摘要:

In this study the authors assessed human and economic consequences of low birth weight linked to the lack of prenatal care for indigent women. Low birth weight infants were defined as those who weighed between 860 and 2220 g, corresponding to the 50th percentiles at 26 and 34 weeks' gestation. Women seeking prenatal care had a significantly decreased incidence of low birth weight infants compared with those without such care. Concomitantly, low birth weight infants born to women with prenatal care had significantly better perinatal survival as well as less frequent respiratory distress and intraventricular hemorrhage. Because of these factors, infants born to clinic mothers used fewer neonatal intensive care days and had shorter hospitalizations. Hospital costs were reviewed for 175 surviving infants and failure to obtain prenatal care was associated with a 50% increase in costs for each infant. The frequencies of the most common pregnancy complications in women with and without prenatal care, coupled with corresponding obstetric interventions, suggest that such care facilitates identification and management of women at risk for delivery of low birth weight infants. The authors conclude that there are important human and economic advantages of antenatal care for indigent women.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Intensive metabolic control of diabetes is probably important during formation of the embryo early in pregnancy. The purpose of this study was to determine the efficacy and complications of continuous subcutaneous insulin infusion therapy during the fifth to the tenth week of gestation. Twenty-four insulin-dependent subjects were trained to use blood glucose self-monitoring and the Auto Syringe portable insulin infusion pump (AS6C). Regular insulin was administered as a basal infusion of 18 ± 8 U/24 hours (± SD) (12.2 ± 3.9 mU kg-1h-1) and as bolus injections of 6 ±3 U before meals and 1.2 ± 1 U before snacks. Reasonable control of fasting (119 ± 30 mg/dL) and postprandial (133 ± 34 mg/dL) hyperglycemia was achieved, accompanied by an average of 2.2 ± 1.5 symptomatic hypoglycemic episodes per week. The frequency of complications with this new therapy declined as the authors gained experience in teaching the system. The persistence of good diabetic control in many of the subjects after they returned to conventional insulin therapy points to the need for a controlled trial of continuous subcutaneous insulin infusion therapy versus intensive conventional therapy in pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Factors associated with early pregnancy vomiting were investigated in 9098 first-trimester registrants in the Collaborative Perinatal Project. Vomiting in the absence of hyperemesis or gastroenteritis was noted in 56% of all women, and was more common among primigravidas (P=.002), younger women (P<.001), women with less than 12 years of education (P<.001), nonsmokers (P<.001), and women weighing 77.1 kg (170 lb) or more (P=.003). Adjustment for confounders did not change these associations. Women reporting vomiting were less likely to experience miscarriage or stillbirth (P=.002) and delivery before 37 weeks' gestation (P=.004), but there was no difference in infant birth weight between mothers with and without vomiting (P = .48). Women who vomit in one pregnancy are more likely to vomit in subsequent pregnancies than are comparable women who did not vomit.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Despite the widespread use of the nonstress test, there has been no consensus on the criteria for normal reactivity. The authors studied 495 nonstress tests of 230 normal term fetuses, using a standardized protocol. The frequency distribution of movement-associated fetal heart rate (FHR) accelerations exceeding 15 beats per minute and 15 seconds' duration was examined in windows, ranging from ten to 40 minutes. Mean, median, and modal frequencies of movement- associated FHR accelerations were determined in 1910, 1418, 895, and 473 windows of ten, 20, 30, and 40 minutes, respectively. No significant difference in movement-associated FHR acceleration frequency was observed for any sequential ten-minute window, but movement-associated FHR accelerations were absent in 19.5, 8.8, 5.2, and 5.0% of 10-, 20-, 30-, and 40-minute windows, respectively. The broad frequency distributions of movement-associated FHR accelerations, produced by normal fetuses, precludes discrete diagnostic cutoffs in short time windows, unless one is willing to accept significant negative predictive errors.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A prospective randomized study was performed to determine whether or not oral ritodrine therapy significantly prolonged the latent period in patients with prematurely ruptured membranes. Compared with a control group of similar patients, those treated had a significantly prolonged mean latent period. In addition, 47.6% of the treatment group versus 14.2% of the control group had a latent period of more than one week.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

One hundred eighteen nulliparous patients delivered under conduction anesthesia who met the standard criteria for low forceps delivery were randomly assigned to one of three groups to be delivered by low Tucker-McLane forceps, Silastic vacuum extraction system, or Mityvac vacuum extractor. Significant maternal soft tissue trauma was identified in 48.9% of the forceps group, 36.1% of the Silastic group, and 21.6% of the Mityvac group. Superficial fetal scalp changes were found in 71% of the forceps group, 44% of the Silastic group, and 46% of the Mityvac group. Of these, cephalhematomatas were noted in 2.2% of the forceps group, 13.9% of the Silastic group, and 16.2% of the Mityvac group. All three instruments were considered effective outlet delivery instruments

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Magnetic resonance imaging is a new noninvasive diagnostic technique that involves no ionizing radiation, has no known significant adverse biologic effects, and produces high resolution cross-sectional body images. When compared with sonography and x-ray computed axial tomography, magnetic resonance imaging may have several advantages. To investigate its clinical role in obstetrics, magnetic resonance imaging was used to examine 11 women with abnormal pregnancies. Prior ultrasound examination showed abnormal appearing fetuses in five, abnormalities of the amnionic fluid volume in five, and one each with a large adnexal mass and a molar pregnancy. Examples of images obtained from these women are presented and described. Maternal anatomy was well visualized in all women studied. Based on the preliminary experience, the authors believe that magnetic resonance imaging will be a useful adjunct for diagnostic visualization of normal and abnormal maternal anatomy. Detailed fetal imaging was also possible, and it is anticipated that magnetic resonance imaging will prove useful for fetal evaluation, especially fetal intracranial anatomy and fetal anatomy in pregnancies complicated by oligohydramnios. Because fetal subcutaneous fat is prominently depicted with magnetic resonance imaging, this technology may be useful for assessment of fetal nutritional status.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A prospective, double-blind, randomized controlled trial was carried out, comparing α-methyldopa and clonidine hydrochloride in 100 pregnant women with hypertension. There was no difference in hypotensive effect or reported maternal side effects with either agent. There was one neonatal loss in each group (98% survival). Neither drug caused clinically significant hypotension nor rebound hypertension in the neonates. Clonidine hydrochloride, like methyldopa, appears to be a safe antihypertensive agent in pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Intestinal parasites and pregnancy commonly coexist. Environmental, nutritional, and immunologic factors influence the clinical manifestations and determine the need for treatment of intestinal parasitism during pregnancy. No serious medical or obstetric problems attributable to intestinal parasites developed among 147 parasitized pregnant refugees living and delivering in a refugee camp in Southeast Thailand. These patients received adequate nutrition, careful prenatal monitoring, and no antiparasitic drug therapy. During pregnancy chemotherapy for intestinal parasites should not be used unless required for appropriate clinical and public health reasons.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The vaginal examination data (dilation, station, and time) were examined from 2845 consecutive uncomplicated patients who were admitted in early labor to Cleveland Metropolitan General Hospital between January 1, 1979 and December 31, 1982, using data from the computer database of the Perinatal Clinical Research Center. The length of the latent phase of labor was calculated in 2479 of these patients to form the study group. Individual effects of parity and the cervical dilation on the length of the latent phase of labor resembled Friedman's results from 20 years ago. Furthermore, the average and prolonged lengths of the latent phase confirmed that labors have not changed appreciably in 20 years. However, multivariable analysis and standard stepwise regression on all of the vaginal examination data revealed that the largest influence on the length of latent labor was the admitting cervical dilation. Parity had only a small effect when cervical dilation was controlled. Thus, a multiparous patient may progress as slowly as a primiparous patient if they both are admitted with a low cervical dilation.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID