摘要:

The present study was performed to investigate whether determination of serum relaxin concentrations would allow assessment of the gestation further than that provided by determination of hCG. Serum relaxin concentrations were quantified in women with resorbing ectopic gestations (as documented by declining titers of β-hCG). The control group consisted of individuals with intrauterine pregnancies. As an additional control, we studied pregnancies conceived through ovulation induction, which usually have an increased volume of relaxin-secreting luteal tissue. On days 39-70 of gestation, the mean serum relaxin concentrations were significantly lower in ten resorbing ectopic gestations (P<.001, permutation test) than in the normal control group of 13 intrauterine pregnancies. The median serum relaxin concentrations in patients who had ovulation induction with Pergonal were substantially higher than the median for all normal controls; values in clomiphene citratetreated patients were within the normal range. These data suggest that relaxin secretion correlates with luteal function in both normal and abnormal gestations and reflects the status of the pregnancy. Thus, relaxin may serve as a useful clinical marker.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

We evaluated levels of corticotropin-releasing factor in the plasma and amniotic fluid of women who had spontaneous vaginal delivery or elective cesarean. Corticotropin-releasing factor binding sites were also studied in placental tissue collected from vaginal or cesarean birth. Plasma samples were collected hourly from seven women from the onset of labor until delivery, and from ten women before and during elective cesarean. Amniotic fluid samples were collected from 40 women at different stages of labor and from ten women during elective cesarean. Maternal plasma corticotropin- releasing factor levels increased during labor, showing the highest values at delivery. No significant differences in amniotic fluid immunoreactive corticotropinreleasing factor levels were observed at the different stages of cervical dilatation. At cesarean, maternal plasma levels did not differ significantly from those found before surgery, and in the amniotic fluid they were similar to those found in pregnancy. The number of125I-corticotropin-releasing factor binding sites in placental tissue was higher after vaginal than after cesarean delivery. These results suggest that corticotropin-releasing factor secretion is activated by the stress of labor.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Ninety pregnancies conceived by infertile couples using assisted reproductive technologies and 86 pregnancies conceived by infertile couples with routine infertility treatment were analyzed to determine the outcome of and the complications experienced during the pregnancies. Pregnancies ending after 24 weeks' gestation were evaluated for the following complications: pregnancy-induced hypertension, diabetes mellitus, preterm labor, premature rupture of membranes, placenta previa, and fetal growth retardation. A matched control group of normal fertile patients admitted to the obstetric service at Vanderbilt University Medical Center was used to compare the incidence of pregnancy complications among the groups. In the group treated by assisted reproduction, 81 pregnancies were singleton and nine were multiple gestations, whereas in the routine group, 84 were singleton and two were multiple gestations. In the group treated by assisted reproduction, 29 of 90 gestations (32%) ended before 24 weeks, compared with 18 of 86 (21%) in the routine group, a nonsignificant difference. Mean birth weight and gestational age were similar among the three groups for singleton gestations. Among multiple gestations, the mean (± standard error of the mean [SEM]) birth weights were 2513 ± 115, 724 ± 57, and 2282 ± 132 g in the group treated by assisted reproduction, the group receiving routine methods, and the control group, respectively (P<.001 when those treated by routine methods were compared with the other two groups). The mean (± SEM) gestational ages were 36 ± 1.2, 26.5 ± 2.0, and 35.5 ± 1.2 weeks, respectively (P<.01 comparing those treated by routine methods and the other two groups). There were no differences in pregnancy complications for singleton gestations among the three groups. Forty-two of 55 (76%) of those treated by assisted reproduction and 43 of 66 (65%) in the routine group had no complications during the last half of pregnancy. There were no differences in the frequency of late pregnancy complications among the three groups for patients with multiple gestations, although the infants delivered by the patients treated by routine methods were smaller and delivered at an earlier gestational age than those conceived by assisted reproduction or those of controls (P<.01). We conclude that multiple gestations in infertile patients are at high risk for spontaneous abortion and preterm delivery and should be followed closely, whereas singleton gestations appear to have no higher risk for complications than do those of normal fertile controls.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Failure to respond to human menopausal gonadotropin (hMG) with adequate ovarian stimulation is associated with a poor prognosis in subsequent cycles in women participating in an in vitro fertilization/embryo transfer program. Sera from 26 menstruating women (mean age 38 ± 4.3 years) identified as “low responders” with either tubal or male factor infertility, mean baseline FSH values of 11 mlU/mL, and peak serum estradiol levels lower than 300 pg/mL were assessed for specific antibodies to human ovary and gonadotropins. Twenty-five infertile women with tubal or male factor infertility with a good response to hMG served as controls. Ninety-two percent of low responders had antibodies to FSH and 65% had antibodies to LH when assessed by enzyme-linked immunosorbent assay. Similarly, 77% of low responders had ovarian antibodies. No hepatic antibodies were found in the sera of low responders, indicating that the positivity was not a general interaction with cell components. None of the “good responders” had antibodies to gonadotropins or to ovarian or liver tissue. The significant differences in antibodies between the groups supports a possible immunologic cause for low ovarian stimulation response to gonadotropin

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Bacteria can be isolated from most seminal fluid samples, but the significance of these microorganisms is uncertain because most men lack symptoms associated with bacterial infection of the reproductive tract. We obtained semen samples from 37 men attending a Special Infertility Clinic and assessed the relationship between seminal fluid microorganisms and seminal fluid analysis including sperm motility, morphology, and concentration; the numbers of polymorphonuclear leukocytes and other white blood cells; and the hamster zona-free oocyte sperm penetration assay. Aerobic and/or anaerobic bacteria were recovered from 36 of the 37 samples. One hundred eighty-eight isolates (113 aerobes, 74 anaerobes, and one yeast) were recovered, with a mean of 5.2 isolates per semen specimen. The microorganisms recovered from the samples included: coagulase-negative staphylococci (89%), viridans streptococci (65%), diphtheroids (86%), Peptostreptococcus sp (62%), Bacteroides sp (27%), Gardnerella vaginalis (19%), Lactobacillus sp (16%), Actinomyces sp (16%), Enterococcus (11%), and Veillonella (11%). Other microorganisms including group B streptococcus, Hemophilus, Escherichia coli, Mobihincus, and Clostridium were each recovered from fewer than 10% of the specimens. When the microbiology of seminal fluid specimens with or without polymorphonuclear leukocytes was compared, the presence of polymorphonuclear leukocytes in the semen was not associated with the isolation of staphylococci (33 versus 25%), viridans streptococci (33 versus 28%), Bacteroides sp (17 versus 37%), or Peptostreptococcus (31 versus 33%) (P>.05 for each comparison). The proportion of semen samples yielding bacterial isolates was similar after categorization by normal motility (more than 60%), pyospermia (six or more leukocytes per 100 sperm), sperm concentration, morphology, and a normal sperm penetration assay (11% or more). Likewise, the median numbers of isolates per specimen were similar for each group. These observations suggest that bacteriospermia is not associated with either pyospermia or abnormal sperm function and probably represents bacterial colonization rather than active infection.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Seventy cases of ureteropelvic junction obstruction, bilateral or unilateral, were followed prospectively throughout gestation and postnatally for an average of 2.3 years. Cases of ureteropelvic Junction obstruction with a renal pelvis dilated less than 1 cm uniformly did well; those with a pyelectasis more than 2 cm, both bilateral and unilateral, had a favorable outcome in approximately three-quarters. Surprisingly, pelvis dilatation between 1-2 cm had a better outcome if bilateral than if unilateral.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

To study the possible effects of epidural anesthesia on the Doppler velocimetry of the fetal umbilical and maternal uterine arteries, 15 normal term parturients were examined during active labor. Each Doppler study, conducted over 90 minutes after a 500-mL intravenous volume pre-load, was divided into three phases: 30 minutes of pre-anesthetic control, 30 minutes during epidural catheter placement and dosing, and 30 minutes after establishing effective regional blockade. During each phase, maternal blood pressure and pulse were monitored every 5 minutes, and continuouswave Doppler recordings of the umbilical and uterine arteries were made at three separate intervals. Epidural placement and dosage techniques were similar for all patients; 0.25% bupivacaine solution was used and sensory levels of T6obtained. The mean maternal systolic and diastolic blood pressures and pulse rate declined significantly, but no woman experienced hypotension. Mean systolic/diastolic ratios and pulsatility indices of the umbilical and uterine arteries did not change significantly during the study. We conclude that effective epidural anesthesia does not have a significant impact on Doppler flow characteristics of either the maternal or fetal umbilical vasculature, despite lowered maternal blood pressure and pulse rate.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Twenty patients with triplet pregnancies underwent continuous- wave Doppler ultrasound umbilical artery waveform studies as part of a multiple-pregnancy surveillance program. One or more infants was small for gestational age in nine of these triplet pregnancies. In all of these cases, at least one abnormal umbilical artery velocity waveform was present. Two infants were stillborn, and both had a grossly abnormal umbilical artery waveform (absent diastolic flow) recorded consistently for several weeks before fetal death. The use of umbilical artery Doppler studies may delineate those triplet pregnancies in which more intensive fetal surveillance is appropriate.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The present study was conducted to determine whether triplet pregnancies are associated with a significantly worse perinatal outcome than twin pregnancies. Maternal and neonatal outcome was evaluated in 15 triplet and twin pregnancies that were matched for maternal age, race, type of medical insurance, delivery mode, parity, and history of previous preterm delivery. Preterm labor occurred significantly more often in triplet than in twin gestations (80 versus 40%), as did preterm delivery (87 versus 26.7%). Triplets had a significantly lower mean birth weight (1720 versus 2475 g) and gestational age at delivery (33 versus 36.6 weeks). In addition, 53.3% of triplet pregnancies but only 6.7% of twin pregnancies had one or more neonates with intrauterine growth retardation. Discordancy also occurred more frequently in triplets than in twins (66.7 versus 13.3%). The mean averaged neonatal hospital stay was significantly higher in triplets (29 versus 8.5 days), and triplets had a fivefold increased risk of requiring neonatal intensive care as compared with twins. However, there were no significant differences between the groups in maternal morbidity or major neonatal complications such as respiratory distress syndrome or intraventricular hemorrhage. We believe that these data will be useful in counseling patients with respect to the anticipated perinatal outcome of triplet pregnancies.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

To determine whether vaginally born breech infants are at increased risk for morbid events as compared with breech infants delivered by cesarean, we studied 1240 singleton breech infants without congenital anomalies delivered in Northern California Kaiser Permanente Medical Care Program hospitals during 1976-1977. Medical record review provided information on indications for method of delivery, delivery complications and injuries, neonatal complications, and neurologic sequelae up to 4 years of age. The relative risk estimates for asphyxia (1.0; 95% confidence interval 0.7, 1.4), head trauma (1.6; 95% confidence interval 0.2, 17.0), neonatal seizures (0.8; 95% confidence interval 0.1, 7.1), cerebral palsy (1.6; 95% confidence interval 0.2, 17.4), and developmental delay (2.0; 95% confidence interval 0.9, 4.4) for vaginally born compared with cesareandelivered infants indicated that vaginally born infants were not at increased risk for these outcomes. We used multiple logistic regression to control for confounding variables. The adjusted relative risk estimate for the combined-outcome category of head trauma, neonatal seizures, cerebral palsy, mental retardation, or spasticity was 0.5 in vaginally delivered infants (95% confidence interval 0.1, 3.2). When all morbid outcomes were considered in combination, the adjusted relative risk estimate was 0.9 for vaginally delivered infants (95% confidence interval 0.6, 1.4).

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID