摘要:

Intrauterine growth retardation (IUGR) may affect up to 10% of pregnancies and results in substantially increased perinatal morbidity and mortality. Although many infants are small on a constitutional basis and not as a result of disease, many others suffer malnutrition from chronic progressive uteroplacental insufficiency. Genetic disease, embryonic infection, and various drug exposures may also result in IUGR. Inconsistency of diagnostic criteria has seriously hampered clinical research aimed at clarification of both the short- and long-term implications of IUGR. This part of the report examines both the significance and clinical definition of IUGR and reviews the diagnostic tests used for the detection of the problem of impaired fetal growth. The clinical approach to the management of IUGR is presented in the subsequent part of the report, which includes the ultrasonic evaluation and management of this entity.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

There is growing interest in the relationship between hospital size and the comparative safety of childbearing. Using death certificates received from each state health department for 1974 to 1978 and data provided by the American Hospital Association, national maternal mortality rates were calculated by hospital size (number of inpatient beds) and size of hospital obstetric service (annual number of live births). The smallest and largest hospitals had higher rates of maternal mortality than intermediate-size hospitals. These findings may have implications for improving the safety of childbearing in the United States.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The relation between bodily build and susceptibility to eclampsia has been controversial for nearly two centuries and the issue has been confused by modern studies of women with nonconvulsive hypertensive disorders in whom the diagnosis of preeclampsia is frequently erroneous. The present study is based upon 193 previously nulliparous and 49 multiparous eclamptic women. Sixty-three of the previously nulliparous women were compared with normal controls matched for age, race, parity, clinic, non-clinic, or private status, and as closely as possible with the time of delivery. Eclampsia spares no habitus, but has a slight predilection for underweight women.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The purpose of the present clinical investigation was to determine the influence of aggressive management, associated medical/obstetric complications, race, and gestational age on fetal, neonatal, and maternal risks associated with severe preeclampsia. Three hundred and three consecutive pregnancies complicated by severe preeclampsia were studied. All patients were delivered within 48 hours after admission to the perinatal center. In 91 patients the disease was superimposed on chronic hypertension. There was a significant difference between patients with and those without prior chronic hypertension regarding perinatal mortality (32 versus 7.7%), incidence of abruptio placentae (10 versus 4%), and frequency of small-for-gestational-age infants (33 versus 14%). Fifty-one patients (17%) had thrombocytopenia, 26 (8.5%) had hemolysis, elevated liver enzymes and low platelet count syndrome, and 22 (7.3%) had disseminated intravascular coagulopathy. There was a significant difference between white and black patients regarding the frequency of thrombocytopenia (28 versus 13%), hemolysis, elevated liver enzymes, and low platelet count syndrome (19.7 versus 5.3%), and coagulopathy (13 versus 1.4%). However, most of this apparent racial difference resulted from higher incidence of abnormal hematologic findings among patients who had conservative management by private physicians before transfer. Perinatal survival was zero when severe preeclampsia developed at or before 28 weeks, whereas it was 100% when disease developed after 36 weeks' gestation. The above factors should be considered in counselling patients with severe preeclampsia.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

In this prospective blind study, 735 patients with high-risk pregnancies referred for antepartum testing of fetal well-being were randomly assigned to either a fetal biophysical profile scoring (375 patients) or a nonstress testing scheme (360 patients). Management was based on the results of antepartum tests, but the method of testing used was not disclosed. Fetal biophysical profile scoring resulted in a significantly higher positive predictive value in regards to low Apgar scores. Sensitivity, specificity, and accuracy, although higher with fetal biophysical profile scoring, did not demonstrate significant differences when compared with the nonstress test. The negative predictive value between the two methods was similar. All major anomalies were detected during ultrasound scanning, whereas none of these anomalies were detected by heart rate testing alone.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The thesis that obstetric health care personnel can discriminate characteristics of baseline fetal heart rate (FHR) and FHR patterns by auscultation needs to be tested. For this study, audiotones of the FHR signals were recorded for eight representative FHR patterns. Each recording was for three minutes and included one uterine contraction. Physicians and nurses who use continuous electronic FHR monitoring on a regular basis listened to the eight recordings and attempted to identify the baseline rate, variability, and periodic patterns, and then matched their perceptions with the eight corresponding FHR tracings (not in order). Baseline FHR and FHR without periodic patterns were most frequently identified correctly. Late decelerations with and without good baseline variability were misdiagnosed 18.4 and 33% of the time, respectively. Although the FHR characteristics and periodic patterns were correctly identified most of the time, failure to recognize significant periodic patterns by as many as one-third of the participants is unacceptable in modern obstetrics.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Between September 1, 1976, and December 31, 1980, there were 4629 contraction stress tests performed at Women's Hospital, Memorial Hospital Medical Center of Long Beach, California. Forty-four (1.0%) of these tests were completely nonreactive. Eight of 3367 negative contraction stress tests (0.2%), 19 of 1124 equivocal contraction stress tests (1.7%), and 17 of 63 positive contraction stress tests (27.0%) were nonreactive. When compared with patients who had reactive tests, only those patients with a nonreactive, positive contraction stress test had significantly increased perinatal mortality and infants with low Apgar scores. Twelve percent of patients with nonreactive contraction stress tests had fetuses with congenital anomalies. Eighteen percent of patients with nonreactive tests were taking phenobarbital or other sedative drugs, and 45% of patients with nonreactive tests were hypertensive. Excluding anomalous fetuses, there were no perinatal deaths and no Apgar scores below 7 at five minutes in patients with nonreactive negative, or nonreactive equivocal, contraction stress tests as the worst test result. The hypothesis that the completely nonreactive negative contraction stress test as the worst test result is associated with increased perinatal mortality and morbidity could not be substantiated. Standardization of criteria for reactivity and interpretation of the contraction stress test using the entire testing period is desirable.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Four hundred eight-five fetal monitor patterns were reviewed to correlate the incidence of postparacervical fetal bradycardia with the preceding fetal heart rate pattern. Three hundred and one patients received a total of 408 paracervical blocks, with an overall incidence of bradycardia of 11.3%. Patients with reassuring patterns had an incidence of 8.4%, those with concerning patterns 20%, and those with very concerning patterns 39.1%.'Restricting the use of paracervical anesthesia to patients with reassuring fetal heart rate patterns should minimize this complication of obstetric anesthesia.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Glycosylated hemoglobin and blood sugar levels in the fasting state and two hours after oral 100 g glucose load were measured in 180 patients. Glycosylated hemoglobin was measured by cation exchange column chromatography, and blood sugar was measured by hexokinase reaction. Patients with an elevated postprandial and/or fasting blood sugar level (positive screen) subsequently underwent three-hour glucose tolerance test. The mean value of glycosylated hemoglobin in patients with a negative screen and normal hemoglobin was 6.17 ± 0.61%; and the value for glycosylated hemoglobin in patients with class A diabetes and normal hemoglobin electrophoresis was 6.85 ± 0.73% (P< .001). A glycosylated hemoglobin value greater than 6.78 (mean + 1 SD) was considered elevated. Glycosylated hemoglobin values were elevated in 21 of 33 patients with gestational diabetes and in 27 of 147 patients with normal blood sugar levels. The sensitivity and specificity of glycosylated hemoglobin for the diagnosis of gestational diabetes were 63.6 and 81.6%, respectively. Fifty percent of patients with an initially elevated glycosylated hemoglobin value delivered macrosomic infants, whereas no patient with a normal glycosylated hemoglobin value had a macrosomic infant. An elevated glycosylated hemoglobin value may alert the obstetrician of a potentially elevated mean blood sugar level and may warrant aggressive management of gestational diabetes.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Forty insulin-dependent diabetic women in the first trimester of pregnancy were studied. Fetal crown-rump length was measured by ultrasound and related to maternal hemoglobin A1c. Thirty mothers with normal size fetuses had an average hemoglobin A1clevel of 7.8%. Ten mothers had fetuses that were smaller than normal (equivalent to eight to 14 days less growth) and also had higher hemoglobin A1c, 8.9% (P< .05), indicating a more poorly controlled diabetes. Careful metabolic compensation in very early diabetic pregnancy should therefore be attempted to prevent induction of early fetal growth delay.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID