Initial Prenatal Visit Research Articles

Cigarette, alcohol and other drug use among small city pregnant adolescents

Purpose: To determine the prevalence of cigarette, alcohol and other drug use and associated factors of use among predominantly Caucasian small-city pregnant adolescents, a little-studied population. Methods: At the initial prenatal visit 117 enrouees completed a self-administered questionnaire. Patients provided urine samples for drug metabolites. Chart review determined medical provider documentation of substance use. Results: Thirty-five percent of patients were positive for alcohol or other drug use by questionnaire self-report, provider report or initial urine drug screening test. Thirteen percent of patients were positive for at least one drug metabolite in the urine. Multiple logistic regression analysis indicated a model with four significant risk factors associated with pregnant adolescent alcohol and other drug use: lack of closeness with the father of the baby, neither parent in the home, patient experiencing consequences of alcohol and other drug use, and father of the baby experiencing consequences of alcohol and other drug use. Conclusions: The high prevalence of cigarette, alcohol and other drug use in this predominantly Caucasian sample was comparable to previous inner city data. Awareness of risk factors may improve identification and management of substance use among pregnant adolescents.

Antiphospholipid Antibodies in Predicting Adverse Pregnancy Outcome: A Prospective Study

To determine if the presence of antiphospholipid antibody (aPL) in healthy pregnant women is associated with adverse pregnancy outcome, including 1) intrauterine fetal loss, 2) maternal pregnancy complications, 3) low birth weight, and 4) low 5-minute Apgar scores. Prospective cohort study in women with normal pregnancies. Obstetrics clinic at the University of Colorado Health Sciences Center. Eligible patients included 451 low-risk, nulliparous pregnant women who came to the obstetrics clinic before 25 weeks gestation; 408 were enrolled and 389 had blood drawn at the first prenatal visit and completed clinical follow-up. Blood for six aPL measures was drawn at the first prenatal visit and for 239 patients at delivery. Ninety-five patients (24.4%) had elevated aPL levels by one or more measures at the first prenatal visit: 15.8% of the aPL-positive and 6.5% of the aPL-negative patients experienced fetal loss (relative risk, 2.44; 95% CI, 1.29 to 4.62). However, an elevated IgG anticardiolipin antibody level at the first prenatal visit was the only aPL measurement that was significantly associated with fetal loss (relative risk, 3.5; CI, 1.56 to 8.07). Adjustment for confounding variables decreased the relative risk of aPL for fetal loss slightly, but the difference remained statistically significant. Neither a positive aPL result at the initial visit nor a positive result at delivery was associated with maternal complications of pregnancy, low birth weight, or low Apgar scores. Patients with elevated aPL levels at their initial prenatal visit had an increase in fetal loss but no increase in maternal pregnancy complications, low birth weight, or low Apgar scores. Immunoglobulin G anticardiolipin antibody was the only single test of aPL significantly associated with fetal loss.

Headache recurrence in pregnant women with migraine.

The goal of this study was to evaluate to what extent pregnancy influences headache recurrence in women with a diagnosis of migraine at, or before, their first prenatal visit. Data from the large, prospective Collaborative Perinatal Project of 55,000 pregnancies were reviewed. Less than 2% of women in the sample of first study pregnancies were considered to have migraine at their initial prenatal visit (n = 508). Of the 484 women with a complete data set, 17% experienced complete cessation of headache throughout pregnancy and another 62% experienced two or fewer headaches in the third trimester. These observations lead to the conclusion that many migraineurs (79% in this sample) experience improvement in headache recurrence during pregnancy. Only 21% experienced no improvement at all. No demographic or obstetrical factor was associated with headache improvement.

A study of various tests to detect asymptomatic urinary tract infections in an obstetric population

<h3>Objective.</h3> —To compare rapid screening techniques for detecting asymptomatic urinary tract infections (AUTIs) in pregnant women. <h3>Design.</h3> —Comparison of results of the screening tests of urinalysis, urine dipstick, and Gram's staining with the results of standard urine culture at an initial prenatal visit. In follow-up visits, urine dipstick testing was compared with urinalysis. <h3>Setting.</h3> —Departments of Family Medicine and Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn. <h3>Patients.</h3> —Pregnant women (1047) from the local community were screened for AUTI on initial and follow-up visits. <h3>Methods.</h3> —Initial prenatal urine was tested by using urine dipstick testing, urinalysis, Gram's staining, and urine culture. At each follow-up visit, urine specimens were tested by using urine dipstick and urinalysis. <h3>Main Outcome Measures.</h3> —Sensitivity and specificity, incremental patient costs, and clinical outcomes were used to assess the effectiveness of the techniques. <h3>Results.</h3> —On initial visits, rapid screening tests for AUTI in pregnant women revealed the following: Gram's staining identified 22 of 24 patients with AUTI (sensitivity, 91.7%; specificity, 89.2%); urine dipstick, 12 of 24 (sensitivity, 50.0%; specificity, 96.9%); and urinalysis with presence of leukocytes, six of 24 (sensitivity, 25.0%; specificity, 99.0%). In follow-up visits, urine dipstick tests detected 19 infections and urinalysis, three (positive predictive value, 5% compared with 3%). <h3>Conclusions.</h3> —Urine dipstick testing for nitrites identified half of all patients with urinary tract infections and was superior to urinalysis on follow-up visits. Although Gram's staining is more expensive, it was more accurate for AUTI than urinalysis or urine dipstick test for nitrites. Urinalysis was never the test of choice because it was more expensive and detected fewer positive cultures. Leukocyte measurement correlated poorly with AUTI. (<i>JAMA</i>. 1993;270:1971-1974)

A Study of Various Tests to Detect Asymptomatic Urinary Tract Infections in an Obstetric Population

To compare rapid screening techniques for detecting asymptomatic urinary tract infections (AUTIs) in pregnant women. Comparison of results of the screening tests of urinalysis, urine dipstick, and Gram's staining with the results of standard urine culture at an initial prenatal visit. In follow-up visits, urine dipstick testing was compared with urinalysis. Departments of Family Medicine and Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn. Pregnant women (1047) from the local community were screened for AUTI on initial and follow-up visits. Initial prenatal urine was tested by using urine dipstick testing, urinalysis, Gram's staining, and urine culture. At each follow-up visit, urine specimens were tested by using urine dipstick and urinalysis. Sensitivity and specificity, incremental patient costs, and clinical outcomes were used to assess the effectiveness of the techniques. On initial visits, rapid screening tests for AUTI in pregnant women revealed the following: Gram's staining identified 22 of 24 patients with AUTI (sensitivity, 91.7%; specificity, 89.2%); urine dipstick, 12 of 24 (sensitivity, 50.0%; specificity, 96.9%); and urinalysis with presence of leukocytes, six of 24 (sensitivity, 25.0%; specificity, 99.0%). In follow-up visits, urine dipstick tests detected 19 infections and urinalysis, three (positive predictive value, 5% compared with 3%). Urine dipstick testing for nitrites identified half of all patients with urinary tract infections and was superior to urinalysis on follow-up visits. Although Gram's staining is more expensive, it was more accurate for AUTI than urinalysis or urine dipstick test for nitrites. Urinalysis was never the test of choice because it was more expensive and detected fewer positive cultures. Leukocyte measurement correlated poorly with AUTI.

Early Detection and Treatment of Sexually Transmitted Disease in Pregnant Adolescents of Low Socioeconomic Status

This study evaluated the prevalence of sexually transmitted disease (STD) in adolescents presenting to a primary pediatric care clinic (PPCC) for the diagnosis of pregnancy and our ability to eradicate identified infections. We followed 168 pregnant adolescents of low socioeconomic status from their original pregnancy diagnosis until their first prenatal clinic visit. We collected screening cervical cultures for Neisseria gonorrhoeae and Chlamydia trachomatis by completing a pelvic examination on 91 patients at our PPCC. At the PPCC visit, 29% were positive for gonorrhea, chlamydia, or both. Screening tests for these infections were collected on all patients at the initial prenatal clinic visit. The risk for presenting to the prenatal clinic with a STD was significantly greater in patients not screened and treated for STD at the PPCC. Average delay from diagnosis to first prenatal clinic visit was 35.7 days. Thus, in this adolescent population, primary care providers are missing an important therapeutic opportunity by failing to identify and treat STD at initial diagnosis of pregnancy.

