American journal of obstetrics and gynecology
-
Am. J. Obstet. Gynecol. · Dec 1979
The "intra-abdominal version technique" for delivery of transverse lie by low-segment cesarean section.
Cesarean section is the delivery method of choice in all shoulder presentations of viable fetuses. The classic cesarean section is usually recommended when there is a transverse lie because of the potential technical difficulties associated with extraction of the fetus when a low-segment incision is used. This paper illustrates a technique that avoids the need of a classic cesarean section and permits the use of the more desirable low-segment cesarean section. The advantages of the procedure are discussed.
-
Of 128 patients receiving primary treatment for molar pregnancy at Women's Hospital, Los Angeles County/University of Southern California Medical Center, after uterine evacuation 12 (10.7%) developed self-limited, acute pulmonary complications characterized by tachycardia, tachypnea, and hypoxemia. Multiple contributing factors have been identified which include trophoblastic deportation, hyperthyroidism, fluid overload, dilutional anemia, and pre-eclampsia. ⋯ These patients are also at an increased risk for postmolar trophoblastic disease. The diagnosis and management of the postmolar pulmonary complications are discussed.
-
Am. J. Obstet. Gynecol. · Sep 1979
Clinical Trial Controlled Clinical TrialRelief of dysmenorrhea with the prostaglandin synthetase inhibitor ibuprofen: effect on prostaglandin levels in menstrual fluid.
The prostaglandin synthetase inhibitor ibuprofen was evaluated for relief of severe primary dysmenorrhea in a controlled, double-blind, cross-over study in seven patients for a total of 23 menstrual cycles. In eight untreated cycles, the amount of prostaglandin (PG) in the menstrual fluid was higher than in nondysmenorrheic subjects. There was good to excellent relief of dysmenorrhea in seven ibuprofen-treated cycles, which was associated with a threefold to fourfold reduction in menstrual PG released. ⋯ In individual patients, there was a remarkable correlation between the severity of menstrual pain as assessed daily by the patient and the level of menstrual PG released during the corresponding period. The effect of ibuprofen therapy on menstrual fluid volume was inconsistent. The study shows that in severe primary dysmenorrhea there is increased release of PG in the menstrual fluid; this can be effectively suppressed with ibuprofen, which provides excellent relief from the symptoms of dysmenorrhea.
-
Am. J. Obstet. Gynecol. · Jun 1979
Effects of magnesium sulfate treatment on perinatal calcium metabolism. I. Maternal and fetal responses.
Serial maternal and cord blood determinations of the ions and hormones involved in calcium homeostasis were made in pre-eclamptic women treated with intravenous magnesium sulfate. A 4 gm loading dose followed by 1 to 2 gm/hr caused maternal serum magnesium concentrations to rise 150%, to levels of 3.3 to 4.5 mEq/L, and ionized calcium levels to fall 16%, to 1.89 mEq/L. The hypocalcemia etly altering calcitonin. ⋯ At the time of delivery the offspring of these women were hypermagnesemic and relatively hypocalcemic, although less so than their mothers. Fetal ionized calcium levels, although lower with magnesium treatment than in control subjects, were within the lower limits of the normal range, which perhaps explains why the fetus did not respond with increased PTH or decreased calcitonin output. These results indicate that the principal maternal response to magnesium-induced hypocalcemia involves increased parathyroid hormone secretion which tends to preserve maternal calcium homeostasis, while the fetus is partially protected from hypermagnesemia and hypocalcemia by the placenta.
-
Am. J. Obstet. Gynecol. · Jun 1979
Relationship of fetal bradycardia to maternal administration of lidocaine in sheep.
The casual relationship between the use of lidocaine and fetal bradycardia and the effect of the drug on maternal and fetal hemodynamics were studied on 13 chronically instrumented pregnant sheep. Lidocaine was infused intravenously to the mother for 60 minutes during arterial lidocaine concentrations were maintained at 2 to 5 microgram per milliliter in the mother and at less than 2 microgram per milliliter in the fetus. A decrease in uterine blood flow and an increase in uterine vascular resistance and uterine activity occurred immediately following the administration of lidocaine to the ewe. ⋯ These phenomena were seen in the absence of such predisposing conditions as maternal hypotension and fetal acidosis. It would appear that the mechanism responsible for a transient fetal bradycardia following regional obstetric anesthesia, particularly paracervical block anesthesia, in the initially nonasphyxiated fetus may in part be related to a brief decrease in perfusion of intervillous spaces. The bradycardia can occur at low lidocaine concentrations in both the maternal and fetal blood in a range similar to that observed in clinical practice.