Showing papers on "Pregnancy published in 1985"
TL;DR: The incidences, prevalences, definitions, cardinal signs, and patients at increased risk for hypertensive disorders in pregnancy are discussed and successful management of these disorders is early detection.
Abstract: Hypertensive disorders in pregnancy are the leading cause of maternal death in the United States and in many other parts of the world. A recent prospective study has indicated that the susceptibility to preeclampsia-eclampsia is inherited and probably is determined by a single recessive gene. However, the causes are still unknown. The incidences, prevalences, definitions, cardinal signs, and patients at increased risk for hypertensive disorders in pregnancy are discussed. Successful management of these disorders is early detection. Further discussions are made on the management of preeclampsia, eclampsia, and chronic hypertension in regard to treatment, intrapartum course, and maternal and perinatal outcome.
746 citations
TL;DR: It is suggested that cocaine influences the outcome of pregnancy as well as the neurologic behavior of the newborn, but a full assessment will require a larger number of pregnancies and longer follow-up.
Abstract: With the increasing use of cocaine in the United States, there has been growing concern regarding its effects on the fetuses and neonates of pregnant cocaine abusers. Twenty-three cocaine-using women enrolled in a comprehensive perinatal-addiction program were divided into two groups: those using cocaine only and those using cocaine plus narcotics. These two groups were compared with a group of women who had used narcotics in the past and were maintained on methadone during pregnancy, and with a group of drug-free women. All four groups were similar in maternal age, socioeconomic status, number of pregnancies, and cigarette, marijuana, and alcohol use. Their medical histories indicated that the cocaine-using women had a significantly higher rate of spontaneous abortion than the women in the other two groups. In the pregnancies under study, four cocaine-using women had onset of labor with abruptio placentae immediately after intravenous self-injection of cocaine. Neonatal gestational age, birth weight, length, and head circumference were not affected by cocaine use. However, the Brazelton Neonatal Behavioral Assessment Scale revealed that infants exposed to cocaine had significant depression of interactive behavior and a poor organizational response to environmental stimuli (state organization). These preliminary observations suggest that cocaine influences the outcome of pregnancy as well as the neurologic behavior of the newborn, but a full assessment will require a larger number of pregnancies and longer follow-up.
715 citations
TL;DR: The corticosteroid and low-dose aspirin regimen appears to improve perinatal outcome in cases in which the mother has the lupus anticoagulant, but such practices as careful fetal surveillance and preterm delivery when appropriate are also important to successful obstetric management of such cases.
Abstract: We identified eight patients with the lupus anticoagulant (an autoantibody acquired by some patients with systemic lupus erythematosus), by observation of an increased activated partial thromboplastin time and abnormal results on a tissue thromboplastin-inhibition test. The patients had experienced a total of 30 spontaneous abortions and fetal deaths in 31 previous pregnancies (96.8 per cent). During their next pregnancy, the patients were treated with 40 to 50 mg of prednisone per day and 81 mg of aspirin per day. The therapy shortened their activated partial thromboplastin times, produced normal values for tissue thromboplastin inhibition, and reduced the rate of pregnancy loss to 37.5 per cent. However, preeclampsia developed in the five patients who gave birth to live infants, and fetal growth retardation occurred in three cases. The corticosteroid and low-dose aspirin regimen appears to improve perinatal outcome in cases in which the mother has the lupus anticoagulant, but such practices as careful fetal surveillance and preterm delivery when appropriate are also important to successful obstetric management of such cases.
546 citations
TL;DR: Because of various prenatal diagnoses, 606 fetal blood samplings were carried out in 562 pregnancies from the gestational week 17 to 38 with use of a 20-gauge needle guided by ultrasound, which could replace fetoscopy and initiate an important field of new investigations.
494 citations
TL;DR: Estimated maternal age-specific rates of trisomy among all recognized pregnancies were calculated and suggest that a majority of oocytes of women aged 40 years and older may be aneuploid.
Abstract: The effect of maternal age on the incidence of chromosomally normal spontaneous abortion and different categories of chromosome abnormality among all clinically recognized human pregnancies was evaluated. The results provide no evidence for a significant association of age with sex chromosome monosomy or polyploidy, but clearly demonstrate an effect of age on the frequency of trisomy and chromosomally normal spontaneous abortions. Estimated maternal age-specific rates of trisomy among all recognized pregnancies were calculated and suggest that a majority of oocytes of women aged 40 years and older may be aneuploid.
456 citations
TL;DR: Antiplatelet therapy given early in pregnancy to high-risk patients may protect against pre-eclampsia and fetal growth retardation.
421 citations
TL;DR: The World Health Organisation sponsored a multicentre, collaborative investigation of a standard approach to evaluating infertile couples, conducted between 1979 and 1984 in thirty-three medical centres in twenty-five countries throughout the developed and developing world.
419 citations
TL;DR: Results show that maternal hypothyroidism is accompanied by thyroid hormone deficiency of the conceptus before the fetal thyroid functions, and alterations of T4 and T3 concentrations persist until term, and development is also delayed.
Abstract: Embryonic tissues were obtained from normal (C) and thyroidectomized (T) rats between 9 and 21 days of pregnancy. We determined the number and weight, as well as the T4 and T3 contents (RIA), of 9- to 12-day-old embryotrophoblasts, of 13- to 21-day-old embryos and placentas, and of liver, lung, and brain from 20- and 21-day-old fetuses. T4 and T3 were found in all samples obtained from C dams, both before and after onset of fetal thyroid function. Despite low levels of both iodothyronines in fetal plasma near term, their concentrations in fetal brain and lung had reached half the maternal values. The T3/T4 ratio in fetal organs was the same, or higher, than in adult rats. Maternal thyroidectomy resulted in a marked decrease of the number and individual weights of viable conceptuses, throughout gestation. Fetal organ weights near term were also decreased, and changes were found in brain DNA and protein concentrations. T4 and T3 were undetectable in all embryotrophoblasts, embryos and placentas obtained fro...
363 citations
351 citations
TL;DR: It is concluded that fetuses with hydrops are at high risk for fetal or neonatal demise without intervention and have a good chance for survival with maternal transport, planned delivery, and immediate neonatal resuscitation and surgery.
351 citations
Journal Article•
TL;DR: Among 2475 maternal deaths that occurred in the United States from 1974 to 1978, 408 were related to pregnancies with abortive outcomes, and 2067 were due to other causes.
TL;DR: Although this approach is valuable in developing countries, home care of very low birth weight babies would not improve survival in industrialised nations and care of such tiny infants in special care baby units in developed countries could benefit from similar emphasis on education and motivation of mothers and early skin-to-skin contact.
TL;DR: The results suggest that the exposures investigated, other than cytostatic drugs, do not cause a strong reproductive risk and further studies are needed.
Abstract: Nurses working in selected departments of general hospitals in Finland were collected from a central register on health personnel in Finland. Using the Hospital Discharge Register and the Register of Congenital Malformations, case nurses were selected who had had a spontaneous abortion (N = 217) or a malformed child (N = 46) between the years 1973 and 1979. Controls consisted of three nurses who had had a normal birth; the control nurses were matched for age and hospital of employment. Information on exposure in the first trimester of pregnancy was sought through the head nurses of the hospitals. No significant increase in risk of spontaneous abortion or of malformation was observed after exposure to anaesthetic gases (odds ratio for spontaneous abortion 1.2), sterilising gases and soaps, or x-rays. Handling of cytostatic drugs did not affect the frequency of spontaneous abortion but was associated with malformations in the offspring. The odds ratio, based on eight cases, was 4.7 (p = 0.02) when the logistic model was adopted. The results suggest that the exposures investigated, other than cytostatic drugs, do not cause a strong reproductive risk. Further studies are needed, particularly on cytostatic drugs.
TL;DR: It is suggested that extremely large, ultra simple randomised trials are needed, of a size sufficient to permit direct assessment of the effects of treatment not on pre-eclampsia but on perinatal mortality itself, which may require the study of tens of thousands of pregnancies.
Abstract: Over the past 20 years at least 11 randomised trials of the prevention with diuretics of pre-eclampsia and its sequelae have been undertaken. Nine of these were reviewed. Reliable data from the remaining two were not available. The nine reviewed had investigated a total of nearly 7000 people. Significant evidence of prevention of "pre-eclampsia" was overwhelming, even when oedema was not included as a diagnostic criterion. But as the definitions of pre-eclampsia that had been used depended heavily on increases in blood pressure this evidence may simply have reflected the well known ability of diuretics to reduce blood pressure. When the data on perinatal death were reviewed a little difference was seen in postnatal survival. The incidence of stillbirths was reduced by about one third with treatment, but, perhaps owing to small numbers (only 37 stillbirths), the difference was not significant. Thus these randomised trials failed to provide reliable evidence of either the presence or the absence of any worthwhile effects of treatment with diuretics on perinatal mortality. The implications of this for current and future trials of beta blockers and other agents in the prevention of pre-eclampsia and its sequelae are that extremely large, ultra simple randomised trials are needed, of a size sufficient to permit direct assessment of the effects of treatment not on pre-eclampsia but on perinatal mortality itself. This may require the study of tens of thousands of pregnancies.
TL;DR: Spermatozoa were collected by microaspiration from the corpus epididymidis of a 42-year-old man with secondary obstructive azoospermia and used for in vitro fertilization and an ongoing pregnancy was confirmed.
Abstract: Spermatozoa were collected by microaspiration from the corpus epididymidis of a 42-year-old man with secondary obstructive azoospermia and used for in vitro fertilization. At insemination 61% of the spermatozoa were motile, with a motility index of 157. One of five eggs was fertilized and this was subsequently transferred to the patient's wife at the two-cell stage. Ultrasound examination and changing hormone levels confirmed an on-going pregnancy, which is currently at 30 weeks of gestation. This technique will provide a useful alternative for the management of some infertile men with obstructive azoospermia.
TL;DR: A study of the process of maternal role attainment in three age groups over the first year of motherhood found that the role attainment behaviors of feelings of love for the baby, gratification in the maternal role, observed maternal behavior, and self-reported ways of handling irritating child behaviors did not show a positive linear increase over the year.
Abstract: A study of the process of maternal role attainment in three age groups (15 to 19 years, 20 to 29 years, and 30 to 42 years) over the first year of motherhood found that the role attainment behaviors of feelings of love for the baby, gratification in the maternal role, observed maternal behavior, and self-reported ways of handling irritating child behaviors did not show a positive linear increase over the year. Behaviors peaked at 4 months postbirth, but declined at 8 months. Interview data suggested that the challenges of the infant's developmental behaviors at 8 and 12 months contributed to feelings of role incompetency. Although age groups functioned at different levels, their patterns of behaviors over the year did not vary, except for gratification in the role, indicating that the maternal role presented similar challenges for all women. There were no significant differences by maternal age in role strain or self-image as a mother over the year.
TL;DR: The herpesvirus family, which includes herpes simplex, varicella–zoster, and Epstein–Barr viruses, are ubiquitous agents that infect almost all human beings at some point during the...
Abstract: Herpes Simplex Virus Infections DURING the past decade, genital herpes simplex virus infections have attracted increasing attention because of their prevalence, the alarm associated with a chronica...
TL;DR: Withdrawal of progesterone locally by RU 486 treatment resulted in the development of a regular uterine activity which was in sharp contrast to the low level contractility pattern found in the untreated control patients.
TL;DR: Women with tubal infertility frequently have serological evidence of prior infection with C. trachomatis and have a distinctive antigen-specific humoral immune response, which further support the etiologic role of infection with
Abstract: We compared the prevalence of antibody to Chlamydia trachomatis among 88 women undergoing an evaluation for infertility and 49 women attending an antenatal clinic. Demographic data regarding sexual behavior were also collected. Eighteen women had tubal infertility and 70 had infertility due to a variety of other reasons. In comparison with women who had other causes for infertility, women with tubal infertility began coitus sooner (17.7 +/- 2.2 years vs. 19.5 +/- 3.4 years, P less than .05) and had more lifetime sex partners (4.5 vs. 1.33, P less than .001). Women with tubal infertility had a higher prevalence of antibody to C. trachomatis (13 of 18) than did women with nontubal causes for infertility (6 of 70, P less than .0001) or pregnant women (11 of 49, P = .0003). This high prevalence of antibody to C. trachomatis among women with tubal infertility was independent of sexual experience. By immunoblot analysis, an antigen of approximately 57,000 Da was immunodominant in 11 of 13 seropositive subjects with tubal infertility vs. 2 of 6 seropositive subjects with nontubal infertility (P = .046) and 1 of 11 seropositive pregnant women (P = .0003). Thus, women with tubal infertility frequently have serological evidence of prior infection with C. trachomatis and have a distinctive antigen-specific humoral immune response. These results further support the etiologic role of infection with C. trachomatis in tubal infertility.
TL;DR: In this article, the effects of disturbances in carbohydrate metabolism during gestation were studied in the offspring of 1049 Pima Indian women who had no previous diagnosis of diabetes and found that women with abnormal glucose tolerance during pregnancy had higher mean percent desirable weight and a higher mean postchallenge plasma glucose concentration than did offspring of women with normal glucose tolerance.
Abstract: The effects of disturbances in carbohydrate metabolism during gestation were studied in the offspring of 1049 Pima Indian women who had no previous diagnosis of diabetes. Rates of fetal and maternal complications of pregnancy among women with diabetes first diagnosed during the pregnancy were similar to those among women in whom diabetes was recognized before gestation. Offspring, aged 5-19 yr, of women with abnormal glucose tolerance during pregnancy had a higher mean percent desirable weight and a higher mean postchallenge plasma glucose concentration than did offspring of women with normal glucose tolerance. Percent desirable weight and glucose concentration, however, were both lower than found in offspring of women with diabetes diagnosed before the pregnancy. Thus, metabolic events during pregnancy, as indicated by the detection of abnormal glucose tolerance during gestation, appear to have long-term effects on obesity and glucose tolerance in the offspring.
TL;DR: The collection of split ejaculates and the careful preparation of spermatozoa, by sedimentation and layering methods, proved to be beneficial, improving sperm motility and raising the chance of fertilization.
TL;DR: The immunoreactive theory (IMRT) is borrowed from studies of sex ratios and is the only explanation consistent with negative parity effects in the occurrence of pregnancy complications and certain neurodevelopmental disorders.
Abstract: Males are selectively afflicted with the neurodevelopmental and psychiatric disorders of childhood, a broad and virtually ubiquitous phenomenon that has not received proper attention in the biological study of sex differences. The previous literature has alluded to psychosocial differences, genetic factors and elements pertaining to male “complexity” and relative immaturity, but these are not deemed an adequate explanation for selective male affliction. The structure of sex differences in neurodevelopmental disorders is hypothesized to contain these elements: (1) Males are more frequently afflicted, females more severely; (2) disorders arising in females are largely mediated by the genotype; in males, by a genotype by environment interaction; (3) complications of pregnancy and delivery occur more frequently with male births; such complications are decisive and influence subsequent development. We hypothesize that there is something about the male fetus that evokes an inhospitable uterine environment. This “evocative principle” is hypothesized to relate to the relative antigenicity of the male fetus, which may induce a state of maternal immunoreactivity, leading either directly or indirectly to fetal damage. The immunoreactive theory (IMRT) thus constructed is borrowed from studies of sex ratios and is the only explanation consistent with negative parity effects in the occurrence of pregnancy complications and certain neurodevelopmental disorders. Although the theory is necessarily speculative, it is heuristic and hypotheses derived from it are proposed; some are confirmed in the existing literature and by the authors' research.
TL;DR: A case-control study to investigate the relation between prenatal exposure to x-rays and childhood cancer, including leukemia, in over 32,000 twins born in Connecticut from 1930 to 1969 found documented prenatal x-ray exposures were found for 39% of the cases and for 26 per cent of the controls.
Abstract: We conducted a case-control study to investigate the relation between prenatal exposure to x-rays and childhood cancer, including leukemia, in over 32,000 twins born in Connecticut from 1930 to 1969. Twins as opposed to single births were chosen for study to reduce the likelihood of medical selection bias, since twins were often exposed to x-rays to diagnose the twin pregnancy or to determine fetal positioning before delivery and not because of medical conditions that may conceivably predispose to cancer. Each of 31 incident cases of cancer, identified by linking the Connecticut twin and tumor registries, was matched with four twin controls according to sex, year of birth, and race. Records of hospitals, radiologists, and private physicians were searched for histories of x-ray exposure and other potentially important risk factors. Documented prenatal x-ray exposures were found for 39 per cent of the cases (12 of 31) and for 26 per cent of the controls (28 of 109). No other pregnancy, delivery, or...
TL;DR: Pituitary responsiveness to gonadotropin-releasing hormone is normal in such women, however, and a normal pattern of gonadotropic hormone pulsatile secretion is restored with small, repetitive doses of the hormone, which support the concept that hyperprolactinemia is a cause of infertility.
Abstract: HYPERPROLACTINEMIA has been found to be the cause of infertility in about one third of women presenting with this problem1 2 3 Hyperprolactinemia may impair the hypothalamic–pituitary–ovarian axis at several levels, with the primary site of inhibition probably at the hypothalamic level4 , 5 Studies of gonadotropin secretion in hyperprolactinemic subjects sometimes show decreased pulsatile secretion,6 , 7 which reverts to normal in most women when hyperprolactinemia is corrected by bromocriptine treatment6 , 7 Pituitary responsiveness to gonadotropin-releasing hormone is normal in such women, however, and a normal pattern of gonadotropin pulsatile secretion is restored with small, repetitive doses of the hormone7 Such data support the concept that
Journal Article•
TL;DR: Screening interviews to determine the extent of physical abuse were conducted for 742 women seen in the University of Virginia obstetric clinics, finding that women living with an abusive partner did not experience a greater frequency of adverse pregnancy outcomes than did those who had left abusive relationships.
TL;DR: It appears that pregnancies in women of advanced maternal age in the 1980s who are delivered in a modern tertiary care center may be of no higher risk for adverse outcome than pregnancies in younger parturients.
TL;DR: During the last two decades, the important progress that has been made in the control of human reproduction, in medical care during pregnancy and the neonatal period, and more recently in in vitro fertilization has focused interest on the understanding of the causes of the high mortality rate.
Abstract: During the last two decades, the important progress that has been made in the control of human reproduction, in medical care during pregnancy and the neonatal period, and more recently in in vitro fertilization (Schlesselman, 1979; Biggers, 1981) has focused interest on the understanding of the causes of the high mortality rate among human conceptuses before, during, and shortly after birth. It has been recognized that chromosomal abnormalities are among the most important causes of this high mortality rate, and thus couples with a history of pregnancy wastage are now frequently referred to a geneticist for counseling.
TL;DR: It is reported that chronic administration in ratsof low doses of the widely used drug cyclophosphamide had minimal effects on the male reproductive system and fertility, but resulted in malformations and retardation of growth in the surviving fetuses and a high frequency of fetal death.
Abstract: The use of cytotoxic, mutagenic and carcinogenic agents as treatment for various types of cancer may be particularly hazardous in men of reproductive age as there exists the possibility that this may lead to congenital malformations in the progeny. Such agents can affect fertility and other aspects of male reproductive function, for example, treatment with anti-cancer drugs such as cyclophosphamide has been associated with oligozoospermia, azoospermia and increased levels of serum follicle-stimulating hormone (FSH). Depending on the cumulative dose and the duration of treatment, spermatogenesis often returns but this may take years. The relevance of the effects of such chemicals on the male reproductive system to the offspring is poorly understood. We have set out to determine whether present tests of male reproductive function (that is, endocrine status, numbers of spermatozoa, fertility) can predict deleterious effects of a paternally administered agent on the offspring. Here, we report that chronic administration in rats of low doses of the widely used drug cyclophosphamide had minimal effects on the male reproductive system and fertility, but resulted in malformations and retardation of growth in the surviving fetuses and a high frequency of fetal death. Thus, adverse effects on the fetus cannot be predicted from the effects of a drug on the male reproductive system.
Journal Article•
TL;DR: In this paper, the authors determined the prevalence of certain major congenital disorders among live-born infants of 6509 mothers in a prepaid health plan for the 30-month period of January 1, 1980 through June 30, 1982 who used a wide variety of drugs during the first trimester of pregnancy.