1/5. Expectant management of placenta accreta following stillbirth at term: a case report.placenta accreta is a rare complication of pregnancy with high rates of morbidity and mortality. We report a case of expectant management. This strategy may prevent catastrophic postpartum haemorrhage requiring peripartum hysterectomy.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/5. Severe newborn encephalopathy unrelated to intrapartum hypoxic events: 3 case reports.INTRODUCTION: Newborn encephalopathy is an important clinical problem associated with considerable morbidity and mortality and is pertinent in the assignment of blame in obstetrics litigation. CLINICAL PICTURE: We report 3 babies with severe neonatal encephalopathy. OUTCOME: In all 3 cases, intrapartum hypoxic insult was unlikely to be a significant contributing factor towards the development of neonatal encephalopathy. The aetiology was unclear in the first 2 cases and there was antecedent antenatal cause of feto-maternal haemorrhage in the last case. CONCLUSION: Prevention of neonatal encephalopathy was not possible in these 3 cases. We recommend that umbilical cord blood gases be clearly documented in such cases to reduce unnecessary obstetrics litigation of intrapartum asphyxia as the significant contributing factor to the poor neonatal outcome. Clinicians must have a high index of suspicion of antecedent causes and perform the necessary investigations to elucidate the aetiology of the neonatal encephalopathy.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
3/5. Sinusoidal fetal heart rate pattern due to massive feto-maternal transfusion.A 30-year-old woman presented with mild abdominal discomfort and decreased fetal movements in the 34th week of her third pregnancy. fetal monitoring revealed a sinusoidal heart rate pattern, and abdominal delivery was promptly performed, with the newborn having a hematocrit of 7% due to massive fetomaternal transfusion. Fetal resuscitation was followed by a favorable outcome. The sinusoidal heart rate is discussed, with emphasis on the need for proper and prompt recognition of its significance.- - - - - - - - - - ranking = 48662.9866595keywords = fetomaternal, transfusion (Clic here for more details about this article) |
4/5. Occult fetomaternal haemorrhage as a cause of fetal mortality and morbidity.Spontaneous fetomaternal haemorrhage is an important, but usually overlooked, cause of perinatal mortality and morbidity. Although fetomaternal bleeding in the third trimester of pregnancy is common it is normally less than 0.1 ml. A fetal macrotransfusion (greater than 5 ml) is uncommon, but is important because it is insidious, unexpected and usually occurs in completely normal pregnancies. This paper analyses the perinatal mortality and morbidity associated with occult fetomaternal haemorrhage at the Royal women's Hospital, Melbourne. It may lead to fetal distress before and during labour, unexplained stillbirth, or nonhaemolytic neonatal anaemia. A Kleihauer test on maternal blood will readily detect fetomaternal bleeding, and we describe a simple way of calculating the absolute volume of fetal red cells present. Greater awareness of the problem may eventually lead to diagnosis sufficiently early to permit effective treatment.- - - - - - - - - - ranking = 388769.54312852keywords = fetomaternal, transfusion, haemorrhage (Clic here for more details about this article) |
5/5. Abnormal cortical plate (polymicrogyria), heterotopias and brain damage in monozygous twins.We report 5 cases of abnormal cortical plate (polymicrogyria or microgyric-like pattern) and heterotopias associated with hypoxic-ischemic brain injuries in monochorionic diamniotic twin fetuses of respectively 22, 26, 28, 31, 32 weeks gestation. These fetuses belonged to a series of 5 pairs of patients (10 cases) presenting with the characteristic features of the twin-to-twin transfusion syndrome. Three of them (2 donors and 1 recipient) were macerated and the brains were not available for study. Two (most likely recipient twins) survived. In the remaining 5 fetuses (3 donors and 2 recipients) with neuropathological study there were cortical plate abnormalities. In 2 cases, the cortex was dysmorphic and consisted of focal nodular distribution or vertical stripes of neurons. True polymicrogyria was focal in 2 cases and involved almost the entire surface of the hemispheres in another one. Heterotopias of immature cells were found in 4 cases, either in the white matter or in the cortex or in both sites. There was a focal laminar necrosis only in 2 cases. The morphological pattern of the anomalies depends on the time of occurrence of the insult and on its severity. These abnormalities, although similar to those already described in singleton fetuses, illustrate the variety of cortical dysmorphia which may be associated with fetal hypoxic-ischemic injuries and emphasize the particular vulnerability of the brain in monozygotic twins, whether it belongs to the donor or the recipient.- - - - - - - - - - ranking = 13.855131986683keywords = transfusion (Clic here for more details about this article) |