Showing papers on "Gestational age published in 1985"
TL;DR: It is suggested that cocaine influences the outcome of pregnancy as well as the neurologic behavior of the newborn, but a full assessment will require a larger number of pregnancies and longer follow-up.
Abstract: With the increasing use of cocaine in the United States, there has been growing concern regarding its effects on the fetuses and neonates of pregnant cocaine abusers. Twenty-three cocaine-using women enrolled in a comprehensive perinatal-addiction program were divided into two groups: those using cocaine only and those using cocaine plus narcotics. These two groups were compared with a group of women who had used narcotics in the past and were maintained on methadone during pregnancy, and with a group of drug-free women. All four groups were similar in maternal age, socioeconomic status, number of pregnancies, and cigarette, marijuana, and alcohol use. Their medical histories indicated that the cocaine-using women had a significantly higher rate of spontaneous abortion than the women in the other two groups. In the pregnancies under study, four cocaine-using women had onset of labor with abruptio placentae immediately after intravenous self-injection of cocaine. Neonatal gestational age, birth weight, length, and head circumference were not affected by cocaine use. However, the Brazelton Neonatal Behavioral Assessment Scale revealed that infants exposed to cocaine had significant depression of interactive behavior and a poor organizational response to environmental stimuli (state organization). These preliminary observations suggest that cocaine influences the outcome of pregnancy as well as the neurologic behavior of the newborn, but a full assessment will require a larger number of pregnancies and longer follow-up.
764 citations
TL;DR: Using a controlled, randomized design, patients determined to be at high risk before 18 weeks' gestation on the basis of the Creasy system are randomly assigned to the Preterm Labor Prevention Clinic or serve as high-risk controls.
189 citations
TL;DR: Data indicate that a neurologic classification at 1 year of age provides a guide for monitoring very low-birth-weight infants and can be helpful in alerting school personnel to potential needs.
Abstract: The changing patterns of neurologic and developmental functioning between 1 and 7 years of age were studied in very low-birth-weight infants (birth weight less than or equal to 1,500 g). Subjects included 42 infants born in 1975 who were followed for 7 years. Based on the 1-year neurologic assessment, 22 infants were classified as normal, 12 as suspect, and eight as abnormal. The three groups did not differ in birth weight, gestational age, sex, or Hollingshead socioeconomic status (SES) score. The neurologic findings at 7 years of age were significantly related to the neurologic examination findings at 1 year of age. Seventy-seven percent of the normal group, 58% of the suspect group, and 100% of the abnormal group remained in the same neurologic category at 7 years of age. Children in the abnormal group had the greatest improvement in cognitive functioning between 1 and 7 years of age but did not achieve the IQ level of children in the normal group. Forty-five percent of the normal group, 75% of the suspect group, and 100% of the abnormal group had poor visual-motor integration. Fifty-eight percent of the suspect group and 87% of the abnormal group were reading below age level. Of the total sample, 54% required special education or resource help at 7 years of age, and the three groups differed significantly in their need for a special educational plan (P less than .05). These data indicate that a neurologic classification at 1 year of age provides a guide for monitoring very low-birth-weight infants and can be helpful in alerting school personnel to potential needs.
184 citations
TL;DR: The purpose of the present clinical investigation was to determine the influence of aggressive management, associated medical/obstetric complications, race, and gestational age on fetal, neonatal, and maternal risks associated with severe preeclampsia.
Abstract: The purpose of the present clinical investigation was to determine the influence of aggressive management, associated medical/obstetric complications, race, and gestational age on fetal, neonatal, and maternal risks associated with severe preeclampsia. Three hundred and three consecutive pregnancies complicated by severe preeclampsia were studied. All patients were delivered within 48 hours after admission to the perinatal center. In 91 patients the disease was superimposed on chronic hypertension. There was a significant difference between patients with and those without prior chronic hypertension regarding perinatal mortality (32 versus 7.7%), incidence of abruptio placentae (10 versus 4%), and frequency of small-for-gestational-age infants (33 versus 14%). Fifty-one patients (17%) had thrombocytopenia, 26 (8.5%) had hemolysis, elevated liver enzymes and low platelet count syndrome, and 22 (7.3%) had disseminated intravascular coagulopathy. There was significant difference between white and black patients regarding the frequency of thrombocytopenia (28 versus 13%), hemolysis, elevated liver enzymes, and low platelet count syndrome (19.7 versus 5.3%), and coagulopathy (13 versus 1.4%). However, most of this apparent racial difference resulted from higher incidence of abnormal hematologic findings among patients who had conservative management by private physicians before transfer. Perinatal survival was zero when severe preeclampsia developed at or before 28 weeks, whereas it was 100% when disease developed after 36 weeks' gestation. The above factors should be considered in counselling patients with severe preeclampsia.
151 citations
TL;DR: The recognition that some low birthweight babies were the victims of intrauterine growth retardation rather than premature birth was a milestone in perinatal medicine.
Abstract: The recognition that some low birthweight babies (<2500 g) were the victims of intrauterine growth retardation rather than premature birth was a milestone in perinatal medicine.13 Up to 10% of all liveborn babies and at least 30% of those of low birth weight suffer from intrauterine growth retardation; their perinatal mortality is four to 10 times higher than that of normally grown babies?both stillbirth and neonatal deaths contributing. Poor growth also exposes the fetus and the newborn to perinatal complications, which leave their scars in the form of later neurodevelopmental disability.4 No widely accepted, reliable definition of intrauterine growth retardation is applicable before birth. Instead, those babies who are small for dates?who weigh, for example, less than the 10th centile for their gestational age at birth?have, by inference, suffered intrauterine growth retardation. This approach may cause problems: the precise gestational age may be uncertain, especially in those pregnancies vulnerable to intrauterine growth retardation; the lower limit of normal birth weight for gestational age is variously defined as the 3rd, 5th, 10th, or 25th centile, or less than two standard deviations; intrauterine growth and normal standards of birth weight for gestational age are influenced by ethnic and geographical factors56; small for dates babies may be the result of normal genetic constraint rather than pathological growth retardation; and, finally, birth weight is only one index of growth failure, and babies of "normal" weight may none the less have failed to achieve their genetic growth potential.
144 citations
TL;DR: This paper showed that prenatal dexamethasone treatment may stimulate maturation of both the surfactant system and also the antioxidant enzyme system, and this maturation can help protect the premature newborn's lungs from the toxic complications of hyperoxic therapy that may be required because of immaturity.
Abstract: It has recently been determined that fetal lung antioxidant enzyme activity markedly increases late in gestation. A test was made of whether this normal late-in-gestation change in O2-protective enzymes would be responsive to the maturing effect of hormonal (glucocorticoid) treatment. Pregnant rats received 0.2 mg/kg of dexamethasone (or saline) at 48 and 24 hours prior to delivery of their fetuses on gestational days 19, 20, 21, and 22 (newborn). Lung disaturated phosphatidylcholine showed an expected response to prenatal dexamethasone exposure with significant elevations of surfactant lipid at gestational days 20 and 21. A similar effect of prenatal dexamethasone treatment on the lung antioxidant defensive system was found. Superoxide dismutase, catalase, and glutathione peroxidase--enzymes protective against hyperoxia-induced lung injury--showed an accelerated pattern of maturation with significant increases in the dexamethasone-treated fetal lungs compared with control fetal lung enzyme levels at gestational days 20 and 21. The results suggest that prenatal dexamethasone treatment may have dual benefits when used in impending premature deliveries--that is, it may stimulate maturation of both the surfactant system and also the antioxidant enzyme system, and this maturation can help protect the premature newborn's lungs from the toxic complications of hyperoxic therapy that may be required because of immaturity.
140 citations
TL;DR: The results of this retrospective study do not support the use of conservative management for pregnancies complicated by severe preeclampsia in the second trimester.
135 citations
TL;DR: A microprocessor system is described for on‐line analysis of the fetal heart rate detected by conventional Doppler systems, which reduced the signal loss in clinical practice by a factor of 10 and were a better index of fetal well‐being than longer‐term measures.
133 citations
TL;DR: The placentas from pregnancies compli‐cated by pre‐eclampsia and those resulting in a SFD baby had a signifi‐cantly lower total volume, volume of parenchyma and villous surface area when compared with normal pregnancies of comparable gestation.
125 citations
TL;DR: It is speculated that indomethacin may provide some protection against neonatal intraventricular hemorrhage by acting on the cerebral microvasculature.
119 citations
TL;DR: WIC partially protects fetal growth in smokers, except for WIC supplemented smokers (greater than 10 cigarettes/day) whose babies were significantly heavier by +168 g than those of unsupplemented smokers.
Journal Article•
TL;DR: A large cohort of consecutive live births with gestational ages assessed antenatally from 24 to 28 weeks from one tertiary center was studied and little evidence was found from mortality or morbidity data to support routine delivery of infants of borderline viability by cesarean section.
Journal Article•
TL;DR: Amniotic fluid volume was serially assessed by real-time ultrasound in patients who presented with premature rupture of the membranes (PROM) and not in labor and data suggest that in patients with PROM the degree of oligohydramnios is positively correlated with unfavorable pregnancy outcome.
TL;DR: Since serum human chorionic gonadotropin doubling times increase and the exponential rate decreases with gestational age, estimates of normal values should be established for small sampling ranges and/or short intervals of gestation.
TL;DR: It is suggested that fetuses in these groups have a low growth potential because a high placental/fetal weight ratio was associated with an abnormal umbilical artery waveform pattern.
TL;DR: The growth-retarded fetuses showed differences in the quality and quantity of somatic motility in comparison to low risk fetuses of equivalent gestational age, and these observations suggest that some aspects of central nervous system function are disturbed in growth- retarding fetuses, even in the absence of fetal distress.
Journal Article•
TL;DR: Elderly smokers also must be considered to be at a higher risk than younger smokers for developing fetal growth disturbances, and among smokers the reduction in standardized birth weight became more pronounced with increasing maternal age.
TL;DR: Pregnancy was diagnosed with confidence from 30 days, and relationships were established whereby gestational age could be estimated from measurements of certain uterine and fetal dimensions, Crown-rump length provided the most precise estimate of Gestational age.
Abstract: Diagnoses of pregnancy were made on 110 Hereford cross Friesian and 69 blue grey (white shorthorn cross Galloway) cows between 92 and 202 days after last service using a real-time ultrasonic scanning instrument with a 3.5 MHz rectal transducer. Of the 174 cows which subsequently calved, one was wrongly diagnosed as non-pregnant. Of the five cows which did not subsequently calve two were diagnosed as pregnant and may in fact have been pregnant at the time of scanning. The overall level of accuracy of pregnancy diagnosis was 98.3 per cent. In further trials with 16 Hereford cross Friesian and 16 blue grey cows scanned at regular intervals between 20 and 140 days of gestation, pregnancy was diagnosed with confidence from 30 days, and relationships were established whereby gestational age could be estimated from measurements of certain uterine and fetal dimensions. Crown-rump length provided the most precise estimate of gestational age (residual sd +/- 4.5 days) and uterine diameter the least (+/- 12.6 days) with head length and the diameters of trunk, head and nose being intermediate (+/- 6.9 to 8.7 days).
TL;DR: Normal reference ranges for sodium, potassium, urea, creatinine, calcium, phosphate, total protein, albumin, bilirubin, alkaline phosphatase, and aspartate transaminase were determined from 344 fetal and maternal plasma samples between 15 and 38 weeks' gestation.
Abstract: Normal reference ranges for sodium, potassium, urea, creatinine, calcium, phosphate, total protein, albumin, bilirubin, alkaline phosphatase, and aspartate transaminase were determined from 344 fetal and maternal plasma samples between 15 and 38 weeks' gestation. Pure fetal blood was obtained by fetoscopy in the second trimester and in the third trimester by umbilical cord puncture at delivery. All biochemical substances were measured by continuous flow (SMAC, Technicon) except albumin, which was measured by turbidimetry (CobasBio, Roche). The resulting data were analysed on an AMDAHL 470A computer and reference ranges covering 2.5 to 97.5 percentiles were defined. Analysis of variance was performed to examine the overall effect of gestational age on the analytes measured and on the changes in the fetal compartment relative to the mothers'. A paired t test was performed to examine how these biochemical substances in fetal plasma related to maternal plasma from the same pregnancy.
TL;DR: Maternal trauma remains a significant cause of maternal and fetal morbidity and death, and the use of the Kleihauer-Betke analysis is indicated to identify fetomaternal hemorrhage.
TL;DR: The role of infection as a cause of premature rupture of the membranes, premature labour and subsequent perinantal outcome is still unclear though the data would suggest it is not unimportant.
TL;DR: The data support the hypothesis that gestational age is an important variable to consider when interpreting biophysical measurements in the human fetus at 24 to 32 weeks' gestation and may be the single most important measurement of fetal health at these gestational ages.
TL;DR: The controversies are reviewed and management plans are presented for several different gestational age groups for patients with premature rupture of the membranes.
TL;DR: It seems that preterm livebirths do not form a different population with respect to weight from the fetus still in utero, at least until the beginning of the third trimester.
Abstract: Data representing fetal weight gain between 14 and 42 weeks' gestation are presented; firstly to provide suitable curves enabling the growth of the very immature infant to be monitored and secondly to examine the influence of the improved techniques of paediatric and obstetric assessment developed since the publication of previous studies. Data have been collected from the 57 866 livebirths in Sheffield between 1976 and 1984 and from therapeutically terminated and spontaneously aborted fetuses over the same period. It seems that preterm livebirths do not form a different population with respect to weight from the fetus still in utero, at least until the beginning of the third trimester. Previous studies have reported a bimodality of weight distribution in preterm infants at each gestational age which has been attributed to errors in gestational assessment. The pattern of distribution of weight in this study suggests that early ultrasonography and paediatric assessment techniques have exerted a considerable influence on the accuracy of gestational assessment. The mean weights of the sample differ considerably from those of the Gairdner and Pearson chart which are, therefore, considered to be inappropriate for the Sheffield population.
TL;DR: At a corrected age of 3 months, 80 low birth-weight infants were assigned to normal or at-risk groups on the basis of a neurodevelopmental assessment scale and tested at 12 months by an independent psychologist blinded for infant group.
TL;DR: It is concluded that premature babies with a postconceptional age of 35 weeks can discriminate between sweet and not-sweet, and the greater sucking response to glucose than to water at the first trial implies a genetic factor in the preference for sweet in humans.
TL;DR: The arteries of the circle of Willis in fetal brains of 20-40 weeks of gestational age were studied with the operating microscope and in the majority of cases a polygon, much like the "precarious" circle in adults, was dissected.
TL;DR: The presence of subclinical infection must be considered in cases of preterm labor, especially among patients for whom tocolytic therapy is unsuccessful, particularly among patients with a negative C-reactive protein value.
TL;DR: The effect of level of perinatal care on rates of intrapartum fetal death was studied in births of infants weighing greater than 1000 gm in New York City in 1976 to 1978, and findings in a total population are compatible with several studies carried out in single hospitals that have reported declines in intrapartisan fetal death rates.
TL;DR: Most babies had no detectable IgA at birth, and no effect of gestational age or birthweight, or both, on either initial IgA or IgM concentrations could be shown.
Abstract: Immunoglobulin concentrations were determined in 64 consecutively born preterm babies at birth and serially throughout each baby's stay in the neonatal unit. No significant IgG generation was found during the first 15 weeks of life, regression analysis giving an exponential decay model. Concentrations fell to 2 g/l or less in 10 (16%) babies (gestational age 25 to 32 weeks), and were as low as 1 g/l in four babies (gestational age 25 to 29 weeks). The effects of gestational age and birthweight on the concentration of IgG at birth were highly interdependent and significant. Most babies had no detectable IgA at birth, and no effect of gestational age or birthweight, or both, on either initial IgA or IgM concentrations could be shown.