Cases reported "Fetal Death"

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1/9. central nervous system in twin reversed arterial perfusion sequence with special reference to examination of the brain in acardius anceps.

    The twin-reversed arterial perfusion (TRAP) sequence, or acardia, is the most severe complication in monozygotic twinning. Although more than 400 cases with TRAP sequence were reported since 1533, thorough investigations of the brain in those cases with a rudimentary head remained infrequent. We report a TRAP sequence with microcephaly and a severely rudimentary brain anlage. Neuropathologic examination clearly demonstrated two types of change: (1) developmental arrest of brain at the prosencephalic stage (holoprosencephaly), and (2) hypoxic damage to the holospheric brain mantle with cystic change (hydranencephaly). With reference to previous studies in experimental animals showing that lack of oxygen during early embryogenesis can induce severe disruptions of head-brain and heart formation, it is concluded that oxygen deficiency due to TRAP may be responsible not only for the encephaloclastic changes in the acardius anceps, but for the developmental arrest of the brain cases as well. This would make it unnecessary to postulate additional primary causes such as asymmetric zygote cleavage (Schwalbe, '07) for the maldevelopment.
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2/9. In utero development of hypertensive necrotizing pulmonary arterial lesions: report of a case associated with premature closure of the ductus arteriosus and pulmonary hypoplasia.

    Premature closure of the ductus arteriosus (PCDA) is an uncommon defect in which pulmonary hypertension (PH) has been documented by echocardiography in patients and by direct measurement after experimental PCDA in animals. The pulmonary vascular histology in human cases has received little attention but in the few recorded observations the vessels were either normal or showed increased muscularity. We report the case of a 31 week hydropic female stillborn monozygotic twin in whom postmortem examination disclosed PCDA and hypoplasia of the lungs. Atypical plexiform lesions with necrotizing pulmonary arteritis were present. These lesions represent vascular consequences of severe pulmonary hypertension produced by greatly enhanced blood flow through a restricted vascular bed resulting from the combined effects of these two abnormalities. The findings in this case of PCDA with presumed severe PH indicate that severe pulmonary vascular changes can develop in utero and that the interval of time needed for development of such chances in secondary PH is relatively short.
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3/9. A case of intrauterine fetal death associated with maternal campylobacter coli bacteraemia.

    Campylobacter species are known to cause infectious abortion in domestic animals. In humans, Campylobacter are an important cause of enteritis, an occasional cause of systemic infection and have had a rare association with abortion and perinatal infection. A case history of spontaneous abortion, at 26 weeks' duration, associated with maternal bacteraemia, due to campylobacter coli is presented. Transmission, pathogenesis, treatment, and the need for further investigation are discussed.
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4/9. organophosphate poisoning associated with fetal death: a case study.

    The increasing use of organophosphorus insecticides in agriculture and inside homes and schools, as well as its widespread existence in the environment, poses a potential health hazard. As the use of these agents increases, acute and chronic exposure has become more common. As with other organophosphates, chlorpyrifos kills insects and other animals, including human beings, because of its toxicity to the nervous system. Exposure of pregnant women to organophosphates is an important clinical entity because of its effects on two organisms--mother and fetus. There are few reports about fetal toxicity of organophosphates in the literature because of the relatively few cases reported. In this paper we report a case of intoxication from chlorpyrifos, an organophosphorus compound, during pregnancy, causing fetal death.
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5/9. Foetal kidney maldevelopment in maternal use of angiotensin ii type I receptor antagonists.

    We report renal lesions observed in a foetus exposed throughout pregnancy to angiotensin ii type I (AT 1) receptor antagonists. The mother suffered from essential hypertension and was treated with Cozaar (losartan 50 mg). autopsy examination of the foetus revealed severe renal lesions, including tubular dysgenesis, hypertrophy of the endothelial and medial cells lining the arterial and arteriolar walls, hyperplasia of the juxtaglomerular apparatus and poorly developed vasa recta. Similar lesions have already been observed in foetuses of women treated with angiotensin-converting enzyme antagonists and also in foetuses and neonates of animals undergoing experimental blockade of the renin-angiotensin system. The purpose of this report is to describe structural lesions observed in the kidneys, and, particularly, vascular lesions. Our results suggest that the use of AT 1 receptor antagonists during pregnancy may have a severe deleterious effect on kidney development in the foetus.
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6/9. Progression of exencephaly to anencephaly in the human fetus--an ultrasound perspective.

    Exencephaly as a precursor of anencephaly is well delineated in animal studies. In humans, a similar though unproven embryologic sequence is postulated. In the case reported, serial ultrasound studies allowed us to identify a 16-week human exencephalic fetus and observe the cephalic changes during its progression to a classic anencephalic appearance.
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7/9. Should hyperbaric oxygen be used to treat the pregnant patient for acute carbon monoxide poisoning? A case report and literature review.

    Carbon monoxide (CO) is the leading cause of death due to poisoning. Although uncommon, CO poisoning does occur during pregnancy and can result in fetal mortality and neurological malformations in fetuses who survive to term. uncertainty arises regarding the use of hyperbaric oxygen (HBO) as a treatment for the pregnant patient because of possible adverse effects on the fetus that could be induced by oxygen at high partial pressures. While the dangers of hyperoxia to the fetus have been demonstrated in animal models, careful review of animal studies and human clinical experience indicates that the short duration of hyperoxic exposure attained during HBO therapy for CO poisoning can be tolerated by the fetus in all stages of pregnancy and reduces the risk of death or deformity to the mother and fetus. A case is presented of acute CO poisoning during pregnancy that was successfully treated with HBO. Recommendations are suggested for the use of HBO during pregnancy.
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8/9. Perinatal group B streptococcal infections across intact amniotic membranes.

    We reviewed the perinatal mortality due to group B streptococcal infection over a three-year period at a tertiary center. In 6 of 16 perinatal deaths due to group B streptococcus, representing a range of gestational ages, infection occurred with the membranes intact. A review of reports from the obstetric and pediatric literature revealed that 10-50% of group B streptococcal infections occur in this manner. Several investigators of both animals and humans have demonstrated the pathophysiology of an ascending transamniotic infection. The current series emphasized this mode of infection in group B streptococcal disease.
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9/9. Oligohydramnion, meconium and perinatal death concurrent with indomethacin treatment in human pregnancy.

    Three pregnancies in which indomethacin was given for several days to arrest premature delivery ended in oligohydramnion, meconium and perinatal death. These findings, together with previous information from animal experimentation and experience in humans reported on in the literature, show that indomethacin, a prostaglandin synthetase inhibitor, may interfere with the normal uteroplacental circulation, amniotic fluid production, renal functions and neonatal cardiopulmonary adaptation. The possible hazards of indomethacin treatment during the third trimester of pregnancy are discussed.
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