ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02415-9

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractPulse oximetry is widely used to monitor the patient's well‐being in anesthetic and neonatal practice. As a result of recent technologic and theoretical advances, it has emerged as a clinical tool in intrapartum fetal monitoring. Oximeters record both pulse rate and arterial oxygen saturation of the fetus and they may be adapted to derive an estimate of peripheral perfusion. Reflectance oximetry is more accurate than transmission oximetry in intrapartum fetal management. This method uses the pulsatile changes of red and infrared light reflected from tissue to estimate arterial oxygenation. Pulse oximetry is cheap, non‐invasive, simple to operate, relatively accurate and has a fast response time. Factors adversely affecting the accuracy of the pulse oximeter output include transducer displacement, peripheral vasoconstriction, hypotension, anemia, presence of intravascular dyes, meconium staining, fetal hair and scalp edema. Fetal pulse oximetry is limited by a wide normal range and inadequate calibration. The amniochorionic membranes however do not affect oximetry readings so that this method may be applied before rupture of the membranes, i.e. before labor. Once successfully developed, fetal pulse oximetry could potentially be used in combination with other monitoring techniques to reduce instrumental and operative interventions during labor and improve perinatal outcome.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02440-N

出版商:Wiley    

年代:2017

数据来源: WILEY

摘要:

AbstractObjectives: To study the demographic characteristics of patients with placenta accreta and to identify the clinical features, maternal and neonatal complications of this condition. Methods: Sixteen cases of placenta accreta were identified in the Maternity Hospital of Kuwait during the period January 1981 to July 1993. Medical records were reviewed regarding past obstetric history, type of placenta, clinical presentation, maternal and fetal outcome. Results: The rate of placenta accreta was found to be 98 per 1 000 000 deliveries. Emergency hysterectomy was needed in 87.5% of cases. There was one maternal death (6.25%) and three perinatal deaths (18.75%). Hemorrhage was the major presenting symptom either externally and antenatally in previa accreta or postpartum in accreta of the upper segment or internally in the same cases. The major postoperative complications were coagulopathy, urinary injury, pelvic hematoma and abscess, in addition to cardiac arrest. These complications, when considered separately, were not affected by a previous history of uterine scarring. Conclusions: Placenta accreta is a major cause of obstetric hemorrhage and has an adverse effect on maternal and neonatal outcome. It ought to be considered a possibility in patients with previous uterine scarring, placenta previa or retained placenta. It will remain a growing problem in the developing countries due to the rising incidence of previous multiple cesarean sections. Unfortunately the latter do not deter women in this part of the world from insisting upon having big families and refusing tubal ligation.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02418-C

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: To compare obstetric intervention rates between Dutch hospitals. Methods: A total of 28 934 hospital births under secondary care (specialist care for medium‐/high‐risk pregnancies) in 1990 were analyzed in a stratified, random sample of Dutch hospitals based on the records of the Dutch Netherlands perinatal database. Comparisons were made of the intervention rates between hospitals. Results: The intervention rates of the various hospitals differed widely. The most striking difference was in the cesarean section (CS) rate for non‐vertex first twins, with a range of 0–100% and a mean rate of 47.6%. On average a CS for a term breech was performed in 30.8% of cases and sedation or analgesics were administered in 16.2% of cases. The mean rate of episiotomy for a term breech was 71.5%, the lowest rate being 18.8%. Conclusion: Our results show relatively low intervention rates with considerable interhospital variation.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02424-B

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: To determine whether graphic labor record (partogram) can be used to predict the risk of uterine scar rupture in labor following lower segment cesarean section. Methods: Between 1988 and 1991, 236 women had a trial of labor following cesarean section. After the onset of the active phase (3 cm cervical dilatation), a 1 cm/h line was used to indicate an alert line on the partogram. All the active phase partograms were divided into five time zones: A (area to the left of the alert line), B (0–1 h after the alert line), C (1–2 h after the alert line), D (2–3 h after the alert line), and E and F (>3 h after the alert line). For the action line, different lag times after the alert line were defined according to the time zones. Sensitivity, specificity, cesarean section rates and rupture rates were calculated for the different lag times after the alert line, and a receiver‐operating characteristic curve was constructed. Results: Fifty‐five (23.3%) trials of labor ended in a repeat emergency cesarean. There were seven (2.9%) cases of scar rupture. Of the 181 vaginal deliveries, 151 (83%) occurred within 2 h after the progress of labor had crossed the alert line (zones A‐C). Five out of seven cases of scar rupture occurred more than 2 h after the alert line had been crossed (zones D‐F). The 2‐ and 3‐h lag time after the alert line had a sensitivity of 71% and 43%, respectively, and a specificity of 78% and 96%, respectively, in predicting uterine scar rupture. If cesarean sections were performed at 2 or 3 h after crossing the alert line, the projected cesarean rates would have been 36% and 27%, respectively. The scar rupture rates would in turn be 0.8% and 1.6%, respectively. Conclusion: In women undergoing a trial of labor following cesarean section, the partographic zone 2–3 h after the alert line represents a time of high risk of scar rupture. An action line in this time zone would probably help reduce the rupture rate without an unacceptable increase in the rate of cesarean section.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02431-B

