Twenty-one obstetric patients in whom pulmonary artery catheters had been inserted were studied. Complications were minor in nature and unassociated with adverse sequelae. They included transient premature ventricular contraction on insertion of the catheter in two cases and a ruptured balloon and a positive culture of the catheter tip in one case.

Arrhythmias, Cardiac↗

PubMedDate not supplied

Antenatal sonographic diagnosis of arthrogryposis multiplex congenita.

Arthrogryposis Multiplex Congenita (AMC) was suspected on ultrasound examination of a fetus at 30.5 weeks of gestation. The criteria for establishing this prenatal diagnosis as well as the importance of establishing the diagnosis at any gestational age are discussed. The diagnosis of AMC was confirmed at birth in this case.

Adult↗

PubMedDate not supplied

International, collaborative experience of 1789 patients having multifetal pregnancy reduction: a plateauing of risks and outcomes.

OBJECTIVE: To develop the most up-to-date, complete data base of multifetal pregnancy reduction (MFPR) from cases, and to provide the best counseling for couples with multifetal pregnancies. METHODS: From nine centers in five countries, 1789 completed MFPR cases were collected and outcomes evaluated. Pregnancy losses were defined as through 24 weeks and deliveries categorized in groups of 25-28, 29-32, 33-36, and 37 or more weeks. RESULTS: Overall, the pregnancy loss rate was 11.7% but varied from a low of 7.6% for triplets to twins and increased with each additional starting number to 22.9% for sextuplets or higher. Early premature deliveries (25-28 weeks) were 4.5% and varied with starting number. Loss rates by finishing number were highest for triplets and lowest for twins, but gestational age at delivery was highest for singletons. CONCLUSIONS: Multifetal pregnancy reduction has been shown to be a safe and effective method to improve outcome in multifetal pregnancies. Outcomes are worse with higher-order gestations and support the need for continued vigilance of fertility therapy.

Abortion, Spontaneous↗

PubMedDate not supplied

Prophylactic and emergent arterial catheterization for selective embolization in obstetric hemorrhage.

Treatment of obstetric hemorrhage by the selective embolization of damaged pelvic vessels under fluoroscopy holds promise as an alternative to surgical intervention. Unfortunately, the effectiveness of selective embolization is often compromised by its use in emergent settings following the failure of primary operative approaches. Therefore we compared the efficacy of prophylactic versus emergent catheter placement for selective embolization in nine patients with or at risk for obstetric hemorrhage. In four patients with acute obstetric hemorrhage catheterization and embolization was carried out following the failure of initial medical and surgical approaches. In five patients determined to be at risk for intrapartum hemorrhage based on sonographic findings, catheters were inserted into the hypogastric vessels prior to elective cesarean delivery. Three of these five patients subsequently required selective embolization. In comparison to patients undergoing selective embolization following prophylactic catheter placement, patients in the emergent group all had a coagulopathy at the time of embolization, sustained substantially greater blood loss, and had an increased rate of postpartum complications. Finally, there was a significant reduction in total embolization time and therefore in radiation exposure in patients undergoing prophylactic catheter placement prior to selective embolization. These data support the conclusion that in patients determined to be at risk for intrapartum or postpartum hemorrhage the prophylactic placement of catheters allows for selective embolization in a hemodynamically intact patient with stable coagulation indices, theoretically reducing the risk of maternal morbidity and possibly mortality.

Adult↗

PubMedDate not supplied

Hypertension in pregnancy: the use of ultrasound.

Great advances in ultrasound instrumentation have enabled the physician to delineate subtle intrauterine changes. Not only can specific measurements of the fetal body be obtained but tissue textures within fetal organs can be appreciated. The perinatologist is constantly searching for ways to learn more about the fetus, and ultrasound has clearly become a major implement in this search. The following discussion will focus on information made available by ultrasound for aid in the modern management of hypertension, one of the most challenging conditions complicating pregnancy.

Body Weight↗