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PubMed2002

[Pregnancy-related thrombocytosis].

Pregnancy-related thrombocythaemia comprises myeloproliferative and inflammatory reactive subsets. In pregnant women treated for myeloproliferative disorders, especially polycythaemia vera and primary thrombocytosis, only 50-70 per cent are delivered successfully of a normal healthy baby. The maternal complications are cerebral, cardiac, and abdominal arterial thrombosis, and with deep venous thrombosis of the legs, whereas bleedings are mainly seen in the case of extreme thrombocythaemia, owing to absorption of factors by the platelets. The foetal complication are dominated by abruptio placentae, pre-eclampsia, placental insufficiency, and death. Reactive thrombocythaemia includes the physiological rise in platelets postpartum, believed to be part of the normal maternal haemostasis, which almost never causes thromboembolic complications, as far as is known today. In contrast, the inflammatory reactive thrombocythaemia, related to severe foetal and/or maternal necrosis, is generally related only to a moderate rise in the platelet count. As the blood-platelet count does not appear to be routine at general pregnancy check-ups, it is necessary to be aware of risk groups, consisting of women with otherwise unexplained abortions or stillbirths, unexplained foetal and placental malformations, and pre-eclampsia, even if the woman has never had any thromboembolic complications.

Anticoagulants↗
PubMed2002

Screening for inherited thrombophilia: indications and therapeutic implications.

BACKGROUND AND OBJECTIVES: In recent years knowledge concerning inherited and acquired causes of thrombophilia has increased greatly. The most common inherited traits (deficiency in antithrombin, protein C, or protein S, factor V Leiden, prothrombin G20210A) and mild hyperhomocysteinemia are diagnosed in at least 40% of patients with venous thromboembolism (VTE). INFORMATION SOURCES: The authors work in this field, contributing to multicenter clinical and laboratory investigations and to peer-reviewed journals with original papers. The material examined in this review includes articles published in journals covered by MedLine. STATE OF THE ART: The associated risk for VTE is different according to genotype, being higher among the carriers of natural anticoagulant deficiencies and homozygotes for factor V Leiden. The overall prevalence of thrombophilic traits in the general population being near to 10% renders the probability of carrying multiple defects not excessively rare, with a further increase in thrombotic risk of up to 20-fold. Thus, clinical penetrance is heterogeneous, producing either mild or severe venous thrombotic manifestations, which can be unprovoked or associated with circumstantial risk factors and occur in either young or advanced age. More recently, inherited thrombophilia has been focused on as an important determinant of complications of pregnancy and puerperium. As expected, inherited thrombophilia produces an increased risk of VTE, particularly during puerperium. Moreover it is well established that thrombophilic women have an increased risk of late and/or recurrent fetal loss; whether they are at higher risk of pre-eclampsia, fetal growth restriction, and abruptio placentae is debated. Overall, 40% of women with obstetric complications other than VTE carry a thrombophilic trait. Yet, as a rule VTE and obstetric complications seem to occur in different individuals, probably because of the presence of unknown factors favoring one or other of these clinical manifestations. CONCLUSIONS AND PERSPECTIVES: Inherited thrombophilia is now viewed as a multicausal model, the clinical event being the result of gene-gene and gene-environment age-dependent interactions; the associated clinical manifestations can be heterogenous as regards severity as well as type of event (VTE or obstetric complication). Therefore the criteria for screening affected individuals who have suffered from the above complications or their relatives should not be very stringent. The patient's genotype could be a main determinant of the features of primary or secondary prophylaxis used in the affected individual.

Antithrombins↗
PubMed2002

[Preterm labor: pathophysiology, risk factors and outcomes].

Preterm labor (PL) is the main cause for hospital admission during pregnancy. 50% of all pregnant women are diagnosed with PL. 7% of all neonates are born prematurely and one third of all preterm births follow PL with intact membranes. Previous history of preterm delivery, young maternal age, low socio-economical status are established risk factors of PL with intact membranes. Intrauterine infection, abruptio placenta praevia and uterine and cervical anomalies are often associated with PL with intact membranes. Cytokines, cortico-releasing hormone and the fetal hypothalamic-pituitary-adrenal axis could trigger the prostaglandin cascade leading to PL. However data are lacking to conclude. Intrauterine infection can also lead to neonatal infection in the preterm babies. This is also an important risk factor of cerebral lesions and cerebral palsy. Outside perinatal infection, PL does not seem to increase neonatal death and neonatal morbidity compared with other causes of preterm delivery.

Corticotropin-Releasing Hormone↗
PubMed1976

Ovarian pregnancy with delivery of a live baby.

A case of a primary ovarian pregnancy culminating in abdominal delivery of a live baby is presented. The absolute necessity of endometrial tissue for development of the fertilized ovum is discussed. Although in advanced ovarian pregnancy there is no profound difference from normal intrauterine gestation, it may mask the presence of an abruptio placentae.

Adult↗
PubMed2003

[Orientation after peripartum asphyxia in the maternity ward: which infants should be transferred to pediatric care units?].

Per-partum anoxia is a frequent situation facing the pediatrician in the maternity ward. The question is to decide which infants require care in a specialized unit. If transfer is decided, the infant must be referred to an appropriate pediatric unit (intensive care or neonatal unit). Cases of severe anoxia are exceptional. Intermediary situations are however much more frequent and raise difficult evaluation problems due to the lack of any specific test. The pediatrician must rely on a combination of elements from the clinical presentation, the medical history, the clinical course, and laboratory tests. Different elements suggest a prudent approach with referral to a pediatric unit. These elements include: imperfect clinical recovery (5-min Agpar <7), major intensive care at delivery (intubation, ventilation, vasoactive agents), anomalies in the cord blood or first hour blood tests (cord pH<7, base deficit 12, cord or blood lactate 9 mmol/l). Obstetrical circumstances which led to per-partum anoxia must be well identified because those interrupting placental flow (abruptio placenta, uterine rupture) suggest prudence is necessary even if the infant appears to have recovered well. All neonatal disorders (macrosomia, prematurity, infection, respiratory distress) increase the risk of rapid decompensation and may argue for hospitalization. Likewise, if even minimal signs of neurological, respiratory or hemodynamic disorders are present from birth to two hours, surveillance in a specialized unit is required, the level depending on local facilities. Certain situations nevertheless always require referral to a pediatric intensive care unit: use of vasoactive drugs, respiratory distress, abnormal neurological exam, poor recovery (5-min Agpar <4).Finally, it must be remembered that per-partum anoxia is rarely predictable and can occur any at any time of day or night. The pediatrician must also train other delivery room personnel, including the midwives, in intensive care techniques.

Apgar Score↗
PubMed2002

[Spontaneous hematoma of the rectus sheath during pregnancy: a case report].

A case of spontaneous rectus sheath hematoma is reported in a 32-year-old multigravida transferred to our antepartum unit for premature labor and persistent cough related to Candida dubliniensis upper airway infection. In pregnant patients presenting sudden-onset severe abdominal pain and parietal tenderness, there are two main differential diagnoses: abruptio placentae and aseptic necrobiosis of a uterine leiomyoma. The correct diagnosis may be obtained by ultrasonography and sometimes by computed tomography. In the present case an emergency cesarean section was performed at 35 weeks gestation after a 40% decrease in maternal hemoglobin and onset of fetal heart rate anomalies.

Adult↗
PubMed2002

Thromboprophylaxis throughout pregnancy in women with previous history of recurrent miscarriages of unknown aetiology.

The purpose of this prospective preliminary clinical study was to assess the efficacy of thromboprophylaxis throughout pregnancy in women with a history of unexplained first trimester recurrent miscarriages. From the 53 patients originally assigned to the study 15 were excluded. The remaining 38 were treated with low molecular weight heparin (LMWH-natroparine calcium 0.3 ml twice daily) and low dose aspirin from the day the fetal heart motion was detected until the 37th week or earlier at the onset of premature labor. Among the patients treated (n = 38) thrombophilia screening was positive in 16 patients and in the remaining 22 no causative factor was detected. The overall success rate (viable pregnancy > or = 24 weeks) was 92.2% with no significant difference between patients with positive or negative thrombophilia screening. The most significant complications were: preeclampsia (21%), IUGR (26%), placenta abruptio (5.2%), injection site haematoma (44%) and skin reaction (15.7%). No abnormal bleeding was observed during vaginal or caesarean section. The results of this study suggest that thromboprophylaxis during pregnancy, which has already been successfully tried in patients with recurrent miscarriages with a causative factor, may be similarly effective in patients with such a pregnancy complication but of unknown aetiology.

Abortion, Habitual↗
PubMedDate not supplied

Mechanical reaction of the frontal abdominal wall to the impact load during gravidity.

THE AIM OF THE STUDY: Selected parameters of mechanical characteristics of the gravid abdomen under impact load. TYPE OF THE STUDY: Experimental biomechanical study carried out in a human in vivo. METHOD: Damped vibration of the gravid abdomen was detected after a defined impact load using speed cinematographic recording of 103 pictures/sec. A women in 32nd week of gestation, performing toe stand and fall down to the heel, the drop was 0.08 m. The recording was digitalized and the values mathematically analysed. The method used was PAM (polynomial approximation method) of approximation of discrete coordinates. The umbilikus' trajectory in reaction to the impact load was described analytically and interpreted graphically. Parameters of abdomen vibration were detected in horizontal profile by tensometric belt. Impact in interaction of soles with the underlay was detected with the help of tensometric platform Kistler. Ultimate strength point of myometrium was set by tearing experiment in 12 samples. RESULTS: Calculation of characteristics of damped, aperiodic vibration of hydro-viscous elastic system as the outside behaviour of the gravid abdomen. Parameters in vertical direction of umbilicus: impulse in abdominal area - 2,72 Ns, T-period - 0.1299 s, amplitude - 0,009 m, frequency - 7,7 Hz, functional damping - from -6 to +12 Nsm-1. In horizontal direction: frequency 5,4 Hz, damping 123 Nsm-1. Impact in soles' sphere 40 Ns with maximum value 1511 N, which represents level 2,2 G. Ultimate strength point of myometrium is 0,1 - 1,1 MPa. CONCLUSION: The results show one of the possible critical, risky frequencies of the gravid abdomen, that is, in this concrete case, the frequency of the vibrating system of cca 7,7 Hz in vertical direction and cca 5,4 Hz horizontally. This implies that e.g. this frequency is dangerous (possible abruptio placentae) and is necessary to be avoided e.g. when travelling by means of public transportation. The applied analytic methods and presented parameters will be used for e.g. modelling the examined gravid system under impact load of a general character--locomotion, work-load, car accidents, etc.

Abdominal Wall↗
PubMed2003

Socio-economic and psychosocial factors in the management and prevention of preterm labour.

Socio-economic factors associated with preterm labour include social class, (usually assessed by earnings and education), working conditions (professional status, ergonomic environment, working hours), physical and travelling activities, daily life activities, lifestyle, family status and psychosocial state as related to past and current pregnancy history together with current stress factors. A review of the association of these factors with preterm birth will be reported with an emphasis of the biological plausibility linking mostly emotional, and at a lesser degree, physical and psychological stress to the occurrence of preterm labour. A case control study, carried out in Quebec City among 101 women in preterm labour and 202 matched pregnancies for parity and gestational age, identified 7 risk factors in an explanatory multivariate model among 117 variables: Body mass index (BMI) <20 (OR; 95% CI: 3.96; 2.61-7.09), previous preterm labour (OR; 95% CI: 3.61; 1.12-11.65) previous low birth weight (OR; 95% CI: 2.24; 1.05-7.71), standing at work >2 hours (OR; 95% CI: 3.90; 1.53-9.91), Abruptio placentae (OR; 95% CI: 5.88; 1.20-28.76), urinary tract infection (UTI) (OR; 95% CI: 4.4.3; 1.47-13.34), and stress score >5 (OR; 95% CI: 2.56; 1.20-5.54). The most stressful events were related to family illness, mortality, disruption, violence or financial distress. Some risk factors cannot be modified (previous preterm labour, low birth weight and UTI), while preventive efforts should be directed towards attaining BMI >20 before conception, modifying working conditions during current pregnancy and appropriate management of acute emotional stress.

Body Mass Index↗
PubMed2003

Placental sonolucency and pregnancy outcome in women with elevated second trimester serum alpha-fetoprotein levels.

BACKGROUND AND PURPOSE: Women with unexplained elevation of serum alpha-fetoprotein (AFP) are at increased risk for adverse pregnancy outcomes, including small for gestational age neonate, preterm labor, abruptio placentae, preeclampsia, intrauterine fetal death, and congenital malformations. This study investigated the association between placental sonolucency, elevation of maternal serum AFP, and pregnancy outcomes. METHODS: Singleton pregnancies (n = 168) with second trimester serum AFP level >/= 2.0 weight-adjusted multiples of the median (MoM) were recruited as the study group. Women with second trimester serum AFP level between 0.4 and 2.0 weight-adjusted MoM (n = 150) served as controls. A maternal Kleihauer-Betke stain was obtained for all participants. All participants were prospectively evaluated and the pregnancy complications were assessed by chart analysis after delivery. RESULTS: Compared with control subjects, women with placental sonolucent areas were not at increased risk for pregnancy complications, while women without sonolucent areas had higher risk of pregnancy complications. Singleton pregnancies with elevated serum AFP level had increased incidence of feto-maternal hemorrhage when placental sonolucency was observed. CONCLUSIONS: Our data suggest that feto-maternal hemorrhage may be the major factor contributing to elevated maternal serum AFP levels in pregnancies carrying placental sonolucencies. Screening for pregnancies with both elevated serum AFP and placental sonolucencies would help to identify the low-risk cases and facilitate cost-effective obstetric management.

Adult↗
PubMed1992

[Pregnancy in patients with essential thrombocythemia. Three cases].

The authors report 3 pregnancies in 3 patients with essential thrombocythemia. In the 3 cases, the course of the pregnancy was successful, with normal delivery in 2 cases, and premature delivery of a live fetus because of an abruptio placentae in the third case. From these 3 cases and a review of the literature, the authors analyse the fetal and maternal risks of pregnancy in these patients and the potential usefulness of preventive treatments (platelet antiaggregating drugs, anticoagulants). Besides, in these 3 cases a steadily decrease in blood platelet counts was observed during pregnancy with a nadir just before delivery followed by a sharp increase in the days following delivery. These findings may give some useful information on the regulation of thrombopoiesis.

Adult↗
PubMed2003

[Prevention of preeclampsia].

THE CURRENT SITUATION: Preeclampsia is associated with increased risk of adverse maternal (abruptio placentae, HELLP syndrome, eclampsia.) and perinatal death. Its prevention, therefore, is of particular importance. The latter must be determined together with the group of women who would benefit from it. THE INTEREST OF ASPIRIN: The best studied preventive treatment is low dose aspirin. The various studies on low-dose aspirin have confirmed its safety in pregnant women. These studies, in small cohorts of selected patients at risk or in large series of women with moderate risk, show that the use of aspirin is associated with a 15% reduction in the risk of preeclampsia. OTHER THAN ASPIRIN: Other preventive treatments, such as calcium have not demonstrated their efficacy, or their effect requires confirmation, such as with anti-oxidants or low molecular weight heparin. IN PRACTICE: The prevention of preeclampsia currently relies on low-dose aspirin started at the beginning of pregnancy. The moderate benefit of such prevention justifies its administration in patients at high risk, selected on their obstetrical past history.

Adult↗
PubMedDate not supplied

The antiphospholipid syndrome.

The antiphospholipid syndrome encompasses a wide spectrum of presentations cutting across all subspecialties of medicine. It is characterized by recurrent thrombotic events involving both the arterial and venous systems. Large arteries and veins as well as the microcirculation are involved. Recurrent strokes, myocardial infarction, pulmonary embolism, gangrene of the digits, etc. cause much morbidity and mortality in affected patients. It is recognized as an important cause of recurrent pregnancy loss. The risk in pregnancy extends to a propensity towards pre-eclampsia, abruptio placentae and intrauterine growth retardation. It often manifests as asymptomatic thrombocytopenia and sometimes as a life-threatening form called catastrophic anti-phospholipid syndrome. The management of thrombotic events rests on high grade anticoagulation (INR 3-4) as lower values of INR than this often fail to prevent recurrence. Aspirin is generally added in case of arterial thrombosis. A combination of heparin and aspirin at least in the first trimester and sometimes throughout pregnancy is used to prevent foetal loss.

Abortion, Habitual↗
PubMed1992

Factors influencing pregnancy outcome after trauma.

Trauma complicating pregnancy represents a significant threat to maternal survival and successful pregnancy outcome. Combining trauma center and perinatal center capabilities may provide improved outcome for pregnant trauma victims. The authors report their experience with 39 patients over a 10-year period to identify factors that influenced pregnancy outcome. There was 100 per cent maternal survival with a 77 per cent successful pregnancy rate. Unsuccessful pregnancy was associated with significantly higher injury severity score (ISS); regional abdominal abbreviated injury scores (AIS) and hospital charges; longer hospital and intensive care unit lengths of stay; a higher incidence of intubation and placenta abruptio; and a lower admission systolic blood pressure. Fetal ultrasound or Doppler were routinely used and contributed to trauma management. These findings support close cooperation and coordination of trauma and perinatal services to achieve optimal maternal and pregnancy outcomes.

Abbreviated Injury Scale↗
PubMed2004

Amnioreduction.

Pregnancies complicated by hydramnios are at increased risk of both maternal and fetal complications. Since amniotic pressure is elevated in polyhydramnios, it has been suggested that the complications may be mediated by anomalies connected with amniotic pressure. The rationale behind amnioreduction is thus to restore normal amniotic pressure by draining a large amount of amniotic fluid volume in order to reduce maternal discomfort, improve uteroplacental perfusion, and prolong pregnancy by limiting the risk of preterm labour and rupture of the membranes. The procedure has a complication rate in terms of spontaneous premature rupture of membranes, abruptio placenta, or chorioamnionitis, regardless of the technique adopted.

Drainage↗
PubMed2001

[Maternal morbidity and mortality in HELLP Syndrome].

OBJECTIVE: To describe the maternal morbidity and mortality in pregnancies complicated by HELLP Syndrome. STUDY DESIGN: This is a descriptive and prospective study of women with HELLP Syndrome managed at our center from January 1998 through March 2000. Patients are grouped into 3-class system of Mississippi classification. RESULTS: 170 cases were analysed, 156 (92%), ocurred ante partum and 14 (8%) postpartum; 15 cases (9%) developed at < 27 weeks, 112 (66%) between 28 to 36 weeks of gestational age and 43 (25%) at term. Maternal morbidity included acute renal failure (13.5%), abruptio placentae (6.6%), pneumonia (3%), subcapsular liver hematoma (2.3%), pulmonary edema (2.3%), diseminated intravascular coagulopathy (1.7%) and cerebral hemorrhage (1.2%). Maternal mortality was 4.7% (8 patients), 7 deaths ocurred in patients with class I disease and only one with class II HELLP Syndrome. 6 maternal deaths (75%) were associated to eclampsia. Up to 85% of the maternal morbidity and mortality developed with class I disease (platelet nadir < 50,000 mm3. CONCLUSIONS: There is a progressive rise in maternal morbidity and mortality as the pregnancy moves from class III to class I HELLP Syndrome. 75% of maternal mortality was associated with eclampsia. Early diagnosis of this syndrome could improve maternal prognosis and outcome.

Adult↗
PubMed2004

Smoking during pregnancy--United States, 1990-2002.

Cigarette smoking during pregnancy adversely affects the health of both mother and child. The risk for adverse maternal conditions (e.g., premature rupture of membranes, abruptio placentae, and placenta previa) and poor pregnancy outcomes (e.g., neonatal mortality and stillbirth, preterm delivery, and sudden infant death syndrome) is increased by maternal smoking. Infants born to mothers who smoke weigh less than other infants, and low birthweight (<2,500 grams) is a key predictor for infant mortality. Infertility and conception delay also might be elevated by smoking. National health objectives for 2010 target an increase in cessation to 30% among pregnant smokers during the first trimester and abstinence from cigarettes by 99% of women giving birth. To assess progress toward these goals, CDC analyzed state-specific trends in maternal smoking during 1990-2002 by using data collected on birth certificates. This report summarizes the results of those analyses, which indicated that whereas participating areas observed a significant decline in maternal smoking during the surveillance period, 10 states reported recent increases in smoking by pregnant teens. Although the widespread public health message to abstain from smoking during pregnancy has helped decrease maternal smoking, to reduce prevalence further, implementation of additional interventions are required.

Adolescent↗
PubMed1992

Cocaine: its effects on maternal and child health.

Cocaine abuse has become one of America's leading public health problems. Its use throughout pregnancy is associated with an increased risk of abruptio placentae, stillbirth, and preterm labor. Cocaine-associated neonatal complications include congenital malformations, decreased fetal growth, seizures, cerebral infarction and hemorrhage, auditory system deficits, sudden infant death syndrome, cardiac arrhythmias, necrotizing enterocolitis, and behavioral changes. Children followed throughout the first year of life continue to show developmental delay. Infants and children growing up in cocaine-abusing families are at risk for drug-related injuries. Accidental and intentional intoxication has occurred in infants and children from the smoke of freebase cocaine. The drug has also caused intoxication in breast-feeding infants. Adolescents experimenting with cocaine are at risk, with an apparently high frequency of seizures and loss of consciousness, as well as behavioral changes and psychosocial dysfunction.

Abnormalities, Drug-Induced↗