摘要:

ObjectiveTo assess 6 years' neurologic outcome of a complete cohort of survivors of intrauterine intravascular transfusions.MethodsFrom January 1986 to December 1991, 136 intra-vascular transfusions were performed in 43 fetuses presenting with signs of severe erythroblastosis. Before the initial transfusion, 11 of 43 fetuses had some degree of hydrops fetalis, and hemoglobin values ranged between 1.5 and 10.7 g/dL. Neurologic outcome of a complete cohort of 35 long-time survivors was assessed for up to 6 years by reviewing the hospital charts and questionnaires sent to the family physicians or pediatricians.ResultsLong-time follow-up was available in all survivors with hydrops at initial transfusion (seven of seven) and in 23 of 28 survivors without hydrops. Only one of 35 survivors had mild psychomotoric disabilities up to 1 year of age, but was free of sensorineural problems on further examination. In a second case, delayed speech development was observed. Fetuses presenting with hydrops fetalis before initial transfusion tended to have a higher perinatal mortality and had a significantly higher rate of preterm delivery (P= .03). However, moderate or severe neurologic impairment was never observed, even when severe cases with hydrops fetalis or extremely low hemoglobin levels were included.ConclusionTreatment of severe fetal erythroblastosis by intrauterine intravascular transfusions is associated with a favorable neurologic long-time outcome.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine the incidence of maternal antiplatelet antibodies in cases of thrombocytopenia during pregnancy, using the monoclonal antibody–specific immobilization of platelet antigens assay; and to assess the usefulness of this assay for predicting risk of neonatal thrombocytopenia.MethodsA total of 6770 pregnant women were included in the study, and the monoclonal antibody–specific immobilization of platelet antigens assay was done when platelet counts were less than 150 × 109/L. Platelet counts were determined in 6103 newborns.ResultsThe incidence of maternal thrombocytopenia was 11.6% (95% confidence interval [CI] 10.8, 12.4). Among newborns, 1.3% (95% CI 0.5, 2.7) born to thrombocytopenic mothers were thrombocytopenic, compared with 0.4% (95% CI 0.2, 0.6) born to nonthrombocytopenic women. Antiplatelet antibodies were detected in 37 (8.6%) of 430 thrombocytopenic women; autoantibodies were detected in 28 cases (circulating or bound to platelets), alloantibodies in eight cases, and an association of alloantibodies and autoantibodies in one case. The positive and negative likelihood ratios for predicting neonatal thrombocytopenia were 4.6 and 0.7, respectively.ConclusionThe monoclonal antibody–specific immobilization of platelet antigens assay did not predict the risk of neonatal thrombocytopenia in an unselected population of thrombocytopenic pregnant women.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine the effectiveness of antenatal steroids in the reduction of neonatal morbidity and mortality in obstetric subgroups of preterm labor with intact membranes, preterm premature rupture of membranes (PROM), and pregnancy-associated hypertension. The secondary objective was to determine the effect of antenatal steroids in appropriate for gestational age (AGA) and growth-restricted neonates.MethodsWe studied the neonatal outcomes for all women who delivered infants weighing 1750 g or less at birth between January 1990 and July 1997 at our institution. The study population was divided primarily into three clinical groups: preterm labor with intact membranes, PROM, and pregnancy-associated hypertension. Secondarily, the total population was divided based on birth weight and gestational age into AGA and growth-restricted neonates. Within each obstetric subgroup, neonates exposed to antenatal steroids were compared with unexposed neonates for respiratory distress syndrome (RDS), intraventricular hemorrhage and periventricular leukomalacia, the incidence of major brain lesions, necrotizing enterocolitis, proved neonatal sepsis, patent ductus arteriosus, and neonatal death. The subgroups were also compared for gestational age at delivery, birth weight, birth weight percentile, Apgar scores, postnatal surfactant exposure, and clinical and histologic chorioamnionitis. Descriptive statistics, Studentttest,χ2, Fisher exact test, and logistic regression were used for analysis.ResultsA total of 1148 neonates weighing 1750 g or less were delivered during the study period. There were 447 and 410 neonates delivered after preterm labor with intact membranes and PROM, respectively, and 245 neonates born to mothers with pregnancy-associated hypertension. Nine hundred twenty-eight neonates were AGA and the remaining 220 neonates were growth restricted. Antenatal steroids significantly decreased the incidence of RDS, the incidence and severity of intraventricular hemorrhage and periventricular leukomalacia, necrotizing enterocolitis, and neonatal mortality in preterm labor with intact membranes. In the presence of PROM, it significantly decreased the incidence and severity of intraventricular hemorrhage and periventricular leukomalacia and decreased neonatal mortality, with no apparent effect on the incidence of RDS. Antenatal steroids did not show any beneficial effect in pregnancy-associated hypertension and fetal growth restriction (FGR). Additionally, a significant increase was observed in the incidence of proved neonatal sepsis when antenatal steroids were used in pregnancy-associated hypertension.ConclusionThe effectiveness of antenatal steroids varies with the obstetric population studied. Antenatal steroids significantly decreased the incidence of major neonatal morbidity and mortality in the AGA preterm neonate delivered after preterm labor with intact membranes. Antenatal steroids did not show any benefit in cases of pregnancy associated with maternal hypertension or FGR. Its effect in the presence of PROM is limited to a significant reduction in the incidence and severity of intraventricular hemorrhage and periventricular leukomalacia and in neonatal death.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine whether platelet-activating factor–acetylhydrolase activity in fetal plasma obtained at birth from umbilical vessels is different from that in maternal plasma, and (2) to compare platelet-activating factor–acetylhydrolase activity in cord plasma from fetuses with fetal growth restriction (FGR) and those with appropriate growth for gestational age (AGA).MethodsPlatelet-activating factor–acetylhydrolase activity was measured in the plasma of 22 nonpregnant healthy women, 16 pregnant women at term during labor, 28 fetuses exhibiting AGA, and seven fetuses with FGR.ResultsPlasma platelet-activating factor–acetylhydrolase activity in normotensive pregnant women at 37–41 weeks' gestation was 28.1 ± 16.6 nmol/mL per minute, which was not statistically different from the activity in nonpregnant women (30.8 ± 11.1 nmol/mL per minute). Platelet-activating factor–acetylhydrolase activity in venous cord plasma from AGA fetuses was significantly (P< .01) lower than that in maternal plasma (6.3 ± 2.6 nmol/mL per minute), and there was no difference between the activities found in arterial and venous cord samples. In FGR fetuses, venous cord platelet-activating factor–acetylhydrolase activity was significantly (P< .01) higher (12.1 ± 1.4 nmol/mL per minute), than the activity seen in AGA fetuses, and when the data from AGA and FGR fetuses were considered together, there was a negative correlation between cord plasma platelet-activating factor–acetylhydrolase activity and neonatal body weight (r= .46,P= .006).ConclusionPlatelet-activating factor hydrolysis is significantly lower in fetuses than adults. Further, the comparatively high platelet-activating factor–acetylhydrolase activity in FGR fetuses suggests the existence of a compensatory mechanism to maintain microcirculation within the placenta.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo establish the influence of fetal behavior states on venous and arterial pulmonary blood flow velocity waveforms in the normally developing term fetus.MethodsThe relation between venous and arterial pulmonary blood flow velocity waveforms and fetal behavior states was investigated in 18 normal term fetuses. Recordings of the venous pulmonary blood flow velocity waveforms were obtained just proximal to the entrance in the left atrium, and the arterial pulmonary blood flow velocity waveforms were taken from the most proximal branch of the pulmonary artery in the same lung using color Doppler imaging. Time-averaged peak systolic, peak diastolic, and end-diastolic flow velocity; peak systolic to peak diastolic ratio; pulsatility index; and fetal heart rate were calculated from both venous and arterial Doppler recordings obtained during behavior states 1F (quiet sleep) and 2F (active sleep). Fetal behavior states were determined from combined recordings of fetal eye and body movements.ResultsRecordings of sufficient quality for analysis were obtained from ten fetuses. Venous pulmonary blood flow velocity waveforms demonstrated a statistically significant increase in time-averaged peak diastolic and end-diastolic velocity during fetal behavior state 2F. No behavior-state-related changes were observed for the arterial pulmonary blood flow velocity waveform.ConclusionThe data suggest an increased pressure gradient between the pulmonary venous system and the left atrium during behavior state 2F. Flow velocity waveforms from the proximal arterial pulmonary branch are independent of behavioral state.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine the sensitivity of prenatally detected fetal cardiac asymmetry as a sonographic marker for congenital heart disease.MethodsThe normal ratios of pulmonary artery to aorta diameters and of right ventricle to left ventricle diameters were derived from normal fetuses scanned at 17 weeks or more in a 65-month period. Cross-sectional diameters of cardiac ventricles and great arteries were measured at the level of the valves at the time of the scan. Fetuses with confirmed cardiac anomalies detected prenatally during the study were examined to identify how many had cardiac asymmetry, determined by abnormal ratios.ResultsLinear regression analysis of the group of 881 normal fetuses showed the normal pulmonary artery to aorta diameter ratio remained constant throughout pregnancy and the normal right ventricle to left ventricle ratio increased slightly with progressing gestational age. The 90% confidence intervals were 0.79, 1.24 for the right ventricle to left ventricle ratio and 0.84, 1.41 for the pulmonary artery to aorta ratio. Of the 73 fetuses with abnormal hearts, 66% had either ventricular or great artery asymmetry (at least one of the two ratios was abnormal). However, if no asymmetry was present, the cardiac defect was more likely to be a minor one.ConclusionCardiac asymmetry was present in two-thirds of fetuses with cardiac anomalies diagnosed prenatally. If cardiac asymmetry is found, a more thorough examination of the fetal heart is indicated.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine whether higher levels of anti-β2-glycoprotein 1 before 25 weeks' gestation are independently associated with either pregnancy loss or pregnancy-induced hypertension.MethodsSerum samples for the immunoglobulin (Ig) G and IgM isotypes of anti-β2-glycoprotein 1, anticardiolipin antibody, and antiphosphatidylserine were collected from 325 low-risk nulliparas who presented for prenatal care before 25 weeks' gestation. This cohort was followed prospectively for the development of pregnancy loss and pregnancy-induced hypertension.ResultsThe adjusted odds ratios (OR) and 95% confidence intervals (CI) of elevated antiphospholipid antibody levels for pregnancy loss were: IgG anti-β2-glycoprotein 1, OR 1.2 (CI 0.5, 2.8); IgG anticardiolipin antibody, OR 8.4 (CI 2.3, 31); and IgG antiphosphatidylserine, OR 5.2 (CI 1.4, 18.7). The relative risks of pregnancy loss for all IgG antiphospholipid antibodies were higher among women who had blood collected after 10 weeks' gestation compared with those studied before 10 weeks' gestation. However, there were only marginal differences in the attributable risks, suggesting that the impact of elevated levels of antiphospholipid antibodies might be similar in early and later stages of pregnancy. None of the antiphospholipid antibodies was associated with pregnancy-induced hypertension.ConclusionIn this study, elevated levels of IgG anticardiolipin and IgG antiphosphatidylserine antibodies were markers of pregnancy loss, but an elevated level of anti-β2-glycoprotein was not a strong predictor of fetal loss.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo measure plasma levels of C-type natriuretic peptide in women with normal pregnancies and those complicated by gestational hypertension and preeclampsia.MethodsWe collected venous plasma samples from 20 women with normal pregnancies, 15 with gestational hypertension, and nine with preeclampsia. Gestational ages ranged from 26–39 weeks. We measured C-type natriuretic peptide concentrations by radioimmunoassay. Statistical comparisons were made by one-way analysis of variance and Tukey test.ResultsThe mean plasma concentration of C-type natriuretic peptide in the women with normal pregnancy was 7.1 ± 2.5 pg/mL, in those with gestational hypertension 9.6 ± 4.2 pg/mL, and in those with preeclampsia 8.1 ± 2.4 pg/mL. There were no statistically significant differences between groups. The statistical power to detect a difference of 3 pg/mL at the 5% significance level was 78% for the group with gestational hypertension and 64% for the preeclamptic group.ConclusionOur results suggest that C-type natriuretic peptide plasma levels are not significantly different in normal pregnancies and those complicated by gestational hypertension or preeclampsia. In hypertensive pregnancy disorders, C-type natriuretic peptide showed a distinct course compared with atrial natriuretic peptide and brain natriuretic peptide.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine whether measurement of platelet angiotensin II binding at 20 weeks' gestation identifies women destined to develop pregnancy-induced hypertension.MethodsOver a 2-year period, we recruited 325 unselected, normotensive primigravidas from the hospital antenatal department after their routine 20-week scan appointments. Each woman had a singleton pregnancy, was normotensive at the time of entry into the study, and had an unremarkable medical history. Ninety-three nonpregnant women were recruited from the hospital staff for comparison. Platelet angiotensin II binding was measured in all participants. After delivery, the case notes were screened to determine pregnancy outcome.ResultsTwo hundred sixty-seven women remained normotensive to delivery, 30 developed nonproteinuric pregnancy-induced hypertension, 23 developed proteinuric pregnancy-induced hypertension, four had transient hypertension, and one was diagnosed subsequently as having essential hypertension. The median platelet angiotensin II binding for the nonpregnant subjects was 15.7 fmol/109platelets, which differed significantly from the value for normotensive pregnant subjects (4.8 fmol/109platelets,P< .001) and from the value for those who developed either nonproteinuric pregnancy-induced hypertension (4.95 fmol/109platelets) or proteinuric pregnancy-induced hypertension (7.2 fmol/109platelets,P< .001). There was no significant difference between pregnant women who remained normotensive and those who developed nonproteinuric or proteinuric pregnancy-induced hypertension.ConclusionMeasurement of angiotensin II binding in the second trimester has no value as a screening test for nonproteinuric or proteinuric pregnancy-induced hypertension.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo assess the effect of cervical carcinoma in situ (CIS) and its management on subsequent pregnancy outcome.MethodsWe used a population-based retrospective cohort design that included record linkage between cancer data and birth records. The Cancer Surveillance System records of women with CIS (n= 1851, 312 diagnosed during pregnancy) diagnosed between 1984 and 1992, were linked to birth certificates of their first subsequent deliveries after CIS diagnosis. The comparison group (n= 9201) was a random sample of women without CIS who gave birth during the same years. The outcome measures were preterm and low birth weight infants subsequent to CIS diagnosis and treatment. Treatments included no therapy, dilation and curettage or endocervical curettage, cryosurgery or laser vaporization, and conization.ResultsWomen with CIS who were not treated with conization had a small increased risk of preterm delivery (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.0, 2.0) and no increased risk of low birth weight infant (OR 1.0, 95% CI 0.7, 1.6), compared with women without CIS, after adjusting for maternal smoking, race, parity, marital status, and history of induced pregnancy termination. Women with CIS who had conization were more likely to deliver premature infants (OR 1.6, 95% CI 1.2, 2.0) than women without CIS, after adjusting for the same confounding factors. The apparently increased risk of low birth weight (OR 1.8, 95% CI 1.4, 2.4) seemed to be a reflection of premature delivery.ConclusionThe risk of prematurity increased after conization for CIS and did not increase when women with CIS had other procedures.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID