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PubMed1995

Uterine artery Doppler velocimetry in the detection of adverse obstetric outcomes in women with unexplained elevated maternal serum alpha-fetoprotein levels.

OBJECTIVE: We hypothesized that in pregnancies complicated by unexplained elevations of maternal serum alpha-fetoprotein, second-trimester uterine artery Doppler findings would detect adverse obstetric outcomes. STUDY DESIGN: One hundred three subjects with unexplained elevations of maternal serum alpha-fetoprotein had uterine artery Doppler velocimetry studies performed at the time of targeted ultrasonographic examination (17 to 22 weeks). A resistance index > 95th percentile or the presence of a uterine notch was considered abnormal. Adverse outcomes included preeclampsia, preterm birth, low birth weight, intrauterine growth restriction, abruptio placentae, and fetal death. Statistical analysis was performed by Student t test, chi 2 analysis, and stepwise logistic regression analysis. RESULTS: An elevated uterine resistance index was associated with an increased relative risk for both preeclampsia (relative risk 41.82, 95% confidence interval 5.36 to 326.13) and low birth weight (relative risk 4.65, 95% confidence interval 1.90 to 11.39). A uterine artery notch was associated with an increased risk of preeclampsia (relative risk 52.22, 95% confidence interval 6.82 to 399.70), preterm birth (relative risk 3.21, 95% confidence interval 1.32 to 7.81), and low birth weight (relative risk 4.18, 95% confidence interval 1.64 to 10.66). When the presence of a uterine notch, vaginal bleeding, and level of maternal serum AFP were analyzed by stepwise logistic regression, the presence of a notch was found to be the only significant factor (odds ratio 6.95, 95% confidence interval 1.24 to 39.10) for the development of an adverse outcome. CONCLUSIONS: Abnormal uterine artery Doppler findings are associated with an increased frequency of adverse obstetric outcomes in women with unexplained elevated maternal serum AFP levels. Abnormal Doppler findings demonstrated high sensitivity for the development of preeclampsia but were less sensitive in predicting other outcomes. The presence of a uterine artery notch is a better independent predictor of adverse outcome than are early vaginal bleeding or maternal serum AFP level.

Adult↗

PubMed1995

Multiple nuchal cord entanglements and intrapartum complications.

OBJECTIVE: Our purpose was to evaluate the outcomes of pregnancies complicated by a multiple (double, triple, or quadruple) nuchal cord entanglement. STUDY DESIGN: Computerized data from our University Hospital perinatal database were reviewed between 1990 and 1994. Only singleton, vertex, and term pregnancies undergoing labor were analyzed. Patients with active perinatal complications were eliminated to reduce bias. Pregnancies with infants with either a single or no nuchal cord entanglement served as comparison groups. A comparison of frequencies in the three groups was by chi 2 testing and a comparison of means by a two-tailed Student t test and analysis of variance. RESULTS: Of the 8565 deliveries, the frequency of two or more cord entanglements at delivery was 3.8%. Compared with a single or no cord entanglement, pregnancies with a multiple entanglement were more likely to exhibit an abnormal fetal heart rate pattern during advanced labor (p < 0.001) and to require low or midforceps application (p < 0.001). The study infants were also more likely to have meconium (p = 0.013), a low 1-minute Apgar score (p < 0.001), and an umbilical artery pH < or = 7.10 (odds ratio 2.2, p = 0.013) than the controls. Rates of abruptio placentae, cesarean delivery, and 5-minute Apgar scores < 7 were no more common in the multiple entanglement than the control groups. CONCLUSION: A multiple nuchal cord entanglement was associated with a greater risk of meconium, an abnormal fetal heart rate pattern during advanced labor, the need for operative vaginal delivery, and mild umbilical artery acidosis at birth; however, there was no added risk of an adverse neonatal outcome.

Acidosis, Respiratory↗

PubMed1992

The challenge of grandmultiparity in Nigerian obstetric practice.

A retrospective analysis of 733 Nigerian grandmultiparae seen at the University of Nigeria Teaching Hospital (UNTH) over a 3 year period was carried out. A high incidence of grandmultiparity (11%) was noted, and most of them (62%) belonged to the lower socioeconomic class. Anemia, hypertensive diseases, abruptio placentae, breech presentation and abnormal lie were significant complications of grandmultiparity. The incidence of multiple pregnancy, low birthweight babies, cesarean deliveries and perinatal deaths were markedly increased in the grandmultipara. Improvement in socioeconomic conditions of the populace, health education and widespread practice of family planning are suggested to reduce the incidence of grandmultiparity.

Adult↗

PubMed1995

Low-dose vaginal misoprostol for induction of labor with a live fetus.

OBJECTIVE: To test the effectiveness and safety of low-dose vaginal misoprostol for induction of labor with a live fetus. METHODS: Labor was induced in 666 pregnant women with a live fetus in the cephalic position, who had no medical complications and no history of uterine surgery. One-fourth of a 200-micrograms tablet of misoprostol (50 micrograms) was placed in the posterior vaginal fornix every 12 h for a maximum of four doses or until active labor commenced. Time from induction to delivery, side effects and neonatal outcome were evaluated. RESULTS: Labor was successfully induced in all cases. The mean time from induction to delivery was 10.4 h. The cesarean section rate was 7.8%. There were eight perinatal deaths, six of which occurred in low birth weight fetuses. There was one case of abruptio placenta, which was less than that expected in the study population. CONCLUSION: Vaginal misoprostol, in very low doses, was a remarkably efficient and safe method for induction of labor with a live fetus.

Administration, Intravaginal↗

PubMed1986

The impact of prenatal care on the outcome of pregnancy.

In a 12-months' prospective project all women delivering at the Soroka Medical Center, Beer-Sheba, Israel, were studied with regard to the type of prenatal care (P.C.) and the outcome of pregnancy. The Soroka Medical Center is the sole medical facility providing obstetric and neonatal services to the 300,000 inhabitants of the region. Prenatal care is delivered by a uniform network of 70 community-based stations. The availability, type and quality of services were uniform for all women and were not altered throughout the study period. The project encompassed 7308 deliveries. 2154 Bedouin women were excluded in order to avoid possible bias due to cultural and genetic characteristics. Data regarding 5154 Jewish women were analysed. Perinatal mortality was inversely proportional to the number of prenatal contacts. The uncorrected mortality rates were 12.7% in women entirely lacking P.C. and 6.2%, 1.9% and 1.0% in patients who had 1-6, 7-10 and 11 or more prenatal contacts respectively. The low-birthweight rate was significantly increased in women lacking prenatal care (22.8%) or having rudimentary care (17.4%) as compared to those who had 11 or more prenatal contacts with medical personnel (5.9%). Prenatal care reduced neonatal morbidity as expressed by the length of hospitalization, the frequency of infants with multiple diagnoses and the incidence of specific pathologies such as respiratory distress syndrome, light for dates and asphyxia. The incidence of some complications of pregnancy (abruptio placentae, premature labor, PROM) was significantly increased in women lacking P.C. or having inadequate P.C. (1-6 prenatal contacts). Moreover, lack of prenatal care was clearly connected with high-risk delivery, thus increasing the danger to the baby. It is suggested that many adverse effects of various socio-economic, genetic and general health factors may be diminished by proper prenatal care coupled with adequate obstetric and neonatal services.

Adult↗

PubMed1994

Intra-partum fetal death due to thrombosis of the ductus venosus: a clinicopathological case report.

Thrombosis of the umbilical cord vessels is a rare but life-threatening event, usually leading to the death of the fetus. This report presents a case of an intra-partum fetal death due to thrombosis of the ductus venosus, hitherto not described in the literature. Labour was induced with intravenous oxytocin in a 21-year-old nulliparous woman because of postmaturity at 43 weeks gestation. Abrupt fetal bradycardia developed at 5 cm dilatation and fetal demise occurred within minutes without any sign of abruptio placentae or uterine hyperactivity. A cesarean section was performed because of failure to deliver the macrosomic fetus by vacuum extraction. On autopsy a fresh occlusive thrombus was found at the beginning of the ductus venous in the portal sinus. Maternal and fetal risk factors known to be associated with umbilical cord thrombus formation were excluded. Repeated assessment of Bishop scores is thought to have caused local infection of the membranes at the internal cervical os, resulting in general amnionitis and vasculitis of the umbilical cord. Secondary to the infection thrombus formation took place either primarily in the portal sinus and ductus venosus or in the umbilical vein with subsequent detachment and embolisation into the portal sinus, therewith occluding the ductus venosus leading to fetal death.

Adult↗

PubMed1995

The value of urine screening for glucose at each prenatal visit.

OBJECTIVE: To determine whether chemical (dipstick) urinalysis for glucose at each prenatal visit predicts gestational outcomes such as gestational diabetes, abruptio placentae, preterm delivery, fetal heart rate abnormality, cesarean delivery for dystocia, fetal macrosomia, and shoulder dystocia. METHODS: We retrospectively evaluated each of the 3217 women who were delivered at St. Joseph's Hospital between July 1, 1990, and September 1, 1993, and who had received all prenatal care at Marshfield Clinic. Study subjects had complete urinalyses at the first prenatal visit, blood glucose diabetes screening at 24-28 weeks, and dipstick urinalysis for glucose at each prenatal visit. Women were excluded because of preexisting diabetes, multiple gestation, glucosuria at the first prenatal visit, or failure to complete the recommended blood screening at 24-28 weeks. The remaining 2965 women were grouped according to whether their dipstick urine tests were positive for glucose. Then the two groups were compared with regard to relevant pregnancy outcomes. RESULTS: Women with glucosuria in the first two trimesters had a significantly higher incidence of gestational diabetes (12.8 versus 2.9%, P = .003). For women without evidence of gestational diabetes, there were no clinically important differences in the measured pregnancy outcomes between the two groups. CONCLUSION: Routine dipstick urinalysis for glucose can identify gravidas at increased risk for gestational diabetes, possibly allowing certain women with gestational diabetes to be diagnosed earlier than 24-28 weeks. However, most glucosuria testing is performed after a patient has completed routine blood screening for gestational diabetes. This third-trimester testing is not predictive of any clinically important pregnancy outcome.

Diabetes, Gestational↗

PubMed1995

Maternal and perinatal outcome of patients with preterm labor and meconium-stained amniotic fluid.

OBJECTIVE: To determine the clinical significance of meconium-stained amniotic fluid (AF) observed at amniocentesis in patients with preterm labor. METHODS: A nested case-control study was constructed based on the color of AF during amniocentesis. Forty-five women admitted with preterm labor and meconium-stained AF were matched for gestational age at admission and compared with 135 women with preterm labor and clear AF. All AF samples were cultured for aerobic and anaerobic bacteria and mycoplasma. RESULTS: The rates of positive AF cultures for microorganisms, overall preterm birth (before 36 weeks), preterm birth before 32 weeks, and clinical chorioamnionitis were all significantly higher in patients with meconium-stained AF than in those with clear AF (positive AF cultures, 38 versus 11%, P < .001; preterm delivery before 36 weeks, 73 versus 41%, P < .001; preterm delivery before 32 weeks, 51 versus 17%, P < .001; and clinical chorioamnionitis, 22 versus 6%, P = .003). In contrast, no significant differences were observed between groups with respect to maternal age, gravidity, parity, abruptio placentae, placenta previa, fetal distress, cesarean rate, or puerperal morbidity. CONCLUSION: Patients with preterm labor and meconium-stained AF had higher rates of microbial invasion of the amniotic cavity, clinical chorioamnionitis, and premature deliveries than those with clear AF.

Adult↗

PubMed1995

Pooled patient samples as reference material for D-Dimer.

A low-D-Dimer concentration has a high negative predictive value for thromboembolic events. Actual and proposed applications include exclusion diagnosis of DIC, DVT and pulmonary embolism (1-7), follow up of cancer therapy (8) and diagnosis of abruptio placentae(9). A variety of tests are commercially available. Unfortunately, due to differences in standardization protocols, the cut-off normal/pathological of one test can usually not be used for another(10). As was shown by Nieuwenhuizen, one way to at least reduce these discrepancies is to use patient material as a reference(11). We have used this approach to standardize the latex test Tinaquant a D-Dimer against the ELISA test Asserachrom D-Dimer.

Enzyme-Linked Immunosorbent Assay↗

PubMed1995

D-Dimer in intra-uterine growth retardation and gestational hypertension.

Pregnancy is sometime related to thromboembolic complications (1) and alterations in different hemostatic parameters have been reported in pregnancy (2-4). In particular, a progressive increase in fibrinogen and D-dimer levels occurs during normal pregnancy (5-9). D-dimer levels may be predictive for some complications such as preeclampsia (10) and they have been also reported to be useful for diagnosis of abruptio placentae (6). However, it remains to be established if common ELISA for D-dimer are able to discriminate pathologic samples in conditions such as intrauterine growth retardation (IUGR) or gestational hypertension (GH). Aim of the present study has been to evaluate the behavior of D-dimer in pregnant women with IUGR and GH.

Adult↗

PubMed1991

Cocaine abuse during pregnancy: psychiatric considerations.

Cocaine abuse is an increasing problem in the obstetric population. It not only poses a health risk to the pregnant woman, but can precipitate premature labor and abruptio placentae, and has been associated with a number of physical and behavioral problems in the newborn. Evaluation and management of the pregnant cocaine abuser is similar in most respects to that of nonpregnant adults, but diagnosis, psychotherapy, and pharmacotherapy is strongly influenced by the pregnancy. This article describes the risks of cocaine use during pregnancy and outlines the evaluation and management of the pregnant cocaine abuser.

Child Custody↗

PubMed1989

Current status of antifibrinolytic drugs.

Antifibrinolytic drugs, in particular, epsilon-aminocaproic acid and tranexamic acid, have been used in the management of a wide range of both bleeding and non-haemorrhagic disorders. Recognition of their side-effects and complications, comparison of their efficacy with other forms of therapy and more critical evaluation of their value has reduced the range of their definitive indications to a limited number of relatively uncommon situations; these comprise primary hyperplasminaemia, menorrhagia in women in whom oestrogens are contraindicated or in those with von Willebrand's disease, severe traumatic hyphaema, dental extraction in haemophiliacs and hereditary angioedema in patients in whom treatment with anabolic steroids is contraindicated. In a few conditions the possible benefit of antifibrinolytic agents, alone or supplementary to other forms of therapy, is unresolved; these include upper gastrointestinal bleeding, recurrent epistaxis and abruptio placentae.

Antifibrinolytic Agents↗

PubMed1996

Maternal serum CA 125 is of prognostic value in patients with uterine bleeding in the detection of small-for-gestational-age neonates.

OBJECTIVE: The purpose of this study was to investigate whether maternal serum CA 125 determination in women with uterine bleeding has a prognostic value in the detection of women at risk for delivering a small-for-gestational-age neonate. STUDY DESIGN: The patients population consisted of women with uterine bleeding at a gestational age greater than 20 weeks. Patients with abruptio placentae, placenta previa, fetal distress and history of coagulopathy were excluded. Maternal serum CA 125 was measured at admission. Receiver operating characteristics curve analysis and logistic regression were used for statistical purposes. RESULTS: Fifty-nine women were enrolled into the study. Six of these had a small-for-gestational-age neonate, 8 had premature rupture of membranes and 33 delivered preterm. No relationship was found between maternal serum CA 125 concentrations and preterm delivery or PROM. Women who delivered a small-for-gestational-age infant (10.1%) had lower maternal serum CA 125 levels than those who delivered an appropriate-for-gestational-age infant (P < 0.02). Patients with uterine bleeding and serum CA 125 < or = 10 U/ml had a twofold risk to deliver a small-for-gestational-age neonate. Sensitivity, specificity, positive and negative predictive values were 66.6%, 79.2%, 26.6% and 95.4%, respectively. CONCLUSION: Our results show that a decreased maternal serum CA 125 concentration in women with uterine bleeding during the second half of pregnancy is of prognostic value in identifying those who will deliver a small-for-gestational-age infant.

Adult↗

PubMed1990

Cocaine and fetal death.

Toxicologic screening for cocaine and its metabolites was performed on 103 cases of fetal death autopsied in the Office of Chief Medical Examiner, City of New York. In 64 cases cocaine or its metabolites were found in the blood or in the brain. Some malformations were also found. The study indicates that maternal use of cocaine may lead to abruptio placentae, abortion and fetal death. The importance of toxicologic examination in these deaths is emphasized.

Brain Chemistry↗

PubMedDate not supplied

Cocaine use in pregnancy: perinatal morbidity and mortality.

With the increasing use of cocaine in the United States, there has been growing concern regarding its effects on the fetuses and neonates of pregnant cocaine abusers. Fifty-two cocaine-using women enrolled in a comprehensive perinatal addiction program were evaluated and compared with 73 women who had used narcotics in the past and were maintained on methadone during pregnancy. The groups were similar in maternal age, socioeconomic status, number of pregnancies and cigarette, marijuana and alcohol use. The cocaine-using women had a significantly higher rate of premature labor, precipitous labor, abruptio placentae, fetal monitor abnormality and fetal meconium staining than the women in the methadone group. Neonatal gestational age, birth weight, length and head circumference were not affected by cocaine use compared to methadone use. However, the Brazelton Neonatal Behavioral Assessment Scale revealed that infants exposed to cocaine had significant depression of organizational response to environmental stimuli (state organization) when compared to methadone-exposed infants. In another aspect of the study, an increased rate of SIDS (15%) was found for 66 cocaine-exposed infants as compared to a 4% rate of SIDS in 50 methadone-exposed infants.

Adult↗

PubMedDate not supplied

Dose-dependent consequences of cocaine on pregnancy outcome in the Long-Evans rat.

The number of obstetric patients abusing cocaine has increased dramatically in recent years. To better understand its effect on pregnancy and to establish the LD50s for maternal and fetal fatalities, the dose-dependent effects of cocaine on pregnancy outcome were investigated in the Long-Evans rat. Pregnant animals were given either saline or 40, 50, 60, 70, 80, or 90 mg/kg cocaine hydrochloride from gestation days 7 to 19 inclusive. An additional group was non-treated and had ad lib access to food and water. Animals were sacrificed on gestation day 20 and the fetuses were examined. Despite treatment during the major periods of organogenesis and brain development, few congenital abnormalities were observed. There were, however, dose-dependent effects on maternal weight gain, maternal food and water consumption, fetal weight, maternal and fetal fatalities, fetal edema, abruptio placentae and cephalic hemorrhages. Despite suppression of maternal weight gain, there was preservation of fetal weights at cocaine doses up to and including 80 mg/kg/day, suggesting some protection of fetal growth. In addition to providing information on the gestational effects of cocaine in the rat, the present study provides information useful in guiding the selection of cocaine doses for subsequent behavioral teratology studies.

Abnormalities, Drug-Induced↗

PubMed2006

Pregnancy after biventricular repair for pulmonary atresia with ventricular septal defect.

Information on pregnancy and delivery in women with biventricular repair for isolated noncomplex pulmonary atresia with a ventricular septal defect (PAVSD) is limited. Using a nationwide congenital heart disease registry (CONgenital CORvitia [CONCOR]), 9 women with biventricular repair for PAVSD (aged 21 to 38 years) were identified. Ten pregnancies were observed in 5 different women with PAVSD, including 3 spontaneous miscarriages. Clinically significant (non)cardiac complications were documented in 3 of 7 completed pregnancies. These complications were: (1) atrioventricular reentry tachycardia with symptomatic right-sided heart failure; (2) eclampsia with hemolysis, elevated liver enzymes, and low platelets syndrome further complicated by abruptio placentae leading to premature delivery of a small-for-gestational-age child; and (3) premature delivery due to cervical insufficiency with antepartum demise of an immature child. Furthermore, none of the women reported infertility. Moreover, none of the women reported irregularities of their natural menstrual cycle (age at menarche 13 years; cycle duration 28 days), with the exception of delayed menarche (>16 years) in 2 patients. In conclusion, successful pregnancy in patients with biventricular repair of PAVSD is possible, although often complicated by serious clinically significant events. Infertility and menstrual cycle disorders do not appear to be more prevalent, except for a high incidence of primary amenorrhea.

Adult↗

PubMed2005

Early antiplatelet and antithrombotic therapy in patients with a history of recurrent miscarriages of known and unknown aetiology.

OBJECTIVES: To assess the efficacy of early thromboprophylaxis throughout pregnancy in women with previous history of first trimester recurrent miscarriages of unknown aetiology. METHODS: Low dose aspirin and low molecular weight heparin (LMWH) were administered from the day of detection of the fetal heart up to the 37th week, in two groups of patients of known (Group A, n = 24) and unknown aetiology recurrent miscarriages (Group B, n = 27). RESULTS: The success rate (viable pregnancy >24 weeks) was high and equally effective in both Groups A and B (83.3% and 85.1%, respectively). The complications recorded (pre-eclampsia, IUGR, placenta abruptio, injection site heamatomas and skin reactions) were more prevalent in Group A but of no significant difference. No abnormal bleeding was observed during vaginal delivery or caesarean section. CONCLUSIONS: Our results reaffirm previous reports that the use of LMWH in combination with low dose aspirin throughout pregnancy is safe and effective. It was also shown that the treatment is equally effective against recurrent miscarriages in both groups of patients, of known and unknown aetiology.

Abortion, Habitual↗