摘要:

To assess the risks and benefits of vaginal delivery in patients with prior cesarean section, the English literature on this subject from 1950 to 1980 was reviewed. The following conclusions were reached: 1) Properly conducted vaginal delivery after cesarean section is relatively safe, with a 0.7% incidence of uterine rupture, 0.93 perinatal mortality, and no maternal deaths due to uterine rupture. 2) Of those patients allowed a trial of labor, 66.7% were successfully delivered vaginally. Successful vaginal delivery occurred in 74.2% of those patients with a nonrecurrent indication for their previous cesarean section and in 33.3% of those patients whose indication for previous cesarean section was cephalopelvic disproportion. Sixty-seven percent of those patients with a prior vaginal delivery versus 47.1% of those patients without a prior vaginal delivery subsequently delivered vaginally. 3) A classic uterine scar clearly increases the probability of uterine rupture. However, the precise magnitude of the increased risk cannot be accurately determined. 4) Certain basic safety requirements such as available operating room facilities and adequate personnel for careful observation are mandatory, but other management policies that remain controversial include use of regional anesthesia, oxytocin administration, timing of hospital admission, artificial rupture of membranes, mode of delivery, proper method to evaluate the uterine scar, and delivery of fetuses in breech presentation and twins. 5) A policy of selective vaginal deliveries among patients with prior cesarean sections will result in cost reductions due to decreased postpartum hospitalization.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Two grams of cefoxitin was administered intramuscularly to 31 premenopausal women when they were called to the operating room for a scheduled vaginal hysterectomy. Serum and tissue samples were obtained to determine cefoxitin concentration. The mean concentration of cefoxitin at the reported peak in serum after an intramuscular injection (30 minutes) was 25.3 /µg/ml. The mean serum concentration at the time of uterine excision (a mean of 143 minutes after the on-call dose) was 18.0 /µg/ml. The mean concentrations of cefoxitin in the uterine fundus and the lower uterine segment at the time of uterine excision were 1.1 and 1.8 µg/g tissue, respectively.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Sixty-seven cases of eclampsia were managed between August 1977 and July 1980. Routinely acquired laboratory tests of these cases have been analyzed. In addition, the group of patients with eclampsia was compared with a group of 24 healthy pregnant women. There was no significant difference in platelet count, serum fibrinogen, and bilirubin values. The activated partial thromboplastin time was abnormal in 42% of patients with eclampsia. There was no clinical evidence of disseminated intravascular coagulation in any patient. Patients with eclampsia had abnormalities of lactic dehydrogenase, alkaline phosphatase, SGOT, uric acid, BUN, and creatinine. However, in any individual patient there was no single test of great clinical usefulness and no test predictive of maternal or fetal outcome. At present the authors recommend complete blood count (including blood smear and platelet count), clot observation, and serum creatinine tests. Liver function tests are reserved for the patient with upper abdominal pain. Additional tests are recommended if the diagnosis of eclampsia is questionable or if an additional disease process is suspected.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Intervillous blood flow was measured using a133Xe clearance technique during the first stage of labor in 9 parturients with severe preeclampsia before and after lumbar epidural analgesia. Analgesia was produced with 10 ml of 0.25% bupivacaine. After the lumbar epidural block the intervillous blood flow significantly improved, suggesting that epidural analgesia is the obstetric analgesic method of choice in cases of severe preeclampsia.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The bacterial growth-inhibiting activity of amniotic fluid from patients with polyhydramnios was compared with that of inhibitory and noninhibitory fluid from healthy women. Although it was postulated that an altered solute concentration in polyhydramnios may interfere with expression of bacterial inhibition, fluids from polyhydramnios cases were fully inhibitory. The inhibitory property in amniotic fluid from polyhydramnios cases was similar to previously described characteristics of a phosphate-sensitive inhibitor.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Serum relaxin concentrations were quantitated throughout pregnancy. Relaxin levels were higher in the first than in either succeeding trimester of pregnancy. Relaxin concentrations in third-trimester twin pregnancies were not significantly different from those in singleton pregnancies. Relaxin levels in toxemic pregnancies were similar to those of normal pregnancy. In contrast, relaxin concentrations in pregnancies beyond 43 weeks' gestation and in women with premature labor were significantly lower than levels in normal women in the third trimester of pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The free cortisol concentration in umbilical cord plasma and the pH of umbilical artery blood were determined in 108 full-term fetuses delivered vaginally. Eighty-six of the labors were spontaneous and 22 were induced with oxytocin. The cortisol values correlated significantly with the pH values (r= −.608, P<.001). The cortisol values averaged 0.73 ±0.48 (µ mole/liter in the spontaneous labor group and 0.65 ± 0.42 µmole/liter in the induced labor group. No statistically significant differences (P>.05) in the cortisol and pH values emerged between the groups. The results indicate that the human fetus reacts readily to intrauterine hypoxia and acidosis with endogenic cortisol secretion in both spontaneous and induced labors.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Cytologic examination of oxazone-stained (nile blue) samples of amniotic fluid has become increasingly accepted as a reliable, inexpensive, and simple method of assessing fetal maturity. The present study focused on the ultrastructure of amniotic fluid cells in late human pregnancy. By means of light microscopy and scanning electron microscopy of the same cell in a series of cells, it was possible to observe the ultrastructural counterpart to the cell pattern indicative of fetal maturity. The type of cell indicating immaturity had a cytoarchitecture different from that of cells indicating maturity. The latter had an amorphous surface and coarse cytoplasmic strands; their oxazone-stainable, orange fat droplets were not found at electron microscopy. It is concluded that cells indicating maturity and those indicating immaturity differ in ultrastructure.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Placental transfer mechanisms were investigated in pregnant Macaca fascicularis and Macaca mulatta during the gestational age of 120 to 130 days. These primates underwent an operative procedure that allowed continuous fetal blood sampling. The administration of [14C]phenylalanine into the maternal circulation revealed a significant increase of radioactive material in the fetal circulation, indicating an active placental transport mechanism unidirectional to the fetus. When [l4C]phenylalanine was injected into the fetus, radioactive aromatic amino acids in the maternal circulation increased only slightly over time, resembling a simple diffusion process.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A group of 155 puerperal volunteers were surveyed by anonymous questionnaire about personal and sexual histories before and during pregnancy. Results were viewed in regard to the influences of prior life experience and pregnancy itself upon attitudes, behavior, and response to sex in pregnancy. Although many differences among the population could be found the general trend of attitude, behavior, and response was to a progressive decline in coital frequency toward the end of pregnancy. Masturbation persisted or increased in inverse relationship to attitudes regarding coitus. Other past or present individual circumstances had no statistically significant effect on these trends. Poor conjugal relationships tended to deteriorate more rapidly than good ones. The author concludes that pregnancy strongly influences human behavior regardless of many individual or group characteristics. Sexually experienced and satisfied women compensate better in changed circumstances than inexperienced or sexually unfulfilled women. Rewarding sexual circumstances retard the rate of decline in interest and activity experienced by most women during late pregnancy, but do not avert this decline. Pregnancy is a potent influence over sexuality irrespective of an individual's conditioning.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID