Cases reported "Fetal Death"

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1/10. Pressure in the hydrocephalic fetal head during the first stage of labor.

    Intraamniotic pressure was studied in the 30th week of amenorrhea in relationship with fetal intracranial pressure with open-tip catheters. The fetus had a severe hydrocephalus (echoscopy 16 cm) due to a teratologic malformation of the cerebrum. Clinically nonoperative treatment was indicated. intracranial pressure (X) was invariably higher than intraamniotic pressure (Y) between contractions: Y = 2.04 0.54 X, and during contractions: Y = 5.30 0.55 X. There was no definite relationship between intrauterine and intracranial pressure, and the fetal tachogram. A definite relationship was established with the supine position of the patient and decelerations in the fetal tachogram. It is suggested that when fetal cardiac decelerations are seen during the first stage of labor it seems advisable to look for factors such as umbilical cord compression and decrease of materno-placental perfusion rather than fetal head compression.
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2/10. Transabdominal amnioinfusion to avoid fetal demise and intestinal damage in fetuses with gastroschisis and severe oligohydramnios.

    BACKGROUND/PURPOSE: Despite dramatic improvement in survival rate for neonates with gastroschisis, significant postoperative morbidity and a low mortality rate still occur. Furthermore, even in recent publications, some fetal death has been reported. Does this mean that antenatal diagnosis of gastroschisis is a missed opportunity? In fact, decreased amniotic fluid (AF) volume is observed in some fetuses with gastroschisis. However, oligohydramnios is associated with an increased risk of fetal suffering. When severe oligohydramnios is observed, intrapartum amnioinfusion, to restore AF volume, may help avoid fetal complications. methods: Two fetuses with gastroschisis and severe oligohydramnios were treated antenatally with amnioinfusion of saline solution. In one case, fetal heart beat decelerations were observed at 27 weeks' gestation among with the oligohydroamnios and serial transabdominal amnioinfusions were performed. In the second case, severe oligohydramnios was observed at 31, weeks and an amnioinfusion was performed. The 2 babies were delivered at 31 and 34 weeks, respectively. RESULTS: In both cases, exteriorized bowel was nearly normal at birth, and primary closure could be performed. Outcome was favorable, and they were discharged home on day 43 and day 54, respectively. CONCLUSIONS: Because fetuses with gastroschisis and oligohydramnios are part of a particular high-risk group, serial ultrasound examination and computerized fetal heart beat monitoring are necessary during the third trimester. In selected cases of gastroschisis associated with severe oligohydramnios, serial amnioinfusion may be required.
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3/10. Umbilical vein thrombosis as a possible cause of perinatal morbidity or mortality: report of two cases.

    Significant occlusion of the lumen of the umbilical vein by thrombus was observed in 2 patients with unexplained intrauterine fetal death (IUFD)/fetal distress. Although a normal non-stress testing result was obtained 7 days prior to IUFD in one patient, IUFD was noted during regular antenatal care at 39 weeks of gestation; intrapartum abrupt onset of deceleration in fetal heart rate pattern was observed at 40 weeks of gestation, lasting 14 min until vacuum extractor-assisted delivery in the other patient. Umbilical vein thrombosis was considered contributory to IUFD and the abrupt deterioration in fetal heart rate pattern in these 2 patients. Histological examination of the umbilical cord is thus important in unexplained fetal death/fetal distress.
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4/10. Motor vehicle accident associated with minimal maternal trauma but subsequent fetal demise.

    Traumatic fetal injury in the absence of significant maternal injury is rare. A 21-year-old woman at 27 weeks estimated gestational age sustained a front-end motor vehicle collision at 35 mph while wearing a seatbelt and shoulder harness with minimal maternal injury. Marked variable fetal heart rate decelerations were noted on the patient's presentation. Although the initial ultrasound examination was normal, sequential examinations showed an enlarging fetal intracranial mass. Fetal demise occurred five days after the accident with necropsy confirming cerebral hemorrhage, hepatic hemorrhage, and hemoperitoneum. In this case, an abnormality of fetal heart rate first suggested a severe fetal injury, with ultrasonography confirming the injury four days later.
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5/10. fetal distress associated with the anticardiolipin antibody and a history of intrauterine fetal demise. A case report.

    A woman with a history of fetal demise, an elevated anticardiolipin antibody titer, lupus anticoagulant but no evidence of systemic lupus erythematosus received anticoagulation with heparin in adjusted subcutaneous doses. Daily fetal monitoring demonstrated reactive nonstress tests and normal biophysical profiles initially. At 30 weeks' gestation, however, repeated spontaneous decelerations developed, and fetal bradycardia necessitated delivery. The combination of a poor obstetric history and the presence of high cardiolipin antibody titers requires close fetal surveillance. The benefits of anticoagulation in this setting deserve further study.
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6/10. Cord entanglement in monoamniotic twin pregnancies.

    Monoamniotic twin pregnancy involves a heavy risk of fatal umbilical cord entanglement. Two cases are reported. In the first case, both twins were found dead in the 36th week, and the monoamnionicity was recognized at birth. In the second case, the monoamnionicity was discovered during an ultrasound examination, and cord entanglement was suspected in the 35th week on the basis of a non-stress test (NST) with variable decelerations. cesarean section was performed and two healthy children were delivered.
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7/10. The significance of cardiotocographic monitoring in pregnancy complicated by intrauterine growth retardation and prematurity.

    Intrauterine growth retardation is a condition of chronic fetal compromise. The most accurate method of fetal assessment in this condition is by serial cardiotocography. In pregnancy associated with intrauterine growth retardation, abnormal cardiotocography with spontaneous decelerations may be an indicator of imminent fetal death in utero. Delivery should be effected immediately if the fetus is at a gestation where viability is probable.
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8/10. Loss of beat-to-beat variability and a negative oxytocin challenge test: an ominous prognostic sign.

    The reputation of the predictive accuracy of a negative oxytocin challenge test (OCT) has been somewhat tarnished by recent sporadic reports of intrauterine fetal death relatively soon after a negative OCT. We have analyzed probable causes and the possibilities of reducing to a minimum "false-negative" results of the OCT. In particular, several of these reports did not take into account the loss of baseline fetal heart rate (FHR) variability recorded during the OCT and, in the absence of late decelerations, the OCT was interpreted as negative. We suggest that recordings showing a loss of baseline beat-to-beat FHR variability and a negative OCT illustrate a complete inability of the fetus to react to any stimulus and that, in these cases, a negative OCT should in no way be reassuring, but rather a warning sign of severe fetal compromise. Two cases are presented to illustrate this phenomenon.
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9/10. Sudden fetal death in labor. The significance of antecedent monitoring characteristics and clinical circumstances.

    Three patients experienced sudden fetal death in labor. The clinical presentations of the patients and their preceding monitoring patterns are discussed. A typical example of a benign, sustained deceleration in a healthy fetus is given for comparison. The characteristics of the clinical and monitoring behavior of the premorbid patient are discussed, and suggestions for appropriate responses to avoid fetal death are offered.
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10/10. Intrauterine fetal demise after negative oxytocin challenge tests.

    The oxytocin challenge test was used to evaluate the fetoplacental unit in 572 patients over a 5-year period. Four fetuses died in utero within 7 days of a negative test. None had periodic fetal heart rate decelerations of any type. All 4 showed periodic accelerations of the fetal heart rate (FHR) in association with fetal movement. Two had baseline changes in the fetal heart rate during the oxytocin challenge test.
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