摘要:

Eighty-five cases of multifetal pregnancy reduction were performed transabdominaliy at 9.5-13 weeks' gestation. All pregnancies consisted of three or more fetuses (28 triplets, 47 quadruplets, four quintuplets, four sextuplets, one septuplet, and one nontuplet), and all except five were reduced to twins. Forty-five women have delivered viable infants and eight lost all of the fetuses; 32 pregnancies are ongoing. No temporal relationship was noted between the pregnancy losses and the procedures. The mean gestational age at delivery was 35.7 weeks; 16 women (35.5%) delivered at or after 37 weeks, 16 (35.5%) between 34.5-37 weeks, nine (20%) between 32-34.5 weeks, and four (9%) before 32 weeks. There were no perinatal deaths, and all infants are healthy except for one who developed sequelae of severe hyaline membrane disease.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Forty patients with multiple gestations, all resulting from infertility treatment, underwent transabdominal multifetal pregnancy reduction at an average of 12 weeks' gestation. Twenty-three women with triplets, 13 with quadruplets, and four with quintuplets had their pregnancies reduced to twins, except for two (one reduced from five to three and one from three to one). Twenty-eight women have delivered and 12 have ongoing pregnancies; none of the 40 lost the entire pregnancy after the procedure. There was one neonatal death from prematurity, and one fetus died because of growth retardation. Ten (36%) delivered after 37 weeks' gestation, 16 (57%) between 33-36 weeks, and two (7%)before 33 weeks. No maternal complications directly related to the procedure were encountered. We conclude that selective termination is a safe procedure that may improve multifetal pregnancy outcome.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

CA 125 has been found in high concentrations in human amniotic fluid throughout gestation, with significant quantities seen in the decidua and chorion. Because disruption of the epithelial basement membrane of the fetal membrane or the decidua could theoretically lead to a rise in maternal CA 125 levels, this increase may be a predictor of subsequent spontaneous abortion of the fetus. A study was initiated to investigate whether a sudden rise in the serum CA 125 level might predict spontaneous first-trimester abortions. CA 125 levels of 101 pregnant women were evaluated 18-22 days from conception and 6 weeks from conception (a frequent time for spontaneous abortion) to determine whether there is a sudden increase (from baseline or early trimester levels) during the middle or late first trimester immediately before or at the time of abortion. The results indicated that although there was a definite correlation found between elevation of CA 125 and spontaneous abortion, the higher levels occurred early in the first trimester whereas the majority of abortions did not occur until much later, after fetal viability was established. Six of ten women with CA 125 levels of 150 U/mL or greater aborted, compared with four of 92 women with CA 125 levels less than 150 U/mL. One of 11 women pregnant after in vitro fertilization had a CA 125 level above 150 U/mL, and she aborted.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Previous studies in pregnant ewes have demonstrated that intravenous (IV) cocaine produces increased maternal blood pressure and vasoconstriction of the uterine arteries, resulting in decreased uterine blood flow and decreased fetal oxygen levels. To determine whether these responses to cocaine were mediated by α1-adrenergic receptor stimulation, cocaine was administered to four pregnant ewes before and after phenoxybenzamine hydrochloride, an α1receptor antagonist. Before phenoxybenzamine infusion, cocaine 2.0 mg/kg produced a 53% increase in maternal mean arterial pressure (MAP), a 50% reduction in total uterine blood flow, and a 191% increase in uterine vascular resistance. Cocaine also increased fetal MAP by 24%, increased the fetal heart rate (FHR) by 51%, and reduced fetal PO2by 29%. Alpha1receptor blockade after phenoxybenzamine 5.0 mg/kg was confirmed by a lack of change in uterine blood flow to IV norepinephrine 30 μg before cocaine administration. After phenoxybenzamine, cocaine produced no increase in maternal or fetal MAP. However, total uterine blood flow decreased 44%, uterine vascular resistance increased 59%, FHR increased 36%, and fetal PO2fell 18%. Because the fetal responses mimicked the maternal responses to cocaine both before and after phenoxybenzamine, phenoxybenzamine apparently crossed the placenta to block fetal α1receptors as well. Alpha1-adrenergic receptor stimulation is the major mechanism for the maternal and fetal hypertensive responses to cocaine. Although cocaine produces uterine artery vasoconstriction primarily by α1adrenergic receptor stimulation, its vasoconstrictive effects may involve other vasoactive neurotransmitters, such as dopamine or serotonin.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

For treating Chlamydia trachomatis cervical infection in pregnancy, the Centers for Disease Control guidelines recommend either erythromycin base or erythromycin ethylsuccinate. There is no alternate therapy. Because of compliance problems with erythromycin regimens due to gastrointestinal side effects, such an alternative is needed. For this reason, we compared, in an open trial, the efficacy and patient compliance of amoxicillin (500 mg three times a day for 7 days) with those of erythromycin base (500 mg four times a day for 7 days) in treating Ctrachomatiscervical infections during pregnancy. In the amoxicillin group, 63 of 64 women (98.4%) had negative cervical cultures after treatment, compared with 55 of 58 women (94.8%) treated with erythromycin base. Vertical transmission to the infants was assessed by culture and/or persistent or rising immunoglobulin G antichlamydial antibody. In the amoxicillin group, 37 of 39 infants (94.9%) had no evidence of chlamydial infection, compared with 32 of 36 infants (88.8%) in the erythromycin group. These differences were not significant. The frequency of side effects was higher with erythromycin base than with amoxicillin (15 versus 8%), although not significantly so. However, the frequency of stopping medication because of side effects was significantly higher with erythromycin base than with amoxicillin (13 versus 2%; P<.006). These results suggest that amoxicillin may be an acceptable alternative treatment for chlamydial infections in pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Fifty-two women undergoing labor induction and vaginal delivery at term were randomized between two oxytocin infusion protocols, involving hourly versus quarter-hourly increases in dose. Potential differences were sought for duration of labor, amount of uterine activity generated, and amount of oxytocin required. Starting at 0.5 mU/minute, oxytocin infusion was increased regularly in small increments every hour or every 15 minutes, according to group assignment. No differences were observed in potentially confounding clinical and demographic factors between the groups, including time to ruptured membranes. There were no clinically or statistically significant differences found for the duration of any phase or stage of labor, quantitative assessment of uterine activity, incidence of hyperstimulation, or neonatal outcome. The average dose of oxytocin used was lower in the hourly than in the quarter-hourly protocol (4.4 versus 6.7 mU/minute; P<.005). Significantly fewer patients on the hourly protocol required a maximum infusion rate exceeding 8 mU/minute (P<.05). More patients on the hourly protocol either had oxytocin discontinued completely or were maintained at 4 mU/minute or less during the active phase of labor (P<.05 and P<.001, respectively). We conclude that a slower rate of increase in oxytocin administration via continuous infusion results in no prolongation of any phase of induced labor, while permitting lower infusion rates of the drug.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Magnesium sulfate has been shown in vivo and in vitro to decrease the frequency of uterine contractions while maintaining the amplitude; we therefore decided to assess the use of magnesium sulfate infusion in cases of uterine hyperstimulation. The medical records were reviewed retrospectively for 37 term pregnant patients diagnosed as having uterine hyperstimulation during labor. None of them had medical or obstetric complications. Twenty-two of them received oxytocin augmentation for abnormal labor. Although the vast majority of these patients had a decrease of the hyperstimulation while being given the magnesium, 31.8% ultimately underwent cesarean, as compared with 13.7% in the group receiving oxytocin alone (P<.05). Fifteen additional patients received magnesium sulfate for uterine hyperstimulation although they were not receiving oxytocin; of these, 16.7% required cesarean delivery. This rate was no different from that of the patients who required labor augmentation, but was double the overall primary cesarean rate at our hospital. There appears to be a group of patients with abnormal uterine activity (either spontaneous or associated with oxytocin augmentation) that responds to treatment with magnesium sulfate.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The association between episiotomy and severe (third- and fourth-degree) perineal lacerations was studied in 24,114 women. The overall rates of severe lacerations were 8.3 and 1.5% for primiparous and multiparous women, respectively. Women who had midline episiotomies were nearly 50 times more likely and women who had mediolateral episiotomies were over eight times more likely to suffer a severe laceration than were women who did not undergo an episiotomy. Severe lacerations were also more common after use of forceps, in occiput transverse and posterior presentations, among women with smaller pelvic outlet measurements or lower prepregnant weight, and with larger fetuses. The same factors that caused a woman to have an increased risk of laceration also made performance of an episiotomy more likely. After statistical adjustment for these risk factors, mediolateral episiotomy was associated with a 2.5-fold reduction in the risk of severe lacerations among primiparous women, and a statistically nonsignificant 2.4-fold increase among multiparous women, compared with no episiotomy. Midline episiotomy was associated with statistically significant 4.2- and 12.8-fold increases in the risk of lacerations among primiparous and multiparous women, respectively. We conclude that the risks and benefits of midline episiotomy should be evaluated in a randomized clinical trial that compares policies of “usual” versus conservative use of episiotomy.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A population-based case-control study was conducted to examine the relationship between maternal smoking and the occurrence of abruptio placentae and to assess the joint relationship of smoking and small for gestational age (SGA) status with abruption. Cases (N=1089) reported on Washington state birth certificates from 1984-1986 were compared with randomly selected births (N=2323) from the same period. The occurrence of placental abruption was associated with both smoking (relative risk=1.6; 95% confidence interval 1.3-1.8) and SGA status (relative risk=2.6; 95% confidence interval 2.0-3.3). The association with SGA status was identical for smokers and non-smokers. Thus, the increase of SGA infants in women whose pregnancies are complicated by abruption is not explained by maternal smoking, and in some cases may result from placental dysfunction induced by the process of placental separation.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

In normal early pregnancy, serum free thyroxine (T4) increases and serum TSH decreases, indicating that the thyroid gland is activated physiologically. To identify the factor responsible for this thyroid activation, we measured the serum thyroid-stimulating activity in comparison with the serum level of hCG in 39 normal women in early pregnancy. Serum thyroid-stimulating activity was measured by a sensitive cyclic adenosine 3'5'-monophosphate (cAMP) accumulation assay using a rat thyroid cell line (FRTL-5). Thyroid- stimulating activity was detected in 37 women (95%), and the activities of individuals correlated positively with their serum free T4 levels (r=0.474; P<.01) and negatively with their serum TSH levels (r=-0.376; P<.02). Moreover, serum thyroid-stimulating activity correlated closely with the serum hCG level (r=0.741; P<.001), but was completely abolished by pre-treatment of the sera with hCG antibodies. These data indicate that in normal early pregnancy, the thyroid gland is physiologically activated by serum hCG, which has intrinsic thyroid-stimulating activity.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID