Abstract：
OBJECTIVE:We sought to test the hypothesis that elective delivery of infants diagnosed with macrosomia by ultrasonographic studies in diabetic women will significantly reduce the rate of shoulder dystocia without significantly increasing cesarean section rate. STUDY DESIGN:In a prospective study diabetic women with ultrasonographic estimated fetal weight > or = 4250 gm underwent elective cesarean section; women with estimated fetal weight > or = 90th percentile but < 4250 gm underwent induction of labor. Maternal and neonatal outcomes were analyzed and compared for the periods before and after initiation of the protocol. RESULTS:A total of 2604 diabetic patients were included in this study. The rate of shoulder dystocia was significantly lower after instituting the protocol (2.4% vs 1.1%, odds ratio 2.2). The cesarean section rate increased significantly between the two periods (21.7% vs 25.1%, p < 0.04). Ultrasonography correctly identified the presence or absence of macrosomia in 87% of patients. Only 10.6% of diabetic patients at term required intervention under the protocol (6.8% labor induction, 3.8% elective cesarean section). The rate of shoulder dystocia was 7.4% in macrosomic infants delivered vaginally. CONCLUSION:An ultrasonographically estimated weight threshold as an indication for elective delivery in diabetic women reduces the rate of shoulder dystocia without a clinically meaningful increase in cesarean section rate. This practice, in conjunction with an intensified management approach to diabetes, improves the outcome of these high-risk women and their infants.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Conway DL,Langer Odoi
10.1016/s0002-9378(98)70524-1subject
Has Abstractpub_date
1998-05-01 00:00:00pages
922-5issue
5eissn
0002-9378issn
1097-6868pii
S0002-9378(98)70524-1journal_volume
178pub_type
杂志文章abstract：:In pregnancy a decrease in fibrinolytic activity, which is due to an increase in plasminogen activator inhibitor activity and plasminogen activator inhibitor type 1 and type 2, has been described. Because the placenta is a source of both type 1 and type 2 plasminogen activator inhibitor, we have studied them and other...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(91)90242-j
更新日期：1991-07-01 00:00:00
abstract：:Five hundred eighty-eight women who were delivered of twins at 13 hospitals affiliated with the Northwestern University Medical School or its outreach institutions between 1971 and 1975 were studied. Eighty-six of the infants did not survive the pregnancy, delivery, or the first week post partum. Maternal demographic ...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1980-12-01 00:00:00
abstract：:In November, 1978, the fetal heart rate nonstress test (NST) was instituted as the primary screening procedure for the evaluation of fetal well-being at Vanderbilt University Hospital. The results of the first 1,000 patients tested are presented. The stillborn rate within 8 days of a reactive NST was 6.4 per 1,000, wi...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0002-9378(16)32583-2
更新日期：1981-09-15 00:00:00
abstract：OBJECTIVE:Betamethasone administration in singleton pregnancies causes maternal hyperglycemia. With the increased risk of glucose intolerance in twin pregnancies, we sought to determine whether maternal hyperglycemia after dexamethasone administration is different in twin vs singleton pregnancies. STUDY DESIGN:Patient...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2008.08.004
更新日期：2008-10-01 00:00:00
abstract：OBJECTIVE:The primary objective of this study was to identify specific educational goals for obstetrics and gynecology residents in the ambulatory setting. STUDY DESIGN:A cross-sectional study of current practice patterns in primary care, benign gynecology, and office procedures was performed with mailings to local pr...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2004.07.070
更新日期：2004-11-01 00:00:00
abstract：OBJECTIVE:We examined the effect of administering a long-acting adenosine analog, L-2-N6-(phenylisopropyl) adenosine, into the cerebrospinal fluid of the fourth ventricle on fetal sheep heart rate accelerations. STUDY DESIGN:Pregnant ewes between 123 and 130 days' gestation were anesthetized, and the fetal head was ex...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(93)90017-d
更新日期：1993-10-01 00:00:00
abstract：OBJECTIVE:Disorders that lead to preterm delivery influence the fetal inflammatory response. STUDY DESIGN:We calculated odds ratios of elevated concentrations of 25 blood proteins on the first postnatal day in 798 infants born before the 28th week and classified by the pregnancy disorder that lead to preterm delivery....
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2010.12.010
更新日期：2011-05-01 00:00:00
abstract：:A retrospective analysis of 29 cases of squamous cell neoplasia of the vagina following hysterectomy is presented. Two groups of patients were identified; the first presented following hysterectomy for cervical dysplasia or neoplasia on an average of 5.7 years later, and the second presented following hysterectomy for...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(81)90016-8
更新日期：1981-02-01 00:00:00
abstract：:Surgical experience with carcinomas of the uterus and rectum has provided new insights into the surgical anatomy of a lamina, which separates the paravesical space from the pararectal space. It has been proved that each of the lamina consists of the cardinal and lateral ligaments and pelvic splanchnic nerves, descendi...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(91)90614-w
更新日期：1991-01-01 00:00:00
abstract：OBJECTIVE:Our purpose was to test whether cocaine stimulates uterine activity in nonpregnant and pregnant rats. STUDY DESIGN:The carotid artery and jugular vein were chronically catheterized, and a microballoon probe was inserted into the uterine cavity of 15 pregnant and 14 nonpregnant female rats. Conscious animals ...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0002-9378(96)70273-9
更新日期：1996-07-01 00:00:00
abstract：:The maturation of the glomerular filtration rate (GFR) and the interrelationship between the GFR and the renal transport of sodium and chloride have been evaluated during the last trimester of gestation with the use of long-term experiments in fetal lambs. An increase in GFR (milliliters per minute) parallel to the in...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(77)90712-8
更新日期：1977-08-01 00:00:00
abstract：:Components of fetal behavioral state organization reflect the successful integration of the central nervous system, have a specific developmental timetable, and can be studied with fetal ultrasonographic techniques. To test the hypothesis that evaluation of state organization is a marker of abnormal central nervous sy...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(89)90380-3
更新日期：1989-09-01 00:00:00
abstract：:To stimulate first-trimester human cytomegalovirus infection, pregnant guinea pigs were inoculated with a low dose of guinea pig cytomegalovirus during the first trimester of pregnancy. Maternal viremia, which was cleared by 2 weeks after inoculation, was found to reappear near the time of delivery in one third of the...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(87)90159-1
更新日期：1987-05-01 00:00:00
abstract：OBJECTIVE:The molecular mechanisms underlying ectopic implantation have not been well characterized. Here we investigate HOXA10 gene expression at the site of ectopic implantation as compared with the endometrium and with the normal fallopian tube. STUDY DESIGN:Northern blot analysis was used to evaluate HOXA10 gene m...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2004.01.066
更新日期：2004-05-01 00:00:00
abstract：:Prospective pregnancy evaluation through the combined use of a radioimmunoassay (RIA) for the beta-subunit of human chorionic gonadotropin (beta-hCG) and ultrasound during the first 42 days of gestation after ovulation was performed on a population asymptomatic for first-trimester spontaneous abortion. One hundred for...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(83)90977-8
更新日期：1983-08-15 00:00:00
abstract：:Matings between mice carrying the heterozygous autosomal gene Steel produce 25% homozygous Sl/Sld mutants having agametic gonads composed of somatic tissue alone. Mutants show a normal 1:1 male:female sex ratio and gonadal sex corresponds to genotypic sex. Gonads from both normal and mutant male and female fetuses wer...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(83)90319-8
更新日期：1983-02-15 00:00:00
abstract：:Maternal serum alpha-fetoprotein concentration was measured at 14 to 20 weeks' gestation in 138 twin pregnancies. All patients had at least one ultrasonographic examination (86% before 20 weeks' gestation). Two pregnancies were discordant for open fetal defects (one anencephaly, one gastroschisis). The median serum al...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(90)91308-y
更新日期：1990-04-01 00:00:00
abstract：OBJECTIVE:Cervical inflammation has been proposed as a cofactor in the development of cervical cancer. The purpose of this study was to document the prevalence of cervical (pre)neoplastic changes in asymptomatic women with a cytologically diagnosed Gardnerella vaginalis infection. STUDY DESIGN:Data were collected from...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2008.04.036
更新日期：2008-11-01 00:00:00
abstract：OBJECTIVE:To define the incidence of hypoglycemia and identify risk factors in neonates from term, singleton, nondiabetic pregnancies. STUDY DESIGN:We conducted a matched case-control study of term, singleton infants weighing more than 2500 g in nondiabetic pregnancies. Cases with hypoglycemia (glucose < 50 mg/dL) wer...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2008.10.015
更新日期：2009-05-01 00:00:00
abstract：OBJECTIVE:The purpose of this study was to compare the effect of a single 48-hour exposure to betamethasone or dexamethasone in the NCI-H441 cell line and in human type II pneumocytes. STUDY DESIGN:NCI-H441 cells were exposed 48 hours to varying concentrations of betamethasone or dexamethasone (10(-10) to 10(-7) mol/L...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2004.01.015
更新日期：2004-04-01 00:00:00
abstract：OBJECTIVE:Sampling of the umbilical artery for determination of acid-base status is performed within 60 minutes of birth, but is not feasible in all hospitals on a 24-hour basis. A desirable alternative would be to perform the arterial cord blood gas analysis hours after the sample was obtained at delivery with reliabl...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1994-06-01 00:00:00
abstract：OBJECTIVE:Our purpose was to evaluate the effect of peritoneal fluid from women with endometriosis on sperm motility and function in an in vitro model. STUDY DESIGN:Peritoneal fluid was collected at laparoscopy from patients with and without endometriosis. Human donor sperm was diluted with this fluid, and its effect ...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0002-9378(96)70210-7
更新日期：1996-06-01 00:00:00
abstract：:The first reported case of recurrent acute fatty liver of pregnancy confirmed by biopsy is described. In this case a high index of suspicion led to an early diagnosis and intervention with resultant improved maternal and fetal outcome. Electron microscopic examination of a liver biopsy specimen proved more beneficial ...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(90)91191-e
更新日期：1990-08-01 00:00:00
abstract：OBJECTIVE:The purpose of this study was to determine whether ultrasonography is more accurate than vaginal examination in the determination of fetal occiput position in the second stage of labor. STUDY DESIGN:Eighty-eight patients in the second stage of labor were evaluated by vaginal examination and by combined trans...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2004.01.029
更新日期：2004-08-01 00:00:00
abstract：:We report a case of splenic rupture after cesarean delivery for abruptio placentae. The diagnosis was not suspected until a laparotomy was performed. Diagnosis and management were complicated by disseminated intravascular coagulation and renal failure. The importance of early diagnosis and management modalities are di...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(95)90199-x
更新日期：1995-07-01 00:00:00
abstract：:Presented are the results over a 4-year period of the conservative management of cases of premature rupture of the membranes. Perinatal mortality in infants delivered more than 24 hours after rupture of the membranes is not higher than that in infants delivered within 24 hours of rupture of the membranes, if these res...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(83)90819-0
更新日期：1983-06-15 00:00:00
abstract：:The distribution of human chorionic gonadotropin levels in 184 patients with ectopic pregnancy is examined. The impact of changing the sensitivity of human chorionic gonadotropin testing on the incidence of false negative results is discussed. Pregnancy blood tests with a detection threshold of 200 mIU/ml were associa...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(85)90593-9
更新日期：1985-09-01 00:00:00
abstract：:Simulation in obstetrics allows us to practice in a safe environment. Simulations can improve the performance of individuals and obstetric teams. The evidence is overwhelming that, with simulated practice, obstetricians improve their technical and communication skills. Evidence is emerging that simulation ultimately m...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章,评审
doi：10.1016/j.ajog.2011.09.012
更新日期：2012-06-01 00:00:00
abstract：:To determine the usefulness of the assays of maternal serum alpha-fetoprotein, human placental lactogen, and pregnancy-specific beta 1-glycoprotein in prenatal diagnosis of fetal alcohol syndrome, these proteins were followed in 35 problem drinkers (greater than 100 gm of ethanol weekly) and in 14 abstinent women thro...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(86)90286-3
更新日期：1986-09-01 00:00:00
abstract：:The serum vitamin B12 level falls progressively during pregnancy, when measured either by microbiologic assay or by a radioisotope dilution technique. The concentration of the vitamin assayed by radioisotope dilution was consistently higher than the value obtained by microbiologic assay. This discrepancy was greatest ...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(75)90609-2
更新日期：1975-05-01 00:00:00
