1/12. Variations in maternal serum zinc during pregnancy and correlation to congenital malformations, dysmaturity, and abnormal parturition. serum zinc concentrations in 234 gravidae showed a gradual fall during the first and second trimesters. From the 25th week of gestation until delivery there is a levelling out of mean zinc values. No correlations between serum zinc, serum HCS, or urinary excretion of oestriol were found. women with mature infants born by normal delivery showed significantly higher serum zinc during pregnancy than women with abnormal deliveries and/or abnormally developed infants (p less than 0.001). Eight infants showed congenital malformations. Five of the 8 mothers showed the lowest serum zinc concentrations recorded during respective week of pregnancy. A diabetic woman gave birth to an immature infant with multiple skeletal malformations. She showed the lowest serum zinc in the 21st week, and at the same time a very low alkaline phosphatase activity. Her serum proteins and serum HCS were normal. women with dysmature infants showed significantly lower zinc values during pregnancy (p less than 0.02) than women with mature infants born by normal delivery. Data from studies on zinc metabolism show that there is a requirement of at least 375 mg of zinc during pregnancy in order to meet the demands of normal weight gain. Teenagers, women with multiple pregnancies, women with impaired intestinal absorption due to disease or drugs and in particular women with a low-protein, high-phytate diet seem to risk developing zinc deficiency during pregnancy. ( info) |
2/12. Legal aspects of consent 3: the duty of care to inform. Mrs Pearce was expecting her sixth child. The expected date of delivery was 13 November 1991. On 27 November when she saw the consultant the baby had still not arrived. She begged the doctor to induce her or to carry out a caesarean. He preferred to let nature take its course, and explained to her the risks of induction and a caesarean section. The baby died in utero sometime between 2 and 3 December. The delivery of a stillborn baby was induced on 4 December. She brought an action alleging that the consultant should have advised her of the increased risk of stillbirth as a result of the delay in delivery between 13 November and 27 November (Pearce v United Bristol Healthcare NHS trust, 1998). ( info) |
3/12. Excessive maternal weight and pregnancy outcome. OBJECTIVES: This study was undertaken to determine the influences of increased maternal prepregnancy weight and increased gestational weight gain on pregnancy outcome. STUDY DESIGN: This was a longitudinal retrospective study of 7407 term pregnancies delivered from 1987 through 1989. After excluding cases with multiple fetuses, stillbirths, fetal anomalies, no prenatal care, selected medical and surgical complications, and those with incomplete medical records, 3191 cases remained for analyses by determination of odds ratios for obstetric outcomes, by chi 2 tests for significant differences and by adjustment for risk factors with stepwise logistic regression. RESULTS: Both increased maternal prepregnancy weight (body mass index) and increased maternal gestational weight gain were associated with increased risks of fetal macrosomia (p less than 0.0001), labor abnormalities (p less than 0.0001), postdatism (p = 0.002), meconium staining (p less than 0.001), and unscheduled cesarean sections (p less than 0.0001). They were also associated with decreased frequencies of low birth weight (p less than 0.001). The magnitude of the last was less than that of the other outcomes. CONCLUSIONS: Increased maternal weight gain in pregnancy results in higher frequencies of fetal macrosomia, which in turn lead to increased rates of cesarean section and other major maternal and fetal complications. Because these costs of increased maternal weight gain appear to outweigh benefits, weight gain recommendations for pregnancy warrant careful review. ( info) |
4/12. Erosion of a B-Lynch suture through the uterine wall: a case report. BACKGROUND: The B-Lynch uterine suture brace has been used for the surgical treatment of postpartum hemorrhage. To date, no complications of this procedure have been reported. We describe B-Lynch suture erosion through the uterine wall identified at a 6-week postpartum visit. CASE: A 19-year-old primigravida underwent a primary low transverse cesarean section at term for arrest of descent. The surgery was complicated by postpartum hemorrhage secondary to uterine atony unresponsive to medical management. The patient underwent successful placement of a B-Lynch suture using delayed, absorbable suture for control of the hemorrhage and had an uneventful postoperative course. At her 6-week postpartum examination, she was found to have the suture protruding from the uterine cervical os. The suture was removed in its entirety without difficulty. Follow-up sonohysterography at 6 months identified a small defect in the anterior wall of the lower uterine segment, corresponding to the probable site of suture erosion. CONCLUSION: Erosion of suture through the uterine wall can be a complication of the B-Lynch uterine suture brace. Delayed, absorbable suture is less desirable than absorbable suture for this procedure due to the risk of erosion through the uterine wall. ( info) |
5/12. Detection of wallerian degeneration in a newborn by diffusion magnetic resonance imaging (MRI). We present the case of an infant with hypoxic-ischemic encephalopathy in whom wallerian degeneration is demonstrated in white-matter fiber tracts by diffusion magnetic resonance imaging (MRI). MRI was undertaken on days 2 and 9 and then at 9 months of age. On day 2, conventional MRI was normal, but diffusion MRI showed bioccipital abnormalities. On day 9, diffusion MRI showed marked abnormalities in the deep white matter of the occipital regions (left > right), corpus callosum, left posterior limb of the internal capsule, and left cerebral peduncle. water apparent diffusion coefficient values showed a significant reduction in the left occipital white matter and corpus callosum between days 2 and 9 while demonstrating the expected pseudonormalization in cortical gray matter. Images at 9 months showed left occipital porencephaly and atrophy of the left cerebral peduncle, with the infant displaying right hemiplegia at 18 months of age. In this case, the time course of diffusion changes differed between white and gray matter, with diffusion MRI showing delayed wallerian degeneration of the cerebral white matter. This case characterizes this degeneration with clinical and follow-up MRI at 9 months of age. ( info) |
6/12. uterine rupture at term pregnancy with the use of intracervical prostaglandin E2 gel for induction of labor. Prostaglandin E2 is a powerful oxytocic agent that reliably initiates labor, even in the presence of an unripe cervix. The low incidence of fetomaternal complication contributes to its universal use. We report a rare case of uterine rupture after intracervical application of prostaglandin E2 gel. Thus far no prostaglandin compound or method of administration seems to be exempt from such a complication. ( info) |
7/12. Sinusoidal heart rate pattern and face presentation in a fetus from a postterm pregnancy. A case report. A case of sinusoidal fetal heart rate pattern occurred in association with postdate pregnancy and face presentation. The case met the criteria for sinusoidal pattern established by Modanlou and Freeman except for a prior period of reactivity. Prompt recognition and action precluded the potential adverse outcome associated with this tracing. ( info) |
8/12. fetal heart rate decelerations after oxytocin infusion in an abdominal pregnancy. fetal heart rate (FHR) decelerations during a contraction stress test are recognized as signs of possible uteroplacental insufficiency. Although these decelerations have been described commonly in intrauterine pregnancies, they have not been noted in extrauterine pregnancies. Reported herein are FHR decelerations associated with oxytocin infusion in an extrauterine pregnancy and a discussion of the possible pathophysiologic mechanisms. ( info) |
9/12. 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. ( info) |
10/12. Sleeping foetus?--Medicolegal consideration of an incredibly prolonged gestational period. In libya, sexual intercourse between an unmarried couple is unlawful even if it was consensual. The defendant in this case pleaded not guilty to the charge despite the fact that she delivered a baby 29 months after divorce. She imputed paternity of the child to her ex-husband, who denied the allegation on the grounds of the extremely long gestational period. Her claim was that the baby was conceived three months prior to divorce, but had ceased to grow for some time. Her plea was based on the widely accepted notion amongst lay people, the so-called 'sleeping foetus'. Following the medical opinion, the court dismissed the plea and the woman was convicted of unlawful sexual intercourse. ( info) |