摘要:

ObjectiveTo compare pregnancy outcome in a homogeneous group of women glucose with that of women without this disorder.MethodsThis was retrospective study of all women with singleton cephalic-presenting pregnancies delivered at University of Texas Southwestern Medical Center during the period January 1, 1991, through december 31, 1995. During this period, women were screened selectively for glucose intolerance and National Diabetes Data Group thresholds were used to diagnose gestational diabetes. Women with class A1gestational diabetes were compared with nondiabetic women within the cohort. Effects of confouding variables were analyzed using multiple logistic regression and a matched-control comparison. Controls were matched according to ethnicity, maternal age, maternal weight, and parity.ResultsA total of 61,209 nondiabetic women with singleton caphalic pregnancies were delivered during the study period, and 874 were diagnosd with class A, gestational diabetes. Women with class A1gestational diabetes wee significantly older, heavier, of greater parity, and more often of Hispanic ethnicity. Hypertension (17 vérsus 12%), caesarean delivery (30 versus 17%), and shoulder dystocia (3 versus 1%) were significantly increased (allP< .001) in these women compared with the general obstetric population. Infants born to women with class A1gestational diabetes were significantly larger (mean birth weight 3581 ± 616 versus 3290 ± 546 g,P< .001), and this accounted for the increased incidence of dystocia. The attributable risk for large for gestational age (LGA) infants due to class A1gestational diabetes was 12%.ConclusionThe main consequence of class A1gestational diabetes is excessive fetal size leading to increased risk of difficult labor and delivery. We estimate that approximately one of eight women with class A1gestational diabetes mellitus delivers an LGA infant attributable to glucose intolerance.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether circulating concentrations of defined cell adhesion molecules, which are thought to reflect endothelial expression, are increased in insulindependent diabetic women during pregnancy.MethodsPregnant diabetic women demonstrating good glycemic control and without major complications before pregnancy were studied at 8–12(n= 15), 18 (n= 15), 28 (n= 16), 32 (n= 16), and 36 (n= 16) weeks' gestation. A subgroup of ten diabetic women was sampled longitudinally through all five gestational ages. The diabetic women were compared with healthy nondiabetic women sampled cross sectionally at 12(n= 19), and 36 (n= 19) weeks' gestation. Nonpregnant diabetic (n= 22) and nonpregnant nondiabetic women (n= 28) also were studied. Plasma concentrations of the cell adhesion molecules E-selectin, intercellular adhesion molecule-1 (ICAM-1), and vascular endothelial cell adhesion molecule-1 (VCAM-1) were measured by enzymelinked immunosorbent assay.ResultsSignificantly higher median (range) concentrations of E-selectin (63.0[20.2–107.01) and ICAM-1 (2815.5 [171.6–778.4] ng/mL) but not VCAM-1 (459.7 [301.0–909.7] ng/mL) were found in nonpregnant diabetic women compared with nonpregnant nondiabetic women (43.5 [18.1–93.2], 243.6 [174.4–329.2], and 476.0 [253.8–929.4] ng/mL, respectively). During pregnancy] these significantly differences between diabetic and control groups were lost. The median (range) concentration of E-selectin (50.0 [21.2–96.3] ng/mL) was significantly lower in pregnant compared with nonpregnant diabetic women. The plasma concentrations of E-selectin and ICAM-1 did not change significantly with gestation in either diabetic or nondiabetic pregnant groups. Vascular endothelial cell adhesion molecule-1 concentration changed significantly with gestation in the diabetic pregnant group only.ConclusionCirculating concentrations of defined vascular cell adhesion molecules are not increased abnormally in diabetic women with good glycemic control during otherwise uncomplicated pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether the incidence of gestational diabetes mellitus (GDM) is increased in patients receiving corticosteroids with or without β-adrenergic agents for threatened preterm delivery.MethodsWe reviewed the laboratory records of 3396 patients undergoing screening (1-hour glucose) and diagnostic testing (3-hour glucose tolerance test [GTTD FOR GDM over 2 years. Patients with antepartum admissions during jwhich they received corticosteroids with or without β-adrenergic agents for threatened preterm delivery were compared with a control group during group during e same period. Differences between the study and control groups were analyzed using χ2, Studentttest, or Fisher exact test where appropriate.P< .05 was considered significant.ResultsFifty patients in the study group were compared with 1985 control patients. The ramaining 1361 patients failed to meet inclusion criteria. The overall incidence of diagnosed GDM was significantly greater in the corticosteroid-β-adrenergic agents study group, in which five (23.8%) of 21 patients screened had abnormal 3-hour GTT results, compared with 79 (4.%) of 1985 controls (P= .001). One- Hour glucose screening test results were abnormal in 60% of the study group compared with 25% of the controls (P< .001).ConclusionPatients treated with β-adrenergic agents and corticosteroids for threatened preterm delivery are at a significantly increased risk for developing GDM. The high rate of abnormal results in response to the 1-hour glucose screen suggests that this test is of limited value in patents exposed to these medications.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the magnitude of the risk and the predictive clinical characteristics for development of preeclampsia when triploidy is diagnosed in the second trimester.MethodsA retrospective analysis of databases maintained by the cytogenetics laboratories at the University of Iown and University North Carolina was performed to identify all cases of triploidy. We examined the karyotype, maternal serum screening (particularly the hCG level), ultrasound results, and evidence of maternal hypertensive disease.ResultsSeventeen cases of triploidy were identified between 1987 and 1996. Preeclampsia or hypertension complicated six of these cases with onset between 15 and 22.5 weeks' gestation. In these six cases, the serum hCG level was extremely high. Serum results were available in seven cases in which preeclampsia did not develop, and the hCG levels were under 0.09 multiples of the median in five of the seven cases. In all six cases in which preeclampsia or hypertension developed, there was stenographic evidence of placentomegaly. Sonographic findings in 16 17 cases revealed fetal growth restriction, oligohydramnios, fetal anomalies, placentomegaly, or a combination of these.ConclusionIn our series of pregnancies complicated by triploidy, the risk of developing preeclampsia or hypertension in the second trimester was 35%. It appears that elevated serum hCG levels and placentomegaly are associated with a higher risk of preeclampsia but low hCG levels are not. This information is important in counseling patients who are hesitant to terminate a pregnancy purely for a fetal abnormality, even if the anomaly is lethal.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether different molecular forms of hCG in serum and urine are elevated in preeclamptic pregnanciesMethodsForty-three pregnant women were studied: 25 preeclamptic women and 18 normotensive women. Immediately after blood and urine samples were collected, the protease inhibitors leupeptin (0.35mM) and phenanthroline (22 mM were added. Various molecular forms of hCG in serum (complete hCG, nonnicked hCG, complete free beta hCG) and in urine (complete hCG, beta-core fragment hCG) were measured by matched immunoassays with a common enzyme-labeled tracer antibody. The nicked hCG assay used a coating of beta-subunit monoclonal antibody with the addition of scavenger antibody to remove nonnicked hCG. Mann-WhitneyUtest andX2test were used for statistical analyses.ResultsPreeclamptic women had significantly higher median (range) levels of serum complete and nicked hCG than did normotensive women (3620 [850–12,0001 versus 2420 [310–4850] ng/mL,P= .024; and 102 [45–275] versus 71 [11–143] ng/mL,P= .010, respectively). Both median (range) urinary complete hCG-creatinine and beta-core fragmentcreatinine ratios were significantly higher in preeclamptic women that in normotensive women (37.6 [0.5–185] versus 11.3 [1.9–54],P= .013; and 11.8 [2–67] versus 5.3 [0.3–29],P= .009, respectively).ConclusionVarious molecular forms of hCG in serum and urine were significantly higher in preeclamptic than in normotensive pregnancies.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare random urine protein-creatinine rations with 24-hour protein excretion rates in patients hospitalized with hypertensive disorders in pregnancy.MethodsAll hospitalized, hypertensive patients requiring 24-hour urine protein excretion collections were eligible for the study. During the 24-hour urine collection a separate 2-mL aliquot was taken for a protein and creatinine determination.ResultsSeventy-one samples were collected from patients with the following diagnoses: gestational hypertension (n= 56), preexisting hypertension and superimposed gestational hypertension (n= 11), and syndrome of hemolysis, elevated liver enzymes and low platelets (n= 4). The correlation coefficient between the random protein-creatinine ratio and the 24-hour urine protein excretion was 0.94. Calculated excretion rates with at least 300 mg protein in 24 hours had a sensitivity of 0.93, specificity of 0.90, and positive and negative predictive values of 0.87 and 0.95, respectively. For those samples with calculated excretion rates at least 5 g protein in 24 hours, the sensitivity was 1.00, specificity was 0.99, and positive and negative and negative predictive values wee 0.75 and 0.99, respectively.ConclusionIn nonambulatory hypertensive pregnant patients, there is a strong correlation between random voided protein-creatinine ratios and 24-hour urine protein excretions.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare the abortifacient efficacies of two intravaginally administered misoprostol doses and gemeprost in termination of second-trimester pregnancy.MethodsEighty-one women between 12 and 24 weeks' gestation requesting abortion were randomized to receive intravaginally either 100 μg of misoprostol at 6-hour intervals (n= 27), 200 μg of misoprostol at 12-hour intervals (n= 26), or 1.0 mg of gemeprost at 3-hour intervals (n= 28). The regimen was continued until abortion, or for 36 hours, with assessment of the rate of complete and incomplete abortions as well as side effects within 48 hours from the start of the treatment.ResultsThe final rates of terminations were 74% in the 100 μg misoprostol group, 92% in the 200-μg misoprostol group, and 89% in the gemeprost group. Abortion was complete in 37%, 61% and 32% in each group, respectively (P= .03, when the 200-μg misoprostol group was compared with the two other groups). The inductions- to-abortion interval was longer (P= .001) in he misoprostol groups (mean 23.1 hours for the 100-μg and 27.8 hours for the 200-μg dose) than in the gemeprost group (14.5 hours). There was less pain (P= .01), and vomiting (P= .01) in the misoprostol groups that in the gemeprost group. The mean blood loss in the misoprostol groups was lower than in the gemeprost group (P= .001).ConclusionIntravaginal application of 200 μg of misoprostol at 12-hour intervals in induction of second-trimester abortion is equally effective to a standard gemeprost regimen. Misoprostol causes fewer side effects and is cheaper and more practical to use.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the potential impact of ACOG and Centers for Disease Control and Prevention (CDC) consensus strategies for the prevention of perinatal group B streptococcal disease.MethodsWe evaluated cases of early-onset group B streptococcal disease identified by active surveillance during 1995, in four areas in North America with an aggregate 186,000 births per year. We reviewed the hospital records of mothers and infants and any prenatal records available on site. Cases were determined to be preventable based on whether group B streptococcal screening could have been performed prenatally, sensitivity of screening, presence of obstetric complications, and opportunity to administer antibiotics.ResultsWe reviewed records for 245 of 246 infants with early-onset group B streptococcal disease in the surveillance areas. Most of the 53% case-mothers who delivered preterm and 192 who delivered full-term had at least one prenatal visit (83% and 99%, respectively). Few case-mothers had prenatal group B streptococcal screening cultures, although compliance was high for other prenatal screening tests. Fifty percent of case-mothers had a recognized obstetrick risk factor for group B streptococcal disease: labor or rupture of membranes at less than 37 weeks, rupture of membranes for 18 hours or longer, or temprerature 38C or greater. The estimated preventable portion of early-onset group B streptococcal cases was 78% for the screening-based approach (range 74% to 82% by area), compared with 41% for the risk-based approach (range 39% to 53% by area).ConclusionComprehensive implementation of either of the recommended prevention strategies could potentially prevent a substantial proportion of early-onset group B Streptococcal disease.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo develop a scoring system to predict the likelihood of vaginal birth in patients undergoing a trial of labor after previous cesarian delivery using factors known at the time of hospital admission.MethodsTrial of labor was attempted in 5022 patients who were assigned randomly to score derivation and score testing groups. Multivariate logistic regression modeling was used in the score derivation group to develop a predictive scoring system for vaginal birth. The scoring system was then applied to the testing group to evaluate its predictive ability.ResultsFive variables significantly affected the mode of birth and were incorporated into a weighted scoring system. Rates of successful vaginal birth after cesarean ranged from 49% in patients scoring 0–2 to 95% in patients scoring 8–10. Increasing score was associated linearly with increasing probability of vaginal birth after cesarean.Conclusionincreasing scores correlate with increasing probability of vaginal birth after cesarean. The admission vaginal birth after cesarean scoring system may be useful in counseling patients regarding the option of vaginal birth or repeat cesarean delivery. This information could be particularly valuable for the patient who opts for trial of labor but has second thoughts about her mode of birth when labor begins.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare the safety and efficacy of intravaginal misoprostol gel with that of tablets for ripening the cervix and inducing labor in women with unfavorable cervices.MethodsFour hundred sixty-seven gravidas were randomized to receive misoprostol tablets (n= 234) or misoprostol gel (n= 233). The gel was prepared in the antepartum unit immediately before use by dissolving the tablet in 1 mL normal saline and mixing with 4 mL hydroxyethylcellulose gel. In both groups, a 50-μg dose was applied intravaginally every 8 hours for two doses, then increased to 100-μg for a total of six application or 500 μg.ResultsThe mean interval in hours from drug administration to start induction or labor (13.8 versus 18.2) and delivery (22.4 versus 29.0) was significantly less in the tablet group that in the gel group (P= .01 for both). Oxytocin and epidural use and the mean number of misoprostol insertions (1.4 versus 1.9) were lower in the tablet group than in the gel group (P< .05 for all). The incidences of tachysystole (13.7 versus 7.3%) and hyperstimulation (15.8versus 7.7%) were significantly higher in the tablet group than in the gel group. Cesarean delivery rates and neonatal outcomes were similar between the groups.ConclusionIntravaginal misoprostol gel is associated with fewer uterine contractile abnormalities than the tablet form of the drug but results in a slower time to labor or delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID