摘要:

ObjectiveWe evaluated the need for vigorous resuscitation (bag-and-mask ventilation, tracheal intubation, kand cardiopulmonary resuscitation) in certain common cesarrean deliveries at term to evaluate the need for pediatrician attendance on behalf of the fetus.MethodsRecords of singleton cesarean deliveries (repeat, nonprogressive labor, fetal malposition, fetal heart rate abnormality) at term over 2 years were reviewed for the following: need for vigorous resuscitation, Apgar scores, anesthesia used, and the need for newborn intensive care. The next consecutive, uncomplicated singleton vaginal delivery in each case was used to create a control group. Exclusion criteria included the presence of maternal disease (diabetes, pregnancy-induced hypertension, placenta previa) or suspicion of fetal abnormalities (growth restriction, congenital defect, known meconium staining of the amniotic fluid). There were 834 cesarean deliveries and 834 controls (low-risk vaginal deliveries).ResultsCompared with vaginal deliveries, Apgar scores of 6 or less at 1 minute were more frequent in all cesarean deliveries except for the repeat cesarean category. The incidence of needing vigorous resuscitation was as follows: vaginal 1.7%, repeat 3.0%, nonprogressive labor 4.8%, fetal malposition 11.2%, and fetal heart rate abnormality 17.7%. The use of regional anesthesia reduced the need for vigorous resuscitation in cesarean deliveries for the repeat group and the group with nonprogressive labor without fetal heart rate abnormalities to a level similar to that in uncomplicated vaginal deliveries (2.1%, repeat, 1.6% nonprogressive labor without fetal heart rate abnormality).ConclusionsBoth repeat cesarean deliveries and cesareans done for nonprogressive labor without signs of fetal heart rate abnormality, when performed under regional anesthesia, may not need a pediatrician in attendance because of minimal fetal risk.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo quantify the roles of suspected sociodemographic, anthropometric, behavioral, and pathologic determinants in the etiology of abruptio placentae.MethodsWe performed a hospital-based cohort study of 36,875 nonreferred births January 1978 and March 1989. Gestational age was based on menstrual dates confirmed (within 7 days) by early ultrasound.ResultsParity, maternal education, pre-pregancy weight, and the rate of net gestational weight gain did not have significant independent associations with abruption. Significant determinants included the following: severe small for gestational-age (SGA) birth (odds ratio [OR] 3.99; 95% confidence interval [CI] 2.75, 5.77), chorioamnionitis (OR 2.50; 95% CI 1.58, 3.98), prolonged rupture of membranes (OR 2.38; 95% CI 1.55, 3.65), preeclampsia (OR 2.05; 95% CI 1.39, 3.04), pregnancy-induced hypertension without albuminuria (OR 1.57; 95% CI 1.00, 2.46), pre-pregnancy hypertension (OR 1.77; 95% CI 1.05, 2.99), maternal age at least 35 years (OR 1.50; 95% CI 1.14, 2.01), unmarried status (OR 1.50; 95% CI 1.13, 1.98), cigarette smoking (OR 1.40; 95% CI 1.00, 1.97 for ten to 19 cigatettes per day and OR 1.13; 95% CI 0.81, 1.59 for at least 20 cigarettes per day), and male fetal gender (OR 1.38; 95% CI 1.12, 1.70). Removal of SGA from the regression model resulted in little change in the magnitude of the other associations.ConclusionsSevere fetal growth restriction, prolonged rupture of membranes, chorioamnionitis, hypertension (before pregnancy and pregnancy-induced), cigarette smoking, advanced maternal age, unmarried status, and male fetal gender are significant etiologic determinants of placental abruption. Non-SGA determinants appear to operate largely independently of their effects on fetal growth.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether there is a difference between the types of cardiac lesions detected as abnormal prenatally and those that are not detected.MethodsConsecutive fetuses at 14 weeks' gestation or more were scanned in our unit from February 1990 through July 1995 and later were delivered at our hospital. Outcome information was obtained from neonatal echocardiograms and autopsies. Our results were compared to sensitivities for individual cardiac lesions based on pooled data from studies published previously.ResultsThere were 111 fetures with cardiac anomalies, of which 73(66%) were identified correctly as abnormal prenatally. Senitivities for the most common cardiac lesions were as follows: 87% atrioventricular septal (endocardial cushion) defects, 65% tetralogy of Fallot, 63% transposition of the great arteries, 50% aortic coaractation, and 445 isolated ventricular septal defects. The lesions that went undetected most frequently were isolated septal defects (n= 17); most of these were ventricular and small or moderate in size. Based on our sensitivities and those calculated from previous studies, the fetal cardiac lesions with the highest detection rates involve hypoplastic ventricles and atrioventricular septal defects, followed by lesions of the great arteries and finally by isolated septal defects.ConclusionsThe sensitivity of sonographic screening to detect fetal cardiac anomalies varies with the type of lesion. Isolated septal defects are the most difficult lesions to detect.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the clinical significance of in utero detection of fetal cerebral lateral ventricular asymmetry.MethodsWe used hig resolution ultrasonography to study asymmetries of the fetal lateral ventricles in the human brain. A retrospective survey was conducted on 7200 pregnant women who presented at two large district hospitals in Israel. Only fetuses with a difference of greater than 2.4 mm (two standard deviaitions) in the width of the lateral ventricles, with no known brain pathology, were included in the study. Index cases were evaluated regarding maternal complication, prenatal ultrasound examinations, postnatal imaging studies, and neonatal out come up to 6 months of age.ResultsLateral ventricular asymmetry was found in 21 subjects, all with available clinical data. In 15 fetuses (71%), the body or the occipital horn of the left lateral ventricles was larger than the right, whereas in six fetuses (29%), the right was larger than the left. In four cases (20%), serial scans noted resolution of asymmetry; in 15 (75%), it was persistent; and in one (5%), asymmetry increased. In one case, termination of pregnancy was performed, however, pathologic examination of the fetal brain failed to detect any structural abnormality. Underlying cerebral pathology was later found only in three fetuses (14%); one had subclinical cytomegalovirus ventriculitis, one had insidious periventricular hemorrhage, and in one fetus with increased asymmetry, trisomy 21 was verified. All the remaining 17 cases had normal neurologic development.ConclusionsSome degree of asymmetry of the lateral ventricles exists in the human fetal brain and is detectable in utero. Lateral ventricular asymmetry alone is probably not clinically significant, and it may be considered as a normal variant, rather than a pathologic finding.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the changes in the vessel-wall thickness and the radius of the lumen in tertiary-stem villi of the placenta with advancing gestational duration and their relationship to umbilical artery Doppler studies.MethodsPlacentas from 63 miscarriages and preterm and term deliveries (between 19 and 40 weeks) were used for morphometric study of the tertiary-stem villi vessels. Each women had undergone Doppler flow study of the umbilical arter. The resistance index (RI) was determined from the Doppler flow velocity waveform. Placental paraffin sections of 4-μ thickness were stained with hematoxylin and eosin and with periodic acid-Schiff reagents. The tertiary-stem villi and their vessels were examined microscopically and assessed morphometrically using a personal computer with math co-processor and a touch-sensitive screen overylying a video monitor. The monitor received microscopic images from a video camera that was mounted on a microscope. We determined vessel-wall thickness by tracing the outer and inner circumferences of digitized vessel-wall images.ResultsWall thickness, but no lumen size, of the tertiarystem villi vessels decreased significantly overall at a rate of 0.63μ/week (P< .001). The rate of decrease was 0.64μ/week (P< .001) during the second trimester and 0.50μ/week (P< .001) during the third trimester. There was a significant correlation between the decrease in thickness and in RI (r= .083) [P< .001],r= 0.78 [P< .001] in the second and third trimesters, respectively). Resistance indices were all within normal limits.ConclusionPlacental tertiary-stem villi vessel-wall thickness decreases with advancing gestational age. There is a correlation between the changes in RI of the umbilical artery Doppler flow and the changes in mean wall thickness of the placental vessels.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether blood levels of atrial natriuretic peptide in small for gestational age (SGA) fetuses are related to Doppler indices measured in arterial and venous vessels.MethodsAtrial natriuretic peptide was assayed in fetal blood obtained at funipuncture in 42 third-trimester fetuses, of whom 11 were appropriate for gestational age (AGA) and 31 were SGA. Small for gestational age fetuses were divided into three groups according to Doppler findings in the umbilical artery and inferior vena cava: 1) normal in both vessels (n= 10); 2) abnormal in the umbilical artery but normal in the inferior vena cava (n= 10); and 3) abnormal in both vessels (n= 11). Atrial natriuretic peptide levels were related to Doppler indices and acid-base status of the fetal blood.ResultsSmall for gestational age fetuses with abnormal waveforms in both vessels had higher atrial natriuretic peptide blood levels (median 544.8 pg/mL, range 404.2–1112.3) compared with AGA fetuses (median 316.8 pg/mL, range 129.3–470.1;P≤ .001), SGA fetuses with normal waveforms only in both vessels (median 299.8 pg/mL, range 242.6–480.5;P≤ .001) and SGA fetuses with abnormal waveforms only in the umbilical artery (median 367.6 pg/mL, range 1925.7–748.9;P= .002). Blood levels of atrial natriuretic peptide were significantly related to the preload index in the inferior vena cava (ρ = 0.554.P< .001). This relation remained significant when the analysis was restricted to the SGA fetuses with abnormal waveforms in the umbilical artery and the inferior vena cava (ρ = 0.673,P= .03).ConclusionsSmall for gestational age fetuses with abnormal velocity waveforms in the inferior vena cava have significantly higher concentrations of atrial natriuretic peptide. This may represent a compensatory mechanism in the SGA fetus for regulation of an abnormal hemodynamic condition.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the maternal age at which twin gestations have a risk of fetal aneuploidy comparable to that of singleton pregnancies at maternal age 35, accounting for variation in dizygotic twinning rates by maternal age and race.MethodsKnown aneuploidy risks and rates of dizygotic twinning by maternal age and race were used to calculate the risk of fetal aneuploidy at term and in the second trimester by maternal age and race in twin gestations, using previously published calculations.ResultsThe risk of at least one aneuploid twin at term is 1/193 at maternal age 31 for both white and African-American women, which is comparable to the risk of 1/192 for an aneuploid singleton term pregnancy at amniocentesis at maternal age 31 is 1/190 for white and 1/187 for African-American women, which slightly lower than the rate in sinletons of 1/135.ConclusionInvasive prenatal diagnosis for detection of fetal aneuploidy should be offered to all women with twin gestations at age 31, regardless of race.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare resistance index (RI) and pulsatility index (PI) in the spiral and intervillous arteries, and peak systolic velocity of the continuous intervillous flow in normal and abnormal first-trimester pregnancy.MethodsTransvaginal color and pulsed Doppler were used in a prospective analysis of 60 normal (controls) and 54 abnormal (30 missed abortions and 24 anembryonic) pregnancies (6–12 weeks' gestation). Repeated-measures analysis of variance was used for comparison between groups.ResultsA gradual decrease in spiral artery RI and PI was found in women with anembryonic pregnancies. No difference in spiral artery impedance was noted in women with normal pregnancies, but there was a progressive increase in spiral artery RI and PI in women with missed abortion. A significant increase in continuous intervillous blood flow velocity was noted from the 11th week onward in the normal pregnancy group (8.0 ± 0.9 versus 12.2 ± 1.4 cm/second). Intervillous arterial blood flow signals did not demonstrate any difference in RI and PI with advancing gestational duration. Significantly lower PI values were obtained from the intervillous arteriesw in women with anembryonic pregnancy (PI 0.54 ± 0.04) than in controls (PI 0.80 ± 0.04) and those with missed abortions (PI 0.75 ± 0.04). However, there was no statistically significant difference in the intervillous RI between subgroups.ConclusionThe new generation of sensitive Doppler units can detect intervillous flow as a continuous progressive process during the first trimester of normal and abnormal pregnancy. There is a significant difference in intervillous artery vascular impedance between normal and anembryonic pregnancies.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the influence of maternal diabetes on the risk of group B streptococcus colonization during pregnancy.MethodsWe prospectively analyzed data on 105 pregnant women with diabetes mellitus, both pregestational and gestational, and a control group of 300 pregnant women without carbohydrate intolerance. All had singleton gestations, negative tests for human immunodeficiency virus, and intact membranes at enrollment. Culture specimens for group B streptococcus were obtained from the lower vaginal walls and rectum. Two-tailed unpaired Studentttest, Mann-WhitneyUtest, and χ2test were used as appropriate. Multiple logistic regression analyses were performed to evaluate the independent influence of maternal diabetes on the rate of group B streptococcus colonization.ResultsCompared to controls, diabetic women had a higher colonization rate (43.8 versus 22.7%, odds ratio [OR] 2.56, 95% confidence interval [CI] 1.6, 4.1). The prevalence of group B streptococcus colonization in pregestational diabetic women was 54.1% and in women with gestational diabetics it was 35.1% (P= .05). Among women with pregestational diabetes, the prevalence of group B streptococcus colonization was 59.1% in class B and 50.0% in class C to R (P= not significant). After we adjusted fir maternal age, race, and obesity, diabetic women continued to be at increased risk of group B streptococcus colonization (OR 3.1, 95% CI 1.8, 5.2).ConclusionCarbohydrate intolerance appears to be an independent risk factor for group B streptococcus colonization during pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine if the measurement of hCG levels in vaginal fluid is useful for the diagnosis of premature rupture of membranes (PROM).MethodsAfter irrigating the posterior vaginal fornix with 3 mL. of sterile and procuring vaginal washings, we measured hCG levels. Samples were analyzed from 188 normal pregnant women, 42, 61, and 85 during the first, second, and third trimesters, respectively. Levels of hCG were compared with those of 24 women with confirmed PROM.ResultsThe median and 95% confidence intervals (CIs) of vaginal fluid hCG levels of normal pregnant women were 37.9 (1.9, 725.6), 9.5 (0.8, 95.8), and 6.3 (0.6, 62.2) mIU/mL during the first, second, and third trimesters, respectively. That of women PROM was 420.6 (216.3, 918.3) mIU/mL. For the second trimester, sensitivity was 100%, specificity 91.8%, positive predictive value 82.8%, negative predictive value 100%, and accuracy 94.1%, and for the third trimester, sensitivity was 100%, specificity 96.5%, positive predictive value 88.9%, negative predictive value 100%, and accuracy 97.2%, using a threshold value of 50 mIU/mL.ConclusionThe hCG level in vaginal fluid is a useful marker of PROM during the second and third trimesters.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID