ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Investigators have found an association of low birth weight with the isolation of genital mycoplasmas from the maternal cervix and urine. In other studies, Ureaplasma urealyticum and Chlamydia trachomatis have been implicated in nongonococcal urethritis, currently the predominant sexually transmitted disease. The lower genitourinary tract is the probable route of access of these organisms to the endometrium and the fetal membranes. The present study was designed to investigate the presence of urea-plasmas, mycoplasmas, chlamydiae, fungi, aerobic and anaerobic bacteria, and cytomegalovirus in fetal membranes and to determine their association, if any, with perinatal morbidity and mortality.The placentas of three groups of subjects were cultured: fetuses or neonates which died in the perinatal period, newborns admitted to the intensive care unit, and normal controls. The perinatal-death group included 75 fetuses which were stillborn after at least 20 weeks of gestation and 69 infants who died after birth. The intensive care group consisted of all infants (452 in number) admitted to the intensive care unit, whose birth weights were 1500 gm or less. One live-bom infant was selected as a control for each member of the perinatal-death group.Ureaplasma and mycoplasma were isolated most frequently from the placentas of intensive care infants. Also, isolation rates among the placentas of stillborn and dead infants were approximately double those among the controls. Twenty-five per cent of such placentas harbored either or both of the microorganisms. The variation in the isolation rate of any mycoplasma among the four groups (counting stillborn and dead infants as separate groups) was significant (P < 0.0007). Isolation of group B streptococci did not differ significantly among the four groups (P = 0.18). Cytomegalovirus was isolated once from the placenta of an intensive care infant. Neither C. trachomatis nor Mycoplasma pneumoniae was isolated from the cnoriontc surface. Although aerobic and anaerobic bacteria and fungi were isolated, they were present infrequently among the four groups.In subsequent analyses, the stillbirth and infant-death groups were combined as one perinatal-death group. The association between placental cultures positive for U. urealyticum and birth weight is shown in Table 1. Among all subjects, recovery of ureaplasma from the placenta showed a strong and stable inverse relationship with birth weight. Similar results were obtained when the data were analyzed according to gestational age. Among all infants, relative to those born at 36 or more weeks of gestation, the odds ratios for U. urealyticum were: 3.6 for 20–27 weeks, 2.8 for 28–31 weeks, and 1.7 for 32–35 weeks. An appropriate relationship between birth weight and gestational age was found in both ureaplasma-positive and ureaplasma-negative subjects.Upon histological examination, inflammation of the membranes was seen in 60 per cent of the 58 placentas from which ureaplasma was isolated. Twenty-nine per cent of the membranes with cultures negative for ureaplasma showed inflammation. This difference in the occurrence of chorioamnionitis was significant (P = 0.0001). A significant excess was observed for inflammation of the umbilical cord also. No association was found between U. urealyticum and inflammation of the chorionic villi.Maternal diabetes and preeclampsia were negatively related to colonization with U. urealyticum. The following maternal characteristics were positively related to such colonization: race other than white or black, age less than 25 years, single status, student status, primigravidrty, spontaneous rupture of membranes, membrane rupture 48 or more hours before delivery, and status as a cigarette smoker at time of delivery. Little or no association was seen between colonization with U. urealyticum and the following characteristics: prior pelvic inflammatory or venereal disease, consumption of alcohol or coffee, prior spontaneous or induced abortion, method of payment, or

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Magnesium sulfate is effective in the treatment of eclampsia as well as in that of essential hypertension. It has both anticonvulsive and hypertensive properties without deleterious effects on the fetus or newborn. The present authors report here the hemodynamic data gathered after intravenous administration of the drug in two patients with eclampsia, one of whom had pulmonary edema also.Patient 1, aged 22 years, with no remarkable medical history, was in the 37th week of her first pregnancy when hypertension (190/100 mm Hg) and proteinuria (3 gm/24 hours) were diagnosed. Her weight gain was 11 kg. The abrupt occurrence of convulsions led to a cesarean section and the birth of a normal infant weighing 2250 gm. New convulsions and a massive pulmonary edema occurred after the cesarean section. Upon admission, the patient had a PaO2at 24 mm Hg and a PCO2at 45 mm Hg under an FiO2of 0.5, and her pulmonary edema was rich in protein (49 gm/liter). An optic fundus examination showed papilledema, and the cranial tomodensitometer disclosed a cerebral edema. She was placed on artificial ventilation and given thiopental.After the administration of magnesium sulfate, the patient's blood pressure was reduced to 140/80 mm Hg, and convulsions did not reappear after discontinuation of thiopental 12 hours later. A brisk diuresis (1.81) occurred between the 4th and 7th hour after magnesium sulfate administration, resulting in a negative water balance. The pulmonary edema cleared up within 24 hours, and artificial ventilation was discontinued. The brain and papillary edemas disappeared also. A renal examination, made 2 months later, yielded normal results.Patient 2, aged 24 years, with a previous rapidly progressive extracapillary glomerulonephritis, was in the 24th week of her first pregnancy when she became oliguric in spite of plasmaphoresis treatment. Eclampsia developed in the 27th week, when the patient was edematous and hypertensive (190/110 mm Hg). After magnesium sulfate administration, blood pressure decreased to 135/100 mm Hg, and the convulsions ceased. Later hypertension and uremic state were controlled by beta-blockers and daily hemodialysis, but the fetus died 4 weeks later.Hemodynamic studies were performed in both cases by means of a Swan-Ganz catheter and thermodilution techniques. Before the administration of magnesium sulfate, and at 30, 60, and 120 minutes after, measurements were taken of the following: systemic blood pressure, right auricular pressure, pulmonary artery pressure, wedge pressure, and cardiac output. Systemic and pulmonary vascular resistances were derived from these measurements, and the cumulative water balance (infusion-diuresis) was calculated.The results are summarized in Tables 1 and 2. In both patients, after magnesium sulfate administration, there was a progressive fall in blood pressure. Cardiac output decreased, but systemic vascular resistance did not change. Wedge pressure, pulmonary artery pressure, and pulmonary vascular resistance decreased. Cumulative water balance during the first 120 minutes did not change significantly (-50 ml in patient 1 and +120 ml in patient 2).

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

At the end of 1979, Vietnam veterans in Australia claimed that the rate of congenital anomalies in their children was high, attributing this to their exposure in Vietnam to the defoliant Agent Orange. The present study was undertaken to determine whether the risk of fathering a child with an anomaly was greater for Vietnam veterans than for other men, including contemporary members of the Australian Army who did not serve in Vietnam.Case infants were those with anomalies diagnosed at, or shortly after, birth. Controls were live-bom babies with out diagnosed anomalies and were individually matched to case infants by hospital, period of birth, age of mother, and (where feasible) hospital payment category. Each father's surname and initials were compared with those of every member of the Australian Army who served at any time between 1962 and 1972, the period of Australian involvement in Vietnam. The data were analyzed by means of conditional logistic regression. This technique allows a fully matched analysis which takes into account several potentially confounding variables.

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The present authors have monitored the fetal heart rate of very-low-birth weight infants born at their hospital over a period of years. The aim of this study was to determine how fetal heart rate patterns are related to perinatal outcome in terms of Apgar scores, perinatal death, and idiopathic respiratory distress syndrome, of infants with birth weights between 500 and 1250 gm.The study included a group of 79 fetuses for which heart rate recordings were available, and a second group of 46 fetuses without recordings. The mean gestational ages, mean birth weights, mode of delivery, and perinatal mortality in the two groups are shown in Table 1.Normal reactive patterns were observed in nine fetuses, nonreactive patterns in 54, silent patterns in 45, decelerations in 58, and combined distress patterns in 36. A combined distress pattern was recorded when a deceleration and a silent pattern were observed together in the same 30-minute recording. A decision for cesarean section was made most often when the combined distress pattern was noted.Twenty-seven fetuses died in utero, 43 in the neonatal period, and two later. Respiratory distress syndrome was diagnosed in 32 infants, 16 of whom died. The main causes of death in the two groups are shown in Table 2.The risk of neonatal death was lower after abnormal fetal heart rate patterns than in the group without abnormality (Table 3). The risk of respiratory distress syndrome was not significantly associated with abnormal fetal heart rate patterns.

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The present article reviews the authors' experience in treating Graves' disease during pregnancy from 1960 to 1979. It is based on the records of 25 women, aged 17 to 40 years, with Graves' thyrotoxicosis. The outcome of pregnancy and the status of mother and child were known in each case.The diagnosis was established principally by means of history, physical examination, and determinations of total and free thyroxine. Six patients were treated medically, 10 surgically (including a 10− to 14-day treatment with Lugol's iodine solution preoperatively), and nine with a combination of medical and surgical therapy.In the six medically treated patients, three different types of regimen were used (Table 1). One patient was treated with propranolol postpartum and ablated with131| after delivery. Four of the remaining five were delivered of term infants, and the fifth had an uncomplicated premature delivery.The authors prepared the thyrotoxic surgical patients with Lugol's iodine solution and repeated the treatment postoperatively (for a brief time) in selected instances. This preparation was followed by bilateral subtotal thyroidectomy, leaving 1–3 gm on each side. Of the five patients who underwent thyroidectomy during the first trimester, two aborted spontaneously 6–7 weeks after the operation, two had premature delivery, and one had term delivery. One of the spontaneous abortions occurred in a patient whose pregnancy was unsuspected at operation. Of the four patients operated on during the second trimester, one had an induced abortion for nonmedical reasons, and three

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Most pregnant patients with isolated thrombocytopenia will have idiopathic thrombocytopenic purpura. Because the disease is caused by an IgG antiplatelet autoantibody that can cross the placenta, the infant also is at risk for thrombocytopenia. The management of the pregnant patient with idiopathic thrombocytopenic purpura is difficult. The physician must treat the mother, whose platelet count is easily monitored, and the fetus, whose platelet count cannot be assessed.Many recommendations for the management of idiopathic thrombocytopenic purpura in pregnancy have been based on reviews of case reports. This method of analysis, however, may not provide useful information on the true impact of the disease on mothers and infants. Recently, three prospective studies and one study of consecutive pregnant patients have been made. These included unselected patients (90 mothers having 99 conceptions during 95 pregnancies). The present author has analyzed these studies in an effort to provide a more accurate estimate of the implications of the disease.Patients with idiopathic thrombocytopenic purpura have increased numbers of megakaryocytes in the bone marrow and usually have larger than average platelets on the peripheral blood film. Most patients have increased levels of platelet-associated IgG. Although the presence of IgG is a highly sensitive test for idiopathic thrombocytopenic purpura (approximately 90 per cent), its low specificity limits its diagnostic usefulness. Unless an alternative cause of the thrombocytopenia is shown, patients with isolated thrombocytopenia during pregnancy should be presumed to have idiopathic thrombocytopenic purpura and managed accordingly.The prospective studies analyzed here indicate that the risk of significant morbidity is low for both mother and infant. Five of the 99 conceptions in 95 pregnancies died, but the deaths occurred in utero between the 18th and

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Few investigators have attempted to describe the surgical complications associated with cesarean section. The present study was undertaken to identify such complications prospectively, to uncover possible risk factors, and to assess the possibility of reducing the complication rate by altering delivery and/or surgical routines.All surgical complications were divided into two groups, minor and major. Minor complications included blood transfusions and minor injuries without sequelae to the infant. Major complications included injury to the urinary bladder, tears in the cervix or vagina, bilateral bleeding from the uterine arteries, lacerations involving most of the corpus uteri, and injury to the infant with sequelae.

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

As the rate of cesarean section increases, there are growing fears of complications in subsequent pregnancies. The present authors have analyzed the course of pregnancies after cesarean section in cases delivered at a Swedish hospital from 1970 to 1972, with a follow-up period of 5 to 7 years. The aim of the investigation was to determine the incidence of vaginal births and the rate of abortions and extrauterine pregnancies after cesarean section.A questionnaire was sent to the 543 patients delivered by cesarean section during the target period. Of the 440 women who responded, 244 (55.5 per cent) had become pregnant after cesarean section, the total number of subsequent pregnancies being 306. The course of these pregnancies is shown in Table 1.Among the 215 women who completed new pregnancies, elective cesarean section was performed in 81 cases, the majority of whom had narrow pelves. Trial of labor occurred in 134 cases, 91 of them giving birth vaginally and 43 being delivered by cesarean section (Table 2). As many as 21 (49 per cent) of the patients having cesarean section after trial of labor proved to have narrow pelves, discovered during the course of labor. Of these 21 patients, eight had contracted pelves, and 13 were borderline cases.The incidence of manifest or imminent uterine rupture at the next birth was investigated also. A partial uterine rupture was detected during labor in one woman. Cesarean section was performed, and the subsequent course was uneventful for both mother and child. The patient had previously undergone cesarean section because of threatened fetal asphyxia.These findings were compared with those of the total experience from the same department, covering the years 1973–1977 and comprising 18,367 pregnancies. Of these, 1,286 (7.0 per cent) terminated in spontaneous abortion

ISSN:0029-7828    

出版商:OVID    

年代:1984

数据来源: OVID