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PubMedDate not supplied

[Course of pregnancy and labor following in vitro fertilization. A retrospective study of 246 deliveries].

This record concerns the statistical registration and analysis of the courses and developments having taken place in 246 pregnancies and births after in-vitro-fertilization. The cases were registered retrospectively, the degree of registration being 77.2% approximately; the scientific evaluation was carried out on the basis of the BPE 1987. It can be shown that there is an increased incidence of the EPH-gestosis, the clinically relevant placenta insufficiency syndrome, the intrauterine death of fetus, the abruptio placentae and prematurity. As predisposing factors must primarily be seen and discussed the ovarian hyperstimulation being--in most cases--connected with IVF and the higher age of the patients; it can be supposed that the method of fertilization in vitro itself is of minor importance. Its importance in the pathogenesis of abruptio placentae, however, cannot be exactly evaluated so far. The frequency of multiple pregnancies represents a special problem. Though the rate is lower in the examined group than in comparable--that is due to the limited number of collected oocytes--it should be aimed at a further lowering of multiple pregnancy rates.

Adult↗
PubMed1996

Case report: torsion of a gravid horn of a didelphic uterus.

Acute abdominal pain during pregnancy presents a dilemma as signs and symptoms are often modified. Abdominal massage by traditional birth attendants (TBAs') during early labour is a common practice in the rural population, as it is perceived to give a soothening effect to the labouring mother. Many instances of abruptio placentae were reported in the past by this procedure, and in this case, the clinical picture presented as an abruptio placenta. Malpresentation and failure to progress were the indications for caesarean section despite the fetal demise. Severe post partum haemorrhage and failure to contract despite massive oxytocics resulted in the hysterectomy of the gravid horn, leaving the other horn intact.

Abdominal Pain↗
PubMed1986

Fetal outcome with oligohydramnios in the second trimester.

Thirty-four cases of oligohydramnios in the second trimester were diagnosed by ultrasonography. Nine of these pregnancies were associated with fetal anomalies including Potter syndrome (three), atrioventricular dissociation (two), congenital absence of thyroid (one), and multiple anomalies (three). There were ten unexplained stillbirths, one demise due to abruptio placentae, eight with perinatal morbidity after premature labor or abruptio placentae, and six with live-born term infants. Although oligohydramnios in the second trimester is associated with increased perinatal morbidity, this finding is not associated with a universally poor outcome.

Amniotic Fluid↗
PubMed1993

Ultrasound diagnosis of uterine myomas and complications in pregnancy.

OBJECTIVE: To evaluate myomas for ultrasound-documented size, location, position, and relation to the placenta, and to relate these findings to complications during pregnancy, at delivery, and in the puerperium. METHODS: Among 12,708 pregnant patients who had ultrasound scans, 492 had uterine myomas. Single myomas were found in 88% of cases and multiple myomas in 12%. The myomas were evaluated for size, number, position, location, relationship to the placenta, and echogenic structure, and the outcome of pregnancy was compared to that of patients in the control group. RESULTS: A statistically significant increased incidence of threatened abortion, threatened preterm delivery, abruptio placentae, and pelvic pain was observed in patients with uterine myomas (P < .001). Abruptio placentae was particularly evident in women with myoma volumes greater than 200 cm3, submucosal location, or superimposition of the placenta. Pelvic pain was related to myoma volume greater than 200 cm3 and ultrasound findings of heterogeneous echo patterns and cystic areas. Mode of delivery, abortion, preterm birth, premature rupture of membranes, and fetal growth did not seem to be affected by the presence of myomas. Thirty-two women with uterine myomas were managed surgically. Thirteen underwent myomectomy during pregnancy. Of these, eight delivered at term and five delivered preterm after the 32nd week of gestation. None of the deliveries were associated with neonatal death. The other 19 patients had surgery at delivery. Nine myomectomies were performed at cesarean delivery. Of these, three were complicated by severe hemorrhage necessitating hysterectomy. Another nine hysterectomies were performed during cesarean and one after vaginal delivery. CONCLUSIONS: In addition to myoma size, the ultrasound evaluation of pregnant women with myomas should include position, location, relationship to the placenta, and echogenic structure. These ultrasound findings make it possible to identify women at risk for myoma-related complications and could be useful in managing the pregnancy.

Abortion, Spontaneous↗
PubMed2002

Prevalence and complications of physical violence during pregnancy.

OBJECTIVES: To assess the incidence of self-reported physical violence in pregnancy and describe the association with foeto-maternal complications and birth outcome. METHOD: Seven thousand one hundred and five pregnant women over a 3 year period were assessed for self-reported physical violence. Maternal ante-natal hospitalization, low birth weight and pre-term delivery. Odd ratio (OR) and 95% confidence interval (CI) were calculated to measure association between physical violence, maternal morbidity and birth outcome. RESULTS: The prevalence of physical violence was 21%. Women who reported/experienced physical violence, were more likely to be hospitalized ante-natally for maternal complications such as trauma due to blows/kicks on the pregnant abdomen, abruptio-placenta, pre-term labor and kidney infections. There was a positive association between physical violence during pregnancy and cesarean section, abruptio-placenta, fetal distress, and pre-maturity. CONCLUSION: Physical violence during pregnancy is common and is associated with adverse materno-fetal outcome.

Abdomen↗
PubMed1996

[The perinatal outcome in adolescents with eclampsia and the HELLP syndrome].

Nineteen adolescent patients with eclampsia were studied in the course of 6 years. In 68% of the cases eclampsia (E) occurred antepartum, in 5% intrapartum. Maternal mortality was 52.65% (one patient with HELLP syndrome). Serious maternal morbidity included disseminated intravascular coagulations (10.52%), abruptio placentae (15.8%), pulmonary edema (5.26%) and acute renal failure (5.26%). Abruptio placentae was strongly correlated with the development of disseminated intravascular coagulation (p 0.0001), acute renal failure (p 0.001) and pulmonary edema (p 0.001). Eclampsia and HELLP syndrome were the most dangerous complications in adolescent pregnancies. They are associated with a serious maternal morbidity, especially when it arises in the postpartum period.

Adolescent↗
PubMed1987

Platelet inhibitory activity in placentas from normal and abnormal pregnancies.

Retroplacental blood flow requires inhibition of coagulation in the absence of an endothelial lining. We confirmed that trophoblast releases an inhibitor of platelet aggregation which functions via degradation of adenosine diphosphate. This inhibitor appears to be deficient in some pregnancies with abruptio placentae and intrauterine growth retardation. Unimpeded retroplacental blood flow may depend upon the local inhibition of platelet aggregation. Placental tissue contains an inhibitor of platelet aggregation which appears to be an adenosine diphosphatase distinct from heat-stable alkaline phosphatase. Placental tissue from patients with abruptio placentae contains abnormally low amounts of this enzyme.

Abruptio Placentae↗
PubMedDate not supplied

Relevance of plasma fibrinogen estimation in obstetric complications.

We present a study of fibrinogen levels in 133 patients who were prone to develop disseminated intravascular coagulation as a result of an underlying complication of pregnancy such as abruptio placentae, pregnancy-induced hypertension, missed abortion, septic abortion, intrauterine fetal death, vesicular mole and amniotic fluid embolism. A high incidence of hypofibrinogenemia was found in cases of abruptio placentae (43.9%) and pregnancy-induced hypertension (25%). Hypofibrinogenemia occurred in 10% cases of intrauterine fetal death within 4 weeks of fetal demise. The use of this simple investigation makes possible the diagnosis of hemostatic failure and also helps to guide replacement therapy during the fibrinopenic state. There were 4 maternal deaths and 12 perinatal losses in this study.

Abruptio Placentae↗
PubMed2001

First-birth cesarean and placental abruption or previa at second birth(1).

OBJECTIVE: To assess the association between first-birth cesarean delivery and second-birth placental abruption and previa. METHODS: We conducted a population-based, retrospective cohort analysis using data from the Washington State Birth Events Record Database. The study cohort included all primiparas who gave birth to live singleton infants in nonfederal short-stay hospitals from January 1, 1987, through December 31, 1996, and who had second singleton births during the same period (n = 96,975). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for placental abruption or previa at second births associated with first-birth cesareans. RESULTS: Among our study cohort, abruptio placentae complicated 11.5 per 1000 and placenta previa 5.2 per 1000 singleton deliveries at second births. In logistic regression analyses adjusted for maternal age, women with first-birth cesareans had significantly increased risk of abruptio placentae (OR 1.3, 95% CI 1.1, 1.5), and placenta previa (OR 1.4, 95% CI 1.1, 1.6) at second births, compared with women with prior vaginal deliveries. CONCLUSION: We found moderately increased risk of placental abruption and previa as a long-term effect of prior cesarean delivery on second births.

Abruptio Placentae↗
PubMed1993

Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome)

OBJECTIVE: Our purpose was to describe the incidence and effects of serious obstetric complications on maternal outcome in pregnancies complicated by HELLP syndrome. STUDY DESIGN: A prospective cohort study was performed on 442 pregnancies with HELLP syndrome managed at this center from August 1977 through July 1992. RESULTS: Of 437 women who had 442 pregnancies with HELLP syndrome; 309 (70%) of the cases occurred ante partum and 133 (30%) post partum; 149 (11%) developed at < 27 weeks and 80 (18%) at term. Maternal mortality was 1.1% (five patients). Serious maternal morbidity included disseminated intravascular coagulation (21%), abruptio placentae (16%), acute renal failure (7.7%), pulmonary edema (6%), subcapsular liver hematoma (0.9%), and retinal detachment (0.9%). Fifty-five percent of patients required transfusions with blood or blood products, and 2% required laparotomies for major intraabdominal bleeding. Abruptio placentae was strongly correlated with the development of disseminated intravascular coagulation (p < 0.0001), acute renal failure (p < 0.001), and pulmonary edema (p < 0.01). Moreover, there was a strong association between pulmonary edema and acute renal failure (p < 0.0001). There were no differences in laboratory findings between HELLP syndrome before and after delivery; however, women with postpartum HELLP syndrome had significantly higher incidences of pulmonary edema and renal failure. CONCLUSION: HELLP syndrome is associated with serious maternal morbidity, especially when it arises in the postpartum period.

Abruptio Placentae↗
PubMed1989

Comparative study of placental protein 19, human chorionic gonadotrophin and pregnancy-specific beta 1-glycoprotein as immunohistochemical markers for extravillous trophoblast in pregnancy and trophoblastic disease.

PP19, a new placental tissue protein, has alpha 1-beta 1 electrophoretic mobility, a molecular weight of 36,500 and 3.9% carbohydrate. To study immunocytochemical PP19 localization in extravillous trophoblast, we obtained formalin-fixed specimens from extravillous tubal pregnancy at gestational weeks (GW) 7-9 (12 blocks); four early intrauterine pregnancies at GW 7-13 (12 blocks); four late pregnancies at GW 28-38 complicated with intramural uterine myoma, placenta increta and abruptio placenta (8 blocks); four invasive complete moles (9 blocks); and seven primary and metastatic gestational choriocarcinomas (12 blocks). Immunohistochemical staining was done for PP19, pregnancy-specific beta 1-glycoprotein (SP1) and human chorionic gonadotrophin (hCG) using the indirect-labeled antibody method [purified PP19 (Lot no. 225/242) and antibody against PP19 (Lot no. 632ZA) prepared by H. Bohn, antibodies against hCG (Behringwerke, Marburg, FRG) and SP1 (Dakopatts, Copenhagen, Denmark)]. In both early and late intrauterine pregnancies, the extravillous syncytiotrophoblastic cell (XST) showed positive staining for hCG and SP1 in the cytoplasm, as well as for PP19, which stained more intensively in the nucleus than in the cytoplasm. The three proteins were not seen in the evtravillous cytotrophoblastic cell (XCT) in the trophoblastic cell column and shell. The interstitial cytotrophoblast-like cell (ICT), which infiltrated into the decidua and myometrium, and their blood vessels, was immunoreactively positive for PP19 but negative for hCG and SP1 with the exception of SP1-positive ICT in the myometrium in late pregnancy. XST and ICT in the endosalpinx of tubal pregnancy stained for all three proteins.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomarkers↗
PubMed1977

The association of maternal and neonatal thrombocytopenia in high-risk pregnancies.

In this study of 136 women with pre-eclampsia, eclampsia, placenta previa, or abruptio placentae, 21 mothers were noted to have thrombocytopenia. Seventeen of the 21 were in the pre-eclampsia group. Of the 21 thrombocytopenic mothers, nine were associated with thrombocytopenia in the children, seven children had normal platelet counts, and five had no counts performed. Eight of the nine thrombocytopenic neonates were associated with pre-eclampsia in the mother, and five of these were not believed to have disseminated intravascular coagulation as the etiology of the platelet defect. The results suggest that thrombocytopenia is common in high-risk pregnancies in both the mother and the baby. However, the etiology of the platelet defect cannot be easily explained on the basis of a hypercoagulable state.

Arizona↗
PubMed1979

The duration of maternal cigarette smoking, fetal and placental disorders.

Data from a large prospective study of pregnancy were used to determine whether the number of years a mother had smoked cigarettes influenced the development of common fetal and placental disorders. Three disorders increased in frequency when mothers had smoked for more than 6 yr: placenta previa +143%, abruptio placentae +72% and large placental infarcts +37% (all P less than 0.05). Mothers' current smoking habits had a smaller influence on the frequency of these disorders, and the effects of smoking were largely independent of maternal pregnancy weight gain. The placentas of smokers had microscopic evidences of underperfusion from the uterus. The placental abnormalities were influenced by both the number of years mothers had smoked and by their current smoking habits.

Arteries↗
PubMed1999

Obstetric determinants of neonatal survival: antenatal predictors of neonatal survival and morbidity in extremely low birth weight infants.

OBJECTIVE: The aim of the study was to compare clinical and ultrasonographic variables obtained before delivery as predictors of neonatal survival and morbidity in infants weighing </=1000 g at birth. STUDY DESIGN: Maternal data available before the birth of singleton infants with birth weights </=1000 g who were delivered at the 11 tertiary perinatal centers of the National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Research Units were studied. Births that followed extramural delivery, antepartum stillbirths, multiple gestations, induced abortions, infants with major malformations, and fetuses delivered at <20 weeks' gestation were excluded. Ultrasonographic variables, including estimated fetal weight, obstetrically estimated gestational age, femur length, and biparietal diameter, and clinical variables, such as maternal race, antenatal care, substance abuse, medical treatment, reason for delivery, fetal gender, and presentation, were studied with logistic regression as predictors of neonatal outcome, including intrapartum stillbirth, neonatal death, and survival to 120 days after birth or to discharge from the hospital with or without the presence of markers of major morbidity. RESULTS: Eight hundred eight infants met enrollment criteria; 63 were excluded because of incomplete data and 32 were excluded because of malformations, leaving 713 for analysis, 386 of whom had an ultrasonographic examination within 3 days of delivery that recorded femur length, biparietal diameter, and estimated fetal weight. Forty-two percent of births were the result of preterm labor, 22% were the result of preterm ruptured membranes, 12% were the result of preeclampsia or eclampsia, 9% were the result of fetal distress, 4% were the result of placenta previa or abruptio placentae, and 2% were the result of intrauterine growth restriction. Perinatal mortality before 24 weeks' gestation exceeded 81% (19% stillbirths and 62% neonatal deaths) but declined sharply thereafter. Most survivors born before 26 weeks' gestation had serious morbidity. Fetal femur length and estimated gestational age predicted survival better than did biparietal diameter or estimated fetal weight. Infants who survived with markers of serious long-term morbidity could not be distinguished from those who survived without morbidity markers before delivery by ultrasonography or clinical data. Threshold values for ultrasonographic measurements of biparietal diameter and femur length were developed to distinguish fetuses with no chance of survival. CONCLUSION: Ultrasonographic assessment of either fetal femur length or gestational age predicts neonatal mortality better than do other antenatal tests. No tests accurately predicted neonatal morbidity in infants weighing </=1000 g at birth.

Female↗
PubMed1985

[Cesarean section with subsequent hysterectomy].

We had 65 Caesarean hysterectomies from 1960-1982 at our hospital. 43 patients were elected for various reasons: contraception 26, fibromatosis 13, intraepithelial neoplasia 4. 22 had vital indications: rupture of the uterus 12, placenta increta/percreta 5, abruptio placentae 3, atony 2. The time we needed for the operation was up to 100 minutes in the elective group, 160 minutes in the non-elective group. In vital indications, postoperative morbidity was higher than when treatment was elective. In the group of vital indication, 4 patients died, whereas no patient died if operation was performed on an elective basis.

Adult↗
PubMed1986

Older maternal age and pregnancy outcome: a review of the literature.

We are in the early phase of a period when the increased numbers of women born during the 1947 to 1965 baby boom are entering their later child-bearing years. They are also part of a generation of women who are increasingly delaying childbirth until their 30s. These two factors will likely increase the proportion of total births accounted for by this 35- to 49-year age group by 72 per cent, from 5.9 per cent in 1982 to 8.6 per cent by the turn of the century. There are important and specific risks related to pregnancies for older women as compared to younger women. It is likely that a woman's ability to conceive declines steadily to where it has been estimated that 34 to 46 per cent of women age 35 and older are unable to become pregnant. Hypertension, preeclampsia, and diabetes mellitus are not only more common but seem to carry an even greater risk for older women, resulting more frequently in fetal demise. Although there are conflicting findings, older women seem to have more babies weighing under 2,500 gm and more over 4,000 gm. It appears that there are more problems with abnormal labor patterns and a definite higher incidence of cesarean section. The literature seems to support the finding of high incidences of late pregnancy bleeding from placenta previa and abruptio placenta. Many of those factors contribute to a several-fold increase in maternal mortality for older compared to younger pregnant women. The fetus, likewise, is at greater risk. There appears to be a greater risk for spontaneous abortion, although the magnitude of the risk is unclear because of the potential confounding from gravidity, birth order, and reduced fecundity. The stillbirth rate seems to double by the late 30s and increases to 3- to 4-fold by the mid-40s. The neonatal mortality rate seems to have a mild association with maternal age. Chromosome abnormalities, especially trisomies 13, 18, and 21, and sex chromosome aneuploidies, increase exponentially with maternal age starting in the 30s, reaching levels of 1.4 per cent at age 35, 1.9 per cent at 40, and 8.9 per cent at 45, according to amniocentesis data. Some of those contribute to the higher stillbirth rate resulting in a slightly smaller incidence of chromosome abnormalities in newborns. Overall, the literature supports the finding that women and their offspring experience significant increased problems as maternal age progresses through the mid-30s and beyond.(ABSTRACT TRUNCATED AT 400 WORDS)

Chromosome Aberrations↗
PubMed2005

Cervicitis decidualis: a rare cause of antepartum hemorrhage.

This report describes the case of a patient with clinically antepartum hemorrhage and a colposcopic lesion resembling invasive cervical cancer. A 28-year-old patient sought treatment at 28 weeks of pregnancy with significant antepartum hemorrhage, clinically thought to be a result of placenta previa or abruptio placenta. Colposcopy showed a lesion resembling an invasive cervical cancer for which a biopsy was taken. Abnormal placentation was ruled out by ultrasound examination of the uterus. Histologic analysis showed a cervical decidual reaction with focal surface ulceration accounting for the cervical growth and hemorrhage. We describe an unusual cause of significant intrapartum hemorrhage attributable to cervical decidual reaction, mimicking abnormal placentation clinically and invasive cervical cancer colposcopically.

Adult↗