摘要:

We present an ethically justified, clinically comprehensive management strategy for third-trimester pregnancies complicated by fetal anomalies, based on 72 cases diagnosed at a gestational age of more than 24 weeks. These cases are organized into three categories: A) nonaggressive management and termination of pregnancy offered, three of 72 (4%); B) aggressive and nonaggressive management offered, 18 of 72 (25%); and C) aggressive management recommended, 51 of 72 (71%). We then ethically justify a clinically comprehensive management strategy. First, we describe the disclosure requirements of the informed-consent process. Second, we provide an ethical justification for the physician's recommendations among management alternatives. The justification for such recommendations is based on a continuum of beneficence-based obligations to the fetus that is developed in terms of a classification scheme of fetal anomalies, based on the degree of probability of antenatal diagnosis and degree of probability of outcome. When there are ho beneficence-based obligations to the fetus, the physician should recommend only termination of pregnancy or nonaggressive management. When there are minimal beneficence-based obligations to the fetus, only aggressive or nonaggressive management should be recommended. Finally, when there are more than minimal beneficence-based obligations to the fetus, only aggressive management should be recommended.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The majority of fetuses with omphalocele have other congenital abnormalities and, in many cases, an abnormal karyotype. We retrospectively studied 22 consecutive fetuses with sonographically diagnosed omphalocele and available karyotype to determine whether the contents of the omphalocele could predict the karyotype. Of these 22 fetuses, 18 had normal and four had abnormal karyotypes. Sixteen of the karyotypically normal fetuses had liver herniated into the omphalocele and two had only bowel present in the defect. All four of the fetuses with abnormal chromosomes had only bowel in the defect.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

We investigated the risk of maternal contamination in antenatal DNA diagnosis after second- and third-trimester transabdominal placental biopsy. For this purpose, we compared the restriction fragment length polymorphism (RFLP) patterns of 11 chorionic villus DNA samples after late chorionic villus sampling (CVS) with those of the corresponding maternal DNA. Ten of 11 aspirated tissue samples were not separated from maternal contamination before DNA extraction. All 11 mother-embryo pairs were informative for analysis of maternal contamination, ie, the mother showed one RFLP allele not present in the embryo. In none of the 11 cases did the fetal DNA show maternal contamination after molecular hybridization, although ten samples were contaminated with maternal tissue macroscopically and microscopically. Despite some maternal tissue admixture, the risk of contamination seems to be lower in the second- and third-trimester CVS than in first-trimester CVS, based on previous reports and our own experiences. This is most likely due to the anatomically closer contact of villi and decidua in the first trimester of pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Sonographic growth curves of biparietal diameter (BPD), head circumference, abdominal circumference, head circumference/abdominal circumference ratio, and femur length were generated from 24 uncomplicated, concordant triplet pregnancies. These were compared with the standard curves derived for singletons used in our medical center. Slowing of BPD, head circumference, and abdominal circumference growth was noted in triplets from the 28th week of gestation, whereas the head circumference/abdominal circumference ratio was similar to that of singletons. Femur growth was parallel to that of singletons, although on the low margin of the two standard deviations. We conclude that the growth patterns of triplets are different from those of singletons. We suggest that femur length derived for singletons may be suitable for the follow-up of triplets. However, when growth retardation is suspected, the growth curves presented herein may be used to identify the growthretarded fetus.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The transverse cerebellar diameter was obtained in 44 small for gestational age (SGA) fetuses between 27-42.8 weeks. Twenty-nine of 44 fetuses had antepartum and/or neonatal complications consistent with intrauterine growth retardation. The cerebellar diameter was normal in 12 (27.3%), between 1-2 SDs below the mean for gestational age in six (13.6%), and greater than 2 SDs below the mean in 26 (59.1%). Hence, the transverse cerebellar diameter cannot be used to assess gestational age in those fetuses suspected of being SGA.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Seventy-eight women at earlier than 35 weeks' gestation with premature rupture of membranes and/or preterm labor were randomly assigned to receive either 10 mg vitamin K1intramuscularly (IM) or no treatment. If delivery did not occur within 4 days, the dose of vitamin K1was repeated. Women whose pregnancies continued beyond 8 days received 20 mg of vitamin K1orally every day until the end of the 34th week or until delivery, whichever occurred earlier. The median maternal plasma vitamin K1level was significantly higher in treated than in untreated subjects (11.592 versus 0.102 ng/mL;P< .001). The median cord plasma levels were 0.024 ng/mL in the treated group and 0.010 ng/mL in the controls, a significant difference (P= .046). Median plasma vitamin K1levels were comparable in mothers receiving the drug by the IM route only and by both the IM and oral routes (10.533 versus 11.928 ng/mL;P= .460). The infants of the latter group, however, had significantly higher median cord plasma levels (0.42 versus 0.017 ng/mL;P< .001). There was no correlation between cord plasma vitamin K1levels and gestational age or duration of maternal supplementation with vitamin K1. We conclude that, in preterm pregnancies, vitamin K1crosses the placenta slowly and to a limited degree.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

In a randomized, controlled trial in five regional centers with state health department clinics, 1458 women at high risk for low birth weight (LBW) outcome received either prenatal interventions provided by nurse-midwives and nurses under their supervision or the standard high-risk prenatal care provided by obstetricians. The intervention administered by the nurse-midwives included patient education to identify the signs and symptoms of preterm labor, activity counseling in response to monitoring of the cervix by frequent examinations, stress reduction by enhancing social support, nutrition counseling with emphasis on weight gain, and substance-abuse counseling. For women in the control group, care was provided by obstetricians according to local standards for the management of high-risk pregnancies. We hypothesized that the LBW rate among live births to women who had received care from nursemidwives would be lower than that in the control group. Although the LBW rate was lower in the intervention group than in the control group, the observed difference was not statistically significant. Race was not prespecified as a possible effect modifier, but examination of the data post hoc suggested that black women at high statistical risk of giving birth to an LBW infant may have derived benefit from the program. Although the results do not suggest any striking advantage of the nurse-midwifery intervention over standard obstetric care for women at high statistical risk of having an LBW infant, neither do they suggest any disadvantage. Nurse-midwives could provide care to certain populations of high-risk women and facilitate future coverage of these presently underserved populations.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Uterine contractility patterns were studied in an attempt to identify those women on tocolytic therapy at risk for preterm delivery. One hundred sixteen women treated successfully after an episode of preterm labor were followed with an ambulatory tocodynamometer system. Contractions were monitored twice daily for 1 hour until delivery or until 36 completed weeks of gestation. In this group, 52 women (45%) delivered preterm and 64 (55%) delivered at term. The analysis revealed that 1) from 24-29 weeks' gestation, there was no significant difference in the uterine activity between the two groups; and 2) beginning at 30 weeks' gestation and continuing until the end of the 36th week of gestation, uterine activity was significantly greater in women destined to deliver preterm. These observations suggest that the patterns of daily uterine contractility observed in patients after an episode of preterm labor can identify those at greater risk for a preterm delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Little information exists to help determine the presence or significance of labor abnormalities in women attempting vaginal birth after previous cesarean. A case-control study was performed to obtain information on patterns of labor progress and the incidence of dysfunctional labor in patients having a trial of labor after previous cesarean delivery. Sixty-eight such women were matched to nulliparous and multiparous controls. Labor-curve characteristics for the group of women with previous cesarean differed significantly from those of both the nulliparas and multiparas. When stratified by history of previous vaginal birth, however, those with no previous vaginal birth were indistinguishable from nulliparous controls and those with a previous vaginal birth were indistinguishable from multiparous controls. Parity-specific criteria for the diagnosis of dysfunctional labor were thus indicated. Labor disorders were present most frequently in the previous-cesarean group with no previous vaginal birth (41.9%). This incidence did not differ significantly from that in the control nulliparas (27.1%) (P=.15), but did differ from that in the multiparas 15.8%) (P<.01). Previous-cesarean patients with a previous vaginal birth had a frequency of labor disorders (14.3%) not significantly different from that of multiparous controls. We conclude that trial of labor in women with a previous cesarean should be evaluated by standard criteria for nulliparas if there has been no previous vaginal birth, and by criteria for multiparous women if there has been any previous infant born vaginally.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

When used for patients undergoing trial of labor after previous cesarean, oxytocin is associated with an increased failure rate. Previous reports have not studied why this occurs. From October 1984 to April 1986, 237 patients with previous cesareans underwent a trial of labor. The delivery outcomes of 73 women who received oxytocin were compared with those of the 164 who did not. Rates were similar for uterine scar dehiscence, uterine rupture, operative vaginal delivery, blood transfusions, endometritis, and low Apgar scores. Successful trial of labor occurred in 68% in the oxytocin group, compared with 89% in the no-oxytocin group. Failed trial of labor was significantly more frequent in patients who received oxytocin for induction of labor than in those who did not. When subjects who received oxytocin were divided into induction (N= 47) and augmentation (N= 26) groups, successful trial of labor occurred in 58% of the former group versus 88% of the latter group. Other characteristics of the augmentation group were spontaneous labor, greater cervical dilation and effacement at initiation of oxytocin, shorter duration of infusion, and lower oxytocin infusion rates. For patients who have had previous cesareans and who desire trial of labor, oxytocin by controlled infusion is safe. Successful trial of labor may be enhanced by awaiting spontaneous labor or inducing with a favorable cervix.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID