摘要:

Between January 1, 1986 and July 1, 1988, 56 cases of congenital syphilis were identified at the University of Miami/Jackson Memorial Medical Center. The overall rate was 18.4 cases per 10,000 births, with a threefold increase found from 1986 to 1988. A case-control study using matched pairs was done to identify differences in maternal demographics and pregnancy outcome. Congenital syphilis case mothers were predominantly black American women who lacked prenatal care (67%) and who were substance abusers (71%) significantly more often than their matched controls (P<.005). Three cases of seroconversion in pregnancy were identified. Failure to screen or inappropriate treatment occurred in four patients. Seven women were treated during pregnancy: Five received benzathine penicillin G for 3 consecutive weeks and two received erythromycin. All treated patients presented for initial care in the late second or third trimester. Thirty-seven infants (66%) were live-born and 19 (34%) were stillborn. Preterm labor and premature rupture of the membranes were significantly more common in infected pregnancies than in controls (P<.005). Live born case infants had significantly lower birth weights than controls (P<.005), with 21% of case infants growth retarded. Seven neonatal deaths and one infant death occurred. The resultant perinatal mortality rate from congenital syphilis in this series was 464 per 1000

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The American College of Obstetricians and Gynecologists' “Guidelines for vaginal delivery after a previous cesarean birth” include a precautionary statement regarding estimated fetal weight of more than 4000 g. To evaluate the validity of this restriction, we conducted an analysis of the outcomes of 301 trials of labor with birth weights equal to or greater than 4000 g. In the birth-weight range of 4000–4499 g, 139 of 240 patients (58%) delivered vaginally. In the group with birth weights exceeding 4500 g, 26 of 61 patients (43%) delivered vaginally. When compared with 1475 trials of labor with birth weights under 4000 g, no significant differences in perinatal or maternal morbidity were found. Comparison with a control group of 301 women with no previous uterine surgery who delivered macrosomic infants also demonstrated no significant differences in perinatal or maternal morbidity. The medical literature does not support elective cesarean section for suspected fetal macrosomia in nondiabetic women, and based on our experience, there appears to be no reason for treating previous-cesarean mothers differently

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The application of correction factors for maternal serum alpha-fetoprotein (MSAFP) is expected to increase the accuracy of this screening tool. Correction for maternal weight compensates for the dilution effect of a larger plasma volume in women of greater weight. We analyzed the effect of a previously published linear correction formula for weight on the frequency of abnormal MSAFP results. Serum samples from 8276 patients were studied for AFP and were grouped according to maternal weight in 50-lb increments. Abnormal results were defined as 0.4 or less or 2.5 or more multiples of the median for gestational age. Without correction, the highest rate (15%) of low MSAFP results was obtained in the obese population. Conversely, the rate of elevated MSAFP was highest (3.8%) in the lowest maternal weight group. Correction for weight up to 250 lb significantly increased the rate of abnormally high results in the obese group, indicating an overcorrection effect. The number of amniocenteses indicated for abnormal MSAFP was reduced by about 9% with weight correction. We suggest that linear correction of serum AFP results is adequate for maternal weights up to 200 lb. Results in women weighing more than this upper limit should be corrected as if the weight were 200 lb only. This balances the frequency of abnormal results in all weight groups and maintains the reduction in number of procedures performed

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Preliminary reports about patient-controlled analgesia during labor have been promising. The purpose of this investigation was to compare our experience with meperidine given intravenously by the patient versus by a nurse. Sixtyfour healthy women beginning active labor (cervical dilation 3 cm) at term were randomly assigned to either self administer a 10-mg dose as often as every 20 minutes or have a nurse administer 25-50 mg every 3 hours as requested. The total meperidine dose and consumption rates were greater when administered by the patient than by a nurse. Maternal side effects occurred with similar frequency in both groups, and pain relief was judged to be equivalent. Maternal and umbilical serum concentrations of meperidine at delivery increased in the patient-controlled group if active labor lasted longer than 2 hours. Neonatal naloxone therapy was used more often when meperidine was administered by the patient than by a nurse (five of 31,16%, versus three of 33, 10%, respectively). Self-administration of intravenous meperidine by the laboring patient was not found to be advantageous over nursing administration, and may pose an increased threat to the infant

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

This report reviews an 8-year experience with surgical management of leiomyomata during pregnancy at Los Angeles County Women's Hospital. Fourteen patients had such surgery, for a rate of 1.1 operations per 10,000 births. Five women had exploratory laparotomy only, six had myomectomy, and three had hysterectomy; one patient aborted after surgery. Thirteen other women had incidental myomectomies at cesarean delivery; one of these had an intraoperative hemorrhage. No other complications occurred. Surgical management of leiomyomata during pregnancy is safe in carefully selected patients

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We reviewed all closed obstetric claims in the records of a major physician-sponsored malpractice insurer that has written policies from 1982 to the present. Of the 54 files closed during the 6.5-year period covered by this study, 21 (39%) involved physician reports of bad outcomes that did not lead to a formal claim. Of the 33 formal claims, 14 (42%) were dismissed, either by the plaintiff's attorney or by the courts. Eighteen of the remaining 19 claims were settled before trial, with an average payment to the plaintiff of $185,000. The one suit that went to trial resulted in a defense verdict. A review of the case histories demonstrated that in the majority of cases when a payment was made, probable medical negligence had taken place. Non-meritorious claims were not compensated. For those cases in which a payment was made, the size of the settlement was commensurate with the seriousness of the injury, which almost always involved damage to the infant. Poor physician judgment was the most common source of error

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A prospective study of the relationships among fetal heart rate pattern, meconium staining of the amniotic fluid, umbilical cord artery pH, and Apgar score was carried out in 1219 consecutive births. Interpretable cardiotocogram patterns and cord arterial pH and blood gas analysis were obtained in 698 cases. The sensitivity of an abnormal cardiotocogram at any time for acidosis (more than 1 SD below the mean, pH less than 7.17) was 80%, and for severe acidosis (more than 2 SDs below the mean, pH less than 7.085) was 83%. However, the predictive value was low, and 32% of fetuses had an abnormal cardiotocogram but no acidosis. If only cardiotocogram abnormality in the first stage of labor was considered, sensitivity was still 47% for acidosis and 67% for severe acidosis, and the false-positive rate was reduced to only 14%. We attempted to improve the prediction of acidosis by including meconium staining of the amniotic fluid, but 65% of the variation in umbilical cord artery pH and 72 and 86% of the variation in 1- and 5-minUte Apgar scores, respectively, remained unexplained. In light of these poor correlations, the current practice of considering cardiotocogram abnormality, meconium staining of the amniotic fluid, acidosis, and low Apgar scores as indicating one single disorder, “fetal distress,” is not valid

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Funipuncture offers direct access to the fetal circulation. The blood gas and acid-base status of the fetus can be studied, and fetal hypoxia and acidosis can be diagnosed directly. To establish normal ranges of fetal blood gas and acid-base status, we analyzed umbilical venous blood samples obtained by funipuncture from 62 normal fetuses (20–35 weeks). These fetuses were studied because of suspected fetal diseases and were subsequently proved to be normal by the fetal blood examinations. Umbilical vein pH and pO2decreased whereas pCO2and bicarbonate increased with gestational age. The umbilical vein base excess did not correlate with gestational duration, but oxygen saturation tended to decrease with gestational age. Twenty hydropic fetuses with Bart hemoglobinopathy were also studied; they were found to be more acidotic, hypoxic, and hypercarbic than normal fetuses

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Recent studies suggest that fetal biometry may allow recognition of pregnancies at risk for Down syndrome. Secondtrimester biparietal diameter (BFD)/femur length and observed- to-expected femur length ratios were examined in 48 chromosomally abnormal fetuses and compared with those of a control population composed of both low-risk patients (maternal age less than 35 years) and high-risk patients (maternal age 35 years or more). Biparietal diameter/femur length ratio correctly identified 18% of Down syndrome pregnancies with a positive predictive value of one in 169 and a false-positive rate of only 4%. When trisomies 21,18, and 13 were considered collectively, a sensitivity of 29% and a predictive value of one in 78 were achieved, with no increase in the false-positive rate (4%). Observed-to-expected femur length ratio was less valuable in detecting chromosomally abnormal fetuses. These data suggest that the BPD/femur length ratio holds promise as a screening tool for the antenatal detection of fetal chromosomal abnormalities. Although encouraging, extrapolation of these results to other centers is not recommended without independent verification

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In 89 consecutive twin pregnancies, monthly Doppler ultrasound measurements were made of the umbilical artery blood flow velocity waveforms of each fetus. In total, 453 Doppler studies were performed. Of the 178 infants, 32 were small for gestational age (SGA); only 24 of the 82 SGA Doppler studies were abnormal, giving an overall sensitivity of the test in the prediction of the SGA fetus of 29% and a positive predictive value of 34%. Furthermore, neither the sensitivities nor the positive predictive values were above 50% in any of the gestational-age intervals individually studied. We conclude that Doppler study of umbilical artery flow velocities is not of much value in the prediction of SGA infants in twin pregnancies, although persistently absent end-diastolic velocities were associated with poor outcome

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID