ISSN:1340-9654    

DOI:10.3109/01443618709068505

出版商:Taylor&Francis    

年代:1987

数据来源: WILEY

ISSN:1340-9654    

DOI:10.3109/01443618709068506

出版商:Taylor&Francis    

年代:1987

数据来源: WILEY

摘要:

SummaryScreening was based on maternal serumα-fetoprotein' estimation and pregnancy dating by ultrasonic scan. Three thousand two hundred and fifty-eight of 3754 patients (86 per cent) were screened at between 16 and 19 weeks pregnant. Of the patients carrying a singleton live fetus 165 (5 per cent) had a serumα-fetoprotein at or above the 95th centile and these underwent detailed ultrasonic survey; 74 patients had amniocentesis. Among these. 6 open neural tube defect pregnancies were detected and the pregnancies terminated. Two additional neural tube defect fetuses (1 open and 1 closed lesion) were detected by ultrasound and abortion performed. The prevalence of neural tube defects in South Gwent is 2.1 per 1000.An amniocentesis service is of value in patients whose serumα-fetoprotein is greater than the 97th centile and whose detailed ultrasonic scan does not detect neural tube defect abnormality.Before June 1983 antenatal patients were booked in the early mid trimester. Gestational age was estimated by dates and by correlation with clinically assessed uterine size. Serum a-fetoprotein screening during 1978–1980 was only possible in 59 per cent of patients (Evans and Stokes, 1985) because of the high incidence of booking after 19 weeks, and the prevalence of neural tube defect was 3.9 per 1000, including those having abortions and those found after delivery.From July 1983 we booked antenatal patients as early as possible and offered them assessment of gestational age by a 'dating' ultrasonic scan and a serum a-fetoprotein estimation at 16–19 weeks pregnant. The outcome of the first year of this comprehensive screening of patients booked between I July 1983 and 30 June 1984 is reported. The aim of this study was: (a) to offer comprehensiveα-fetoprotein screening; (b)to find the current prevalence of neural tube defects for the South Gwent area; (c)to establish, the sensitivity of serum a-fetoprotein based on pregnancy dating by ultrasonic scan; (d)to establish sensitivity of a detailed ultrasonic fetal survey and to see if this could replace amniocentesis.

ISSN:1340-9654    

DOI:10.3109/01443618709068507

出版商:Taylor&Francis    

年代:1987

数据来源: WILEY

摘要:

SummaryTwo hundred and eighty-nine pregnancies with rhesus antibodies delivered at Queen Charlotte's Maternity Hospital between 1974 and 1983 were reviewed. The cut-off antibody titre. measured by the indirect Coombs' test, at which amniocentesis is routinely performed should remain at 1 in 16.In rhesus negative women, measurement of rhesus antibody levels is the principal method by which further investigation and management are planned. At Queen Charlotte's Maternity Hospital, titres are measured by the indirect Coombs' test and an amniocentesis is performed if the antibody titre is equal to, or greater than, 16. A small number of amniocenteses are carried out at titres of 8. We have reviewed this practice.

ISSN:1340-9654    

DOI:10.3109/01443618709068508

出版商:Taylor&Francis    

年代:1987

数据来源: WILEY

摘要:

SummaryDetection of phosphatidyl glycerol (PG) in amniotic fluid of complicated pregnancies is now a well accepted technique for determining fetal lung maturity. Previous methods reported have been technically difficult and can only be performed in specialised laboratories. We report a simple one dimensional thin layer chromato-graphic method using a stain that specifically identifies phosphatidyl. glycerol by its unique colour. The method is simple to perform, faster and more economical than two dimensional methods.In addition to its simplicity the method detects lower levels of PG than have been previously reported and may allow a better understanding of the development of surfactant.Phosphatidyl glycerol (PG) is a surface active phospholipid that is present in the amniotic fluid of mature pregnancies (Hallman et al., 1976; Bent et al., 1982; Whittle et al., 1982). The presence of PG has been shown to coincide with fetal lung maturity (Whittle et al., 1982) and when it is in detectable amounts, respiratory distress syndrome rarely occurs, despite low lecithin-sphingomyelin (US) ratios (Plauche et al., 1982; Whittle et al., 1983).PG estimations have been demonstrated to be more reliable than L/S ratios for the prediction of fetal lung maturity in diabetes mellitus. rhesus incompatibility and premature rupture of membranes. It has been recommended that both L/S ratio and PG estimation are measured in the management of high risk obstetric cases before preterm delivery is undertaken (Bustos et al., 1979; Hallman and Teramo, 1979; Cunningham et al., 1982; Whittle et al., 1982).The conventional practice is to measure PG using a two dimensional thin layer chromatography system (Whittle et al., 1981). We describe a simple and reliable one dimensional method that is suitable for routine use in hospital laboratories. The method provides a rapid quantitative measurement of PG concentration. A specific PG stain is used, thus eliminating possible confusion with other phospho-lipids or other impurities. The method conveniently allows the simultaneous testing of multiple samples and each may be performed in duplicate.

ISSN:1340-9654    

DOI:10.3109/01443618709068509

出版商:Taylor&Francis    

年代:1987

数据来源: WILEY

摘要:

SummaryThe problems of physical deformities and metabolic defects in the pregnant osteogenesis imperfecta patient are discussed. The benefit of epidural anaesthetic is stressed.Osteogenesis imperfecta (fragilitas ossium—the brittle bone disease) is a rare inherited and heterogeneous disorder with an incidence of 1 in 25000–30000 births (Graffeo et al., 1953). The main clinical feature of bone fragility may be slight or severe, producing a wide spectrum of disease.Other clinical manifestations include blue sclerae, early hearing loss, fragile teeth, lax joints and heart valve incompetence (Albright and Millar, 1981; Smith et al., 1983). The metabolic findings include decreased platelet aggregation, increased serum and urine inorganic pyrophosphate and increased metabolic rate, with hyperpyrexia under general anaesthesia (Roberts and Solomons, 1975). Biochemical studies show the disease arises from a variety of inborn errors of collagen synthesis.Two forms, congenita and tarda, are distinguished (Sillence et al., 1979). The congenital form is lethal, with death in utero or in the immediate neonatal period. Inheritance is by an autosomal recessive gene. Osteogenesis imperfecta tarda is transmitted by an autosomal dominant gene with highly variable penetrance and expression.

ISSN:1340-9654    

DOI:10.3109/01443618709068510

出版商:Taylor&Francis    

年代:1987

数据来源: WILEY

摘要:

SummaryFetal and early neonatal left and right ventricular systolic time intervals were assessed by simultaneous records of M-mode echocardiography and electrocardiography. in a longitudinal study in 68 normal subjects. There was no difference between left pre-ejection period (LPEP) and right pre-ejection period (RPEP) before delivery. LPEP remained unchanged from before to within the 30min after delivery but was increased 12h later. RPEP increased from before delivery to within the 30min after delivery. Left ventricular ejection time (LVET) increased almost linearly from before to after delivery. Right ventricular ejection time (RVET) remained unchanged from before to within 30min after delivery. and increased gradually thereafter. LPEP/LVET decreased from before delivery to within 30min after delivery, and changed little subsequently. RPEP/RVET increased from before to within the 30min after delivery. and decreased almost linearly thereafter. As a result, RPEP/RVET was greater than LPEP/LVET within the 30 min after delivery (P0.05). The assessment of cardiac functions with left and right ventricular systolic time intervals is useful to determine the physiological and pathological changes of cardiac dynamics before and after delivery.Tw left ventricular systolic time intervals measured from simultaneous records of the electrocardiogram, phonocardiogram and carotid arterial pulse tracing are useful indicators of left ventricular performance in adults (Weissler et al., 1961, 1968, 1969). An M-mode echocardiogram with an electrocardiogram tracing makes feasible a non invasive evaluation of left and right ventricular function, in both children and adults, and there is an excellent correlation etween systolic time intervals calculated by echocardiography and the conventional methods (Hirschfeld et al., 1975a. b; Stefadouros and With-am. 1975). Circulatory changes in newborn babies and neonates have been studied using the same technique (Riggs et al., 1977; Halliday et al., 1978; Halon et al., 1979; Yoshida et al., 1983).Numerous studies have been done on systolic time intervals in human fetuses, using fetal electrocardiograms and Doppler cardiograms (Goodlin et al., 1972; Wolfson et al., 1977; Robinson et al., 1978: Marata et al., 1978a). With this method, the signals obtained are limited to findings in the left ventricle, as reflected in aortic and mitral valve recordings. With M-mode echocardiograms. the motions of the mitral, tricuspid. aortic and pulmonary valves can be clearly recognised; that is. right- as well as left-sided cardiac valves are visualised (DeVore et al., 1982; Hata et al., 1983c). Therefore. the left and right ventricular systolic time intervals of the fetus in utero can be clearly assessed using simultaneous records of fetal M-mode echocardiograms and electrocardiograms (DeVorr et al., 1981: Hata et al., 1983a).In the present work, we ascertained the fetal circulatory changes during both the antenatal and early neonatal periods in normal human subjects.

ISSN:1340-9654    

DOI:10.3109/01443618709068511

出版商:Taylor&Francis    

年代:1987

数据来源: WILEY

摘要:

SummaryNeutral-mctdlloendopeptiddse in maternal plasma rises progressively during pregnancy, but no further vdriation was detected during spontaneous or induced labour. The level of the enzyme in amniotic fluid decreascs from mid pregnancy to term. Cord plasma enzyme activity was only one third of that in maternal plasma.Neutral-metalloendopeptidase (NEP; EC 3.4.24,11) was initially assumed to be, like angioten-sin I-converting enzyme (ACE; 3.4.15.2), a peptidyl-dipeptidase because it cleaves enkephalins at the same site as ACE (Erdos et al., 1978). Although it was called a true 'enkephalinase' (Schwartz et al., 1981). in humans and in animals the enzyme is identical to a neutral endopeptidase of the kidney (Almenoff and Orlowski, 1983; Erdos et al., 1985) which like ACE, cleaves many biologically active peptides. including enkephalins, angiotensins, substance P and neurotensin.We wanted to establish the activity of this enzyme in maternal and cord plasma and in amniotic fluid during pregnancy and labour, in view of the importance of its substrates in the nociception and modulation of pain from uterine contractions. We also investigated NEP activity at different stages in spontaneous and oxytocin induced labour, because the pain threshold during labour seems to be related to the number and intensity of uterine contractions and it is a general clinical observation that oxytocin induced labour is often painful, suggesting a possible impairment of the anti-nociceptive system.

ISSN:1340-9654    

DOI:10.3109/01443618709068512

出版商:Taylor&Francis    

年代:1987

数据来源: WILEY

摘要:

SummaryExcluding preterm deliveries before 33 weeks, macerated fetuses and congenitally abnormal babies, the perinatal risk was calculated separately for first and second twins and for breech and vertex twins delivered vaginally or abdominally. The perinatal mortality rate was higher for breech first twins born vaginally than for vertex fiat twins or for breech second twins. Caesarean section appeared safer than vaginal delivery but should be reserved for patients whose first twin is in a breech presentation.Perinatal loss in twin gestation has not been favourably influenced by attempts at preventing preterm labour. Attention has shifted to the intra-partum period with emphasis on the optimum mode of delivery, particularly for malpresentations (Kel-sick and Minkoff, 1982).

ISSN:1340-9654    

DOI:10.3109/01443618709068513

出版商:Taylor&Francis    

年代:1987

数据来源: WILEY

摘要:

SummaryCase notes of 138 patients admitted during the 5 year period 197%1983 with rupture of the uterus in pregnancy were reviewed. There was I ruptured uterus for every 1285 deliveries and in 42 per cent the uterus had a previous caesarean section scar. In those without a scar. the dominant features were multiparity and prolonged duration of labour. Bladder injury was present in 14 per cent of the patients and was associated with a higher morbidity. This was also true for those patients who had a hysterectomy and if the operating time was in excess of 90 minutes. Some preventable factors are discussed.Rupture of the uterus continues to be one of the serious life-threatening complications of pregnancy. Unfortunately, it is more likely to occur and to be a more serious threat to life in the rural areas of developing countries, where obstetric care is often limited and transportation poor. Although its incidence is low in the developed countries, it remains high in the developing countries.The aim of the study was to attempt to identify retrospectively epidemiological factors associated with uterine rupture and to relate the type of rupture and the form of surgical treatment to maternal morbidity and mortality.

ISSN:1340-9654    

DOI:10.3109/01443618709068514

出版商:Taylor&Francis    

年代:1987

数据来源: WILEY