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At least 919 records · Page 51Linked to original sources
PubMed1999

[Anesthetic management of parturients with cerebrovascular diseases].

From January 1992 to December 1997, 13 parturients with cerebrovascular diseases had childbirth at our institution. Among them, 8 patients received anesthesia for delivery. Five patients had a history of ruptured arteriovenous malformation (AVM), cerebral aneurysm, or intraventricular bleeding due to moyamoya disease, and they had radical operations. Of these 5 patients after radical operations, three had a repeat cesarean section under spinal anesthesia, and two had a vaginal delivery under epidural anesthesia to avoid excessive hypertension and hyperventilation. There were two patients with a history of cerebrovascular diseases but had no radical operations. Of these two, one patient who was diagnosed as having aneurysm underwent elective cesarean section under spinal anesthesia, and another patient with a history of cerebral bleeding underwent cesarean section under general anesthesia for abruptio placentae. These 7 patients did well during pregnancy and puerperium. The eighth patient experienced severe headache followed by loss of consciousness caused by ruptured AVM, and required an emergency operation. Simultaneous cesarean section and craniotomy were performed at another hospital. Intrauterine fetal death (IUFD) occurred, but mother survived.

Adult↗
PubMed1999

Hypertensive disorders of pregnancy at Umtata General Hospital: perinatal and maternal outcomes.

BACKGROUND: Hypertensive disorders are a major cause of maternal and perinatal morbidity and mortality worldwide. The incidence and complications at Umtata General Hospital have not yet been documented, but clinical experience shows that hypertension is a common and serious problem. OBJECTIVE: To determine the incidence, clinical features, complications, and perinatal outcome in patients with hypertensive disorders of pregnancy. DESIGN: A cross-sectional analytical study. SETTING: Umtata General Hospital (UGH), a referral and tertiary institution. SUBJECTS: All patients with hypertension who delivered at Umtata General Hospital from January 1993 to December 1994. MAIN OUTCOME MEASURES: The incidence, presentation, maternal complications, and perinatal outcome. RESULTS: Of the 16,376 deliveries at UGH during this period, 760 (4.6%) were complicated by hypertension. The median age of the hypertensive women was 25 years. Teenagers comprised 27.3% of the cases and primigravidae accounted for 42.9% of all the cases. Proteinuric hypertension was present in 66% of the hypertensive women at admission and in 53.8% at delivery. Eclampsia occurred in 15% of the hypertensives, and the incidence of eclampsia in the general obstetric population at UGH was high at 7 per 1000 deliveries. Other maternal complications of hypertension included, pulmonary oedema (3.9%), abruptio placentae (1.7%), HELLP syndrome (1.2%), maternal death (1.0%), acute renal failure (0.9%), coma with cerebral pathology (0.5%), and DIC (0.5%). Hypertension accounted for 33% of all maternal deaths during this period, and almost all were eclamptic. The perinatal complications which occurred included preterm delivery (34%), low birthweight (19.9%), IUFD (11.2%), IUGR (6.6%), and neonatal deaths (3.8%). In general, eclamptic patients had significantly more maternal and foetal complications than non-eclamptic hypertensive women. CONCLUSION: Hypertensive disorders of pregnancy are a major cause of maternal and perinatal morbidity and mortality at UGH, as in other parts of South Africa. Only quality obstetric care can reduce the adverse effects of hypertension.

Adolescent↗
PubMed1999

Perinatal substance abuse and the drug-exposed neonate.

Tobacco and alcohol are the substances most abused during pregnancy. Alcohol (ethanol) is the human teratogen that produces the most serious neurobehavioral effects on the fetus. Cocaine is associated with spontaneous abortions, premature labor, precipitous labor, stillbirths, meconium staining and abruptio placentae. Heroin use during pregnancy has been associated with low birth weight, miscarriage, prematurity, microcephaly and intrauterine growth retardation. Marijuana is not scientifically linked to significant teratogenic effects. Since most substance abusers use multiple drugs, a positive screen for marijuana may indicate a high-risk patient. Cigarette smoking has been associated with spontaneous abortions, premature rupture of membranes, preterm delivery, perinatal death, low birth weight infants, and deficits in learning and behavior.

Adult↗
PubMed1999

[Antepartum brain injuries].

It is generally accepted that congenital brain lesions and especially cerebral paralysis are produced nearly always during the process of delivery. The origin can be hypoxia or obstetrical trauma. This has been true until the 70s, but from that period onwards, the incidence due to the delivery process has been reduced so dramatically, that its appearance can be considered as an accident, as in the umbilical cord prolapsus or during abruptio placentae. More than 80% of the cerebral paralysis occur before delivery due to a variety of causes that are detailed in this report and only the resting 20% can be related to foetal asphyxia, only if the following 4 signs appear: 1 Umbilical artery pH lower than 7.2 Apgar test after 5 minutes of 3 or less. 3 Appearance of a neurological hypoxic-isquemical syndrome. 4 Lesions in another organ that can be attributed to hypoxia. This new international definition indicates, the necessity to put aside the old definition still more generally accepted when a fetus is simply depressed but not with asphyxia. In the same way, the actual concept of fetal suffering during delivery needs also to be rejected not necessarily alterations are followed and can be considered as pejorative. Only if the suffering continues with asphyxia can be accepted.

Asphyxia Neonatorum↗
PubMed1999

[Myomectomy during cesarean section].

The purpose of this prospective study is to assess the possibility of myomectomy during CS as a routine method. The material includes 21 cases of myomectomy during CS. 162 consecutive CS without myomectomy are control group for hemorrhage during the operation. The myomectomy is accomplish according classical technique. Our data show that the myomas and pregnancy is found mainly in women after 30 years of age and is prevalent in nulliparas (70%). Single myomas were found in 85% of cases, 63% located in the corpus uteri and 46% of all myomas are confined to the myometrium. Related to the isthmus uteri are 23% of myomas. Myomectomy as a separate operation during CS increases the hemorrhage by 10%. The analysis of the cases with severe hemorrhage point to the placental disorders (abruptio placentae and placenta praevia) as a main cause of overall increased blood lost. Our limited experience with myomectomy as a protocol during CS irrespective of number and magnitude of myomas shows that this is possible. The postoperative period is without complications.

Adult↗
PubMed2000

[Inherited thrombophilia and pregnancy].

Inherited thrombophilia include deficiences of antithrombin III, protein C and protein S, and the factor V Leiden mutation, the prothrombin gene variant, and homozygosity for the thermolabile variant of methylenetetrahydrofolate reductase (MTHFR). The incidence of thromboembolism events during pregnancy and postpartum period among women with thrombophilia is not well known and depends on the prethrombotic state resulting from the interaction of the underlying thrombophilic defect(s), history of congenital thrombophilia, and additional risk factors. In that way, many patients with congenital thrombophilia will require antenatal thromboprophylaxis, the timing of which will depend on the patient's history and thrombophilic disorders. Low molecular weight heparin appeared to be a safe alternative to unfractionated heparin for both the fetus and the mother during the pregnancy. Case-control studies have recently demonstrated that serious obstetrical complications i. e severe preeclampsia, abruptio placentae, intrauterine growth restriction, and stillbirth were frequently associated with inherited thrombophilia. Controlled trials are now urgently needed to determine the possible potential benefits of anticoagulant therapy in pregnancy outcome. Finally, there is no evidence to support routine screening for congenital thrombophilia during pregnancy.

Antithrombin III Deficiency↗
PubMed2000

[Hyperhomocysteinemia and pregnancy: a dangerous association].

Homocysteine results from the demethylation of the essential amino acid methionine. Its metabolism depends primarily on three enzymes and several vitamin cofactors (vit. B6, B9 and B12). Genetic abnormality in these enzymes or deficiency of these vitamins lead to Hyperhomocysteinemia. Hyperhomocysteinemia belongs among the congenital thrombophilies and is a long-known vascular disease risk factor. The discovery that hyperhomocysteinemia may also be responsible for several pregnancy complications has only recently been made. Studies in this area are still scarce and report on limited numbers of patients. It nevertheless appears clear that HHCh is associated with the syndromes of repeated miscarriage, pre-eclampsia, placenta abruptio, thromboembolic events, neural tube defects, and perhaps with fetal death-in-utero and intra-uterine growth retardation. Supplementation with vitamin B9 can reduce plasma HC levels, and is thus recommended in patients with HHCh. The prevention of thromboembolic events during pregnancy by anticoagulant treatment is also desirable in these patients.

Abortion, Habitual↗
PubMed2000

Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates.

Data on maternal morbidity make it possible to assess how many women are likely to need essential obstetric care, and permit the organization, monitoring and evaluation of safe motherhood programmes. In the present paper we propose operational definitions of severe maternal morbidity and report the frequency of such morbidity as revealed in a population-based survey of a cohort of 20,326 pregnant women in six West African countries. The methodology and questionnaires were the same in all areas. Each pregnant woman had four contacts with the obstetric survey team: at inclusion, between 32 and 36 weeks of amenorrhoea, during delivery and 60 days postpartum. Direct obstetric causes of severe morbidity were observed in 1215 women (6.17 cases per 100 live births). This ratio varied significantly between areas, from 3.01% in Bamako to 9.05% in Saint-Louis. The main direct causes of severe maternal morbidity were: haemorrhage (3.05 per 100 live births); obstructed labour (2.05 per 100), 23 cases of which involved uterine rupture (0.12 per 100); hypertensive disorders of pregnancy (0.64 per 100), 38 cases of which involved eclampsia (0.19 per 100); and sepsis (0.09 per 100). Other direct obstetric causes accounted for 12.2% of cases. Case fatality rates were very high for sepsis (33.3%), uterine rupture (30.4%) and eclampsia (18.4%); those for haemorrhage varied from 1.9% for antepartum or peripartum haemorrhage to 3.7% for abruptio placentae. Thus at least 3-9% of pregnant women required essential obstetric care. The high case fatality rates of several complications reflected a poor quality of obstetric care.

Adult↗
PubMed2000

[Long-term course of liver rupture in preeclampsia. A case report].

A case report is presented of one preeclamptic patient with rupture of a big right subcapsular hematoma of the liver which was misdiagnosed with cholecystitis. A cesarean delivery was performed, which resulted is stillbirth, with abruptio placentae of 50%. The emergent treatment of the liver rupture was the right hepatic artery ligation, the postoperative development was favorable. Long term follow-up using ultrasound and liver function values were performed for 14 months and showed that the lesion has regressed with a normal hepatic imaging.

Adult↗
PubMed2000

[Dengue fever and pregnancy. A study of 38 cases in french Guiana].

OBJECTIVES: Evaluation of the consequences of a dengue fever infection on mother and foetus during pregnancy. PATIENTS AND METHODS: Between February 1, 1992 and December 31, 1999, 172 patients with non malaria hyperthermia were tested for dengue fever infection at the maternity of the Saint-Laurent-du-Maroni hospital in French Guyana. The diagnosis was considered positive when specific IgM was present and/or with virus isolation or viral ARN detection using RT-PCR. Among the 38 cases of mothers infected by dengue fever throughout the three trimesters of pregnancy, it was possible to take 19 fetal blood samples. RESULTS: The major consequences for the mothers were risk of premature delivery in 55% of the cases, one case of severe hemorrhagic complications during a cesarean section, and one case of abruptio placentae. The consequences for the fetus were premature birth in 22% of the cases, 5 in utero fetal deaths, 4 cases of acute fetal distress during labor and 2 cases of mother-to-child transmission. CONCLUSION: In case of dengue fever infection of the mother during pregnancy, there is a serious risk of premature birth and fetal death. In case of infection close to term, there is a risk of hemorrhage for both the mother and the newborn.

Dengue↗
PubMed2000

[Spontaneous rupture of uterine varices in the third trimester of pregnancy].

We report a case of spontaneous rupture of a uterine varicosis in the third trimester of pregnancy resulting in massive peritoneal hemorrhage and maternal shock. This patient with an uncomplicated pregnancy presented symptoms suggestive of abruptio placenta with foetal distress. A caesarean section was performed identifying the cause and permitting the treatment of this syndrome. Since 1950, only 8 cases have been reported.

Adult↗
PubMed2000

[Triplet pregnancies in materials from the Obstetrics and Perinatology AM in Lublin in 1989-1999].

A retrospective analysis of 14 triplet pregnancies at the Department of Obstetrics and Perinatology, University School of Medicine in Lublin, from January 1, 1989 to June 30, 1999 was undertaken. All pregnancies were ended by cesarean section. No difference in Apgar score and in average birth weight between I, II and III foetus was observed. The mean hospitalisation time for mothers was 32.5 +/- 29.01 days and the mean gestational age at delivery was 32.14 +/- 3.44 weeks. The indication for cesarean section in all cases was triplet pregnancy and additional complications: threatened intrauterine infection, threatened intrauterine asphyxia, abruptio placentae, preterm labour. Perinatal mortality rate was 12.82%.

Adult↗
PubMed2001

An audit of perinatal mortality.

Perinatal mortality rates are considered in the western world to be a quantitative barometer of maternity care. This 6-year prospective perinatal audit was conducted at a tertiary hospital in order to determine foetal outcome, and the common causes of foetal and early neonatal deaths. Of a total of 30,987 births, there were 469 stillbirths and 391 early neonatal deaths, giving a perinatal mortality rate of 27.7 per 1000 total births. The leading causes of stillbirths were the hypertensive disorders of pregnancy, abruptio placentae, diabetes mellitus, intrapartum foetal distress and lethal congenital anomalies. Neonatal deaths were mainly due to the respiratory distress syndrome (57.8%), birth asphyxia (22.2%) and sepsis (13.5%). A dedicated medical team, including a neonatologist, to manage pre-eclampsia, and more senior obstetric involvement in the labour ward are recommended.

Birth Weight↗
PubMed2001

[Perinatal results in patients with chronic hypertension at the National Institute of Perinatology].

There are many causes of Chronic Hypertension, and all can be present in pregnant women. The literature reports an incidence between 1-3%. The prognosis usually is favorable, if we have an excellent control of blood pressure along pregnancy. But the risks like abruptio placentae, fetal demise or fetal growth restriction have a greater incidence than in the health population, furthermore the superimposed preeclampsia increase notably the perinatal morbidity. The objective of this study is to determine the perinatal outcomes in women with chronic hypertension in the Instituto Nacional de Perinatología. In the study we included 66 patients with chronic hypertension with age between 21-45 years old, and 54.4% had an age between 30-40 years. The evolution time of hypertensive disease was 5 years or less principally (71.2% of the patients).

Adult↗
PubMed2001

Thrombophilia, thrombosis and pregnancy.

The risk of venous thromboembolism (VTE) in pregnancy is 0.05-1.8%, six times greater than in the non-pregnant state, and pulmonary embolism remains the most common cause of maternal death. Maternal age, previous history of VTE, Caesarean section and the presence of thrombophilia, significantly increase the risk of VTE. Acquired or hereditary thrombophilia occur in almost two-thirds of women presenting with recurrent miscarriages, pre-eclampsia, intrauterine growth restriction, abruptio placentae, or stillbirth, which are associated with microvascular thrombosis in placental blood vessels. Women with VTE during pregnancy and especially those with thrombophilia require individualized management, based on the type of defect, the family history and the presence of additional risk factors. These factors are important in determining the dose and duration of antithrombotic therapy during pregnancy and the puerperium, and the thromboprophylactic strategy for future pregnancies. Oral anticoagulants are now seldom used during pregnancy because of their significant side effects. Low-molecular-weight heparins (LMWHs) are increasingly replacing unfractionated heparin in the prevention and treatment of VTE during pregnancy. LMWHs have also been shown to be effective in improving the outcome of pregnancy in women with previous obstetric complications.

Female↗
PubMed2001

[Frequency of antiphospholipid antibodies and Leiden mutation of hemostasis Factor V in unexplained recurrent fetal and embryo loss].

Object of the study are women with a history of unexplained recurrent embryo, fetal and early neonatal death, severe preeclampsia, fetal growth retardation, abruptio placentae, puerperal thromboses. Quite often placental insufficiency is linked to abnormal vascular system and hemostatic disturbancies. In about 65% of the women with a complicated and in 18% of the women with a normal pregnancy are observed different genetic anomalies that lead to a hypercoagulative state. A major place is taken by the Leiden mutation of hemostasis factor V, by protein C and protein S deficiency, etc. Another disease that leads to arterial and venous thromboses and is most often linked to recurrent miscarriage is the antiphospholipid syndrome. Many authors confirm the findings of large placental infarctions and thromboses in women who are positive for antophospholipid antibodies.

Abortion, Habitual↗
PubMed1975

Disseminated intravascular coagulation in gynecologic cancer.

Disturbances in the blood coagulation mechanism are seen by the obstetrician and gynecologist as rare complications of abruptio placentae, retained dead fetus syndrome, amniotic fluid embolism, toxemia, saline amnioinfusion, and septic abortion. Two cases of disseminated intravascular coagulation complicating gynecologic malignancy are presented. Laboratory studies showed thrombocytopenia, hypofibrinogenemia, and increased fibrin degradation products. Derangements of hemostasis in patients with malignancy are discussed from a clinical viewpoint.

Blood Coagulation Tests↗
PubMed2002

Clinical and laboratory features of congenital factor XIII deficiency.

OBJECTIVE: This is a retrospective analysis of the clinical and laboratory features of 17 cases of factor XIII deficiency that were followed in tertiary care hospitals in Riyadh, Kingdom of Saudi Arabia, over 20 years. Cases were referred to these hospitals from other health care centers in the country. METHODS: We performed a retrospective analysis of 17 cases of factor XIII deficiency comprising 11 males and 6 females, who were seen over a period of 20 years (1978-1998) in Riyadh, Kingdom of Saudi Arabia. Data variables including age, sex, origin, clinical presentation, bleeding time, prothrombin time, partial thromboplastin time, factor XIII screening and assay, hemoglobin, and platelet count were collected and analyzed. The diagnosis of factor XIII deficiency was made by urea clot lysis test alone in one patient and urea clot lysis test in combination with factor XIII quantitative assay in 16 patients. RESULTS: Eleven patients were males and 6 were females. Median age at the time of diagnosis was 9 years (3-29 years). Ten patients (59%) had a family history of excessive bleeding. Presenting symptoms included ecchymosis and recurrent hematomas in 12 patients (71%), bleeding after circumcision in 6 male patients (55%), umbilical stump bleeding in 7 (41%), poor wound healing and keloids in 3 patients (18%), and intracranial bleeding in 3 patients (18%). Other manifestations included cephalohematoma, abortion, abruptio placenta, and intraperitoneal bleeding (one patient each). Laboratory evaluation revealed a normal prothrombin time, partial thromboplastin time, bleeding time and platelet count in all patients. Factor XIII screening test was positive in all 17 patients tested and assay for factors XIII was <0.06 U/ml in 16 patients tested. CONCLUSION: Our data confirms that factor XIII deficiency is a rare bleeding disorder characterized by variable bleeding manifestations but consistent laboratory findings. The occurrence of keloid in our patient group may reflect the poor quality of the clotting, associated with loss of tensile strength of fibrin polymers, caused by factor XIII deficiency and leading to abnormally large scar formation.

Adolescent↗