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Main indications for antenatal administration glucocorticoid to pregnant women are premature contractions, hemorrhage during pregnancy, conditions of fetal distress and maternal diseases. There are some absolute or relative contraindications as well: severe forms of preeclampsia, diabetes mellitus, premature rupture of membranes, maternal and/intrauterine infections. In a retrospective evaluation of the data obtained at our institution of 637 nonrandomized cases from the years 1980-1985, we could demonstrate the dependence of the therapeutic results on the sex of the newborn. The RDS incidence is significantly different after betamethasone prophylaxis. It was 1/25 (4%) in girls compared to 13/31 (42%) in boys. A marked reduction of the RDS incidence is only detectable after betamethasone therapy from the 32nd to the 34th week of gestation. Thus we recommend RDS prophylaxis for all patients with premature contraction, mainly between the 32nd and 34th week of pregnancy. In addition, it should be given in cases of confirmed lung immaturity. Special restrictions are necessary in cases of preeclampsia, eclampsia, diabetes and confirmed maternal infections. In the group of diabetes or preeclampsia patients an RDS prophylaxis should only be given, if at all, when it can be performed under intensive care conditions.
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PMID:Clinical aspects of antenatal glucocorticoid treatment for prevention of neonatal respiratory distress syndrome. 344 99

The fibrinolytic response to venous occlusion was assessed in 29 women with normal or complicated pregnancy, by measurements of total t-PA and free t-PA with specific ELISAs. The release of t-PA from the vessel wall was 11 +/- 9 ng/ml in non-pregnant women (mean +/- SD, n = 6) but was markedly reduced throughout pregnancy. Following venous occlusion, free t-PA increased by 12 +/- 11 ng/ml in non-pregnant women but remained below the detection limit of 2 ng/ml towards the end of pregnancy. A markedly reduced t-PA release with absence of free t-PA was also observed during late pregnancy in patients with insulin-dependent diabetes mellitus, intra-uterine growth retardation and pre-eclampsia. Plasma levels of fragment D-dimer of cross-linked fibrin were measured with a specific ELISA in 79 pregnant women. D-dimer levels were 129 +/- 36 ng/ml (mean +/- SD, n = 8) in non-pregnant women and increased to 400 +/- 170 ng/ml (n = 25) and 440 +/- 220 ng/ml (n = 22) during the second and third trimester of pregnancy respectively. Significantly higher levels than observed in uncomplicated third trimester pregnancies were found in 3 out of 6 diabetic and in 2 out of 7 pre-eclamptic women. It is concluded that the t-PA release after venous occlusion is significantly reduced during pregnancy. In addition, released t-PA is rapidly inhibited. The levels of fragment D-dimer increase during pregnancy, suggesting that, notwithstanding the marked impairment of the fibrinolytic response to venous occlusion, the fibrinolytic system remains functionally active.
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PMID:Fibrinolytic response to venous occlusion and fibrin fragment D-dimer levels in normal and complicated pregnancy. 344 23

Nutritional antioxidants support prostacyclin synthesis by preventing lipid hydroperoxide-mediated inhibition of prostacyclin synthetase. Recent preliminary clinical studies indicate that supplementary antioxidants exert antithrombotic effects in vivo that are most likely attributable to enhanced prostacyclin production. Optimal antioxidant nutrition may thus have preventive and therapeutic value for disorders in which inappropriate platelet aggregation plays an etiologic role, including MI, stroke, atherogenesis, pre-eclampsia, and the vascular complications of diabetes. In light of evidence that platelet aggregation encourages the implantation of hematogenous tumor metastases, supplemental antioxidants should also impede tumor dissemination--an effect which will be complemented by the immunostimulant actions of these nutrients. By exerting anticarcinogenic, immunostimulant and anti-metastatic effects, nutritional antioxidants should act to inhibit neoplasia at each stage of its development.
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PMID:An antithrombotic role for nutritional antioxidants: implications for tumor metastasis and other pathologies. 352 Feb 53

High-risk pregnancies require specialized obstetric and anesthetic care. A basic understanding of how specific pathophysiology and pharmacologic therapy interact with anesthetic care is essential for both obstetrician and anesthesiologist. This paper selectively focuses on preeclampsia/eclampsia, diabetes mellitus, prematurity, multiple gestations, infectious disease, preexisting neurologic disease, and preexisting cardiac disease, reviewing anesthesia for labor and vaginal and cesarean delivery for each high-risk problem, as practiced at a Level III perinatal unit. Emphasis will be placed, when appropriate, on recent experience with monitoring and aggressive pharmacologic therapy of the critically ill parturient.
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PMID:Anesthesia for the high-risk parturient. 355 69

The perinatal mortality of 613 children who were born to women with diabetes mellitus who attended the Diabetic Clinic of The Royal Women's Hospital between 1970 and 1985 was 4.5%. In 399 children who were born to mothers with pre-existing diabetes (95% of whom were insulin-dependent) the over-all perinatal mortality was 7.5%. In successive five-year periods, perinatal mortality in this group declined from 12.2% to 3.9% (1981-1985). In 214 children who were born to mothers with gestational diabetes, the perinatal loss was 1.4%. Between 1970 and 1985, the fetal loss that was attributed to poor control of diabetes declined; however, the prevalence of congenital abnormalities remained unchanged and these were the major cause of fetal loss in 1981-1985. Other high-risk categories that were identified included obstetric complications, particularly that of pre-eclampsia. Neonatal complications had little effect on the eventual outcome, but respiratory distress, macrosomia, hypoglycaemia, jaundice, polycythaemia, hypocalcaemia and hypomagnesaemia were documented frequently and required specialized assessment. The causes of the improvement in the outcome of pregnancy in women with pre-existing diabetes appear to be multifactorial and due to team management in a specialized unit. A reduction in the increased prevalence of major congenital abnormalities is the major challenge for the future.
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PMID:Pregnancy in women with diabetes mellitus. Fifteen years' experience: 1970-1985. 357 10

All cases (884) of placental abruption reported on Washington State birth or fetal death certificates in 1980 and 1981 were compared with 789 randomly selected births from the same time period. The incidence of reported cases of placental abruption was 6.5 per 1000 total births. The combined stillbirth and first month death rate of all abruption cases was 21%. Increased risks of placental abruption were associated with pre-eclampsia, diabetes, and unmarried status. Neither parity nor maternal age was associated with an increased risk. Infants born after abruption were significantly smaller-for-gestation than control infants, more likely to be male, and had malformations more frequently than control infants. Apgar scores of liveborn abruption infants were significantly lower than those of controls after adjustment for infant weight, gestational age, and sex.
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PMID:Correlates of placental abruption. 358 Mar 16

Pregnancy hypertension, blood pressure during labor, and the umbilical cord blood lead concentration were assessed in 3851 women for whom additional demographic, medical, and personal information was available. Lead levels correlated with both systolic (Pearson r = 0.081, p = 0.0001) and diastolic (r = 0.051, p = 0.002) blood pressures during labor. The incidence of pregnancy hypertension increased with lead level. Multivariate models of pregnancy hypertension and systolic blood pressure as a function of maternal age, parity, hematocrit, ponderal index, race, and diabetes were improved by including lead as a predictor variable. At these observed levels of exposure (mean blood lead, 6.9 +/- 3.3 [SD] micrograms/dl), lead appears to have a small but demonstrable association with pregnancy hypertension and blood pressure at the time of delivery, but not with preeclampsia.
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PMID:Pregnancy hypertension, blood pressure during labor, and blood lead levels. 365 74

To measure changes in bone alkaline phosphatase (EC 3.1.3.1) activity in serum as a function of duration of pregnancy, we adapted our existing alkaline phosphatase (ALP) isoenzyme assay (which has been used to measure bone, hepatic, and intestinal ALP activities in serum, in the absence of placental ALP) to allow quantification of individual ALP isoenzyme activities in the presence of placental ALP. The resulting CV for repeat measurements of bone ALP activity in artificial isoenzyme mixtures ranged from 23% for samples in which the bone isoenzyme represented 7% of total ALP activity to 11% for samples in which bone ALP accounted for 48% of total ALP activity. Values for repeat determinations of bone ALP activity in human serum samples (i.e., including samples obtained from pregnant women and from nonpregnant controls) varied by an average of 18%. We find, in initial applications of this method, that (a) the amount of bone ALP activity in serum is increased during pregnancy (P less than .001), and remains increased at six weeks postpartum, in non-lactating women (P less than .001), and (b) bone ALP activity at term was not significantly different in pregnant women with pre-eclampsia, diabetes, premature rupture of membranes, or premature labor, compared with normal pregnancies at term. Our data support the hypothesis that maternal bone formation may be increased during pregnancy.
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PMID:Time-dependent changes in bone, placental, intestinal, and hepatic alkaline phosphatase activities in serum during human pregnancy. 366 32

A comparison of pregnancy course and outcome between 648 Hmong refugee women and 5278 non-Hmong controls, all of whom delivered at a Minnesota medical center in 1976-83, indicated that Hmong women were 5 times as likely to have a history of previous perinatal loss. In terms of demographic factors, Hmong women were more likely to be age 35 years or above at delivery (14% versus 2% among controls), to be grant multiparas (33% versus 3% among controls), and to be married (95% versus 61% among controls). While 59% of controls began prenatal care during the 1st trimester, only 16% of Hmong women fell into this category and 31% delayed receiving care until the 3rd trimester. A review of the obstetric histories revealed that 18.1% of Hmong women compared with 3.7% of controls had experienced 1 or more previous perinatal loss. Medical conditions found with significant frequency in the Hmong population included anemia, tuberculosis, malaria, and parasitic infestations. Preeclampsia, hypertension, diabetes, urinary and vaginal infections, and gonorrhea occurred less frequently among Hmong women than among controls. Moreover, the incidence of premature rupture of the membranes was only 4.2% among Hmong women compared to 11.8% among controls. The prematurity rate was 48.5/1000 in the study group and 117/1000 in controls; in addition, only 7.8% of Hmong infants compared to 10.9% of control infants were low birthweight (under 2500 grams). The perinatal mortality rate was similar in both groups: 14.6/1000 among Hmong infants and 15.0/1000 among controls. Contraception was accepted by 50% of the Hmong mothers, but under 10% remained users 12 months after delivery and 27% were pregnant again. The generally good pregnancy outcomes recorded among these Hmong women despite the existence of numerous high-risk factors--short stature, advanced maternal age, grand multiparity, late prenatal care, and poor nutrition--is surprising. It appears that relocation to the US has enabled this population to overcome the factors that contributed to their previous high rates of perinatal loss.
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PMID:Pregnancy in Hmong refugee women. 369 14

Forty-four of 75 pregnant women with juvenile-onset insulin-dependent diabetes, who attended a preconceptional clinic, were seen regularly by a diabetologic team. Glycemic control was obtained by intensified insulin therapy and monitored by blood glucose self-monitoring. When these patients were compared with a group of 31 nonattenders of the preconceptional clinic, in the former normoglycemia and normal hemoglobin A1 values were achieved before conception, whereas in the latter good control was reached by the second trimester. This group had also more maternal complications, such as preeclampsia, and higher cesarean section rates. Congenital anomalies were 9.6% among offspring of nonattenders, while none occurred in those with preconceptional counseling. We confirm the evidence accumulated in the recent literature that congenital malformations in pregnancy complicated by diabetes may be linked to disturbances in maternal metabolism during the period of embryogenesis. Consequently we concur with the recommendation that tight diabetic control is required before the patient attempts to conceive.
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PMID:Pregnancy outcome in patients with insulin-dependent diabetes mellitus with preconceptional diabetic control: a comparative study. 374 Jan 44


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