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PubMed2003

Fetal bilateral renal agenesis, phocomelia, and single umbilical artery associated with cocaine abuse in early pregnancy.

BACKGROUND: Maternal cocaine abuse in pregnancy is associated with complications such as intrauterine growth retardation, abruptio placentae, and preterm delivery. CASE: We report what is, to our knowledge, the first published observation of fetal bilateral renal agenesis associated with a vascular disruption syndrome comprising upper limb reduction defect and a single umbilical artery following maternal cocaine abuse in early pregnancy. CONCLUSIONS: This constellation in a fetus aborted at 18 weeks extends the spectrum of complications possibly associated with cocaine abuse in pregnancy.

Abnormalities, Multiple↗

PubMed2001

Second-trimester maternal serum alpha-fetoprotein (MSAFP) is elevated in women with adverse pregnancy outcome associated with inherited thrombophilias.

Obstetric complications, such as severe pre-eclampsia, fetal growth restriction, abruptio placentae, or stillbirth are associated with abnormally elevated second-trimester maternal serum alpha-fetoprotein (MSAFP) and beta subunit of human chorionic gonadotrophin (betahCG). This has been attributed to placental abnormalities. Women with thrombophilias have been shown to have abnormalities of the placenta resulting in adverse pregnancy outcome in these patients. The purpose of the present study was to evaluate whether women with pregnancy complications and inherited thrombophilias have abnormally elevated second-trimester MSAFP or betahCG. Sixty-two women with pregnancy complications were tested for inherited thrombophilias several months after delivery. The thrombophilia group included 29 women with pregnancy complications and an inherited thrombophilia and the control group included 33 other patients without thrombophilia. Patients in the thrombophilia group had a higher median MoM MSAFP compared to the controls (1.337 vs. 1.086, p=0.0516). The incidence of abnormally elevated MSAFP (>2.5 MoM) was also significantly higher in the thrombophilia group compared to controls (21% vs. 3%, p=0.04). Neither the median MoM betahCG nor the incidence of abnormally elevated betahCG were significantly different between the groups. We conclude that second trimester MSAFP, but not betahCG, is abnormally elevated in patients with thrombophilia and obstetric complications.

Adult↗

PubMed1992

Chorionic mosaicism: association with fetal loss but not with adverse perinatal outcome.

Cytogenetic data from the United States NICHD collaborative study of chorionic villus sampling (CVS) were used to evaluate the clinical significance of chorionic mosaicism. The 10,754 patients with normal cytogenetic results were compared with 108 patients (1.0 per cent) with placental mosaicism and 181 patients (1.6 per cent) with pseudo-mosaicism. Of the pregnancies intended to continue, the pregnancy loss rate was significantly greater in patients with placental mosaicism than in the cytogenetically normal cohort (8.6 vs. 3.4 per cent, p less than 0.05). However, there was no difference in the frequencies of abruptio placenta, preterm labour or delivery, small-for-gestational-age newborns, pregnancy-induced hypertension, or neonates with Apgar scores less than 7.

Abortion, Spontaneous↗

PubMed1994

Re-evaluation of the colorimetric assay for cytidine deaminase activity.

This study re-evaluated the colorimetric assay for cytidine deaminase (CTD), and showed that the optimum conditions were pH 7.5, 37 degrees C, and up to 24 h. In addition, this method was found to require protein precipitation. Following these modifications, intra-assay and inter-assay coefficients of variation were below 5 per cent, indicating that the assay was highly reliable. CTD activity was determined in 282 serum samples from 206 normal pregnant women by the incubation of 100 microliters of serum and 400 microliters of 1.4 mmol/l cytidine substrate for 16 h at 37 degrees C. Following protein precipitation, the ammonia liberated during conversion was measured by a colorimetric procedure. The mean (+/- SD) CTD activity was 7.31 +/- 2.50 U at 3-12 weeks of gestation, 8.70 +/- 2.12 U at 13-24 weeks, 7.59 +/- 2.25 U at 25-36 weeks, and 7.29 +/- 2.16 U at 37-42 weeks. High levels of CTD activity were found in patients with abruptio placentae and amnionitis associated with intrauterine fetal death (IUFD). The increase in CTD activity was noted from 3 days to 1 week before the confirmation of IUFD. The placenta contains extremely high levels of CTD, but cord serum does not. Thus, the excessive elevation of CTD activity was probably derived from progressive placental damage. This modified CTD assay was concluded to be simple and reliable, and may perhaps be useful in detecting pregnancy disorders.

Colorimetry↗

PubMed1995

Normal fetal growth in women with antiphospholipid syndrome treated with high-dose intravenous immunoglobulin (IVIG).

Antiphospholipid antibodies are associated with fetal distress and fetal death. Although different therapeutic regimens have been used, the incidence of fetal growth retardation varies between 30 and 60 per cent of reported cases. We report the evolution of fetal growth in patients with antiphospholipid antibody syndrome treated with high-dose intravenous immunoglobulins (IVIG). Fourteen patients with a history of recurrent spontaneous abortion and immunological diagnosis of antiphospholipid syndrome were followed longitudinally. Intravenous immunoglobulin at a dose of 0.5 g/kg body weight for two consecutive days was started from the fifth week of pregnancy and repeated every 4 weeks until the 33rd week of gestation. Fetal biometry was evaluated longitudinally from the appearance of the gestational sac at 4 weekly intervals. In the period between 26 and 34 weeks, the frequency of evaluation was increased to every 14 days. Data obtained were compared with a control group of 70 fetuses with uneventful pregnancies matched for gestational age. Neonatal weight is shown in relation to the centiles for the normal population. One patient out of 14 (7.1 per cent) developed gestational hypertension and abruptio placentae. No other pregnancy complications were seen. No proteinuria was found. The mean maternal age was 31.2 +/- 3.8 years. Median birth weight was 3433 g +/- 287. The median centile of the birth weight was 65.3 +/- 18.6. Mean gestational age at delivery was 1.3 weeks. No fetal or neonatal growth retardation was seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Habitual↗

PubMed1992

Cardiovascular complications of cocaine abuse.

Cardiovascular complications are among the most common and dangerous complications of cocaine abuse, ranging from episodic arrhythmias to myocardial infarction, strokes, cardiomyopathy, and sudden death. The central nervous system-mediated action of cocaine triggers an increase in circulating catecholamines, resulting in arterial vasoconstriction, increase in myocardial oxygen demand, myocardial ischemia, tachycardia, and other arrhythmias. The peripheral cardiovascular action of cocaine involves the inhibition of reuptake of catecholamines at adrenergic nerve terminals, with local release of epinephrine, direct stimulation and vasospasm of the coronary arteries, coronary intimal hyperplasia, inhibition of baroreceptors, interference with the electrical conduction through the myocardium, and direct myocardial toxicity. The cardiovascular complications of cocaine include cardiac dysrhythmias and hypertension, acute myocardial infarction, myocarditis, infectious endocarditis, ventricular dysfunction, dilated cardiomyopathy, hypotensive shock, and cerebral strokes. Cocaine-related vascular changes in the pregnant woman and fetus have been related to an increased incidence of abortion, abruptio placentae, and congenital anomalies of the fetus.

Cardiovascular Diseases↗

PubMed1984

3D Display of stillbirth in Indonesian obstetrics part 3: antenatal visits as preventive determinant.

Expansion of previous analytical work with MCM data in Indonesia focuses on antenatal visits (AV). AV is introduced as a systematic co-control of the risk of SB with either registration status, maternal morbidity, complication of labor/delivery or birth weight. 20 out of 22 control categories reveal risk profiles dependent on antenatal visits, the two exceptions being placenta abruptio and very low birth weight (less than 1500g). A systematic confrontation of relative risks obtained across antenatal visits with relative risks obtained within the four co-control variables highlights AV as being an important preventive determinant of late fetal death. In a second step, a clinical baseline of "NOCARE" shows a very strong association with education and a weak association with family planning within controlled education categories. A v-shaped pattern across maternal age is also noted. Two hypotheses are derived. Since FP precedes AV, the next analytical focus is on FP (CONUSE). If co-controlled with the five control factors used so far, the QUINTET will lead to a "closed six-variable control system" (SEXTET) of the risk of stillbirth.

Female↗

PubMed1996

Retrorectal tumors complicating pregnancy. Report of two cases.

PURPOSE: Retrorectal tumors are rare entities often found in females during reproductive age. Reports of retrorectal tumors complicating pregnancy are scant. This study presents two cases of retrorectal tumors complicating pregnancy and a literature review. METHODS: Two patients bearing retrorectal tumors diagnosed during pregnancy were referred to our care at the postpartum period. Both then underwent exploratory laparotomy. RESULTS: One patient had premature delivery by cesarean section because of hemorrhage from abruptio placentae followed by fetal mortality. Attempts to resect the tumor immediately after delivery had been unfruitful. The tumor was also unresectable on exploratory laparotomy. Biopsy studies of the tumor were consistent with low-grade myosarcoma. Another patient had a benign cystic mass that had been conservatively monitored throughout pregnancy. A healthy baby was delivered at term by cesarean section. The cyst was later resected via Kraske's incision and was diagnosed as cystic teratoma. CONCLUSIONS: Retrorectal tumors may cause significant local effects such as complicated pregnancy. Early detection in the population at risk is needed, as correct diagnosis and treatment may be done only on surgical exploration. During pregnancy, careful monitoring of advanced tumors is mandatory and may be sufficient to prevent maternal and fetal complications.

