ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Studies in the past year have clarified the roles of inflammatory mediators in preterm labour. Exploration of possible genetic predisposition is just beginning. Ultrasound measurement of cervical length has the potential to predict women at risk of preterm delivery several weeks before it occurs. Biochemical testing such as fetal fibronectin can possibly increase its predictive value and differentiate true preterm labour from more innocent preterm contractions. The use of antibiotics for preterm premature rupture of membranes has been clarified with the ORACLE I trial, which shows health benefits for the neonate with the use of erythromycin, whereas antibiotics do not seem to play a beneficial role in spontaneous preterm labour without evidence of clinical infection. There have been further studies suggesting that agents other than beta-agonists are preferable for acute tocolysis and that repeated doses of corticosteroids should be used with caution.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Bacterial vaginosis is associated with adverse pregnancy outcomes across all gestational ages. It is linked to first and second trimester fetal loss, chorioamnionitis, preterm delivery, low-birthweight infants and maternal/neonatal infectious morbidity. Infants who survive preterm birth are at an increased risk of subsequent neurodevelopmental delays and handicap, more so if there was underlying choriomnionitis. The exact mechanisms and pathways through which bacterial vaginosis exerts these adverse effects are incompletely understood. Not surprisingly, intervention studies in bacterial vaginosis-positive pregnant women have shown conflicting results, both in women at high and low risk of preterm birth. A much better understanding of the pathobiology of bacterial vaginosis in pregnancy is required to focus the designs of intervention studies on the disturbed cellular and biochemical pathways. Such studies may address the benefits of the treatment of bacterial vaginosis before conception and during early pregnancy, to determine whether treatment in populations of pregnant women may be beneficial.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Worldwide, pre-eclampsia and eclampsia contribute to the death of a pregnant woman every 3 min. In the UK in recent decades, hypertensive disorders of pregnancy have remained one of the leading causes of both maternal and perinatal morbidity and mortality. The management of pregnancies complicated by hypertension has not significantly altered for many years, possibly as a result of little progress being made in our understanding of the condition. New insights, however, have recently been gained into the pathophysiology of pre-eclampsia. These have yet to be translated into new interventions or to make any impact on clinical management of these pregnancies. This review will therefore focus on recent advances relating to research into the aetiology and pathogenesis of pre-eclampsia, but will conclude with a brief update on current therapeutic strategies.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Pathophysiological processes underlying intrauterine growth restriction are very complex and poorly understood. Growth restricted fetuses are at risk of hypoxia and, therefore, an early diagnosis of intrauterine growth restriction is important for initiation of fetal surveillance. Application of a three-dimensional ultrasound method for estimation of fetal weight promises better precision. Use of conditional standard deviation scores of fetal biometric variables has been suggested for improved individualized evaluation of intrauterine growth. Application of umbilical artery Doppler velocimetry in the clinical management of growth-restricted fetuses after 32 weeks of gestation leads to decreased perinatal mortality and lower rates of obstetric interventions. Evaluation of fetal state before 32 weeks is difficult and should include Doppler examination of placental circulation and several fetal arterial and venous vessel beds. In addition, recordings of short-term variability of fetal heart rate and biophysical profile have been suggested for fetal surveillance. Important new data on the time sequence of Doppler changes in various vessels of compromised very preterm growth restricted fetuses have been presented, which will enable the establishment of clinical management protocols for evaluation in prospective randomized studies.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Congenital heart disease in pregnancy is increasingly common because of the advances in surgery and medical therapy which have taken place over the last 30 years, which means that more affected women are surviving into the reproductive age. Antenatal counselling needs to be tailored to the specific lesion, with pulmonary hypertension and cyanotic disease presenting a risk of maternal mortality of up to 50%. The use of anticoagulants in women with artificial valves presents a particular challenge, heparin being safer for the baby and warfarin for the mother. Peripartum cardiomyopathy and Marfan's syndrome may be less dangerous than once thought. The risk of congenital heart disease in the fetus is increased, from twice to 20-fold, depending on the nature of the mother's lesion. Care throughout pregnancy and in the puerperium should be multidisciplinary and include cardiologists, obstetricians and midwives with experience of such cases, preferably in a tertiary centre.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This update discusses the evidence to link maternal smoking during pregnancy with adverse pregnancy outcome, and also the potential long-term effects on health of in-utero exposure to tobacco smoke. Smoking cessation strategies will also be considered.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This update focuses on recent neonatal research of potential interest to obstetricians. Accurate information on outcomes for infants born at the edges of viability is critical to informing management decisions. New research, population based, gives guidance on short-term survival and long-term neurodevelopmental outcome. Recent research has also highlighted the variation in attitudes to end-of-life decision-making and important influences on this that cross different boundaries. Although research is dominated by issues related to prematurity, some important developments relevant to term infants will be covered. There is accumulating evidence that challenges the traditional approach of using 100% O2in resuscitation. For infants suffering intrapartum asphyxia there are new approaches to neuroprotection actively being explored. Therapeutic interventions such as extracorporeal membrane oxygenation and inhaled nitric oxide, available for some time, are having their place in neonatal intensive care more clearly defined.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Ongoing trends in prenatal diagnosis aim at early, rapid, and ideally noninvasive diagnosis as well as at the improvement of risk-screening for aneuploidy. Interphase-fluorescence in situ hybridization and quantitative fluorescence polymerase chain reaction are efficient tools for the rapid exclusion of selected aneuploidies in addition to the established direct preparation of chromosomes from chorionic villi. Interphase fluorescence in situ hybridization has also made possible the diagnosis of selected chromosome abnormalities in single cells (e.g. in preimplantation genetic diagnosis) or noninvasive diagnosis. More complex multicolor fluorescence in situ hybridization approaches are currently being evaluated. Single cell polymerase chain reaction is the key technique for the molecular diagnosis of a growing number of monogenic conditions before implantation or, still more experimental, in fetal cells retrieved from the maternal circulation. New sources for noninvasive diagnosis came into play such as fetal DNA or cell nuclei in maternal plasma. The combination of biochemical parameters in the maternal serum, namely free beta-human chorionic gonadotropin with pregnancy associated plasma protein A and sonographic markers, has already dramatically increased the sensitivity of risk screening in the first trimester of pregnancy.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID