Prelabour rupture of the membranes--why hurry?
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Biomedical subjects
Publications and source records attributed to S L Duncan.
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OBJECTIVE: To compare the frequency of common antenatal problems, the amount of antenatal surveillance and the obstetric and neonatal outcome in women with and without a history of infertility. DESIGN: A prospective cohort study with age and parity matched controls. SETTING: A single consultant unit at the Jessop Hospital for Women, Sheffield, over a 22-month period. SUBJECTS: 114 women with a history of infertility who reached 16 weeks gestation with a singleton live fetus and 114 control women matched for age and parity. MAIN OUTCOME MEASURES: Frequency of antepartum complications, amount of antepartum surveillance, obstetric and neonatal outcome. RESULTS: Common antenatal complications were not increased. In the infertility compared with the control group, the relative risk of requiring an emergency caesarean section was 2.43 (95% CI 1.05-5.63). There was no difference in birthweight. CONCLUSION: Many of the previously observed differences in outcome of pregnancy in women after infertility compared with those without are associated with age and parity but these characteristics do not explain the increased frequency of emergency caesarean section.
Sixty six women with first or second trimester fetal loss were investigated for the presence of lupus anticoagulant by routine coagulation tests and the dilute Russell's viper venom time with a platelet neutralisation procedure, and for raised anticardiolipin antibodies by an enzyme linked immunosorbent assay. Of 35 women with recurrent fetal loss, seven were positive for lupus anticoagulant and six had increased IgG anticardiolipin antibodies, while of 31 women with only one or two episodes of fetal loss, one had lupus anticoagulant and none increased IgG anticardiolipin antibodies. These findings were significantly different. There was no difference in the incidence of increased IgM anticardiolipin antibodies between the two groups (three and two cases, respectively). A further 11 women with intrauterine death in the third trimester were studied and lupus anticoagulant and raised IgM anticardiolipin antibodies were found in one case. No woman was known to have systemic lupus erythematosus. It is concluded that lupus anticoagulant and increased IgG anticardiolipin antibodies are independently associated with recurrent first and second trimester fetal loss and that such cases should be investigated, even in the presence of otherwise good health, by a comprehensive methodological approach.
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A structurally abnormal X chromosome was found in a nine year old girl with mild mental retardation and dysmorphic features. Subsequent clinical examination at 18 years of age showed tall stature and gonadal dysgenesis. Re-examination of her karyotype using a variety of banding techniques on prometaphase chromosomes allowed the identification of the abnormal chromosome as a duplication/deficient X chromosome, 46,Xder X(pter----q28::p11.2----pter). The clinical features are discussed in terms of karyotype/phenotype correlation.
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A 25 year old woman with gonadal dysgenesis but no other somatic features of Turner's syndrome was found to have a 45,X/46,XidicX(p22.3) karyotype. It is postulated that because her stature is within the normal range there has been no loss of genetic material in the fusion of the two Xs. Her mother, who also had a history of menstrual problems, was found to be a 46,XX/47,XXX mosaic.
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Uterine activity was measured quantitatively during subsequent labor after prostaglandin E2 gel (PGE2). Thirty primigravidae with a low Bishop score were included in this randomized double-blind study. Fewer women who received PGE2 required subsequent surgical induction. The pattern of uterine activity was different. Cervical dilatation was achieved with less uterine activity in the PGE2 group, especially during the shorter latent phase.
Women's ratings of their experience of childbirth were compared with midwives' ratings of the women's experience. The midwives' ratings were significantly different from those of their patients. Midwives presented a more positive picture of the woman's experience than did the woman herself. Furthermore, the women reported using psychoprophylactic techniques for controlling discomfort for significantly more of the time than the midwives reported that the women used such techniques. The results are discussed in the context of similar findings reported in the literature.
Six further cases of acute fatty liver of pregnancy are presented and discussed in relation to the world literature on this rare disease of pregnancy, the aetiology of which is still unknown. The importance of vomiting in late pregnancy is emphasized. A common feature seems to be a metabolic stress, possibly related to infection, which tips a susceptible liver into metabolic failure.
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Function of the pituitary-adrenal axis was assessed in 16 adult female patients who had been taking cyproterone acetate for greater than 1 year. Some evidence of reduced basal cortisol output was seen in 25% of the patients, but plasma cortisol levels could be stimulated both by hypoglycaemia and by direct corticotrophin (ACTH) stimulation. The latter effect was confirmed by analysis of steroid excretion in urine although basal excreation rates indicated extensive adrenal suppression. These results suggest that cyproterone acetate does have some glucocorticoid activity which is able partially to suppress the pituitary--adrenal axis, but leaves it still responsive to stress.
The value of routine regular antenatal cardiotocography (CTG) in the management of high-risk pregnancy was assessed in a prospective randomized controlled study of 353 patients. All patients had a weekly CTG trace during the last 6 weeks of pregnancy and according to the random allocation the tracings were concealed from, or available to, the clinicians. Other methods of assessing fetal welfare were available to both groups. There was no significant difference between the concealed and revealed groups in the timing and mode of delivery, birthweights, Apgar score and neonatal morbidity. No apparent effect from the routine use of antenatal CTG in high-risk pregnancy was shown.
Oxygen consumption of human endometrial tissue was measured in vitro in air and high oxygen gas phases using an oxygen electrode. The oxygen consumption increased throughout the proliferative phase, peaking around ovulation and then decreasing during the secretory phase. This pattern persisted whether the oxygen consumption was expressed on a dry weight, DNA or protein basis. Storage of the tissue and mincing produced lower values of oxygen consumption.
Of 298 women who had mid-trimester amniocentesis carried out in a single hospital unit in a 6-yr period, an increasing proportion were carried out for detection of neural tube defects. A clinical decision could be made following the first amniocentesis in 77% of cases. There were 16% where liquor was not obtained at the first attempt, and a further 7% where cell growth or biochemical testing was unsatisfactory. The outcome was influenced by the experience of the operator and timing of procedure. The success of the first procedure was 59% before 16 wk of gestation and 86% between 16 and 20 wk. The incidence of blood-staining of the liquor was higher with an anterior placenta (19%). Despite difficulties, the abortion rate (3.5%) does not appear to be higher than would be expected.
A study of 79 twin pregnancies was conducted between 1973 and 1976 with particular reference to the use of ultrasound and hormone analysis. There were 17 perinatal deaths, a perinatal mortality rate of 107 per 1000 deliveries. The contributing factors were antepartum anoxia (40%), prematurity (30%), congenital abnormalities (18%), and obstetric trauma (12%). During the period of study there was a complete change in the method of confirming twin pregnancies, ie, in 1973, 84% were confirmed by x-ray and in 1976, 86% by ultrasound. About 40% were diagnosed at 28 weeks' gestation or earlier. The ranges (mean +/- 2 SD) for human placental lactogen (hPL) and urinary estrogens have been established for twin pregnancy, and the value of these measurements in the antenatal management of twin gestations is discussed.