摘要:

The use of estrogen replacement therapy in postmenopausal women is under close scrutiny. The indications and side effects of replacement therapy are reviewed, and recommendations regarding its use are made. Hot flashes, atrophy of the vaginal epithelium, and prevention of osteoporosis have been established as indications for estrogen replacement therapy. Prevention of cardiovascular disease, aging changes of skin, and the occurrence of mental illness have also been suggested as indications, but beneficial effects of estrogen replacement therapy for these problems have not been clearly established. Studies have shown that side effects of estrogen replacement therapy include endometrial cancer, hypertension, gallbladder disease, and angina pectoris. Breast cancer may also be a risk factor, but a consensus of opinion has not been established. Pulmonary embolism, cerebral vascular accident, or myocardial infarction has not been associated with estrogen replacement therapy. The use of progesterone with estrogen replacement therapy has been shown to reduce the occurrence rate of endometrial carcinoma, but it does not prevent all the actions of estrogen. Oral administration of estrogen is the preferred route despite misgivings about portal absorption and liver metabolism. Further studies must examine this question. Various agents have been shown to be effective in treating some climacteric symptoms. These include progestogens for hot flashes and calcium for the prevention of osteoporosis. Other agents may also be effective but have not been tested critically.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

It has been reported that determinations of maternal serum unconjugated estriol (E3) and estetrol (E4) concentrations provide clinicians with more or less identical information on fetal status. If this is true, then theoretically the levels of E3should be equally correlated with those of E4in all conditions of pregnancy. To resolve this question, a study of the relationship between E3and E4was performed before labor in normal and complicated pregnancies. In normal pregnancy, they were highly correlated (r=.683,P<.0001); in complicated cases, they were still correlated, but at a lower level (r=.522,P< .003). To determine the effect of labor on this correlation, E3and E4levels were measured in normal subjects during labor as well as in the corresponding fetuses. The correlations between maternal E3and E4, maternal and fetal E4, maternal and fetal E3, and fetal E3and E4were highly significant. A similar study with complicated pregnancies, however, indicated no such correlation except between fetal E3and E4. In addition, day-to- day variability of serial measurements of E3and E4on an individual basis was determined in normal and diabetic subjects. The variability was qualitatively determined graphically and quantitatively determined algorithmically. The results of calculated individual variabilities indicated that the variability of E4was less than that of E3in most cases. It is therefore concluded that complications in pregnancy and the onset of labor have some effect on E3-E4correlations, and that measurement of E4has an additional advantage due to less variability.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Estimates are made of the rates of all clinically significant cytogenetic abnormalities in live births by 1-year maternal age intervals ranging from ages 15 to 49. Down syndrome results from the most prevalent clinically significant cytogenetic abnormality, yet the rates of disorders associated with other cytogenetic abnormalities also increase with maternal age and significantly contribute to the overall rate at the older ages. The estimated rate of all clinically significant cytogenetic abnormalities rises from about 2 per 1000 (1 per 500) at the youngest maternal ages to about 2.6 per 1000 (1 per 270) at age 30, 5.6 per 1000 (1 per 180) at age 35, 15.8 per 1000 (1 per 60) at age 40, and 53.7 per 1000 (1 per 20) at age 45.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A circulating factor capable of inducing symptoms of dysmenorrhea has been demonstrated in 10 women by collecting plasma during periods of dysmenorrhea and infusing it during asymptomatic intervals. Typical symptoms of abdominal pain occurred in 8 of 12 women who received plasma infusion that had been drawn at the time symptoms were present. Plasma drawn at the time of no symptoms, when given to 10 women, produced no abdominal pain (P< .01). Combinations of pain and/or emotional irritability were found in 11 of 12 women after symptomatic units were infused and in only 2 of 10 women after asymptomatic units were infused (P<.001). The uterus need not be involved, as 7 of 10 patients had a hysterectomy prior to the infusions. It is suggested that a circulating factor may activate prostaglandin synthesis, which in turn may stimulate the neuronal system, thus causing symptoms.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

It has been suggested that the decrease in blood pressure during sleep is greater in patients with chronic hypertension than in preeclamptic patients. The DINAMAP (device for indirect noninvasive automatic mean arterial pressure) monitor was used to determine the mean arterial, systolic, and diastolic blood pressure, at 15-minute intervals, for 24 hours. Three groups of 15 patients each were studied: mildly preeclamptic, chronically hypertensive, and normotensive patients in the third trimester. In addition, 2 patients with severe preeclampsia were studied. The automatic readings were compared with auscultated blood pressures. There was short-term variation in the systolic and diastolic blood pressure of 20 to 40 and 15 to 30 mmHg, respectively, with consecutive 15-minute recordings. A decrease in blood pressure during sleep was seen in all groups, except in the 2 patients with severe preeclampsia. This fall varied between 5 and 20 mmHg systolic and 5 and 18 mmHg diastolic. The auscultated blood pressure differed from the automatic blood pressure by 5 to 40 mmHg systolic and 5 to 35 mmHg diastolic. In the clinical management of patients, these findings are significant, as they demonstrate short-term variation in blood pressure and differences in the auscultated versus automatic blood pressure readings. Also, changes in blood pressure occur during sleep; this may be important with regard to the timing and dose of medication given to pregnant patients with chronic hypertension or preeclampsia.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Seventy patients treated with isoxsuprine for premature labor were studied. In patients with intact membranes, prolongation of pregnancy for more than 7 days occurred in 77% of women with 50% cervical effacement or less and 3 cm dilatation or less at the initiation of therapy, and in none with more than 50% effacement and more than 3 cm dilatation. Cervical effacement was the primary factor in determining success. Cord isoxsuprine concentrations averaged 90% of maternal concentrations at delivery. Maternal and cord isoxsuprine concentrations at delivery were inversely correlated with the drug-free interval before delivery. An interval of more than 5 hours was necessary to attain a cord concentration of less than 2 ng/ml, a level not associated with neonatal problems. Drug-free intervals of 2 hours or less usually resulted in cord isoxsuprine values of more than 10 ng/ml, levels that are associated with severe neonatal problems. Seventy-seven percent of infants with cord isoxsuprine concentrations of more than 2 ng/ml and 91% with values of more than 10 ng/ml were delivered of mothers with more than 3 cm dilatation or more than 50% effacement at the initiation or reinstitution of intravenous therapy. Most severe neonatal problems are preventable if patients are selected carefully.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Twenty-three patients with premature uterine contractions occurring between the 27th and 35th weeks of pregnancy were treated in a prospective and randomized study with intravenous ritodrine in a 0.1 wt/vol% solution of isotonic saline (N= 12) or isotonic glucose (N= 11). The aim of the study was to record the effects of these agents on the water- salt metabolism. In both the saline and the glucose groups there was a statistically significant fall in hemoglobin, hematocrit, and serum albumin (P<.001). This fall correlated significantly with the dose of ritodrine (P<.001). Serum renin and aldosterone levels revealed a statistically significant increase (P<.0005). Seven of 12 patients in the saline group, but none in the glucose group, developed pulmonary congestion requiring treatment. The combination of ritodrine and saline should be used very cautiously, and the authors recommend accurate monitoring of the fluid balance during ritodrine treatment.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The relationship between amniotic fluid optical density at 650 nm (OD650) and the lecithin: sphingomyelin (L:S) ratio was compared in 174 samples of amniotic fluid from 143 patients. An OD650greater than 0.15 accurately predicted an L:S ratio greater than 2.0 with an overall reliability of 67.9%. There were 19.5% false-negative and 12.6% falsepositive predictions. The OD650was found to have close correlation with the number of fetal squames in suspension in amniotic fluid. Pure surfactant phospholipid standards were found to exhibit negligible absorbance at 650 nm. OD650may be more closely related to fetal cutaneous maturity than to pulmonary surfactant content and bears only an indirect relationship with pulmonary preparedness for independent existence. The OD650test does not appear to be sufficiently reliable and specific to replace phospholipid determination as a data base upon which to make clinical decisions regarding fetal pulmonary surfactant maturity.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The diagnostic effectiveness of the lecithin: sphingomyelin (L:S) ratio was compared with that of the quantitative amniotic fluid foam stability index (FSI) test in the prenatal evaluation of pregnancies associated with fetuses appropriately grown for gestational age (AGA) and with intrauterine growth retardation (IUGR). In 27 such pregnancies, both the L: S ratio assay and the FSI test were performed on amniotic fluid specimens collected within 72 hours of delivery. Of the 27 low birth weight (LBW) neonates studied, 15 were small for gestational age (SGA) but did not have idiopathic respiratory distress syndrome (IRDS), whereas of 12 AGA neonates, 9 had IRDS. The 15 IUGR cases were characterized by FSI values varying from 0.47 to 0.55, whereas the 12 AGA cases had values varying from 0.42 to 0.48. Thus, the FSI showed excellent differentiation between these 2 entities. The L:S ratio ranged from 1.1 to 3.4 in cases associated with IUGR and from 1.0 to 2.4 in AGA cases, showing a high degree of overlap. The combination of an L:S ratio of less than 1.5 and an FSI value of less than 0.47 consistently identified the fetus who would have IRDS.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

This study examined fetal heart rate (FHR) variables during maternal sleep in subsequent siblings of infants who died of sudden infant death syndrome (SIDS) and who are thus at increased statistical risk for SIDS, and controls. Four findings differentiated the tracings of subsequent siblings of SIDS infants and controls: 1) FHR variability in subsequent siblings of SIDS infants ranged between 11 and 25 beats/min, compared with 6 to 10 beats/min in controls (P<.001). 2) Bradycardia was more frequent in subsequent siblings of SIDS infants. 3) FHR accelerations (more than 150 beats/min) followed by heart rates below 120 beats/min were elevated in subsequent siblings of SIDS infants (P<.01). 4) Strong respiratory arrhythmia was more frequent in subsequent siblings of SIDS infants. These siblings exhibited more reactive FHR patterns. Although these data cannot be interpreted as clinical markers identify the infant who will die of SIDS, they are compatible with the hypothesis that mild chronic hypoxia is associated with risk for SIDS.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID