摘要:

Objective:To determine whether home uterine activity monitoring reduces the likelihood of preterm birth in women successfully treated for preterm labor in their current pregnancies.Methods:Women between 20-34 weeks' gestation who had been treated successfully for preterm labor were solicited to participate in a randomized clinical trial of home uterine activity monitoring versus routine high-risk care. The sample size of 56 was based on power calculations using the results of earlier investigators. Twenty-eight women were randomized to home uterine activity monitoring and 29 were assigned to the type of care appropriate for women discharged after hospitalization for parenteral treatment of preterm labor. One of the routine-care subjects was lost to follow-up. The two groups were comparable in distribution for race, insurance status, multiple gestation, marital status, gestational age at beginning of the study, and incidence of prior preterm birth.Results:The 28 women receiving routine care had a 54% incidence of preterm birth, whereas the incidence was 57% in monitored women (relative risk 1.08, 95% confidence interval 0.6-1.9;P=.79). The incidences of delivery before 32 weeks and 34 weeks also were unaffected by the intervention.Conclusion:Home uterine activity monitoring is not effective in reducing the likelihood of preterm delivery in patients successfully treated for preterm labor in their current pregnancies.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To determine the outcome of pregnancies in cardiac allograft recipients.Methods:Thirty women who became pregnant after heart transplantation were identified from cases managed personally, questionnaires sent to all cardiac transplant centers, and review of the literature. Mothers were evaluated for evidence of rejection and for obstetric complications. The infants were observed for congenital abnormalities and perinatal morbidity or mortality.Results:Frequent pregnancy complications included chronic hypertension (48%), preeclampsia (24%), and preterm labor (28%). The rate of cesarean delivery was 32%. Six episodes of rejection required treatment, and three late maternal deaths occurred. Among the 27 live births, 17 infants were born after 36 weeks' gestation and ten were preterm, five were small for gestational age, and four had neonatal complications. There were no congenital anomalies.Conclusion:Pregnancies in heart transplant recipients present management problems similar to those seen in patients with other allografts and should be considered high risk.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To assess the safety of vaginal recombinant human relaxin in pregnant women treated before the induction of labor and to collect preliminary data on the efficacy of recombinant human relaxin in promoting cervical ripening.Methods:In a multi-center, randomized, double-blind placebo-controlled trial, 40 women were studied before induction of labor because of post-dates. The women were randomized to receive either 1.5 mg recombinant human relaxin in 3% methylcellulose gel or gel only, placed into the posterior vaginal fornix after a cervical assessment on the evening before scheduled induction. If a subject did not go into spontaneous labor overnight, another cervical assessment was performed 15 hours following treatment, immediately before the standard induction regimen of the hospital.Results:No important maternal or fetal-neonatal complications could be attributed to the drug. The differences between the recombinant human relaxin group and the placebo group for all the outcome measures of efficacy did not achieve statistical significance. Placebo patients were more likely to report moderate or strong uterine contractions in the first 4 hours following treatment than were the recombinant human relaxin-treated patients.Conclusions:The use of recombinant human relaxin at a dose of 1.5 mg was not associated with any significant maternal or fetal-neonatal complications. The relatively small number of subjects in this study was chosen deliberately because this was the first use of the drug in pregnant subjects. Assessment of efficacy will require studies that include more patients and a range of relaxin doses.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To compare the effect of delivery on cerebral blood flow velocity between normotensive and preeclamptic women, adjusting for mode of delivery and change in hematocrit values.Methods:Twenty-three normotensive and 46 preeclamptic women had maternal middle cerebral blood flow velocity assessed antepartum and at 24 and 48 hours postpartum. In addition, hematocrit changes and method of delivery were recorded. We then compared the effect of delivery on cerebral blood flow velocity changes using analysis of variance with Studentttest for significance.Results:Cerebral blood flow velocity was significantly higher in preeclamptic than in normotensive women (P< .05) and rose significantly in the postpartum period (P< .004). Neither hematocrit change nor mode of delivery affected cerebral blood flow velocity changes.Conclusion:Cerebral blood flow velocity showed minimal peripartum changes in the normotensive group but increased significantly postpartum in preeclamptic women in a setting of minimal arterial pressure change.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To investigate the distribution of penicillin in the maternal-placental-fetal unit at term gestation.Methods:Twenty-five healthy gravidas at 38-39 weeks' gestation scheduled for elective repeat cesarean delivery under spinal anesthesia received benzathine penicillin G, 2.4 million units intramuscularly (IM) preoperatively. Ten women delivered 1 day after injection, five delivered 2-3 days after, and ten delivered 7 days after. We collected maternal serum and cerebrospinal fluid, amniotic fluid (AF), and cord serum at delivery. Penicillin levels were measured using a validated agar disc diffusion method (sensitivity 0.006 µg/mL) withMicrococcus luteaas the test organism.Results:There was no significant difference in mean penicillin levels at day 1, day 2-3, or day 7 for maternal serum, maternal cerebrospinal fluid, cord serum, or AF. The mean (± standard error) penicillin concentration (range 0.005-0.59 µg/mL) in maternal serum declined from 0.14 ± 0.04 µg/mL 1 day after injection to 0.08 ± 0.06 µg/mL 7 days after injection. The proportion of patients with a penicillin concentration at or above 0.018 µg/mL in the maternal serum declined significantly from day 1 to day 7 (P=.03). Overall, nine of 25 women (36%) had serum penicillin levels that were less than 0.018 µg/mL.Conclusion:A wide range of penicillin levels were observed in gravidas at term in the maternal serum, cerebrospinal fluid, umbilical cord serum, and AF within 1 week after 2.4 million units of benzathine penicillin G IM. We speculate that altered pharmacokinetics may affect the efficacy of this drug for prevention of congenital syphilis in the near-term gestation.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To compare levels of tumor necrosis factor (TNF) and interleukin 1 (IL-1) and 6 (IL-6) with levels of the soluble receptors for TNF in maternal and neonatal urine and amniotic fluid (AF).Methods:Levels of soluble TNF receptors (p55, p75) in AF and urine from 21 women and their newborns were measured by immunoassay. The amniotic concentrations of IL-1 and IL-6 were assessed by biologic assays, whereas an immunoassay was used to measure TNF levels. The comparison between receptor concentrations in different compartments was performed by one-way analysis of variance, and Studentttest was used to compare pairs of groups. Correlation studies were performed when indicated.Results:A high correlation was observed between the concentrations of p55 and p75 in all compartments. The concentration of p55 in AF was significantly higher than that in both maternal and neonatal urine, but the correlation between TNF receptor concentrations in the AF samples and the concomitant levels of cytokines was not statistically significant.Conclusion:The high concentration of receptors in the AF compared to those of other biologic compartments suggests that the pregnancy-associated increased receptor shedding takes place in intrauterine tissues. Physiologic levels of cytokines, such as those accompanying normal delivery at term, did not seem to influence the soluble TNF receptor release.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To determine whether the use of metronidazole by pregnant women increases the risk of birth defects in the offspring.Methods:Two cohorts of pregnant women who delivered live-born or stillborn infants between January 1, 1983 and December 31, 1988 were identified from the Tennessee Medicaid enrollment files. The exposed cohort consisted of 1387 women who filled a prescription for metronidazole between 30 days before and 120 days after the onset of their last normal menstrual period. The unexposed cohort consisted of 1387 comparable women who did not fill a prescription for metronidazole during the same time. Medical records for 94% of the offspring of both study cohorts were then reviewed to ascertain the occurrence of birth defects.Results:Pregnancy outcomes were similar for the exposed and unexposed cohort members. There was no excess of overall birth defect occurrence in the offspring of exposed women (risk ratio 1.2, 95% confidence interval 0.9-1.6), nor could an excess risk be detected for any category of birth defects.Conclusion:This study provides no evidence that prenatal use of metronidazole increases the risk of overall birth defect occurrence.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To determine whether plasma erythropoietin is increased in fetuses with anemia due to Rh isoimmunization.Methods:Hemoglobin and erythropoietin were measured in samples obtained by funipuncture from 15 fetuses with Rh isoimmunization (gestational age 26.2 ± 5.0 weeks, mean ± standard deviation) and from 13 control fetuses (23.1 ± 6.7 weeks). Hemoglobin and erythropoietin also were determined in umbilical cord blood collected at birth from 20 term fetuses delivered by elective cesarean.Results:Fetuses with Rh isoimmunization had lower hemoglobin and higher plasma erythropoietin measurements than mid-gestation controls (6.1 ± 3.9 versus 10.7 ± 1.5 g/dL and 105.5 ± 168.1 versus 12.5 ± 3.1 mU/mL,P< .05, respectively). Hemoglobin and plasma erythropoietin increased with gestational age in control fetuses. There was an inverse association between hemoglobin and plasma erythropoietin in control and Rh-isoimmunized fetuses (r=—0.56,P< .005). Using multiple linear regression, hemoglobin and gestational age were associated independently with plasma erythropoietin (overall F2,25=12.3, multiple r2=0.49,P< .001). Despite marked decreases in hemoglobin, fetuses below 24 weeks' gestation had minimal increases in plasma erythropoietin compared to fetuses above that gestational age. Mildly anemic Rh-isoimmunized fetuses (hemoglobin 11.6 ± 2.0 g/dL) delivered vaginally had significantly higher erythropoietin levels in umbilical cord plasma than Rh-isoimmunized fetuses with comparable hemoglobin (10.9 ± 3.5 g/dL) delivered by elective cesarean without labor (1246 ± 856 versus 106 ± 66 mU/mL, respectively,P< .05).Conclusion:Fetuses with anemia at mid to late gestation respond with increases in plasma erythropoietin, but these changes are substantially attenuated before 24 weeks' gestation.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objective:To derive a formula for calculating fetal weight in small for gestational age (SGA) fetuses and to determine prospectively whether the use of such a targeted formula reduces birth weight prediction errors.Methods:Standard ultrasonic measurements were made in 159 SGA fetuses within 7 days of delivery. Three classes of fetal weight formulas (linear, quadratic, and cubic) were fitted to the data using stepwise regression analysis. Birth weight predictions using these three formulas were then compared prospectively with five previously reported formulas in 187 SGA fetuses.Results:R2was 0.97 for each of the three derived formulas. The 95% prediction intervals were comparable for the three formulas (eg, cubic model mdash;11.6, 17.8%), and none were statistically superior to previous formulas. Each of the formulas evaluated prospectively had a systematic error and, with the exception of the present study's linear formula, all had percentage errors that varied systematically over the range of actual birth weights.Conclusion:Clinically useful birth weight predictions can be made in SGA fetuses, although no particular formula estimates birth weight significantly more accurately than any other.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Objectives:To derive a formula for sonographic estimated fetal weight (EFW) based on a two-compartment model of fetal volume and to test it against two widely used formulas, especially at the extremes of fetal weight for which existing formulas are generally inaccurate.Methods:We analyzed 865 consecutive sonograms that met the following inclusion criteria: singleton pregnancy, normal anatomy, delivery within 3 days of sonography, and measurements of biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). The weight of the fetal head was modeled to be proportional to HC3, and the weight of the trunk proportional to AC2× FL. The proportionality constants were found by multiple linear regression on 380 sonograms performed in 1990 (the “derivation set”). The new formula was tested for accuracy of prediction of actual birth weight against the formulas of Hadlock et al and Shepard et al using 485 sonograms from 1991-1992 (the “validation set”).Results:In the derivation set, the formula EFW=(0.23718 × AC2× FL) + (0.03312 × HC3) was fit; the correlation with actual birth weight had an r value of 0.996. In the validation set, the new formula produced smaller systematic errors and smaller absolute errors than either the Hadlock or Shepard formula both overall and in fetal weight strata from less than 1000 g to over 4000 g.Conclusion:The new formula makes geometric sense and provides accurate estimates of fetal weight across a broad range of weights.

ISSN:0029-7844    

出版商:OVID    

年代:1993

数据来源: OVID