[Perinatal mortality].
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A case-controlled study of the cerebral ultrasound appearances of neonates following placental abruption was undertaken. Twenty-nine index subjects (median gestation 29 weeks) were identified over a 2-year period with gestation- and sex-matched controls. Placental abruption was associated with a four-fold increased incidence of periventricular leukomalacia and extensive periventricular haemorrhage, without increased mortality. Ten infants (34%) developed cystic periventricular leukomalacia following placental abruption, compared with three (10%) in the control group. Intraventricular haemorrhage (excluding subependymal haemorrhage) and haemorrhage into the brain parenchyma occurred in 21 (72%) infants in the abruption group, compared with 14 (48%) in the control group (P < 0.05).
A 25-year-old woman delivered a healthy baby in the 34th week of gestation by caesarean section due to placental abruption and fetal bradycardia. On the following day she developed dyspnea, tachycardia, hypotension and rising serum transaminase levels. After exclusion of a pulmonary embolism, the abdominal CT scan and cavography revealed a subcapsular hematoma of the entire dorsal liver surface and compression of the retrohepatic vena cava. During laparotomy a spontaneous rupture of the liver capsule with intraperitoneal hemorrhage was found. The dorsal liver was decapsulated and the subcapsular hematoma completely removed. The postoperative course was uneventful.
AIM: The aim of this prospective study was to assess the role of uterine artery colour Doppler waveform analysis in the prediction of adverse pregnancy outcome such as preeclampsia, intrauterine growth retardation, placental abruption or a combination of outcome parameters. METHODS: Various uterine artery Doppler ultrasound parameters (RI>0.58, RI>0.7 and unilateral or bilateral notching) were tested. A second objective was to compare the predictive power of uterine artery Doppler ultrasound at 19-22 gestational weeks and 23-26 weeks' gestation for an adverse pregnancy outcome. RESULTS: The mean time of delivery was 39+0 weeks of gestation. Eight newborns (2%) were delivered before 34 weeks of gestation. The mean birth weight was 3,240 g. Dystrophic fetuses (<10% percentile) were registered in 35 cases (10%). In 31 of the 346 women (9%) a cesarean section was performed because of abnormal fetal heart recording. Preeclampsia was diagnosed in 17 cases (5%). In 5 cases (1.4%) a placental abruption and 2 (0.6%) intrauterine fetal deaths were diagnosed. The sensitivity of notching for the prediction of preeclampsia was 88% and for the prediction of a severe pregnancy complication (preeclampsia and/or intrauterine growth retardation and/or intrauterine fetal death and/or placental abruption) at any gestational age was 62% with relative risks of 9.7 and 2.2, respectively. The sensitivity of notching for severe pregnancy complications requiring delivery before 34 weeks was 64% with a relative risk of 2.4. The sensitivity of notching in the uterine arteries for developing an IUGR was 56% with a relative risk of 1.7. CONCLUSION: The predictive value of uterine artery Doppler for adverse pregnancy outcome in a low-risk population is of limited diagnostic value. Performing uterine artery Doppler studies at 23-26 weeks' gestation instead of 19-22 weeks' gestation increases the predictive value for adverse pregnancy outcomes.
OBJECTIVE: The objective was to determine if uterine leiomyoma increases the risk of cesarean section (CS) among women who conceived following fertility treatment. STUDY DESIGN: The study population consisted of all women who conceived after fertility treatment with singleton gestation and who delivered between the years 1988 and 1999 in the Soroka University Medical Center. A comparison was performed between patients with and without uterine leiomyomas. The Mantel-Haenszel procedure was used to obtain the weighted odds ratio (OR) for CS, while controlling for confounding variables. RESULTS: During the study period 1,995 women conceived following fertility treatment. Of these, 63 patients had uterine leiomyomas (3.2%). Women treated for fertility with uterine leiomyomas had statistically significant higher rates of CS than those without uterine leiomyomas (61.9% vs. 28.1%, OR=4.2, 95% CI 2.4-7.2; P<0.001). Stratified analysis (the Mantel-Haenszel technique) was used to control for possible confounders, such as gestational diabetes, hypertensive disorders, maternal age, failure of labor to progress, placental abruption, malpresentation, hydramnios, oligohydramnios, and a previous CS. None of those variables changed the significant association or explained the higher incidence of CS in the uterine leiomyoma group. CONCLUSIONS: Uterine leiomyoma is an independent risk factor for CS among women who conceived following fertility treatment.
The aim of the present study by a retrospective chart review was to examine the recurrence rate after placental abruption. Between 1985 and 1998, 81 patients had a placental abruption. We had 2-year follow-up information about 31 patients and 27 of them had a total of 34 subsequent pregnancies. Recurrent placental abruption was observed in 6 pregnancies in 6 patients (6/27, 22.2%). Of the 6 recurrent placental abruptions, the gestational age was 1-3 weeks earlier than that of previous abruption in 4 patients. One patient delivered a healthy baby after her first abruption and then experienced a second abruption. We conclude that careful management is needed after 30 weeks in pregnant women with a previous history of placental abruption.
We recently identified a missense variant (Glu298Asp) that lies within exon 7 of the endothelial nitric oxide synthase (eNOS) gene, and that is associated with severe preeclampsia (proteinuric hypertension that develops as a consequence of pregnancy). Maternal hypertension is the most consistently identified factor predisposing to placental abruption. Our objective, therefore, was to analyze the association between the Glu298Asp eNOS gene variant and placental abruption. The study participants included 35 patients with histories of placental abruption and 170 control subjects. Screening for the Glu298Asp eNOS gene variant was carried out by analysis of polymerase chain reaction/restriction fragment length polymorphism. The analyses revealed that the frequency of the Glu298Asp variant (Glu298Asp homozygotes and heterozygotes) was significantly (P<0.001) higher in the placental abruption group (n=14; 40%) than in the control group (n=24; 14%). We conclude that the presence of the Glu298Asp eNOS gene variant could be a marker of increased risk of developing placental abruption.
PURPOSE: This study evaluates the current morbidity and mortality of Crohn's disease presenting for the first time in pregnancy. METHODS: A review of the English-language literature was performed to collect all reported cases of Crohn's disease presenting in pregnancy. RESULTS: This review demonstrates a maternal mortality of 4 percent and morbidity of 40 percent and a fetal mortality of 38 percent, with 24 percent normal outcome of pregnancy. CONCLUSIONS: This study shows improved maternal and fetal outcome compared with earlier data.
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Explore the source record for details and available documents.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.