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PubMed2004

[Postpartum hemorrhage: frequency, consequences in terms of health status, and risk factors before delivery].

In the developing countries, postpartum hemorrhage is the leading cause of maternal death and affects approximately 1% of pregnant women. In developed countries like ours, maternal mortality is one hundred fold lower but remains the cause of maternal death for about 10 women per 100,000 births. In the last decade, French confidential inquiries show that the number of maternal deaths by postpartum hemorrhage are probably the double of the number in nearby countries, whereas hemorrhage should no longer be the leading cause of maternal death in our countries. Postpartum hemorrhage is defined as the loss of 500 ml or more blood in the 24 hours following delivery (5% of deliveries), but maternal tolerance is really threatened starting from 1,000 ml (1% of the women approximately). "Life-threatening" situations concern approximately one patient in one thousand so that obstetricians are rarely faced with this situation. For maternal morbidity or mortality, the risk factors of postpartum hemorrhage are nearly the same: maternal age, multiple pregnancies, uterine scars, abruptio placentae, cesarean section, poor social condition and absence of prenatal care constitute the main risk factors of postpartum hemorrhage. Maternal age must be kept in mind because it is the most related to mortality by hemorrhage, even if prevention is difficult. However, progress in delivery care which are applied to all the patients could make it possible to limit the harmful effects of this risk factor. A recent study showed that organizational factors also part of the factors of risk of maternal morbidity/mortality and could be studied for intervention.

Cause of Death↗

PubMed2004

Postmortem diagnosis of Diamond-Blackfan anemia.

Diamond-Blackfan anemia (DBA) is a rare etiology for congenital anemia, but this diagnosis should be considered when aregenerative hypoplastic anemia occurs in infancy. A term infant girl received a red blood cell transfusion at birth for neonatal anemia (hemoglobin 75 g/L) initially attributed to abruptio placentae. There were no additional investigations. Hemoglobin gradually decreased during the first 4 weeks of life, leading to severe anemia and death despite transfusions. A postmortem diagnosis of DBA was made by extraction of DNA collected on blood filter paper showing a deletion in RPS19 gene. Neonatal anemias should be carefully investigated and close follow-up should be performed during the first months of life, even if there is an obvious hemorrhagic etiology.

Anemia, Diamond-Blackfan↗

PubMed1992

Doppler ultrasound in prenatal prediction and diagnosis.

Preeclampsia, intrauterine growth retardation, and abruptio placentae are associated with the failure of the placenta to create an adequate communication with the maternal vasculature and subsequently reduced placental perfusion, with secondary effects on villous maturation and placental function, thereby failing to meet the needs of the growing fetus. Also, primary failure of placental maturation has been linked with the chromosomally abnormal fetus. Doppler ultrasound allows examination of blood flow in maternal and fetal vessels and assists in our ability to understand, predict, and diagnose pregnancy complications. Over the last 10 years there has been a rapid development in the capacity and complexity of the equipment used for clinical Doppler examination, from simple continuous wave devices to duplex-color flow systems, and the advantages of these developments continue to be defined. As with all innovations there has been a period of extensive appraisal of this technology, and further applications of Doppler await clarification. This review puts the most recent publications in perspective, and points to the likely areas of interest in the future.

Blood Circulation↗

PubMed1992

[Maternal mortality at the Maternity and Neonatology Center in Rabta of Tunis from 1986 to 1989].

We studied 29 cases of maternal death occurring over a period of 3 years in the "Centre de Maternité et de Néonatologie de La Rabta-Tunis"; managed by the same staff. 42,028 live births occurred during the study years with 43,220 total births from April 24th 1986 to April 23rd 1989. The maternal mortality rate was 69 per 100,000 live births. A maternal age of under 35, nulliparity and grand multiparity were found, as is well known, to be risk factors. Maternal transfer in obstructed labour from rural maternity units raises the maternal death risk 12 times: 14 deaths out of 29 occurred in transferred patients. Haemorrhage represents a quarter of the causes of death (8 cases) while anaesthetic accidents were responsible for one in six maternal deaths. Some factors were not found such as abruptio placentae, while others such as eclampsia were reduced. We concluded that the maternal mortality rate even though it has been reduced over the last 3 decades it is still high compared with developed countries. We can cut it in half by avoiding maternal transfer in labour.

Adolescent↗

PubMed2005

[Smoking and pregnancy complications].

Because of changing trends in feminine behavior concerning smoking and pregnancy, we must seriously modify our objectives of prevention. The deleterious risks attributable to smoking in pregnant woman are well known. Abruptio placentae is one of the most devastating. It is also known that the risk falls rapidly with abstinence from smoking. So why so much silence on the topic? Why so little interest in motivating our patients to stop smoking while other efforts in gynecology-obstetrics have met with success? The objective could be to imitate our Swedish colleagues. In 1983, 31% of Swedish women smoked daily in the beginning of pregnancy, in 1997 not more than 16%.

Female↗

PubMed2005

Frequency of thrombophilia in patients with adverse pregnancy outcome.

OBJECTIVE: To determine the association between adverse pregnancy outcomes and thrombophilia. METHODS: This is a descriptive study, incorporating retrospective analysis of patients with recurrent pregnancy losses, intrauterine deaths, abruptio placenta and early onset pre eclampsia. Patients with adverse pregnancy outcomes in whom co-morbid factors were excluded underwent screening for both acquired and inherited thrombophilia. RESULTS: A total of 40 patients were screened for acquired and inherited thrombophilia with adverse pregnancy outcomes. Anticardiolipin antibodies were found positive in 55% of patients and 45% of patients were found deficient for natural anticoagulants protein C and S. Two patients were found positive for both acquired and inherited thrombophilia. CONCLUSION: Thrombophilia, both acquired and inherited are associated with adverse pregnancy outcomes. Patients in whom other co-morbid factors are excluded, should be offered screening for thrombophilia. Liaison between hematologist and obstetrician is the corner stone for success.

Female↗

PubMed2005

Fertility outcomes following myomectomy in an urban hospital setting.

OBJECTIVE: Infertility is rarely a consequence of myomas. However, a causal relationship may be suspected when other causes of infertility have been excluded. Uterine myomas have been reported in 27% of infertile women; 50% of women with unexplained infertility become pregnant after myomectomy. The objective of this study was to establish the impact of the surgical removal of myomas on fertility outcomes in women experiencing recurrent pregnancy loss or unexplained infertility. Fallopian tube, anovulatory disorders and male fertility factors had been appropriately excluded. DESIGN: This was a retrospective study in which we compiled data from the medical records of eight patients from 2003-2004 who underwent abdominal myomectomy for infertility or recurrent pregnancy loss. We calculated rates for subsequent spontaneous abortion, preterm delivery, cesarean delivery, malpresentation and postpartum hemorrhage. RESULTS: There were two patients who were nulliparous premyomectomy, and six had recurrent pregnancy losses. There was a cumulative success rate of 75% (six live births in eight patients) following myomectomy. One had two subsequent pregnancies. There were no spontaneous abortions. Three (37.5%) patients failed to conceive postmyomectomy, one of which was found to have bilateral tubal occlusion. Of the six pregnancies achieved, two (33%, 95% CI 2.06, 3.14) were preterm deliveries, six (100%, 95% CI 1.74, 3.50) were delivered by cesarean section and three (50%, 95% CI 3.50, 1.73) were malpresentations (two breech, one transverse lie). One patient (16%, 95% CI 2.06, 3.30) had abruptio placentae and two patients (33%, 95% CI 2.06, 3.14) experienced postpartum hemorrhage. CONCLUSION: This study suggests that there may be a beneficial effect of surgical removal of myomas on enhancing fertility and successful pregnancy outcome. However, the sample was too small to achieve statistical significance.

Abortion, Habitual↗

PubMed2006

Associated risk factors with ante-partum intra-uterine fetal death.

OBJECTIVE: To determine ante-partum maternal risk factors for intrauterine fetal death. METHODS: We carried out a case control retrospective study, at the Maternity and Children's Hospital, Jeddah, Kingdom of Saudi Arabia. We included all pregnant women diagnosed as singleton intra-uterine fetal death in the third trimester with fetal weight of 1500 gm and more, admitted to the hospital over a 2-year (2001-2002) period (study group). We examined the following risk factors: diabetes, hypertension, abruptio-placenta, age, gestational age, parity, trauma, sepsis, booking, chromosomal abnormality, previous history of intra-uterine fetal death (IUFD) and intra-uterine growth restriction (IUGR). We compared the results to those pregnant women with live pregnancy admitted before and after each case (control group). RESULTS: There were 157 cases of singleton IUFD during that period. The intra-uterine fetal death rate was 10.1 per 1000 deliveries. In 28% of the cases, we could not determine the associated risk factors. Among cases there were 57.3% (odds ratio [OR] 2.4 95% confidence interval [CI] 1.4-4) lacking antenatal care, cord accident in 56.6% (OR 5.1% 95 CI 2.7-9.5), 29.3% (OR 5.5 95% CI 2.4-12.6) hypertension, 26.1% (OR 12.9 95% CI 5.5-30.6) diabetes, IUGR in 24.8% (OR 1.73% 95% CI 1.1-2.7), 14% (OR 23.4% 95% CI 4.6-119.3) abruption-placenta, and previous history of IUFD in 8.3% (OR 7.01 95% CI 2.1-23.6). Other risk factors found were age between 20-30 years in 51.6%, gestational age between 37-41 weeks in 58.6%, parity between 0-5 in 77.1%, and chromosomal abnormality in 5.7% (OR 0.91% 95% CI 0.91-0.99). CONCLUSION: The identified risk factors for IUFD in our community appear preventable. We should pay attention to health education with emphasis on antenatal care and the benefits of regular clinic attendance. Patients compliance is important in reducing most of these preventable fetal deaths.

Case-Control Studies↗

PubMed1991

Reproduction in the older gravida. A literature review.

Infertility, spontaneous abortions and trisomic anomalies increase with maternal age, as do ectopic pregnancy, low birth weight, macrosomia, abruptio placentae and labor dysfunction. However, those phenomena are multifactorial in origin and cannot be ascribed solely to advancing age. Older pregnant women are also at increased risk for diabetes and hypertension. Whereas the older gravida is at increased risk for maternal mortality and morbidity and for fetal and infant mortality, those problems are explainable in large part by coexisting medical complications. The healthy older pregnant woman who receives appropriate prepregnancy counseling and up-to-date perinatal care can achieve results comparable to those achieved by younger ones.

Abortion, Spontaneous↗

PubMed1991

Cocaine, fetal loss, and the role of the forensic pathologist.

Adverse obstetrical outcomes are often associated with maternal cocaine use. These have included intrauterine growth retardation, abruptio placentae, and an increased incidence of spontaneous abortion and pre-term labor. This report details the case of an 18-week-gestation fetus recovered from a sewage treatment plant. A brain specimen was positive for cocaine. With the present epidemic of cocaine abuse, it is important for the forensic pathologist to seek toxicologic evidence of cocaine in all suspicious fetal and neonatal deaths.

Brain Chemistry↗

PubMed1991

External cephalic version of term singleton breech presentations with tocolysis: a retrospective study in a community hospital.

External version with the use of tocolysis in low-risk patients has been shown to be relatively safe and effective. A retrospective analysis was undertaken to see if version was practical for a smaller community-based hospital. Thirty-two antepartum external cephalic versions with ritodrine tocolysis during a 4-year period were reviewed. Successful version occurred in 59.4% of attempts. Of patients with a successful version, 68.4% delivered vaginally. One successful version occurred spontaneously with ritodrine tocolysis alone. A stillbirth due to abruptio placentae occurred 20 hours after a failed version attempt.

Adult↗

PubMed1991

[Analysis of hysterectomies in 118 obstetric cases].

During a period of 36 years, the rate of hysterectomy was 0.054% of all obstetric patients in our hospital, 0.0446% of cesarean section cases, and 0.005% of vaginal deliveries respectively. From 50 s to 80 s, the cesarean section rate greatly increased while the hysterectomy rate in parturition decreased. The indications for cesarean hysterectomy change from ruptured uterus, abruptio placenta and intrapartum infection to uterine atony highly increased placenta or myoma of the uterus. Cesarean hysterectomy rate due to splitting of uterine wound after cesarean section highly increased in 80 s. Bleeding for more than 1,000 ml during operation accounted for 62.7% of them. However, operative complication rate reached to 11.8%. To reduce cesarean hysterectomy rate, we suggest emphasizing maternal health care, use of uterine packing to lessen bleeding and careful management of operation as important means for reducing uterine incision wound splitting after cesarean section.

Adult↗

PubMed1991

Perinatal mortality in Jinnah Postgraduate Medical Centre, Karachi.

During the one year period from 1st January to 31st December, 1989, there were 6,826 deliveries and 695 perinatal deaths, of these 553 were still-born and 142 were neonatal deaths (died within 7 days of birth). The perinatal mortality rate was 101.8 per thousand total births. The still-birth rate was 81 per thousand total births. Of the perinatal deaths, 7.9% occurred in booked and 92.1% in non-booked cases. The commonest cause of death was antepartum haemorrhage (APH), 24.2% followed by mechanical which accounted for 23.6% deaths. Abruptio placentae was the leading cause among all still-births and low-birth weight (LBW) in all neonatal deaths.

Academic Medical Centers↗

PubMed1991

The causes of perinatal deaths in the greater Cape Town area. A 12-month survey.

A detailed analysis of 854 perinatal deaths according to both fetal and obstetric cause is presented. The ratio of stillbirths to neonatal deaths was 2.3:1. Almost 25% occurred in unbooked mothers. The major problems identified were preterm labour, unexplained stillbirth, abruptio placentae, infection, and protein-uric hypertension.

Cause of Death↗

PubMed1991

Evaluation and treatment of the gravida and fetus following trauma during pregnancy.

The management of trauma during pregnancy requires an interdisciplinary team approach involving surgeons, emergency medicine physicians, and obstetricians. Management principles are similar to those utilized in nonpregnant patients, but a number of unique circumstances must be considered, including physiologic changes of pregnancy, diagnosis and management of abruptio placentae and fetomaternal hemorrhage, and the management of traumatic cardiac arrest during pregnancy. The routine use of cardiotocography, Kleihauer-Betke assay, and perimortem cesarean section are discussed as new principles in the management of trauma during pregnancy.

Female↗

PubMed1991

[Successful pregnancy after 6 years complete remission in patient with acute myeloblastic leukemia].

A 25-year-old woman was diagnosed as acute myeloblastic leukemia (M1 in FAB classification) in May 1983, and treated with DCMP regimen, which led to the complete remission. Intensification therapies and maintenance therapy with OK-432 were continued until August 1988, and 10 months later she conceived. She delivered a healthy 2,680 g male baby at 36th week of pregnancy by Cesarean section because of abruptio placentae. This case suggests that normal pregnancy is possible in patients with acute leukemia who received anti-cancer drugs.

Adult↗

PubMed1991

Platelet count and liver function tests in proteinuric and chronic hypertension in pregnancy.

Platelet counts and plasma enzyme estimations were performed in 207 pregnant patients with proteinuric hypertension and in 60 patients with chronic hypertension. Patients with abruptio placentae were excluded. In the proteinuric hypertensive patients a low platelet count (less than 150,000/mm3) was found in 63 (30%) and elevated transaminase levels in 50 (24%) and both abnormalities were present in 47 patients (23%). The serum lactate dehydrogenase (LDH) value was mildly elevated in most proteinuric hypertensive women, but a markedly elevated LDH level (greater than 400 IU/l) was usually associated with other evidence of liver necrosis. Raised plasma alkaline phosphatase and gamma-glutamyltransferase levels were not related to the occurrence or severity of liver necrosis. In proteinuric hypertensive patients a low platelet count or elevated transaminase level was associated with deteriorating renal function, increased maternal morbidity, increased incidence of low-birth-weight babies and a raised perinatal mortality rate (149/1,000). In patients with chronic hypertension, 1 had a low platelet count but none had elevated transaminase, LDH or other enzyme levels and there was no recorded perinatal mortality.

Adolescent↗

PubMed1991

Developmental pathogenesis of defects associated with prenatal cocaine exposure: fetal vascular disruption.

Prenatal exposure to cocaine is associated with a spectrum of defects that are secondary to interruption of blood flow to developing or previously developed structures. The defects include prenatal onset growth deficiency, prematurity, abruptio placentae, intercranial hemorrhage, nonduodenal intestinal atresia, limb reduction defects, urinary tract anomalies, and neurodevelopmental problems limited at present to the neonatal period.

Abnormalities, Drug-Induced↗