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PubMed2000

Yield and costs of screening growth-retarded infants for torch infections.

Many infants with intrauterine growth retardation (IUGR) are screened for TORCH infections. The yield and costs of such a practice may not be justifiable. Medical charts of infants with IUGR who had a workup for toxoplasmosis, other (infections), rubella, cytomegalovirus (infection), and herpes (simplex) (titer) (TORCH) infections were reviewed for the presence of clinical findings, laboratory and head ultrasound abnormalities associated with intrauterine infections. Maternal charts and reports of placental pathology were reviewed for identifying maternal illnesses and placental causes associated with IUGR. Seventy-five out of 182 infants (41%) with IUGR had a workup for TORCH infection. Maternal conditions associated with IUGR included: pregnancy-induced hypertension (19%), tobacco use (43%), alcohol abuse (21%), illicit drug use (24%), chronic hypertension, diabetic vasculopathy or collagen vascular disease (12%), and multiple gestation (3%). Placental pathology was available in 53/75 cases. Thirty-six of fifty-three (67%) placentae had abnormalities associated with IUGR: placental infarcts (22 of 36), vasculitis/villitis (15 of 36), placenta previa (1 of 36), abruptio placenta (2 of 36), and velamentous insertion of umbilical cord (1 of 36). Clinical findings among infants included hepatosplenomegaly, cataract or rash (1 of 75), thrombocytopenia and/or neutropenia and/or direct hyperbilirubinemia (11 of 75). Seven out of 75 infants had dysmorphic features. None of the infants (0 of 75) had positive IgM titers for toxoplasma, rubella, cytomegalovirus (CMV), or herpes simplex virus (HSV). No infants (0 of 43) had elevated total IgM titers; one infant (1 of 57) had a positive urine culture for CMV. One infant had evidence of calcifications on head ultrasound and a second infant had hydrocephalus (2 of 43). The costs associated with workup for TORCH infections among 75 infants included: TORCH titers determination: $17,816, total IgM titers: $1318, urine culture for CMV: $5734, and head ultrasound: $28,165. The yield of workup for TORCH infection among infants with IUGR is poor and does not justify the incurred costs.

Adult↗
PubMedDate not supplied

The impact of the factor V Leiden mutation on pregnancy.

A resistance to the anticoagulant activity of activated protein C (APC), most frequently due to a point mutation in the Factor V gene (the Leiden mutation), represents the most common genetic cause of thrombophilia. The Leiden mutation has been significantly related to pregnancy complications associated with hypercoagulation, e.g. deep vein thrombosis during pregnancy (8-fold increased risk), pre-eclampsia (prevalence of the mutation up to 26%), placental infarction extending to > 10% of the placenta (10-fold increased risk), abruptio placentae (prevalence of the mutation up to 29.6%), and second- and third-trimester pregnancy failure (prevalence of the mutation up to 31.3%). An association of the maternal mutation with recurrent first-trimester miscarriage does not emerge from the literature, although fetal mutation (frequency higher than twice compared with that of the general population) has been related to early spontaneous miscarriage. Although some evidence suggests an association between APC resistance and intrauterine growth retardation, no significant relationship emerges currently from the literature. Screening for the Leiden mutation would seem advisable in women with previous pregnancy complications amongst those associated with APC resistance. Carriers of the mutation should be given appropriate counselling. The screening of asymptomatic women is not recommended at present.

Factor V↗
PubMed2002

Labor induction after fetal death. A retrospective analysis.

OBJECTIVE: To describe the delivery outcomes in patients with stillborn infants after labor induction versus spontaneous onset of labor. STUDY DESIGN: A retrospective chart review was performed of singleton pregnancies complicated by fetal death over a three-year period when awaiting spontaneous onset of labor was a common practice. Exclusion criteria were prior multiple cesarean deliveries, placenta previa, preeclampsia or suspected abruptio placentae. Outcome measures included time spent in the labor and delivery unit and rates of maternal hemorrhagic morbidity and endomyometritis. RESULTS: Two hundred eight patients, 100 patients undergoing labor induction and 108 with spontaneous onset of labor, met the study criteria. Patients delivering after induction spent a longer time in the labor and delivery unit (13.7 versus 4.4 hours). The endomyometritis rate was higher in the spontaneous labor group (6% versus 1%). There were no differences in the frequency of postpartum hemorrhage, retained placenta or need for blood transfusion. CONCLUSION: Induction following diagnosis of fetal death is safe and may reduce maternal infectious morbidity.

Adult↗
PubMed1995

Obstetrics hysterectomy--five years experience at Jinnah Postgraduate Medical Centre, Karachi.

During the five years period (1st January 1988 to 31st December 1992), 106 hysterectomies were performed for obstetric indications in the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre (JPMC), Karachi. The frequency was 1 in 331 deliveries (total 35,172 deliveries). In all except one hysterectomy was performed as a life saving measure. The major indications were ruptured uterus in 61 (58%) cases and severe postpartum haemorrhage due to uterine atony in 18 (17%). Other indications included haemorrhage due to placenta praevia in 11 (10%), placenta accreta 7 (7%) and abruptio placentae 5 (5%), severe infection 2 (2%) and broad ligament haematoma following caesarean section 1 (1%). There were 10 (9%) maternal deaths all due to severity of the conditions necessitating hysterectomy. Obstetric hysterectomy can save many lives but requires proper judgement and skill. Senior resident staff in obstetric units in the developing countries should be trained for it.

Adolescent↗
PubMed1998

Is conservative treatment of HELLP syndrome safe?

HELLP syndrome is associated with a high rate of maternal and perinatal morbidity and mortality, and often leads to immediate fetal extraction. However, this condition may occur very early in pregnancy and conservative approaches have been recently proposed. The limits of this approach are discussed with two cases of conservative management of HELLP syndrome complicated by abruptio placentae.

Abruptio Placentae↗
PubMed1976

Coagulation changes in eclampsia: their frequency and pathogenesis.

The maternal coagulation mechanism has been investigated in an effort to identify its role, if any, in the pathogenesis of eclampsia. Thrombocytopenia was identified in 28 of 95 cases (29 per cent), a prolonged thrombin time in 19 of 38 (50 per cent), abnormally elevated serum fibrinogen-fibrin degradation products in two of 65 (3 per cent), and circulating fibrin monomer in one out of 20 (5 per cent). Overt hemolysis was rare (2 per cent). Thus the pattern as well as the degree of change in the maternal coagulation mechanism differed remarkably from that typical of severe abruptio placentae and of prolonged retention of a dead fetus, the classic obstetric models of fast and slow disseminated intravascular coagulation. It is concluded that the coagulation changes when present in eclampsia are effect rather than cause. Moreover, the changes may evolve primarily from platelet adherence at sites of vascular endothelial damage as the consequence of segmental vasospasm and vasodilatation rather than be triggered by the escape of thromboplastin from the placenta into the maternal circulation.

Abruptio Placentae↗
PubMed2002

[HELLP syndrome and hemorrhagic gestosis].

In the year 1817, Charlotte daughter of Georges IV and princess of Wales, died on an unknown condition with uteroplacental hemorrhage and fetal death called at the time "Uteroplacental Apoplexy" and later "Abruptio Placentae". This affection was described in the classical books as an hemorrhagic complication of labor. In 1961 we have at first related the Abruptio with acute toxemia (preeclampsia) and have proposed the term "Gestosis hemorrágica" to design it. In 1982 Weinstein has described the called HELLP syndrome (Hemolysis, Elevated liver Enzymes, at Low Platelets) which basically is the same pathological picture as the described by us as "hemorrhagic toxemia". The aim of the paper is to demonstrate the identity of both syndromes and to claim for the priority of our definition.

Abruptio Placentae↗
PubMed1977

Maternal smoking, pregnancy complications, and perinatal mortality.

Analysis of data from the Ontario Perinatal Mortality Study has shown that perinatal mortality increases directly with the level of maternal smoking during pregnancy. Increases in smoking level are associated with increases in the frequency of early fetal deaths and of neonatal deaths due to premature delivery. These deaths in turn are associated with smoking-related increases in the incidence of bleeding during pregnancy, abruptio placentae, placenta previa, and premature and prolonged rupture of the membranes.

Abruptio Placentae↗
PubMed1997

The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis.

