摘要:

The most reliable tool at present for the prenatal detection of open neural tube defects is the amniotic fluid alpha-fetoprotein assay. Nevertheless its nonspecificity and false-positive results produced by fetal blood admixture and other less well-defined causes have spurred the search for a more specific test. Increased amniotic fluid acetylcholinesterase activity has been reported in association with open neural tube defects. The authors have assayed acetylcholinesterase iri second-trimester amniotic fluid samples with previously determined alpha-fetoprotein values from 200 pregnancies with 96.5% of the outcomes known. These pregnancies were selected because of known fetal abnormalities or difficulties in prenatal diagnosis. High alpha-fetoprotein and acetylcholinesterase activity was detected in all 66 cases of open neural tube defects. The authors were able to reclassify correctly 89% of normal pregnancies with spuriously high alpha-fetoprotein by demonstrating no acetylcholinesterase band after slab gel electrophoresis. Nine cases with a normal outcome but high alpha-fetoprotein values and acetylcholinesterase activity constitute the remaining false-positive results. Notwithstanding the false-positive results, which may have been due to undetected fetal blood admixture, the acetylcholinesterase gel electrophoresis assay is clearly a valuable adjunctive test to the alpha-fetoprotein assay for the prenatal detection of neural tube defects. Although not specific for open neural tube defects, acetylcholinesterase analysis by gel electrophoresis of amniotic fluid is significantly less influenced by fetal blood than is alpha-fetoprotein and, furthermore, may prove as reliable a diagnostic test for open neural tube defect.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

To study time trends in maternal mortality in the United States and to attempt to compare the risk of cesarean with vaginal delivery, information from the Professional Activities Study of the Commission on Professional and Hospital Activities for 3 years—1970,1974, and 1978—was reviewed. For all deliveries, mortality per 100,000 deliveries declined from 25.7 in 1970 to 14.3 in 1978. For vaginal deliveries, mortality per 100,000 deliveries declined from 20.4 to 9.8. For cesarean deliveries, mortality per 100,000 births decreased more than for vaginal deliveries, from 113.8 to 40.9. Mortality for deliveries with no mention of complications, lacerations, or uterine rupture declined significantly from 1970 to 1978. Mortality for deliveries complicated by dystocia or malpresentation declined significantly from 1970 to 1974, but failed to decline thereafter. Mortality for deliveries complicated by a previous cesarean or by antepartum hemorrhage did not decline significantly from 1970 to 1978. For all complications with a sufficient number of vaginal and cesarean deliveries, except deliveries complicated by malpresentation or antepartum hemorrhage, mortality was at least twice as high in cesarean as in vaginal deliveries. Based on a comparison of mortality after a previous cesarean with mortality for all vaginal deliveries and for vaginal deliveries with no complication, the authors conclude that cesarean delivery is probably neither less than 2 nor more than 4 times more hazardous than vaginal delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Preterm and term deliveries were analyzed at The Johns Hopkins Hospital from January 1,1976, through December 31, 1977, to determine maternal infection risks associated with premature rupture of the membranes (PROM). Gravidas who delivered preterm infants demonstrated an increased incidence of endometritis with or without PROM. The risk of endometritis attributable solely to PROM was insignificant compared with the risk attributable to preterm delivery. These findings implicate infection in the mechanism of preterm labor, with or without PROM.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A study on induction of labor was carried out to test the hypothesis that changing the cervix will enhance the effectiveness of induction of labor. Fifty pregnant women near term with Bishop scores of 4 or less were divided into 5 study groups, in which a 12-hour preparation phase procedure was carried out to produce cervical or myometrial changes. All women had continuous measurement of uterine activity by an extraovular catheter. The patients were divided into 1) control subjects, and into groups treated with 2) laminaria, 3) Foley catheter, 4) amniotomy, and 5) oxytocin infusion. These preparation techniques were used for 12 hours, after which rupture of membranes was carried out in all cases. Although all procedures significantly changed the cervix, none but oxytocin affected the induction-to-delivery interval. The authors concluded that when a study design rigidly controls for cervical Bishop score, timing of rupture of membranes, and oxytocin infusion rates, the cervical preparation alone will not enhance inducibility.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Over the past decade, 24-hour urinary estriol determination has become an integral part of the evaluation and monitoring of high-risk obstetric patients for fetal well-being. This study was undertaken to assess the utility of estriol determinations obtained by simpler collection methods: serum estriol and first morning urine specimens. Serum estriol proved to be an unreliable predictor of 24-hour urine values and of estriol fluctuations. Although the correlation between first morning and 24-hour urinary estriol: creatinine ratios was statistically significant (P<.0001), any single first morning specimen value chosen at random was a poor predictor of the corresponding 24-hour specimen value. However, in the monitoring of high-risk obstetric patients, it is the significant changes with respect to time rather than the absolute estriol levels that are of interest. As the plots of first morning and 24-hour specimen values with respect to time in 8 subjects exhibit time trends of equivalent diagnostic utility, it is concluded that first morning values may be used in place of 24-hour values to monitor high-risk obstetric patients, making the process simpler and quicker.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Ultrasonography now offers the opportunity to evaluate selected high-risk pregnancies for the presence of fetal malformations that are amenable to corrective measures as well as of those that remain incompatible with life. The authors observed major fetal malformations in 1% of 6050 cases that underwent antenatal ultrasonographic evaluation. A series of 9 prenatally diagnosed gastrointestinal tract anomalies, including the first documented instances of esophageal atresia diagnosed in utero, is presented in detail. Abdominal wall defects were those most commonly encountered in this series and were diagnosed as early as 16 weeks' gestation. The gastrointestinal system is not only one of the most common sites of birth defects, but it is also the one wherein lies the greatest hope for a successful neonatal outcome. The value of prenatal diagnosis in a comprehensive perinatal approach to congenital gastrointestinal lesions is emphasized. Forewarning the obstetrician and alerting the pediatric-surgical team for resuscitation, immediate postnatal evaluation, and timely intervention decrease neonatal mortality and increase the chance of long-term infant survival.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Seventeen patients treated with clomiphene citrate were examined using real-time ultrasound during 28 ovulatory cycles to determine the pattern of follicular development under clomiphene stimulation. The rate of growth was faster, but the follicular diameter range at ovulation was similar to that during spontaneous cycles. This information was used to time midcycle human chorionic gonadotropin (hCG) administration in over 97 cycles in 21 patients responsive to clomiphene who had not conceived. When hCG was given when the mean follicular diameter reached 18 mm, 92% of these cycles were ovulatory. Fourteen patients (67%) conceived within 6 ovulatory' treatment cycles. Five of 7 patients (71%) who did not conceive were found to have endometriosis at laparoscopy. Midcycle cervical scores were significantly lower in clomiphene-treated as compared with spontaneous ovulatory cycles, and additional treatment with ethinyl estradiol did not effect a significant improvement. Timing of midcycle hCG using ultrasound is an effective method of inducing ovulation in patients in whom an estrogenic follicular response without ovulation is obtained with clomiphene treatment.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Fifteen patients with idiopathic hirsutism, who had no attenuated adrenal hyperplasia, obesity, enlarged ovaries, or amenorrhea, were studied. Excessive androgen secretion by adrenal tissue was suggested by the finding of increased levels of dehydroepiandrosterone sulfate, which decreased after dexamethasone administration but did not change after human chorionic gonadotropin (hCG) injection. Excessive androgen secretion by ovarian tissue was suggested by the finding that testosterone and androstenedione levels were elevated, correlated significantly with the levels of luteinizing hormone, decreased with administration of estrogenprogestagen, and increased after hCG injection. Notably, free testosterone levels, which were significantly increased, were only partially suppressed during dexamethasone or estrogen-progestagen administration. These results provide further evidence that both the adrenals and the ovaries secrete androgens excessively in patients with idiopathic hirsutism.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Two groups of subjects living at different altitudes were stimulated with synthetic luteinizing hormone-releasing hormone (LH-RH) or with an LH-RH analog. One hundred (Ag LH-RH was given subcutaneously to 19 men and 19 women, all normal, of reproductive age, and living at sea level, and to 19 men and 20 women living at a high altitude (2940 m). In neither sex, however, were the differences in peak responses for both gonadotropins significantly different between the sea level and high-altitude groups. Plasma levels of LH and follicle-stimulating hormone (FSH) were also measured after administration of [D-Leu6, des Gly- NH210]-LH-RH ethylamide (25 µg subcutaneously) in 32 men and 37 women living at sea level and at high altitude. The analog induced a powerful and protracted stimulation of the release of LH and FSH irrespective of altitude and sex. The responses of men and women to the LH-RH analog, both for LH as well as for FSH, were significantly greater at sea level than at high altitudes.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Thirteen of 14 patients with vaginismus have been successfully treated using systematic in vivo desensitization and other simple but individualized behavioral techniques. Resolution of symptoms was usually effected within 3 to 4 weekly sessions with important supplementary home assignments. All but 1 patient were seen without partners. Neither mechanical dilators nor hymenotomy was employed. Primary orgasmic dysfunction was associated with vaginismus in a minority of patients and was treated concomitantly. Vaginismus appears to be more frequent than the literature indicates and can be situational or absolute. Presenting symptoms include an inability to tolerate pelvic examination, severe superficial dyspareunia, and a history of unconsummated coitus. Although gynecologic experience with vaginismus has been generally limited, the gynecologist is seen as a potentially ideal therapist for establishing or confirming the diagnosis at the time of pelvic examination.

ISSN:0029-7844    

出版商:OVID    

年代:1982

数据来源: OVID