American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Jan 1988
The role of cervical cerclage in the management of preterm premature rupture of the membranes.
The presence of a cervical cerclage at the time of preterm premature rupture of the membranes potentially complicates this already difficult management problem. An analysis of 44 patients presenting with preterm premature rupture of the membranes and cervical cerclage was conducted. Twelve patients were immediately delivered because of fetal distress, labor, or mature fetal pulmonary studies. ⋯ The latency period from premature rupture of the membranes until delivery was not affected by the presence or removal of the cerclage. There was no difference in infectious complications. These data suggest that the presence of a cervical cerclage at the time of preterm premature rupture of the membranes does not increase the risk of delivery or infectious morbidity as long as the cerclage is removed early in the management protocol.
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Am. J. Obstet. Gynecol. · Jan 1988
Neuromuscular transmission studies in preeclamptic women receiving magnesium sulfate.
The purpose of the study was to evaluate the neuromuscular transmission defect in preeclamptic women receiving intravenous magnesium sulfate and to study the correlation of the degree of defect with serum magnesium and calcium levels. The study population included: group 1, 14 preeclamptic women receiving magnesium sulfate and undergoing induction of labor; group 2, six preeclamptic women studied in the postpartum period while receiving magnesium sulfate; and group 3, 10 normotensive women undergoing induction of labor. The neuromuscular transmission studies were performed with standard techniques before and during the administration of magnesium sulfate. ⋯ There was significant correlation between the degree of the neuromuscular transmission defect and serum magnesium levels, serum calcium levels, and the magnesium/calcium ratio in groups 1 and 2. All studies were normal in group 3. The findings confirm the occurrence of abnormal neuromuscular transmission in preeclamptic women receiving magnesium sulfate, and the intensity of the defect correlates significantly with increased serum magnesium levels and decreased serum calcium levels.
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Am. J. Obstet. Gynecol. · Dec 1987
Comparative StudyCerebrospinal fluid levels of magnesium in patients with preeclampsia after treatment with intravenous magnesium sulfate: a preliminary report.
The purpose of this study is twofold: (1) to correlate magnesium levels of serum with those of cerebrospinal fluid in patients with preeclampsia receiving intravenous magnesium sulfate, and (2) to determine whether the magnesium ion crosses the blood-brain barrier in significant amounts after intravenous magnesium sulfate therapy. Of the 21 patients in whom spinal anesthesia was used for delivery, ten patients with preeclampsia with therapeutic serum magnesium levels made up the study group and 11 term nontreated normotensive gravid women served as controls. ⋯ For the preeclamptic group who received intravenous magnesium sulfate, the mean cerebrospinal fluid magnesium level was 3.04 +/- 0.12 mg/dl (range 2.9 to 3.2 mg/dl). Although only a small amount of magnesium crosses the blood-brain barrier after intravenous magnesium sulfate treatment, this increment is highly significant (p less than 0.001).
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Am. J. Obstet. Gynecol. · Nov 1987
Case ReportsInsufficient transplacental digoxin transfer in severe hydrops fetalis.
A case of severe nonimmune hydrops fetalis caused by supraventricular tachycardia is presented. Maternal treatment with digoxin and the subsequent addition of verapamil and propranolol failed to be effective. Simultaneous measurement of maternal serum and cord blood digoxin levels showed insufficient transplacental digoxin transfer. Other modalities of treatment are discussed.
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Am. J. Obstet. Gynecol. · Nov 1987
The pregnant brain dead and the fetus: must we always try to wrest life from death?
This article deals with the ever more timely and often vexing topic of maintaining a brain-dead mother as an incubator for her developing offspring. It explores the issue by: (1) reviewing the history of the problem and the "state of the art" today, (2) examining the moral problem of using brain-dead persons as incubators for potential or actual others, (3) searching for moral differences between maternal death early or late in pregnancy, and (4) presenting a possible resolution in such tragic cases. It concludes that (1) a moral necessity to deliver viable infants from brain-dead mothers exists; (2) the farther from viability brain death occurs, the more maintaining the mother as an incubator resembles experimental therapy with its imperative for careful, informed consent; (3) experimental therapy not being morally necessary, its proceeding under these tragic circumstances should invoke community support for the next of kin in dealing with the immediate and long-term costs; (4) all ethical problems proceed in a context to which the moral actors must be sensitive and one that alters the conclusions made.