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

A multidisciplinary team composed of obstetricians, pediatricians, and pathologists examined the causes of 453 consecutive perinatal deaths, which occurred between 1978 to 1982. A clear distinction between obstetric diagnosis and infant cause of death was made, and a prinicpal obstetric and infant diagnosis was assigned to each death. Perinatal death rates by obstetric category were calculated. The rates varied from 6.1 per 1000 births in uncomplicated cases to 217.4 per 1000 births in isolated intrauterine growth retardation. The causes of perinatal death within obstetric categories were tabulated. Nonviability or the complications of prematurity (65%) were the leading causes of death when there was third-trimester bleeding, premature labor, or premature rupture of membranes. Anoxia (59%) was the most frequent cause of death when there was hypertension/pre-eclampsia or other uteroplacental insufficiency states. Death from congenital abnormality accounted for 17.7% of all perinatal deaths. A focus on the causes of perinatal death with obstetric diagnostic categories helps weigh the risk of prematurity versus the risk of anoxia in the management of high-risk gravidas.
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PMID:Obstetric diagnosis and perinatal mortality. 365 Nov 88

Between November 1979 and April 1984, 790 consecutive pregnant women who considered themselves as having a "normal" pregnancy were followed in private practice from 9 weeks' gestation until 6 weeks post partum. The women had no pre-existing disease or problem classified as a risk to the pregnancy at the time of their first visit, had a singleton pregnancy and gave birth at Notre-Dame Hospital, Montreal. Maternal complications occurred during the course of pregnancy in 181 women (23%). Complications were mostly related to obstetric conditions (10%), such as preterm labour, intrauterine growth retardation (IUGR) and antepartum hemorrhage, or to medical conditions (12%), the most prevalent of which was hypertension (77% of medical conditions). Neonatal complications occurred in 183 infants (23%). The corrected perinatal death rate was 2.5 per 1000. Prematurity, IUGR and dysmaturity/postmaturity accounted for nearly half of the complications. Hyperbilirubinemia occurred in 7% of the cases. Among women without any maternal complications during pregnancy, the frequency rate of neonatal complications was 19%, compared with 23% among the entire group of 790 women. Our results suggest that the absence of maternal complications does not protect the infant from a neonatal complication. Further refinement is needed to identify markers of obstetric, medical and neonatal complications in pregnancies with no risk factors.
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PMID:Maternal and neonatal outcome in pregnancies with no risk factors. 365 44

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

Overt thrombocytopenia (defined as a platelet count of less than 100,000/microL) was not identified at or soon after delivery in any of 262 infants of mothers with hypertension induced or exacerbated by pregnancy. The platelet counts were 100,000 to 149,000/microL in 11 (4.2%) of the offspring and 150,000/microL or higher in the rest, even though the platelet counts of the 258 mothers were less than 150,000/microL in 77 (30%), less than 100,000/microL in 51 (20%), and less than 50,000/microL in 17 (7%). Some infants of hypertensive mothers did develop overt thrombocytopenia later; however, the frequency and intensity appeared to be no greater than it was in infants with similar complications (prematurity, growth retardation, infection, and meconium aspiration) whose mothers were normotensive. We conclude that the fetus whose mother has preeclampsia-eclampsia is very unlikely to be thrombocytopenic during labor and delivery, even when the mother is thrombocytopenic. Therefore, neither cesarean delivery to avoid labor nor scalp blood platelet counts during labor need be performed.
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PMID:How often does maternal preeclampsia-eclampsia incite thrombocytopenia in the fetus? 382 73

Renal transplantation is compatible with pregnancy in women under permanent dialysis, and leads to no problems for the mother or the transplant. The seven pregnancies observed in the authors' center over the past fifteen years progressed satisfactorily. There were no rejections, no cases of renal failure. In two cases, however, there was an aggravation of hypertension with acute gravidic toxemia and spontaneous abortion. The effects on the fetus of immunosuppressive drugs are difficult to evaluate; the main risk is prematurity.
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PMID:[Pregnancy in renal transplant patients]. 388 36

Early reports on SLE were too small in number to determine that pregnancy was contraindicated in patients with renal involvement. Later reports show that patients with lupus nephropathy can have successful pregnancies provided certain preconditions are established. Optimal preconditions include prepregnancy remission of at least 6 months, renal function with serum creatinine 1.5 mg/dl or less or creatinine clearance of 60 ml/min or more or proteinuria of 3 g/24 hr or less. Successful pregnancies have been recorded in some patients with more severe renal impairment. Renal function will remain unchanged in approximately 60% of pregnancies; and although deterioration may occur, it is only severe or permanent in less than 10%. In 26% of patients, mild to severe renal impairment was transient, with recovery to prepregnancy levels of renal function. Proteinuria with good creatinine clearance may not be dangerous. Hypertension or superimposed preeclampsia jeopardizes the outcome. Fetal outcome averaged approximately 70% (range, 41-77%) live births, 17.8% (range, 5.1-40%) spontaneous abortions, 19.7% (range, 3.0-38.5%) prematurity, and 8.2% SGA. Therapeutic abortion is not a modality of treatment of lupus nephropathy. Management of patients with lupus nephropathy is twofold and includes suppression of underlying lupus activity as well as the serial evaluation of chronic renal disease. In chronic lupus nephropathy with inactive SLE maternal and fetal outcome is the same as for pregnant patients with chronic renal disease of other causes. Strict fetal surveillance must be performed to decrease the stillbirth rate. The concomitant increase in prematurity demands the services of a tertiary care neonatal unit. Management necessitates the team approach of the obstetrician, nephrologist, rheumatologist, and neonatologist working in collaboration. The reports which contain large numbers of patients now allow better counseling of these patients who are contemplating pregnancy.
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PMID:Lupus nephropathy and pregnancy. 389 19

Forty-six hydropic infants with homozygous alpha-thalassaemia born during a period of 10 years have been reviewed. The incidence was 1:1550 total births, and accounted for 81% of all non-immune hydrops. The male to female ratio was 1:1.4. There was increased incidence of anaemia, pregnancy induced hypertension, antepartum haemorrhage, malpresentation, prematurity, fetal distress, difficult vaginal delivery, caesarean section, retained placenta, postpartum haemorrhage and congenital abnormalities. Antenatal diagnosis by DNA hybridization with subsequent abortion of the affected fetuses is the best method to decrease maternal morbidity and to reduce the incidence of hydrops fetalis in couples at risk. For those with no previous history, but with early onset hypertension and/or polyhydramnios, sonography is useful in making an earlier diagnosis, and in reducing avoidable morbidity, because DNA analysis can be done before caesarean section and aggressive neonatal management is instituted.
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PMID:Homozygous alpha-thalassaemia: clinical presentation, diagnosis and management. A review of 46 cases. 401 25

All 749 deaths recorded by a rural hospital during 1983 were listed in five age groups according to the 9th revision of the International Classification of Diseases. The largest number of deaths were in adults aged 50 years and over and in children aged under 2 years, and the most frequent causes of death were malnutrition, hypertension, prematurity, heart failure and gastro-enteritis.
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PMID:Causes of death in a rural hospital in 1983. 404 75

The authors report the special obstetric characteristics of grand multiparas (GMs) and the extent to which the parturient's age affected the incidence of complications. 8 deliveries were chosen as the minimum of deliveries for classifying parturients as GMs in this study. In a series of 1567 deliveries over 10 years in the same hospital in Oulu, Finland, differences were noted between the obstetric behavior of GMs as compared with other parturients. Hypertensive disease was distinctly more frequent among GMs than among the other parturients (p0.001). The frequency of abruptio placentae, placenta previa, and retained placenta was also significantly higher in GMs. Although the difference was not statistically clear in this study, the incidence of uterine rapture has been reported to be higher in GMs than in other parturients. Unlike the majority of reports, this study showed breach presentation to be less frequent among GMs. The incidence of operative deliveries was roughly similar in both groups. Caesarean section, including repeat sections, was distinctly lower among GMs (p0.01). The maternal mortality rate of GMs in the series was significantly (p0.01) higher than that of the other parturients (.12%). The primary causes of death were abruptio placentae (0.19%), rupture of the uterus (0.12%), and eclampsia (0.06%); a state of shock was a feature common to all the fatalities. No difference appeared in the incidence of multiple pregnancy, nor in the incidence of prematurity. The difference in number of stillbirths was not statistically demonstrable between GMs (3.71%) and other parturients (2.68%). The incidence of hypertensive disease was definitely correlated to age, whereas high parity played a small part. Abruptio placenta is affected both by high parity and age; placenta previa is independent of age and predisposed by high parity. Under careful supervision and proper treatment, the GM, despite the higher risk of complications, does not run a greater risk of mortality than other parturients.
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PMID:Hazards of grand multiparity. 530 54

The results of a series of 6 pregnancies (including 1 set of twins) in renal transplant patients are presented with a review of the relevant literature. There were no fetal anomalies or deaths, or episodes of renal compromise or graft rejection. The important complications were hypertension (4), prematurity (4) and fetal growth retardation (2).
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PMID:Pregnancy after renal transplantation. 637 Feb 22


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