ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo investigate the relationship between very low maternal serum alpha-fetoprotein levels (MSAFP), neonatal size, and possible associations with obstetric complications.METHODSThis is a retrospective case-control study in a population managed prospectively by a standardized protocol. Perinatal outcomes were compared between patients with unexplained very low MSAFP (less than or equal to 0.25 multiples of the median) and control pregnancies with normal MSAFP, matched by precise gestational age, parity, maternal age within 1 year, and gender of the newborn.RESULTSOf the 84,909 women screened, 464 (0.55%) met the definition of very low MSAFP. On tertiary evaluation, 226 had dates reassigned by ultrasound. After exclusion of overt diabetics, patients who were not pregnant, invalidated MSAFP, and 17 patients lost to follow-up, 178 women (0.21% of the total) had true very low MSAFP. True very low MSAFP was associated with subsequent miscarriage in 67 women and with fetal aneuploidy and/or serious abnormalities in 12 patients, leaving a population of 97 women (1.14 per 1000 women screened) with unexplained very low MSAFP. Without obvious demographic or obstetric factors, these women had heavier babies, more babies above the 90th percentile, more delivery complications caused by large birth weight (41 versus 16, χ2,P< .001) compared with gestational-age matched controls from the same screened population who had normal MSAFP.CONCLUSIONVery low MSAFP predicts an unusually high rate of large birth weight infants, with increased fetal, intrapartum, and neonatal consequences. Maternal medical conditions or obvious demographic factors do not explain these consequences. These findings suggest a role for close fetal surveillance in the third trimester and extended efforts to assess maternal and neonatal glucose status.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate predictors of neonatal hypoglycemia and macrosomia in 107 consecutive pregnancies in type 1 diabetic women.METHODSWe conducted a case record analysis of singleton type 1 diabetic pregnancies between January 1994 and January 1999 following institution of standardized management.RESULTSThe duration of diabetes in the women was 12.9 ± 6.8 years, and 44 were primigravidas. The mean HbA1c throughout pregnancy was 7.2 ± 0.8%. There was no relationship between neonatal blood glucose (checked before the second feed) and HbA1c at any point in pregnancy or mean pregnancy HbA1c (R= 0.20,P> .1). However, there was a negative correlation between neonatal blood glucose and maternal blood glucose during labor (R= −0.33,P< .001). When maternal blood glucose during labor was greater than 8 mM (144 mg/dL), neonatal blood glucose was usually less than 2.5 mM (mean 1.7 ± 0.4 mM or 31 mg/dL). There was no relationship between mean HbA1c and birth weight (R= 0.02,P> .1) or between maximum insulin dose and birth weight (R= 0.09,P> .1). Fetal abdominal circumference measured by ultrasound at 34 weeks correlated strongly with birth weight (R= 0.72,P< .001).CONCLUSIONNeonatal hypoglycemia correlates with maternal hyperglycemia in labor, not with HbA1c during pregnancy. Macrosomia does not correlate with HbA1c during pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo find patterns characteristic of maternal heart rates recorded by an electronic fetal monitor and compare them with concomitant fetal heart rate (FHR) patterns.METHODSMaternal heart rates and FHRs during active labor and delivery were simultaneously recorded in 26 parturients with singleton pregnancies in vertex presentation. The FHRs were obtained by an external ultrasound transducer or via a spiral scalp electrode and maternal heart rates by a triple-wire cable with electrocardiographic electrodes attached to the chest. Representative tracings of 30–60 minutes duration were selected from all stages of labor and after delivery of the placenta. Quantitative assessments were carried out under guidelines from the National Institute of Child Health and Human Development after blinding the source of these tracings. Patterns were compared by appropriate statistical analyses.RESULTSBaseline maternal heart rates were significantly lower and their variability significantly higher than FHRs during all stages of labor. Maternal heart rates showed no decelerations; the proportion of tracings with accelerations increased as labor advanced, most of them coinciding with uterine contractions or bearing down efforts. The FHRs had both decelerations and accelerations. However, tracings with only accelerations (and no decelerations) were observed in decreasing frequency as labor advanced. Maternal accelerations had higher amplitudes and longer durations than fetal accelerations, especially in the second stage of labor.CONCLUSIONMaternal heart rate patterns recorded by electronic fetal monitors closely resemble fetal patterns. Baseline “fetal bradycardia,” the absence of decelerations in the second stage of labor, and marked accelerations coinciding with uterine contractions may suggest a maternal heart rate rather than an FHR recording.