ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In the past year, the results of the European trial comparing chorionic villus sampling and amniocentesis have been published, supporting the findings of the Canadian Collaborative Study of an increased risk associated with chorionic villus sampling. The reporting of an increase in limb reduction abnormalities with chorionic villus sampling before 9 weeks has made us review our current practice. Other developments covered by this review include the management of mild cerebral ventriculomegaly, the treatment of tachyarrhythmias, and developments in fetal surgery. Throughout, the needs for continued collaboration, pooling of data, and the formation of international registers to extend the database from which both doctors and patients may benefit are highlighted.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The possible involvement of genetic and immune mechanisms in the etiology of preeclampsia has attracted increasing attention. Preeclampsia is characterized by a generalized disturbance in endothelial physiology, and not merely by an isolated defect in vascular prostacyclin synthesis. The increased production of oxygen-free radicals, elastase, or both by activated lymphoid cells in the pregnant decidua, a mainly lymphoid tissue, may be the link between the hypothetical immunologic mechanisms and the endothelial injury occurring in preeclampsia. New treatment protocols emphasize timely referral to a perinatal center to obtain optimal maternal and perinatal care. Intensive fetal and maternal monitoring are of vital importance. Optimal management usually involves balancing risks of expectant management for mother and fetus against the risks of extreme prematurity from immediate delivery.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Progress in medical disorders in pregnancy has inevitably occurred over a wide front. Highlights of the past year include the use of real-time ultrasound rather than venography to diagnose deep vein thrombosis in pregnancy, the establishment of Doppler ultrasound for noninvasive measurement of cardiac output, better awareness of the risk to the fetus if the mother has immune thrombocytopenic purpura, the description of the maturation of fetal thyroid function, the problems ofin uterotreatment of congenital adrenal hyperplasia in the fetus, and an appreciation of the fetal risk if maternal phenylketonuria is not managed by strict dieting in pregnancy.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Preterm birth, due to shortened gestation with birth prior to 37 completed weeks gestation, accounts for up to 75% of perinatal morbidity and mortality in the United States. Much basic and clinical research is focused on understanding the epidemiology, pathobiology, and possible means to treat or prevent preterm labor, premature rupture of membranes, and cervical factors leading to preterm birth. Recent key areas of progress in these problems are selectively reviewed, emphasizing aspects that are considered most important for further progress.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A randomized prospective trial has shown that folic acid started before conception and continued for the first trimester reduces the risk of recurrence of neural tube defects by 72% in women with a previously affected child. Carbamazepine exposurein uterois associated with a 1% risk of spina bifida. Long-term follow-up of antenatal exposure to phenobarbital and carbamazepine in two groups of infants shows no neurologic differences between the two groups. Magnesium sulfate is more effective in prevention of recurrent eclamptic seizures than phenytoin. During pregnancy, the need for thyroxine increases in many women. Vitamin B6and ginger are both effective for nausea and vomiting in early pregnancy. Low-dose aspirin does not change the course of preeclampsia when it is started after the diagnosis is made. Angiotensin-converting enzyme inhibitors cause significant disturbances of fetal and neonatal renal function. Prophylactic β-adrenergic agents fail to prevent prematurity in twins. Oral tocolysis with magnesium chloride or ritodrine is no more effective than observation alone. The risk of primary pulmonary hypertension in the newborn after indomethacin tocolysis is increased with prolonged therapy. Lithium causes polyhydramnios from fetal diabetes insipidusin utero. Treatment ofUreaplasma urealyticuminfection with erythromycin during pregnancy does not eliminate the organism from the lower genital tract and does not improve perinatal outcome.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Acquired immunodeficiency virus infections had recently been the leading cause of death in minority women of reproductive age in several urban cities in the United States. In addition, more than 80% of infants with human immunodeficiency virus type 1 infection acquired the infection perinatally. These alarming data have spawned a prodigious body of information about perinatal human immunodeficiency virus type 1 infection. Some of the most recent advances are highlighted in this review. Revolutionary techniques, initially developed in molecular biology, such asin situhybridization, the polymerase chain reaction, and gene sequencing, have also recently made a significant contribution to the diagnosis and better understanding of viral and bacterial infections. For example, organisms such as cytomegalovirus, herpes simplex,Chlamydia, parvovirus,Pneumocystis carinii, and toxoplasma are now detectable by polymerase chain reaction methods. The most recent information in these areas is also briefly reviewed.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A major advance in neonatal care, surfactant replacement therapy, has received wide endorsement and approval after being subject to over 30 clinical trials. Details of clinical application and full impact on outcomes are in the process of being determined. Neonatal outcome data indicate that the focus of improvement in survival now rests primarily on the extremely low birth weight (<750 g) infant. There is additional need for clarity of actual survival by gestational age in the less-than-28-week cohort. The differences and limitations of neonatal and obstetric methods of gestational age assessment are important. Significant contributions to our knowledge of problems such as retinopathy of prematurity, syphilis, and infants of diabetic mothers have recently appeared.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Maternal and perinatal mortality are important health problems in the United States. Emerging causes of maternal deaths are embolism, cardiomyopathy, anesthesia complications, adult respiratory distress syndrome, and acquired immunodeficiency syndrome. Maternal deaths continue to be underreported. Active surveillance is needed to better identify maternal deaths and to understand their causes and risk factors. Although perinatal deaths have declined recently—primarily because technologic advances have improved low-birth-weight babies' chances for survival—they remain a problem, particularly among blacks. Clinicians should strive to reduce preventable deaths among black normal-birth-weight babies and to prevent low birth weight and premature birth among black infants. Future research should focus on determining whether early prenatal care and cesarean delivery actually reduce perinatal mortality. A better understanding of prenatal and intrapartum care and their benefits will help in the development of strategies to reduce perinatal and maternal deaths.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID