摘要:

This report details the outcome of pregnancy in 469 patients admitted before 34 weeks' gestation with premature labor with intact membranes (253 patients) or premature rupture of the membranes (PROM) but no labor (216 patients). Betamethasone significantly reduced the incidence of severe respiratory distress syndrome (RDS) both in patients with intact membranes and in those with PROM. PROM had a significant beneficial effect on the incidence of RDS in both groups of patients, those who had received betamethasone and those who had not. Fetal sex did not significantly influence the respiratory response to either PROM or betamethasone administration, except that betamethasonetreated female fetuses showed a significantly better response to PROM than similarly treated males. Except in patients with PROM associated with a cervical suture, betamethasone administration did not increase the risk of perinatal or maternal infection.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Thirty patients at term undergoing cesarean section received intraoperative irrigation with either cefamandole, cephalothin, or ampicillin to prevent postoperative infection. Serum drug levels were measured at 15, 60 and 120 minutes after completion of irrigation. Serum levels at each sampling interval were highest for cefamandole and lowest for cephalothin. Less than 2% of the total drug dose was excreted in the urine during the first 2 postoperative hours. In most patients, maximum serum antibiotic concentrations exceeded minimal inhibitory concentrations for several recognized pelvic pathogens. It is concluded that the mechanism of action of intraoperative irrigation may in part be due to systemic absorption of antibiotic and not simply to a local effect on the endometrium. Moreover, the degree of systemic absorption may be sufficient to cause allergic drug reactions and to exert selective pressures for the emergence of drug-resistant microorganisms.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

After double-blind controlled studies demonstrated cefamandole nafate irrigation of the uterus during cesarean section to be effective in reducing the rate of endomyometritis, antibiotic irrigation was adopted as a standard procedure at Tripler Army Medical Center. The present study analyzes the outcome in patients undergoing cesarean section before (comparison group) and after (treatment group) routine use of antibiotic irrigation began. The incidence of endomyometritis in 100 patients from the comparison group was 20% and in 298 patients from the treatment group 1.7% (P<.0001). Serum analysis for cefamandole nafate demonstrated little systemic absorption of the antibiotic. Cefamandole nafate intrauterine irrigation at cesarean section effectively prevents endomyometritis.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

From 1960 to 1980 at Memorial Hospital Medical Center-Miller Children's Hospital, the mean birth weight for termsize neonates increased from 3381 to 3458 g in spite of increases in ethnic groups known to have smaller neonates. More significantly, the incidence of macrosomic neonates (birth weight greater than 4000 g) increased from 7.0 to 10.7%. Because of this marked increase in the incidence of neonatal macrosomia, a prospective study was designed to characterize the macrosomic neonate anthropometrically. The results of this study revealed that neonates experiencing shoulder dystocia had significantly greater shoulder-to-head and chest-to-head disproportions than did macrosomic neonates delivered by cesarean section for failed progress in labor or macrosomic neonates delivered without shoulder dystocia. In addition, neonates of diabetic mothers also showed significantly greater shoulder-head and chest-head size differences than did neonates of nondiabetic mothers of comparable weight. These data suggest that antenatal ultrasonic measurements to compare chest-head size difference in fetuses suspected to be macrosomic and in diabetic pregnancies could be of value in selecting patients for the appropriate route of delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The value of perceived fetal activity as an indicator of fetal health has been studied prospectively. Pregnancies in which there were fewer than 10 movements in 12 hours were associated with a significant increase in perinatal mortality, fetal distress, and fetal compromise. The potential for fetal movement counting as a screen for all pregnancies is discussed.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The nonstress test (NST) was used as the primary tool in the management of 318 high-risk pregnancies. A simple and reliable method for interpreting the NST is obtained by dividing the total number of fetal heart rate accelerations associated with fetal movements by the total number of fetal movements. This is expressed as a percentage called the acceleration:fetal movement ratio. Fetuses at risk who were delivered within 7 days of the last NST form the basis of this report. The incidence of fetal distress and small-for-gestational-age infants was significantly higher (P<.05) in 47 fetuses with an acceleration:fetal movement ratio below 10% than in the group with a ratio over 10%. Also, perinatal mortality was more common in this group. The advantages and limitations of applying this quantitative method of interpreting the NST to the management of high-risk pregnancies are discussed.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The nonstress test (NST) and the contraction stress test (CST) have had wide application to term pregnancies, but little has been reported of use in the management of preterm fetuses. Seventy-two of 438 high-risk gravidas, receiving both tests between 25 and 34 weeks' gestation, delivered singleton infants before completion of their 34th week. On the basis of the last NST and CST preceding delivery, the 72 fetuses could be divided into reactive-negative and nonreactive-positive groups. Nonreactive-positive fetuses experienced greater perinatal mortality and significantly higher rates of intrapartum fetal distress, neonatal depression, respiratory distress syndrome (RDS), intrauterine growth retardation, and cesarean section. Pulmonary complications in nonreactive-positive fetuses, regardless of the lecithin: sphingomyelin ratio, were significantly increased if intrapartum fetal distress had preceded delivery. Most neonatal deaths stemmed from RDS-related complications, 86% preceding the 31st week of gestation; however, nearly half of the perinatal deaths before the 30th week followed reactive NSTs. The data suggest that for clinical management of preterm pregnancy, fetal heart rate testing should be initiated after the 29th week; earlier, test significance is less clear and infant survival less likely. Maternal estriol determinations aid little in the management of nonreactive-positive fetuses. Rather, the care of these selected pregnancies should be temporized through the 30th week; when delivery is then elected, intrapartum fetal distress should be avoided through liberal use of cesarean section in the nonreactivepositive group.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Serum glucose levels were measured in 50 nondiabetic pregnant women between 33 and 43 weeks' gestation following a nonstress test (NST) to determine the relationship between maternal glucose levels and the results of the NST. Two comparable groups of 25 patients each were formed based on the NST results, reactive and nonreactive. Overall, maternal glucose level for the study population was 71.3 ± 20.1 mg/dl. Although the difference was not statistically different, the nonreactive NST group did demonstrate slightly higher glucose levels (71.6 ± 17.3 mg/dl) than did the reactive group (70.9 ± 17.3 mg/dl). Furthermore, patients studied for suspected intrauterine growth retardation or who had a history of a prior stillbirth had significantly lower (P<.025) glucose levels than those tested for other indications. These results suggest that there is no correlation between the NST results and maternal serum glucose concentrations in a nondiabetic population. The significantly lower maternal glucose levels observed in the intrauterine growth retardation and prior stillbirth groups warrant further investigation.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Twenty-five study patients in whom laminaria tents had been used for the preinduction ripening of the cervix were compared with 28 control patients in a retrospective study. Both groups had comparable indications for induction, parity, mean maternal age, mean birth weight, and gestational age. Although laminaria appeared to be effective in reducing the duration of induction, no difference in the incidence of cesarean birth was apparent between the laminaria and nonlaminaria groups. Maternal endometritis was present in 15 of 25 mothers in the laminaria group, and in 3 of 28 in the control groups (P<.05). All 9 mothers who had cesarean deliveries in the study group had endometritis, whereas it occurred in only 3 of 11 in the control group (P<.005). Six of the 16 patients in the study group who delivered vaginally had endometritis, whereas none of 17 in the control groups had it (P<.01). Five of 25 neonates in the study group had sepsis, but there was no evidence of sepsis in the 28 control neonates (P<.05). Three of the 5 septic neonates died, There were no neonatal deaths in the control group. The findings suggest that laminaria use is associated with significant risk of maternal and neonatal infectious morbidity.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The distribution and content of luteinizing hormone-releasing hormone (LH-RH) in human placental tissues were detected by enzymatic antibody and immunofluorescence techniques. Anti-LH-RH was taken up strongly by cytotrophoblasts and the villous stroma at 8 weeks of pregnancy; the uptake decreased with the progress of pregnancy. Anti- LH-RH was not taken up at all by syncytiotrophoblasts throughout pregnancy. These findings suggest that LH-RH is synthesized in the cytotrophoblast and villous stroma. The role of placental LH-RH in the synthesis of human chorionic gonadotropin is discussed.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID