摘要:

Thirty-four children have been cared for at SUNY-Health Science Center at Brooklyn with diagnoses of either acquired immunodeficiency syndrome (AIDS) or AIDS-related complex. Reported here are descriptions of pregnancies resulting in these children. Few of the mothers (four of 32) were symptomatic; however, low birth weight (11 of 34), preterm birth (11 of 34), and premature rupture of membranes (ten of 32) were common. Of 33 patients whose mode of delivery was known, cesarean section was used in ten cases, including one elective repeat. Among mothers who had children before their affected offspring, the average birth weight of the older children significantly exceeded that of the affected (3241 ± 508 versus 2712 ± 722 g, P <.05). The affected child's age at onset of symptoms did not correlate with birth weight, mode of delivery, or status of membranes at the onset of labor.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Although several hundred cases of acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC) in infants have been reported, there is little information available concerning the follow-up of mothers and these children or subsequently born children. Thirty-four children with perinatally acquired AIDS and ARC (19 AIDS; 15 ARC) have been followed at the Downstate Medical Center. Although no mother had AIDS or ARC during her pregnancy, after an average follow-up (±SD) of 27.8 ± 21.6 months, five had AIDS and ten had ARC. For 22 of the mothers, T4/T8ratios were obtained; 15 of these were less than 1, and five were between 1 and 1.5. Among 11 subsequently born siblings for whom HTLV-III antibody status was known, four were positive; of these, two had ARC and one had AIDS. We conclude that the diagnosis of AIDS or ARC in a child indicates a risk for the development of illness in the mother and subsequently born siblings.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Overt thrombocytopenia (defined as a platelet count of less than 100,000/μL) was not identified at or soon after delivery in any of 262 infants of mothers with hypertension induced or exacerbated by pregnancy. The platelet counts were 100,000 to 149,000/μL in 11 (4.2%) of the offspring and 150,000/μL or higher in the rest, even though the platelet counts of the 258 mothers were less than 150,000/μL in 77 (30%), less than 100,000/μL in 51 (20%), and less than 50,000/μL in 17 (7%). Some infants of hypertensive mothers did develop overt thrombocytopenia later; however, the frequency and intensity appeared to be no greater than it was in infants with similar complications (prematurity, growth retardation, infection, and meconium aspiration) whose mothers were normotensive. We conclude that the fetus whose mother has preeclampsia-eclampsia is very unlikely to be thrombocytopenic during labor and delivery, even when the mother is thrombocytopenic. Therefore, neither cesarean delivery to avoid labor nor scalp blood platelet counts during labor need be performed.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Using a regional perinatal network database of 60,456 births, a study compared 3457 postdate (42 weeks or longer) infants to a control group of 8135 infants born at 40 weeks' gestation from 1982 through 1985. Both patient groups included only uncomplicated pregnancies. Although the differences were small, women who delivered postdate infants had a lower parity, higher weight at delivery, and higher blood pressure during pregnancy than controls. The postdate infants were heavier, more likely to be delivered by forceps or cesarean section, and more likely to experience shoulder dystocia. They also had lower Apgar scores and more meconium aspiration and congenital malformations. Although the overall perinatal mortality was not statistically different, the higher perinatal morbidity in postdate infants suggests that careful attention should be paid to this high-risk problem.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The obstetric component of The Johns Hopkins Adolescent Pregnancy Program is described and the pregnancy outcome for adolescents delivering btween 1976 and 1981 is compared with that of similar young women who were delivered in the same facilities, by the same staff, but who received their prenatal care in other Hopkins-related programs. The adolescent program is comprehensive, providing intensive psychosocial support and patient education in addition to medical care, using a team approach coordinated by an individual case management system. Enrollees had fewer pregnancy complications and lower perinatal mortality. Between 1979 and 1981, the frequency of birth weight below 2500 g was 9.9%, and below 1500 g, 1.9% for program adolescents, compared with 16.4 and 3.9%, respectively, for controls. Younger adolescents in the program entered prenatal care significantly later than older ones. However, those aged 14 years and below had infants with the highest average birth weight and no greater risk of perinatal death than those of older adolescents.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Although the maternal mortality rate in South Carolina has decreased at an impressive and statistically significant rate over the past 15 years, the overall rate is still 77% higher than in the United States as a whole. Certain epidemiologic variables related to the maternal deaths were analyzed statistically for three five-year periods: 1970–1974, 1974–1979, and 1980–1984. Deaths were more frequent in older, nonwhite, single mothers. Amniotic fluid embolus and ectopic pregnancy have become the leading causes of death. Maternal mortality declined more rapidly in smaller hospitals than in larger ones, probably due to the transfer of high-risk patients. Improved obstetric techniques and practice have reduced these mortality rates thus far. If rates are to decrease still more, this trend must continue along with a sustained effort to provide comprehensive prenatal care to indigent pregnant women in a regionalized perinatal care system.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A prospective study of 757 adolescents who gave birth to singleton live-born infants was undertaken to assess effects of prenatal care on pregnancy outcome. The analysis indicated that the odds of low pregnancy weight gain for gestation was reduced by a factor of two (odds ratio = 0.50, P <.05) for adolescents with adequate prenatal care; the risk of preterm delivery was reduced with both adequate (odds ratio = 0.34, P <.01) and intermediate prenatal care (odds ratio = 0.46, P <.05). Birth weight was increased by an average of 157 g with adequate care (P <.05) and 107 g with intermediate care (P <.05). After adjusting for pregnancy weight gain and preterm delivery, differences in birth weight were much smaller and no longer statistically significant, suggesting indirect effects of care on birth weight (ie, improvements in weight gain adequacy and in preterm delivery).

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Seventy-four patients in preterm labor at 20–35 weeks' gestation were randomly assigned to receive ritodrine (N = 36) or ritodrine plus magnesium sulfate treatment (N = 38) for tocolysis. Ten did not complete therapy and were excluded from analysis. Nineteen of 32 patients (59%) in the ritodrine plus magnesium sulfate group were successfully treated, compared with only 11 of 32 patients (34%) in the ritodrihe-only group (P <.05). Of the 21 patients who failed to respond to the initial ritodrine treatment, 16 received intravenous magnesium sulfate supplemental therapy; 75% of this group were treated successfully. The frequency of adverse maternal and fetal side effects did not differ between the treatment groups. In the combined group compared with the ritodrine group, the dose requirements for ritodrine therapy as well as the total duration of treatment for both ritodrine and magnesium sulfate were reduced significantly. We conclude that concurrent administration of ritodrine and magnesium sulfate is more efficacious than ritodrine alone and does not appear to increase the frequency of adverse side effects.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A randomized double-blind study evaluated the analgesic efficacy and influence of maintaining a continuous epidural infusion of 0.75% lidocaine during the second stage of labor in nulliparous women. When the cervix was 8 cm or more dilated, unidentified study solution was substituted for the known 0.75% lidocaine solution and continued until delivery. The study solution for 26 patients was 0.75% lidocaine; 27 subjects received saline. During the first stage of labor, 88% of women in the lidocaine group and 81% of women in the saline group had analgesia of excellent or good quality, a nonsignificant difference. During the second stage, there was a tendency (not statistically significant) toward improved analgesia quality in the lidocaine patients, but there was no significant difference in the frequency of perineal anesthesia (23% lidocaine, 7% saline). There was no difference between the groups in the duration of the second stage of labor (73 ± 63 versus 76 ± 48 minutes). Operative delivery frequency was similar (31 and 37%), as were umbilical cord blood acid-base values. It is concluded that maintenance of the continuous epidural infusion of 0.75% lidocaine did not prolong the second stage of labor, but it also did not significantly differ from saline in quality of second stage analgesia or frequency of perineal anesthesia.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Halogenated anesthetic agents have been used to supplement nitrous oxide during balanced general anesthesia for cesarean delivery to decrease maternal awareness. However, these agents can interfere with uterine contractility and hence have the potential to increase blood loss at the time of cesarean section. To ascertain the effect of the addition of halogenated anesthetic agents for cesarean section anesthesia versus conduction or a simple balanced general anesthetic, we retrospectively assessed three aspects that may reflect operative blood loss at the time of cesarean section. Significantly more women whose balanced general anesthesia for cesarean section was supplemented with a halogenated agent (usually 0.5% halothane) versus those with a conduction or balanced general anesthetic required transfusion therapy, had a postpartum hematocrit less than 30 vol % and had a decrease in the pre- to postdelivery hematocrit of at least 8 vol %. The addition of halogenated anesthetic agents to a balanced nitrous oxide anesthesia for the purpose of decreased maternal awareness must be weighed against the risk incurred from the increased requirement for blood replacement and/or from postpartum anemia.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID