Urinary tract infections in women.
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Adolescent↗
Biomedical subjects
L C Gilstrap
Publications and source records attributed to L C Gilstrap.
Pathophysiology of preeclampsia.
In summary, the major pathophysiologic event that occurs in women with preeclampsia or pregnancy-induced hypertension is vasospasm. In turn, vasospasm leads to a wide range of dysfunction in many organ systems.
Angiotensin II↗
Early repair of episiotomy dehiscence.
Early repair of episiotomy dehiscence was performed in 22 women with an initial fourth-degree episiotomy, four with third-degree episiotomy, and five with a mediolateral episiotomy. Early complications were limited to development of a pinpoint rectovaginal fistula in two women, both subsequently repaired by a rectal mucosal flap procedure. Of the 27 women now 1 year or more post-repair, all are completely continent and report resumption of normal coital activity.
Dyspareunia↗
Maternal and fetal effects of heroin addiction during pregnancy.
Heroin addiction during pregnancy has been reported to be associated with adverse maternal and perinatal effects. In a study of a large obstetric service in Dallas, pregnancy outcome and health status of infants born to 24 heroin addicts were compared to those in a group of 100 unexposed women and their infants. Women who used heroin during pregnancy tended to use other substances (tobacco, alcohol, cocaine) more often than did controls. The frequency of preterm birth was increased significantly in women who abused heroin during pregnancy. Sexually transmitted diseases were not increased in frequency in pregnant heroin addicts as compared to women who did not use heroin during pregnancy. Heroin addicts had infants who were significantly shorter and lighter in weight than did controls. No significant differences in head circumference or frequency of congenital anomalies were observed.
Apgar Score↗
Intrapartum asphyxia in pregnancies complicated by intra-amniotic infection.
Intra-amniotic infection has been reported to be associated with intrapartum asphyxia; however, the criteria used to define asphyxia have been imprecise. In the present study of 123 women with intra-amniotic infection and 6769 women without infection, the mean umbilical artery pH was 7.28 in both groups. The frequency of acidemia (umbilical artery pH less than 7.20) was not significantly different between the infection group and controls (15 versus 10%; P = .12). Likewise, there was no significant difference between the groups when a lower umbilical artery pH value (less than 7.15) was used to define acidemia. None of the infants from infected mothers had metabolic acidemia with a pH of less than 7.15 and none had a pH of less than 7.00. Significantly more (P less than .05) infants in the infected group did have low 1-minute (20 versus 5%) and 5-minute (3 versus 1%) Apgar scores of 6 or less, criteria often used to define asphyxia. However, none of the newborns from the infected group had recently proposed criteria for the diagnosis of birth asphyxia (ie, leading to neurologic impairment) such as metabolic acidemia, seizures in the immediate newborn period, and low Apgar scores (3 or less). Birth asphyxia is rarely associated with intra-amniotic infection, and in the absence of other signs of fetal jeopardy such as an ominous fetal heart rate pattern, an immediate cesarean to prevent asphyxia does not appear justified once the diagnosis of chorioamnionitis is made.
Acidosis↗
Pharmacokinetics of azidothymidine during late pregnancy in Long-Evans rats.
Azidothymidine (Zidovudine) is used to treat symptomatic human immunodeficiency virus infection. It has the ability to reverse seropositivity as well as decrease serum viral titers, and perhaps decrease potential for transmission of the virus. An animal model (pregnant Long-Evans rats) was used to investigate the potential for placental transmission of azidothymidine. The drug crosses the placenta to reach concentrations in the placenta and fetus that are comparable to 75% and 58%, respectively, of those in the maternal serum by 2 hours after administration. By 4 to 6 hours after administration azidothymidine concentrations in the placenta and fetal liver significantly exceed maternal concentrations.
Animals↗
Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction.
Imprecise diagnosis of birth asphyxia coupled with uncertainties about causal factors for neurologic abnormalities in the newborn have greatly fueled the current litigation crisis in obstetrics. Our goal was to more precisely define birth asphyxia based on fetal condition as measured by umbilical artery blood pH, Apgar scores, and neurologic condition of newborns. We selected for study 2738 patients with singleton pregnancies with cephalic presentations who were delivered of infants at term to avoid complications such as prematurity, which may affect infant outcome independent of birth condition. The basis for study of these particular patients were defined criteria for high risk and an indicated arterial cord pH value. A total of five infants demonstrated cerebral dysfunction as evidenced by seizures during the neonatal period. Infection was linked to seizures in three of these infants; one infant had neonatal asphyxia and only one infant's clinical course could be attributed solely to birth events (uterine rupture). Stratification of umbilical artery blood pH values, Apgar scores, and combinations of these dependent variables in relation to newborn clinical outcomes revealed that infants must be severely depressed at delivery before birth asphyxia can be reliably diagnosed. Such depression includes Apgar scores less than or equal to 3 at 1 and 5 minutes plus umbilical artery pH values less than 7.00.
Acid-Base Equilibrium↗
Use of laser vaporization for management of extensive genital tract condyloma acuminata during pregnancy.
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Condylomata Acuminata↗
Cardiovascular drugs during pregnancy.
There are little available information regarding the fetal risk for the majority of cardiac medications. Fortunately, however, clinical experience with many of these drugs as a necessity would indicate that most are probably safe for use during pregnancy. Since most of these medications are clearly indicated, they should not be withheld simply because the patient is pregnant. For most cardiac conditions, the disease process itself generally carries more of a risk to the mother and fetus than any risk that could be postulated from the medications used to treat the condition.
Abnormalities, Drug-Induced↗
Urinary tract infections in women.
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Female↗
Umbilical artery acid-base status in the preterm infant.
It is becoming increasingly apparent that Apgar scores are generally lower in otherwise uncomplicated preterm newborns than in term newborns. However, there is little information regarding normal values for umbilical artery blood gas measurements in the preterm infant. The present study included 77 otherwise uncomplicated preterm infants and 1292 uncomplicated term infants. Although preterm infants did have significantly lower 1- and 5-minute Apgar scores, there was no significant difference in the frequency of acidemia (umbilical artery pH below 7.20). The mean pH was 7.29 in preterm infants and 7.28 in term infants. Mean values for pCO2, pO2, HCO3, and base deficit were similar in each group. There were no significant differences in umbilical artery blood gas values in the 77 preterm infants according to birth weight groups. Umbilical cord blood acid-base determination may prove a useful adjunct in assessing the condition of the newborn preterm infant.
Acid-Base Equilibrium↗
Maternal height and weight gain during pregnancy as risk factors for cesarean section.
Maternal height, maternal weight, infant weight, and maternal weight gain during pregnancy were examined as factors associated with the likelihood of delivery by cesarean section for cephalopelvic disproportion (CPD). Sixty-four women, delivered by cesarean section for CPD, were compared with matched controls who delivered vaginally. The only factor associated with an increased risk of cesarean section for CPD was short stature: women shorter than 63 inches were 4.9 times more likely to have CPD than taller women.
Adult↗
Postpartum endometritis.
Despite the widespread use of prophylactic antibiotics, postpartum endometritis remains a common complication following cesarean section. Metritis is generally polymicrobial and responds to a wide variety of antibiotic regimens. During the past decade, single agents have been shown to be safe and efficacious. The pathogenesis, diagnosis, and treatment options for endometritis are reviewed.
Anti-Bacterial Agents↗
Acute chorioamnionitis.
In summary, acute intra-amniotic infection or chorioamnionitis is a relatively common complication of pregnancy and may be associated with significant maternal and neonatal morbidity. Maternal mortality is rare, as is mortality in term infants. Mortality in premature infants is probably related to prematurity itself rather than infection per se. Diagnosis is based primarily on the presence of maternal fever. Treatment consists of antibiotics and delivery. Antibiotics should be begun as soon as the diagnosis is made unless delivery is imminent (less than 1 hour). Cesarean section offers no specific advantage to the fetus and may carry increased risk to the mother.
Anti-Bacterial Agents↗
Alcohol abuse during pregnancy: changes in frequency in a large urban hospital.
The reported frequency of alcohol abuse during pregnancy was studied in a large urban public hospital in Dallas, Texas. During 1977-1980, 5602 pregnant women were surveyed and 0.7% (95% confidence interval 0.6-0.8%) reported abusing alcohol during pregnancy. In 1987, 1.4% (95% confidence interval 1.3-1.5%) of 1032 pregnant women, who were surveyed before delivery, reported alcohol abuse according to the same definition used 10 years earlier. The increase in the frequency of reported alcohol abuse during pregnancy between 1977-1980 and 1987 is statistically significant (P less than .05).
Adolescent↗
Cocaine abuse during pregnancy: maternal and fetal implications.
Cocaine abuse during pregnancy has been reported to be associated with a variety of fetal complications and with preterm labor. In this cohort study, pregnancy outcome and health status of infants born to 53 cocaine abusers were compared with those of another group of 100 unexposed women and their infants. Significantly more (P less than .05) pregnancies of abusers were associated with preterm labor. In addition, significantly more (P less than .05) infants had complications at birth (ie, meconium, tachycardia). Infants born to cocaine abusers also had significantly lower (P less than .05) birth weight than infants of controls, and an excess of congenital cardiac anomalies (P less than .01).
Adult↗
Meconium in the amniotic fluid and fetal acid-base status.
Of 323 pregnancies with meconium-stained amniotic fluid at 36-42 weeks' gestation, 68 (21%) had a pH less than 7.20 in umbilical arterial blood, 21 (7%) had a pH less than 7.15, and only three newborns (0.9%) had true metabolic acidemia. At birth, of the 74 newborns with normal electronic fetal heart rate (FHR) tracings, eight (11%) had an umbilical arterial pH less than 7.20. There was a significantly higher frequency of acidemia (defined as pH less than 7.20) in newborns with both baseline and periodic FHR abnormalities. Although there was a significant difference (P less than .05) in the frequency of meconium found below the cords in these neonates with an umbilical artery pH less than 7.20 compared with those with values exceeding 7.20, there was no significant difference in the frequency of clinical meconium aspiration syndrome. We conclude that meconium-stained amniotic fluid correlates poorly with infant condition at birth as reflected by umbilical cord acid-base measurements.
Acid-Base Imbalance↗