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PubMed1991

[Multivariate analysis on factors associated with preterm delivery].

In order to estimate the occurrence of Preterm Delivery (PD) and factors associated with PD, 1141 perinatal cases at first affiliated hospital were collected by the method of systematic random sampling. The occurrence rate of PD was 6.0%. Multivariate analysis revealed that the history of premature birth, twin pregnancy, polyhydramnios, placenta praevia, premature rupture of fetal membranes and Bart's fetal hydrops were the main risk factors with statistical significance. Path analysis showed that the history of premature birth had indirect positive effect (elevating risk of PD) on PD through premature rupture of the fetal membranes and Bart's fetal hydrops. Similarly, twin pregnancy had indirect positive effect through premature rupture of the fetal membranes and polyhydramnios. It is suggested that proper health care of the pregnant mother attending to the risk factors should be emphasized to prevent the occurrence of PD.

China↗
PubMedDate not supplied

[Twin pregnancies with fetofetal transfusion syndrome].

During an observation period of 10 years 30 cases (11%) of twin transfusion syndrome were observed in a collective of 286 twin pregnancies at the University Women's Clinic Heidelberg. Typical symptoms of a twin transfusion syndrome as polyhydramnios, hydrops fetalis, polyserositis, disparity in fetal growth of the twins and pathological CTGs were examined for their diagnostic and prognostic values. A difference in birth weight of more than 25% was noted in only 28% of cases (range 2-58). A polyhydramnios was diagnosed in 63% of cases, an acute form in 30%. Eight of the nine pregnancies with an acute hydramnios ended in an abortion or intrauterine death up to 28 weeks of gestation. Amniocentesis for reduction of the excessive amount of amniotic fluid had no positive therapeutic effect. Eight of the pregnancies, in which a hydramnios had been detected, were further complicated by a hydrops fetalis (23%). Typical sinusoidal CTGs were registered in only 3 cases. Intrauterine fetal mortality respectively abortion up to 28 weeks of gestation was noted in 6 patients (12/60; 20%). Fetal mortality after 28 weeks of gestation occurred in 9/60 cases (15%). Four infants died more than 7 days post partum (7%). The fetal malformation rate was determined in our collective with 7% (4/60 fetuses). No chromosomal abnormalities were observed. The data collected show the prognostic relevance of the parameters analysed and reveal the cases in which a therapy might be effective. Ultrasonographic scanning of fetal activity or doppler flow measurements are further diagnostic procedures that can be employed in surveillance of risk pregnancies with twin transfusion syndrome. Also umbilical cord puncturing under direct ultrasonographic monitoring is of certain diagnostic and therapeutic value.

Cardiotocography↗
PubMed1989

[Myasthenia and pregnancy: a clinical and immunologic study of 42 cases (21 neonatal myasthenia cases)].

Forty-two pregnancies in 39 myasthenic mothers were studied between 1978 and 1987. In 4 cases myasthenia gravis began during pregnancy and for 20 patients the clinical condition exacerbated in 15 cases, usually during the first 3 months, or during the postpartum. Except for 1 case, clinical exacerbation was controlled by anticholinesterase drug adjustment. Obstetrical problems were uncommon: abortion in 1 case and premature delivery in 4 cases. In 2 babies with severe fetal involvement polyhydramnios was present. Twenty-one babies had neonatal myasthenia gravis (NMG). In 17 cases, transient symptoms were present at delivery or shortly afterwards and full recovery occurred from a few days to 4 months. In 4 babies the clinical presentation was atypical: 1 showed a long evolution (15 months) and residual facial bilateral weakness, and three others presented fetal involvement (arthrogryposis). In these latter cases, presentation was severe with polyhydramnios, respiratory failure and long standing evolution in 2 cases (4 months and 1 year). Antiacetylcholine receptor antibodies (anti-AChR Ab) were found in all myasthenic babies and in 19 out of 20 asymptomatic babies. Maternal antibody titers were usually slightly higher than umbilical cord titers. There was a good correlation between maternal titer and onset or severity of disorder in baby. Among the 15 high titer mothers (greater than 60 nM), 13 had a myasthenic baby, 6 of them with serious disease. Conversely all low titer mothers (less than 10 nM) had a symptom-free baby. Therefore, anti-AChR Ab titration in the mother is predictive for NMG onset. Mother's myasthenia gravis severity and treatment were not correlated to the clinical condition of the newborns.

Acetylcholine↗
PubMed1988

High spontaneous premature labor rate in insulin-dependent diabetic pregnant women: an association with poor glycemic control and urogenital infection.

The incidence of spontaneously occurring premature labor in insulin-dependent diabetic pregnancies is unclear, because previous studies have been confounded by a high rate of iatrogenic prematurity. The purpose of this study was to determine, in a large population of insulin-dependent diabetic pregnant women, the rate of spontaneous occurrence of premature labor and the various factors that may affect it. We hypothesized a priori that spontaneously occurring premature labor occurs at a high rate in insulin-dependent diabetic pregnant women, mainly because of poor control of diabetes during pregnancy, and is related to the presence of polyhydramnios and hypomagnesemia. One hundred forty-five insulin-dependent diabetic women undergoing 181 pregnancies were recruited since 1978 in an interdisciplinary prospective study. The goals of glucose control were a fasting blood glucose less than 100 mg/dL and a 90-minute postprandial glucose less than 140 mg/dL. The rate of spontaneous premature labor, 31.1%, was significantly higher (P less than .01) than that in a control population managed by the same obstetricians in similar clinical settings (20.2%). The following variables were not significantly associated with the onset of premature labor: maternal age, parity, gravidity, diabetic class according to White, presence of renal disease or retinopathy, previous elective abortion, chronic hypertension or pregnancy-induced hypertension, cigarette smoking, first-trimester or post-20 weeks' gestation vaginal bleeding, maternal serum magnesium concentration, or polyhydramnios.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Prenatal sonographic diagnosis and clinical consequences in small intestine obstruction].

Fetal intestinal obstructions can be diagnosed and differentiated from other intra-abdominal lesions with prenatal sonography. The characteristic signs are persistent echo-free areas in the fetal abdomen which frequently show peristaltic movements, and the accompanying polyhydramnios. A vaginal delivery near term is desirable and tocolytic agents and therapeutic amniocentesis should be used in the event of premature labour and maternal distress due to polyhydramnios. Premature labour also necessitates the induction of pulmonary maturation with corticoids. At least weekly ultrasonic controls are advisable to detect the rare bowel perforation. In the case of an intestinal rupture, the risk of prematurity must be weighed against the risk of abacterial meconium peritonitis before labour is induced. Own observations in five prenatally diagnosed intestinal obstructions and a review of the literature confirm the proposed management in these infants.

Diseases in Twins↗
PubMed1986

Severe neonatal centronuclear (myotubular) myopathy: an X-linked recessive disorder.

Prenatal onset and rapidly fatal course of centronuclear myopathy are described in four male newborns including two brothers. Diagnosis was established by muscle biopsy within the first week of life in two and at autopsy in the two other patients: Central nuclei, central aggregation of oxydative enzyme activity in the majority of muscle fibers and type 1 fibre hypotrophy were demonstrated. Prenatal manifestation included polyhydramnios, reduced fetal movements and breech presentation. All four newborns developed respiratory insufficiency requiring artificial ventilation immediately after birth. Severe muscular weakness and hypotonia as well as hardly elicitable grasping, deep tendon reflexes and Moro response were noticed. Additional findings included high arched palate, joint contractures, thin ribs, lung hypoplasia, abundant skin and cryptorchidism. In two families, the pedigree contains other affected males, suggesting X-linked inheritance. Seven female carriers were clinically healthy and one of them showed normal muscle histology. Fourteen previously published neonatal cases of centronuclear myopathy are reviewed and compared with our findings. This severe perinatal form of centronuclear myopathy has to be considered in male fetuses and newborns with polyhydramnios and respiratory failure due to muscular weakness or in infants who died of unexplained postnatal asphyxia. Diagnosis should be established by muscle biopsy.

Genetic Carrier Screening↗
PubMed1980

Congenital cystic adenomatoid malformation in bilateral renal agenesis. Its mitigation of Potter's syndrome.

Potter's syndrome develops secondary to a deficiency of amniotic fluid, such as occurs in renal agenesis. Congenital cystic adenomatoid malformation (CCAM), on the other hand, is frequently accompanied by polyhydramnios. We describe a newborn with both renal agenesis and CCAM who had only mild features of Potter's syndrome. The pathogenesis of polyhydramnios in CCAM is discussed with regard to the ultrastructural findings of numerous type 2 pneumocytes lining the cysts. The association between CCAM and bilateral renal anomalies is emphasized.

Abnormalities, Multiple↗
PubMed1982

Nonimmunologic hydrops fetalis: a review of 61 cases.

Sixty-one cases of nonimmunologic hydrops fetalis were studied. The incidence of nonimmunologic hydrops fetalis, 1 in 3748 births, was unchanged in 2 decades. The mortality from nonimmunologic hydrops fetalis remained high (98%). Polyhydramnios (75%), anemia (45%), and preeclampsia (29%) were the commonest prenatal maternal complications, whereas postpartum hemorrhage or difficulty with placental delivery, or both, occurred in 64%. Ultrasound examination always was successful in detecting the hydropic state. Many presumed etiologic factors were noted, although in 38% no possible cause was found. A major congenital anomaly was present in 41%. The obstetric and neonatal care of nonimmunologic hydrops fetalis must be improved. If nonimmunologic hydrops fetalis is diagnosed during the investigation of polyhydramnios, consideration should be given to early delivery in the interest of the fetus.

Edema↗
PubMed1994

Perinatal characteristics of low birthweight infants in postdate pregnancies.

BACKGROUND: Early literature discussed postdate pregnancy in relation to difficult delivery of mothers with an excessively large fetus; more recent reports imply that the risk of perinatal death exists especially for the small, growth-retarded fetus. However there is little in the literature concerning low birthweight infants in postdate pregnancies. METHODS: A 6-year retrospective review of 135 low birthweight infants with 40 or more weeks' gestation was conducted. Among the subjects, 19 cases had a gestational age greater than 42 weeks (Group 1), 26 cases, between 41 and 42 weeks (Group 2), and 90 cases, between 40 and 41 weeks (Group 3). Assess was made of the outcomes of low birthweight infants in postdate pregnancies, comparing Group 1 with Group 2 and Group 3. RESULTS: Group 1 infants had significantly higher rates of chromosomal (21.1%) and congenital (31.6%) abnormalities and perinatal mortality (21.1%) than either Group 2 or Group 3 infants. Also, in Group 1 there were two cases of polyhydramnios and they both had abnormal karyotypes. CONCLUSIONS: The outcome of low birthweight infants in postdate pregnancies appears to be worse than predicted. This finding could offer for managing the cases which have a high frequency of abnormal karyotype (21.1%), especially when combined with polyhydramnios.

Adult↗
PubMed1976

Clinical effects of myotonic dystrophy on pregnancy and the neonate.

The article describes pregnancies and labors of five women with myotonic muscular dystrophy and their four severely involved infants, and reviews the pertinent literature. Three of the four neonatal cases died by 3 weeks of age of respiratory failure or aspiration; the fourth infant is now 4 months old and has respiratory and swallowing difficulties. The symptoms of myotonic dystrophy worsen during pregnancy. A high rate of fetal loss occurs due to spontaneous abortion, prematurity, and neonatal involvement with the disease. Prolonged labor has been described as a consistent complication, but the evidence does not justify this conclusion. Although many neonates with myotonic dystrophy are asymptomatic, severely affected newborns have a recognizable disorder unrelated to the severity of the maternal disease. The most common clinical manifestations in the neonate are arthrogryposis involving predominantly the lower extremilies, generalized hypotonia and weakness, and pharyngeal weakness. Less constant features include polyhydramnios, facial diplegia, diaphragmatic paralysis, respiratory failure, decreased motility of the gastrointestinal tract, congenital cataracts, and electrocardiographic abnormalities.

Adult↗
PubMed1996

The detection of non-immune hydrops through second-trimester maternal serum screening.

The objective was to investigate whether non-immune hydrops in euploid pregnancies is associated with alterations in the second-trimester levels of maternal serum alpha-fetoprotein (AFP), unconjugated oestriol (uE3), and human chorionic gonadotropin (hCG). Ten singleton cases of fetal non-immune hydrops were identified. The aetiology and timing of onset of the earliest signs of non-immune hydrops, including polyhydramnios, in relation to maternal serum screening for Down syndrome were assessed. There was no clear relationship between the aetiology of non-immune hydrops and the analyte levels, as aetiologies varied widely. AFP levels were elevated overall (median = 1.78 MOM) and uE3 levels were unremarkable (median = 0.82 MOM). hCG levels were elevated (median = 3.53 MOM) when non-immune hydrops was present at the time of screening, but were unremarkable (median = 0.82 MOM) when the non-immune hydrops presented later. It is concluded that second-trimester non-immune hydrops is associated with elevated hCG levels.

Adult↗
PubMed1996

Prenatal diagnosis and clinical significance of hypoplastic umbilical artery.

This study reports the maternal, fetal, and neonatal outcomes in cases with hypoplastic umbilical artery. The sonographic finding of a three-vessel umbilical cord showing an artery-to-artery diameter difference of more than 50 per cent was defined as hypoplastic umbilical artery. All fetuses diagnosed with hypoplastic umbilical artery underwent genetic amniocentesis and ultrasound. Fetal, maternal, and neonatal outcomes were analysed. Twelve fetuses with hypoplastic umbilical artery were detected over a 6-year period (1989-1995). Associated abnormalities included trisomy 18 (one case), polyhydramnios (three cases), congenital heart disease (one case), and fetal growth restriction (two cases). Maternal diabetes was detected in four cases. The pregnancy was terminated in one case; one neonate with severe fetal growth restriction expired; and one survived with congenital heart disease. The presence of hypoplastic umbilical artery was associated with increased perinatal morbidity and congenital abnormalities. Diabetes was frequently detected. Fetal surveillance and echocardiography are indicated in cases of hypoplastic umbilical artery.

Female↗
PubMed1997

Transabdominal chorionic villus sampling in the second and third trimesters of high-risk pregnancies.

Late chorionic villus sampling (placental biopsy) under ultrasound guidance was carried out in 800 (80 per cent) cases in the second trimester and 200 (20 per cent) cases in the third trimester of pregnancy. Out of 1000 placental biopsies, 250 (25 per cent) were performed because of suspicious ultrasonographic findings. Colour Doppler was used to investigate the uteroplacental and fetal vessels in 300 (30 per cent) pregnancies before and after late chorionic villus sampling (CVS). In the same group, mean serum alpha-fetoprotein (AFP) levels increased after sampling in 20 (6.7 per cent) patients. In 20 patients (2 per cent), complications between sampling and delivery were found. A placental haematoma measuring 0.5-1 ml was seen at the sampling site in 4 (0.4 per cent) patients in the second trimester of pregnancy and in 3 (0.3 per cent) in the third trimester. Two (0.2 per cent) demonstrated fever, but there were no instances of chorioamnionitis. There were only three (0.3 per cent) spontaneous abortions 4-6 weeks after late CVS. However, there was no correlation between AFP elevation, placental haematoma, Doppler measurements, and spontaneous abortion. Cytogenetic findings were obtained in 990 (99 per cent) of 1000 placental samplings. We found 60 (6.0 per cent) chromosomal abnormalities. In the group with suspicious ultrasonic findings (250 cases), we found significant oligohydramnios in 125 (50 per cent) and significant polyhydramnios in 60 (24 per cent), and 45 (18 per cent) had chromosomal abnormalities. Among the 60 patients with chromosomal abnormalities, ultrasonographic findings in 10 (16.7 per cent) were detected after the 20th week of pregnancy. There were no significant differences in mean pulsatility index (PI) in the uteroplacental and fetal vessels before and after late CVS. Preliminary data from five trisomic fetuses (three trisomy 21 and two trisomy 18) showed abnormally increased umbilical PI and abnormally decreased middle cerebral artery PI.

Adult↗
PubMed2000

Prenatal ultrasound of regional akinesia with Pena-Shokier phenotype.

This report describes sonographic features of the Pena-Shokeir phenotype secondary to regional akinesia at 28 weeks of gestation with maternal perception of good fetal movement. The diagnosis was based on the findings of no fetal activity in some parts of the body (upper limbs, a part of the face, and thorax), with deformation sequence of fixed flexion at wrist, elbow, and shoulder joints, fixed open mouth, fetal growth restriction, lung hypoplasia, polyhydramnios and normal chromosome study. Surprisingly, fetal akinesia involved only the upper limbs, a part of the face, and chest, whereas the lower limbs were completely normal in both morphology and activity. With vibroacoustic stimulation, the response of fetal heart rate acceleration, gross body movement including fetal head, spine and lower limb movement were observed, but the movement of the upper limbs and fetal breathing were completely absent. Spontaneous labour and delivery occurred at 29 weeks' gestation. Postnatal autopsy confirmed the prenatal findings. In conclusion, prenatal sonography plays an important role not only in detecting Pena-Shokeir phenotype but also in providing the detailed pattern of fetal akinesia. Finally, this case reaffirms the concept that function is an integral part of normal development.

Abnormalities, Multiple↗
PubMedDate not supplied

Feto-feto-fetal triplet transfusion syndrome (FFFTTS).

We report a case of feto-feto-fetal-transfusion-syndrome (FFFTS) in a spontaneous monochorionic triamniotic triplet pregnancy primarily diagnosed at 17 weeks of gestation. During the course of pregnancy, sequentially two triplets appeared as donor. Symptoms of a recipient (polyhydramnios, tricuspid valve insufficiency, and ascites) were present in the third triplet. The second of the donor twins died in utero at 25 weeks. At 27 weeks, a cesarean section was performed mainly due to pre-eclampsia. The first donor triplet developed normally, whereas the recipient showed periventricular leucomalacia and neurological impairment.

Cesarean Section↗
PubMedDate not supplied

Ballantyne syndrome: is placental ischemia the etiology?

Ballantyne syndrome is a condition in which the gravid patient essentially "mirrors" the in utero state of the hydropic fetus. The exact pathophysiological mechanism, however, is unclear. At 25 weeks gestation, a 28-year-old G3P2 presented with acute onset lower extremity edema, hyperuricemia, polyhydramnios, generalized pruritus, hemodilutional anemia, and pre-term labor. The human chorionic gonadotrophin (hCG) level was markedly elevated, at 570,020 mIU/ml. Postpartum, she developed a pre-eclampsia-like syndrome with oliguria and pulmonary effusions. Associated placental findings included a 8 x 7 x 7 cm chorangioma. Underlying placental ischemia, reflected by a hyperproliferative trophoblast, increased hCG secretion, and increased placental resistance may account for the maternal findings of Ballantyne syndrome.

Adult↗
PubMedDate not supplied

Successful management of fetal cervical teratoma using the EXIT procedure.

Fetal cervical teratoma is a cause of polyhydramnios, premature labor, and newborn airway obstruction. Formation of a multispecialty team and use of the EXIT procedure is essential for survival of the neonate. Without a team, there is little hope for fetal survival; mortality will be 80-100%. Early diagnosis and planning are essential. Cervical teratomas can contribute to pulmonary insufficiency and chondromalacia because of a mass effect in utero and underdevelopment of the fetal lungs.

Adult↗
PubMed1968

Renal tumors in the neonatal period.

Eight infants with renal tumors diagnosed in the first month of life are presented. Three well-differentiated mesenchymal tumors were studied using angiographic and electron-microscopic techniques in addition to conventional histologic methods. The morphology of these unusual tumors is presented in detail and classification as benign fibromyoma or fibromyomatous hamartoma is defended. An association between renal tumors in the newborn and maternal polyhydramnios is also documented for the first time.

Female↗