American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Jul 1992
ReviewEthically justified guidelines for family planning interventions to prevent pregnancy in female patients with chronic mental illness.
This article proposes ethically justified clinical guidelines for family planning interventions to prevent pregnancy in female patients. ⋯ Three sets of guidelines for three groups of patients, representing the continuum of chronically and variably impaired autonomy, are proposed: (1) a set of guidelines for patients who can achieve thresholds of autonomy, (2) a set of guidelines for patients irreversibly near thresholds of autonomy, and (3) a set of guidelines for patients irreversibly below thresholds of autonomy. These guidelines should contribute significantly to the quality of obstetric and gynecologic care for female patients with chronic mental illness.
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Our objective was to determine the normal sequence of neurobehavioral development in the human fetus between 14 weeks' gestation and delivery. ⋯ During the first half of the midtrimester there was a high rate of spontaneous movement that appeared randomly distributed. By the end of that trimester an increase in the duration of intervals of quiescence resulted in activity appearing cyclically distributed, with the duration of quiet cycles progressively increasing to term. Fetal mouthing and breathing were linked with cyclic behavior from the time of their emergence. Fetal heart rate pattern A could be recognized from around 32 weeks, due to a reduction in baseline variability in quiet cycles after 30 weeks, whereas pattern B could be recognized several weeks earlier. From the time cyclic behavior and heart rate patterns could be recognized, intervals of coincidence of the fetal behavioral state variables increased progressively with advancing gestation.