摘要:

We conducted a randomized clinical trial in which patients with severe preeclampsia between 26-36 weeks of gestation received either nifedipine (10-30 mg sublingually, then 40-120 mg/day orally; N=24) or hydralazine (6.25-12.5 mg intravenously, then 80-120 mg/day orally; N=25). Effective control of blood pressure was achieved with nifedipine in 95.8% of subjects and with hydralazine in 68%, a statistically significant difference (P<.05). Maternal side effects were minor in both groups. Acute fetal distress developed in one nifedipine subject and in 11 treated with hydralazine. Mean prolongation of gestation was 15.5 ± 10 days with nifedipine and 9.5 ± 11 days with hydralazine, a difference that did not reach statistical significance (P<.07). Infants born to women treated with nifedipine were delivered at more advanced gestational ages (34.6 ± 2.3 versus 33.6 ± 2.4 weeks; statistically not significant), weighed more (1826 ± 456 versus 1580 ± 499 g; statistically not significant), and tended to have fewer, mainly minor, complications. The average number of days spent in the neonatal intensive care unit was significantly lower in the nifedipine group (15.1 versus 32.7 days; P<.005), leading to an average 31% reduction in total (maternal and neonatal) hospitalization related charges for each nifedipine-treated pregnancy. We conclude that nifedipine is an effective, convenient, and low-cost treatment for patients with severe preeclampsia, and is not associated with undesirable side effects

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

As a pilot study of occupational stress and pregnancy, we measured urinary catecholamine excretion in ten pregnant physicians and three intensive care nurses between 26-37 weeks' gestation, once during a work day and again during a non-work day. Urinary catecholamines were increased by 58% (P<.03) during work periods compared with non-work periods. Catecholamine levels were also increased by 64% (P<.025) over those of a working non-physician control group of similar gestational age. Urinary catecholamine levels are a direct reflection of plasma catecholamine levels. Catecholamine levels are known to increase with physical stress, such as standing, and with mental stress, such as difficult problem-solving. Catecholamines are also known to decrease uterine blood flow. Measurement of catecholamines may be a helpful marker in investigating the relationship between occupation and pregnancy outcome

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To assess the expectations of preterm birth prevention, we determined the causes of preterm birth in a population of indigent women. We studied 13,119 singleton births in a predominantly black, indigent population occurring between November 1982 and April 1986 to identify the proportion of preterm births that may have been prevented using current treatment modalities. Forty-four percent of the preterm births occurred at 35 to 36 weeks' gestational age, a time when most practitioners do not attempt tocolysis. Of the remainder, 17% occurred before 35 weeks but were indicated for maternal medical or obstetric complications, and another 17% occurred before 35 weeks but followed spontaneous premature rupture of the membranes. Therefore, of the 1445 preterm births, we calculated that only 336 (23.2%) were theoretically preventable. A fourth of these presented at less than 3 cm cervical dilatation and were treated appropriately with tocolytics, but delivered anyway. Therefore, most of the potentially preventable births occurred in the group that presented with cervical dilatation of more than 3 cm. We conclude that improving the preterm birth rate significantly below current levels may be difficult to achieve

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This study compared the safety, efficacy, local anesthetic usage, patient satisfaction, and anesthesia manpower demands of patient-controlled epidural analgesia and continuous epidural infusion during labor. After establishment of epidural analgesia, 88 parturients with vertex presentation were assigned randomly to receive either patient-controlled epidural analgesia or continuous epidural infusion, using 0.125% bupivacaine containing 1 μg/mL of fentanyl. Inadequate analgesia was treated in both groups with a 10-mL “top-up” of 0.25% bupivacaine. Patients receiving patient controlled epidural analgesia required significantly fewer supplemental top-up doses (36 versus 71%; P<.05) and insignificantly less local anesthetic (13.6 ± 0.6 versus 14.6 ± 0.5 mL/hour; P=.10). The two groups did not differ in incidence of hypotension, high sensory blockade (above T8), mode of delivery, or patient satisfaction assessed by questionnaire. Use of local anesthetic solution was examined with respect to cervical dilatation and did not increase late in labor. Patients generally viewed infusion technology favorably. These findings suggest that patient-controlled epidural analgesia is safe and effective, reduces anesthesia manpower needs, and is well accepted

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We report on engineering risk factors associated with clinician- applied forces during vaginal delivery of newborns. Specifically, we present and interpret data from a series of experiments using force-sensing devices on 29 randomly selected vaginal births, including two shoulder dystocia deliveries and one birth injury. The results indicate that clinician-applied peak forces are typically about 47 N for routine deliveries, 69 N for difficult deliveries, and 100 N for a shoulder dystocia delivery (P<.01). The time required to deliver fetal shoulders doubles for nonroutine deliveries (P<.01). In addition, impulse and rate of application of force distinguish between routine and nonroutine deliveries (P<.03). We conclude that, if properly perceived, force, force rate, and the duration of force are objective parameters that can be used in recognizing and managing shoulder dystocia and in predicting thresholds for birth injury

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

In February 1988, an ACOG Committee Opinion substantially revised the classification of forceps operations. The revision addressed two significant shortcomings of the old system: Outlet forceps had been defined too narrowly and midforceps too imprecisely. We now report the results of a prospective study of 357 forceps deliveries classified using each system. Allowing up to 45° of rotation in an outlet forceps delivery did not increase morbidity measured by any criterion. Dividing the old midforceps group by precisely identifying station and rotation permitted greater stratification of the risks of short-term neonatal and maternal morbidity. We conclude that our results validate the 1988 classification scheme

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Fetal growth retardation may be associated with maternal cocaine use during pregnancy. The pattern of fetal growth retardation was analyzed in infants born to 80 women who used cocaine, but not alcohol, during pregnancy, and in two comparison groups: 100 infants born to mothers who used neither alcohol nor cocaine during pregnancy and 67 infants whose mothers used alcohol but not cocaine during pregnancy. There were statistically significant differences in head size between the unexposed and cocaine-exposed infants (P<.001). Notably, head circumference was reduced proportionately more than birth weight in cocaine-exposed infants, a pattern similar to that observed in alcohol-exposed infants. Alcohol- and cocaine-exposed infants were not statistically different in head circumference. We conclude that brain growth of cocaine-exposed infants is similar to that reported for alcohol-exposed infants, and that cocaine exposed infants may be characterized as having asymmetrical growth retardation

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Transvaginal color Doppler was used to investigate the uteroplacental circulation of 45 patients with normal intrauterine pregnancies at 4-18 weeks' gestation. The main uterine artery and the radial and spiral arteries were demonstrated, and characteristic flow velocity waveforms were obtained in more than 90% of cases. The indices of impedance to flow decreased with gestation and there was a progressive fall in these indices from the uterine artery, through the radial, to the spiral artery. Blood velocity in the uterine artery increased exponentially with gestation

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Renal blood flow velocity waveforms were recorded by Doppler ultrasonography in 114 growth-retarded fetuses and in 97 post-term fetuses. The pulsatility index (PI) values were compared with our reference limits for gestational age and related to the amount of amniotic fluid. Growth retarded fetuses showed significantly increased PI values compared with normally grown fetuses, and this difference was particularly evident in cases of oligohydramnios. Furthermore, there was a significant negative correlation between the increase in PI and the amniotic fluid volume. Post-term fetuses showed no significant differences in PI values compared with term fetuses and no significant correlation between the amount of amniotic fluid and PI values

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Twenty-two of approximately 450 high-risk pregnancies referred to a regional center for a level II sonographic examination after 20 weeks' gestation were characterized by absent or reversed diastolic flow in the umbilical artery. Ten fetuses had congenital malformations or were aneuploid. Ten were growth-retarded in association with other problems: maternal hypertension, preeclampsia, cyanotic heart disease, elevated maternal serum alpha-fetoprotein levels, or twin gestation. In two cases, no etiology could be identified. Knowledge of the fetal karyotype, fetal anatomy, gestational age, maternal disease, and fetal status as determined by other tests of fetal well-being was required to optimize outcome in each case. In view of the heterogeneous etiologies of absent or reversed diastolic flow, management of such cases must be individualized

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID