摘要:

During what has proved to be a critical period in the practice of modern obstetrics, 1965 to 1980, when cesarean birth rates increased dramatically in centers across the United States from less than 5 to more than 15%, the number of infants born in the National Maternity Hospital, Dublin, was 108,987. Although the incidence of cesarean section remained virtually unchanged at 4.2, 4.2, 4.1, and 4.8% in 1965, 1970,1975, and 1980, respectively, perinatal mortality continued to fall from 42.1 to 36.5, 24.0, and 16.8 per 1000 infants born at 500 g or more. These results do not support the contention that the expansion in cesarean birth rates has contributed significantly to reduced perinatal mortality in recent years. Consideration of indications shows that the threefold difference in cesarean birth rate which now exists between Dublin and similar centers across the United States can be accounted for almost entirely by a different approach to management of labor in nulliparous women, compounded by rigid adherence to the precept “once a section, always a section.” (Obstet Gyttecol 61:1, 1983)

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Demographic and behavioral characteristics, including use of alcohol, were investigated among 1711 women registering for prenatal care at Boston City Hospital. During personal interviews, 9% reported drinking heavily, 37% moderately, and 53% rarely or not at all. The women who drank heavily differed from the rest of the pregnant population on several traits, including age, education, use of cigarettes, marijuana and other drugs, parity, and association with others who drank heavily. Multiple regression analysis revealed that these traits had little predictive power for whether a woman was a heavy drinker. A systematic drinking history remains the most practical method in identifying problem drinkers. (Obstetrics & Gynecology 61:6, 1983)

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The clinical utility of concurrent measurements of the fetal biparietal diameter, as measured by ultrasonography and fetal pulmonary maturity, as assessed by the amniotic fluid foam stability index test, is reported. The clinical material consisted of 57 cases in which pregnancy produced a low birth weight neonate (less than 2500 g). The combination of a small fetal biparietal diameter (less than 8.5 cm) and a mature foam stability index value (0.47 or greater) was associated with small­for­gestational­age neonates in 16 of 19 cases. In addition, the occurrence of an immature foam stability index value (less than 0.47) and a fetal biparietal diameter of less than 8.5 cm was associated with appropriate­ for­gestational­age newborns in 16 of 16 cases. The discriminating ability of the foam stability index test in identifying the small­for­gestational­age infant was lost when the fetal biparietal diameter was 8.5 cm or more. Of clinical note was the fact that 14 cases in which the neonatal respiratory distress syndrome occurred were all associated with appropriate­for­gestational-age infants and foam stability index values of less than 0.47 (ie, immature). The results of this study suggest a potentially important clinical role for the concurrent measurement of fetal biparietal diameter and performance of the amniotic fluid foam stability index test in the prenatal evaluation of the high­risk, small, third­trimester fetus. (Obstet Gynecol 61:13, 1983)

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Fetal heart rate (FHR) accelerations associated with fetal movements is considered a sign of fetal well-being. Fetal movements as felt by the pregnant woman and visualized by real-time ultrasonography were correlated to FHR accelerations in 52 normal and high-risk pregnant women. All fetal movements felt by the mother or seen in the real-time ultrasonography were associated with large FHR accelerations (more than 15 beats per minute lasting 15 seconds or more) or small accelerations (fewer than 15 beats per minute). The large accelerations were associated with 78.6% of fetal movements felt by the mother and 99.6% of fetal movements seen by real-time ultrasonography. The small accelerations were associated with 52.9% of fetal movements felt by the mother and 82.4% of fetal movements seen by ultrasonography. Mothers felt 75.7% of fetal movements seen by real-time ultrasonography. It was concluded that fetal movements could be verified by existence of large accelerations on the FHR tracing. (Obstet Gynecol 61:16, 1983)

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The norepinephrine concentration in 77 umbilical, arterial, and venous plasma samples, and in 31 simultaneous maternal plasma samples, was measured. The mean (±SEM) of 8.7 ±1.9 ng/ml in the umbilical artery was higher (P < .001) than that of 3.6 ± 0.9 ng/ml in the umbilical vein. In paired fetal-maternal venous samples the norepinephrine concentration of 3.8 ±1.7 ng/ml in the fetus was higher (P < .05) than that of 0.3 ±0.1 ng/ml in the mother. Among the different types of vaginal deliveries the umbilical arterial norepinephrine concentrations were: 5.8 ±2.1 ng/ml in uncomplicated vaginal deliveries; 16.4 ±2.1 ng/ml in breech deliveries (P < .05 as compared with uncomplicated vaginal deliveries); 8.8 ±2.5 ng/ml in vacuum extraction deliveries; and 0.8 ±0.3 ng/ml and 11.3 ±7.7 ng/ml in twin A and twin B deliveries, respectively. All these values were higher (P < .001) than those after elective cesarean section, except that for twin A, which was lower (P < .01) than that for twin B, indicating that labor and vaginal delivery induced activation of the fetal sympathoadrenal system. (Obstet Gynecol 61:19, 1983)

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The contraction stress test (CST) and nonstress test (NST) are used as fetal health assessments. Severe sickle hemoglobinopathies in the parturient have been shown to place the fetus significantly at risk. This study correlates these fetal health assessment tests with outcome data in 58 pregnancies occurring in women with sickle cell disease. There were 30 patients with homozygous sickle cell anemia (HbS-S), 19 with hemoglobin S-C disease (HbS-C), and nine with hemoglobin S-thalassemia (HbS-That). All received prophylactic partial exchange transfusions as part of their antepartal care. At 34 weeks' gestation, NSTs followed by CSTs were begun in each patient. A total of 255 tests were performed. Of these, 19 NSTs and 24 CSTs were unsatisfactory or questionably abnormal and were repeated. There were no nonreactive NSTs, and no patient demonstrated a positive CST. The neonatal outcome revealed one infant who was small for gestational age and two infants who were of low birth weight but appropriate for gestational age. All infants survived and were normal. These data suggest that the fetal reactivity and placental reserve among these parturients with severe sickle hemoglobinopathies were uncompromised, as these tests have been shown to be relatively sensitive assessments of fetal well-being in other maternal disorders.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

In a review of the antenatal-postnatal records of 6062 patients attending the prenatal clinic at a large university perinatal center during 1980, 8.3% of the pregnant patients seen were Rho(D) negative and 91.7% were Rho(D) positive. Through routine antibody screening of all patients, 115 were found to have irregular antibodies which would otherwise not have been detected. Fifteen of these patients were Rho(D) negative, but they would have been included for antibody screening due to their Rho(D) negative status. Of the remaining 100 Rho(D) positive patients, clinically significant antibodies were observed in six patients; however, no maternal morbidity or hemolytic disease of the newborn was reported. Antecedent maternal risk factors for development of irregular antibodies were not sufficiently selective for predicting outcomes of such pregnancies. Furthermore, the only four patients with irregular antibodies requiring blood transfusion were cross-matched without difficulties. Findings suggest that screening all patients for irregular antibodies cannot be justified due to the prohibitive costs involved. However, because of the racially homogenous population studied, variations in the frequency of red blood cell genotypes between racial groups, and the irregular pattern of occurrence of irregular antibodies, the authors believe that further studies on the clinical impact and costeffectiveness of screening all antenatal patients for presence of irregular antibodies are necessary.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Since 1965 there has been a substantial increase in the number of women in the United States who use the intrauterine contraceptive device (IUD). A collaborative multi-center case-control study was conducted to examine uterine perforation and uterine incarceration as well as several other suspected complications related to use of an IUD. To determine which attributes of the IUD and which user characteristics contribute to the risk of uterine perforation and incarceration, the authors analyzed 32 women with uterine perforation requiring transperitoneal removal, 106 women with uterine incarceration of an IUD which was removed transcervically, and 497 controls. Most important, women who were lactating at the time of IUD insertion were 10 times as likely to have had a uterine perforation as women with at least 1 live birth but who were not lactating at the time of insertion. An incarcerated IUD resulting in a difficult removal was 2.3 times as likely among women lactating at the time of insertion compared to women not lactating at the time of insertion. The likelihood of both uterine perforation and uterine incarceration were unchanged regardless of the type of IUD used.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The clinical course of 40 patients with a uterine scar who were undergoing second-trimester abortion induced with either hypertonic saline or prostaglandin F2rt was reviewed. In the 38 patients with a previous cesarean scar, and in the 2 patients with a hysterotomy scar, the uterine contents were evacuated with no evidence of uterine rupture. A review of the literature dealing with uterine rupture subsequent to induced midtrimester abortion revealed that the typical multiparous uterus was more prone to rupture if oxytocin was used in conjunction with or a few hours after instillation of the abortifacient, or if oxytocin was used continuously for more than 12 hours. Although rupture after use of prostaglandin in a previously scarred uterus has been reported, there is no case reported of rupture after use of hypertonic saline. This review and the authors' experience lead them to conclude that hypertonic saline is a safe abortifacient during the second trimester, especially between 18 and 22 weeks' gestation, in a previously scarred uterus when careful monitoring is employed and oxytocic agents are used judiciously.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

To prevent infection in 40 patients who underwent vaginal or abdominal hysterectomy, each patient received a single 15-mg/kg dose of either cefoxitin or cefamandole by rapid (5- minute) intravenous injection before the operation. Samples of serum, myometrium, endometrium, ovaries, and tubes were obtained at various intervals after injection of the antibiotic and were assayed for cephalosporin concentration. Maximum tissue concentrations of 30 μg/g of both drugs were detected approximately 30 minutes after the dose, with levels dropping below 3 μg/g in approximately 2 hours. Although both antibiotics achieved closely similar concentrations in serum and tissues, the ratios of these levels to their usual mean minimum inhibitory concentrations for Bacteroidesfragiliswere appreciably higher for cefoxitin than for cefamandole. These pharmacokinetic observations support the current dosage recommendations for the use of cefoxitin in treating and preventing gynecologic infections, as well as the recommendation that it be administered shortly before the operation to maximize tissue levels during the perioperative period.

ISSN:0029-7844    

出版商:OVID    

年代:1983

数据来源: OVID