摘要:

Using maternal mortality reviews as an historic model, fetal and infant mortality reviews are proposed to reduce infant mortality in the united States. The national program has three elements: 1) guidelines and direction from a national multidisciplinary steering panel and staff, 2) a technical advisory capacity to translate guidelines and to work with local and regional review committees, and 3) local review committees. A special emphasis, lacking in the limited efforts of previous infant mortality reviews, would be given to fetal mortality. The plan proposes a broad classification of potential contributing causes of mortality, from those related strictly to medical care, to the health system and to individual patient factors. This will allow different and more effective targeted responses to factors identified locally. Critical impetus will be gained with The American College of Obstetricians and Gynecologists leading the effort from the private medical sector in partnership with national medical societies.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

During the last decade, 89 sets of triplets were born in Denmark with a gestational age of more than 25 completed weeks. Fifteen pregnancies (16.9%) were complicated by fetal death in the third trimester, with a total of 17 intrauterine deaths. Six neonatal deaths occurred, leaving 22 survivors among these 15 patients. Four triplet gestations were diagnosed as twins until delivery. Eight women conceived spontaneously, two gestations followed assisted fertilization and embryo transfer, and five women had had various forms of ovulation stimulation. The mean maternal age was 27.8 years (range 17–38). Seven women were parous and eight were nulliparous. Maternal complications included hydramnios (three), preeclampsia/hypertension (three), and anemia (nine). All women delivered preterm. Of the 11 gestations diagnosed as triplets, fetal death was diagnosed at 32.2 ± 2.9 weeks (mean ± SD) and delivery occurred at 32.6 ± 3.0 weeks. Nine of 11 women had cesarean deliveries. Continuation of pregnancy after fetal death could be considered in only three subjects. In eight women, obstetric reasons required immediate delivery. Fetal death was associated with monochorionic or dichorionic placentation, and growth retardation was a frequent complication before fetal death. Anencephaly of one fetus, umbilical cord problems in two, and severe hydrops in two were the only obvious causes of fetal death. Fetal death should not be the sole indication for delivery. In cases with severe prematurity and a stable intrauterine situation, frequent assessments of fetal well-being are recommended, with prompt delivery when indicated.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Doppler ultrasound of the umbilical artery flow velocity waveform was studied prospectively as an admission test at the labor ward. Recordings were made in 575 women in various stages of labor before, during, and after uterine contractions, and evaluated in relation to intrapartum and fetal outcome variables. No association was found between abnormal flow velocity waveforms and cord complications, meconium-stained amniotic fluid, or abnormal fetal heart rate tracing, nor was there any association with operative delivery for fetal distress or low Apgar scores at 1 and 5 minutes. Small for gestational age fetuses had significantly more abnormal flow velocity waveforms than appropriate for gestational age fetuses, and so had those with umbilical artery acidemia compared with those with normal pH. The results indicate that Doppler recording of the umbilical artery flow velocity waveform as an admission test at the labor ward is not a good predictor of fetal distress in an unselected population.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Pulsed Doppler and M-mode maternal echocardiography were combined with uterine and umbilical artery Doppler velocimetry to characterize the hemodynamic changes associated with fluid preload and epidural anesthesia in 12 normal laboring gravidas at term. Fluid preload alone was associated with significant (P< .05) increases in heart rate (11%), stroke volume (10%), and cardiac output (20%), and a decrease in systemic vascular resistance (19%). There were no changes in mean arterial pressure (MAP) or ejection fraction during any stage of the study. Following placement of the epidural block, stroke volume and cardiac output returned to values not significantly different from baseline, whereas heart rate remained elevated and systemic vascular resistance remained decreased. There were no changes in uterine or umbilical artery systolic-diastolic (S-D) ratios during any stage of the study. We conclude that fluid preload and epidural anesthesia cause significant changes in maternal cardiac output, heart rate, stroke volume, and systemic vascular resistance without affecting MAP. These maternal changes do not correlate with any changes in uterine or umbilical artery S-D ratios following epidural anesthesia in the normal laboring gravida.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To study the effects of epidural anesthesia on uterine and umbilical artery blood flow in preeclampsia, we observed 25 patients in active labor at 36 or more weeks' gestation. Seven had preeclampsia, eight had chronic hypertension, and ten had no complications. Doppler velocimetry of the uterine and umbilical arteries was performed before and after intravenous fluid loading and at 30 and 60 minutes after epidural blockade. Maternal vital signs and fetal heart rate were monitored continuously. After epidural block, mean maternal blood pressure fell significantly in all groups, but no maternal hypotension was observed. Mean maternal and fetal heart rates were unchanged. After epidural block, mean uterine artery systolic-diastolic (S-D) ratios did not change in the chronic-hypertension and normal groups, but fell significantly in the preeclamptic group to values similar to those of the normal group. Umbilical artery S-D ratios did not change in any group. In preeclamptic pregnancy, epidural anesthesia may help to reduce uterine artery vasospasm and may benefit intrapartum fetal well-being.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

High-frequency transvaginal probes were used at 20–40 weeks' gestation to develop a systematic examination of the fetal brain. Modeling the procedure after the standard neonatal neurosonographic examination, we attempted to obtain three coronal sections (anterior, midline, posterior) and two sagittal sections (midsagittal, right or left parasagittal). In 70 normal patients, all planes were imaged with a similar frequency (74–76%) except for the posterior coronal plane, which was imaged 59% of the time. Among the first 35 cases, 17% had a complete study, compared with 71% of the second 35 cases. Transvaginal sonography established or changed the diagnosis in five of the 13 cases with central nervous system or other abnormalities. We recommend that a complete fetal neurosonographic examination include transvaginal sonography to complement and enhance the transabdominal examination, especially for cases in which a fetal abnormality is suspected.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To determine the relationship between age and female fecundity, 210 women were studied prospectively. The subjects had negative infertility evaluations and were receiving therapeutic donor insemination. Life-table analysis was performed on 751 donor insemination cycles. For comparison, patients were divided into five separate age groups and into two separate groups, ages 19–34 and 35–45. Monthly fecundity and cumulative conception rates were calculated for each group. A significant difference was found when all age groups were compared (P = .05) and when those at or above age 35 and those below age 35 were compared (P < .05). Frozen semen was used in 92% of all cycles. The average monthly fecundity of all patients treated with frozen semen was 16%. This study confirms a progressive decline in fecundity with age in a completely evaluated group of women undergoing therapeutic donor insemination and demonstrates that frozen semen can yield acceptable fecundity provided sufficient numbers of motile sperm are used for each procedure.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To assess the impact of assisted reproductive technologies on the potential fertility of older women, we report our experience with gamete intrafallopian transfer (GIFT) in a large number of women 40 years of age and older. One hundred twenty-two GIFT cycles were initiated in 59 women over 18 months. Seventy-three tubal transfers were performed, resulting in seven clinical pregnancies, a rate of 9.6% per transfer. This contrasts with a 27.3% clinical pregnancy rate per transfer in women under 40. Thus, older patients require thorough counseling regarding the decreased likelihood of success despite the use of assisted reproductive technologies.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The purpose of this study was to measure the effects of several variables on energy transmission and power density through the CO2laser laparoscope. The factors studied included the laser beam diameter, coupler optics, laparoscope lumen size, and absorption of the laser wavelength by the insufflation gas. The addition of CO2insufflating gas to the operating channel at higher power settings not only reduced the energy transmitted to tissue by 35–58% with a 7.2-mm laparoscopic operating channel and by as much as 61% with a 5-mm operating channel, but also increased the spot size. This “blooming” of the laser beam definitely reduced power density at tissue and eliminated the pinpoint spot size needed for microdissection. Even under optimal conditions regarding lumen size and beam diameter, our data indicate a point of diminishing returns for power density above 40 W for the systems tested. Power densities obtainable at laparotomy were not possible. Clinically, this effect resulted in optimal cutting (vaporization) at low power settings and coagulation accompanying cutting at higher settings.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Contemporary adhesion-prevention regimens for infertility surgery emphasize the use of barrier materials to effect physical separation of injured surfaces before reperitoneal-ization. Poloxamer 407 is a biocompatible polymer that displays reverse thermal gelation characteristics; that is, the material exists as a liquid at room temperature and as a solid at body temperature. These properties make it an ideal material for use in laparoscopic surgery. The antiadhesion properties of poloxamer 407 were evaluated in two models. In the first experiment, Golden hamsters were subjected to a standardized adhesion-producing lesion in the left uterine horn. Poloxamer solutions in concentrations ranging from 15–35% were applied to the injured horn. Location, thickness, and extent of adhesion formation were assessed 14 days later. Significant reduction in post-traumatic adhesion formation was observed following treatment with the 30–35% solutions. The second experiment was designed as a paradigm of the typical situation encountered in infertility surgery: prevention of adhesion reformation after lysis of established adhesions. New Zealand White rabbits were subjected to three laparotomies at 14-day intervals for placement of the adhesion-producing lesion, evaluation (pre-score) and surgical lysis of induced adhesions, and subsequent evaluation of adhesion reformation (post-score). The effect of applying poloxamer 407 after adhesiotomy was compared with controls (no treatment). Adhesion reformation (post-score) was markedly reduced by poloxamer-407 treatment. Further trials of this material in the clinical setting are indicated.

ISSN:0029-7844    

出版商:OVID    

年代:1991

数据来源: OVID