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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The most important advancement in perinatology during the past few years has been the possibility to selectively establish a criterion to judge high risk pregnancies, which still represent the great majority of cases of materno-infant morbimortality. Social, economic, and cultural factors, age, biological antecedents of the mother, previous pregnancies, and medical history, have all a great influence in the evaluation of gestation. Through the years several models have been constructed to evaluate high perinatal risks; excluding complications due to danger of congenital abnormalities only 19% of women are exposed to high risk pregnancy. Among prenatal risk factors the most common are toxemia, chronic hypertension, severe cardiopathy, and diabetes; risk factors that may become more evident during delivery or shortly before it are toxemia again, premature rupture of membranes, meconial amniotic fluid, and abnormal presentation.
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PMID:[Perinatal medicine. Medico-social implications. I. Technics used in the identification of high risk pregnancy]. 45 11

The Murless head extractor has been used since long time ago as a vector, extractor and head rotator through cesarean section diminishing the injury feto-maternal. From march to june 1991, 50 patients with cesarean section indication and with fetus in head presentation were gotten out using this way, analyzing 12 maternal parameters and 9 fetal. The most frequent indication of cesarean section was severe Preeclampsia 41%, third cesarean section 14.7%, fetal distress 14.7%, low reserve fetal 11.7%, PROM 8.8% and others 9.1%. The height of the head was at the first plane in 59.4%. The Apgar score at the minute was of 9 in 6.0%, of 8 in 60.6%, of 7 in 18.1%, of 6 in 12.1% of 4 in 3.3%. The Apgar score at five minutes was 9 in 84.8% and 8 in 12.1% for a total of 96.9%. An USG transfontanelar was practiced in 40 products from which 37 (92.5%) were normal and in 3 (7.5%) it was found: in one brain light edema and in two hypoxical encephalopathy (caused by severe Preeclampsia, chronic hypertension and superimposed preeclampsia and fetal distress due to cord around the neck. In the other ten cases USG was not used for another reasons. Maternal morbi-mortality and general due to extractor use, was not obtained not either fetal morbi-mortality. It was concluded that the head extractor is useful, does not increase the obstetrical injury and it is easily applied).
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PMID:[Evaluation of the Murless head extractor]. 147 10

A case-control study on preterm delivery was conducted in Jianan and Jianhan District, Wuhan City in 1988. 130 singleton preterm infants were included with 260 term infants as control. The results showed that the risk factors in prematurity were edema-proteinuria-hypertension syndrome (OR 1.8), maternal diseases in pregnancy (OR 1.6), hyperemesis gravidarum (OR 5.1), vaginal bleeding during pregnancy (OR 2.4), premature rupture of membranes (OR 3.6), low weight gain and low average weight gain per week during pregnancy, psychosocial stress during pregnancy, inadequate prenatal care, maternal stature less than 158 cm (OR 1.7), menarche before age 12 (OR 4.3), multi-gravida (OR 2.1), previous induced abortion (OR 2.1) and passive cigarette smoking during pregnancy. The author suggests that early treatment of complications of pregnancy and forcing prenatal care should be emphasized in order to reduce the incidence of preterm births.
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PMID:[Preterm delivery and its risk factors]. 150 73

Prenatal cocaine use has become an increasingly important public health problem in the last decade. Interpretation of epidemiologic studies designed to assess the association between cocaine use and adverse pregnancy outcomes is limited by inaccurate measurement of cocaine use, misclassification of users as non-users, confounding by socioeconomic factors, and reporting bias. Studies have consistently documented placental abruption as a maternal reproductive risk associated with cocaine use. Although suggested, less evidence is available to link cocaine use with premature rupture of membranes, spontaneous abortion, pregnancy-induced hypertension, precipitate delivery, or fetal death. Infant outcomes consistently associated with prenatal cocaine use include decreased birth weight, prematurity, and decreased fetal growth. Data on the relationship between prenatal cocaine use and congenital anomalies are limited, but one large retrospective study has documented an association between maternal cocaine use and congenital abnormalities of the urinary tract. Evidence linking prenatal cocaine use and an increased incidence of perinatal cerebral infarction or sudden infant death syndrome is lacking. Future studies should focus on the effect of maternal cocaine use on pregnancy outcome in diverse socioeconomic groups, longitudinal follow-up of exposed children, and the relationship between cocaine use and maternal behaviors that may affect access to prenatal care.
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PMID:Risks associated with cocaine use during pregnancy. 156 65

A three-county program in southern West Virginia was developed by an obstetric practice to deliver prenatal care to a population of uninsured patients. Between January 1984 and December 1986, 1331 (29.4%) of 4534 patients were delivered at a level 2 hospital after prenatal care within the clinic program. The hospital-wide fetal death ratio declined from 11.8 to 7.2 per 1000 live births during the years of clinic operation, a statistically significant reduction (P = .02). Uninsured patients experienced a statistically significant reduction in fetal death ratio during the program, from 35.4 to 7.0 per 1000 live births (P = .02), whereas those covered by medical assistance did not experience a reduction. Privately insured patients also had a significant decrease, from 10.0 to 3.1 per 1000 live births (P less than .001). The increasing operating expense, mainly due to rising malpractice insurance premiums, required suspension of the program in December 1986. The fetal death ratio returned to 10.3 deaths per 1000 live births in 1987. Factors that varied significantly during the "clinic" phase included: higher rates of cesarean, diagnosed maternal hypertension, and diabetes mellitus; and lower rates of premature rupture of membranes and non-white population. Other factors, including age over 35 years, postdatism, incidence of twins, incidence of lethal congenital anomalies, and single marital status, did not vary significantly before, during, or after the clinic program. This study identified a high-risk population of patients who did not qualify for medical assistance coverage and were de facto "uninsured." The results suggest that prenatal care for this high-risk population of uninsured patients can reduce the fetal death rate.
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PMID:The impact of prenatal care on fetal and neonatal death rates for uninsured patients: a "natural experiment" in West Virginia. 172 83

Three uremic patients receiving hemodialysis for more than 5 years became pregnant and proceeded to the third trimester. A variety of complications were noted, including threatened abortion, vanished twin, preterm premature rupture of membranes, polyhydramnios, intra-uterine fetal death, intra-uterine growth retardation, premature labor and hypertension. Two of these 3 mothers gave birth to healthy babies under the management of the high-risk pregnancy team.
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PMID:Pregnancy outcome in patients undergoing long-term hemodialysis. 174 53

Premature separation of the normally implanted placenta is a serious complication of pregnancy and a leading cause of maternal and perinatal morbidity and mortality. Using data from the National Hospital Discharge Survey, we estimated rates of abruptio placentae in the United States for the years 1979-1987 and examined the association of this condition with several demographic risk factors and coexisting obstetric conditions. In 1987, the national rate was 11.5 cases per 1000 deliveries. The rate of abruptio placentae increased significantly between the years 1979-1987 among women of all racial groups. The increase in the rate of placental abruption occurred mainly among women under the age of 25, unmarried women, and women on Medicaid compared with those who had private insurance. Women with placental abruption were 54 times more likely to have coagulopathies and 11 times more likely to have stillbirths than those without placental abruption. Twin gestations, preterm premature rupture of membranes, chorioamnionitis, chronic hypertension, and preeclampsia/eclampsia were also associated with placental abruption. Although the cause for the increase in the incidence of abruptio placentae is not known, most of the increase occurred among women likely to be financially and socially disadvantaged.
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PMID:National trends in the incidence of abruptio placentae, 1979-1987. 194 12

Current recommendations for appropriate weight gain in pregnancy suggest an optimum of 120% of ideal body weight (IBW) at delivery. This represents an increase of approximately 24 pounds in the normal weight woman and even the obese patient (more than 135% IBW) is told to gain 16 pounds. Information concerning gestational weight gain in the morbidly obese woman (more than 160% IBW) has not been reported. We evaluated 40 morbidly obese pregnant women for maternal morbidity relative to gestational weight gain. No correlation was found between maternal weight gain and the development of gestational diabetes, pregnancy-induced hypertension, preeclampsia, preterm labor, premature rupture of membranes, incompetent cervix, or intrauterine growth retardation. The incidence of primary cesarean delivery was statistically greater in those women gaining more than 24 pounds (p less than 0.05). It appears that current recommendations for gestational weight gain in the morbidly obese are excessive and may result in increased maternal risk.
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PMID:Effects of gestational weight gain in morbidly obese women: I. Maternal morbidity. 198 61

Ninety pregnancies conceived by infertile couples using assisted reproductive technologies and 86 pregnancies conceived by infertile couples with routine infertility treatment were analyzed to determine the outcome of and the complications experienced during the pregnancies. Pregnancies ending after 24 weeks' gestation were evaluated for the following complications: pregnancy-induced hypertension, diabetes mellitus, preterm labor, premature rupture of membranes, placenta previa, and fetal growth retardation. A matched control group of normal fertile patients admitted to the obstetric service at Vanderbilt University Medical Center was used to compare the incidence of pregnancy complications among the groups. In the group treated by assisted reproduction, 81 pregnancies were singleton and nine were multiple gestations, whereas in the routine group, 84 were singleton and two were multiple gestations. In the group treated by assisted reproduction, 29 of 90 gestations (32%) ended before 24 weeks, compared with 18 of 86 (21%) in the routine group, a nonsignificant difference. Mean birth weight and gestational age were similar among the three groups for singleton gestations. Among multiple gestations, the mean (+/- standard error of the mean [SEM]) birth weights were 2513 +/- 115, 724 +/- 57, and 2282 +/- 132 g in the group treated by assisted reproduction, the group receiving routine methods, and the control group, respectively (P less than .001 when those treated by routine methods were compared with the other two groups). The mean (+/- SEM) gestational ages were 36 +/- 1.2, 26.5 +/- 2.0, and 35.5 +/- 1.2 weeks, respectively (P less than .01 comparing those treated by routine methods and the other two groups).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Complications of pregnancy in infertile couples: routine treatment versus assisted reproduction. 218 7

The results are presented of fluorescence polarization as a method for measurement of surfactant production in 159 specimens of amniotic fluid collected from pregnant women with diabetes, hypertension, Rh immunization, premature rupture of membranes (for more than 48 h prior to delivery) and intrauterine growth retardation (IUGR). The predictability of the development of respiratory distress syndrome has been assessed by this assay. Its specificity, sensitivity and overall accuracy were similar to the lecithin/sphingomyelin (L/S) ratio. The influence of the conditions detailed on fetal lung maturation was determined, lung development being enhanced until near term by Rh immunization, rupture of membranes and hypertension with IUGR.
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PMID:Measurement of fetal surfactant production by fluorescence polarization of amniotic fluid in complicated pregnancies. 311 58


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