摘要:

The beta core fragment of hCG (βC-hCG) accounts for a large proportion of hCG immunoreactivity in the urine of pregnant women. It is often increased in the urine of patients with gynecologic tumors and may become an important diagnostic tool in early pregnancy and cancers. Despite the importance of βC-hCG, little is known about its stability in urine under conditions of differing pH and temperature. This study examined the effect of repeated freeze-thaw cycles; storage at room temperature, 4C, and –20C over several months; and the effect of alteration of urine pH. The two specific immunoassays for βC-hCG used do not significantly cross-react with intact hCG or the free α subunit. Despite different cross-reactivities of the antibodies to the free β subunit and higher immunoactivity when the radioimmunoassay was used, there was excellent correlation between the two assays in pregnancy urine. This suggests that there is little free β subunit in urine from pregnant women. In addition, this study evaluated the stability of intact hCG and β-hCG under identical conditions. No alterations in their irnmunoactivities were found under most conditions of storage. It is concluded that, for clinical purposes, βC-hCG as well as intact hCG and free β subunit are very stable molecules.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

One hundred thirty-six patients were enrolled in a randomized, double-blind, placebo-controlled trial of oral antibiotic therapy (amoxicillin) versus placebo following successful intravenous (IV) antibiotic therapy for postpartum endometritis. No subjects were readmitted to the hospital for recurrent endometritis and there were no wound infections or recurrent fevers. Minor side effects were seen in 10% of those taking amoxicillin and 14% of those taking placebo. Compliance was fair; only 52% of those taking amoxicillin and 65% of those taking placebo completed therapy. The lack of infectious complications in this high-risk population suggests that oral antibiotic therapy is unnecessary after successful IV antibiotic therapy for endometritis.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The sensitivity and specificity of maternal serum screening for Down syndrome with different biochemical markers were evaluated. Detection rates with different combinations of maternal serum alpha-fetoprotein (MSAFP), hCG, and unconjugated estriol (uE3) were established by retrieving and analyzing 54 serum specimens from women with confirmed Down syndrome pregnancies, compared with 657 specimens from women with normal outcomes. With a risk cutoff of 1:270 at the second trimester, the detection rate with MSAFP, hCG, and uE3 was two to three times higher than with MSAFP alone. With all three markers, the detection rate for Down syndrome increased from 50 to 77% as maternal age increased, and was 60% in a representative screened population. If uE3 was omitted, the detection rate decreased from 60 to 48%. One thousand women were screened prospectively, either with MSAFP or with all three markers. The false-positive rate was 4.6% with all three markers and 4.1% with MSAFP. With the three markers, the positive predictive value for Down syndrome was 2.2% overall and as high as 5.9% in older women. Therefore, the addition of hCG and uE3 to the maternal serum screen increases the positive predictive value by 50–300%, depending on maternal age. These results confirm the efficacy of screening for Down syndrome using maternal age and three serum markers.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A case-control study was performed to study risk factors for postpartum hemorrhage. Cases of hemorrhage were defined by a hematocrit decrease of 10 points or more between admission and post-delivery or by the need for red-cell transfusion. Patients with antenatal bleeding were excluded. Among 9598 vaginal deliveries, postpartum hemorrhage occurred in 374 cases (3.9%). Three controls were matched to each case and multiple logistic regression was used to control for covariance among predictor variables. Factors having a significant association with hemorrhage were prolonged third stage of labor (adjusted odds ratio 7.56), preeclampsia (odds ratio 5.02), mediolateral episiot-omy (4.67), previous postpartum hemorrhage (3.55), twins (3.31), arrest of descent (2.91), soft-tissue lacerations (2.05), augmented labor (1.66), forceps or vacuum delivery (1.66), Asian (1.73) or Hispanic (1.66) ethnicity, midline episiotomy (1.58), and nulliparity (1.45). These data may help predict postpartum hemorrhage and may be useful in counseling patients about the advisability of home delivery, intravenous access in labor, or autologous blood donation.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A case-control study was performed to study risk factors for hemorrhage in cesarean deliveries. Hemorrhage was defined by a pre- to post-delivery hematocrit decrease of 10 points or more or by the need for red-cell transfusion. Patients with antenatal bleeding were excluded. Among 3052 cesarean deliveries, hemorrhage occurred in 196 cases (6.4%). Three controls were matched to each case and multiple logistic regression was used to control for covariance among predictor variables. Factors having a significant association with hemorrhage were: general anesthesia (adjusted odds ratio 2.94), amnionitis (odds ratio 2.69), preeclampsia (2.18), protracted active phase of labor (2.40), second-stage arrest (1.90), and Hispanic ethnicity (1.82). After adjustment for these variables, a classic uterine incision had a small but significant association (odds ratio 1.06) with hemorrhage. Previous cesarean, parity, gestational age, and several other factors had no association with hemorrhage. These data allow one to anticipate hemorrhage in patients at risk and may be useful in planning appropriate use of blood bank resources, including antepartum autologous blood donation.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The isthmic segment of the uterine artery's ascending branch has a freer course and wider diameter than distal parts of the vessel. Therefore, we assumed that this arterial segment would provide better blood flow and prevent hypoxia of the trophoblast. As a result, placenta previa pregnancies would be complicated by hypertensive disorders less often than are pregnancies with normally implanted placentas. To test this hypothesis, 491 placenta previa pregnancies, among a population of 106,866 pregnant women, were compared with pregnancies with normally implanted placentas. Clinically meaningful and statistically significant reductions in the rates and risks of hypertensive disorders were found in placenta previa pregnancies (P= .002, relative risk = 0.44, 95% confidence interval 0.25–0.78). The differences persisted when primiparous and multiparous women were examined separately and when preterm and term deliveries were separated. In a multivariate logistic regression analysis, patients with placenta previa had a third of the risk for hypertensive disorders compared with pregnant women with normally implanted placentas (relative risk = 0.36, 95% confidence interval 0.20–0.64), even after controlling for parity and preterm or term delivery. In the same model, primiparity and preterm delivery were each associated with a doubling of risk for hypertensive disorders, regardless of the placental implantation site. Thus, regardless of parity and preterm or term delivery, placenta previa and hypertensive disorders are inversely related.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

There has been a notable improvement in the outcome of the pregnancies of insulin-dependent diabetics. This improvement has resulted from intensive health care programs and increased awareness among patients and health providers of the need for specialized prenatal care. We hypothesized that participation in a specialized program providing early gly-cemic control would benefit the patient's subsequent pregnancy, despite progression of the diabetic disease process. We prospectively studied 55 insulin-dependent diabetic patients enrolled before 9 weeks' gestation through two consecutive pregnancies: sequence 1 and sequence 2. A control group of 55 insulin-dependent diabetic patients, entering the program for the first time, were matched with the sequence 2 pregnancies of the study group by maternal age and year of pregnancy. Specific outcomes related to glycemic control in early gestation were significantly improved from sequence 1 to sequence 2 pregnancies: earlier week of entry (P = .0001), lower glycohemoglobin at 9 weeks (P = .005) and at 14 weeks (P = .02), and improved fetal outcome (decreased rate of spontaneous abortions or major malformations; P < .01). Week of entry and glycohemoglobin at 9 and 14 weeks were also significantly improved compared with the control group. Seventy-three percent of the patients entered the program earlier in their sequence 2 pregnancies (P = .001) and had lower glycohemoglobin concentrations at 9 weeks (P = .005) compared with their sequence 1 pregnancies. Sixty-five percent of the patients in sequence 2 had advanced diabetic disease (White class D-RF), compared with 46% in sequence 1 (P < .05) and 44% of the controls (P < .05). Thus, despite the ongoing pathologic diabetic process, specific outcomes related to glycemic control in early pregnancy were improved in sequence 2 pregnancies in our program. We conclude that patients gain valuable educational experience in a perinatal center specializing in diabetic pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

AlthoughHaemophilus influenzaeis recognized as a major pathogen of infants, its role in maternal and neonatal infections is not as well appreciated. We analyzed the records of all mothers and neonates infected withH influenzaeover a 10-year period. Twenty-eight mother/neonate sets were identified in which at least one had documented infection withH influenzae.Of the 18 mothers with documented infection, 13 had chorioamnionitis, endometritis, or both, and two of these mothers were bacteremic withH influenzae.Of the 23 infected neonates, 15 presented with early sepsis and/or pneumonia and nine had conjunctivitis. During the period of the study, only group B streptococci andEscherichia coliwere more common as causes of early neonatal bacteremia. Under the conditions of this retrospective study, maternal infection predicted neonatal infection. However, prospective studies in which asymptomatic patients are cultured will be required to determine how well maternal colonization/infection withH influenzaepredicts neonatal infection.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Two hundred fifty women in labor were screened for vaginal colonization by group B streptococcus using standard culture and two rapid tests. This primarily Hispanic population had a group B streptococcus vaginal colonization rate of 2.4% (95% confidence interval 0.9–5.2%) for the patients sampled. An enzyme immunoassay and a latex agglutination test for group B streptococcus antigen both had sensitivities of 33% and had specificities of 99 and 95%, respectively, when compared with culture. Neither rapid test appeared to be clinically useful for detecting colonized women in labor, although both can be useful in excluding colonization.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The changes in intracellular free calcium concentration [Ca2+]i) induced by oxytocin in single cells of cultured human puerperal myometrium were measured with the calcium-sensitive fluorescent dye fura 2 in a digital imaging fluorescence microscopic system. Oxytocin at concentrations of 30–300 nmo1/L induced a dose-dependent increase in [Ca2+]i with a peak at 20 seconds. This increase depended mainly on extracellular calcium ([Ca2+]ex) at concentrations of 0.6–4.8 mmo1/L. In the absence of [Ca2+]ex, the increase was only 167c of that in its presence. The voltage-sensitive calcium channel blockers nicardipine, nifedipine, and nitrendipine had similar effects, causing significant suppression of the increase in [Ca2+]i induced by oxytocin. Diltiazem also suppressed the increase in [Ca2+]i, though less than the other calcium channel blockers. These data indicate that the increase in [Ca2+]i induced by oxytocin is predominantly dependent upon [Ca2+]ex. Furthermore, the data explain why calcium channel blockers are effective for weakening uterine muscle contractions and indicate which type of blocker is most effective.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID