RESUMEN
OBJECTIVE: To assess the specificity of sonographic diagnosis of vasa previa and pregnancy outcome in sonographically diagnosed cases. METHODS: We prospectively collected cases of vasa previa diagnosed by color Doppler sonography. Delivery by elective Cesarean section after demonstration of fetal pulmonary maturity and prior to the onset of labor was recommended unless obstetric complications supervened. Data regarding maternal obstetric courses and newborn status were collected. RESULTS: Eleven cases of vasa previa without placenta previa were diagnosed among 33 208 women over an 8-year period. Ten patients had confirmation of the diagnosis by the delivering obstetrician and/or placental examination, giving a specificity of diagnosis of 91%. Among the 10 patients with confirmed vasa previa, two were delivered at 31.5 and 35.5 weeks' gestation prior to demonstration of lung maturity, and the remainder were delivered at 34-37.5 weeks, after lung maturity. All infants had normal Apgar scores and survived. One baby had Scimitar syndrome, which was not suspected from sonography. CONCLUSIONS: The specificity of sonographic diagnosis of vasa previa at our center was 91%. Antenatal diagnosis permitted us to prevent the catastrophic outcomes commonly associated with vasa previa.
Asunto(s)
Placenta Previa/diagnóstico por imagen , Placenta/irrigación sanguínea , Ultrasonografía Prenatal , Adulto , Cesárea , Femenino , Humanos , Embarazo , Resultado del Embarazo , Estudios Prospectivos , Factores de Riesgo , Ultrasonografía Doppler en Color , Hemorragia Uterina/diagnóstico por imagenRESUMEN
Group A beta-hemolytic Streptococcus is a rare cause of peripartum infection, but it remains an extremely virulent pathogen with devastating consequences, thus requiring awareness of its presentation. We describe a case of fulminant group A Streptococcus sepsis resulting in a generalized Shwartzman reaction and death in a woman 48 hours postpartum.
Asunto(s)
Trastornos Puerperales/microbiología , Sepsis/microbiología , Fenómeno de Shwartzman/microbiología , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes , Adulto , Coagulación Intravascular Diseminada/etiología , Resultado Fatal , Femenino , Humanos , Trastornos Puerperales/complicaciones , Trastornos Puerperales/terapia , Sepsis/complicaciones , Sepsis/terapia , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/terapia , Factores de TiempoRESUMEN
There has been recent interest in autologous blood donation in obstetric patients, but little attention has been paid to whether such programs are needed or whether the patients that will require transfusion can be accurately predicted. At the University of California San Diego Medical Center from July 1 to Dec. 31, 1988, there were 2265 deliveries; 13 women (0.57%) received blood transfusions. Traditionally accepted risk factors were identified in 251 patients, with only four (1.6%) requiring transfusion. Among the 150 patients delivered by repeat cesarean section, only one (0.7%) required blood. one of 27 (3.7%) multiple gestations, two of eight (25%) patients with placenta previa, and none of the 66 grandmultiparous women had transfusions. These data suggest that autologous blood donation may not be beneficial or cost effective when the low frequency of blood transfusions in this high-risk obstetric population and the difficulty in accurately predicting those likely to require transfusions are considered.
Asunto(s)
Donantes de Sangre , Transfusión de Sangre Autóloga , Hemorragia Posparto/terapia , Cesárea , Femenino , Humanos , Trabajo de Parto , Embarazo , Factores de RiesgoRESUMEN
The present study was designed to test the hypothesis that arginine vasopressin mediates the fetal cardiovascular response to acute hypoxia. Chronically catheterized sheep fetuses at 126 to 138 days' gestation were infused with either an arginine vasopressin pressor antagonist (n = 8) or saline solution as control (n = 8). A 30-minute hypoxia was induced by infusion of nitrogen containing 5% carbon dioxide into the maternal trachea. Fetal arterial PO2 decreased 13.1 +/- 1.3 (SE) mm Hg from a basal value of 23.8 +/- 1.5 mm Hg and there was no significant difference in the degree of hypoxia between the two groups. Fetal arterial and venous pressures increased significantly, whereas the blood volume decreased, but these changes were similar between the control and arginine vasopressin-blocked fetuses. Heart rate fell similarly in both groups during hypoxia by an average of 35 beats/min. At the termination of hypoxia, heart rate in the blocked group rebounded to levels significantly above baseline and remained elevated for 30 minutes, whereas heart rate in the control group returned slowly to basal values. Recovery of arterial pressure, venous pressure, and blood volume were similar in the two groups. Thus it appears that arginine vasopressin may mediate in part the fetal heart rate response to acute hypoxia. However, the blood volume, arterial pressure, and venous pressure responses to hypoxia appear to be induced by factors other than arginine vasopressin.
Asunto(s)
Sistema Cardiovascular/fisiopatología , Hipoxia Fetal/fisiopatología , Vasopresinas/fisiología , Animales , Arginina Vasopresina/administración & dosificación , Arginina Vasopresina/análogos & derivados , Arginina Vasopresina/sangre , Presión Sanguínea , Dióxido de Carbono/sangre , Femenino , Edad Gestacional , Frecuencia Cardíaca Fetal , Concentración de Iones de Hidrógeno , Oxígeno/sangre , Embarazo , Radioinmunoensayo , Ovinos , Presión VenosaRESUMEN
Maternal floor infarction of the placenta is a relatively rare disorder that on gross examination is characterized by a thickened gray-yellow maternal floor of the placenta with histologic evidence of massive fibrin deposition involving the decidua basalis and the contiguous villi. This lesion has been associated with fetal death, preterm delivery, and intrauterine growth retardation and is thought to be recurrent. Sixty cases of maternal floor infarction were identified in 48 women. Fetal death occurred in 24 of the 60 cases (40%). Preterm birth occurred in 21 of 36 (58.3%) live-born infants, and 19 of the 35 (54.2%) live-born infants for whom a birth weight was known had evidence of intrauterine growth retardation. Among the 41 multiparous patients in our series there were five documented recurrences (12.2%). Review of the past reproductive history of these 48 patients (196 pregnancies) demonstrated a significant incidence of fetal death (24.1%), intrauterine growth retardation (31.3%), and preterm death (35.4%). The association of fetal death and maternal floor infarction emphasizes the importance of a placental examination with all cases of fetal death and infants with intrauterine growth retardation. Given the risk of recurrence, the identification of maternal floor infarction should alert the clinician to the potential for growth retardation, preterm birth, and fetal death in subsequent pregnancies.