RESUMEN
STUDY OBJECTIVE: To compare health-risk behaviors, maternal, and neonatal outcomes of pregnant adolescents less than 18 years old who reported employment more than 15 hours per week with those who did not report working. We hypothesized that working teens compared with nonworking adolescents would report higher rates of health-risk behaviors. METHODS: A structured interview was conducted at the first prenatal visit and the medical chart was reviewed to extract pregnancy (pregnancy-induced hypertension, preterm labor with hospitalization, and preterm delivery) and neonatal outcomes (low birthweight, small for gestational age, and admission to the neonatal intensive care unit). The study was conducted at an outpatient maternal and child health clinic at a university teaching hospital. A total of 384 white (n=111), African American (n=151), and Mexican American (n=99) adolescents, aged 12 to 17 years, who initiated care between January 2, 1992, and December 31, 1994, and delivered an infant at our institution were consecutively sampled. A structured interview assessed various health-risk behaviors including age at first intercourse, substance use (tobacco, alcohol, and other illicit drug use), and number of sexual partners. Medical records were reviewed to obtain information on pregnancy complications (pregnancy-induced hypertension, preterm delivery, and preterm labor with hospitalization) and negative birth outcomes (infant birthweight and neonatal intensive care admission). RESULTS: Controlling for chronological age, logistic regression analyses found that adolescents reporting employment at their first prenatal visit (n=40) compared with those not employed at this visit (n=331) were more likely to be characterized by school enrollment, higher economic status, partner employment, partner alcohol use, and a longer relationship with the father of their baby. Multivariate logistic regression found that employed females were 4.6 times more likely to deliver a small-for-gestational-age infant. CONCLUSIONS: Employment reported at the time of the first prenatal visit does not appear to be associated with an increase in health-risk behaviors or obstetric complications, but a relationship between working more than 15 hours and small-for-gestational-age delivery was detected.
Asunto(s)
Conducta del Adolescente , Empleo , Embarazo en Adolescencia , Embarazo de Alto Riesgo , Asunción de Riesgos , Adolescente , Femenino , Humanos , Recién Nacido , Embarazo , Resultado del Embarazo , TexasRESUMEN
Pneumonia occurs in the pregnant population with a frequency equal to that in the general population. However, its course is often more virulent, and mortality rates from certain pathogens may be high. The pregnant woman is more susceptible to injury to the respiratory tract due to a number of factors. These include alterations in the immune system which involve cell-mediated immunity and mechanical and anatomical changes involving the chest and abdominal cavities. The cumulative effect is decreased tolerance of hypoxia and acute changes in pulmonary mechanics. The spectrum of pathogens is similar to that for nonpregnant individuals, and the management of pneumonia in pregnancy does not differ in general from the nonpregnant state. However, careful attention should be paid to the fetoplacental unit with delivery generally indicated for obstetric purposes only. Issues that also need to be addressed include effects of certain infections, medications, fever, and hypoxia on the developing fetus.
Asunto(s)
Neumonía Bacteriana , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Femenino , Humanos , Neumonía Bacteriana/prevención & control , Neumonía Bacteriana/terapia , Neumonía Bacteriana/virología , Neumonía Viral/microbiología , Neumonía Viral/prevención & control , Neumonía Viral/terapia , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Complicaciones Infecciosas del Embarazo/terapiaRESUMEN
OBJECTIVE: To evaluate the effects of intravascular transfusion (IVT) on the fetal umbilical arterial pressure (UAP) in pregnancies complicated by red cell alloimmunization. STUDY DESIGN: UAP and amniotic fluid pressures (AFP) were measured immediately before and after IVT. Mean UAP was calculated by computing 1/3 (systolic blood pressure - diastolic blood pressure) + diastolic blood pressure. The fractional increase in fetoplacental blood volume with transfusion was calculated by dividing the net volume of blood transfused by the sum of the net volume transfused and the fetoplacental volume based on the estimated fetal weight by ultrasound. Statistical techniques included paired t-test, and the Pearson product correlation. Significance was defined as p < 0.05. RESULTS: The fetal umbilical artery was punctured during a total of 27 procedures in 21 patients. Pre- and posttransfusion mean UAPs were recorded in 16 of these procedures. Mean UAP increased from 34.0 +/- 14.2 mm Hg pretransfusion to 38.6 +/- 12.8 mm Hg posttransfusion (p = 0.34). There was no correlation between the fractional change in fetoplacental blood volume and the calculated difference between pre- and posttransfusion blood pressure. Bradycardia occurred during 5 procedures (31.2%). Fetal demise occurred after 2 procedures (12.5%). CONCLUSION: IVT appears to have a minimal effect on the fetal UAP. Fetal bradycardia occurs in a significant percentage of these cases.
Asunto(s)
Presión Sanguínea/fisiología , Transfusión de Sangre Intrauterina , Eritroblastosis Fetal/fisiopatología , Eritroblastosis Fetal/terapia , Isoinmunización Rh , Humanos , Recién Nacido , Estudios Retrospectivos , Arterias Umbilicales/embriologíaRESUMEN
OBJECTIVE: To evaluate the change in fetal serum bilirubin levels in response to intrauterine transfusion for red cell alloimmunization. METHODS: The records of 37 patients who underwent more than one intrauterine transfusion were reviewed. The following indices were extracted: pre- and post-transfusion fetal hematocrit, total and direct serum bilirubin, reticulocyte count, Kleihauer-Betke test results, volumes of intravascular and intraperitoneal transfusions, and the source used for transfusion. The data were compared for interval 1 (transfusion 1 to 2) and interval 2 (transfusion 2 to 3). The rates of change in bilirubin, reticulocyte count, and percent fetal cells on the Kleihauer-Betke test were defined as the differences between the initial values of one transfusion and the initial values of the next transfusion divided by the number of days between transfusions. Analysis of variance, sign-rank test, and linear regression analysis were used when appropriate. P < .05 was significant. RESULTS: The median number of intrauterine transfusions for each patient was 3 (range 2-8). Gestational ages ranged from 22 to 37 weeks. Total bilirubin remained above the 97.5 percentile for gestational age in all but five patients. There was a significant decrease in reticulocyte count and fetal cells on the Kleihauer-Betke test, and an increase in hematocrit with serial intrauterine transfusions. Bilirubin increased significantly after the first intrauterine transfusion (3.9 versus 5.0 mg/dL) and remained elevated thereafter. CONCLUSION: Fetal total serum bilirubin remains elevated with repeated intrauterine transfusions in fetal alloimmunization. Total bilirubin should not be used to evaluate fetal hematologic responses to the transfusions.