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Query: UMLS:C0029713 (immaturity)
 4,335 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In spite of the successful results of fetal reduction, the author's express concern that the practice not become a part of reproduction management, but as a practice to help infertile couples and prevent the unwanted effects of multiple pregnancies. Since 1977 there has been the ability to promote fertility through use of drugs such as clomiphene citrate and personal and in vitro fertilization with the consequence in multiple embryos. The risks to the mother may be pre-eclampsia, post partum hemorrhage, and thrombophlebitis, and/or fetal pre-maturity, immaturity, and perinatal morbidity and mortality. SInce 1986 fetal reduction techniques have been available. This imposes ethical difficulties. The authors report the results of 22 Belgian patients, who carried 87 fetuses between 1985 and 1989, and received multiple pregnancy reduction (MPR). Of these, 4 are still pregnant at 32 weeks, 4 were lost completely and 1 lost in utero, and 33 live births. The live birth rate was 82% with mild morbidity. 78% were low birth weights including 2 under 1000 grams, but with no losses. It appears from the available evidence that the 15% lost is comparable. The procedure, which is described, was changes from transcervical aspiration to intra thoracic KC1 (potassium chloride) injection due to concern for vaginal bacterial growth, and the safe affects on the remaining fetuses. Complication during pregnancy included three patients with pre- eclampsia, but delivered successfully, and 1 with a Shirodkar cerclage at 20 weeks and with ruptured membranes at 37 weeks, but delivered successfully, and 1 preterm labor at 22 weeks who delivered successfully after 28 weeks with 1 dying in utero. She has been infused with beta- mimetics and maintained on indomethacin in the Trendelenburg position.
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PMID:Multifetal pregnancy reduction: a Belgian experience. 200 43

A case is reported of early-onset pre-eclampsia combined with severe malformations including holoprosencephaly and hydrocephaly caused by triploidy. By ultrasonic diagnosis, maternal risks caused by either prolonged pregnancy because of immaturity or inappropriate obstetrical management, i.e. by caesarean section, could be avoided. Ventriculocentesis of the macrocephalic fetus was performed and abortion induced.
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PMID:[Early manifestation of severe gestosis (pre-eclampsia) in fetal triploidy--diagnosis and obstetrical management]. 270 31

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

Adolescent pregnancies are often considered pregnancies at risk due to the multiple medical concerns involved. Prenatal care begins with the confirmation of the pregnancy and then with various clinical examinations to determine the pregnancy's normalcy. However, one of the most important factors of early prenatal care is education. Normal psychological and physiological changes should be discussed with the patient. As the woman progresses with her pregnancy, prenatal visits should become more frequent. Lack of early prenatal care may result in complications further in pregnancy. Multiple studies have shown that adolescents may start prenatal care later than older women; this may be caused by denial of pregnancy or fear of abortion or medical procedures. Complications with labor due in part to lack of prenatal care may be: breech births resulting in greater morbidity and mortality; greater risk for caesarean section die to physical immaturity; and/or preeclamptic seizures. Complications associated with adolescent pregnancy include preeclampsia, intrauterine growth retardation, and anemia. Contraception during the postpartum period is encouraged, especially among adolescent mothers, to prevent repeat unexpected pregnancies.
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PMID:Adolescent obstetrics. 360 39

Based on a new concept of maturation of the placental villous tree and its disorders (synchronous and asynchronous immaturity, asynchronous maturity, hypermaturity, and terminal villi deficiency) we studied the possible effect of the placental villous tree on the premature onset of labour. In mature normal neonates irregular and asynchronous villous patterns were found in 50% of cases. In prematurely delivered neonates, only 33% of the corresponding placentas show synchronous immature villous patterns. Uterine bleeding in the first trimester was associated with a 42% of incidence of premature maturation of the villous tree. These findings strengthen the idea that hormonal imbalance in early pregnancy influenced villous development. In "prematurity without recognizable cause" there was a higher percentage of villous maldevelopment (33%) than that previously described in the literature. In severe pre-eclampsia combined with premature onset of labour, 60% of our cases showed hypermaturity of the villous trees. Synchronous immaturity was reduced to 15%. We conclude, that even a rather rough definition of the histological features of placental villi is sufficient to produce numerous correlations between clinical events preceding premature delivery and placental structure. So the influence of placenta on the premature onset of labour needs more attention.
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PMID:Morphology of placental villi after premature delivery and its clinical relevance. 377 91

Severe thrombocytopenia, abnormal liver function, and renal dysfunction may occur as manifestations of preeclampsia. Failure to recognize that this cluster of abnormalities represents a form of preeclampsia may result in erroneous initial diagnoses. Management of 13 such patients has shown a direct correlation between the degree of thrombocytopenia and the measures of liver dysfunction. Platelet counts and liver functions improved prior to delivery in five patients treated with corticosteroids. Management should be directed toward investigation and correction of deranged physiology and appropriate monitoring of maternal-feto-placental status. Early delivery is indicated in patients with progressive thrombocytopenia and in those with evidence of fetal maturity or distress. Provided that the disease process remains stable, consideration should be given in cases of fetal immaturity, to the use of betamethasone therapy. The occurrence of severe thrombocytopenia in 20% of neonates should be a consideration in selecting the mode of delivery.
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PMID:Thrombocytopenia in preeclampsia: associated abnormalities and management principles. 647 14

Animal experimental studies conducted at the turn of the century resulted in the use of magnesium sulphate as an anticonvulsant in humans. In U.S. clinics, parenteral administration of magnesium sulphate became a routine procedure in the treatment of eclampsia and pre-eclampsia. This treatment has proved very effective in treating convulsions in pregnancy provided an adequate dosage was given amounting to up to 60 g daily. Mother and infant mortality were largely eliminated. Numerous clinical studies showed a negligible side effect rate. Side effects in the foetus: These are due to penetration of magnesium into the foetal blood circulation. Reports on an inhibition of cardiac rate fluctuation and changes in calcium levels have been contradictory, and hence not generally accepted. It is claimed that the parathormone level may drop slightly. Isolated reports on foetal magnesium intoxications associated with depression of breathing, slackness and hyporeflexia often prompt the conclusion that this disease pattern had been due to immaturity and asphyxia. Generally, foetal magnesium blood levels do not correlate well with signs of magnesium intoxication. Urine excretion is greatly slowed down in foetal immaturity. Side effects in the mother: Short-term relaxing action on the uterus has been described frequently. High dosages have been successfully used in arresting labour if there is a tendency to premature birth. Increase in uterine blood flow was seen after administration of magnesium sulphate in animal experiments. Magnesium is said to reduce blood coagulation by influencing fibrinolysis and thrombocyte resistance. However, a somewhat enhanced loss of blood during birth is said to be more likely due to relaxation of the uterus than to a disturbance of blood coagulation. Rapid intravenous injection causes short-term flushing, nausea and vomiting. Short-acting drops in blood pressure are possible. The cardiac output is said to increase at the conventional dosage level whereas the peripheral resistance drops due to vasodilation. Increases and decreases in heart rate have been reported, but in most cases no changes were seen. Changes in ventricular action time occur with toxic doses only, which can lead to cardiac arrest in the diastole. Other toxic signs are hyporeflexia, depressed breathing and CNS depressions which may result in coma. Hyporeflexia always occurs before the other toxic signs appear, so that it can be used as a clinical control criterion. Calcium gluconate, given via the IV route, is a good and rapid-acting antidote.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Use of magnesium sulfate as an anticonvulsant in severe pregnancy toxemia and eclampsia]. 655 75

DNA and protein synthesis have been studied in placental villi from normal and pathological cases by in vitro incorporation of tritiated thymidine or tritiated proline and subsequent counting or autoradiography. It appeared that cytotrophoblastic DNA synthesis continued until term and that it was particularly important in preeclampsia cases and in cases of villous immaturity (rhesus sensitization). Protein synthesis was also increased in preeclampsia and seemed to be due to a very active cytotrophoblastic metabolism. The most interesting finding was that in preeclampsia cases, especially when intrauterine growth retardation was superimposed, villous capillary endothelial cell proliferation was as prominent as in cases where villous maturation was not achieved. Such results are highly suggestive of an important compensatory proliferative mechanism in the placentae of preeclamptic women.
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PMID:Cellular proliferation in villi of normal and pathological pregnancies. 670 38

Pre-eclampsia/toxemia (PET) is an idiopathic hypertensive disorder of pregnancy elicited in susceptible mothers by exposure to placental trophoblast. Three facts regarding the placenta in PET are known: an association with large placentas (excessive trophoblast), a tendency for superficial implantation, and inappropriate trophoblastic immaturity, as assessed by ultrastructural and biochemical criteria. A unitary hypothesis is that PET is related to a maturation defect leading to excessive accumulation of inappropriately immature intermediate trophoblast in the placental implantation site. We studied the implantation site of PET and control placentas from three gestational age groups (25 to 30, 30 to 35, and 36 to 40 weeks old [five per group]) by morphometry and immunohistochemistry using antibodies to three phenotypic markers (cytokeratin, human placental lactogen (HPL), and beta 2-microglobulin) and two markers of cell dynamics (proliferating cell nuclear antigen [PCNA] and bcl-2]). Implantation sites in the PET group had increased amounts of intermediate trophoblast (cell number and longitudinal extent) with an increased proliferative index (percentage of PCNA positive) and evidence of phenotypic immaturity (HPL negative). Intermediate trophoblast from both groups was uniformly bcl-2 negative and beta 2-microglobulin positive. Based on these data and the findings of other investigators, we propose that the diagnostic term "atypical implantation site" be added to acute atherosis, villous infarction, and increased syncytial knotting as a characteristic of placentas from pre-eclamptic pregnancies.
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PMID:Pre-eclampsia is associated with an excess of proliferative immature intermediate trophoblast. 777 87

Although fetal lung maturity determination is carried out more and more rarely in the German-speaking area, a reliable information about the degree of lung maturity is still very important in the care of high-risk pregnancies. The side effects and costs of a postpartal surfactant administration can be avoided if lung maturity is proved. Indications for determination of fetal lung maturity are the threatening preterm delivery and the premature rupture of membranes before the 34th week of gestation and uncertain gestational age. Furthermore, in preeclampsia resp. in diabetes mellitus, which is difficult to control, premature delivery may be necessary. To improve lung maturity testing we introduce a new "sequence scheme" containing three lung maturity tests which are easy to carry out (in the following sequence: Amniostat-FLM ultrasensitive, counting of the lamellar bodies in amniotic fluid, surfactant/albumin ratio with TDx-FLM). The principle of this scheme is, that if any of these three tests indicates lung maturity, the sequence is terminated and no further test is performed. Only if all three tests indicated immaturity, the child was at risk for RDS. In 87 amniotic fluid samples with 7 RDS-cases, we achieved high predictive values for lung maturity (specificity 90%, sensitivity 100%, predictive value of positive test 47%, predictive value of negative test 100%). In 62% only one test was needed for lung maturity determination. It is possible to use other combinations in such a scheme (e.g. the L/S ratio). This might lead to equal or perhaps better results. An advantage of this suggested "sequence scheme" is that it can be performed in any clinic.
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PMID:[Prenatal determination of lung maturity from amniotic fluid--indications and new methods]. 785 9


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