OBJECTIVE: Our purpose was to determine the incidence of placenta previa based on the available epidemiologic evidence and to quantify the risk of placenta previa based on the presence and number of cesarean deliveries and a history of spontaneous and induced abortion. STUDY DESIGN: We reviewed studies on placenta previa published between 1950 and 1996 on the basis of a comprehensive literature search with use of MEDLINE and by identifying studies cited in the references of published reports. Studies were chosen for inclusion in the metaanalysis if the incidence of placenta previa and its cross-classification with either prior cesarean delivery or abortions (both spontaneous and induced) or both were available. We also extracted details about the study design (case-control or cohort study) and place where they were conducted (United States or other countries). Published case reports dealing with placenta previa and studies relating to abruptio placentae were excluded from this review. We also restricted the search to studies published in English. No attempts were made to locate any unpublished studies. Data from studies identified during the literature search were reviewed and abstracted by a single author. In case of discrepancies or when the information presented in a study was unclear, abstraction by a (blinded) second reviewer was sought to resolve the discrepancy. RESULTS: Data on the incidence of placenta previa and its associations with previous cesarean delivery and abortions were abstracted. Subgroup analyses were performed to identify potential sources of heterogeneity by study design and place where they were conducted. Statistical methods used for the metaanalysis included the fixed-effects logistic regression model, whereas potential sources of heterogeneity among studies were evaluated by fitting random-effects models. The tabulation of 36 studies identified a total of 3.7 million pregnant women, of whom 13,992 patients were diagnosed with placenta previa. The reported incidence of placenta previa ranged between 0.28% and 2.0%, or approximately 1 in 200 deliveries. Women with at least one prior cesarean delivery were 2.6 (95% confidence interval 2.3 to 3.0) times at greater risk for development of placenta previa in a subsequent pregnancy. The results varied by study design, with case-control studies showing a stronger relative risk (relative risk 3.8, 95% confidence interval 2.3 to 6.4) than cohort studies did (relative risk 2.4, 95% confidence interval 2.1 to 2.8). Four studies, encompassing 170,640 pregnant women, provided data on the number of previous cesarean deliveries. These studies showed a dose-response pattern for the risk of previa on the basis of the number of prior cesarean deliveries. Relative risks were 4.5 (95% confidence interval 3.6 to 5.5) for one, 7.4 (95% confidence interval 7.1 to 7.7) for two, 6.5 (95% confidence interval 3.6 to 11.6) for three, and 44.9 (95% confidence interval 13.5 to 149.5) for four or more prior cesarean deliveries. Women with a history of spontaneous or induced abortion had a relative risk of placenta previa of 1.6 (95% confidence interval 1.0 to 2.6) and 1.7 (95% confidence interval 1.0 to 2.9), respectively. Substantial heterogeneity in the results of the metaanalysis was noted among studies. CONCLUSION: There is a strong association between having a previous cesarean delivery, spontaneous or induced abortion, and the subsequent development of placenta previa. The risk increases with number of prior cesarean deliveries. Pregnant women with a history of cesarean delivery or abortion must be regarded as high risk for placenta previa and must be monitored carefully. This study provides yet another reason for reducing the rate of primary cesarean delivery and for advocating vaginal birth for women with prior cesarean delivery.

Abortion, Induced↗
PubMed1998

Simultaneous measurement of adenosine and hypoxanthine in human umbilical cord plasma using reversed-phase high-performance liquid chromatography with photodiode-array detection and on-line validation of peak purity.

A new, robust and sensitive reversed-phase high-performance liquid chromatographic method was developed for concomitant measurement of plasma concentrations of the ATP catabolites adenosine and hypoxanthine in human umbilical cord blood. Deproteinized cord plasma was chromatographed on Hypersil C18 columns, using UV photodiode-array detection, spectral analysis of peaks and on-line confirmation of peak purity. Elution with a gradient of acetonitrile-tetrahydrofuran in ammonium dihydrogen phosphate buffer pH 4.7, yielded sharp, well-resolved peaks of adenosine and hypoxanthine within 16 min. Peak areas were quantified from external calibration curves and converted to plasma concentrations via cord blood hematocrits. In seven deliveries, gestational ages 32-40 weeks, adenosine (range, 0.1-2.1 microM) was less than hypoxanthine (range, 1.6-18.5 microM) in the same cord plasma sample. Arteriovenous levels of each purine were similar, except in an abruptio placenta delivery.

Abruptio Placentae↗
PubMed2001

Placental abruption and perinatal death.

Studies of risk factors for abruptio placentae (AP) are partly conflicting and studies of risk factors for perinatal death in these pregnancies are scarce. Using the population-based Swedish Birth Registry from 1987 to 1993, we were able to study these risks in 795,459 singleton pregnancies. Logistic regression analysis was used to estimate odds ratios (OR) for risk of AP and risk of perinatal death in pregnancies with and without AP. Risk factors for AP were: age, primiparity, high parity, not cohabiting with infant's father, low education, smoking, infertility, pregestational diabetes, essential hypertension, pregnancy-induced hypertensive diseases, preterm premature rupture of membranes, preterm birth and small-for-gestational-age (SGA) births. Risk factors for perinatal death in pregnancies with placental abruption were smoking (1--9 and > or =10 cigarettes/day; OR 1.4 and 1.7 respectively), severe pre-eclampsia (OR 2.0) and SGA (OR 1.9), whereas in pregnancies without abruption, risks were also increased in maternal age > or =35 years, primiparity, infertility, essential hypertension and pregestational diabetes. These findings support the theory that, in cases of AP, a general impairment of the placenta and/or a defect placentation may be fatal.

Abruptio Placentae↗
PubMed1985

Pregnancy in physicians: characteristics and complications.

The course of 72 pregnancies in a personal series of 37 physicians has been reviewed. The patients were generally older than average at the time of pregnancy. Most physicians continued to work until they went into labor. The spontaneous abortion rate was similar to the general population; the induced abortion rate was lower than the general population. Forty-nine deliveries occurred. The infants weighed more than average and there was a tendency for postmature pregnancy. There was an increased incidence of threatened preterm labor; a much higher incidence of abruptio placentae occurred, the latter complication resulting in an increased cesarean section rate.

Abortion, Spontaneous↗
PubMed1990

A prospective controlled study of outcome after trauma during pregnancy.

In a prospective cohort study, 85 women who suffered varying degrees of trauma during pregnancy (12 to 41 weeks) were compared with a control group of pregnant women matched for gestational age. Fetomaternal transfusion occurred significantly more frequently in the study group (30.6% vs 8.2%, p less than 0.05). Study subjects whose placentas were anteriorly placed were at increased risk for fetomaternal transfusion on comparison with other placental positions (47% vs 23.5%, p less than 0.05). Immediate adverse outcomes including abruptio placentae occurred frequently in the study group (9.4%) and were not predictable on the basis of injury severity. When immediate adverse outcomes were excluded, there was no difference in pregnancy outcome. Four hours of cardiotocographic monitoring used as a screening tool was found to be an extremely sensitive but nonspecific indicator of immediate adverse outcomes. On the basis of these findings, it is recommended that routine screening for fetomaternal transfusion occur in all pregnant women who suffer trauma during pregnancy beyond 11 weeks' gestation and that a minimum of 4 hours of cardiotocographic monitoring occur in women greater than 20 weeks' gestation.

Abruptio Placentae↗
PubMed1993

Treatment of obstetrical hemorrhagic emergencies.

The common hemorrhagic complications of pregnancy remain among the leading causes of maternal mortality. We review new methods of diagnosis and offer suggestions for management. Abruptio placenta, disseminated intravascular coagulation, placenta previa, uterine rupture, and postpartum hemorrhage are included in this review.

Abruptio Placentae↗
PubMed1989

Acute Rh isoimmunization following abdominal trauma associated with late abruption placenta.

Acute exacerbation of Rh isoimmunization following abdominal trauma is a rare complication of pregnancy. The report describes a case of a mild case of erythroblastosis fetalis following maternal exposure to massive fetal-maternal transfusion, occurring after abdominal injury in motoring accident. Abruptio placenta 7 days following the trauma indicated emergency cesarean section, at which a severely affected fetus (erythroblastosis fetalis) was delivered. Late abruption--in the presence of no other risk factor--is considered to call for prolonged surveillance. Any abdominal trauma in a Rh-negative woman should alert one to the possibility of massive transplacental hemorrhage and augmentation of the maternal immune response.

Abdominal Injuries↗
PubMedDate not supplied

Prenatal cocaine use associated with down regulation of receptors in human placenta.

Cocaine use during pregnancy has been associated with abruptio placentae and spontaneous abortions. These effects may be secondary to the vasoconstrictive effects of cocaine or to other alterations. Since it has been demonstrated that the use of opiates during pregnancy alters placental receptors, the effects of cocaine on placental receptors was studied. Women who used cocaine during pregnancy showed a significant lowering of the total number of beta-adrenergic receptor binding sites and delta-opiate receptor binding sites. The decreases in Bmax for each of these receptors was not associated with a decrease in the Kp. The potential causes for the receptor down regulation and effects are discussed.

Cocaine↗
PubMed1985

Risk factors for early neonatal sepsis.

The authors undertook a case-control study of 113 cases of neonatal sepsis and 347 randomly selected controls. All cases and controls were selected from the 1980 and 1981 Washington State birth certificates. The increased risk for males (odds ratio (OR) = 1.75, p = 0.012) and the large risk associated with low birth weight (OR = 99.1, p less than 0.001 if less than 1,500 g and OR = 5.17, p less than 0.001 if 1,500-2,500 g) are consistent with past studies. The relationship of maternal age (OR = 2.00, p = 0.01 if less than or equal to 20 years and OR = 1.74, p = 0.05 if greater than 30) parallels the overall risk of many pregnancy-related complications in these age groups. Interpretation of the elevated risk associated with amniocentesis is hampered by small numbers but is provocative. The strong association of an Apgar score of 6 or less at five minutes (OR = 36.25, p less than 0.001) with neonatal sepsis suggests the possibility of routine sepsis evaluation in such neonates born in areas with high incidence rates of early neonatal sepsis. We found no previous reports associating either abruptio placentae (OR = 12.70, p = 0.028) or preeclampsia (OR = 6.43, p = 0.017) with neonatal sepsis.

Abruptio Placentae↗