Postdates pregnancy. Assessment of fetal risk and obstetric management

Two hundred forty-eight well-dated pregnancies that exceeded their expected dates of confinement were followed with serial maternal urinary or plasma estriol determinations and weekly fetal heart rate tests. Most pregnancies (176) delivered after spontaneous labor, while 72 had labor induced for abnormal test results or electively. Perinatal mortality (8.1/1,000) was comparable to that of our term (37-40-week) population; the two deaths occurred in the 43rd week. Intrapartum fetal distress, meconium staining, postmaturity syndrome and primary cesarean section rates all increased with gestational age beyond the 40th week. Induced labors, irrespective of indication, were significantly longer than spontaneous ones and were associated with higher rates of fetal distress and primary cesarean section. In the study group, fetal distress often arose during labor and was not anticipated by the antenatal testing.     

Antacids for obstetric patients.

The aspiration of regurgitated or vomited gastric contents is the most common cause of maternal deaths associated with anesthetics, causing an estimated 2 per cent of all maternal deaths in the United States. The incidence of aspiration is estimated to be one of every 430 patients who undergo cesarean section with general anesthesia. The pulmonary complications of aspiration are improved or avoided if the pH of the gastric contents is higher than 2.50. The oral administration of 30 c.c. of magnesium trisilicate has been shown to increase the pH of the gastric contents to above 2.50 in 100 per cent of treated patients, whereas only 60 per cent of the control group were found to have a pH above 2.50. Oral preoperative or predelivery antacid therapy may help to eliminate the morbidity and deaths secondary to aspiration and as such may be an adjuvant to, but not a substitute for, the safe management of the obstetric patient.     

Recommendations for renovating an operating theater at an emergency obstetric care facility.

The importance of emergency obstetric care (EmOC) in reducing maternal mortality has focused attention on both the skills of the clinicians to provide high quality care and on the health facilities in which the care is provided. Essential elements of EmOC include the capacity to perform cesarean sections for which an operating theater is needed. This article focuses on renovation of existing operating theaters to meet the necessary standards. While building, adding to, or renovating operating theaters can be expensive, this article emphasizes appropriate materials that are likely to be locally available and relatively inexpensive. The importance of proper maintenance is discussed.     

Perinatal risk management: obstetric methods to prevent birth asphyxia

Because obstetric care frequently is associated with the potential for liability, the purpose of this article is to familiarize the reader with perinatal risk management using the concept of foreseeability of harm and its potential application to obstetric care. At the same time, this article introduces the concept of notice, and explains the critical conduct intervals that are used to gauge how well the health care teams handle obstetric emergencies. The focus then shifts to incorporate these concepts into several maternal-child health quality management programs. It is hoped that this article will result in an improvement of perinatal outcome for pregnant women and their unborn children.     

Ultrasound in the diagnosis of fetal malformations. Implications for obstetric management

The prenatal diagnosis of congenital malformations through ultrasonography leads to major considerations regarding subsequent pregnancy management. These diagnoses are useful in reaching decisions concerning elective abortion, planning the time and method of delivery, and arranging for appropriate support personnel. Although the possibility of fetal anomaly must be considered in all obstetric ultrasonograms, review of 56 malformations diagnosed prenatally found that 31 were studied because of uterine size incompatible with gestational age. Polyhydramnios was associated with 24 of these cases. Multiple fetal abnormalities were found postnatally in 24 of the 51 cases in which one or more malformations were diagnosed through ultrasonography, emphasizing the need for careful counseling and follow-up examination.     

Epidural anesthesia for obstetric patients

The use of epidural anesthesia for the obstetric patient is increasing in many areas of the country. The maternity nurse needs to have a basic understanding of the technique used by the physician to initiate this type of anesthesia, and also has a responsibility to know the contraindications, possible complications, and disadvantages and advantages of epidural anesthesia. This information is presented below. Skilled nursing and medical management will reduce the potential risks of epidural anesthesia for both the mother and fetus.     

Recommendations on the management of fragility fracture risk in women younger than 70 years

The risk for fragility fracture represents a problem of enormous magnitude. It is estimated that only a small fraction of women with this risk take the benefit of preventive measures. The relationship between estrogen and bone mass is well known as they are the other factors related to the risk for fracture. There are precise diagnostic methods, including a tool to diagnose the risk for fracture. Yet there continues to be an under-diagnosis, with the unrecoverable delay in instituting preventive measures. Women under the age of 70 years, being much more numerous than those older, and having risk factors, are a group in which it is essential to avoid that first fragility fracture. Today it is usual not to differentiate between the treatment and the prevention of osteoporosis since the common aim is to prevent fragility fractures. Included in this are women with osteoporosis or with low bone mass and increased risk for fracture, for whom risk factors play a primary role. There is clearly controversy over the type of treatment and its duration, especially given the possible adverse effects of long-term use. This justifies the concept of sequential treatment, even more so in women under the age of 70, since they presumably will need treatment for many years. Bone metabolism is age-dependent. In postmenopausal women under 70 years of age, the increase in bone resorption is clearly predominant, related to a sharp drop in estrogens. Thus a logical treatment is the prevention of fragility fractures by hormone replacement therapy (HRT) and, in asymptomatic women, selective estradiol receptor modulators (SERMs). Afterwards, there is a period of greater resorption, albeit less intense but continuous, when one could utilise anti-resorptive treatments such as bisphosphonates or denosumab or a dual agent like strontium ranelate. Bone formation treatment, such as parathyroid hormone (PTH), in women under 70 years will be uncommon. That is because it should be used in cases where the formation is greatly diminished and there is a high risk for fracture, something found in much older women.     

Fetal malformations associated with breech delivery. Implications for obstetric management

Among 1,411 breech deliveries at the Soroka Medical Center, Beer-Sheva, Israel, there were 116 cases of congenital anomalies (8.2 %). Forty-nine fetuses (3.47%) exhibited major congenital anomalies and 67 (4.7%), minor ones. The incidence of chromosomal anomalies was 0.63% (1 per 159 births) as compared with 0.25% in the general population. The frequency distribution indicated that most of the fetuses with congenital abnormalities weighed 2,000 gm or more. In view of the high incidence of chromosomal aberrations and major congenital anomalies among fetuses with breech presentation, it seems desirable to consider ultrasonographic assessment and chromosomal analysis during the last trimester of pregnancy.     

加强产科急重症患者管理，降低母儿死亡率

降低孕产妇死亡率及5岁以下儿童死亡率不但是联合国千年目标,更是提高我国国民素质的基本保障。经过近20年的努力,全球孕产妇死亡率已大幅下降,而中国在促进母婴健康方面更是取得令人瞩目的成绩。最新数据统计显示,我国的孕产妇死亡率从2000年53.0/10万下降至34.2/10万,较上世纪90年代下降59%[1];1990-2007年     

Identifying the obstetric patient at high risk of multiple-unit blood transfusions.

We sought to characterize the obstetric patient who required more than the 1 or 2 units of blood products typically available by autologous donation. Medical records from 1988 were reviewed retrospectively. During this period, 16,462 deliveries were performed. Twenty-seven patients (0.16%) received more than 2 units of blood products during their pregnancies. The most common diagnoses associated with a transfusion were placenta previa (10), uterine atony (8) and abruption (5). Platelets, fresh frozen plasma and cryoprecipitate were administered to 7, 12 and 4 patients, respectively. An antepartum condition associated with hemorrhage was identified in only 11 of the 27 patients (41%) who received greater than or equal to 3 units of blood products. The remainder of the cases were not diagnosed during the antepartum period, when autologous donation is an option.