Citations from the literature/International
Journal of Gynecology & Obstetrics 52 (19%) 217-227
care nursery, than the babies of mothers who had been allocated phenytoin. There is now compelling evidence in favor of magnesiumsulphate, rather than diazepam or phenytoin, for the treatment of eclampsia.
were made between those patients with recurrent shoulder dystocia. Conclusion: Shoulder dystocia recurred at a rate approximately seventimes higher than our primary rate. Whether patients with a history of shoulder dystocia should be offered an elective abdominal delivery requires further investigation.
Bhdness associated with preeclampsia and eclampsia
Cunningham F.G.; Femandez C.O.; Hemandez C. AM J OBSTET GYNECOL 1995 17z4 I (1291-1298) Objective: Over a 14-year period at Parkland Hospital, the clinical courses of 15 women with severe preeclampsia or eclampsia were further complicated by blindness. Our purpose is to describetheir managementand outcome, as well as to offer insight to the pathophysiologic characteristics of blindness complicating pregnancy-induced hypertension. Study design: Prospective ascertainment of women with blindness and pregnancy-induced hypertension was done. These cases were managed according to the standardized preeclampsiaeclampsia regimen used at our hospital since 1955.Briefly, this regimen includes magnesium sulfate given intramuscularly to prevent or control seizures, hydralazine to lower dangerously elevated blood pressure, intravenous fluid restriction, and delivery. Results: There were 15 women with blindness that persisted from 4 h to 8 days; it subsequently resolved completely in all. Of the 13women who underwent computed tomography, 8 had low-density areaslocalized predominantly in the occipital lobes. Five of these 13 subsequently underwent magnetic resonance imaging and 2 showed corresponding hyperintense lesions in the occipital areas. Conclusions: On the basis of previously published experiences with computed tomography in women with eclampsia, as well as the experiences described here, we conclude that cortical blindness associated with preeclampsia-eclampsia results from petechial hemorrhages and focal edema in the occipital cortex. These lesions are likely stimulated by disparity in cerebral regional blood flow that is characterized by vasospasm and diminished flow primarily affecting the posterior circulation. Recurrencerate of shoulder dystocia Lewis D.F.; Raymond R.C.; Perkins M.B.; Brooks G.G.; Heymann A.R. AM J OBSTET GYNECOL 1995 172/5(1369-1371) Objective: Shoulder dystocia continues to be a major complication of obstetrics, and several factors have been identified to help predict its occurrence. A previous shoulder dystocia is one of the risk factors. However, the recurrence rate is unknown. The purpose of this study is to report the recurrence rate of shoulder dystocia. Study design: Our obstetric database was usedto identify all vaginal deliveries between January 1983 through December 1992. A subset of vaginal deliveries complicated by shoulder dystocia was selectedfrom this database. These records were reviewed to identify subsequent pregnancies, outcomes, risk factors, and demographic data. Results: During the study period there were 37 465 total vaginal deliveries, with shoulder dystocia complicating 747 (overall rate 2%). Of these747 cases,101patients had 123subsequentvaginal deliveries, with shoulder dystocia complicating 17 of these pregnancies (13.8% recurrence rate, P < 0.0001). Comparisons
Doppler ultrasoaograpby in highrisk review with meta-analysis
Alfirevic Z.; Neilson J.P. AM J OBSTET GYNECOL 1995 172/5(1379-1387) Objective: Our objective was to review all available (published and unpublished) randomized controlled trials of Doppler ultrasonography of the umbilical artery in high-risk pregnancies. Study design: Only completed randomized controlled trials were included and reviewed according to the prespecified protocol. Data were sought for 24 prespecified perinatal outcomes.All meta-analyseswere based on the ‘intention to treat’. Primary outcome was defined as perinatal death (any death in utero or postnatally recorded during duration of individual randomized controlled trial). Reported perinatal outcomesthat were not prespecilied were meta-analyzed on a posthoc basis. Results:Twenty randomized controlled trials of Doppler ultrasonography were identified; 12 fulfilled the prespecified criteria. Meta-analysis shows a significant reduction in the number of antenatal admissions(44%, 95% confidence interval 28 to 57%), inductions of labor (20%, 95% confidence interval 10 to 28%), and cesareansections for fetal distress (52%, 95% confidence interval 24 to 69%) in the Doppler group and that the clinical action guided by Doppler ultrasonography reduces the odds of perinatal death by 38% (95% confidence interval 15 to 55%). The reduction in perinatal deaths was also observed in five mortality subgroups (i.e., stillbirths, neonatal deaths, deaths of normally formed babies, normally formed stillbirths, and deaths of normally formed neonates). Post hoc analyses revealed a statistically significant reduction in elective delivery, intrapartum fetal distress, and hypoxic encephalopathy in the Doppler group. Conclusion: There is now compelling evidence that women with high-risk pregnancies,including preeclampsia and suspectedintrauterine growth retardation, should have access to Doppler ultrasonographic study of umbilical artery waveforms.
Strategies to respond to polymerase chain reaction deoxyribonucleic acid amplitkation failure in a preimplantation genetic diagwaisprogram
Gibbons W.E.; Gitlin S.A.; Lanzendorf SE. AM J OBSTET GYNECOL 1995 172/4 I (1088-1096) Objectives: Our purpose was to identify and evaluate practical methods within a preimplantation genetic diagnosis program that will increasethe percentage of embryos for which a genetic diagnosis can be obtained, including clinical responses after failure of deoxyribonucleic acid amplification has occurred. STUDY Design: Known human lymphoblast cell lines and human embryo blastomereswere evaluated in a single-cell, nestedprimer polymerasechain reaction systemwith primer se-