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo study the association between meconium and maternal infection.METHODSThis was a retrospective cohort study of 678 pregnant women. All term deliveries during a 31-month period with meconium passage were included. Each meconium delivery was matched with a consecutive delivery without meconium at the same gestational age.RESULTSThe overall infection rate was 16%, with 13% of the infections directly related to the pregnancy, labor, and delivery. The endometritis rate was 5%, with 7.1% and 3% in the meconium and no-meconium group, respectively. The chorioamnionitis rate was 8.3%, with 9.5% in the meconium and 7.1% in the no-meconium group. Factors found to be associated with overall obstetric infections had the following odds ratios (ORs) and 95% confidence intervals (CIs): meconium (OR 1.8, 95% CI 1.1, 2.8), internal monitoring (OR 3.4, 95% CI 1.9, 5.9), amnioinfusion (OR 2.0, 95% CI 1.3, 3.3), number of vaginal exams (OR 4.5, 95% CI 2.8, 7.1), length of labor (OR 2.8, 95% CI 1.8, 4.4), and cesarean (OR 3.1, 95% CI 1.9, 5.1). Logistic regression analyses revealed the following ORs and 95% CIs: 1) for endometritis–cesarean (OR 4.2, 95% CI 1.9, 8.9), internal monitoring (OR 2.5, 95% CI 1.1, 5.9), and meconium (OR 2.5, 95% CI 1.1, 5.5), and 2) for chorioamnionitis–length of labor greater than 10 hours (OR 2.7, 95% CI 1.4, 5.6), number of vaginal exams greater than seven (OR 3.4, 95% CI 1.7, 6.6), and use of internal monitors (OR 2.5, 95% CI 1.2, 5.3).CONCLUSIONMeconium passage increases the risk of post-partum endometritis but not chorioamnionitis. Length of labor, internal monitoring, and number of vaginal exams are risk factors for chorioamnionitis.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo investigate the number and type of serious complications associated with optical-access trocars reported by sources other than the medical literature.METHODSOptical-access trocars, first introduced in 1994, were designed to decrease the risk of injury to intra-abdominal structures by allowing the surgeon to visualize abdominal wall layers during placement. To date, very few complications with their use have been reported in the medical literature. MEDLINE, the Food and Drug Administration's Medical Device Reporting, and the Manufacturer and User Facility Device Experience databases were searched for reports of complications occurring during the use of optical-access trocars for laparoscopic access.RESULTSOnly two serious complications resulting from the use of optical-access trocars (vena cava injuries) have been reported in the medical literature. However, 79 serious complications using these techniques have been cited in the Medical Device Reporting and Manufacturer and User Facility Device Experience databases since 1994. These include 37 major vascular injuries involving aorta, vena cava, or iliac vessels, 18 bowel perforations, 20 cases of significant bleeding from other sites, three liver lacerations, and one stomach perforation. Four of these complications resulted in patient deaths.CONCLUSIONOptical-access trocars may be associated with significant injuries despite having the ability to visualize tissue layers during insertion.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate absorption of estradiol (E2) and compare two low doses of 17 β-E2 (25 μg and 10 μg) in postmenopausal women with atrophic vaginitis.METHODSIn a double-masked, randomized, parallel-group study, 58 postmenopausal women were treated with 25 μg or 10 μg of 17 β-E2 for 12 weeks. We report data for 42 eligible subjects who had serum E2 concentrations below 20 pg/mL at baseline and complete data available at the baseline visit (30 minutes before tablet insertion) and weeks 2 and 12. Serum E2 and FSH concentrations were measured at specified intervals. The area under the curve, maximal concentration, and time to maximal concentration were measured for serum E2 concentrations. Maturation values of vaginal epithelial cells were assessed as indicators of change in vaginal epithelium condition in response to treatment.RESULTSAfter 12 weeks of treatment, the area under the curve, maximal and average over 24-hour E2 concentration were higher in the 25-μg (563 pg · hour/mL, 49 and 23 pg/mL) than in the 10-μg (264 pg · hour/mL, 22 and 11 pg/mL) group. Seventy-four percent in the 25-μg and 96% in the 10-μg groups had low systemic absorption of E2, that is, area under the curve (0–24 hour) less than 500 pg/mL. All but three women who received 25 μg had mean FSH levels below 35 mIU/mL.CONCLUSIONTreatment with 25 or 10 μg of 17 β-E2 vaginal tablets resulted in low absorption of estrogen without systemic effects often associated with hormone replacement therapy. After 12 weeks of therapy for atrophic vaginitis, absorption patterns remained consistent, and women did not have accumulations of circulating E2.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate the efficacy of vaginal misoprostol for medical management of missed abortion.METHODSFifty women with missed abortion were randomized to treatment with up to two 800-mg doses of misoprostol vaginally or a placebo. Participants were reviewed daily for 2 days, then again at 1 week. A blood sample for hemoglobin and serum β-human chorionic gonadotropin (βhCG) was obtained on day 1 and the hemoglobin level checked again on day 7. Complete abortion was defined as expulsion of the products of conception without dilation and curettage (D&C) and a negative follow-up urine βhCG test after 4 weeks, or as no products of conception obtained at D&C in cases of suspected incomplete abortion.RESULTSThe rate of complete abortion was 80% (20 of 25) in the misoprostol group and 16% (four of 25) in the placebo group, relative risk 0.20 (0.08, 0.50),P< .001. The rate of D&C was 28% (seven of 25) in the misoprostol group and 84% (21 of 25) in the placebo group, relative risk 0.33 (0.17, 0.64),P< .001. One participant in the misoprostol group had an emergency D&C for heavy bleeding. No participants required blood transfusion. The mean reduction in hemoglobin from day 1 to day 7 was 3.2 g/L in the misoprostol group versus 4.3 g/L in the placebo group,P= .72. Patient satisfaction with misoprostol treatment was high with 19 of 21 participants reporting they would try medical management again if they experienced another missed abortion.CONCLUSIONMedical management of missed abortion is effective, reduces the need for D&C, and is associated with high levels of patient satisfaction.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo study if the pathologist's examination of surgical abortion tissue offers more information than immediate fresh tissue examination by the surgeon. Immediate examination of the fresh tissue aspirate after surgical abortion helps reduce the risk of failed abortion and other complications. Regulations in some states also require a pathologist to analyze abortion specimens at added cost to providers. We conducted this study to evaluate the incremental clinical benefit of pathology examination after surgical abortion at less than 6 weeks' gestation.METHODSAs part of a prospective case series of women who had early surgical abortions at the Planned Parenthood League of Massachusetts during a 32-month period, we collected data on clinical outcomes and the results of postoperative tissue examinations. Using outcomes verified by in-person follow-up as the “gold standard,” we calculated the validity of the tissue examinations by the surgeons and the outside pathologists.RESULTSA total of 676 women had documented outcomes and complete tissue examination data. The sensitivity (ability of the examiner to detect an outcome other than complete abortion) was 57% (95% confidence interval [CI] 35, 76) for the surgeons' tissue inspections and 22% (95% CI 8, 44) for the pathologists' examinations. The predictive value of a positive (abnormal) tissue screen was 14% (95% CI 8, 24) and 7% (95% CI 3, 17) for the surgeons and pathologists, respectively.CONCLUSIONRoutine pathology examination of the tissue aspirate after early surgical abortion confers no incremental clinical benefit. Although the surgeons' tissue inspections predicted abnormal outcomes poorly, the pathologists did no better. Our results challenge the rationale for state regulations requiring pathologic analysis of all surgical abortion specimens.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID