Journal of perinatal medicine
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Today we known that the coagulation system of the neonate differs in many ways from that of the adult system. We see a general reduction of the coagulation factors II-XIII (except VIII), the fibrinogen and of the coagulation inhibitors ATIII, protein C and heparin cofactor II at the same time. In addition the newborns show different levels of the coagulation factors for premature and full-term infants. ⋯ This is due to the general reduction of the coagulation factors with a reduction of the coagulation inhibitors at the same time. The physiologically low level of the vitamin K dependent and other coagulation factors and ATIII leads to a prolonged aPTT and reduced PT of the newborn. As well as these differences, known from literature, we found the following specialities: lower vWF and PAI and higher D-Dimer levels of the newborn compared with their mothers.
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The excretion of ketobemidone into human breast milk was investigated in three women who obtained ketobemidone as postoperative pain relief after Cesarean section and two women premedicated with 5 mg of ketobemidone before currettage after delivery. The highest observed concentration of ketobemidone in breast milk was 36 ng/ml three hours after administration, and 4-7 hours after administration the concentration was 3-5 fold that in maternal plasma. It could be estimated that the newborn will be exposed to less than 2 micrograms of ketobemidone during the first 24 hours.
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Paracervical block during labor following normal, uncomplicated pregnancy is occasionally accompanied by fetal bradycardia. To evaluate whether a paracervical block with bupivacaine causes changes in the vascular resistance of uteroplacental and umbilicoplacental blood flow, a total of 12 singleton, uncomplicated pregnancies in active labor at the end of pregnancy were included to this study. By using pulsed color Doppler ultrasound techniques the pulsatility indices were measured from both uterine and umbilical arteries before, one minute and 20 minutes after a paracervical block with bupivacaine. ⋯ When the fetal bradycardia ceased the pulsatility indices returned to the levels at the beginning of the study. Paracervical block with bupivacaine in normal pregnancies without signs of chronic or acute fetal distress does not change the vascular resistance in the uterine or umbilical arteries. If fetal bradycardia develops, it seems to be due to the direct effect of bupivacaine on the fetus, mainly on the umbilical vessels.
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The objective of the study was to assess the prevalence of unclassified hypertension during pregnancy and its consequences on infant's health in an African urban setting: Pikine, a suburb of Dakar, Senegal. A cross-sectional study of a random sample of pregnant women and a prospective study, from the inclusion to seven days after delivery, were performed. 886 women attending the prenatal centers were included in the cross-sectional study. 471 pregnant women were included in the follow-up study. The prevalence of DBP > or = 120 mmHg was 0.7%; 5.7% of the women had DBP > or = 95 mmHg. ⋯ Using 95 mmHg as a cutpoint, the relative risk of adverse outcome associated with a DBP > or = 95 mmHg was 2.5 (CI 95%: 1.4-4.3). This risk was significantly increased among women who reported difficult living conditions. Eight percent of the adverse outcomes of pregnancy, 10% of the low birth weights and 8% of the perinatal mortality were found to be associated with DBP > or 95 mmHg.
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Salbutamol infusion, 4 micrograms/kg in 5 ml of water infused for 20 minutes, was given to treat hyperkalaemia (potassium level > 6.0 mmol/l) in 10 critically ill preterm infants (median gestational age 26 weeks). Seven infants had acute renal failure, two had persistent metabolic acidosis without renal failure and the remaining infant had a combination of acute renal failure and persistent metabolic acidosis. No infant developed a tachycardia or became hyperglycaemic in response to the infusion. ⋯ In response to the infusion the potassium level fell in 7 infants with acute renal failure by a median of 1.1 mmol/l (range 0.7-1.8) at one hour but in the three infants with a persistent metabolic acidosis, the potassium level continued to rise. We conclude that salbutamol infusion achieves, without side-effects, at least a temporary reduction in hyperkalaemia in preterm infants with renal failure, but not metabolic acidosis. Its effect is of sufficient duration to allow ample time for definitive therapy to be instituted and thus may be a useful alternative for infants in whom the possible hypoglycaemic side-effects of glucose and insulin should be avoided.