Pregnancy Episodes Research Articles

Diagnosis and management of Graves' disease in pregnancy.

Most of the hyperthyroidism seen in association with pregnancy is Graves' disease. The best treatment is prevention. For most patients there is an opportunity to treat the hyperthyroidism decisively with radioiodine or surgery before the patient becomes pregnant. Pregnancy complicated by hyperthyroidism is often a consequence of the conscious decision to treat hyperthyroidism in women in the childbearing years with antithyroid drugs. Propylthiouracil (PTU) is the preferred treatment for hyperthyroidism in pregnancy, but it does cross the placenta and can induce fetal goiter, with mental and physical retardation. Hence, the lowest possible PTU dose should be used. One should aim for high normal or slightly elevated thyroid function in the mother. Patients should be followed at 3-week intervals if progress is satisfactory, more often otherwise. Thyroid function should be monitored by the free T4 assay. PTU dosage should be reduced progressively in anticipation of the customary steady amelioration in the hyperthyroidism that occurs in later stages of pregnancy. Since pregnant hyperthyroid patients are sometimes irresponsible and continue PTU without supervision, PTU prescriptions should be limited to the amount required for the time until the next scheduled visit. For about one third of patients, PTU can be discontinued in the second half of the pregnancy. After the pregnancy is terminated, persistent or recurrent hyperthyroidism should be treated definitively to prevent another episode of pregnancy complicated by hyperthyroidism.

Fetal heart rate response to vibroacoustic stimulation during low and high heart rate variability episodes in late pregnancy

In 52 women in late pregnancy, the mean durations of transient fetal tachycardia after vibroacoustic stimulation during low fetal heart rate variability (4.8 minutes) and high fetal heart rate variability (6.3 minutes) were similar. The fetal heart rate continued with high variability in all cases, suggesting that the fetus did not return to its prestimulation state after vibroacoustic stimulation during quiescence. In 10 women, the duration of high variability after vibroacoustic stimulation during low fetal heart rate variability was significantly shorter (mean, 22 minutes) than the preceding (mean, 36 minutes) or subsequent (mean, 43 minutes) high-variability components of complete rest activity cycles. In another 10 women, the duration of high variability after vibroacoustic stimulation during high fetal heart rate variability was similar to preceding and subsequent high-variability episodes. In these 20 women, the next complete rest-activity cycle after vibroacoustic stimulation was not different in duration to the complete cycle recorded on the previous day.

Transient and lasting effects of reproductive episodes on NaCl intake of the female rat

Following recovery from experimental sodium depletion, both the need-free and the future need-induced NaCl intakes of the rat are increased. The present experiments asked whether a naturally occurring episode of sodium need, pregnancy and lactation, would also enhance NaCl intake. The daily 0.3 m NaCl intake of Long-Evans rats increased from 18.2 ml (prior to pregnancy) to 28.7 ml during pregnancy, and increased further to 36.2 ml during lactation. The daily intakes remained increased after the weaning of the second litter, at 28.5 ml/24h for females which had access to 0.3 m NaCl during the reproductive episodes (DAM + Na) and at 27.6 ml/24h for those which did not (DAM). When they were subsequently sodium depleted, the need-induced NaCl intake of the DAM, but not the DAM + Na group, was significantly increased compared to virgin female rats. The sodium depletion-induced water intakes of both groups were significantly increased. Neither the need-free nor the need-induced intakes of their offspring (as adults) were increased. In summary, pregnancy and/or lactation, in the absence of a sodium deficit, produced increased intakes of NaCl which persisted beyond the reproductive episodes

EARLY PUERPERAL RISING

Abstract Report is made of the experiences in three Army hospitals with 221 parturitions after which a regimen of early exercise and activity was directed. The routine included standing for one minute the first day post partum, sitting in a chair for five minutes the second day, abdominal exercises in bed, and two five-minute sitting episodes the third day, knee-chest exercises and two thirty-minute sitting periods the fourth day, walking about and toilet privileges on the fifth or six day, a shower the seventh day, and discharge from the hospital on the eighth day when desired or necessary. The incidence of complications, subinvolution, prolonged lochia rubra, episiotomy breakdown, infections, and uterine retroversion was not greater than that found in any series of women treated puerperally with bed rest for six or seven days and hospitalization to the tenth day. It is felt that early puerperal rising in uncomplicated cases of childbirth is desirable and without danger or unfavorable sequelae. The women have a sense of well-being and are benefited psychologically not only during the puerperium, but in their attitude toward the entire episode of pregnancy. They are prepared by the regimen of increasing activity to leave the hospital by the eighth day post partum, and their convalescence at home is shortened considerably.

Early puerperal rising

Report is made of the experiences in three Army hospitals with 221 parturitions after which a regimen of early exercise and activity was directed. The routine included standing for one minute the first day post partum, sitting in a chair for five minutes the second day, abdominal exercises in bed, and two five-minute sitting episodes the third day, knee-chest exercises and two thirty-minute sitting periods the fourth day, walking about and toilet privileges on the fifth or six day, a shower the seventh day, and discharge from the hospital on the eighth day when desired or necessary.The incidence of complications, subinvolution, prolonged lochia rubra, episiotomy breakdown, infections, and uterine retroversion was not greater than that found in any series of women treated puerperally with bed rest for six or seven days and hospitalization to the tenth day.It is felt that early puerperal rising in uncomplicated cases of childbirth is desirable and without danger or unfavorable sequelae. The women have a sense of well-being and are benefited psychologically not only during the puerperium, but in their attitude toward the entire episode of pregnancy. They are prepared by the regimen of increasing activity to leave the hospital by the eighth day post partum, and their convalescence at home is shortened considerably.

PARAPLEGIA OF PREGNANCY (SUBACUTE COMBINED DEGENERATION OF THE CORD)

Of the neuropsychiatric episodes of pregnancy, the best known are the psychoses. Aside from accidental cerebral complications (hemorrhage, thrombosis, embolism), disturbances of the central or peripheral nervous system proper, that is, pure organic nerve lesions, are relatively rare. For the most part the lesions are in the peripheral nerves and are classified either as pressure neuritis—that is, they result from pressure by the pregnant uterus on the sacral plexus—or as polyneuritis. Lesions of the spinal cord are uncommon. According to Hosslin,1who enumerated nearly every conceivable disease of the spinal cord as a possible direct or indirect complication of pregnancy, the most frequent form seems to be transverse or compression myelitis. However, neither Hosslin nor later observers (Berkwitz and Lufkin,2for instance) described subacute combined degeneration of the cord as a complication of pregnancy, regardless of the fact that pregnancy is frequently associated with anemia. So far as