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1/38. Pelvic abscess in the second half of pregnancy after oocyte retrieval for in-vitro fertilization: case report.

    We describe a very late manifestation of pelvic abscesses after oocyte retrieval for in-vitro fertilization (IVF). In a twin pregnancy achieved after intracytoplasmic sperm injection, rupture of bilateral ovarian abscesses occurred at the end of the second trimester. An emergency laparotomy was necessary because of an acute abdomen. This complication led to severe maternal and neonatal morbidity, preterm birth and neonatal death. The rare occurrence of acute abdomen in pregnancy due to pelvic infection and the non-specific symptoms of a pelvic abscess after oocyte retrieval for IVF are discussed.
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ranking = 1
keywords = death
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2/38. Are bilateral fetal lung masses double trouble?

    OBJECTIVES: To examine the perinatal natural history of bilateral fetal cystic lung masses. methods: The records of a tertiary medical center over a 3-year period were reviewed for cases of fetal bilateral pulmonary masses. RESULTS: Three of 98 fetuses referred for evaluation over a 3-year period from September of 1995 to August of 1998 had bilateral lung lesions. Two of these cases resulted in live births, while one, associated with hydrops, resulted in death after preterm delivery. CONCLUSIONS: Similar to prenatally diagnosed unilateral lung lesions, hydropic fetuses with bilateral cystic lung lesions have a poor prognosis. Nonhydropic fetuses, however, may be asymptomatic despite persistent lesions on postnatal CT scan. These observation may prove helpful for prenatal counseling for these rare lesions.
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ranking = 1
keywords = death
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3/38. Delayed interval delivery in multiple gestations.

    Two multiple pregnancies with delayed delivery after expulsion of dead fetus are presented. Case 1: A woman with a twin pregnancy and one intrauterine fetal death at 20 weeks' gestation delivered a dead fetus at 27 weeks' gestation. She delivered a healthy male infant weighing 2430 g at 33 weeks' gestation (42 d after the delivery of the first twin). Case 2: A woman with quadruplets pregnancy (2 live fetuses, one empty sac, and one fetocide at 7 weeks' gestation) got a intrauterine fetal death at 21 weeks' gestation at one fetus among 2 live fetuses and delivered a dead fetus at 24 weeks' gestation. She delivered a healthy female infant weighing 2110 g at 33 weeks' gestation (58 d after the delivery of a dead fetus). On the basis of our experience and the review of literature, delayed delivery with careful observation of fetal and maternal condition is recommended for improved survival and decreased morbidity among latter-born siblings.
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ranking = 2
keywords = death
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4/38. Conservative management of triplet pregnancy after delivery of one foetus.

    This paper intends to demonstrate that the conservative management of triplet pregnancy after delivery of one foetus is a feasible and reasonable approach. Three cases of triplet pregnancy with successful conservative management after miscarriage of one foetus, are presented and compared with cases in the literature. The route of delivery, as well as the role of tocolysis, cerclage, prophylactic antibiotic therapy and corticosteroids are discussed. Guidelines for conservative treatment are proposed. The deliveries of our three pregnancies were delayed by 63, 44 and 22 days respectively. Foetal and neonatal evolution are normal in five of the remaining foetuses. Only one intrauterine death is observed. No maternal complications with sequelae are reported. After abortion of the first triplet, contractions often persist and the birth of the two remaining foetuses may be unavoidable. Nevertheless, in our experience, confirmed by some reports in the literature, prolongation of the pregnancy after expulsion of the first foetus is possible. It can be achieved by cervical cerclage associated with tocolytic and antibiotic therapy. This management is not associated with significantly increased foetal-maternal morbidity.
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ranking = 1
keywords = death
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5/38. Complications of third-trimester amniocentesis using continuous ultrasound guidance.

    OBJECTIVE: The objective of the study was to estimate the risks of third-trimester amniocentesis with continuous ultrasound guidance. methods: Cohort study. We reviewed the medical records of women who had an amniocentesis with continuous ultrasound guidance after 30 weeks' gestation at a single institution from January 1991 through December 1994. For procedures performed from January 1991 to February 1994, we obtained information from a chart review. From March 1994 to December 1994, we collected data prospectively. The primary outcome was whether or not there were any complications within 48 hours of the procedure. We also sought to determine any risk factors associated with complications. RESULTS: Complete records and data were available for 562 amniocenteses during the study period. The mean gestational age at the time of amniocentesis was 34.9 weeks. Of the 562 procedures, five (0.8%) were unsuccessful and 50 (9%) required more than one needle stick. The complication rate was 0.7% (95% confidence level (CI) = 0.02%, 1.9%). These included spontaneous labor in a preterm gestation (1), premature rupture of the membranes (1), placental abruption (1), and fetal-maternal hemorrhage (1). No patient required an emergency cesarean delivery and none suffered a perinatal death (95% CI 0, 0.8%). Complications were not associated with the number of needle sticks, the presence of bloody amniotic fluid, or the level of operator experience. CONCLUSIONS: Third-trimester amniocentesis performed with continuous ultrasound guidance has a high success rate and low risk for complications.
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ranking = 1
keywords = death
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6/38. Acute appendicitis during pregnancy.

    Acute appendicitis is the most common surgical emergency occurring during pregnancy. To determine possible methods for improving diagnostic and management accuracy, a retrospective review was conducted of 23 pregnant patients who underwent laparotomy with a preoperative diagnosis of acute appendicitis. Gestational stage at presentation included the first trimester in 2 patients, the second trimester in 6 patients and the third trimester in 15 patients. Eighteen patients (78.26%) had pathologically proven acute appendicitis. Perforation occurred in 2 patients. Postoperative fetal complications included one intrauterine death (4.3%) and three premature births. There was no maternal deaths and morbidity was limited to atelectasis and wound infection in 4 patients. Gestational physiologic changes make difficult the diagnosis of acute appendicitis. Prompt surgical intervention prevent maternal complications and foetal loss.
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ranking = 869.68667296786
keywords = maternal death, death
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7/38. Pelvic fractures in pregnancy: factors influencing maternal and fetal outcomes.

    BACKGROUND: The purpose of this study was to determine factors influencing maternal and fetal outcomes associated with pelvic fractures in pregnancy. methods: A literature review of pelvic and acetabular fractures during pregnancy was performed, providing 101 cases for analysis (1 case report was included). Factors influencing maternal and fetal mortality were evaluated. RESULTS: Pelvic and acetabular fractures during pregnancy were associated with a high maternal (9%) and a higher fetal (35%) mortality rate. Automobile-pedestrian collisions had a trend toward a higher maternal mortality rate, and vehicular collisions had a trend toward a higher fetal mortality rate, compared with falls. Injury severity influenced both maternal and fetal outcomes. Fracture classification (simple vs. complex), fracture type (acetabular vs. pelvic), the trimester of pregnancy, and the era of literature reviewed did not influence mortality rates. When considering potential causes of fetal death, direct trauma to the uterus, placenta, or fetus was not associated with a higher fetal mortality rate, compared with maternal hemorrhage. Pelvic and acetabular fracture surgery has rarely been reported in this patient population. CONCLUSION: Pelvic and acetabular fractures in pregnancy continue to be associated with a high fetal mortality rate. Mechanism of injury and injury severity appeared to influence mortality rates, whereas the fracture classification, the fracture type, the trimester of pregnancy, and the era of literature reviewed did not.
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ranking = 1
keywords = death
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8/38. ritodrine therapy in the presence of chronic abruptio placentae.

    BACKGROUND: Betamimetic therapy is usually contraindicated for the treatment of premature labor associated with abruptio placentae. We report prolongation of a pregnancy for 7 weeks using ritodrine despite the presence of placental abruption. CASE: A 33-year-old primigravid woman presented at 25 weeks' gestation with irregular uterine contractions, vaginal bleeding, and sonographic evidence of abruptio placentae. Port wine-colored amniotic fluid was found during amniocentesis, and serial hematocrits decreased from 36 to 25%. A diagnosis of abruptio placentae was made, and because the maternal cardiovascular and fetal biophysical indices were normal, tocolytic therapy was started. Before the administration of ritodrine, the patient and her husband were given an extensive review of the risks, including blood transfusion, adult respiratory distress syndrome, disseminated intravascular coagulopathy, and maternal or fetal death. CONCLUSION: Although clinical suspicion of abruptio placentae remains a contraindication to betamimetic therapy, exceptions may be made if fetal and maternal well-being can be monitored and if a fully staffed operating room is always available for immediate cesarean delivery. The benefits of this management may outweigh the associated risks for carefully chosen, very preterm gestations.
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ranking = 1
keywords = death
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9/38. Obstetric and gynecologic complications in women with marfan syndrome.

    OBJECTIVE: To analyze the maternal and fetal outcomes of pregnancy and gynecologic problems in women with marfan syndrome. STUDY DESIGN: The outcomes of 14 pregnancies in 4 women with marfan syndrome were prospectively observed between January 1988 and December 2000. The cardiovascular and obstetric complications were analyzed. During pregnancy all the patients were carefully monitored with serial echocardiography and close attention to symptoms. RESULTS: Of the 14 pregnancies, 5 (35.7%) ended in abortion, and 3 of them occurred in the early second trimester due to cervical incompetence. Premature onset of labor occurred in 2 pregnancies at 31 and 34 weeks. postpartum hemorrhage complicated 3 deliveries, and inversion of the uterus occurred in 1 patient. Significant cardiovascular complications occurred in 2 patients, who required surgical correction of the aortic aneurysm and replacement of the aortic valve. In one patient the operation was performed within hours of vaginal delivery, and the other patient underwent surgery 8 weeks postpartum. No maternal death occurred in the study. One infant in the series was diagnosed as having marfan syndrome. A premature infant delivered at 31 weeks died on the second day of life. CONCLUSION: women with marfan syndrome are at high risk of aortic dissection in pregnancy even in the absence of preconceptional aortic root dilatation. Obstetric complications in patients with this condition have been underreported in the past. women with aortic root dilatation of < 40 mm usually tolerate pregnancy well, with good maternal and fetal outcomes. women with marfan syndrome should be counseled regarding the risk of pregnancy to both mother and fetus. patients who have cardiac decompensation or aortic dilatation > 40 mm are advised to avoid pregnancy.
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ranking = 868.68667296786
keywords = maternal death, death
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10/38. Abruptio placenta following sexual intercourse: case report.

    This is a case of Abruptio Placenta resulting from sexual intercourse. Pelvic Examination revealed active bleeding per vaginam. The pregnancy resulted into intra-uterine foetus death. The foetus membranes were ruptured and labour progressed. A still born male baby was delivered.
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ranking = 1
keywords = death
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