摘要:

Objective:To compare the measured volume of amniotic fluid (AF) in term gestations to the volume predicted sonographically.Methods:One hour before elective cesarean delivery, 40 women had sonographic measurement of the AF index and largest vertical pocket diameter. At surgery, a suction catheter was placed into a 1‐cm uterine incision and a second catheter was used to aspirate AF from the operative field. Hemoglobin concentration was measured in the collected AF to determine the extent of blood contamination.Results:The mean measured AF volume was 532 mL (range 40‐1692). The correlation cofficient between AF index and AF volume was 0.744 (P< .001). A similar value (r= 0.755,P< .001) was observed for the largest vertical pocket measured with ultrasound.Conclusion:Sonographic measurements of the largest vertical pocket and the AF index have similar positive correlations with measured AF volumes at term. Current methods of estimating AF volume have low sensitivity for detecting oligohydramnios.(Obstet Gynecol 1994;83: 955‐8)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine in pregnant women with preterm labor the relative efficacy of the amniotic fluid index (AFI) and the two‐diameter pocket to detect abnormalities in amniotic fluid volume (AFV), and to relate these findings to pregnancy outcome.Methods:Fifty‐seven healthy women with preterm labor underwent amniocentesis in the third trimester to detect subclinical chorioamnionitis and assess fetal lung maturity. The AFV was estimated by the AFI and two‐diameter‐pocket methods, then confirmed by a dye (aminohippurate sodium)‐dilution technique. Each labor was evaluated for severe variable decelerations requiring amnioinfusion, fetal distress resulting in cesarean delivery, and a 5‐minute Apgar score below 7.Results:Using fluid volume confirmed by dye dilution, the AFI correctly diagnosed AFV as low (less than 500 mL) in only two of 23 (8.7%) patients, compared to 14 of 23 (61%) for the two‐diameter pocket (P< .001). Fetal distress requiring cesarean delivery occurred significantly more often in the hydramnios group (three of six) compared to those with normal AFV (one of 23) (P< .03), and approached significance in the oligohydramnios group (two of 21) (P= .056). There were no significant differences among the three patient groups regarding the need for amnioinfusion for severe variable decelerations or the occurrence of 5‐minute Apgar scores below 7.Conclusions:Compared to the AFI, the two‐diameter pocket is a superior sonographic measurement for the detection of oligohydramnios. In an otherwise low‐risk pregnancy with preterm labor, oligohydramnios is associated with no greater risk for an adverse outcome than is a normal AFV.(Obstet Gynecol 1994;83:959‐62)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To evaluate the fetal heart rate (FHR) response to vibroacoustic stimulation of fetuses entering the second stage of labor as a predictor of neonatal outcome.Methods:Three hundred sixteen cases and 316 controls were studied during the second stage of labor. All cases had vibroacoustic stimulation on entering the second stage of labor using an electronic artificial larynx. For control patients, the artificial larynx was not activated. The patients were stratified into groups based on the quality of FHR response: acceleration (n= 124), acceleration followed by deceleration (n= 120), and no response (n= 72).Results:Subsequent FHR accelerations and accelerations followed by decelerations were significantly more frequent in the study group than in controls (77.2 versus 15.2%;P< .05). The frequencies of low 5‐minute Apgar scores (below 7) and low umbilical cord arterial pH (below 7.20) did not differ significantly in the group with the acceleration response when compared to those with acceleration followed by deceleration and the no‐response groups. The incidence of nuchal cord was significantly higher for the group with a response pattern of acceleration followed by deceleration than for the acceleration and no‐response groups (39.2 versus 10.5 versus 11.1%;P< .05).Conclusions:Vibroacoustic stimulation in the second stage of labor is associated with FHR reactivity, but the quality of FHR respons does not predict neonatal outcome and therefore appears to have little value in enhancing the management of the second stage of labor. However, an acceleration followed by deceleration response suggests the presence of nuchal cord.(Obstet Gynecol 1994;83:963‐6)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine the relation between magnesium sulfate therapy and fetal heart rate (FHR) variability.Methods:Twelve women diagnosed with preeclampsia who were to receive magnesium sulfate for seizure prophylaxis were recruited. Exclusion criteria included delivery anticipated within 2 hours, gestational age less than 28 weeks, abnormal fetal testing, fetal growth retardation, and use of illicit drugs or medications. Six grams of magnesium sulfate in 100 mL 0.9% saline was administered intravenously over 20 minutes, followed by a continuous infusion of 2 g/hour. A cardiotocogram analysis computer system was used to analyze various elements of the FHR pattern before, during, immediately after, and 60 minutes following magnesium sulfate loading. For each time interval, the basal heart rate, number of accelerations and decelerations, number of minutes of high and low variability, mean minute range variation, and the short‐term (3.75‐second interval) variability were measured.Results:There was a statistically significant decrease in short‐term variability 60 minutes after initiation of therapy (6.7 ± 2.0 versus 9.8 ± 3.3 milliseconds;P= .003). Long‐and medium‐term variability did not change significantly after magnesium sulfate was administered.Conclusion:Although magnesium sulfate therapy was associated with an objectively measured, statistically significant decrease in short‐term variability, the decrease was not clinically significant; furthermore, it was not associated with a decrease in long‐term variability or in the number of accelerations measured.(Obstet Gynecol 1994;83:967‐70)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objectives:To describe the use of fetal scalp blood sampling on a large teaching service over 7 years and to assess any association between changes in use and the rates of cesarean delivery for fetal distress and of various indirect indicators of perinatal asphyxia in term infants.Methods:We reviewed computerized and tabular data bases for fetal scalp blood sampling, cesarean delivery for fetal distress, Apgar score, and the clinical diagnoses of asphyxia and meconium aspiration syndrome for the years 1986‐1992.Results:Live births averaged 16,330 annually. The rate of fetal scalp blood sampling for the first 3 years of the study period was 1.76%, consistent with the rate of 1.5‐2.0% noted for the preceding decade at our institution. An increase in sampling in 1987 was followed by a steady decline over the next 4 years, to a low of 0.03% in 1992. During the period of declining scalp pH usage, there was no increase in the cesarean rate for fetal distress, low Apgar score (less than 5 at 5 minutes) requiring neonatal intensive care unit admission, or the clinical diagnosis of perinatal asphyxia or meconium aspiration syndrome.Conclusions:Fetal scalp blood sampling has been virtually eliminated without an increase in the cesarean rate for fetal distress or an increase in indicators of perinatal asphyxia. The role of fetal scalp blood sampling in clinical practice is questioned.(Obstet Gynecol 1994;83:971‐4)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To examine the changes in hematologic and coagulation indices in the surviving twin when the co‐twin dies because of the twin‐twin transfusion syndrome.Methods:Fetal blood was obtained by funipuncture in seven surviving twins upon the death of their co‐twins. Five of them were monochorionic. In one case at 32 weeks' gestation, two repeated funipunctures were done in both twins before and in the surviving twin after the death of the co‐twin. Fetal blood was examined for blood coagulation factors as well as complete blood counts.Results:Although coagulation factors were not abnormal, three of the five monochorionic surviving twins had cerebral abnormalities postnatally. The fetal blood profile revealed anemia in the surviving twin, especially in the cases in which funipunctures were performed within 24 hours after the co‐twin's death. This demonstrates that acute anemia in the surviving twin was induced by hemorrhage from the larger to the smaller twin at the time of death.Conclusion:Following the death of one twin, morbidity in the surviving twin can be produced by hypotensive ischemia of the brain due to hemorrhage through placental vascular anastomoses.(Obstet Gynecol 1994;83:975‐8)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To assess whether differences in verbal memory might be related to estrogen use in a group of healthy, well‐functioning, postmenopausal community‐residing women from a broad socioeconomic range.Methods:Healthy postmenopausal women drawn from the general population were given tests of verbal and spatial memory, language, attention, and general spatial skills. The performance of women taking estrogen was compared to that of women from the same population who were not taking any form of estrogen replacement therapy.Results:There were no differences between the estrogen users and non‐users on any sociodemographic variables. However, the scores of women taking estrogen were significantly higher on tests of immediate and delayed paragraph recall compared to the scores of non‐users. No differences were apparent on other tests of cognitive functioning, including tests of spatial memory.Conclusion:Estrogen appears to have a specific effect on verbal memory skills in healthy postmenopausal women. The clinical relevance of these findings for healthy older women remains to be determined.(Obstet Gynecol 1994;83:979‐83)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine whether women with genuine stress incontinence and low urethral closure pressure (20 cm H2O or lower) had more severely impaired pressure transmission to the urethra than women with stress incontinence and normal urethral pressures.Methods:Seventy‐six women who underwent multichannel urodynamic testing were included for comparative analysis. They were classified into the following groups: genuine stress incontinence with low urethral pressure (N= 20), genuine stress incontinence without low urethral pressure (N= 32), and continent controls (N= 24). Urodynamic indices and pressure transmission ratios were calculated from static and stress urethral pressure profiles, respectively. Multiple demographic cofactors, urethral mobility, and previous surgeries were correlated for associations with urodynamic results.Results:Women with stress incontinence and low urethral pressure were significantly older (57.6 years,P< .0071). There were no differences with regard to urethral mobility and previous surgeries. Mean maximum urethral closure pressure and the distance from the proximal margin of the urethra to the point of maximum urethral closure pressure were statistically less in women with low urethral pressure. There were no differences in pressure transmission ratios between any of the study groups.Conclusion:Because there are no differences in pressure transmission ratios between women with genuine stress incontinence with and without low urethral closure pressure, the higher risk for surgical failure with low urethral pressure appears to result from another pathophysiologic process.(Obstet Gynecol 1994;83:984‐8)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To compare the prevalences of demographic, historic, and behavioral risks for pelvic inflammatory disease among women with sexually transmitted disease (STD) pelvic inflammatory disease versus those with non‐STD pelvic inflammatory disease.Methods:Subjects included patients diagnosed with acute pelvic inflammatory disease at San Francisco General Hospital between January 1, 1981 and August 20, 1989, who had been entered into clinical treatment trials. At a minimum, endocervical cultures forNeisseria gonorrhoeaeandChlamydia trachomatiswere required for study eligibility. All but nine women also had upper reproductive tract cultures forN gonorrhoeae, C trachomatis,and anaerobic and facultative bacteria. Five hundred eighty‐nine patients were included in this analysis. The medical records of study subjects enrolled between January 1981 and October 1986 were abstracted (n= 321). Subjects recruited after October 1986 were interviewed during hospitalization using a standardized data base instrument (n= 268). Independent variables examined included age, race, insurance status, education, pregnancy history, menstrual history, contraceptive history, sexual history, douching history, STD history, and pelvic inflammatory disease history. Both univariate associations and multivariate (multiple logistic regression) analysis were performed.Results:An STD organism was present in 65% of pelvic inflammatory disease cases.Neisseria gonorrhoeaeandC trachomatiswere recovered from 324 (55%) and 129 (22%) of the patients, respectively. In 30% of cases only anaerobic and/or facultative bacteria were isolated. In univariate analysis of STD versus non‐STD pelvic inflammatory disease, statistically significant increases in STD risks were found for the following: black race (relative risk [RR] 1.76; 95% confidence interval [CI] 1.39‐2.24), two or more sexual partners in the past 30 days (RR 1.25; 95% CI 1.08‐1.45), no contraception (RR 1.36; 95% CI 1.18‐2.57),N gonorrhoeaewith previous episode of pelvic inflammatory disease (RR 1.97, 95% CI 1.39‐2.80), and reported duration of pain 3 days or less (RR 1.17; 95% CI 1.02‐1.35). Risks associated with non‐STD pelvic inflammatory disease included: current intrauterine device (IUD) use (RR 0.25; 95% CI 0.11‐0.61), history of IUD use (RR 0.82; 95% CI 0.68‐0.98), and pelvic surgery in the past 30 days (RR 0.48; 95% CI 0.30‐0.76). Multivariate analysis of the risks found that black race was associated with STD pelvic inflammatory disease (odds ratio 2.56; 95% CI 1.68‐3.90), and current IUD use was associated with non‐STD pelvic inflammatory disease (odds ratio 3.87; 95% CI 1.30‐11.53). Neither univariate nor multivariate analysis identified douching as a risk differentiating STD from non‐STD pelvic inflammatory disease.Conclusions:Pelvic inflammatory disease is a complex polymicrobial disease. This study demonstrates that risk factors associated with pelvic inflammatory disease cases can be differentiated by microbial etiology. We found that black race was associated with STD pelvic inflammatory disease and recent IUD use was associated with non‐STD pelvic inflammatory disease.(Obstet Gynecol 1994;83:989‐97)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To evaluate the efficacy and safety of ampicillin‐sulbactam (3 g every 6 hours) in patients with pelvic inflammatory disease or postpartum endometritis using a randomized, comparative, multicenter study of parallel design.Methods:Eligible patients with pelvic inflammatory disease were randomized to receive either ampicillin‐sulbactam or cefoxitin (2 g every 6 hours) plus doxycycline (100 mg every 12 hours). Those with endometritis were randomized to ampicillin‐sulbactam or clindamycin (900 mg every 8 hours) plus gentamicin (1.5 mg/kg every 8 hours). In the ampicillin‐sulbactam group, chlamydia‐positive patients also received oral doxycycline.Results:For pelvic inflammatory disease, the clinical response rates (cure or improvement) were 85.5% (47 of 55) and 89.6% (43 of 48) in the ampicillin‐sulbactam and cefoxitin and doxycycline groups, respectively (X2= 0.10,P= .76). For endometritis, the clinical response rates were 88.7% (141 of 159) and 90.8% (139 of 153) in the ampicillinsulbactam and clindamycin and gentamicin groups, respectively (X2= 0.15,P= .70). The percentages of patients with pelvic inflammatory disease who had adverse experiences were not significantly different in the cefoxitin and doxycycline group (47% [29 of 62]) than in those receiving ampicillin‐sulbactam (33% [22 of 66]) (P= .12). These adverse effects were mostly mild or moderate. In the endometritis subjects, the incidence of adverse experiences in the ampicillin‐sulbactam group (11% [20 of 179]) was comparable to that during treatment with clindamycin and gentamicin (12% [22 of 180]). These adverse experiences were also mostly mild to moderate.Conclusion:Ampicillin‐sulbactam is as effective and well tolerated as combination regimens using cefoxitin plus doxycycline and clindamycin plus gentamicin for the treatment of pelvic inflammatory disease or endometritis, respectively.(Obstet Gynecol 1994;83:998‐1004)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID