Showing papers in "Obstetrical & Gynecological Survey in 1987"
TL;DR: An examination of the maternal vascular response to placentation shows that physiological changes in the placental bed normally extend from the decidua into the inner myometrium, pointing to a defect in the normal interaction between migratory trophoblast and maternal uterine tissues in pre-eclampsia and in SGA.
Abstract: An examination of the maternal vascular response to placentation shows that physiological changes in the placental bed normally extend from the decidua into the inner myometrium. In pre-eclampsia and in a proportion of pregnancies with small-for-gestational age infants (SGA) the physiological changes are restricted to the decidual segments alone. In addition, complete absence of physiological changes throughout the entire length of some spiral arteries is seen in pre-eclampsia and SGA. This new observation is confirmed in a study of basal plates of placentas from abnormal pregnancies. Intraluminal endovascular trophoblast may be seen in the placental bed spiral arteries in the third trimester in pre-eclampsia and SGA, a feature not seen beyond the second trimester in normal pregnancy. These findings point to a defect in the normal interaction between migratory trophoblast and maternal uterine tissues in pre-eclampsia and in SGA.
397 citations
TL;DR: Prenatal and perinatal factors predicting cerebral palsy, using multivariate analysis to investigate which factors were most important and the proportion of cases for which they accounted, found maternal mental retardation, birth weight below 2001 g, and fetal malformation were among the leading predictors.
Abstract: We examined prenatal and perinatal factors predicting cerebral palsy, using multivariate analysis to investigate which factors were most important and the proportion of cases for which they accounted. Maternal mental retardation, birth weight below 2001 g, and fetal malformation were among the leading predictors. Breech presentation was also a predictor, but breech delivery was not. A third of the children with cerebral palsy who had breech presentations had a major noncerebral malformation. Among 189 children with cerebral palsy, 40 (21 percent) had at least one of three clinical markers suggestive of asphyxia; only 17 of these 40 children (9 percent of all cases) lacked major congenital malformation or other intrinsic defects that might have contributed to an unfavorable outcome. When all the principal risk factors present by the time labor began were considered, the 5 percent of the population at highest estimated risk was seen to have contributed 34 percent of the cases. When all the risk factors present during the period beginning before pregnancy and extending through the nursery stay were included, the 5 percent at highest risk was seen to have contributed 37 percent of the cases. Thus, the inclusion of information about the events of birth and the neonatal period accounted for a proportion of cerebral palsy only slightly higher than that accounted for when consideration was limited to characteristics identified before labor began.
312 citations
TL;DR: A protective effect was seen in women who had used oral contraceptives for as little as three to six months, and it continued for 15 years after use ended, independent of the specific oral-contraceptive formulation and of the histologic type of epithelial ovarian cancer.
Abstract: Although several studies have reported that the use of oral contraceptives decreases the risk of ovarian cancer, it is not clear whether the effect varies according to the oral-contraceptive formulation or the histologic type of cancer. To characterize this association more fully, we used data from a case-control study, the Cancer and Steroid Hormone Study. From 1980 to 1982, 546 women 20 to 54 years of age with ovarian cancer were enrolled from eight population-based cancer registries. The controls were 4228 women selected from the same areas. Women who had used oral contraceptives had a risk of epithelial ovarian cancer of 0.6 (95 percent confidence interval, 0.5 to 0.7) as compared with those who had never used them. This protective effect was seen in women who had used oral contraceptives for as little as three to six months, and it continued for 15 years after use ended; it was independent of the specific oral-contraceptive formulation and of the histologic type of epithelial ovarian cancer. (We could not adequately assess the association with nonepithelial ovarian cancers because of an insufficient number of cases.) We conclude that the use of oral contraceptives decreases the risk of epithelial ovarian cancer.
263 citations
TL;DR: It is shown that in patients with SLE planned rheumatologic care of the mother, with special obstetrical and perinatal attention, may reduce the high maternal and fetal morbidity/mortality.
Abstract: Our prospective study attempted to better define the reciprocal relation between pregnancy and systemic lupus erythematosus (SLE), to reduce maternal morbidity/mortality, and fetal loss. Our protocol included all the pregnancies in our total of patients with SLE between the years 1974-1983. There were 102 pregnancies in 75 patients during this period; SLE was exacerbated in 59.7% that started with inactive disease, most with mild episodes. Hematologic manifestations and renal disease, however, required moderate or high doses of steroids. There were no maternal deaths. There were 49% premature newborns in the entire group and this increased to 59% in mothers with active SLE; 23% of newborns were small for gestational age in the entire group and the rate increased to 65% in mothers with active SLE. There was a 16% spontaneous abortion rate with no difference between mothers with active or inactive disease, 5 stillbirths and one neonatal death, with a total fetal loss of 22% (compared with 6.7% in the control group p less than 0.001). There were 32 cesarean sections with live outcomes and 14 newborn infants with a weight below 1.5 kg survived. Our study shows that in patients with SLE planned rheumatologic care of the mother, with special obstetrical and perinatal attention, may reduce the high maternal and fetal morbidity/mortality.
244 citations
TL;DR: In this article, a multifollicular ovarian appearance was observed in women with weight-loss-related amenorrhoea, which may represent a normal ovarian response to weight-related hypothalamic disturbance of gonadotropin control.
Abstract: By means of pelvic ultrasonography, a multifollicular ovarian appearance was observed in women with weight-loss-related amenorrhoea. Multifollicular ovaries (MFO) are normal in size or slightly enlarged and filled by six or more cysts 4-10 mm in diameter; in contrast to women with polycystic ovaries (PCO), stroma is not increased. Unlike PCO patients, women with MFO were not hirsute and serum concentrations of luteinising hormone and follicle stimulating hormone were normal and decreased, respectively. The uterus was small indicating oestrogen deficiency. In MFO, treatment with gonadotropin releasing hormone (LHRH) induced ovulation in 83% of cycles and there were seven pregnancies in 8 women; in PCO, only 40% of cycles were ovulatory and there were eleven pregnancies (8 women) but six of these aborted. In MFO ovarian morphology reverted to normal in ovulatory cycles, whereas in PCO the polycystic pattern persisted despite the presence of a dominant follicle. MFO may represent a normal ovarian response to weight-related hypothalamic disturbance of gonadotropin control.
194 citations
TL;DR: The clinical and pathological features of 207 ovarian Sertoli-Leydig cell tumors from the authors' consultation and hospital files were reviewed and the prognosis correlated most meaningfully with the stage and degree of differentiation of the tumor.
Abstract: The clinical and pathological features of 207 ovarian Sertoli-Leydig cell tumors from our consultation and hospital files were reviewed. The patients ranged in age from 2 to 75 (average 25) years. Seventy-five percent of them were 30 years of age or younger and less than 10% were over 50 years of age. One-third of the patients presented because of unequivocal evidence of androgen excess, and an additional 10% had a history suggesting androgen excess; most of the remaining patients complained of abdominal swelling or pain. At operation, 97.5% of the tumors were Stage I, 1.5% were Stage II, and 1% were Stage III. Both ovaries were involved in 1.5% of the cases. The tumors ranged from microscopic to 51 cm in diameter (average 13.5 cm); 15% of them were ruptured. Thirty-eight percent of the tumors were solid, 58% were solid and cystic, and 4% were cystic. The solid tissue was typically lobulated and yellow. On microscopic examination, 11% of the tumors were well differentiated, 54% were of intermediate differentiation, 13% were poorly differentiated, and 22% contained heterologous elements according to the criteria of the World Health Organization; a prominent retiform pattern was present in 15% of them. Follow-up was obtained for 164 patients. The tumor was clinically malignant in 18% of them. The prognosis correlated most meaningfully with the stage and degree of differentiation of the tumor. The high-stage tumors were all clinically malignant. All the well-differentiated tumors were benign, but 11% of those of intermediate differentiation, 59% of the poorly differentiated tumors, and 19% of those with heterologous elements were malignant. In a few cases radiation therapy, chemotherapy, or a combination of the two, in addition to surgical excision, was of benefit in the management of the malignant tumors.
177 citations
TL;DR: It is demonstrated that smoking exerts a powerful inducing effect on the 2-hydroxylation pathway of estradiol metabolism, which is likely to lead to decreased bioavailability at estrogen target tissues.
Abstract: Epidemiologic data indicate that cigarette smoking is associated with an important anti-estrogenic effect, and increased hepatic metabolism has been suggested as a possible mechanism. We examined the hypothesis that cigarette smoking in women induces an increase in estradiol 2-hydroxylation. This irreversible metabolic pathway yields 2-hydroxyestrogens, which possess minimal peripheral estrogenic activity and are cleared rapidly from the circulation. We found a significant increase in estradiol 2-hydroxylation in premenopausal women who smoked at least 15 cigarettes per day. The extent of the reaction (mean +/- SEM) was 53.6 +/- 2.2 percent among 14 smokers and 35.1 +/- 1.8 percent among 13 nonsmoking controls--an increase of approximately 50 percent (P less than 0.001). The extent of 2-hydroxylation among five smokers did not vary during the follicular and luteal phases of their menstrual cycles. In addition, urinary excretion of estriol relative to estrone was significantly decreased among smokers (P less than 0.01), providing evidence that the smoking-induced increase in 2-hydroxylation diminishes the competing metabolic pathway involving 16 alpha-hydroxylation. This study demonstrates that smoking exerts a powerful inducing effect on the 2-hydroxylation pathway of estradiol metabolism, which is likely to lead to decreased bioavailability at estrogen target tissues. Elucidation of the mechanism responsible for smoking-induced changes in 2-hydroxylation may be useful in the development of strategies to reduce the risk of hormone-dependent tumors.
158 citations
121 citations
TL;DR: Observations show that varicella during pregnancy was associated with maternal morbidity and evidence of fetal infection, but that herpes zoster was not.
Abstract: We investigated the consequences of maternal infection with varicella-zoster virus in a prospective study of 43 pregnancies complicated by varicella and 14 pregnancies complicated by herpes zoster. Nine of 43 pregnant women with varicella had associated morbidity--pneumonia (4 women), death (1), premature labor (4 of 42), premature delivery (2 of 42), and herpes zoster (1). Intrauterine varicella infection was identified on the basis of clinical evidence (anomalies characteristic of the congenital varicella syndrome, acute varicella at birth, or herpes zoster in infancy) or immunologic evidence (IgM antibody to varicella-zoster in the neonatal period, persistent IgG antibody to varicella-zoster at one to two years of age, or in vitro lymphocyte proliferation in response to varicella-zoster virus antigen). The congenital varicella syndrome occurred in 1 of 11 infants of women with first-trimester varicella. Immunologic evidence of intrauterine varicella infection was present in 7 of 33 infants tested; 4 of these infants were asymptomatic. According to clinical or immunologic criteria, 8 of 33 infants had evidence of intrauterine varicella infection. These observations show that varicella during pregnancy was associated with maternal morbidity and evidence of fetal infection, but that herpes zoster was not.
121 citations
TL;DR: Dot hybridization with radiolabeled human parvovirus DNA probes revealed viral DNA in several tissues from both fetuses, indicating that they had been infected by the virus in utero.
Abstract: Human parvovirus is the causative agent of erythema infectiosum, a mild epidemic illness. In a recent outbreak in northeast Scotland, six women had serologic evidence of having contracted human parvovirus infection during pregnancy. Two of the women had midtrimester abortions, and both abortuses were grossly hydropic with anemia. They had similar microscopical histopathological features--a pronounced leukoerythroblastic reaction, hepatitis, excessive iron pigment in the liver, and eosinophilic changes in the hematopoietic cell nuclei. Dot hybridization with radiolabeled human parvovirus DNA probes revealed viral DNA in several tissues from both fetuses, indicating that they had been infected by the virus in utero. The remaining four women had uncomplicated pregnancies and delivered apparently healthy babies, none of whom had human parvovirus-specific IgM antibody at delivery. We conclude that this common virus may pose a serious risk to the fetus after maternal infection.
117 citations
TL;DR: In this paper, two forms of inhibin (A and B) have been purified from porcine follicular fluid and characterized as heterodimers of relative molecular mass (Mr) 32,000 (ref. 2).
Abstract: Inhibin is a gonadal protein that specifically inhibits the secretion of pituitary follicle-stimulating hormone (FSH). Two forms of inhibin (A and B) have been purified from porcine follicular fluid and characterized as heterodimers of relative molecular mass (Mr) 32,000 (ref. 2). Each inhibin is comprised of an identical alpha-subunit of Mr 18,000 and a distinct but related beta-subunit of Mr 13,800-14,700 linked by interchain disulphide bond(s). Throughout the purification of inhibins, we consistently observed two fractions which stimulated the secretion of pituitary FSH. We report here the isolation of one of the FSH-releasing proteins; it has a Mr of 24,000 and its N-terminal sequences up to residue 32 are identical to those of each beta-subunit of inhibins A and B. In the presence of reducing agents, SDS-polyacrylamide gel electrophoresis resolves the FSH-releasing substance into two subunits which are identical in their migration behaviour to the reduced beta-subunits of inhibins A and B. Based on the N-terminal sequence data and Mr of the intact and reduced molecules, we propose that the FSH-releasing substance, which is active in picomolar concentrations, is a heterodimeric protein composed of the two beta-subunits of inhibins A and B linked by interchain disulphide bond(s). The structural organization of the FSH-releasing substance is homologous to that of transforming growth factor-beta (TGF-beta), which also possesses FSH-releasing activity in the same bioassay. We suggest that the substance be called activin to signify the fact that it has opposite biological effects to inhibin.
TL;DR: The specific stimulation of synoviocytes by the neuropeptide substance P represents a pathway by which the nervous system might be directly involved in the pathogenesis of rheumatoid arthritis.
Abstract: Several clinical features are consistent with nervous system involvement in the pathogenesis of rheumatoid arthritis. The neuropeptide substance P is one possible mediator of this interaction, since it can be released into joint tissues from primary sensory nerve fibers. The potential effects of the peptide on rheumatoid synoviocytes were examined. The results show that substance P stimulates prostaglandin E2 and collagenase release from synoviocytes. Furthermore, synoviocyte proliferation was increased in the presence of the neuropeptide. Similar effects were observed with a truncated form of substance P. Synoviocytes were sensitive to very small doses of the neuropeptide (10(-9) M), and its effects were inhibited by a specific antagonist. Thus, the specific stimulation of synoviocytes by the neuropeptide substance P represents a pathway by which the nervous system might be directly involved in the pathogenesis of rheumatoid arthritis.
TL;DR: Experimental use of S-adenosyl-L-methionine, a methyl donor active in estrogen conjugation, reverses some estrogen-induced liver changes, such as cholestasis, pruritus, and bile acid abnormalities in pregnancy.
Abstract: Throughout pregnancy, women with nausea and vomiting in early pregnancy showed a different metabolic pattern compared to asymptomatic pregnancies. Women suffering from nausea and vomiting seem to have a low "functional reserve" of their liver capacity and could tentatively be described as hypersensitive to estrogens or their metabolites, e.g., catecholestrogens. These steroids have "emetic" properties, which might be explained by their direct stimulation of area postrema. It is known that estrogens increase the brain's excitability. Another possible mechanism could be by interacting with liver metabolism, resulting in the production of irregular metabolites, which in turn possess "emetic" qualities.
TL;DR: Findings portray normal pregnancy as a state of physiologic absorptive hypercalciuria and call into question the widespread practice of supplementing calcium intake in otherwise well-nourished women during pregnancy.
Abstract: An increase in circulating, 1,25-dihydroxyvitamin D level and net intestinal calcium absorption have been previously demonstrated in pregnant women and have been widely regarded as compensatory mechanisms whereby fetal mineral demands are satisfied. The alternate possibility, that these adjustments might anticipate such demands, has not previously been considered. To examine the effects of pregnancy on the intestinal absorption and renal excretion of calcium, oral calcium tolerance tests were performed and urinary calcium excretion was measured in 16 healthy women receiving a moderate calcium intake during and after pregnancy. Circulating 1,25-dihydroxyvitamin D levels and indexes of parathyroid function were also measured. As expected, 1,25-dihydroxyvitamin D levels were significantly (p less than 0.05) elevated throughout pregnancy (94 +/- 11, 118 +/- 9, and 117 +/- 11 pg/ml in the first, second, and third trimesters, respectively, versus 51 +/- 5 pg/ml after delivery). Twenty-four-hour calcium excretion also increased sharply (247 +/- 54, 316 +/- 42, 300 +/- 61 mg versus 91 +/- 18 mg), often to the point of hypercalciuria. Calcium tolerance test results included significant increases in the calciuric and calcemic responses during each trimester, whereas fasting calcium excretion and parathyroid function remained normal. These findings portray normal pregnancy as a state of physiologic absorptive hypercalciuria and call into question the widespread practice of supplementing calcium intake in otherwise well-nourished women during pregnancy.
TL;DR: Anti-androgen therapy appears to be beneficial in the treatment of hidradenitis suppurativa and both treatments produced substantial improvement in disease activity.
Abstract: In order to examine whether anti-androgen therapy was effective in hidradenitis suppurativa (HS), ethinyloestradiol 50 micrograms/cyproterone acetate 50 mg in a reverse sequential regimen was compared with ethinyloestradiol 50 micrograms/norgestrel 500 micrograms (Eugynon 50) in 24 female patients. Both treatments produced substantial improvement in disease activity. Seven patients cleared and have remained free of disease for 18 months, five patients improved, four remained unchanged, while two deteriorated. Cyproterone acetate was not clinically significantly more effective than E50, and both gave a similar reduction in free androgen index. Anti-androgen therapy appears to be beneficial in the treatment of hidradenitis suppurativa.
TL;DR: It is concluded that surgery with general anesthesia is associated with a higher incidence of abortion, and it is conjectural at present which factor(s) account for the observed increase in fetal risk.
Abstract: In an attempt to define the risk to the fetus associated with anesthesia and surgery during pregnancy, a study was performed using health insurance data from the province of Manitoba (1971 to 1978). Each of the 2,565 women undergoing incidental surgery during pregnancy (Group A) was paired with a pregnant female not undergoing surgery (Group B) by maternal age and area of residence. Both groups were linked to a separately maintained provincial congenital-anomalies registry to ascertain the frequency of anomalies. There was no significant difference in the rate of congenital anomalies between the two groups, implying no strong teratogenic effect. However, there was an increased risk of spontaneous abortion in those undergoing surgery with general anesthesia in the first or second trimester, most notably after gynecologic procedures (estimated risk ratio = 2.00), but also following procedures anatomically remote from the conceptus (estimated risk ratio = 1.54). While it is concluded that surgery with general anesthesia is associated with a higher incidence of abortion, it is conjectural at present which factor(s) account for the observed increase in fetal risk.
TL;DR: The reliability of ultrasound fetometry for estimating gestational age (GA) in the second trimester was evaluated, using the fetal variables: biparietal diameter (BPD), occipitofrontal diameter (OFD), mean abdominal diameter (AD), and femur length (FL), each value being taken as the mean of five measurements.
Abstract: The reliability of ultrasound fetometry for estimating gestational age (GA) in the second trimester was evaluated, using the fetal variables: biparietal diameter (BPD), occipitofrontal diameter (OFD), mean abdominal diameter (AD), and femur length (FL), each value being taken as the mean of five measurements. Of the individual variables, BPD gave the best precision, with a standard deviation (SD) from true GA of 3.2 days. Using a combination of all four variables, GA could be estimated with a SD of 2.2 days, which was not significantly better than the formula, GA = BPD X 1.2 + FL X 1.0 + 49, which gave results with a SD of 2.4 days. Equations obtained from regression analysis of the variables against true GA were tested in 44 cases where the precise date of conception was known, GA being estimated by BPD with a SD of 3.2 days, and by the combination of BPD and FL with a SD of 2.7 days; the maximum difference between GA estimated by BPD and by FL was 7 days. Using a combination of BPD and FL to estimate GA in the total population, the number of post-term deliveries was only marginally less than when using BPD alone.
TL;DR: Treatment of hyperprolactinemia increases bone mass in most amenorrheic women with osteopenia, normalization of serum prolactin levels in such women is associated with prevention of bone loss, and a subset of untreated women with hyper Prolactinemic amenorrhea have progressive oste Openia, which could have adverse long-term health consequences.
Abstract: Hyperprolactinemia occurs in 25 to 30 percent of young women with amenorrhea, and this condition is known to be associated with osteopenia. To determine whether the osteopenia is affected by treatment of hyperprolactinemia, we studied 32 women with hyperprolactinemic amenorrhea prospectively for 12 to 72 months to investigate the effects of sustained hyperprolactinemia or return of gonadal function on bone mass. We studied 18 patients using direct photon absorptiometry before and after normalization of serum prolactin levels. Initial bone densities ranged from 0.55 to 0.77 g per square centimeter (mean ±1 SD, 0.64±0.05) — densities significantly lower (P<0.001) than those of controls (0.71±0.04 g per square centimeter). After therapy, bone density increased significantly (P<0.001), to 0.67±0.05 g per square centimeter, but remained lower (P<0.05) than normal. Fourteen patients were followed without therapy. Their initial bone densities ranged from 0.62 to 0.75 g per square centimeter (mean, 0.67±...
TL;DR: Sera from patients with repeated abortions who had the lupus anticoagulant contained antibodies that were most often of the IgG class with affinity for negatively charged phospholipids, according to enzyme-linked immunosorbent assays.
Abstract: The frequency of positive tests for antibodies to nuclear antigens (antinuclear, deoxyribonucleic acid, Ro, La, Smith, and ribonucleoprotein) or to phospholipids was investigated in 82 patients with isolated repeated abortions. Patients with a positive antibody test (positive or negative deoxyribonucleic acid antibodies) appeared to be a separate subgroup of those with unexplained repeated abortions from those with antibodies to cardiolipin. A total of 13.1% of the 61 patients with unexplained repeated abortions had elevated levels of IgM and/or IgG anticardiolipin antibody, while none were found in patients with explained abortions (p less than 0.1). Enzyme-linked immunosorbent assays for antibodies binding to other phospholipids suggested that sera from patients with repeated abortions who had the lupus anticoagulant contained antibodies that were most often of the IgG class with affinity for negatively charged phospholipids. Binding of IgG but not IgM antibodies to cardiolipin correlated closely with that to other negatively charged phospholipids. The use of clotting tests for the lupus anticoagulant to screen patients with repeated abortions for associated autoantibodies is likely to significantly underestimate the extent of this clinical problem.
TL;DR: Serial measurements of bone mass to estimate a woman's rate of bone loss are relatively imprecise, increase the cost of screening, and have at best a limited role in screening women to assess risk for osteoporotic fractures.
Abstract: The increasing availability of noninvasive methods for measuring bone mass raises the issue of whether perimenopausal women should routinely have such measurements to identify those at ris...
TL;DR: It is concluded that antepartum maternal cultures do not predict the infant's risk of exposure to herpes simplex virus at delivery.
Abstract: In 414 pregnant women with a history of recurrent genital herpes simplex infection, we studied the correlation between asymptomatic viral shedding in late pregnancy and at the time of delivery. Antepartum cultures for asymptomatic reactivation of herpes simplex virus were positive in 17 of the 414 women (4.1 percent). None of these women had positive cultures at the time of delivery. Cultures of specimens obtained at delivery from 5 of 354 asymptomatic mother-infant pairs (1.4 percent) were positive for asymptomatic excretion of herpes simplex virus. None of these women had had antepartum cultures that documented asymptomatic excretion of herpes simplex virus, despite the fact that culturing was repeatedly performed during the four weeks before delivery. Asymptomatic shedding of herpes simplex virus occurred with the same frequency at delivery, whether or not any episodes of symptomatic recurrence were noted during the pregnancy (1.4 vs. 1.3 percent). We conclude that antepartum maternal cultures do not predict the infant's risk of exposure to herpes simplex virus at delivery.
TL;DR: Healthy women with uncomplicated low-risk pregnancies who feel well enough to attend school or work during pregnancy, even in a job requiring some standing, may do so without fear that their infant will suffer shortened gestation or impaired intrauterine growth.
Abstract: The impact of mothers' work during pregnancy upon neonatal outcome has not been fully elucidated. A study of maternal health habits and neonatal outcome conducted from 1977 to 1979 at Boston City Hospital assessed the effects of paid work outside the home during pregnancy, particularly third trimester work in a standing position, upon duration of gestation and intrauterine growth, while controlling for potentially confounding variables. Postpartum, 1,690 low-income women were interviewed to provide detailed information on their sociodemographic and health characteristics. Of the 1,507 women whose work status during pregnancy could be classified, 55% did not perform paid work outside the home or attend school, 7% worked into the third trimester in a standing position, and 38% had other work histories or attended school. Infants were examined according to a standard protocol by pediatricians blind to mothers' work history. There was no significant relationship between the mothers' work history during pregnancy and the infants' length of gestation, weight, or head circumference at birth, when confounding variables were controlled statistically by multiple regression analyses. However, women who worked in a standing position into the third trimester delivered infants who were longer than infants born either to mothers with other work histories or to mothers who did not work or attend school. Healthy women with uncomplicated low-risk pregnancies who feel well enough to attend school or work during pregnancy, even in a job requiring some standing, may do so without fear that their infant will suffer shortened gestation or impaired intrauterine growth.
TL;DR: The incidence of multiple gestation is 3.29% to 5.39%, higher than previously believed, and the sonographic criteria for "vanishing twin" are discussed.
Abstract: Review of the sonographic findings of 1000 pregnancies with viable gestations in the first trimester revealed a minimum incidence of twinning of 329% Of these, 212% demonstrated the "vanishing twin" phenomenon, often with associated bleeding, but with a good prognosis for the remaining fetus Ovulation induction did not appear to alter these data The sonographic criteria for "vanishing twin" are discussed The incidence of multiple gestation is 329% to 539%, higher than previously believed
TL;DR: The anatomy of the conduction system was studied in 8 patients who had isolated congenital complete heart block and the heart from the only child whose maternal serum was anti-Ro negative had nodoventricular discontinuity of theconduction system.
Abstract: The anatomy of the conduction system was studied in 8 patients who had isolated congenital complete heart block. Atrial-axis discontinuity was seen in 7 hearts from children born to mothers with anti-Ro antibodies. The anticipated area of the atrioventricular node was occupied by fibrous and adipose tissue. The heart from the only child whose maternal serum was anti-Ro negative had nodoventricular discontinuity of the conduction system. This difference in anatomy may have etiologic significance.
TL;DR: Polyhydramnios is a relatively common obstetrical complication and prolongation of the pregnancy for further fetal maturation may be achieved with timely therapeutic amniocenteses.
Abstract: Polyhydramnios is a relatively common obstetrical complication. Major causes include maternal diabetes, chromosomal disorders, isoimmunologic disease, congenital abnormalities, multiple gestations, and idiopathic reasons. Perinatal morbidity and mortality is high and maternal complications are frequent. Successful management depends upon appropriate diagnostic evaluation. Prolongation of the pregnancy for further fetal maturation may be achieved with timely therapeutic amniocenteses.
TL;DR: It appears that maintenance prophylactic therapy with oral ketoconazole is effective in preventing recurrent episodes of vulvovaginal candidiasis, but that relapse is common after withdrawal of the drug.
Abstract: In a prospective, placebo-controlled study, 74 women with recurrent vulvovaginal candidiasis were treated with oral ketoconazole (400 mg daily for two weeks) and were then randomly assigned to receive placebo (Group A), prophylactic ketoconazole, 400 mg daily for five days beginning with the onset of menses for six menstrual cycles (Group B), or low-dose ketoconazole, 100 mg daily for six months (Group C) Within a six-month follow-up period, 15 of 21 women (714 percent) treated with placebo had symptomatic recurrence of candidal vaginitis In contrast, candidal vaginitis recurred in 6 of 21 (286 percent) and in 1 of 21 (48 percent) women in Groups B and C (P less than 001; P less than 0001) After the prophylaxis was discontinued, the recurrence rates of candidal vaginitis were high in women in Groups B and C At the end of 12 months of follow-up, 238 percent of the women in Group A remained asymptomatic and attack-free, in contrast to 429 percent of the women in Group B (P greater than 005) and 524 percent in Group C (P less than 005) It appears that maintenance prophylactic therapy with oral ketoconazole is effective in preventing recurrent episodes of vulvovaginal candidiasis, but that relapse is common after withdrawal of the drug Because of the risk of hepatotoxicity, caution is essential in selecting patients for long-term ketoconazole therapy and in following patients undergoing such treatment
TL;DR: It is concluded that in normal girls, the pubertal growth spurt also results from the action of estrogens rather than of adrenal androgens, and physiologic estrogen replacement in hypogonadal females should be started at a bone age of about 11 years, and should not be delayed in the hope of achieving a greater mature height.
Abstract: Spontaneous pubertal growth was studied in eight patients with the syndrome of androgen insensitivity to obtain information on the growth-promoting action of estrogens. In one additional patient (who had a gonadectomy before puberty), the effect of exogenous estrogens was studied. Mean age at peak height velocity (12.7 years) was closer to that in normal girls than to that in normal boys. Mean peak height velocity (7.4 cm/yr) was as in normal giris (7.3 cm/yr), but was lower than in normal boys (9.3 cm/yr). Bone age corresponded normal men (−0.6 SD), but higher than in normal women (+1.4 SD). In the better to male standards. Mean adult height (172.3 cm) was lower than in patient who had a gonadectomy, estrogen replacement caused a higher peak height velocity (12 cm/yr), but lower adult height (160.5 cm) than in the patients with intact gonads who received no treatments. We conclude than in normal giris, the pubertal growth spurt also results from the action of estrogens rather than of adrenal androgens. To ensure normal pubertal growth, physiologic estrogen replacement in hypogonadal females should be started at a bone age of about 11 years, and should not be delayed in the hope of achieving a greater mature height.