1/3. Velamentous insertion of the umbilical cord and vasa previa.We report 31 cases with velamentous insertion of the umbilical cord of whom two had coexistent vasa previa. The prevalence of the former was 0.22% and of the latter 0.014%. perinatal mortality was low, 3.2%, but there was a high rate of complications during pregnancy, such as threatened abortion, antepartum and intrapartum bleeding, premature delivery and fetal distress. Fifteen patients underwent caesarean section. Four of the term infants were small for gestational age. One infant had congenital malformations. The two cases with vasa previa are described in detail. We conclude that velamentous insertion of the umbilical cord should be kept in mind in the differential diagnosis of fetal distress accompanied with antepartum or intrapartum vaginal bleeding.- - - - - - - - - - ranking = 1keywords = umbilical (Clic here for more details about this article) |
2/3. Umbilical artery occlusion and fetoplacental thromboembolism.BACKGROUND: To our knowledge, fetoplacental thromboembolism has been described only in autopsy specimens. We report the antepartum diagnosis of an umbilical artery occlusion and neonatal diagnosis of an aortic thrombus and placental emboli. CASE: A gravida at 31 weeks' gestation was referred for evaluation of decreased fetal movement and an enlarged fetal bladder. A two-vessel umbilical cord with a collapsed, echogenic third vessel was noted, whereas views of a normal three-vessel cord were available from an examination 5 weeks earlier. A positive oxytocin contraction test prompted delivery. Neonatal color flow Doppler imaging demonstrated an aortic thrombus below the renal arteries and above the bifurcation. Gross and microscopic study of the placenta demonstrated necrosis of the collapsed umbilical artery and numerous placental emboli. The aortic thrombus resolved gradually, and the infant went home on the 39th day of life. CONCLUSION: Umbilical artery occlusion can be diagnosed ultrasonographically and may be a sign of fetoplacental thromboembolism. Assessment of fetal oxygenation status by biophysical profile or contraction stress test may be helpful in the evaluation of umbilical artery occlusion.- - - - - - - - - - ranking = 15.362519340815keywords = umbilical artery, umbilical, artery (Clic here for more details about this article) |
3/3. A prospective, randomized trial of nifedipine vs. ritodrine in threatened preterm labor.OBJECTIVES: To compare the tocolytic efficacy and maternal tolerance of nifedipine with ritodrine in the management of threatened preterm labor. methods: Prospective randomized study of 52 singleton pregnancies with preterm labor between 26 and 34 week's gestation. The capacity to delay delivery 48 h, 7 days, until week 36 or until fetal weight reached 2500 g were the outcome variables assessed. Doppler ultrasound studies were performed on the fetal umbilical artery as control. RESULTS: No significant differences were found in the delay of delivery, but significantly fewer maternal side-effects were found in the nifedipine group. Doppler ultrasound results were similar in both groups. CONCLUSIONS: nifedipine is a valid and well-tolerated alternative among the tocolytic drugs, and apparently does not significantly alter fetal vascular blood flow.- - - - - - - - - - ranking = 5.0642999908602keywords = umbilical artery, umbilical, artery (Clic here for more details about this article) |