摘要:

A retrospective survey of Winnipeg Rh laboratory data from January 1, 1981 to December 31, 1984 determined that, despite placental localization, 2.6% of 974 women having amniocenteses performed at 16 to 18 weeks' gestation for genetic reasons and 2.3% of 1215 women having amniocenteses performed between 32 and 38 weeks' gestation had fetal-maternal transplacental hemorrhages greater than or equal to 0.1 ml of fetal red cells due to placental trauma. In 1.6 and 1.8%, respectively, the fetal transplacental hemorrhages were greater than or equal to 1 mL. Four of 99 alloimmunized women undergoing 257 amniocenteses for determination of severity of fetal erythroblastosis had fetal transplacental hemorrhages all greater than 5 mL of fetal red cells. The 1.9% incidence of fetal transplacental hemorrhages after amniocentesis in alloimmunized women is 83% less than the 11.2% incidence that occurred in the authors' institution from February 1963 to December 1966. However, in three of the four women, there was a very rapid rise in Rh antibody titer and increased severity of Rh fetal disease. Only the alloimmunized woman who meets strict criteria, indicating that her fetus is at risk of fetal death, should be subjected to amniocentesis, and then only after careful placental localization by ultra sound. Because fetal transplacental hemorrhages occur after amniocentesis despite ultra sound placental localization, 300 jug of Rh immune globulin should be administered to all unimmunized Rh negative women after amniocentesis.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

To investigate metabolic and endocrine changes in the fetus during prolonged maternal tocolysis with beta sympathomimetic drugs, ritodrine hydrochloride (2.1 µg/kg per minute) was infused into pregnant sheep near term. Confirming earlier studies, maternal plasma metabolite and hormone levels changed greatly during the first six to eight hours of infusion. Changes in the fetus paralleled these closely: glucose, lactate, and insulin increased sharply, but glucagon and a-amino acid nitrogen decreased. After this, most maternal and fetal plasma metabolite and hormone levels returned to the normal range and were unchanged by infusion for 72 to 96 hours. Fetal lactate levels, however, remained elevated. Similar changes occurred during interrupted maternal infusions of ritodrine. Prolonged infusion of ritodrine leads to diminished responsiveness in β-adrenergic mechanisms regulating maternal plasma metabolite and hormone levels. Comparable unresponsiveness of fetal β-adrenergic mechanisms, though less certain, could increase hazards during delivery and adaptation to postnatal life.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The risk factors associated with the occurrence of shoulder dystocia were examined in the general obstetrical population of women delivering vaginally. An increasing incidence of shoulder dystocia was found as infant birth weight increased. Although one-third of shoulder dystocia occurred in pregnancies at 42 + weeks, except for those resulting in infants weighing 4500+ g, the vast majority was unaffected by shoulder dystocia. The incidence of shoulder dystocia in nondiabetic gravidas delivering an infant weighing 4000 to 4499 and 4500+ g vaginally was 10.0 and 22.67r, respectively. Within the 4000- to 4499-g group, no labor abnormality was clearly predictive; however, in the heaviest birth weight group, an arrest disorder heralded a shoulder dystocia in 55.0% of cases. Diabetics experienced more shoulder dystocia than nondiabetics. Among them, 31% of vaginally delivered neonates weighing 4000+ g experienced shoulder dystocia. Nevertheless, the risk factors of diabetes and large fetus (4000+ g) could predict 73% of shoulder dystocia among diabetics; large fetus alone flagged 52% of shoulder dystocia in nondiabetics. Cesarean section is recommended as the delivery method for diabetic gravidas whose estimated fetal weight is 4000+ g. If others confirm the risk, the authors advise serious consideration of cesarean section for gravidas who are carrying fetuses estimated to be 4500+ g and who experience an abnormal labor.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

This investigation compared the safety and efficacy of 3- and 5-mg doses of prostaglandin E2topical gel used for cervical ripening in 60 high-risk obstetric patients before oxytocin induction of labor. Both dosages significantly increased the Bishop score, unrelated to parity or gestational age. Induction time was significantly shortened, and the average maximum amount of oxytocin required was significantly less with the 5-mg dose, but not with the 3-mg dose, when compared with a placebo. Prostaglandin E2did not influence the cesarean section rate. Uterine contractions were stimulated in 87.5% of the patients who received the drug, and 37.5% went into active labor, suggesting that prostaglandin E2in these dosages is not an appropriate agent for local cervical ripening.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

This investigation was undertaken to determine the relationship, if any, between peripheral placental separation and idiopathic premature labor. Ninety placentas from prematurely delivered patients (who had had no antepartum bleeding) were examined grossly and microscopically. Criteria for antepartum peripheral placental separation included adherent clot, with fibrin deposition and lamination, as well as polymorphonuclear infiltration and marginal decidual necrosis. Forty-nine placentas showed unequivocal evidence of previous peripheral separation. Another three placentas showed presumptive evidence of previous peripheral separation. It is suggested that this separation is of venous origin, and that it may play a role in the process of premature labor. This is not necessarily a cause and effect relationship.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Reported are sonographic criteria for distinguishing the chorionic type of twin pregnancies prenatally. Thirty-four twin pregnancies were prospectively evaluated with correct assignment of chorionic type in 33 cases. The ability to determine the chorionic type of twin gestation facilitated the prenatal diagnosis and management in eight of the studied cases. Knowledge of the type of twinning antenatally is important in the management of twin pregnancies.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The effectiveness of several measures that may reduce the risk of luteal phase pregnancies after interval tubal sterilization was analyzed. Using data from the Collaborative Review of Sterilization on 5495 women, 18 luteal phase pregnancies were identified. Women who underwent sterilization after their estimated date of ovulation had a low risk of having a luteal phase pregnancy if they used oral contraceptives or an intrauterine device in the month before sterilization. Of the 18 luteal phase pregnancies, 14 (78%) occurred among the 16.8% of the women who were sterilized after their estimated date of ovulation and who had used barrier, rhythm, or withdrawal methods of contraception in the month before sterilization. The use of concurrent dilatation and curettage in these women al increased risk of luleal phase pregnancy did not lower their risk to that of women who were sterilized before their estimated date of ovulation.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The effect of norethisterone on bone mineral metabolism was examined in 43 postmenopausal women. A significant decline in serum calcium, phosphate, and alkaline phosphatase in urinary calcium/creatinine ratio and in tubular maximum reabsorption of phosphate was demonstrated. There was no alteration in urinary hydroxyproline/creatinine ratio. The bone mineral content measured over two years by single photon absorptiometry was compared in 20 patients receiving norethisterone and a matched control group receiving placebo. There was significant protection against bone loss in the norethisterone group.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Two hundred ninety-four women with cervical intraepithelial neoplasia were treated once with either cryotherapy or laser vaporization. Treatment results were controlled for grade, size, and distribution of cervical intraepithelial neoplasia. Cervical intraepithelial neoplasia measuring less than 3 cm in diameter without extension into the endocervix had similar low failure rates (4 to 5%), regardless of histologic grade or instrument used. Carbon dioxide laser produced comparatively better results for lesions larger than 3 cm in diameter (92%) and those with up to 5 mm extension into the endocervical canal (89%), compared with 62 and 50%, respectively, with cryotherapy. Complications after cryo- and laser therapy were 0.6 and 7.4%, respectively, and included bleeding and pelvic inflammatory disease. Tailoring treatment modalities according to cervical intraepithelial neoplasia size and location rather than using a single treatment approach provides for the most cost-effective and therapeutically rewarding clinical practice.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

This is a retrospective review of 11 cases of primary malignant neoplasm of the female urethra seen at the Louisiana State University Medical Center in Shreveport from 1951 to 1984. The disease was relatively more frequent in the 60- to 79-year age-group. Squamous cell carcinoma was the most common among the different observed histopathology. A modified clinical staging system is introduced. At diagnosis, eight of 11 subjects (73%) had locally extensive disease. The majority of the patients were treated with radiotherapy alone or in combination with surgery. The overall severe complication rate was low. The poor results (20% local control and survival) obtained in this small experience suggest that perhaps n study using promising adjuvant chemotherapeutic agents is warranted. A literature review summary of reported radiotherapy results is included.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID