摘要:

The purpose of this retrospective investigation was to evaluate the duration of labor in women having a trial of labor after a previous low transverse cervical cesarean delivery for dystocia. We specifically sought to determine whether these patients experienced a labor similar to that of the nulliparous or multiparous woman. During the study period, 73 women who had previously undergone a cesarean for dystocia had a successful trial of labor. We matched each study patient to two controls. One control was nulliparous and the second was a woman who had undergone a previous uncomplicated vaginal delivery. Thirty-six study patients had had a cesarean in the latent phase of labor (group I), 29 in the active phase of labor (group II), and eight in the second stage of labor (group III). With the exception of group I patients, the first and second stages of labor were similar to those of nulliparous control patients. Patients in group I had a significantly longer first stage of labor than did the nulliparous controls. There was no significant difference in oxytocin requirements among the three groups. We conclude that primiparous women who have had a previous cesarean delivery for dystocia have a duration of labor similar in length or longer than that of nulliparous women.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Early repair of episiotomy dehiscence was performed in 22 women with an initial fourth-degree episiotomy, four with third-degree episiotomy, and five with a mediolateral episiotomy. Early complications were limited to development of a pinpoint rectovaginal fistula in two women, both subsequently repaired by a rectal mucosal flap procedure. Of the 27 women now 1 year or more post-repair, all are completely continent and report resumption of normal coital activity.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Bacterial species associated with bacterial vaginosis have been isolated more frequently from endometrial cultures of patients with postpartum endometritis than expected from the prevalence of bacterial vaginosis among pregnant women. To further assess the association between bacterial vaginosis and postpartum endometritis, vaginal Gram smears were obtained from women admitted for delivery. Vaginal smears of women delivered by cesarean were scored as normal or as indicating bacterial vaginosis. Factors related independently to postpartum endometritis by multiple logistic regression analysis included maternal age less than 25 years, any duration of membrane rupture, and bacterial vaginosis. The unadjusted odds ratio for the development of postpartum endometritis associated with bacterial vaginosis (odds ratio=6.1, 95% confidence interval 3.3-15.9) was not appreciably changed in the multivariable analysis (odds ratio=5.8, 95% confidence interval 3.0-10.9) after adjusting for maternal age, duration of labor, and duration of membrane rupture. At the time of endometritis,Bacteroidessp,Peptostreptococcussp, andGardnerella vaginaliswere isolated more frequently from the endometrium using a triple lumen endometrial sampling method among patients with bacterial vaginosis than among those with a normal Gram stain. Bacterial vaginosis appears to be an important risk factor for postpartum endometritis after cesarean delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Growth disturbance in the trisomic fetus is believed to be primarily fetal in origin. There has been only sparse description of placental pathology in the third trimester in these fetuses, and therefore the placental role in their growth and development remains unexplored. We performed quantitative morphometric analysis on the placentas of 18 fetuses with trisomy and ten normal control fetuses. Doppler umbilical artery analysis was performed on ten abnormal fetuses and all controls. The placentas of trisomic fetuses exhibited a significant reduction in small muscular artery count and small muscular artery/villus ratio. Abnormal Doppler waveforms correlated closely with reduced small muscular artery counts. Undervascularization and increased vascular resistance of the placenta of trisomic fetuses may contribute to diminished fetal growth. The placenta appears to be another fetal organ whose structure and function are affected adversely by abnormal karyotype.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

When elevated maternal serum alpha-fetoprotein (MSAFP) results lead to diagnostic amniocentesis, a decision of whether to karyotype fetal cells must be made. We examined our experience with MSAFP screening in 71,563 unselected pregnancies in which karyotyping was performed when amniocentesis was done because of MSAFP elevations. A total of 727 women (1.0%) underwent amniocentesis because of elevated MSAFP values and among this group, seven chromosomal anomalies (incidence one in 104) were detected. Of the 727 women, 658 (91%) had normal amniotic fluid AFP. In this group, there were six (one in 109) chromosomally abnormal fetuses: three with triploidy, two with 47,XXX, and one with 46,XX,1q-. Among the 69 pregnancies with elevated amniotic fluid AFP, one fetal chromosomal anomaly (trisomy 13) was diagnosed. The incidence of all chromosomal anomalies observed in women undergoing amniocentesis because of elevated MSAFP is comparable to that reported in women 36 years of age undergoing testing because of advanced maternal age. We believe that chromosome analysis should be performed on amniotic fluid samples obtained because of elevated MSAFP unless there are compelling financial circumstances that preclude this. Even in such cases, cell cultures should be established until the amniotic fluid AFP result is available. Chromosome analysis is essential when the amniotic fluid AFP is elevated because of the known association between open fetal defects (spina bifida, omphalocele, and scalp defects) and trisomies 13 and 18.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The prenatal diagnosis of a genitourinary anomaly was made in 53 fetuses. Sonographic findings, antenatal course, and postnatal treatment and outcomes were examined. No interventional therapy was undertaken in utero, and the natural history could be examined in the 44 of 53 (83%) who did not electively terminate their pregnancies. Twenty-three of the total 53 (43%) had unilateral disease and 30 (57%) had bilateral involvement. Thirty-five of 53 (66%) survived, with 22 undergoing operative therapy postnatally. In all but one of the 35 survivors, the anomaly was isolated to the genitourinary tract, and the majority of surviving fetuses had unilateral disease. Oligohydramnios was present in only three of 35 survivors, and none had severe oligohydramnios. Nine of 53 women underwent termination of pregnancy and nine others experienced a neonatal death. All 18 of their fetuses had bilateral disease, with oligohydramnios present in 14 (78%). All five fetuses with chromosomal abnormalities were found in this group of 18. The majority of fetuses with a genitourinary anomaly will do well postnatally. Pulmonary hypoplasia, extrarenal anomalies, and chromosomal defects are frequent findings in the minority with poor outcomes. A multidisciplinary approach to management of the pregnancy with a fetal genitourinary tract anomaly is essential to optimize outcome.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

In previous studies, we reported a high rate of spontaneous abortions in insulin-dependent diabetic pregnancies. Abortions were associated with poor first-trimester glycemic control. We hypothesized that improvement of glycemic control from one pregnancy to the other would improve fetal outcome and that deterioration of glycemic control would increase the likelihood of abortion. We studied prospectively 43 insulin-dependent diabetic women (White class B-RF) with two consecutive pregnancies, recruited before 9 weeks' gestation. Preprandial and 90-minute postprandial blood glucose concentrations were measured at each weekly visit. Glycohemoglobin A1was measured at 9 weeks' gestation. Twenty women had two successful pregnancies and 15 had an abortion followed by a successful pregnancy (abortion- no abortion); the sample sizes for other sequences (no abortion-abortion,N=5; and abortion-abortion,N=3) were too small to allow for analysis. Glycohemoglobin A1concentrations were stable in the sequence no abortion-no abortion (9.7 ± 0.5 versus 9.8 ± 0.4%, mean ± SEM; not significant), whereas in the sequence abortion-no abortion, there was a significant decrease in glycohemoglobin A1values from the nonsuccessful to the successful pregnancy (10.7 ± 0.6 versus 9.3 ± 0.4%; P=.01). Similarly, in the sequence abortion-no abortion, there was a significant decrease in mean postprandial blood glucose from first to second pregnancy (166 ± 13 versus 135 ± 11 mg/dL; P=.04), whereas in the sequence no abortion-no abortion, mean postprandial blood glucose did not change significantly (160 ± 14 versus 144 ± 11 mg/dL; not significant). Logistic regression analysis, taking into account variables such as maternal age, age at onset of diabetes, and White classification, confirmed a decrease of glycohemoglobin A1at 9 weeks as the best indicator of a successful outcome after a spontaneous abortion. We conclude that improvement of glycemic control from one pregnancy complicated by abortion to the next one is associated with improved outcome in the second pregnancy. Because glycohemoglobin A1at 9 weeks reflects early first-trimester glycemic control, we speculate that patient education and prenatal counseling which followed the first abortive event were successful in improving both glycemic control and fetal outcome.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Maternal glycosylated hemoglobin and glycosylated protein and cord glycosylated protein were measured at delivery in 20 normal mothers of 20 macrosomic neonates over 4000 g (group I) and compared with values in two groups of mother/infant pairs: 20 normal/20 appropriate for gestational age (group II) and nine diabetic mothers/ten neonates (group III). Infants in group I, by design, weighed more (mean ± SD 4403 ± 337 g) than those in group II (2902 ± 278 g) or group III (3365 ± 898 g) (P<.001). There was no significant difference in weight between group II and group HI infants. Birth weight ratio was greater (P< .001) in group I than in group II or group III (1.39 ± 0.1, 0.9 ± 0.08, and 1.08 ± 0.25, respectively); group III infants had a higher birth weight ratio (P< .05) than those in group II. Hematocrit (%) was higher (P< .05) in group III (62 ± 3) than in group I (59 ± 5) or group II (57 ± 6) infants. Glycosylated hemoglobin values were similar in all three groups. Mean serum glycosylated protein was higher (P<.001) in group III (13.8 ± 2%) than in group I (10 ± 2%) or group II (9.8 ± 2.5%) mothers. Cord glycosylated protein was also higher (P< .001) in group III (12.3 ± 1.9%) than in group I (9 ± 1.3%) or group II (8.6 ± 1.7%) neonates. Maternal glycosylated protein correlated (P<.001; r=0.825) with cord glycosylated protein in the combined groups; the correlation was also significant within group I and group II, but not within group III pairs. Maternal glycosylated hemoglobin and glycosylated protein and cord glycosylated protein correlated poorly with birth weight, birth weight ratio, and 1-hour neonatal plasma glucose. Birth weight was significantly related to weight gain during pregnancy (R2=0.31, b'=0.53; P<.001) and gestational age (AK2=0.13, b'=0.37; P<.01). In summary, glycosylated protein is a good indicator of recent glycemic control in diabetic mothers and their neonates; glycosylated protein and glycosylated hemoglobin are not significantly correlated with birth weight, birth weight ratio, or glucose levels in the neonate.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Collagen content, acid-soluble collagen, degradation activity, and collagen biosynthesis were measured in 22 normal and 20 prematurely ruptured membranes from pregnancies near term (37 weeks or more). Although no significant differences were found in the collagen content, a clear correlation was found between this value and the interval from premature rupture to delivery. Collagenolytic activity and collagen solubility were higher and collagen synthesis was lower in amniotic membranes that ruptured prematurely. These studies suggest that premature rupture of membranes is associated with extensive changes in collagen metabolism.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Between January 1, 1970, and December 31, 1983, 817 patients with serous ovarian carcinoma were seen at M. D. Anderson Cancer Center. Within this population, we identified those patients with normal-sized ovaries (4 cm or less in maximum diameter) and those with papillary serous histology, exclusive of borderline tumors. The 74 patients so identified were classified as having papillary serous carcinoma of the peritoneum, and form the basis of this report. The average age at diagnosis was 57.4 years. The majority of the patients (90.5%) were white. Common presenting symptoms included abdominal pain (54.9%) and abdominal distention (51.5%). In 89.1% of patients, disease involved the omentum. Clinical response to chemotherapy was seen in 63.6% of the patients; 40.9% of them had partial responses and 22.7% complete responses. At second-look laparotomy, 27.3% of 33 patients demonstrated a surgical complete response, 21.2% had microscopically positive disease only, and 51.1% had grossly positive disease. The median survival for the total group was 24.0 months. Neither patient age nor presence of residual disease after cytoreduction predicted survival. Patients treated with combination chemotherapy fared better than patients treated with single-agent regimens (29.5 versus 16.5 months; P=.01). Patients receiving cisplatin- containing regimens also did better (31.5 versus 19.5 months; P=.02). Among several pathologic characteristics analyzed, only the absence of mitoses predicted improved survival (76.5 versus 21.4-27.0 months; P s .05). Papillary serous carcinoma of the peritoneum, though biologically and histologically similar to ovarian carcinoma, is a distinct clinicopathologic entity not uncommonly encountered by the gynecologist.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID