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

A study of 147 nulliparous adolescents 15 years of age or younger who sought prenatal care at the University of Texas Medical Branch at Galveston during 1992-94 investigated whether young adolescents were more likely to develop perinatal complications than older adolescents and adult women. 287 adolescents 16-17 years of age and 107 women 20-22 years old who delivered at the same facility during the study period were used for the comparison. Younger adolescents were significantly more likely to develop anemia and less likely to deliver an infant who required admission to the intensive care unit than their older counterparts. There were no differences between the three groups, however, in terms of the prevalence of pregnancy-induced hypertension, preterm labor, preterm premature rupture of membranes, chorioamnionitis, meconium staining, endometritis, preterm delivery, low birth weight, low Apgar score, or fetal death. This study suggests that young age is not an independent risk factor for most perinatal complications.
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PMID:Adverse perinatal outcomes in young adolescents. 933 51

The purpose of this study was to determine by two groups of physicians the use of pregnancy bed rest, the types of activity restriction prescribed, if there is variability in prescription, and if side effects of this treatment are observed. A national survey of 44 directors of maternal fetal medicine (MFM) and a random selection of 47 practicing obstetricians certified by the American College of Obstetricians and Gynecologists (ACOG) was conducted. The survey contained questions about home and hospital bed rest and whether or not side effects of bed rest were observed. Physicians were also asked to indicate the type/degree of activity restriction prescribed for 16 diagnostic scenarios for women with mild hypertension, chronic hypertension, incompetent cervix, preterm labor, premature rupture of membranes, placenta previa, and twin pregnancy. Repeated measures analysis of variance was used to analyze the type of activity restriction prescribed at 20, 24, 28, 32, and 36 weeks' gestation. Results reveal that bed rest was prescribed extensively (89%-93%), but few any physical and psychologic side effects. Physicians in both groups demonstrated marked variability in prescribing the location (home or hospital) and the severity of activity restriction even when treating the same condition. MFM directors were significantly more likely to treat pregnancy-induced hypertension (p < 0.01) and placenta previa with hospital bed rest (p < 0.05). ACOG physicians preferred to prescribe either home or hospital bed rest across all diagnostic scenarios, whereas the prescription by MFM directors related more to the individual diagnosis than to a general preference. Choice of location of bed rest and the severity of activity restriction appear to be functions of physicians' practice style.
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PMID:Prescription of activity restriction to treat high-risk pregnancies. 958 Sep 15

To investigate the perinatal outcome of patients with oligohydramnios (amniotic fluid index < or = 5 cm), but without premature rupture of membranes and fetal congenital anomalies, data from 245 singleton pregnancies were analyzed and compared to those with normal amniotic fluid volumes (5 < amniotic fluid index < 24 cm, n=27,261). Significantly higher incidences of primiparity, pregnancy-induced hypertension, premature separation of placenta, past history of intrauterine fetal death, past history of preterm delivery, postterm pregnancy, and advanced maternal age were noted to be associated with the occurrence of oligohydramnios. Pregnancies complicated by a markedly diminished amniotic fluid volume assessed antenatally by ultrasound were significantly more frequently associated with adverse perinatal outcomes such as preterm delivery, low or very low birth weight, low Apgar scores, intrauterine fetal death, small-for-gestational-age newborns, meconium staining, cesarean delivery, neonatal intensive care, and neonatal death.
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PMID:Perinatal outcome of oligohydramnios without associated premature rupture of membranes and fetal anomalies. 962 87

This article reviews the reported experience with pregnancy after liver transplantation and describes obstetric risks and medical issues that the maternal fetal medicine specialist has a reference for managing these pregnancies and for providing appropriate preconception counseling. Women who undergo liver transplantations have a higher risk of preeclampsia, worsening hypertension, preterm premature rupture of membranes, anemia, small for gestational age, preterm delivery, and cesarean section than the normal obstetric population. Women with preconceptional renal dysfunction appear to be at greatest risk for pregnancy complications. Women who conceived within 6 months of transplant had a high risk of rejection. Reproductive-aged recipients of liver allograft should receive contraception and preconception counseling. In an appropriately timed and planned pregnancy, women who undergo liver transplantations can have successful pregnancies with little risk to their allograft function.
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PMID:Pregnancy after liver transplantation. 963 9

A 35 year old women with premature ovarian failure and another 30 year old women with gonadal dysgenesis were the recipients of donated supernumerous frozen embryos after successfully prepared with cyclic steroid replacement therapy as described previously. One patient received 4 and the second 2 frozen embryos, transferred transcervically on the 3rd day of progesterone administration. Both patients had viable twin pregnancies. The plasma beta hCG levels for both patients at 2 weeks post replacement (4 weeks gestation) were lower than the median values in our normal, uncomplicated singleton pregnancy for the same gestation. The level after 4 weeks post-replacement (6 weeks gestation) became comparable. Plasma progesterone profiles suggested a level of above 70 ng/ml would be enough to support the twin pregnancies. The first patient developed antepartum haemorrhage of unknown origin at 34 weeks of gestation preceding preterm premature rupture of membranes and subsequently had preterm labour. The second patient developed proteinuric hypertension at 33 weeks of gestation. Both ended in a lower segment cesarean section. Both sets of twins and their mothers were discharged well.
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PMID:The first 2 case reports of frozen embryo donation twin pregnancies in Singapore: hormonal profiles and obstetrical outcome. 971 91

The outcome of 32 pregnancies in renal allograft recipients is reported. The mean age at the time of conception was 27.3 years (range, 20 to 37) with an average interval of 47 months from the time of transplantation to conception (range, 2 to 163). Twenty-nine patients received the graft from a living related donor, one from a living no related donor an 2 from cadaver donors. All patients continued their immunosuppressive regimen during pregnancy and only 6 patients were taking cyclosporine A. Hypertension during pregnancy was observed in 10 patients (31%), superimposed preeclampsia in 4 (14%), preterm labor in 4 (14%) and premature rupture of membranes in 2 (7%). Twenty-eight pregnancies resulted in 28 liveborn infants and there were 4 miscarriages. Cesarean section was performed in 17 cases and 11 had vaginal delivery. Intrauterine growth retardation was observed in 4 cases (14%), fetal distress in 2 (7%) and one neonatal death due to multiple malformations. There was not significative impairment of renal function in this group.
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PMID:[Maternal and perinatal morbidity-mortality in pregnant women with renal transplant]. 1063 56

Our objective was to relate pathology of the very low birthweight (VLBW) infant's placenta to pregnancy and fetal characteristics. We correlated the pathologic features of 1146 placentas from infants with birth weights of 500-1500 g who were born between 1/1/91 and 12/31/93 to the number of gestations per pregnancy, initiator of preterm delivery, gestational age, birth weight Z score, and duration of rupture of membrane (ROM). Placental correlates of acute inflammation and villous edema were associated with preterm labor (PTL), prelabor premature rupture of membranes (PROM), lower gestational age, and higher birth weight Z score. In PTL pregnancies delivered within 1 h of membrane rupture, 61% of placentas already had membrane inflammation. Placental correlates of pregnancy-induced hypertension (PIH) were seen more commonly with PIH pregnancies, older gestational age, and lower birth weight Z score. We found a more prominent histopathologic signature for singleton than for multiple gestation placentas. The placental pathologic findings associated with the clinical diagnoses of infection, PIH, and low-birth weight Z scores in our VLBW/preterm population are similar to those in the literature regarding term pregnancies. The presence of multiple histologic findings consistent with inflammation in placentas of PTL pregnancies with duration of ROM lasting <1 h suggests that some cases of PTL are precipitated by a more long-standing infection than that previously suspected. Morphologic placental features appear to be correlates of the phenomena leading to premature delivery. Examination of the VLBW infant's placenta provides insight into the etiology and management of VLBW/preterm deliveries.
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PMID:Very low birthweight Infant's placenta and its relation to pregnancy and fetal characteristics. 1089 Sep 26

The obstetrical and neonatal courses in pregnancies following orthotopic liver transplantation were studied. Maternal and neonatal records were reviewed from six patients (eight pregnancies), cared for by a single practitioner, who had undergone orthotopic liver transplantation prior to pregnancy between 1984 and 1999. Demographic data, reason for transplantation, interval from transplantation to pregnancy, immunosuppressive agents, antepartum complications, and maternal and neonatal outcomes were reviewed. Many reasons for transplantation were noted, and no acute graft rejection occurred. Maternal complications noted were mild renal insufficiency, chronic hypertension, pregestational diabetes, and erythema nodosum. Antepartum complications included oligohydramnios, preterm labor, premature rupture of membranes, severe preeclampsia, fetal growth restriction, multiple congenital anomalies, and intra-amniotic infection. There was one miscarriage at 8 weeks, one previable and one periviable delivery, and the remainder delivered after 34 weeks. In our cohort of patients, once fetal viability was achieved, patients with a prior liver transplant had reasonable maternal and neonatal outcomes.
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PMID:Obstetrical and neonatal outcome in pregnancies after liver transplantation. 1114 11

The authors performed a population-based epidemiologic study to evaluate and contrast risk factor profiles for placental abruption among singleton and twin gestations. Data were derived from linked US birth/infant death files for 1995 and 1996, comprising 7,465,858 singleton births and 193,266 twin births. The authors also evaluated effect modification between smoking and hypertension and the effect of a dose-response relation with number of cigarettes smoked daily on abruption risk. Abruption was recorded in 5.9 per 1,000 singleton births and 12.2 per 1,000 twin births. Risk factors for abruption among singleton and twin births, respectively, included preterm premature rupture of membranes (adjusted relative risks (RRs) = 4.89 and 2.01), eclampsia (RRs = 3.58 and 1.67), anemia (RRs = 2.23 and 2.33), hydramnios (RRs = 2.04 and 1.66), renal disorders (RRs = 1.54 and 2.56), and intrapartum fever (>100 degrees F) (RRs = 1.17 and 1.69). Chronic hypertension (RR = 2.38) and pregnancy-induced hypertension (RR = 2.34) were risk factors for abruption in singleton births but not in twin births. Number of cigarettes smoked daily demonstrated a dose-response trend for abruption risk in singletons and twins. Abruption was more likely to occur among smokers with chronic hypertension (RRs = 4.66 and 3.15) and eclampsia (RRs = 6.28 and 5.08). The authors conclude that abruption is twice as likely to occur in twins as in singletons with differing risk factor profiles. This suggests that abruption in twins may result from different pathophysiologic processes.
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PMID:Placental abruption among singleton and twin births in the United States: risk factor profiles. 1129 49

The lack of a valid indicator precludes a true estimate of zinc deficiency in pregnancy in various populations. However, it is possible that mild to moderate deficiency (as assessed by available indicators) may be common in the developing world. Animal experiments indicate that zinc deficiency can result in adverse maternal and fetal consequences. Human data, particularly from prenatal zinc supplementation trials, has failed to document a consistent maternal or infant benefit on evaluated outcome measures including pregnancy induced hypertension, preterm/post-term labour, premature rupture of membranes, maternal infection, postpartum haemorrhage, perinatal mortality, congenital malformations and fetal growth and gestation. Preliminary data suggest a beneficial effect of prenatal zinc supplementation on infants' neurobehavioural development and immune function (evaluated by diarrhoeal and ARI morbidity incidence in the first year of life). Future research should focus on these functional consequences and congenital malformations (with adequate sample sizes), and simultaneously address the safety issue, particularly in relation to micronutrient interactions. In the light of the currently available information, routine zinc supplementation can not be advocated to improve pregnancy outcome.
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PMID:Effect of gestational zinc deficiency on pregnancy outcomes: summary of observation studies and zinc supplementation trials. 1150 97


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