Cases reported "Placental Insufficiency"

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1/4. 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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keywords = deceleration
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2/4. pregnancy in a patient with Raynaud's disease.

    We report a patient who, at the time of her third pregnancy at the age of 35, had had Raynaud's disease for 18 years. Her first pregnancy (during which she took Marcumar, an anticoagulant) ended in a miscarriage at three months gestation. The second pregnancy ended in fetal death due to placental insufficiency. The third pregnancy was also complicated by placental insufficiency which became evident during the second trimester. The patient was observed carefully and allowed to continue to 37 weeks gestation when a Caesarean section was done for late fetal heart rate decelerations during early labour of spontaneous onset. The baby had a low birth weight but developed normally. The placenta showed certain abnormalities which are described.
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keywords = deceleration
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3/4. 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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keywords = deceleration
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4/4. Nonspecific decelerations in fetal heart rate during high-risk pregnancy.

    Solitary nonspecific decelerations in fetal heart rate occurring in three patients during antepartum cardiotocography are described. The decelerations were nonspecific in that they were neither variable nor late nor associated with maternal hypotension. All occurred in pregnancies complicated by hypertension and placental insufficiency. In the three patients described, the fetus lived for at least three days after the first nonspecific deceleration was observed. Although solitary nonspecific decelerations may indicate may indicate danger to the fetus from placental insufficiency, these decelerations should not be considered as an indication for immediate delivery.
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keywords = deceleration
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