摘要:

ObjectiveTo determine whether ritodrine-stimulated production of prostaglandin (PG) F2αby pregnant uterine tissues can be blocked by the concurrent administration of ketorolac, a PG synthesis inhibitor.MethodsWe infused saline, ritodrine, ketorolac, or a combination of ritodrine and ketorolac into chronically catheterized pregnant sheep. Concentrations of PGF2αin uterine venous plasma were measured by radioimmunoassay at 0, 1, 2, 3, 4, and 24 hours during the infusions.ResultsRitodrine significantly increased uterine venous PGF2α; mean percent increases at 4 hours were 330% and 380%, and at 24 hours 370%, compared with controls. During concurrent ritodrine and ketorolac infusion, there was no increase in uterine venous PGF2αat any time.ConclusionsKetorolac completely blocks ritodrine-stimulated production of PGF2αin pregnant uterine tissues. We conclude that ritodrine stimulates PG production through mobilization of arachidonic acid, and this can be effectively blocked with a PG synthesis inhibitor. This finding may have important clinical applications in the treatment of preterm labor.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectivesTo find out whether the tendency toward poor outcome in lupus pregnancies could be explained by changes in prostacyclin/thromboxane production, to relate these changes to the presence of antiphospholipid antibodies, and to study the potential benefits of low-dose aspirin.MethodsWe followed the urinary output of prostacyclin metabolites (6-keto-prostaglandin [PG]F1α, 2,3-dinor-6-keto-PGF1α) and thromboxane metabolites (thromboxane B2, 2,3-dinor-thromboxane B2) using high-pressure liquid chromatography followed by radioimmunoassay. We studied 14 pregnant women with systemic lupus erythematosus (SLE), of whom six had detectable antiphospholipid antibodies. The patients were randomized by a computerized program to receive either 50 mg aspirin daily (six women) or placebo (eight women). Nine healthy pregnant women served as controls.ResultsThe production of prostacyclin was normal in early pregnancy in SLE patients but was reduced during late gestation in those without antiphospholipid antibodies. The production of thromboxane was increased in SLE patients compared with controls, and this increase was highest (two-to threefold rise) when antiphospholipid antibodies were detectable. Aspirin eliminated thromboxane dominance without affecting prostacyclin production.ConclusionThese data suggest that the presence of antiphospholipid antibodies in SLE patients may trigger thromboxane dominance, possibly contributing to the adverse outcome of these pregnancies. This thromboxane dominance can be eliminated with aspirin.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo compare the safety and efficacy of intravaginal misoprostol versus intravenous (IV) oxytocin infusion for labor induction.MethodsOne hundred thirty patients were randomly assigned to one of two induction groups: 1) intravaginal misoprostol or 2) IV oxytocin by continuous infusion, with prior cervical ripening using prostaglandin (PG) E2gel if necessary.ResultsAmong 129 patients evaluated, 64 were allocated to the misoprostol group and 65 to the oxytocin group. Prostaglandin E2gel was administered to 29 patients (45%) in the oxytocin group with unripe cervices. Uterine tachysystole occurred more frequently in patients in the misoprostol group (34.4%) than in the oxytocin group (13.8%) (P< .05). Nevertheless, no statistically significant differences were noted between the groups in intrapartum complications including uterine hyperstimulation syndrome, mode of delivery, and neonatal or maternal adverse outcomes. The interval from induction to vaginal delivery was significantly shorter in the misoprostol group (11 versus 18 hours;P= .004). In 74% of patients in the misoprostol group, only one intravaginal dose was required for successful labor induction.ConclusionsIntravaginal administration of misoprostol safely and effectively induces labor while minimizing the expense associated with IV oxytocin infusion. The higher frequency of uterine tachysystole associated with the use of misoprostol did not increase the risk of adverse intrapartum or perinatal outcomes. The use of PGE2gel for cervical ripening contributed to the longer induction-to-vaginal delivery interval noted in the oxytocin group. Clinical trials appear warranted to detail misoprostol's optimal route, dose, and schedule for labor induction and its safety.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo assess lipid composition, lipid peroxidation, and fluidity of the membrane of platelets from preeclamptic women.MethodsWe studied 40 primigravid women at 28–32 weeks' gestation; 20 were preeclamptic and 20 were normotensive. After preparing platelet membranes, we extracted lipids, measured cholesterol and phospholipid concentrations, and calculated the proportion of unsaturated to saturated fatty acids. Lipid peroxides expressed as conjugated dienes were determined by spectrophotometry. Membrane fluidity was determined by means of fluorescent lipophilic probes. Statistical analysis was performed by the Studentttest, with significance atP< .05.ResultsCholesterol concentration, cholesterol-to-phospholipid ratio, the amount of unsaturated fatty acids, conjugated dienes, and membrane fluidity significantly increased in platelets from preeclamptic patients as compared with the normotensive women.ConclusionsThe discrepancy between cholesterol increase and membrane fluidity increase is consistent with the increase in unsaturated fatty acid content. In the platelet membrane, unsaturated fatty acids constitute the larger substrate for lipid oxidation and can also take part in the formation of thromboxane. Therefore, platelet membrane damage in preeclampsia, through imbalance of thromboxane A2/prostacyclin production, may contribute to the onset or maintenance of vasoconstriction and hypertension.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo determine the relationship between maternal serum hCG levels and small for gestational age (SGA) infants.MethodsMaternal serum hCG levels were measured in 638 consecutive pregnant women in whom gestation was dated by crown-rump length and who later delivered a singleton infant. Fetal growth was compared between the women with elevated maternal hCG (above 2 multiples of the median) and those with normal levels.ResultsElevated maternal hCG values were found in 6.6%, of whom 19% delivered SGA infants. In the normal maternal hCG group, 3.9% of the infants were SGA. These differences were statistically significant by χ2analysis. Mothers with elevated hCG also had a significantly higher risk for fetal death, preterm rupture of the membranes, and abruptio placentae by the Fisher exact probability test.ConclusionElevated maternal serum hCG levels correlate with SGA infants.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo determine how well the extent of glucose abnormality, as reflected by the number of abnormal values on the 3-hour oral glucose tolerance test (GTT), correlates with the level of carbohydrate intolerance during pregnancy and with the severity of adverse outcome.MethodsWe followed 764 gestational diabetic women under a once-per-week fasting and 2-hour postprandial serum glucose monitoring system. The subjects were stratified by the number of abnormal values on their GTTs. The level of glucose control and incidence of large for gestational age (LGA) infants were then determined and compared with the findings in 636 gravidas with abnormal screening but all normal GTT values.ResultsPatients with one or more abnormal GTT values had comparable incidences of LGA infants, which were all significantly greater than that in the 0-abnormal group (23–27% versus 13%;P< .01). This difference was due to subjects with poor glucose control. The means of the GTT values for each sampling time were greater and the GTT periodicity (the time for the GTT curve to return to the fasting level) was longer with an increasing number of GTT abnormal values (zero versus one versus two versus three versus four abnormal values,P< .02). The mean fasting, 2-hour postprandial, and overall mean glucose values during the study were positively associated with the number of abnormal GTT values.ConclusionsOne or more abnormal GTT values were associated with comparably elevated incidences of LGA infants in patients with poor glycemic control. Achievement of recommended glucose control decreased adverse outcomes to near normal levels.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo relate hypothyroidism to perinatal outcome.MethodsA cohort of 68 hypothyroid patients with no other medical illnesses was divided into two groups according to the initial thyroid function tests. The first group had 23 women with overt hypothyroidism, and the second had 45 subjects with subclinical hypothyroidism. We sought to identify the pregnancy outcomes of gestational hypertension, low birth weight, fetal death, congenital anomalies, maternal anemia, and postpartum hemorrhage.ResultsGestational hypertension—namely, eclampsia, preeclampsia, and pregnancy-induced hypertension—was significantly more common in the overt and subclinical hypothyroid patients than in the general population, with rates of 22, 15, and 7.6%, respectively. In addition, 36% of the overt and 25% of the subclinical hypothyroid subjects who remained hypothyroid at delivery developed gestational hypertension. Low birth weight in both overt and subclinical hypothyroid patients was secondary to premature delivery for gestational hypertension. Except for one stillbirth and one case of clubfeet, hypothyroidism was not associated with adverse fetal and neonatal outcomes.ConclusionNormalization of thyroid function tests may prevent gestational hypertension and its attendant complications in hypothyroid patients.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo establish the prevalence of cocaine use in private obstetric patients during their prenatal care and at admission to delivery units.MethodsUrine samples were collected anonymously during routine sampling from 1425 patients in six private hospitals and four private physicians' offices.ResultsPositive cocaine metabolites were identified in three of 555 urine specimens (0.54%) obtained from hospitals and in two of 870 (0.23%) obtained from private offices during prenatal examinations. The total positive urine cocaine results were five of 1425 (0.35%).ConclusionsUniversal screening in a private obstetric population similar to that found in Denver would not be cost-effective. We urge health care providers to ask patients about substance abuse arid to screen patients who are at high risk for substance use.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo study the effect of subtotal hysterectomy on a woman's sexuality.MethodsOne hundred four women were interviewed 1 month before and 1 year after surgery. Data concerning their sexuality before and after the operation were evaluated using a multivariate method.ResultsHalf of the women reported improvement in their sexuality after surgery and 21% reported deterioration. There were only small changes in sexual variables: Frequency of cyclicity of sexual desire was reduced, coital frequency increased, and frequency of desire, frequency of orgasm, and multiplicity of orgasm were unchanged for the entire series. The best predictive factors for sexuality after surgery were presurgical coital frequency, cyclicity of arousability, frequency of desire, and frequency of orgasm. Multiplicity of orgasm, cyclicity of desire, and attitude to the sexual partner also correlated with postoperative sexuality. Preoperative deep dyspareunia had a small influence, although 83% (48 of 58) with deep dyspareunia experienced relief after the operation. Preoperative deterioration of desire and coital activity had no correlation to sexuality after surgery.ConclusionPreoperative sexual activity is more important in predicting postoperative sexuality than is the occurrence of dyspareunia or deterioration of sexual activity because of uterine disease.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectiveTo analyze the relation between hysterectomy with or without oophorectomy and the risk of subsequent ovarian cancer.MethodsWe have conducted a case-control study since 1983 in a network of general and university hospitals in the greater Milan area. The cases were 953 women aged less than 75 years with histologically confirmed epithelial ovarian cancer. Women younger than 75 years residing in the same geographic area and admitted for acute conditions to the same network of hospitals where the cases had been identified were eligible as controls. Potential controls were excluded if they had been admitted for gynecologic, hormonal, or neoplastic diseases or had previously undergone bilateral oophorectomy. A total of 2758 controls were interviewed.ResultsFifty-two cases (5.5%) and 215 controls (7.8%) reported a history of hysterectomy, including eight cases and 38 controls who also reported unilateral oophorectomy. In comparison with women with intact uterus and ovaries, the age-adjusted relative risk (RR) was 0.7 in both women who reported hysterectomy alone (95% confidence interval [CI] 0.5–0.9) and in those reporting hysterectomy plus unilateral oophorectomy, though the latter finding was not statistically significant (95% CI 0.3–1.4). The risk of ovarian cancer was inversely related with time from hysterectomy. Compared with women reporting no pelvic surgery, the RR was 0.9 (95% CI 0.4–1.7), 0.7 (0.3–1.6), 0.7 (0.3–1.4), and 0.5 (0.3–0.8), respectively, in women reporting hysterectomy within 4 years or less and 5–9, 10–14, and 15 years or more before interview.ConclusionHysterectomy approximately halves the risk of ovarian cancer, possibly because of altered ovarian blood flow or the opportunity that hysterectomy provides for examining the ovaries.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID