[Hazards of pregnancy and labor in very young primiparae].
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To evaluate the utility of conventional electronic fetal monitoring in detection of established perinatal sepsis, we conducted a case-controlled study of fetal monitor results in 18 patients delivering newborns with sepsis. Eleven of the 18 newborns (61%) demonstrated clinically reassuring fetal heart rate patterns, not significantly different from controls (p = 0.80). No pattern predictive of presumed perinatal sepsis could be identified. Obstetric factors traditionally associated with increased risk of perinatal infection, such as long duration of labor, use of internal fetal monitoring, and increased number of vaginal examinations were not significantly different from controls. Preterm rupture of membranes greater than 24 hours occurred in less than 50% of the cases. Clinical diagnosis of chorioamnionitis was established in only one third of the patients who delivered newborns with sepsis. In this study, use of conventional electronic fetal monitoring did not accurately identify newborns with presumed intrauterine infection.
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Data from a large study were used to determine the frequency of fatal disorders associated with low Apgar scores. 5-min scores had the best correlation with mortality rates. Death rates were more than ten times greater with abnormal than with normal 5-min scores. This difference was only 3-fold for 1-min values. Amniotic fluid infections were responsible for nearly half of the deaths in preterm and 24% of the deaths in term neonates with 5-min Apgar scores 0--6. The respective values for disorders that cause antenatal hypoxia were 25 and 24% and for major congenital anomalies, 7 and 28%.
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A group of 383 women with pregnancy risks were screened at the onset of labour. 70% of the EPH-Gestosis, 56% of the urinary tract infections and cervical incompetence, 48% of the anaemias, 38,6% of the premature labour, 11% of the hypotension and 4% of the antepartal haemorrhages were found still to be present at the onset of labour. In those women with EPH-Gestosis at the onset of labour, the risk of cesarean section was markedly higher. When the risks premature contractions and cervical incompetence were recorded, the resulting birth weights were lower and the necessity for intensive paediatric care higher than normal. EPH-Gestosis and urinary tract infections which were still present at the onset of labour were of a longer duration. If the risks premature contractions and cervical incompetence were present at the onset of labour one could imply a shorter period of gestation.