摘要:

The recent dramatic increase in the use of alkaloidal cocaine (“crack”) has led to concern about possible deleterious fetal effects associated with its use during pregnancy. Crack, which is not destroyed by heating, can be smoked, and delivers a large quantity of cocaine to the vascular bed of the lung, producing an effect similar to that from intravenous injection. To describe the association of crack use with pregnancy outcome, we conducted a retrospective matched cohort study of 55 women who admitted to the use of crack during pregnancy and 55 non-drug-using women who delivered during the same period. The groups were matched for age, parity, socioeconomic status, alcohol use, and presence or absence of prenatal care. A significantly larger number of women using crack delivered at 37 weeks or earlier (50.9 versus 16.4%;P=.001). Crack-exposed infants were 3.6 times more likely to have intrauterine growth retardation (P<.006) and 2.8 times more likely to have a head circumference less than the tenth percentile for gestational age (P<.007). Premature rupture of the membranes was 1.8 times more common in the crack group (P<.03). Sixty percent of crack-using mothers received no prenatal care. Abnormal neurobehavioral symptoms were present in a minority of infants and were usually mild. (Obstet Gynecol 72:147, 1988)

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We used data from the National Infant Mortality Surveillance project to examine the effect of older maternal age on infant mortality for the 1980 United States birth cohort. The 1,579,854 births and 14,591 deaths of singletons who were black or white and whose mothers were 25-49 years of age were included. Direct standardization was used to calculate birth-weight-adjusted relative risks of neonatal and postneonatal mortality, using the birth weights of infants with maternal age 25-29 as the standard. We found that the risk of infant mortality was nearly equal for infants born to mothers 25-29 and 30-34 years of age; infants born to mothers 35-39 years of age were at a slightly elevated (18% higher) risk, and those born to mothers 40-49 years of age were at a much more elevated (69% higher) risk. Among whites, the higher neonatal mortality associated with a maternal age of 35-39 was mostly due to an increased prevalence of low birth weight; among blacks, it was due to higher birth-weight-specific risks. Neither white nor black postneonatal mortality risks were much elevated until a maternal age of 40-49, and this last elevation was mostly due to higher birth-weight-specific risks. These findings suggest that infertility and fetal mortality aside, and considering only the effect on infant mortality, it is relatively safe for women to postpone childbearing into their middle, and perhaps late, thirties.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We studied the longitudinal association of birth order and birth weight in two series of very large sibships, each consisting of at least seven children, and compared the findings with those based on analysis of cross-sectional data from a large population-based survey, the Jerusalem Perinatal Study. The birth weights of the cross-sectional sample were adjusted by multiple linear regression for a number of factors known to confound cross-sectional studies, including maternal age, education, marital status, religion, smoking, height and prepregnant weight, gestational age, and sex of the newborn. Birth weight increased with increasing birth order in both adjusted cross-sectional and socioeconomically homogeneous longitudinal data.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Fifty-five patients with a history of two or more cesarean sections underwent a trial of labor. Forty-two had had previous uterine incisions of unknown type, 11 had had low cervical transverse incisions, and two had had low vertical incisions. Twenty-five women (45%) had successful vaginal deliveries, and 30 (55%) receivedoxytocinaugmentation of labor. The incidence of vaginal delivery was significantly lower in patients who required oxytocin augmentation (30 versus 64%,P<.01). Three of the 55 patients had scar separation detected at the time of delivery. Two patients underwent hysterectomy. There were no maternal or neonatal deaths. A history of multiple cesarean sections need not exclude the patient from the option of trial of labor.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Autologous transfusion, storage of one's own blood for subsequent infusion if needed, is safe and effective in a variety of scheduled operative procedures. Obstetric involvement in such programs is very limited, however. Thirty pregnant women with placenta previa or other potential complications underwent 55 phlebotomies in an autologous transfusion program. Phlebotomies were performed at an average gestational age of 32.4 weeks (range 13-40). Changes in mean diastolic blood pressure and pulse were minimal. Electronic fetal monitoring tracings were normal during the 34 procedures in which it was used. The frequency of mild donor reactions (4%) was consistent with that in nonpregnant donors. After entry into this program, 15 patients received a total of 29 U of packed red blood cells (23 autologous; six homologous). Homologous transfusion was avoided in 86.7% of patients receiving blood. Selected pregnant women can participate safely in autologous blood collection programs, minimizing the need, and therefore the risks, of homologous transfusion.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Serum 5-nucleotidase enzyme activity and serum sialic acid concentrations were measured in 219 pregnant women to establish the incidence of cholestasis of pregnancy and the effect of rapid fetoplacental growth on serum sialic acid level. Serum 5-nucleotidase activity increases in diseases of the liver and obstruction of the biliary tract, whereas the level of serum sialic acid, a carbohydrate component of plasma membrane and cellular glycoproteins, rises in the presence of rapidly proliferating cells such as tumors. Serum 5-nucleotidase activity did not change between the first and the third trimesters of pregnancy. The elevation of serum 5-nucleotidase activity and of alkaline phosphatase in one case most likely indicated a cholestatic effect of pregnancy, and represented an incidence of 0.45% in the women studied. Among 201 cases, we found a graded and significant increase in the mean (± SD) serum sialic acid concentration with progressing pregnancy, from 1.63 ± 0.3 mmol/L at the onset of pregnancy (five to eight weeks) to 2.06 ± 0.49 at term; in the last stages of pregnancy, some of the values may overlap with those of cancer patients. We could not find any earlier report in the literature regarding the increase in serum sialic acid level in pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The incidence of spontaneously occurring premature labor in insulin-dependent diabetic pregnancies is unclear, because previous studies have been confounded by a high rate of iatrogenic prematurity. The purpose of this study was to determine, in a large population of insulin-dependent diabetic pregnant women, the rate of spontaneous occurrence of premature labor and the various factors that may affect it. We hypothesized a priori that spontaneously occurring premature labor occurs at a high rate in insulin-dependent diabetic pregnant women, mainly because of poor control of diabetes during pregnancy, and is related to the presence of polyhydramnios and hypomagnesemia. One hundred forty- five insulin-dependent diabetic women undergoing 181 pregnancies were recruited since 1978 in an interdisciplinary prospective study. The goals of glucose control were a fasting blood glucose less than 100 mg/dL and a 90-minute postprandial glucose less than 140 mg/dL. The rate of spontaneous premature labor, 31.1%, was significantly higher (P<.01) than that in a control population managed by the same obstetricians in similar clinical settings (20.2%). The following variables were not significantly associated with the onset of premature labor: maternal age, parity, gravidity, diabetic class according to White, presence of renal disease or retinopathy, previous elective abortion, chronic hypertension or pregnancy-induced hypertension, cigarette smoking, first-trimester or post-20 weeks' gestation vaginal bleeding, maternal serum magnesium concentration, or polyhydramnios. The following factors were significantly associated with premature labor: premature rupture of membranes (P<.01), history of premature delivery (P=.001), poor glycemic control during the second trimester of pregnancy as assessed by maternal hemoglobin Ax concentration at 26 weeks' gestation (P<.03), and urogenital infection (P<.005). We speculate that strict glycemic control and eradication of infection may decrease the spontaneous premature labor rate in insulin-dependent diabetic pregnant women.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The relationship between growth of the fetal femur and foot length was examined between 14-40 weeks' gestation in 182 normal singleton pregnancies. A significant correlation was demonstrated (r=0.98;P<.0001). The femur/foot length ratio was found to be approximately 1 throughout this age range. The fifth and 95th percentile confidence intervals of the femur/foot length ratio versus gestational age were then defined. The femur/foot length ratio was also measured directly in 12 fetuses after second-trimester abortion; these measurements compared favorably with the ultrasound femur/foot length ratio nomogram. The discriminatory power of the femur/foot length ratio chart to differentiate fetuses with skeletal dysplasias from those with pseudolimb reduction due to constitutional factors or intrauterine growth retardation (IUGR) was tested in 16 sequential cases with femur measurements below the fifth percentile. Two cases suspected of having symmetrical IUGR and five cases suspected of being constitutionally small were found to have femur/foot length ratios within the 90th percentile range. Limb reduction deformities were suspected in the nine remaining cases, and the femur/foot length ratios in these fetuses were all found to be less than the fifth percentile. The femur/foot length ratio nomogram appears to be a useful parameter to help differentiate fetuses that have dysplastic limb reduction from those whose limbs are short because of constitutional factors or IUGR.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

During a 22-month period, 6288 women undergoing prenatal sonographic studies in the second and third trimesters were evaluated prospectively to determine the incidence of choroid plexus cysts in the fetus, to follow the natural course of these cysts in intrauterine life, and to determine the association of chromosomal and anatomic anomalies in these fetuses. We diagnosed choroid plexus cysts in 41 fetuses, an incidence of 0.65%. Unilateral and bilateral cysts were equally frequent, and in most cases diagnosed by 21 weeks' gestation. On follow-up scans, the cysts had completely disappeared by 23-24 weeks in 80% of the cases, and by 28 weeks in another 10%. Once resolved, the cysts did not recur, and a normal sonogram in the late second trimester predicted normal scans in late pregnancy and in the neonate. One fetus had a chromosomal abnormality (trisomy 18). Associated anatomic anomalies were detected in three fetuses, including the one with trisomy 18. We believe that in the great majority of cases, fetal choroid plexus cysts are benign transient variants of normal intracranial anatomy. It is, however, important to conduct a careful sonographic search for associated anomalies. Chromosomal studies are strongly recommended whenever associated anatomic abnormalities are detected and when the choroid plexus cysts are large, bilateral, and persistent beyond 20-22 weeks' gestation

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Adrenal weights and histologic features in an autopsy population of 759 fetuses and neonates were correlated with the presence or absence of pregnancy-induced hypertension. Hypoplastic fetal adrenals with normal proportions of fetal and adult cortical layers (miniafure histologic type) had combined adrenal weights less than 1 g, and were noted in 11 fetuses and neonates born to 39 mothers with pregnancyinduced hypertension, two born to 35 mothers with suggested pregnancy-induced hypertension, and 45 born to 685 mothers with no pregnancy-induced hypertension. Hypoplastic fetal adrenals were associated significantly with pregnancy-induced hypertension by x2analysis (P<.01). When a more stringent criterion for fetal adrenal hypoplasia was used (combined adrenal weight/body weight ratio of less than 1:1000), five cases were associated with pregnancy induced hypertension, three with suggested pregnancy induced hypertension, and seven with normal maternal blood pressures (P<.001). This study confirms the relationship between pregnancy-induced hypertension and reduced fetal adrenal mass. We speculate that reduced production of dehydroepiandrosterone sulfate by the small adrenals may be related to maternal hypertension.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID