摘要:

Preterm delivery accounts for a substantial percentage of perinatal mortality and morbidity. A large body of evidence suggests that perinatal infections may play an etiologic role in preterm rupture of membranes and preterm labor. The interaction between a patient's vaginal flora and her local defense mechanisms (antibacterial activity of amniotic fluid and cervical mucus) may help determine who delivers prematurely. The evidence implicating infection as a cause of labor is reviewed, and the organisms which may be responsible are identified. Potential avenues of investigation and intervention are outlined which would delineate the role of infections in preterm delivery and lead to a means of preventing some preterm deliveries caused by infection.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Factors associated with risk of postoperative infection after cesarean section were studied in 321 patients not given antibiotic prophylaxis. Infections occurred in 56 (25%) of the 228 patients who were delivered by emergency cesarean section and in eight (9%) of the 93 patients who underwent elective surgery (P<.01). These frequencies corresponded well with the infection rates reported after administration of antibiotics in other studies. Risk factors were: duration of operation more than one hour; blood loss more than 800 ml; presence ofStaphylococcus aurensin the nares; signs of intrauterine infection before surgery; and failure of progress in labor. The results indicated that obstetric interventions had been performed more frequently in patients at risk of infection, rather than being the real cause of the infections. The importance of strict preoperative hygienic routine is discussed.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

To determine neonatal risk of exposure to intrapartum antimicrobials given to reduce maternal infection following cesarean delivery, 642 mother-infant pairs were evaluated. In 464, the mother was given an initial dose of antimicrobial(s) before cord clamping, whereas in the remaining 178 administration of these drugs was not begun until after delivery. Despite the facts that all infants were at equivalent risk for infection and that none were proved to have bacteremia, 28% of those exposed to intrapartum maternal antimicrobials were evaluated for sepsis whereas only 15% of those not exposed were evaluated (P<.001). Excess hospital charges for infants in whom sepsis workup was initiated was $127 greater than that for infants not suspected of having sepsis (P<.025). Of 305 women given three-dose perioperative antimicrobial therapy, 255 were given the initial dose before cord clamping and 24% experienced a subsequent uterine infection. This was not significant when compared with a uterine infection rate of 22% in 50 women in whom three-dose therapy was not initiated until after cord clamping. As maternal benefits that accrue from such intrapartum therapy are equivalent regardless of the timing of three-dose treatment, and as fetal exposure to these drugs has significant clinical and economic impacts, it is concluded that antimicrobials given to these women at high risk should be withheld until after cord clamping.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Genetic counseling before amniocentesis has been advocated by many geneticists with little evidence to support their contention. Records of patients referred exclusively for advanced maternal age were evaluated for additional diagnostic information obtained from the genetic counseling process that could place these patients at additional risks for previously unsuspected fetal abnormalities. A significant number of patients (43.3%) were at additional risk or had significant concerns regarding one or more hereditary or congenital disorders requiring extensive genetic counseling. The results of the present study provide a scientific basis for the consideration of genetic counseling as a standard part of all prenatal diagnostic procedures.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Twenty-five external cephalic versions were attempted on 14 transverse and 11 breech malpositioned second twins. In ten of 14 (71%) transverse presentations and eight of 11 (73%) breech presentations, version was successful and resulted in subsequent vertex vaginal delivery. Successful version was not associated with parity, gestational age, or birth weight but was associated with mode of anesthesia and disparity in twin size. Among the 25 attempted versions, seven (28%) had one-minute and two (8%) had five-minute Apgar scores below 7. Analysis by birth weight and mode of delivery is presented. Time interval between delivery of twins had no association with outcome. One neonatal death occurred in a 28-week, 1100-g infant. The authors believe that external version is useful in the management of the second twin who has an abnormal presentation, and that routine cesarean section is not always necessary. Further investigation, especially at lower birth weights, is necessary to confirm the safety and efficacy of this method of management.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The frequency of subsequent childbearing and the method of subsequent delivery among 149 primigravidas who required instrumental delivery for midcavity arrest of the fetal head in the second stage of labor and 1258 primigravidas who delivered spontaneously were compared. The frequency of subsequent childbearing was similar in the two groups, but operative delivery for cephalopelvic disproportion (CPD) in a second pregnancy was six times greater in the instrumentally delivered group (11.2 versus 2%;P<.005). Nevertheless, more than 75% of instrumentally delivered primigravidas who delivered heavier infants in their second pregnancy did so spontaneously. It is concluded that relative CPD is not a common factor necessitating midcavity deliveries, even if cases in which peridural anesthesia is used and deliveries for fetal bradycardia are excluded from consideration. This probably accounts for the fact that over 97% of instrumentally delivered infants suffered no birth trauma or birth asphyxia.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

One hundred ninety-seven women who had completed 42 weeks of gestation underwent weekly evaluation of the cervix according to the Bishop score until the spontaneous onset of labor. Confirming the clinical impression that the cervix is seldom favorable in prolonged pregnancy, the initial Bishop score was only 3.6, and in only 8.27% was the score 7 or more. The degree of dilatation at the last predelivery examination was significantly related to an infant's Apgar score at one and five minutes; effacement was significantly related to the Apgar score at one minute. The Bishop score at 42 weeks and more was not related to the patient's parity or to the infant's birth weight. Finally, dilatation and effacement of the cervix and station of the head were more predictive of the interval from examination until delivery than were other elements of the Bishop score.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Perinatal asphyxia at term is a major cause of mortality and morbidity. In many instances obstetric or maternal complications during pregnancy, labor, or delivery account for the asphyxia, but there is a group of infants in whom asphyxia occurs without any recognizable risk factors. The histories of 1602 infants were evaluated with these problems in mind. There were 547 infants without any complicating factors, 329 with obstetric complications, and 356 with miscellaneous maternal, fetal, and neonatal problems. The mean gestational age of these infants was 277.4 days. Fetal distress was noted in 183 cases without subsequent neonatal disease; the mean gestation of these infants was 282.7 days. Unexpected intrapartum asphyxia was observed in 187 instances with a mean gestation of 288.8 days. Those who died or had neurologic symptoms had the longest mean gestation, 291 days. Only 5% of the infants dying of unexpected perinatal asphyxia and less than 16% of those with neurologic symptoms were born before their due dates; approximately 64% of the infants with obstetric complications, miscellaneous problems, or no complications or morbidity were born before 280 days. The implications for management of pregnancy at or beyond 280 days are discussed.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The complication rate among 282 women undergoing interval tubal sterilization by laparotomy was studied as part of the prospective multicenter Collaborative Review of Sterilization. Using a standard definition of major complications, the overall complication rate was 5.7 per 100 procedures. Women experiencing complications had a significantly lengthened postoperative recovery period before the resumption of normal activities. Important risk factors for complications included diabetes, cigarette smoking, previous abdominal or pelvic surgery, and a history of pelvic inflammatory disease. Women with an initial abdominal incision of 7 cm or longer had three times the complication rate of women with shorter incisions. These results provide objective evidence that, for tubal sterilizations, minilaparotomy (laparotomy with a small abdominal incision) is associated with lower morbidity than is conventional laparotomy.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The dilatation and evacuation procedure was explored in 1971 as an alternative method of second-trimester abortion. The results in 11,747 cases from 1972 through 1981 are presented. Although complications do occur—most notably hemorrhage, cervical laceration, fever, and perforation—the overall complication rate was lower than that reported for saline or prostaglandin in other large series. Further study and refinement of technique may help bring this shorter, safer, and more convenient procedure within the reach of larger numbers of women seeking second-trimester abortion.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID