The Journal of maternal-fetal medicine最新文献

{"title":"Acute effect of exercise on blood glucose and insulin levels in women with gestational diabetes","authors":"M. Avery, A. J. Walker","doi":"10.1080/jmf.10.1.52.58-4","DOIUrl":"https://doi.org/10.1080/jmf.10.1.52.58-4","url":null,"abstract":"Objective : To evaluate the effect of a single session of exercise (cycling), at rest (control condition) and at two intensity levels (low- and moderate-intensity exercise conditions), on blood glucose and insulin in pregnancy complicated by gestational diabetes mellitus (GDM). Methods : A one-group repeated measures design was used. Women aged 18-38 with GDM, no other complications, not on insulin, and not exercising regularly were recruited. The women rested or exercised at the two intensities for 30 min and rested for 2 h after each session. Blood was sampled for blood glucose, insulin and hematocrit at baseline and every 15 min. Results : There was no difference at baseline in blood glucose levels. The blood glucose level was significantly lower for each exercise condition compared to rest, and for moderate compared to low-intensity exercise (5.2 vs. 4.3 vs 3.9 mmol/l) at the end of exercise (30 min), and for the two exercise conditions compared to rest at 15 min after exercise (4.9 vs 4.4 vs. 4.0 mmol/l). By 45 min after exercise, the blood glucose values were nearly identical. The area under the curve for blood glucose was significantly lower for low- and moderate-intensity exercise than for rest ( p = 0.01). The slope of change in insulin among the three conditions, from baseline to the 30-min session, approached significance ( p = 0.065). The power for that analysis was 0.51. A sample of 23 would have been required to increase the power to 0.80. Conclusions : Significant declines in blood glucose level were observed during low- and moderate-intensity exercise compared to rest. These differences were gone by 45 min after exercise. Continued research should examine those with high body mass index and more pronounced hyperglycemia for further evaluation of the effect of exercise on blood glucose and insulin levels in women with GDM.","PeriodicalId":79464,"journal":{"name":"The Journal of maternal-fetal medicine","volume":"10 1","pages":"52 - 58"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/jmf.10.1.52.58-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60756549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidelines and recommendations for safe use of Doppler ultrasound in perinatal applications","authors":"S. Barnett, D. Maulik","doi":"10.1080/jmf.10.2.75.84","DOIUrl":"https://doi.org/10.1080/jmf.10.2.75.84","url":null,"abstract":"Technological development has led to significant improvements in ultrasonographic capabilities in recent years, and this has been accompanied by increases in acoustic output. Meanwhile, there is a developing trend to use ultrasound at early stages of pregnancy when the developing embryo is known to be highly sensitive to damage by physical agents. The advent of pulsed spectral Doppler and color flow imaging has revolutionized perinatal applications. Doppler ultrasound has become widely accepted as a valuable diagnostic tool in obstetric medicine, where it has particular benefits for high-risk pregnancies. The benefits of Doppler screening are less well established. United States Food and Drug Administration (FDA) regulations now provide an option whereby equipment that provides a form of output display can be used to apply substantially higher acoustic output to the embryo or fetus than equipment approved for use under application-specific intensity limits. The Output Display Standard recently adopted by the FDA, in the USA, encourages self-regulation of acoustic exposure by the ultrasound user, on the basis of assumed knowledge of the implications of biophysical interactions. When modern sophisticated equipment is used at maximum operating settings for Doppler examinations, the acoustic outputs are sufficient to produce obvious biological effects, e.g. significant temperature increase in tissue or visible motion of particles due to radiation pressure streaming effects. The risk of inducing thermal effects is greater in the second and third trimesters, when fetal bone is intercepted by the ultrasound beam and significant temperature increase can occur in the fetal brain. Non-thermal bioeffects may be more significant in early gestation, when the relatively loosely tethered embryonic tissues are exposed to an ultrasound beam in a liquid path. The likelihood of producing cavitation-type non-thermal effects is enhanced by the presence in the sound-field of gas-encapsulated echo-contrast media. To ensure the continued safe use of ultrasound in obstetrics, it is important that international ultrasound organizations, such as the International Perinatal Doppler Society, issue advice to members to allow sensible assessment of risk : benefit and the practical implementation of the ALARA (as low as reasonably achievable) principle.","PeriodicalId":79464,"journal":{"name":"The Journal of maternal-fetal medicine","volume":"10 1","pages":"75 - 84"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/jmf.10.2.75.84","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60756948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preterm premature rupture of membranes is not an independent risk factor for neonatal morbidity","authors":"B. Furman, I. Shoham-Vardi, A. Bashiri, O. Erez, M. Mazor","doi":"10.1080/jmf.10.2.107.111-6","DOIUrl":"https://doi.org/10.1080/jmf.10.2.107.111-6","url":null,"abstract":"Objective : To evaluate the risk factors for development of neonatal morbidity in cases of preterm premature rupture of membranes (PPROM). Methods : The study population consisted of 2326 singleton preterm births occurring between 1994 and 1997 at Soroka University Medical Center. The neonatal morbidity included respiratory distress syndrome, intraventricular hemorrhage (grade III-IV), necrotizing enterocolitis, periventricular leukomalacia, bronchopulmonary dysplasia, neonatal pneumonia and sepsis. A cross-sectional study was designed to compare neonatal morbidity between two groups: the study group consisted of patients with PPROM ( n = 376) and the comparison group of patients without PPROM ( n = 1950). Results : The prevalence of the neonatal morbidity associated with PPROM was 13.0% (49/376). There was no statistically significant difference in neonatal morbidity rates between the PPROM group and the group with intact membranes in any of the birth-weight groups (Mantel-Haenszel weighted odds ratio 1.20; 95% CI 0.80-1.20), or gestational-age groups (Mantel-Haenszel weighted odds ratio 1.03; 95% CI 0.79-1.55). There was no statistically significant difference in neonatal morbidity between patients with PPROM and those with intact membranes according to clinical chorioamnionitis. Congenital anomalies did not influence the neonatal morbidity when comparing patients with and without PPROM (44.4% vs. 32.8%, respectively; p = 0.23). Conclusions : PPROM was not an independent risk factor for neonatal morbidity in preterm births. Neonatal morbidity was affected mainly by prematurity itself, rather than by the occurrence of PPROM.","PeriodicalId":79464,"journal":{"name":"The Journal of maternal-fetal medicine","volume":"10 1","pages":"107 - 111"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/jmf.10.2.107.111-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60757108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mandated preterm delivery: its prevalence and impact at a tertiary referral center","authors":"W. Fronterhouse, F. Christensen, L. Rayburn, G. Gilson, L. Curet, W. Rayburn","doi":"10.1080/jmf.10.3.162.165","DOIUrl":"https://doi.org/10.1080/jmf.10.3.162.165","url":null,"abstract":"Objective : To determine the prevalence and impact of mandated preterm deliveries at a tertiary referral center. Methods : A chart review was conducted at our institution on all livebirths from 24 weeks to completion of 37 weeks' gestation between 1 January 1998 and 31 December 1999. Mandated delivery was defined as intentional intervention because of a deteriorating maternal or fetal condition. Reasons for intervention and intrapartum courses were compared with two other preterm groups (premature ruptured membranes, spontaneous labor) delivering during the same period. Statistical analyses included the Student t test, univariate ANOVA, h 2 test and Mann-Whitney test. Results : A total of 894 pregnancies delivered preterm, with 132 (14.8%) being mandated. Primary reasons for mandated delivery included severe pre-eclampsia (69.0%), vaginal bleeding (11.4%), deteriorating maternal illness (10.6%), worsening fetal growth restriction (6.1%) or major fetal malformation (3.0%). Delivery at less than 34 weeks was more common in the mandated group (68.9%) than in the ruptured membranes group (41.2%, p < 0.005) or in the spontaneous labor group (46.5%; p < 0.01). Cesarean section rates were higher in the mandated group (69.7%) than in the ruptured membranes group (18.3%; p < 0.001) or in the spontaneous labor group (21.5%; p < 0.001). The presence of an unfavorable cervix, unsuccessful trial of labor, non-cephalic fetal presentation, or fetal intolerance of labor explained the high rate of surgery. Conclusions : Conditions mandating delivery accounted for 14.8% of all preterm births. Mandated delivery is associated with a greater need for delivery before 34 weeks, often by Cesarean section.","PeriodicalId":79464,"journal":{"name":"The Journal of maternal-fetal medicine","volume":"10 1","pages":"162 - 165"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/jmf.10.3.162.165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60757827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a rapid optical immunoassay-based test for group B streptococcus colonization in intrapartum patients","authors":"R. Samadi, A. Stek, J. Greenspoon","doi":"10.1080/jmf.10.3.203.208","DOIUrl":"https://doi.org/10.1080/jmf.10.3.203.208","url":null,"abstract":"Objective : To compare an optical immunoassay (OIA) rapid diagnostic kit to standard culture for the diagnosis of vaginal colonization with group B streptococcus (GBS) and to assess the accuracy and reproducibility of the OIA results. Method : A total of 301 patients in labor were prospectively evaluated for GBS colonization with a test approved by the Food and Drug Administration (STREP B OIA kit, Biostar, Boulder, CO, USA) and by culture. The vagina was simultaneously sampled with two swabs. Rectal culture was obtained separately. Results : By the criterion of a positive culture, the vagina was colonized by GBS in 33 of 301 (11%) patients; and the rectum in 42 of 301 (13.9%). The vagina or rectum or both were colonized by GBS in 54 of 301 (17.9%) of patients. The OIA had sensitivity, specificity, positive predictive value and negative predictive value of 63.6%, 86.3%, 37.5% and 94.8%, respectively. The OIA had a kappa statistic score of 0.59. Conclusion : The OIA is not an adequately sensitive rapid kit for reliable detection of GBS colonization of the vagina. The results of the OIA were only moderately accurate and reproducible.","PeriodicalId":79464,"journal":{"name":"The Journal of maternal-fetal medicine","volume":"10 1","pages":"203 - 208"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/jmf.10.3.203.208","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60757833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary hyperparathyroidism and acute pancreatitis during the third trimester of pregnancy","authors":"M. Hong, B. Chen, P. Chou","doi":"10.1080/jmf.10.3.214.218","DOIUrl":"https://doi.org/10.1080/jmf.10.3.214.218","url":null,"abstract":"The simultaneous occurrence of maternal primary hyperparathyroidism (PHPT) and acute pancreatitis during pregnancy is very rare. We report a case of concurrent PHPT and pancreatitis during the third trimester of pregnancy. A summary of the relevant literature regarding the clinical course and recommended management in relation to this case is also presented.","PeriodicalId":79464,"journal":{"name":"The Journal of maternal-fetal medicine","volume":"10 1","pages":"214 - 218"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/jmf.10.3.214.218","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60757960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regulation of prostaglandin synthesis in the human uterus","authors":"T. Zakar, F. Hertelendy","doi":"10.1080/jmf.10.4.223.235","DOIUrl":"https://doi.org/10.1080/jmf.10.4.223.235","url":null,"abstract":"Prostaglandins are important regulators of many aspects of reproductive processes from ovulation, fertilization and pregnancy recognition to labor and parturition. These biologically potent compounds are members of the large family of eicosanoids, derived from polyunsaturated fatty acids, principally arachidonic acid, found in the membrane phospholipids of virtually every cell of the human body, accounting for the ubiquity of prostaglandins, which act in a paracrine or autocrine fashion via discrete receptors. The availability of specific prostaglandins in various cells and tissues depends on the presence and activity of specific enzymes that convert a common precursor to the end product, as well as on the rate of enzymatic or spontaneous inactivation of the bioactive compounds. Here we offer a brief review of the regulation of prostaglandin generation in human uterine tissues, focusing on their role in labor and parturition at term and preterm.","PeriodicalId":79464,"journal":{"name":"The Journal of maternal-fetal medicine","volume":"10 1","pages":"223 - 235"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/jmf.10.4.223.235","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60758025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of intermittent vaginal administration of two different doses of misoprostol suppositories with continuous dinoprostone for cervical ripening and labor induction","authors":"A. Khoury, Qianyun Zhou, D. Gorenberg, B. Nies, G. E. Manley, F. Mecklenburg","doi":"10.1080/jmf.10.3.186.192","DOIUrl":"https://doi.org/10.1080/jmf.10.3.186.192","url":null,"abstract":"Purpose : To compare the efficacy of a vaginal insert administering continuous dinoprostone with vaginal suppositories containing two different doses of misoprostol for cervical ripening and induction of labor. Study design : In this prospective, randomized, double-blinded study, 118 patients with indications for induction of labor and an unfavorable Bishop score were randomly assigned to receive either continuous dinoprostone, misoprostol 35- w g suppositories, or misoprostol 50- w g suppositories. Results : No significant differences were noted among the three groups in the change of Bishop score, induction of active labor or the time from initial treatment to delivery. Active labor occurred in roughly two-thirds of the patients in an average of about 5.7-6.7 h regardless of treatment assignment. When the two misoprostol groups were combined, a shorter interval from insertion to vaginal delivery was observed in the nulliparous women receiving misoprostol than those receiving continuous dinoprostone (21.3 vs. 27.2 h, p = 0.019). Except for the significantly lower incidence of tachysystole observed in the combined misoprostol group (3.8% vs. 15.4%, p = 0.036), there were no other significant differences between the groups in mode of delivery or in adverse maternal, fetal, or neonatal effects. Conclusion : Misoprostol suppositories appeared to be as effective and safe as continuous dinoprostone in inducing cervical ripening in this sample.","PeriodicalId":79464,"journal":{"name":"The Journal of maternal-fetal medicine","volume":"10 1","pages":"186 - 192"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/jmf.10.3.186.192","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60758073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of variable heart rate decelerations on intraventricular hemorrhage and other perinatal outcomes in preterm infants","authors":"P. Holmes, L. Oppenheimer, A. Gravelle, M. Walker, M. Blayney","doi":"10.1080/jmf.10.4.264.268","DOIUrl":"https://doi.org/10.1080/jmf.10.4.264.268","url":null,"abstract":"Objective: We investigated the hypothesis that repetitive variable heart rate decelerations in labor are associated with an increased incidence of neonatal complications in premature infants. Methods: This was a retrospective case-control study. Singleton fetuses weighing between 750 and 2500 g at 25-35 weeks' gestation were considered for the study. Fetuses delivered by Cesarean section prior to labor were excluded. Heart rate traces were retrieved from an electronic archive and were assessed for the presence of variable decelerations. Cases had at least three variable decelerations in the hour prior to delivery and were matched 1 : 1 with controls for gestation, sex and birth weight. Results: A review of 6500 deliveries yielded 41 matched pairs. The groups were compared for the following outcomes. Measures of acute morbidity were cord pH at delivery, 5-min Apgar score and resuscitation; measures of chronic morbidity were intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis and death. There was no difference in measures of acute morbidity between the groups. The incidence of chronic morbid outcome measures in the cases was six (15%) vs. one (2.5%) in controls ( p = 0.01). Conclusions: This study suggests that variable decelerations in preterm infants are associated with chronic morbidity, particularly intraventricular hemorrhage through a mechanism independent of fetal acidemia. Further study is required to determine whether these infants would benefit from early Cesarean section.","PeriodicalId":79464,"journal":{"name":"The Journal of maternal-fetal medicine","volume":"10 1","pages":"264 - 268"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/jmf.10.4.264.268","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60758525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Absence of physiological tolerance to cocaine in pregnant sheep","authors":"D. Burchfield, N. Hargrove, K. Anderson","doi":"10.1080/jmf.10.5.341.349","DOIUrl":"https://doi.org/10.1080/jmf.10.5.341.349","url":null,"abstract":"Objective: To determine whether repetitive administration of cocaine to sheep during pregnancy altered basal hemodynamic states in the mother and fetus, and to determine whether this cocaine exposure would alter subsequent hemodynamic responses to cocaine. Methods: Cocaine or saline was administered to 16 pregnant sheep daily from day 75 to day 128 of gestation (term = 145 days). At 128 days' gestation, maternal and fetal basal physiological measurements, including organ-specific blood flow in the fetus, were determined. Each experimental and control ewe then received cocaine 2 mg/kg and these physiological parameters were again measured over the next 30 min to determine whether the experimental animals had developed tolerance to the effects of cocaine. Results: No differences were seen in basal physiological parameters between treatment groups. Likewise, following an acute administration of cocaine, physiological parameters in both groups responded in a similar fashion. Fetal hypoxemia occurred in both groups after the ewe received cocaine. In response to hypoxemia, whether it was the animals' first or 53rd exposure to cocaine, fetal cerebral, myocardial and adrenal blood flow increased so that oxygen delivery was unimpaired. Conclusions: For the cardiovascular parameters measured in this study, we found no tolerance to cocaine in the ewe or fetus. The acute hemodynamic effects of maternal cocaine administration were as severe for animals having received it more than 50 times as for those that received it for the first time.","PeriodicalId":79464,"journal":{"name":"The Journal of maternal-fetal medicine","volume":"10 1","pages":"341 - 349"},"PeriodicalIF":0.0,"publicationDate":"2001-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/jmf.10.5.341.349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60758937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}