1/52. Neonatal end-stage renal failure associated with maternal ingestion of cyclo-oxygenase-type-1 selective inhibitor nimesulide as tocolytic.Cyclo-oxygenase-type-2 (COX-2) enzyme is fundamental for nephrogenesis, upregulated on fetal membranes and myometrium at parturition. Fetal COX-2 inhibition, due to maternal nimesulide assumption, can be responsible for neonatal chronic renal failure.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/52. Failure of amniotic septostomy in the management of 3 subsequent cases of severe previable twin-twin transfusion syndrome.INTRODUCTION: Amniotic septostomy has been described as a method to treat twin-twin transfusion syndrome. A case report of 3 patients treated in this way is described. CASE REPORT: Three subsequent patients, who presented with twin-twin transfusion syndrome, were treated by amniotic septostomy. All 3 showed initial improvement in the amniotic fluid volume and mobility of the donor fetus. However, all three pregnancies were lost within 5 days of the amniotic septostomy due to ruptured membranes and premature labour. CONCLUSION: In our experience, amniotic septostomy did not improve the pregnancy outcome in twin-twin transfusion syndrome. Possible reasons for this are discussed.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
3/52. amniotic band syndrome in triplet pregnancy.We present a case of amniotic band syndrome leading to encephalocele in one triplet. In this case, discordance in fetal growth was observed at 9 weeks' gestation, and the amniotic membrane was not recognized in the sac of the smallest fetus. Thus, significant first-trimester growth discordance in multifetal pregnancies suggests congenital anomalies, and examinations considering amniotic band syndrome should be performed. Absence of the amniotic membrane in the gestational sac may be a useful marker of amniotic band syndrome.- - - - - - - - - - ranking = 2keywords = membrane (Clic here for more details about this article) |
4/52. Acardiac fetus in a triplet pregnancy: ultrasound pitfalls. A case report.This communication aims at illustrating ultrasound diagnostic difficulties in early pregnancy with acardiac fetus. Our case concerns a spontaneously conceived triplet pregnancy. It was diagnosed as a twin pregnancy at 11 weeks of amenorrhea. One and a half months later the patient was referred to our center for spontaneous premature rupture of membranes with the diagnosis of a fetal demise in a triplet pregnancy. The definite diagnosis of acardia was assessed sonographically by the presence of a reverse blood flow through the umbilical cord, reflex movements, limbs anomalies and discordance between femoral and crown-rump length. Two days after admission, the patient developed chorioamnionitis and the three fetuses were expelled.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
5/52. Delayed interval delivery military style.INTRODUCTION: Intentionally delaying the delivery of a second twin from a previable state to a gestational age when survival is possible is a heroic measure whose outcome is unpredictable. We report the case of delayed interval delivery in a patient transported via air evacuation to a tertiary care center. CASE REPORT: A 31-year-old gravida 3 para 0020 at 18 weeks with a twin gestation presented to a medical treatment facility for evaluation of uterine cramps. She subsequently delivered Twin A. With cessation of labor, the patient was air evacuated to a medical center for continued care. Seven weeks later, she delivered a viable male infant. DISCUSSION: The treatment of multiple gestations presenting with preterm labor or rupture of membranes remains expectant. When delayed delivery of a previable second twin is undertaken, appropriate care includes the use of antibiotics, tocolytics, and cervical cerclage. Anticipation of preterm birth warrants continued care in a tertiary care center offering neonatal intensive care.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
6/52. Successful pregnancy outcome after preterm premature rupture of membranes at < 20 weeks. A report of three cases.BACKGROUND: Spontaneous preterm premature rupture of the membranes occurring before 20 weeks' gestation carries a perinatal mortality of approximately 82% and potential for considerable morbidity for mother and fetus. This is in contrast to amniotic fluid leakage after second-trimester amniocentesis, when the prognosis is usually good. CASES: We report three cases of spontaneous rupture of the membranes before 20 weeks' gestation, all associated with reaccumulation of amniotic fluid and satisfactory neonatal outcomes. CONCLUSION: Our cases may represent a subgroup with a relatively good prognosis. The existence of such subgroups would better be determined in a prospective, cohort study, and it might need to be a multicenter one. It requires well-defined entry criteria, management protocols and neonatal follow-up as well as information about pregnancies where termination, rather than continuation, is chosen.- - - - - - - - - - ranking = 6keywords = membrane (Clic here for more details about this article) |
7/52. Complications of third-trimester amniocentesis using continuous ultrasound guidance.OBJECTIVE: The objective of the study was to estimate the risks of third-trimester amniocentesis with continuous ultrasound guidance. methods: Cohort study. We reviewed the medical records of women who had an amniocentesis with continuous ultrasound guidance after 30 weeks' gestation at a single institution from January 1991 through December 1994. For procedures performed from January 1991 to February 1994, we obtained information from a chart review. From March 1994 to December 1994, we collected data prospectively. The primary outcome was whether or not there were any complications within 48 hours of the procedure. We also sought to determine any risk factors associated with complications. RESULTS: Complete records and data were available for 562 amniocenteses during the study period. The mean gestational age at the time of amniocentesis was 34.9 weeks. Of the 562 procedures, five (0.8%) were unsuccessful and 50 (9%) required more than one needle stick. The complication rate was 0.7% (95% confidence level (CI) = 0.02%, 1.9%). These included spontaneous labor in a preterm gestation (1), premature rupture of the membranes (1), placental abruption (1), and fetal-maternal hemorrhage (1). No patient required an emergency cesarean delivery and none suffered a perinatal death (95% CI 0, 0.8%). Complications were not associated with the number of needle sticks, the presence of bloody amniotic fluid, or the level of operator experience. CONCLUSIONS: Third-trimester amniocentesis performed with continuous ultrasound guidance has a high success rate and low risk for complications.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
8/52. acyclovir treatment of primary herpes in pregnancy complicated by second trimester preterm premature rupture of membranes with term delivery: case report.Primary genital herpes simplex virus (HSV) infection in pregnancy is associated with an increased risk of vertical transmission to the fetus, especially with rupture of membranes. Two cases of primary herpes and two cases of recurrent herpes in pregnancy with preterm premature rupture of membranes and expectant management have been reported, all delivering preterm. We report a case of primary maternal genital HSV infection with preterm premature rupture of membranes at 24 weeks' gestation who subsequently went on to deliver at term. This case was managed with intravenous acyclovir. Neonatal serology for HSV I (immunoglobulin m [IgM] and IgG) and HSV II (IgM) were negative. antibodies for HSV II (IgG) were positive. Subsequent 6-month follow-up titers were negative for all herpes antibodies. On the basis of an extensive search of the English literature from 1966 to 2001, this is the first reported case of primary herpes in pregnancy associated with preterm premature rupture of membranes with a subsequent term delivery.- - - - - - - - - - ranking = 8keywords = membrane (Clic here for more details about this article) |
9/52. Shigellosis complicating preterm premature rupture of membranes resulting in congenital infection and preterm delivery.BACKGROUND: The association of chorioamnionitis with preterm birth is well established. Intra-amniotic infection complicates 13-60% of preterm premature rupture of membranes (PROM) with enteric gram-negative pathogens accounting for 20-40% of recoverable organisms. However, the source of enteric pathogens leading to premature birth has been poorly characterized. CASE: A 36-year-old multiparous woman presented at 2567 weeks with preterm PROM. She reported a 5-day history of bloody, mucous diarrhea. A fourth cesarean delivery was performed secondary to the onset of labor. fetal blood, placental membrane, and vaginal pool cultures revealed the presence of shigella sonnei. With appropriate antibiotic therapy, the patient was discharged home on postoperative day 5. Neonatal stool cultures revealed evidence of in utero fetal transmission. CONCLUSION: It is prudent to treat pregnant patients with clinical symptoms suggestive of shigellosis because this pathogen can result in preterm PROM and preterm delivery. Neonatal testing is indicated if maternal disease is suspected before delivery.- - - - - - - - - - ranking = 6keywords = membrane (Clic here for more details about this article) |
10/52. Caput succedaneum mimicking a cephalocele.Caput succedaneum is relatively common at birth but infrequently diagnosed in utero. It has a benign prognosis, but it is very important not to misdiagnose it as a cephalocele, which carries a guarded prognosis. We present the case of a patient who experienced preterm labor and premature rupture of the membranes at 28 weeks' menstrual age. Our initial diagnosis was cephalocele, but after the male infant was delivered by cesarean section, examination revealed no bone defect, and our final diagnosis was caput succedaneum. We also discuss the sonographic findings and diagnostic differences between caput succedaneum, cephalocele, and other fetal head masses.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
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