摘要:

Imaging with ultrasound is common in obstetric practice. Several laboratory animal studies have shown retardation in fetal growth after experimental ultrasound exposure. This investigation was conducted to determine whether human fetuses exposed to diagnostic ultrasound (sonography) have a greater risk of growth retardation than fetuses not so exposed. This retrospective cohort study compares the birth weights of 1598 exposed and 944 unexposed single live births at the Johns Hopkins Hospital in Baltimore, Maryland during calendar year 1981. Confounding variables, defined as those associated with both exposure status and birth weight outcome, were included in multivariable analysis. Both exposure to more than one ultrasound procedure and first exposure during the third trimester were associated with a reduction in birth weight. However, the most consistent effect associated with birth weight appeared to be the indication for an ultrasound examination. The relationship of ultrasound exposure and reduced birth weight appeared to be due to shared common risk factors, which lead to both exposure and a reduction in birth weight.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A real-time ultrasound screening examination was performed in 3208 unselected singleton pregnancies at 18 and 34 weeks to detect small for gestational age (SGA) fetuses below the tenth percentile weight for age. Such cases accounted for 4.9% of this population. Biparietal diameter (6PD) was used at the first examination to confirm the true gestational age. The growth was measured at 34 weeks with a combination of BPD and transverse abdominal diameter. With a cutoff level of -1.5 standard deviations (SD), the sensitivity of a single measurement was 62.2%, the specificity was 93.2%, and the positive predictive value was 32.4%. With a cutoff level of - 1 SD, the values were 76.3, 84.8, and 20.4%, respectively. The positive predictive value approached 48.7% before birth in the group that was rescanned before delivery. The simple method of a combined measurement of BPD and transverse abdominal diameter provided efficient antenatal screening for diagnosis of SGA fetuses in the general population. A somewhat low positive predictive value indicates a control examination of fetuses suspected of being SGA. Nonlinear methods, such as the measurement of abdominal circumference, appear suitable for ruling out false-positive cases.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Obstetric ultrasound performed in conjunction with genetic amniocentesis at 14-18 weeks' gestation identified 16 fetuses with structural malformations among 4781 examinations. The outcomes for these 16 fetuses included 12 terminations, two fetal deaths, one related death six months after birth, and one transient abnormality with no apparent significant sequelae. The ultrasound examination failed to detect at least nine other fetuses with structural malformations. The relatively small size and early stage of development of the fetuses at the time of genetic amniocentesis appears to have contributed to the failure of ultrasound to detect these malformations. A brief search for fetal malformations during obstetric ultrasound performed at early genetic amniocentesis appears productive enough to be worthwhile. However, if there is a special indication to search for fetal malformations, the ultrasound examination should probably be repeated later.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The purpose of this study was to describe the ultrasonic measurement of fetal foot length and to develop mathematical models to quantify the relationships between menstrual age and commonly measured fetal structures. We evaluated 120 patients with known last menstrual periods and normal pregnancies to develop a cross-sectional study population. All patients had ultrasonic measurement of the fetal foot length, biparietal diameter, head circumference, abdominal circumference, and femur length. Least-squares estimation of linear models was used to select the best mathematical models to describe the relationship between menstrual age and fetal foot length. A similar evaluation of the relationship between fetal foot length and the other measured parameters was performed. All models were best described by a linear equation. An R2value of 0.94, with a standard error of the estimate of 0.204, was obtained for menstrual age versus fetal foot length. When the model for fetal foot length and menstrual age was compared with published anatomical data, close agreement was seen over the time interval studied. Our results suggest that the measurement of feta! foot length with ultrasound gives a reliable assessment of anatomical fetal or neonatal foot length and is highly correlated to the menstrual age of the fetus.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Records were reviewed retrospectively on 72 infants with open spina bifida followed from birth through one year of age. Thirty-two infants were born by cesarean section and 40 vaginally. The following variables were compared between the two groups: 1) mortality in the nursery and between nursery discharge and one year of age, 2) incidence of meningitis in the neonatal period, 3) length of initial hospital stay, and 4) neurologic and developmental status at one year. No significant differences were noted between the two groups. Although it has been suggested that cesarean section may improve the prognosis for infants with open spina bifida, our data do not support that conclusion.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To determine whether the fetal heart accelerates in response to a sound stimulus in labor, 40 women at various stages of labor were chosen at random to receive either a vibroacoustic stimulus or sham stimulus over the fetal head. Subsequent fetal heart rate (FHR) accelerations occurred to a significantly greater extent in study patients. One hundred thirty- two high- and low-risk patients were studied to determine correlations between the acceleration response and other maternal and fetal variables. There was a statistically significant negative correlation between the heart rate response to stimulation and three maternal variables: the degree of cervical dilation, the presence of ruptured membranes, and use of epidural anesthesia. The degree of fetal response did not correlate significantly with fetal distress at delivery or abnormal FHR tracings at the time of stimulation. Fewer than one-fifth of the fetuses manifested variable heart rate decelerations after the stimulation. In light of possible risks, the clinical use of the fetal acoustic stimulation test in labor should wait until its diagnostic value is better defined.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Women giving birth in two university hospitals, one in the Netherlands and the other in the United States, were surveyed postpartum regarding expectations of pain in labor and availability of medication for its relief, perceptions of the painfulness of labor, and use of analgesia and anesthesia. American women expected labor to be more painful, anticipated that they would receive medication for it, and did receive such medication in significantly greater proportions compared with Dutch parturients. These findings point to fundamental, culturally determined differences between these two societies with respect to women's views of the painfulness of childbirth.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Cervical cerclage as a temporizing measure for the treatment of patients with placenta previa was evaluated in 25 patients admitted to the hospital for vaginal bleeding between 24-30 weeks' gestation and sonographic evidence of a placenta previa. The patients were randomly assigned to either cerclage (13) or conventional management (12). Cerclage patients had significantly better perinatal outcome, as indicated by more advanced gestational age at the time of delivery (34.9 ± 3.0 versus 31.6 ± 2.9 weeks;P=.02), larger birth weight (2709 ± 511 versus 1812 ± 506 g;P=.002), and fewer neonatal complications (two of 13 versus ten of 12 infants;P=.001). Maternal bleeding was more frequent and severe for patients in the control group. The total hospital cost was less for cerclage patients than for those receiving conventional expectant management ($9898 ± 3943 versus $27,271 ± 9901;P=.02). These results support the use of cervical cerclage for the treatment of patients with symptomatic placenta previa early in gestation.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Nine cases of early and six cases of advanced abdominal pregnancy managed at the University of Mississippi Medical Center over a 20-year period are reviewed. An incidence of one abdominal pregnancy in 4857 deliveries occurred in this series. A perinatal mortality rate of 83% and no maternal mortality were noted, in contrast to published rates of 40-95% and 0.5-18%, respectively. Important current concepts of management include difficulty in diagnosis, predisposing risk factors, suggestive signs and symptoms, the diagnostic role of ultrasound, and the appropriate surgical management of parturients with this ominous pregnancy complication.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We asked the question: What can be expected of expectant management in preterm ruptured membranes? Our findings showed that ruptured membranes during the first half of the third trimester occurred in only 1.7% (N=298) of 17,877 pregnancies delivered at our institution, yet accounted for 20% of the total perinatal deaths during the study period. Expectant management was seldom successful; only 20 (7%) of pregnancies with preterm ruptured membranes did not begin labor within 48 hours. The condition of preterm ruptured membranes was also frequently associated with other obstetric complications such as twins, breech presentation, chorioamnionitis, and fetal heart rate decelerations in labor. We conclude that preterm ruptured membranes is an uncommon but complex obstetric problem that remains largely unsolved.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID