1/9. Legionnaire's disease complicating pregnancy: a case report with intrauterine fetal demise.OBJECTIVE: Legionnaire's disease complicating pregnancy is an unusual event that can seriously compromise both the mother and the fetus. CASE REPORT: We describe one case of such association, with an unfavourable intrauterine fetal outcome, secondary to acute placental insufficiency, related to infection. DISCUSSION: It is important in these high risk pregnancies complicated by acute pneumonia to take into consideration the diagnosis, as early as possible, and the appropriate treatment or the careful monitoring of fetal wellbeing.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/9. Rapid onset of severe twin-twin transfusion syndrome caused by placental venous thrombosis.We report a case of rapid onset of severe twin-twin transfusion syndrome (TTTS) at 25 weeks gestation in a monochorionic twin pregnancy that was uneventful before that time. Thrombosis of a main venous branch draining several arteriovenous (AV) anastomoses to the donor changed the previous hemodynamic balance that existed between multiple bidirectional AV anastomoses. The opposing AVs became hemodynamically uncompensated and, despite amnioreductions, severe TTTS developed. At 27 weeks a cesarean section was performed because of worsening cardiotocography parameters of both fetuses. Birth weights were 750 and 1840 g, and initial hemoglobin concentrations were 9.2 and 13.4 mmol/liter for donor and recipient, respectively. The recipient twin died 5 months later of an ischemic, necrotic, and perforated small intestine due to a thrombosed superior mesenteric artery. The donor is well at 2.5 years. No abnormalities in several factors associated with thrombophilia, including factor v Leiden mutations, were found in the parents.- - - - - - - - - - ranking = 0.2keywords = pregnancy (Clic here for more details about this article) |
3/9. oxytocin challenge test in high-risk pregnancy.Seven hundred sixty-seven oxytocin challenge tests (OCT) were performed on 333 high-risk maternity patients. All of the patients had pregnancies complicated by diabetes mellitus, suspected postmaturity, preeclampsia, intrauterine growth retardation, hypertension and other disorders. In conjunction with OCT, 24-hour urinary estriol determinations were performed. Negative OCT's were reassuring for fetal well-being. There were 26 positive OCT's on 24 patients. A positive test was significant in identifying endangered fetuses existing in a markedly unfavorable environment. In our experience, we found the OCT more reliable and more predictable than urinary estriol determination. The oxytocin challenge test proved to be significant in the successful management of these 333 high-risk patients.- - - - - - - - - - ranking = 0.8keywords = pregnancy (Clic here for more details about this article) |
4/9. Advanced tubal pregnancy associated with severe fetal growth restriction: a case report.A case is described of advanced tubal pregnancy associated with severe fetal growth restriction delivered at 27 weeks. The placenta was implanted on the salpinx and on the uterotubal angle. Progressing tubal pregnancy and its placental histological characteristics could be a model of placental dysfunction typically associated with intrauterine growth restriction.- - - - - - - - - - ranking = 1.2keywords = pregnancy (Clic here for more details about this article) |
5/9. The dehydroepiandrosterone loading test. III. A possible placental function test.The dehydroepiandrosterone loading test (DLT) has been used in a small population of normal and high-risk obstetric patients, to date, in an attempt to develop a dynamic test of placental function. In spite of its limited applications, it has shown reliability in discriminating, with statistical significance, between high-risk pregnancies that result in normally grown, undistressed infants, and high-risk pregnancies that result in infants showing signs of placental insufficiency. The present report expands the study population by presenting our data on 40 loading tests performed in 37 high-risk and normal obstetric patients. Results of 19 of these DLT's have been previously reported and are included herein for statistical analysis. The DLT utilizes an excess substrate load of dehydroepiandrosterone to assess the maximum capability of the placenta to convert it to estrogen. Although our previous report did not show false positive or negative results in the conversion rates, the present results (40 DLT's) found two (2 out of 17) false positives (12%) and two (2 out of 19) false negatives (11%). The highly significant correlation between DLT result and pregnancy outcome seen previously was preserved. In addition, the data of another five DLT's in four patients are presented. This group includes a pregnancy with a fetus with multiple congenital malformations, two patients with intrauterine fetal death, and a nonpregnant woman. The results are not included in the statistical analysis, but discussion of these results has interesting pathophysiologic implications.- - - - - - - - - - ranking = 0.4keywords = pregnancy (Clic here for more details about this article) |
6/9. Pregnancy in a patient with Raynaud's disease.We report a patient who, at the time of her third pregnancy at the age of 35, had had Raynaud's disease for 18 years. Her first pregnancy (during which she took Marcumar, an anticoagulant) ended in a miscarriage at three months gestation. The second pregnancy ended in fetal death due to placental insufficiency. The third pregnancy was also complicated by placental insufficiency which became evident during the second trimester. The patient was observed carefully and allowed to continue to 37 weeks gestation when a Caesarean section was done for late fetal heart rate decelerations during early labour of spontaneous onset. The baby had a low birth weight but developed normally. The placenta showed certain abnormalities which are described.- - - - - - - - - - ranking = 0.8keywords = pregnancy (Clic here for more details about this article) |
7/9. Placental lakes, absent umbilical artery diastolic flow and poor fetal growth in early pregnancy.Uteroplacental insufficiency is a common cause of intrauterine growth retardation in the third trimester of pregnancy. We report a case in which placental vascular lesions, absent end-diastolic frequencies in the umbilical artery and high maternal serum levels of alpha-fetoprotein and human chorionic gonadotropin were observed from the beginning of the second trimester in a patient with a history of recurrent first- and second-trimester miscarriages. Fetal growth started to slow down from 14 weeks of gestation and no end-diastolic phase was found in the umbilical artery until 18 weeks of gestation, when the pregnancy was terminated. In apparently healthy women with or without a history of fetal death during the first half of pregnancy, the discovery of placental vascular lesions together with a high resistance to blood flow in the umbilical circulation should prompt early antepartum surveillance.- - - - - - - - - - ranking = 1.4keywords = pregnancy (Clic here for more details about this article) |
8/9. Two cases of maternal antenatal splenic rupture and hypotension associated with Moebius syndrome and cerebral palsy in offspring. Further evidence for a utero placental vascular aetiology for the Moebius syndrome and some cases of cerebral palsy.We wish to report two cases of congenital abnormality after antenatal car accidents resulting in ruptured spleen and severe hypotension in the mothers at 8 and 14 weeks gestation. The first case had the classical Moebius syndrome with 6th and 7th cranial nerve palsy with abnormal brain stem evoked responses, presumably due to hypoxic/ischaemic brain stem damage and the second case had severe retardation and hypertonic cerebral palsy which at post mortem was found to be due to old hypoxic/ischaemic lesions to the caudate nucleus putamen and striatum. Conclusion: The cases described provide evidence that severe maternal hypotension during pregnancy can be associated with lesions to the midbrain and brain stem of offspring. The mechanism is probably utero-placental insufficiency, and extrapolation from these two unusual cases would support utero-placental insufficiency as a cause of Moebius syndrome and limb deficiency after chorionic villus sampling.- - - - - - - - - - ranking = 0.2keywords = pregnancy (Clic here for more details about this article) |
9/9. Nonspecific decelerations in fetal heart rate during high-risk pregnancy.Solitary nonspecific decelerations in fetal heart rate occurring in three patients during antepartum cardiotocography are described. The decelerations were nonspecific in that they were neither variable nor late nor associated with maternal hypotension. All occurred in pregnancies complicated by hypertension and placental insufficiency. In the three patients described, the fetus lived for at least three days after the first nonspecific deceleration was observed. Although solitary nonspecific decelerations may indicate may indicate danger to the fetus from placental insufficiency, these decelerations should not be considered as an indication for immediate delivery.- - - - - - - - - - ranking = 0.8keywords = pregnancy (Clic here for more details about this article) |