[Importance of fetal cardiac rhythm monitoring at home in the follow-up of pregnancies at risk: evaluation following 2 years of utilization].
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Biomedical subjects
Publications and source records attributed to H Thoumsin.
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The purpose of this randomized study was to compare the efficacy of ritodrine alone (51) versus ritodrine plus magnesium gluconate (56). We concluded that high oral doses of magnesium therapy (4 x 3 gr) potentiate the effects of intravenous beta-agonists, allowing a reduction of the dosage needed and a better "tolerance". Considering the low side effects, it seems reasonable to consider using magnesium in the treatment of premature labour.
After decreasing in the first trimester of pregnancy, the total red blood cell mass increases in the second and third trimesters to peak at term at about 120% to 125% of nonpregnant values, but how this is brought about by changes in the rate of erythropoiesis is not known. We evaluated erythropoiesis by measuring serum transferrin receptor (TfR) levels in 406 women during normal pregnancy (N = 317), at delivery (N = 63), or in the early postpartum (N = 27). Despite the presence of the placenta and the frequent occurrence of iron deficiency, TfR levels remained low in the first two trimesters and increased in the third trimester and at delivery. To explain why erythropoiesic activity was relatively low in early pregnancy, we also measured serum immunoreactive erythropoietin (Epo) in relation to the degree of anemia. There was a very strong correlation between serum TfR and Epo levels in the entire group (r = .59, P less than .0001) as well as in each period of pregnancy. Epo levels remained low for the degree of anemia and did not correlate with hematocrit in the first two trimesters, but recovered afterwards. In the early postpartum, Epo production and erythropoiesis were normal. We conclude that: (1) erythropoiesis is decreased in the first part of pregnancy but increases afterwards; and (2) blunted Epo production in early pregnancy could be responsible for that observation.
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Pregnancy induces anatomical and physiological changes in the urinary tract. In this condition a bacteriuria, even asymptomatic, may lead more frequently to pyelonephritis. Asymptomatic bacteriuria in pregnant women has therefore got to be treated. According to recent studies, long course antibiotherapy did not prove to be more effective than a single-dose one in the case of non-complicated bacteriuria. Moreover, the maternal and foetal toxicity should be reduced in the latter regimen. In this paper we present the preliminary results of our study comparing a single-dose treatment by fosfomycin trometamol (3 g) and nitrofurantoin (200 mg per day during a week).
45 patients in premature labor entered the study, four dropped out for administrative reasons. The remaining 41 patients started all with an intravenous treatment followed by oral treatment with sustained-release ritodrine at a daily dosage of 120 mg per day until the 36th week of gestation. The mean gestational age at entry was 31.26 weeks +/- 3.27 and at delivery 37.76 weeks +/- 2.11 or a mean gain in days of 44.61 days +/- 20.85. A cluster analysis splitting the patients into four groups regarding the gestational age at entry and the Baumgarten tocolytic index showed that even the high-risk patients benefit remarkably by the treatment. The side effect rate was low as well for palpitation as for tremor. The patient compliance was excellent. No neonatal deaths or stillborns occurred during this study.
We studied 209 women during normal pregnancy, at delivery, or in the early postpartum, to determine whether erythropoietin (EPO) response was appropriate for the degree of anaemia. Serum immunoreactive EPO was measured in 74 nonpregnant women, including 33 normal subjects (16.4 +/- 4.1 mU/ml) and 41 women with hypoplastic, haemolytic, dyserythropoietic, or iron-deficient anaemia. An inverse linear relationship (R = -0.88, P less than 0.0001) between log(EPO) and Hct was observed. Predicted EPO values were derived for each Hct and an O/P ratio of observed/predicted log(EPO) was calculated for each sample (1.00 +/- 0.10, range 0.80-1.20). Serum EPO levels (mU/ml) were significantly higher during pregnancy (30 +/- 16, n = 142), at delivery (31 +/- 16, n = 41), and on day 7 postpartum (37 +/- 35, n = 26) than in normal women (P less than 0.001). EPO levels increased steadily from 18 +/- 6 mU/ml in the first, to 26 +/- 14 mU/ml in the second, and to 35 +/- 18 mU/ml in the third trimester (P less than 0.0001). The O/P ratio was normal on day 7 postpartum (1.01 +/- 0.16), at delivery (1.03 +/- 0.16), and in the third trimester (0.96 +/- 0.15), but was significantly reduced in the first two trimesters (0.88 +/- 0.15, P less than 0.001). A significant negative correlation between log(EPO) and Hct was lacking in the first two trimesters, was present but with a reduced slope during the third trimester and at delivery, and was normal postpartum. We conclude that EPO response to anaemia is impaired in early pregnancy, recovers in late pregnancy, and normalizes rapidly in the postpartum.
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Ten Belgian maternity hospitals have collaborated in an international clinical multicenter trial: Multicenter Fetal Movement Trial. Nine maternity hospitals were already managing a computerized data bank before their participation in the trial. In seven of these centers the local team was able to write a program for direct transmission of data, using standard sequential ASCII files. This procedure presents many advantages: there is a gain in time and money, since it is no longer necessary to fill out data collecting forms, or coding at a central level. Transcription errors are avoided, adhesion to strict and standard definitions is guaranteed, the micro-systems are performing in a suitable fashion in each center, modifications of parameters (and corrections) are done very quickly and, automatically carried out, on the basis of clinical data as well as "research" data, transmission by telecommunication is immediately and easily feasible.
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A review of the literature shows that intensive neonatal care has reduced the incidence of neurological handicaps in children. Babies born before term and small for date are, however, more exposed to these handicaps. The pregnancy and socio-economical factors which are now known to play a role in the occurrence of prematurity and small-for-date babies bring about acute fetal distress which results in a demand for more intensive care. However, long-term neurological defects also result from these factors. Prospective studies can be used to assign a predictive score for these predisposing factors. The Maternity Hospital in Liège University has been using a score of these factors for more than 10 years to set up "a risk of premature birth coefficient." This could help towards a more scientific prognosis of the neurological state of the infant.
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The therapeutic effect of DHEA-S has been studied in 15 cases of intra-uterine growth retardation. This double-blind study has not been able to demonstrate any difference between the effect DHEA-S and of NaCl on oestriol excretion, HPL values, and biparietal diameter. Only the uterine growth seems to be affected by DHEA-S. Thus it can be concluded that DHEA-S has no therapeutic effect on placental insufficiency.