摘要:

The major concern with the use of unopposed estrogen is its neoplastic effect on the endometrium. Progestins used to oppose the estrogen may be associated with vaginal bleeding and reversal of estrogen's protective changes in serum lipoprotein concentrations. A study was performed in which all postmenopausal women received conjugated equine estrogen for days 1–28; with group I receiving 2.5 mg medroxyprogesterone acetate for days 1–28, group II receiving 5 mg medroxyprogesterone acetate for days 1–28, and group III receiving 5 mg medroxyprogesterone acetate for days 17–28. Pre- and postdrug evaluations of the endometrium revealed atrophic changes after therapy with continuous combined estrogen-progestin. Pre- and poststudy evaluation of serum lipoprotein concentrations demonstrated significant declines in cholesterol and low-density lipoprotein cholesterol within groups I and III, and no change in group II. All patients kept a weekly diary recording any vaginal bleeding or change in vasomotor symptoms. The results suggest that a continuous regimen of 0.625 mg conjugated equine estrogen with 2.5 mg medroxyprogesterone acetate is beneficial as a primary hormonal replacement therapy for the postmenopausal patient.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Forty-four patients with ectopic pregnancies were followed with serial serum progesterone determinations for up to 40 days after surgery. Seven patients (16%) failed to show luteal function during the study. Thirty-seven (84%) demonstrated luteal activity (serum progesterone at least 3 ng/mL): in six patients by days 17–19, in 50% by day 24, and in 72% by day 30. Because hormonal contraception delayed until the first postoperative office visit would miss the onset of folliculogenesis in approximately three-quarters of ectopic pregnancies, contraception should be begun immediately after surgery.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A highly circadian incidence of premature rupture of the fetal membranes was found in the Collaborative Perinatal Project data base. Among term deliveries without membranitis, the peak incidence of premature rupture of the membranes occurred at 3:00 AM, and the amplitude of a fitted sinusoid was 45%. Rupture hour was markedly influenced by latent interval and by membranitis. In the absence of membranitis, in term cases with a latent interval of less than three hours, rupture hour peaked at 2:00 AM, with an amplitude of 64%. Those with a latent interval of three to 35 hours peaked at 4:15 AM, with an amplitude of 37%. Those with 36 or more hours' latent interval showed little circadian variation. Preterm premature rupture of the membranes was also segregated into subgroups by latent interval. Preterm premature rupture of the membranes with a three- to 35-hour latent interval peaked at 4:00 AM, with an amplitude of 31%, similar to the corresponding term group. A circadian factor thus appears to cause most cases of premature rupture of the membranes in term and preterm births when membranitis is absent. The observed stratification by latent interval indicates that the mechanisms of premature rupture of the membranes may differ between the subgroups. With membranitis, the early-morning peak in premature rupture of the membranes was not statistically demonstrable in any of the term or preterm latent interval subgroups. This indicates that there may be unique rupture mechanisms associated with membranitis. The data in this study should assist efforts to classify premature rupture of the membranes and study its mechanisms.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The recent reaffirmation of the National Collaborative Study and similarly designed studies that reject the efficacy of corticosteroid administration to patients with preterm premature rupture of the membranes prompted us to reevaluate patients screened for inclusion in our recently reported series. Fetal maturity studies performed upon 135 consecutive singleton pregnancies of 26–35 weeks' gestation produced values consistent with fetal immaturity in only 6% (eight of 135) cases. The percentage that was immature did not change substantially when gestational age was restricted to those less than 34 weeks' gestation (11%; eight of 73). This information, from an institution whose patients were members of the original collaboration, suggests that the design of that study (which did not require maturity studies in gestations less than 34 weeks) and other studies with similar or less restrictive enrollment criteria may have permitted the inclusion of a significant number of fetuses in whom pulmonary maturity was already present, thus reducing the likelihood that differences in outcome could be demonstrated between groups.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

To define the relationship between amniotic fluid concentrations of β-endorphin immunoreactivity and onset of parturition, we measured this opioid in samples obtained during cesarean section at term. A total of 27 women were studied, 14 without labor and 13 in early labor. Mean (± SE) amniotic fluid β-endorphin levels were significantly lower in patients in labor than in those not in labor (3.2 ± 0.05 versus 8.4 ± 1.0 fmol/mL). The mean β-endorphin level (21.1 ± 4.2 fmol/mL) in other amniotic fluid samples obtained during the second trimester of pregnancy was significantly higher than mean values at term. These differences in amniotic fluid β-endorphin levels may support the theory of an opioid mechanism involved in parturition.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Blood infusion through standard 20− and 22-gauge spinal needles, with varying hematocrit and rates of 1–6 mL/minute, did not result in significant amounts of erythrocyte hemolysis.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

High-risk pregnancies require specialized obstetric and anesthetic care. A basic understanding of how specific pathophysiology and pharmacologic therapy interact with anesthetic care is essential for both obstetrician and anesthesiologist. This paper selectively focuses on preeclampsia/eclampsia, diabetes mellitus, prematurity, multiple gestations, infectious disease, preexisting neurologic disease, and preexisting cardiac disease, reviewing anesthesia for labor and vaginal and cesarean delivery for each high-risk problem, as practiced at a Level III perinatal unit. Emphasis will be placed, when appropriate, on recent experience with monitoring and aggressive pharmacologic therapy of the critically ill parturient.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

In this study, the concepts of decision theory have been applied to a clinical obstetric controversy—the management of the selected mature breech presentation. We have reviewed in detail the literature published since 1974 and estimated the probabilities of various outcomes after different treatment strategies. We conclude that a policy of selected vaginal delivery will result in four perinatal deaths for every 1000 patients delivered. A similar probability of neurologic handicap, at least until discharge from hospital, can also be attributed to this method of delivery. These unfavorable outcomes were reported less frequently in more recent reports covering the years since 1974. In these cases, the probability of fetal death due to a trial of vaginal delivery is approximately two in 1000. Cesarean section rates have risen, however, and 18–40% of trials of labor for breech presentation now result in “emergency” cesarean section. Decision analysis has demonstrated that a policy of elective cesarean section for all cases would not necessarily increase maternal mortality and morbidity. Thus the greater dangers of emergency compared with nonelective surgery may abolish the advantages of attempting a vaginal delivery. Depending on the relative dangers of elective and emergency cesarean section, planned delivery becomes the safer option when 16–30% of trials of vaginal breech delivery are unsuccessful. The strength and limitations of this probabilistic approach to the breech presentation are discussed in detail.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID