[State of nonspecific factors of immunological resistance in pregnancy and labor complicated by pyelonephritis].
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The course of delivery and fetal outcome in 149 women with forecoming normal pregnancy and a prepregnancy body mass index (BMI) less than 20.0 were compared to a similar group of women with BMI between 20.0 and 24.9 after matching for age and parity. None of the women was undernourished. Suspected intrauterine asphyxia was significantly more common in primipara with BMI below 18.0 than in their controls (6/12 vs. 1/12), and there was a trend towards fewer babies weighing at least 4,000 g in the women with low BMI. No other significant differences related to BMI were found. It is concluded, that constitutional low weight for height is not a predictor of complications during delivery, and no special observation of this group is recommended.
Spontaneous subcutaneous and mediastinal emphysema is a rare but potentially dangerous complication of delivery. The condition was observed in a 24-year-old, small and slightly-built primipara after vaginal delivery of a large infant.
The activity of some enzymes of indirect metabolic rate in maternal and umbilical blood were measured in the cases of normal and complicated by the severe intrauterine foetal asphyxia labours. It is concluded that the severe foetal asphyxia caused by the umbilical conflict is reflecting in the changed levels of the majority of examined enzymes in the umbilical blood.
Liver disease is a rare complication of pregnancy which can be serious for both the mother and the infant. In particular, HELLP syndrome (hemolysis, elevated liver enzymes and a low platelet count) is a life threatening complication of severe preeclampsia. Pregnancies complicated by the HELLP syndrome are usually associated with increased maternal and perinatal morbidity and mortality including disseminated intravascular coagulopathy, pulmonary and cerebral oedema, acute renal failure, rupture of the liver hematoma and a variety of hemorrhagic complications. The HELLP syndrome occurs in 4 to 12% of patients with severe preeclampsia and prompt delivery is the only treatment. We report two cases of HELLP syndrome which developed in women during delivery and without any predictive factors during pregnancy.
A fist-sized tumour was seen in a Caesarean section scar of a 28-year old pregnant Turkish woman who had been operated on three years previously. The tumour was excised during Caesarean section and diagnosed as desmoid tumour. Etiology and pathogenesis of these rare soft tissue tumours are discussed and the literature reviewed.
The simple pelvic osteotomy in the techniques of Chiari and Salter respectively has become a frequently performed operation on the hip joint to improve the acetabulum in congenital hip dysplasia. Both techniques were simulated in a macerated, normally developed, natural female pelvis. Various parameters which indicate the deformation of the pelvis were measured. The results lead to the conclusion that both operations - especially when bilaterally performed - can cause changes of the birth canal which may prevent spontaneous labour.
Based on data retrieved from the Danish Medical Birth Register, deliveries among Danish and immigrant women were compared in the years 1983-1987. The women were divided into two groups, primiparous and multiparous, and then compared by frequency and type of complications and interventions during labour. Five hospitals in the Copenhagen area were selected and more than 40,000 women were included in the survey. About 3,500 were from Yugoslavia, Turkey, Pakistan and Morocco and the remainder were from Denmark. An increased frequency of complications and interventions during labour was recorded among primiparous in comparison to multiparous during the period. This observation was not related to nationality. Stimulation of labour by intravenous drugs was more frequent among immigrant women than Danish women and was particular frequent among Moroccan and Pakistani women. Among these nationalities higher frequencies of complications were not recorded and the use of intravenous drugs did not imply more instrumental deliveries. It is presumed that one of the reasons why the use of intravenous drugs is more frequent among immigrant women is due to a feeling of insecurity during labour. This might be caused by defective communication between the woman in labour and the midwife. The subject calls for closer investigations based on case records and the women's own experiences. The necessities for special training of immigrant women and staff members in maternity wards are pointed out.
An epidemiological and a clinical study were conducted to examine the importance of pregnancy and delivery complications in the genesis of cerebral dysfunction, the studies comprising a total of 495 children of 8 years of age. In the case definition of cerebral dysfunction, methodic improvements were used that had been demanded by those who had been critical of the clinical procedure. The results showed that clinical dysfunction is a risk factor for diseases in child psychiatry. There were no signs pointing to uniform psychopathological patterns (on the lines of a hyperkinetic syndrome) in children with cerebral dysfunction. There was no enhanced incidence of other diseases in the anamnesis of children with cerebral dysfunction. On the whole, the concept of cerebral dysfunction cannot be upheld at least to the extent presumed so far. A comparison between field study random samples and clinical study random samples showed that the classical postulates of the concept apply at most to a negligible minority only.
In a retrospective study of 80 chronic DSM III-R schizophrenics and 80 controls, the occurrence of obstetric complications (OCs) into the development of chronic schizophrenias was investigated using Leonhard's distinction in systematic schizophrenia (no obvious familial loading) and unsystematic schizophrenia (mainly genetically determined according to Leonhard). The Lewis & Murray and Fuchs scales were used for evaluation. In both scales, unsystematic schizophrenias did not differ from controls, but those with OCs were significantly (p < 0.01) earlier hospitalized (20.5 years) than those without OCs (25.6 years). Systematic schizophrenics had an increased frequency, severity and total score of OCs compared to controls in the Fuchs scale (p < 0.01). Likewise, in the Lewis & Murray scale systematic schizophrenia showed an increased presence of OCs compared to controls (p < 0.05) and to unsystematic schizophrenia (p < 0.1). Systematic schizophrenias were significantly allocated to maternal infectious diseases during mid-gestation. Patients with maternal infections showed more additional OCs than those without (p < 0.05; Lewis & Murray scale). In systematic schizophrenia, a history of OC was not associated with an early onset of the disease. In the genetic determined schizophrenias prenatal and perinatal disturbances lead to an early onset of the disease, however, in systematic schizophrenias they seem to be of causal importance for the development of the disease.
Maternal cardiorespiratory compromise has been reported to occur during the treatment of preterm labor with tocolytic agents. The risk for these complications is increased by the following factors: multiple gestation, the combination of magnesium sulfate and beta-adrenergic agonist, and the use of adrenocortico-steroids to hasten fetal pulmonary maturity. A case is presented of labor at 28 weeks' gestation complicated by pulmonary edema associated with the three risk factors listed above. The beta-agonist was discontinued with resolution of pulmonary edema. Intravenous magnesium sulfate was continued for 11 days. When uterine contractions finally overcame the tocolysis, delivery occurred. It appeared that uterine quiescence was achieved through the continued use of magnesium sulfate despite pulmonary edema in this case. The risk of continued tocolysis seemed to be counterbalanced by the benefits of prolonged intra-uterine existence for the fetuses.
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BACKGROUND: Epidural placement for obstetric anesthesia is a common procedure. Pneumocephalus, the introduction of air into the cranial cavity after epidural placement, is a rare complication encountered when air is used for identification of the epidural space. CASE: A 42-year-old primipara undergoing epidural placement reported sudden onset of severe headache with associated neurologic symptoms and nuchal rigidity. Emergent CT scan revealed pneumocephalus. With conservative management, her symptoms resolved with interval resumption of the air collection evidenced on interval CT. CONCLUSION: Acute onset headache after epidural placement can present with impressive neurologic signs and symptoms. Prompt identification of the cause of this pathology is of vital importance to delineate pneumocephalus from potentially treatable or life-threatening disorders.