摘要:

A randomized trial of intrapartum versus postpartum antibiotic treatment of women with intra-amniotic infection was conducted. Intra-amniotic infection was treated with ampicillin and gentamicin during labor (at the time of diagnosis) in 26 women and immediately after umbilical cord clamping in 19 women. Intrapartum treatment led to a lower incidence of neonatal sepsis (0 versus 21%;P= .03) and a shorter neonatal hospital stay (3.8 versus 5.7 days;P= .02) when compared with postpartum treatment. There were no significant differences in the microbiologic results, the gestational age, or the birth weight between the groups. Intrapartum-treated mothers had a shorter mean postpartum stay, a lower mean number of febrile days, and a lower mean peak postpartum temperature than did postpartum-treated mothers; these differences were all statistically significant (P= .05). The treatment of clinical intra-amniotic infection during labor results in improved outcome.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A randomized study was undertaken to test the effects of antibiotics as an adjunct to established methods of tocolysis. One hundred fifty patients with cervical dilation of 1 cm or more and no clinically identifiable cause for preterm labor qualified for the study. Fifty-three (35%) received 500 mg ampicillin orally every 6 hours, 50 (33%) received 500 mg erythromycin orally every 6 hours, and 47 served as controls. Antibiotics were prescribed for 10 days, and the treatment was not altered by the results of cervical cultures. Of these 150 patients, 16 (11%) had positive amniotic fluid cultures. The pregnancies with positive amniotic fluid culture were characterized by significantly less time gained after admission (2.6 versus 28.7 days) and lower birth weight (1262 versus 2470 g) than in those with negative cultures. Histologic studies of the placenta revealed chorioamnionitis in 22 (16%) of 134 patients with negative amniotic fluid cultures; these pregnancies were associated with less time gained after admission (12.5 versus 31.9 days) and lower birth weight (1680 versus 2618 g) compared with pregnancies without histologic chorioamnionitis. In patients with similar gestational age and cervical dilation, the adjunctive use of antibiotic therapy resulted in a statistically significant delay from admission to delivery (30 versus 17 days). In cases of negative amniotic fluid cultures, cervical colonization with group B streptococcus and/orGardnerella vaginalisincreased the risk of prematurity, which improved significantly when ampicillin was given.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Previous studies have demonstrated diminished ultrasonic fetal growth parameters in women delivering preterm. In this study, we tested the following hypothesis: In pregnancies complicated by spontaneous preterm labor, 1) unsuccessful tocolysis is likely to be associated with diminished fetal growth, and 2) successful tocolysis is likely to occur when fetal growth is normal. Ultrasound examinations were performed in 78 pregnancies complicated by preterm labor before 35 weeks' gestation. Tocolysis was attempted unless contraindicated or unless cervical dilatation was advanced (4 cm or greater). Pregnancies delivering before 36 weeks' gestation were compared with those delivering after this gestational age. Among the 48 pregnancies delivered before 36 weeks' gestation, a significantly greater proportion had ultrasonic growth parameters lower than normal values at corresponding gestational ages. In contrast, those pregnancies that had successful tocolysis and delivered near term demonstrated a normal distribution of ultrasound growth parameters. In pregnancies complicated by preterm labor, ultrasonic documentation of diminished fetal growth may identify the subgroup at increased risk for preterm delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Recent data suggest that fetal breathing movement incidence declines while fetal heart rate (FHR) and body movement incidence do not change within 72 hours of spontaneous term labor. We conducted a retrospective study to determine whether the length of time from testing to spontaneous labor onset could influence these biophysical test parameters. Eighty-one normal term fetuses underwent 60-minute tests 1–40 days before the onset of spontaneous labor: 41 were tested within 7 days of labor (19 within 3 days and 22 within 4–7 days) and 40 were tested more than 7 days before labor. We simultaneously acquired and analyzed FHR baseline, frequency of accelerations between ten to 14 beats per minute and more than 15 beats per minute in amplitude, percent of time spent in breathing and moving, and fetal breath rate. These biophysical parameters were not significantly different between the groups, implying that they may continue to provide clinically useful information in the prelabor period.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Biophysical profile scoring was the principal technique of antepartum fetal surveillance in 238 well-controlled diabetic pregnancies. Fifty insulin-dependent diabetics had twice-weekly testing, and 188 gestational diabetics had weekly testing. Intervention was not pursued unless there were maternal or fetal complications. There were no stillbirths and three neonatal deaths, all resulting from congenital anomalies, giving a corrected perinatal mortality rate of 0. The incidence of abnormal biophysical profile scores, eight of 238 (3.3%) overall, was low, with no significant difference between types of diabetics. In those with an abnormal score, intervention was mandated; the cesarean section rate was 50% and the rate of intensive care nursery admissions was high. Of the 230 fetuses with a normal biophysical profile score, 200 (87%) were delivered at term with minimal maternal or neonatal morbidity. Amniocentesis for phospholipid profile was performed in only 33 cases (13.9%). Hyaline membrane disease was confined to five premature neonates (incidence 2.1%). We conclude that antepartum fetal surveillance using the biophysical profile score permits safe expectant management in the diabetic pregnancy, yielding significant clinical advantages to both mother and fetus.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The cause(s) of the low plasma antithrombin III activity in women with preeclampsia is unknown. The purpose of this study was to evaluate the relationship between plasma antithrombin III activity and both clotting parameters (platelet count and fibrinopeptide A) and renal parameters (serum creatinine and uric acid concentration). Forty-seven preeclamptic women were studied within the 2-day interval before delivery. Creatinine did not correlate significantly with any of the other study parameters. However, there were significant correlations between antithrombin III activity and platelet count (r= 0.53,P< .005) and between antithrombin III and fibrinopeptide A (r= −0.29,P< .05). The correlation between platelet count and fibrinopeptide A was not significant. These findings support the hypothesis that antithrombin III consumption by fibrin generation is initiated by platelet activation, and is at least one cause of the low activity level known to occur in women with preeclampsia.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Ninety-two primigravidas were screened biweekly by measurement of plasma cystyl aminopeptidase from 28 weeks' gestation until delivery. Fourteen developed hypertension with or without proteinuria after 36 weeks. The hypertensive group had significantly higher levels of the enzyme at 30 weeks, although this difference was not significant at 34 weeks. The rise in the hypertensive group was less than 50% between weeks 30–34 in all cases, whereas it was over 50% in all but two of the 43 controls. The difference in the rates of increase of the enzyme and its action on antidiuretic hormone may have some bearing on the subsequent development of hypertension.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Risk factors for uterine fibroids were analyzed in a hospital-based case-control study conducted in the greater Milan area, based on 275 women with histologically confirmed fibroids and 722 controls with acute nongynecologic or hormone-related conditions. Questions were asked about menstrual and reproductive characteristics, education, history of various diseases, and lifetime use of oral contraceptives and other hormonal treatments. The risk of uterine fibroids was reduced in parous women relative to nulliparous ones (relative risk 0.6) and in those who were post-menopausal (relative risk 0.1 compared with premenopausal women of the same age). Women with fibroids tended to have an earlier age at menarche and at the last birth, to be more educated, and to use intrauterine devices and oral contraceptives more frequently, although these findings were not statistically significant. Current smoking (but not past smoking) lowered the fibroid risk by about 40%. No associations were found with body mass index, history of spontaneous or induced abortions, and age at first birth.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

During a 10-year period, vaginal myomectomy was attempted in 46 women with a symptomatic prolapsed pedunculated submucous myoma. The procedure was successful in 43 and failed in three patients, necessitating an abdominal operation. Vaginal myomectomy for this condition was simple and quick, and the postoperative course was usually uneventful. Only 8.8% of 34 patients with a median follow-up of 5.5 years required a repeat vaginal myomectomy, and only 5.9% needed a hysterectomy. Vaginal myomectomy is recommended as the initial treatment of choice for prolapsed pedunculated submucous myoma, except in those cases in which other indications necessitate an abdominal approach.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Mechanical stapling of the vaginal cuff during hysterectomy has been proposed as a way to minimize bacterial contamination, thereby reducing infectious morbidity and hospital stay. Twenty-four pathogen-free New Zealand white rabbits underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy using either chromic suture or copolymer staple to close the vaginal cuff. Aerobic and anaerobic cultures were obtained from the peritoneal cavity upon entering, and from the vaginal cuff during the initial operation and on postoperative day 3 or 8. When compared with chromic suture, stapling of the vaginal cuff during hysterectomy did not result in significant reduction of postoperative bacteria isolated from the vaginal cuff or peritoneal cavity. In addition, copolymer staples were associated with histologic evidence of more extensive necrosis and cellular exudate while significantly increasing adhesion formation between the vaginal apex and surrounding viscera. Stapling the vaginal cuff does not significantly reduce bacterial count after hysterectomy, significantly increases adhesion formation, and may interfere with normal wound healing in an animal model.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID