摘要:

The maternal mortality ratio in New York City during the 3-year period of 1981-1983 was 36.1 deaths per 100,000 live births. Eight (7%) of 120 deaths occurred more than 42 days after termination of the pregnancy. Eighteen (15%) of the cases involved white, non-Hispanic women, 66 (55%) were black, and 32 (27%) were Hispanic. Fifty-seven deaths were associated with cesarean delivery, although most of these could not be attributed to the mode of delivery. Sixty-six (55%) of the deaths were classified as direct maternal deaths. The age ranged from 16-44 years, with 83 (69%) of the women aged 20-34, 11 (9%) 19 or less, and 26 (22%) aged 35 or older. Increasing age and parity were associated with greater maternal mortality ratios. The leading causes of pregnancy-associated mortality were found to be ectopic pregnancy, pulmonary embolism, anesthetic complications, amniotic fluid embolism, intracranial hemorrhage, hypertensive diseases of pregnancy, infection, and cardiac disease. Abortion-related mortality was about nine times less than the maternal mortality ratio, and the cesarean death-to-case rates could be considered roughly comparable to overall maternal mortality.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The outcomes of 72 pregnancies in 20 women with either hemoglobin CC or C-β-thalassemia are described. Except for mild to moderate hemolytic anemia, maternal complications caused by the hemoglobinopathy were infrequent and perinatal outcomes were generally good. In eight women, blood volume expansion determined by51chromium-tagged erythrocytes was similar to that for normally pregnant women. Mean red-cell survival was determined 11 times in eight women, and the red-cell half-life of 22 days was significantly shorter than that of 35 days for normally pregnant women.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Because identification of patients at risk and preventive therapies are imperfect, eclamptic seizures continue to occur occasionally during the puerperium. During an 18-year span in a single tertiary medical center, 36 of 254 patients with eclampsia (14.2%) experienced postpartum seizures at a mean gestational age of 35.6 weeks. Early (before 48 hours) postpartum eclampsia was experienced by 72% of patients, and 28% had late (after 48 hours) postpartum eclampsia. Prospectively only 67% of patients were correctly diagnosed, and retrospectively only 83% could be considered to have had preeclampsia before seizure. Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome was present in 30% of the affected patients. Seven patients were receiving magnesium sulfate by controlled infusion when an eclamptic seizure occurred. The presence or absence of diuresis was unrelated to seizure occurrence. Preeclampsia recurred in 38.5% of subsequent gestations. It appears that HELLP syndrome may be a predisposing factor for eclampsia.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Fifty-six primigravid women at 28-32 weeks' gestation were studied prospectively to compare the roll-over test with the stand-up pressor test in the prediction of gestational hypertension. Blood pressures were measured in the different positions continuously using an automated machine. Twenty patients developed gestational hypertension; two of these were accurately predicted by roll-over test and six by stand-up pressor test (P<.001). However, there was no significant difference between the tests in the rates of false negatives, specificity, and negative and positive predictive values. Concomitant measurement of blood pressures in the standing position may increase the sensitivity of the rollover test for the prediction of gestational hypertension.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

To study whether the estimated date of confinement (EDC) for women with optimal menstrual histories is predicted best from the last menstrual period (LMP) or biparietal diameter (BPD), 2320 women had the EDC estimated by both LMP and BPD measured Sonographically in the second trimester. Those who delivered after the spontaneous onset of labor are reported here. Compared with the EDC calculated from the LMP, the EDC calculated from the BPD was postponed more than 1 week for 406 women (17.5%) and advanced more than 1 week for 56 (2.4%). For these women, the BPD estimate of EDC turned out to be closer to the day of delivery in 264 cases, whereas the LMP estimate was closer in 125 (P<.001). For 73 women, the estimates were equally good. For 80.1% of the women, the two estimates of EDC differed by 1 week or less; in these cases, the estimates were equally good in predicting the day of delivery. We conclude that the BPD is a better predictor of the spontaneous onset of labor than is the LMP.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Sonograms from 1622 consecutively scanned singleton pregnancies at a mean gestational age of 28.5 weeks were analyzed to determine whether maternal obesity affected visualization of fetal anatomy. Fetal head (cerebral ventricles), heart (four-chamber view), stomach, kidneys, bladder, diaphragm, intestines, spinal column, extremities, and umbilical cord were classified as visualized or suboptimally visualized. Maternal body mass index was used as a measure of relative leanness. No significant impairment of ultrasound visualization was noted until a body mass index above the 90th percentile, when visualization fell by an average of 14.5%. Reduction in visualization was most marked for the fetal heart, umbilical cord, and spine. Among non-obese women, advancing gestation and decreasing body mass index were the most important determinants of visualization. However, among obese women, body mass index was the best predictor of visualization, with no improvement seen with advancing gestation or duration of examination.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The purpose of this investigation was to determine whether an extended-spectrum antibiotic with a long duration of action was more effective for prophylaxis for cesarean delivery than a limited-spectrum agent with a shorter duration of action. Patients were eligible for the study if they were in labor or had ruptured membranes at the time of surgery. In a randomized, double-blind manner, 377 women were assigned to receive 2 g of cefazolin (192) or 2 g of cefotetan (185) intravenously immediately after the infant's umbilical cord was clamped. There were no significant differences between groups with respect to the frequency of febrile morbidity (22.4 versus 21.6%), the mean fever index (15.8 versus 14.9 degree-hours), the frequency of endometritis (19.3 versus 21.1%), or the mean duration of postoperative hospitalization (3.8 versus 3.9 days). Among patients who became infected despite prophylaxis, enterococcus was isolated with disproportionate frequency. This organism was responsible for 89% of the postoperative urinary tract infections and all three cases of bacteremia. It was also the second most common isolate in women with endometritis. A single dose of cefazolin is comparable in effectiveness to cefazolin. In view of the cost difference between the two antibiotics, there is no justification for use of the more expensive, extended-spectrum agent.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Infection with the human immunodeficiency virus (HIV) among reproductive-age women occurs disproportionately among inner-city minority populations. These women are at risk because of intravenous drug abuse and heterosexual transmission from partners infected through drug abuse. From July 1, 1988 to December 31, 1988, we conducted routine voluntary screening for HIV antibody among 923 women who requested induced first-trimester abortion at Grady Memorial Hospital. Eight (8.7 per 1000) women were seropositive on repeat enzyme-linked immunosorbent sorbent assay and Western blot testing. Two infected women had had heterosexual contact with a person at risk for HIV infection, two others reported “crack”cocaine use, and four acknowledged no risk factors. Thirteen percent of seronegative women reported risk factors for HIV infection. Nearly all women consented to HIV testing, and most completed the risk-behavior questionnaire. These data suggest that women seeking first-trimester abortion at our hospital are at risk for HIV infection.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Intra-amniotic infection has been reported to be associated with intrapartum asphyxia; however, the criteria used to define asphyxia have been imprecise. In the present study of 123 women with intra-amniotic infection and 6769 women without infection, the mean umbilical artery pH was 7.28 in both groups. The frequency of acidemia (umbilical artery pH less than 7.20) was not significantly different between the infection group and controls (15 versus 10% P=.12). Likewise, there was no significant difference between the groups when a lower umbilical artery pH value (less than 7.15) was used to define acidemia. None of the infants from infected mothers had metabolic acidemia with a pH of less than 7.15 and none had a pH of less than 7.00. Significantly more (P<.05) infants in the infected group did have low 1-minute (20 versus 5%) and 5-minute (3 versus 1%) Apgar scores of 6 or less, criteria often used to define asphyxia. However, none of the newborns from the infected group had recently proposed criteria for the diagnosis of birth asphyxia (ie, leading to neurologic impairment) such as metabolic acidemia, seizures in the immediate newborn period, and low Apgar scores (3 or less). Birth asphyxia is rarely associated with intra-amniotic infection, and in the absence of other signs of fetal jeopardy such as an ominous fetal heart rate pattern, an immediate cesarean to prevent asphyxia does not appear justified once the diagnosis of chorioamnionitis is made.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The purpose of this study was to relate histologic chorioamnionitis to the isolation of microorganisms from the freshly separated chorioamnion in women who had early preterm delivery (before 35 weeks' gestation) following spontaneous labor. Histologic chorioamnionitis was identified in 51 of 95 study subjects. It was more common in the second trimester (72%) than from 27-34 weeks' gestation (33%) (P<.001). Culture specimens were obtained for aerobic and anaerobic bacteria, yeasts, mycoplasmas, and Chlamydia. Microorganisms were recovered from 38 subjects; all culture reports were negative in 36. A statistically significant association was demonstrated between histologic chorioamnionitis and positive culture results. If any microorganism was recovered, 68% of the subjects had histologic chorioamnionitis, versus 39% if all cultures were negative. Of cases of histologic chorioamnionitis in the third trimester, 92% were associated with positive cultures, compared with 54% in the second trimester. Our results suggest that histologic chorioamnionitis is not synonymous with infection, especially in the second trimester.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID