ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The hospital records were reviewed of 64 infants born at or after 37 weeks of amenorrhea who suffered perinatal mortality during a 3-year period at Boston Hospital for Women. The most frequent cause of death of a term or post-term infant was extrinsic perinatal hypoxia, and the second most common was lethal malformation. Half the deaths of term infants occurred ante partum. Further reduction in perinatal mortality for this group may require extension of antepartum fetal monitoring techniques to all pregnancies. Intrapartum loss was rare, occurring at a rate of 0.43 per 1000 for infants delivered at term, and not at all among post-term infants. Massive aspiration of amniotic sac content was found frequently in antepartum and intra-partum death, and death from meconium aspiration occurred in neonates despite intrapartum monitoring and early suctioning of the pharynx and trachea. Asphyxiated term and post-term infants consistently pass meconium. Prevention of all deaths from meconium aspiration, thus, will require the prevention of asphyxia. A goal for obstetric care is that no fetus alive in utero at 37 weeks of amenorrhea should subsequently die in the perinatal period, provided no lethal malformation is present.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Birth weight percentiles for gestational age were defined in 10,896 normal single live births of known maturity. Six hundred ninety-six infants with birth weights below the tenth percentile were compared with 574 controls to assess the effects of growth retardation and mode of delivery on fetal condition at birth. An Apgar score of less than 5 at 5 minutes was present in 112 growth-retarded infants and 50 normal infants; clinical fetal distress was present in 190 growth-retarded infants and 78 normal infants. Thirty growth-retarded infants died, 21 of them after 36 weeks' gestation. Apgar scores of less than 5 at 1 and 5 minutes were more often seen in immature infants, but the additional effect of growth retardation was not seen in this group. Forty-nine percent of the growth-retarded infants had low 5-minute Apgar scores after delivery by elective cesarean section, although less mature than the control group. Normal and breech deliveries were also more commonly associated with low scoring in growth-retarded infants, although immaturity was rare. Rotational forceps delivery was well tolerated. Breech and normal vertex deliveries were associated with depression at birth and increased perinatal mortality and morbidity in the growth-retarded infant, irrespective of maturity. Delivery by elective cesarean section was not shown to reverse this trend.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Several authorities have recommended cesarean section for all intrapartum breech presentations. The present study documents that judiciously selected fetuses at term in breech presentation may be safely delivered vaginally by a selective management protocol that requires cesarean section when mandated criteria are not met. The outcome and performance of 6 years of vaginal breech deliveries were evaluated. Those in the control groups were delivered by spontaneous vertex vaginal and elective repeat cesarean section procedures. Morbidity was not different in the protocol breech vaginal delivery group and in the controls. Mortality was found only in the nonprotocol-managed breech vaginal delivery group, which also had a morbidity 5 times greater than that of controls. Approximately half the term breech presentations that are properly selected and managed may be safely delivered vaginally, thereby avoiding a significant number of cesarean sections and the subsequent inherent risks. (Obstet Gynecol 56:687, 1980)

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

There are indications that prophylactic administration of 17α-hydroxyprogesterone caproate (17α-OHP-C) could be beneficial in the treatment of women at risk for preterm delivery. Since twin pregnancy is commonly associated with prematurity, 77 women with twin pregnancy were treated during the last trimester until the 37th gestational week with weekly injections of either 17α-OHP-C or a placebo, following double-blind principles. The gestational length and birth weight and the outcome of the neonates were similar in both groups. The administration of 17α-OHP-C thus seems ineffective in the prevention of prematurity risks associated with twin pregnancy. (Obstet Gynecol 56:692, 1980)

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Over an 18-month period, the cesarean section rate was 21.6%. The primary cesarean section rate was 14.9%. The various indications for the primary cesarean section are detailed. Cephalopelvic disproportion and breech presentation accounted for 50% of the primary cesarean sections. The frequencies of various types of morbidity (ie, endometritis, wound infection, and urinary tract infection) are presented and analyzed with respect to several variables. Patients who underwent primary cesarean section were at significantly greater risk of developing postoperative endometritis than were patients undergoing a repeat procedure. Labor, ruptured membranes, and the use of internal fetal-maternal monitoring were not significant risk factors for endometritis in the patients in this study. (Obstet Gynecol 56:696, 1980)

