摘要:

The aim of this retrospective study in 8320 patients with premature rupture of the membranes (PROM) was to determine the consequences of prolongation of the latent period. Among patients with pregnancies of more than 37 weeks' duration, those with PROM and latent periods of more than 1 day demonstrated an increased incidence of intrapartum fever (IPF), whereas those with latent periods of more than 3 days demonstrated a marked increase in fetal (but not neonatal) deaths. Although IPF and perinatal mortality were more common in preterm pregnancies, neither was found to increase or decrease with prolonged latency, provided differences in gestational ages and race were taken into account. In the absence of chorioamnionitis, there appears to be no benefit to delivery before 37 weeks' gestation.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A controlled prospective evaluation of pregnancy complicated by chronic hypertension is proposed and preliminary data on population selection and pregnancy outcome are presented. Sixty-three women with evidence of underlying hypertensive disease were followed prospectively throughout pregnancy. Twenty-three patients were followed in a protocol of intensified prenatal care and randomized assignment of antihypertensive agents: placebo, hydralazine, or methyldopa. Forty patients were followed in the high-risk pregnancy clinics at Duke University. The incidence of preeclampsia in the randomized prophylactic antihypertensive group was statistically lower than that in the nonrandomized group (8.7 versus 32.5%;P<.01). There were no other statistically significant differences between the groups. The 63 hypertensive women had a high incidence of diabetes mellitus diagnosed during pregnancy (49.2%) as compared to the authors' general obstetric population (8.1%).

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The metabolic changes in pregnant patients treated with subcutaneous terbutaline for premature labor were studied. Arterial lactic acid, serum electrolyte, and glucose concentrations were measured in 29 patients. Samples were obtained before and 1 hour after the initial dose of terbutaline. Data included statistically significant changes in arterial pH and lactate levels and in serum glucose and potassium. In all patients tested, lactic acid and glucose concentrations increased and the potassium level significantly decreased. An increase occurred in the mean insulin level of 6 patients. It was therefore concluded that significant metabolic alterations occur in normal pregnant patients undergoing subcutaneous terbutaline treatment for premature labor. Hypokalemia, hyperglycemia, and an increase in lactic acid occur and, although these changes are handled readily and corrected rapidly in the normal pregnant patient, all patients, especially those with underlying metabolic alterations or cardiac disease, should have baseline electrolyte and glucose levels evaluated before consideration of terbutaline therapy for premature labor.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Results of 90 vacuum extraction (VE) deliveries were compared with effects on the mother and fetus of forceps delivery or cesarean section. Forceps delivery increased the incidence of birth canal trauma threefold and the incidence of anemia sevenfold (18% for VE versus 48% for forceps delivery, and 4 versus 30%, respectively) (P≤ .001). When cesarean section was the alternative operation, the incidence of blood loss was significantly increased (72%, versus 18% with VE), as was febrile morbidity (48%, versus 6% with VE) (P≤ .001). Hospitalization time and costs in the present and future for cesarean section deliveries are markedly higher than for VE. Maternal requirements for anesthesia are markedly reduced with VE because of the gentleness of the operation. A failed trial of VE in 7 patients did not constitute any greater hazard to the mother than initial management by cesarean section. However, babies born by cesarean section after failed VE had a slightly lower Apgar score at 1 minute (P≤ .05) but not at 5 minutes, as compared with babies born by cesarean section attempted initially. Otherwise, Apgar scores of infants born by VE did not differ from those of infants delivered by forceps or cesarean section. Infants delivered by VE had a higher incidence of transient cosmetic deformations, including “chignon” and cephalhematoma, whereas infants delivered by forceps had forceps marks and facial lacerations more frequently. Neither perinatal mortality nor serious traumatic complications were attributable to VE, due to its judicious use for a limited time of approximately 15 minutes.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Acute cystitis during pregnancy is a distinct clinical entity characterized by lower urinary tract symptoms, the absence of systemic symptoms, and a positive urine culture. Over a 6-year period there were 9734 deliveries at Wilford Hall USAF Medical Center and 126 patients with acute cystitis, for an incidence of 1.3%. The majority of cystitis patients had a negative initial screening urine culture, and most cases of bladder infection occurred in the second trimester. The most common bacterial isolate was Escherichia coli. Only 17% of cystitis patients had a recurrence of urinary tract infection. All women were treated as outpatients with oral antimicrobial agents.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Four cases of combined vaginal-abdominal delivery of twins are presented, and an additional 5 cases from the recent literature are discussed. Malposition, malpresentation, and contracted cervix were the main indications for cesarean section for the birth of twin B. In the 9 cases presented, there were 2 perinatal deaths.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Eight cases of nonimmunologic hydrops fetalis (HF) were seen at Cedars-Sinai Medical Center over a 3.5-year period. The etiology of the HF included 2 cases of fetal-maternal hemorrhage and 1 each of sacral teratoma, tachyarrhythmia, diaphragmatic hernia, neuroblastoma, and heart disease. For 1 infant, the cause was never found. These cases involved various diagnostic and therapeutic dilemmas. Only 4 were anticipated ante partum by ultrasound scanning. Two of the 8 fetuses died in utero, whereas 4 others died in the neonatal period. Earlier diagnosis and evaluation are likely to improve these outcomes.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

In an earlier publication we reported on 18 patients who had what was described as prolonged fetal heart rate (FHR) deceleration in the second stage of labor and who had uniformly good outcome. It was believed that the reason for the good outcome was early diagnosis and rapid delivery when the FHR deceleration did not improve by the time the patient entered the delivery room. We have continued to handle this type of deceleration pattern in a similar fashion with good results, but 18 additional cases of prolonged end-stage FHR deceleration associated with a poor outcome are reported along with 1 case of intrauterine demise. Physicians who use the fetal monitor need to be aware of this potentially ominous FHR pattern.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Androgen excess, found occasionally in gonadal dysgenesis, may be associated with hilus cell hyperplasia within the gonadal streaks. This report describes a phenotypic female with Turner syndrome, clitoromegaly, hilus cell hyperplasia, and a gonadal-to-peripheral venous step-down gradient for testosterone, androstenedione, and estradiol. Cytogenetic analysis of cells from peripheral blood and both streak gonads revealed a mosaic karyotype, 45,X/46,X,iso(X). The isochromosome was a nonfused dicentric type (pter &U279D; q2105 &U279D; pter). Despite absence of the Y chromosome, serologic analysis revealed the presence of H-Y antigen, thereby suggesting occult Y chromosomal function in the patient's gonads.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Forty human spontaneous abortuses were identified as triploid, 34 by karyotype and 6 by DNA measurement. Of the 40, 26 were embryos of 5 to 7 weeks' developmental age, 6 were intact empty sacs, 4 were early growth-disorganized embryos, and 4 were fetuses. In an attempt to determine the extent to which embryonic phenotype reveals triploid karyotype, the phenotypes of the 26 triploid embryos were compared with those of the 40 embryos of known nontriploid karyotype identified in a larger study of consecutive spontaneous abortuses. Each embryo was scored for presence or absence of each of 4 abnormal phenotypic features: retarded limb development, facial dysplasia, subectodermal hemorrhage, and cystic chorionic villi. Whereas this combination of features was found in a few abortuses with normal or trisomic karyotype, it was both common and most frequent with triploidy. Approximately half (12 of 22) of the triploid embryos had at least 3 of the features. Conversely, among assessable embryos of known karyotype, four fifths (12 of 15) of those with at least 3 of the 4 abnormal features were triploid. Thus, while not definitive, such phenotypic information can be used with caution in counseling for subsequent pregnancies.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID