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PubMedDate not supplied

Mucoepidermoid tracheal adenoma during pregnancy.

A 30-year-old, 36-week pregnant, female was admitted to the hospital with progressive "asthma" and wheezing. She was markedly dyspneic and unable to lie down or to sleep for periods over an hour. Bronchoscopy demonstrated an endobronchial tumor just above the carina. Following ventilating tracheal bronchoscopy with dilatation of the trachea and establishment of an airway through the tumor, a cesarean section was performed with resultant delivery of a healthy, female, infant. A partial abruptio placentae was noted. Under the same anesthetic, a right posterior lateral thoracotomy with resection of the tracheal tumor was performed. Preoperative and operative considerations are described.

Adenoma↗
PubMed1984

Antepartum diagnosis of fetal intracranial hemorrhage by ultrasound.

Presented is a patient with acute onset of preeclampsia and abruptio placenta at approximately 26 weeks' gestation. Ultrasonography demonstrated evidence of in utero fetal intracranial hemorrhage, which was confirmed at autopsy. The implication of this finding is discussed.

Adult↗
PubMed1984

Trends in adolescent pregnancies at Tygerberg Hospital, 1976-1980.

This study was undertaken to highlight trends relating to pregnancies among females aged less than 21 years seen at Tygerberg Hospital, Parowvallei, CP, during the 5-year period 1976-1980 inclusive. There was a fairly steady decline in the pregnancy rate for Coloured adolescents over this period. The rate for Black adolescents increased after a 3-year decline, and that for Whites also increased after a 2-year drop. The caesarean section rate increased after a marked drop in 1978, both in White adolescents and in the White group as a whole, possibly due to an increase in the instrumental delivery rate in 1978. The caesarean section rate has increased steadily among non-Whites, while the forceps delivery rate for non-Whites declined to below the normal level of 15% and that for Whites fell after a steep increase in 1978. Vacuum extractions appeared to be very popular during the first 3 years, but the rates declined rapidly towards 1979-1980, particularly in the White group. Pre-eclamptic toxaemia remains a problem among White adolescents. Among both Whites and non-Whites 1978 seems to have been a disastrous year as far as the outcome of pregnancies is concerned, with an increase in the incidence of miscarriage. A drop in the non-White stillbirth rate in 1978 was followed by a sharp rise in 1979-1980. The incidence of abruptio placentae and placenta praevia rose in 1978, but in 1979-1980 dropped to below 10% for Whites and to below 15% for non-Whites. Premature deliveries are still common among non-Whites, with average incidences of 23% for the 5-year period for non-Whites and 8,5% for Whites. Pregnancy rates for unmarried Coloured and Black adolescents remain high, and the rate for Whites increased slightly over the 5-year period.

Abortion, Spontaneous↗
PubMed1983

Maternal age, obstetric complications, and the outcome of pregnancy.

Data from 44,386 pregnancies were analyzed to determine if advancing maternal age influences frequency or outcome of antenatal disorders. The perinatal mortality rate progressively increased from 25/1000 at age 17 ro 19 years to 69/1000 after age 39. Stillbirths accounted for 92% of this increase. Fourteen percent of the increase was due to congenital malformations and 50% to disorders associated with uteroplacental underperfusion, ie, abruptio placentae, large placental infarcts, and placental growth retardation. Sclerotic lesions in the myometrial arteries are a possible cause of underperfusion because the proportion of arteries with these lesions increased from 11% at age 17 to 19 years to 83% after age 39.

Adolescent↗
PubMedDate not supplied

[Detection and treatment of renovascular syndromes of pregnancy excluding their progressive complications].

Three symptoms define the renovascular syndromes during pregnancy: hypertension, edemas and proteinuria. It is essential to detect them as soon as possible during the antepartal examinations. The directions for treatment consist in simple acts which are easy to perform in overseas conditions. They intend to prevent very serious disorders such as abruptio placentae and eclampsia which should not be found any longer.

Female↗
PubMed1981

Cesarean section indication and the risk of respiratory distress syndrome.

The frequency of respiratory distress syndrome (RDS) was assessed according to indications for delivery and the presence of antecedent labor among 236 newborns delivered by cesarean section. The presence of labor preceding cesarean section did not reduce the risk of RDS significantly, although a trend, not statistically significant, was noted in this direction. Of the delivery indications evaluated, only abruptio placentae appeared to be associated with an increased risk of RDS. However, prematurity was shown to be a possible confounding variable in this regard. These data suggest that the risk of RDS associated with cesarean section is related to the mode of delivery per se and not necessarily to any of the associated factors evaluated in this study.

Birth Weight↗
PubMed1982

A case-control study of stillbirths at a teaching hospital in Zambia, 1979-80: antenatal factors.

A total of 266 mothers of stillborn babies (cases) and 266 mothers of live-born babies (controls), matched for parity, were studied in an attempt to define the causes of the stillbirths. Altogether, 16% of mothers in the former group were over 35 years old, compared with 9% in the latter; in addition, 16% of cases had a history of past perinatal death, compared with only 2.4% among the controls.Mothers of stillborn babies had fewer attendances at the antenatal clinic and a longer interval between the last visit and delivery, compared with the control group; 8% of the former group had no antenatal care. Only 47% of mothers had a Venereal Disease Research Laboratory (VDRL) test reported before delivery. The VDRL test was positive in 34% of the cases tested and in 7% of controls.Of the 266 stillborn infants, 56% were of low birth weight; 12% of the 170 macerated stillbirths were associated with intrapartum problems that may have contributed to death, compared with 46% of the 96 fresh stillbirths. Prolonged labour and prolapsed cord were the commonest intrapartum factors associated with death. The most common antepartum factors were a positive VDRL test, abruptio placentae, and a history of illness. A total of 5% of the stillborn infants had some congenital abnormality. No cause of death could be identified in 13.5% of these infants, the majority of whom were of low birth weight.

Adult↗
PubMed1982

Causes of fetal and neonatal mortality in a South African black community.

Little has been published about the underlying disorders responsible for the high perinatal mortality rates found in African cities. We searched for answers by identifying the causes of fetal and neonatal death in Blacks living in and around Durban. A 91% autopsy rate was achieved when 506 postmortem examinations were performed in 557 consecutive cases of fetal and early neonatal death. The perinatal mortality rates were 55/1000 for single births and 170/1000 for twins; 29% of the deaths were due to amniotic fluid infections, 9% to abruptio placentae, 5% to birth trauma, 4% to congenital syphilis, 4% to obstructed labour, 4% to major congenital malformations, 2% to umbilical cord compression and the rest to more than 20 other specific disorders.

Africa, Northern↗
PubMed1980

Morphologic evidence of accelerated closure of the ductus arteriosus in preterm infants.

In preterm infants, closure of the ductus arteriosus (DA) is often delayed, especially in those with respiratory distress syndrome (RDS). However, it has been suggested that functional closure of the DA may occur as early as 24 hours of age in some preterm infants exposed to intrauterine stress, and this is usually associated with decreased incidence of RDS. This suggests that accelerated maturation of the DA as well as of the lungs occurs in utero. Accordingly, histologic evidence of accelerated maturation of the DA was sought in a prospective autopsy study of 55 preterm infants ranging in gestational age from 19 to 32 weeks. There were four infants with clinically closed DA which showed histologic evidence of closure. The birth weight of these four infants ranged from 750--1,100 gm, the gestational age ranged from 24--32 weeks, and age of death was 39 hours to 6 days. The immediate causes of death were intracerebral hemorrhage or intrapulmonary hemorrhage, or both. Obstetric complications included chronic second trimester vaginal bleeding, abruptio placenta, malnutrition, diabetes, pulmonic stenosis of moderate degree, and chronic hypertension. These findings support the hypothesis that in some preterm infants exposed to chronic intrauterine stress, maturation of the DA is accelerated. This may result clinically in effective postnatal closure of the DA.

Ductus Arteriosus↗
PubMed1980

A clinical assessment of stillborn infants.

One hundred and fifty stillborn infants delivered at Groote Schuur Hospital were clinically examined at birth to try to establish the probable cause of death. In 84,7% a likely explanation for the stillbirth was identified, with abruptio placentae, gross amniotic fluid infection and severe congenital abnormality the commonest diagnoses. Sex, birth weight, gestational age and degrees of maceration were also documented. These data provide a better understanding of the causes of stillbirth in Cape Town and will help in the rational planning of antenatal care aimed at reducing the perinatal mortality rate. It is recommended that clinical examination of all stillborn infants and their placentas be carried out at birth, especially if an autopsy is not performed.

Birth Weight↗
PubMed1980

Sinusoidal heart rate pattern and fetal distress secondary to severe anemia.

A case of sinusoidal fetal heart rate (FHR) pattern with fetal anemia is described. The etiology of the pattern appears to have been fetal anemia from an umbilical cord knot, abruptio placentae and fetal asphyxia. The poor neonatal outcome in our case and a review of the literature suggest that a sinusoidal pattern is an ominous sign demanding complete evaluation of fetal well-being and often prompt obstetric intervention. The use of scalp capillary hematocrit is suggested.

Adolescent↗
PubMed1980

Intra-uterine deaths after suspicious, uncertain and normal antenatal fetal heart rate monitoring.

Stressed and non-stressed antenatal fetal monitoring was carried out 9 520 times in 5 932 high-risk patients. Intra-uterine death occurred in 48 patients. In 19 patients the fetus died within 1 week of monitoring but before the onset of labour; the results of monitoring had been normal in 14 of these. Abruptio placentae was the cause of 6 of these deaths. Many of the other causes of intra-uterine death were also acute complications such as haemorrhage due to placenta praevia, amniotic fluid infection, and cord prolapse. True false-negative test results were rare, and were seen most often in patients with preeclampsia, diabetes and haemolytic disease. Twin pregnancies also caused a problem, as double recording of the heart rate of the normal fetus could create a false sense of security.

Adolescent↗
PubMed1980

Fatal echovirus 11 disease in premature neonates.

Four cases of fatal echovirus 11 disease occurred in premature infants during a community outbreak of enteroviral disease in Massachusetts in 1979. Each infant developed nonspecific symptoms and jaundice at 4 to 6 days of age, and subsequent progressive hepatic failure and generalized bleeding. Only one infant survived longer than six days. Virus was recovered from multiple sites premortem, and from virtually all tissue cultured at autopsy. Myocarditis was not present clinically or pathologically. Clinical and laboratory evidence implicated perinatal transmission of virus from mother to infant. Three mothers experienced a febrile illness with abdominal pain within the last five days of pregnancy. In two, the illness led to a false diagnosis of abruptio placenta and interruption of pregnancy by cesarian section. Review of case reports of this syndrome caused by other echovirus serotypes revealed that many had similar perinatal events. Each mother ultimately developed neutralizing antibody to echovirus 11. However, all four infants were born without passively acquired antibody, probably because they were delivered prior to the appearance of specific maternal IgG. Although laboratory studies by others have shown other factors may be responsible for the ability of enterovirus to cause overwhelming disease in neonates, uncontrolled data from these four infants and their mothers suggest that timing of maternal illness in relation to delivery of the infant may also be important.

Adult↗
PubMed1993

Oligohydramnios: problems and treatment.

Oligohydramnios is a severe and common complication of pregnancy. The finding of oligohydramnios can be associated with fetal anomalies, PROM, uteroplacental insufficiency (eg, growth retardation, postdatism, abruptio placenta, significant maternal illness), abnormalities of twinning, and idiopathic oligohydramnios. Ultrasound detection of this complication should prompt the clinician to thoroughly evaluate the gravida for hypertension, diabetes, or other significant illness. In addition, a thorough fetal anatomic survey focusing on the genitourinary tract and an attempt at visualizing free amniotic bands should be performed with ultrasound. Karyotype should be considered. The role of amnioinfusion to assist in diagnosis should be considered. Once diagnosed, oligohydramnios with or without associated conditions should lead to intensive fetal biophysical surveillance including frequent ultrasound evaluation. Delivery in the term patients must be considered. The role of amnioinfusion as an adjunct to continuous fetal monitoring in labor to improve neonatal outcome appears beneficial in select series. The role of repetitive amnioinfusion in the preterm patient remote from term may offer marginal clinical benefit to neonatal outcome and is considered experimental at this time.

Congenital Abnormalities↗
PubMedDate not supplied

Assessment and initial management of the pregnant trauma patient.

The pregnant trauma patient with a blunt or penetrating injury presents a unique and challenging clinical situation. Two patients must be treated simultaneously: the mother and fetus. The author reviews the assessment changes of pregnancy, which can both mask and mimic injury. The unique injuries that occur in this patient population are described, including abruptio placentae, preterm labor, fetomaternal hemorrhage, and uterine and fetal trauma. Successful resuscitation of the pregnant trauma patient requires early and frequent collaboration with the obstetrical staff. Within a team approach, the dual assessment of mother and fetus can render prompt identification and treatment of injuries. Diagnostic tests, including laboratory data, radiographic exams, and abdominal and obstetrical procedures, are reviewed.

Female↗
PubMed1994

Trauma in pregnancy.

In the assessment and management of the pregnant trauma patient, all efforts should be directed toward stabilizing the mother first, according to Advanced Trauma Life Support protocols, with airway, breathing, and circulation being priorities. Subsequent to this, attention can be turned to evaluation of the fetus. Standard laboratory values must be seen in the context of changes in maternal physiology. Volume resuscitation generally is the mainstay of therapy for shock. Vasoactive drugs should be avoided, unless absolutely indicated, because of their propensity to cause shunting of blood away from the uterus. In assessing maternal injury, consideration has to be given to the variety of injuries that can occur to the uterus, including abruptio placentae and uterine rupture. Evaluation of the fetus requires a multidisciplinary approach, involving both obstetricians and pediatricians, along with the surgical team in an attempt to provide an optimal solution for management.

Critical Care↗
PubMed1994

[Surgical delivery: comparison of two 5-year periods].

Operative delivery prevalence is considered in two periods: 1980-1985 and 1986-1990. Reduced prevalence of repeated cesarean section is reported for the second period as opposed to the first one. A larger prevalence of cesarean sections for anomalous presentation (breech presentation included), fetal distress. EPH gestosis, abruptio placentae is reported in the second half of '80's. Vacuum Extractor applications are reduced in the second period compared to the first one for with concern secondary uterine hypokinesia; larger V.E. applications are reported in the second period for fetal distress in the second stage of labor. Relatively rare forceps applications in both periods.

Breech Presentation↗
PubMed1993

Abdominal pain in pregnancy.

Abdominal pain in pregnancy is most commonly caused by complications of the pregnancy, e.g., abortion, ectopic pregnancy and abruptio placentae. A careful history and methodical physical examination and, if necessary, simple ultrasonographic investigations will reveal the cause in most of these conditions. In a few cases of abdominal pain in pregnancy a gynaecological condition, such as torsion of an ovarian cyst, or a nongynaecological (medical or surgical) one is the cause. Some of these conditions are serious, e.g., acute appendicitis, and unless the correct diagnosis is made and the appropriate management promptly instituted both the mother and her baby may suffer tragic consequences. Moreover, these conditions are more likely to be misdiagnosed during pregnancy. This is because the anatomical and physiological changes which occur in pregnancy tend to change and obtund the expected clinical features and laboratory data which are used to diagnose these conditions. Their early diagnosis therefore requires a high index of suspicion together with awareness of the ways in which they may present in pregnancy.

Abdominal Pain↗