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Spontaneous abortion rate
spine was located laterally, rather than in an AP position, success was greater.
Tocolysis Unnecessary for Version Robertson A, Kopelman J, Read J, Duff P, Magelssen D, Dashow E: External Cephalic Version at Term: Is a Tocolyctic Necessary? OBSTET GYNECOL 70(6):896-899, 1987. External version was also the subject of this study. Fifty-eight patients at 37-41 weeks were randomly assigned to tocolysis or control group before their version was attempted. All had ultrasound, maternal serum AFP, Kleinhauer-Betke test, and NST before and after version. The tocolysis group received 200 g/minute ritodrine IV x 20 minutes before version. Version was successfully accomplished in 67% of the tocolysis group and in 68% of the control group. The nine patients who could not be turned in the control group then served as their own controls and were given the ritodrine treatment; the authors could only turn one additional fetus after this treatment. There were no maternal or fetal complications in either group. There were no significant differences between groups in panty, maternal weight, gestational age, or EFW. Panty was not a significant difference in this study, although version was accomplished in 60% of the nulliparous patients and in 72% of the multips. The authors were unable to demonstrate increased success or increased safety with ritodrine therapy for external version. They suggest tocolysis and its related complications can be used less extensively.
Ectopic Mortality Atrash H, Friede A, Hogue C: ECtopic Pregnancy Mortality in the United States, 1970-1983. OBSTET GYNECOL 70(6):817-822, 1987. From 1970- 1983, the risk of death from ectopic pregnancy fell from 35.2 per 10,000 cases to 5.3, almost a seven-fold decline. However, this progress was offset in the same period by a four-fold increase in the incidence of ectopics. In 1957, death from ectopic accounted for 7.2% of all maternal deaths; in 1982, they accounted for 14.7% of U.S. maternal mortality.
Journal of Nurse-Midwifery
??Vol.
This report examines the effects of age, race, and region of residence on the risk of dying from an ectopic pregnancy. Data was obtained from the National Hospital Discharge Survey, a sampling of discharge face sheets from 400 U.S. hospitals, and from the CDC Ectopic Pregnancy and Abortion Surveillance Systems. Women aged 15-19 had the highest mortality risk from ectopic pregnancy. Nonwhite women died at a rate three times that of white women. From 1970-1976, women who lived in the South had twice the risk of mortality of Western residents, the region with the lowest risk; however, by 1977-1983 there were no regional differences. The authors conclude that prenatal care in the first trimester is important in reducing mortality risk by increasing early diagnosis and treatment.
Spontaneous Abortion Rate Cashner K, Christopher C, Dysert G: Spontaneous Fetal Loss After Demonstration of a Live Fetus in the First Trimester. OBSTET GYNECOL 70(6): 827-830, 1987. MacKenzie W, Holmes D, Newton J: Spontaneous Abortion Rate in Ultrasonigraphically Viable Pregnancies. OBSTET GYNECOL 71(1):81-83, 1988. The purpose of both studies was to determine the pregnancy loss rate after a normal first trimester ultrasound examination. The Cashner study was done in a private practice population. Patients were prospectively enrolled from December 1983 to January 1986; none had any instrumentation in the first trimester. An ultrasound exam was performed at the first visit; if the exam indicated a gestational age of less than eight weeks, the patient was rescanned in four weeks by a single sonographer. A fetal heart was demonstrated in 489 patients in the first trimester; they constitute the Outcome Analysis Group with followup of 99% to term. In addition, 82 patients registered after 13 weeks, the Late Care Group, and 26 patients had a blighted ovum. The blighted ovum group was significantly older than the other two groups. There were 10 losses before 20 weeks
33, No. 3, May/June
1988
in the Outcome Analysis Group for a loss rate of 2%. 49 women had vaginal bleeding between enrollment and 20 weeks; 20% of these preceeded to abort despite the reassuring ultrasound findings at the initial visit. Those who had vaginal bleeding did not have a higher rate of preterm deliveries. If a woman had a previous loss, she had a significantly greater incidence of loss in this pregnancy 5.2% versus 1.4% without previous loss. There was a trend toward increasing rate of loss with advancing maternal age. The MacKenzie study was done at Birmingham Maternity Hospital where all patients also had an ultrasound exam at their first visit. A fetal heart was demonstrated in 500 patients who were less than 12 weeks at registration. Ten miscarriages occurred for a loss rate of 2% overall; however, six of the losses occurred in the first trimester. The rate of abortion at less than 10 weeks was three times greater than those occurring after 10 weeks. Women with previous loss again demonstrated greater loss rates. In this study, they were 10 times more likely to miscarry; the rate of loss for these women was 5.5% versus 0.6% for those without previous pregnancy loss. The authors suggest that the 2% rate of spontaneous loss is the background loss to use when evaluating additional risk from chorionic villus sampling.
Back Pain Berg G, Hammar M, Moller-Nielsen J, Linden U, Thorblad J: Low Back Pain During Pregnancy. OBSTET GYNECOL 71(1):71-75, 1988. This study was done to prospectively ascertain the incidence, time of onset and seventy of low back pain in pregnancy, and to identify its causes if the pain was debilitating. All prenatal patients from a clinic in Sweden answered a questionnaire in the 20, 30, and 35th week. Of the 862 replies, 41% were nulliparous. Panty was not a significant contributor to back pain, but if a woman had pain in a previous pregnancy, it increased the likelihood of its recurrence; 49% of the respondents had low back pain at least once during the present pregnancy; 10% had pain in all three time periods questioned.
145
Tocolysis Unnecessary for Version Robertson A, Kopelman J, Read J, Duff P, Magelssen D, Dashow E: External Cephalic Version at Term: Is a Tocolyctic Necessary? OBSTET GYNECOL 70(6):896-899, 1987. External version was also the subject of this study. Fifty-eight patients at 37-41 weeks were randomly assigned to tocolysis or control group before their version was attempted. All had ultrasound, maternal serum AFP, Kleinhauer-Betke test, and NST before and after version. The tocolysis group received 200 g/minute ritodrine IV x 20 minutes before version. Version was successfully accomplished in 67% of the tocolysis group and in 68% of the control group. The nine patients who could not be turned in the control group then served as their own controls and were given the ritodrine treatment; the authors could only turn one additional fetus after this treatment. There were no maternal or fetal complications in either group. There were no significant differences between groups in panty, maternal weight, gestational age, or EFW. Panty was not a significant difference in this study, although version was accomplished in 60% of the nulliparous patients and in 72% of the multips. The authors were unable to demonstrate increased success or increased safety with ritodrine therapy for external version. They suggest tocolysis and its related complications can be used less extensively.
Ectopic Mortality Atrash H, Friede A, Hogue C: ECtopic Pregnancy Mortality in the United States, 1970-1983. OBSTET GYNECOL 70(6):817-822, 1987. From 1970- 1983, the risk of death from ectopic pregnancy fell from 35.2 per 10,000 cases to 5.3, almost a seven-fold decline. However, this progress was offset in the same period by a four-fold increase in the incidence of ectopics. In 1957, death from ectopic accounted for 7.2% of all maternal deaths; in 1982, they accounted for 14.7% of U.S. maternal mortality.
Journal of Nurse-Midwifery
??Vol.
This report examines the effects of age, race, and region of residence on the risk of dying from an ectopic pregnancy. Data was obtained from the National Hospital Discharge Survey, a sampling of discharge face sheets from 400 U.S. hospitals, and from the CDC Ectopic Pregnancy and Abortion Surveillance Systems. Women aged 15-19 had the highest mortality risk from ectopic pregnancy. Nonwhite women died at a rate three times that of white women. From 1970-1976, women who lived in the South had twice the risk of mortality of Western residents, the region with the lowest risk; however, by 1977-1983 there were no regional differences. The authors conclude that prenatal care in the first trimester is important in reducing mortality risk by increasing early diagnosis and treatment.
Spontaneous Abortion Rate Cashner K, Christopher C, Dysert G: Spontaneous Fetal Loss After Demonstration of a Live Fetus in the First Trimester. OBSTET GYNECOL 70(6): 827-830, 1987. MacKenzie W, Holmes D, Newton J: Spontaneous Abortion Rate in Ultrasonigraphically Viable Pregnancies. OBSTET GYNECOL 71(1):81-83, 1988. The purpose of both studies was to determine the pregnancy loss rate after a normal first trimester ultrasound examination. The Cashner study was done in a private practice population. Patients were prospectively enrolled from December 1983 to January 1986; none had any instrumentation in the first trimester. An ultrasound exam was performed at the first visit; if the exam indicated a gestational age of less than eight weeks, the patient was rescanned in four weeks by a single sonographer. A fetal heart was demonstrated in 489 patients in the first trimester; they constitute the Outcome Analysis Group with followup of 99% to term. In addition, 82 patients registered after 13 weeks, the Late Care Group, and 26 patients had a blighted ovum. The blighted ovum group was significantly older than the other two groups. There were 10 losses before 20 weeks
33, No. 3, May/June
1988
in the Outcome Analysis Group for a loss rate of 2%. 49 women had vaginal bleeding between enrollment and 20 weeks; 20% of these preceeded to abort despite the reassuring ultrasound findings at the initial visit. Those who had vaginal bleeding did not have a higher rate of preterm deliveries. If a woman had a previous loss, she had a significantly greater incidence of loss in this pregnancy 5.2% versus 1.4% without previous loss. There was a trend toward increasing rate of loss with advancing maternal age. The MacKenzie study was done at Birmingham Maternity Hospital where all patients also had an ultrasound exam at their first visit. A fetal heart was demonstrated in 500 patients who were less than 12 weeks at registration. Ten miscarriages occurred for a loss rate of 2% overall; however, six of the losses occurred in the first trimester. The rate of abortion at less than 10 weeks was three times greater than those occurring after 10 weeks. Women with previous loss again demonstrated greater loss rates. In this study, they were 10 times more likely to miscarry; the rate of loss for these women was 5.5% versus 0.6% for those without previous pregnancy loss. The authors suggest that the 2% rate of spontaneous loss is the background loss to use when evaluating additional risk from chorionic villus sampling.
Back Pain Berg G, Hammar M, Moller-Nielsen J, Linden U, Thorblad J: Low Back Pain During Pregnancy. OBSTET GYNECOL 71(1):71-75, 1988. This study was done to prospectively ascertain the incidence, time of onset and seventy of low back pain in pregnancy, and to identify its causes if the pain was debilitating. All prenatal patients from a clinic in Sweden answered a questionnaire in the 20, 30, and 35th week. Of the 862 replies, 41% were nulliparous. Panty was not a significant contributor to back pain, but if a woman had pain in a previous pregnancy, it increased the likelihood of its recurrence; 49% of the respondents had low back pain at least once during the present pregnancy; 10% had pain in all three time periods questioned.
145