Adult↗

PubMed1994

[Liver pathology within the scope of HELLP syndrome].

Liver pathology is one of the main features of HELLP syndrome and develops on the basis of a generalised activation of intravascular coagulation. Fibrin deposits and haemorrhagic necrosis predominantly develop in the periportal areas and may eventually lead to subcapsular haematomas or even rupture of the liver. While the compensated form of activation of intravascular coagulation, which is diagnosed by a decrease in antithrombin III and an increase in thrombin-antithrombin III complex (TAT) and the appearance of fibrin, monomers and D-dimers, is found in almost all cases of HELLP syndrome, the decompensated form of intravascular coagulation with prolonged bleeding time (PT, PTT) and drop in fibrinogen is found only in the most severe forms. The development of a decompensation of coagulation correlates with the appearance of severe complications such as liver haematoma, abruptio placentae, renal failure and pulmonary oedema. The best prophylaxis against the development of life-threatening complications is early diagnosis and termination of pregnancy after stabilisation of the maternal condition, consisting of magnesium sulphate infusion, antihypertensive treatment with dihydralazine or calcium antagonists, steroids etc. Severe complications of HELLP syndrome have occasionally been observed in the postpartum period. As prophylaxis against postpartal worsening of HELLP syndrome, curettage of the uterus and continuation of the treatment with calcium antagonists and dexamethasone have been recommended.

Biopsy↗

PubMedDate not supplied

Obstetric outcomes of adolescent pregnancies in Turkey.

Pregnancy in adolescence has been and continues to be a problem in public health. The purpose of this study was to investigate obstetric outcomes of adolescent pregnancies in Samsun, Turkey. A cross-sectional study was conducted between January 1 and December 31, 2004, at 3 hospitals in Samsun, Turkey. Of the 10,100 women who gave birth during this period, 357 (3.5%) were 18 years of age or younger; these patients were included in the study. Participants with a history of any chronic disease were excluded. Data were provided as median values (min- max) and percentages. In this study, the rate of birth for females 18 years or younger was found to be 35 per 1000. The median age of participants was 18 (14-18) years. The prevalence of cesarean section was calculated at 55.7%. Prevalences of low-birthweight infants, preterm delivery, and eclampsia/preeclampsia were recorded as 44 (12.3%), 34 (9.5%), and 30 (8.4%) cases, respectively. Although the stillbirth rate was determined to be 1.7%, no congenital deformity was noted in infants, and none of the mothers died. The cephalopelvic disproportion rate was 5.9%, and only 2 adolescents experienced abruptio placentae. To reduce the occurrence of adolescent childbearing, pregnancy intentions must be assessed in multiple ways. Information/education may provide benefit to those female adolescents with inconsistent pregnancy intentions.

Adolescent↗

PubMedDate not supplied

The offspring of epileptic mother.

The offspring of an epileptic mother is an issue-currently getting attention because of its several implications. A complex interaction between epilepsy during pregnancy and its adverse impact on foetus, labor, neonate, congenital malformation, psychosocial and medico-social concern and treatment challenges of such cases is increasingly being realised. Some of the significant observations has been reviewed extensively in this article. Maternal epilepsy is likely to adversely affect the off-spring at its various stages of development amounting to increased morbidity and mortality. Increased seizure frequency during pregnancy with resultant increased risk is well documented but its mechanism is poorly understood. Low apgar score, increased still birth rates (1.3 to 14%) in offspring of epileptic mother (OEM) is reported. So also, the neonatal and perinatal deaths are twice more common in OEMS than normal control. Small for dates, and prematurity in OEM is reported to be 7 to 10% and 4-11% respectively. Adverse impact on labor and delivery like preclampsia, abruptio placentae, polyhydramnios, assisted delivery, cesarean section and IUGR poses particular challenges to the obstetrician. Pediatrician's alertness is needed to anticipate and deal with the bleeding manifestation due to deficiency of Vit-K dependent clotting factors and various anticonvulsant drug (AED) withdrawal symptoms. Significant risk of developing congenital malformation is the result of epilepsy perse and the AED used during pregnancy. AED exposure leads to other distinct clinical syndromes, the orofacial clefts and cardiac anomalies being the commonest manifestation. Epilepsy in mother but not in father has significant adverse impact. Management strategies in the context of available observation has been discussed.

Abnormalities, Drug-Induced↗

PubMed2002

Circulating biomarkers of oxidative stress in complicated pregnancies.

Increased lipid peroxidation (LPO) and reduced antioxidant activity may contribute to the development of complications in pregnancy. The present study discusses the possibility of LPO and antioxidant activity in both maternal and umbilical cord blood as an indicator of oxygen radical activity. For this aim, pregnancies with hypertension and pre-eclampsia, diabetes mellitus (insulin dependent diabetes mellitus and gestational diabetes mellitus), oligohydramnios and abruptio placentae, as well as a healthy control group, were subjected in the present study. Simultaneous determination of glutathione S-transferase (GST), selenium dependent glutathione peroxidase (Se-GPx), catalase (CAT) activities and thiobarbituric acid reactive-substances (TBARs) levels were carried out in maternal erythrocyte and plasma in the antenatal period (in the third trimester) and immediately after the delivery. The same oxidative stress-related parameters were determined in umbilical cord blood as well. Erythrocyte GST activity was significantly increased in insulin-dependent diabetic pregnancy (IDDP) when compared to the control (P<0.05). Erythrocyte Se-GPx activity was found to be significantly increased in hypertensive preeclamptic pregnancy (HPP) (P<0.05) and in IDDP (P<0.05). Alterations in enzyme activities were accompanied by a simultaneous significant increase in the levels of TBARs in plasma samples of HPP (P<0.05), and IDDP (P<0.05). Enzyme activities were found to be significantly lower in cord blood samples than the maternal values, except GST. This enzyme represents about two- to threefold higher activity than those of the maternal activity in uncomplicated and complicated groups. Cord blood erythrocyte and plasma Se-GPx and CAT activities were decreased significantly in the HPP group when compared to the maternal value (P<0.05). Cord blood erythrocyte CAT activity was significantly decreased in the HPP group compared to the control (P<0.05). Cord blood TBARs levels were significantly lower than the before deliveries maternal value in the HPP group (P<0.05). No difference was detected between umbilical cord blood and maternal blood TBARs levels after delivery. The results of the present study suggest that oxidative stress and subsequent lipid peroxidation accompany the complications of hypertension, preeclampsia and diabetes mellitus in pregnancy. Maternal erythrocyte GST activity seems to be a sensitive indicator of oxidative stress in IDDP before delivery. The same enzyme can be used in cord blood as a biomarker of oxidative stress upon a sudden increase in oxygenation during delivery. These multiparameter biomarkers can also be used in monitoring the efficiency of antioxidant supplementation in complicated pregnant women, as has recently been suggested for diabetic and preeclamptic pregnancies.

Adult↗

PubMed2000

The fertility and pregnancy outcomes of the patients who underwent preservative operation followed by adjuvant chemotherapy for malignant ovarian tumors.

The fertility and pregnancy outcomes of the patients were studied, who previously underwent preservative operation for malignant tumors, including those of borderline malignancy, in our ward from 1981 to 1995. For each of the 9 patients, unilateral ovary was preserved, the range of their ages before operation was 10 to 28 years old, and histologically, 7 patients had tumors derived from germ cells, and 2 had those from epithelial cells. As for clinical stages according to the FIGO's criteria, 5, 1, 2 and 1 patients were in stage I, II, III and IV, respectively. The regimens of the combination chemotherapy for patients with germ cell tumors were PVB (cisplatin, vinblastine and bleomycin), PEP (cisplatin, etopside and pepleomycin), PVP (cisplatin, vinblastine and pepleomycin), AVAC (doxorubicin, vincristine, actinomycin-d and cyclophosphamide). Those for the patient with epithelial tumors were CAP (cyclophosphamide, doxorubicin and cisplatin), CP (cyclophosphamide and cisplatin). Eight patients have been doing well, although 1 of them experienced recurrence and died. Amenorrheic periods of 2 to 12 months were noticed in 3 patients, although in all of them, ovulatory cycles recovered. Eight pregnancies were reported: 5 term delivery with normal babies, and others were preterm termination due to abruptio placenta with a baby of appropriate for date, spontaneous abortion, and artificial termination. We suppose that the combination chemotherapy applied for the patients in the present study affected neither the fertility of the patients nor the outcomes of the pregnancies.

Adolescent↗

PubMed2000

Disseminated intravascular coagulopathy in pregnancy: thorough comprehension of etiology and management reduces obstetricians' stress.

In pregnancy and puerperium disseminated intravascular coagulopathy may accompany abruptio placenta, intrauterine fetal demise with retained dead fetus, amniotic fluid embolism, endotoxin sepsis, preecalampsia with HELLP and massive transfusion. Clinical signs and symptoms of DIC can include oozing from venipuncture sites and/or mucous membranes, red cell lysis from activation of the complement system, hemorrhage from coagulopathy and possible uterine atony, hypotension from hemorrhage and/or bradykinin release, and oliguria from end-organ insult and hypovolemia/hypotension. Treatment of DIC consists of replacement of volume, blood products, and coagulation components and cardiovascular and respiratory support with elimination of underlying triggering mechanism.

Disseminated Intravascular Coagulation↗

PubMed2002

Congenital mesoblastic nephroma associated with polyhydramnios and hypercalcemia.

Congenital mesoblastic nephroma (CMN) can present with atypical clinical and imaging findings. A premature male neonate was born to an 18-year-old woman after 33 weeks' gestation, which was complicated by polyhydramnios and placenta abruptio. A right abdominal mass was diagnosed antenatally. From the 1st day of life, the newborn had hypercalcemia with initially normal parathormone levels and polyuria for the first hours of life and normal urine output afterwards. Ultrasonographic study and magnetic resonance imaging of the abdomen showed at the upper pole of the right kidney a heterogeneous, solid, poorly defined mass, partially surrounded by a subcapsular fluid collection mimicking malignant rhabdoid tumor of the kidney. Surgical resection revealed a CMN of mixed, classic, and in areas, cellular type. One year after the resection, the patient is asymptomatic and normocalcemic. In conclusion, CMN may present with atypical clinical and imaging findings, necessitating an extensive work-up in order to exclude highly malignant renal tumors of the neonatal period.

Adolescent↗

PubMed1979

Outcome of normal and dysfunctional labor in different racial groups.

Spontaneous labor in patients of different racial groups has been studied relating progress and outcome to whether labor was dysfunctional as defined by the partogram and action line. Forty-three percent of primigravidas and 17.6 to 25.8% of multigravidas passed the action line and had a lower admission cervical dilatation and a longer observed first stage than those patients whose labor progress remained to the left of the action line. White and black primigravidas whose labor progressed to the right of the action line had lower 1 and 5 minute Apgar scores and delivered heavier babies than those to the left. The cesarean section rates were 1.6% and 1.4% (left) and 7.6% and 18.2% (right) in white and black primigravidas, respectively. The cesarean section rate was significantly higher in black primigravidas irrespective of the relationship to the action line due to the high incidence of the complications of hypertension such as fetal distress and abruptio placentae in those in normal labor as well as those in dysfunctional labor due to cephalopelvic disproportion in those patients whose cervimetric progress went to the right of the action line.

Age Factors↗

PubMed1982

Clinical implications from monitoring fetal activity.

The monitoring of fetal motion in high-risk pregnancies has been shown to be worthwhile in predicting fetal distress and impending fetal death. The maternal recording of perceived fetal activity is an inexpensive surveillance technique which is most useful when there is chronic uteroplacental insufficiency or when a stillbirth may be expected. The presence of an active, vigorous fetus is reassuring, but documented fetal inactivity required a reassessment of the underlying antepartum complication and further fetal evaluation with real-time ultrasonography, fetal heart rate testing, and biochemical testing. Fetal distress from such acute changes as abruptio placentae or umbilical cord compression may not be predicted by monitoring fetal motion. Although not used for routine clinical investigation, electromechanical devices such as tocodynamometry have provided much insight into fetal behavioral patterns at many stages of pregnancy and in pregnancies with an antepartum complication.

Circadian Rhythm↗

PubMed1983

The relationship between induced abortion and outcome of subsequent pregnancies.

We analyzed interview and record review data from 9,823 deliveries to evaluate the relationship between prior history of induced abortion and subsequent late pregnancy outcomes. Complications such as bleeding in the first and third trimesters, abnormal presentations and premature rupture of the membranes, abruptio placentae, fetal distress, low birth weight, short gestation, and major malformations occurred more often among women with a history of two or more induced abortions. A logistic regression analysis to control for multiple confounding factors showed that a history of one induced abortion was statistically significantly associated with first-trimester bleeding but with no other untoward pregnancy events, and a history of two or more induced abortions was statistically associated with first-trimester bleeding, abnormal presentations, and premature rupture of the membranes. While these relationships merit further research, the results of this study are largely reassuring. A history of one or more prior induced abortions does not appear to increase substantially the risk of adverse late outcomes of subsequent pregnancies.

Abortion, Induced↗