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Fetal growth achievement and neurodevelopmental disability
198
Citations from the Literature
The percentage of women in preterm labor who presented early enough to receive tocolysis increased from 51% to 98%, and those in preterm labor who delivered at term increased from 56% to 96%. Requiring primarily education and increased awareness, this preterm birth prevention program was successful and inexpensive and may be applicable to similar rural primary care practices. Fetal growth achievement and neurodevelopmental Taylor DJ; Howie PW
disability
Department of Obstetrics and Gynaecology, Ninewells Hospital and Medical School, Dundee DDl9S Y; United Kingdom British Journal of Obstetrics and GynaecologyI9617 (789794)/1989/ To investigate the role played by chronic intrauterine insult in the genesis of neurodevelopmental disability (NDD), three analyses have been applied to a case-controlled study which compared a population of children with NDD with a control group of normally developed children. In the first analysis, average birthweight in children with NDD was 3138 g (SD 592) which was significantly less than in normally developed children, 3280 g (SD 491) (P < 0.0005). After correction for confounding factors, birthweight-for-gestation (Z score) remained lower in children with NDD (- 0.42) than in normal children ( - 0.21) (P < 0.0025). In the second analysis the fetal growth achievement of children, who had NDD after the prenatal complications, severe hypertension, unclassified antepartum haemorrhage and preterm uterine activity, was significantly less (Z score, - 0.76) than children who were normally developed after the same maternal prenatal complications (Z score, -0.37) (P < 0.03). In the third analysis, a risk analysis to assess the relative importance of fetal growth achievement and prenatal complications in the genesis of NDD suggested that the latter was the dominant factor. These data are consistent with the hypothesis that prenatal complications, severe enough to retard fetal growth, can compromise fetal brain development and make an important contribution to NDD. Eetal and neonatal cardiovascular complications sympathomimetic therapy for tocolysis Katz VL; Seeds JW
from beta-
Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC27514; USA American Journal of Obstetrics and Gynecology/l6111 (l4)/1989/ beta-Sympathomimetic drugs cross the placenta freely. Just as these agents cause serious cardiovascular changes in the mother, they may cause severe cardiovascular complications in the fetus. beta-Sympathomimetic agents for tocolysis have been associated with fetal heart rate and rhythm disturbances, stillbirth, neonatal cardiac failure, myocardial hydrops, ischemia and infarction, and neonatal death. Prospective studies have documented changes in interventricular septa of babies exposed to these drugs. Histologic changes have been reproduced in animal models and in vitro similar to those seen in infants with myocardial disease caused by beta-mimetic therapy. The mechanism of beta-mimetic toxicity appears to be
Int J Gynecol Ob.rtet 31
increased myocardial intracellular calcium leading to overexcitation and cell necrosis. Since serious fetal cardiovascular effects may occur with beta-mimetic use, benefits should clearly outweigh risks before these drugs are administered. The association between decreased amniotic fluid volume and treatment with nonsteroidal anti-inflammatory agents for preterm labor Hickok DE; Hollenbach KA; Reilley SF; Nyberg DA
Department of Obstetrics and Gynecology, Swedish Hospital Medical Center, University of Washington, Seattle, WA 98104; USA American Journal of Obstetrics and Gynecology/l60/6 (1525 -1531)/1989/ From a cohort of women treated for preterm labor at the Swedish Hospital Medical Center for l-year period, 58 patients were identified as receiving one or more tocolytic agents. Twenty-seven of the 58 patients met study criteria for the determination of the effects of tocolytic therapy on amniotic fluid volume both before and during treatment by means of ultrasound examination. Fourteen of 17 patients (82.3%) treated with nonsteroidal anti-inflammatory drugs demonstrated a decrease in amniotic fluid, whereas none of the 10 patients treated with other tocolytic agents experienced a decrease in fluid volume. Decreased amniotic fluid associated with nonsteroidal anti-inflammatory drug treatment was reversible in seven of eight patients when treatment was discontinued and ultrasound examinations were performed after treatment. Magnesium supplementation during pregnancy: blind randomized controlled clinical trial Sibai BM; Villar L MA; Bray E
A double-
Maternal-Fetal Division, Department of Obstetrics and Gynecology, University of Tennessee, Memphis, TN38/03; USA American Journal of Obstetrics and Gynecology/l61/1 (115119)/1989/ Four hundred young normotensive primigravid women between 13 and 24 weeks’ gestation were randomly allocated to one of two study groups. One group received placebo tablets and the other group received 365 mg of elemental magnesium daily (as magnesium aspartate hydrochloride). Three hundred seventy-four patients completed the study, 189 in the placebo group and 185 in the treatment group. There were no significant differences between the two groups regarding serum calcium, uric acid, or electrolyte levels. However, the magnesiumsupplemented group had significantly higher magnesium levels at delivery (1.68 f 0.03 mg/dl vs. 1.56 & 0.03 mg/dl, P < 0.01). There were no significant differences in either systolic or diastolic blood pressures between both groups either at time of enrollment or at subsequent gestational ages later during pregnancy. Analysis of variance for repeated measurements and Fisher’s least significant difference testing indicated a significant increase (P < 0.01) in blood pressure from the level at the time of enrollment to the level achieved at or beyond 37 weeks’ gestation in each group. There were no significant differences between the two groups regarding any of the following parameters: incidences of preeclampsia, fetal growth retardation, pre-
Citations from the Literature
The percentage of women in preterm labor who presented early enough to receive tocolysis increased from 51% to 98%, and those in preterm labor who delivered at term increased from 56% to 96%. Requiring primarily education and increased awareness, this preterm birth prevention program was successful and inexpensive and may be applicable to similar rural primary care practices. Fetal growth achievement and neurodevelopmental Taylor DJ; Howie PW
disability
Department of Obstetrics and Gynaecology, Ninewells Hospital and Medical School, Dundee DDl9S Y; United Kingdom British Journal of Obstetrics and GynaecologyI9617 (789794)/1989/ To investigate the role played by chronic intrauterine insult in the genesis of neurodevelopmental disability (NDD), three analyses have been applied to a case-controlled study which compared a population of children with NDD with a control group of normally developed children. In the first analysis, average birthweight in children with NDD was 3138 g (SD 592) which was significantly less than in normally developed children, 3280 g (SD 491) (P < 0.0005). After correction for confounding factors, birthweight-for-gestation (Z score) remained lower in children with NDD (- 0.42) than in normal children ( - 0.21) (P < 0.0025). In the second analysis the fetal growth achievement of children, who had NDD after the prenatal complications, severe hypertension, unclassified antepartum haemorrhage and preterm uterine activity, was significantly less (Z score, - 0.76) than children who were normally developed after the same maternal prenatal complications (Z score, -0.37) (P < 0.03). In the third analysis, a risk analysis to assess the relative importance of fetal growth achievement and prenatal complications in the genesis of NDD suggested that the latter was the dominant factor. These data are consistent with the hypothesis that prenatal complications, severe enough to retard fetal growth, can compromise fetal brain development and make an important contribution to NDD. Eetal and neonatal cardiovascular complications sympathomimetic therapy for tocolysis Katz VL; Seeds JW
from beta-
Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC27514; USA American Journal of Obstetrics and Gynecology/l6111 (l4)/1989/ beta-Sympathomimetic drugs cross the placenta freely. Just as these agents cause serious cardiovascular changes in the mother, they may cause severe cardiovascular complications in the fetus. beta-Sympathomimetic agents for tocolysis have been associated with fetal heart rate and rhythm disturbances, stillbirth, neonatal cardiac failure, myocardial hydrops, ischemia and infarction, and neonatal death. Prospective studies have documented changes in interventricular septa of babies exposed to these drugs. Histologic changes have been reproduced in animal models and in vitro similar to those seen in infants with myocardial disease caused by beta-mimetic therapy. The mechanism of beta-mimetic toxicity appears to be
Int J Gynecol Ob.rtet 31
increased myocardial intracellular calcium leading to overexcitation and cell necrosis. Since serious fetal cardiovascular effects may occur with beta-mimetic use, benefits should clearly outweigh risks before these drugs are administered. The association between decreased amniotic fluid volume and treatment with nonsteroidal anti-inflammatory agents for preterm labor Hickok DE; Hollenbach KA; Reilley SF; Nyberg DA
Department of Obstetrics and Gynecology, Swedish Hospital Medical Center, University of Washington, Seattle, WA 98104; USA American Journal of Obstetrics and Gynecology/l60/6 (1525 -1531)/1989/ From a cohort of women treated for preterm labor at the Swedish Hospital Medical Center for l-year period, 58 patients were identified as receiving one or more tocolytic agents. Twenty-seven of the 58 patients met study criteria for the determination of the effects of tocolytic therapy on amniotic fluid volume both before and during treatment by means of ultrasound examination. Fourteen of 17 patients (82.3%) treated with nonsteroidal anti-inflammatory drugs demonstrated a decrease in amniotic fluid, whereas none of the 10 patients treated with other tocolytic agents experienced a decrease in fluid volume. Decreased amniotic fluid associated with nonsteroidal anti-inflammatory drug treatment was reversible in seven of eight patients when treatment was discontinued and ultrasound examinations were performed after treatment. Magnesium supplementation during pregnancy: blind randomized controlled clinical trial Sibai BM; Villar L MA; Bray E
A double-
Maternal-Fetal Division, Department of Obstetrics and Gynecology, University of Tennessee, Memphis, TN38/03; USA American Journal of Obstetrics and Gynecology/l61/1 (115119)/1989/ Four hundred young normotensive primigravid women between 13 and 24 weeks’ gestation were randomly allocated to one of two study groups. One group received placebo tablets and the other group received 365 mg of elemental magnesium daily (as magnesium aspartate hydrochloride). Three hundred seventy-four patients completed the study, 189 in the placebo group and 185 in the treatment group. There were no significant differences between the two groups regarding serum calcium, uric acid, or electrolyte levels. However, the magnesiumsupplemented group had significantly higher magnesium levels at delivery (1.68 f 0.03 mg/dl vs. 1.56 & 0.03 mg/dl, P < 0.01). There were no significant differences in either systolic or diastolic blood pressures between both groups either at time of enrollment or at subsequent gestational ages later during pregnancy. Analysis of variance for repeated measurements and Fisher’s least significant difference testing indicated a significant increase (P < 0.01) in blood pressure from the level at the time of enrollment to the level achieved at or beyond 37 weeks’ gestation in each group. There were no significant differences between the two groups regarding any of the following parameters: incidences of preeclampsia, fetal growth retardation, pre-