摘要:

Human immunodeficiency virus (HIV) infection occurs disproportionately among inner-city minority women of reproductive age. Once pregnant, these women have a high risk of delivering infants with perinatally acquired infection. Identification and counseling of HIV-infected parturients may be an effective means of preventing perinatal HIV infection. Few data are available on the seroprevalence of HIV infection in the inner-city population or on the clinical and demographic determinants of risk. To better characterize HIV infection in inner-city parturients in Atlanta, we conducted routine antepartum screening for HIV antibody in 3472 women. Ten (2.8 per 1000) were seropositive on enzyme-linked immunosorbent assay (ELISA) and Western blot testing. Four women were seropositive on repeat ELISA but negative on Western blot. Four infected women had had heterosexual contact with a person at risk for HIV, three were intravenous drug users, one had possibly become infected via blood transfusion, and two had no apparent risk factors. Seven of the seropositive women had no selfidentified risk factors and would not have been identified if screening had been performed using current Centers for Disease Control criteria. Ten percent of the women screened had self-identified risk factors for HIV infection and were seronegative. Ninety-six percent of women consented to HIV testing. These data suggest that inner-city parturients in Atlanta are at risk for HIV infection and that routine antepartum HIV screening can be performed provided the appropriate multidisciplinary team is in place for counseling and follow-up. (Obstet Gynecol 74:289, 1989)

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Gonorrhea is an important marker for endocervical chlamydial infections in nonpregnant women. Concomitant infection rates as high as 50% have been reported. There are few data on concomitant infection rates in pregnant patients. The purpose of this study was to examine the prevalence of endocervical chlamydial infections in pregnant women with gonorrhea. Patients with cervical cultures positive for Neisseria gonorrhoeae at their initial prenatal visit had endocervical specimens for Chlamydia trachomatis culture obtained before anti-gonorrheal therapy. Control patients were selected at random from the same prenatal population. The prevalence of C trachomatis in patients with gonorrhea was significantly greater than that in the control population (46 versus 5%; P<.001). Patients with gonorrhea were younger, less often married, and more often black than the control population, but these demographic differences did not account for the large difference in the chlamydial prevalence. Erythromycin 500 mg four times daily provided an excellent cure rate without intolerable side effects. Pregnant patients being evaluated or treated for gonorrhea should also be considered at high risk for concomitant cervical chlamydial infection. (Obstet Gynecol 74: 295, 1989)

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The risk of recurrent intra-amniotic infection was assessed in 76 women with a previous pregnancy complicated by intra-amniotic infection. Recurrent intra-amniotic infection occurred in five (6.6%), not significantly different from the incidence of 4.4% in a comparison population. When controlled by logistic regression for the increased cesarean section rate in the group with previous intra-amniotic infection, the incidence of endometritis was not significantly different between the groups. After eliminating nulliparas and patients who did not undergo labor, the incidence of intra-amniotic infection in patients with previous infections was not significantly increased over the comparison group. Those patients who did develop recurrent intra-amniotic infection had significantly longer labors (P<.001), duration of ruptured membranes (P=.002), and duration of internal monitoring (P<.001), and an increased number of vaginal examinations (P<.001). (Obstet Gynecol 74:299, 1989)

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Not all mothers who smoke during pregnancy deliver small infants. Nutritional supplementation during pregnancy apparently protects the fetuses of some mothers. Our previous studies showed that plasma levels of carotene and cholesterol were correlated with birth weight. The present study examined the association between mid-pregnancy plasma levels of carotene and cholesterol and subsequent birth weight. In a prospective study of 388 women (47.8% smokers), levels of plasma nutrients and demographic and anthropometric measurements were obtained at 19 and 36 weeks' gestation and related to indices of infant size at birth. In non-smokers, the level of plasma cholesterol at midpregnancy correlated positively with birth weight. In contrast, in mothers who smoked more than ten cigarettes daily, the relationship of cholesterol to birth weight was dependent on the simultaneously observed level of plasma carotene. When plasma cholesterol and carotene concentrations were both low at mid-pregnancy, birth weight was low. On the other hand, when the carotene level was high and the cholesterol level low, birth weight was at least equivalent to that of non-smokers. The interactive effect of smoking, cholesterol, and carotene on birth weight was significant (P=.017) after adjusting for gestational age, sex, prenatal care, race, previous low birth weight infants, parity, weight at mid-pregnancy, and total weight gain during pregnancy. Among smokers, the smallest infants were born to mothers having the greatest decrease in plasma carotene between 19- 36 weeks' gestation. Smokers whose plasma carotene remained constant or increased had larger infants; a similar association was not observed for cholesterol. The simplest interpretation of our data is that carotene nutriture and cholesterol have a positive influence on fetal growth, and that the effect of carotene is particularly evident in fetuses of women who smoke. An alternative but more obscure interpretation is that maternal levels of plasma cholesterol and carotene are indicators of an as yet uncharacterized phenomenon that protects the fetus from adverse effects of smoking. (Obstet Gynecol 74:302, 1989)

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Pregnant women who are underweight for height and gestational age are at risk of delivering infants weighing less than infants born to women of standard weight. This study demonstrated that a nutrition intervention program geared toward these high-risk women improved infant outcome. A group of 57 underweight and failure-to-gain pregnant women (treated) who received extensive nutrition counseling and follow-up from a nutritionist throughout their pregnancy was compared with a similar group of 52 underweight pregnant women (control) who received no counseling. Women in the treated group gained significantly more weight during their pregnancy than did controls. The treated women also delivered infants who averaged 300 g heavier than those born to the control group, a statistically significant difference. Other factors reported to compromise infant outcome such as ethnic background, income status, age, and smoking did not significantly affect infant birth weight. (Obstet Gynecol 74:310, 1989)

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In order to determine the occurrence of antenatal complications in twin pregnancies, we examined the medical records of 939 consecutive twin gestations delivered at Women's Hospital, Los Angeles County/University of Southern California Medical Center between 1980-1985. The rates of occurrence of the eight most common antenatal complications were determined and compared with their incidence in singleton gestations. In addition, complication rates were related to zygosity, levels of antenatal care, and time of antenatal diagnosis. Twin gestations had an 83% incidence of antenatal complications, in contrast to a 32% incidence in singleton gestations. The increased complication rate was due to the disproportionate increase in three complications: preterm labor, pregnancy-induced hypertension, and fetal death. Other complications did not occur more frequently in twin gestations than in singleton gestations. Monozygotic gestations were more frequently complicated by fetal death, and dizygotic gestations by pregnancy-induced hypertension. (Obstet Gynecol 74:313, 1989)

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Twenty cases of fetal death complicating a multiple pregnancy after 20 weeks' gestation are reviewed. We evaluated gestational age at diagnosis and delivery (29.3 ± 0.7 and 31.8 ± 0.9 weeks, respectively), interval from diagnosis to delivery (2.6± 0.6 weeks), and cause of fetal death as a group and by type of placentation (76.5% monochorionic). Eighty-five percent of the surviving fetuses were delivered preterm, and the four neonatal deaths were all due to extreme prematurity, with a mean ( ±SEM) birth weight of 794 ±237 g. Perinatal mortality was 585 per 1000, 450 for twin A and 750 for twin B. The causes of fetal death varied. Maternal disseminated intravascular coagulation was not diagnosed in any pregnancy in the present series. The high risk of complications related to preterm birth, compared with the low risk of problems related to continuation of a multiple pregnancy after diagnosis of a fetal death, argues in favor of conservative management in this setting. (Obstet Gynecol 74:318, 1989)

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In the past, difficult labors have been associated with maternal and infant damage. Today, changing patient management is associated with less trauma and more frequent use of cesarean births to avoid potential fetal neurologic damage. In this report, arrests of dilatation and descent and prolongation of the decelerative phase of labor were reviewed with respect to the later appearance of brain damage in infants after 2 years of age, in association with obstetric interventions including cesarean birth, forceps, and oxytocin. Charts of 413 infants born after abnormal labors were studied. Log-linear analysis was performed to determine the contribution of method of delivery and oxytocin use to the presence of neurologic abnormalities. Statistical testing ruled out the presence in the model of a three-way interaction, and excluded the two-way interactions of neurologic abnormalities-oxytocin use and neurologic abnormalitiesmethod of delivery. Chi-square tests of partial association and marginal association for the delivery-oxytocin interaction yielded values of 33.54 (P<.0001) and 33.78 (P<.00001). This model asserted that method of delivery and use of oxytocin were unrelated to the presence of neurologic abnormalities, but were related to each other. (Obstet Gynecol 74:321, 1989)

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In order to describe the relationship between fetal death rate and impaired fetal growth, we examined over 850,000 births in Illinois between 1980-1984 (using the state computer data file) and assessed the mean/modal birth weights at each gestational age and the relationship between birth weight and fetal death rate at each gestational age. We were interested in the following questions: 1) Is the relationship between impaired fetal growth and fetal death rate the same at each gestational age? and 2) What birth weight would result in a quadrupling of the fetal death rate at each gestational age? Using exponential regression analysis, we determined for each gestational age the fetal death rate at the modal birth weight and similarly, the birth weight expected to result in a quadrupling of the fetal death rate. As gestational age advanced, the birth weight percentile resulting in the constant outcome also increased (second percentile at 25 weeks; 17th percentile at 42 weeks). We also compared these data with similar data from Denver. The findings indicate the following: 1) Fetal death rate increases exponentially as birth weight decreases at each gestational age; 2) the birth weight percentile that results in a constant outcome is not consistent at each gestational age; and 3) if assessment of risk is to be inferred based on the relationship between birth weight and gestational age, the tenth percentile (whether Denver, Illinois, or elsewhere) does not predict stillbirth accurately. The implications point to the use of outcome-oriented risk assessments to predict fetal death when examining the relationship between birth weight and gestational age

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We studied the relationship between preoperative umbilical artery Doppler waveforms and umbilical vein pO2and pH at elective cesarean section. An absence of end-diastolic velocities had a strong statistical association with hypoxia and acidosis, and was an accurate clinical test for hypoxia (sensitivity 78%, specificity 98%, positive predictive value 88%, and negative predictive value 98%) and acidosis (sensitivity 90%, specificity 92%, positive predictive value 53%, and negative predictive value 100%). It was also a clinically sensitive indicator of perinatal morbidity and mortality. Most fetuses with no end-diastolic velocities were growthretarded, but the reverse was not true. The absence of end-diastolic velocities also divided both mature and immature fetuses into high- and low-risk groups for hypoxia and acidosis. In the presence of end-diastolic velocities, only very high S/D ratios (above 4.5) have any association with hypoxia. As a noninvasive test of fetal umbilical vein pO2and pH, umbilical artery Doppler performs well

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID