal membranes and AF were obtained at the time of elective Cesarean section (CS group, n=11) and Cesarean section due to fetal distress without labor pains (FD group, n=5). MAO‐A and ‐B activities were radiometrically measured using14C‐5‐hydroxytriptamine for MAO‐A substrate and14C‐benzylamine for MAO‐B substrate. CA concentrations in AF were measured by high performance liquid chromatograph with an electro‐chemical detector.Results. Both MAO‐A and ‐B activities in decidua obtained from CS were significantly lower than those obtained from FD. Both norepinephrine (NE) and epinephrine (EP) concentrations were significantly lower in the CS group than the FD group. A significant positive correlation between decidual MAO‐A activity and NE concentration in AF was observed. No significant correlation was observed between MAO‐B activity and the concentration of NE in AF. There was no correlation between EP concentrations and MAO activities.Conclusion. These results suggest that CA concentration in AF may be related to the activity of MAO in fetal membranes, determined by certain physiological processes during pregnancy. It has been suggested that metabolism of monoamines in fetal membranes also plays an important role in reducing monoamine influx into mate

ISSN:0001-6349    

DOI:10.3109/00016349609033347

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective. A plasma platelet aggregating factor (PAF) has been implicated in the pathogenesis of platelet activation in thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). Similar mechanism may be operative in pre‐eclampsia. Methods. Coagulation profile and detailed in vitro platelet aggregation with various agonists were studied. PAF was demonstrated by spontaneous aggregation of normal platelets with test plasma. Non‐parametric Wilcoxon's rank sum test and Krauskal Wally's one way analysis of variance were applied.Result. Twenty‐two pre‐eclamptic patients and 20 normal pregnant controls were studied. Anti‐thrombin III levels were within normal range and fibrin degradation products were only border line raised (>10<40 μg/ml) in 14 (65.4%) patients. In vitro platelet aggregation was abnormal in 17 (77.2%) patients. PAF was demonstrable in 10 of 22 (45.5%) patients.Conclusion. Platelet aggregation studies indicated the presence of both activated (hyperaggregable) as well as exhausted (hypoaggregable) platelets in circulation. PAF demonstrable in 45.4% pre‐eclampsia patients would suggest its role in the pathogenetic mechanism of platelet activation in

ISSN:0001-6349    

DOI:10.3109/00016349609033348

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective, To compare the effect of endothelin on isolated resistance arteries from different vascular beds in normal and preeclamptic women before and after pretreatment with the ETA receptor antagonist BQ‐123.Materials and methods. Resistance arteries from myometrial and omental biopsies obtained at cesarean section of normal pregnant and preeclamptic women were dissected and mounted in organ baths for recording of isometric tension. The contractile response to endothelin‐1 in presence and absence of BQ‐123 was recorded.Results. Endothelin‐1 induced similar concentration‐dependent contractions in all arteries investigated. In women with preeclampsia the contractile response induced by endothelin‐1 was significantly higher in omental as compared to myometrial vessels. Pretreatment with BQ‐123 significantly shifted the concentration‐response curve to the right but only reduced the maximum contractile response in omental vessels.Conclusion. Endothelin‐1 is a potent constrictor of resistance arteries from different vascular beds in normal pregnancy and preeclampsia. The contractile effect is at least in part mediated by ETA receptors, since it was significantly reduced after pretreatment with BQ‐123. In preeclamptic but not in normal pregnant women the response to endothelin‐1 was reduced in myometrial as compared to omental arteries, possibly secondary to rec

ISSN:0001-6349    

DOI:10.3109/00016349609033349

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background. Certain risk factors for development of ischemic heart disease are influenced by pregnancy related changes of female sex hormone levels.Postpartum values were similar to prepregnancy levels, except serum triglycerides which remained 35% higher (p<0.001) and blood glucose (p<0.05).Conclusions. The major serum lipid fractions, and blood glucose, were significantly different during pregnancy and postpartum, which may influence the risk of cardiovascular disease development in women.Methods. As a part of the cardiovascular risk factor studies in Finnmark county, Norway, 1974‐75 and 1977‐78, cross‐sectional clinical and non‐fasting laboratory data were obtained prior to conception (n=463), during pregnancy (n=335), and following delivery (n=451).Results. Compared with prepregnancy values, total cholesterol was on average 7% lower in the first trimester (p<0.001), and 30% higher at the end of gestation (p<0.001). High density lipoprotein cholesterol was 38% higher at mid‐pregnancy (jxO.001), but only 14% higher in the last trimester (p<0.01). Serum triglycerides were 18% lower in the first (p<0.001) and 123% higher in the third trimester (p<0.001). Blood glucose was 5% lower than baseline in mid‐pregnancy (p<0.001). Except for the second trimester, when only 27% of women smoked, more than 40% of the women examined w

ISSN:0001-6349    

DOI:10.3109/00016349609033350

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background. Hypertension in pregnancy is associated with increased maternal and fetal morbidity and mortality. The aim of this prospective study was to evaluate the obstetric outcome of patients with pregnancy induced hypertension (PIH) that delivered at the Maternity Hospital Kuwait within a period of six months and evaluate the economic implications of present management strategies.Methods. This was a comparative study with age and parity, as matching variables, in 224 pregnant hypertensive women and 224 normotensive controls.Results. During the study period, the incidence of PIH was 4.9 percent. They were more associated with diabetes mellitus and multiple pregnancy than controls (p<0.02). About 43 percent of the hypertensive parturients used antihypertensive therapy. More of them had induction of labor (p<0.001), preterm delivery (p<0.002) and cesarean section (p<0.001), and babies with low birthweight (p<0.01). In the linear regression analysis, hypertension in pregnancy gave rise to more hospitalisation, intrauterine growth retardation and operative deliveries than the normotensive controls. The perinatal mortality was higher (p<0.001).Conclusion. Despite the economic expenditure of about five times more for hypertensive women in pregnancy than in controls, both obstetric and neonatal outcome, are still significantly worse in the former. This study therefore advocates more research into the prevention, prediction and management, including neonatal care, of hypertensive disorders of pregnancy.

ISSN:0001-6349    

DOI:10.3109/00016349609033351

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background. The use of human recombinant erythropoietin (rHuEPO) in pregnant patients has been limited by the fear of eventual maternal and fetal repercussions (either direct or indirect).Methods. The authors present their experience with the use of rHuEPO during pregnancy, with two pregnant women with kidney transplants and in three others with chronic renal insufficiency (one with diabetic nephropathy, another dialysis dependent), all with hematocrit below 30% and adequate iron reserves.Results. Three of the patients had needed blood transfusions before beginning therapy, and another needed transfusion after significant metrorrhagia. The length of the treatment varied between 2 and 23 weeks and the hematocrit at delivery varied between 26% and 36%. Secondary effects (appearance or worsening of hypertension and seizures) were nil. There was one fetal death at 23 weeks of pregnancy (following an abruptio placentce), two neonates weighing between the 5th and the 10th percentiles, and three needing phototherapy (1 to 2 days). One year after birth, all showed a normal ponderal and neurologic development.Conclusions. Among the cases presented, no maternal and perinatal complications attributable to rHuEPO were registered. It is important that institutions report their experiences with the use of rHuEPO, given its restrictive indications and the limited experience of each institution.

ISSN:0001-6349    

DOI:10.3109/00016349609033352

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background. Pregnancies complicated by fetal cystic hygroma in the second and third trimesters are often associated with hydrops fetalis, oligohydramnios or intrauterine fetal death which may make genetic assessment more difficult. We investigated the roles of amniocentesis. postmortem chorionic villus sampling and cystic hygroma paracentesis in cytogenetic evaluation of cystic hygroma under such circumstances.Methods. Thirty‐five fetuses of cystic hygroma associated with hydrops fetalis, oligohydramnios, or intrauterine fetal death were studied. All fetuses were delivered at Mackay Memorial Hospital, Taipei, Taiwan between January, 1987 and July, 1995. Data collected included maternal age, prenatal sonograms, gestational age at diagnosis, fetal karyotypes and diagnostic procedures.Results. Of 35 fetuses, all had hydrops fetalis, 19 had suffered IUFD at the time of diagnosis, and 10 had severe oligohydramnios. Cytogenetic studies were performed via amniocentesis, postmortem chorionic villus sampling, or cystic hygroma paracentesis. Successful karyotyping was achieved in 32 fetuses and the karyotype of 45,X was found in 24 fetuses. In cases with IUFD, successful karyotyping rates on cells from amniotic fluid, chorionic villi and cystic hygroma fluid were 88.9% (8 of 9), 69.2% (9 of 13) and 20% (1 of 5), respectively, whereas, in cases with living hydropic fetuses, successful karyotyping was achieved in 12 of 12 amniotic fluid and 5 of 5 cystic hygroma fluid samples.Conclusions. Amniocentesis is a better method for cytogenetic evaluation of fetal cystic hygroma associated with intrauterine fetal death than postmortem chorionic villus sampling and cystic hygroma paracentesis. However, in the case with a living hydropic fetus and oligohydramnios. cystic hygroma paracentesis appears to be a practical alternative for cytogenetic assessmen

ISSN:0001-6349    

DOI:10.3109/00016349609033353

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective. Accurate assessment of the difference in birthweight between first and second live‐births to the same woman having excluded the effects of physiological factors known to affect birthweight.Design. Retrospective longitudinal observational study.Results. The mean crude birthweight difference between first and second pregnancies was an increase of 138 g. Significant differences between the paired pregnancies were found in maternal booking visit weight, blood pressure, maternal age and gestation at delivery. Independent factors affecting difference in birthweight were gestation at delivery, maternal booking weight and baby's sex. Regression towards the mean was demonstrated which meant that a woman delivering a first baby weighing more than 3720 g could expect a lighter baby for her second delivery provided that all other factors remained constant.Conclusions. In general terms a woman is more likely to deliver a heavier baby in her second pregnancy than in her first pregnancy. However, maternal physiological factors differ in the two pregnancies and these differences have additional effects on birthweight. The effects of both these observations are tempered by regression towards the mean which has a profound influence in predicting the likely change in birthweight between first and second pregnancies. Clinical decisions should not be based on the assumption that a second baby will inevitably be heavier than the first baby.Setting. Three large obstetric units in the East Midlands of the United Kingdom. Subjects and methods. Women in whom data were recorded for their first two pregnancies on the UK East Midlands Obstetric database which resulted in the delivery of a liveborn, singleton and congenitally normal baby. Six thousand five hundred and thirty such cases were identified, of which 3457 had complete datasets and delivered both babies at term (259 to 300 days). An analysis was performed of changes between the paired pregnancies of physiological factors known to affect birthweight. Regression analyses were used to enable prediction of the second birthweight with the knowledge of the first birthweigh

ISSN:0001-6349    

DOI:10.3109/00016349609033354

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background.Active management with oral ergometrine 0.4 mg was compared with expectant management for the control of blood loss in the third stage of labor in women at low risk of postpartum hemorrhage (PPH).Methods.A three‐arms randomized trial in which 0.4 mg ergometrine (2 tablets of 0.2 mg) was set off against placebo, both groups allowing comparison with a standard oxytocin regimen of 5 IU.Women at low risk for PPH. Of 367 parturients, 146 were randomised to ergometrine 0.4 mg, 143 to placebo and 78 to intramuscular oxytocin in a 2:2:1 design.Results.Compared with placebo, ergometrine reduced blood loss with 5% (‐5%; Confidence interval: −20% to +13%). Oxytocin reduced blood loss with 9% (−9%; Confidence interval: −26% to +12%) versus placebo.Conclusion.Oral ergometrine has too little effect on blood loss after childbirth in order to be a good alternative to parenteral prophylactic m

ISSN:0001-6349    

DOI:10.3109/00016349609033355

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY