11/48. Placental growth hormone during pregnancy in a growth hormone deficient woman with type 1 diabetes compared to a matching diabetic control group.In pregnancy, pituitary growth hormone (GH) is gradually replaced by placental growth hormone (hPGH). GH deficient pregnant women may take advantage of GH substitution during pregnancy, but this issue still remains unresolved. Also, in pregnancy diabetes may cause macrosomia. The combination of GH deficiency, GH substitution therapy and type 1 diabetes mellitus may influence pregnancy in unforeseen ways. We present a case of pregnancy in a GH deficient woman with type 1 diabetes who continued on GH replacement until week 21. In gestational week 37 a thin and mildly small-for gestational-age (length 55 cm, 3 SD, 99th centile and weight 2445 g., -1.4 SD, 10th centile) but otherwise healthy boy was born. The patient had levels of serum hPGH at the lower end of the range of values found in a matching group of diabetic women. serum IGF-I levels were at the upper end of the range of values in the control group. A positive correlation between serum hPGH and IGF-I values was seen in the control group when using the area-under-the-curve (r=0.84; p<0.001). The patient's child had lower birth weight and ponderal index, but was otherwise healthy. serum IGF-I, but not hPGH, correlated to the absolute birth weight (r=0.63; p=0.015) and the birth weight z-score (r=0.55; p=0.039) in the control group. serum hPGH and IGF-I declined rapidly after delivery. In conclusion, hPGH correlated to IGF-I in type 1 diabetes mellitus (DM), and IGF-I values correlated to the birth weight. Both type 1 diabetes mellitus and GH deficiency (with GH substitution therapy) may influence fetal growth, and in combination, the net influence may be difficult to predict.- - - - - - - - - - ranking = 1keywords = pregnancy, gestation (Clic here for more details about this article) |
12/48. 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.- - - - - - - - - - ranking = 1keywords = pregnancy, gestation (Clic here for more details about this article) |
13/48. Normal birth after transfer of cryopreserved human embryos generated by microinjection of cryopreserved testicular spermatozoa into cryopreserved human oocytes.OBJECTIVE: To report the first birth after transfer of cryopreserved embryos generated by intracytoplasmic sperm injection of cryopreserved testicular spermatozoa into cryopreserved human oocytes. DESIGN: Case report. SETTING: Tertiary center for reproductive technology. PATIENT(S): A 36-year-old woman with primary infertility of 3 years' duration and a 37-year-old man with congenital bilateral absence of the vas deferens. INTERVENTION(S): cryopreservation of human embryos after oocytes and sperm thawing. MAIN OUTCOME MEASURE(S): live birth. RESULT(S): A healthy, normal female infant with a birth weight of 2,950 g was born by cesarean section at 38 weeks' gestation, with normal 6-month follow-up. CONCLUSION(S): Embryo cryopreservation can lead to successful results, even with the use of cryopreserved gametes.- - - - - - - - - - ranking = 0.035527121944051keywords = gestation (Clic here for more details about this article) |
14/48. Retinal haemorrhages in premature infants: a pathogenetic alternative diagnosis to child abuse.PURPOSE: To present the occasional observation of retinal haemorrhages in premature babies, as a diagnostic alternative to those observed as part of shaken baby syndrome. methods: We carried out an observational study on 11 infants in whom retinal and/or vitreous haemorrhages had been observed within their first months of life. Ten infants were under surveillance for retinopathy of prematurity (ROP), with gestational ages and birth weights in the ranges of 27--34 weeks and 790--1665 g, respectively. One infant was diagnosed with Zellweger's syndrome and one received substitution therapy for coagulation factor II deficiency. The last child had been delivered at 38 weeks, weighing 2070 g; he died on day 5 from severe brain oedema with incarceration and extensive bilateral fundus bleeding. RESULTS: Four of the 11 infants had some evidence of ROP, and two later received retinal ablation therapy. Contrary to the quick absorption (<1-2 weeks only) usually seen in most newborn term infants, the ocular bleeding in preterms was generally longstanding. A quick increase in intracranial pressure probably played a role in the lethal case with delivery near term, and one infant received lung physiotherapy for pneumonia at the age of 6 months. Some bleeding appeared to be truly postnatal (i.e. it was observed as a new occurrence during the course of surveillance). CONCLUSIONS: In the series under study there was no suspicion of child abuse. In term infants, retinal haemorrhages are extremely rare except when due to shaking, but other diseases should be ruled out, coagulopathies in particular. We suggest that prematurity as such is added to the list of possibly underlying causes when retinal bleedings are evaluated in very small infants and shaken baby mechanisms are suspected.- - - - - - - - - - ranking = 0.035527121944051keywords = gestation (Clic here for more details about this article) |
15/48. superfetation as a cause of growth discordance in a multiple pregnancy.A triplet pregnancy is described, in which the diagnosis of in utero growth restriction is questioned after postnatal suspicion of superfetation, by using neurosonography and ophthalmic examination to aid gestational age assessment.- - - - - - - - - - ranking = 0.55160809756177keywords = pregnancy, gestation (Clic here for more details about this article) |
16/48. Pregnancy after liver transplantation: report of 8 new cases and review of the literature.Improved survival and quality of life following liver transplantation are associated with an increased frequency of pregnancies in liver-transplanted women. We investigated the outcome, complications, and management of those pregnancies. We have reviewed the literature and report 8 pregnancies in 6 transplant recipients. Seven pregnancies were completed at 38 /-2 (mean /-standard deviation) weeks. One miscarriage occurred at week 12. Newborns' weight averaged 2938 /-156 g. Main complications were preeclampsia (n=1) and reversible cholestasis (n=1). Among 285 pregnancies reported in literature, 78 /-20% were successful and the main complications were: preeclampsia (26 /-19%), hypertension (28 /-19%), reversible liver dysfunction (27 /-21%), cesarean delivery (23 /-10%), preterm birth (31 /-28%), small for gestational age infants (23 /-10%), rejection (10 /-7%). Gestational weeks were 36.7 /-1.3, perinatal mortality was 4 /-10%, malformation rate 3%. The rates of both abortions and complications (preeclampsia and/or hypertension) were inversely related to the time interval between transplantation and conception (p<0.05). Abortions occurred more often in recipients whose underlying disease was autoimmune cirrhosis than in recipients with inherited disorders. Rejection rate was approx. 10%, which appears higher than reported in a non-pregnant population after a comparable time interval from transplant (2-3%). Up to 28 months after delivery, maternal death was 5.5 /-7%. We conclude that: the time intervals between transplantation and conception as well as the original cause of liver failure influence the outcome and complications of pregnancies in liver recipients. However, neonatal survival is high, while malformations are relatively rare.- - - - - - - - - - ranking = 0.035527121944051keywords = gestation (Clic here for more details about this article) |
17/48. Follow-up of a pregnancy with risperidone microspheres.A follow-up of a case of pregnancy with risperidone microspheres is reported. overall, there was a normal development of the female child during pregnancy and the first 2 1/2 years of her life.- - - - - - - - - - ranking = 0.61929717074127keywords = pregnancy (Clic here for more details about this article) |
18/48. Acardiac acephalic monster extremely larger than its co-twin. A case report.The acardiac monster represents a rare but one of the severest congenital anomalies which occur only in multiple pregnancy. The affected fetus is sustained by a parasitic anastomosis to the umbilical blood vessels of the normal fetus. We report an interesting case of a macrosomic acardiac acephalic fetus weighing 4.5-fold of another variable donor fetus (approximately 6 kg) in a twin pregnancy.- - - - - - - - - - ranking = 0.20643239024709keywords = pregnancy (Clic here for more details about this article) |
19/48. retinopathy of prematurity. review of 7 cases.A retrospective review of children with ROP, stage 2 or more, diagnosed between 24 April 1985 and 31 December 1990, is presented. The 7 patients had been born prematurely. The gestational age at birth ranged from 24 to 31 weeks. Their birth weight was less than 1430 g. Spontaneous evolution and evolution following cryotherapy are described. The follow-up period ranged from 2.5 to 30 months.- - - - - - - - - - ranking = 0.035527121944051keywords = gestation (Clic here for more details about this article) |
20/48. prenatal diagnosis in autosomal dominant beckwith-wiedemann syndrome.A 20-year-old woman with beckwith-wiedemann syndrome (BWS) was ultrasonographically appraised at intervals during her pregnancy. Unequivocal evidence for a diagnosis of BWS was obtained in the fetus and this was confirmed postnatally. Early ultrasound diagnosis enabled appropriate genetic counselling to be given; neonatal complications, such as hypoglycaemic episodes, were prevented.- - - - - - - - - - ranking = 0.10321619512354keywords = pregnancy (Clic here for more details about this article) |
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