摘要:

Data were analyzed from a large prospective study to try to determine whether or not women's smoking during pregnancy affects their children's mental development. Many confounding variables were controlled by multiple regression analysis and by intrapair comparisons of siblings whose mothers had smoked during one but not in the other of the two pregnancies. Hyperactivity, short attention span, and lower scores on spelling and reading tests were more frequent for children whose mothers had smoked throughout pregnancy. The cognitive abnormalities were mild, with achievement test scores only 2 to 4% lower in children whose mothers had smoked during pregnancy. The behavioral abnormalities in children of smokers were associated with elevated neonatal hemoglobin levels and low birth weights, suggesting that fetal hypoxemia possibly may contribute to the genesis of behavioral abnormalities.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Twelve cases of severe second trimester oligohydramnios are reported. The outcome of these pregnancies was uniformly poor, with no survivors in the present series. Four patients had therapeutic abortions, one woman had spontaneous labor at 22 weeks' gestation, and seven patients continued to viability. Of these, five patients had severe renal abnormalities incompatible with life. Two infants died at, or shortly after, birth from severe intrauterine growth retardation (IUGR), one of which had a triploid karyotype. Review of the literature shows a similar poor outcome for pregnancies with severe oligohydramnios in the second trimester.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Suicide attempts during pregnancy usually present as intentional drug overdoses after interpersonal conflicts. During a recent four-year period, 119 (0.07%) of all 179,893 telephone inquiries at a metropolitan poison control center involved drug overdoses by 111 pregnant women. This was usually the first such attempt and telephone notification occurred primarily within the first hour. The ingested substance was known in 109 (98%) cases and consisted mostly of an excess of a single drug. The 50 different types of over-the-counter and prescription medications consisted primarily of analgesics (most notably acetaminophen), vitamins or iron, sedatives, antibiotics, and antihistamines or decongestants. No maternal deaths were reported. Signs or symptoms were nonexistent or mild in 61 (55%) women, and major or lifethreatening in 50 (45%) women. Compliance with recommendations given by telephone and referral to the primary physician or emergency room was good, especially when major symptoms or life-threatening illnesses were apparent. Close emotional support and a search for depression during pregnancy and the postpartum period are recommended.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The outcome of 53 cases expectantly managed with premature rupture of membranes (PROM) before fetal viability (16 to 25 weeks) was retrospectively reviewed. Forty-one percent of patients developed amnionitis, four had prolonged hospital stays (longer than seven days), and one each had sepsis and pelvic thrombophletibis. Twenty-two mothers (41%) had no complications. No serious long-term maternal sequelae were noted. Eighteen patients were delivered after 26 weeks, and there were 13 surviving neonates with birth weights ranging from 740 to 2170 g.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The effect of lumbar epidural on the course of labor, delivery, and outcome was studied in 115 parturients with a previous cesarean section who were given a trial of vaginal delivery. One hundred three women were multiparous and 12 were grandmultiparous. Uterine contractions and fetal heart rate (FHR) were monitored continuously in all patients. Epidural block was performed using 8 mL of 0.35% bupivacaine without adrenaline. Supplemental doses were administered through an indwelling catheter. At the beginning of the second stage, 10 mL of 0.25% bupivacaine was added in the sitting position. Forty-eight women delivered spontaneously and 54 had an assisted second stage. Thirteen women delivered by a repeat low segmental cesarean section; dehiscence was observed in only one woman. Fetal outcome was satisfactory and similar to that of the authors' general parturient population.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A retrospective analysis of 239 postdate patients who delivered within seven days of their last nonstress test between 1 July 1980 and 30 June 1981 was done to determine whether or not there was a relationship between variable fetal heart rate (FHR) decelerations, a decline in the FHR of at least 15 beats per minute and lasting 15 seconds, on the nonstress test and pregnancy outcome. Of the 505 nonstress tests, the results were considered either reactive (424 to 84%) or nonreactive (81 to 16%). Variable FHR decelerations or bradycardias were encountered on 95 nonstress tests (18.8%) in 80 (33.5%) postdate patients. Fetal heart rate bradycardia was encountered in nine patients (3.8%). Based on the last nonstress test, pregnancy outcome for the nonreactive group was less favorable than for the reactive group. However, when the reactive group was separated as to whether FHR decelerations or bradycardias were present or absent on the last test, the reactive group with FHR decelerations had a significant increase in meconium passage, cesarean delivery for fetal distress, and Apgar scores less than 7 at one minute. This group also had a similarly poor outcome as the nonreactive group of postdates patients. These data suggest that the nonstress test, when reactive without evidence of FHR decelerations, is a reliable indicator of fetal well-being in the postdate pregnancy. However, a reactive nonstress test with evidence of FHR decelerations is associated with a significant increase in perinatal morbidity.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Thirty-three normoglycemic pregnant diabetic patients (White B-R) were studied in the course of one year during 732 weeks of therapy with 176 dose adjustments of insulin to determine patterns of insulin requirements. By means of an empirical formula, the insulin requirements within a 24-hour period can be calculated. Insulin requirement in the course of pregnancy decreases significantly between the tenth and the 16th week of gestation ( − 12%,P=<.001). From the 17th to the 36th week it increases slightly at first and more markedly from the 28th week onward (+ 62%), decreasing again from the 36th week onward. Insulin distribution during the day depends on whether or not a residual function of beta cells and, consequently, basal insulin secretion exists. Either four doses of regular insulin are injected or three doses of regular insulin are combined with one to two doses of variously long-acting insulin. The ideal distribution regarding the type and amount of insulin follows certain patterns and can therefore be approximated.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A retrospective analysis of 254 term breech deliveries was done, with term breech presentations managed by a protocol in which cesarean section was done for nonfrank breech presentation, or estimated fetal weight in excess of 4000 g. Patients with frank breech presentation were assigned to one of three groups based on x-ray pelvimetry and estimated fetal weight. Of 70 group 1 patients (adequate pelvis with estimated fetal weight <3600 g), 79% had a vaginal delivery. Of 21 group 2 patients (borderline pelvis or estimated fetal weight of 3600 to 4000 g), 67% delivered vaginally. In group 3 (contracted pelvis or estimated fetal weight >4000 g), all patients were delivered by cesarean section. The overall cesarean section rate for frank breech infants was 36%. Apgar scores were not significantly different for infants delivered vaginally or abdominally. The crude perinatal mortality rate was 11.8; the corrected perinatal mortality rate was 0. These findings further substantiate the safety of these criteria in management of term breech presentations.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Bilateral breast stimulation was used to evoke a spontaneous contraction stress test. The success rate and incidence of abnormal uterine activity using the stimulus was compared with patients tested by the authors' standard oxytocin stress test protocol. Bilateral breast stimulation was initially used for 346 tests between 32 and 43 weeks of gestational age. A satisfactory test, or three contractions within ten minutes, was obtained in 239 (69%) patients. The testing time was reduced with successful breast stimulation. The incidence of abnormal uterine activity after breast stimulation was not statistically different from that observed with oxytocin administration alone. However, when oxytocin was administered after breast stimulation, there was a significant increase in the incidence of prolonged contractions.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Reported is the analysis of morbidity, mortality, and mode of delivery in 38 cases of ventral wall defects identified from among 128,500 consecutive live births in Maine (January 1975 to December 1982). Thirteen of the ventral wall defects were classified as gastroschisis, and only one had an additional defect not directly attributable to the ventral wall defect itself. By contrast, 16 of the 25 omphalocele cases had additional defects, including eight congenital heart lesions, four genitourinary malformations, two neural tube defects, and three trisomies. Ten cases of omphalocele and one of gastroschisis died, all as a result of independent defects or involvement of adjacent structures. Intrauterine growth retardation was prominently associated with gastroschisis. Vaginal delivery occurred in three of the six ventral wall defects diagnosed antenatally and in 28 of the 32 ventral wall defects not diagnosed until delivery. The only episode of birth trauma to ventral wall defect sac or abdominal viscera occurred during cesarean section in an undiagnosed case. The present data provide a basis for prognosis and management of antenatally diagnosed ventral wall defects and suggest that these defects are not, a priori, an indication for abdominal delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1984

数据来源: OVID