American journal of perinatology
-
An abdominal gunshot wound in pregnancy warrants prompt surgical exploration but does not mandate uterine evacuation. Despite an entry and exit bullet wound to the uterus an apparent desire for pregnancy termination, a conservative approach was adopted with primary repair of the uterus, in conjunction with surgical repair of associated injuries.
-
Uterine incision to delivery interval has been suggested as a critical determinant of neonatal outcome; however, studies of skin incision and uterine incision to delivery intervals have usually not analyzed the contribution of obstetric factors relative to time factors in determining outcome. A group of 204 patients undergoing cesarean delivery were studied. Stepwise multivariate regression was used to examine the relative contribution of obstetric and anesthetic factors to Apgar scores and umbilical cord blood gases. ⋯ Skin incision and uterine incision to delivery intervals did not significantly contribute to Apgar scores nor umbilical cord blood gases when corrected for these factors. We conclude that careful attention to maternal status prior to cesarean delivery and optimal anesthetic management appear to be the most important factors for good neonatal outcome. Surgical techniques should be directed at gentle, atraumatic delivery of the fetus for the good of the fetus and the mother.
-
Comparative Study
Rapid mechanical ventilation effects on tracheal airway pressure, lung volume, and blood gases of rabbits.
The purpose of this study was to demonstrate that ventilation of rabbit lungs (whose mechanics are similar to those of human infants) at rapid rates will lead to large alterations in tracheal airway pressures, tidal volume, and functional residual capacity (FRC) with only minor changes in arterial blood gases. Thirteen rabbits were ventilated at rates of 30, 60, 90, and 120 breaths per minutes (BPM) with pressures of 17/2 cm H2O. Tracheal peak inspiratory pressure (PIP) was always lower than ventilator PIP and decreased to 11 +/- 1 cm H2O at 120 BPM. ⋯ The increased tracheal PEEP and FRC are manifestations of inadvertent PEEP. The increased FRC without concomitant increase in PaO2 implicates alveolar overdistention. We speculate that rapid-rate ventilation of human infants having lung mechanics similar to rabbits, will also result in inadvertent PEEP and alveolar overdistention.
-
Today, influenza A infections are an uncommon cause of maternal morbidity and mortality. This is a report of a 20-year-old pregnant woman who died from pneumonia caused by influenza A/Philippines/1982. The decreased immune system and respiratory functions of pregnancy make pregnant women especially susceptible to having a complicated influenza infection, though such infections probably do not directly threaten the fetus. The use of influenza immunizations and antiviral medication during pregnancy is discussed.