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PubMed1995

Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis.

OBJECTIVE: Our purpose was to describe subsequent pregnancy outcome and long-term maternal prognosis in women with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) during the index pregnancy. STUDY DESIGN: This is a descriptive and analytic study of women with HELLP syndrome admitted to E.H. Crump Women's Hospital between August 1977 and July 1992. HELLP syndrome was defined by previously published laboratory criteria. Only patients who were delivered > 2 years ago were included (median 4 years, range 2 to 14 years). Data on these patients were obtained from our obstetric clinics, local physicians, local health departments, and hospital records. RESULTS: Adequate follow-up data were available on 341 patients. One hundred fifty-two women subsequently became pregnant. One hundred thirty-nine normotensive women had 192 subsequent pregnancies. Complications included preeclampsia (19%), preterm delivery (21%), intrauterine growth restriction (12%), abruptio placentae (2%), perinatal death (4%), and HELLP syndrome (3%). Seven of the 113 women with at least 5 years' follow-up (6.2%) had chronic hypertension, and 98 received oral contraceptive pills without complications. Thirteen women with preexisting chronic hypertension had 20 subsequent pregnancies. These women had a higher rate of preeclampsia (75%), preterm delivery (80%), intrauterine growth restriction (45%), abruptio placentae (20%), and perinatal death (40%) but a low rate of recurrent HELLP syndrome (5%). CONCLUSIONS: Women with HELLP syndrome have an increased risk of obstetric complications in future pregnancies but a low risk for recurrent HELLP syndrome. Oral contraceptive pills should not be contraindicated in normotensive women.

Adult↗

PubMedDate not supplied

[Significance of myoma-induced complications in pregnancy. A comparative analysis of pregnancy course with and without myoma involvement].

In the present study we analyzed the relation between complications in pregnancy--fetal growth retardation, premature rupture of membranes, preterm labour, abruptio placentae, mode of delivery, puerperium--and the size, number and location of myomas. A retrospective comparison was performed in 474 patients (94 pregnant women with myoma and 380 with a normal uterus as controls). The course of pregnancy, the mode of delivery and the puerperium were examined. The study showed that retroplacental submucous myomas increase the risk of fetal growth retardation (14% vs. 6.6%) and abruptio placentae (3.2% vs. 1.3%). The size of the myomas was not relevant. A caesarean section, especially for fetal malpresentation, was also more frequent in patients with submucous myoma (52.9% vs. 27.9%). There was no difference, however, in the postpartal course between the submucous myoma group and the controls, respectively. Subserous or intramural fibroids had no influence on the course of pregnancy, the mode of delivery or the postpartal period.

Adult↗

PubMed1995

Biophysical profile testing as an indicator of fetal well-being in high-order multiple gestations.

OBJECTIVE: The purpose of this investigation was to determine the value of biophysical profile testing in preventing intrapartum death in patients with high-order multiple gestations (triplets or quadruplets). STUDY DESIGN: A retrospective review was performed of patients with triplets and quadruplets cared for by Phoenix Perinatal Associates from October 1988 to December 1991. Biophysical profile testing was used as the primary method of fetal surveillance in these pregnancies. Fetal heart rate monitoring on an external monitor was used as back-up and in cases sent to labor and delivery for problems. The ultrasonographic parameters of the biophysical profile score were used without the nonstress test component because of technical difficulty with that test in high-order multiple pregnancies. A score of 6 to 8/8 was therefore considered reassuring, 4/8 equivocal, and 0 or 2/8 possibly abnormal. Testing was done twice per week. RESULTS: Eighteen patients with triplets and six patients with quadruplets constituted the study group. The last biophysical profile before delivery was examined to evaluate the value of the test. There were no antepartum deaths in these 78 babies. The last biophysical profile score was 2/8 in nine fetuses of five triplet pregnancies and two fetuses of one quadruplet pregnancy. These six pregnancies (25%) were delivered on the basis of biophysical profile results and clinical circumstances. There was no morbidity or mortality in the 19 babies delivered because of abnormal biophysical profile testing. Four pregnancies had poor outcome at delivery in spite of 8/8 biophysical profile scores on all babies within 4 days of delivery. Of these four, two patients had worsening pregnancy-induced hypertension, one had abruptio placentae, and one had a severely growth-retarded infant. CONCLUSION: There were no stillbirths in this series. Twenty-five percent of these pregnancies eventually were delivered for nonreassuring biophysical profile testing, with good outcome. Four pregnancies had poor neonatal outcome in spite of normal biophysical profile testing. All of these pregnancies had active changes in physiologic features leading to delivery (two worsening pregnancy-induced hypertension, one abruptio placentae, one spontaneous rupture of membranes and labor). The biophysical profile appears to be a reliable antepartum test of fetal well-being in triplets and quadruplets.

Female↗

PubMed1999

[Multicystic neonatal encephalopathy after a traffic accident with minor maternal injuries].

We report a case of traffic accident at 30 weeks of gestation. The maternal injuries were minor. The fetal heart rate patterns showed tachycardia and decreased modulation. Ultrasound scanning was normal, without abruptio placentae. Ten days after the accident, a cesarean section was done on altered fetal heart rate with a normal infant at birth. This baby died 17 days latter from an ischemic multicystic encephalomalacia. With the view of the literature, we try to explain the pathophysiological mechanism of this severe fetal outcome despite minor maternal injuries. Hypovolemic collapsus, caval syndrome and maternal stress could be the cause of placental hypoperfusion. Abruptio placenta and feto-placental hemorrhage are others explanations. We propose the management for first aid workers and the specialized unit care.

Accidents, Traffic↗

PubMed1995

Intra-uterine infection in women with preterm premature rupture of membranes: maternal and neonatal characteristics.

OBJECTIVE: Our purpose was to determine the prevalence of intra-uterine infection in patients with preterm premature rupture of membranes and to evaluate the clinical characteristics of women and neonates according to the presence or absence of intrauterine infection. STUDY DESIGN: Trans-abdominal amniocentesis was performed in 90 consecutive patients admitted with preterm premature rupture of membranes. Maternal clinical parameters evaluated included maternal age, origin, gravidity, parity, habitual abortion, previous perinatal death, previous preterm birth, urinary tract infection, fetal distress, abruptio placentae, gestational diabetes, admission-delivery interval and cesarean rate. Neonatal clinical parameters evaluated were gestational age at delivery, birth weight, Apgar score, neonatal gender, perinatal death and neonatal sepsis. RESULTS: The prevalence of intra-uterine infection was 66.6% (60/90). No differences between patients with intra-uterine infection and those without intra-uterine infection were observed in maternal age, origin, gravidity, parity, habitual abortion, previous perinatal death, fetal distress, abruptio placentae, gestational diabetes, admission-delivery interval, cesarean section, neonate's gender, Apgar score at 5 min and neonatal sepsis. On the other hand, gestational age at delivery, birth weight and Apgar score at 1 min were significantly different between the groups. CONCLUSION: An intra-uterine infection was found in two thirds of women presenting with preterm premature rupture of membranes. Women presenting with preterm premature rupture of membranes and intra-uterine infection had a lower gestational age at delivery and consequently had a lower neonatal birth weight than those without intra-uterine infection.

Amniotic Fluid↗

PubMed1999

A prospective study on the occurrence of autoantibodies in low-risk pregnancies.

OBJECTIVE: This investigation was done to study the prevalence of anti-nuclear antibodies (ANA), anti-cardiolipin antibodies (aCL), and rheumatoid factor (RF), in presumed healthy women during their pregnancies. STUDY DESIGN: During an 18 month period blood samples were taken in the first, second and third trimester from 1200 pregnant women, representing a low-risk population. Clinical data on the pregnancy outcome were obtained by birth statistics after their deliveries. The diagnoses of preeclampsia, intrauterine growth retardation, fetal death, or abruptio placentae were stated in 57 of these women. An age- and parity-matched control group of 207 women with normal pregnancy outcome was drawn from the same low-risk population (n= 1200). A nonpregnant control group consisted of 157 women. The prevalence of ANA (immunofluorescence microscopy on HEp-2 cells), aCL-immunoglobulin G (enzyme-linked immunosorbent assay), and RF (latex agglutination test) in preeclampsia, intrauterine growth retardation, fetal death, or abruptio placentae were compared to the normal pregnancies, and to the nonpregnant controls. RESULTS: ANA occurred significantly more often (P<0.05) in pregnancies complicated by preeclampsia when compared to normal pregnancies. aCL occurred sparsely in normal as well as complicated pregnancies. RF was infrequently seen among all women in this study. CONCLUSION: An association was noted between the occurrence of ANA and preeclampsia. However, this association was too insensitive to use as a clinical tool.

Antibodies, Anticardiolipin↗

PubMed2002

Cerebral palsy in preterm infants: a population-based case-control study of antenatal and intrapartal risk factors.

UNLABELLED: Previous studies have indicated that foetomaternal infection increases the risk of spastic cerebral palsy (CP) in term infants, whereas this association appears to be less evident in preterm infants. The aim of this study was to analyse infection-related risk factors for spastic CP in preterm infants. A population-based series of preterm infants with spastic CP, 91 very preterm (<32 wk) and 57 moderately preterm (32-36 wk), born in 1983-90, were included and matched with a control group (n = 296). In total, 154 maternal, antenatal and intrapartal variables were retrieved from obstetric records. In the entire group, histological chorioamnionitis/pyelonephritis, long interval between rupture of membranes and birth, admission-delivery interval <4 h and Apgar scores of <7 at 1 min just significantly increased the risk of CP, and Apgar scores of <7 at 5 and 10 min were strongly associated with an increased risk. Abruptio placentae, Apgar scores <7 at 1 min and pathological non-stress test (reason for delivery) were significant risk factors of CP only in the moderately preterm and hemiplegic groups, whereas fever before delivery was a significant risk factor in the very preterm and spastic diplegic groups. Antibiotics during pregnancy was associated with CP only in the spastic diplegic CP group. CONCLUSION: Antenatal infections marginally increased the risk of CP. Low Apgar score and abruptio placentae were associated with CP, especially in moderately preterm infants with hemiplegic CP.

Apgar Score↗

PubMed1987

Teratogenicity of cocaine in humans.

To study teratogenicity of cocaine in humans, we studied three groups of pregnant women and their offspring: group 1, 50 women who abused cocaine only; group 2, 110 women who were polydrug abusers; and group 3, 340 who were drug free. All three groups were similar for socioeconomic status, cigarette smoking, and ethnicity. Maternal age of group 1 was similar to that of group 3, but group 2 mothers were significantly older. Gravidity was significantly higher in groups 1 and 2 compared with group 3. No statistical difference was found in spontaneous abortion rate among the three groups, but the stillbirth rate was significantly higher in group 1 (chi 2 = 6.89, P less than or equal to 0.01). All stillbirths were related to abruptio placentae. Birth weight, length, and head circumference were significantly decreased in infants in groups 1 and 2 compared with group 3 (P less than or equal to 0.0001), but no statistical difference was found between groups 1 and 2. The congenital malformation rate was significantly higher in group 1 compared with group 3 (chi 2 = 7.07, P less than or equal to 0.01). We conclude that cocaine abuse in humans significantly reduces weight of the fetus, increases the stillbirth rate related to abruptio placentae, and is associated with a higher malformation rate.

Abnormalities, Drug-Induced↗

PubMed1988

Cocaine use in pregnant women in a large public hospital.

Cocaine has been reported to be associated with several pregnancy complications such as abruptio placentae, an increase in the incidence of low birthweight infants, and congenital malformations in the newborn. With the increasing frequency of cocaine abuse of women of childbearing age in the United States, clinicians can reasonably be expected to encounter increasing numbers of pregnant women who use cocaine. The exact prevalence of cocaine use during pregnancy is not known. In the present series of 102 pregnant women, the prevalence of cocaine use was 9.8%, with a 95% confidence interval of 3.9 to 15.7%. There was one mother who had an abruptio placentae and there was one infant who had a congenital malformation among the ten women with a history of cocaine use during pregnancy. The mean birthweight was 3180 +/- 380 gm for infants born to mothers who used cocaine compared with 3250 +/- 422 gm (p = NS) for the infants born to mothers who did not use cocaine. A significant number of pregnant women in our population use cocaine during pregnancy.

Adult↗

PubMed1995

Relationship between placental histologic features and umbilical cord blood gases in preterm gestations.

OBJECTIVE: Our purpose was to test the hypothesis that placental histologic lesions reflect abnormal placental respiratory function in preterm gestations. STUDY DESIGN: A retrospective study of preterm deliveries from 22 to 32 weeks revealed 431 patients with umbilical venous or arterial blood gas values. Excluded were stillbirth, multiple gestations, placenta previa, maternal medical diseases, and fetal anomalies. Charts were reviewed for principal indication of delivery, diagnosis of labor, and mode of delivery. Blood gases were studied within 10 minutes of delivery on a model 178 automatic pH analyzer (Corning Med, Boston). Placental data included uteroplacental vascular lesions and related villous lesions, lesions of acute inflammation, chronic inflammation, and coagulation. Contingency tables and analysis of variance considered p < 0.05 as significant. RESULTS: Mean +/- SD umbilical vein pH was 7.36 +/- 0.07 (range 6.94 to 7.56) and umbilical artery pH was 7.30 +/- 0.08 (range 6.83 to 7.55). Increasing severity of uteroplacental thrombosis, villous lesions reflective of uteroplacental vascular pathologic mechanisms, avascular villi, histologic evidence of abruptio placentae, chronic villitis, and increased circulating erythrocytes were associated with decrease in umbilical vein and artery pH, increase in umbilical vein and artery PCO2, and decrease in umbilical vein and artery PO2. Histologic evidence of acute infection and villous edema were associated with a higher pH and PO2 and a lower PCO2 in both umbilical vein and artery. Umbilical vein or artery base excess was not related to placental lesions. Labor was not related to blood gas values in this data set, although a subset of cases of extremely preterm premature rupture of membranes and preterm labor who labored and were delivered by cesarean section had significantly poorer umbilical venous and fetal arterial blood gas values (all p < 0.005). Lesions related to poorer blood gas values were significantly more frequent in preterm preeclampsia and nonhypertensive abruptio placentae than in premature rupture of membranes or preterm labor. CONCLUSIONS: Changes in umbilical vein and artery pH, PO2, and PCO2 are significantly related to lesions of uteroplacental vascular pathologic mechanisms and intraplacental thrombosis. Placental lesions may be associated with chronic fetal distress by altering fetal oxygen availability and acid-base status. Placental immaturity resulting from prematurity may be associated with inefficient placental respiratory function and an increased likelihood of cesarean delivery in cases of premature rupture of membranes or preterm labor. Altered fetal acid-base balance plus excess numbers of circulating nucleated erythrocytes suggests that placental respiratory function is functionally abnormal when these lesions are present and leads to fetal tissue hypoxia.

Acidosis↗

PubMed2004

Maternal and fetal outcomes in HELLP syndrome complicated with acute renal failure.

OBJECTIVE: This study reviews maternal and fetal outcomes in HELLP syndrome complicated with acute renal failure (ARF), and compares clinical and laboratory findings of the cases of HELLP syndrome that did not develop ARF. MATERIALS AND METHODS: All pregnant women with hypertensive disorders admitted or referred to the maternal and fetal unit were recorded into a perinatal database between January 15, 2002 and September 15, 2003. During the study period, out of 615 cases of hypertensive pregnancy, we followed and delivered 347 cases of severe preeclampsia, of them 132 cases were diagnosed as HELLP syndrome. ARF was defined as creatinine level > or =1.2 mg/dL and/or oliguria <400 mL/24 hr. The cases were divided into three groups on the basis of the highest creatinine level recorded during hospitalization: creatinine <1.2 mg/dL, creatinine > or =1.2 to 2.0 mg/dL, and creatinine > or =2.0 mg/dL. Statistical comparisons were performed by Student t test, X2 analysis, and Fisher's Exact test as appropriate. The value of P < .05 was considered significant. RESULTS: ARF developed in 8.9% (n:31) of severe preeclampsia (n:347); of them, 15 (4.3%) cases were nonoliguric, and all had mildly elevated creatinine levels between 1.2 and 1.9 mg/dL. Moderately elevated creatinine levels were 2 to 3.9 mg/dL in 10 cases, and severely elevated creatinine levels were 4 to 8.4 mg/dL in 6 cases, for a total of 16 (4.6%) cases; creatinine levels were > or =2.0 mg/dL (range: 2.0-8.4 mg/dL). HELLP syndrome was the most frequent cause of ARF, 64.5% (n:20/31), and was observed in 15% (n:20) of 132 cases of HELLP syndrome. Fourteen (88%) of 16 cases that had oliguria and creatinine levels > or =2 mg/dL were detected in HELLP syndrome (n:14/132; 10.6%). Major maternal complications in HELLP syndrome with ARF and creatinine level > or =2 mg/dL in the study group were abruptio placentae (42.8%; n:6/14), incisional hematoma (21%; n:3/14), pulmonary edema (14%; n:2/14), cesarean hysterectomy (7%; n: 1/14), and dialysis (50%; n:7/14). There was no maternal mortality. All patients complicated with ARF were discharged without renal impairment. Perinatal mortality was 26.1% in the cases of HELLP syndrome with ARF-creatinine > or =1.2 mg/dL and further increased to 37.5% when creatinine levels were above 2.0 mg/dL, compared with 11.8% in the cases having creatinine <2.0 mg/dL, and the difference was statistically significant (p:.007). CONCLUSIONS: The most contributing factors leading to ARF in HELLP syndrome were abruptio placentae and HELLP syndrome complicated with ARF, particularly, oliguric ARF has relatively higher maternal complications and perinatal mortality.

Acute Kidney Injury↗

PubMed1995

Improved perinatal mortality rates in 1001 patients with severe pre-eclampsia.

OBJECTIVE: To ascertain the change in perinatal mortality (PNM) rate over a period of 10 years in 1001 patients with severe pre-eclampsia. METHODS: Patients with severe pre-eclampsia before a gestational age of 34 weeks were managed expectantly. Initial treatment consisted of the administration of magnesium sulphate to prevent convulsions and dihydralazine to reduce blood pressure. Methyldopa alone or in combination with other oral antihypertensive drugs was started soon after admission. In order to prevent fetal death from abruptio placentae, the fetal heart rate was monitored at least four times per day. Patients were delivered either at 34 weeks' gestation or when fetal or maternal indications for immediate delivery were present. The 10-year study was divided into four successive time periods and the PNM rate was calculated separately for each of these time periods. RESULTS: Perinatal survival was low if patients were delivered before or at 26 weeks' gestation but improved rapidly if delivered thereafter. There were only 33 intrauterine deaths of babies who weighed 1000 g or more. The majority of these deaths were due to abruptio placentae which had occurred prior to admission to hospital. The PNM rate for babies of 1000 g or more decreased from 61 in the first time phase and 83 in the second to 19 in the last. The overall PNM rate during the 10-year study was 62. CONCLUSION: Improved knowledge about the management of patients with severe pre-eclampsia in early pregnancy resulted in a decline in the PNM rate. Although the exact cause of this reduction towards the end of the study is not known, several factors probably played a role. They are expectant management with a little gain in the gestational age, better fetal monitoring before and during labour, earlier detection of fetal distress, earlier referral to the tertiary hospital and improved neonatal care.

Blood Pressure↗

PubMed1998

Placental pathology in patients using cocaine: an observational study.

OBJECTIVE: Although retroplacental hemorrhage is a major cause of fetal death, its etiology often remains obscure. In some reports, cocaine use by pregnant women has been associated with retroplacental hemorrhage and clinical abruptio placentae. This study was designed to assess the occurrence of chorionic villus hemorrhage, an entity shown recently to be associated with retroplacental hemorrhage, in the placentas of cocaine users. METHODS: Twenty-nine placentas from cocaine users and 15 placentas from drug-free controls, as determined by questionnaire and urine toxicology screen, were examined prospectively, and pathological findings documented. The prevalence of retroplacental hemorrhage, chorionic villus hemorrhage, edema, chorioamnionitis, funisitis, infarction, fetal vessel thrombosis, and intervillus hemorrhage was examined in the two groups. RESULTS: Chorioamnionitis was the most frequent finding in both groups (58% of cocaine users, 66% of controls). Edema of moderate severity or greater was found only in the cocaine-using group (17%). The prevalence of chorionic villus hemorrhage among women using cocaine also was 17%. CONCLUSION: Cocaine use during pregnancy may be associated with chorionic villus hemorrhage and villus edema, even in the absence of clinical abruptio placentae. The relationship between abnormal placental morphology and adverse perinatal outcomes remains to be determined.

Adult↗

PubMed1991

Prevention of fetal growth retardation with low-dose aspirin: findings of the EPREDA trial.

The efficacy of low-dose aspirin in preventing fetal growth retardation was tested in a randomised, placebo-controlled, double-blind trial. A secondary aim was to find out whether dipyridamole improves the efficacy of aspirin. 323 women at 15-18 weeks' amenorrhoea were selected at twenty-five participating centres on the basis of fetal growth retardation and/or fetal death or abruptio placentae in at least one previous pregnancy. They were randomly allocated to groups receiving placebo, 150 mg/day aspirin, or 150 mg/day aspirin plus 225 mg/day dipyridamole, for the remainder of the pregnancy. In the first phase of the trial all actively treated patients (n = 156) were compared with the placebo group (n = 73). Mean birthweight was significantly higher in the treated than in the placebo group (2751 [SD 670] vs 2526 [848] g; difference 225 g [95% CI 129-321 g], p = 0.029) and the frequency of fetal growth retardation in the placebo group was twice that in the treated group (19 [26%] vs 20 [13%]; p less than 0.02). The frequencies of stillbirth (4 [5%] vs 2 [1%]) and abruptio placentae (6 [8%] vs 7 [5%]) were also higher in the placebo than in the treated group. The benefits of aspirin treatment were greater in patients with two or more previous poor outcomes than in those with only one. In the second analysis, of aspirin only (n = 127) vs aspirin plus dipyridamole (n = 119), no significant differences were found. There was no excess of maternal or neonatal side-effects in the aspirin-treated patients.

Adult↗

PubMed2004

Influence of perinatal risk factors on CD3+/TCR alphabeta and CD3+/TCR gammadelta lymphocytes in cord blood of preterm neonates.

BACKGROUND: The aim of the study was the evaluation of CD3+/TCR alphabeta and CD3+/TCR gammadelta lymphocytes in the cord blood of the preterm neonates. METHODS: The study included 26 term neonates as a control group delivered both by spontaneous labor and by cesarean section and 41 preterm neonates: (i) by cesarean section due to abruptio placentae, (ii) by cesarean section due to the danger of intrauterine asphyxia, (iii) by cesarean section due to preterm rupture of membrane (PROM), and (iv) by spontaneous labor. Immunological analysis was performed in the flow cytometer FACScan, using anti-CD3, anti-TCR alphabeta and anti-TCR gammadelta monoclonal antibodies from Becton Dickinson (San Jose, California USA). RESULTS: It was shown that the way of delivery does not influence the value of CD3+/TCR alphabeta lymphocytes. A decrease of the percentage and number of CD3+/TCR gammadelta lymphocytes was found in neonates delivered by elective cesarean section. However, the danger of intrauterine fetal asphyxia, as a reason for preterm delivery, influenced a considerable increase of the number of CD3+/TCR alphabeta and CD3+/TCR gammadelta lymphocytes. Perinatal risk factors (abruptio placentae, PROM) were related to the lowest number of CD3+/TCR gammadelta lymphocytes in the blood of the preterm neonates. CONCLUSION: The obtained results suggest that in spite of considerable immaturity, both a term and preterm neonate is prepared for the immune response and is able to activate cell mechanisms. The precise mechanism that links CD3+/TCR alphabeta and CD3+/TCR gammadelta lymphocytes and pathological condition of preterm birth remains unclear.

CD3 Complex↗

PubMed1988

Utilization of red blood cell transfusion in an obstetric setting.

The transfusion experience for a 1-year period (September 1985 to August 1986) at a tertiary referral obstetric hospital was reviewed retrospectively. During the review period 7731 mothers were delivered and 6003 patients (83%) underwent type-and-screen procedures. A total of 1057 units of red blood cells were crossmatched, and 362 of these 1057 units were transfused to 100 parturient women so that the overall crossmatch/transfusion ratio was 2.9:1. Five percent of transfused patients received 1 unit; 52% of patients received 2 units, 19% received 3 units and 24% received greater than or equal to 4 units of packed red blood cells. Major indications for transfusion were uterine atony, 27%; retained placenta, 17%; trauma, 17%, placenta previa, 7%; and abruptio placentae, 5%. In 12% of patients transfusions were done because of anemia. This study shows the value of audit and confirms that the type-and-screen procedure is an effective way of reducing the crossmatch/transfusion ratio without compromising patient care, even in high-risk patients.

Blood Grouping and Crossmatching↗

PubMed2003

Place of embolization of the uterine arteries in the management of post-partum haemorrhage: a study of 12 cases.

OBJECTIVE: To assess the current place of embolization of the uterine arteries in the treatment of severe post-partum haemorrhages. MATERIALS AND METHODS: A retrospective study of 13,160 deliveries in a level III maternity unit between January 1996 and December 2001. Five hundred and forty-nine post-partum haemorrhages were diagnosed. Seventeen (0.13%) patients had a haemorrhage which did not respond to treatment using obstetric manoeuvres and uterotonic drugs. Twelve patients aged between 19 and 34 years old benefited from embolization of the uterine arteries. Nine patients had delivered by Caesarian section and three vaginally. The aetiologies found were uterine atony (n=8), placenta praevia (n=1), placenta accreta (n=1), abruptio placentae (n=1) and uterine myomas (n=1). RESULTS: The success rate of embolization was 91.6%. One failure, resulting from cardiovascular shock during the procedure, led to the patient being transferred as an emergency to the operating theatre for a haemostasis hysterectomy. It was due to placenta increta. No maternal deaths were reported. No complications because of the technique used were noted. One patient successfully delivered, following a normal pregnancy, one year after embolization. CONCLUSION: Embolization of the uterine arteries is indicated in severe post-partum haemorrhage, irrespective of the aetiology or the type of delivery. It should be offered as soon as primary management measures undertaken for haemorrhage are judged as ineffective. Its place in the treatment strategy, is in all cases before embarking on surgery, which is the final recourse in the case of failure. It is a fairly uninvasive procedure, which preserves the potential for future pregnancies.

Adult↗

PubMed1996

Caesarean section deliveries at Tikur Anbessa Teaching Hospital, Ethiopia.

This prospective hospital-based study was done at Tikur Anbessa Teaching Hospital (TATH) between July 1991 and July 1992 in order to obtain base-line data on the rates of caesarean section, pregnancy out-come, major indications for caesarean and caesarean section complications. Out of a total of 3237 deliveries conducted during the study period, 318(10%) were caesarean section. The leading or the major indication for abdominal deliveries were: repeat caesarean section, 103(32.4%), cephalo-pelvic disproportion, 93(29.2%), placenta previa and abruptio-placentae 40(12.6%). Age ranged from 15-40 years, 58(18.2%) were women under the age of 20, and 182(57%) were between 20 and 30 years of age which is the safest period to bear children. Eighty one (25%) of the mothers were primiparae, 158(50%) were between para one and para four, 79(25%) were grand multiparae. Seventy six (24%) of the cases were not registered for antenatal care in any health institutions. Two hundred and fifteen (67.6%) of the mothers had primary caesarean section. The chance of repeat caesarean section was statistically significant (P < 0.001). Fifty seven (18%) had elective caesarean section and 261 (82%) were emergency caesarean section. On eight (2.5%) of the patient, obstetric hysterectomy was performed. There were five maternal deaths among the caesarean section cases. The main cause of maternal death was failure to control bleeding during the caesarean section. These were preventable deaths in experienced hands. There were nine (2.8%) stillbirths and 15(4.7%) early neonatal deaths. A foetal wastage of 24(7.5%) was noted in the study. The mean birthweight among booked caesarean section were 3108 grams and unbooked caesarean section were 2991 grams. The major obstetric complications in the cases were antepartum haemorrhage, and 34(11%), pregnancy induced-hypertensive disorder, 32(10%). Sixty one (19%) had blood transfusion. The blood loss was significantly more in operations done by residents compared to consultants even using the most crude measurement as estimated by the operator at the time.

Adolescent↗