摘要:

Objective:To determine the frequency of active tuberculosis during pregnancy in two hospitals located in an area where tuberculosis is epidemic and to describe its course and association with human immunodeficiency virus (HIV) infection.Methods:We reviewed and analyzed the medical records of 16 pregnant women diagnosed with tuberculosis between 1985‐1992 at Kings County Hospital (n= 12) and Saint Vincent's Hospital (n= 4) in New York City.Results:Ten of the 16 pregnant women with proven active tuberculosis had pulmonary tuberculosis, two had tuberculous meningitis, and one each had mediastinal, renal, gastrointestinal, and pleural tuberculosis. Eleven were tested for HIV, and seven were seropositive. One HIV‐infected patient with pulmonary tuberculosis died of respiratory failure. In the 6 years between 1985‐1990, five cases of active tuberculosis during pregnancy were identified (12.4 per 100,000 deliveries). During the 2 years of 1991‐1992, 11 cases were recorded (94.8 per 100,000 deliveries).Conclusion:Cases of active tuberculosis are increasing among pregnant women in epidemic communities and are associated with HIV infection. Early tuberculin skin test screening with appropriate preventive therapy should reduce morbidity due to tuberculosis in HIV‐infected women of reproductive age. Identification of pregnant women with tuberculosis requires a high index of suspicion.(Obstet Gynecol 1994;83:911‐4)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To report our experience with essential thrombocythemia complicating pregnancy.Methods:Over a 5‐year period, we studied 21 women of reproductive age affected by essential thrombocythemia. Diagnoses were based on previously published Polycythemia Vera Study Group criteria.Results:Five of our 21 patients became pregnant (total six pregnancies). All pregnancies were carried to term, with uncomplicated deliveries of normally formed infants. No thrombotic or hemorrhagic complications were encountered.Conclusion:Normal pregnancy and delivery is readily possible in patients with essential thrombocythemia.(Obstet Gynecol 1994;83:915‐7)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To test the hypothesis that strict control of diabetes during pregnancy can reduce the risk for neonatal hypocalcemia in infants of diabetic mothers.Methods:One hundred thirty‐seven pregnant women with insulin‐dependent diabetes enrolled before 9 weeks' gestation were randomized to one of two treatment groups. In 68 subjects, the goals were fasting blood glucose level less than 4.44 mmol/L (80 mg/dL) and 1.5‐hour postprandial blood glucose level less than 6.66 mmol/L (120 mg/dL) (strict control), whereas in 69 the goals were fasting blood glucose level less than 5.55 mmol/L (100 mg/dL) and 1.5‐hour postprandial glucose level less than 7.77 mmol/L (140 mg/dL) (customary control).Results:Infants in the strict control group had a significantly lower rate of hypocalcemia (mean calcium less than 8.0 mg/dL in term infants and less than 7.0 mg/dL in preterm infants) than infants in the customary control group (17.6 versus 31.9%;P< .05). Using logistic regression analysis and after adjusting for the effects of gestational age, asphyxia, and White class on hypocalcemia, the difference between groups remained significant. The lowest infant serum calcium concentration correlated significantly with maternal glycohemoglobin A1concentration at delivery (P= .03), gestational age (P= .0001), and the lowest serum magnesium concentration (P= .0001).Conclusion:Strict management of diabetes in pregnancy is associated with a reduction in the rate of neonatal hypocalcemia.(Obstet Gynecol 1994;83:918‐22)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To identify and quantitate the risk factors that might be predictive of hemorrhage during abdominal delivery.Methods:Over a 2‐year period, 1610 women underwent cesarean delivery and 127 (7.9%) had hemorrhage, defined as a decrease in hematocrit of 10% or greater, estimated blood loss greater than 1500 mL, or packed red blood cell administration. These women were compared through a casecontrol study design with the next abdominal birth without hemorrhage that could be matched for age, parity, indication for cesarean delivery, type of anesthesia, type of skin incision, and antepartum hematocrit.Results:Preeclampsia (odds ratio 3.6, 95% confidence interval [CI] 1.8‐7.4), disorders of active labor (odds ratio 4.4, 95% CI 1.4‐13.7), Native American ethnicity (odds ratio 6.4, 95% CI 1.8‐22.4), previous postpartum hemorrhage (odds ratio 8.4, 95% CI 1.9‐37.4), and obesity of greater than 250 lb (odds ratio 13.1, 95% CI 1.7‐102.7) were all statistically associated with significant bleeding during abdominal delivery. Combinations of two or more of these factors were associated with a markedly increased risk for hemorrhage, with odds ratios of 18.4 or greater.Conclusions:Patients undergoing cesarean delivery who have factors exposing them to increased risk of hemorrhage can be identified prospectively. These women will benefit greatly from extended preoperative counseling when possible, effective utilization of blood bank technology through type and cross‐match requests, and preventive measures during abdominal delivery to minimize blood loss.(Obstet Gynecol 1994;83:923‐6)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To report a prospective multicenter comparison of outcomes of patients who attempted trial of labor and those who underwent elective repeat cesarean.Methods:During the study interval, all pregnant women with previous cesarean delivery cared for at Kaiser Permanente Hospitals in Southern California were studied regardless of whether trial of labor or elective repeat cesarean was planned.Results:Of 7229 study patients, 5022 (70%) had a trial of labor and 2207 had elective repeat cesarean operations. Seventy‐five percent (3746) of those opting for trial of labor went on to deliver vaginally. The rate of uterine rupture was less than 1% and there were no maternal deaths related to uterine rupture. The hospital length of stay, incidence of postpartum transfusion, and incidence of postpartum fever were all significantly higher in the elective repeat cesarean group than in the trial of labor group.Conclusions:Labor after previous cesarean delivery has a 75% success rate, with a risk of uterine rupture of less than 1%. Neither repeat cesarean delivery nor trial of labor is risk‐free. With careful supervision, trial of labor eliminates the need for a large proportion of repeat cesarean operations.(Obstet Gynecol 1994;83:927‐32)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To examine several variables that may affect the success rate for a trial of labor after previous cesarean delivery, as well as those affecting the rate of uterine rupture.Methods:Between June 1, 1990 and December 31, 1991, we performed a consecutive, prospective study of 593 pregnant women who had had at least one abdominal delivery in the past, and attempted a trial of labor in each. Particular attention was given to the success rate of vaginal delivery, the type of previous uterine incision, use of oxytocin, estimated maternal blood loss, 5‐minute Apgar scores, and reason for the previous cesarean operation.Results:Four hundred seventy‐eight patients (81%) had a successful vaginal delivery. Oxytocin induction or augmentation was successful in 46 of 67 (69%) and 117 of 167 cases (70%), respectively. Estimated maternal blood loss was less than 500 mL in 453 cases (95%). Five patients (0.8%) experienced true uterine rupture, resulting in severe neurologic sequelae in one infant. The only consistent indication of uterine rupture was an abrupt and prolonged fetal bradycardia. The majority (463; 97%) of infants who were delivered vaginally had 5‐minute Apgar scores of 8 or greater.Conclusion:Our success rate of 81% suggests that a trial of labor after previous cesarean delivery is a safe and desirable option, but only after thorough patient counseling. An abrupt and persistent fetal bradycardia may be the only indication that uterine rupture has occurred.(Obstet Gynecol 1994;83:933‐6)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine whether leaving the membranes intact in active‐phase arrest would affect the cesarean delivery rate or the incidence of maternal morbidity secondary to infection.Methods:We conducted a randomized trial of healthy, spontaneously laboring women at term with an intact chorioamnion and active‐phase arrest (defined as 1 cm or less of cervical change over 2 hours in the active phase of labor). Patients were assigned to either oxytocin augmentation with intact chorioamnion or oxytocin augmentation with amniotomy and internal monitoring of the fetal heart rate and uterine contractions.Results:The intact group (n= 58) and the amniotomy group (n= 60) were similar with respect to maternal age, race, parity, labor epidural usage, gestational age, cervical dilatation at randomization, number of vaginal examinations, and infant birth weight. Four patients in the intact group and five in the amniotomy group underwent cesarean delivery (P= 1.0). No patients in the intact group and three in the amniotomy group were diagnosed with chorioamnionitis (P= .24). Endometritis did not occur in the intact group, whereas four cases occurred in the amniotomy group (P= .12). There were no cases of maternal infection in the intact group, versus seven in the amniotomy group (P= .01). The interval between randomization and vaginal delivery was 44 minutes longer in the intact group than in the amniotomy group (P= .11).Conclusion:In women with active‐phase arrest of labor and intact membranes, oxytocin augmentation with elective amniotomy and internal monitoring increases maternal infectious morbidity.(Obstet Gynecol 1994;83:937‐40)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To examine changes in lymphocyte subpopulations in early pregnancy using a methodologically appropriate study design that addresses previous sources of bias.Methods:Thirty‐seven healthy women without risk factors for human immunodeficiency virus (HIV) were reviewed when less than 9 weeks pregnant (median 51 days, range 44‐61) and again at least 4 weeks following termination of pregnancy. No woman took the oral contraceptive pill. Blood was taken on each occasion at the same time of day under the same conditions of rest and food intake, transported immediately to the laboratory, and directly prepared for analysis. Lymphocyte surface markers were determined by staining with dual‐colored, isotype‐matched monoclonal antibody fluorescent conjugates, followed by whole blood lysis and subsequent flow cytometric analysis.Results:Pregnancy was associated with a significant reduction in total lymphocytes (P< .0001) and also in CD4+ cells, whether expressed as a percentage of lymphocytes (P= .004), an absolute count (P= .0006), or a ratio (P= .01). Change was independent of the basal level except for lymphocytes, and almost all indices had significant correlations between pregnant and nonpregnant values.Conclusions:In this study design, each woman served as her own control and all factors remained constant except the pregnancy state. Early pregnancy causes a reduction in total lymphocytes of about 6% expressed as a percentage of total white cell count, and in CD4+ cells by 3% as a percentage of lymphocytes, or 100/mm3. We believe this fall can be accepted as definitive.(Obstet Gynecol 1994;83:941‐6)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To test the hypothesis that increased echogenicity of the fetal bowel at second‐trimester scans results from intra‐amniotic bleeding.Methods:We studied 726 patients undergoing secondtrimester amniocentesis for advanced maternal age. Three groups were identified according to the color of the amniotic fluid (AF) obtained: clear fluid, blood‐stained fluid, and dark brown fluid. Two to 4 weeks after the amniocentesis, all patients had a targeted ultrasound examination for the detection of fetal structural anomalies and markers of chromosomal abnormalities, which included a survey of the fetal bowel. The incidence of hyperechogenic bowel in each group was compared by Fisher exact test.P< .05 was considered significant.Results:In 694 cases, the AF was clear (95%), in 20 blood‐stained (3%), and in 12 dark brown (2%). Hyperechogenic bowel was detected in 14 fetuses with clear fluid (2%), in two with blood‐stained fluid (10%), and in three with dark brown fluid (25%). Fetuses with proven intra‐amniotic bleeding (ie, dark brown or blood‐stained AF at amniocentesis) had a significantly higher incidence of hyperechogenic bowel compared to those with clear AF (five of 32 [15.6%] and 14 of 694 [2.0%], respectively;P< .001, 95% confidence interval for the difference in proportions 6.3‐17.6%).Conclusions:Our study demonstrates that intra‐amniotic bleeding is associated with an increased incidence of fetal hyperechogenic bowel at second‐trimester ultrasound scans. This sonographic phenomenon may be due to the presence of blood in the fetal bowel caused by fetal swallowing of bloody AF.(Obstet Gynecol 1994;83:947‐50)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To measure fetal lung volume by echo‐planar magnetic resonance imaging (MRI).Methods:Twenty singleton pregnancies were scanned on one occasion each using echo‐planar imaging, a form of MRI. Cases of fetal growth restriction and macrosomia were excluded from the study.Results:Lung volumes increased with gestational age from 21 mL at 23 weeks' gestation to a maximum of 94 mL at term. The relation between lung volume and gestational age was exponential. The ratio of lung volume to total fetal volume decreased with gestational age.Conclusion:The use of echo‐planar imaging allows estimation of normal fetal growth; it has clear applications for the diagnosis of lung hypoplasia and potential use for the study of lung maturity.(Obstet Gynecol 1994;83:951‐4)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID