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PubMedDate not supplied

Intrauterine fetal death: mediconursing and psychosocial considerations for the childbearing patient.

The purpose of this article is to provide the perinatal nurse with a current review of the pregnancy complication, intrauterine fetal death. The causes, associated complications, and mediconursing management of this pregnancy complication are reviewed. Additionally, by use of the Snyder childbearing trajectory model, the psychosocial effects of intrauterine fetal death are discussed. The presentation of the Snyder model is intended to provide the nurse with a conceptual framework through which psychosocial nursing interventions can be derived.

Disseminated Intravascular Coagulation↗
PubMedDate not supplied

[Cerebrovascular diseases in pregnancy and puerperium].

The incidence, prognosis and causes of strokes associated with pregnancy or puerperium are poorly known, and we do not know whether and to what extent they differ from those of the general female population of childbearing age. Based on early and mostly hospital-based studies, it has been claimed that pregnancy increases the likelihood of cerebral infarction to about 13 times the rate expected outside of pregnancy. However, because of methodological weaknesses, these estimates must be regarded with caution. In a recent study in Ile de France, the incidence of arterial ischemic strokes associated with pregnancy or early puerperium was 4.3 per 100,000 deliveries (95% confidence interval, 2.4 to 7.1), a rate not much different from that for all women of childbearing age. Ischemic strokes related to various etiologies have been reported in pregnancy and the puerperium. Their relative frequency is poorly known because there are no recent large series of pregnancy-related ischemic strokes benefiting from detailed investigation with modern imaging techniques. Most of the known causes of ischemic stroke in the young been reported during pregnancy. In most of these conditions, it is uncertain whether pregnancy is coincidental or plays a role in the occurrence of stroke. Among pregnancy-specific causes, eclampsia may be associated with focal neurological deficits of sudden onset, consistent with a clinical diagnosis of stroke. However, the precise pathogenesis of these stroke-like focal deficits remains poorly understood. Except for some women who have persisting neurological deficits and neuroradiological abnormalities suggesting brain infarction, the reversibility of the neurological clinical signs and neuroradiological lesions within a few days or weeks in most cases argues against the existence of true cerebral ischemic necrosis. The two other pregnancy-specific causes-choriocarcinoma and amniotic fluid embolism-are rarely responsible for focal cerebral ischemia. Other diseases such as peripartum cardiomyopathy and postpartum cerebral angiopathy were initially considered as pregnancy-specific causes but subsequently reported outside of pregnancy. In a significant number of patients, the cause of the stroke remains undetermined, despite an extensive etiological workup. Whether hypercoagulable state and vessel wall changes associated with pregnancy may play a role in the occurrence of these otherwise unexplained ischemic strokes remains unknown. Too frequently, the stroke is considered at the first attempt as a complication of pregnancy and another underlying etiology may be missed. Therefore, evaluation of arterial ischemic stroke in pregnancy should proceed as in the non-pregnant state. There are no follow-up studies that consider the risk of recurrent stroke in future pregnancies. No data are available on the risk associated with use of oral contraception in a woman who had ischemic stroke during pregnancy. The frequency of cerebral venous thrombosis associated with pregnancy and the puerperium is not precisely known. Indeed, epidemiologic studies have been difficult to perform because cerebral venous thrombosis may have a misleading presentation and a definite diagnosis requires angiography, MRI or autopsy. The incidence of cerebral venous thrombosis has been estimated at 10 to 20 per 100000 deliveries in occidental countries, whereas rates of 200 to 500 per 100,000 deliveries have been reported in India. The pregnant and puerperal state accounts for 5 to 20% of all cerebral venous thrombosis in occidental countries; this proportion may reach 60% in developing countries. Labor and delivery are characteristically normal in occidental countries. The occurrence of cerebral venous thrombosis is clearly linked to the puerperial state, suggesting a direct role of the puerperial state.(ABSTRACT TRUNCATED)

Cerebrovascular Disorders↗
PubMed1981

[Clinical pathological analysis of peripartum maternal mortality (author's transl)].

All maternal deaths which occurred in relation to labour at the Department of Obstetrics and Gynaecology, University Hospital, Graz, between 1963 and 1978 were reviewed and analysed. 24 mothers died over this 15-year period. The maternal death rate was 0.34 per thousand. In all cases a post mortem examination was performed. The youngest woman was 19, the oldest 42 years old. Most of the decreased mothers were primiparae. The main cause of maternal death was post-partum haemorrhage, followed by infection of the uterus especially after Caesarean section. Three mothers died of liver distrophy. The remaining causes were eclampsia (2 cases); pulmonary artery embolism after Caesarean section (2 cases); irreversible shock from amniotic fluid and air embolism (one case each); uraemia due to glomerulo- or pyelonephritis (one case each); malignant melanoma (one case). It is demonstrated that special risk factors are advanced maternal age, low social status and lack of antenatal care.

Adult↗
PubMed1997

Premature rupture of the amniotic membranes diagnosed by placental bed biopsy.

Biopsies of the maternal placental bed are usually made to investigate abnormalities of the uteroplacental vasculature. A placental bed biopsy was taken from a 36-year-old, gravida 4, para 3 woman. She had delivered normally at 39 weeks of gestation, following spontaneous labor, without clinical signs of premature rupture of the membrane. She was discharged without complications of the delivery. The placental bed biopsy showed histologic signs of amniotic rupture. There were desquamated stratified squamous epithelial cells in edema fluid between muscle fibers, surrounded by intense neutrophilic inflammation. Uterine venules contained fibrin clots with squamous epithelial cells. Some veins had plugs of detached, coiled, and occlusive amniotic thrombi. To our knowledge, histologic evidence of amniotic membrane rupture and amniotic fluid thrombosis with local embolization has not been previously reported in a biopsy of the placental bed.

Adult↗
PubMed2006

[The dynamics of lethal maternal outcome reasons based on the data of the Baku clinical maternity hospital].

This work represents the study of dynamics of maternal lethal outcome reasons (MLO) based on the materials of Baku clinical maternity hospital N5 for the period of 10 years. The purpose of the study is to conduct the expert assessment of the prime documentation of 17 MLO cases. While performing a retrospective analysis of the clinical sources the MLO decline for the last 5 years from 0.11% to 0.05% has been registered. In the structure of MLO reasons the obstetric bleeding takes the first place, followed by sepsis, embolism caused by amniotic fluid and gestosis. Some organizational shortcomings, doctors' and obstetrician-gynaecologists' low qualification, irregular observation of the pregnant in maternity welfare centres in order to timely detect main obstetric pathologies, a low number of post-mortem examinations, which in turn do not enable to draw clinical-anatomical parallels, have been detected. The problem of maternal mortality continues to be of medical and social importance and requires dynamic clinical expertise in order to determine the ways of its reduction.

Adult↗