摘要:

Twelve women experienced major rupture of the uterus during a trial of labor after previous cesarean (low transverse cervical incision in 11, low vertical in one). Two women required hysterectomy and a third had serious postoperative complications. There were three perinatal deaths, and two infants suffered significant long-term neurologic impairment. Although vaginal birth after cesarean delivery is considered safe in most instances, these cases serve as a reminder that catastrophic events can occur. Potential complications have important implications for clinicians when counseling patients about the route of delivery and for the management of any trial of labor after cesarean delivery. (Obstet Gynecol 77:811, 1991)

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We report eight cases of rupture of low transverse cesarean scars occurring during trials of labor. The cases occurred in five hospitals in the Denver metropolitan area during a 13-month period. The estimated incidence was 0.7% of planned trials of labor. Complications of rupture included one neonatal death, two cases of severe neonatal asphyxia, three maternal bladder lacerations, and one hysterectomy. (Obstet Gynecol 77:815, 1991)

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This study was conducted to test the hypothesis that nonclosure of the visceral and parietal peritoneum during low transverse cervical cesarean delivery is not associated with increased intraoperative or immediate postoperative complications. One hundred thirteen patients scheduled for low transverse cervical cesarean were randomized to either closure of both the visceral and parietal peritoneum with absorbable suture (N=59) or no peritoneal closure (N=54). Patients were cared for in the usual postoperative manner without reference to treatment group. There were no demographic differences between the groups and no differences in method(s) of anesthesia, operative indication^), or use of peripartum epidural narcotics. The incidence of fever, endometritis, or wound infection was similar between groups. There were no differences in the number of patients requiring parenteral narcotic analgesia or in the number of doses per patient. The number of oral analgesic doses was significantly greater with closure than without (P=.014). The frequency with which postoperative ileus was diagnosed in each group was similar, and there was no difference regarding the day on which patients were advanced to liquid or select diets. Bowel stimulants were administered more frequently to the closure than to non-closure patients (P=.03). The average operating time was shorter for the open group than for the closure group (P<.005). We conclude that non-closure of the visceral and parietal peritoneum at low transverse cervical cesarean delivery appears to have no adverse effect on immediate postoperative recovery, may decrease postoperative narcotic requirements, allows less complicated return of bowel function, and provides a simplified and shorter surgical procedure. (Obstet Gynecol 77:818, 1991)

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The safety of pregnancy after myocardial infarction remains a significant dilemma for both the obstetrician and the cardiologist. Only 20 cases of pregnancy after myocardial infarction have been reported. To clarify this problem, we add our experience of four such cases in which conception occurred 9 months to 9 years after myocardial infarction with no previous consultation. Each woman had an uneventful pregnancy with no cardiac or obstetric complications related to the myocardial infarction. All patients were under the strict supervision of an obstetrician and a cardiologist during pregnancy in our conjoined antepartum-cardiologic clinic. The mode of delivery in all patients was related to the obstetric indications. Our experience and the accumulated experience in the literature demonstrate good prognosis for patients who conceive after myocardial infarction. (Obstet Gynecol 77:822,1991)

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We sought to evaluate the effectiveness of a policy of early elective hospitalization on the outcomes of 522 consecutive twin gestations delivered at our institution between 1983- 1987. During the first 2 years (1983-1985), 237 twin pregnancies were delivered with a policy of elective hospitalization when twin pregnancy was diagnosed between 24-32 weeks' gestation. When possible, elective hospitalization started at 24 weeks' gestation. Electively admitted women remained hospitalized until 34 weeks' gestation, at which time they were discharged unless complications developed requiring continued hospitalization. During 1985-1987, 285 women with twin gestations were intentionally managed as outpatients unless intercurrent complications required hospitalization. A total of 211 twin pregnancies was excluded from analysis because the women did not present for prenatal care (19%) or were undiagnosed until delivery (22%). Of the remaining 311 pregnancies available for study, 134 were managed when the elective admission policy prevailed and 177 when this policy was not in effect. Although the elective admission policy did result in a small reduction in the incidence of low birth weight among the 58 pregnancies hospitalized electively (mean [± SEM] gestational age at elective hospitalization 27.7 ± 0.3 weeks) compared with outpatient management, this policy did not result in an improvement in prematurity (32 versus 36%; P>.05) or perinatal morbidity as reflected by requirement for neonatal intensive care (12 versus 11%; P>.05) and mechanical ventilation (8 versus 9%; P>.05). Moreover, perinatal mortality was actually higher in the electively hospitalized pregnancies (8 versus 2%; P=.01). This policy also had considerable economic impact, as reflected by significantly higher total hospital bills ($17,519 versus 11,916; P<.02). (Obstet Gynecol 77:826, 1991)

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Monoamniotic twins are uncommon but are at high risk (reportedly 50%) for perinatal death, commonly from cord accidents. Until recently the diagnosis of monoamniotic twinning was seldom made before delivery, but modern ultrasound technology permits diagnosis during prenatal care, creating a management dilemma. This is a report of the experience with monoamniotic twins of 20 or more weeks' gestation at the University of Iowa Hospitals from 1961- 1989. Twenty monoamniotic twin pregnancies were compared with 40 monochorionic, diamniotic controls regarding antepartum and intrapartum complications. Overall, monoamniotic twins were delivered earlier, were more likely to die in utero, and had lower birth weights than diamniotic twins. When only live-born twins were considered, however, there were no differences in gestational age at delivery, birth weight, or 5-minute Apgar scores. No fetal death occurred after 32 weeks, suggesting that prophylactic preterm delivery may not be indicated in all cases. Labor and vaginal delivery were not associated with an increased risk of fetal death. (Obstet Gynecol 77:832, 1991)

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Data from three Swedish health care registries—the Medical Birth Registry, the Registry of Congenital Malformations, and the Hospital Discharge Registry—were linked for the 9-year period 1973-1981 to identify women who had appendectomy during pregnancy and their offspring, and to determine several pregnancy outcomes (gestational duration, birth weight, perinatal mortality, and congenital anomalies). Among the 720,000 deliveries during this period, 778 were complicated by appendectomy (one in 936), and the diagnosis of appendicitis was confirmed in 64% of the cases (one in 1440). Significant findings included: 1) an increase in the risk of delivery the week after appendectomy when the operation was performed after 23 weeks' gestation, with no further increase if the pregnancy continued beyond 1 week; 2) a decrease in mean birth weight of 78 ± 24 g with more infants than expected weighing less than 3000 g; 3) an increase in the number of live-born infants dying within 7 days of birth; 4) no increase in the number of stillborn infants; and 5) no increase in the number of congenitally malformed infants. (Obstet Gynecol 77:835, 1991)

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

During pregnancy, mineralization of the fetal skeleton creates a demand for approximately 30 g of calcium from maternal sources. We examined whether this fetal demand results in maternal femoral bone mineral loss. Femoral bone mineral density was measured twice by dual photon densitometry, once before conception and again within 15 days of parturition, in 32 white women aged 20-40 years. Femoral bone mineral density was also measured twice in 32 nonpregnant controls matched to the cases for weight, height, age, and parity. There was no significant mean bone mineral density loss in cases compared with controls (P>.63). Pregnant women with smaller body size, expressed as Quetelet index, were more likely to have femoral neck bone mass increase than their matched controls (P<.03). This study provides evidence that fetal demand for calcium has a minimal effect on bone. mineral density at parturition. Smaller women may experience a slight increase in femoral bone mineral density compared with controls. (Obstet Gynecol 77:841, 1991)

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Poor glycemic control in early pregnancy in insulindependent diabetes is associated with an increased risk for spontaneous abortions and congenital malformations. Strict glycemic control from the initial stages of embryogenesis is one of the major goals of management in these pregnancies. We hypothesized that insulin-dependent diabetic patients attending a pre-conception program would have improved glycemic control compared with insulin-dependent diabetic patients who enrolled after conception and would have better pregnancy outcome, with fewer spontaneous abortions and fewer major malformations. Ninety-nine pregnant insulin-dependent diabetic patients were recruited before reaching 9 weeks' gestation and were followed prospectively throughout pregnancy. Twenty-eight had attended a pre-conception clinic to optimize glycemic control (study group) and 71 had enrolled after conception (control group). Early glycemic control was significantly better in the study group: Glycohemoglobin values at the first prenatal visit and at 9 and 14 weeks' gestation were significantly lower than in the control group. The rate of spontaneous abortion was significantly lower in the study group (7%) than in the controls (24%). There was one major malformation in the control group and none in the study group. We conclude that patients with insulin-dependent diabetes attending a preconception program have a decreased rate of early pregnancy loss compared with those receiving prenatal care early in pregnancy. (Obstet Gynecol 77:846, 1991)

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Despite reduced fertility, pregnancy is likely to occur with increasing frequency in cystic fibrosis in proportion to the number of patients reaching childbearing age. Thirty-eight pregnancies in 25 patients with cystic fibrosis are presented. Twelve of the 25 mothers were pancreatic-sufficient. Despite previous reports of the hazards of pregnancy in cystic fibrosis, we found that pregnancy was well tolerated by the vast majority of our patients and had little effect on their pulmonary and nutritional status. Therapeutic abortion for medical indications was required in two pregnancies. The incidence of prematurity and the neonatal mortality rate were low, and no congenital abnormalities occurred. We conclude that pregnancy can be tolerated by the majority of cystic fibrosis patients, particularly those who are pancreatic- sufficient. (Obstet Gynecol 77:850,1991)

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID