Assuntos
Air Bags/efeitos adversos , Ruptura Prematura de Membranas Fetais/diagnóstico , Monitorização Fetal/métodos , Frequência Cardíaca Fetal/fisiologia , Resultado da Gravidez , Acidentes de Trânsito , Adulto , Eletrocardiografia , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Seguimentos , Humanos , Escala de Gravidade do Ferimento , GravidezRESUMO
Amniotic fluid (AF) plays multiple roles in fetal development and wellbeing. A global consideration of the possibilities of AF manipulation allows for the maximum benefits to be derived from assessing and selectively augmenting AF in clinical practice.
Assuntos
Ruptura Prematura de Membranas Fetais/diagnóstico , Monitorização Fetal , Frequência Cardíaca Fetal/fisiologia , Resultado da Gravidez , Adulto , Feminino , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Humanos , Ocitocina/administração & dosagem , Gravidez , Segundo Trimestre da GravidezRESUMO
BACKGROUND: Breech presentation is associated with increased risk. External cephalic version (ECV) has been successful in decreasing the incidence of intrapartum breech presentation. CASE: Funic presentation occurred as a complication of successful ECV. CONCLUSION: The wide-spread use of version calls for increased surveillance for adverse sequelae. At the completion of ECV, ultrasound analysis, pelvic examination and fetal heart rate monitoring are appropriate to exclude serious cord complications.
Assuntos
Apresentação Pélvica , Complicações na Gravidez/etiologia , Versão Fetal/efeitos adversos , Adulto , Feminino , Monitorização Fetal , Humanos , Gravidez , Resultado da Gravidez , Cordão Umbilical/patologia , Versão Fetal/métodosRESUMO
OBJECTIVE: To evaluate the utility of the prenatal three-generation pedigree in assessment of the obstetric patient's primary medical risks. STUDY DESIGN: In a case series, 250 charts of patients referred for amniocentesis on the basis of advanced maternal age were reviewed for a significant genetic risk of a primary care disorder. RESULTS: A total of 40 patients (16%) were at significantly increased risk for a primary care disorder. Thirty-eight patients (15.2%) were at increased risk for medical conditions for which early screening, detection and/or intervention are established. CONCLUSION: For the advanced maternal age population, formal genetic risk assessment performed prior to amniocentesis can be beneficial in primary care risk assessment.
Assuntos
Aconselhamento Genético , Obstetrícia , Atenção Primária à Saúde , Adulto , Feminino , Humanos , Idade Materna , Prontuários Médicos , Linhagem , Gravidez , Gravidez de Alto Risco , Medição de RiscoAssuntos
Sofrimento Fetal/fisiopatologia , Monitorização Fetal/métodos , Frequência Cardíaca Fetal/fisiologia , Oligo-Hidrâmnio , Adulto , Âmnio , Cesárea , Feminino , Sofrimento Fetal/etiologia , Humanos , Recém-Nascido , Infusões Parenterais , Trabalho de Parto Induzido , Masculino , Oligo-Hidrâmnio/diagnóstico , Oligo-Hidrâmnio/fisiopatologia , Gravidez , Ultrassonografia Pré-NatalAssuntos
Macrossomia Fetal/fisiopatologia , Parada Cardíaca/fisiopatologia , Frequência Cardíaca Fetal/fisiologia , Monitorização Fisiológica , Insuficiência Respiratória/fisiopatologia , Adulto , Eletrocardiografia , Evolução Fatal , Feminino , Macrossomia Fetal/complicações , Macrossomia Fetal/diagnóstico , Parada Cardíaca/complicações , Humanos , Recém-Nascido , Gravidez , Diagnóstico Pré-Natal , Insuficiência Respiratória/complicaçõesRESUMO
OBJECTIVE: To determine the adequacy of genetic risk assessment among primary care providers and to evaluate the efficacy of genetic counseling before "routine" genetic amniocentesis. STUDY DESIGN: A retrospective cohort study was undertaken. Charts of 275 consecutive patients referred for genetic counseling and amniocentesis on the basis of advanced maternal age (AMA) were compared with charts of 103 consecutive patients referred for an abnormal maternal serum alpha-fetoprotein (MSAFP) finding. Pedigree information obtained during counseling of these patients was compared with the family histories charted by the referring physician. RESULTS: In 35.6% of pedigrees evaluated, a significant genetic risk was discovered during genetic consultation that had not been noted by the referring physician. Furthermore, 9.8% of AMA patients and 10.7% of patients with abnormal MSAFP results underwent additional genetic testing or screening on the basis of genetic counseling. Additional genetic testing of 0.8% of amniotic fluid specimens was done on the basis of the genetic risk assessment elicited during counseling. Although a significant difference in increased genetic risk was observed between the AMA and abnormal MSAFP groups (AMA 30.8% positive, MSAFP 48.5% positive; relative risk 0.81, confidence limit 0.70 to 0.93), no significant difference was observed between the two groups with regard to patient interventions (relative risk 0.97, confidence limit 0.79 to 1.21) or amniotic fluid testing (p = 0.57, not significant). CONCLUSIONS: The data support the importance of genetic counseling before amniocentesis. Furthermore, the findings support the relevancy and usefulness of genetic counseling in more accurately ascertaining genetic risk and in maximizing the benefits of genetic evaluation of patients seemingly at low risk for other genetic diseases.
Assuntos
Amniocentese , Doenças Fetais/genética , Aconselhamento Genético , alfa-Fetoproteínas/análise , Adulto , Estudos de Coortes , Intervalos de Confiança , Feminino , Doenças Fetais/diagnóstico , Aconselhamento Genético/tendências , Humanos , Idade Materna , Pessoa de Meia-Idade , Gravidez , Valores de Referência , Estudos Retrospectivos , Medição de RiscoRESUMO
We are engaged in studying the process of human birth by developing a computer-based dynamic model that can be adapted to specific birth scenarios. The individual characteristics of a given pregnant woman and fetus, embedded in their clinical measurements and CT and MRI images, are captured in the model. One can thereby predict adverse events that might happen during labor and delivery. Based on our findings from a preliminary design and execution of this model, we believe it holds great promise as an accurate, cost-effective diagnostic and teaching tool that will help predict conditions during individual labor scenarios that might cause traumatic birth injuries, and thereby enable us to make the most informed clinical decisions possible.
Assuntos
Simulação por Computador , Processamento de Imagem Assistida por Computador/instrumentação , Trabalho de Parto/fisiologia , Imageamento por Ressonância Magnética/instrumentação , Tomografia Computadorizada por Raios X/instrumentação , Interface Usuário-Computador , Traumatismos do Nascimento/etiologia , Técnicas de Apoio para a Decisão , Feminino , Humanos , Recém-Nascido , Masculino , Complicações do Trabalho de Parto/etiologia , Pelvimetria/instrumentação , GravidezAssuntos
Acidentes por Quedas , Bradicardia/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Frequência Cardíaca Fetal , Adulto , Bradicardia/etiologia , Cesárea , Ecocardiografia Doppler em Cores , Feminino , Doenças Fetais/etiologia , Monitorização Fetal/instrumentação , Humanos , GravidezAssuntos
Monitorização Fetal , Frequência Cardíaca Fetal/efeitos dos fármacos , Imipramina/intoxicação , Adulto , Transtorno Depressivo/tratamento farmacológico , Feminino , Humanos , Imipramina/uso terapêutico , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/psicologia , Tentativa de SuicídioRESUMO
A vital component of selective protocols in term breech presentation management is exclusion of the gravida with borderline pelvic dimensions. Computed tomographic (CT) pelvimetry was employed to evaluate potential candidates for a trial of labor with a breech fetus at term. Thirty-seven of 39 women who underwent labor after this selection had a successful assisted vaginal breech delivery. Adequate pelvic dimensions by CT pelvimetry reliably predicted a safe vaginal delivery in patients managed within a standard breech protocol.
Assuntos
Apresentação Pélvica , Complicações do Trabalho de Parto/diagnóstico por imagem , Pelvimetria/métodos , Tomografia Computadorizada por Raios X/métodos , Prova de Trabalho de Parto , Protocolos Clínicos , Parto Obstétrico/métodos , Feminino , Humanos , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/terapia , Valor Preditivo dos Testes , Gravidez , Resultado da GravidezAssuntos
Monitorização Fetal/instrumentação , Frequência Cardíaca Fetal , Feminino , Humanos , GravidezRESUMO
An automated amniotic fluid surfactant-albumin ratio (SAR) test was performed as a screening test for pregnancies requiring fetal pulmonary maturity testing. Of the 178 neonates delivered within 3 days of the testing, respiratory distress syndrome (RDS) developed in 21 (11.8%) and transient tachypnea of the newborn infant (TTN) in 11 (6.1%). A positive test was defined as one which predicted RDS or TTN. Sensitivity was interpreted as the proportion of neonates with RDS or TTN detected by SAR less than 70 mg/gm. Sensitivity was 90.7% with a specificity of 76.1%. The positive predictive value was 45.3%; the negative predictive value 97.4%. The interassay coefficient of variability was 3.5%. The SAR test has proven to be a rapid, precise laboratory tool. Our combined testing protocol uses the SAR as an initial screening test with the lecithin/sphingomyelin ratio used as backup if the SAR did not predict maturity (SAR < 70 mg/gm). This protocol has markedly lowered the use of lecithin/sphingomyelin ratios while maintaining necessary clinical accuracy.