摘要:

ObjectiveTo determine if the signs and symptoms of genital herpes in pregnancy accurately identify primary genital herpes infections using serologic testing for final classification.MethodsTwenty-three women with clinical signs and symptoms suggestive of primary genital herpes infections in the second and third trimesters of pregnancy were subsequently cultured and tested serologically (for herpes simplex virus type 1 and herpes simplex virus type 2 antibodies) and clssified as having true primary (no herpes simplex virus type 1 or type 2 antibodies), nonprimary (heterologous herpes simplex virus antibodies present), or recurrent (homologous antibodies present) infections.ResultsOnly one of 23 women with clinical illnesses consistent with primary genital herpes virus simplex infections had serologically-verified primary infection. This primary infection was caused by herpes simplex virus type 1. Three women had nonprimary type 2 infections, and 19 women had recurrent infections. Among culture-proven recurrent infections, 12 were caused by herpes simplex virus type 2 and three by herpes simplex virus type 1. Only one infant was born preterm, and no clinically significant perinatal morbidity was observed.ConclusionCorrect classification of gestational genital herpes infections can be accomplished only when clinical evaluation is correlated with viral isolation and serologic testing using a type-specific assay. Severe first episodes of genital herpes infections among women in the second and third trimesters of pregnancy are not usually primary infections and are not commonly associated with perinatal morbidity.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare the prevalence of anal incontinence remote from delivery (approximately 30 years postpartum) in 29 women whose index delivery was complicated by anal sphincter disruption versus a matched control group of 89 women who had an episiotomy without extension to the anal sphincter and versus a group of 33 women who delivered via cesarean.MethodsIn this retrospective cohort study, a structured questionnaire was sent to women in the above categories who delivered at a university hospital between 1961 and 1965 amd for whom we could obtain current addresses. Outcome measures included frequent fecal and flatus incontinence and bothersome fecal and flatus incontinence.ResultsThe three groups did not differ significantly in age, weight, age at delivery, parity, weight of largest baby, postmenopausal status, estrogen replacement usage, most medical conditions, or rectocoele, rectovaginal fistula, or incontinence surgeries. Frequent flatus incontinence was reported by nine (31.0%), 38 (42.7%), and 12(36.4%) women with bothersome flatus incontinence was higher in the anal shpincter disruption episiotomy, and cesarean groups, respectively (not significant). The number of women with bothersome flatus incontinence was higher in the anal sphincter disruption group: 17 (58.6%) versus 27 (30.3%) in the episiotomy only group and versus five (15.2%) in the cesarean group (P= .001). Frequent fecal incontinence was reproted by two (6.9%), 16 (18.0%), and 0 women (P= .008 between cesarean and episiotomy only groups), whereas bothersome fecal incontinence was reported by eight (27.6%), 23 (25.8%), and five (15.2%) women (not significant) in the anal sphincter disruption, episiotomy only, and cesarean groups, respectively.ConclusionRegardless of the type of delivery, anal incontinence occurs in a surprisingly large number of middleaged women.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo test the clinical value of magnetic resonance imaging (MRI) pelvimetry for the diagnosis of cephalopelvic disproportion.MethodsAll deliveries from January 1993 through December 1994 were reviewed to identify 42 nulliparas at term with vertex presentation and cesarean delivery due to dystocia. Complete data were available for 41 women, and subjects were diveded into the following two subgroups, according to clinical data: “cephalopelvic disproportion” (n= 28) and “failure to progress” (n= 13). Ten nulliparous women with uncomplicated vaginal delivery served as controls. Pelvimetry data from postpartum MRI were correlated with fetal and neonatal dimensions to evaluate various criteria for the diagnosis of cephalopelvic disproportion.ResultsComparing both the fetal head volume derived from antepartum ultrasound assessment and the neonatal head volume (postpartum measurement) with maternal pelvic capacity determined by MRI, cephalopelvic disproportion (head volume exceeding pelvec capacity) indicated that 25 and 27, respectively, of the 28 women had been clinically diagnosed correctly with cephalopelvic disproportion, corresponding to sensitivities of 89% and 96%, respectively. Feltal head volume was not larger than pelvic capacity in any of the women in the control group. In seven of the 13 women diagnosed as “failure to progress,” the fetal head volume exceeded the pelvic capacity.Conclusiona fetal head volume estimate exceeding MRI measured pelvic capacity is a frequent finding in nulliparas with cesarean birth due to cephalopelvic disproportion. An appropriate prospective study to determine the benefits of an antepartum diagnosis of cephalopelvic disproportion in high-risk nulliparas is warranted.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the safety and clinical effectiveness of intravaginal misoprostol, a synthetic prostaglandin, E1analogue, for labor induction in gravidas with premature rupture of membranes (PROM) at term.MethodsOne hundred forty-one pregnant women with term PROM were assigned randomly to one of two induction groups: 1) intravaginal misoprostol or 2) intravenous oxytocin by continuous infusion.ResultsSeventy subjects were allocated to the misoprostol group and 71 to be oxytocin group. The mean (± standard deviation) interval from induction to delivery was significantly shorter in the misoprostol group (416 ± 276 compared with 539 ± 372 minutes;P= .04). In 85.7% of patients in the misoprostol group, only one dose was required. Intrapartum complication rates, mode of delivery, and neonatal or maternal adverse event rates were similar in the two treatment groups. Uterine tachysystole occurred more frequently with misoprostol than with oxytocin (28.6% compared with 14.0%;P< .04).ConclusionIntravaginal administration of misoprostol induces labor safely and effectively in patients with PROM at term.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveMacrosomia at term is associated with increased maternal and neonatal morbidity, including a higher rate of cesarean delivery and shoulder dystocia. Induction of labor has been suggested as a means to prevent further weight gain and improve outcome. The aim of this study was to determine whether or not induction of labor in these cases improves maternal and neonatal outcome.MethodsPatients at term with an ultrasonic fetal weight estimation of 4000-4500 g were prospectively randomized into two groups: induction of labor (group I) and expectant management (group II). Patients with diabetes, a previous cesarean delivery, or nonvertex presentation were excluded. Outcome variables included mode of delivery, arterial cord pH, presence of shoulder dystocia, brachial plexus injury, clavicular fracture, cephalophematoma, and intraventricular hemorrhage.ResultsOf 273 patients who were eligible for the study, 134 were randomized to group I and 139 to group II. Parity, gestational age, and fetal weight estimation were similar in the two groups. The neonates of group II patients were significantly heavier (4132.8 ± 347.4 versus 4062.8 ± 306.9 g;P= .024). The rate of cesarean delivery was 19.4% in group I and 21.6% in group II patients (not significant [NS]). Cord pH was similar in both groups. shoulder dystocia was diagnosed in five grup I and six group Ii patients (NS). None developed brachial plexus injury in group Ii patients without documented shoulder dystocia. Mild intraventricular bemorrhage was diagnosed in three of 44 group I and two of 31 group II neonates evaluated (NS).ConclusionIn this prospective, randomized study, induction of labor for suspected macrosomia at term did not decrease the rate of cesarean delivery or reduce neonatal morbidity. Ultrasonic estimation of fetal weight between 4000 and 4500 g should not be considered an indication for induciton of labor.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo investigate the correlation between sex steroid hormones and their receptors during normal and dysfunctional labor.MethodsMyometrial and decidual biopsies along with maternal and cord blood samples were taken from women with or without labor activity. Estrogen and progesterone receptor contents in myometrum and decidua were determined by enzyme immunoassay, and hormone concentrations were analyzed by radioimmunoassay.ResultsIn the lowere segment of the uterus, the prosgesterone receptor concentrations of myometrum were significantly lower in oxytocin-resistant dystocia compared with those of normal labor and before labor (P< .04,P< .005. respectively). No significant difference was found in the estrogen receptors of myometrum from the upper segment showed higher concentrations in active labor compared with those before labor and oxytocin-resistant labor (P< .01,P< .05, respectively). Estrogen receptors from the upper segment showed no significant difference in these regards. The was no difference in peripheral and myometrial sex hormone levels in the groups studied.ConclusionThese data suggest that, in the human, 1) oxytocin-resistant labor is associated with low levels of progesterone receptors, 2) estrogen receptors, 2) estrogen receptors content in myometrium might have no or little relation to labor, and 3) functional labor seems not to be related to a decreased progesterone activity in the myometrium.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo comare safety and cost-effectiveness of domiciliary antenatal fetal monitoring (cardiotocography and obstetric surveillance) with in-hospital monitoring in high-risk pregnancies.MethodsFrom September 1992 to June 1994, 150 consecutive women with high-risk pregnancies, who would other wise be monitored in the hospital, entered a randomized controlled trial of in-hospital (n= 76) monitoring. The main outcome measures were neonatal safety (Prechtl neurologic optimality score, the proportion of non-optimals) and cost-effectiveness. To test a two-point defference in mean Prechtl scores (two-tailed α = .05, 1-β = .80), 150 women were needed. Safety and cost-effectiveness were analyzed according to intention to treat. Conditional on the safety outcomes, a cost-minimization analyses based on actual resource use was performed. Uncertainty of results was explored by sensitivity analyses.ResultsNeonatal outcomes were equal. No cost-shifting between the antenatal and psotpartum period occurred. Substituting domiciliary for in-hospital monitoring reduced mean (standard deviation) antenatal costs from $3558 ($2841) to $1521 ($1459) per woman (P< .01). If costs were varied by the addition of 50%, costs were still reduced. The magnitude of the reduction was sensitive to the costs of domiciliary monitoring.ConclusionDomiciliary monitaring is safe and reduces costs by one-half. The technique seems transferable to other settings but local circumstances may sometimes hamper its dissemination.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the effect of a structured program for early neonatal discharge from a tertiary medical center on the risk of neonatal readmission.MethodsAn early-discharge program was instituted at our tertiary medical center in July 1993, with the objective of discharging mothers and infants within 24 hours after vaginal birth. The readmission rate of vaginally delivered infants during the early-discharge period (July 1, 1993, through March 31, 1995) was compared with the rate during a conventional-discharge period (January 1, 1992, through June 30, 1993). Analyses were performed to examine two groups within the early-discharge group: those discharged within 24 hours of vaginal delivery; and those discharged within 1 hospital day of vaginal delivery.ResultsDuring the early-discharge period, 1.24% of neonates were readmitted within 10 days of birth, compared with 1.35% during the conventional-discharge period. In the early-discharge period group, infants born vaginally and discharged within 24 hours of birth had a readmission rate of 1.46% compared with 1.14% for those who stayed longer than 24 hours after delivery. Similarly, the readmission rate was no different for infants who were discharged within 1 hospital day. The primary indications for readmission in both periods were infections and jaundice.ConclusionImplementation of a structured program for early neonatal discharge does not have an association with increased risk of neonatal readmission to the hospital.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo analyze whether first-trimester embryonic (fetal) heart rates (FHR) are useful in predicting pregnancy outcome for infertility patients.MethodsPatients in a university-based reproductive endocrinology and infertility practice were studied prospectively. Infertile women who achieved clinical pregnancy underwent first-trimester transvaginal sonographic evaluation, and FHR in patients achieving viable pregnancies were compared with those experiencing fetal loss.ResultsOverall, 99 pregnancies reached viability and 17 resulted in fetal loss before 20 weeks' gestation. Patient age, methods of conception, and number of previous fetal losses did not differ significantly between the two groups. A significant correlation (r= .70,P< .00l) was found between increasing FHR levels and advancing gestational age in patients with viable pregnancies and, although to a weaker extent, patients who miscarried (r= .52,P< .05). A significantly higher number of viable pregnancies, compared with fetal losses, had FHR falling within one (70.7% compared with 41.2%,P< .025) and two (99.0% compared with 64.7%,P< .00l) standard deviations of the mean for viable pregnancies at corresponding gestational ages. The majority of FHR of failing pregnancies fell below the individual reference ranges.ConclusionFirst-trimester FHR can help predict pregnancy outcome for infertility patients. Women with FHR outside the reference range from the mean for viable preg-nancies at corresponding gestational ages may be at risk for eventual pregnancy loss.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo investigate the association between adverse perinatal outcomes and abnormal elevations of serum marker levels (alpha-fetoprotein [AFT] and free β-hCG) or a falso-positive screen for Down syndrome.MehtodsPregnancy outcome information was available for 5885 Taiwanese women under 35 years of age who had second-trimester maternal serum screening for Down syndrome, using AFP and free β-hCG, and delivered a chromosomally normal fetus. Those with AFT at least 2.0 multiples of the median (MoM), free β-hCG at least 2.5 MoM, or a false-positive screen (risk ratio at least 1:270) were identified, and the risk for adverse perinatal outcome was assessed.ResultsA serum AFP level at least 2.0 MoM (n= 176, 3.0%) was sognificantly associated with the occurrence of preterm delivery, low Apgar scores, small-for-gestationa-age infants, low birth weight or very low birth weight, fetal death, premature rupture of membranes, oligohydramnios, and a higher incidence of perinatal mortality. a serum free β-hCG level at least 2.5 Mom (n= 416, 7.1%) was significantly associated with low birth weight, an abnormally adherent placementa, and the occurrence of meconium-stained amniotic fluid. A higher incidence of fetal structural anomalies other than neural tube or abdominal wall defects, large-for-gestational-age infants, and postpartum hemorrhage was observed for a calculated risk of at least 1:270 (n= 311, 5.3%) independent of the other biochemical markers.ConclusionAsian women with unexplained elevations of serum AFP or free β-hCG, of a false-positive screen for Down syndrome are at increased risk for various adverse perinatal outcomes. Careful fetal ultrasound examination and thoughtful stragtegy for perinatal management are warranted for these patients.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID