摘要:

Objective:To determine the incidence, size, and outcome of spontaneous massive fetomaternal transplacental hemorrhage in Manitoba.Methods:The Kleihauer maternal-fetal screening records at the Rh Laboratory were reviewed for the period October 1970 to December 1992. Rh Laboratory correspondence for the 7-year period ending December 31,1992, was reviewed to determine those instances of fetomaternal transplacental hemorrhage for which there was knowledge regarding fetal and neonatal outcome.Results:Twenty-seven of 30,944 Rh-negative women undergoing routine Kleihauer screening at delivery had fetomaternal transplacental hemorrhages of at least 80 mL of fetal blood (incidence one in 1146 pregnancies); in 11 of the 27, the hemorrhages were 150 mL of blood or more (one in 2813 pregnancies). In non-routinely screened, selected maternal blood samples, sent because of unexplained fetal distress, fetal death, or neonatal anemia, 36 had evidence of fetomaternal transplacental hemorrhage of at least 80 mL of blood, 28 of which were in the 7-year period ending December 31, 1992 (one in 3893 pregnancies). Of these 28, 25 had hemorrhages of at least 150 mL of blood (one in 4360 pregnancies). Ascertainment of fetomaternal transplacental hemorrhage of 150 mL or more in women referred because of fetal or neonatal problems was 2813/4360 x 100=64.5%. Twenty-six cases in the final 7-year period had information regarding perinatal outcome. The incidence of adverse outcomes following massive fetomaternal transplacental hemorrhage was 46% (12 of 26). There were ten perinatal deaths, one infant death at 6 months, and one infant with spastic quadriplegia.Conclusions:Massive fetomaternal transplacental hemorrhage is uncommon but not rare, and subsequent adverse outcomes are common. A high index of suspicion with prompt investigation and appropriate management may improve the perinatal outcome following massive fetomaternal transplacental hemorrhage.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To quantify the current perinatal consequences associated with intrapartum detection of meconium in the amniotic fluid (AF).Methods:We compared retrospectively the outcomes in 8136 term singleton cephalic pregnancies with meconium and 34,573 similar pregnancies with clear AF.Results:Virtually all measures of adverse fetal-neonatal outcomes were significantly increased with meconium. For example, perinatal mortality increased from 0.3 per 1000 births with clear AF to 1.5 deaths per 1000 with meconium (P<.001). Most of these deaths resulted from meconium aspiration. Other unwanted outcomes also increased; eg, severe fetal acidemia at birth (umbilical artery blood pH 7.00 or less) increased from three per 1000 to seven per 1000 when meconium was diagnosed (P<.001). Delivery by cesarean also increased with meconium, from 7 to 14% (P<.001).Conclusion:Meconium in the AF is an obstetric hazard with small but significantly increased risks of adverse fetalneonatal outcomes.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To review our experience with the antenatal detection and subsequent neonatal outcome of fetuses with a pelvic kidney.Methods:A retrospective review of 25,551 obstetric ultrasound examinations performed after 16 weeks' gestation identified 13 cases of fetal pelvic kidneys (one per 1965 examinations).Results:Three pelvic kidneys were dysplastic; the remainder appeared sonographically normal. Seven pelvic kidneys were measured; five were smaller than expected for gestational age. Associated anomalies were detected in three cases.Conclusions:Careful second- and third-trimester ultrasound examinations can detect an absence of the kidney in the renal fossa. Evaluating the migratory path of the kidney from the pelvis to the renal fossa will frequently result in detection of an ectopic kidney.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To evaluate the safety and diagnostic efficacy of ultrasound-guided fetal skin sampling for the prenatal diagnosis of genodermatoses.Methods:Seventeen pregnancies seen over 6.5 years were analyzed retrospectively. Fifteen were at risk for junctional epidennolysis bullosa and two for recessive dystrophic epidermolysis bullosa. Under ultrasound guidance, a biopsy forceps was inserted through a 14-gauge catheter and directed toward the fetus (thorax, back, or buttocks) to obtain skin samples. The procedures were performed at a mean of 18.3 weeks' gestation (range 16.5-19.5).Results:Fetal skin sampling was successful in all cases; the mean number of biopsies taken was 3.6 (range two to five). Five of the 17 fetuses were determined to be affected, each with junctional epidermolysis bullosa; these pregnancies were terminated electively and the prenatal diagnoses confirmed. The remaining 12 pregnancies resulted in the delivery of healthy infants at or after 37 weeks' gestation. There were no pregnancy-related complications, specifically preterm rupture of the membranes or pretenn labor. Three of the 12 infants had minor skin blemishes believed to be due to the skin sampling.Conclusion:Ultrasound-guided fetal skin sampling is the procedure of choice when fetal skin is required for prenatal diagnosis of genodermatoses.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To develop birth weight-for-gestational age nomograms based on a computerized perinatal data base collected prospectively from 1975-1992.Methods:Using information from over 60,000 singleton deliveries (January 1975 through October 1992) at the Metro- Health Medical Center in Cleveland, Ohio, standard curves for normal birth weights were computed. Nomograms were developed for the overall population and for subgroups determined by factors known to affect fetal growth, including sex, race, smoking status, and gestational diabetes. The nomograms included the tenth, 50th, and 90th percentiles of birth weights for 24-44 weeks' gestation. Gestational age was based on clinical obstetric estimates confirmed by Dubowitz assessment of the neonate. In addition, thirdorder regression models were developed to predict median birth weight using gestational age. These models were validated using delivery data for the months of November and December, 1992, which were not included in model development.Results:The most significant predictors of median birth weight were the first-, second-, and third-order gestational ages, which explained over 80% of the total variation in birth weight. Other significant factors influencing birth weight included infant gender, maternal race, parity, smoking, and diabetes status. Among the marginally significant factors influencing birth weight were pay status and maternal age. In general, before 33 weeks' gestation, there were few differences in the birth weight percentiles of various groups except for those with diabetes; infants of diabetic women exhibited greater birth weights as early as 26 weeks' gestation.Conclusions:Considering the large size of the data base and the diverse background of the study population, we believe that these nomograms provide useful norms of birth weight for an indigent urban population. These norms enhance the obstetrician's and neonatologist's ability to identify true cases of retardation or acceleration of intrauterine growth. Simple mathematical models provide easy calculation of the median birth weights for 24-44 weeks while adjusting for many confounding factors.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine the effect of cardiac valve replacement on pregnancy outcome.Methods:We reviewed retrospectively 151 pregnancies in 88 women: 56 pregnancies in 31 women with mechanical valves and anticoagulation therapy, and 95 pregnancies in 57 women with porcine tissue valves. Student t, X2and Fisher exact tests were used for analysis.Results:There was a significantly greater rate of fetal loss in patients with mechanical valve replacements than in those with porcine tissue valves (27.7 versus 12.3%, respectively;P<.05). No significant differences were found in prematurity (5.9 versus 7.7%) or small for dates infants (8.8 versus 10.8%). Two congenital anomalies were noted in the mechanical valve group. Maternal complications in patients with mechanical valves included valve dysfunction (three), thromboembolism (three), abruptio placentae (two), postpartum hemorrhage (two), severe oligohydramnios (two), and puerperal fever caused by brain abscess (one). Four cases of valve dysfunction and one of infectious endocarditis complicated the condition of patients with porcine tissue valves. The 10-year graft survival rate in the porcine valve group was lower following two subsequent pregnancies (16.7%) than following one (54.8%).Conclusion:Fewer fetal and maternal complications occurred in subsequent pregnancies after porcine valve replacement. However, the need for reoperation is more likely, and pregnancy might accelerate the degenerative process.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To identify risk factors associated with severe preeclampsia and to determine whether these factors are similar in nulliparous and multiparous patients.Methods:Patients whose pregnancies were complicated by severe preeclampsia (n=70) were compared retrospectively to 18,964 non-preeclamptic controls. Information on maternal demographic factors; medical, obstetric, and family histories; and neonatal outcome was retrieved and analyzed by univariate and multivariate analysis.Results:By logistic regression, the only risk factors associated with the development of severe preeclampsia were severe obesity in all patients (adjusted odds ratio 3.5, 95% confidence interval [CI] 1.68-7.46) and a history of preeclampsia in multiparous patients (adjusted odds ratio 7.2, 95% CI 2.74-18.74).Conclusion:Severe obesity and a history of preeclampsia are the only maternal risk factors identified for the development of severe preeclampsia.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine whether tight control of blood glucose is associated with normal outcomes in gestational diabetes.Methods:We studied 150 consecutive patients with gestational diabetes referred to a diabetes in pregnancy clinic. Selection criteria were an abnormal glucose tolerance test, diabetic management by one physician, capillary blood glucose monitoring in the prenatal period, and delivery at Grace Hospital. Degree of glucose control during pregnancy and maternal and perinatal outcomes were determined by chart review.Results:Overall average glucose levels were 4.9 mmol/L (89 mg/dL) before meals and 6.7 mmol/L (122 mg/dL) 1 hour after meals. Thirty-one percent of the patients were treated with insulin in the prenatal period. In this series, there was no perinatal mortality and no increased incidence of large or small for gestational age infants, cesarean delivery, preterm labor, pregnancy-induced hypertension, neonatal respiratory distress, hypoglycemia, polycythemia, symptomatic hyperbilirubinemia, symptomatic hypocalcemia, or congenital malformations.Conclusion:Tight glucose control is associated with normal perinatal outcome in gestational diabetes.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To determine the expected neonatal outcome in a hypothetical obstetric population with various screening and intrapartum management protocols for the prevention of neonatal group B streptococcal infections.Methods:We used decision analysis to investigate the performance of various antenatal and intrapartum group B streptococcal screening protocols combined with selective or universal intrapartum antibiotic prophylaxis in preventing neonatal early-onset group B streptococcal disease. Population characteristics, screening test performance, and treatment efficacy profiles were abstracted from previous investigations.Results:In the absence of screening or treatment, the estimated neonatal attack rate and mortality rate were 3.6 and 0.60 cases per 1000 neonates, respectively. Universal antenatal screening at 26-28 weeks' gestation and selective intrapartum prophylaxis (treatment of colonized women with risk factors) or nonselective prophylaxis (treatment of all colonized women) had attack rates of 1.64 and 1.08 and mortality rates of 0.21 and 0.18 cases per 1000 neonates, respectively. Rapid intrapartum screening and selective prophylaxis had an estimated attack rate of 1.92-2.58 and a mortality rate of 0.26-0.40 cases per 1000 neonates, with results dependent upon the time required to attain test results. Similarly, rapid intrapartum screening and nonselective prophylaxis had an attack rate of 1.44-2.30 and a mortality rate of 0.24-0.38 cases per 1000 neonates. Empirical prophylaxis of all women delivering prematurely, regardless of culture status, had an attack rate of 2.40 and mortality rate of 0.36 cases per 1000 neonates.Conclusions:Under ideal circumstances, antenatal group B streptococcal screening at 26-28 weeks' gestation with vaginal-rectal cultures and subsequent intrapartum prophylaxis is associated with lower projected neonatal attack and mortality rates than protocols using rapid intrapartum screening methods. However, in a non-research population, difficulties frequently encountered with antenatal screening procedures may minimize these differences.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine the risk of antiphospholipid antibody-related disorders in women with elevated levels of these antibodies.Methods:We used an historic cohort study design. Surveys of medical and obstetric histories for the interval from initial antibody testing to the time of patient interview were used to calculate age-adjusted rates for the development of medical disorders associated with antiphospholipid antibodies. The cohort included 130 women with lupus anticoagulant, medium to high levels of immunoglobulin G anticardiolipin antibodies, or both.Results:The median interval of study was 3.2 years (range 0.7-9.5, mean 3.7). Sixty-three subjects (48%) developed at least one new disorder during the study interval. The age-adjusted rates (per 1000 patient-years; ± standard error) for the development of the disorders studied were as follows: thrombosis (156.8 ± 30.0), cerebrovascular accident (93.8 ± 25.1), amaurosis fugax (57.1 ± 23.2), transient ischemic attack (170.4 ± 27.6), systemic lupus erythematosus (9.8 ± 3.8), and autoimmune thrombocytopenia (56.0 ± 22.2). Of the 34 thrombotic events that occurred during the study interval, eight were associated with pregnancy and eight occurred while the patients were taking anticoagulant medications.Conclusions:Our subjects developed complications associated with antiphospholipid antibodies at a substantial rate, and almost half suffered at least one new event during the study interval. The high rate of thrombosis in individuals with antiphospholipid antibodies, especially associated with pregnancy, underscores the need to evaluate long-term anticoagulation in these patients.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID