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

A total of 99 patients with pre-eclampsia and proteinuria were managed conservatively between 30 and 37 weeks of gestation, based on serial urinary estriol, liquor amnii, and renal function studies. The over-all perinatal wastage was 14 per cent, but was 35 per cent in association with subnormal estriol excretion and oligohydramnios (less than 250 ml.). In severe pre-eclampsia (blood pressure greater than 170/110 mm. Hg with proteinuria greater than 5 Gm. per liter) the incidence of subnormal estriol was 73 per cent and, becuase of this and the associated maternal hazards, conservative treatment had little place. However, in less severe pre-eclampsia with proteinuria early in the third trimester, this prospective study, based on serial placental and renal function tests, showed that frequently the pregnancy could be prolonged and fetal losses due to prematurity avoided. It should be stressed that such conservative treatment should not be continued when there are strong clinical contraindications. Irrespective of the severity of the prior pre-eclampsia, it was unusual for patients to show residual hypertension, proteinuria, or abnormal pyelography at their postnatal examination. Postpartum renal biopsy showed either normal histology or regression of the classical glomerular lesion in 77 per cent of cases.
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PMID:Placental function and renal tract studies in pre-eclampsia with proteinuria and long-term maternal consequences. 98 68

From January 1987 to December 1990 at Chang Gung Memorial Hospital, the fetal membrane ruptured in 47 singleton pregnancies at the 20th to the 28th gestational weeks. Sixty-six percent of the patients delivered within three days and 91.5% within one week. Only six (12.8%) patients carried their pregnancies over the 28th week. Of the 47 patients, 16 (34.0%) developed clinical evidence of chorioamnionitis during the latent period. The development of chorioamnionitis was not related to any of clinical factors [gestational age at rupture of the membranes, duration of rupture of the membranes before admission, positive endocervical culture, tocolysis, latent period or the presence of oligohydramnios (p > 0.05)]. The neonatal survival rate was 12.7% (six out of 47). Neonatal death was mainly attributable to prematurity. Gestational age beyond the 28th week and body weight greater than 1000 gm are two factors contributing to fetal survival. When fetal lung maturity has not occurred expectant management in the absence of infection is an alternative treatment.
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PMID:Pregnancy outcome of preterm premature rupture of the membranes before 28 weeks. 129 50

Among 58,187 women tested, 1002 had a maternal serum alpha-fetoprotein measuring greater than or equal to 2.5 multiples of the median after correction for race, weight, and insulin-dependent diabetes. They were stratified into three groups: group 1, 2.5 to 2.9; group 2, 3.0 to 5.0; group 3, greater than or equal to 5.0 multiples of the median. The initial risk of a serious abnormality detected by ultrasonography or amniocentesis was 17% (5%, 12% and 65% in groups 1, 2, and 3, respectively). After correction for twins and dates, this risk became 23% (7%, 18%, and 71% in groups, 1, 2, and 3, respectively). Among the women with high maternal serum alpha-fetoprotein levels, 556 (77%) had normal ultrasonographic and amniocentesis studies, and the risk of adverse pregnancy outcome ws 27% (19%, 29%, and 70% in groups 1, 2, and 3, respectively). There was a statistically significant increase in late fetal and perinatal death, prematurity and growth retardation, oligohydramnios, abruptio placentae, preeclampsia, and congenital abnormalities. The overall risk for abnormality or adverse outcome was 24% in group 1, 41% in group 2, and 91% in group 3.
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PMID:Risks associated with an elevated maternal serum alpha-fetoprotein level. 171 19

Early amnion rupture is a sporadic event that results in mechanical teratogenesis due to amniotic-band disruption and/or compression. It may cause abortion or stillbirth, craniofacial clefts, and cerebral, body wall and limb/skeletal defects. Prolonged and premature rupture of membranes and oligohydramnios result in the dry-lung syndrome and pulmonary hypoplasia. The risk of chorioamnionitis is also increased, with serious consequences to the fetus and neonate. Placental lesions are associated with fetal growth retardation, preterm birth, fetal malformations and other neonatal disorders (congenital infections, erythroblastosis, alpha thalassaemia). In particular, the impact of extremely preterm births on perinatal mortality rates and health costs is substantial. The 1-year survival rate of singleton infants born at the Monash Medical Centre was 10% at a gestation period of 23 weeks, 37% at 24 weeks, 42% at 25 weeks, 61% at 26 weeks and 78% at 27 weeks (11% at birthweights of 500-599 g, 30% at 600-699 g, 55% at 700-799 g and 71% at 800-899 g). Proven measures to minimize the neonatal consequences of extremely preterm delivery include in utero transfer of at-risk fetuses to a perinatal centre and antepartum corticosteroids. Research into the pathophysiological basis of placental and membrane dysfunction may help reduce the prematurity rate.
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PMID:Neonatal consequences of placental and membrane dysfunction. 195 32

Severe pregnancy-induced hypertension complicated by hemolysis, elevated liver enzymes and low platelets (HELLP) is considered an indication for immediate delivery, often resulting in premature or even previable infants. In five cases, temporary reversal of the HELLP syndrome was achieved using low-dose aspirin and corticosteroids. Pregnancy was prolonged an average of 4 weeks; three pregnancies were prolonged, beginning at less than or equal to 25 weeks, for an average of 5.5 weeks. Two of seven infants died, one from pulmonary hypoplasia due to oligohydramnios and the other from complications of prematurity. No long-term maternal morbidity was encountered, though one patient had peripartum disseminated intravascular coagulation and a seizure. A review of the literature supports the usefulness of low-dose aspirin in this setting; the impact of corticosteroids as part of the reversal strategy has not been discussed previously.
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PMID:Prolongation of premature gestation in women with hemolysis, elevated liver enzymes and low platelets. A report of five cases. 229 13

The neonatal outcomes of 30 pregnancies that were complicated by premature and prolonged rupture of the membranes that had started in the second trimester of pregnancy, were reviewed. The neonatal mortality was 11 (36%), the main cause of death being pulmonary hypoplasia. Two infants died of sepsis, but these were the only proved episodes of maternal or fetal infection. Of the survivors, 27% developed compressive limb abnormalities, all of which responded to passive physiotherapy. Pulmonary hypoplasia was significantly associated with earlier onset of rupture of the membranes, and the absence of fetal breathing movements. Compressive limb abnormalities were significantly associated with longer periods of oligohydramnios. We conclude that premature rupture of the membranes, even with onset in the second trimester, may be associated with a favourable outcome and this may be predicted by the persistence of fetal breathing movements. We therefore, recommend expectant management of such pregnancies, but suggest elective delivery at 34 weeks to limit fetal exposure to uterine compression and minimise the risks of prematurity.
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PMID:Neonatal outcome after prolonged rupture of the membranes starting in the second trimester. 319 69

We have studied 68 cases of severe oligohydramnios and compared them with the published literature on the aetiology, pathology, diagnosis, complications and prognosis. The principal aetiological features have been malformations of the fetal urinary tracts, intra-uterine growth retardation, high maternal blood pressure, nicotine poisoning and prolonged pregnancy. The perinatal mortality and morbidity, as well as the caesarean section rate, are raised because of the complications, such as the tetrad of oligohydramnios, prematurity, fetal distress in labour and post-maturity. When oligohydramnios is the sole presenting feature the prognosis for the fetus is better.
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PMID:[Oligohydramnios. Diagnosis. Etiology. Prognosis]. 333 Jul 32

Severe oligohydramnios, defined as a condition in which the largest pocket of amniotic fluid measures less than 1 cm in its vertical axis as determined by an ultrasound method, was observed in 113 patients in a population of 15,431 referred high-risk patients (0.7%). In all cases, intervention took place unless there was a recognized structural anomaly or extreme prematurity. Overall gross perinatal mortality was 132.7/1000, and the incidence of major anomaly was 13.3%. With intervention the corrected perinatal mortality rate was 17.7/1000, a rate not significantly different from that observed in the entire population. All end points of perinatal mortality were significantly increased in patients with severe oligohydramnios, in comparison with randomly selected control subjects with normal amniotic fluid. These findings are interpreted to indicate that severe oligohydramnios in a structurally normal fetus is an indication for delivery.
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PMID:Ultrasound evaluation of amniotic fluid: outcome of pregnancies with severe oligohydramnios. 351 48

Late amniocenteses (greater than 20 weeks' gestation) were performed in 114 pregnancies with no a priori genetic risk, but referred because of abnormal clinical and/or ultrasound findings suggesting fetal malformations. Reasons for referral included polyhydramnios (51 cases), oligohydramnios (15 cases), fetal growth retardation (FGR) (16 cases) and abnormal fetal ultrasound findings excluding anencephaly (32 cases). In 42 of these cases, referral was motivated by a combination of the above abnormal findings. When polyhydramnios was the sole anomaly (25 cases), 5 fetuses were malformed (20%), abnormal fetal karyotype and/or elevated amniotic fluid alphafetoprotein (AFP) were demonstrated in 2 cases. Oligohydramnios was the sole anomaly in one case; the infant died of prematurity. Fetal growth retardation was the sole anomaly in 14 cases, 11 otherwise normal newborns were small for date, 2 died at birth and 1 was malformed (1/14, 7%). In this group all fetal karyotypes were normal and in 2 cases amniotic fluid AFP were increased. In the 32 pregnancies without abnormal amniotic fluid volume and/or FGR and with fetal malformation(s) suggested by ultrasound, all malformations except one (ovarian cyst possibly ruptured during birth) were confirmed at birth, amniotic fluid AFP was elevated, and/or karyotype was abnormal in 6 cases. In 42 pregnancies where more than one alarm sign was present, abnormal karyotype and/or elevated amniotic fluid AFP level were recorded in 21 of the 39 cases where amniocentesis was performed, 33 fetuses were malformed (79%) and 13 died in the perinatal period (31%). The high incidence of abnormal results of amniocentesis found in this survey of pathological pregnancies, particularly in those with multiple alarm signs, emphasizes the need for amniocentesis in these situations.
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PMID:Pathological pregnancies. Results of amniotic fluid studies and fetal outcome. 352 Nov 86

The Edinburgh Register of the Newborn 1964-1968 and the Edinburgh Scoliosis Clinic 1964-1971 have been used to establish the population frequency in the city of the idiopathic forms of talipes equinovarus and calcaneovalgus, metatarsus varus, congenital dislocation of the hip, and infantile scoliosis. A survey of 165 patients now aged 7 to 11 years showed an aetiological relationship, but with differing environmental factors. These factors were established by comparison with the Edinburgh Register control group of 692 normal infants born over the same period, giving a unique opportunity to obtain more accurate antenatal data than has previously been possible. The principal associations were: talipes equinovarus with antepartum haemorrhage and maternal hypertension; metatarsus varus with twin pregnancies; congenital dislocation of the hip with first born children, older than average fathers, breech presentation, a significant lack of menstrual problems in the mother, and maternal upper respiratory infection during pregnancy; infantile idiopathic scoliosis with breech presentation, prematurity, and the onset of the curve in the winter months. No significant association with raised intrauterine pressure (hydramnios or oligohydramnios) was found among these simple idiopathic deformities. It is concluded that the multifactorial genetic background in likely to be similar in all, but that the additional environmental element is variable.
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PMID:Aetiology and interrelationship of some common skeletal deformities. (Talipes equinovarus and calcaneovalgus, metatarsus varus, congenital dislocation of the hip, and infantile idiopathic scoliosis). 714 83


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