摘要:

Eighty-six fetuses of 21–41 weeks' gestation with arrhythmias were studied with ultrasound and heart ratemonitoring. The type of arrhythmia was identified by M-mode studies and was confirmed by postnatal electrocardio-gram in 70 infants. The most common arrhythmia waspremature atrial contractions (761, followed by prematureventricular contractions (five), paroxysmal supraventriculartachycardia (four), and atrial fibrillation/flutter (one). Dop-pler echocardiography was performed in 54 fetuses to mea-sure flow velocities across the atrioventricular and semilunarvalves. After isolated premature atrial and ventricular con-tractions, post-extrasystolic potentiation was demonstratedby an increase in fractional shortening (N = 32) of 49 2 6%in the right ventricle and 64 2 7% in the left ventricle. Whenpost-extrasystolic beats were compared with normal beats, Doppler-determined time-velocity integrals increased 43%across the tricuspid valve, 41% across the mitral valve, 34%across the pulmonary valve, and 38% across the aortic valve. Mean velocity increased significantly after conversion tonormal sinus rhythm in the five fetuses with supraventricu-lar tachycardia (P < .05). By studying the physiologicconsequences of fetal arrhythmias using two-dimensional Doppler and M-mode ultrasound, we have documented thepresence of post-extrasystolic potentiation after prematurecontractions, the existence of the Frank-Starling mechanism, and an increase in mean velocity (and therefore in cardiacoutput) after conversion of fetal tachyarrhythmias to normalsinus rhythm.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Seventy-five high-risk pregnancies were studied in order defineto the clinical value of the analysis of fetal blood flowvelocity waveforms in early screening for growth retarda-tion. Recordings were obtained at 26–28 weeks' gestation, inthe absence of ultrasonographic signs of growth retardation, using a pulsed duplex Doppler system. The pulsatility indexwas evaluated a t the level of the umbilical artery, descend-ing aorta, and internal carotid artery. Fetuses (N = 23) whodeveloped growth retardation showed higher values ofpulsatility index in the umbilical artery (P < .001) anddescending aorta (P < .05) than fetuses of normal growth. Inthe internal carotid artery, the pulsatility index was lower (P < .001) in the fetuses who developed growth retardationthan in those with normal growth. The ratio between thepulsatility indexes of the umbilical and internal carotidarteries proved an accurate predictor of growth retardation(specificity 92.3%; sensitivity 78.2%; positive predictivevalue 81.8%; negative predictive value 90.5%; accuracy 88%).

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A computer-assisted analysis of perinatal variables wasundertaken in order to characterize the growth-discordanttwin. We studied 124 twin pairs grouped at four degrees ofdiscordancy: over 5, 10, 15, and 20% birth weight difference, using the larger twin as 100%. Twins with birth weightdiscrepancy below these figures were considered concor-dant. Highly discordant second twins showed significantlylower birth weight, gestational age, and Apgar scores, andprolonged neonatal hospitalization, as compared with discordant first twins. Complex presentations and a highercesarean section rate characterize discordant first and con-cordant twins. It is suggested that a 15% birth weightdiscordancy be used as the safety limit for birth weightdisparity. We also recommend special attention when dis-cordancy seems to increase, especially if the discordant isthe second twin.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A case of suspected fetal cardiac asystole with normalumbilical cord blood gas values is reported. Possible expla-nations of this apparent discrepancy were examined bymeasuring sequential changes in fetal arterial acid-base andblood gas values after induced cardiac asystole in chroni-cally instrumented fetal lambs at 132–141 days' gestation. Arterial pH values did not decrease from baseline for at leastten minutes. Elevation of pCO2 values were observed at 30minutes. Arterial p 0 2 and HC03 values remained un-changed for at least 30 minutes. Therefore, we conclude thatsudden fetal cardiac asystole occurring within ten minutesof delivery may be one reason why umbilical cord acid-baseand blood gas values do not correlate with Apgar scores.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The nonstress test (NST) remains in widespread use forantepartum fetal surveillance. Our institutional experiencewith 14,028 patients and 38,645 tests over eight years revealsa fetal death rate of 2.6 per 1000 within seven days of areactive NST. The autopsy findings of 53 fetal deaths arepresented. The most common findings, in descending orderof frequency, were meconium aspiration, perinatal infec-tion, and abnormal umbilical cord position. These findingssupport changes we have made in our anteparturn assess-ment protocols.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

This study evaluated the effects of labor pain on maternalarterial hemoglobin oxygen saturation and neonatal acid-base status. Arterial oxygen saturation was monitorednoninvasively by pulse oximetry during labor and delivery. The patients studied (N = 46) were divided into four groupsaccording to obstetric history (primiparas and multiparas)and pain management during labor (lumbar peridural anes-thesia versus meperidine and nitrous oxide). Nine patientsat term but not in labor served as controls. Decreases ofarterial oxygen saturation were related to both subjectivepain, reported by visual pain analog scales, and to neonatalacid-base status at delivery. All values are reported as mean+- standard deviation (SD). Primiparas with peridural anes-thesia showed significantly less decrease in arterial oxygensaturation (1.7 2 1.4%; P < .001; N = 151, superior scores onthe visual pain analog scale (3.5 f 2.01, and a significantlybetter neonatal acid-base status (pH 7.29 t 0.06; P = .01;base excess −6.4 f 2.2; P < .05) as compared withprimiparas treated with meperidine and nitrous oxide (Sa027.2 ? 3.9%; visual pain analog scale 7.1 f 1.2; pH 7.21 2 0.1;base excess −9.5 2 4.5; N = 16). In multiparas there was nostatistically significant difference in decrease of arterial ox-ygen saturation, visual pain analog scale, and neonatalacid-base status.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Low birth weight infants are delivered with increased frequency in women who have elevated maternal serum alphafetoprotein values in the second trimester. Maternal serum alpha-fetoprotein elevations, however, are found more often in lighter-weight women, a group known to have lowerweight infants regardless of maternal serum alphafetoprotein levels. To clarify the association between elevated maternal serum alpha-fetoprotein levels and low birth weight independent of maternal weight, we applied a weight correction formula to maternal serum alphafetoprotein values from 9507 singleton viable pregnancies without major fetal malformations. Before adjusting for weight, 486 of the women (5.1%) had maternal serum alpha-fetoprotein values of 2.0 or more multiples of the median. The weight adjustment process removed 100 lighter-weight women from this category, added 58 heavier women, and led to an equivalent proportion of women in the various weight categories who were classified as having maternal serum alpha-fetoprotein values of 2.0 or more multiples of the median. Of the 388 low birth weight pregnancies (2500 g or less), 50 initially had maternal serum alpha-fetoprotein values of 2.0 or more multiples of the median; after weight adjustment, seven lighter-weight women were removed, four heavier women were added, the median birth weight fell from 2217 to 1956 g, and a threefold increase in risk was found for low birth weight outcome regardless of weight class. Maternal serum alpha-fetoprotein elevations predict increased risk for low birth weight outcome independent of maternal weight.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The occurrence of fatal conditions was substantially similar in a large population of recent, healthy oral contraceptive users and comparable nonusers at Group Health Cooperative of Puget Sound during the years 1977–1981. There were no deaths from cardiovascular disease among those who were oral contraceptive users at the onset of their cardiovascular illness; there was one death from liver cancer, probably attributable to oral contraceptive use; and there were no deaths from complications of pregnancy among either users or nonusers. Newer formulations of oral contraceptives and greater care in prescribing oral contraceptives to the healthiest younger women may have substantially lessened the risks identified with earlier preparations and prescription practices.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Danazol (200 mg/day) or placebo was administered to patients with premenstrual syndrome from the onset of symptoms until the onset of menses, for two cycles each, in a prospective, double-blind, crossover design. Eleven of 14 patients improved on danazol. The symptom scores with danazol were significantly lower than those with placebo (P < .035). No side effects were reported from the medication. We conclude that danazol, given periodically and in a relatively low dose, appears to have a beneficial effect in the treatment of premenstrual syndrome.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A double-blind, placebo-controlled, randomized multiple crossover study was designed to determine the effectiveness of alprazolam i n the treatment of premenstrual syndrome. Patients maintained daily diaries of 22 premenstrual symptoms for one pretreatment control cycle and four treatment cycles. Alprazolam 0.25 mg or placebo was administered three times daily from cycle day 20 until the second day of menstruation, at which time the dosage was tapered by one tablet per day to minimize withdrawal effects. The results of the clinical trial indicate that alprazolam is significantly more effective than placebo in relieving the severity of premenstrual nervous tension, mood swings, irritability, anxiety, depression, fatigue, forgetfulness, crying, cravings for sweets, abdominal bloating, abdominal cramps, and headache. The low incidence of side effects makes alprazolam an acceptable treatment for premenstrual syndrome for those women unresponsive to other therapies.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID