摘要:

Objective: To estimate the influence of adequacy of prenatal care and other known risk factors on the risk of repeating low birth weight (LBW) (less than 2500 g).Methods: This was a retrospective cohort study of women having two births in Washington state during 1984–1990, as recorded using linked birth certificate records. Logistic regression was used to control for maternal age, marital status, smoking, miscarriage, inter-pregnancy interval, and prenatal care.Results: Compared to the reference group of women with normal-weight first births (at least 2500 g), women with LBW first births, either preterm or small for gestational age (SGA), were significantly more likely to have an LBW second birth. The estimated relative risk of repeating LBW in general was 7.0 (95% confidence interval 4.8–10.1). Smoking during the second pregnancy was a significant effect modifier. The risk estimates were not significantly affected by any of the other variables entered into the models, including adequate prenatal care.Conclusions: Prior delivery of a preterm or SGA LBW infant was the strongest predictor of LBW delivery in a subsequent pregnancy. Adequate prenatal care during the second pregnancy did not provide statistically significant protection against the risk of repeat LBW. The tendency for women to have repeat LBW deliveries despite adequate prenatal care indicates a need for a better understanding of the underlying pathophysiology of preterm and SGA delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective: To document the relation between stillbirth and various demographic, obstetric, and medical risk factors.Methods: We analyzed the risk factors and medical origins of 403 stillbirths. The population studied included 34,350 births occurring during the March of Dimes Preterm Birth Prevention Trial. All births occurring in five perinatal centers from 1982–1986 were included in the analysis. Stillbirth was defined as those infants born at 20 weeks' gestation or later whose Apgar score was 0 at 1 and 5 minutes.Results: Stillbirth occurred in 1.2% of all births. Fifty-one percent occurred before 28 weeks and only 18% were at term. Blacks had a greater risk of stillbirth when compared to other women. Prior preterm delivery yielded nearly a twofold increase in the risk of stillbirth. Preeclampsia, chronic hypertension, and class A or class B-R diabetes were not associated with an increased risk of stillbirth. Other medical factors (hemoglobinopathies, Rh sensitization) resulted in a greater than sixfold increase in the rate of stillbirth, and congenital anomalies resulted in a fivefold increase. Abruption was associated with a 12-fold increase in the risk of stillbirth; nearly 14% of all stillbirths were associated with abruption.Conclusion: Eighty-two percent of all stillbirths occurred before term, and more than 50% occurred before 28 weeks. The majority of stillbirths were not explained by medical complications, but instead were often associated with other risk factors related to preterm birth. Further investigations are needed to understand the complex etiology of stillbirth.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective: To assess the feasibility and efficacy of a protocol for universal screening for group B streptococci combined with selective intrapartum prophylaxis at a teaching hospital.Methods: This is a descriptive study of experience with a standardized protocol in which patients were screened at 26–28 weeks with a rectal and genital culture placed directly in selective media. As risk factors, we used clinical chorio-amnionitis, preterm birth, and rupture of the membranes greater than 12 hours. Participants were all women receiving prenatal care at our hospital. Major outcomes were compliance and neonatal sepsis due to group B streptococci.Results: The prevalence of rectal and genital group B streptococci was 18.5% of 3721 screened women. Of culture-positive women, 35% developed risk factors (9% chorioamnionitis, 13% preterm birth, and 13% membrane rupture greater than 12 hours at term). With strict application of criteria, the compliance rate in administering indicated prophylaxis was 80.3%. Of women receiving prophylaxis, 42% had the first dose for 4 hours or less before delivery. There were five cases of group B streptococcal neonatal sepsis, resulting from either protocol violations, protocol failures, or both. Compared to the historic rate of group B streptococcal sepsis of 1.5 per 1000 births at our hospital, the rate in these 2 years was 1.0 per 1000 (1.6 per 1000 in the first year and 0.5 per 1000 in the second).Conclusions: It is feasible to conduct such a protocol, but compliance is only moderately good because the algorithm is complex. The protocol is not foolproof in preventing neonatal group B streptococcal sepsis, as there are protocol failures and violations.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective: To determine: 1) the frequency with which standard fetal biometry (head circumference [HC], abdominal circumference [AC], and femur length [FL]) and the transverse cerebellar diameter can be measured in twin pregnancies; and 2) the efficacy of fetal biometry using these measures in the detection of twin growth discordancy.Methods: The study population consisted of 203 twin pregnancies reviewed retrospectively. The frequency with which standard biometry and the transverse cerebellar diameter could be obtained was recorded. Forty-nine twin pairs who were delivered within 3 weeks of their last ultrasound examination were divided into three groups based on birth weight differences: 20% or more, 10–19%, and less than 10%. The sensitivity, specificity, and predictive values of the specific fetal biometric measurements and of the sonographic estimation of fetal weight were assessed for this subgroup for the prediction of twin discordancy.Results: The FL could be measured consistently throughout gestation, but the ability to measure the AC decreased after 35 weeks' gestation. The frequency with which HC and transverse cerebellar diameter could be measured decreased with advancing gestation. The transverse cerebellar diameter could be measured only in 91 of 151 and 14 of 49 pregnancies at 31–35 and 36–40 weeks' gestation, respectively. An intra-pair AC difference of 20 mm or more had a sensitivity and a positive predictive value of 83% for the detection of twin discordancy, defined as at least a 20% difference in birth weight. Estimated fetal weight had a sensitivity and positive predictive value of 92.9 and 72%, respectively. In contrast, a difference of 4 mm or more in the intra-pair transverse cerebellar diameter had a sensitivity of 28% and a positive predictive value of 50% in detecting twin weight discordancy.Conclusions: Appropriate twin fetal biometry can be measured throughout gestation. Estimated fetal weight has a higher sensitivity but a lower positive predictive value than AC for predicting twin growth discordancy.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective: To test previously proposed but unproven antenatal ultrasound prognostic criteria in fetal gastroschisis.Methods: Thirty consecutive gastroschisis-affected pregnancies and their outcomes were reviewed retrospectively. Data were tabulated by review of antenatal ultrasound videotapes, with blinded comparison to indicators of short-and long-term infant outcomes obtained from the medical records. Criteria of previous reports were applied to these data, focusing on their ability to prognosticate effectively.Results: Applying a criterion of 10 mm bowel dilatation proved minimally useful in prognosticating infant outcomes. However, a stricter 17-mm criterion for clinically important bowel dilatation provided prognostic information, with remarkable improvement in specificity (75 versus 37%) and positive predictive value (55 versus 37%) for infant morbidity, with comparatively little loss of sensitivity (71 versus 85%).Conclusions: Bowel dilated more than 17 mm on antenatal ultrasound appears to be associated with increased short-and long-term infant morbidity. Whether this finding warrants obstetric intervention in the preterm gastroschisis-affected pregnancy with substantial bowel dilatation remains to be determined.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective: To establish a gestational age reference range for fetal plasma aldosterone concentration and to determine whether anemia, growth retardation, or hydrops are associated with abnormal levels.Methods: Aldosterone concentration was measured in umbilical venous blood obtained by funipuncture from pregnancies complicated by red blood cell isoimmunization (n = 17), fetal growth retardation (n = 8), and nonimmune hydrops fetalis (n = 17). Values were compared to reference ranges constructed from the study of samples obtained by funipuncture or at elective cesarean delivery from 40 essentially normal fetuses and maternal blood from 33 uncomplicated pregnancies.Results: In the control group, the fetal plasma aldosterone concentration increased linearly with gestation, reaching adult levels at term. In nonimmune hydrops and red blood cell isoimmunization, the aldosterone concentration was increased. In the growth-retarded fetuses, the levels were not significantly different from normals.Conclusion: The gestational age-related increase in fetal plasma aldosterone concentration presumably reflects maturation of adrenal function. In certain abnormal pregnancies, fetal aldosterone concentrations increase.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective: To test the hypothesis that women with insulin-dependent (type I) diabetes have a threshold of glycemic control in early pregnancy for increased risks of spontaneous abortion and congenital malformations.Methods: Receiver-operating characteristic (ROC) curves were formed for the occurrence of abortion and malformations as a function of the median first-trimester preprandial blood glucose concentration and the first measured glycohemoglobin concentration in pregnant women with type I diabetes.Results: Fifty-two of the 215 women (24%) who enrolled before 9 weeks' gestation had spontaneous abortions. Six percent of the women enrolled before 14 weeks had infants with major congenital malformations. Thresholds for an increased risk of abortion and malformations were a median first-trimester blood glucose concentration of 120–130 mg/dL or an initial glycohemoglobin concentration of 12–13% (6.2–7.5 standard deviations above the normal mean).Conclusions: Type I diabetic women with initial glycohemoglobin concentrations in pregnancy above 12% or median first-trimester preprandial glucose concentrations above 120 mg/dL have an increased risk of abortion and malformations. Below these glycemic thresholds, the risks are comparable to those in nondiabetic women.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective: To measure the amniotic fluid (AF) and plasma concentrations of cortisol in women with preterm labor and intact membranes.Methods: Thirty-eight normal healthy women with singleton gestations, preterm labor, and intact membranes at 32–36 weeks' gestation underwent amniocentesis for evaluation of the microbiologic status of the amniotic cavity. Nineteen women delivered within 1 week of amniocentesis (preterm labor and delivery group), and 19 delivered at term (preterm labor and term delivery group). Maternal plasma and AF concentrations of cortisol were measured with sensitive and specific, commercially available radioimmunoassay kits.Results: The median plasma cortisol concentration was significantly higher in women who delivered prematurely than in those who delivered at term (260 versus 240 ng/mL; P = .014). However, no significant differences in median AF cortisol concentrations were detected between the groups (13 versus 14 ng/mL).Conclusions: Although maternal plasma cortisol concentrations were significantly higher in women with preterm birth, no similar changes were found in the AF. The rise in maternal plasma cortisol may be related to the stress mechanism of labor.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective: To determine the clinical course and perinatal outcomes of women with pneumonia complicating pregnancy.Methods: Between 1989 and 1993, we admitted 71 pregnant women for treatment of community-acquired pneumonia. Exposure and outcome variables as well as characteristics of their clinical course were identified and analyzed. Two-sample Wilcoxon rank-sum and Fisher exact tests were used for statistical analyses.Results: Five women had adverse pregnancy outcomes related to pneumonia: two maternal-fetal deaths, one preterm delivery, one fetal death, and one early abortion. Compared with women whose pregnancies went to term, these five women had a significantly lower mean oxygen pressure on admission (68 versus 83 mmHg). Other risk factors for adverse outcome included diffuse radiologic pulmonary involvement and current smoking of more than ten cigarettes per day. Neither illicit drug use nor anemia were risk factors. Although 31 of these 71 women had underlying chronic diseases, these were not associated with negative outcomes.Conclusions: Despite prompt hospitalization and treatment, antepartum pneumonia is potentially serious, even in young, otherwise healthy women. Although underlying maternal disease appears to be related to the development of antepartum pneumonia, we did not confirm previous reports that suggested its relation to adverse pregnancy outcome.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective: To identify sensitive epidemiologic predictors of a positive hepatitis C virus antibody test in asymptomatic persons, and to compare the cost of testing only persons with an epidemiologic predictor to that of universal screening.Methods: Seventeen hundred consecutive pregnant women were tested by enzyme-linked immunosorbent assay for antibody to hepatitis C virus. Seventy-five subjects tested positive and were compared with 257 pregnant women who tested negative. Cohort and control patients were interviewed and their medical records were reviewed to identify those with chosen predictors of a positive hepatitis C virus antibody test.Results: Seventy-four of 75 cohort patients and 108 of 257 controls had one or more predictors of a positive antibody test. Cohort patients were significantly more likely (P < .001) to have the following: human immunodeficiency virus infection, a sex partner with a risk factor for hepatitis, age greater than 30 years, and a history of drug use, blood transfusion, sexually transmitted disease, hepatitis, or incarceration. The sensitivity and specificity of a single predictor in identifying a person with a positive test were 99 and 58%, respectively. The cost of finding a single individual with a positive antibody test by universal screening was $674, compared to $303 by selectively screening persons with one or more predictors of a positive antibody test.Conclusions: Most individuals with positive hepatitis C virus antibody tests can be identified on the basis of epidemiologic predictors, reducing the cost of testing by 55%. These patients may receive appropriate medical therapy, and their children may be evaluated for possible infection by vertical transmission of hepatitis C virus.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID