摘要:

To clarify the role of disseminated intravascular coagulation (DIC) in women with the hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, serial coagulation studies were performed prospectively in 18 patients. A semiquantitative DIC scoring system was used retrospectively to augment the diagnostic confidence of coagulopathy. At the time of admission to the hospital, three patients showed no evidence of DIC, eight had suspected DIC, and seven had manifest DIC. The intravascular coagulation process was progressive in all patients; upon delivery, eight patients proved to have suspected DIC and ten had manifest DIC. The laboratory criteria of DIC were found to agree with the degree of organ dysfunction. Patients with manifest DIC at delivery developed significantly more life-threatening maternal complications than did patients with suspected DIC (P<.02). Conservative management was not possible in any patients who were admitted with overt DIC because of deterioration of maternal and fetal status. Application of a sensitive DIC scoring system may be valuable in managing patients with the HELLP syndrome and selecting patients who may be treated expectantly

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

While an abnormal oral glucose tolerance test (GTT) is known to be associated with an increased risk of pregnancy complications, the impact of one abnormal value is not clear. In 1986 we screened 4618 pregnant women for gestational diabetes at 24-28 weeks' gestation. Eighty-seven percent had normal results; of the 13% with abnormal screening tests, 139 had one abnormal value on the subsequent 3-hour oral GTT. These women were then compared with 725 randomly selected patients with a normal screening test. The frequency of chronic hypertension, cesarean section, 5-minute Apgar score below 7, preterm delivery, shoulder dystocia, congenital malformations, and perinatal mortality did not differ significantly between the groups. The incidence of macrosomia (birth weight above 4000 g) was significantly greater in the study group (18.0%) than in the control group (6.6%) (odds ratio 2.18; 95% confidence interval 1.77-5.37), a relationship that persisted after controlling for confounding risk factors by logistic regression modeling (odds ratio 2.55; 95% confidence interval 1.44-4.52). The incidence of preeclampsia/ eclampsia was significantly greater in the study group (7.9%) than in the control group (3.3%) (odds ratio 2.51; 95% confidence interval 1.14-5.52), which also persisted after controlling for confounding risk factors using logistic regression modeling (odds ratio 2.81; 95% confidence interval 1.26-6.28). Our results suggest that patients with one abnormal value on an oral GTT during pregnancy are at risk for delivering macrosomic infants and developing preeclampsia/eclampsia

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The effect of birth orter, Presentation, and mode of Delivery on neonatal outcome in nondiscordant twin gestations under 1500 g was investigated. All neonates had echoencephalograms performed by the fourth day of life to diagnose the presence and severity of intraventricular hemorrhage. One hundred fifty-six sets of twins were included in the study, of which 59 were in a vertex/vertex presentation, 59 in vertex/ nonvertex presentation, and 38 with twin A in a nonvertex presentation. Second twins were characterized by a higher incidence of respiratory distress syndrome (RDS): 66 versus 54% (P<.05), and severe grades of intraventricular hemorrhage: 30 versus 19% (P<.01). For vertex/vertex twins, cesarean delivery did not result in improved outcome. Rather, the incidence of RDS was significantly increased in neonates from this group delivered by cesarean birth: 67 versus 46% (P<.01). Among twins in which at least one of the fetuses was in a nonvertex presentation, those born via cesarean delivery demonstrated a lower incidence of both severe grades of intraventricular hemorrhage and mortality. However, after multivariate analysis to correct for differences in birth weight between the groups, no advantage for cesarean delivery could be demonstrated. Therefore, differences in birth weight, rather than in mode of delivery, accounted for the differences in the neonatal outcome of nonvertex-presenting twins

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The purpose of this randomized study was to evaluate whether the combined use of corticosteroids and thyrotropin- releasing hormone would enhance fetal lung maturation to a greater degree than would corticosteroids alone. The study was restricted to patients under 34 weeks' gestation with a lecithin/sphingomyelin (L/S) ratio less than 2.0. The patients were randomized into a study group receiving intravenous thyrotropin-releasing hormone along with intramuscular corticosteroids over 48 hours and a control group receiving only corticosteroids. Patients undelivered 1 week after the onset of therapy underwent a repeat amniocentesis to document changes in the L/S ratio. In those patients delivering within 1 week of therapy, the neonatal clinical course was established by two investigators blinded to the antenatal therapy. Compared with the control group, the group receiving antenatal corticosteroids plus thyrotropin- releasing hormone showed a greater post-therapy increase in L/S ratio, fewer respirator days, and a lower incidence of bronchopulmonary dysplasia. The results of this study suggest that the combined use of corticosteroids and thyrotropin-releasing hormone results in enhanced fetal pulmonic maturation superior to that achieved with corticosteroids alone

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Prophylaxis of threatened premature labor with ritodrine may lead to prolonged fetal exposure to the drug. To investigate the direct consequences of this, 11 fetal lambs were given ritodrine hydrochloride for periods of 2-4 days by continuous intravenous infusion at 5 or 10/tig/minute (1- 3/ug/minute/kg estimated fetal weight). These dosages had no measurable effects on the ewes. In the fetus, measurements confirmed and extended the results of earlier shortterm experiments, but differences from the effects of longterm maternal ritodrine infusion imply little placental transfer of the drug in sheep. Ritodrine had little or no effect on mean arterial pressure, blood pH, pCO2, plasma alphaamino acid nitrogen, or growth hormone, but resulted in marked hypoxemia, tachycardia, hyperlactacidemia, hyperglycemia, and hyperinsulinemia during the first 24-48 hours of infusion. Despite continued ritodrine infusion, heart rate and the metabolic parameters returned toward normal within 72 hours. Hypoxemia persisted longer, but tended to lessen after 2 days of infusion. The results indicate that tachyphylaxis to ritodrine develops in the fetal lamb during prolonged administration, but that when fetal well-being is already compromised, ritodrine's effects on oxygenation and Iactacidemia could jeopardize fetal survival

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Among the many factors that have altered the practice of obstetrics-gynecology are the following: the numbers of obstetrician-gynecologists, the increasing percentage of women entering the specialty, the expansion of ambulatory services with a simultaneous reduction in hospital admissions, a decrease in gynecologic surgical procedures, a stabilized number of total births with an anticipated increase in those to socially deprived and unmarried women, an increasing number of elderly women, general social and behavioral changes, and increasing outside control of practice. A proposal is presented for improving the education of residents and obstetrician-gynecologists in practice

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

This article presents a diagnostic and treatment planning guide that can be used when a patient complains of a sexual problem. The basic principles are summarized in the form of a grid. The axes of the grid represent “problem focus” and “influencing variables.” The grid can be used to aid in diagnosis, to assess the severity of a sexual problem, to suggest a direction for treatment, and to guide referral

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID