摘要:

ObjectiveDoppler waveform analysis of the umbilical artery is an important tool for the evaluation of high-risk pregnancies. Yet, available data are based on normal values from three-vessel umbilical cords. Our purpose was to evaluate the value of umbilical artery Doppler velocimetry in fetuses with a single umbilical artery.MethodsOne hundred thirteen consecutive singleton fetuses with a single umbilical artery between 16 and 40 weeks' gestational age were studied prospectively at a tertiary referral center for prenatal diagnosis and therapy. Complete follow-up was obtained from 103 cases.ResultsThe systolic-diastolic ratio in the umbilical artery was abnormal in 31 fetuses (30%) and normal in 72 fetuses (70%). Fetuses with abnormal Doppler waveform analysis in the umbilical artery were significantly more likely to be growth restricted (55 compared with 15%), to have complex malformations (58 compared with 1%) or an abnormal karyo-type (29 compared with 0%), or not to survive the fetal/perinatal period (42 compared with 0%) than those with normal Doppler waveform analysis.ConclusionFetuses with a single umbilical artery and abnormal umbilical Doppler velocimetry had a significantly increased risk of adverse fetal and neonatal outcome compared with those with a single umbilical artery but normal Doppler studies.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether uterine artery atherosclerosis is associated with known cardiovascular risk factors in women undergoing hysterectomy.MethodsSeventy-four women undergoing hysterectomy between September 1995 and March 1996 were evaluated. Following hysterectomy, samples of the uterine artery were collected for histologic evaluation. Plaque complexity and histologic measurements were compared with regard to known cardiovascular risk factors.ResultsAmong the 59 premenopausal women, 55.9% had intimal thickening, 40.7% had simple plaques, and 3.7% had complex lesions in the uterine artery samples. Among post-menopausal women, 40% had intimal fibrosis, 20% had simple plaques, and 40% had complex lesions. Postmenopausal status was correlated strongly with the presence of advanced atherosclerotic disease (P< .001). Postmenopausal women had significantly greater intimal area (P= .01), intimal area/medial area (P= .002), intimal area/vessel area (P= .002), maximal intimal thickness/medial thickness (P= .01), and significantly less medial thickness (P< .001). A significant linear correlation existed between age and the intimal/medial ratio among premenopausal women (P= .04) and postmenopausal women (P= .01). Patients with electrocardiogram (ECG) abnormalities had significantly greater intimal/medial area as well (P= .02). Hypertension was associated with complex lesions among the postmenopausal patients (P= .01). Preoperative cholesterol levels greater than 200 mg/dL were associated with greater intimal thickness (P= .05) and intimal thickness/medial thickness (P= .03).ConclusionThe severity of uterine artery atherosclerosis is significantly correlated with known risk factors for cardiovascular disease: increasing age, postmenopausal status, ECG abnormalities, and hypertension. Uterine artery histologic analysis may provide a means of assessing the degree of atherosclerosis in other, critical, vascular beds.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo measure the vibratory response of the fetal head and abdominal wall in sheep during vibroacoustic stimulation.MethodsA piezoresistive accelerometer was attached to the skulls of seven sheep fetuses (128-134 days' gestational age), and a miniature hydrophone was attached to the skin overlying the fetal temporal bone. During fetal preparation and vibroacoustic stimulation procedures, ewes were anesthetized and supine. Vibroacoustic stimulation of the maternal abdomen was produced by each of two clinical devices that differed in spectral content, and an electric toothbrush.ResultsThe approximate fundamental frequencies (f0) and first overtones (f1), as determined by both recordings of intrauterine sound pressure level and fetal head acceleration, were as follows: fetal acoustic stimulator, 75 and 150 Hz; electronic larynx, 150 and 300 Hz; and electric toothbrush, 25 and 50 Hz, respectively. At fundamental frequencies and first overtones, the ranges of fetal head accelerations (expressed in 1/12-octave bands) were as follows: fetal acoustic stimulator, 10-53 and 25-224 mm/sec2; electronic larynx, 10-53 and 18-114 mm/sec2; and electric toothbrush, 33-792 and 8-116 mm/sec2, respectively. Sound pressure levels exceeded 110 dB in all cases. High sound pressure levels in the uterus were proportional to fetal head vibration levels.ConclusionVibroacoustic stimulation of the surface of the abdomen of pregnant sheep is accompanied by both acoustic and vibratory exposure of the fetus.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess whether women who experienced physical violence by their partner during the 12 months before delivery were more likely to delay entry into prenatal care than were women who had not experienced physical violence.MethodsWe analyzed data from the Pregnancy Risk Assessment Monitoring System. The sample included 27,836 women who delivered live infants during 1993-1994 in nine states and were surveyed 2-6 months after delivery. We calculated risk ratios and 95% confidence intervals (CIs) to measure the association between physical violence within the 12 months before delivery and entry into prenatal care.ResultsThe prevalence of delayed entry into prenatal care (entering after the first trimester) was 18.1% and that of reported physical violence was 4.7%. Overall, women who experienced physical violence were 1.8 times more likely (95% CI 1.5, 2.1) to have delayed entry into prenatal care than women who had not experienced such violence. When stratifying by selected maternal characteristics, this association was found only for groups of women who were 25 years of age or older or were of higher socioeconomic status.ConclusionOlder women and women of higher socioeconomic status who reported physical violence were more likely to delay entry into prenatal care than younger or less.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compute ratios of severe pregnancy complications (the number of hospitalizations for pregnancy complications per 100 deliveries) and to examine factors associated with their prevalence.MethodsUsing population-based California hospital discharge data to estimate hospitalization ratios of pregnancy complications during 1987--1992, we defined cases by preselected pregnancy complication codes from the InternationalClassification of Diseases, Ninth Revision, Clinical Modification, excluding induced abortions and delivery-associated complications. All hospital deliveries of liveborn or stillborn infants were included in our denominator. We examined ratios by age, race-ethnicity, payment source, total hospitalization charges, and length of hospital stay.ResultsThere were 833,264 hospitalizations for pregnancy complications in California (25 complications per 100 deliveries), which included admissions for preterm labor (33%), genitourinary infection (16%), and pregnancy-induced hypertension (15%). Age-specific ratios were highest for women 14 years old and younger (38 per 100 deliveries) and lowest for women 25--29 years old (23 per 100 deliveries). Ratios of complications varied by race-ethnicity; black women had the highest (42 per 100 deliveries), and Asian-Pacific Islander women had the lowest (21 per 100 deliveries). Ratios were unaffected by payment source. In 1987, Medicaid charges were $118 million for 33% of the number of total hospitalizations for complications. In 1992, such Medicaid hospitalizations accounted for $356 million (49%) of the $734 million in total charges and for 183,295 (45%) of the 409,000 total hospital days.ConclusionOur results showed disparities in ratios of severe complications of pregnancy by age and race-ethnicity as well as a shift of financial burden to Medicaid. These findings suggest that such complications may be reduced by identifying risk factors and targeting high-risk groups.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare the efficacy of nifedipine with ritodrine in the management of preterm labor.MethodsOne hundred eighty-five singleton pregnancies with preterm labor were assigned randomly to either ritodrine intravenously (n= 90) or nifedipine orally (n= 95). The principal outcome assessed was delay of delivery.ResultsRitodrine was discontinued in 12 patients because of severe maternal side effects, and their results were excluded from further analysis. More women in the ritodrine group delivered within 24 hours (22 versus 11,P= .006), within 48 hours (29 versus 21,P= .03), within 1 week (45 versus 36,P= .009), and within 2 weeks (52 versus 43,P= .005) compared with those receiving nifedipine. There were significantly fewer maternal side effects in the nifedipine group. Apgar scores and umbilical artery and vein pHs were similar in both groups. The number of admissions to the neonatal intensive care unit (NICU) in the nifedipine group was significantly lower than in the ritodrine group (68.4 versus 82.1%,P= .04).ConclusionNifedipine in comparison with ritodrine in the management of preterm labor is significantly associated with a longer postponement of delivery, fewer maternal side effects, and fewer admissions to the NICU.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the efficacy, safety, and duration of induced labor using an integrative approach (prostaglandin, amniotomy, oxytocin) and to depict these findings graphically.MethodsFive hundred ninety-seven pregnancies requiring induction of labor between October 1993 and May 1995 were analyzed prospectively. Patients were categorized by Bishop score at entry and by parity for comparison of success of induction, maternal and fetal complications, and duration of labor.ResultsThe women who had a Bishop score at entry of 3 or less had significantly higher rates of failed induction (9.4 versus 0.7%,P< .01) and of cesarean delivery (29 versus 15.4%,P< .01) than those with a Bishop score above 3. Compared with spontaneous labor, the rates of cesarean delivery in induced labor remained significantly elevated. Complications of induction were infrequent, regardless of Bishop score. The time from initiation of induction to achievement of active phase was significantly longer in women with lower Bishop scores.ConclusionRegardless of cervical status and parity, vaginal delivery can be anticipated in the majority of patients undergoing labor induction. The induction characteristics described may assist in the management of induced labor.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine if streptococcicidal levels of penicillin G benzathine can be detected in maternal serum 4 weeks after treatment with 4.8 million units.MethodsThirty-seven pregnant women with positive group B streptococcus vaginal or urine cultures were each given 4.8 million units of penicillin G benzathine. Maternal blood samples were collected after injection and at delivery. Serum penicillin levels were measured by high-pressure liquid chromatography. Follow-up cultures were done when possible.ResultsNone of the patients had serum penicillin levels below 0.20 μg/mL 30 days after treatment. Cord blood levels were approximately 50% lower than maternal levels. In all but three subjects, cord blood levels exceeded 0.06 μg/mL, the minimal inhibitory concentration for group B streptococcus. The three exceptions were patients who delivered more than 100 days after treatment. Group B streptococcus cultures were negative at the time of delivery in 72% of cases. None of the patients with positive cultures were moderately or heavily colonized.ConclusionIn pregnant women, penicillin G benzathine levels are high enough to inhibit the growth of group B streptococcus for more than 4 weeks after injection with 4.8 million units. Further studies are needed to evaluate whether this regimen can prevent neonatal colonization and invasive group B streptococcus disease.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the levels of free estrone (E1) and estradiol (E2) in breast adipocytes of premenopausal women, premenopausal women using oral contraceptives (OCs), postmenopausal women, and postmenopausal women using estrogen replacement therapy (ERT).MethodsBreast adipose tissue was obtained from 36 premenopausal and 29 postmenopausal women, and adipocytes were separated from stromal and epithelial cells through collagenase digestion and centrifugation. Oil was rendered from adipocytes, and E1 and E2 levels were measured by specific radioimmunoassays after extraction with methanol-water.ResultsEstrone and E2 levels were approximately 2.4- and 7.8-fold higher, respectively, in premenopausal women than in postmenopausal women. In premenopausal women, E1 and E2 correlated with the time since last menses (R2= .55 and .62, respectively), whereas in postmenopausal women, E1 and E2 correlated with body mass index (BMI) (r= .48 and .52, respectively). Estrone levels were always greater than E2 levels in adipocytes, with the E1/E2 ratio being 2.7-fold higher in postmenopausal women than in premenopausal women. The use of OCs decreased E1 and E2 levels in premenopausal women, and ERT increased levels in postmenopausal women.ConclusionFree estrogen in breast adipocytes is characterized by E1 dominance, with levels in premenopausal women correlating with the menstrual cycle and levels in postmenopausal women correlating with BMI.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the efficacy of performing Pomeroy tubal ligation using microlaparoscopic techniques.MethodsThirty-eight consecutive women desiring permanent sterilization underwent laparoscopic Pomeroy tubal ligation using small (2 or 5 mm) transumbilical laparoscopes and secondary midline sites (5 mm and 14 gauge). The procedures were performed under general anesthesia (n= 28) or local anesthesia with conscious sedation (n= 10).ResultsThe mean operative time ± standard deviation (SD) in minutes was 33.0 ± 10.3. The mean recovery time ± SD in minutes was 104.3 ± 41.6. There were no operative complications, and no cases required conversion from the microlaparoscopic technique to a traditional method.ConclusionThe results of this study indicate that the Pomeroy tubal ligation may be performed using microlaparoscopic techniques. Furthermore, in selected cases, this technique can be performed under local anesthesia in an outpatient setting.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID