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PubMed1982

Horner syndrome during lumbar epidural analgesia for obstetrics.

Horner syndrome (ptosis, miosis, anhidrosis, and facial and conjunctival vasodilation) is a recognized complication of lumbar epidural analgesia for labor and delivery. Alone, it presents no significant risk to mother or fetus, as resolution is spontaneous and complete. Horner syndrome may, however, be associated with significant maternal hypotension and therefore should be an indication for close maternal and fetal monitoring to provide reassurance.

Adult↗
PubMedDate not supplied

Factors predictive of maternal-fetal transmission of HIV-1. Preliminary analysis of zidovudine given during pregnancy and/or delivery.

OBJECTIVE: To assess maternal risk factors potentially influencing vertical transmission of human immunodeficiency virus, type 1 (HIV-1), including maternal CD4 cell count; presence of immune complex dissociated (ICD) p24 antigen; maternal zidovudine therapy during pregnancy and/or delivery; complications of pregnancy, such as preterm labor and birth; and obstetric events during labor and delivery, such as duration of labor, mode of delivery, chorioamnionitis, and maternal blood exposure. DESIGN AND SETTING: A nonrandomized prospective cohort study at a university medical center and two general hospital affiliates. PATIENTS: Sixty-three HIV-1-seropositive pregnant women and their 68 infants. INTERVENTION: Twenty-six mothers received zidovudine therapy during pregnancy and/or during labor and delivery. MAIN OUTCOME MEASURE: HIV-1 infection status of the infant. RESULTS: Thirteen of the 68 infants were vertically infected with HIV-1. Mothers with events involving fetal exposure to maternal blood were more likely to transmit infection (four [31%] of 13 vs three [5%] of 55, P = .02), as were women with plasma ICD p24 antigenemia at delivery (six [67%] of nine vs 11 [25%] of 44, P = .02). Zidovudine treatment was associated with a significant reduction in vertical transmission (one [4%] of 26 mothers treated with zidovudine vs 12 [29%] of 42 mothers not treated with zidovudine, P = .01). There was a significant protective effect of zidovudine treatment despite lower mean absolute CD4 cell counts (0.37 x 10(9)/L) in the 24 zidovudine-treated nontransmitters and in the nine non-zidovudine-treated transmitters (0.37 x 10(9)/L) than in the 24 non-zidovudine-treated nontransmitters (0.62 x 10(9)/L) (P = .008). CONCLUSION: Maternal-fetal HIV-1 transmission is multifactorial, with increased risk associated both with ICD p24 antigenemia at term and with intrapartum events that increase fetal exposure to maternal blood. Zidovudine therapy given during pregnancy and/or labor and delivery was associated with a significant reduction in vertical transmission. These data suggest that the beneficial effects of zidovudine therapy in reducing maternal-fetal HIV-1 transmission recently found in protocol 076 of the placebo-controlled Acquired Immunodeficiency Syndrome Clinical Trials Group Study may extend to women with lower CD4 cell counts and suggest that prolonged treatment of infants may not be necessary.

Adult↗
PubMedDate not supplied

Obstetric performance in Ethiopian immigrants compared with Israeli parturients.

It was the aim of this study to evaluate the obstetric performance of Ethiopian Jewish immigrants in comparison to the general Jewish obstetric population. The study was performed at the Soroka Medical Center, Beer Sheva, which manages the busiest delivery ward in Israel. Between 1988 and 1991 a total of 20,047 non-Ethiopian women (Group N) and 431 parturients of Ethiopian origin (group E) delivered at the Soroka Medical Center. Group E included a significantly higher percentage of grandmultiparous women than group N. Among diseases complicating pregnancy there was a statistically significant higher incidence of severe pregnancy-induced hypertension (PIH) in group E than in group N. Mild PIH and chronic hypertension were of comparable prevalence in both groups. The prevalence of class A diabetes mellitus was significantly lower in group E than in group N; the same trend was also observed for diabetes class B but without reaching statistical significance. There was no significant difference between the groups in the prevalence of polyhydramnios, postdatism and poor obstetric history, or fetal distress, s/p cesarean section, and prolapse of cord. Statistical analysis indicated a tendency towards significance for higher prevalence of premature rupture of membranes in group N. Malpresentations and malpositions were of similar prevalence in both groups. The incidence of premature delivery in group E showed a higher relative risk, suggesting a tendency of significance. The incidence of meconium-stained amniotic fluid in group E was significantly higher than in group N. There was no significant difference in the prevalence rates of placental complications such as placenta previa and abruption of placenta between the groups. The mode of delivery, the prevalence of complications during the third stage of labor, birthweight of infants and perinatal mortality were similar for both groups. In conclusion, the obstetric performance in Ethiopian Jewish immigrants is surprisingly similar to that of Israeli Jewish parturients. The only prominent pathology that does not seem to be related to life-style and nutrition is pregnancy-induced hypertension.

Birth Weight↗
PubMed1994

A preventable cause of foot drop during childbirth.

Compression of the peroneal nerve is an uncommon complication of labor and delivery. We describe a case of common peroneal nerve injury associated with positioning the knees in hyperflexion during delivery. The pathophysiologic mechanisms, clinical course, and possible prevention of this uncommon complication are discussed.

Adult↗