American journal of obstetrics and gynecology
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Twenty-one patients were seen with puerperal sepsis owing to group B streptococci (GBS), resulting in an attack rate of 2/1,000 deliveries. Most were young primiparous black women from a population with a known high incidence of GBS carriage. The association among abdominal delivery, endometritis, and puerperal sepsis was striking. ⋯ Seven neonates developed serious GBS infections; intrauterine exposure occurred in at least four cases. Fetal exposure to GBS also occurred in three of four cases in which parturients with GBS bacteremia were delivered of their infants by cesarean section. Because of the high incidence of puerperal and perinatal GBS infections in this population, antibiotic prophylaxis regimens may be beneficial.
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Am. J. Obstet. Gynecol. · May 1982
Helicopter transportation of patients with obstetric emergencies in an urban area.
Regionalization of perinatal care has contributed to a decline in perinatal morbidity and mortality in neonates delivered at tertiary centers when compared to neonates delivered and transported to the intensive care nurseries. Transportation of the mother to the perinatal center in an emergency situation must be evaluated critically for neonatal outcome, response time, and cost. ⋯ This experience was examined with respect to response time, cost, obstetric problems, and newborn outcome in our first 100 patients. The results are indicative that when patient and neonates would benefit from delivery at a perinatal center, helicopter transport, even in an urban area, is highly successful and cost effective.
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Am. J. Obstet. Gynecol. · Apr 1982
Comparative StudyFetal and maternal plasma catecholamine levels at elective cesarean section under general or epidural anesthesia versus vaginal delivery.
Fetal and maternal plasma levels of catecholamines were measured at birth in 40 women with normal term pregnancies who underwent elective cesarean section. Twenty women were operated on under general anesthesia, and 20 under epidural anesthesia. For comparison, the same measurements were also made in 10 women who underwent vaginal delivery without signs of intrapartum fetal distress. ⋯ In spite of that, neonates delivered vaginally showed a markedly higher sympathoadrenal activation (norepinephrine and epinephrine, 31.8 +/- 24.1 and 5.1 +/- 7.6 nmoles/L, respectively) than those born by elective cesarean section. In the latter group, however, it was found that the type of maternal anesthesia influenced fetal sympathoadrenal activation, since neonatal levels of catecholamines were higher in the epidural section group (norepinephrine and epinephrine, 9.5 +/- 6.4 and 4.0 +/- 4.5 nmoles/L, respectively) than in the general anesthesia group (norepinephrine and epinephrine, 3.2 +/- 2.7 and 1.0 +/- 1.4 nmoles/L, respectively). These results may have a certain clinical relevance since fetal sympathoadrenal activation is thought to promote extrauterine adaptation.
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Am. J. Obstet. Gynecol. · Mar 1982
Comparative StudyThe effect of maternal glucose infusion on breathing movements in human fetuses with intrauterine growth retardation.
forty-nine patients with suspected intrauterine growth retardation (IUGR) were studied under rigid experimental conditions to determine baseline fetal breathing movement (FBM) activity and the response to 90-minute maternal glucose infusion, as compared to that of normal control subjects. Patients with IUGR showed a normal amount of FBMs during maternal fasting. All groups exhibited a significant increase in FBMs after glucose was administered. During the final 60 minutes of the glucose infusion, the severe IUGR group (weight for gestational age less than the third percentile) showed less FBM activity (p less than 0.01) than the other study and control groups.