摘要:

Neural tube defects are a heterogeneous group of malformations resulting from failure of neural tube closure during early embryogenesis. They range widely in severity from the lethal condition of anencephaly, to severely disabling meningomyeloceles, to completely surgically correctable meningoceles. Occurring in 1.4 to 1.6 per 1000 live births, neural tube defects rank second only to cardiac abnormalities as a cause of major congenital malformations in the United States. Technical developments over the past decade have enabled better detection of these conditions prenatally. Understanding of the etiology, neonatal treatment, and potential prevention of neural tube defects is increasing. Further, the ethical issues of treatment and screening are being widely discussed in both news magazines and the Congressional Record. Thus, it is timely to review this important area of prenatal counselling, diagnosis, and management.

ISSN:0029-7844    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The relationship between the deterioration of glucose tolerance and plasma prolactin (PRL) levels was investigated in 15 normal pregnant women and in 15 women with gestational diabetes mellitus. Oral glucose tolerance tests were performed in late pregnancy and postpartum, and the insulin, glucagon, and PRL responses were measured. In late pregnancy the gestational diabetics revealed significantly elevated fasting glucose levels compared with the normal pregnant women and after the glucose challenge their insulin responses were significantly diminished and the suppression of glucagon less pronounced. These differences in glucose metabolism were markedly reduced early postpartum. There was no difference in basal PRL concentrations between the two groups neither in pregnancy nor postpartum. The PRL levels were not altered during the oral glucose tolerance tests and nocorrelationbetween thedeteriorationof glucose tolerance and the PRL concentrations could be demonstrated in either group. These results indicate that abnormal PRL levels are not of pathophysiologic importance for the development of gestational diabetes mellitus.

ISSN:0029-7844    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The effect of breast stimulation on cervical ripening was studied. One hundred patients who had completed 38 weeks' gestation and had uncomplicated antenatal courses were recruited and divided into two groups: treatment and control. In the treatment group, gentle breast stimulation of: alternate breasts was performed first for 1.5 hours under monitoring in the hospital and then for three hours daily for three days at home. No uterine hypertonus was detected. It was found that there was a significant change in the Bishop score of 3.96 ± 1.34 points in the stimulated group as compared with the control group 1.04 ± 1.03 points. After three days, a cross-over trial was performed with the extreatment group becoming the control and the excontrol group undergoing breast stimulation for the same period of time and under the same conditions. Again, the excontrol group was found to have a better mean cervical score (3.11 ± 1.42 points) than the extreatment group (0.76 ± 0.97 points) during breast stimulation. It is stressed that no uterine hypertonus was detected with gentle, unilateral breast stimulation, and there were no maternal or fetal complications as a result of this modality of cervical ripening.

ISSN:0029-7844    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Uterine contractions produced by three methods of breast stimulation and a placebo were compared in 202 high-risk women between 35 and 44 weeks' gestation during contraction stress tests. Manual stimulation produced significantly more successful responses of three or more contractions within ten minutes than did a heating pad or a placebo, but did not show significant differences when compared with a breast pump. The placebo group showed an increase in contractions over a resting state. Of the women with successful contraction stress tests, over 50% demonstrated exaggerated uterine activity (a hypertonic contraction of greater than 90 seconds, or five or more contractions in a ten-minute period).

ISSN:0029-7844    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The route of administration of prophylactic antibiotics was studied in a randomized prospective trial. Cefoxitin was administered to high-risk patients at cesarean section by three treatment regimens: intravenous antibiotic (2 g) for eight doses, irrigation of uterus and peritoneum with 2 g of antibiotic, and a combination of intravenous and irrigation as described. A control group received no antibiotic prophylaxis. The incidence of febrile morbidity was similar in each treatment group: intravenous, two of 39 (5%); irrigation, three of 42 (7%); intravenous and irrigation, two of 38 (5%), and were all significantly lower than the control group 14 of 39 (36%) (P< .05). Similar results were found when prevention of endometritis was the end point: intravenous, two of 39 (5%); irrigation, two of 42 (5%); intravenous and irrigation, two of 38 (5%) compared with 13 of 39 (33%) in the control group (P< .05). Administration of antibiotics by irrigation is equally effective in preventing postoperative febrile morbidity and endomyometritis as intravenous dosing and a combination of intravenous and irrigation. This affords a potential cost savings.

ISSN:0029-7844    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

This prospective screening program of a large obstetric population was designed to determine the effectiveness of ultrasonic biometry to diagnose intrauterine growth retardation. The results of 3616 pregnancies were analyzed. All pregnancies were dated before the 24th week by ultrasonic measurements. The study compared the effectiveness of three ultrasonic growth parameters: biparietal diameter (BPD), head circumference, and abdominal circumference, to detect intrauterine growth retardation and to determine the optimal gestational age to perform the scan for this purpose. To maintain a high sensitivity required in a screening program, all ultrasonic measurements below the 25th percentile for gestational age were considered abnormal. The predictive value of a positive test in this situation ranged from 0.25 to 0.55, depending on the week of gestation in which the scan was performed. Accuracy of predictions improved greatly when the scans were performed within two weeks of delivery. Abdominal circumference measurements were more predictive of intrauterine growth retardation than either head circumference or BPD measurements or the combination of these parameters. In view of the sensitivity of the test and the prevalence of the disorder, it is concluded that 34 ± 1 weeks of gestation is the optimal time to screen patients ultrasonically for intrauterine growth retardation.

ISSN:0029-7844    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The obstetric background of early fetal growth retardation, leading to intrauterine death between 25 and 34 weeks or to delivery before 34 weeks' gestation, was investigated in a group of 100 women. Hypertensive disorders were the most common causative factor (59%). Other causes included antepartum hemorrhage and congenital anomalies. In 20% of the cases no obvious explanation for the fetal growth retardation could be found. The recurrence rate of fetal growth retardation in 49 women who had a subsequent pregnancy was found to be nearly 50%. In one-third the severity of growth compromise was comparable to that in the previous pregnancy, whereas in the hypertensive group this incidence reached nearly 50%. Because of the poor prognosis in current and subsequent pregnancies, it is suggested that women with early fetal growth retardation should be treated at centers where all obstetric and neonatal facilities are available.

ISSN:0029-7844    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

From June 1978 to December 1983, 100 patients with viable pregnancies involving opaque, discolored, second-trimester amniotic fluid were identified. During this period 7018 genetic amniocenteses were performed for an incidence of discolored fluid of 1.4%. Compared with case matched control subjects there were no statistically significant differences in the incidence of elevated amniotic fluid α-fetoprotein, preterm labor, fetal distress during labor, intrauterine growth retardation, or stillbirth. The rate of spontaneous abortion (7 versus 0%;P< .05) was increased in the discolored fluid group. The patients with discolored fluid also had an increased incidence of prior vaginal bleeding (P< .001).

ISSN:0029-7844    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Preeclampsia-eclampsia and trophoblastic disease have been associated with a wormlike organism,Hydatoxi lualba, recently discovered in smears from circulating blood, trophoblastic tumor tissue, and placental tissue of toxemic patients. To investigate these findings peripheral blood smears from patients with preeclampsia-eclampsia, patients with hydatidiform mole, normal pregnant patients, and nonpregnant subjects were studied. The smears were stained with toluidine blue-O and Giemsa. The average size of wormlike forms found was 2.5 by 0.23 mm. None stained with Giemsa. The frequency of positivity for toxemic patients was 56.5% and 81.8% for normal pregnant patients. Samples from molar pregnancies were negative. Observations performed directly in fresh blood were also negative. The forms were observed not only in peripheral blood but also in serum obtained after centrifugation or passage through Millipore filters. No evidence of reproductive elements was found, and electron microscopy revealed no particular structure. The results suggest that the organism is an artifact.

ISSN:0029-7844    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

This study of 74 diabetic pregnant women shows that tight maternal blood glucose control before the 32nd week of gestation significantly reduces the incidence of fetal macrosomia (11%) when compared with that of patients with fair to poor control before the 32nd week of gestation (44%,P< .05) or with those whose good diabetic control was not achieved until after the 32nd week of gestation (34%,P< .05). The macrosomic infant produced by a diabetic mother is associated frequently with an elevated amniotic fluid C peptide level, which shows the evidence of intrauterine fetal hyperinsulinism. The use of tight diabetic control early in pregnancy to reduce the risk of fetal macrosomia and/or neonatal complications is of clinical importance in the management of diabetes in pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1986

数据来源: OVID