摘要:

During a 4.5-year period, over 2% of 24,000 obstetric patients at Parkland Memorial Hospital were admitted for acute pyelonephritis. Chills accompanying back pain was the most common presenting complaint in these 656 women; lower urinary tract symptoms and nausea and vomiting were also common. All women had fever and, with few exceptions, costovertebral angle tenderness. In most cases, the clinical impression was confirmed by bacteriuria. Significant transient renal dysfunction was demonstrated in 60 (21%) of 282 women tested. Of 501 of the 656 women with antepartum pyelonephritis who delivered at Parkland Hospital, 23% developed recurrent pyelonephritis; in half of these patients, this recurrence was antepartum. Of 393 of the 501 women tested, 20% had asymptomatic bacteriuria at delivery. An 8- to 13-year follow-up study was done on 208 of the 501 women following the index pregnancy; 42% were treated for 1 or more episodes of symptomatic urinary infection when not pregnant. In 140 of the 501 women, a subsequent pregnancy was cared for at Parkland Hospital. Thirty-eight percent of these patients had at least 1 urinary infection during 1 of these pregnancies: 29% had pyelonephritis, and 9% had either asymptomatic bacteriuria or cystitis.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

As women giving birth to large for gestational age (LGA) infants are at risk for glucose intolerance during pregnancy, fasting plasma glucose (FPG) and glycohemoglobin levels (Hb AIc) were studied in the immediate postpartum period (less than 10 days). These laboratory tests, in addition to infant birth weights and perinatal histories in a group of 146 women whose infants were above the 95th percentile for gestational age, were compared with those of a group of women whose infants were appropriate for gestational age (AGA: above the 25th percentile but below the 75th percentile) as well as with those of a group of control mothers without diabetic risk factors. Mean Hb AIcand FPG were elevated in the mothers of the LGA infants. When either the LGA group alone or all 3 groups together were analyzed by linear regression, significant relationships were observed for maternal Hb AIcversus FPG (P< .001); maternal Hb AIcversus birth weight corrected for gestational age (P< .001); and maternal FPG versus birth weight corrected for gestational age (P< .001). In addition, infant birth weight correlated with maternal prepregnancy weight (r= .36), maternal weight gain in pregnancy (r= .23), and maternal height (r= .17), but not with any of the paternal anthropometric features studied. Twenty-six women with LGA infants underwent postpartum oral glucose tolerance tests before discharge. Four had abnormal results and all had Hb AIcvalues above 2 SD of the nonrisk control values (5.8% total Hb). Of the 16 mothers of LGA infants with FPG levels greater than 85 mg/dl (above 2 SD of the nonrisk control values), 7 (44%) also had Hb AIclevels of more than 5.8%. Moreover, on retrospective analysis, the LGA infants manifested increased perinatal morbidity (P< .05) compared to the combined control groups.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A major limitation in the use of the nonstress test (NST) has been the high frequency of nonreactive NSTs in the absence of fetal distress. Exogenous factors causing loss of fetal heart rate reactivity (FHRR) have not been fully evaluated, although it has previously been shown that chronic smokers have an increased incidence of nonreactive NSTs in the absence of fetal distress. A group of chronically smoking high-risk pregnant women at 31 to 44 weeks' gestation was studied to determine if the acute effects of smoking caused the NST to become nonreactive. After a reactive NST was obtained, each patient smoked 1 cigarette and the effects on the fetus were observed. Twenty-six studies were performed on 25 patients. A transient mild elevation of baseline fetal heart rate was noted after smoking in several studies; however, no significant change was found in FHRR, indicating that the acute effects of smoking a single cigarette are not responsible for the increased incidence of nonreactive NSTs in smokers.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The frequency and severity of respiratory distress syndrome (RDS) were evaluated in 69 infants whose amniotic fluid lecithin:sphingomyelin (L:S) ratio was less than 2. Amniotic fluid was obtained at the time of either nonelective or elective cesarean section in 58 cases. An additional 11 patients were delivered within 48 hours after amniocentesis. Gestational ages ranged from 27 to 41 weeks. Few women had been in labor, none had ruptured membranes for more than 12 hours, and all but 3 were delivered by cesarean section. A variety of pregnancy complications were represented. All 14 infants with an L:S ratio less than 0.5 developed RDS, and 10 died. Of 19 infants with an L:S ratio of 0.5 to 0.99, 8 developed RDS; 3 of the 8 died and another 3 required ventilatory support. Of 36 infants whose L:S ratio exceeded 1.0, only 1 developed RDS. No infant who had an L:S ratio greater than 0.8 died of RDS, and RDS was absent in infants with an L: S ratio as low as 0.6. These findings could not be attributed to intraassay or interassay variability or to laboratory methodology. The importance of individual laboratory evaluation of L:S values in relation to respiratory outcome is emphasized.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Two hundred sixty-four antenatal patients were monitored by maternal observation of fetal movements to predict fetal condition at birth. Abnormal fetal movements were significantly associated with fetal death as well as with poor fetal condition at birth. The sensitivity, specificity, and predictive value of monitoring abnormal fetal movements are presented. The mean weekly count decreased with advanced gestational age but not predictably so in each patient. Fetal outcome was studied prospectively in 138 patients with normal fetal movements and 23 patients with abnormal movements at term. Perinatal outcome was significantly poorer in the group with abnormal movements (P=.0015). Cognizance should be taken of patients reporting a decrease in fetal activity at term, as this may indicate fetal compromise.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Continuous intrauterine transcutaneous PO2(tcPO2) measurement was performed in 30 deliveries. The various characteristics of labor (peak of contractions, duration, and contraction interval) were correlated with the tcPO2integral. The best correlation was seen between the tcPO2integral and that of the contraction intervals. As the data show significant correlations with the pattern of labor, continuous tcPO2measurement is a reliable and sensitive method for recognizing PO2alterations early, especially in high-risk deliveries.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The effect of experimental hyperprolactinemia and hypoprolactinemia on human chorionic gonadotropin (hCG) concentration was studied in 34 healthy volunteers between weeks 6 and 11 of normal pregnancy. Hyperprolactinemia was induced in 12 women with 150 mg of sulpiride daily for 2 weeks; treatment led to a mean plasma prolactin (PRL) rise from 14.6 to 84.1 µg/liter after 1 week and to 83.0 µg/liter after 2 weeks. Hypoprolactinemia was effected in 11 women with 5.0 to 7.5 mg of bromocriptine, daily for 2 weeks; treatment decreased the mean plasma prolactin from 19.2 to 6.0 µg/liter after 1 week and to 5.2 µg/liter after 2 weeks. These PRL changes were significant (P< .001) in comparison with the plasma PRL concentrations in the 11 control women. Hyperprolactinemia induced by the sulpiride treatment was accompanied by a significant decrease in hCG concentration, whereas no difference in hCG was seen between hypoprolactinemia and control groups. This may suggest a synergistic action of hCG and PRL, or a direct effect of sulpiride on hCG, but the final mechanism and biologic importance of the phenomenon remain to be investigated.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

To investigate the effect of maternal HLA antibodies on the evolution of pregnancy, we tested sera from 187 pregnant women for the presence of lymphocytotoxic antibodies (anti-HLA-A, -B, and -C and anti-B lymphocytes or anti- HLA-DR). Patients were studied before 20 weeks, between 21 and 30 weeks, and between 31 and 40 weeks' gestation. No correlation was found between the presence of such antibodies and obstetric complications, fetal wastage, placental weight, or infant birth weight. Patients with anti-DR antibodies delivered more female than male infants by a 3:1 ratio.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Umbilical cord serum prolactin concentrations were determined in 17 full-term infants of mothers using narcotic agents during pregnancy and in 18 infants of similar birth weight and gestational age whose mothers did not use narcotics. The median value for the narcotic-exposed group was 266.6 ng/ml (range, 157.5 to 448.7 ng/ml); in the normal group the median was 193.7 ng/ml (range, 69.8 to 693.1 ng/ml). These differences were statistically significant (P< .05). Although only full-term and borderline premature infants who were not at appreciable risk for respiratory distress syndrome (RDS) were studied, it may be speculated that elevated prolactin blood levels in fetuses of addicted mothers may at least in part explain the reported decrease in the incidence of RDS in this group.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The length of umbilical cords was studied in 536 term deliveries to test the hypothesis that a short or long umbilical cord is more frequently associated with certain intrapartum complications. The mean umbilical cord length was 55 cm (range, 14 to 129 cm). A short cord was defined as 35 cm or less (lower sixth percentile), whereas a long cord was 80 cm or more (upper sixth percentile). Umbilical cord accidents were most frequent in the presence of a long cord (20 of 32 cases, 62%). Inadequate fetal descent was significantly more common when a long cord or an excessively short cord (25 cm or less, lower first percentile) was found. Fetal heart rate (FHR) abnormalities that primarily reflected cord compression patterns were significantly more frequent in the presence of a short (17 of 27 cases, 63%) or a long cord (28 of 32 cases, 87%), as compared with a normal length cord (145 of 393 cases, 37%). The measurement of umbilical cord length requires minimal effort, no expense, and may explain certain intrapartum FHR abnormalities or an arrest of fetal descent.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID