摘要:

Rising cesarean rates call for review of the indications for this procedure. Suspicion that subtle operatives, not reflected in morbidity and mortality rates, might be present inspired the study presented here. Three hundred fifty-two cesarean operations were done at Huron Road Hospital in the years 1952-1954. Examination of family records identified 97 probands delivered by cesarean after prolonged active labor before or during that period. Research efforts yielded 54 cases that were free of complications and had full historic data for both proband and sibling(s) of the same parentage, totaling 122 children. The intelligence quotient (IQ) scores of these families compared with that of the proband undergoing successive hours of labor suggested a detrimental effect of increasing length of trial labor. Statistical analyses of the 30 families in which the probands' trial labors exceeded 12 hours support that notion, as the probands had significantly lower IQ scores than their siblings born by elective cesarean with no labor (P=.006 toP<.001). Probands had the lowest IQ scores in their families significantly more often (P<.025) than could be expected to occur randomly. A similar pattern of school success occurred within the families.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

One hundred twenty-three women were randomized to receive either of two regimens of oxytocin for labor induction. Sixty-one received a low-dose regimen, with oxytocin increases at intervals of not less than 60 minutes. Patients with unripe cervices received prolonged low-dose oxytocin priming before membrane rupture. Sixty-two others received a traditional protocol, with oxytocin increased every 20 minutes as required. Both groups had amniotomy when deemed safe and feasible. Oxytocin was adjusted for uterine hyperstimulation or abnormal fetal heart rate patterns in 29 and 58% of low-dose and traditional protocol subjects, respectively (P<.001, odds ratio 3.6). No significant increase in time to delivery was seen with low-dose oxytocin infusion. Cesarean delivery and cesareans for fetal distress were more frequent in the traditional protocol group. This study demonstrates that a continuous low-dose protocol for oxytocin induction of labor is effective in establishing active labor and achieving vaginal delivery in women with both ripe and unripe cervices. It is also associated with fewer episodes of uterine hyperstimulation requiring adjustments of oxytocin infusion than is the traditional protocol of this institution.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Ninety-four nulliparous women with a poor cervical score (less than 6) who had premature rupture of membranes at term were randomized by sealed envelope into two groups. One group received immediate stimulation of labor with oxytocin infusion. The second group received two prostaglandin E2(PGE2) 3-mg pessaries 4 hours apart, followed by oxytocin infusion, if necessary. The interval between initiation of therapy to onset of labor was significantly longer in the PG group, but the length of labor was similar in both groups. The maximum dose of oxytocin needed was significantly higher in the oxytocin group. The cesarean delivery rate in the oxytocin group was 14.9%, compared with 19.1% in the PG group (not significantly different). All seven cesareans in the oxytocin group and seven of nine in the PG group were for failed stimulation of labor. Neonatal Apgar scores at 1 and 5 minutes and admission to the neonatal intensive care unit were similar in the two groups. The incidence of maternal and neonatal infection was small and was not different in the two groups. The use of PGE23-mg pessaries 4 hours apart, followed by oxytocin infusion if necessary, did not confer any benefit over the use of intravenous oxytocin in obstetric or neonatal outcome when both agents were started a few hours after admission.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The relationships among epidural anesthesia, forceps use, parity, episiotomy, and laceration were studied in 9493 uncomplicated vertex deliveries of spontaneous onset and normal course. The use of epidural anesthesia was not associated with an increased incidence or severity of birthcanal trauma. Episiotomy was associated with a decreased rate of perineal laceration, but an overall increase in the rate of perineal trauma. The trauma that did occur with episiotomies was four times more likely to be major than that when no episiotomy was performed.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Spontaneous preterm labor remains a significant cause of high morbidity and mortality in the newborn. Chorioamnionitis with an associated rise in prostaglandins (PGs) is thought to be one of the factors responsible for the onset of preterm labor. In this study, 52 placentas and membranes from gestations of 35 weeks' or fewer were collected. Tissue samples of membranes and placentas were incubated in pseudoamniotic fluid, and the levels of PGs and leukotriene B4 were assayed. Swallowed amniotic fluid aspirated from the infants' stomachs was analyzed for PGs and examined microscopically for the presence of degenerate neutrophilic polymorphonuclear leukocytes (pus cells) and bacterial organisms. Prostaglandins E and F and leukotriene B4 production were significantly higher in the membranes and placentas with chorioamnionitis than in those without. Although the comparison of PG levels in the gastric fluid of infants with and without chorioamnionitis did not reach statistical significance, there was a trend toward higher levels of PGs with chorioamnionitis. Prostaglandin E levels from membranes and placentas and PGF from placentas were significantly elevated in the gastric fluid of infants with pus cells and organisms. These findings support the hypothesis that chorioamnionitis may initiate preterm labor.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Prophylactic amnioinfusion was assessed in term and postdates pregnancies with decreased amniotic fluid volume. Subjects were randomly assigned to one of three groups: amnioinfusion with warmed saline solution, roomtemperature saline, or control. Patients receiving prophylactic amnioinfusion had a significant decrease in both the frequency and severity of variable decelerations in the first stage of labor (P=.006) and in the average total number of variable decelerations in the first and second stages of labor (P=.01) compared with controls. There was no observed effect on newborn serum electrolyte levels with amnioinfusion, nor was there any apparent benefit of infusion of warmed saline compared with room-temperature saline. In contrast to premature gestations with oligohydramnios, prophylactic amnioinfusion was not associated with a significant improvement in mean umbilical arterial and venous pH or a significant decrease in cesarean delivery for fetal distress (P=.09). This is perhaps because the term fetus has an enhanced ability to tolerate recurrent episodes of heart rate decelerations without demonstrating the rapid metabolic changes seen in the premature fetus.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Forty term pregnant women with singleton breech gestations admitted for external cephalic version underwent biophysical profile testing before any fluid infusion or medication. After magnesium sulfate had been infused for contraction prophylaxis, the maternal serum magnesium level was measured and a second biophysical profile was performed. The mean (± SD) serum magnesium was 5.1 ± 1.0mg/dL. The biophysical profile score decreased significantly, reflecting a decrease in fetal breathing activity. In patients with therapeutic maternal serum magnesium levels, loss of any component of the biophysical profile other than respiration cannot be attributed to the elevation in magnesium concentration.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Women who develop preeclampsia during pregnancy excrete less calcium than healthy pregnant women. Whether this reduction in calcium excretion precedes or follows hypertension is unknown. We prospectively measured urinary calcium excretion in 103 consecutive nulliparous women at risk for preeclampsia and presenting for prenatal care before 24 weeks' gestation. Serial 24-hour urine specimens were obtained at 10-24 weeks, 25-32 weeks, and 33 weeks to term. After delivery, the charts were reviewed for the presence of preeclampsia and gestational hypertension. At the first collection, patients who later developed preeclampsia excreted less urinary calcium (169 ± 30 mg/24 hours; mean ± standard error of the mean) than those who remained normotensive (298 ± 15 mg/24 hours) (P<.05); this reduction persisted throughout gestation. Using a receiver operator curve, we calculated a predictive threshold calcium value for hypertension of 195 mg/24 hours. The difference in the incidence of preeclampsia between pregnant women with calcium excretion values at or below 195 mg/24 hours (87%, 95% confidence interval 52-98%) and those with values above that level (2%, confidence interval 0.3-8%) was highly significant (Fisher exact test,P<.0001). The 95% lower limit of relative risk for preeclampsia in patients with a calcium excretion equal to or below 195 mg/24 hours in the first collection was 9.4. These observations suggest a pathophysiologic role for altered urinary calcium excretion in women with preeclampsia that may contribute to the early identification of patients at risk for this disease.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Hypocalciuria is a feature of preeclampsia. The roles of parathyroid hormone (PTH) and vitamin D 1,25(OH)2D3(calcitriol) in its pathogenesis have not yet been determined. Fourteen preeclamptic women were compared with 12 women with chronic hypertension and 11 normotensives, all in the third trimester. Preeclamptics had the lowest urinary calcium excretion rate (62.1 ± 32.8 mg/24 hours) compared with chronic hypertensive women (162.6 ± 97.8 mg/24 hours) and normotensive controls (225.6=146.9 mg/24 hours) (P<.05). Serum PTH was lowest in preeclamptics (9.8 ± 5.5 pg/mL), in contrast to the chronic hypertensives (18.5 ± 2.7 pg/mL) and normotensives (16.4 ± 3.2 pg/mL) (P<.005). Similarly, urinary cyclic adenosine monophosphate (cAMP) excretion was 2.9 ± 1.4μmol/24 hours in the preeclamptics, 5.1 ± 1.7μmol/24 hours in the chronic hypertensives, and 4.6 ± 1.3μmol/24 hours in the normotensive group (P<.05). These data suggest that the mechanism of hypocalciuria in preeclampsia is independent of the PTH-calcitriol axis. Therefore, it is suggested that the hypocalciuria of preeclampsia is due to intrinsic renal tubular dysfunction.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The average time until the resolution of thrombocytopenia, which as a part of HELLP syndrome accompanies 4-16% of cases of severe preeclampsia, has not been defined previously. We followed 25 patients with severe preeclampsia, platelet counts below 100,000/μL, and elevated liver enzymes until their platelet counts returned to levels above 100,000/μL. Among severe preeclamptics who did not receive platelet transfusions, the average time from delivery to the resolution of thrombocytopenia was 60 hours, and all had platelet counts above 100,000/μL by 95 hours. Seven patients were followed after their platelet counts exceeded 340,000/μL; all showed a rebound phenomenon, with platelet counts reaching values of 413,000-871,000/μL

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID