摘要:

ObjectiveTo determine the optimal dosage of vaginal misoprostol for cervical priming before vacuum aspiration abortion.MethodsOne hundred twenty women were assigned randomly to receive 200, 400, 600, or 800 μg of misoprostol given vaginally. Vacuum aspiration was performed 3–4 hours after the insertion of misoprostol tablets. The degree of cervical dilation before operation was measured with a Hegar dilator. Preoperative and intraoperative blood loss and associated side effects also were assessed.ResultsTwenty-nine (96.7%) women in the 400-μg group and all in the 600-μg and 800-μg groups achieved cervical dilation of at least 8 mm. The success rate for the 200-μg group was only 23.3%, significantly less efficacious than the 400-μg dose (odds ratio 95.3; 95% confidence interval 10.9, 830.9;P< .001). There was no significant difference among the 400-, 600-, and 800-μg groups (P= .364) with respect to achieving cervical dilation at least 8 mm. However, 800 μg was associated with significantly more side effects than 600 μg (preoperative and intraoperative blood loss,P< .001; abdominal pain,P= .005; products of conception at os,P< .001; fever higher than 38.0C,P= .002). When 400 μg and 600 μg were compared, we found that the higher dose also was associated with significantly more side effects. The 600-μg group was used twice in the comparison, but allPvalues remained significant even after the Bonferroni adjustment for multiple comparisons.ConclusionVaginal application of 400 μg of misoprostol is the optimal dose for vacuum aspiration preabortion cervical dilation in first-trimester nulliparas.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo examine the outcome of trial second labor after a first cesarean performed because of cephalopelvic disproportion, defined according to strict diagnostic criteria.MethodsObstetric details of nulliparous women delivering at 37 or more weeks' gestation by cesarean for cephalopelvic disproportion, between 1975 and 1990, were recorded prospectively. The diagnostic criteria for cephalopelvic disproportion were cervical dilation arrested after 5 cm, unresponsive to oxytocin augmentation, after active dilatation of 2 cm or more in 2 hours. Fetal malpresentations and malpositions were excluded. The outcome of next delivery in our hospital by each woman enrolled was then examined.ResultsEighty-four of 42,793 women met the criteria for disproportion, and 40 with cephalic presentations delivered their next baby in our hospital. All 40 underwent a trial of labor and 27 (68%) delivered vaginally, comprising seven (47%) women with larger second and 20 (80%) with smaller second babies. Of 15 women previously delivered by cesarean at full dilatation, 11 (73%) delivered vaginally with no serious maternal or neonatal morbidity.ConclusionThe strictly defined diagnosis of nulliparous cephalopelvic disproportion should not constitute an automatic “recurrent” indication for elective cesarean delivery, because 68% of patients in our series had successful vaginal deliveries in their next pregnancies. This rate is similar to those reported after all nulliparous cesareans for dystocia.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo compare the effects of 50 mg or 200 mg of oral mifepristone with placebo on cervical ripening and induction of labor in primigravid women at term with unfavorable cervices.MethodsThis was a double-blind study in which 80 primigravidae at term with a modified Bishop score of 4 or less were randomly assigned to one of three treatment groups. They were assessed at 24-hour intervals for 72 hours, after which labor was induced if it had not occurred spon-taneously.ResultsTwo hundred milligrams of mifepristone resulted in a favorable cervix (with a Bishop score greater than 6 or in spontaneous labor) in significantly more women than placebo (P= .01). An improvement in cervical ripening was seen in the group given 50 mg of mifepristone, but this was not statistically significant. There were more cesarean deliveries performed for fetal distress in the group treated with 200 mg of mifepristone than placebo, but this was not statistically significant and was not associated with any differences between groups in terms of neonatal outcome.ConclusionMifepristone, a progesterone antagonist, is known to cause softening and dilation of the human early pregnant cervix and an increase in uterine activity. It is theoretically attractive for use as an adjunct in cervical priming and labor induction. In this study, 200 mg of mifepristone was significantly more likely to result in a favorable cervix than placebo.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo compare the efficacy and vaginal birth intervals after intravaginal or oral misoprostol for labor induction.MethodsOne hundred seventy-eight women were randomized to one of two double-blind groups: 1) oral misoprostol 200 μg and one-half tablet placebo intravaginal or 2) oral placebo tablet and one-half tablet of a 100-μg misoprostol intravaginal (dose 50 μg). Doses were repeated every 6 hours until labor was established (maximum of three doses).ResultsNinety-three subjects were assigned to oral misoprostol and 85 to intravaginal administration. Oral administration was accompanied by significantly shorter intervals to the onset of uterine contractility (133 ± 78 minutes versus 168 ± 93,P< .01) but a higher incidence of abnormal uterine contractile activity (tachysystole 38.7% versus 20.0%,P< .01; hyperstimulation syndrome 44.1% versus 21.2%,P< .01). No adverse maternal or neonatal outcomes were noted, nor were there differences in cesarean delivery rates or total lengths of labor.ConclusionOral administration of 200 μg misoprostol has similar efficacy to intravaginal administration of 50 μg but is associated with more frequent abnormal uterine contractility.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine whether racial differences in risk of low birth weight infants among black and white parents can be attributed to differences in demographic, behavioral, medical, and socioeconomic factors.MethodsWe analyzed 203, 815 singleton births from the 1992 California birth certificate data set for the risk of very low birth weight (500–1499 g) and moderately low birth weight (1500–2499 g) infants. Additional study variables included maternal (race, age, education, marital status, parity, obstetric history, tobacco use, medical complications, medical insurance, and use of prenatal care), paternal (race, age, and education), infant (gestational age and gender), and community (median household income from the 1990 US Census) characteristics.ResultsFor both very low and moderately low birth weight infants, the unadjusted risk associated with parental race showed a gradient of risk, from highest to lowest, for black mother/black father, black mother/white father, white mother/black father, and white mother/white father parents. After adjusting for other risk factors, the odds ratio associated with black mother/black father parents was reduced from 3.37 to 1.73 for very low birth weight infants and from 2.51 to 1.60 for moderately low birth weight infants, but both remained elevated. Interracial parents no longer had an elevated risk of very low birth weight infants and white mother/black father parents no longer had an elevated risk of moderately low birth weight, compared with white parents.ConclusionAfter controlling for parental, infant, and community factors, most but not all of the increased risk of low birth weight infants associated with black parental race was explained.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveUsing receiver-operating characteristic (ROC) curves, we tried to determine the diagnostic threshold of amniotic fluid index (AFI) that will identify abnormal fetal size (birth weights under 2500 g or at least 4000 g) at 37 weeks or beyond.MethodsWe analyzed prospectively over 2 years all parturients with intact membranes and known AFI in early labor. Patients with the following conditions were excluded: pregestational or gestational diabetes, known anomalies, and preterm labor. Two ROC curves were constructed, and the areas (± standard error of the mean [SE]) under the curves were calculated.P< .05 was considered significant.ResultsOf the 1038 subjects meeting study criteria, 3.6% and 11.5% gave birth to infants who were small for gestational age (SGA) or macrosomic, respectively. Overall, 28.7% had oligohydramnios (AFI at most 5.0 cm) and 3.6% had hydramnios (AFI at least 24.0 cm). Small for gestational age was more common in patients with AFI at most 5.0 cm (6.4%) than in those with adequate fluid (AFI 5.1–23.9; 2.5%), or hydramnios (2.7%;P= .012). Macrosomic newborns were less likely to be born to women with oligohydramnios (7.7%) than to those with adequate amniotic fluid (13.1%) or hydramnios (13.5%). Areas under ROC curves are not significantly different from the area under the nondiagnostic line, indicating that AFI (0–34 cm) cannot differentiate between newborns under 2500 g and at or over 2500 g or under 4000 and at or more 4000 g.ConclusionIntraparterium AFI appears to be a poor screening test to identify risk for delivery of SGA or macrosomic fetus.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine whether fetal splenic enlargement predicts anemia in Rh-alloimmunized nonhydropic singleton fetuses.MethodsSplenic circumference was measured before funipuncture in 21 singleton pregnancies on 47 occasions. The spleen was imaged in an axial section of the fetal abdomen close to the level used for measurement of the abdominal circumference. The splenic length and width were measured and the circumference calculated by the formula (length and width × 1.57). One measurement per patient was used for each analysis. Splenic circumference was measured and expressed as multiples of the normal median (MoM) for gestational age. One hundred twenty-one cases were used to provide cross-sectional normative data. The expected median splenic circumference values were derived from a normal group. Fetal anemia was defined as hemoglobin deficit, ie, mean hemoglobin concentration for gestation minus the measured value. Anemia was defined as hemoglobin deficit exceeding 2 g/dL, and severe anemia as hemoglobin deficit exceeding 5 g/dL. Receiver operator characteristics curves for the prediction of anemia using different splenic circumference (MoM) values were constructed.ResultsSplenic circumference was an excellent predictor of severe anemia in cases with no prior transfusion: sensitivity 100% and specificity 94.7% (area under the curve = .97,P< .03). The measurement did not correlate significantly with severe anemia in the group with prior transfusion (area under the curve = .73,P= .19).ConclusionSplenomegaly is sensitive for the detection of severe anemia in nonhydropic Rh sensitized cases without prior transfusion. The splenic enlargement could be explained by extramedullary erythropoiesis.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo evaluate the importance and evolution of isolated, mild fetal pyelectasis, detected in early pregnancy by high-resolution transvaginal sonography, and to determine its association with abnormal fetal karyotypes.MethodsTransvaginal scan at 11–16 weeks' gestation and transabdominal ultrasound examinations at the time of amniocentesis (16–18 weeks) were performed in 1093 pregnant women undergoing genetic amniocentesis because of advanced maternal age. In 795 cases, transabdominal scans were repeated at 22–24 weeks. Women were excluded if they had a spontaneous abortion, chose to terminate their pregnancy, or declined amniocentesis. Each patient was screened for fetal pyelectasis, defined as an increase in anteroposterior renal pelvic diameter, using cutoff values related to various stages of pregnancy.ResultsIsolated fetal pyelectasis was detected at the first ultrasound examination in 56 women (5.1%) in early pregnancy, in 32 (2.9%) at the time of amniocentesis, and in 23 (2.9%) at 22–24 weeks' gestation. Two fetuses with diagnoses of mild pyelectasis at the first transvaginal ultrasound demonstrated abnormal karyotypes at amniocentesis. In one case, the pyelectasis disappeared at 22–24 weeks' gestation.ConclusionThis retrospective study shows that pyelectasis is more frequently detectable by high-resolution transvaginal sonography in the first half of pregnancy than in the second half. When detected in early pregnancy, the finding is frequently transient and not associated with an increased risk of abnormal fetal karyotypes.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo examine the use of prenatal intramuscular steroids in a community setting as outlined in National Institutes of Health (NIH) guidelines to reduce respiratory distress syndrome in premature infants.MethodsWe performed a complete chart review for 1 year of deliveries to Medicaid mothers at 25–34 weeks' gestation at all obstetric units in Arkansas, analyzing time of arrival to the hospital, time of delivery, and dosage, and route of steroid administration to compare processes between community and teaching center sites, and general performance with NIH guidelines.ResultsOf 191 deliveries at 25–34 weeks' gestation, 63.4% of mothers received at least one dose of corticosteroids before delivery. Only 124 (65%) of these mothers presented to the hospital more than 4 hours before delivery and 87% of these mothers received at least one dose of corticosteroids before delivery. Ninety percent of women who were transferred after presenting in labor and 94.9% of women who delivered at the tertiary care referral center received corticosteroids. There was no statistically significant difference in corticosteroid administration rates for women with or without preterm premature rupture of membranes. Many women received corticosteroids at dosages and intervals disparate with NIH guidelines.ConclusionObstetric providers in Arkansas administered antenatal steroids to Medicaid women in preterm labor at a rate higher than stated in previous literature. Delivery at a nonreferral center or within 4 hours of arrival to the hospital were associated with reduced antenatal corticosteroid administration. Improved performance efforts should target institutional usage and behavior of mothers at risk for premature delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo develop patient-centered outcome measures for clinical research by characterizing the effects of pregnancy and childbirth on functioning.MethodsFive focus groups of mothers (n= 33) and three focus groups of clinicians (midwives [n= 8], obstetricians [n= 4], and family practitioners [n= 7]) were convened. Discussions were audiotaped and transcribed. Major narrative themes were identified by using two independent readers and were confirmed by participants and additional clinicians.ResultsThemes were grouped into four outcome domains: physical, psychologic, sexual, and social. Themes identified included lack of knowledge about postpartum health, emotional lability, sexual satisfaction, depression, parenting skills, body image, fatigue, and incontinence. Lack of knowledge about typical postpartum health was the dominant theme for mothers and clinicians. Mothers felt unprepared for the health consequences of pregnancy and delivery. Clinicians lamented that paucity of data made counseling and treating patients difficult. Decreased functioning months after delivery was reported. Differences between mother and clinician concerns surfaced, particularly in emphasis. Mothers wanted more information about their health; providers emphasized newborn care. Mothers reported inspiration to improve their economic circumstances; clinicians emphasized improving maternal health. Mothers wanted control during labor, whereas clinicians believed control was not always possible.ConclusionWomen often felt poorly prepared for the postpartum period in part because functional health consequences are not well understood. This study suggests maternal functional health may be decreased for months after delivery, even among uncomplicated patients. This study identified new maternal outcome measures, which are being incorporated into an outcomes questionnaire.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID