1/268. dexamethasone-facilitated postponement of delivery of an extremely preterm pregnancy complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelets.OBJECTIVE: patients with severe preeclampsia and the syndrome of hemolysis, elevated liver enzymes, and low platelets (hellp syndrome) are at increased risk for perinatal and maternal morbidity, especially in very preterm gestations. When this condition affects a pregnancy on the cusp of viability, a therapeutic intervention to prolong gestation without undue risk to the mother or fetus could be beneficial. METHOD: A single case report and review of the literature. Result: We report a patient with hellp syndrome in whom antenatal administration of high-dose dexamethasone helped achieve disease stabilization and delivery postponement for 9 days of a very preterm fetus estimated to weight less than 600 g. Both mother and infant did well postpartum. CONCLUSION: Administration of antenatal high-dose dexamethasone can be used in carefully selected preterm patients with hellp syndrome to delay delivery while in utero fetal maturation is accelerated and the maternal condition is optimized. This can be beneficial in carefully selected pregnancies without apparent adverse maternal or perinatal impact.- - - - - - - - - - ranking = 1keywords = gestation, pregnancy (Clic here for more details about this article) |
2/268. Delayed interval delivery in multiple gestations.The incidence of higher-order gestations is increasing primarily as a result of menstrual cycle manipulation, with concomitant increased risk in maternal and fetal complications. perinatal mortality rates range between 47 and 120 per 1000 births for twins and 93 to 203 per 1000 births for triplets. The critical period of perinatal mortality and morbidity is between weeks 23 and 28 of gestation. attention has recently turned to methods of delaying the birth of second and higher order fetuses to improve newborn survival and decrease neonatal morbidity in these high-risk pregnancies. We report two cases of delayed interval delivery. Neither pregnancy involved a monochorionic/monoamniotic gestation. The first case was a twin gestation delivered at 21 weeks with an interval of 5 days and extreme prematurity of both twins. The second case was a triplet gestation delivered at 21 weeks with an interval of 5 days. Triplet A was stillborn; triplets B and C succumbed in extreme prematurity. Preterm labor in multiple gestations usually results in delivery of all fetuses. On occasion, the uterus will spontaneously cease to contract after the birth of one or more premature infants. review of the literature now reports 48 twin pregnancies exposed to delayed interval delivery with 40 surviving infants of 96 fetuses. Whereas delaying the delivery of remaining fetuses improves their prognosis, there is currently no consensus regarding technique nor is there statistical significance in techniques currently used. Furthermore, study is indicated to reduce preterm birth and associated costs.- - - - - - - - - - ranking = 1.5885533678642keywords = gestation, pregnancy (Clic here for more details about this article) |
3/268. Preterm labor and accidental hemorrhage after disopyramide therapy in pregnancy. A case report.BACKGROUND: Treatment of arrhythmias during pregnancy is complicated by concerns about the safety of antiarrhythmic therapy. This is the first case report of preterm labor and abruptio placentae following the administration of disopyramide during pregnancy. CASE: A 26-year-old woman, gravida 2, para 1, was diagnosed as having wolff-parkinson-white syndrome during the third trimester of pregnancy. Recurrent episodes of supra-ventricular tachycardia were refractory to medical therapy and required repeated direct current cardioversion. Administration of disopyramide led to the initiation of painful uterine contractions and accidental hemorrhage. CONCLUSION: Caution must be exercised during the use of disopyramide during pregnancy, and intensive monitoring should be instituted to avoid adverse maternal and fetal effects.- - - - - - - - - - ranking = 1.1371488773786keywords = pregnancy (Clic here for more details about this article) |
4/268. Pelvic abscess in the second half of pregnancy after oocyte retrieval for in-vitro fertilization: case report.We describe a very late manifestation of pelvic abscesses after oocyte retrieval for in-vitro fertilization (IVF). In a twin pregnancy achieved after intracytoplasmic sperm injection, rupture of bilateral ovarian abscesses occurred at the end of the second trimester. An emergency laparotomy was necessary because of an acute abdomen. This complication led to severe maternal and neonatal morbidity, preterm birth and neonatal death. The rare occurrence of acute abdomen in pregnancy due to pelvic infection and the non-specific symptoms of a pelvic abscess after oocyte retrieval for IVF are discussed.- - - - - - - - - - ranking = 0.85286165803394keywords = pregnancy (Clic here for more details about this article) |
5/268. pica: sorting it out.pica, a culture-bound illness, has occurred for centuries. The ingestion of nonfood substances such as starch, cornstarch, clay, dirt, and other material is fairly common, although the distribution of the condition varies by cultural and socioeconomic factors. The underlying cause of pica is not known, although the condition often is associated with pregnancy. There is conflicting evidence about the association of nutrient deficiencies and pica. This article presents a clinical example of pica in a pregnant 33-year-old African American woman. Implications for culturally appropriate care are discussed.- - - - - - - - - - ranking = 0.14214360967232keywords = pregnancy (Clic here for more details about this article) |
6/268. Intrapartum drainage of fetal pleural effusion.Our objective was to describe our experience with intrapartum thoracocentesis in fetuses with severe bilateral pleural effusion. We describe the outcome of four consecutive cases of fetal pleural effusion due to chylothorax that were managed by intrapartum thoracocentesis. These fetuses were not candidates for pleuro-amniotic shunting either because of the need for prompt delivery (three fetuses) or because of advanced gestational age (one fetus). Thoracocentesis was performed in the operating theatre under ultrasound guidance prior to Caesarean delivery. gestational age at the time of diagnosis and thoracocentesis ranged between 26-34 weeks and 31-34 weeks respectively. Bilateral thoracocentesis was performed in two fetuses and unilateral in the remaining two fetuses. All four infants were born in a relatively good condition; however, all eventually required intubation, ventilation and chest tubes. chest tubes were introduced between 2 h and 5 days after delivery in three infants, and immediately after birth in one infant who was hydropic. Two infants survived and are developing normally. One infant died from sepsis following successful pleurodesis and one from aspiration on day 51. Our conclusions are that intrapartum thoracocentesis seems to be a relatively simple procedure, that allows newborns with pleural effusion, to breathe spontaneously or be more easily ventilated. This in turn, reduces the need to introduce chest tubes in an emergency situation.- - - - - - - - - - ranking = 0.14464097581919keywords = gestation (Clic here for more details about this article) |
7/268. Fatal course of veno-occlusive disease of the liver (endophlebitis hepatica obliterans) in a preterm infant.We describe the fatal course of a preterm infant of 34 weeks' gestation with veno-occlusive disease of the liver and refractory ascites. Despite aggressive medical management, the baby died twenty-two hours post partum because of cerebral haemorrhage before potentially life-saving organ transplantation could take place. At autopsy, paucity of lymphoid tissue in lymph nodes, thymus, spleen, and gastrointestinal tract were also seen. To our knowledge, this is the youngest infant with veno-occlusive disease of the liver reported in the literature.- - - - - - - - - - ranking = 0.14464097581919keywords = gestation (Clic here for more details about this article) |
8/268. Perinatal hypophosphatasia: diagnosis and detection of heterozygote carriers within the family.We report on two families in which one or two children had a severe disorder of skeletal development detected by prenatal ultrasonography. The children died postnatally and showed typical radiological and biochemical findings of perinatal hypophosphatasia. Biochemical analysis revealed a low activity of alkaline phosphatase (AP) and a high value of pyridoxal-5-phosphate (PLP), one of its natural substrates. The screening for mutations of the tissue nonspecific alkaline phosphatase (TNSALP) gene showed homozygosity for a point mutation (G 317 --> D) in the two affected children of the first family. The affected child of the second family was homozygous for a nonsense mutation (R 411 --> X). family screening revealed that the determination of AP and PLP is helpful for detection of heterozygotes. However, heterozygote children had values of AP in the lower normal range during phases of rapid growth. The determination of PLP proved to be more sensitive in these cases. It should be kept in mind that during the last trimester of gestation there is an increase in maternal AP activity and a normalization of PLP due to placental AP, which is not affected. Therefore, in the course of a prenatal diagnosis in an index case, paternal blood should be analyzed in parallel. For detailed genetic counseling and early prenatal diagnosis in following pregnancies, the possibility of mutation analysis should be used.- - - - - - - - - - ranking = 0.14464097581919keywords = gestation (Clic here for more details about this article) |
9/268. Failure of amniotic septostomy in the management of 3 subsequent cases of severe previable twin-twin transfusion syndrome.INTRODUCTION: Amniotic septostomy has been described as a method to treat twin-twin transfusion syndrome. A case report of 3 patients treated in this way is described. CASE REPORT: Three subsequent patients, who presented with twin-twin transfusion syndrome, were treated by amniotic septostomy. All 3 showed initial improvement in the amniotic fluid volume and mobility of the donor fetus. However, all three pregnancies were lost within 5 days of the amniotic septostomy due to ruptured membranes and premature labour. CONCLUSION: In our experience, amniotic septostomy did not improve the pregnancy outcome in twin-twin transfusion syndrome. Possible reasons for this are discussed.- - - - - - - - - - ranking = 0.14214360967232keywords = pregnancy (Clic here for more details about this article) |
10/268. amniotic band syndrome in triplet pregnancy.We present a case of amniotic band syndrome leading to encephalocele in one triplet. In this case, discordance in fetal growth was observed at 9 weeks' gestation, and the amniotic membrane was not recognized in the sac of the smallest fetus. Thus, significant first-trimester growth discordance in multifetal pregnancies suggests congenital anomalies, and examinations considering amniotic band syndrome should be performed. Absence of the amniotic membrane in the gestational sac may be a useful marker of amniotic band syndrome.- - - - - - - - - - ranking = 0.85785639032768keywords = gestation, pregnancy (Clic here for more details about this article) |
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