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Query: UMLS:C0728731 (prematurity)
 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A questionnaire survey and review of the literature show that pregnancy can be well tolerated in most women with renal transplants. Fifty-two per cent of the renal transplant recipients who became pregnant had full-term infants with no serious complications. With therapeutic abortions, excluded, 71% of the 308 pregnancies permitted to continue resulted in full-term infants. Rejection episodes were occasionally a serious problem, occurring in 9% of the pregnancies. Mechanical interference with renal excretion or preventing vaginal delivery occurred in 5.6% of the cases. Hypertension and proteinuria, often existing prior to pregnancy, became frequently increased during pregnancy. Infections not associated with rejection were common but easily controlled in most cases. Prematurity was frequent but related to renal function and the time interval from transplant to conception. The most serious infant complications were related to prematurity. Unknown is the future of these infants and their progeny because of their intrauterine exposure to immunosuppressive drugs.
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PMID:Pregnancy in renal transplant patients: a review. 37 91

This paper describes the pregnancy outcome of women who delivered in 1975 and 1976 in the area of the Machakos project near Nairobi, Kenya. The study utilized a surveillance system comprising of home visits on 3700 households by 12 fieldworkers. Total number of children born during the study period was 2246. General fertility rate was 235/1000 women of reproductive age. Birth rate was 43.0/1000. There were unexpectedly low mortality rates. Stillbirths were 29.8/1000 total births, neonatal rate, 22.5/1000 total births while infant death rate was 50.0/1000 live births. There was 1 maternal death among the 2223 deliveries. Higher perinatal mortality was attributed to maternal age of less than 25 and over 34 years, a history of previous perinatal death, and breech delivery. Differences in outcome of pregnancy were not affected by parity, marital status, birth interval, and maternal height. Stillbirth rate of hospital-born children (26.4%) was 4.4% compared with 2.4% among children born at home. Half of all perinatal deaths were caused by either prematurity or birth trauma. Infections accounted for 75% of all infant deaths after the first week of life. A subsequent paper will relate the outcome of pregnancy to antenatal and delivery care received.
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PMID:Machakos Project Studies: agents affecting health of mother and child in a rural area of Kenya. XVI. The outcome of pregnancy. 54 95

Infections of the cervix with Chlamydia trachomatis are common, at least in those groups of sexually active women of child-bearing age who are seen in STD (sexually-transmitted diseases) clinics. Persistent untreated infection presents a hazard to the women themselves during pregnancy and to their infants who may develop chlamydial conjunctivitis. The clinical and laboratory findings in 1009 women and in 103 infants with conjunctivitis are presented. Practical problems of diagnosis and control of neonatal chlaymdial conjunctivitis are described. A possible association between prematurity and chlamydial infection is discussed.
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PMID:Maternal genital chlamydial infection as a cause of neonatal conjunctivitis. 59 78

Infections in pregnancy with Ureaplasma urealyticum have been associated with a wide range of adverse outcomes, such as early abortion, stillbirth, prematurity, and neonatal morbidity and mortality. Causality has been difficult to demonstrate secondary to the high prevalence of asymptomatic lower genital tract (LGT) colonization and culture data from inaccessible or potentially contaminated sites. Between 1985 and 1989, 2461 second-trimester genetic amniocenteses were evaluated at the cytogenetics section of the Children's Hospital Medical Center of Akron. All were cultured for the genital mycoplasmas: Mycoplasma hominis and Ureaplasma urealyticum. A total of nine patients were positive, all for Ureaplasma urealyticum, with one patient excluded because of subsequent therapeutic abortion. In addition, complete follow-up data, such as indication for amniocentesis, serum alpha-fetoprotein levels, gestational age at parturition, and outcome of pregnancy, were available on 86 Ureaplasma-negative (U-) patients during an approximate 2-year span within the time-frame of the study. This was in part due to physician response to a questionnaire sent after amniocentesis. Of the eight positive cultures, 100 per cent were associated with an adverse outcome, defined as fetal loss or premature delivery. This was significant compared with the U- group (p less than 0.001) with a more than eight times greater risk of adverse outcome. Six (75 per cent) resulted in spontaneous miscarriage within 4 weeks of amniocentesis and at less than 21 weeks' gestation. Two (25 per cent) delivered prematurely, with one (12.5 per cent) neonatal death at 24+ weeks. Histological examination of all eight placentae and the seven fetuses revealed a 100 per cent incidence of chorioamnionitis and pneumonia, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Adverse outcome in pregnancy following amniotic fluid isolation of Ureaplasma urealyticum. 155 56

This prospective study was designed to determine the value of a daily modified biophysical profile in detecting infection in patients with preterm premature rupture of the membranes who were managed expectantly. Ninety-nine patients received daily nonstress tests and biophysical profile scores. Results of the last predelivery study were related to subsequent development of amnionitis or fetal sepsis. Infection was present in 16 patients. When the biophysical profile score was 0/8, infection was uniformly present. When fetal breathing was absent (biophysical profile score, less than or equal to 4/8) and nonstress test was nonreactive, infection was present in 75% of cases (sensitivity, 75%; specificity, 95%). Because a nonreactive nonstress test could be secondary to prematurity instead of infection, these results were analyzed over time. Those who initially had a reactive nonstress test that subsequently became nonreactive were more likely to be infected. We conclude that a daily biophysical profile score and nonstress test can detect infection and propose delivery of patients with a biophysical profile score of 0/8 and nonreactive nonstress test. Patients with absent fetal breathing and a nonstress test that changes from reactive to nonreactive also should be considered for delivery. Absent fetal breathing with a reactive nonstress test or a consistently nonreactive nonstress test should have further testing to rule out infection.
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PMID:Preterm premature rupture of membranes: detection of infection. 195 22

Sexually transmitted diseases (STDs) are now the most common group of identifiable infectious diseases in many countries, especially among those ages 15-50 and in infants. Their control is important considering the high incidence of acute infections, complications and sequelae, their socioeconomic impact, and their role in increasing transmission of the human immunodeficiency virus (HIV). THe worldwide incidence of major bacterial and viral STDs is estimated to be over 125 million cases yearly. STDs are hyperendemic in many developing countries. However, in industrialized countries, the bacterial STDs such as syphilis, gonorrhea, chancroid declined from their peak during WW II until the late 1950s, increased during the 1960s and early 1970s, and have again decreased since that time. In the industrialized world, diseases due to Chlamydia trachomatis, genital herpes virus, human papillomaviruses, and HIV are now more significant than the classical bacterial ones; both groups remain major health problems in most developing countries. Infection rates are similar in both men and women, but women and infants bear the major burden of complications and serious sequelae. Infertility and ectopic pregnancy are often a result of pelvic inflammatory disease and are preventable. STDs in pregnant women can result in prematurity, stillbirth, and neonatal infections. In many areas, 1-5% of newborns are at risk of gonococcal ophthalmia neonatorum, a disease that blinds and congenital syphilis causes up to 25% of perinatal mortality. Genital and anal cancers (especially cervical cancer) are associated with viral STDs (genital human papillomavirus and herpes virus infections). Urethral stricture and infertility are frequent sequelae in men. (author's modified)
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PMID:Epidemiology of sexually transmitted diseases: the global picture. 228

Prematurity remains the major cause of perinatal mortality and morbidity in Singapore. Prevention of prematurity is therefore of vital importance. Epidemiological methods using historical variables have been superseded by ongoing pregnancy factors including work, exercise and cervical dilatation. PGF levels bear a positive correlation to duration and cervical dilatation but are not elevated at onset. PGE production is high in ruptured membranes. Progesterone and relaxin are potent inhibitors before labour. Infection must play an important role in developing countries as organisms not thought of to be pathogenic produce phospholipase A2. For prediction, cervical assessment and topography are proving important. In view of the dangerous side effects of tocolytic drugs and the difficulty in diagnosis of preterm labour, absence of fetal breathing is a useful index of progressive labour. In those labours that are advanced, whether to allow vaginal delivery or not will be determined by the presentation and condition of the fetus. The complementary role of other drugs to reduce morbidity from hyaline membrane disease and intraventricular haemorrhage is being studied. Fetal acidosis should be avoided and the infant delivered without trauma under optimal circumstances. In utero transfer to a facility with neonatal intensive care carries a better prognosis for the baby.
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PMID:Current concepts in the management of preterm labour. 269 76

Imprecise diagnosis of birth asphyxia coupled with uncertainties about causal factors for neurologic abnormalities in the newborn have greatly fueled the current litigation crisis in obstetrics. Our goal was to more precisely define birth asphyxia based on fetal condition as measured by umbilical artery blood pH, Apgar scores, and neurologic condition of newborns. We selected for study 2738 patients with singleton pregnancies with cephalic presentations who were delivered of infants at term to avoid complications such as prematurity, which may affect infant outcome independent of birth condition. The basis for study of these particular patients were defined criteria for high risk and an indicated arterial cord pH value. A total of five infants demonstrated cerebral dysfunction as evidenced by seizures during the neonatal period. Infection was linked to seizures in three of these infants; one infant had neonatal asphyxia and only one infant's clinical course could be attributed solely to birth events (uterine rupture). Stratification of umbilical artery blood pH values, Apgar scores, and combinations of these dependent variables in relation to newborn clinical outcomes revealed that infants must be severely depressed at delivery before birth asphyxia can be reliably diagnosed. Such depression includes Apgar scores less than or equal to 3 at 1 and 5 minutes plus umbilical artery pH values less than 7.00.
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PMID:Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction. 278 67

The rates and the causes of infantile mortality between 1970 and 1986 in the district of Ille-et-Vilaine are reported. During that period, infantile mortality rate decreased from 18.7 to 7.06% and from 12.4 to 3.6% during the first week (0-6 days), thereby suggesting the efficacy of medical care programs for this pediatric age group in France. Since 1980, with more accurate record keeping, using the recommended international classifications, there is a relative stagnation in the rate or early neonatal deaths (3.97 to 3.67) as compared to a sizable drop in the rates of late neonatal deaths (1.90 to 0.73) and post neonatal deaths (4.63 to 2.57). Congenital abnormalities have become the most important cause of death (34%) before prematurity (24.58%). However, the number of congenital anomalies should quickly decrease with prenatal screening programs leading to interruption of pregnancies. Although the percentage of infantile deaths due to prematurity has decreased from 66% between 1970 and 1974 to 24.58% in recent years, prematurity remains an important cause of death. Infections have decreased and the Sudden Infant Death Syndrome is currently the most important cause of death during the postneonatal period. The well known factors of risks are confirmed and particularly increased vulnerability of the population with a low socio-economic status which should lead to appropriate prevention programs. Despite these very impressive results, birth remains the most vulnerable period of life and current efforts should continue. Priority must be given to the improvement of prenatal care which requires good ongoing collaboration between obstetrics and pediatrics and the use of the Maternity Health Booklet.
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PMID:[Infantile mortality in Ile-et-Vilaine (1970-1986)]. 278 7

Group B streptococcal infection may result in significant morbidity and mortality in both infants and adults. The experience with group B streptococcal disease was analyzed at one medical center over a ten-year period from 1975 to 1984. Streptococcus agalactiae bacteremia was observed in 29 adults and 26 infants, with an attack rate of 0.2 cases per 1000 adult admissions and 3.2 cases per 1000 live births, respectively. The majority of adult infections apparently occurred as a result of nosocomial acquisition and was associated with a high mortality rate of 38%. Risk factors for group B streptococcal sepsis in adults include diabetes mellitus, malignancy, and hepatic failure. The majority (73%) of neonatal cases occurred within seven days of birth and occurred in a setting of maternal fever, prolonged rupture of membranes, or prematurity. The mortality rate in infants was remarkably low at only 15%. Fatalities occurred in both adults and infants, despite appropriate antimicrobial therapy. Infection control strategies against group B streptococcus must address potential nosocomial dissemination in adults as well as vertical transmission in infants.
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PMID:Group B streptococcal sepsis in adults and infants. Contrasts and comparisons. 327 72


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