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PubMed1993

[Fetal death, 1-year prospective analysis].

Fetal death (FD) over 22 weeks are analyzed during a one year period in a service with approximately 12,000 deliveries per year. 118 FD were found and the study was completed in 97 pregnancies (100 FD). A control group was included. The pathologies more related with FD were the premature rupture of membranes, chorioamnionitis and premature delivery. Followed by the funicular pathology, abruptio placentae, preeclampsia and intrahepatic cholestasia. Mother's educational level and prenatal care were clearly better in the control group. The majority of the FD occurred out of the hospital (70%). The anatomopathological study was performed in few cases (34%). We concluded that an important number of FD are preventable with an accurate prenatal care and that a complete and modern anatomopathological study including the placenta will decrease the high number (26%) of FD that remaining without diagnoses.

Chile↗
PubMed1994

Preterm birth--its etiology and outcome.

This is a retrospective case control study. Out of a total of 1238 births occurring over a period of 8 months at the Aga Khan University Medical Centre, Karachi, 9.4% were preterm. Factors found to be associated with preterm labour were age > 35, height < 156 cm, anaemia or urinary tract infection in pregnancy, abruptio placentae, polyhydramnios, preterm rupture of membranes, intrauterine growth retardation, fetal distress and intrauterine death. Previous bad obstetric history was also relevant. A preterm baby was found to be at higher risk of postnatal complications resulting in neonatal death or admission to the Neonatal Intensive Care Unit (NICU) than a full term baby.

Adolescent↗
PubMedDate not supplied

Cocaine use in pregnancy.

BACKGROUND: Cocaine use during pregnancy has many deleterious effects on both the mother and the fetus, including the following: preterm labor (< 37 weeks' gestation), congenital anomalies, intrauterine growth retardation (IUGR), abruptio placenta, low-birth-weight infants (< 2500 g), neonatal death, and sudden infant death syndrome (SIDS). Potentially catastrophic maternal outcomes include a pre-eclampsia-like syndrome, acute pulmonary edema, seizures, cardiac arrhythmia, and sudden death. Family physicians who practice obstetrics might encounter cocaine-abusing women as part of their primary care practice. This article reviews the current knowledge regarding the pharmacology, pathophysiology, prevalence, demographics, and methods of detecting cocaine use in pregnancy. METHODS: Material for this paper came from a MEDLINE review of the literature from 1988 to the present. RESULTS AND CONCLUSIONS: Family physicians who practice obstetrics, especially those who practice in urban minority settings, are likely to encounter pregnant women who are abusing cocaine. Signs of maternal cocaine use are dilated pupils and increased heart rate, blood pressure, respirations, and reflexes. Other signs include agitated sensorium, arrhythmias, and seizures. Preterm labor, pre-eclampsia, and acute pulmonary edema can all be caused by maternal cocaine use. Methods of testing for cocaine are urine or meconium drug screening. Hair analysis is presently being researched but is not yet at a level of clinical reliability. Getting the patient into prenatal care as early as possible has been shown to improve birth outcomes.

Cocaine↗
PubMedDate not supplied

Is the HELLP syndrome due to inherited factors? Report of two cases.

The etiology and pathogenesis of the HELLP syndrome, a multisystem disease occurring only in pregnancy, are still unclear. Curiously, very few authors have investigated whether inherited factors may be involved. We report two cases of HELLP syndrome in two unrelated women whose fetuses were relatives (first cousins). The first case concerned a woman aged 32 with a normal course pregnancy who was admitted to the hospital for fever, nausea and vomiting, low platelets, hemolysis and increased liver enzymes. Abruptio placentae with fetal death and severe disseminated intravascular coagulation with hemorrhages ensued within a few hours. Hysterectomy was then performed. After treatment with transfusions and drugs the patient slowly improved; 28 days later she left the hospital in good condition. The second case involved a woman aged 31 with a normal course pregnancy who was admitted to the hospital for epigastric pain, nausea, low platelets, hemolysis and increased liver enzymes. The patient underwent an immediate cesarean section and delivered a live infant; no bleeding occurred during or after delivery. The patient's condition rapidly improved and she left the hospital after 13 days. Until now, no author has proved that inherited fetal factors are at work in the HELLP syndrome. Our observations suggest a role for genetic factors, and this needs to be investigated in prospective studies.

Adult↗
PubMed1994

Spontaneous intra-partum rupture of uterine vein--an uncommon cause of intra-abdominal haemorrhage.

A rare case of spontaneous rupture of a branch of the uterine vein in a primigravida is discussed. The patient with an uncomplicated pregnancy presented with signs and symptoms suggestive of abruptio placenta with foetal distress. Lower segment Caesarean section was performed. The cause of acute pain was identified to be intra-abdominal bleeding secondary to the rupture of a branch of the uterine vein. The pathophysiology of the problem is discussed.

Abdominal Pain↗
PubMed1994

Pregnancy following cardiac prosthetic valve replacement.

OBJECTIVE: To determine the effect of cardiac valve replacement on pregnancy outcome. METHODS: We reviewed retrospectively 151 pregnancies in 88 women: 56 pregnancies in 31 women with mechanical valves and anticoagulation therapy, and 95 pregnancies in 57 women with porcine tissue valves. Student t, chi 2, and Fisher exact tests were used for analysis. RESULTS: There was a significantly greater rate of fetal loss in patients with mechanical valve replacements than in those with porcine tissue valves (27.7 versus 12.3%, respectively; P < .05). No significant differences were found in prematurity (5.9 versus 7.7%) or small for dates infants (8.8 versus 10.8%). Two congenital anomalies were noted in the mechanical valve group. Maternal complications in patients with mechanical valves included valve dysfunction (three), thromboembolism (three), abruptio placentae (two), postpartum hemorrhage (two), severe oligohydramnios (two), and puerperal fever caused by brain abscess (one). Four cases of valve dysfunction and one of infectious endocarditis complicated the condition of patients with porcine tissue valves. The 10-year graft survival rate in the porcine valve group was lower following two subsequent pregnancies (16.7%) than following one (54.8%). CONCLUSION: Fewer fetal and maternal complications occurred in subsequent pregnancies after porcine valve replacement. However, the need for reoperation is more likely, and pregnancy might accelerate the degenerative process.

Adult↗
PubMed1993

Expectant management of early onset of severe pre-eclampsia in Durban.

Fifty patients with severe pre-eclampsia who presented before 32 weeks' gestation were managed conservatively (sedation, bed rest, antihypertensive therapy and intensive fetal and maternal monitoring) until intervention was indicated. Twelve patients presented before 26 weeks of pregnancy and there were no fetal survivors in this group; 23 presented between 26 and 29 weeks and 8(34,8%) of the babies in this group survived. The rate of perinatal loss in those presenting between 30 and 32 weeks was 26,6% (N = 4). Patients who had a history of a hypertensive disorder in their previous pregnancy(ies) had a higher perinatal mortality rate; 23 such mothers experienced 16 perinatal losses compared with 27 mothers who had no such history and who had only 8 perinatal losses. There was 1 maternal death, there were 2 cases of eclampsia, 3 of pulmonary oedema, 4 of abruptio placentae and 1 case of renal failure; 2 patients had disseminated intravascular coagulation. The local indigent and underprivileged black population have a more aggressive form of early onset of severe pre-eclampsia than that reported for other population groups. The high maternal complication rate of 30,8% and the low fetal survival rate before 26 weeks indicate that there is no place in our setting for expectant management of severe pre-eclampsia in patients presenting before 26 weeks. This applies particularly to those with a previous history of hypertension in pregnancy.

Adolescent↗
PubMed1993

[Acute renal failure in severe pregnancy induced hypertension: a report of 19 cases].

Twenty-six pregnant women complicated with acute renal failure (ARF) were admitted to Beijing Friendship Hospital during Jan. 1972 to Dec. 1990, the incidence rate was 0.045%. Among them, 4 cases of ARF were due to non-specific factors to pregnancy (15.4%) and 22 cases (84.6%) were due to factors correlated with pregnancy. Severe pregnancy induced hypertension (PIH) was the main cause of ARF in late pregnancy accounting for 86.4% (19 cases). In this series, 7 cases with eclampsia and 12 cases with preeclampsia, the incidence rate of ARF in preeclampsia and eclampsia was 0.91% and 11.3% respectively. The average age was 28.3 yr. 9 out of 19 cases were parous women. During pregnancy and labour, patients had more than one complications. 4 cases each were complicated with abruptio placentae, postpartum hemorrhage, intracranial hemorrhage and serious puerperal infection respectively. 3 cases were complicated with HELLP syndrome and one each with acute fatty liver, hypertension or gentamycin nephrotoxicity. 10 cases had deliveries preceded admission. The cesarean rate was 52.6% (10 cases). ARF onset before labour in 9 cases and postpartum in 10 cases. Developed only in 1 case of postpartum ARF in our department, this patient had a twin gestation, also complicated with severe PIH and acute fatty liver. Auria and oliguria ARF were found in 18 cases, nonauria in only 1 case. In this study, the highest serum BUN was 7.5-39.3 mmol/L (21-110 mg/dl). Medical management and rectal dialysis or peritoneal dialysis were performed in 10 cases who were in early stage, mild ARF or those ARF occurred before admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1993

[Risks related to chronic arterial hypertension: strategy before pregnancy].

.5% to 3% of pregnancies are complicated by chronic hypertension. These pregnancies are at increased risk for the development of superimposed pre-eclampsia, abruptio placentae, and poor perinatal outcome. The risk of development of adverse outcomes are not identical for all the patients. Several questions must be solved during the pre-pregnancy visit: What is the seriousness of the chronic hypertension? Is the chronic hypertension essential or secondary? Are there any organic repercussions of chronic hypertension? Why and how organize a special survey for such pregnancies? This complete pre-pregnancy cheek up permit to identify the high risk patients and to inform them of necessity of adjusted monitoring of the future pregnancy.

Antihypertensive Agents↗
PubMed1993

[Emergency obstetrics].

Sudden bleeding in the advanced stage of pregnancy is usually caused by abruptio placentae. Pre-eclampsia may develop rapidly into eclampsia and should lead to immediate hospitalization of the patient. A pregnant woman suffering from high blood pressure, headaches and epigastric pains, might be developing the life threatening HELLP syndrome. Sudden labour at term, either at home or in the ambulance, does not usually involve major complications. Hypothermia of the newborn baby should be avoided by drying it and placing it at the mother's breast. The umbilical chord is cut at the obstetrical department.

Acute Disease↗
PubMed1977

A false negative oxytocin challenge test.

A negative oxytocin challenge test has been considered a very reassuring finding in managing pregnancies in which the fetus is at risk from uteroplacental insufficency. In the case described here a fetal death in utero occurred 4 days after a negative oxytocin challenge test in a Class D diabetic patient, but in that period of time the patient's metabolic status deteriorated. A negative oxytocin challenge test does not protect the fetus from a subsequent acute event such as abruptio placentae, a cord accident, or diabetic ketoacidosis.

Adult↗
PubMed1977

Pregnancy in women over forty.

In a retrospective review of 440 pregnancies occurring in women over the age of 40, increased frequencies of both perinatal and maternal complications were noted. The perinatal mortality rate of the study group was three times greater than that of the general obstetric population. There were increased incidences of both low and high birthweight infants. Neonatal morbidity was increased. Congenital abnormalities were noted in 12 infants, including 2 infants with cytogenetic abnormalities. Hypertensive disorders complicated one-third of the pregnancies. Diabetes mellitus and abruptio placentae occurred with increased frequency. Cesarean section was required in 12.2% of the deliveries.

Adult↗
PubMed1993

Fetal growth in patients with elevated maternal serum hCG levels.

OBJECTIVE: To determine the relationship between maternal serum hCG levels and small for gestational age (SGA) infants. METHODS: Maternal serum hCG levels were measured in 638 consecutive pregnant women in whom gestation was dated by crown-rump length and who later delivered a singleton infant. Fetal growth was compared between the women with elevated maternal hCG (above 2 multiples of the median) and those with normal levels. RESULTS: Elevated maternal hCG values were found in 6.6%, of whom 19% delivered SGA infants. In the normal maternal hCG group, 3.9% of the infants were SGA. These differences were statistically significant by chi 2 analysis. Mothers with elevated hCG also had a significantly higher risk for fetal death, preterm rupture of the membranes, and abruptio placentae by the Fisher exact probability test. CONCLUSION: Elevated maternal serum hCG levels correlate with SGA infants.

Adult↗
PubMed1993

[Twin pregnancy complicated by single intrauterine death. Report of six cases and literature review].

From 1982 to 1991, six twin pregnancies, in which one of the fetuses died in utero, have been encountered. The causes of antepartum death in twin gestation could be identified in four cases; one with abruptio placenta, one with twin-to-twin transfusion syndrome, one with twisting of cord and one with velamentous insertion of cord. All six surviving infants had no abnormality in the follow-up of two to seven years. Although a conclusion about the prognosis could not be drawn from such a small series, these good results may have resulted from 1) 2 cases having been dichorionic twins, and 2) the other 4 monochorionic twins of 31-36 gestation weeks were delivered 1 to 5 days after the diagnosis. Conservative treatment was usually suggested until the fetal lung was mature enough for induction of labor. One case was treated after the death of its counterpart with tocolytic agent for a further 15 days because of prematurity. Cesarean section was performed finally for fetal distress resulting from chronic abruption placenta. The other five cases were delivered through vaginal route. According to experience as well as literature review, to improve the prognosis, obstetricians should be familiar with the management of one fetal death in twin pregnancy, especially in those with monchorionic twins.

Adult↗
PubMed1993

Pregnancy and delivery in women with a traumatic spinal cord injury in Sweden, 1980-1991.

OBJECTIVE: To evaluate the incidence of delivery in women after a traumatic spinal cord injury and to describe pregnancy outcome in this group of patients. METHODS: Between 1980-1991, 29 women with a traumatic spinal cord injury experienced 49 pregnancies and gave birth to 52 children in Sweden. A retrospective chart review of the antepartum, intrapartum, and perinatal records of these patients was performed. In addition, all patients participated in a telephone interview held by one of the authors. Of the 29 women, 12 had lesions above T5 and 17 had lesions at T5 or below. RESULTS: Antenatal complications occurred frequently in this group. Nine of 12 patients with lesions above T5 had symptoms of autonomic hyperreflexia during pregnancy and/or delivery. Only in a minority of the women was the problem recognized by the medical professionals. Nine of the infants (19%) were born preterm and two were small for gestational age. The perinatal mortality rate was two of 52 (3.8%) and occurred in two cases of abruptio placentae. Few of the patients were allowed to deliver vaginally. The cesarean delivery rate for women with lesions above T5 was 47% and for women with lesions below that level, 26%. CONCLUSION: The overall prognosis for these women was favorable. However, women with higher spinal cord lesions would probably benefit from referral to centers with a particular interest and expertise in the management of their problems.

Cesarean Section↗
PubMed1996

[Hypertension associated with pregnancy. Epidemiologic study of 311 consecutive cases].

The epidemiologic aspects of 311 consecutive cases of hypertension associated with pregnancy seen in the Department of Obstetrics and Gynecology, Hospital de Santa Maria/University of Lisbon Medical School between January 1st 1988 and December 31st 1992, are reviewed. Seventeen cases were multifetal pregnancies. Using the criteria proposed by the American College of Obstetricians and Gynecologists the cases were classified as follows: Mild preeclampsia, 64 cases (7 in twins); severe preeclampsia 50 cases (5 in twins); chronic hypertensive disease, 81 (1 in twins); chronic hypertension with superimposed preeclampsia, 16 (all singleton pregnancies); transient hypertension of pregnancy, 84 (4 in twins); unclassified hypertension, 16 cases of singleton pregnancies. No maternal deaths occurred. The most frequent maternal complications (eclampsia, HELLP syndrome, abruptio placentae and acute renal failure) were seen in preeclampsia (mild and severe forms). Only 2 significant maternal complications were observed in the cases of superimposed preeclampsia on chronic hypertensive disease. In the other groups maternal complications were seldom seen. Excepting in transient hypertension, perinatal morbidity and mortality were frequent in all groups, specially in severe preeclampsia and superimposed preeclampsia, when the delivery occurred before 34 weeks; after that time of pregnancy there were no neonatal deaths in any of the groups and intrauterine growth retardation and fetal distress were the most common fetal complications in all groups. In the whole, uncomplicated chronic hypertension and transient hypertension of pregnancy were the clinical situations in which maternal and perinatal complications were milder and less frequent. No perinatal problems were found in the group of unclassified hypertension.

Chronic Disease↗
PubMedDate not supplied

Adverse perinatal outcome in the older primipara.

Delayed childbearing has become common and has raised the awareness of the possible risks for the mother and the newborn infant. The increased maternal and neonatal risks have been attributed largely to the lack of proper prenatal care. The aim of this study was to assess whether advanced maternal age is a significant risk factor in mothers who receive good prenatal care. We matched 161 cases 1:1 according to the following criteria: maternal and paternal ethnic origin, chronic diseases, marital status, and smoking during pregnancy. Our results show that the older women had babies with a significantly higher incidence of low birth weight (< 2500 gm, p = 0.001), prematurity (< 37 weeks, p = 0.02), intrauterine growth retardation (p = 0.001), abruptio placentae (p = 0.002), and cesarean section (p < 0.001). The average hospital stay for the babies of the older mothers was longer than that for babies of the younger mothers (8.4 vs 6.1 days, p = 0.003), and the incidence of hospitalization for more than 3 days in the neonatal intensive care unit was increased (10.3% vs 2.2%). Logistic regression did not support maternal age of 35 years and older as being the single significant risk factor for adverse neonatal and maternal outcome. We conclude that maternal age older than 35 years entails a higher risk for the mother and her newborn infant, even when good prenatal care is taken.

Adult↗
PubMed1977

Fetal movements in utero: nature, assessment, prognostic value, timing of delivery.

Fetal movements in utero are an expression of fetal well-being. However, a sudden increase of fetal movements is a sign of acute fetal distress, such as in cases of cord complications or abruptio placentae. Decreased fetal movements are seen in cases of chronic fetal distress such as preeclampsia, hypertension in pregnancy, etc. It was shown that in these cases a pronounced decrease up to cessation of fetal movements occurred before fetal death in utero while fetal heart beats were still audible for at least 12 hours. This situation was called "movements alarm signal" (MAS). This sign points to a severely disturbed fetus and indicates impending intrauterine fetal death. Such a development is an indication for immediate delivery of the fetus, provided it is viable. High-risk pregnant women are instructed to assess and record fetal movements daily as a monitor of fetal condition. A special device which records fetal movements is used to confirm the women's assessment of fetal movement. It was shown that fetal movement monitoring was found to be more reliable than the urinary estriol determination in predicting impending fetal death in utero. It was also shown that in cases of MAS, fetal heart rate (FHR) changes will appear 1 to 4 days after the MAS has appeared. Meconium was found in only 50% of these cases. Increased fetal movements are manifested as a response to various stimuli such as sound, light, touch, and ultrasound. Classification of high-risk pregnancies into 3 groups according to the hormone assays, enzyme assays, ultrasonic cephalometry, fetal movements, and FHR is suggested.

Acoustic Stimulation↗