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11/107. streptococcus bovis bacteremia and fetal death.

    BACKGROUND: Preterm premature rupture of membranes leading to intraamniotic infection and fetal death may be due to unusual bacterial species. CASE: A young multipara presented at 24 weeks and 6 days' gestation with rupture of membranes of 2 days' duration. She was febrile and hypotensive. No fetal heart activity was noted. Antibiotics, fluid resuscitation, and oxytocin were begun with delivery of a 798-g stillborn fetus. Maternal and fetal cultures demonstrated streptococcus bovis as the infectious agent. CONCLUSION: Unusual bacteria such as S bovis are sometimes responsible for severe maternal and fetal infections. Aggressive fluid resuscitation, uterine evacuation, and triple antibiotic therapy until culture results are available are indicated.
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ranking = 1
keywords = death
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12/107. hydrops fetalis secondary to parvovirus B19 infections.

    BACKGROUND: Fetal infection by human parvovirus B19 is a common cause of fetal anemia, nonimmune hydrops fetalis, and spontaneous abortion and can result in fetal death. Recent improvements in diagnosing parvovirus infections and the availability of intrauterine transfusion have reduced the overall rate of fetal loss after maternal exposure. methods: We report two cases of maternal parvovirus infection with classic findings of hydrops fetalis and review various aspects of parvovirus infection with emphasis on the developing management options in pregnancy. RESULTS AND CONCLUSIONS: Different management led to different results. In the first case there was normal neonatal and infantile development, and in the second case, the fetus died. With accurate laboratory testing, obstetric sonography, and fetal transfusion, the fetal mortality from parvovirus infection has been reduced considerably, and most pregnancies complicated by maternal parvovirus infection result in healthy outcomes.
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ranking = 0.2
keywords = death
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13/107. Congenital cytomegalovirus infection after recurrent infection: case reports and review of the literature.

    cytomegalovirus (CMV) is one of the most common causes of congenital infections in developed countries with reported incidences varying between 0.15% and 2.0%. The effects of congenital CMV infection may vary from a congenital syndrome to an asymptomatic course. Infants that are asymptomatic at birth may still present handicaps at a later age. It is generally accepted that symptoms of congenitally infected children are more severe after primary infection than after recurrent infection. In this article, we present two case reports which demonstrate that the outcome of recurrent maternal CMV infection may be severe. In the first case, early pregnancy serology showed positive IgG and IgM, but negative IgA, whereas at the time of diagnosed fetal death, 5 weeks later, there was only positive IgG. The second case showed positive IgG and negative IgM and IgA both in early pregnancy and after delivery. Since in both cases CMV was isolated from several organs, these findings are compatible with recurrent rather than primary CMV infection. In the reported patients, fetal death and necrotising enterocolitis occurred after a congenital CMV infection, with mothers having pre-existing immunity to CMV. In conclusion, these case reports and review of the literature emphasise that the outcome of recurrent maternal CMV infection may be severe and that congenital CMV infection should be considered in cases of pregnancy loss and necrotising enterocolitis with recurrent maternal CMV infection.
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ranking = 0.4
keywords = death
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14/107. measles infection in pregnancy.

    OBJECTIVES: measles during pregnancy has deleterious effects on both the perinatal outcome and the mother. However, in-depth knowledge about gestational measles is lacking. The objectives of this study were to describe the clinical course of eight cases of gestational measles and to study the effect of measles and pregnancy on each other. methods: From late 2000 to early 2001, we experienced a measles outbreak with eight infected pregnant women. The clinical course of each case is described in detail. RESULT: Three of the four cases before 24 weeks of gestation ended in spontaneous abortion or stillbirth. The clinical course of the three abortions and stillbirth were singular because of the sudden onset of the abortion and the spontaneous pregnancy termination. In contrast, the four pregnancies after 25 weeks of gestation ended in live-term delivery and two out of the four neonates were diagnosed with congenital measles. There was no maternal death, instead two pneumonia cases and one hemorrhagic shock case. CONCLUSIONS: Gestational measles may potentially damage the fetus and is one of the serious complications that can occur during pregnancy.
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ranking = 163.12556044257
keywords = maternal death, death
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15/107. hemorrhagic fever with renal syndrome presenting with intrauterine fetal death. A case report.

    BACKGROUND: Hantavirus infection in pregnancy is rare. Only 2 cases of hantavirus pulmonary syndrome have been reported in the English-language literature. We report a case of hemorrhagic fever with renal syndrome (HFRS) complicating pregnancy to alert clinicians to this rare possibility. CASE: A 29-year-old woman had experienced persistent, high fever for 6 days, no fetal movement for 2 days and frequent vomiting for 1 day before being referred to our department with the additional symptoms of headache, lumbodynia and orbital pain. On examination, she had a normal body temperature, flushing of the face, conjunctive congestion, pharyngeal congestion, bulbar conjunctive edema, severe jaundice, petechiae and ecchymosis at sites of venipuncture, deranged liver and renal function tests, heavy proteinuria and hematuria, and coagulation disturbance. The diagnosis of HFRS complicating pregnancy was made on account of the clinical picture and antihantavirus IgM titer of 1:20. The patient's condition quickly deteriorated, with frank hematuria, oliguria and finally anuria, together with shock. Hemodialysis was immediately commenced, and a stillborn, male infant, of 3,200 g, was delivered vaginally following combined induction 12 hours after hemodialysis. The fetus showed no obvious abnormalities, but the parents declined an autopsy. After hemodialysis and delivery, the patient recovered and was discharged 3 weeks later. The repeat titer for antihantavirus IgM was 1:80 10 days after presentation. CONCLUSION: HFRS is a rare complication of pregnancy. The symptoms are nonspecific. early diagnosis and appropriate management are necessary to improve the maternal and fetal outcome. Clinicians should include this condition in the differential diagnoses when a combination of hematologic, hepatic, renal and gastrointestinal problems presents in pregnancy.
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ranking = 0.8
keywords = death
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16/107. Fatal maternal laryngeal papillomatosis in pregnancy: a case report [corrected]

    Although genital condylomata worsen with pregnancy, we are unaware of any reports of fatal maternal laryngeal papillomatosis. A maternal death at 20 weeks' gestation of a patient with chronic laryngeal papillomatosis is described. Pregnant patients with a history of this disorder who have symptoms should be considered candidates for immediate evaluation.
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ranking = 163.12556044257
keywords = maternal death, death
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17/107. In utero herpes simplex encephalitis.

    BACKGROUND: Transplacental intrauterine infection with herpes simplex virus is an extremely rare complication of primary herpes simplex in pregnancy. Overwhelming fetal sepsis might result in multiorgan failure, including fetal brain death. CASE: A 34-year-old multigravida presented with a healing ulcerative genital rash at 16 weeks' gestation. She subsequently reported at 28 weeks' gestation that there had been no fetal movements for 2 weeks. A cardiotocograph showed absent short- and long-term variability. At delivery, an infant was born with disseminated herpes simplex infection in poor condition. Active treatment was subsequently withdrawn, and postmortem examination confirmed disseminated herpes simplex type 2 infection. CONCLUSION: Transplacental herpes simplex is a rare and potentially lethal form of congenital herpes. Overwhelming in utero sepsis should be considered in the differential diagnosis of fetal brain death.
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ranking = 0.4
keywords = death
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18/107. endocarditis during pregnancy.

    The incidence of infective endocarditis during pregnancy has been reported to be 0.006%. The maternal mortality rate can reach 33%, with most deaths related to heart failure or an embolic event. The rate of fetal mortality can reach 29%. heart diseases are the most important nonobstetric causes of maternal death during pregnancy, accounting for 10% of maternal deaths. As many as 3% of women have a form of cardiac disease diagnosed during or in the period preceding pregnancy, with 70 to 80% of the cardiac conditions having congenital causes.
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ranking = 326.45112088514
keywords = maternal death, death
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19/107. Occlusion of a coronary ostium by an ingrowing endocardial vegetation: a case report.

    A 21-year-old primi, with a period of gestation of 35 weeks, was found collapsed in the toilet of a maternity hospital in Colombo, sri lanka. She had been admitted five days previously and echocardiography had detected a tight aortic stenosis with grade I aortic regurgitation. At autopsy, the heart showed multiple, large (> 10mm), friable vegetations on a stenosed, bicuspid aortic valve. A 5 mm long part of a vegetation had extended into the ostium of the left main coronary artery and caused an obstruction. Histopathology showed scattered fibrosis and focal inflammatory cell infiltrate in the myocardium. The vegetations on the valve cusp were composed of colonies of bacteria, fibrin exudate and polymorphs. The cause of death was acute myocardial infarction in a pregnant woman due to occlusion of the left coronary artery by an infective endocarditis vegetation. A medline search of the past 25 years failed to find a similar case.
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ranking = 0.2
keywords = death
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20/107. A case of intrauterine fetal death associated with maternal campylobacter coli bacteraemia.

    Campylobacter species are known to cause infectious abortion in domestic animals. In humans, Campylobacter are an important cause of enteritis, an occasional cause of systemic infection and have had a rare association with abortion and perinatal infection. A case history of spontaneous abortion, at 26 weeks' duration, associated with maternal bacteraemia, due to campylobacter coli is presented. Transmission, pathogenesis, treatment, and the need for further investigation are discussed.
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ranking = 0.8
keywords = death
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