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

Cigarette smoking, alcohol and drug abuse, and stressful life events are significant contributors to prematurity and low birth weight in the United States. Identification and treatment of pregnant women with these risk factors require obtaining complete and accurate psychosocial histories. The purpose of this study was to determine whether a computer interview developed by our staff is appropriate for assessing behavioral risk factors for adverse pregnancy outcomes and for educating pregnant women about healthy behaviors during pregnancy. This computer interview asks about pregnant patients' perceived life stressors, diet, use of cigarettes and alcohol, and abuse of drugs. The study population consisted of 201 medically insured Hispanic and non-Hispanic white women attending a health maintenance organization--based prenatal clinic. Almost all subjects rated the computer interview favorably. Medical record reviews were conducted to compare participants' reports of cigarette, alcohol, and drug use obtained from paper-and-pencil interviews with behaviors reported during the computer interview. Although self-reported rates of smoking did not differ between the two interview techniques, a much higher percentage of women reported alcohol and drug use during the computer interview. Study participants scored significantly higher on a test measuring knowledge of the effects of stress, diet, and substances of abuse on pregnancy than did a control group. Results demonstrated the potential value of computer-interactive software programs for assessing high-risk behaviors among pregnant women in this population and educating them about healthy behaviors during pregnancy.
Am J Obstet Gynecol 1991 Sep
PMID:Prenatal behavioral risk screening by computer in a health maintenance organization-based prenatal care clinic. 189 74

Antenatal administration of glucocorticoids is often used to facilitate fetal lung maturation in cases of prematurity; however, the effects of betamethasone on maternal immune function have not been established. Therefore maternal immune function was assessed with the use of in vitro techniques. Transient and incomplete suppression of the proliferative response to the T-cell mitogen phytohemagglutinin was demonstrated as early as 24 hours after administration of betamethasone. The magnitude and duration of suppression showed a corresponding increase with advancing gestational age, but these effects were not cumulative and were always short-lived (less than 72 hours). No such suppression of the B-cell mitogen lipopolysaccharide was detected. The nonspecific cellular resistance to infection of maternal monocytes was determined through coincubation with the facultative intracellular pathogen Listeria monocytogenes. Increased phagocytic activity with a normal bactericidal effect was measured in the cell preparations obtained from recipients versus nonrecipients of betamethasone. Taken together, these findings clearly show that both specific and nonspecific immune function are intact in the preterm gravid woman after administration of betamethasone and should allay concerns over its use for reasons of infection control alone.
Am J Obstet Gynecol 1991 Sep
PMID:The effects of betamethasone on maternal cellular resistance to infection. 189 86

The outcome of 13 sets of triplet infants delivered between January 1, 1981, and December 31, 1988, is analyzed with specific regard to immediate neonatal morbidity. Thirty-nine viable infants were born with no perinatal deaths. Overall, 80% of triplet infants incurred some morbidity, including hyperbilirubinemia (51.3%), hypoglycemia (30.8%), respiratory distress syndrome (28.2%), respiratory compromise (23.1%), anemia (17.9%), patent ductus arteriosus (15.4%), and intraventricular hemorrhage (10.3%). All morbidities occurred in infants who averaged less than 2,000 g and 35 weeks' gestation at birth. As a background to understanding these observations, a review of reports of triplet morbidity and mortality in the United States and Europe is presented. Over the past 80 years, a continual decline in triplet perinatal mortality has occurred despite no change in the average gestational age at delivery over the past 40 years. The triplet perinatal mortality rate is now less than 10%, and prematurity is no longer as influential on perinatal mortality as it is on morbidity. Improvement in neonatal resuscitation and care and delivery by cesarean section are felt to be responsible for lower mortality rates. We believe that the optimum level of care for triplet gestations includes antenatal and neonatal care at tertiary perinatal centers and, except for special circumstances, delivery by cesarean section.
J Perinatol 1991 Sep
PMID:Triplet pregnancy: changes in morbidity and mortality. 191 16

To study the safety and efficacy of administering human recombinant erythropoietin (rHuEPO) to infants with anaemia of prematurity, a combined phase I/II trial of weekly intravenous injections for 4 weeks was undertaken. We treated 16 infants with 10, 25, 50, 100 or 200 units/kg body weight in groups of two to four patients per dose level. They were all born prematurely (mean gestational age: 29 weeks; range 27-32), had a mean post-natal age of 42 days (range: 25-59) and haemoglobin concentration of 87 g/l (range: 72-94) when treatment was started. Four patients (25%) needed a transfusion during the trial, one at day 7 treated with 10 units/kg and 3 at days 15, 25, 29 with 100 units/kg. In the others, a progressive rise in mean haemoglobin values was seen in each group after 21 days of treatment, without a dose-dependent effect. A positive change in absolute reticulocyte counts with a peak after 7-14 days of therapy was observed with low (25-50 units/kg) but not with higher doses, with a significant difference at day 14 between 25 and 100 units/kg (P less than 0.01). A dose-limiting severe neutropenia (absolute neutrophil count less than 0.5 x 10(9)/l) occurred transiently in five patients, with doses greater than 25 units/kg. No infectious complication and no sign of iron deficiency were observed. Weekly low doses of rHuEPO appear safe, convenient to administer and able to induce a reticulocytic response in infants with anaemia of prematurity. A phase III placebo-controlled trial is needed to confirm these results. Neutropenia associated with rHuEPO administration in infants might be related to their stage of human ontogeny.
Eur J Pediatr 1991 Sep
PMID:Weekly intravenous administration of recombinant human erythropoietin in infants with the anaemia of prematurity. 195 38

This population-based study examined whether the neonatal outcome of primiparae is determined by maternal age or by her socioeconomic background. Data on all births in Israel during a three-month period was made available from a nation-wide census. Primiparae 30 years of age or older had a significantly (P less than 0.001) higher risk of low birthweight and prematurity. Perinatal mortality rates and low 5-min Apgar scores were not associated with maternal age, but were significantly (P less than 0.001) increased for the socioeconomically disadvantaged parturients. Our results suggest the growth retardation and short gestation among older primiparae may reflect biological aging of maternal tissues and the effect of diseases of pregnancy such as hypertension and preeclampsia, found significantly (P less than 0.001) more common for these mothers. Excessive perinatal mortality, on the other hand, may be attributable to environmental disadvantage of socioeconomically deprived populations.
Int J Gynaecol Obstet 1990 Sep
PMID:The effect of maternal age and socioeconomical background on neonatal outcome. 197 36

In the western world, bacterial vaginosis is now being recognised as the commonest cause of vaginitis. Bacterial vaginosis represents a major disturbance in vaginal microbiology with the massive overgrowth of predominantly anaerobic bacteria normally found in the vagina. Accordingly, high population levels of non-fragilis Bacteroides sp., peptostreptococci, Gardnerella vaginalis and Mobiluncus sp. are found, with a corresponding decline in Lactobacillus sp. Excessive polyamine production by anaerobes is responsible for the offensive vaginal discharge, and G. Vaginalis adherent to epithelial cells produces pathognomonic clue cells, which together with elevated vaginal pH constitute the hallmark of diagnosis. The pathogenesis of bacterial vaginosis remains poorly understood and the role of sexual transmission is controversial. Bacterial vaginosis may cause symptoms but is frequently asymptomatic. It is more than a nuisance vaginal infection in that (a) many patients have recurrent episodes, and (b) it has recently been associated with post-partum and post-operative fever, upper genital tract infection, amnionitis and prematurity. Therapy for symptomatic bacterial vaginosis is currently dominated by metronidazole; however, clindamycin and a host of new agents may enjoy similar success. Women with recurrent bacterial vaginosis constitute a major therapeutic problem, as do pregnant women. The cause of frequently recurring bacterial vaginosis remains obscure. New data are presented here indicating that early recurrences are due to relapse and not reinfection. No evidence has emerged that suggests that relapse is due to antimicrobial resistance.
Br J Clin Pract Suppl 1990 Sep
PMID:Bacterial vaginosis. 209 36

A descriptive study of 125 infants with abdominal wall defects was undertaken to determine the effect of mode of delivery on outcome. Fifty-six infants had gastroschisis and 69 had omphalocele. Overall, there were no differences between the omphalocele and the gastroschisis groups in either cesarean section rate (22% vs 26%) or prematurity rate (26% vs 30%). However, the omphalocele group had a significantly higher infant death rate (22% vs 7%, p less than 0.001), a significantly higher incidence of associated major congenital anomalies (29% vs 5%, p less than 0.001), and a higher incidence of long-term infant morbidity (14.5% vs 8.9%). Within either group there was no significant difference between vaginal and cesarean delivery regarding either infant mortality, acute or long-term infant outcome, or frequency of associated major anomalies. We conclude that vaginal delivery of infants with abdominal wall defects does not adversely affect infant outcome.
Am J Obstet Gynecol 1990 Sep
PMID:The effect of mode of delivery on the perinatal outcome in fetuses with abdominal wall defects. 214 50

To determine the values of individual and combined biophysical fetal surveillance tests in a general high-risk population, we examined 1000 consecutive pregnancies complicated by either postdatism, hypertension, intrauterine growth retardation, or diabetes mellitus. Nonstress tests, amniotic fluid pocket measurements, and umbilical artery Doppler velocimetry were performed on each patient; each test was rated against gestational age-adjusted standards. Clinical end points included perinatal mortality, intrapartum fetal distress, 5-minute Apgar score less than 7, and neonatal acidosis in pregnancies without major anomalies or extreme prematurity (age at birth greater than 32 weeks), delivered within 72 hours of final tests. Each testing method had specificity greater than 90%. Sensitivities ranged from 69% (nonstress test) to 21% (Doppler velocimetry). Negative predictive values of each method exceeded 85%; positive predictive values ranged from 81% (nonstress test) to 42% (amniotic fluid measurements). The positive predictive value for any abnormal test was 54% and increased to 100% when all tests were abnormal; this latter condition occurred in only 2% of the total population. Amniotic fluid measurements or Doppler velocimetry, when compared with the nonstress test, appeared to be less powerful "stand-alone" screening tests. The performance of all tests in a single session confers little improvement in detection of fetal compromise if the nonstress test is normal; however, this approach may aid decision-making in the management of pregnancies when fetal maturity is not established.
Am J Obstet Gynecol 1990 Sep
PMID:The diagnostic values of concurrent nonstress testing, amniotic fluid measurement, and Doppler velocimetry in screening a general high-risk population. 220 56

Acardiac twinning affects 1 in 100 monozygotic twin pregnancies and 1 in 35,000 pregnancies overall. The presence of an acadiac twin requires the normal (or "pump") twin to provide circulation for itself, as well as the acardiac sibling. In many cases the acardiac twin is almost equal to the normal twin. The principal perinatal problems associated with acardiac twinning are pump-twin congestive heart failure, maternal hydramnios, and preterm delivery. We reviewed the perinatal courses of 49 acardiac twin pregnancies to identify factors prognostic of favorable outcome. The overall perinatal mortality was 55%, primarily associated with prematurity. Mean (+/- SD) gestational age at delivery was 29 +/- 7.3 weeks, with a mean (+/- SD) normal twin weight of 1378 +/- 1047 gm. The acardiac weight averaged 651 +/- 571 gm. However, the occurrence of hydramnios, the occurrence of preterm labor, and perinatal outcome were strongly related to the ratio of the acardiac and pump-twin's weight. The mean overall ratio of the twin weights was 52% +/- 42%. However, the mean weight ratio for patients delivered before 34 weeks was 60% versus 29% (p less than 0.04). Preterm delivery was strongly associated with the development of hydramnios and congestive heart failure in the pump twin (p less than 0.01). If the twin-weight ratio was above 70% (25% of cases), the incidence of preterm delivery was 90%; hydramnios, 40%; and pump-twin congestive heart failure, 30% compared with 75%, 30%, and 10%, respectively, when the ratio was less (p less than 0.05). Regression of the weight of the acardiac twin against its longest dimension (L) resulted in this equation for prediction of acardiac weight: Weight (grams) = 1.2 L2-1.7L; r = 0.79, p less than 0.01. These data suggest that estimation of the relative weights in acardiac twins provides prognostic information regarding outcome. Poor outcome occurs with congestive heart failure and hydramnios in the normal twin. Use of the above data may assist in counseling patients and determining optimal management.
Am J Obstet Gynecol 1990 Sep
PMID:Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. 220 78

Young maternal age is associated with an increased incidence of low birth weight and prematurity; controlling for sociodemographic factors reduces the significance of this relationship. We hypothesized that this is partly because in a sociodemographically homogeneous population the adverse effects of maternal subfecundity on fetal growth confound the relationship between maternal age and infant outcome. To test this hypothesis, we studied the reproductive histories of 90 adolescent (less than 20 years old) and 35 adult lower socioeconomic, black prenatal patients. We found a strong, positive relationship between maternal age at conception and duration of unprotected intercourse prior to conception (r = 0.40; p less than 0.0001). Adults reporting 2 or more years of unprotected intercourse prior to conception were at highest risk for low birth weight (p = 0.02). Our findings demonstrate that it is important that adult controls for adolescent pregnancy studies have voluntarily postponed conception.
J Adolesc Health Care 1990 Sep
PMID:Subfecundity: a prenatal risk factor for adults but not for adolescents. 221 Dec 77


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