摘要:

Mycotic cultures of 33 couples, in which the women had a diagnosis of chronic recurrent vulvovaginitis, were prepared from the oral cavity, the rectum, the vagina, and the male ejaculate. Reservoirs of infection were found in the oral cavities of 36% of the couples, the rectum in 33%, and the ejaculate in 15%. Prostatic cultures of the male were negative in each case. In most instances, the same organism was present in the reservoir and in the vagina. Elimination of the mycotic organisms in each site and restriction of sexual contact with the reservoir of mycotic organisms effected cures in these previously recurrent vulvovaginitis patients.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Lamicel is a synthetic osmotic cervical dilator reported to work within two hours. To evaluate its efficacy and side effects, we conducted a double-blind, randomized clinical trial comparing Lamicel with multiple laminaria for cervical dilation in 219 patients before second-trimester abortion. A single Lamicel produced significantly less initial dilation (two-tailedPvalue = .03) than did multiple laminaria, but the techniques had comparable degrees of difficulty in subsequent dilation to 43 French units (two-tailedPvalue > .05) and rates of achieving dilation of 43 French units with rigid dilators (relative risk 1.0; 95% confidence interval 0.9–1.1). Lamicel removal resulted in a significantly lower rate of bleeding from the os (relative risk 0.3; 95% confidence interval 0.2–0.5). Because of its greater convenience, lower cost per patient, and comparable efficacy, Lamicel appears to be an attractive alternative to multiple laminaria for cervical dilation before abortion at 14–16 menstrual weeks' gestation.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

In this preliminary investigation, we sought evidence of increasing impedance to placental blood flow from both sides of the placenta and evidence of compromised fetal aortic blood flow in 35 human pregnancies exceeding 42 weeks' gestation. Fetal age was confirmed by biparietal diameter (BPD) measurements obtained before 21 weeks. Pourcelot's Index, calculated from Doppler sonograms recorded with a noninvasive technique from small arteries in the myometrium and from an umbilical cord artery, did not correlate with the duration of the pregnancy beyond term. However, this “resistance index” of Pourcelot was higher in the umbilical cord arteries of fetuses with a worse clinical outcome. Doppler blood cell velocity in the fetal descending aorta correlated significantly and negatively with the prolongation of gestation. Fetal aortic velocities appeared to be lower in fetuses who passed meconium before delivery. Our findings suggest that fetal compromise in prolonged pregnancy is more a fetal-placental problem than a uteroplacental problem.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A noninvasive pulsed Doppler ultrasound technique was used to characterize blood flow in the descending thoracic aorta and the intra-abdominal part of the umbilical vein in 159 fetuses suspected of intrauterine growth retardation (IUGR) on the basis of ultrasound fetometry. From this group, 74 infants with IUGR (defined as gestational age-related birth weight of 2 standard deviations [SD] or more below the population mean) were born. The blood flow results were not available to the clinicians managing the pregnancies. Blood flow mean velocity in the fetal aorta was lower, pulsatility index and rising slope higher, and umbilical volume flow and umbilical flow per 100 g placental tissue were lower in the pregnancies with IUGR than in 21 normal pregnancies. The waveform of the maximum aortic velocity envelope was related to operative delivery for fetal distress, Apgar score, and umbilical cord blood pH. The pulsatility index and the configurational assessment of the diastolic part of the waveform were combined to form a new concept, the blood flow class. The blood flow class was abnormal in 57% of the fetuses classified as having IUGR at birth and in 93% of those growth-retarded fetuses who subsequently developed signs of fetal distress requiring operative delivery. Waveform analysis, in terms of blood flow class, seems to be a useful tool in the surveillance of fetuses when IUGR is suspected. Abnormal blood flow class is a marker of fetal distress and probably gives an earlier indication than antenatal nonstressed cardiotocography. The results of this study point to a strong association between IUGR and impaired fetal blood flow. The aortic volume blood flow, unlike waveform analysis, does not seem to be a variable sensitive enough to predict fetal outcome in the individual pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The documented association between heavy meconium in early labor and increased perinatal morbidity and mortality has alerted physicians to the presence of a potential high-risk fetal condition and to the possible need for immediate fetal blood pH determination. The purpose of this study was to determine whether antepartum fetal assessment can predict whether a postterm fetus with heavy meconium in early labor is at low or high risk for an adverse perinatal outcome. Eight hundred thirty-nine postterm patients were followed with antepartum testing, consisting of twice-weekly fetal heart rate (FHR) testing and ultrasonic amniotic fluid volume estimation. Overall, patients with heavy meconium in early labor had a significantly greater frequency of fetal distress. However, when women with heavy meconium in early labor were separated according to their antepartum testing results, those with normal results were found to have no greater risk for fetal distress or perinatal morbidity than women with normal testing and subsequently clear amniotic fluid. These findings suggest that postterm patients with heavy meconium in early labor and normal antepartum testing can be managed in labor in the same manner as low-risk patients without meconium.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A prospective study of the diagnostic accuracy of ultrasound in the prediction of fetal microcephaly was performed on a study population of 24 patients. An occipitofrontal diameter larger than the predicted mean −2 standard deviations (SD), a head perimeter larger than the predicted mean −2 SD, and a head perimeter/abdominal perimeter larger than the predicted mean −1 SD were found to exclude fetal microcephaly. An occipitofrontal diameter smaller than the predicted mean −4 SD, a head perimeter smaller than the predicted mean −5 SD, a head perimeter/abdominal perimeter smaller than the predicted mean −3 SD, and a femur length/head perimeter larger than the predicted mean +3 SD were found to cause no errors in the diagnosis of microcephaly. If neither of these two groups of tests is satisfied, fetal microcephaly cannot be reliably diagnosed or excluded on the basis of a single ultrasound examination.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Ultrasonography is able to detect some fetal abnormalities as early as the first trimester of pregnancy. Using high-resolution ultrasound equipment, it is possible to demonstrate physiologic herniation of the midgut, which usually occurs between eight and nine weeks' gestation (calculated by last menstrual period). Fourteen cases have been studied with weekly ultrasound examinations between seven and 12 weeks' gestation. This herniation varied to a large extent in the different embryos depending on the amount of protruding intestine. In embryologic terms, the return of the intestine into the peritoneal cavity, and its rotation and fixation to the posterior abdominal wall, should be concluded at ten to 12 weeks. In all cases studied, the persistence of umbilical herniation could be ruled out by sonographic visualization of the umbilical cord insertion between ten and 12 weeks. Therefore, the suspicion of a severe congenital abdominal wall defect, such as omphalocele, umbilical herniation, or gastroschisis can reliably be confirmed only after 12 weeks' gestation.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

To study the effect of intrauterine growth retardation (IUGR) on fetal peripheral neuronal elements, we examined preputial skin tissues of ten growth-retarded neonates (mean gestational age 36 ± 2.3 weeks) and six normal control neonates (mean gestational age 35 ± 3.0 weeks) by transmission electron microscopy. The myelinated and unmyelinated nerve fibers of growth-retarded neonates contained significant ultrastructural alterations, consisting of 1) local aggregation of mitochondria, 2) loss of mitochondrial cristae, 3) the presence of large vacuoles within the axoplasm, and 4) myelinated fiber degeneration. The Schwann cells of these neonates exhibited accumulation of glycogen, disruption of cytoplasm, dilatation of rough endoplasmic reticulum, and extensive development of polyribosomes. None of the above changes were observed in the control infants, those appropriate for gestational age. We conclude that IUGR may cause significant ultrastructural changes in developing peripheral neuronal tissue.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The plasma androgen responses to multiple-dose insulin infusions were determined in six normal females, four normal males, five obese females, and in three females with severe insulin resistance, hirsutism, and acanthosis nigricans. During the insulin infusions, the plasma glucose concentrations were maintained at 85 ± 1 mg/dL by variable infusions of dextrose. Plasma androstenedione was augmented by 27–39% at physiologic insulin concentrations in the normal subjects and the obese group, and by 25% at hyperinsulinemic levels in the insulin-resistant group with acanthosis nigricans. The increased androstenedione concentrations achieved in the normal females and obese females were similar to the hyperandrogenemic levels seen in the acanthotic subjects in the basal state. Plasma cortisol also increased in all groups from 19% in normal females to 135% in obese females during the insulin infusions, but these changes did not reach statistical significance. These studies suggest that hyperinsulinemia may play a pathogenic role in the hyperandrogenemia of polycystic ovarian disease.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

It has been suggested that tubal ligation may cause luteal phase defects. To assess this possibility, we performed a retrospective analysis of the incidence of luteal phase defects in 72 women who had undergone tubal sterilization. In preparation for tubal reanastomosis, late luteal phase endometrial biopsy was performed. The biopsy was dated in a blind manner and designated either normal or out of phase. This group of patients was compared with a group of 32 women seen for artificial insemination with donor sperm. Luteal phase defect was defined as two biopsies out of phase by two or more days. There were no cases of luteal phase defect in either of the two groups; luteal phase defects were found in 4% of all infertility patients seen during the time of this study. These data do not support the contention that sterilization by tubal ligation leads to an increased incidence of luteal phase defect.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID