1/61. Severe hemolytic disease from rhesus anti-C antibodies in a surrogate pregnancy after oocyte donation. A case report.BACKGROUND: Maternal sensitization with rhesus anti-C antibodies is comparatively rare and usually benign. In pregnancies conceived using donor oocytes, the mother's blood group may differ from that of both the father and the oocyte donor, making blood group incompatibility more likely. CASE: twins, the result of a surrogate pregnancy using donor oocytes, were born with severe hemolytic disease due to rhesus anti-C antibodies. Both infants required exchange transfusion for profound anemia at birth. Isoimmunization in the surrogate mother was not detected antenatally. The twins were delivered by emergency cesarean section due to fetal compromise, detected fortuitously when the mother attended for routine fetal assessment at 35 weeks' gestation. CONCLUSION: Isoimmunization with anti-C antibodies is not always benign and may cause significant hemolytic disease. With the success of in vitro fertilization and oocyte donation, more infertile couples may use these methods to conceive, with or without surrogacy arrangements. In such cases, the provision of antenatal care may become a complex matter, involving several parties, and good communication between everyone involved is vital. In pregnancies conceived with donor oocytes, there may be a higher risk of blood group incompatibility, and special vigilance is warranted.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
2/61. Outcome of a baby born from a mother with acquired juvenile hypothyroidism having undetectable thyroid hormone concentrations.We report a baby born from a mother with strongly positive thyroid stimulation blocking antibody (TSBAB) and nearly undetectable T4 level. This case is a unique model of nearly complete absence of thyroid hormones during fetal and early neonatal life in humans. The infant girl was born by cesarean section, because of fetal bradycardia, after 41 weeks gestation and received mechanical ventilation for 3 days. The TSH level was more than 120 microU/mL in the neonatal thyroid screening. At age 17 days, the results of a thyroid function study showed undetectable free T3 and free T4 concentrations, TSH 550 microU/mL, and TSH receptor antibody (TRAB) 87%. thyroxine at a dose of 30 microg/day was started at age 17 days. The patient required thyroxine treatment until age 8 months. The brain magnetic resonance image at age 2 months revealed reduced brain size. Her auditory brain stem response was absent at age 2 months. The audiogram at age 4 yr revealed sensorineural deafness of 70 dB. When she was 6 yr of age, motor development remained the same as that at age 4 months. Her height was 106 cm (- 1.5 SD). The results of thyroid function study of the mother 23 days after delivery showed undetectable free T3 and free T4, TRAB 84%, and TSBAB 83%. In conclusion, the outcome of severe thyroid hormone deficiency in utero and early in human neonatal life was normal physical growth, fetal distress resulting in cesarean section, difficulty in the onset of breathing, permanent deficit in auditory function, brain atrophy, and severely impaired neuromotor development despite the start of an adequate dose of thyroxine replacement during the neonatal period.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
3/61. Effect of corticosteroids on hellp syndrome: a case report.The hellp syndrome is associated with a high rate of prematurity, which is the major cause of neonatal morbidity and mortality. Several studies have demonstrated the feasibility of prolongation of pregnancies complicated by HELLP syndrome. Until now the role of an additive pharmacological regimen, and particularly the role of corticosteroids, is still not clear. We report a case of a successful prolongation of a pregnancy complicated by hellp syndrome and note a direct relationship with application and withdrawal of corticosteroids. A 26-year old primigravida was admitted with hellp syndrome in the 25th week of gestation. We commenced a therapy with 40 mg methylprednisolone i.v. once daily, with clinical symptoms and biochemical parameters improving within two days. On day 6 we discontinued steroid medication with a consecutive deterioration of all biochemical data and clinical symptoms. Corticosteroids were recommenced and within two hours an improvement of all symptoms and laboratory data was observed. overall we were able to prolong the pregnancy for 33 days. This case report underlines the beneficial effect of corticosteroids in patients with hellp syndrome. Thus steroids might be helpful for postponing deliveries in very preterm gestation and for stabilizing the maternal status.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
4/61. Late second stage rupture of the uterus and bladder with vaginal birth after cesarean section: a case report and review of the literature.Rupture of a uterine scar during labor with concomitant severe injury to the maternal bladder has been reported sporadically. Previously reported cases have been diagnosed under a variety of conditions, commonly at the time of repeat Cesarean delivery. A case of maternal bladder rupture diagnosed following forceps-assisted vaginal delivery after Cesarean is presented. Severe bradycardia developed suddenly in the second stage of labor. Rupture of the uterine scar was diagnosed after sudden onset of severe lower abdominal pain with delivery of the placenta. At laparotomy, extensive injury to the bladder was found and successful repair of both injuries was performed. A review of previously reported similar cases with their mechanism of injury and presentation is presented. Serious maternal bladder injury at the time of uterine rupture remains a risk of attempted vaginal delivery after prior cesarean section.- - - - - - - - - - ranking = 4keywords = liver (Clic here for more details about this article) |
5/61. Umbilical vein thrombosis as a possible cause of perinatal morbidity or mortality: report of two cases.Significant occlusion of the lumen of the umbilical vein by thrombus was observed in 2 patients with unexplained intrauterine fetal death (IUFD)/fetal distress. Although a normal non-stress testing result was obtained 7 days prior to IUFD in one patient, IUFD was noted during regular antenatal care at 39 weeks of gestation; intrapartum abrupt onset of deceleration in fetal heart rate pattern was observed at 40 weeks of gestation, lasting 14 min until vacuum extractor-assisted delivery in the other patient. Umbilical vein thrombosis was considered contributory to IUFD and the abrupt deterioration in fetal heart rate pattern in these 2 patients. Histological examination of the umbilical cord is thus important in unexplained fetal death/fetal distress.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
6/61. Unnecessary emergency caesarean section due to silent CTG during anaesthesia?We present a case of a probably unnecessary Caesarean section due to misinterpretation of the cardiotocography (CTG) trace during general anaesthesia. A 27-yr-old patient in her 30th week of an uneventful, normal first pregnancy presented with a deep venous thrombosis in the pelvic region. She was to undergo an emergency thrombectomy under general anaesthesia. During the operation, the CTG showed a lack of beat-to-beat heart rate variation (silent pattern CTG) with normal fetal heart rate. This silent CTG pattern was probably a result of the effect of general anaesthesia on the fetus. The CTG pattern was interpreted as indicating fetal distress, and an emergency Caesarean section was performed after the thrombectomy. The infant was apnoeic and had to be resuscitated and admitted to the neonatal intensive care unit. The pH at delivery was 7.23 and the baby was extubated 2 days later. Mother and child recovered without short-term sequelae. In the absence of alternative explanations, reduced fetal beat-to-beat variability with a normal baseline heart rate during general anaesthesia is probably normal.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
7/61. Critical pulmonary stenosis with intact ventricular septum and fetal arrhythmias.A 23-year-old woman, gravida 1, was referred to our hospital for possible fetal distress at 32 weeks of pregnancy. A fetal cardiotochogram showed a reactive pattern, but mild continuous bradycardia and an intermittent pulse were observed, regarded as a sinus type and a type of A-V block, respectively. The continuous deceleration of the heart rate to 95 bpm was observed frequently at 35 weeks, 3 days of gestation. Thus, an emergent cesarean section was performed and a viable 2,082 g female infant was delivered. The neonate gradually became cyanotic, and an echocardiogram was performed. The neonate was regarded as a right ventricular outflow obstruction with intact ventricular septum. Unlike other cases, the infant revealed a moderately developed right ventricle despite a severely stenotic tricuspid valve. The infant died 27 days after birth and an autopsy established the diagnosis of critical pulmonary stenosis with intact ventricular septum. Right ventricular myocardial sinusoidal-coronary artery connections, one of the major features of this type of heart anomaly, was speculated to be involved in the cause of fetal bradyarrhythmias.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
8/61. Fetal and neonatal neurologic case histories: assessment of brain disorders in the context of fetal-maternal-placental disease. Part 2: Neonatal neurologic consultations in the context of adverse antepartum and intrapartum events.The more conventional role of the pediatric neurologist involves the evaluation of the child after birth. Although the pediatric neurologist rarely attends the delivery of the neonate, consultation by the neurologist should begin immediately following stabilization by the neonatal resuscitation team. Four interrelated aspects of the neurologist's clinical assessment will be discussed in the context of reaching a consultative opinion, which must incorporate knowledge of chronologic events before as well as during labor and delivery. This evaluation encompasses an assessment of levels of arousal, increased or decreased muscle tone, presence of seizures, and effects of systemic diseases on the central nervous system, which are the essential elements of a complete neurologic examination. documentation of the neonate's neurologic condition, together with knowledge of maternal, fetal, and placental diseases, will help anticipate neuroresuscitative decisions, as well as subsequent neurologic deficits.- - - - - - - - - - ranking = 2keywords = liver (Clic here for more details about this article) |
9/61. Extrusion of fetus into the abdominal cavity following complete rupture of uterus: a case report.A gravida 10 para 9, after one cesarean section (CS) followed by four vaginal deliveries was admitted at term without uterine contractions complaining of abdominal pain. The type of uterine scar was unknown. Severe bradycardia was observed at admission and an emergency cesarean section was performed. A complete uterine rupture was revealed, the fetus in intact membranes and placenta were found in the abdominal cavity.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
10/61. Checkmark fetal heart rate pattern associated with severe fetal hypoxia. A case report.A 31-year-old nulliparous woman developed vaginal bleeding after spontaneous rupture of the membranes at 40 weeks of gestation. fetal heart rate monitoring showed checkmark and sinusoidal patterns. A 3,281 g male neonate was delivered by emergency cesarean section, with Apgar scores of 1 and 3 at 1 and 5 min, respectively. The neonate exhibited severe acidosis with arterial blood gas pH of 6.96, and was diagnosed to have severe hypoxic-ischemic encephalopathy. An umbilical artery branch was noted in the membrane near the cervical os and found to be torn, representing hemorrhagic vasa previa. Severe fetal hypoxia resulting from hemorrhagic vasa previa might be associated with checkmark fetal heart rate pattern.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
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