1/4. The association of hypopituitarism with small pituitary, invisible pituitary stalk, type 1 arnold-chiari malformation, and syringomyelia in seven patients born in breech position: a further proof of birth injury theory on the pathogenesis of "idiopathic hypopituitarism".We report seven cases of hypopituitarism all having a history of breech delivery, asphyxia at birth, and syringomyelia. A small pituitary gland was found on MRI or CT in six cases, invisible pituitary stalk on MRI in five cases, and type 1 arnold-chiari malformation in six cases. A constellation of these abnormalities are best explained by traction of brain and spinal cord of the subjects exerted during breech delivery and further support the primary role of birth trauma in the genesis of "idiopathic hypopituitarism".- - - - - - - - - - ranking = 1keywords = asphyxia (Clic here for more details about this article) |
2/4. pregnancy complicated by multiple pituitary hormone deficiencies.We report a case of pituitary dwarfism and diabetes insipidus due to pituitary stalk transection in a pregnant Japanese woman, 138 cm in height, born by breech delivery with no evidence of ante- or intrapartum asphyxia. The patient had no central nervous disturbance, was diagnosed with pituitary dwarfism during childhood and was treated at another hospital with growth hormone supplement from 5 to 14 years of age. This patient was referred to our department at 17 weeks' gestation due to a change of residence. At 30 weeks' gestation, she was hospitalized for assessment of hydronephrosis and polyuria (15-20 L/day). Analysis of a 24-h urine sample showed creatinine clearance of 157 mL/min and urine osmolality of 38 mOsm/L. The patient's urine output decreased after receiving a test dose of 0.75 g of 1-desamino-8-D-arginine vasopressin (DDAVP). Cranial magnetic resonance imaging showed transection of the pituitary stalk. Subsequently, the patient's urine output was well controlled by a maintenance dose of 0.275 mL/day intranasal DDAVP. A cesarean section was performed at 37 weeks, as the patient height was 138 cm, and a pelvic X-ray showed cephalopelvic disproportion. She delivered a female baby weighing 2302 g, and both 1- and 5-min Apgar scores were 9. The patient was followed up after 4 months and showed no visual deterioration or polyuria while on DDAVP therapy, while the neonate grew favorably.- - - - - - - - - - ranking = 1keywords = asphyxia (Clic here for more details about this article) |
3/4. Has an increased cesarean section rate for term breech delivery reduced in incidence of birth asphyxia, trauma, and death?To evaluate whether the dramatic rise in the cesarean section rate for breech presentation (from 22% in the decade 1963 to 1973 to 94% in 1978 and 1979) has been justified, 770 term breech deliveries at the Royal victoria Hospital during the period 1963 to 1973 and during 1978 and 1979 have been reviewed. Neonatal outcome, as determined by one neonatologist during the entire period of this study, was analyzed according to vaginal or cesarean section breech deliveries of primiparous and multiparous women. For each method of delivery and state of parity the occurrence of asphyxia neonatorum, abnormal cerebral signs, postasphyctic congenital heart failure or renal failure, and intrapartum and neonatal deaths was studied. The most severe cases were individually reviewed. While breech presentation has become a virtual indication for cesarean section in many centers, to date , there has not been an evaluation of how effective this procedure is in reducing birth asphyxia and trauma. In this study we assessed whether the trend to perform cesarean section in all term breech presentations is justified and whether neonatal morbidity and mortality rates have actually improved as a result.- - - - - - - - - - ranking = 6keywords = asphyxia (Clic here for more details about this article) |
4/4. Radiologic imaging of severe cervical spinal cord birth trauma.The radiological approach of a child with severe cervical spinal cord injury after a difficult breech delivery is presented. This diagnosis is often missed due to concurrent asphyxia. Ultrasound studies clearly showed the localisation and the extent of the injury. These findings were later confirmed by MRI. CONCLUSION: ultrasonography is recommended as the initial imaging technique to evaluate possible spinal cord lesions in the neonate.- - - - - - - - - - ranking = 1keywords = asphyxia (Clic here for more details about this article) |