1/24. prenatal diagnosis of thoracopelvic dysplasia. A case report.BACKGROUND: Thoracopelvic dysplasia, a variant of asphyxiating thoracic dysplasia (Jeune syndrome), is an uncommon skeletal disorder characterized by a small thorax, pelvic abnormalities and other complex, combined anomalies, including hypomelia, polydactyly and renal anomalies. CASE: A 32-year-old woman, gravida 1, para 0, was referred at 27 weeks' gestation due to polyhydramnios. Sonography revealed hydramnios, low fetal thoracic circumference (TC) and abdominal circumference (AC) ratio (0.78), skull and skin edema, increased nuchal translucency (7 mm), micrognathia, low-set ears, left cardiac deviation (66 degrees), overriding fingers, and club and rock-buttock feet. amniocentesis revealed a normal karyotype (46, XY). Asphyxiating thoracic dysplasia was considered. At 40 weeks' gestation, a male infant was delivered vaginally. Besides the prenatal findings, cryptorchidism and high-arched palate were noted. radiography of the infant revealed a narrow, funnel-shaped thorax and small pelvis with short, flared iliac bones; poorly developed acetabulum; and small, shallow sciatic notch. No dyspnea was observed at five months postpartum. CONCLUSION: Thoracopelvic dysplasia should be considered when a low TC/AC ratio (< 0.8) is observed. In this case the final diagnosis was made after detailed exclusion of other disorders combined with observation of a small thorax. prenatal diagnosis of thoracopelvic dysplasia is possible.- - - - - - - - - - ranking = 1keywords = gestation (Clic here for more details about this article) |
2/24. "Shake hands"; diagnosing a floppy infant--myotonic dystrophy and the congenital subtype: a difficult perinatal diagnosis.myotonic dystrophy is a multi-organ disease inherited in a complicated way. Congenital myotonic dystrophy is a distinct entity with severe symptoms leading to a high rate of perinatal morbidity and mortality. The occurrence of congenital myotonic dystrophy often allows a subsequent diagnosis in the mother with important implications for her life, her further pregnancies and offspring. Genetic principles of anticipation and somatic mosaicism are involved and hamper the prenatal diagnostic possibilities. A family is presented in which maternal myotonic dystrophy and congenital myotonic dystrophy were diagnosed after the third pregnancy. The key features leading to the diagnosis were obstetric history, neonatal hypotonia and asphyxia, facial abnormalities in the mother together with the inability to bury eyelashes and delayed release of grip after shaking hands. The disorder is reviewed with respect to clinical symptoms, pathogenesis and genetics.- - - - - - - - - - ranking = 0.14986190347514keywords = pregnancy (Clic here for more details about this article) |
3/24. Fetal trauma: brain imaging in four neonates.The purpose of this paper is to describe brain pathology in neonates after major traffic trauma in utero during the third trimester. Our patient cohort consisted of four neonates born by emergency cesarean section after car accident in the third trimester of pregnancy. The median gestational age ( n=4) was 36 weeks (range: 30-38). Immediate post-natal and follow-up brain imaging consisted of cranial ultrasound ( n=4), computed tomography (CT) ( n=1) and post-mortem magnetic resonance imaging (MRI) ( n=1). pathology findings were correlated with the imaging findings ( n=3). Cranial ultrasound demonstrated a huge subarachnoidal hemorrhage ( n=1), subdural hematoma ( n=1), brain edema with inversion of the diastolic flow ( n=1) and severe ischemic changes ( n=1). In one case, CT demonstrated the presence and extension of the subarachnoidal hemorrhage, a parietal fracture and a limited intraventricular hemorrhage. Cerebellar hemorrhage and a small cerebral frontal contusion were seen on post-mortem MRI in a child with a major subarachnoidal hemorrhage on ultrasound. None of these four children survived (three children died within 2 days and one child died after 1 month). Blunt abdominal trauma during pregnancy can cause fetal cranial injury. In our cases, skull fracture, intracranial hemorrhage and hypoxic-ischemic encephalopathy were encountered.- - - - - - - - - - ranking = 0.79972380695027keywords = gestation, pregnancy (Clic here for more details about this article) |
4/24. Pregnancy in renal transplant recipients: case report.Pregnancy in a renal homograft recipient resulted in an emergency cesarean section at 32 weeks' gestation secondary to maternal small bowel obstruction with necrotic bowel and subsequent intestinal perforation. The 1814 gm female product of this pregnancy had a moderate degree of in utero asphyxia, which subsequently, based on radiologic studies, had to be differentiated from the possibility of a congenital viral infection. Several concerns arose regarding the effects on the fetus by maternal immunosuppressive therapy, the risk factors faced by both the fetus and the mother secondary to the mother's renal disease, and the general outcome of the increasing number of pregnancies in this population.- - - - - - - - - - ranking = 0.64986190347514keywords = gestation, pregnancy (Clic here for more details about this article) |
5/24. Pathological findings in the temporal bone of newborn infants with neonatal asphyxia.Hypoxia in adults frequently causes damage to the brain, but not the inner ear. However, hypoxia in neonates with inadequate blood-inner ear barrier function causes damage to the inner ear, leading to hearing loss and equilibration disorder. Clinically, asphyxiated neonates sometimes have the complication of sensorineural hearing impairment at high frequencies. Many reports suggest that this problem is caused by hypoxic encephalopathy. However, it is not clear whether inner ear disorders are present. In this report we examined the inner ear pathology of four asphyxiated neonates using serial sections of temporal bone.The subjects (n=4) were 1-13-day-old neonates with pregnancy periods of 24-36 weeks. Their fetal growth curves were within the normal range. There was one case each of twin pregnancy, placental abruption, placenta previa and meconium aspiration syndrome.For the case of severe neonatal asphyxia, damage to the inner ear included the degeneration and disappearance of outer hair cells of the organ of corti and edematous changes in the stria vascularis. Degeneration of spiral ganglion and vestibular ganglion cells was observed in two of the other cases.- - - - - - - - - - ranking = 0.29972380695027keywords = pregnancy (Clic here for more details about this article) |
6/24. oxytocin-associated rupture of an unscarred uterus in a primigravida.BACKGROUND: Intrapartum rupture of the unscarred uterus is an uncommon event, usually associated with such risk factors as grand multiparity, malpresentation, history of gestational trophoblastic disease, or instrumented delivery. Rupture during first pregnancy is extremely rare. CASE: A 30-year-old primigravid woman was admitted for labor augmentation with oxytocin at 40.5 weeks of gestation. The oxytocin infusion rate was increased during the first and second stages of labor despite contractions occurring at a rate of 4-5 per 10 minutes. The uterus ruptured during second stage. Despite emergency cesarean delivery, the baby had evidence of severe asphyxia. CONCLUSION: This case of uterine rupture in a primigravida with no prior uterine surgery and a structurally normal uterus underscores the importance of careful contraction monitoring and judicious control of oxytocin infusion rates.- - - - - - - - - - ranking = 1.1498619034751keywords = gestation, pregnancy (Clic here for more details about this article) |
7/24. Developmental intervention in the newborn intensive care unit.Developmental intervention for infants with perinatal asphyxia requires an individualized therapeutic plan. A team approach incorporating developmental goals and intervention strategies into the nursing care of these infants is essential for optimal developmental outcome. Therapeutic management must always be appropriate for the infant's health status, gestational age, and organizational capabilities. An understanding of the neurophysiologic basis for intervention and the therapeutic management techniques for infants who are sick, recuperating, or convalescing will help the nurse to promote optimal development when caring for the asphyxiated infant.- - - - - - - - - - ranking = 0.5keywords = gestation (Clic here for more details about this article) |
8/24. Prolonged hyperinsulinism and hypoglycemia. In an asphyxiated, small for gestation infant. case management and literature review.The authors describe a term female, asphyxiated, small for gestational age (SGA) infant with documented hyperinsulinism and hypoglycemia occurring at approximately 45 hours of age. The hypoglycemia was refractory to a high rate glucose infusion and steroid administration but responded to diazoxide. The subsequent hospital course was complicated by right-sided heart failure and sepsis. With the onset of sepsis, a transient hyperglycemia was noted that required intermittent insulin therapy for 10 days. hypoglycemia and hyperinsulinism reemerged and responded to diazoxide therapy. An attempt to discontinue diazoxide at age 6 months was aborted at 2 weeks when hyperinsulinism and hypoglycemia recurred. The infant required diazoxide for 7 more months, then she recovered without having any sequelae. The review of this uncommon hypoglycemia etiology in an SGA and asphyxiated infant and the merits of long-term diazoxide treatment are discussed.- - - - - - - - - - ranking = 2.5keywords = gestation (Clic here for more details about this article) |
9/24. Meconium-induced vasocontraction: a potential cause of cerebral and other fetal hypoperfusion and of poor pregnancy outcome.Chronically meconium-stained fetuses may ultimately suffer cerebral palsy and other devastation. The mechanism is unknown. Innocuous pregnancy complications may cause some fetuses to discharge meconium, which may become hazardous, independently of aspiration. We herein report previously undescribed, meconium-induced umbilical and placental vascular necrosis. To investigate whether meconium causes vasocontraction, we tested umbilical vein tissue with an isometric transducer connected to a polygraph. The specimens were suspended in a 30-mL organ bath with Krebs solution (pH, 7.4; temperature, 37 degrees C; under aeration with 95% O2 and 5% CO2). We exposed the tissue to meconium and compared meconium-induced vasocontraction with that induced by Krebs solution and 10(-5) molar serotonin. Meconium maximally produced 62.9% of serotonin-induced vasocontraction. Krebs solution and boiled meconium did not produce vasocontraction. We hypothesize that meconium may cause placental and umbilical cord vasocontraction, cerebral and other fetal hypoperfusion, and major poor outcome.- - - - - - - - - - ranking = 0.74930951737568keywords = pregnancy (Clic here for more details about this article) |
10/24. Post-asphyxial encephalopathy in a preterm infant.An infant born at 31 weeks gestation had abnormalities consistent with post-asphyxial encephalopathy, including decelerated fetal heart-rate, cord-blood acidosis and depressed Apgar scores. Clinical signs included respiratory depression, hypotonia and severe seizures. When seen at six months corrected age, however, he had no abnormal neurological signs. The authors conclude that asphyxia in preterm infants may result in clinical abnormalities similar to those in mature infants, but that the abnormalities are separate from haemorrhage and ischaemia.- - - - - - - - - - ranking = 0.5keywords = gestation (Clic here for more details about this article) |
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