RESUMO
With the purpose of know the behaviour of the thromboplastic acceleration time in amniotic fluid, there were analized 390 amniotic fluids, 241 from normal pregnancies and 149 from abnormal pregnancies, of these, 52 from diabetic women, and 97 from hypertensive women. It was found an important increase in T.A.T. with the progress of pregnancy and their usefulness as fetal lung maturity test. It was concluded, that this method is easy, cheap, and highly specific, so it can be the first election test for determination of fetal lung maturity in low resources Obstetric Centers.
Assuntos
Líquido Amniótico/fisiologia , Pulmão/embriologia , Feminino , Maturidade dos Órgãos Fetais , Humanos , Hipertensão , Tempo de Tromboplastina Parcial , Gravidez , Complicações Cardiovasculares na Gravidez , Gravidez em Diabéticas , Estudos ProspectivosRESUMO
Posterm pregnancy still is a topic full of controversies in many aspects, such as diagnosis, perinatal risk and management. This paper suggests that a great number of fetuses from prolonged pregnancies, still grow after term, secondary to a persistent and adequate placental function; it's demonstrated, by comparing the distribution of newborn weights between term and posterm pregnancies. In the posterm group a significant increase in the incidence of hypertrophic newborns, is found. Dismature newborns, products of the placentary insufficiency in posterm pregnancy, although the point of interest of obstetricians, pediatricians and perinatologists because of its high rates of morbimortality, constitute a minority in comparison with fetus of posterm pregnancies with high newborn weights. It is possible that fetal hypertrophy by it self may be another cause of morbimortality in posterm pregnancies (because of dystocias, prolonged labor, altered fetopelvic relations, increased rates of cesarean sections, and others) that must be determined in future longterm, prospective analysis.
Assuntos
Peso ao Nascer , Desenvolvimento Embrionário e Fetal , Gravidez Prolongada , Feminino , Idade Gestacional , Humanos , Gravidez , Estudos Prospectivos , Estatística como AssuntoRESUMO
Fifty seven cases of intrauterine growth retardation were analyzed at the Department of Perinatal Medicine, "Luis Castelazo Ayala" Hospital, IMSS. The main purpose of the study was to establish the usefulness of cardiotocography in the decision of pregnancy interruption. The patients were divided in three groups in relation to the last non stress test made before delivery (reactive, non reactive, non reactive, non reactive with declarations). It is concluded that cardiotocography is a useful procedure for the surveillance of these fetuses and it was found a good correlation between progressively ominous traces and fetal condition at birth.
PIP: Early diagnosis, adequate follow-up, and determination of the ideal moment for delivery are fundamental aspects of management of intrauterine growth retardation. This study evaluates the usefulness of cardiotocography in follow-up such cases and in the identification of the best moment for delivery. 57 cases of intrauterine growth retardation were studied at the Department of Perinatal Medicine of a Mexican Institute of Social Security hospital in Mexico City between July 1986-June 1987. The 57 cases were divided into 3 groups based on the results of the most recent nonstress test made 72 hours or less before delivery. Group 1 consisted of 15 cases with reactive tests, group 2 of 17 cases with nonreactive tests, and group 3 of 25 cases of nonreactive tests with decelerations. In group 1 there were no histories of previous complicated pregnancies. In group 2 there were 3 cases of low birth weight and 7 of preterm birth in previous pregnancies. In group 3 there were 3 cases of low birth weight, 2 of preterm birth in previous pregnancies. In group 3 there were 3 cases of low birth weight, 1 of preterm birth, 5 of stillbirth and 1 neonatal death. 77.1% of the 57 mothers were hypertensive, 5.2% had cardiopathies, and 1.7% each had lupus erythematosus, prolonged pregnancy, and hyperparathyroidism. There was no associated pathology in 12.2% of cases. There were 13 caesareans and 2 vaginal deliveries in group 1, with a fetal indication for cesarean in 3 cases. In group 2 there were 13 caesareans and 4 vaginal deliveries, with 9 maternal and 4 fetal indications for cesarean. 24 of 25 deliveries in group 3 were cesarean, with fetal indications in 22 cases and both fetal and maternal indications in 2 cases. The nonstress test was the basic criterion for the indication in group 3. The average birth weight and gestational age respectively were 1798 g and 37.2 weeks for group 1, 1681 g and 36.5 weeks for group 2, and 1551 g and 37 weeks for group 3. The average Apgar score at the minute of birth was 6.8 for group 1, 6.6 for group 2l, and 5.1 for group 3. There were 3 fetal deaths, 2 in group 2 including 1 case of anencephaly and 1 which occurred 48 hours after a recommendation for cesarean following a deterioration in the nonstress test. 1 death in group 3 followed a misinterpreted nonstress test. 4 neonatal deaths included 1 in group 1 from septicemia probably acquired in the nursery and 3 in group 3 attributed to cerebral hemorrhage. The results indicate that the presence of spontaneous decelerations in the fetal heart beat strongly suggest fetal compromise, and are an alarm signal in case of intrauterine growth retardation. The nonstress test is a useful tool in such cases.