摘要:

ObjectiveTo measure the levels of digoxin-like immunoreactive substance and digitalis-like factor bioactivity as manifested by sodium-potassium-adenosine triphosphatase (ATPase) inhibition throughout pregnancy.MethodsSerum samples were collected from primigravidas in early (15 ± 1.8 weeks), mid (26 ± 1.2 weeks), and late (36 ± 1.1 weeks) gestation, as well as at 6 ± 1.1 weeks postpartum (mean ± standard error). Digoxin-like immunoreactive substance levels were determined by radioimmuno-assay and digitalis-like factor bioactivity was determined by inhibition of ATPase. Data were analyzed by means of repeated measures analysis of variance.ResultsIn 41 women with normal pregnancy outcomes, levels of digoxin-like immunoreactive substance rose progressively and significantly (P< .001) throughout pregnancy and returned to normal levels postpartum. Inhibition of ATPase activity also rose significantly (P< .004), but not as dramatically, during pregnancy and remained elevated 6 weeks postpartum.ConclusionAlthough digoxin-like immunoreactive substance levels rise in pregnancy, functional digitalis-like factor activity, as manifested by inhibition of ATPase, does not parallel this rise strictly, implying that digoxin-like immunoreactive substance receptors may be reset during normal pregnancy. The enhanced cardiac performance that occurs in normal pregnancy may be mediated in part by increased digitalis-like factor activity.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether increased concentrations of the N-terminal peptide of proatrial natriuretic peptide and of atrial natriuretic peptide are related to the severity of preeclampsia and gestational hypertension.MethodsBlood samples were collected from 70 healthy pregnant women, 48 women with preeclampsia, and 19 women with gestational hypertension in the third trimester. We used a specific radioimmunoassay (RIA) method suitable for the determination of the plasma N-terminal peptide of proatrial natriuretic peptide in unextracted plasma. The atrial natriuretic peptide was measured by RIA from Sep-Pak C18-extracted plasma.ResultsThe N-terminal peptide of proatrial natriuretic peptide levels were significantly higher in preeclamptic women than in healthy pregnant controls (median 571 [range 189–20001 versus 266 pmol/L [80-6341,P< .001) and also significantly higher in women with severe preeclampsia than in women with mild preeclampsia (766 [431-20001 versus 492 pmol/L [189–1283],P= .01). The N-terminal peptide of proatrial natriuretic peptide values were significantly elevated in the subgroup of hypertensive pregnancies with abnormal Doppler velocimetry. At entry into the study the values for the N-terminal peptide of proatrial natriuretic peptide were higher in the subgroup of women who developed severe preeclampsia and/or gave birth to a small for gestational age (SGA) infant compared to the values in the subgroup of women in whom the hypertensive condition remained stable (710 [271–1475] versus 407 pmol/L [189–1067],P= .006). Similar comparisons of atrial natriuretic peptide values did not reach significant differences.ConclusionThe levels of N-terminal peptide of proatrial natriuretic peptide were higher in women with preeclampsia than in those with gestational hypertension and higher in women with gestational hypertension than in those with normal pregnancies. A marked elevation in N-terminal peptide of proatrial natriuretic peptide may predict development of severe preeclampsia and/or an SGA infant.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the site of origin of increased concentrations of plasma endothelin-1 in patients with severe preeclampsia.MethodsTwelve patients with severe preeclampsia undergoing an indicated abdominal delivery had endothelin-1 levels measured from plasma specimens drawn from right and left uterine and antecubital veins before delivery and after placenta removal with uterine curettage. Twelve uncomplicated control patients undergoing abdominal delivery had endothelin-1 concentrations drawn by an identical protocol. Clinical staff members were blinded to endothelin-1 results and laboratory staff were blinded to patient group assignment and sample source. Endothelin-1 plasma concentrations were determined by radioimmunoassay and data were analyzed by pairedttest.ResultsNo difference in endothelin-1 concentration was noted with respect to placental location, central versus peripheral, or predelivery versus postdelivery sampling procedures. Overall, patients with preeclampsia had higher plasma concentrations of endothelin-1 (mean 11.0 ± 6.6 pg/mL) compared with normotensive patients (mean 8.4 ± 46.7 pg/mL,P< .005).ConclusionThe decidual-placental interface does not appear to be the source of increased plasma endothelin-1 concentrations found in severe preeclampsia. The origin of this increase remains uncertain.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether two techniques of vacuum extraction delivery—continuous vacuum and intermittent vacuum—have different effects on maternal-fetal outcomes.MethodsPatients to be delivered by vacuum extraction were randomized to receive continuous or intermittent vacuum. All deliveries were performed using the M-cup. In the continuous group, the level of vacuum was brought to 600 mmHg between contractions and was maintained at that level until delivery of the infant. Active efforts were made to prevent fetal loss-of-station between contractions by maintaining traction. In the intermittent group, the level of vacuum was decreased to 100 mmHg between contractions and no effort was made to prevent fetal loss-of-station.ResultsA total of 322 patients were randomized: 164 in the continuous arm and 158 in the intermittent group. The continuous method did not effect delivery faster (continuous 167 ± 175 seconds versus intermittent 167 ± 150 seconds;(P= .97), nor did it lead to a reduction in method failures (continuous 12, intermittent nine;(P= .72). The intermittent method did not appear to offer any benefit to the neonate regarding cephalhematoma formation (continuous 20, intermittent 17;(P= .686) or any other measure of neonatal outcome. Maternal lacerations and episiotomy extensions were evenly distributed between the groups. Overall, the efficacy rate of the vacuum cup was 93.5% and the cephalhematoma rate was 11.5%.ConclusionNo differences in maternal or fetal outcome could be demonstrated if the level of vacuum was decreased between contractions or if an effort was made to prevent fetal loss-of-station. The clinical results obtained in this trial using the M-cup are similar to the published results with the stainless-steel Malmstrom cup.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the validity of prenatal diagnosis work-up for congenital cytomegalovirus (CMV) in women with primary infection.MethodsSixty-three pregnant women with primary cytomegalovirus disease (including two with twin pregnancies), referred to three tertiary perinatal centers over 4 years, underwent evaluation for congenital cytomegalovirus. Fetal diagnosis was made after 21 weeks' gestation by amniocentesis and fetal blood sampling (40 subjects), or amniocentesis only (23 subjects).ResultsTwenty-two (35%) pregnancies showed evidence of vertical transmission: 13 of them underwent funipuncture, but only ten (77%) of the 13 showed positive immunoglobulin (Ig)-M results in fetal blood. No cases of positive fetal serum Ig-M with negative amniotic fluid culture or polymerase chain reaction were observed. In nine (41%) of the 22 pregnancies with evidence of vertical transmission, abnormal ultrasonographic findings were recorded. Six (27%) women with evidence of vertical transmission continued their pregnancies and in only one (with prenatal ultrasonographic abnormalities) was an infant born with neurologic sequelae. In 41 (65%) pregnancies, no evidence of vertical transmission was found, and 37 continued to term. Only one newborn from this subgroup subsequently showed mild motor disability during a median of 23 months of follow-up.ConclusionAmong pregnant patients with primary CMV infection, analysis of amniotic fluid detected all of the infected fetuses. Thus, this is a reliable tool for counseling pregnant women with primary infection. This may guide the patient as to whether or not pregnancy can be continued with a high level of confidence.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether misoprostol (a prostaglandin El analogue) 400 μg orally (group 1) or 800 μg vaginally (group 2) will cause complete uterine evacuation in women with early pregnancy failure.MethodsTwenty subjects were recruited for a prospective, non-blinded, randomized clinical trial. Early pregnancy failure was diagnosed by transvaginal ultrasound examination; only women with a closed cervical os and minimal vaginal bleeding were enrolled. Subjects returned 24 hours after misoprostol administration for a transvaginal ultrasound examination. If the gestational sac was still present, the misoprostol dose was repeated and the subject returned again 24 hours later. Subjects who failed to expel the pregnancy were offered a suction curettage.ResultsTwelve and eight women were randomized to groups 1 and 2, respectively. Complete uterine evacuation occurred in three of 12 [25%, 95% confidence interval (CI) 1%, 50%] and seven of eight (88%, 95% CI 65%, 100%,P= .010) subjects in groups 1 and 2, respectively. Vomiting occurred in 30% and 13%, respectively, and diarrhea in 50% and 38%, respectively.ConclusionVaginal misoprostol 800 μg is more effective than oral misoprostol 400 μg for uterine evacuation of early pregnancy failure and may be an effective alternative to dilation and curettage.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether serum inhibin A and inhibin B concentrations are lower in patients with luteal dysfunction than in women with normal luteal function.MethodsSerum samples were collected from seven healthy women with regular menstrual cycles. Serum samples on days +5 to +9 after the LH surge were collected from patients with luteal dysfunction. The diagnosis of luteal dysfunction was based on a luteal phase duration less than 11 days and a single midluteal progesterone level below 10 ng/mL. Serum levels of inhibin A, inhibin B, progesterone, estradiol (E2), FSH, and LH were measured.ResultsThe serum inhibin A levels were increased toward the late follicular phase. The levels reached a maximum during the midluteal phase, followed by a fall during the late luteal phase. The serum inhibin B levels were high during the follicular phases and the early luteal phase. The levels decreased during the midluteal and late luteal phases. Serum levels (mean ± standard error of the mean) of inhibin A in patients with luteal dysfunction were significantly lower than those in women during the midluteal phase (26.2 ± 2.9 compared to 41.9 ± 2.8 pg/mL;P< .01) in addition to the expected decrease in serum progesterone levels (6.3 ± 0.7 compared to 14.7 ± 1.2 ng/mL;P< .01). Serum inhibin B levels did not differ significantly between normal women and those with luteal dysfunction. There also were no significant differences in the E2, FSH, and LH levels.ConclusionLevels of inhibin A, but not of inhibin B, may reflect the human luteal function.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the usefulness of routine screening for other associated autoimmune endocrine disorders in patients with karyotypically normal spontaneous premature ovarian failure.MethodsOne hundred nineteen women with karyotypically normal spontaneous premature ovarian failure (FSH exceeding 40 mIU/mL) who desired fertility were evaluated at a tertiary care academic center by physical examination, measurement of serum free thyroxine and TSH, ACTH stimulation test, fasting serum glucose, 3-hour glucose tolerance test, measurement of serum electrolytes including total calcium, and measurement of serum vitamin B12.ResultsTwenty-two of 119 patients (18.5%) were known to have hypothyroidism and three were known to have Addison disease. Ten new cases of hypothyroidism and three new cases of diabetes mellitus were discovered. However, no new cases of adrenal insufficiency, hypoparathyroidism, or pernicious anemia were found.ConclusionScreening for hypothyroidism and diabetes appears justified in those patients with karyotypically normal spontaneous premature ovarian failure who desire fertility. However, our findings suggest that in these patients, testing for other associated autoimmune endocrine disorders may be reserved for those with clinical indications.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the hypothesis that a postcoital test, optimally performed in the periovulatory period of cycles in which gonadotropin-induced superovulation was used, correlates with cycle fecundity.MethodsOf 1135 total consecutive cycles, 367 first cycles were analyzed from the reproductive endocrinology and infertility service of a university medical center. This referral population had a mean age of 34.6 years for the female partner, a nulliparity rate of 81%, and a mean length of infertility of 4.8 years. Postcoital tests were performed 36–40 hours after hCG administration in gonadotropin-stimulated cycles. Clinical pregnancy was defined as fetal cardiac activity as seen on transvaginal ultrasound examination.ResultsCouples with no sperm observed per high-power field in the cervical mucus achieved a 16% fecundity rate (21 pregnancies in 129 cycles), one to ten sperm a 18% fecundity rate (28 pregnancies in 154 cycles), and more than ten sperm a 15% fecundity rate (13 pregnancies in 84 cycles). There was no significant difference between groups (n= 367,P= .85); the power to detect a statistically significant difference was .82. As validation of optimal cervical mucus, fecundity rates were compared with these postcoital test values across the entire range of peak periovulatory serum estrogen levels, and no correlation was seen (P= .61, .86, and .96 for estrogen levels of 201-500, 501-1500, and 1501-3433 pg/mL, respectively).ConclusionWith precise periovulatory timing and supraphysiologic estrogen levels optimizing qualitative cervical mucus characteristics in gonadotropin-induced cycles, the number of sperm observed per high-power field does not correlate with cycle fecundity.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo describe current professional activities, demographic profiles, and attitudes of directors of clerkships in university and community teaching sites.MethodsWritten surveys were mailed to departments of obstetrics and gynecology in the United States and Canada. Results were analyzed for differences in demographics, professional activities, and responses to statements describing career development of medical teachers and levels of institutional support.ResultsResponses from 132 of 148 (89%) medical schools and 67 of 96 (70%) known community-based clerkship directors showed no significant differences between the two groups in demographics or professional responsibilities. Three-quarters were men. The mean age was 47 years, mean duration as a faculty member 11 years, and mean tenure as clerkship director 8 years. One-half had been a clerkship director less than 5 years. The average clerkship director reported working approximately 56 hours per week, of which 44% was devoted primarily to patient care, 24% to teaching, and 18% to administration. These faculty members describe the activities of their position as fulfilling and worthy of recognition in the academic promotions process.ConclusionDirectors of clinical clerkships in obstetrics and gynecology in both university- and community-based programs spend about one-half of their time in teaching and administration. They find their work fulfilling and worthwhile. Profiles are consistent over time and comparable to those described by clerkship directors in other specialties.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID