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Intravenous nitroglycerin has been reported to be efficient in various emergency obstetric situations. We report here the first case of intravenous nitroglycerin use in a 20-week pregnant woman with abruptio placentae and hypertonia leading to in utero fetal death and difficult delivery.
Folate metabolism is sometimes deranged in the early weeks of pregnancy at the time of placentation and organogenesis. Maternal folate deficiency may result in general impairment of fetal growth, which is reflected in low birthweight. Such women also have a high incidence of abortion, abruptio placentae and fetal malformation. Megaloblastic anaemia is the commonest and most easily recognised manifestation of folate deficiency.
Twelve hundred nineteen maternal deaths occurring from 1957 through 1966 in the State of California have been reviewed by the Maternal Mortality Committee of the California Medical Association and the Bureau of Maternal and Child Welfare of the State of California. In 56 of these deaths the underlying causes were due to disorders of placental separation and placental bed hemostasis. Each of these 56 cases has been analyzed. Profiles of characteristics of patients dying from placenta previa, placenta abruptio, and uterine atony are given. The expected causes of death due to delay in giving adequate amounts of blood and fibrinogen occurred in this series but the most striking results of this study were the findings of (1) a large number of cases of placenta acreta in patients with repeat cesarean sections and (2) the lack of manual exploration of the uterus in many patients dying from uterine atony.
Pregnancy-induced hypertension is a disorder of unknown etiology unique to pregnant women. Classic clinical manifestations include hypertension, proteinuria, and edema. Early recognition and proper management of this disease may serve to avoid serious maternal complications. Ultimate maternal treatment depends on delivery of the fetus and placenta. Advanced stages of this disease result in multi-organ system dysfunction that may be life-threatening to the mother and her fetus. Such maternal complications of PIH include severe hypertension, oliguria or anuria, HELLP syndrome, eclamptic seizures, liver rupture, pulmonary edema, cerebral edema, and abruptio placentae. A multidisciplinary approach of the critical care team often will effect a reduction in maternal morbidity and mortality.
The study was undertaken to determine the causes of the more frequent pre-term deliveries, fetal and neonatal deaths associated with maternal urinary-tract infections during pregnancy. The combined perinatal mortality rate for eight common placental and fetal disorders was 42 per thousand births in the infected vs. 21 per thousand in the noninfected, owing to a greater mortality from noninfectious placental and fetal disorders in the gestations with the urinary-tract infections (P less than 0.001). All the mortality excess took place when the urinary-tract infections occurred within 15 days of delivery. Death rates were highest when the urinary-tract infections coexisted with maternal hypertension and acetonuria.Hydramnios, amniotic-fluid bacterial infections and abruptio placentae were responsible for two thirds of the more frequent preterm deliveries in the pregnancies complicated by urinary-tract infections.
The perinatal mortality rate in a large U. S. study was 139 per 1,000 births for twins and 33 per 1,000 for singletons. Sixteen per cent of the twin deaths were due to amniotic fluid infections, 11 per cent to premature rupture of the membranes, 8 per cent to the monovular twin transfusion syndrome, 8 per cent to large placental infarcts, 7 per cent to congenital anomalies, and the rest to over 20 other disorders. The perinatal mortality rate for monozygotic twins was 2.7 times that for dizygotic twins, mainly due to more amniotic fluid infections, congenital anomalies, and the twin transfusion syndrome in the monozygotic pairs. To study the role of poor maternal nutrition on twins, a similar study of perinatal mortality rates was undertaken in Addis Ababa, Ethiopia. Addis Ababa twins had 2.5 times the mortality rate of U. S. twins, mainly due to a higher frequency of amniotic fluid infections, abruptio placentae, cord accidents, obstructed labors, congenital syphillis, and the twin transfusion syndrome in the Ethiopians.
Retroplacental hemorrhage (RPH), or abruptio placentae, usually occurs in the third trimester of pregnancy and may or may not be clinically significant. Sonographic criteria necessary for diagnosis of RPH include visualization of a linear or biconcave, and usually well-marginated mixed echogenic or anechoic region posterior to the placenta. Large areas of hemorrhage may cause bulging of the chorionic plate while small areas may be difficult to discern with routine scanning. Secondary signs of RPH include associated intraplacental anechoic regions secondary to bleeding or infarction and visualization of intra-amniotic hemorrhage. In this report, nine cases of pathologically confirmed RPH are reviewed. Also reviewed are normal and other pathological conditions of the placenta which may mimic RPH but should not be confused with the sonographic diagnosis.
Prenatal case histories and labours of 908 mothers who delivered prematurely at the University of Heidelberg, Department of Gynaecology and Obstetrics in Mannheim, between the years 1966-1971 were compared with a freely selected group of 782 mothers who delivered healthy mature infants with birth weights over 2500 g. (Premature infants -- under 2501 g; Stillborn infants -- under 2501 g and a minimum 35 cm crown-heel length). A tendency to premature delivery was observed in primipara, multipara with at least 4 previous deliveries, unmarried mothers, and in women with a preceding miscarriage or with closely spaced pregnancies less than 24 months apart. Bleeding during pregnancy, EPH-Syndrome, inadequate prenatal care, premature amnion rupture, abruptio placentae, pathological presentation and complications during labour were more frequently observed in mothers who delivered prematurely than those at full term. Histo-pathological changes of the placentas were found in 11,2% in cases of premature births as opposed to 3,6% in full term cases.
The case of a 28 year old woman with pregnancy of 32 weeks, exposed to mercury vapors at home, without clinical manifestations or mercurial intoxication, but with toxic urinary levels. A review of medical literature about mercury intoxication during pregnancy and its obstetrical and fetal consequences, was carried out. Abruptio placentae was described as a manifestation not previously described.
The study sought to determine what proportion of the perinatal mortality excess associated with prolonged gestations was due to placental insufficiency. Using data from a large prospective study of pregnancy, the perinatal mortality rate was 20.9/1000 births for post-term and 11.7/1000 for term infants. Only a quarter of the perinatal mortality rate excess in the post-term pregnancies was due to disorders related to inadequate uteroplacental perfusion, i.e., abruptio placentae, large placental infarcts and marked placental growth retardation. Twenty-six per cent of the mortality excess was due to congenital malformations, 19% to amniotic fluid infections, 8% to Rh erythroblastosis fetalis and the remaining 22% to a variety of other disorders. The post-term mortality excess due to congenital malformations was in infants who had hypoplastic adrenal glands, a well-known cause of prolonged gestation. The 4205 placentas of the post-term infants did not show any significant increases in those microscopic lesions that are characteristic of uteroplacental under-perfusion.
The control of plasma levels fibrinstabilizing factor (factor XII) by women with abruptio placentae early resulted evident values under mean values. The cause of factor deficiency is still unclear. Supposed connections must still cleared up.
The underlying causes of 80% of perinatal deaths were identified in a study of 53,518 pregnacies in the United States: 17% of the deaths were due to amniotic fluid infections, 11% to abruptio placentae, 10% to premature rupture of the membranes, 9% to congenital anomalies, 6% to large placental infarcts, and the rest to more than 20 other specific disorders.
In a 5-year period, the stillbirth rate in a teaching hospital in Hong Kong was 4.4 per 1,000 total births, which accounted for 61% of the perinatal deaths. The stillbirth rate was 5.8 times higher in twin pregnancies, and 17 times higher in triplet pregnancies. One quarter of the patients were nonbooked, and 14.5% had no antenatal care. The stillbirth rates were 3.8 and 8.0 per 1,000 among the booked and nonbooked cases respectively. The major causes of stillbirths were congenital abnormalities, haemoglobin Bart disease, abruptio placentae and gestational diabetes. No specific cause could be found in 46% of cases. There were 31 intrapartum deaths, of which 5 were potentially salvageable.
Evan's syndrome was initially diagnosed in a 26-year-old pregnant patient. Following the introduction of high dose steroid therapy, the patient developed possible disseminated gonococcal infection which was followed by preterm labor and abruptio placentae. A cesarean delivery was performed at the 34th week of pregnancy following platelet infusion. While the infant survived, the mother had delayed postpartum hemorrhage.
We report a case of splenic rupture after cesarean delivery for abruptio placentae. The diagnosis was not suspected until a laparotomy was performed. Diagnosis and management were complicated by disseminated intravascular coagulation and renal failure. The importance of early diagnosis and management modalities are discussed.
A case report is described in which the inadvertent placement of a standard intrauterine pressure catheter in a laboring woman caused partial abruptio placentae and disseminated intravascular coagulation. Altering catheter placement technique and giving attention to aspects of placement can help avoid mishaps, and awareness of possible complications can lead to earlier diagnosis with increased appropriate intervention.
We aimed to identify the risk factors and subsequent maternal and perinatal outcome associated with the procedure of peripartum hysterectomy. This was a retrospective case review carried out at the National Maternity Hospital, Dublin, of all patients who underwent a peripartum hysterectomy from January 1990 to December 1999. Seventeen cases were performed during the study period from a total of 64 563 deliveries (0.03%). Mean maternal age was 34 years (21-43). There were no nulliparous patients. Eight patients had previous vaginal deliveries. The other nine had a history of previous caesarean section, four of whom had two or more caesarean sections. The indications for the hysterectomy were placenta praevia (5), secondary postpartum haemorrhage (3), abruptio placentae (3), atonic postpartum haemorrhage (2), placenta accreta (2), traumatic postpartum haemorrhage (1) and broad ligament haematoma (1). All patients received blood transfusions, 74% receiving more than 10 units. There were no maternal deaths. There were two neonatal deaths secondary to placental abruption (perinatal mortality rate 118/1000). In conclusion, there was no maternal death in this study but the associated maternal morbidity and perinatal mortality was high. More than half the cases were associated with previous caesarean section. The caesarean section rate is increasing worldwide for many reasons, including recent emphasis on maternal request. We recommend that caesarean section be performed only for valid clinical indications, which should help to reduce the problems associated with peripartum hysterectomy.
OBJECTIVE: We investigated whether low human chorionic gonadotropin from maternal serum screening is associated with adverse pregnancy outcome. STUDY DESIGN: Women between 15 and 20 completed weeks of gestation who had a maternal serum screen performed from June 1999 to November 2001 were studied. Cases included women with human chorionic gonadotropin values of 0.5 and <2.0 multiples of the median, and estriol values of >0.6 and <2.0 multiples of the median. Control subjects were selected randomly from the population of women with normal values for all three analytes. RESULTS: There were 146 case subjects and 292 control subjects. There was no increased risk in the study group compared with the control subjects for preterm delivery, intrauterine fetal death, low birth weight, abruptio placentae, preeclampsia, or preterm premature rupture of membranes. CONCLUSION: An isolated low human chorionic gonadotropin level from second-trimester maternal serum screening is not associated with adverse pregnancy outcome.