Home monitoring of uterine activity.
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Female↗
Biomedical subjects
D C Dyson
Publications and source records attributed to D C Dyson.
Prevention of preterm birth in high-risk patients: the role of education and provider contact versus home uterine monitoring.
A total of 394 patients were enrolled in a study to assess the effectiveness of an educational preterm delivery prevention program and to determine whether the addition of home uterine monitoring to the program improved results in patients at high risk of preterm labor. Both the educational program and home uterine monitoring were found to increase the percentage of women with preterm labor who sought care while still favorable for long-term suppression, resulting in a decreased incidence of preterm births and improved outcome when compared with similar high-risk patients who did not participate in these programs. In a randomized, prospective study, addition of home uterine monitoring to the educational program was found to significantly improve outcome in twin gestations but not in singleton gestations. However, the number of singleton pregnancies was too small to rule out possible benefit from home uterine monitoring in that group.
Female↗
Death due to high-output cardiac failure in fetal sacrococcygeal teratoma.
Fetal sacrococcygeal teratoma (SCT) is being recognized with increasing frequency. Placentomegaly and hydrops fetalis are preterminal events, and it has been suggested that fetal death may be due to high-output cardiac failure from arteriovenous shunting through the tumor. We had a chance to examine this hypothesis when a 21-week fetus presented with a huge sacrococcygeal teratoma. There were marked placentomegaly, cardiomegaly, hyperdynamic ventricles, and a pericardial effusion. Doppler studies showed tremendous flow through the SCT with extreme enlargement of the inferior vena cava, consistent with congestive heart failure from increased flow through the tumor. Hydrops developed, and the fetus was delivered because of placental abruption. This case provides supportive evidence that the teratoma acts as a large arteriovenous shunt, causing high-output cardiac failure. We have now collected 18 more cases of sacrococcygeal teratoma diagnosed in utero. Of the total 45 cases of fetal SCT, 9 had placentomegaly and/or fetal hydrops and all 9 fetuses died in utero or shortly after birth. We conclude that the only hope for survival in these severely affected fetuses is to reduce blood flow to the tumor before birth.
Cardiac Output↗
A comparison of tocolysis with nifedipine or ritodrine: analysis of efficacy and maternal, fetal, and neonatal outcome.
Nifedipine, a dihydropyridone calcium entry blocker, has been used with increasing frequency in the treatment of preterm labor. We studied 66 patients in this prospective, randomized trial to evaluate the efficacy and maternal, fetal, and neonatal outcome associated with tocolysis with nifedipine or ritodrine. Delivery was delayed for 48 hours, 7 days, and until the thirty-sixth week of gestation in 84%, 70%, and 41%, respectively, of patients in the nifedipine group, compared with 72%, 63%, and 52% of patients in the ritodrine group (difference not significant). Maternal side effects were more common and more serious in the group of patients who received ritodrine compared with those who received nifedipine (18 of 38 versus 5 of 38, p less than 0.01); however, fetal and neonatal outcome appeared to be similar when the groups were compared. On the basis of this study, it appears that tocolysis with either nifedipine or ritodrine is equally efficacious; however, maternal side effects are less common with nifedipine treatment. We conclude that nifedipine may have a role in the treatment of preterm labor but suggest further careful evaluation of this agent before it is considered for routine clinical use.
Female↗
Cardiovascular and metabolic effects associated with nifedipine and ritodrine tocolysis.
Recent investigations have indicated that nifedipine, a calcium channel entry blocker, may be useful in the treatment of preterm labor. This prospective, randomized study compares cardiovascular and metabolic effects measured in association with sublingual and oral administration of nifedipine with those noted with the intravenous and oral administration of the beta-adrenergic agent ritodrine. Serial measurements of cardiovascular parameters, hematocrit, electrolytes, glucose, blood urea nitrogen, creatinine, calcium, and serum glutamic-oxaloacetic and glutamic-pyruvic transaminase were compared between groups. Sublingual and oral nifedipine caused minimal cardiovascular alterations. At doses sufficient to achieve tocolysis, ritodrine caused more pronounced cardiovascular changes than nifedipine. Both agents had a hemodilutional effect, but nifedipine was not associated with alterations in serum electrolytes or a dramatic hyperglycemia. On the basis of this study, it appears that the use of nifedipine for preterm labor management is associated with hemodilutional changes but not the adverse cardiovascular or metabolic effects often associated with ritodrine tocolysis.
Blood Glucose↗
Fetal surveillance vs. labor induction at 42 weeks in postterm gestation.
Perinatal mortality and morbidity are increased in prolonged pregnancy. The application of antepartum fetal testing and intrapartum fetal heart rate monitoring in prolonged pregnancy has decreased the perinatal mortality and morbidity, but the perinatal morbidity remains higher in patients delivering after term than in those delivering at term. Recent evidence suggests that delivery at an earlier gestational age using modern labor-induction techniques may prevent the increase in perinatal mortality and morbidity associated with prolonged pregnancy without increasing the incidence of prolonged labor and cesarean delivery.
Apgar Score↗
Management of prolonged pregnancy: induction of labor versus antepartum fetal testing.
Three hundred two low-risk obstetric patients with an unfavorable cervical examination and well-established gestational age of at least 287 days were randomly selected for management by either antepartum fetal testing or prostaglandin gel cervical ripening followed by aggressive induction of labor and delivery. The patients managed by induction of labor had a lower incidence of meconium-stained amniotic fluid, meconium aspiration, low Apgar scores, postmaturity syndrome, fetal distress, and cesarean delivery than did patients managed with antepartum fetal testing. Our data suggest that prostaglandin gel cervical ripening and induction of labor and delivery by 42 weeks' gestation may be the most appropriate management for patients with well-established gestational age and an unfavorable cervical examination.
Dinoprostone↗
Maternal and fetal factors affecting success of antepartum external cephalic version.
We studied 172 patients who were considered for external cephalic version with tocolysis at term. Before a single attempt at version, a variety of maternal and fetal factors considered likely to affect success were coded for each patient. Maternal age, height, and Quetelet index did not affect success. However, successful version was more likely in parous women than in nulliparous women, and less likely with cornual than with other placentations. Amniotic fluid volume, fetal abdominal circumference, type of breech, and the specific nature of the maternal-fetal spatial relation were also important determinants of success. Fetal biparietal diameter, gestational age, and estimated fetal weight were not. All of these factors can be evaluated before attempting version and can be used when counseling candidates for version.
Adolescent↗
Antepartum external cephalic version under tocolysis.
Reported are 172 patients considered for external cephalic version at gestational age greater than 37 weeks. Their outcome was compared with 40 similar patients in whom external version was not attempted. One hundred fifty-eight patients had attempted version, and success was achieved in 122 (77%). Intrapartum vertex presentation occurred in 12% of the control population and in 77% of the version patients. Cesarean section was performed in 80% of the control patients and in 32% of the version patients. There were no maternal or fetal complications directly attributable to external cephalic version. Antepartum external cephalic version under tocolysis is associated with a high success rate, an acceptably low rate of complications, and a decreased incidence of cesarean section for breech presentation at term.
Adult↗
Intrapartum external cephalic version.
Intrapartum external cephalic version at term was employed in 15 patients with intact membranes and breech presentations; successful version occurred in 11 patients. There were no untoward maternal or fetal outcomes.
Breech Presentation↗
Respiratory arrest during therapy for premature labor in a patient with myasthenia gravis.
A case of premature labor in a woman whose pregnancy was complicated by myasthenia gravis is presented. Ritodrine was given for tocolysis, and betamethasone was administered to accelerate fetal lung maturation. An acute, life-threatening exacerbation of muscular weakness requiring intubation and mechanical ventilation occurred. It appears that betamethasone initiated the respiratory crisis. It is apparent, however, that tocolytic agents currently being used in patients with premature labor (namely, beta-2-sympathomimetics and magnesium sulfate) also have the potential to produce severe exacerbations of weakness, and even respiratory arrest in patients with myasthenia gravis. Each must be used with extreme caution if prescribed for women with this disorder.
Adult↗
Neutralization of herpes simplex virus by antibody in amniotic fluid.
The ability of amniotic fluid to neutralize herpes simplex virus type 2 (HSV-2) was quantitated and compared with the serum neutralization titer in 158 pregnant women. Neutralizing activity was expressed as the ability of 0.1 ml of amniotic fluid to reduce the expected number of plaque-forming units (pfu) in the inoculum by 99%. All amniotic fluid samples from 32 women with serum titers of 1:40 or greater neutralized 5 pfu or more; at term, 96% of these fluid samples neutralized 50 pfu or more, 83% neutralized 500 pfu or more, and 61% neutralized 5000 pfu or more. Only 76% of the amniotic fluid samples obtained at term from women with serum titers of 1:5 to 1:39 contained detectable neutralizing activity and only 8% neutralized 5000 pfu or more. None of the amniotic fluid samples from 30 women with serum titers less than 1:5 neutralized 5 pfu or more. All neutralizing activity was removed when immunoglobulin G was removed from the amniotic fluid samples. Sera were obtained from 51 pregnant women 4 to 8 weeks prior to delivery. All women with serum titers of 1:40 or higher gave birth to infants who also had serum titers of 1:40 or higher. Therefore, it is possible to predict the neutralization titer in amniotic fluid and in the infant's serum by measuring the mother's titer in the third trimester.
Amniotic Fluid↗