摘要:

The effects of alcohol on the fetus include a wide range of problems; the complete fetal alcohol syndrome is the extreme end of the spectrum. At critical doses alcohol has the potential for multiple adverse effects on the maternal-placental- fetal system. Variability of outcome probably is related to individual differences in drinking patterns as well as in biologic susceptibility. At Boston City Hospital Prenatal Clinic, therapy was provided for pregnant women who reported drinking heavily. Reduction in maternal alcohol consumption before the third trimester was associated with improved neonatal outcome. The obstetrician's office is a potential site for prevention programs. A 10-question drinking history enables physicians to identify pregnant women at risk. Supportive counseling focused on reduction of alcohol use can be integrated with regular prenatal care. Pregnant women who do not respond promptly should be referred to specialized treatment programs. This strategy has the potential to improve the health of both mother and infant.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

At term 365 (5.6%) of 6497 pregnant women weighed over 90 kg; in these obese patients there were significantly increased incidences of hypertension (43.6%), hyperglycemia (16.9%), and subnormal urinary estriol excretion (18.6%). Infants weighing 4000 g or more at birth were more than twice as common (20.5%) in this group of patients, but increased fetal size was not due to associated maternal hyperglycemia and did not lead to increased rates of operative delivery although obstructed labor occurred in 5 multiparas. The increased incidence of labor exceeding 24 hours after amniotomy (12.3%), primary postpartum hemorrhage (7.1%), neonatal asphyxia (14.0%), and puerperal pyrexia (9.6%) emphasizes the problems of management of labor in the obese parturient. Perinatal mortality was not increased and there was no maternal death. Obesity is not associated with less favorable maternal or perinatal results when prenatal care includes monitoring of glucose tolerance and fetoplacental function and when cephalopelvic disproportion is considered in every labor.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The influence of weight gain during pregnancy on duration of gestation and infant size at birth was examined among women beginning pregnancy underweight and at normal weight. Results of the review of 654 prenatal and delivery records revealed that 1) Prepregnancy weight status was not associated with the amount of weight gained during pregnancy; 2) underweight women who gained the same amount of weight as normal weight women delivered infants at a younger gestational age and of lower birth weight and length; 3) more than half the infants born to underweight women failing to gain more than 9 kg during pregnancy weighed less than 2501 g. These results suggest that recommendations for weight gain during pregnancy be based on prepregnancy weight status and that adequate weight gain is of critical importance to women beginning pregnancy underweight.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Data from 8193 pregnancies were analyzed for clues to the mechanisms responsible for the fetal growth retardation associated with maternal cigarette smoking. The retardation proved independent of mothers' prepregnancy body weights and pregnancy weight gains; therefore, it was not due to undernutrition. As the retardation was present in intrapair comparisons of siblings whose mothers had smoked in only 1 of their pregnancies, it was not due to genetic factors. Cigarette smoking causes permanent damage to uterine arteries; however, this did not retard fetal growth because retardation was absent when mothers stopped smoking during pregnancy. Results of the study exclude undernutrition, genetic factors, and placental underperfusion as major contributing factors to the fetal growth retardation associated with cigarette smoking.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Forty-six patients in premature labor were initially successfully treated with ethanol infusion. Twenty-three of these patients were then given prolonged oral terbutaline sulfate therapy until 38 weeks' gestation, and the remaining 23 patients were given placebo. The treated group gained significantly more time in gestation than the placebo group (P<.05), although the placebo group started with a higher Bishop score. In addition, idiopathic respiratory distress syndrome was seen significantly less often in the treated group. There was no perinatal mortality in either group.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Two hundred consecutive autopsies of stillborn infants were reviewed. Twenty-five cases of histologically evident amniotic fluid aspiration were identified. Among these 25 cases, 8 had identifiable intraalveolar meconium. The clinical setting and histologic features of these cases are reviewed, and the significance of intrauterine meconium aspiration is discussed.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The frequency of respiratory distress syndrome (RDS) was assessed according to indications for delivery and the presence of antecedent labor among 236 newborns delivered by cesarean section. The presence of labor preceding cesarean section did not reduce the risk of RDS significantly, although a trend, not statistically significant, was noted in this direction. Of the delivery indications evaluated, only abruptio placentae appeared to be associated with an increased risk of RDS. However, prematurity was shown to be a possible confounding variable in this regard. These data suggest that the risk of RDS associated with cesarean section is related to the mode of delivery per se and not necessarily to any of the associated factors evaluated in this study.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Thirty-seven intrauterine transfusions were performed on 17 severely Rh-sensitized women utilizing a technique entirely dependent upon ultrasound for needle insertion. The neonatal survival rate was 71%; 57% (4 of 7) of the hydropic fetuses and 80% (8 of 10) of those with no antenatal evidence of ascites survived. Twenty-five percent of the 12 neonatal survivors received their initial transfusion at 26.5 weeks or earlier. These results are comparable to the best of those in series relying on x-ray or fluoroscopy techniques for performing the procedure. Intrauterine transfusion continues to play an essential therapeutic role in the management of the severely affected erythroblastotic fetus. It is recommended that techniques relying on ultrasound be utilized in preference to those using x-ray to reduce radiation exposure in utero.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Meconium aspiration syndrome occurs more commonly in infants subjected to fetal distress. The baboon model was utilized to produce in utero aspiration of meconium in the presence of fetal acidosis. Fifteen fetal baboons underwent acute catheterization of the femoral artery and a Swan-Ganz balloon was placed in the maternal aorta. Meconium was added to the amniotic fluid and the balloon was repetitively inflated to produce hypoxemia in 3 fetuses and hypoxemia and acidosis in 4. Two fetuses served as controls and the balloon was not inflated. Acidosis alone was produced in 3 others by maternal cooling. Maternal administration of fentanyl, a narcotic analgesic and respiratory depressant drug, was found to reduce the degree of in utero meconium aspiration in 3 distressed fetuses by inhibiting gasping respirations. It is concluded that fetal respiratory depressants may be useful in this circumstance but only when expert resuscitative capability is present in the delivery room.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Antepartum dexamethasone administration was associated with a significant lowering of the incidence of respiratory distress syndrome (RDS) and with marked reduction of early neonatal mortality in premature infants. Dexamethasone had its greatest effect in infants delivered between 28 and 32 weeks' gestation (P < .001), and the difference was still significant up to 34 weeks' gestation (P < .05). Although the effect of dexamethasone was more marked in patients with intact membranes, it was also effective in those with prolonged rupture of the membranes. Membrane condition before delivery was unrelated to the incidence of RDS. The effectiveness of dexamethasone was analyzed with respect to the condition of the infant at delivery, the mode of delivery, and multiple births. As compared to the controls, dexamethasone was most effective in singletons, infants delivered vaginally, and those with high Apgar scores. The effect of dexamethasone was not significant in twins, breech deliveries, cesarean section deliveries, or infants with low Apgar scores. The effects of dexamethasone appear to be modified by intrauterine asphyxia. Dexamethasone therapy cannot be substituted for optimal delivery conditions of the premature.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID