摘要:

A large cohort of consecutive live births with gestational ages assessed antenatally from 24 to 28 weeks from one tertiary center was studied to determine the association between mode of delivery and in-hospital mortality and morbidity and morbidity at two years of age. Between 1 January 1977 and 31 March 1982, 52.8% (172 of 326) of such infants survived their primary hospitalization. Obstetric factors independently associated with improved survival were increasing gestational age (P<.0001), the absence of maternal hypertension (P=.007), singleton pregnancy (P=.007), and antenatal steroid therapy (P=.018). Although 62.7% (32 of 51) of infants delivered by cesarean section survived compared with 50.9% (140 of 275) of infants delivered vaginally, the increased survival was not statistically significant (X2=1.97). Moreover, the trend favoring cesarean section disappeared after adjustment for confounding obstetric factors. In univariate analyses cesarean births more frequently required ventilatory support and there was a trend toward a lower incidence of cerebroventricular hemorrhage; again, however, when adjusted for extraneous factors these associations disappeared. Of the 172 in-hospital survivors, five died at home unexpectedly; 162 of the remaining 167 were traced; 18 (11.1%) had cerebral palsy and two (1.2%) were deaf. Of the 111 children who were fully assessed, 13.5% had major handicaps, 23.4% were suspect, and 63.1% were free of handicap at two years' corrected age. There was no association between mode of delivery and frequency of handicap. Little evidence was found from mortality or morbidity data to support routine delivery of infants of borderline viability by cesarean section.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Using a 1982 to 1983 regional network data bank of 33,545 delivered infants, a study was conducted comparing 574 macrosomic infants weighing greater than 4500 g to a control group of 18,739 infants whose birth weights were 2500 to 3499 g. Macrosomic infants occurred in 1.7% of the deliveries. Women delivering macrosomic infants were significantly older, of higher parity, more obese (greater than 90 kg), and more frequently diabetic and postmature (longer than 42 weeks) than the controls. The women having macrosomic infants had a higher frequency of cesarean deliveries. The macrosomic infants were more often male and had more birth trauma and shoulder dystocia, higher death rates, and lower Apgar scores. Five-minute Apgar scores were lowest in the very macrosomic subgroup (greater than 5000 g). The high-risk group triad included obesity, diabetes, and postdates and had a macrosomia frequency of 5 to 14%. Macrosomic infants delivered by cesarean section had significantly fewer birth injuries. Because of these serious perinatal problems, women at risk should be screened for macrosomic infants, and if found, they should be delivered electively cesarean section.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Amniotic fluid volume was serially assessed by real-time ultrasound in 90 patients who presented with premature rupture of the membranes (PROM) and not in labor. The degree of oligohydramnios was correlated to the outcome of pregnancy, as reflected by pregnancy prolongation, intrapartum fetal heart rate patterns consistent with umbilical cord compression, cesarean section rate, fetal distress, infection, and perinatal mortality rate. These data suggest that in patients with PROM the degree of oligohydramnios is positively correlated with unfavorable pregnancy outcome.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Use of corticosteroids in the management of rupture of the membranes in a preterm gestation was evaluated. Ninety-three mothers (105 infants) received β-methasone, whereas 105 mothers (112 infants) did not. The incidence of significant neonatal respiratory complications was statistically higher for β-methasone-treated (26.6%) compared with nontreated patients (11.1%) who delivered more than 48 hours after rupture of membranes. Neonatal septic complications also were significantly higher in treated (21.3%) than in nontreated (9.2%) patients delivered 48 hours after rupture of membranes. Maternal sepsis was not statistically different between the two groups. In the nonsteroid-treated patients, the incidence of significant respiratory distress syndrome was greater for those infants delivered within 48 hours (31.0%) than those delivered more than 48 hours (11.1%) from rupture of membranes. The data support conservative management and indicate that corticosteroid administration in a preterm gestation with rupture of membranes is not beneficial to the newborn.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The medical records of 330 patients treated with terbutaline infusion for the inhibition of preterm labor were reviewed over a five-year period. In patients with intact membranes the results were uniformly good, particularly when treatment was instituted before the 30th week. Half these patients had a prolonged labor of six weeks or more; in most cases of treatment failure complications already existed on admission. In only nine patients (2.7%) terbutaline treatment was stopped due to side effects: predominantly maternal tachycardia or vomiting. Two patients had chest symptoms, but in no case was pulmonary edema diagnosed. The results suggest that a low incidence of severe side effects can be obtained if the following precautions are taken: glucose is used as the infusion medium, instead of sodium chloride; concentrated solutions are given to avoid fluid overload; the patients are carefully controlled; and the infusion is immediately reduced or stopped if signs of severe side effects appear.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

To study cost-effective screening criteria for gestational diabetes, a prospective study of 1012 patients was completed. All patients underwent a glucose screen between 26 and 30 weeks of gestation, consisting of a 50-g oral glucose load followed by a one-hour plasma glucose determination. Patients with a glucose screen greater than or equal to 130 mg/dL were studied with a standard three-hour oral glucose tolerance test. The incidence of gestational diabetes was 2.4% (24 of 1012). Only one gestational diabetic was identified with a glucose screen below 150 mg/dL. Twenty-two of the 24 cases were at least 24 years old. Twenty-one of the 24 (88%) gestational diabetes had a glucose screen greater than or equal to 150 mg/dL and were 24 years old or greater. The cost of the diagnosis in these latter patients was 40% of the cost of diagnosis of universal screening with a threshold of 130 mg/dL. It is concluded that screening with a threshold of 150 mg/dL only patients who are at least 24 years old should be considered an alternative to universal screening.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Screening interviews to determine the extent of physical abuse were conducted for 742 women seen in the University of Virginia obstetric clinics. Eighty-one women (10.9%) reported that they had experienced abuse at some point in the past. These women were more likely to be divorced or separated, indigent, and less educated than were the nonabused control patients. They were more likely to have had emotional problems, and 20% had attempted suicide. Twenty-nine of the 81 women reported abuse during the current pregnancy, with 21% reporting increased abuse and 36% noting decreased abuse during pregnancy. Women living with an abusive partner did not experience a greater frequency of adverse pregnancy outcomes than did those who had left abusive relationships. An awareness of the extent of the problem and direct questioning will result in an increased identification of women who are at risk for physical abuse during pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Presented is a prospective, controlled study to determine if intrapartum fetal tachycardia is reliable as an indicator of maternal and fetal infectious morbidity. Thirty neonates with defined intrapartum tachycardia were matched by gestational age and weight with 30 control subjects without defined tachycardia. There was a significant difference in maternal febrile morbidity and a trend toward a difference in maternal infectious morbidity between the two groups. There was no significant difference in maternal complications at delivery or administration of antibiotics to the mother. Among the neonates, there was a significant difference in administration of antibiotics and the incidence of respiratory distress syndrome (RDS) between the two groups; however, both of these were significantly related to birth weight. There was no significant difference between the two groups in duration of ruptured membranes, duration of labor, number of vaginal examinations, or antepartum anemia. Only one study infant had a bacteremia. The data confirm an increased risk of neonatal complications, such as RDS, asphyxia, and meconium aspiration, in association with intrapartum fetal tachycardia.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Postcesarean section febrile morbidity remains a common problem on obstetric services. Although a few preliminary studies have reported on the use of ultrasound to assess the postcesarean section patient, they have not compared sonographic findings with either intraoperative or postoperative events. These reports have noted fluid collections around the incision site. In this report of 100 postcesarean section patients, it is noted that echo-free areas anterior to the incision site, which correspond to the described fluid collections, were present in 29% of patients and were more frequently found in patients with excess blood loss surgery. Patients whose echo-free areas were greater than equal to 3.5 cm were significantly more likely to have postoperative morbidity. The significance of these findings and the role of ultrasound in the evaluation of the postcesarean section patient are discussed.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

It has been suggested that general anesthesia is a risk factor for postcesarean infectious morbidity. A retrospective review of 206 women who underwent repeat cesarean delivery at Duke University Medical Center was conducted. Group 1 consisted of 106 patients whose repeat cesarean section was performed with regional anesthesia, and group 2 included 100 patients whose repeat cesarean section was performed with general anesthesia. Group 2 patients were more likely to be of low socioeconomic status. There were no statistically significant differences between the two groups with regard to multiple indexes of postoperative fever or infection, including febrile morbidity, diagnosis of infection, use of therapeutic antibiotics, fever index, and postoperative hospital stay. General anesthesia, as administered to patients in the present series, does not increase the risk of infectious morbidity after repeat cesarean delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID