摘要:

Congenital heart disease comprises one-third of all major birth defects. Prevalence estimates depend on the definition of the disease and the postnatal period when the disease is diagnosed. The studies with the longest follow-up estimate that 0.9% of infants are afflicted. The cause of these cardiac defects is largely unknown. The effect of embryonic exposure to maternal drugs during cardiogenesis has been widely studied, and the evidence suggests that maternal use of ethanol, anticonvulsants, lithium, and exogeneous female hormones may increase the risk of congenital heart disease. An antiemetic agent containing doxylamine has been implicated in the courts. This review offers an analysis of the epidemiologic evidence of the occurrence of congenital heart disease in relation to maternal drug use during pregnancy. The evidence indicates that the vast majority of heart malformations cannot be attributed to these pharmacologic agents.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

To suppress uterine contractions during cervical ripening induced by prostaglandin E2(PGE2) gel, β -mimetic drugs were given orally 30 minutes before PGE2application to 17 patients with unripe cervix. This prevented the increase in contraction frequency observed during the first four hours after PGE2application in 17 controls. Nevertheless, cervical ripening proceeded at a similar rate and the clinical outcome was comparable in both groups. Prostaglandin E2application caused a transient rise in plasma levels of the PGE2αmetabolite (13,14-dihydro-15-keto), which was not prevented by pretreatment with β -mimetics. Patients with premature rupture of the membranes had higher initial plasma PGF2αmetabolite levels than those with intact membranes but cervical ripening proceeded with the same rate, and the effect of β -mimetics was the same in both groups. Thus, cervical ripening induced by PGE2does not depend on uterine contractions, and increased production of PGF2is unrelated to the ripening process. There was no difference between the three β -mimetic agents in the present study.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A retrospective review of the outcome in multifetal pregnancies from January 1,1980 to July 31,1983 was undertaken to evaluate the role of nonstress test, followed by contraction stress test when indicated, in reduction of intrauterine fetal deaths in twins after 32 weeks of gestation. Of the 90 twin pregnancies managed under the authors' protocol, there were no intrauterine fetal deaths. Intervention leading to delivery occurred in six twin pregnancies with an abnormal nonstress test followed by an equivocal or positive contraction stress test. The authors believe that routine use of weekly nonstress tests after 30 weeks of gestation coupled with contraction stress tests when indicated, and use of other parameters of fetal assessment such as ultrasound, intrauterine fetal death in twin gestation after 32 weeks of gestation, can be significantly reduced.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

One hundred forty-seven cases of partial or complete placenta previa from 1975 to 1982 were reviewed. A history of prior cesarean section was associated with a significant increase in maternal morbidity, including massive hemorrhage, placenta accreta, and hysterectomy. Despite tocolysis and transfusions to delay delivery, nearly two-thirds of the patients were delivered before 36 weeks' gestation. Onset of bleeding before 20 weeks' gestation was associated with a very poor fetal prognosis. The perinatal mortality rate was 81 of 1000. The overall incidence of respiratory distress syndrome was 22%; this was a major cause of neonatal mortality and morbidity. There was a statistically significant correlation between antepartum maternal hemorrhage and the need for neonatal transfusion, and between the neonatal anemia and the amount of intrapartum maternal blood loss.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Five women with pseudocyesis were evaluated during a two-year period. A random, nontimed blood sample was obtained from each woman at the time of initial encounter that revealed a hormone pattern most consistent with polycystic ovarian disease; mean (± SE) concentration of luteinizing hormone (LH) was 14.2 ± 2.1 mlU/mL, follicle-stimulating hormone (FSH) was 3.3 ± 0.7 mlU/mL, prolactin (PRL) was 23.5 ± 1.3 ng/mL, estrone was 74.7 ± 15.0 pg/mL, and estradiol was 54.7 ± 13.0 pg/mL. In four of these patients, serum progesterone concentration was elevated over expected follicular phase values. The opiate antagonist, naloxone, was administered to four women before disclosure of their diagnosis. Naloxone treatment failed to induce LH or PRL release. Because naloxone did not cause a change in hormone concentration, naloxone-sensitive opioid mechanisms are apparently not involved in this disorder. After resolution of pseudocyesis, naloxone-induced LH release was appropriate for the phase of the cycle in which the narcotic blocking agent was administered.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A prospective randomized study was undertaken in 100 patients undergoing cesarean section to evaluate the efficacy of cefotaxime when given as a single-dose versus the more traditional triple-dose regimen for prophylaxis. Analysis of the results demonstrated no significant differences in febrile morbidity (14 versus 20%) or postoperative endometritis (10 versus 14% between the single- and triple-dose groups, respectively. Pretherapy aerobic and anaerobic placental cultures were positive in 60% of the overall study population. In those patients who subsequently developed endometritis, seven (58%) had a positive placental culture, suggesting that this technique is relatively nonspecific as a screening procedure. Results of transcervical culture in the endometritis patients most often demonstrated a polymicrobial picture. Several of the organisms cultured were found to be resistant to cefotaxime, supporting the need to better guide antimicrobial therapy by routine endometrial culturing in patients who fail prophylaxis. The results of the present study suggest that single-dose administration of cefotaxime is equally effective as triple-dose therapy in reducing postcesarean section endometritis.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Twenty-eight regularly menstruating female volunteers made careful collections of their sanitary pads and tampons on a daily basis throughout one menstrual period in such a way that the total fluid volume of the menstrual discharge could be accurately measured independently of the blood loss. The percentage contribution of blood (equivalent to mixed venous blood from the cubital fossa) to the total varied very greatly from woman to woman (1.6 to 81.7%) with a mean of 36.1 ± 3.6% (± SEM). There was a highly significant correlation between total fluid loss and blood loss (r=0.911, P<.001). The proportion of blood remained approximately the same for different total volumes and on different days of the cycle. Women using no contraception or who had undergone tubal sterilization had similar ratios of blood to total fluid loss, whereas intrauterine device (IUD) users had a higher ratio (P<.025) and oral contraceptive users a lower ratio that just reached statistical significance (P<.05). It seems probable that the major component of the fluid loss that cannot be accounted for by blood is from endometrial tissue fluid rather than vaginal or cervical secretions.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The endocrine effects of induction of ovulation with menotropins were studied in 43 patients: 11 with hypothalamic amenorrhea and 32 with the polycystic ovary syndrome. Patients with polycystic ovary syndrome had higher baseline values of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), 17β -estradiol, dehydroepiandrosterone sulfate, testosterone, and a higher testosterone-free index than those with hypothalamic amenorrhea. During treatment with menotropins, patients with polycystic ovary syndrome had higher values of serum LH, prolactin, dehydroepiandrosterone sulfate, testosterone, percent free testosterone, testosterone-free index, arid body weight than those with hypothalamic amenorrhea; serum FSH, dose of menotropins per kilogram body weight, and total follicular volume were higher in patients with hypothalamic amenorrhea than in those with polycystic ovary syndrome. Multiple linear regression after log transformation demonstrated that the testosterone-free index was predicted statistically by total ovarian volume and dehydroepiandrosterone sulfate and that serum 17β - estradiol was predicted statistically by total ovarian volume and testosterone-free index. Adding dexamethasone to menotropins in six patients with polycystic ovary syndrome produced significant decreases in 17Pestradiol, dehydroepiandrosterone sulfate, testosterone, and testosterone-free index. Higher concentrations of endogenous serum LH and dehydroepiandrosterone sulfate in patients with polycystic ovary syndrome in comparison with those with hypothalamic amenorrhea were associated with higher concentrations of serum testosterone, a lower total follicular volume, and an effective response to menotropins at a lower serum FSH and a lower dose of menotropins per kilogram body weight. These data suggest that serum dehydroepiandrosterone sulfate may be a precursor for ovarian steroidogenesis.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The recovery from emergency hysterectomy of 18 Chinese patients is described. During the recovery period, patients experienced fear, depression, anger, doubt, selfreproach, and multiple somatic complaints without physical origins. Sexual activity was reduced. The recovery course was particularly difficult for those patients who were nonsymptomatic before operation, those who still wanted to bear more children, and those who lacked family support. These women needed continuous reassurance and ample opportunities to ventilate their feelings. None of the patients had psychiatric sequelae requiring expert consultation after the operation. It is emphasized that the reactions and needs of these patients deserve recognition, attention, and follow-up.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

This study was performed to demonstrate the phenomenon of discordant human chorionic gonadotropin (hCG) results, in which some serum specimens are positive in one hCG detection procedure but negative in another procedure. Nine different quantitative hCG procedures were used to document discordant hCG results in 22 cases. A two-site monoclonal antibody immunoradiometric assay had the least tendency to give aberrant low-positive hCG values in nonpregnant patients without neoplasms. Potential causes of discordant hCG results are discussed, and guidelines for dealing with them are suggested. Recommended approaches include analysis in an alternate hCG detection procedure that uses a different technology for collection of antigenantibody complex, dilution analysis, and sequential hCG analysis.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID