ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

AbstractsRelaxation of the pelvic joints is an essential and normal accompaniment of pregnancy and may be related to hormonal changes. The authors of this report have found no studies of peripheral joint laxity during pregnancy. They have, therefore, quantified peripheral joint laxity in a group of 63 women, both during pregnancy and after delivery, each subject acting as her own control.Since laxity may fall with age at certain joints, the study population was divided into five age groups: less than 22; 22 to 25; 26 to 28; 29 to 31; and 32 or older. Generalized joint laxity was assessed by a standard scoring system, and extension of the metacarpophalangeal joint of the left index finger was quantified with a finger hyperextensometer. The mean reading for each of the groups after delivery was 65, 63, 63, 65, and 67, respectively. It was concluded that there was little natural reduction in laxity within this age range, and no subsequent factor was applied because of age.No significant change occurred in laxity during and after pregnancy as assessed by the scoring system, although the more precise hyperextensometer showed a higher degree of hyperextension at the metacarpophalangeal joint during pregnancy than after delivery, and this difference was statistically significant. When the degree of hyperextension at the metacarpophalangeal joint was correlated with the duration of pregnancy, there was a slight trend for readings to be highest between the 28th and the 30th weeks. At no time, however, was there a significant difference from any other time during the period of pregnancy studied. There was a highly significant difference in the degree of hyperextension between primigravidae and multigravidae, the latter showing almost three times as much as the former.Since there is some evidence that inherited hyperlaxity prevents the formation of abdominal striae after delivery, the abdomens of all subjects were examined on the second assessment. Forty-one subjects displayed striae, and 27 had none. There was no significant difference in the mean hyperextensometer readings between these two groups either during or after pregnancy (71/65 degrees and 70/64 degrees, respectively).

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

AbstractsFetal movement registration by pregnant women has been suggested as a screening method for intrauterine fetal well-being. Recently, however, it has been questioned whether every movement by a healthy fetus is appreciated by the mother, and a poor correlation has been reported between movements observed by means of ultrasound and those observed by women who felt less than 20 fetal movements during a 45-minute observation period. The aim of this study was to investigate, on a large scale and at different gestational ages, the validity of fetal movement registration by the mother.A total of 284 pregnant women were investigated by means of dynamic ultrasound for fetal movement registration, with 672 scanning periods of 30-minute duration each. Only singleton pregnancies and pregnancies in which the placenta could be identified clearly to cover more than 50 per cent of the anterior or posterior wall were included in the trial. The pregnant women registered 8407 fetal movements, and 9625 fetal movements were seen by means of dynamic ultrasound scanning.In the period between the 20th and 23rd weeks of gestation, there was a significant difference between the mothers' self-registration and the ultrasound registration of fetal movements when the placenta was located on the anterior wall of the uterus. No difference existed between the two methods with a posterior position of the placenta. Mothers with posterior placentas felt significantly more fetal movements than those with anterior placentas. On the other hand, as expected, no difference in the number of FM registered by ultrasound existed between the two placental positions. The agreement between maternal sensation and ultrasound registration with an anterior placenta was 21.0 ± 21.0 per cent (SD), but 61.1 ± 28.1 per cent with a posterior placental location. The difference is significant at P = 0.002. The mean accordance between the two methods for fetal movement registration from 24 to 27 weeks' gestation was 62.3 ± 32.7 per cent (anterior placenta) and 79.4 ± 6.2 per cent (posterior placenta) (P < 0.004).The authors found no significant difference between the number of fetal movements felt by mothers and the number registered by means of dynamic ultrasound from 28 to 40 weeks' gestation, and no higher counts in women with a posterior placental position. The accordance between maternal and ultrasound registration from the 28th to the 31st week was 63.9 ± 30.2 per cent and 84.7 ± 15.0 per cent with an anterior or a posterior placenta, respectively. Between the 32nd and the 39th weeks, the mean accordance varied between 78.4 to 80.7 ± 21.4 to 26.1 per cent and 82.2 to 89.8 ± 1 2.7 to 20.6 per cent, respectively.No significant difference was found between the two methods of fetal movement registration from 40 to 42 weeks' gestation, but the accordance between maternal and ultrasound registrations was significantly better from 36 to 42 weeks' gestation in women with a posterior placental location, as compared to those with an anterior location. The mothers' appreciation of fetal movements was not influenced by parity (P> 0.3).

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

AbstractsIn the presence of a positive serum pregnancy test and a clinical suspicion of ectopic implantation, the ultrasound examination is pivotal in further evaluation of the patient. Recent studies have disclosed, however, that stimulation of the endometrium by hormones from the ectopic pregnancy can produce a pattern in the uterus quite similar to that seen in early intrauterine pregnancy (IUP), i.e., the so-called “decidual cast” (Fig. 1). Distinguishing an early IUP from a decidual cast can be difficult and hazardous prior to visualization of the embryonic echo. For this reason, the authors have attempted to define other morphological features capable of differentiating intrauterine fluid collections due to ectopic pregnancy from those due to early intrauterine pregnancy.The decidua of the decidual cast is fundamentally similar to the decidua parietalis. In the true early intrauterine pregnancy, however, there is not only the decidua parietalis but a decidua capsularis as well. The latter is confined by the decidua parietalis. It has been observed that this configuration results in concentric rings within the cavity of the uterus in true intrauterine pregnancy (Figs. 2 and 3). These concentric rings can be identified at an earlier time in gestation than the embryonic echo. The authors have evaluated the presence of the “double sac” appearance as a definitive morphological indicator of early intrauterine pregnancy and ascertained its accuracy in excluding ectopic pregnancy. This paper discusses their preliminary findings in an ongoing investigation. Initial evaluation of the double sac sign comprised

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

AbstractsAttitudes differ on the value of antenatal radiography in the management of breech deliveries. In every case of breech presentation, a decision must be made as to whether a vaginal delivery can be attempted with safety. This decision is sometimes made on clinical grounds alone, but many investigators recommend radiological pelvimetry for greater accuracy. Apart from its value in diagnosing and determining the type of breech presentation, it may also be helpful in confirming fetal maturity and in detecting abnormalities.A retrospective study was undertaken to discover the influence of antenatal radiography on the management of breech presentations at the National Women's Hospital, Auckland. The study included all deliveries at the hospital. The attitudes of clinicians toward radiological pelvimetry varied widely. There were those who requested it for every patient with a breech presentation, others who never requested it, and many who requested it in specific cases only. It was possible, therefore, to obtain groups of reasonable size for comparison.There were 228 mature singleton breech deliveries during the 2-year study period. Abdominal radiographs were taken of 149 women (65 per cent), either as part of a pelvimetry assessment (68) or to determine the type of presentation (29). In 36 women, the investigation was performed to establish fetal maturity because of unreliable information on gestational age. In 16 women, the radiography was requested to investigate possible fetal abnormality. In the whole series, there were six fetuses (3 per cent) with major abnormalities.Radiological pelvimetry was performed on 86 women (38 per cent), and consisted of an erect lateral pelvic film and a supine antero-posterior abdominal film. Fifty-two of the patients were nulliparous, and 34 were parous.The pelvis was classed as favorable in 42 women, 1 7 (40 per cent) of whom were delivered by cesarean section. Four had elective sections because of footling presentation, and one had previous myomectomy. Twelve women had emergency sections because of indications arising during labor.The pelvis was borderline in 26 women, 16 (61 per cent) of whom were delivered by cesarean section. In 18 patients, the pelvis was unfavorable, and 16 of them (89 per cent) were delivered by cesarean section. The only babies delivered vaginally were two small infants weighing 2.6 and 2.9 kg, respectively, both after short labors.The overall cesarean section rate was greater in the pelvimetry group (57 per cent), as compared to those without pelvimetry (44 per cent). Elective cesarean section was performed in 21 per cent of the women with flexed breech, but in only 6 per cent of those with extended leg breech. The cesarean section rate was similar in the nulliparous patients in both groups, but significantly greater in the parous patients who had pelvimetry (56 compared to 36 per cent, P < 0.05).After vaginal deliveries, the condition of the infants from those patients who had had pelvimetry (as compared with those who had not) was better in terms of fewer with low Apgar scores, of less physical trauma, and of a reduction in neonatal intensive care requirements. There was a similar, though less marked, trend in the condition of infants born by cesarean section during labor. As expected, there was no difference among the infants born by elective cesarean section.The infants born vaginally through pelvises reported as favorable did as well as the infants born by elective cesarean section. These two groups were similar in terms of maternal height, age, parity, and birth weight.Trauma to the infants in the pelvimetry group was represented by one with a cephalohematoma and two with extensive superficial bruising, as compared to five with cephalohematomas, eight with extensive superficial bruising, and one with a fractured right temporal bone in the nonpelvimetry group.In all groups, the main reason for admission to the neonatal intensive care unit was hypoxia (40 of 65 admissions). The fetal outcome in women delivered vaginally was not affected by whether the legs were flexed or extended.

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID