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PubMed2003

Complications of second and third trimester pregnancies.

The second and third trimester of pregnancy is a period of extensive physical growth and maturation of the fetus. Unfortunately, it is also a period that is marked by complications that can be life threatening for both the mother and fetus. The top three complications that affect pregnancy are hemorrhage, infection, and the hypertensive diseases of pregnancy. This article focuses on preterm labor, premature rupture of membranes, chorioamnionitis, bleeding in later pregnancy, and the hypertensive diseases of pregnancy.

Anti-Bacterial Agents↗
PubMed2005

Pelvic organ prolapse complicating third trimester pregnancy. A case report.

The concomitant phenomenon of a third trimester pregnancy with a significant degree of pelvic organ prolapse is extremely rare. We report on a patient with pelvic organ prolapse complicating third trimester pregnancy treated by concomitant cesarean hysterectomy and abdominal sacrocolpopexy. A 30-year-old woman, gravida 6, parity 5, was admitted to the hospital with uterine contractions in week 35 of gestation. Pelvic examination in the dorsal lithotomy position revealed a stage 3 pelvic organ prolapse. A cesarean hysterectomy was performed. After hysterectomy, the vaginal cuff was suspended to the periosteum overlying the sacral promontory. Cesarean hysterectomy might be a therapeutic option for women who have completed their families and are suffering from severe pelvic organ prolapse complicating third trimester pregnancy, particularly in developing countries where access to health care is limited.

Adult↗
PubMed1994

Fetal biophysical activities in third-trimester pregnancies complicated by diabetes mellitus.

OBJECTIVE: Our purpose was to compare third-trimester fetal biophysical activities in normal and well-controlled insulin-dependent diabetic pregnancies. STUDY DESIGN: We performed serial bimonthly fetal biophysical studies from 30 to 38 weeks in 18 normal and 18 well-controlled insulin-dependent diabetic pregnancies (White classes B through D). Each study contained 60 minutes of simultaneous ultrasonographic recordings of fetal breathing movements and rates, baseline heart rate, and body movements. Mean daily blood glucose levels of diabetic patients were determined from home monitors; HbA1c was determined every 6 weeks and ultrasonographic fetal growth rates every 3 weeks. Data were compared with t tests, analysis of variance with repeated measures, and chi 2 tests. RESULTS: Women in the diabetic group maintained good glycemic control and were delivered of normal infants of weights similar to those of nondiabetic gravidas. Their fetuses had higher mean incidences of fetal breathing movement, fetal heart rates, and fetal breathing rates but lower fetal movements and fetal heart rate acceleration counts than did controls throughout the study. Neither short- nor long-term maternal glycemic levels correlated well with fetal biophysical performance. CONCLUSIONS: In spite of good maternal glycemic control fetuses of diabetic women behaved differently from those of nondiabetic women. Modulation of their biophysical activities may be affected by maternal glycemic status before the last trimester. Different standards might need to be applied to interpret their tests.

Adult↗
PubMed2004

Medical management for termination of second and third trimester pregnancies: a comparison of strategies.

OBJECTIVE: Misoprostol and sulprostone are prostaglandins that can be used for the termination of second and third trimester pregnancy. The aim of the present study was to compare the effectiveness of both agents for the termination of second and third trimester pregnancy in cases of congenital or genetic abnormalities, and for the induction of labour in cases of intra-uterine foetal death. STUDY DESIGN: We collected data from all women who had been treated with misoprostol in the second or third trimester of pregnancy between January 2001 and July 2002 in cases of congenital or genetic abnormalities, and for the induction of labour in cases of intra-uterine foetal death. In cases where the foetus was alive, misoprostol was usually (77%) combined with mifepristone. Women were matched to women who had been treated with sulprostone for termination of second and third trimester pregnancy before 2001. We matched for hospital, previous vaginal delivery, intra-uterine death and duration of pregnancy. The primary outcome measure was time to delivery. RESULTS: Since the treatment effect was different in patients in whom labour was induced for intra-uterine death and patients in whom labour was induced while the foetus was alive, the analysis was stratified for this parameter. In 94 patients with intra-uterine death, there was no significant difference in time to delivery, blood loss, operative removal of the placenta and need for pain relief between misoprostol and sulprostone. In vital pregnancy (n = 96), time to delivery was significantly shorter in the misoprostol group. The relative risk for haemorrhage exceeding 1000 ml in this group was 0.40 (95% confidence interval, CI, 0.13-1.2). We observed no significant differences with respect to operative removal of the placenta or need for pain relief. CONCLUSION: In cases of intra-uterine death, the effectiveness of misoprostol for termination of pregnancy is comparable to that of sulprostone. In vital pregnancy, combination of mifepristone and misoprostol is more effective than sulprostone alone.

Abortifacient Agents↗
PubMed1981

Psychotic denial of third-trimester pregnancy.

This paper presents a case report of denial of third trimester pregnancy and discusses practical clinical management of the risks to mother and unborn child, including unanticipated and unprotected labor and delivery, the possibility of neonaticide and/or subsequent child abuse and neglect. Ethically challenging decisions must be made concerning involuntary commitment, use of medication, controlled labor and delivery, curtailment and possible termination of parental rights through court action.

Adult↗
PubMed1982

Changes in maternal serum aldosterone, potassium and prolactin levels during beta-receptor agonist treatment in third trimester pregnancies.

Beta-receptor agonist (terbutalin or isoxsuprin) administration to pregnant women either because of premature labor (therapy group; T; n = 8) or as prophylactic treatment (prophylaxis group; p; n = 8) resulted in a marked drop in serum potassium (p less than 0.001) during the first two hours of infusion in all patients. In five diabetic women in the P group the prolactin was significantly decreased (P less than 0.01) as was serum aldosterone levels (p less than 0.01). These changes were not observed in the T group. The two groups of pregnant women responded with a significant increase in free fatty acids (FFA) and glucose but the magnitude and the time coarse differed. Thus in T women, FFA reached a peak after 30-60 minutes into treatment and then returned to baseline levels. A closer analysis revealed that this pattern was only obtained in patients receiving terbutalin. Among women given prophylactic treatment with terbutalin, a continuous increase in FFA was noted over the initial two hours (p less than 0.001). The increase in serum glucose was continuous in the two patient groups (p less than 0.001). It is suggested that beta-receptor agonists in diabetic women induces a dopaminergic type of response since serum prolactin levels but not TSH concentrations were affected. The possibility that an increased PGE2 synthesis at the expense of PGF2 alpha might mediate this effect of beta-receptor agonists in discussed. It is also suggested that an increased prostaglandin synthesis might interfere with aldosterone secretion. The possibility that falling serum potassium levels may activate dopaminergic systems via PGE2 synthesis is also emphasized.

Adult↗
PubMed2002

Termination of third-trimester pregnancy before term with gemeprost vaginal pessaries.

OBJECTIVE: Determination of the efficacy and side-effects of the synthetic prostaglandin analog gemeprost for termination of pregnancy in the third trimester. PATIENTS: Retrospective record study of 40 women who had undergone third trimester termination of pregnancy before term by serial administration of gemeprost because of intrauterine fetal death or hopeless fetal prognosis. Patients with multiple pregnancy, a Bishop score > 5, contractions or contraindications to prostaglandins were excluded. METHODS: Gemeprost vaginal pessaries (1-mg) were given at 6-hourly intervals until labor intervened. The main parameter studied was the induction-delivery interval, the length of time between administration of the first dose and delivery. Statistical analysis was performed with the chi-square and the Mann-Whitney U-test. RESULTS: The median induction-delivery interval was 14.4 h (range 3-48 h). Delivery occurred within 12 h in 17 women (42.5%), within 24 h in 27 women (67.5%) and within 36 h in 37 women (92.5%). An average of 2.6 doses were given per patient. Multigravidae had a significantly shorter induction-delivery interval than primigravidae (p < 0.01). A total of 87.5% women required analgesia. Side-effects were infrequent. CONCLUSIONS: The administration of gemeprost vaginal pessaries represents an efficient method with few side-effects for the induction of labor in the third trimester, provided patients are chosen carefully and monitored closely.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

New reference values for routine blood samples and human neutrophilic lipocalin during third-trimester pregnancy.

Reference values are usually based on blood samples from healthy men or non-pregnant women. Blood samples from pregnant women may be compared with these reference values. Correct references for pregnancy can be extremely important for clinical decisions such as ablatio placentae, appendicitis, premature rupture of membranes and preeclampsia. Previous studies of normal variations during third-trimester pregnancy are incomplete. Blood samples during pregnancy weeks 33, 36 and 39 as well as 1-3 h postpartum were collected from pregnant women with dietary iron supplement and at least one previous pregancy without a history of hypertension or preeclampsia. When the sampled values were compared with the present reference values from men and non-pregnant women, the following differences were found during normal pregnancy: Haemoglobin and ferritin were reduced, CRP was slightly elevated, WBC (white blood cell count) and HNL (human neutrophilic lipocalin) were elevated during pregnancy and significantly increased postpartum. Albumin was reduced. ALT and AST were slightly elevated and GGT was unchanged during pregnancy. ALP, D-dimer and fibrinogen were elevated. Uric acid increased during the third trimester and thrombocyte count decreased. Separate reference values for pregnant women are essential for correct diagnostic decisions during third-trimester pregnancy. Elevated levels of D-dimer do not necessarily indicate ablatio placentae. A diagnosis of progressive preeclampsia cannot be based on increasing uric acid levels and reduced platelet count in a stable clinical condition. HNL signals activation of neutrophilic granulocytes and can thereby offer a helpful tool for diagnosing infection during pregnancy and postpartum.

Blood Chemical Analysis↗
PubMed1993

Maternal caffeine consumption and fetal behavior in normal third-trimester pregnancy.

OBJECTIVE: Our aim was to perform a longitudinal cohort study of 20 normal third-trimester pregnancies to observe whether the level of long-term maternal caffeine ingestion influenced fetal behavior. STUDY DESIGN: By dietary history 10 normal pregnant women were categorized as "high" caffeine consumers (> 500 mg/day, group H) and 10 as "low" caffeine consumers (> 200 mg/day, group L). Between 30 and 40 weeks biweekly 2-hour continuous ultrasonographic observations of fetal heart rate; breathing activity; and eye, trunk, and extremity movements were conducted. Maternal caffeine levels were determined at each session, and fetal states were identified and their duration quantified. Data were compared by analysis of variance by means of repeated measures or t tests. RESULTS: When compared with group L fetuses, group H fetuses spent similar mean time in state 1F (quiet sleep), less mean time in state 2F (active sleep), and much greater mean time in state 4F (arousal). The mean time spent in no state decreased significantly in group L, was unchanged in group H, and was similar for both groups at term. Both groups had similar mean numbers of state changes at all gestational ages studied. Mean maternal serum caffeine levels in group H were always significantly higher than those in group L. CONCLUSION: Evolving fetal behavior may be influenced by the level of maternal caffeine consumption during the last trimester.

Adult↗
PubMed1990

An ethically justified, clinically comprehensive management strategy for third-trimester pregnancies complicated by fetal anomalies.

We present an ethically justified, clinically comprehensive management strategy for third-trimester pregnancies complicated by fetal anomalies, based on 72 cases diagnosed at a gestational age of more than 24 weeks. These cases are organized into three categories: A) nonaggressive management and termination of pregnancy offered, three of 72 (4%); B) aggressive and nonaggressive management offered, 18 of 72 (25%); and C) aggressive management recommended, 51 of 72 (71%). We then ethically justify a clinically comprehensive management strategy. First, we describe the disclosure requirements of the informed-consent process. Second, we provide an ethical justification for the physician's recommendations among management alternatives. The justification for such recommendations is based on a continuum of beneficence-based obligations to the fetus that is developed in terms of a classification scheme of fetal anomalies, based on the degree of probability of antenatal diagnosis and degree of probability of outcome. When there are no beneficence-based obligations to the fetus, the physician should recommend only termination of pregnancy or nonaggressive management. When there are minimal beneficence-based obligations to the fetus, only aggressive or nonaggressive management should be recommended. Finally, when there are more than minimal beneficence-based obligations to the fetus, only aggressive management should be recommended.

Abortion, Eugenic↗
PubMed1980

Ratio of unconjugated to total estriol in uncomplicated third-trimester pregnancy.

The serum unconjugated estriol, as a percent of total estriol, has been determined in third-trimester pregnancies studied longitudinally. The unconjugated fraction in any specific sample ranged from 4.1% to 21.6% of the total. The mean percent unconjugated estriol in 34 patients sampled 7 to 15 times each between 32 and 40 weeks of gestation ranged from 5.3% to 13.6%. Higher serum total estriol concentration correlates with a lower percent of unconjugated. The mean percent unconjugated decreases during the last eight weeks of gestation from 11.4% to 8.4%, with a calculated regression line of Y = 23.323--0.368X. Thus, the concentration of serum unconjugated estriol is relatively more constant. The majority of patients demonstrate a narrow range of percent serum unconjugated estriol. These circumstances, combined with ease of assay, support the use of serum unconjugated estriol in pregnancy estriol monitoring.

Estriol↗
PubMedDate not supplied

Non-gynecologic laparoscopy in second and third trimester pregnancy: obstetric implications.

PURPOSE: To review the effect of non-gynecologic laparoscopic procedures performed during the second and third trimesters of pregnancy on pregnancy outcome. MATERIALS AND METHODS: A review of the patient log for the antenatal obstetrical unit was used to identify the patients in this series from January 1, 1997 to December 31, 1997. Medical records were then analyzed to identify estimated gestational age at surgery and delivery, type of delivery, use of tocolysis, and complications from surgery. RESULTS: Nine patients were identified as having non-gynecologic laparoscopic surgery (without conversion to laparotomy) during the second or third trimester of pregnancy. The median estimated gestational age at surgery was 25 weeks (mean 24 weeks). The most common procedure performed was laparoscopic cholecystectomy (6 patients). Five patients received tocolysis after the initial procedure. All patients delivered at greater than or equal to 37 weeks estimated gestational age (median 38 weeks). No infants were admitted to the neonatal intensive care unit. CONCLUSIONS: Laparoscopic procedures appear safe in second and third trimester pregnancy. In this study, laparoscopic cholecystectomies were performed as late as 34 weeks estimated gestational age without any adverse effects on pregnancy outcome.

Adult↗
PubMed1999

A comparison of AIUM/NEMA thermal indices with calculated temperature rises for a simple third-trimester pregnancy tissue model. American Institute of Ultrasound in Medicine/National Electrical Manufacturers Association.

Temperature rises due to diagnostic ultrasound exposures have been calculated for a simple third-trimester pregnancy tissue model. This consisted of a layer of soft tissue representing the abdominal/uterine wall, a layer of liquid and a layer of fetal bone. The ultrasound field parameter used in the calculations was the temporal average of the square of the acoustic pressure (p2TA), measured in water but corrected for attenuation in the tissue model. The three-dimensional (3-D) distribution of p2TA was measured for five probes operating in B-mode, and four probes operating in pulsed Doppler and color flow imaging modes. The calculated temperature rises were compared to the AIUM/NEMA-defined thermal indices appropriate to third-trimester scanning. In B-mode, the ratio of calculated temperature rise to thermal index varied between 0.62 and 1.25, with calculated temperature rises as high as 1.4 degrees C. In color-flow imaging mode, this ratio varied between 1.26 and 2.45 and, in pulsed Doppler mode, between 1.46 and 2.92, with calculated temperature rises as high as 1.8 degrees C and 5.8 degrees C, respectively. These results indicate that, for scanning situations where bone is insonated through an overlying low attenuation liquid layer, the thermal index may substantially underestimate the maximum temperature rise that could occur.

Abdominal Muscles↗
PubMed1991

The prevalence of autoantibodies during third-trimester pregnancy complicated by hypertension or idiopathic fetal growth retardation.

Lupus anticoagulant, anticardiolipin, antinuclear, anti-deoxyribonucleic acid, antithyroglobulin, and antithyroid microsomal antibodies were assayed during third-trimester pregnancy (100 normal, 100 with complications). In spite of a normal activated partial thromboplastin time in all instances, lupus anticoagulant was further investigated by three additional procedures: tissue thromboplastin inhibition time, platelet neutralization procedure, and cephalin neutralization test. The prevalence of autoantibodies in pregnancies with hypertension reaches 16% (four with lupus anticoagulant, two with anticardiolipin, and two with antithyroid microsomal antibodies), which is significantly greater than that for idiopathic fetal growth retardation (2%) (one with lupus anticoagulant antibodies) and normal pregnancies (3%) (two with antithyroglobulin and one with autithyroid microsomal antibodies) (p less than 0.01). Autoantibodies were equally distributed between patients with gestational hypertension and those with preeclampsia. When compared with the 42 patients with hypertension and no autoantibodies, the eight patients with autoantibody had a more frequent history of fetal growth retardation (p less than 0.05), but there was no difference in the severity of hypertension, the frequency of obstetric complications, or the outcome of pregnancy. They did not require any specific treatment.

Autoantibodies↗
PubMed1982

Outcome of third trimester pregnancies after cryotherapy of the uterine cervix.

A retrospective study was undertaken to assess the effect of cryotherapy of the uterine cervix on the outcome of third trimester pregnancies. It was concluded that cryosurgery of the cervix had no effect on the onset or progress of labour, or on the infant, an important advantage compared with cold-knife conization as a therapy for young women with cervical intraepithelial neoplasia.

Adolescent↗
PubMed1986

[Ceftazidime: placental transfer and pharmacokinetic parameters in the third trimester pregnancy].

Ceftazidime (CAZ), a newly developed cephalosporin with very high stability to beta-lactamase, was evaluated for its transfer into fetus and amniotic fluid in the third trimester pregnancy, following a single bolus intravenous injection at a dose of 1 g. In subjects with various conditions (background factors) standardized, concentrations of CAZ in maternal venous blood, venous and arterial blood in umbilical cord, and amniotic fluid were determined. High concentration of CAZ (10 micrograms/ml or higher) was found to be maintained in fetal blood and amniotic fluid for ca. 4 hours and ca. 8 hours, respectively, after intravenous injection, showing good placental transfer of CAZ. In view of MICs of CAZ, satisfactory clinical efficacy is expected in perinatal infections.

Amniotic Fluid↗
PubMed1997

The electroencephalogram during normal third trimester pregnancy and six months postpartum.

In 1942 Gibbs and Reid described a slowing of the electroencephalogram (EEG) at the end of a normal pregnancy. To the best of our knowledge this is the only report that addresses the modification of the EEG in normal pregnancy. We performed a spectral multichannel EEG analysis and revealed no differences during third trimester pregnancy and six months postpartum. Therefore EEG changes seen during pregnancy, which were previously regarded as 'subtle changes of pregnancy', may turn out to be clinically relevant changes which indicate either pre-existing EEG dysfunction or EEG abnormalities in the context of a pregnancy-related disorder.

Analysis of Variance↗
PubMed1989

Influence of ritodrine on plasma steroids and human placental lactogen levels in third-trimester pregnancies.

The effects of ritodrine, administered by intravenous, intramuscular or per os routes, upon plasma levels of unconjugated estriol, estradiol, progesterone and human placental lactogen (HPL) were investigated in 24 third-trimester pregnancies. Ritodrine administered at a constant rate of 200 micrograms/min for 3 h, injected intramuscularly 8 x 10 mg/day for 5 days or given orally in doses of 6 x 20 mg/day for 10 days resulted in a significant decrease in the steroid hormone concentration and a significant elevation of HPL levels.

Administration, Oral↗