ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether 15-methyl prostaglandin (PG) F2αshortens the third stage of labor in second-trimester pregnancy loss.MethodsThis was a randomized, double-blind, placebo-controlled study of women between 13 and 28 weeks' gestation admitted for spontaneous or induced pregnancy termination. Subjects were randomized on admission to receive either PG (250 μg) or placebo (normal saline), 1 mL intramuscularly every 20 minutes, for a maximum of three doses if the placenta had not delivered spontaneously within 10 minutes of the fetus. A dilute oxytocin infusion was given to women in both groups. The patients were managed expectantly with hourly vaginal examinations until intervention was required or up to 6 hours, when curettage was scheduled.ResultsThirty-eight women received PG and 29 received placebo. There was no difference between the groups with regard to method of pregnancy termination or gestational age. There was a statistically significant decrease in the time from first injection to placental delivery (40.0 versus 92.5 minutes;P= .02) between the PG and control groups, respectively.ConclusionsThe therapeutic use of PG in the third stage of labor in second-trimester pregnancy loss reduces the time to complete spontaneous placental delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine the effectiveness of a partially homebased, moderate-intensity aerobic exercise program for women with gestational diabetes.MethodsThis was a randomized experimental design. Thirty-three women with gestational diabetes were randomly assigned to the exercise or the no-exercise group. Subjects underwent hemoglobin A1C assay and submaximal cycle ergometer fitness tests at baseline and at study conclusion. Subjects kept diaries of home fasting and 2-hour postprandial blood glucose determinations. Exercise subjects were asked to exercise for 30 minutes three to four times weekly at 70% of estimated maximal heart rate for the weeks of study participation. Two exercise sessions weekly were supervised by the investigator, and two were unsupervised at home. Control-group subjects were asked to maintain their current activity level.ResultsDaily fasting and postprandial blood glucose levels, hemoglobin A1C, incidence of exogenous insulin therapy, and incidence of newborn hypoglycemia were not different between the groups. There was a training effect in the exercise group (P= .005) but not in the control group (P= .25). A significant decline in daily grams of carbohydrate consumed was observed in the control group (P= .03), but not in the exercise group (P= .97). No complications were found in the subjects who exercised.ConclusionsA partially home-based exercise program did not reduce blood glucose levels, but did result in a modest increase in cardiorespiratory fitness. The intervention appeared safe.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether a low transverse cesarean closure method in one or two layers affects subsequent pregnancy outcome.MethodsIn a prospective trial reported previously, 906 women were assigned randomly to either one- or two-layer uterine closure. One hundred sixty-four women had a subsequent pregnancy and delivery (18 weeks' gestation or longer) at our institution. Maternal and neonatal outcomes were ascertained by medical chart review and compared between the one- and two-layer closure groups.ResultsOf the 164 subsequent deliveries, 83 had previous closure in one layer, whereas 81 had involved a two-layer closure. The demographic characteristics of these two groups were similar. Nineteen women (12%) underwent elective repeat cesareans without labor, and the remaining 145 experienced labor. Length of labor, mode of delivery, duration of hospital stay, gestation at delivery, and the incidences of uterine scar dehiscence, chorioamnionitis, postpartum metritis, hemorrhage, transfusion, and abnormal placentation did not differ significantly between the groups. Selected neonatal outcomes, including Apgar scores, cord pH, birth weight, and perinatal death, were similar between groups as well.ConclusionsThese findings suggest that the type of low transverse cesarean closure does not significantly affect the outcome of the next pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo establish the indications for surgical intervention, at the appropriate gestational duration, for brain tumors in pregnant women, and to evaluate any association pregnancy hormones may have with the rate of growth or development of complications of brain tumors.MethodsWe observed seven women with brain tumors associated with pregnancy in a series of 126,413 pregnancies from 1983 to 1995. One woman presented with symptoms of intracranial hypertension, and neurologic signs were the first symptoms in two other women. One woman presented with a sudden hemorrhagic lesion, and three had focal seizures. All were evaluated with computed tomography, magnetic resonance imaging, or both.ResultsSix of the seven women had surgery; the seventh was treated with radiotherapy because the neuroradiologic studies suggested a quickly growing brainstem glioma. Diagnoses were confirmed on histology in six women: two with meningiomas, two with ependymomas, and two with low-grade astrocytomas (one of these had multiple astrocytomas). Estrogen and progesterone receptors were studied in two cases (one meningioma and one astrocytoma) and were present in both.ConclusionManagement of brain tumors should be tailored to the individual patient. There may be a relation between pregnancy hormones and the rate of brain tumor growth mediated through specific intracellular receptors.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare serum levels of ionized and total magnesium with those of ionized calcium, total calcium, sodium, and potassium over the course of pregnancy in normal women and in women who develop preeclampsia.MethodsWe collected venous serum samples from 31 pregnant women during their first, second, and third trimesters. Gestational ages ranged from 6 to 37 weeks. Samples were analyzed for ionized and total magnesium, ionized and total calcium, sodium, and potassium using a biomedical chemistry analyzer. Data were analyzed with repeated-measures analysis of variance and two-way repeated-measures analysis of variance.ResultsIn 22 normal pregnant women, both serum ionized and total magnesium levels decreased significantly with increasing gestational age. No changes in sodium, potassium, or ionized or total calcium were observed. Nine of the 31 subjects developed preeclampsia by term; serum total magnesium levels decreased significantly by the second trimester in these women compared with those of normal pregnant women.ConclusionOur results provide evidence of decreases in ionized and total magnesium levels with increasing gestational age during normal pregnancy, as well as evidence of a magnesium disturbance in women who later develop preeclampsia. Future studies of magnesium balance in women at risk for developing complications of pregnancy are indicated.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate hospital-based practices for perinatal group B streptococcal disease prevention and to identify institutional factors related to the disease.MethodsWe surveyed microbiology laboratories and obstetric programs during 1994 at hospitals in five states with active surveillance for invasive group B streptococcal disease. Institutions provided information on methods for detecting carriers and on obstetric policies for group B streptococcal disease prevention. We used linear regression to identify prevention practices and hospital characteristics that correlated with the number of cases of early-onset disease.ResultsOf 295 hospitals, 247 (84%) laboratories and 154 (52%) obstetric programs completed the survey. Most (83%) laboratories performed group B streptococcal cultures on rectal and vaginal specimens, but only 12 (6%) used selective broth media. Among the obstetric programs, 54 (35%) had policies on some aspect of group B streptococcal disease prevention. Of the hospitals with policies, 21 (48%) recommended intrapartum antimicrobial prophylaxis for women with risk factors outlined by the 1992 ACOG statement. Adjusting for the number of births, there were more cases of early-onset group B streptococcal disease in institutions providing care for more African American women and for more women with no prenatal care. Institutions that had group B streptococcal screening policies had fewer early-onset cases.ConclusionMany institutions with prevention policies followed practices that differed from those recommended in published prevention statements. Having any screening policy, however, was associated with reduced early-onset disease, independent of the risk profile of the patient population. Adopting prevention policies is most urgent for practices serving individuals at increased risk, such as African American women and women without prenatal care.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine the impact of changes in birth weight distribution in individual groups and in birth weight-specific fetal death rates on the decline in the crude fetal death rate in the United States.MethodsData on live births and fetal deaths in the U.S. for the period 1979–1990 were examined by birth weight group and race using Kitagawa's method for analysis of the crude fetal death rate.ResultsIn the period 1979–1990, all racial groups had a decrease in the crude fetal death rate, more so in whites and others (about 22%) than in blacks (10%). In the white population, 73.4% of the total reduction in the crude fetal death rate was attributable to the improvement in birth weight-specific fetal death rates, and the remaining portion of the reduction was due to a favorable change in birth weight distribution. In the black population, the reduction in the crude fetal death rate was entirely attributable to the improvement in the birth weight-specific fetal death rates. However, in other groups, a favorable change in the birth weight distribution was the major determinant. Although black births represented 16.5% of all births in the U.S., they accounted for 26–29% of the crude fetal death rate. Disparity in the crude fetal death rates for blacks and whites is explained almost entirely by differences in birth weight distribution.ConclusionA further decrease in the crude fetal death rate in the U.S. requires a decrease in low birth weights, particularly in blacks.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine which causes of fetal death occur more often in older women and to determine whether these causes have changed significantly since the 1960s and early 1970s.MethodsData from the McGill Obstetrical Neonatal Database were used to calculate rates of specific causes of fetal death in women younger than 35 and in women 35 years or older. Among the 101,640 births between 1961 and 1995, there were 715 stillbirths and 822 neonatal deaths. The autopsy rate was 97% and categorization of the causes of fetal death remained consistent over this 34-year period. The rates of specific causes of fetal death per 10,000 total births were determined for an earlier period (1961–1974) and a later period (1978–1995).ResultsCompared with the 1961–1974 period, there was a 60% reduction in the rates of both fetal and neonatal deaths during 1978–1995 (P< .001). During 1961–1974, women 35 years or older were more likely than their younger counter-parts to have fetal death due to lethal congenital anomalies (odds ratio [OR] 3.2; 95% confidence interval [CI] 1.5, 6.5); this was no longer true in the 1978–1995 period. From 1978 to 1995, older women were at a statistically significant increased risk for “unexplained” fetal death (OR 2.2; 95% CI 1.3, 3.8); women 35 years of age or older had approximately one in 440 births end in unexplained fetal death, compared to one in 1000 births for women younger than 35.ConclusionsAdvanced maternal age is no longer associated with an increased risk for fetal death due to congenital anomalies. However, older women have a significantly higher risk for unexplained fetal death. The identification of those maternal and fetal characteristics that contribute to unexplained fetal death and its prevention remain important challenges for contemporary obstetric practice.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the degree of fetal endothelial involvement in preeclampsia by measuring fetal plasma concentrations of cellular fibronectin.MethodsIn a prospective cohort study, fetal plasma was collected at delivery from the chorionic plate arteries and veins in a convenience sample of 28 pregnancies complicated by preeclampsia and in 28 normal pregnancies. Stored plasma was assayed for cellular fibronectin using a sensitive and specific enzyme immunoassay. On the basis of a desired power of 0.8, α of .05, and expected fetal plasma cellular fibronectin values of 4 ± 2 μg/mL, 26 women were required in each group to detect a 40% difference between the groups. Results were compared using the unpaired Studentttest, χ2 analysis with Yates correction, and linear regression.ResultsThere was no statistically significant difference in fetal plasma concentrations of cellular fibronectin in women with preeclampsia compared with normal pregnant women, either in arteries (3.2 ± 1.1 and 2.9 ± 1.5 μg/mL;P= .33) or veins (3.3 ± 1.5 and 2.8 ± 1.6 μg/mL;P= .18). Plasma cellular fibronectin concentrations in fetal arteries correlated significantly with those in fetal veins (r= 0.45,P< .001), but not with those in maternal veins (r= 0.15,P= .27).ConclusionFetal plasma cellular fibronectin concentrations are similar in preeclamptic and normal pregnancies. We found no evidence that factors responsible for maternal endothelial involvement in preeclampsia are operative in the fetal circulation.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID