摘要:

ObjectiveTo determine whether the autopsy histology of fetal tissues can determine the time of death of stillborn fetuses.MethodsHematoxylin and eosin slides from autopsies of 150 stillborn fetuses with well-timed deaths were evaluated retrospectively. Fetuses were divided into a learning set (100 fetuses) and a test set (100 fetuses).ResultsFrom assessment of the 100 fetuses in the learning set, 23 histologic features were identified with possible temporal associations with fetal death. When those histologic features were randomly and blindly assessed in the 50 test fetuses, ten features performed well as diagnostic tests (sensitivity, specificity, and positive predictive values at or above 0.875), correctly classifying 43 of 50 fetuses (86%) with respect to the time of death. The ten histologic features and their predicted death-to-delivery intervals were: loss of nuclear basophilia in individual cells in renal cortical tubules (4 hours), liver (24 hours), inner half of the myocardium (24 hours), outer half of the myocardium (48 hours), bronchial epithelium (96 hours), and tracheal cartilage (1week); and loss of nuclear basophilia of all cells in the liver (96 hours), gastrointestinal tract (1 week), adrenal (1 week), and kidney (4 weeks). The development of these histologic changes appeared to be accelerated by fetal hydrops and a delivery-to-autopsy interval exceeding 24 hours and decelerated by fetal gestational age under 25 weeks.ConclusionHistologic changes identifiable in hematoxylin and eosin-stained fetal tissue may be useful for estimating the time of death in many stillborn fetuses. (Obstet Gynecol 1992; 80:575-84)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo determine whether placental histologic examination is useful for predicting the approximate time of death in stillborn fetuses.MethodsHematoxylin and eosin slides of 71 placentas of stillborns with accurately timed deaths were studied retrospectively. Fifty–one placentas (learning set) were used to develop proposed histologic criteria for the timing of fetal death, which were then tested in the remaining 20 placentas (test set).ResultsAmong 15 histologic variables assessed in the learning set, three features appeared to correlate well with specific death–to–delivery intervals:1) villous intravascular karyorrhexis (6 or more hours); 2) vascular lumen abnormalities of stem villi, including fibroblast “septation” and total luminal obliteration (multifocal, 2 or more days; extensive, 2 or more weeks); and 3) extensive fibrosis of terminal villi (2 or more weeks). When the placentas in the test set were evaluated using the three histologic criteria, 18 of 20 cases were classified correctly with respect to the approximate time of fetal death.ConclusionsPlacental histologic examination seems to be useful for determining the approximate time of death in many stillborn fetuses. (Obstet Gynecol 1992;80:58–592)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo deteimine how accurately the time of fetal death can be predicted from the extent of external maceration in a stillborn fetus.MethodsAutopsy photographs of 86 stillborns with welltimed deaths were studied retrospectively. Sixty randomly chosen fetuses (learning set) were assessed unblinded to develop proposed gross criteria for timing fetal death; 26 fetuses (test set) were then randomly and blindly assessed to test the accuracy of the proposed criteria.ResultsThe two earliest changes in the learning cases were areas of desquamation measuring at least 1 cm in diameter and brown–red discoloration of the umbilical cord stump. Both changes occurred primarily in fetuses with death–to–delivery intervals of 6 or more hours. Other early changes included desquamation involving the face, abdomen, or back (12 or more hours); desquamation involving 5% or more of the body surface (18 or more hours); brown skin discoloration (24 or more hours); and a moderate or severe extent of desquamation (24 or more hours). The only late change that correlated with a specific duration of intrauterine retention was mummification (2 or more weeks). When the 26 test fetuses were randomly and blindly assessed using these gross criteria, 18 (69%) were classified correctly with respect to the approximate time of fetal death.ConclusionExternal fetal examination is useful for estimating the time of death in many stillborns; this information may be helpful when a complete autopsy cannot be performed. (Obstet Gynecol 1992;80:593–00)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo investigate whether the ratio of fetal cells in the maternal circulation differs before and after the blood passes through the maternal lung.MethodsWe performed polymerase chain reaction–based Y–sequence analysis of DNA derived from antecubital vein blood obtained before and 2 hours after cesarean delivery, and from uterine vein blood obtained during cesarean of 14 women carrying male fetuses.ResultsFetal DNA was detected in 17 tested specimens and, as estimated by comparison with parallel dilution series, the fetal–maternal DNA ratio was 1:10s to l:106. However, there was no significant difference in the amount of Y–chromosomal DNA detectable between uterine vein blood and peripheral blood after polymerase chain reaction and Southern hybridization. In DNA derived from peripheral blood after delivery, the intensity of Y–specific fetal DNA sequences was also not significantly increased.ConclusionOur results argue against the often–stated hypothesis of different ratios of fetal to maternal DNA in the uterine vein versus peripheral blood, and indicate that even delivery does not seem to increase the flow of fetal cells into the maternal circulation.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveCurrently, treatment of respiratory distress syndrome (RDS) of the preterm newborn incorporates exogenous surfactant administration. Because fetuses make breathing motions, we proposed that intra–amniotic administration of an exogenous surfactant, Exosurf, to the preterm rabbit fetus results in uptake of Exosurf into the lungs and improves pulmonary mechanical properties compared with post–delivery treated and untreated litter mates.MethodsTen preterm rabbit fetuses were used in a labeling study. A mixture of iron dextran and Exosurf was given in utero, and the minimum dose required to assure delivery of the mixture into the distal airways was 5 mL. In a lung function study, 30 rabbit pups received either 5 mL Exosurf in utero, 0.2 mL Exosurf post–delivery, or no treatment. Pressure-volume curves, opening pressures, and lung volumes at 50 cm H2O were compared among the three groups.ResultsThose rabbit pups receiving Exosurf either in utero or after delivery had significantly better pressurevolume relationships (P < .001) and lower opening pressures (P < .005) than the rabbit pups with no treatment. There were no differences between the animals treated intra–amniotically and post–delivery.ConclusionsIntrauterine administration of exogenous surfactant results in uptake of the surfactant solution into the lungs and alters the pulmonary characteristics of the preterm rabbit pup. Potential adverse effects of this means of surfactant administration must be evaluated further. Intrauterine surfactant delivery may provide an additional means of RDS prophylaxis in the antepartum period.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo better understand hepatitis C viropathies and seroprevalence by performing an epidemiologic analysis of pregnant women seropositive for antibody against hepatitis C.MethodsWe studied 1013 consecutive obstetric patients at Parkland Memorial Hospital who gave informed consent for detailed interviews and serotesting. Sera were analyzed for antibody to the hepatitis C virus using both C100– and RIBA–assays. Neonatal assessment was carried out in the immediate postpartum period.ResultsHepatitis C antibody was detected in 2.28% (IV =23) of the 1005 women in whom analysis was completed. Factors associated with seropositivity included intravenous (IV) drug use, sexually transmitted diseases, hepatitis B infection, maternal age greater than 22.5 years, increased parity (eg, greater than 2.1), history of transfusion, and three or more different lifetime sexual partners or a sexual partner who used IV drugs. Maternal and neonatal outcome was not different between hepatitis C antibody-positive and–negative groups.ConclusionsEpidemiologic data are consistent with sexual and parenteral modes of transmission. Women with hepatitis C antibody did not have excessive perinatal complications compared with antibody–negative women. A model protocol and cost analysis for screening pregnant women for hepatitis C infection are presented. However, routine screening for hepatitis C is not advocated.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo determine the outcome of treated pregnancies in women with well–characterized antiphospholipid syndrome.MethodsWe reviewed 82 consecutive pregnancies in 54 women with antiphospholipid syndrome who were treated during pregnancy with the following:1) prednisone and low–dose aspirin; 2) heparin and low–dose aspirin; 3) prednisone, heparin, and low–dose aspirin; or 4) other combinations of these medications or immunoglobulin.ResultsThe overall neonatal survival rate was 73%, excluding spontaneous abortions, but treatment failures (fetal and neonatal deaths) occurred in all treatment groups. Patients with successful treated pregnancies had fewer previous fetal deaths than those with unsuccessful treated pregnancies. There were no significant differences in outcome among the four treatment groups. Preedampsia and fetal distress occurred in half of all pregnancies, and fetal growth impairment occurred in nearly one–third. Preterm delivery due to maternal or fetal indications was required in 37% of the pregnancies. Four pregnancies were also complicated by postpartum thrombosis during treatment.ConclusionsPregnancy in women with antiphospholipid syndrome appears to be improved by treatment, but fetal loss may occur despite treatment. Preeclampsia, fetal distress, fetal growth impairment, and premature delivery are common. Because of the clinically significant risk of thrombotic episodes, thrombosis prophylaxis should be considered in these patients.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo determine whether there are predictors of peripartum transfusion, other than placenta previa, that identify a population of pregnant women whose risk of transfusion is high enough to justify antepartum autologous blood donation.MethodsUsing an established perinatal data base, we studied 14,267 consecutive term deliveries without placenta previa. Univariate and multivariate analyses were performed to assess ten predictors of peripartum transfusion that might reasonably be detected in the antepartum period. Costs were calculated for a hypothetical autologous blood donation program to prevent transfusion–related infection.ResultsRed–cell transfusion was used in 150 deliveries (1.1%). A total of 424 units was transfused (2.9 per 100 deliveries). Four risk factors were significantly (P< .05) predictive of peripartum red–cell transfusion: preeclampsia (adjusted odds ratio 3.69), multiple gestation (2.82), elective cesarean (1.71), and nulliparity (1.51). Controlling for these, there was no association between transfusion and previous postpartum hemorrhage, previous cesarean with trial of labor, prior abortions, induction of labor, or ethnic group. A hypothetical antepartum blood donation program restricted to patients with three or more risk factors would cost $2,800-130,700 per case to prevent transfusion–related hepatitis and $6,000,000–,26000,000 per case to prevent human immunodeficiency virus infection.ConclusionIn obstetric patients without placenta previa, the need for peripartum red–cell transfusion cannot be predicted with sufficient accuracy to justify the costs of antepartum autologous blood donation.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo determine whether uterine activity, assessed by either fluid–filled or solid pressure catheters, changes with uterine incision at cesarean delivery.MethodsUterine activity was recorded continuously during low transverse cesarean delivery in ten parturients using fluid-filled pressure catheters and in ten women with solid pressure catheters. Visual analyses were performed of the last 30 minutes of uterine recording before uterine incision and of the period after incision; the analyses were then compared within and between the catheter groups for mean uterine tone and contraction amplitude, frequency, and duration. Oxytocin use, anesthesia method, mean gestational age, birth weight, length of labor, duration of monitoring, and uterine incision–to–delivery time were compared between the groups.ResultsAll obstetric end points were similar in both catheter groups except for a higher mean birth weight in the solid–catheter group. The mean (± standard deviation) duration of post–incision monitoring was 4.7 ± 0.94 minutes. After uterine incision, mean tone and contraction amplitude were unchanged, whereas mean contraction frequency and duration decreased significantly.ConclusionsThough intrauterine monitoring was brief, this model allows a unique view of “controlled” uterine rupture. Spontaneous uterine rupture may evolve more gradually; however, neither catheter type would be likely to aid its early recognition.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo compare the clinical outcome in patients with preterm premature rupture of membranes (PROM) who had a sterile speculum examination with those having a digital vaginal examination.MethodsWe studied 271 singleton pregnancies complicated by preterm PROM from the Memorial Medical Center of Long Beach Perinatal Outreach program that met the criteria for expectant treatment from January 1986 to April 1990. Patients were not included in the study if they had multiple gestations, cerclage, advanced labor, or any indication for delivery on admission (eg, mature lung profile, chorioamnionitis). All subjects were maternal transports to our tertiary care facility and were managed similarly by our perinatal group. The women were questioned as to whether a digital vaginal examination had been performed before transport. Latency period and other obstetric characteristics were then compared. The latency period, defined as days from rupture of membranes until active intervention was initiated or labor began spontaneously, was also stratified by gestational age.ResultsOne hundred twenty–seven subjects had a digital vaginal examination and 144 had a sterile speculum examination. A significantly (P <0001) shorter mean latency period (2.1 ± 4.0 versus 11.3 ± 13.4 days) was found in those who had a digital vaginal examination. In addition, a shorter latency period was noted for each gestational age. No difference in uterine activity or cervical dilatation and effacement was noted between the groups on admission.ConclusionDigital vaginal examinations performed on patients whose pregnancies are complicated by preterm PROM appear to shorten significantly the latency period.

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID