摘要:

The last decade has witnessed an increasing number of reports indicating that ectopic pregnancy (EP) can be successfully and safely treated with methotrexate (MTX). This review summarizes the results. In large series, as many as 45% of a population of women with EP has been treated with MTX. Success rates of 82–95% have been achieved. Tubal patency on the affected side was preserved in 79–91% of the cases. Preliminary assessment of subsequent fertility suggests that 47–69% will obtain an intrauterine pregnancy. Complications have been only few and of minor importance. However, the majority of reports do not include controls. Randomized studies are needed to optimize patient selection, treatment regimens, long‐term toxicity, future fertility, and cost

ISSN:0001-6349    

DOI:10.3109/00016349409072497

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

A case of advanced ectopic pregnancy afterin vitrofertilization complicated by an ovarian hyperstimulation syndrome is presented. Methotrexate was given in spite of high levels of hCG and appeared to be successful. Difficulties in the choice between surgical and conservative treatment are discussed.

ISSN:0001-6349    

DOI:10.3109/00016349409072498

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Urinary trypsin inhibitor is a glycoprotein which has an inhibitory effect on many enzymes, especially neutrophil elastase. The concentration of urinary trypsin inhibitor in serum (maternal and fetal), urine and amniotic fluid was measured in 20 cases of preeclampsia and compared with levels in normal pregnancy. Urinary trypsin inhibitor levels were significantly increased in the maternal and fetal serum of preeclamptic patients compared to normal pregnancy (p<0.0001), as well as in urine and amniotic fluid of the same patients. Relative fluorescence release of a calcium chelating agent (fura‐2) from human umbilical vein endothelial cell cultures was significantly increased by preeclamptic serum compared to serum of normal pregnant women (p<0.03). After incubation of urinary trypsin inhibitor with the cultures, significant decrease of fura‐2 release was observed (p<0.03).Urinary trypsin inhibitor has an effect on suppression of activated neutrophils, elastase production and may have a protective effect on endothelial ce

ISSN:0001-6349    

DOI:10.3109/00016349409072499

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The hypothesis was examined that altered maternal zinc metabolism is involved in the low birthweight associated with raised maternal serum alpha‐fetoprotein (MSAFP). Mothers with clinically normal pregnancy and normally formed infant but with raised MSAFP (>90th percentile) had lower than normal plasma zinc concentration, raised leucocyte zinc and disturbed zinc‐albumin relationship. They delivered offspring with lower birthweights than did women with normal MSAFP concentration, due both to shorter pregnancy and slower intrauterine growth. These results and others identify a subgroup of mothers associated with low infant birthweight, those with raised MSAFP, who have altered zinc distribut

ISSN:0001-6349    

DOI:10.3109/00016349409072500

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective. To assess maternal and fetal outcome at conservative ambulatory care of nulliparous women at term with prelabor rupture of the membranes.Methods. A prospective study of 176 women managed conservatively in an ambulatory setting (nonstress test and assessment of amniotic fluid index every second day).Results. The median rupture of the membrane to delivery interval was 30 hours. Ninety per cent were delivered within 85 hours. The patients were divided into three groups according to the time period between rupture of membranes and delivery (under the 25th, 25th‐75th and above the 75th centile). The maternal infectious morbidity (0, 6, 7% respectively), fetal distress (5, 18, 17% respectively) and instrumental delivery rate (5, 16, 16% respectively) tended to be increased in the upper three quartiles, without reaching a statistically significant level as analysed by χ2‐test. Nonstress test or evaluation of amniotic fluid index was not able to predict intrapartum fetal distress. In no case was there a delay in the management of any complication due to the ambulatory care.Conclusion. Awaiting spontaneous labor in nulliparous women with prelabor rupture of the membranes at term does not seem to be associated with any obvious advantage. If, however, a conservative attitude is implemented, the patients can preferably be treated on an ambulatory b

ISSN:0001-6349    

DOI:10.3109/00016349409072501

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective. The amount of free β subunit hCG (free β) has been reported to be increased in trophoblast disease and Down's syndrome, conditions also associated with high total hCG. Increased total hCG has been reported in hyperemesis gravidarum. We sought to determine if sera from singleton gestations with hyperemesis gravidarum contained a higher proportion of free β hCG compared to controls of comparable gestational age.Methods. Sera from 39 patients with hyperemesis gravidarum was compared with that from 23 control subjects of comparable gestational age with respect to β hCG and its subunits (free β and free α).Results. Hyperemesis patients and controls were comparable with respect to age, weight and gestational age. The concentration of hCG was greater in hyperemesis patients (9237 ± 3613 ng/ml, mean ± s.d.) compared to controls (5543 ± 2290,p<0.005) as was the concentration of free β hCG (101±70 ng/ml vs. 31 + 31,p<0.001). Free α did not differ between hyperemesis patients and controls (399±231 ng/ml vs. 377±214). A percent free β greater than 0.6 was found in 33/39 hyperemesis patients (85%) compared to 5/23 controls (22%),p<0.001.Conclusion. Increased free β hCG is found in hyperemesis gravidarum. This finding, strengthens the association of hyperemesis with abnormal me

ISSN:0001-6349    

DOI:10.3109/00016349409072502

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective. To identify markers for late fetal death, a multicenter study was performed, based on routinely obtained data from maternal health care units.Material and methods. Prospectively recorded data were obtained from maternal health care units belonging to five delivery units. In all, 233 consecutive cases of singleton pregnancy involving late fetal death (≥28 weeks) were identified between 1983 and 1989. As a control for each case, the next consecutive mother giving birth to a live infant at the same delivery unit was selected, the sole matching criterium being parity.Results. After exclusion of pregnancies with lethal malformations or trauma, 205 cases remained for the statistical analysis. Two main subgroups were identified: mothers with placen‐tal abruption (n= 44), and pregnancies with no obvious reason for fetal death (n= 101). An increased risk for late fetal death was evident in expectant mothers ≥40 years (10 vs 1; χ2= 7.6,p<0.01), and in smokers where an association was seen to placental abruption. A significantly increased risk was also seen in women with medical treatment for essential hypertension (8 vs 1; χ2=5.6,p<0.05). On the other hand, we found no correlation between pro‐teinuria, glucosuria, decreasing symphysis‐fundal height, or changes in the Hb, on the one hand, and late fetal demise, on the other. There was no overrepresentation of post dated pregnancy (by ultrasound early in the second trimester) among the cases. Nor did post dated pregnancies (≥42 weeks) estimated from first day of last menstrual period (but not post dated by ultrasound) imply a higher rate of fetal death, as has been suggested in previous studies.Conclusion. In the present material, there was no sign of systematic error in the evaluation of data routinely obtained from the antenatal clinics and maternity units. Apart from placental abruption in smokers, a high maternal age, and medical treatment for essential hypertension, deviating data were recorded as often among controls as among cases. No correlation was evident between a post date pregnancy and fetal demise. A short symphysis‐fundal height was recorded as often among controls as among cases and the even distribution of fetal birthweight in case pregnancies around the standard curve for the normal populatio

ISSN:0001-6349    

DOI:10.3109/00016349409072503

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Background. To evaluate the relationship between stillbirth in singleton pregnancy (≥28 weeks gestation) and maternal weight (weight gain) from 24 completed weeks.Results. Mothers experiencing stillbirth had a significantly lower mean body weight at 24 weeks gestation than control mothers (63.5 kg vs 67.3 kg;t= 2.4,p<0.05). No significant difference between cases and controls was found in mean weight gain during pregnancy from 24 completed gestational weeks to delivery, even when the last three measurements before delivery for cases and controls were compared separately.Methods. All fetal deaths (n= 210) at five delivery units during seven years in southern Sweden were analysed. To each case a control mother was selected, the only matching criteria being parity and place of delivery. Regression analysis was used for comparison of body weight gain in cases and controls.Conclusion. There is no difference in body weight gain between mothers with stillbirth and mothers giving birth to a live infan

ISSN:0001-6349    

DOI:10.3109/00016349409072504

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Background. We wanted to conduct a prospective study on the dynamics of emergency cesarean section (ECS) in terms of fetal survival and morbidity.Methods. The study covered 101 cases of ECS in Helsinki City Hospital, in which the time of alarm, the starting time of the operation, the time of birth, the umbilical arterial gas values, and Apgar scores were known. This group consisted of 60 cases with the operating team in the hospital (group 1) and 41 cases with the team on call (group 2). Means of the parametric variables were compared by the analysis of variance using separate or pooledt‐tests after Levene's test of variances. Difference between the rate of adverse outcome (dead or handicapped) in each group was calculated using chi‐square test.Results. In group 1, the time between the clinical decision and the time of delivery (mean±s.e.mean) was 13.5±0.7 min, in group 2, 23.6±0.9 min. The groups did not differ in terms of birthweight, placental weight, Apgar scores, and umbilical arterial gas values, except for pO2. The mean pO2 in group 1 was lower (1.9±0.1 kPa) than in group 2 (2.5±0.2 kPa).p=0.0023. In group 2, one infant was handicapped by hypoxic ischemic encephalopathy and three fetuses had died in utero. The rate of survivors was significantly higher when the operating team was in hospital (p=0.05).Conclusion. The risk of fetal loss is evident when the operating team is on call outside the hospital, at least if the alarm to operation interval exceeds 20 minutes. The present study suggests that 24‐hour services of anesthesia and operating theater personnel are crucial for optimal management of emergent situations in the del

ISSN:0001-6349    

DOI:10.3109/00016349409072505

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective. To determine whether Kiellands forceps rotational delivery causes a significant reduction in fetal pH or base excess, as compared to a control group delivered using non‐rotational forceps.Design. A prospective observational study.Setting. A teaching hospital labor ward in the UK.Methods. Fetal blood sampling was performed prior to delivery by Kiellands forceps (n=26) or by non‐rotational forceps (n=24). Following delivery, the umbilical vein was sampled.Outcome measures. The changes in fetal pH and base excess.Results. No significant changes in pH were noted in fetuses delivered using Kiellands forceps or in those delivered using Neville Barnes forceps. However, whilst no changes in base‐excess were found in the fetuses delivered using Neville Barnes forceps, there were significant changes in base‐excess in those fetuses delivered using Kiellands forceps.Conclusion. This small study suggests that delivery by Kiellands forceps may result in a significant deterioration in fetal acid‐bas

ISSN:0001-6349    

DOI:10.3109/00016349409072506

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY