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PubMed1978

ABCs of perinatal medicine.

The purpose of this paper is to illustrate the continuum of perinatal risks responsible for developmental handicaps in infancy. The first step is the Assessment of risks during pregnancy so that intervention can occur naturally in the process of preventive health care. A valid risk-assessment system has been developed which can facilitate identification of the high-risk pregnancy. New methods of perinatal care during the Birth process are now available which allow active intervention aimed at reducing the likelihood of a high-risk patient delivering an infant destined to become handicapped. During the neonatal period Critical care has been shown to reduce morbidity and mortality. However, the perinatal profile of the handicap is not yet complete enough to fully explain developmental delay. A new health care strategy based on prospective risk assessment and early intervention must now be seriously considered which will allow technological medicine to continue to improve well-being.

Child Development↗
PubMed1989

A case of sudden death by decidual cell embolism.

A 35-year-old multipara died suddenly of a pulmonary embolism about 12 h after delivery. The morphological features and the entry site of the emboli into the circulation suggested that they were decidual cells. Intact decidual cells accounted for only a minority of the emboli: the great majority were cells that had lost their nuclei and/or had been fragmented. The presence of embolized areas, accompanied by fibroblasts and newly formed capillaries, suggested that the embolization process had started before the beginning of labor. However, no symptoms suggesting embolism had been recorded on the clinical chart.

Adult↗
PubMed1986

Amniotic fluid embolism: a report of four probable cases.

Four probable cases of amniotic fluid embolism (AFE) are reviewed. The outcome appeared to be determined by the severity of the insult, and possibly the gestation of the pregnancy, rather than the management of the AFE. Two cases occurred during early labour; neither patient recovered consciousness. One died two weeks later and the other suffered severe permanent cerebral damage. The other two cases occurred during dilatation and curettage, one for therapeutic abortion at fourteen weeks gestation and the other for missed abortion at twenty weeks gestation. Both patients made full recoveries. Disseminated intravascular coagulation (DIC) was a feature of all four cases. In the patients in labour it occurred almost immediately. In those undergoing dilatation and curettage it occurred after the patients had apparently recovered but were under observation in the intensive care unit. Amniotic fluid embolism can occur during an apparently uneventful labour. It should also be suspected when unexplained collapse occurs during second trimester dilatation and curettage. Because severe DIC may follow, such patients should be transferred immediately to a centre with full haemotology services.

Adolescent↗
PubMed1975

The relaxing effect of terbutaline on the human uterus during term labor.

The uterine and cardiovascular responses to the adrenergic beta2-receptor stimulator terbutaline (TRB) were investigated in 14 patients in normal term labor. TRB, administered intravenously at a rate of 10 to 20 mug per minute, effectively inhibited uterine activity in advanced labor and also expulsion. Intravenous injection of TRB, 250 mug, diminished oxytocin-induced uterine hyperactivity. No serious side effects of the drug were observed; the circulatory effects were minimal, except for a tolerable maternal tachycardia. The mode of action and clinical application of TRB for inhibition of unwanted uterine activity are discussed.

Abortion, Threatened↗
PubMed1983

Magnesium sulfate as a tocolytic agent.

Magnesium sulfate (MgSO4) has been successfully used to inhibit premature labor. A retrospective review was performed on the use of MgSO4 as a tocolytic agent at Memorial Hospital, Long Beach, California, during a 4-year period (1978-1982). Three hundred fifty-five patients with diagnoses of premature labor were treated with MgSO4 after transport from another hospital. Two hundred seventy-four patients (77%) had a singleton pregnancy with intact membranes, 38 (11%) had a singleton pregnancy with ruptured membranes, 35 (10%) had a multiple gestation with intact membranes, and eight (2%) had a multiple gestation with ruptured membranes. Delivery was successfully delayed in the majority of patients, and the incidence of unexplained failure of tocolysis was only 2%. Side effects occurred in 24 patients (7%) and necessitated stopping the drug in only seven (2%). Serum magnesium levels are reported and the use of MgSO4 in patients with significant vaginal bleeding is discussed. MgSO4 was found to be a successful, inexpensive, and relatively nontoxic tocolytic agent that had few side effects.

Female↗
PubMed1995

Limitations in the clinical prediction of intrapartum fetal asphyxia.

OBJECTIVE: Our purpose was to demonstrate the predictive value of clinical risk scoring and fetal assessment for intrapartum fetal asphyxia. STUDY DESIGN: Intrapartum fetal asphyxia was defined by an umbilical artery buffer base < 34 mmol/L. The predictive value of 20 antepartum and intrapartum risk factors was examined in 1909 consecutive pregnancies. The predictive value of clinical risk factors with periodic fetal assessment was examined in a second population of 100 consecutive pregnancies with biochemically determined intrapartum fetal asphyxia. RESULTS: The incidence of intrapartum was 2.3%. Two problems were apparent in these studies. A significant proportion of intrapartum fetal asphyxia occurred in pregnancies with no risk factors. The positive predictive value of clinical risk factors was low, 3%, resulting in a large number of false positives requiring clarification. CONCLUSION: Screening and fetal assessment methods must be improved to ensure the early recognition of intrapartum fetal asphyxia that may require intervention during labor to avoid morbidity and mortality.

Delivery, Obstetric↗
PubMed1983

L/S ratio, biochemical and clinical changes after ritodrine intravenous infusion.

The effects of ritodrine hydrochloride on the L/S ratio, the clinical and biochemical status of the mother, and the amniotic fluid were studied in a total of 46 women between the 28th and 35th wk of their pregnancy. An increase in the L/S ratio and creatinine levels in the amniotic fluid, significant changes in the maternal serum levels of potassium, sodium, alpha 1-antitrypsin and glucose were found, whereas the urea levels remained unchanged. Maternal hyperglycemia and hypokalemia in both maternal serum and amniotic fluid, were more pronounced when the ritodrine was infused in 5% dextrose. The findings from monitoring the cardiovascular systems of both mother and fetus, agreed with previous reports. It was concluded that ritodrine hydrochloride has a positive effect on the fetal lung maturation, probably by accelerating the release of surfactant. Its administration, however, should be under laboratory control.

Amniotic Fluid↗
PubMed1993

Elevation of amniotic fluid interleukin 6 (IL-6), IL-8 and granulocyte colony stimulating factor (G-CSF) in term and preterm parturition.

We determined the levels of inflammatory cytokines such as interleukin 6 (IL-6) granulocyte-colony stimulating factor (G-CSF) and IL-8 in the amniotic fluids from women with premature or term delivery. Cytokines were detectable even in the absence of apparent infection (group 1), but much higher cytokine levels were found in cases of intrauterine infection, particularly in cases of premature delivery (group 2). In cases of term delivery (groups 3-5), all of the cytokine levels showed c. 3- to 4-fold increase during labor pain (group 4) and an 8- to 13-fold increase in the presence of endotoxin (group 5), in comparison with the levels in cases where neither factor was present (group 3). Regarding infection, the cytokine levels were 20- to 30-fold higher in chorioamnionitis-positive premature delivery group (group 2), than in the infection-negative group (group 1). All the cytokines were simultaneously induced in amniotic fluid by labor pain and infection, and a significant positive correlation was observed among these three cytokine levels. In-vitro culture system and immunohistochemical study indicated that the cytokines in the amniotic fluid appeared to originate from trophoblasts and decidual cells. Thus, infection and labor pain may trigger the production of inflammatory cytokines at term as well as premature delivery and the determination of these cytokine levels will be a good indication for the prediction of the presence of intrauterine infection.

Amniotic Fluid↗
PubMed2006

Are the Agency for Healthcare Research and Quality obstetric trauma indicators valid measures of hospital safety?

OBJECTIVE: The objective of the study was to examine whether the United States Agency for Health Care Research and Quality obstetric patient safety indicators are significantly affected by patient-specific and hospital-level characteristics not related to the safety environment. STUDY DESIGN: Administrative data for all nonfederal Illinois hospitals in 2001 were used to analyze the association of a hospital's obstetric trauma rates with patient and hospital-level factors. Multivariable random effects logistic regression analyses was used to account for hospital-level clustering. RESULTS: A total of 175,374 deliveries from 142 Illinois hospitals were available for analysis. The frequency of obstetric trauma was significantly associated with multiple patient-specific and hospital-level factors. Specifically, for any vaginal delivery, premature delivery, multiple gestation, excessive fetal growth, and prolonged pregnancy was associated with obstetric trauma risk. For spontaneous delivery, a prior cesarean was associated with trauma risk as well. Maternal age was associated with trauma risk at cesarean as well as at vaginal delivery. With regard to hospital-level factors, a higher annual delivery volume and a higher cesarean rate were associated with increased risk of trauma with either type of vaginal delivery, whereas in the intensity with which hospitals coded their medical records was associated with trauma risk for all routes of delivery. CONCLUSION: The risk of obstetric trauma is significantly influenced by both patient and hospital characteristics and is not a good indicator of patient safety.

Cesarean Section↗