摘要:

Spontaneous hepatic rupture secondary to severe pregnancy-induced hypertension is associated with a high rate of maternal and fetal mortality. Numerous types of surgical management have been described, but a uniform surgical approach has not been accepted. The purpose of this review was to examine modes of surgical therapy reported in the literature since 1976, as well as the 11-year experience at our institution. Twenty-eight cases were extracted from the literature and seven more were identified at our institution. The incidence in our population was one per 45,145 live births. Among 27 cases managed by packing and drainage, an 82% overall survival was achieved, whereas only 25% of eight patients undergoing hepatic lobectomy survived (P=.006). Hepatic hemorrhage with persistent hypotension unresponsive to blood products should be managed by evacuating the hematoma, packing the damaged liver, and draining the operative site. More aggressive surgical techniques, such as hepatic artery ligation or hepatic lobectomy, should be reserved for refractory cases.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Maternal serum C-reactive protein (CRP) has been studied extensively as an adjunct in the diagnosis of subclinical infection among pregnant women with preterm labor or preterm rupture of membranes. However, before the utility of CRP can be studied in pregnancies with these complications, the effects of normal pregnancy and labor on maternal serum CRP levels must be established. We determined CRP levels serially from 22 weeks' gestation until delivery in healthy pregnant women without antepartum complications. Median CRP values for women not in labor ranged from 0.7-0.9 mg/dL, depending on gestational age; 95% of the values were 1.5 mg/dL or lower. No consistent change in CRP levels with gestational age was found among serially sampled women not in labor. The median CRP value for women in labor at term was 1.3 mg/dL, and 32% of values were over 1.5 mg/dL. Median CRP values in normal pregnancies appear to be higher than standardized values for nonpregnant individuals, and CRP values are further elevated in labor. Understanding the physiology and temporal course of the increase in CRP in normal pregnancy and labor may help to clarify the appropriate use of CRP in complicated pregnancies.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Home monitoring of blood glucose by reflectance meters has been shown to be accurate in the nonpregnant diabetic and is currently used for outpatient glucose control in the pregnant diabetic as well. Beckman ASTRA glucose results from samples collected into sodium fluoride were used as the standard for this study. Comparisons were then made to four glucose reflectance meters: Accu-Check II, One Touch, DiaScan S, and ExacTech. Although the reflectance meters appeared to be useful for assessing blood glucose trends in the pregnant diabetic, the results obtained from these meters would be unacceptable in the laboratory setting. Unfortunately, because of the erratic combination of proportional and constant bias, correction factors are not easily ascertained. Laboratories and physicians should reconsider the use of these reflectance meters for inpatient evaluation and general population screening of pregnant women.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We analyzed the urinary sediment of 30 patients with severe preeclampsia every 4 hours during early labor, delivery, and the postpartum period. Fifteen normal control patients were also followed in a similar fashion. No casts were noticed in the urine samples of the control group. However, the urinary sediment of preeclamptic patients revealed the same uniform pattern regardless of the state of coagulation, or the presence or absence of oliguria or eclamptic seizures. Numerous granular and hyaline casts, red-cell, and tubular cell casts were identified during microscopic evaluation. These data reflect both glomerular and tubular damage in preeclampsia. We conclude that urinary sediment analysis in severe preeclampsia uniformly reflects renal parenchymal damage and does not correlate with or predict the clinical course of the disease.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The relationship between maternal hematocrit and pregnancy outcome at various times in pregnancy was studied in 17,149 iron- and folate-supplemented pregnant women. On univariate analysis, early-pregnancy hematocrits below 37% were associated with preterm delivery. However, this relationship was not confirmed by multivariate analysis controlling for other risk factors. On both univariate and multivariate analyses, both early and later in pregnancy, hematocrits above 40% were associated with preterm delivery. In every gestational time period, at least part of the excess of preterm births was explained by an increase in indicated preterm deliveries. In both early and late pregnancy, and in both the univariate and multivariate analyses, only high hematocrits were associated with fetal growth retardation. The strongest association (odds ratio above 2) between high hematocrit and both fetal growth retardation and preterm delivery occurred with hematocrits at or above 43% at 31-34 weeks' gestation.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A rising cesarean birth rate, both nationally and at our institution, led us to attempt to reverse the trend. Vaginal birth after cesarean (VBAC) was introduced as an alternative to repeat cesarean in 1982. The impact of VBAC on the cesarean rate for our institution was assessed from 1982- 1988. Over the period studied, the rate of repeat cesarean rose from 5.0% in 1982 to 6.9% in 1985, then steadily fell to 5.3% in 1988. During this same period, the primary cesarean rate rose from 7.5% in 1982 to 11.9% in 1986, then declined to 10.6% in 1988. Changes in the rate for all cesareans paralleled those for primary procedures: 12.5% in 1982, 17.6% in 1986, and 15.9% in 1988. In patients with a history of previous cesarean, the relative risk of repeat cesarean dropped from 10.2 (95% confidence interval 8.8-11.8) in 1982 to 5.2 (95% confidence interval 4.5-6.0) in 1988. In the face of a rising rate of primary cesarean births, the introduction of VBAC has helped to stabilize the overall cesarean rate at our institution.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We measured maternal blood pressure and heart rate, fetal heart rate, and umbilical artery velocity waveforms in 25 healthy women placed in the supine and in both right and left 5° and 10° lateral tilt positions. Although we found no significant difference among these variables in the various maternal positions, two of 25 women became hypotensive and symptomatic in the supine and 5° tilt positions. Because we could not predict which women would become symptomatic, we recommend lateral tilt of all pregnant women during operative procedures beyond 20 weeks' gestation, including those in the lithotomy position for vaginal delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Five hundred thirty-four pregnancies exceeding 294 days were monitored by weekly sonographic estimations of amniotic fluid columns, daily maternal recordings of fetal movements, and thrice-weekly nonstress tests. In addition, each woman received twice-weekly studies of the uteroplacental and umbilical circulations by means of Doppler ultrasound. There were no fetal deaths in the study. Of the individual methods of fetal surveillance, absence of enddiastolic frequencies in the umbilical artery was the most sensitive, predicting 91% of fetuses who developed fetal distress in the first stage. Combining the test with sonographic estimation of amniotic fluid columns improved the prediction to 100%, with only a minimal fall in the specificity. These results strongly suggest that a combination of umbilical artery Doppler waveforms and amniotic fluid determinations is an adequate method of monitoring the post-dates pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Analysis of umbilical artery flow velocity waveforms, especially systolic-diastolic (S-D) ratio, can predict some pregnancy abnormalities. Most of the earlier studies did not specify the exact segment of umbilical artery sampled. We studied 53 normal singleton pregnancies between 18-41 weeks' gestation to compare S-D ratio measurements of the umbilical artery at different sites: 1) abdominal insertion site, 2) placental insertion site, 3) mid-cord, and 4) an undetermined site. The mean S-D ratio was significantly different (P<.01) at various segments of the umbilical artery—higher near the abdominal insertion site when compared with the mid-cord, near-placental, and undetermined sites. The S-D ratio at mid-cord was higher than at the undetermined site and the placental insertion site. The near-placental-site S-D ratio was not different from the undetermined site. A lower S-D ratio at the undetermined site may not adequately reflect the true physiologic status of the fetus. Specifying the site of measurement should be an integral part of any report, in order to describe accurately the pathophysiology of fetoplacental circulatory diseases.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Eighty-two patients at 287 days' gestation or longer were tested by nonstress test (NST), amnioscopy, ultrasound assessment of amniotic fluid volume, and Doppler velocimetry. Several maternal and fetal arteries were analyzed: uterine, umbilical, descending thoracic aorta, renal, and middle cerebral. During the study, other maternal-fetal functional indices were recorded: hPL, estriol, hematocrit, platelets, mean platelet volume, and uric acid. No abnormalities were found in the uterine, umbilical, middle cerebral, thoracic descending aorta, and renal artery velocimetry in post-dates gestations. However, a significant reduction of the time-averaged mean velocity in the descending thoracic aorta was associated with an increased incidence of oligohydramnios, meconium-stained fluid, abnormal NST, and cesarean delivery for fetal distress. The present study suggests that serial Doppler flow measurements of mean velocity of the fetal descending thoracic aorta may be a simple and rapid technique for identifying prolonged pregnancies at increased risk for perinatal complications.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID