摘要:

The specific labor aberration of arrest of descent was investigated In 253 nulliparas. It was found to be associated with fetopelvic disproportion in 52%. Delivery outcome was adversely affected by such factors as high fetal station at time of arrest and long duration of arrest. Arrest of descent occurring during the administration of oxy tocin infusion was particularly ominous, no patient subsequently delivering vaginally. The best delivery prognosis was seen in those cases In which apparently causative inhibitory agents, including peridural anesthesia and sedation, were allowed to abate expectantly. Neither immediate operative delivery nor expectancy (other than in the specific abatement cases) was determined to be an appropriate approach to resolving this problem. Postarrest progression, especially if at a rate that was the same as or greater than prearrest descent, proved to be a favorable sign for delivery outcome. Neonatal depression and birth trauma were closely correlated with midforceps procedures, especially when done in conjunction with forceps rotation. Cephalopelvic disproportion yielded poor perinatal results, particularly among those delivered vaginally by instrumental means. Uterotonic stimulation of labor to correct the arrest problem therapeutically also had an adverse effect on the fetus when followed by operative delivery. Based on these observations a program of management was evolved for treating patients with arrest of descent.

ISSN:0029-7844    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

The fetal adrenal cortex has recently been implicated in the etiology of postmaturity on the basis of low cortisol levels found in the plasma of postmature neonates. These findings suggested that labor could be initiated in prolonged pregnancy by iatrogenic elevation of fetal plasma corlisol. In the current investigation designed to test this hypothesis, 500 mg of hydrocortisone sodium succinate, dissolved in the accompanying diluent of bacteriostatic water to form 4 ml of solution, was injected intraamniotically in 10 patients with unfavorable cervices who were 12 or more days past their expected date of confinement. Nine similar patients serving as controls received 4 ml of bacteriostatic water intraamniotically. All patients were followed with daily determinations of urinary estriol. Eight of the 10 patients who received cortisol went into labor within 120 hours of instillation, as compared with 2 of the 9 patients in the control group. Comparison of the two groups revealed a significant difference (p< 0.01). The mean instillation-labor time for the cortisol group was 86 Hours compared with 228 hours in the control group. This difference was also significant (p< 0.001). Urinary estriol excretion declined sequentially following cortisol but not after Infusion of water. These findings are consistent with the hypotheses thata) spontaneous labor in the human may be preceded by a sudden rise in fetal plasma cortisol, as in the sheep;b) the fetal pituitary-hypothalamic axis is responsive to cortisol, hence the falling estriol excretion; andc) ACTH may be the tropic hormone for the provisional zone of the fetal adrenal cortex.

ISSN:0029-7844    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Amniotic fluid specimens from 110 patients in labor were examined for neutrophils and bacteria. Patients with neutropbils in their amniotic fluid had significantly higher fever indices than patients with clear amniotic fluid. The highest fever indices were found in those patients who delivered by cesarean section after neutrophils were present in their amniolic fluid. Febrile morbidity was significantly reduced in a group of 24 such patients by giving prophylactic antibiotics.

ISSN:0029-7844    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

The prenatal diagnosis of anencephaly and spina bifida (neural tube defect. NTD) through amniotic fluid analysis for α-fetoprotein (AFP) is gradually gaining clinical recognition. AFP concentration); were determined in 237 amniotic fluids from normal pregnancies ranging between 7 and 42 weeks of gestation. A steady decline in AFP from 26 μ/ml at 7–9 weeks to 155ng/ml at term is observed. AFP concentration was determined in 35 amniotic fluids from 33 confirmed neural tube defective pregnancies. In 14 cases where amniotic fluid was examined prior to the 26th week of gestation. AFP was markedly elevated when compared with the normal range of the same gestational period. In 21 amniotic fluids past the 26th week, 17 cases (85) had markedly elevated AFP levels; however, 2 cases of anencephaly, 1 of spina bifida, and I of hydrocephaly gave levels within the normal range. It is concluded that elevated AFP in the amniotic fluid is a reliable but nonspecific marker for open neural tube defects prior to the 26th week of pregnancy, but may become normal after the 26th week in a small percentage of patients.

ISSN:0029-7844    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Dehydroepiandrosterone sulphate (DH AS) was administered intravenously to 70 women in the third trimester of pregnancy. By measuring the increase in the concentrations of estrogens in maternal plasma, it was hoped to assess the reserve capacity of the placenta. In normal pregnancies, umonjugated estradiol invariably showed a marked increase within 60 minutes of the injection of DHAS, reaching 174 to 478% above basal levels. Changes in unconjugated estrone were more variable, but significant increases usually occurred 2 to 3 hours after the peak concentration of estradiol. The concentrations of onconjugated estriol showed no significant change. Patients with preeclampsia, essential hypertension, retarded intrauterine growth, diabetes, and twin pregnancies did not show any major differences in response compared to the normal pregnancies. Two patients with intrauterine deaths had low basal concentrations of estrogens but responded to the DHAS injection by having significantly increased concentrations of unconjugated estradiol after 60 minutes. The only patient who did not show any increase in unconjugated estradiol levels after DHAS was thought to have a placental sulphatase deficiency. This test does not appear to have any advantage over existing methods of assessing the endocrine function of the placenta except in confirmation of placental sulphatase deficiency.

ISSN:0029-7844    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Seven hundred sixty-seven oxytocin challenge tests (OCT) were performed on 333 high-risk maternity patients. All of the patients had pregnancies complicated by diabetes mellitus, suspected postmaturity, preeclampsia, intrauterine growth retardation, hypertension and other disorders. In conjunction with OCT, 24-hour urinary estriol determinations were performed. Negative OCT's were reassuring for fetal well-being. There were 26 positive OCT's on 24 patients. A positive test was significant in identifying endangered fetuses existing in a markedly unfavorable environment. In our experience, we found the OCT more reliable and more predictable than urinary estriol determination. The oxytocin challenge test proved to be significant in the successful management of these 333 high-risk patients.

ISSN:0029-7844    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Postpartum hemotytic uremic syndrome is characterized by the findings of renal failure and microangioputbic hemolytic anemia in the puerperium. The case reported and literature reviewed demonstrate the need for early recognition and aggressive therapy in this rare and generally fatal condition.

ISSN:0029-7844    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

A prospective study was made on the duration of lactation in 406 mothers injected postpartum for contraception with medroxyprogesterone acetate (DMPA), 150 or 250–300 mg, IM, at 3-or 6− month intervals. Breast feedings up to 2 per day were recorded, and findings compared with those from 173 nontreated controls. Eighty percent of the DMPA group were nursing successfully at the sixth month and 42% at the 12th month postpartum. These figures are significant and compare favorably with the control group. No advantage was found in the administration of DMPA earlier than the second or third month after delivery. Amenorrhea persisted during lactation. No pathologic breast conditions were observed. The eventual mechanism of DMPA in galactopoiesis has yet to be clarified.

ISSN:0029-7844    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Human corpora lutea of pregnancy obtained at 5 to 11 weeks of gestation were incubatedin vitroin the presence of various concentrations of human chorionic gonadotropin (hCG) and prostaglandin F2α(PCF2α) Progesterone (P) and 17β-estradiol (E2) released into the medium during incubation were measured by radioimmunoassay. Pieces of the corpora lutea were also examined ultrastructurally before and after incubation. Release of P and E2into the medium was significantly increased by the addition of hCG and PGF2αin some cases. However, the response to hCG and PGF2aappeared to vary according to the age of the corpus luteum. Ultrastructurally, the lutein cells were well maintained with respect to the appearance of the smooth endoplasmic reticulum and mitochondria after 120-min incubations. On the basis of these observations, the following conclusions have been reached: 1) This incubation system seems to be suitable for investigating the direct effects of chemicals on lutein cellsin vitro.2) Both hCG and PGF2αdirectly stimulate steroidogenesis in the human corpus luteum of pregnancy, demonstrating their luteotropic actionsin vitro.3). Observed variations in P and E2secretion might have been due to the different activities of aromatizing enzymes at different stages of gestation.

ISSN:0029-7844    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Serum human chorionic somatomammotropin (hCS) was measured in 35 patients with intact unaborted hydatidiform mole by a rapid radioimmunoassay using 70% dioxane in water to separate the bound from unbound Traction. Serum hCG was measured by a hemagglulination inhibition method. Serum hCS ranged from 250 to 5900 ng/ml, while serum hCG ranged from 60 IU/ml on unaborted molar pregnancies. Serum hCS in hydatidiform mole increases from a mean ± SE of 650 ± 88.5 ng/ml at 7 to 9 weeks' gestation to 1986.7 ± 859.3 ng/ml at 22 to 25 weeks' gestation. There was a significant correlation between uterine size and serum hCS in molar pregnancies (correlation coefficient r = +0.5183; P = 0.0025). There was no significant correlation between serum hCS and serum hCG. Serum hCS in a patient with a molar pregnancy who subsequently developed choriocarcinoma was not significantly different from that in patients who did not. The findings indicate: 1) that peripheral hCS increases with increased gestational age in molar pregnancies, 2) that the amount of peripheral serum hCS is related to the mass of molar tissue present and not dependent on serum hCG level, and 3) that the serum hCS level in unaborted hydatidiform mole was a poor index for predicting malignant sequelae.

ISSN:0029-7844    

出版商:OVID    

年代:1976

数据来源: OVID