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PubMed1986

Fetal injury prior to labor: does it happen?

Major advances have been made in the identification and prevention of perinatal factors that lead to long-term handicap or neurologic deficits. When the infant or child exhibits a major handicap, scrutiny of the pregnancy management often occurs in an attempt to define the causal factors. The medical goal of this inquiry is to prevent injuries and, when possible, to eliminate these factors. In the litigious sense, any deviation from optimal, ideal care or any unusual observations, such as unusual or atypical fetal heart rate patterns, are often causally linked to the adverse outcome. There are at least four categories of major fetal injury that probably occur prior to labor. An awareness of, and a diligent search for, details will no doubt clarify the legitimate origins of many so-called birth injuries. Hence the common tendency to fixate on minor deviations and/or deficiencies of labor and delivery management as causing catastrophic injuries will be successfully challenged.

Adult↗
PubMed2006

Hyperoncotic enhancement of fetal pulmonary growth after tracheal occlusion: an alveolar and capillary morphometric analysis.

BACKGROUND/PURPOSE: Previous work has shown that intrapulmonary delivery of oncotic agents enhance overall lung growth after late gestational fetal tracheal occlusion (TO). This study was a post hoc analysis aimed at determining whether actual alveolar and capillary hyperplasias are maximized in this setting. METHODS: Twenty-one near term fetal lambs were evenly divided into 4 groups: group I comprised sham-operated controls; group II had TO alone; and groups III and IV underwent TO and intratracheal infusion of equal amounts of either saline or 25% albumin, respectively. Approximately 2 weeks thereafter, their lungs were examined by detailed alveolar and capillary morphometry before birth. Statistical analysis included analysis of variance and the Bonferroni correction for multiple comparisons (P < .05). RESULTS: Total alveolar and capillary numbers, as well as total alveolar surface area, were significantly higher in group IV and lower in group I compared with all other groups, with no differences between groups II and III. Alveolar capillary load was normal in all groups. CONCLUSIONS: Intrapulmonary delivery of concentrated albumin safely enhances short-term alveolar and capillary hyperplasia in a late gestational model of fetal TO. This therapeutic concept may allow for TO to be effective and predictable when performed late in gestation.

Administration, Inhalation↗
PubMed2003

Prenatal diagnosis and management of fetal anemia secondary to a large chorioangioma.

BACKGROUND: Chorioangiomas are benign vascular tumors of the placenta. Complications occur when their size exceeds 5 cm. CASE: We report the use of peak systolic velocity in the middle cerebral artery, fetal hemoglobin levels in maternal circulation, and maternal serum alpha-fetoprotein levels in the diagnosis and management of fetal anemia in a patient with a large placental chorioangioma. CONCLUSION: Fetal hemoglobin levels in maternal circulation and abrupt elevations of middle cerebral artery peak velocity may be useful in detecting fetal anemia.

Adult↗
PubMed2003

Common arterial trunk in the fetus: characteristics, associations, and outcome in a multicentre series of 23 cases.

OBJECTIVE: To assess the accuracy of prenatal diagnosis, the incidence of extracardiac and chromosomal anomalies, and the perinatal outcome in a population of fetuses with common arterial trunk (CAT). DESIGN: Observational study of 23 fetuses from three referral centres with a confirmed diagnosis of CAT. All underwent fetal echocardiography, detailed anatomical scanning, and karyotyping. In 19 cases, FISH analysis was done to detect 22q11 microdeletion. The following variables were evaluated: gestational age at diagnosis, anatomical variants of the CAT, presence of extracardiac and chromosomal anomalies, pregnancy, and fetal-neonatal outcome. Necropsy reports and postnatal files were available for confirmation of the prenatal diagnosis in all cases. RESULTS: The prenatal diagnosis proved correct in 23 of 24 cases, the last being pulmonary atresia with ventricular septal defect (PAVSD). A second cardiovascular anomaly was present in eight cases (34.8%); extracardiac anomalies were found in 10 (43.4%). FISH analysis showed 22q11 microdeletion in six of 19 cases (31.6%). Outcomes were as follows: eight terminations of pregnancy (34.8%), two intrauterine deaths (8.7%), five postnatal deaths (before or after surgery) (21.7%); the remaining eight neonates (34.8%) are alive and thriving after surgery (six) or awaiting surgery (two). CONCLUSIONS: CAT can be reliably diagnosed and characterised in prenatal life, although differentiation from PAVSD may be challenging. The association with chromosomal anomalies is consistent (8.7%), but there is a higher risk of 22q11 microdeletion (31.6%), in agreement with postnatal studies. The relatively poor survival rate (34.8%) reflects the high rate of terminations and the unfavourable cardiac anatomy in some cases.

Aorta, Thoracic↗
PubMed2006

Hepatic mesenchymal hamartoma: a short review.

Hepatic mesenchymal hamartoma is a hamartomatous growth of mesenchymal tissue in the liver of uncertain etiology. It is a space-occupying lesion that can potentially compress adjacent organs resulting in various complications including death. Hepatic mesenchymal hamartoma is characterized by proliferation of variably myxomatous mesenchyme and malformed bile ducts. The differential diagnosis includes other pediatric hepatic masses. The diagnosis is typically made during infancy, and complete resection is invariably curative.

Bile Ducts↗
PubMedDate not supplied

[Usefulness and limits of a fetal biophysical profile in the management of pregnancy at risk].

Usefulness and limits of fetal biophysical profile (BPP) were determined in 132 high-risk pregnancies, evaluating the relationship between the last biophysical profile result and perinatal outcome. The presence of a low incidence of perinatal complications when BPP is normal permits the conservative management of these pregnancies. When the score is abnormal instead, there is also high false positive rate that may determine an unnecessary intervention with associated perinatal morbidity. On the other hand, BPP seems to become abnormal relatively late in the chronic asphyxial process, when it may be impossible to prevent mortality or a serious perinatal morbidity: its association with other tests is therefore necessary for a better evaluation of fetal risk.

Female↗
PubMed2006

[Perinatal results of the patients assessed by fetal hypomotility].

OBJECTIVE: To describe the perinatal outcome of those patients that come to emergency room because of diminished fetal movements. PATIENTS AND METHOD: This is a case series in which we evaluated the patients who were attended at the Maternal Fetal Medicine Department from January 2002 to December 2003. All patients with prenatal control in the institution whatever the basic pathology were enrolled in the study. They were evaluated following the institution protocol. All data was obtained from maternal and neonatal files. RESULTS: A total of 240 patients with mean age of 27 +/- 7 (SD) years were evaluated in the study. Ninety of them (37%) were primiparous, 66 (27%) secundiparous, and 44 (18%) coursed the third pregnancy. Mean gestational age when they were evaluated for diminished fetal movements was 37.1 +/- 2.5 (SD) weeks. After the evaluation, 195 (81%) patients resulted with a reactive non-stress test, 42 (17%) had a non-reactive stress test with a positive vibroacoustic stimulation test, no patients were found with a non-reactive non-stress test and a negative vibroacoustic stimulation test. In two patients (< 1%) the register showed ominous pattern. In these two preterm cases pregnancy was interrupted. Mean gestational age at birth was 39.1 (+/- 1.7) weeks, and 223 (92.91%) born at term. From the two intervened cases, one had intrauterine growth restriction and the other asphyxia with intraventricular hemorrhage as a consequence. CONCLUSIONS: Hypomotility is one manifestation of the loss of fetal well-being and cannot be ignored because there are some cases in which intervention is needed. A great number of patients without a real risk of asphyxia and with a good perinatal outcome must be evaluated, so we have to look for another mechanism of evaluation for these patients. A clinimetric method could be an intermediary step between clinic and electronic surveillance.

Adolescent↗
PubMed1977

Elective delivery of the term fetus. An obstetrical hazard.

Of 1,020 consecutive admissions to a regional neonatal center, 38 infants were admitted following elective delivery in which no medical condition of the mother or fetus had necessitated immediate delivery. Twenty infants had problems that were not primarily the result of elective delivery, developed in 18. Fifteen of these 18 infants were delivered by cesarean section; in none of the mothers had any assessment of fetal maturity or size (other than the menstrual history and physical examination) been made. The infants remained in the hospital for an average of 12.7 days at a median cost of $2,678 per patient. One infant died. In the absence of pressing medical indications and without an objective assessment of fetal maturity, elective delivery remains potentially hazardous.

Adult↗
PubMed1983

[Pregnancy].

Explore the source record for details and available documents.

Abnormalities, Drug-Induced↗
PubMed1981

Fetal heart rate decelerations during a nonstress test.

In a review of 2000 nonstress tests (NSTs) on 972 pregnant women at high risk at the authors' institution, 94 exhibited fetal heart rate (FHR) decelerations in response to fetal activity in 110 (46.6%) of the 236 NSTs. The NST results were interpreted as either reactive (178) or nonreactive (58). Of those cases with an FHR deceleration pattern, an abnormal cord position was observed in 55.3% (X2 = 68; P less than .001). Of the 74 patients who went into labor, 59.5% demonstrated variable FHR decelerations. Moreover, 8.5% required cesarean section for fetal distress. Of greater importance, 3 intrauterine fetal deaths occurred that appeared to be related to the abnormal cord position. FHR decelerations may occur during reactive as well as nonreactive NSTs. When FHR decelerations are present, they may signify some form of abnormal cord position and require further evaluation by ultrasonography and a contraction stress test.

Adult↗
PubMed1993

[Evaluation of neonatal prognosis using Doppler velocimeter in cases of a high risk fetus].

The authors describe the main characteristics of the Doppler method in the early diagnosis of chronic fetal distress, and report their personal results in the study of 51 high risk pregnancies. In their study the fetal doppler ultrasound findings were correlated with birth weight related to gestational age, and neonatal morbidity. The parameters established from the doppler ultrasound assessment were the placenta resistance (calculated from the formula of Pourcelot: R = S-D/S applied to the umbilical artery) and the cerebro-placental index, Rp/Rc, Rc being the index of cerebral arterial resistance. The diagnosis performance of the method appeared very good: the Rp index was found to be highly specific for hypotrophy (85,7%) and for neonatal morbidity (90%), the RCP index adding its own good sensitivity (85% for hypotrophy and 83,3% for neonatal morbidity). The authors conclude upon the interest to study simultaneously the fetal umbilical and cerebral arterial circulations. The pathological significance of the two indexes appears different so that they are to be complementary in the evaluation of fetal distress.

Female↗