1/14. Variations in maternal serum zinc during pregnancy and correlation to congenital malformations, dysmaturity, and abnormal parturition.serum zinc concentrations in 234 gravidae showed a gradual fall during the first and second trimesters. From the 25th week of gestation until delivery there is a levelling out of mean zinc values. No correlations between serum zinc, serum HCS, or urinary excretion of oestriol were found. Women with mature infants born by normal delivery showed significantly higher serum zinc during pregnancy than women with abnormal deliveries and/or abnormally developed infants (p less than 0.001). Eight infants showed congenital malformations. Five of the 8 mothers showed the lowest serum zinc concentrations recorded during respective week of pregnancy. A diabetic woman gave birth to an immature infant with multiple skeletal malformations. She showed the lowest serum zinc in the 21st week, and at the same time a very low alkaline phosphatase activity. Her serum proteins and serum HCS were normal. Women with dysmature infants showed significantly lower zinc values during pregnancy (p less than 0.02) than women with mature infants born by normal delivery. Data from studies on zinc metabolism show that there is a requirement of at least 375 mg of zinc during pregnancy in order to meet the demands of normal weight gain. Teenagers, women with multiple pregnancies, women with impaired intestinal absorption due to disease or drugs and in particular women with a low-protein, high-phytate diet seem to risk developing zinc deficiency during pregnancy.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
2/14. Outcome in pregnancies complicated by myotonic dystrophy: a study of 31 patients and review of the literature.OBJECTIVES: myotonic dystrophy can be associated with increased obstetric risks, but the maternal contribution for gestational outcome is difficult to establish considering the varying degrees of severity and the influence of fetal factors. STUDY DESIGN: We analyzed the pregnancy course and outcome of 31 women with classic myotonic dystrophy, who delivered a total of 66 children. In addition, 93 gestations from the literature were reviewed. RESULTS: As most patients were not aware of their diagnosis at reproductive age, often the first indication of the maternal disease was a severely affected child (39%). Miscarriages and pre-eclampsia did not increase. Ectopic pregnancies occurred in 4%, placenta previa in 9% of gestations, while postpartum hemorrhage due to uterine atonia was only reported twice. Severe urinary tract infections were reported for 19% of the patients, but were only rarely encountered in the literature. Preterm labor, before 34 weeks, occurred in 19% of gestations and was often, but not exclusively attributed to congenitally affected fetuses in contrast to polyhydramnios (17%). Labor abnormalities of all three stages were frequent, increasing the number of operative deliveries (cesarean section rate 36%). perinatal mortality was 15% and mainly related to congenitally affected children. CONCLUSIONS: The risk for obstetric complications and urinary tract infections increases for pregnant patients with myotonic dystrophy. They need constant obstetric monitoring. It is hoped that a better awareness of the clinical picture might help to improve gestational outcome in myotonic dystrophy.- - - - - - - - - - ranking = 2keywords = urinary (Clic here for more details about this article) |
3/14. The first 18 months of a new perineal trauma clinic.Anal incontinence after childbirth is both distressing and disabling. A perineal trauma clinic was set up at the Birmingham Women's Hospital with an obstetrician, a urogynaecologist and a colorectal surgeon to improve the follow-up of women with obstetric anal sphincter injury or childbirth-precipitated anal incontinence. Fifty-five women attended the clinic. Forty-one had sustained a recognised obstetric anal sphincter injury at delivery and of these women, 61% were symptomatic with 22% leaking solid or liquid faeces. Fourteen women attended with anal incontinence who had not been recognised as sustaining an anal sphincter injury at the time of delivery. Eleven women were offered a secondary surgical repair of their anal sphincter defect. Seven accepted surgical treatment and 85% (six) were continent following surgery. A perineal trauma clinic offers an opportunity for early assessment and reduction of morbidity from childbirth-related anal incontinence.- - - - - - - - - - ranking = 566.5757311443keywords = incontinence (Clic here for more details about this article) |
4/14. Obstetrical anaesthesia and analgesia in chronic spinal cord-injured women.Improved acute and rehabilitative care and emphasis on integrating patients into society after spinal cord injury is likely to result in increasing numbers of cord-injured women presenting for obstetrical care. Anaesthetists providing care to these women should be familiar with the complications resulting from chronic cord injury and aware that many may be aggravated by the physiological changes of normal pregnancy. These complications include reduced respiratory volumes and reserve, decreased blood pressure and an increased incidence of thromboembolic phenomena, anaemia and recurrent urinary tract infections. patients with cord lesions above the T5 spinal level are at risk for the life-threatening complication of autonomic hyperreflexia (AH) which results from the loss of central regulation of the sympathetic nervous system below the level of the lesion. Sympathetic hyperactivity and hypertension result in response to noxious stimuli entering the cord below the level of the lesion. Labour appears to be a particularly noxious stimulus and patients with injuries above T5 are at risk for AH during labour even if they have not had previous AH episodes. morbidity is related to the degree of hypertension and intracranial haemorrhage has been reported during labour and attributed to AH. We report our experience in providing care to three parturients with spinal cord injuries. Two patients had high cervical lesions, one of whom experienced AH during labour and was treated with an epidural block. The second was at risk for AH having had episodes in the past and received an epidural block to provide prophylaxis for AH. In both cases epidural blockade provided effective treatment and prophylaxis for AH.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
5/14. Spontaneous intrapartum vesicouterine fistula.BACKGROUND: Vesicouterine fistulae as an obstetrical complication have been reported only in women with a history of cesarean. We present a patient with no such history who developed a vesicouterine fistula after vaginal delivery. CASE: A 43-year-old gravida 5 at term with no history of cesarean presented in the latent phase of labor. Gross hematuria was noted intrapartum, and a foley catheter was placed. A cystogram showed an extraperitoneal bladder perforation. The patient had urinary incontinence despite Foley catheter drainage. The diagnosis of vesicouterine fistula was made by cystoscopy and fistulogram. The patient had a successful repair at 3 months. CONCLUSION: This is a rare case of a vesicouterine fistula developing during a pregnancy with no previous cesarean. Accurate diagnosis is essential because surgical repair has an excellent outcome.- - - - - - - - - - ranking = 469.33299231379keywords = urinary incontinence, incontinence, urinary (Clic here for more details about this article) |
6/14. Successful late repair of anal sphincter rupture caused by delivery.Successful surgical treatment of anal incontinence due to anal sphincter rupture of 14 years duration is described. Objective evaluations were performed with anal profilometry.- - - - - - - - - - ranking = 141.64393278608keywords = incontinence (Clic here for more details about this article) |
7/14. twins discordant for vater association. Obstructed labor of the second twin due to ascites and persistent cloaca without communication to the exterior.The unusual delivery of a dead second twin with rare malformations is presented. The first twin, born live following a normal labor, had no malformations. The birth of the second twin was obstructed by massive ascites, and its abdomen had to be perforated before delivery. The sex could not be determined due to lack of the internal genitalia and the fetal appearance of the external genitals. The left kidney and ureter were hypoplastic. The right ureter and distal part of the colon were dilated and opened into a large primitive cystic cloaca without communication to the exterior. The ascites was probably caused by the urinary obstruction. These malformations probably represent one of the earliest arrested developments of the embryonic hindgut. The presence of a tracheo-esophageal fistula and a single umbilical artery, together with the anal atresia and the renal anomalies, could indicate that the anomalies formed part of the VATER association.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
8/14. prenatal diagnosis and variable presentation of recessive X-linked ichthyosis.Three infants with X-linked ichthyosis have been observed following pregnancies in which placental sulphatase deficiency (PSD) was suggested prenatally by low oestrogen excretion and an abnormal urinary steroid excretion pattern. This was confirmed in two cases by the absence of placental enzyme activity. In one case labour was spontaneous but all deliveries required Caesarean section. At 8 months the first infant showed an eczema in an atopic distribution but when seen at 5 years had typical X-linked ichthyosis. The skin of the second child peeled extensively at the age of 2 days but was not troublesome for 2 years, when ichthyosis vulgaris was diagnosed on clinical grounds. This pattern has persisted for 3 years. The third infant showed a mildly scaly skin in the neonatal period but at 3 months the features and distribution of X-linked ichthyosis were apparent. X-linked ichthyosis may have a variable presentation which is not always apparent at birth.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
9/14. Autonomic hyperreflexia: a mortal danger for spinal cord-damaged women in labor.Reproductive care of women with spinal cord damage demands knowledge of such women's reproductive potential and the specific complications to which these women are prone during pregnancy and childbirth, especially autonomic hyperreflexia. fertility in cord-damaged women of reproductive age is generally undiminished as are libido, ability to have intercourse, and ability to bear children. Frequent complications of cord-damaged pregnant women include urinary tract infection, anemia, pressure sores, sepsis, unattended birth, and autonomic hyperreflexia. Autonomic hyperreflexia or autonomic dysreflexia occurs during labor in up to two thirds of women with cord lesions above T-6. Autonomic hyperreflexia results from noxious stimuli including distention of the bladder, cervix, or rectum, which evokes mass triggering of sympathetic and parasympathetic afferents that are uninhibited by supraspinal centers below the cord lesion. Autonomic hyperreflexia manifests itself with sudden onset of marked hypertension and headache during uterine contractions, as well as bradycardia or tachycardia, various cardiac dysrhythmias, and marked diaphoresis with piloerection and flushing above the level of the cord lesion. We describe the second reported occurrence of intraventricular hemorrhage due to autonomic hyperreflexia during labor and detail recommendations for anticipating and mitigating this potentially lethal complication of parturition in cord-damaged women. pregnancy and parturition are best carried out with informed cooperation of the patient and of obstetric, cord rehabilitation, anesthetic, and nursing personnel.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
10/14. Antenatal diagnosis of placental sulphatase deficiency.A dynamic test for the antenatal diagnosis of placenta sulphatase deficiency was examined in ten patients, selected on the basis of low urinary oestrogen levels (i.e. below the 10th centile at between 30 and 40 weeks gestation). The test consisted of measurement of plasma oestradiol levels over a period of 120 min after an i.v. injection of dehydroepiandrosterone sulphate. The oestradiol response was vigorous in seven patients, absent in two and small, but significant, in one. The three patients with reduced oestradiol response were also found to have raised levels of urinary steroid monosulphates and thus were probably placental sulphatase deficient. The overall clinical importance of placental sulphatase deficiency and the value of the dehydroepiandrosterone sulphate loading test in antenatal diagnosis are discussed.- - - - - - - - - - ranking = 2keywords = urinary (Clic here for more details about this article) |
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