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Oxytocin (OT) metabolic clearance rates (MCR) were measured during the constant infusion of 4 mU/min synthetic oxytocin (Pitocin) in 22 healthy adult subjects: 6 men, 6 nonpregnant women, and 10 pregnant women. Pregnant subjects were at term and undergoing OT induction of labor. Mean (± SEM) baseline plasma OT concentrations were similar for men, pregnant women, and nonpregnant women. OT MCR was 27 ± 1.8 ml/kg/min in men; 20.6 ± 2.8 ml/kg/min in nonpregnant women; and 23.1 ± 2.6 ml/kg/min in pregnant women. These values were statistically similar. The OT MCR corrected to prepregnancy weight was 25.4 ± 2.0 ml/kg/min. This value is also statistically similar to the values in men and nonpregnant women. OT degradation was studied in vitro in pooled plasma of men, nonpregnant women, pregnant women, and cord blood. No significant degradation was observed in men, nonpregnant women, or cord plasma. There was an 85% per hour decrease in OT concentration in plasma of pregnant women, confirming earlier reports. These results suggest that the cystine amino peptidase enzyme mediating OT degradation in pregnancy plasma is preferentially secreted by tropho-blast cells into maternal plasma and does not seem to cross the placental barrier. (Obstet Gynecol 56:701, 1980)

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

In a series of 366 patients identified as at risk for a fetal neural tube defect (NTD) before the 24th week of pregnancy, 64 had an abnormal fetus. The abnormalities included anencephaly (39), open spinal defect (17), closed spinal defect (2), encephalocele (1), and a miscellany of other abnormalities (5). An ultrasound examination prior to diagnostic amniocentesis positively identified all anencephalic fetuses, the fetus with the encephalocele, and 15 of the 19 fetuses with spina bifida. The spinal defects in 3 of the 4 remaining fetuses were demonstrated at a second examination. Since both amniotic fluid α-fetoprotein (AFP) assays and ultrasound examination have been shown to give false results in the diagnosis of NTDs, the importance of using 2 independent diagnostic techniques is stressed. In patients with elevated levels of maternal serum AFP, a careful ultrasound examination, in addition to identifying the majority of cases associated with an abnormal fetus, provided a good explanation for the elevation in over half of the remainder. In this series more than half the patients (40/69) who underwent amniocentesis because of raised maternal serum AFP levels were shown to have an abnormal fetus. (Obstet Gynecol 56:705, 1980)

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A population of 1320 patients was reviewed to assess the clinical significance of antepartum meconium staining on the occurrence of premature rupture of the membranes. Specimens of amniotic membranes were studied by tensile strength testing from 2 population groups. The results of the retrospective review showed no difference in the incidence of premature rupture of the membranes between the populations with clear amniotic fluid and those with meconium-stained fluid at time of amniorrhexis. The tensile strength testing demonstrated that the study population with antepartum meconium-stained fluid had significantly lower stress tolerance. This investigation demonstrated a significant decrease in stress tolerance of human chorioamniotic membranes associated with a meconium-stained fluid environment, but this loss of stress tolerance is not apparently significant in clinical practice. (Obstet Gynecol 56:711, 1980)

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

To develop objective criteria for the individualization of patient management, the results of a series of investigations of 1764 midtrimester pregnancy terminations are examined. These include intraamniotic instillation of hypertonic saline or prostaglandin F2α, intramuscular 15(S)15-methyl prostaglandin F2α, and intravaginal prostaglandin E2. Laminaria and intravenous oxytocin augmentation have also been used. The relative advantages and disadvantages of these techniques are evaluated in terms of safety, efficacy, and acceptability. The effects of parity and length of gestation are considered. Before 20 weeks' gestation, vaginal prostaglandin E2is believed superior to the other techniques by most criteria, and intraamniotic saline is the authors' method of choice in more advanced pregnancies. (Obstet Gynecol 56:716, 1980)

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID