摘要:

Effects of in utero exposure to estrogens on the testis and prostate were assessed in male perinates. Exposure to diethylstilbestrol alone or combined with other female sex hormones correlated with hypertrophy and squamous metaplasia of the prostatic utricle and ducts, and with high ratios of Leydig cells to spermatogenic cells in the testis. These changes were not correlated with maternal diabetes, other congenital abnormalities, exposure to progestogens and steroidal estrogens, or thyroid hormones. Within the affected group an interaction was found between the hormones administered and the trimester during which treatment was started. These findings suggest that exogenous female sex hormones may interfere with the action of müllerian inhibiting factor in the human male fetus. The prostatic ducts also respond to maternal estrogen treatment. Relevance to later health is unknown.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A review of 251 cervical cerclage procedures in 205 women over a 7.5-year period was conducted to compare the success rate and morbidity of the Shirodkar and McDonald techniques. Fetal survival rate was 19% before 139 elective McDonald operations and 20% before 63 elective Shirodkar procedures. Fetal survival was 78% after elective McDonald operations and 87% after elective Shirodkar procedures, a difference that is not statistically significant (P>.05). Fetal survival rate was 53% after 30 emergency McDonald and 68% after 19 emergency Shirodkar procedures, a difference not statistically significant. Major postoperative morbidity occurred in 2.0% of the elective cerclage procedures, and acute chorioamnionitis accounted for half the complications (1.2%). Mean blood loss was 30 ml with McDonald operations and 44 ml with Shirodkar procedures; the maximum blood loss of 150 ml occurred in 2 emergency operations. Cervical laceration at parturition occurred more often with Shirodkar (11%) or McDonald (14%) procedures than with the 55,688 other deliveries (2.18%) during the 7.5-year study period (P<.001). Cervical scarring and elective cesarean section significantly (P<.025) increased the cesarean section rate to 16% after McDonald procedures and 25% after Shirodkar procedures.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Ninety-three incidents of uterine rupture are reviewed. There is a distinct difference in both the fetal and maternal outcome between the group with a previously scarred uterus and the group with no previous scarring. Rupture of the unscarred uterus is a more dramatic event. The most common etiologic factors appear to be oxytocin, cephalopelvic disproportion, grand multiparity, and abruptio placentae. Abruptio placentae was diagnosed in almost half the maternal deaths. When the uterine tear is longitudinal, the maternal and fetal prognosis is relatively poor. Fetal mortality is much higher in patients with an unscarred uterus. Hysterectomy was more commonly performed in this group. Rupture of a previously scarred uterus is usually incomplete and the tear is transverse. Maternal and fetal prognosis is much better and repair of the uterus with sterilization is more often feasible in this situation.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The authors reviewed 158 cases of endometritis complicating vaginal delivery. The diagnostic criteria included fever over 100F with uterine tenderness and/or foul lochia. The mean temperature at diagnosis was 102.2F, and only 21 (13%) had temperature less than 100.9F. The majority of patients did not have traditional risk factors. Endometritis was characterized as generally early in onset (84% within 7 days) and usually mild in course (5.0% had bacteremia, 93.7% responded to initial antibiotics). Yet a small group (1.9%) developed documented pelvic abscess, fulminant peritonitis, or suspected septic pelvic thrombophlebitis.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Wide interpatient variation in gentamicin elimination rates and dosage requirements was demonstrated in 67 obstetric patients with normal serum creatinine levels. A poor correlation occurred between the elimination rate of gentamicin and creatinine clearance (r=.23). A higher correlation was found between the drug's elimination rate and distribution volume (r=–.62), which suggests that the changing fluid status associated with pregnancy affects the kinetic parameters of gentamicin. Gentamicin dosage regimens were systematically'calculated for each patient from serum concentration- time data to obtain desired serum levels. These individualized regimens demonstrated considerable variability, ranging from 3.0 to 11.6 mg/kg/day. Clinical ototoxicity and nephrotoxicity were not observed. Because of the wide interpatient variation, these increased dosages are not routinely suggested unless serum concentrations are previously measured and each patient's regimen is calculated. These results emphasize the need to measure serum concentrations and make necessary dosage adjustments to ensure therapeutic levels in obstetric patients.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

To study quantitatively the effect of urinary bladder distention on labor and uterine activity, 68 patients requiring catheterization were studied. All patients were in the active phase of labor and had transcervical intrauterine pressure monitoring. Patients were studied in the same lateral position for 30 minutes before and after a catheterization interval, during which time uterine activity units were quantitated on line and changes were noted in cervical dilation and station and contraction frequency and tonus. Results were analyzed for the entire study group, for individual patients, and by urine volumes (10 to 550 ml) obtained at catheterization. Total uterine activity units increased in 43 patients and decreased in 25 after catheterization, but when compared with expected increases calculated from the slopes of the precatheterization interval in individual patients, there were 36 increases and 32 decreases. Individual slopes of uterine activity increased in 36 and decreased in 31 cases. There were no differences when the data were analyzed by urine volume, parity, or birth weight except possibly at large volumes. Changes in rates of cervical dilation and descent of the presenting part conform to the expected normal labor pattern. Within the limits of this study, emptying the urinary bladder has no effect on the course of labor or uterine activity based on the dynamic model of labor.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

As problem pregnancies are increasingly subjected to ultrasound evaluation, the prenatal diagnosis of hydrops fetalis is being made more and more frequently. The authors encountered 5 cases of this disorder in 12,830 deliveries (1:2566) and made the diagnosis prior to delivery in 4 of the 5 cases. Amniocentesis and amniotic fluid bilirubin determination have been performed in association with ultrasound scan and a battery of other diagnostic tests, and the results have been correlated with fetal outcome. In general the combination of fetal ascites and increased amniotic fluid bilirubin denotes a poor fetal prognosis. Unless there are other mitigating circumstances, a conservative course of management is recommended.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Approximately 45% of patients with epilepsy experience an increase in seizure frequency during pregnancy. Despite the availability of effective anticonvulsant medications, there has been no decrease in reported seizure frequency accompanying pregnancy in the past 35 years. The authors prospectively studied concentrations of phenytoin (DPH) and its metabolites in 5 patients throughout pregnancy and during the postpartum period. The concentrations of phenytoin, as well as both unconjugated and conjugated forms of its principal metabolite, 5-(4-hydroxyphenyl)-5-phenylhydantoin (4-OH-DPH), were measured in plasma and urine by a precise high-pressure liquid chromatography method. Four patients experienced a decrease in plasma DPH during gestation, 3 of whom developed seizures at a time of low plasma DPH concentration. Within the therapeutic range, small increments in dosage resulted in large increments in plasma DPH levels, and in the postpartum period high levels of DPH were encountered if the dosage was not reduced. As pregnancy progressed, there was a decrease in the percentage of the daily dosage of DPH excreted as 4-OH-DPH. Based on these observations, the authors conclude that 1) pregnancy is associated with altered DPH absorption or metabolism, or both, and 2) periodic measurement of plasma DPH concentration is valuable when managing a pregnant epileptic patient.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Hydrocortisone or placebo was administered to 126 women at risk for premature delivery who had immature lecithin:sphingomyelin (L:S) ratios in order to induce early surfactant synthesis. In 70 subjects (37 steroid-treated patients, 33 controls), L:S ratio was determined a second time between 9 hours and 7 days after therapy had been initiated. The treatment group showed a significant increase in the L:S ratio when compared to those who received the placebo. Moreover, patients who had fetomaternal disorders that accelerated or delayed lecithin production were also found to have increased L:S ratios after treatment. Fewer newborns developed respiratory distress syndrome (RDS) in the treatment group than in the control group and those in the former category who were affected by RDS had a milder clinical course.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The roll-over test (ROT) was evaluated in normal pregnant patients between 28 and 34 weeks' gestation and found to be an accurate method of screening for small-for-gestational age (SGA) infants and for preeclampsia. Patients with a positive ROT had a significant risk of SGA or preeclampsia or both. In patients with a positive ROT, the development of SGA may be further predicted by an examination of maternal prepregnancy weight and weight gain. Patients with a prepregnancy weight of 50 kg or less, total weight gain of 10 kg or less, and/or differential weight gain of 20% or less have a highly significant risk of developing an SGA fetus. In contrast, patients with a negative ROT have a significantly decreased risk for SGA and/or preeclampsia.

ISSN:0029-7844    

出版商:OVID    

年代:1980

数据来源: OVID