Laura E. Edwards

Pregnancy in the massively obese: Course, outcome, and obesity prognosis of the infant

The obstetric performance and pregnancy outcome in 208 massively obese patients who were delivered over an eight-year period were compared with those of nonobese control subjects. The incidence of obesity in their infants was also compared. No significant increase in the incidence of urinary tract infection, diabetes, breech presentation, cesarean section, forceps delivery, or maternal and infant morbidity was noted in the obese women. Significantly increased incidences of hypertensive disorders of pregnancy (p less than 0.01), gestational diabetes (p less than 0.01), inadequate weight gain (p less than 0.001), and wound or episiotomy infection (p less than 0.05) were observed in the study group. The mean birth weight of the infants of obese women was 209 grams greater than that of the control subjects. A significantly increased number of the obese patients were delivered of excessive-sized infants. Despite this, the incidence of obesity in infants of obese women was not significantly increased at birth or six months of age. By 12 months of age, however, these infants were significantly more obese than the control infants.

Adolescent pregnancy prevention services in high school clinics.

In 1973 the St. Paul Maternal and Infant Care (MIC) Project opened a health clinic in a local junior-senior high school. This article describes the evolution of the program and services offered and discusses the impact of its birth control activities on the adolescent population served. Wide use of services and high rates of contraceptive continuation led fertility rates to decline by 56% between 1973 and 1976 from 79 to 35 births per 1000. A retrospective review of the records of all students who received family planning services and prenatal care between 1973 and 1979 showed that 403 students had received initial family planning educational medical and counselling services in the 3 MIC school clinics. By the end of the 3rd year 92% of pregnant students had obtained prenatal services and the school dropout rate after delivery declined from 45% to 10%. The 12-month contraceptive continuation rate for 1973-76 calculated by the life-table method was 86.4 per 100 women and the continuation rate for the later years of the project increased to 92.8 per 100 women. Comparison of the high school clinic group with the overall MIC adolescent population served shows a higher proportion in the school group belonging to minority races and a lower proportion of never-pregnant contraceptors. Significantly fewer patients were lost to follow-up in the school group than in the overall MIC teen clinic group. Factors contributing to the effectiveness of the program in the schools included consistency of staff offering personalized services with guaranteed confidentiality accessibility of free services and provision of educational and social as well as medical services.

Gonorrhea in pregnancy.

Pregnancy complicated by gonorrhea was studied in 178 patients delivered of their infants over an eight-year period. There was an increased incidence of chorioamnionitis (p less than 0.05) and intrauterine growth retardation (p less than 0.05) in these patients when compared with matched controls. In 19 patients with positive gonorrheal cultures at delivery, there was a significant increase in the incidence of premature rupture of membranes (p less than 0.05), chorioamnionitis (p less than 0.05), and prematurity (p less than 0.05). Recurrence or persistence of positive cultures was found in 18 per cent of the patients with pregnancy gonorrhea. Two required hospitalization for intensive parenteral treatment when repeated attempts at outpatient management were unsuccessful.

Pregnancy in the underweight woman. Course, outcome, and growth patterns of the infant.

The obstetric performance and pregnancy outcome of 354 underweight patients were compared with matched control subjects of normal weight. The growth patterns of their infants were also compared. The underweight women had significantly higher rates of cardiac/respiratory problems, anemia, PROM, and endometritis but were less prone to develop pre-eclampsia. Prematurity and low Apgar scores were significantly more frequent in the infants of underweight women. There was no difference in the frequency of IUGR and in perinatal mortality rates. The mean birth weight of the infants of underweight women was 231 grams less than that of infants of control subjects. Underweight women, particularly if they were anemic, had a higher incidence of low-birth-weight infants despite adequate weight gain. AGA infants of underweight women were more likely to be below the twenty-fifth percentile for weight correlated with length by 12 months of age.

Maternal intravenous ethanol in the prevention of respiratory distress syndrome.

The occurrence of respiratory distress syndrome (RDS) was studied in 68 premature neonates whose mothers were treated with at least one six-hour course of intravenous ethyl alcohol within 48 hours before delivery. At the gestational interval of 28 to 32 weeks, significant differences were observed in the incidence of RDS (p = less than 0.05), in severe RDS (p = less than 0.005), and in the mortality rate from RDS ( = less than 0.05), when compared to premature neonates not treated with alcohol and delivered during the same time interval. Several high-risk factors were found unevenly distributed between treated and control groups of patients, and their relevance to RDS was discussed. Premature rupture of membranes of more than 24 hours did not protect infants from RDS in the patients studied. Explanations for possible mechanisms of action are discussed.

Changing status of tubal sterilization: An evaluation of fourteen years' experience

Abstract A series of 1,150 female patients undergoing tubal sterilization over a 14 year period were evaluated for trends as to age, parity, and indications as well as to safety and surgical risk. The tubal ligation to delivery ratio decreased from 1:17.4 in 1958 to 1967 to 1:4.3 in 1970 to 1971. Average parity decreased from 7.8 to 4.2. In the first 10 year period, only 3.5 per cent were less than 25 years of age, while 31.7 per cent were in this age group in 1971. This change reflects an evolution in policy which does not discriminate on the basis of age, parity, or marital status. The total morbidity and complication rate was 10.0 per cent. Serious complications occurred in 2.6 per cent of the patients. The over-all failure rate was 0.17 per cent.

Adolescent contraceptive use: Experience in 1,762 teenagers

Retrospective analysis was done on 1,762 adolescent family planning patients who used the St. Paul Maternal and Infant Care Project Teen Clinic from 1969 through June 1979. Factors evaluated included method of contraception, demographic data, and continuation rates calculated by Life Table Method. A further comparison was done on 403 of these patients who initiated their family planning care at a project satellite clinic located within a local high school.

A comparison of intrauterine contraceptive devices and oral contraceptives in the nullipara

Abstract Lippes loop and Dalkon shield intrauterine contraceptive devices (IUDs) were used in 266 nulligravid and nulliparous patients over a 4½ year period. Life Table analysis of first segment event rates showed the pregnancy rate to be 2.9, expulsion rate 13.0, and medical removal rate to be 19.4 per 100 women after one year of use. Pregnancy and expulsion rates were higher for Lippes loop than for Dalkon shield patients. A comparative study was done on 266 patients on oral contraceptives matched for age and parity. Although continuation rates at one year were higher in the patients on oral contraceptives, the IUD was also found to be a satisfactory method of contraception in the nulliparous female.

Antepartum fetal testing: II. The acceleration/constant ratio: A nonstress test

For a period of one-half hour of undisturbed fetal monitoring, periodic changes of the FHR in response to spontaneous fetal movements (FMs) were recorded. FMs in patients who subsequently had positive OCTs were less likely to show accelerations (p = 0.001) and more likely to show variable decelerations (p = less than 0.001) and no change (p = less than 0.001) in the FHR when compared with patients who did not have a positive OCT. A ratio between the number of FMs associated with accelerations and the sum of FMs associated with no change and decelerations was defined as the acceleration/constant (A/C) ratio. The outcome in patients who exhibited reactive tests (i.e., A/C ratio greater than 1) was more favorable than the outcome in patients with nonreactive tests (i.e., A/C ratio less than or equal to 1). Patients with positive OCTs universally showed nonreactive tests, whereas patients with false positive OCTs were more likely to have reactive tests. Evidence is presented to suggest that the A/C ratio is more predictive of the intrauterine environment than the OCT.

Antepartum fetal testing

Abstract Two hundred seventy-eight high-risk patients were managed by a comprehensive assessment of the anatomic, biochemical, and functional environment of the fetoplacental unit utilizing predetermined guidelines. Decisions to terminate pregnancy were reserved for patients who demonstrated a positive OCT. Perinatal outcome in patients with positive OCTs was significantly worse than in patients who did not have a positive OCT. Patients with suspicious OCTs frequently had positive OCTs and were more likely to bear growth-retarded infants, whereas negative OCTs in general were associated with a favorable outcome. Correlation of estriol excretion with the OCT and perinatal outcome was inconsistent. There were a total of four prenatal deaths, all of which were considered unpreventable.