Management of pregnancy-induced hypertension in the nulliparous patient remote from term.
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Adolescent↗
Biomedical subjects
F G Cunningham
Publications and source records attributed to F G Cunningham.
Infectious morbidity following cesarean section. Comparison of two treatment regimens.
During a 4-month period 265 women delivered by cesarean section were studied to determine what effect membrane rupture has on the incidence and severity of postoperative infection. There was a definite correlation between the duration of ruptured membranes and the incidence as well as severity of postoperative infections. Only 29% of women with intact membranes subsequently developed endometritis with pelvic cellulitis, in contrast to 85% of those whose membranes were ruptured for less than 6 hours. Wound and pelvic abscesses were encountered in less than 1% of women delivered with intact membranes, yet these complications developed in over 30% of women with membranes ruptured for less than 6 hours. The incidence of septicemia was four times greater in those women whose membranes were ruptured for less than 6 hours. Women with endometritis were treated with one of two empirical antimicrobial regimens chosen randomly. Intravenous penicillin and tetracycline was found to be as effective as, and perhaps slightly more effective than, the combination of intravenous penicillin and intramuscular tobramycin.
Abscess↗
Hematologic considerations of pregnancy-induced hypertension.
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Adult↗
The bacterial pathogenesis of acute pelvic inflammatory disease.
To study the bacterial pathogenesis of acute pelvic inflammatory disease, peritoneal fluid was obtained by culdocentesis in 133 of 344 women with this disease. In 104 of the specimens bacteria were identified both in the gram-stained smear and culture. Neisseria gonorrhoeae was isolated from the lower genital tract in over half of these women, and there were 3 patterns of bacterial recovery from peritoneal fluid: N gonorrhoeae alone (22%), N gonorrhoeae and other organisms (32%), and nongonococcal organisms alone (46%). In women without cervical gonorrhea only nongonococcal organisms were identified from peritoneal fluid. In both groups of women a similar number of nongonococcal organisms were isolated. The results of this study supported those reported prior to availability of antimicrobials and suggest that N gonorrhoeae initiates most cases of pelvic inflammatory disease. A significant number of these women have superinfection with nongonococcal organisms which may preclude recovery of gonococci.
Acute Disease↗
Gonorrhea screening in male consorts of women with pelvic infection.
Neisseria gonorrhoeae was isolated from 39% of male contacts of women with acute gonococcal pelvic inflammatory disease (PID); 22% of these men were asymptomatic. More than half of those women with gonococcal PID had at least one male sexual consort with gonorrhea. Neisseria gonorrhoeae was isolated from 15% of male contacts of women with nongonococcal PID; 30% were asymptomatic. Since a substantial number of male contacts of women with acute PID will have cultures positive for N gonorrhoeae and are asymptomatic, all male sexual consorts should be examined and have cultures grown for gonorrhea.
Disease Reservoirs↗
Evaluation of tetracycline or penicillin and ampicillin for treatment of acute pelvic inflammatory disease.
To evaluate guidelines for outpatient treatment of acute pelvic inflammatory disease recommended by the Center for Disease Control we studied 197 afflicted women. The women were treated either with tetracycline or with procaine penicillin and ampicillin, and 92% were subsequently seen at least once to assess efficacy of clinical and microbiologic treatment. Neisseria gonorrhoeae was isolated from the lower genital tract in 68% of these women, and although they had a quicker symptomatic response than those with nongonococcal infection (P less than 0.01), the two regimens were equally effective in producing clinical cure. However, subsequent identification of a pelvic abscess was 10 times more common in women from whom N. gonorrhoeae was not isolated. Therapy for pelvic inflammatory disease must be empirical since it is impossible to distinguish clinically between gonococcal and nongonococcal infection, and our data indicate that both regimens recommended by the Center for Disease Control are effective.
Acute Disease↗
Serum gamma-glutamyl transpeptidase activity in viral hepatitis: suppression in pregnancy and by birth control pills.
gamma-Glutamyl transpeptidase (GGT) activity in serum was increased in the majority of women with viral hepatitis occurring in the first half of pregnancy. By contrast, GGT activity was abnormal less frequently and the mean value was relatively depressed, even though hepatitis was as severe, in the second half of gestation. Mean GGT activity was also lower, and abnormal values were less frequent, in nonpregnant women with viral hepatitis who were taking birth control pills (BCP). Depressed GGT is not attributable to an inhibitor in serum in women in late pregnancy or taking BCP. The data suggest that estrogen and/or progestational compounds affect liver such that less GGT is released into blood with acute hepatocellular injury. In addition, hyperbilirubinemia was found to be associated with depressed serum GGT activity, and bilirubin added to serum in vitro interfered with measured activity of the enzyme.
Bilirubin↗
Takayasu's syndrome in pregnancy.
Two cases of Takayasu's syndrome in pregnancy are presented. The obstetric courses of these women are compared with those of 7 others described in the literature. Symptoms of this rare condition may respond variably during pregnancy. Of the 9 women, 5 had worsening of their symptoms during gestation while 4 had milder symptoms than they had had prior to pregnancy. The best therapy is rest. Vaginal delivery is recommended and cesarean section should be reserved for obstetric indications.
Adult↗
Short-term versus continuous antimicrobial therapy for asymptomatic bacteriuria in pregnancy.
Asymptomatic bacteriuria was identified in 300 pregnant women prior to the 28th week of gestation. In one group of 200 women short-term treatment with either nitrofurantoin or sulfamethizole was given for 14 days, and in another group of 100 women continuous therapy with one of these drugs was given for the remainder of gestation. Weekly urine cultures were obtained from all the women. Of the women treated with short-term therapy, 65% were abacteriuric for the remainder of pregnancy following one course of therapy, 24% became abacteriuric but subsequently relapsed, 2% had reinfection after becoming abacteriuric, and 9% demonstrated no response. Following treatment with a second course of short-term therapy, another 19% of these women were cured for the remainder of their pregnancy, and 3.5% responded to a third course. In the continuous therapy group, 88% of the women became abacteriuric for the remainder of the gestation, 3% demonstrated relapse, 2% developed reinfection, and 7% had no response to the first drug given. These data demonstrate that short-term administration of antimicrobials, when combined with surveillance for recurrent bacteriuria, is effective for the management of the pregnant woman with asymptomatic bacteriuria.
Bacteriuria↗
Early labor initiation with oral PGE2 after premature rupture of the membranes at term.
Two groups of healthy women at term, who were not in labor 3 hours after premature rupture of the membranes, were studied. In one group labor induction with oral prostaglandin E2 (PGE2) was begun 3 hours after rupture, and in the other group intravenous oxytocin induction was begun 12 hours after rupture. PGE2 was successful in initiating active labor in 88% of women treated. Of the women who were observed for 12 hours, one-half began labor spontaneously during that time. Women in whom labor was induced with PGE2 given 3 hours after rupture of the membranes had a shorter interval of rupture to delivery, a lower cesarean section rate, and shorter postpartum hospitalization. Although significant bradycardia did not occur in fetuses of those women given PGE2, 10% of infants whose mothers were receiving oxytocin were delivered by cesarean section for this reason. It is concluded that oral PGE2 is safe and effective for induction of labor in women with premature membrane rupture. The benefits, to both mother and fetus, of a shorter latent period are discussed.
Adult↗
Oral prostaglandin E2 for labor induction in high-risk pregnancy.
Oral prostaglandin E2 (PGE2) was used alone or synergistically with intravenous oxytocin to induce labor in 84 women whose pregnancies were at high risk. A control group of 84 similar high-risk pregnancies where labor was induced with intravenous oxytocin alone was studied to compare the safety and efficacy of the two regimens. Oral PGE2 administration, combined with the synergistic effect of intravenous oxytocin, is safe for induction of labor in gravid women whose fetuses are at risk. Uterine polysystole, which is potentially dangerous, especially to the high-risk fetus, was not commonly encountered and only once was associated with transient fetal bradycardia. Uterine hypertonus was not encountered with PGE2; however, it did occur with oxytocin stimulation. Nausea and vomiting occurred in one third of the women treated with PGE2 but were well tolerated and required discontinuation of the drug in only one instance. There was no apparent advantage of using the combination PGE2 regimen in patients whose cervices were more favorable for induction of labor (Bishop score, 5 to 9). However, oral PGE2, used either alone or synergistically with oxytocin, appears twice as effective in inducing labor than was oxytocin alone in women in whom labor was considered to be "difficult to induce" (Bishop score, 0 to 4).
Administration, Oral↗
Coagulation changes in eclampsia: their frequency and pathogenesis.
The maternal coagulation mechanism has been investigated in an effort to identify its role, if any, in the pathogenesis of eclampsia. Thrombocytopenia was identified in 28 of 95 cases (29 per cent), a prolonged thrombin time in 19 of 38 (50 per cent), abnormally elevated serum fibrinogen-fibrin degradation products in two of 65 (3 per cent), and circulating fibrin monomer in one out of 20 (5 per cent). Overt hemolysis was rare (2 per cent). Thus the pattern as well as the degree of change in the maternal coagulation mechanism differed remarkably from that typical of severe abruptio placentae and of prolonged retention of a dead fetus, the classic obstetric models of fast and slow disseminated intravascular coagulation. It is concluded that the coagulation changes when present in eclampsia are effect rather than cause. Moreover, the changes may evolve primarily from platelet adherence at sites of vascular endothelial damage as the consequence of segmental vasospasm and vasodilatation rather than be triggered by the escape of thromboplastin from the placenta into the maternal circulation.
Abruptio Placentae↗
Does coagulation have a causative role in eclampsia?
Alternations in the coagulation mechanism were looked for in a population of eclamptic women, most of when were young, nulliparous, and without evidence of chronic vascular disease, and all of whom survived. Thrombocytopenia was identified in 29% of these women. A prolonged plasma thrombin time was demonstrated in 51% yet elevated fibrinogen-fibrin degradation products in serum were uncommon, as was fibrin monomer in plasma. Overt microangiopathic hemolysis was rare. It is concluded that disseminated intravascular coagulation, when it does occur in eclampsia, is the consequence of the disease rather than the cause. Moreover, endothelial damage, rather contents, probably initiates the thrombocytopenia and other coagulation changes.
Adolescent↗
Management of pregnancy-induced hypertension in the nullipara.
Three hundred and forty-six nulliparous women with pregnancy-induced hypertension prior to term were monitored in a high-risk pregnancy unit while awaiting fetal maturity. Management included ambulation as desired, regular hospital diet without salf restriction, blood pressure measured 4 times daily, weight and urine protein determined 3 times each week, creatinine clearance determined weekly, and serial sonography to monitor fetal growth. Sedation and antihypertensive agents were not prescribed. Delivery was delayed until term unless hypertension persisted or recurred following an initial salutary response. Factors other than hypertension that contributed to the decision to effect delivery were 1) rapid weight gain, 2) decreasing creatinine clearance, 3) appearance of significant proteinuria, 4) suspected fetal growth retardation, and 5) the development of severe headache or scotomata. With this method of management the perinatal mortality rate was 9/1000. Only 5 infants developed the respiratory distress syndrome and all survived. There were 26 women who left the unit against medical advice. Severe hypertension subsequently developed in 7 of these women and 4 of their fetuses were stillborn. The perinatal mortality rate among this group of patients was 154/1000. It is concluded that the nulliparous patient with pregnancy-induced hypertension prior to term can be safely managed by hospitalization and close observation as a viable alternative to prompt delivery.
Adolescent↗
Transient renal dysfunction associated with acute pyelonephritis of pregnancy.
Endogenous creatinine clearance was measured in 220 pregnant women with acute pyelonephritis and the results compared to data obtained from 167 pregnant control patients without acute pyelonephritis. These data showed that an appreciable number of patients with pyelonephritis occurring during pregnancy demonstrated a transient but definite diminution in renal function during the acute attack. Causes of this temporary renal dysfunction are discussed.
Creatinine↗
Appendicitis complicating pregnancy.
Thirty-four pregnant women with acute appendicitis presented at Parkland Memorial Hospital during a 15-year period. Abdominal pain, usually accompanied by nausea with or without vomiting, was the most common presenting symptom. Anorexia was less constant, and its occurrence decreased with advancing gestation. Physical findings usually included direct abdominal tenderness and, less often, rebound tenderness. Leukocytosis and/or a "left shift" were common laboratory findings, and the urinalysis was normal in most cases. Diagnosis was increasingly difficult as gestation progressed. This was reflected both by the increasing severity of the disease process found at surgery and by increasing fetal loss. If the diagnosis of appendicitis is suspected in the gravid patient, immediate surgical intervention is indicated to prevent the catastrophic complications associated with procrastination in diagnosis and treatment.
Adolescent↗
Further observations on the nature of pressor responsivity to angiotensin II in human pregnancy.
The pressor dose of infused angiotensin II was determined before and after rapid volume expansion with 800 to 1075 ml of high-hematocrit blood. There was no remarkable change in sensitivity to infused angiotensin demonstrated except in two instances in which transient volume overload developed. The data support the hypothesis that increased angiotensin sensitivity observed in patients with pregnancy-induced hypertension is the consequence of increased vascular responsivity.
Anemia, Sickle Cell↗
The etiology and pathogenesis of pelvic inflammatory disease.
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Acute Disease↗