ISSN:0029-7828    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Higher-than-expected rates of obstetrical and perinatal complications are described in singleton pregnancies afterin vitrofertilization (IVF), but studies comparing IVF and spontaneously conceived twins have given mixed results. This study contrasted 96 IVF twin pregnancies with the same number of control twin pregnancies closely matched for numerous factors: maternal age, parity, race, body size, smoking status, hospital, delivery date, and obstetrical and medical histories. Women who had received IVF were 6 months older on average. Just over two-thirds of both groups were primiparas.Vaginal bleeding was more frequent in IVF pregnancies (32% vs. 19%), with most episodes occurring during the first trimester. There were no significant group differences in gestational diabetes, placenta previa, or preterm membrane rupture. Rates of spontaneous labor, induction, and elective cesarean delivery also were comparable in the two groups. Newborn infants were in similar condition at birth. Both first- and second-born infants weighed less in the IVF group, but the differences were not statistically significant. In all, 61% of IVF infants and 44% of control infants had low birthweight, and about one-fourth of the infants in each group were small for gestational age. Birthweight discordance averaged 17.6% for IVF twins and 14.3% for control twins, and discordance exceeding 25% was more frequent in the IVF group (22.9% vs. 11.5%). Fewer than 4% of infants in each group had congenital malformations. The average number of days in neonatal care was 12.4 for IVF infants and 10.7 for control infants, also not a significant difference, and no particular neonatal problems were significantly more prevalent in IVF children. These findings affirm that, in some respects, the outcomes of IVF twin pregnancies differ from those of naturally conceived twin pregnancies.

ISSN:0029-7828    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

In recent years external cephalic version (ECV) has been increasingly recommended as a safe alternative to either vaginal breech delivery or cesarean delivery. Reports suggest that both the latter outcomes are in fact less frequent with ECV, but fetal risk has not been reliably assessed. This study is a 10-year review of ECV performed at three hospitals from 1988 through 1997. Women having a single fetus in breech presentation, confirmed ultrasonically, were entered into the study when they agreed to attempted version. Version was done using a tocolytic agent, ritodrine, to relax the uterus, but without maternal analgesia. Electronic fetal monitoring was used to detect fetal cardiac dysfunction. The “forward roll” version technique was used; a “back flap” technique was occasionally tried if the fetus did not cross the midline. A second attempt was allowed if the first failed or if the fetus resumed a breech position.Among 923 women enrolled in the study, ECV succeeded in 62.7% of cases, with comparable rates at all three participating hospitals. Success rates were higher in multiparas than in nulliparas (76.6% vs. 55.3%), with a normal amniotic fluid volume (93% with polyhydramnios vs. 65% with a normal fluid volume and 29.6% with oligohydramnios), and incomplete compared with frank breeches (77.3% vs. 56.6%). Version succeeded in converting 72% of 30 transverse-lie fetuses. Two-thirds of 19 women having previous cesarean delivery and three-fourths of those undergoing myomectomy had a successful outcome. Logistic regression analysis disclosed that polyhydramnios was the strongest predictor of success, with a relative risk of 5.8. Version attempted on a multipara or for incomplete breech was 2.5-fold likelier to succeed than when done on a nullipara or for a frank breech. A posterior rather than anterior placenta also was a favorable factor. A second attempt succeeded in 10 of 24 women when the initial attempt failed and in all 8 women when an initially successful result reverted to breech. The risk of vaginal bleeding after version was 1.5%, and that of transient fetal bradycardia, 5.8%. The rate of cesarean delivery was 43% at these hospitals, where it is standard practice to perform cesarean delivery in cases of breech presentation. With one exception (femoral fracture when cesarean delivery followed a failed version), neonatal outcomes were favorable.The investigators believe that ECV is effective in lowering the need for cesarean delivery in term infants in breech presentation. No major adverse infant outcomes have been noted.

ISSN:0029-7828    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Reports suggest that when prospective mothers take supplemental multivitamins containing folic acid during the periconceptional period, the risk of a neural tube defect declines and some types of congenital cardiac defects may be less frequent. This population-based case-control study examined the relation, if any, between maternal multivitamin use and the risk of cardiac defects. Data are from the Atlanta Birth Defects Case-Control Study, in which information was obtained from parents of infants with and without birth defects who were born between 1968 and 1980. The participation rate was 71%, leading to 958 case infants having nonsyndromic cardiac defects and 3029 control infants lacking birth defects of any kind. Infants whose defects were of known genetic or teratogenic origin were excluded. The data source was a stratified random sample of birth certificates.Septal defects, obstructive conditions, and outflow tract abnormalities were most prevalent. Mothers of control infants were more likely to be white and to have delivered in the earlier years of the period under study. Mothers of case infants were likelier to have had a chronic disorder of some kind around the time of conception. Regular use of multivitamins during the periconceptional period was reported by 14.2% of case mothers, whereas another 38.9% reported no such use. Periconceptional use of multivitamins seemed to lower the risk of all heart defects combined by 24% (odds ratio = 0.76, 95% confidence interval = 0.60–0.97). The major differences were a 54% reduction in outflow tract defects and 39% fewer ventricular septal defects. No protection was apparent when mothers started taking multivitamins in the second or third trimester. Should this apparent relationship prove to be causal, approximately one in four major cardiac defects might be prevented by making sure that prospective mothers take multivitamins during the periconceptional period.

ISSN:0029-7828    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Postpartum psychosis, the most serious postpartum psychiatric condition, is often resistant to psychopharmacotherapy, and relatively considerable number of women (4% in one series) may commit infanticide. Because estrogen reportedly is an effective therapy for postnatal depression and may prevent affective disorder, estrogen therapy was evaluated in 10 consecutive women admitted with puerperal psychosis. Psychiatric symptoms had developed in the patients, whose age averaged 31 years, approximately 12 days after delivery, and the women had had symptoms for an average of 10 weeks at the time they entered the study. Six of the women had received psychotherapy or neuroleptic medication but did not respond adequately. Serum estradiol was measured at weekly intervals during 6 weeks of treatment with sublingual 17&bgr;-estradiol. The dose was 1 mg three to six times per day, and the goal was a serum level of 400 pmol/liter (about one-third of the menstrual peak). After the first week, the average daily dose was 4.7 mg. Neuroleptic drugs were gradually withdrawn, and efficacy was measured using the Brief Psychiatric Rating Scale (BPRS).Baseline serum estradiol levels in all patients were below 110 pmol/liter, the threshold value for gonadal failure. During treatment the levels rose gradually to reach an average of 692 pmol/liter at week 6. None of the women menstruated during 6 weeks of follow-up. Florid psychotic symptoms were invariably present at the outset, when the average total BPRS score was 78. Symptom scores decreased significantly to 19 within 1 week, and within 2 weeks the women were nearly free of psychiatric symptoms. The total BPRS score averaged 4 at this time. Serum estradiol levels increased as the symptoms resolved. A women who stopped taking estradiol experienced an abrupt drop in serum estradiol and once again exhibited severe symptoms. The findings in this small pilot study suggest that an insufficient level of estradiol plays a role in the development of postpartum psychosis and that estradiol therapy may be a rational treatment.

ISSN:0029-7828    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Vaginal delivery is the chief precursor of anal incontinence in women. Occult injury to the anal sphincter has been documented even when no tear is diagnosed at delivery, but those with obvious injuries are at the highest risk even if a tear is repaired at the time of delivery. An estimated 30 to 50% of these women have chronic anal incontinence, urgency, dyspareunia, or perineal pain. In this study investigators followed 2883 women prospectively to determine the frequency and characteristics of anal sphincter injury. Subjects made up 77% of all women admitted during the study period. Under ordinary circumstances, deliveries were assisted by midwives, but obstetricians performed all instrumental deliveries and were consulted whenever a perineal laceration was close to the sphincter.Anal sphincter tears were found in 95 women, 3.3% of those followed. They included 88 third-degree tears and 7 fourth-degree injuries. Injury could not be related to age, the number of contractions between passage of the head and delivery, or the use of manual assistance to deliver the shoulders. The midwife’s level of experience also was not a factor, nor did expeditious delivery for suspected asphyxia, fetal presentation, head circumference, or birth position seem to influence the risk of injury. Logistic regression analysis indicated that high birthweight and lack of visualization of the perineum independently increased the risk of injury, more in nulliparous than in parous women. A lower risk was associated with slight perineal edema, only brief bearing-down, manual protection of the perineum, and parity. It is hoped that these observations will lead to new strategies for preventing perineal trauma during childbirth.

ISSN:0029-7828    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Acupressure reportedly prevents nausea and vomiting during spinal anesthesia for cesarean delivery, although the evidence is limited. Because of the limitations of intrathecal fentanyl for postoperative analgesia, bupivacaine and morphine anesthesia was used in this study of the effect of acupressure on nausea and vomiting during and after cesarean delivery. A prospective, randomized, double-blind design was used. Ninety-four women (ASA class I) ranging in age from 18 to 40 years who were scheduled for operative delivery, had no history of postoperative nausea, and had not previously undergone acupressure or acupuncture were enrolled. Actively treated patients had an acupressure band placed at the P6 (pericardium) point on the anterior forearm surface; the same site was subject to placebo stimulation in control patients. Postoperative analgesia included morphine, diclofenac, and codeine.T4 to T5 block was consistently achieved. Hypotension developed in roughly 40% of patients in each group. Nausea and vomiting occurred during surgery in 23% of acupressure patients and 53% of the control group, a significant difference (P = 0.002). Nearly twice as many control patients had nausea or vomiting 14 hours after delivery (66 vs. 36%, P = 0.011). The need for opioids during and after surgery was similar in both groups, but significantly less antiemetic medication (Ondansetron) was required by patients treated with acupressure. Acupressure remained protective after exclusion of patients who received an antiemetic during surgery. After adjusting for age and hypotension, the odds ratio for nausea or vomiting during cesarean delivery in acupressure patients, as compared with control women, was about 0.3. Acupressure seems to be an effective nonpharmacologic means of preventing nausea and vomiting during and after cesarean delivery performed with spinal anesthesia. It is a simple, economical measure with no major side effects.

ISSN:0029-7828    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Group B streptococcus (GBS) remains a leading cause of meningitis, sepsis, and death in newborn infants. Traditionally GBS colonization is detected by culturing combined vaginal and anal secretions in selective broth, but this requires 36 hours or longer and false-negative results may be obtained. In addition, many women unnecessarily receive antibiotic prophylaxis. This study compared culture with an alternative approach to screening for GBS: two DNA-based tests, one a conventional polymerase chain reaction (PCR) assay and the other a rapid fluorogenic PCR assay based on a new DNA-amplification apparatus. Anal, vaginal, and combined specimens were obtained from 112 pregnant women, from 57 of them before and after membrane rupture.Culture of combined specimens identified 29.5% of the women tested as being GBS carriers. This approach was better than culturing only vaginal or anal specimens. All but 1 of 33 carriers were identified by both PCR assays. In the one exception case, only the postmembrane rupture culture was positive. In the specimens obtained after membrane rupture, the PCR assays had specificity and positive predictive values of 100%, were 97% sensitive, and had a negative predictive value of 98.8%. In general, GBS was detected slightly more often by PCR assay than by culture. Results were available in about 100 minutes with the conventional PCR assay and in 30 to 45 minutes with the rapid assay. Culture required at least 36 hours.Analyzing combined vaginal and anal secretions obtained at the time of delivery by a PCR assay is a rapid and reliable screening measure for GBS colonization. Ultimately this test may lower morbidity and mortality caused by GBS infection in both mothers and infants.

ISSN:0029-7828    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

This prospective survey included all infants born in the United Kingdom and Ireland during a 10-month period during 1995 at 20 to 25 weeks’ of gestation. At a median age of 30 months, the children were assessed by an independent examiner using the Bayley Scales of Infant Development and a standardized examination. Of 308 surviving children, 92% were formally evaluated by 10 experienced developmental pediatricians.Nearly one in five children (19%) had a Mental/Psychomotor Development Index more than 3 SDs below the mean and were considered to be severely disabled. Development was moderately delayed (2–3 SDs below the mean) in another 11% of children. Scores did not correlate closely with gestational age or multiple versus single birth, but boys had significantly lower psychomotor scores than girls. One in 10 children had severely disordered neuromotor function, and 14% had less severe disability. A majority of these children, who made up 18% of the study group, had a pattern recognized as cerebral palsy. Seven children, six of them treated for retinopathy of prematurity, were blind or could perceive only light. Squint and other less severe visual impairments were prevalent. Five children had profound, and 36 had less severe, hearing loss. In all, nearly one-fourth of the study cohort, 23%, were severely disabled in some way. These children had smaller head circumferences than those lacking disability. These findings indicate that children born long before term commonly have severe disability.

ISSN:0029-7828    

出版商:OVID    

年代:2001

数据来源: OVID