摘要:

The effect of intrauterine device (IUD) usage on the occurrence of fetal loss after the first trimester of pregnancy was investigated in the Women's Health Study, a multicenter case-control study of the relationship between IUD usage and the occurrence of serious gynecologic and obstetric disorders that was carried out in 16 US hospitals between 1976 and 1978. In this study, 539 cases of second-trimester fetal loss were compared with 336 matched controls. It was found that IUD use prior to conception did not increase the risk of second-trimester fetal loss. Also, if an IUD was in place at conception but was removed during the first trimester of pregnancy, the risk of second-trimester fetal loss was not increased. However, among women with an. IUD in place at conception that was not removed during the first trimester of pregnancy, the risk of second-trimester fetal loss was increased tenfold (relative to the risk among women not having an IUD in place at conception). This increase in risk was much greater for septic second-trimester fetal loss (relative risk approximately equal to 26, 95% confidence interval 6 to 108) than for nonsrptic fetal loss (relative risk approximately equal to 3, 95% confidence interval 0.3 to 22). From this study and from ancillary data concerning IUD usage and failure rates, it is estimated that about 600 cases of second-trimester fetal loss (septic and nonseptic combined) occur annually in the United States as a consequence of an IU of pregnancy. An IUD in place at the beginning of the second trimester of pregnancy also appears to increase the risk of third-trimester fetal loss, but the magnitude of this increase is uncertain.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The correlation of maternal and paternal physical characteristics to the weight of the newborn infant was investigated. It was found that a different anthropomorphic variable best explained the outcome in each group when mothers were divided by weight for height. In women of low weight for height, weight gain was most significantly associated with birth weight (P<.01); and in women of intermediate weight for height, the significant variable was maternal prepregnancy weight (P<.01); in women of high weight for height the outcome was best explained by maternal height (P<.05). The model accounted for 17,21, and 32% of the variance in birth weight in the 3 weight-for-height groups, respectively. It appears that the relative value of genetic and environmental factors may be different depending on the body type of the mother. It is postulated that other genetic and environmental factors, including smoking, alcohol ingestion, and exact gestational age, may be of significance. The conclusions of this study differ from those of previously reported studies. Possible explanations include variable population homogeneity and different socioeconomic groups studied as well as the obscuring of biologically significant variables if outcomes in subjects with different body types are not analyzed separately.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A 3-year experience during which fetal welfare was a major factor in the management of patients delivering between 24 and 27 weeks' gestation is presented. Sixty-two cases of women for whom prenatal assigned gestational age was between 24 and 27 weeks and who had a live fetus on admission were reviewed. Using discharge from the hospital as definition for survival, 34 of the 62 infants (55%) survived. Survival rates ranged from 36% at 24 weeks' gestation to 76% at 27 weeks' gestation. Three of the 34 survivors had major continuing problems at discharge. Of the various strategies used to improve perinatal outcome, the antenatal administration of betamethasone was associated with a significant (P<.03) improvement in infant survival. The authors are encouraged by these results, which indicate that aggressive antenatal and postnatal efforts for pregnancies with gestational ages between 24 and 27 weeks are cost-effective, productive, and worthwhile.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A detailed analysis of 465 primary cesarean sections (10.4% of total deliveries) performed at St. Mary's Health Center during 1977 and 1978 was undertaken. Cephalopelvic disproportion, malpresentation, and fetal distress were the 3 most common primary indications for cesarean section. An analysis of the effects of fetal monitoring seemed to indicate that the procedure was not a significant factor in increased use of cesarean section.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

To test the hypothesis that spacing the injection interval by io minutes would reduce the incidence of post-paracervical block bradycardia, 42 healthy subjects at low risk with normal fetal heart rate (FHR) patterns were included in a randomized trial. Twenty patients were given a conventional paracervical block (ie, almost simultaneous injection of the 2 sides), whereas 22 patients were given the second injection after a 10-minute interval. All patients were laterally positioned for 30 minutes before and 60 minutes after administration of the paracervical block. There were no cases of post-paracervical block bradycardia in either group, but a decrease in the baseline FHR of 5 beats per minute or more occurred in one half of each group. Both groups experienced significant decreases in the mean FHR. The authors conclude that patient selection and perhaps lateral positioning are more important than is spacing the injection interval. Furthermore, in properly selected subjects paracervical block offers simple, effective, and safe analgesia.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Out-of-hospital birth centers are controversial. A retrospective chart review was performed for 150 consecutive patients who had their prenatal care at The Birthplace, a Seattle birth center with certified nursemidwives licensed by the state of Washington. Seventy-two percent of the women were nulliparous. Antepartum or intrapartum hospital referral was necessary for 28% of the patients. An additional 17% of the patients would have been transferred if specific written criteria for transfer had been precisely followed. The cesarean section rate was 6% (9 of 150). Nonoptimal 1-minute Apgar scores of 6 or less were more common in nulliparas (20%) than in multiparas (3%) who delivered at The Birthplace (P<.05). All 5-minute Apgar scores were 7 or more. Three infants had birth weights less than 2500 g. Noncompliance with the transfer criteria was associated with untoward outcome. Patients considering out-of-hospital delivery should be counseled that a high rate of hospital transfer is necessary to minimize risk.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Sixty-nine pregnancies were observed in 57 hyperprolaclinemic women (5 with pituitary macroadenoma, 20 with microadenoma, and 32 with normal ttomograpy of the sella turcica). Ten of these pregnancies took place spontaneously in women with mild to moderate hyperprolactinemia (up to 70 ng/ml); 2 were induced by exogenous gonadotropins, 2 by clomiphene, 42 by bromocriptine, and 9 by metergoline; and 4 occurred after pituitary selective adenomectomy. The observed complications included spontaneous abortion (10 cases); headache (7 cases); sellar enlargement (5 cases); and bitemporal hemianopsia (1 subject with macroadenoma). Among 24 women in whom prolactin levels were reevaluated at least 1 month after parturition and/or lactation, 8 showed a decrease in prolactin concentration (less than 50% of pregestational levels), with actual prolactin normalization in 3 and resumption of cyclic menses in 2 previously amenorrheic women. In contrast, no changes in prolactin levels occurred after pregnancies that ended in abortion. These data suggest the following: 1) conception is not uncommon in women with moderate hyperprolactinemia; and 2) pregnancy may be safely induced without prior surgery and/or radiotherapy in hyperprolactinemic women, except those with large pituitary adenomas, and a considerable number of these patients even show a clinical and biochemical improvement after pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Menotropics (human menopausal gonadotropin [hMG]) are used to induce follicular maturation and ovulation in anovulatory infertile women. To determine how hMG stimulation affected ovarian androgen production during such therapy, plasma androstenedione (A) and testosterone (T) levels were measured at the beginning and end of hMG therapy in 5 patients with anovulatory hypogonadotropism (group 1) and 15 patients with anovulatory polycystic ovary syndrome (group 2). Mean pretreatment levels of plasma estradiol (E2), T, and A were significantly higher in group 2 compared with group 1. Stimulation with hMG caused E2 levels to reach the same maximum value in both groups. Testosterone levels increased from 0.2 ± 0.03 ng/ml (mean ± SE) to 0.4 ± 0.038 ng/ml for group 1 patients, and from 0.53 ± 0.06 ng/ml to 0.8 ± 0.1 ng/ml for group 2 patients. Androstenedione levels increased from 1.5 ± 0.47 ng/ml to 2.1 ± 0.4 ng/ml and from 4.37 ± 0.77 ng/ml to 5.8 ± 1.1 ng/ml in groups 1 and 2, respectively. The influence of hMG on plasma androgen levels was studied in women who received several treatment cycles before they became pregnant. In these women plasma androgen levels reached the same values in all cycles, including the final cycle in which the patient became pregnant. The data indicate that patients treated with hMG become pregnant despite marked gonadal androgen production. These observations suggest that hMG therapy promotes steroidogenesis in both the granulosa and theca cells of the follicle.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The increased occurrence of cervical intraepithelial neoplasia (CIN) in women with in utero exposure to diethylstilbestrol (DES) is described. Among 335 self-referred women exposed to DES, 14.9% (50) had at least 1 cytologic smear interpreted as CIN, and 16.2% (54) had at least 1 biopsy interpreted as CIN. Excluding those with grade 1 CIN, 8.7% (29) had at least grade 2 CIN on biopsy and 4.2% (14) had biopsies interpreted as grade 3 CIN. No invasive lesions were detected. Because the problem of differentiating true intraepithelial neoplasia from morphologically indistinguishable but benign lesions in DES-exposed women remains unresolved, the authors believe a conservative approach to treatment is still indicated. This study supports the recommendation that DES-exposed women merit continued thorough gynecologic evaluation, including regular cytologic evaluation and colposcopy, with biopsies as indicated.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Cryotherapy was used to treat 516 patients with various degrees of dysplasia and carcinoma in situ over a 7-year period. Seventy-one percent of patients had either severe dysplasia or carcinoma in situ. In 88% of the patients treated, a single treatment session was successful in eradicating the lesion. Treatment was defined as successful when cytologic and colposcopic findings were negative 1 year after treatment. Five percent of patients were lost to follow-up. The criteria for selection of patients and possible causes of treatment failure are discussed.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID