1/32. dexamethasone-facilitated postponement of delivery of an extremely preterm pregnancy complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelets.OBJECTIVE: patients with severe preeclampsia and the syndrome of hemolysis, elevated liver enzymes, and low platelets (hellp syndrome) are at increased risk for perinatal and maternal morbidity, especially in very preterm gestations. When this condition affects a pregnancy on the cusp of viability, a therapeutic intervention to prolong gestation without undue risk to the mother or fetus could be beneficial. METHOD: A single case report and review of the literature. Result: We report a patient with hellp syndrome in whom antenatal administration of high-dose dexamethasone helped achieve disease stabilization and delivery postponement for 9 days of a very preterm fetus estimated to weight less than 600 g. Both mother and infant did well postpartum. CONCLUSION: Administration of antenatal high-dose dexamethasone can be used in carefully selected preterm patients with hellp syndrome to delay delivery while in utero fetal maturation is accelerated and the maternal condition is optimized. This can be beneficial in carefully selected pregnancies without apparent adverse maternal or perinatal impact.- - - - - - - - - - ranking = 1keywords = single (Clic here for more details about this article) |
2/32. Acardiac fetus in a triplet pregnancy: ultrasound pitfalls. A case report.This communication aims at illustrating ultrasound diagnostic difficulties in early pregnancy with acardiac fetus. Our case concerns a spontaneously conceived triplet pregnancy. It was diagnosed as a twin pregnancy at 11 weeks of amenorrhea. One and a half months later the patient was referred to our center for spontaneous premature rupture of membranes with the diagnosis of a fetal demise in a triplet pregnancy. The definite diagnosis of acardia was assessed sonographically by the presence of a reverse blood flow through the umbilical cord, reflex movements, limbs anomalies and discordance between femoral and crown-rump length. Two days after admission, the patient developed chorioamnionitis and the three fetuses were expelled.- - - - - - - - - - ranking = 2370.4312554954keywords = umbilical (Clic here for more details about this article) |
3/32. Fetal and neonatal arrhythmia in one of the twins--a case history.There are a lot of publications about fetal arrhythmia in singletons, but up to now there are no published data about fetal arrhythmia in multiple pregnancies. In the present study a case history of fetal and neonatal arrhythmia in one of twins from two mothers treated with betamimetic agents due to imminent preterm labor is reported and discussed. A first case with fetal bradycardia due to complete A-V block had congenital cordis abnormalities (VSD and PFO). The second case with prenatal detected extrasystoles had normal heart anatomy. digoxin was administered to the mother, in the aim to treat fetal arrhythmia without success, because the baby had postnatal bradycardia. After hospitalisation in cardiology Department the described cases were successfully treated. In both cases the second twins were without neonatal arrhythmia and with no structural heart abnormalities. We summarise that in situation of detection fetal arrhythmia the complexity of the problems experienced may warrant early referral to a tertiary centre where the overall management of the mother, fetus and neonate, may be undertaken.- - - - - - - - - - ranking = 1keywords = single (Clic here for more details about this article) |
4/32. Severe oligohydramnios induced by cyclooxygenase-2 inhibitor nimesulide.BACKGROUND: Cyclooxygenase-2 inhibitors might have fewer adverse fetal effects than conventional nonsteroidal anti-inflammatory drugs that inhibit both isoforms of the enzyme. Although cyclooxygenase-2 is expressed in fetal kidneys, there are no reports of adverse effects in human pregnancy. CASE: A 27-year-old woman, gravida 2, para 0, with a twin pregnancy at 24 weeks' gestation had placement of a cervical cerclage. Nimesulide was prescribed for postoperative preterm labor prophylaxis. Three weeks later, severe oligohydramnios was identified in both sacs, despite normal growth, renal anatomy, and umbilical artery and renal artery Doppler flow velocimetry. After stopping the drug, amniotic fluid volumes returned to normal over 2 weeks. There were no adverse neonatal renal effects. CONCLUSION: Selective cyclooxygenase-2 inhibition might cause severe oligohydramnios. If it is used, we advise close fetal surveillance.- - - - - - - - - - ranking = 16900.74658707keywords = umbilical artery, umbilical, artery (Clic here for more details about this article) |
5/32. 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.- - - - - - - - - - ranking = 1keywords = single (Clic here for more details about this article) |
6/32. Intrauterine treatment for an acardiac twin with alcohol injection into the umbilical artery.An acardiac twin is a unique complication of monochorionic twinning, in which a normal pump twin perfuses the acardiac twin. The mortality rate of the pump twin is greater than 50%. Herein we present the successful treatment of an acardiac twin with alcoholization as follows. An acardiac twin was diagnosed at 24 weeks gestation. Circulation interruption of the acardiac twin was successfully achieved by injection of absolute alcohol (5 mL) into the intra-abdominal umbilical artery. Serial ultrasound after the procedure revealed normal growth of the pump twin, whereas the acardiac twin was shrinking. Spontaneous premature delivery at 34 weeks gestation resulted in a normal surviving female baby weighing 2410g and an acardiac female fetus weighing 300g. This experience suggests that this simple technique may be an alternative treatment for an acardiac twin.- - - - - - - - - - ranking = 84466.957723377keywords = umbilical artery, umbilical, artery (Clic here for more details about this article) |
7/32. Heterotopic pregnancy: report of three cases.OBJECTIVE: Heterotopic pregnancy, defined as concomitant intrauterine and ectopic pregnancy, is a rare event. Assisted reproductive technologies have led to an increase in the number of heterotopic pregnancies. MATERIALS AND METHOD: From 1997 to 1999 three cases of heterotopic pregnancies were referred to the gynecological unit of the hospital of St. Polten. The condition was diagnosed at 7, 8 and 12 weeks of gestation, respectively. Two patients had undergone assisted reproductive technologies and former pelvic surgery for tubal pregnancy. Two patients had intrauterine singleton pregnancies and one patient had an intrauterine twin pregnancy. In all cases the ectopic site presented as a ruptured tubal pregnancy and the treatment consisted of laparoscopic salpingectomy. RESULTS: In all patients the postoperative course was uneventful and the intrauterine pregnancy progressed. In one case recurrent preterm labor led to vaginal delivery at 33 weeks of pregnancy. In the case of twin pregnancy, a planned cesarean section was performed at 37 weeks of gestation. One patient delivered at term. All newborns were healthy. CONCLUSION: knowledge of heterotopic pregnancy and understanding the epidemiological risk factors underlying this condition are important for early diagnosis with the aim of improving therapy and clinical outcome.- - - - - - - - - - ranking = 1keywords = single (Clic here for more details about this article) |
8/32. umbilical cord transection in twin-reverse arterial perfusion syndrome with the use of a coaxial bipolar electrode (Versapoint).Umbilical-cord occlusion has been proposed for the treatment of twin-reverse arterial perfusion syndrome (TRAP). Transection of the umbilical cord is necessary in patients with monoamniotic or 'pseudomonoamniotic' TRAP to avoid subsequent cord entanglement and demise of the pump twin. We present a case of TRAP in which the umbilical cord was successfully ligated with suture and transected with the Versapoint electrode.- - - - - - - - - - ranking = 4740.8625109908keywords = umbilical (Clic here for more details about this article) |
9/32. hydrops fetalis and neonatal death from human parvovirus B19: an unusual complication.A case of prenatally diagnosed human parvovirus B19 (HPVB19) infection is reported. The neonate died after intrauterine therapy and premature delivery.The fetus was diagnosed with oedema, cardiomegaly, poor myocardial contractility and a pericardial effusion at 24/40 weeks' gestation. Ultrasound using colour flow Doppler showed a midcerebral artery peak systolic velocity (MCA PSV) raised at 45 cm/s, suggesting fetal anaemia. This was confirmed on fetal blood sampling, but recovery was suggested with a reticulocyte count of 16.8%. The fetal karyotype was normal, 46,XY. Fetal IgM was positive for parvovirus. A week later, severe fetal anaemia was suspected and intrauterine transfusion carried out. Altogether three transfusions were given. At 31/40 weeks, the mother presented to her local hospital with suspected preterm labour, a caesarean section was carried out because of fetal compromise on cardiotocography. The baby was in poor condition at birth and resuscitation was stopped at 45 min of age. The post-mortem examination confirmed the hydrops and proved persistent parvovirus infection, cardiac involvement and severe liver fibrosis.HPVB19 generally follows a benign course with intrauterine therapy; however, in this case, the fetus died despite successful transfusions. The reasons for this are discussed.- - - - - - - - - - ranking = 7.3550423948869keywords = artery (Clic here for more details about this article) |
10/32. A rare form of abruptio placenta and clinical presentation in a preterm labor case: Breus' mole.A normotensive pregnant woman who had no historical risk factors for abruption placenta and found to have Breus' mole that indicates the pattern of single or multiple hematoma protrude above the chorionic plate was encountered. The case resembled a large fetal abdominal wall defect coexisting with a singleton live-born fetus at 27 weeks of gestational age is presented. The obstetric ultrasound showed that multiple coiled masses in the amniotic cavity, both the fetus and the placenta were normal. After two courses of tocolysis therapy, a healthy and, 1,400 g live-born infant was delivered through cesarean section due to fetal distress. Apgar scores at 1 and 5 min were 5 and 8, respectively. The infant died on postnatal day 6 due to severe respiratory distress and prematurity. This rare condition probably occurs frequently in missed abortion and the etiology is unknown, but is probably related to circulatory disturbance on maternal site. We report a rare clinical presentation and review the literature of Breus' mole.- - - - - - - - - - ranking = 2keywords = single (Clic here for more details about this article) |
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