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: To test the usefulness of the fetal transverse cerebellar diameter/abdominal circumference (TCD/AC) ratio in predicting known small‐for‐gestational‐age (SGA) infants. Method: The relationship between fetal TCD and AC throughout the second half of pregnancy was investigated in 635 well‐dated, normal pregnancies and examined with regard to gestational age and infant birth weight percentiles. Results: One hundred eighteen (19%) fetuses were excluded due to inadequate visualization of the fetal cerebellum. A strong correlation was noted between gestational age determined by the last menstrual period and both fetal TCD (r2= 0.91338) and AC (r2= 0.89361) in fetuses with birth weights between the 10th and 90th percentiles (n = 407; mean 14.4, S.D. 1.2). Although the TCD/AC ratio showed a poor correlation with gestational age (r2= 0.15788), a slight increase was noted during gestation. A TCD/AC ratio greater than 15.5 was present in 80% of SGA infants when measurements were performed within 1 week of delivery. Conclusion: Fetal TCD/AC ratio as a gestational age‐independent method could improve diagnostic sensitivity and specificity in the early detection of fetal growth abnormalities.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02423-A

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: To determine whether hysterectomy by the vaginal route is safe and feasible in patients with previous cesarean section. Methods: A retrospective study of the records of private and public hospital patients who underwent vaginal hysterectomy performed by the senior author. Two hundred twenty patients who had had previous cesarean sections were compared with a control group of 200 patients who had not had previous pelvic surgery, with special reference to operative difficulties, intraoperative complications, surgical time and length of hospital stay. Results: It was possible to perform vaginal hysterectomy safely in patients with previous cesarean sections. Three of 200 (1.5%) patients had inadvertent intraoperative urological trauma because of dense adhesions. Conclusions: The vaginal route is the route of choice for performing a hysterectomy in patients with previous cesarean section.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02434-E

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: To evaluate the procedure of aspiration and tetracycline sclerotherapy in the management of simple ovarian cysts. Methods: Twenty‐five cases of simple ovarian cysts were subjected to cyst fluid aspiration and 5% tetracycline injection under ultrasound guidance. Cytological examination of the aspirated fluid was carried out in 24 cases and the patients were followed for 6–36 months. Results: Cytology revealed a cellular sediment in 18 cases (simple cysts), follicular cells in four cases (follicular cysts), and blood and hemosiderin‐laden macrophages in two cases (endometriosis); subsequent surgery was required in only one case (endometriosis). Conclusions: The procedure of aspiration and tetracycline sclerotherapy was easy, safe and acceptable, with no recurrences. It appears to be a valid alternative to cyst aspiration in the management of simple ovarian cysts.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02443-G

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjectives: To assess cervical shortening after loop excision of the transformation zone (LETZ), and confirm the validity of ultrasound measurement of cervical length. Methods: Subjects (n = 29) were patients at the colposcopy clinic of Beth Israel Hospital who underwent vaginal ultrasound measurement of cervical length before and after LETZ. The pathologic specimen was measured by ruler. Mean cervical length (± S.D.), mean percentage (± S.D.) of cervical length removed, and correlation (r) between ultrasound and pathology specimen measurement were determined. Results: Mean (± S.D.) cervical length measurements prior to LETZ were 3.2 ± 0.9 cm and after LETZ were 2.6 ± 0.9 cm, with a difference of 0.7 ± 0.4 cm. The pathologic specimen (mean ± S.D.) was 0.6 ± 0.3 cm. The correlation between ultrasound and pathology measurement was r = 0.9 (p = 0.0001). Mean (± S.D.) cervical length was shortened by 22 ± 12%. Conclusions: There is excellent correlation between ultrasound and ruler measurement of the cervix. There is significant cervical length shortening after LETZ, but further study is needed to see whether this persists or leads to pregnancy complications.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02432-C

出版商:Wiley    

年代:2017

数据来源: WILEY

摘要:

AbstractObjective: To evaluate the hormonal response to the short protocol of gonadotropin‐releasing hormone (GnRH) analog (GnRHa) in patients with polycystic ovarian disease (PCOD). Methods: We enrolled 35 patients (20 infertile) with ultrasonographic and hormonal PCOD characteristics. GnRHa Suprefact was applied subcutaneously at a daily dose of 0.9 ml for 9 consecutive days starting on the 10th–15th day after induced or spontaneous bleeding. Blood sampling for follicle‐stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E2), estrone (E1) and dehydroepiandrosterone sulfate (DHEA‐S) was performed before the treatment and on days 3 and 4 of GnRHa administration. Student's t‐test was used for the analysis of differences between various mean values. All statistical analyses were performed by the computerized statistical package CSS‐Statistica. Results: Pretreatment hormonal levels (FSH 5.68 ± 1.86 IU/l, LH 14.16 ± 1.72 IU/l, E20.29 ± 0.20 nmol/l, E10.35 ± 0.17 nmol/l, T 3.52 ± 1.40 nmol/l, DHEA‐S 7.15 ± 2.89 μmol/l) barely differed on day 3 of GnRHa administration, except for the rise in LH (17.14 ± 10.97 IU/l), which was still not significant. On day 9 of GnRHa application, significant suppression of FSH (3.16 ± 1.55 IU/l) and LH (8.05 ± 5.00 IU/l) was registered compared with pretreatment levels, without changes in the FSH:LH ratio, and in other parameters studied. Although there were no changes in ultrasound characteristics on day 9 of GnRHa administration compared with basal findings, bleeding occurred 14–18 days after the last GnRHa dose in 32 patients. There were three pregnancies out of 20 infertile patients in the treated cycles. Conclusion: Significant suppression of FSH and LH in PCOD patients does not interfere with ovarian steroid production, which is probably maintained due to higher follicular sensitivity to normal FSH and LH levels. Alternatively it may be the consequence of the unaltered FSH:LH ratio in spite of GnRHa‐suppressed absolute values. However the recommencement of menstrual bleeding and 15% of pregnancies in the investigated infertile patients suggest the occurrence of certain temporary intraovarian events, which probably continue after the cessation of GnRHa administration.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02435-F

出版商:Wiley    

年代:2017

数据来源: WILEY