ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Preterm deliveries (PTDs) are a leading cause of neonatal morbidity and mortality in the world. Efforts to prevent PTD have been hampered by a poor understanding of the underlying pathophysiology, inadequate diagnostic tools, and generally ineffective therapies. There is increasing clinical and laboratory evidence that many PTDs result from premature activation of cells in the cervix, decidua, and fetal membranes in response to local mediators of maternal or fetal stress, ascending genital tract infection, and/or decidual hemorrhage. Putative mediators include peptide hormones (e.g. corticotropin releasing hormone (CRH)) and/or inflammatory-cytokines (e.g. interleukin-1, −6, and −8 (IL-1, −6 and −8)) which promote the production of oxytotic factors (e.g. prostanoids and endothelin) capable of eliciting uterine contractions and enhancing expression of proteases capable of initiating cervical change and/or membrane rupture. The identification of cervical, decidual, and/or chorionic extracellular matrix (ECM) proteins (e.g. collagen fragments and fetal fibronectin) and ECM-degrading proteases (e.g. collagenases and granulocyte elastase) in maternal serum and cervicovaginal secretions may provide new approaches to the detection of patients at high risk for PTD. In addition, our growing understanding of the pathogenic processes preceding PTD have led to new therapeutic approaches including antibiotic, anticytokine, and antiprotease treatments.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The concept that endothelial cell activation and injury constitutes the key pathogenetic event is receiving increasing support, but the causative factor or factors are, as yet, unclear. The search for a reliable and clinically useful test to identify pregnant women at risk continues. No definitive conclusions can yet be drawn as to the efficacy and safety of low-dose aspirin prophylaxis. Monitoring of maternal-fetal condition, careful consideration of maternal and perinatal risks, and a balanced decision to continue or terminate pregnancy are key elements of clinical management.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Cordocentesis is a feasible, reliable, and safe method for fetal evaluation of a wide variety of disorders. It has allowed for in-utero treatment of fetal red cell isoimmunization and opened future routes for other fetal therapies. In this review, results of a multicenter intrauterine fetal blood sampling registry will be presented, outlining current indications, techniques, and complications of the procedure. In addition, current research in the assessment and treatment of fetal erythrocyte isoimmunization and infection, as well as the role of cordocentesis in rapid genetic karyotyping, work-up of non-immune hydrops, fetal platelet abnormalities, and fetal growth restriction will be reviewed. Recent work using cordocentesis to better understand fetal metabolism, endocrinology, and immunology will also be reviewed.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Doppler velocimetry of umbilical, fetal, and uteroplacental vessels provides important information on fetal and uterine hemodynamics and has therefore become one of the most dynamic areas of perinatal research. Examinations of umbilical artery velocity waveforms have gained recognition as a valuable clinical method of fetal surveillance in risk pregnancies. Pathological Doppler findings, especially the finding of absent or reverse end-diastolic (ARED) flow velocity, are associated with fetal hypoxia and adverse outcome of pregnancy. The first follow-up studies indicate that abnormal Doppler findings are associated with impaired postnatal neurological development. Velocimetry of the fetal middle cerebral artery provides important information on redistribution of fetal blood flow in hypoxia; its place in clinics remains to be established. Similarily, more studies are needed to evaluate the use of Doppler velocimetry in labor. Possibly, the Doppler method may facilitate the interpretation of equivocal cardiotocography (CTG) tracings. New evidence has been collected on the correlation between hemodynamic findings and the morphology of the placenta and the placental bed. One of the very important applications of Doppler velocimetry is the evaluation of pharmacological effects on fetal circulation of drugs used for treatment in pregnancy and labor.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The most important papers address controversial aspects of fetal cardiology, for example, screening for congenital heart disease (CHD), the diagnosis and the accuracy of diagnosis, and the management of fetal tachycardias. There are some interesting additions to the literature although some conclusions require further evaluation.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The use of drugs for common pregnancy complications like premature labor, hypertensive diseases, and premature rupture of membranes with chorioamnionitis is reviewed. In addition, new publications on antiviral drugs in HIV-positive pregnant patients are also discussed. Among the drugs, suppressing premature labor side-effects of β-mimetics are of growing concern. The effectiveness of other agents like magnesium, indomethacin, and sulindac are addressed. The various mechanisms explaining the beneficial effect of magnesium in pre-eclampsia are reviewed and new data on antihypertensives, such as labetalol, calcium channel blockers, and methyldopa are presented. The evidence from various clinical trials on the value of low-dose aspirin as a prophylactic agent against pregnancy-induced hypertension, pre-eclampsia, and intrauterine growth retardation in high-risk and low-risk patients is compared. Pharmacokinetic data including transplacental transfer of antibiotics and anti-HIV nucleosides are part of this review.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Treatment of fetal anomalies has allowed the intact survival of increasing numbers of fetuses with previously fatal or very likely fatal disorders. Percutaneous in-utero surgery for obstructed bladders and thoracic effusions, and open surgery for diaphragmatic hernias and lung malformations has become increasingly successful. Medical and gene therapy approaches are likewise expanding and will continue to become more available.

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:1040-872X    

出版商:OVID    

年代:1994

数据来源: OVID