Effect of Maternal Race on Outcome of Preterm Infants in the Military

Previous studies suggest that low birth weight black infants have less morbidity and birth-weight-specific mortality during the perinatal period than low birth weight white infants. We studied the effect of maternal race on outcome in preterm infants born at a military hospital that offers free access to obstetric and neonatal care. Between January 1, 1986, and December 31, 1991, data were prospectively collected on all 667 infants delivered at Wilford Hall USAF Medical Center with an estimated gestational age of less than 35 weeks. Three hundred ninety-two white infants and 165 black infants were included in the data analysis. The mean (+/- SD) birth weight was 1701 +/- 65 g for white infants and 1462 +/- 66 g for black infants. The mean estimated gestational age was 31.0 +/- 3.2 weeks for white infants and 29.9 +/- 3.8 weeks for black infants. Preeclampsia was more frequent in black mothers than in white mothers for the entire study population (21% vs 14%), but the birth weight differential between races remained after correction for preeclampsia. There were no significant differences between races in stillbirths, gender, maternal age, maternal transfer status, number of prenatal visits, or percentages of mothers with small-for-gestational-age infants, multiple-gestation infants, prolonged rupture of membranes, or initial prenatal visit during the first trimester. Intraventricular hemorrhage was more frequent in white infants at 27 through 29 weeks estimated gestational age (50% vs 13%). There were no significant differences between the two groups in survival or in the occurrence of severe intraventricular hemorrhage or bronchopulmonary dysplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Effectiveness of Repeated Gonorrhea Cultures in the Third Trimester

Objective: With the high cost of health care today, the universal prophylactic measures recommended, and the availability of effective treatment should infection occur, the practice of routinely repeating the endocervical gonorrhea (GC) culture in the third trimester of pregnancy may be unwarranted. Methods: To test this hypothesis, we reviewed charts from patients who had received routine prenatal care during a 2-year period at the Lafayette and Opelousas parish health units. Those charts, which had documented results of both the initial and repeat GC cultures, were then used for retrospective review. The results ofthe initial GC culture were compared with that taken in the third trimester. Other data recorded included age, gravidity, race, and history of gonorrhea, syphilis, or multiple sexual partners. Results: Two hundred fifty charts were available for extraction; 130 of these had documentation of both GC cultures. Of the 130 cultures obtained during the initial prenatal visit, only 6 (4.6%) were positive. Of the repeat cultures taken during the third trimester, none were positive. Thirteen patients (10.0%) had a documented history of GC infection; none of them had positive cultures during the study period. Conclusions: Screening for GC during pregnancy is important and appropriate. This is commonly accomplished by taking a GC culture during the initial prenatal visit. Based upon the present study, we found that repeating this culture in the third trimester, even in a relatively high-risk population, seems unnecessary, whether the initial culture is negative or not.

Significance of atypical cervical cytology in pregnancy.

To ascertain the significance of squamous atypia encountered during routine Papanicolaou smear screening in pregnancy, we reviewed our experience with 76 pregnant women seen during a 4-year period. All were evaluated with repeat cytology and colposcopy during pregnancy and again postpartum. Colposcopic examination during pregnancy revealed a normal transformation zone without evidence of intraepithelial neoplasia in 46 women. In six of these women, repeat cytology was interpreted as cervical intraepithelial neoplasia (CIN) grade 1. In 30 women, an abnormal transformation zone was identified--14 with a negative repeat cytology. In five women, the transformation zone was interpreted as compatible with CIN 2 or CIN 3. Colposcopically directed biopsies were performed in 31 women, in all but two postpartum. Of the 76 women, human papilloma virus or CIN was identified on biopsy in 16 women (21%). We propose that an isolated report of atypical squamous cells on cervical cytology obtained at the initial prenatal visit does not warrant colposcopic evaluation during pregnancy, unless a repeat cytology suggests CIN. Repeat cytology and evaluation to exclude infections and inflammatory lesions is appropriate. However, if a subsequent cytology is abnormal, postpartum colposcopy and colposcopically directed biopsies seem appropriate, since the prevalence of HPV or CIN was 21%.

The clinical utility of maternal body mass index in pregnancy

To describe maternal body mass index and to compare the use of maternal weight and body mass index for risk assessment at the initial prenatal visit, 6270 gravid women who were consecutively delivered of infants were studied. Body mass index increased with advancing maternal age, parity, and advancing gestational age and was significantly greater in black women than in nonblack women. Risks for the development of adverse outcome associated with maternal obesity, including development of gestational diabetes, preeclampsia, fetal macrosomia, and shoulder dystocia, were comparably predicted by either maternal weight or body mass index greater than 90th percentile. Maternal weight was as predictive of preeclampsia, macrosomia, and shoulder dystocia as was body mass index when these factors were analyzed as continuous variables, whereas increasing body mass index was more predictive of gestational diabetes. The prediction of factors associated with low maternal weights, small-for-gestational-age birth, prematurity, low birth weight, and perinatal death was equivalent for maternal weight and body mass index that was less than 10th percentile. This study indicates that in the initial risk assessment of outcomes related to maternal weight, the calculation of maternal body mass index offers no advantage over simply weighing the patient. This finding contrasts with results in nonpregnant women.

Concomitant infection with Neisseria gonorrhoeae and Chlamydia trachomatis in pregnancy

Gonorrhea is an important marker for endocervical chlamydial infections in nonpregnant women. Concomitant infection rates as high as 50% have been reported. There are few data on concomitant infection rates in pregnant patients. The purpose of this study was to examine the prevalence of endocervical chlamydial infections in pregnant women with gonorrhea. Patients with cervical cultures positive for Neisseria gonorrhoeae at their initial prenatal visit had endocervical specimens for Chlamydia trachomatis culture obtained before anti-gonorrheal therapy. Control patients were selected at random from the same prenatal population. The prevalence of C trachomatis in patients with gonorrhea was significantly greater than that in the control population (46 versus 5%; P less than .001). Patients with gonorrhea were younger, less often married, and more often black than the control population, but these demographic differences did not account for the large difference in the chlamydial prevalence. Erythromycin 500 mg four times daily provided an excellent cure rate without intolerable side effects. Pregnant patients being evaluated or treated for gonorrhea should also be considered at high risk for concomitant cervical chlamydial infection.

Outcomes of the First 527 Births at The Birthplace in Seattle

ABSTRACT: The Birthplace nurse‐midwifery staffing, practice, cost, and outcomes are described. Of 527 women having initial prenatal visits 8 were referred for obstetrician care; 78 moved or dropped out; and 56 were referred to obstetricians later in pregnancy (among them 17 for spontaneous abortions and 10 for breech presentation, 5 for twins, and 6 for pre‐eclampsia).Of 385 women cared for at The Birthplace through the onset of labor, 82 were transported to hospitals during labor, most for failure to progress before and after rupture of membranes and prolonged second stage.Of 303 women delivered at The Birthplace, the following are discussed: the status of labor at admission, durations of stages of labor, incidence of episiotomies and lacerations, medication use, indications for 82 maternal intrapartum transports, mode of delivery of transports, indications for 11 postpartum maternal and 10 neonatal transports, and their outcomes.

Reversible pure red cell hypoplasia in pregnancy

PREGNANCY is normally a state of erythroid hyperplasia. Increased erythropoiesis during pregnancy is controlled by erythropoietin, which is augmented by the action of placental lactogen and inhibited by high levels of estrogen.¹We describe a case of a patient with pure red cell hypoplasia during pregnancy that resolved completely in the postpartum period. <h3>Report of a Case</h3> On Jan 22, 1981, a 23-year-old primigravida came to the obstetric clinic at Naval Regional Medical Center (NRMC), Charleston, SC, for an initial prenatal visit at approximately 24 weeks' gestation. A routine hemoglobin level and hematocrit reading were noted to be 9.0 g/dL and 27.1%, respectively. Administration of ferrous sulfate, 325 mg, one tablet three times a day, was begun. A follow-up visit four weeks later revealed a hemoglobin level of 7.1 g/dL and a hematocrit reading of 24.3%. The patient denied noncompliance with respect to self-administration of the prescribed medication. The

Reversible Pure Red Cell Hypoplasia in Pregnancy

PREGNANCY is normally a state of erythroid hyperplasia. Increased erythropoiesis during pregnancy is controlled by erythropoietin, which is augmented by the action of placental lactogen and inhibited by high levels of estrogen.¹We describe a case of a patient with pure red cell hypoplasia during pregnancy that resolved completely in the postpartum period. <h3>Report of a Case</h3> On Jan 22, 1981, a 23-year-old primigravida came to the obstetric clinic at Naval Regional Medical Center (NRMC), Charleston, SC, for an initial prenatal visit at approximately 24 weeks' gestation. A routine hemoglobin level and hematocrit reading were noted to be 9.0 g/dL and 27.1%, respectively. Administration of ferrous sulfate, 325 mg, one tablet three times a day, was begun. A follow-up visit four weeks later revealed a hemoglobin level of 7.1 g/dL and a hematocrit reading of 24.3%. The patient denied noncompliance with respect to self-administration of the prescribed medication. The

Vitamin B6 status of low-income adolescent and adult pregnant women and the condition of their infants at birth

The vitamin B6 status of 127 low-income pregnant adolescent and adult women was assessed at two stages of pregnancy and related to the condition of the infant at birth. The mean dietary intake of vitamin B6 for a subsample of 57 of the subjects at the initial prenatal clinic visit was 1.37 +/- 1.02 mg (mean +/- SD). The mean stimulation of erythrocyte alanine aminotransferase activity by pyridoxal 5'-phosphate was 34.8 +/- 21.1% at the first clinic visit and 29.4 +/- 14.5% for a subsample of 30 subjects at the 30th wk of pregnancy. Apgar scores of infants whose mothers had high erythrocyte alanine aminotransferase stimulation values (greater than 25%) were significantly lower (p less than or equal to 0.05) than infants whose mothers had normal erythrocyte alanine aminotransferase stimulation values (less than or equal to 25%). These data indicate a vitamin B6 deficiency at two stages of pregnancy in these low-income adolescent and adult women and lower Apgar scores in infants whose mothers were vitamin B6 deficient than those with adequate vitamin B6 status.

Maternal and antenatal factors in the risk of sudden infant death syndrome.

The prenatal course, labor and delivery of 90 mothers of infants who died of Sudden Infant Death Syndrome (SIDS) in Connecticut from 1974 through 1976 were studied by hospital chart reviews. Charts of 90 pair-matched controls whose infants survived the first year of life were also examined. Significant associations were found between SIDS and: 1) maternal age under 20 years, 2) later initial prenatal visit, 3) maternal blood type O, 4) reported conditions during the pregnancy. The racial distribution of the infants of the study population differed significantly from the distribution of births in Connecticut during these years, with a higher than expected proportion of blacks among the case infants. Male infants in the study population outnumbered females three to two, and cases weighed an average of 430 grams less than controls at birth.

Prenatal Care Utilization and Persistence Patterns in a Developing Nation

Utilization of prenatal care services is an important public health issue, in that lack of utilization is associated with poor pregnancy outcomes, particularly among socially and economically high-risk women. This investigation explored factors associated with utilization of prenatal care services in a sample of 185 urban Jamaican women. Data were collected at an initial prenatal care clinic visit, follow-up interviews with those who failed to persist, and from medical records. Findings indicated that the two most important factors in late initiation of prenatal care, and in failure to persist, were cost of service and susceptibility to poor pregnancy outcome.

Practical Prenatal Care: I. Initial Prenatal Care

Most factors which place the mother or fetus at risk are present at the time of the initial prenatal visit or develop during the pregnancy and before admission to the hospital. As many as 40 per cent of all high risk patients may be detected at the initial prenatal visit.

High-risk obstetrics: II. Value of semiobjective grading system in identifying the vulnerable group

An arbitrary system of levying penalties against all presumed adverse obstetric factors was devised. Abnormal conditions were grouped into eight categories and degrees of anticipated perinatal vulnerability were expressed as a numerical value resulting from the sum of all such penalties subtracted from a perfect score of 100. Index scores assigned to 1,001 consecutive ward service patients at the time of their initial prenatal visit permitted three general groupings: a high-risk group with scores of less than 70, 299 patients; a moderate-risk group with scores of 70 to 84, 390 patients; and a low-risk group with scores of 85 or over, 312 patients. There was a consistent trend for patients with the lowest scores to yield the poorest obstetric results. In general, the risk of antenatal and intrapartum complications as well as of poor perinatal outcome among the low scoring patients (29 per cent of the total) was twice as great as that observed in the remaining 71 per cent. This obstetric approach which includes aggressive laboratory investigation can be expected to identify in a broad sample of pregnant women a group of approximately 30 per cent who will give rise to 60 per cent or more of all pathologic outcomes. Gradations of risk occur even within socially deprived groups and the use of a simple, relatively sensitive screening device of the type presented permits a sharper focus of attention and intensification of effort upon the most vulnerable minority.