摘要:

ObjectiveTo assess the effects of pregnancy on cyclosporine levels in six renal allograft patients.MethodsMaternal demographic, laboratory, clinical, and perinatal outcome data were recorded in six pregnant women with previous renal allograft receiving cyclosporine immunosuppression. The cyclosporine and serum creatinine levels wee measured before pregnancy, during each trimester, and postpartum.ResultsThe mean (standard deviation [SD] maternal age was 29.1 (3.8) years. Parity from 0 to 3. Mean serum creatinine levels tended to be lower during pregnancy than before or after, as did the mean cyclosporine levels. After adjusting for dose, five of six patients had declines in cyclosporine level during pregnancy. The mean (SD) gestational age at delivery was 37.5 (2.8) weeks with a mean (SD) birth weight of 2837 (538) g.ConclusionPregnancy in patients with renal allografts can lead to a substantial decline in cycloporine levels.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine he role of homicide and other injuries in maternal deaths in North Carolina over the three-year period from 1992 through 1994.MethodsMaternal deaths were identified from death certificates that indicated a maternal death and through an enhanced surveillance system that matches death certificates with live-birth and fetal-death certificates. Deaths were classified as direct, indirect, medically unrelated, or injuryrelated. Patterns of prenatal care were ascertained from the matching live-birth or fetal-death certificates. Maternal death rates for whites and nonwhites wee calculated.ResultsThe most common cause of maternal death was injury, accounting for 62 of the 167 deaths (37%). Homicide was the most common cause of injury-related death (35.5%). The relative risk of maternal death for nonwhites compared with whites was 1.8 (95% confidence interval [CI]1.6, 2.1]. Similarly, their relative risk for injury-related maternal death was 1.7 (95% CI 1.4, 2.2).ConclusionIt is essential to include an analysis of injuryrelated deaths in maternal mortality reporting. As the most common cause of maternal deaths, injury is not limited to densely populated, metropolitan areas. Counseling regarding injury prevention, domestic violence, and depression should be a part of both prenatal and postpartum care.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine he anatomy of the internal and external anal sphincters in the area of midline obstetric lacerations, to gain insight into sphincter damage and repair.MethodsThe length, craniocaudal extent, and overlap of the internal and external and sphincters in the perineal body were measured in 17 cadavers. Further anatomic observations were made in four sets of whole pelvis crosssections taken in he sagittal, coronal, and transverse planes. During the repair of 20 acute fourth-degree lacerations, observations were made to determine the internal sphincter visibility following birth.ResultsThe external and internal anal sphincters overlap by 17.0 mm (standard deviation [SD]6.9), with the internal sphincter lying between the external sphincter and the anal canal. The internal sphincter extends an additional 12.2 mm (SD 5.9) cranial to the proximal extent of the external sphincter, whereas the caudal margin of the internal sphincter lies 3.7 mm (SD 7.2) cranial to the distal margin of the external sphincter. In pregnant women who sustained a fourth-degree laceration, we found that the internal sphincter can be identified as a rubbery white layer adjacent to the anal submucosa lying between the external sphincter and the anal canal.ConclusionThe internal anal sphincter lies between the anal mucosa and the external anal sphincter and extends more than a centimeter above the cranial margin of the external sphincter, a region where it is disrupted when a fourth-degree obstetric laceration has occurred.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo establish mechanisms of intercellular communication in human myometrium other than action potential propagation.MethodsMonolayer Cultured human myometrium was used as model system. The Calcium-sensitive fluorescent dye, calcium green-1 was used as probe for the concentration of intracellular free calcium. Intercellular calcium waves were initiated by mechanical stimulation and observed with video spectrofluorimetry. This technique allowed initiation of calcium waves from a known location at a known time while simultaneously controlling the flow rate of the bathing solution across the surface of the cells. Intercellular calcium waves were observed at bath flow rates between 0 and 5.1 mL/minute through a 0.4 mL chamber. Experiments were performed using low calcium, high potassium bathing solutions to eliminate the possibility of action potential signaling.ResultsIn still bathing solution, calcium waves radiated symmetrically from the site of initiation. With the bathing solution flowing, two mechanism of intercellular calcium wave propagation were observed--one dependent on and one independent of the direction of bath flow. The Calcium waves that were independent of bath flow used an intracellular mechanism for intercellular communication, were only observed within 100 μm of the site of wave initiation, and demonstrated mean (± standard deviation [SD]) wave speeds of 14.1 ± 2.6 μm/second. The waves dependent on bath flow used an extracellular signaling mechanism, were observed at distances much greater than 100 μm, and exhibited downstream biasing Mean (±SD) wave speeds of flow-dependent calcium waves faster under flow conditions than still bath conditions(36.0 ± 4.7 versus 6.2 ± 1.3 μm/second:P< .001). By exposing the cells to flurbirprofen, a water soluble prostaglandin synthetase inhibitor, both types of calcium waves were inhibited.ConclusionHuman myocytes demonstrate paracrine and intracelluar signaling mechanisms for intercellular communication that are distinctly different from action potential propagation.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo test the hypothesis that an elevated amniotic fluid glycine-valine ratio predicts neonatal morbidity in growth-restricted newborns.MethodsAmniotic fluid (AF) was collected from 122 third-trimester pregnancies (range 31–39 weeks), 49 of which were complicated by fetal growth restriction. Amino acid analysis was performed by high-pressure liquid chromatography. Glycine-valine ratios were compared between normal and growth-restricted fetuses. Neonatal morbidity within the group of growth-restricted fetuses was characterized by evaluation of neonatal hypoglycemia, arterial cord blood gas analysis, and birth weight percentile. We also examined the correlation of AF glycine-valine ratio to the umbilical artery resistance index. The median interval between AF sampling and delivery was 1 day (range 0–8 days). Analyses were performed by StudentttestX2with Yates correction, or simple correlation when appropriate.P< .05 was considered significant.ResultsGrowth-restricted fetuses have a significantly elevated AF glycine-valine ratio compared with control subjects (3.31 ± 1.06 versus 2.61 ± 0.77, respectively,P< .001). There was no association of the glycine-valine ratio with gestational age for either group. An elevated glycinevaline ratio was not associated with neonatal hypoglycemia within the growth-restricted group (hypoglycemia: [n= 16] 3.19 ± 1.07; no hypoglycemia; (n= 30) 3.44 ± 1.09). There were no significant correlations of glycine-valine ratio with arterial cord blood pH (r= −0.10), oxygen pressure (r= 0.04), or base deficit (r= 0.12). There were no significant correlations of glycine-valine ration and birth weight percentile (r= −.24) or umbilical artery resistance index (r= −.14).ConclusionAmniotic fluid glycine-valine ratio is elevated in growth restricted compared with control fetuses. However, he level of glycine-valine elevation is not associated with neonatal morbidity related to hypoglycemia, arterial cord blood gas abormalities, or birth weight percentile.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine if a false-positive trisomy 18 multiple-marker screening test (all three analytes low: maternal serum alpha-fetoprotein [AFP] at most 0.75 multiples of the median [MoM], unconjugated estriol at most 0.60 MoM, and hCG at most 0.55 MoM) indicates increased risk for obstetric complications or is related to maternal weight.MethodsWe accessed our genetic database to obtain multiple-marker screening test results, fetal karyotypes, and pregnancy outcomes from all patients wit a normal multiple-marker screening test (n= 3900) and from all patients with a positive trisomy 18 screening test (n= 103) seen in the prenatal diagnosis clinic from 1992 to 1996. During this period, only maternal serum AFP was adjusted for maternal weight.ResultsA positive trisomy 18 screen identified five of 12 trisomy 18 fetuses. Women with a false-positive trisomy 18 screen were heavier (175.6 ± 43.8 Ib versus 159.9 ± 37.9 Ib,P< .001) and younger (29.7 ± 6.5 years versus 32.3 ± 6.5 years,P< .001) than women with a normal multiple-marker screening test, but were not at increased risk for pregnancy complication. Weight-adjusting all three analytes reduced the false-positive trisomy 18 screen rate by 42% (from 1.9% to 1.1%) but did not change the trisomy 18 detection rate.ConclusionA false-positive trisomy 18 screening test does not indicate increased risk to develop pregnancy complications and may be related to inadequate correction for increased maternal weight.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine the possible association between increased fetal nuchal translucency thickness at 10–14 weeks and congenital diaphragmatic hernia.MethodsThis was a multicenter ultrasound screening study for chromosomal defects in singleton pregnancies by a combination of maternal age and fetal nuchal translucency at 10–14 weeks' gestation. The prevalence of diaphragmatic hernia diagnosed prenatally or postnatally was calculated in the chromosomally normal group and in those pregnancies resulting in live births with no dysmorphic features suggestive of a chromosomal abnormality. We calculated the sensitivity of nuchal transluency above the 95th centile of the normal range in the detection of diaphragmatic hernia and the possible prognostic value of increased nuchal translucency in the prediction of outcome.ResultsThere were 78,639 pregnancies presumed to be normal chromosomally, including 19 with diaphragmatic hernia. In four cases, the parents opted for termination of the pregnancy. The other 15 pregnancies resulted in live births; nine infants survived after successful surgical repair of the hernia, but neonates died because of pulmonary hypoplasia. At the 10- to 14-week scan, the fetal nuchal translucency was above the 95th centile for crown-rump length in seven (37%) cases of diaphragmatic hernia. The translucency was increased in five of the six cases that resulted in neonatal death, compared with two of the nine survivors (z = 2.32,P< .05).ConclusionThe prevalence of diaphragmatic hernia in chromosomally normal fetuses is about one in 4000, and nearly 40% of affected fetuses have increased nuchal translucency at 10–14 weeks' gestation. Increased nuchal translucency may be a marker of intrathoracic compression-related pulmonary hypoplasia.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo test the hypothesis that after vibroacoustic stimulation the ratio between cerebral vascular and umbilical vascular resistance in the growth-restricted fetus is different from that in the normal fetus.MethodsThe pulsatility index (PI) of the middle cerebral artery and that of the umbilical artery (UA) were measured by pulsed Doppler velocimetry in 30 normal and 14 growthrestricted fetuses before and after vibronacoustic fetuses before and after vibroacoustic stimulation. The ratios of cerebral PI TO UA PI and the changes in PI after vibroacoustic stimulation were calculated. Comparisons were made using the Wilcoxon rank-sum test or signed-rank test. The statistical power of the study was 80%.ResultsMean (± standard deviation) cerebral PI values before vibroacoustic stimulation (1.50 ± 0.29 in normals and 1.29 ± 0.26 in the fetal growth restriction [FGR] group) and US PI values (1.00 ± 0.18 in normals and 1.15 ± 0.24 in the FGR group) were significantly different between groups (P< .04) and significantly decreased after vibroacoustic stimulation (P< .05). Although the cerebral to UA PI ratios (1.50 ± 0.38 in normals and 1.13 ± 0.33 in the FGR group) were significantly different between groups (P< .008), the values remained the same after vibroacoustic stimulation (P= .39 and 80, respectively). In all fetuses the fetal heart rate accelerated after vibroacoustic stimulation.ConclusionCerebral vascular resistance was lower and umbilical vascular resistance higher in the growth-restricted fetuses than in normals. The Vascular response after vibroacoustic stimulation in the growth-restricted fetus was not significantly different from the response of the normal fetus, suggesting preservation of regulation of resistance.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the role of cerebral velocimetry as a predictor of Perinatal outcome in high-risk pregnancies.MethodsMiddle cerebral artery pulsatility index was measured in 576 high-risk pregnancies undergoing umbilical velocimetry. The results of both tests were evaluated with respect to the birth of small for gestational age (SGA) infants and adverse perinatal outcome, defined as perinatal death, cesarean delivery for fetal distress, or low Apger score.ResultsOnce umbilical velocimetry was taken into account, cerebral velocimetry did not improve the prediction of fetal growth restriction or adverse perinatal outcome. Neither test was able to predict adverse perinatal outcome in normally grown fetuses. As for SGA fetuses with adverse perinatal outcome, the simultaneous assessment of both umbilical and cerebral velocimetry did not improve diagnostic accuracy (kappa index 0.37 versus 0.41 for umbilical velocimetry only). However, within the group of high-risk pregnancies with abnormal umbilical velocimetry, the risk of being SGA and having an adverse perinatal outcome was doubled (relative risk 2.1, 95% confidence interval 1.1, 4.3) if cerebral velocimetry also was abnormal.ConclusionThe routine use of cerebral velocimetry in high-risk pregnancies adds little information beyond that obtained from umbilical velocimetry; however, it is useful in predicting SGA infants with adverse perinatal outcome when umbilical velocimetry is abnormal.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo measure fetal pericardial fluid in low-risk second-trimester pregnancies and to evaluate outcome for those with measurements greater than 2 mm.MethodsFive hundred and six women were referred for sonography between 16 and 25 weeks' gestation for common obstetric indications (dating, fetal survey, and placental location) unrelated to an increased risk of anomalies. All cases were evaluated with two-dimensional and M-mode real-time ultrasonography with the use of a mechanical sector transducer. The maximum distance of the fetal hyposechoic cardiac rim was recorded. We reviewed maternal and infant charts for those with measurements greater than 2 mm.ResultsMedian (range) maternal age was 25 (15–42) years. Median gravidity and parity were two (1–4) and one (0–11), respectively. Median estimated gestational age was 20.4 (16.324.9) weeks. Fetal pericardial fluid was seen in 360 of 506 (71%) fetuses. Of these 360 fetuses, the mean distance (± 2 standard deviation) of the fetal hypoechoic cardiac rim was 1.20 mm ± 0.91 mm (95% confidence interval 1.15, 1.25). Among the 506 cases, the maximum measurement was 3 mm. Ten of the 506 (2%) cases had measurements greater than 2 mm. None of these ten fetuses had a cardiac structural abnormality or arrhythmia, and perinatal outcome was unremarkable.ConclusionDuring second-trimester fetal ultrasonographic examination, visualization of pericardial fluid up to 2mm in the fetus with current high-resolution technology is common and should not be regarded as pathologic.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID