摘要:

Doppler color flow mapping is widely used in fetal echocardiography. We studied the impact of color flow mapping on fetal cardiac diagnoses. Between January 1, 1989 and June 30, 1990, we performed 854 fetal echocardiograms on 776 fetuses. Color flow mapping was used in 45 of 48 fetuses diagnosed as having cardiac abnormalities. Scans were reviewed to assess how color flow mapping influenced the ultimate diagnoses. Color flow mapping was essential to the correct anatomical diagnoses in 13 fetuses (29%), helpful but not essential in 21 (47%), and added little to two-dimensional examination alone in 11 (24%). It was essential in determining the course and flow direction in the great vessels when outflow obstruction was present or with transposition, and it was helpful but not essential in locating small jets of atrioventricular valve regurgitation. It was not helpful when the anatomical abnormalities were clearly identified from two-dimensional examination alone. We conclude that color flow mapping is helpful in the delineation of anatomical diagnoses in three-quarters of cases of fetal heart disease, particularly when the great vessels are abnormal. It may speed examinations by directing pulsed Doppler sampling. We did not find it essential to the proper recognition of anatomically abnormal hearts

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Induced maternal hypercapnia is a potent stimulus to fetal breathing movements in nonlaboring pregnant women. To determine the effect of maternal CO2administration on fetal breathing movements during spontaneous labor, 14 healthy pregnant volunteers at term and 34 in preterm labor were recruited. If fetal breathing movements were markedly decreased or absent, the subjects were administered a prepared gas mixture of 3% CO2in air. In term labor and in true preterm labor, fetal breathing movements were markedly decreased and could not be induced by maternal hypercapnia. Among women with suspected preterm labor, initial absence of fetal breathing movements and failure to evoke this response by maternal hypercapnia predicted delivery within 48 hours with a sensitivity of 80% and specificity of 96.5%. Induced maternal hypercapnia fails to stimulate fetal breathing movements in true term and preterm labor and may assist in distinguishing between true and false preterm labor

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We assessed the association between first-trimester vaginal bleeding and singleton infant outcomes in a hospital-based population of 11,444 nondiabetic women. Low birth weight (LBW), shortened gestation, LBW at term, and neonatal death occurred more often in women reporting first-trimester bleeding than in those who never bled. These relationships remained statistically significant after adjusting for confounding factors. Women who experienced vaginal bleeding limited to the first trimester (N=1174) had double the risk of delivering a preterm infant compared with those experiencing no bleeding (adjusted risk ratio=2.0; 95% confidence interval 1.6-2.5). Bleeding limited to the first trimester was associated with a 1.6-fold risk of delivery of a term LBW infant (95% confidence interval 1.3-2.0). These results suggest that first-trimester vaginal bleeding is an important correlate of adverse infant outcomes.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A randomized blinded investigation was undertaken to determine the efficacy and safety of sequentially applied intravaginal prostaglandin E2(PGE2) gel for accelerating cervical ripening in an outpatient setting in low-risk prolonged pregnancies. Fifty women with uncomplicated pregnancies at or beyond 41 weeks' gestation and Bishop scores below 9 received twice-weekly outpatient administration of gel containing 2.0 mg of PGE2or placebo. Thirty nulliparas and 20 multiparas were enrolled. The PGE2gel failed to improve cervical ripening over placebo, as judged by Bishop scores. There was no difference between the groups in gestational age on admission to the labor and delivery suite, number of gel applications, requirement for oxytocin, incidence of cesarean delivery, or neonatal outcome. Only two patients (4%) experienced regular uterine contractions after gel insertion; these subsided spontaneously in both. None of the subjects experienced labor, tetanic contractions, evidence of fetal distress, or any other side effects related to gel insertion. We conclude that PGE2gel in this dosage may be used safely in an outpatient setting, but more frequent application or earlier initiation may be required to produce a clinical effect

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We studied the tensile strength and collagen content of the amniotic membrane in the early and late second trimester and at term in specimens obtained after spontaneous, cesarean, and prostaglandin- and stretch-induced deliveries. No significant difference in either tensile strength or collagen content was found among any group of samples. Collagenous tissue of the amnion seems to differ constitutionally from that of the cervix and vagina and to be modulated by different mechanisms during pregnancy and delivery. It also seems to resist strong physiologic tension until it is mechanically ruptured during delivery

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The aim of this study was to determine whether neutrophil activation occurs in the fetal circulation in pregnancy-induced hypertension and to correlate this with evidence of neutrophil activation in the maternal circulation. Twenty-one normal pregnancies and 23 complicated by pregnancy-induced hypertension were studied in the third trimester. The mean length of gestation at delivery was significantly shorter (P<.01) and the mean birth weight percentile was significantly lower (P<.05) in the hypertensive group; otherwise the groups were comparable. Blood was obtained before cesarean delivery or established labor in the mothers and immediately after delivery from the umbilical vein. Plasma neutrophil elastase, which is released after neutrophil activation, was measured by radioimmunoassay as a marker for neutrophil activation. The mean (± standard error) concentration of neutrophil elastase in maternal plasma in the hypertensive group (35.9 ± 4.7 ng/mL) was significantly higher than in the normal group (20.8 ± 0.87 ng/mL) (P<.005). The concentration of neutrophil elastase in umbilical venous plasma was not significantly different between the normal and hypertensive groups. However, significantly higher concentrations of neutrophil elastase were found in the umbilical venous plasma of pregnancies delivered vaginally compared with those delivered by cesarean (P<.05) regardless of diagnosis. There was no correlation between maternal venous and umbilical venous plasma neutrophil elastase concentrations, birth weight percentile, plasma urate, or platelet count. These data suggest that neutrophil activation is confined to the maternal circulation in pregnancy-induced hypertension where it may contribute to vascular damage and dysfunction in areas such as the placental bed. In addition, neutrophil activation occurs in the fetal circulation during vaginal delivery. The neutrophil activation in the fetal circulation may reflect disturbance of the placental endothelium during labor or may be a physiologic mechanism involved in parturition

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Fifty-nine women completed a randomized, double-blind placebo-controlled study of pyridoxine hydrochloride (vitamin B6) for the treatment of nausea and vomiting of pregnancy. Thirty-one patients received vitamin B6, 25-mg tablets orally every 8 hours for 72 hours, and 28 patients received placebo in the same regimen. Patients were categorized according to the presence of vomiting: severe nausea (score greater than 7) or mild to moderate nausea (score of 7 or less). The severity of nausea (as graded on a visual analogue scale of 1-10 cm) and the number of patients with vomiting over a 72-hour period were used to evaluate response to therapy. Twelve of 31 patients in the vitamin B6 group had a pre-treatment nausea score greater than 7 (severe) (mean 8.2 ± 0.8), as did ten of 28 patients in the placebo group (mean 8.7 ± 0.9) (not significant). Following therapy, there was a significant difference in the mean “difference in nausea” score (ie, baseline — post-therapy nausea) between patients with severe nausea receiving vitamin B6 (mean 4.3 ± 2.1) and placebo (mean 1.8 ± 2.2) (P<.01). In patients with mild to moderate nausea and in the group as a whole, no significant difference between treatment and placebo was observed. Fifteen of 31 vitamin B6-treated patients had vomiting before therapy, compared with ten of 28 in the placebo group (not significant). At the completion of 3 days of therapy, only eight of 31 patients in the vitamin B6 group had any vomiting, compared with 15 of 28 patients in the placebo group (P<.05). The adjusted odds ratio for emesis in the treatment versus placebo groups, stratified by the presence or absence of pre-treatment emesis, was 0.1156 (P<.005). In conclusion, the mean “difference in nausea” score in patients with severe nausea and the total number of patients with vomiting were significantly reduced following vitamin B6 therapy

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The decreasing incidence of direct causes of maternal death over the past half century has led to a heightened awareness of nonobstetric factors responsible for maternal mortality. For example, cerebrovascular accidents are an important nonobstetric cause of maternal morbidity and mortality. During the 6.5-year period from 1984 to mid-1990, we encountered 15 women in whom pregnancy or the puerperium was complicated by an acute cerebrovascular accident. Six of these women had hemorrhagic strokes and nine had ischemic strokes. During this same time, approximately 90,000 women were delivered at Parkland Memorial Hospital, and thus the incidence of stroke was about one in 6000 pregnancies. Chronic hypertension or preeclampsia was causative in three cases of hemorrhagic stroke. It is important that 20% of the women died as a result of stroke, and of the 12 survivors, 40% have residual neurologic deficits. An aggressive work-up to define the etiology of stroke is necessary in order to implement cause-specific management, with subsequent reduction in morbidity and mortality.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Cervical effacement may be described as a percentage or as residual cervical length in centimeters. For effective communication among clinicians, the percentage method requires agreement about the length of the uneffaced cervix. Variation in beliefs regarding cervical effacement and length was assessed among practicing obstetricians at a single medical center. The mean estimate for the length of the uneffaced cervix at term was 2.47 ± 0.64 cm, with a range of 1-4 cm and a coefficient of variation of 26%. The mean estimate of physicians in private practice was significantly shorter (P<.001) than that of faculty and house staff combined. There is the potential for miscommunication among physicians based on variation in beliefs about effacement. Adoption of the metric system for description of the cervix would eliminate hidden assumptions about cervical length and the concept of effacement

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Six hundred eighty-five primigravidas followed as a series had complement activation evaluated by the formation of anaphylatoxins (C3a and C5a) and terminal C5b-9 complement complexes in venous blood. Samples for complement determinations were obtained four times during pregnancy, in pregnancy weeks 12-16, 20-24, 28-32, and 34-36. Seven of the women developed preeclampsia and one of them the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). Eleven others with uncomplicated pregnancies were selected as a control group. Plasma samples were taken from these 18 women at delivery and 1 and 7 days after delivery. At delivery, plasma C5a levels were significantly greater in the preeclamptics than in controls, and four of the seven preeclamptics had elevated plasma C3a values compared with controls. One week after delivery, these plasma anaphylatoxins had returned to normal. Elevations of the anaphylatoxins could not be detected before the women developed clinical signs of preeclampsia. No alterations in terminal C5b-9 complement complexes could be observed in the women with preeclampsia. However, the women who developed HELLP syndrome had elevated plasma concentrations of C3a, C5a, and terminal C5b-9 complement complex at delivery. These values returned to the normal range 1 week after delivery. We conclude that complement activation in the systemic circulation does not occur early in pregnancy and that plasma concentrations of C3a, C5a, or terminal C5b-9 complement complex cannot be used as predictors of preeclampsia.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID