morphine and Hemorrhage

Ultrafast T2-weighted (T2-W) MRI sequences are currently considered a routine technique for fetal MR imaging. Limited experience exists with fetal T1-weighted (T1-W) imaging techniques.. To determine MRI patterns of some fetal abdominal or haemorrhagic disorders with particular respect to the diagnostic value of T1-W images.. In addition to standard T2-W single-shot sequences, T1-W single-shot and/or multislice sequences were employed in 25 MR examinations performed in 23 fetuses between 20 and 36 weeks of gestation for more detailed assessment of liver, meconium-filled digestive tract, haemorrhage, or further characterization of a fetal abdominal mass. Diagnostic value and presence of motion artefacts on T1-W images was recorded in each case.. T1-W images enabled superior delineation of fetal liver and large intestine. They provided additional diagnostic information in 9 (39%) of 23 fetuses. One false-positive and one false-negative MRI diagnosis of malrotation anomaly were encountered. Use of single-shot T1-W sequences reduced the occurrence of motion artefacts in 64%.. Our results suggest that the specific signal properties of methaemoglobin, meconium and liver are sufficiently important for T1-W sequences to become a routine part of fetal MRI protocols when dealing with digestive tract anomalies, diaphragmatic and abdominal wall defects, intraabdominal masses, and fetal haemorrhage.

Topics: Abdomen; Female; Hemorrhage; Humans; Liver; Magnetic Resonance Imaging; Meconium; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Prenatal Diagnosis; Retrospective Studies

Two hundred and eighteen cases of hemorrhagic endovasculitis (HEV), a recently recognized abnormality of human placentas, were identified from placentas submitted to the Michigan Placental Tissue Registry over a 2.5-year period. HEV appears to focus on fetal placental blood vessels with resultant fragmentation and destruction of fetal RBCs, hemorrhage into villous stroma, microthrombi in villous capillaries and non-exudative necrosis of medium sized chorionic vessels. Placentas without HEV submitted for evaluation from the same hospitals were selected for comparison. Women with HEV placentas were of similar age, race and parity as control women. The sex of the fetus of HEV cases was somewhat more often female (57% vs. 48%, P = 0.05). The presence of HEV appeared to have a deleterious effect on the outcome of pregnancy: 52% (112/218) of the HEV placentas were associated with stillborn infants, in contrast to only 22% (89/400) of control placentas. The difference in the proportion of stillbirths was greatest when the gestational age was 25 weeks or greater. Other significant positive associations with HEV included the presence of meconium staining, intrauterine growth retardation, smaller placentas, and maternal hypertension or toxemia. Pathologic findings associated with HEV were chronic villitis, erythroblastosis, thrombosis and cord abnormalities. No association was found with infant Apgar score or fetal anomalies. The association of HEV with a high proportion of stillbirths in the registry suggests that further understanding of this lesion might shed light on the problem of unexplained stillbirth.

Topics: Female; Fetal Death; Fetal Diseases; Hemorrhage; Humans; Infant, Newborn; Infant, Small for Gestational Age; Male; Meconium; Placenta Diseases; Pre-Eclampsia; Pregnancy; Registries; Risk; Vasculitis

Topics: Asphyxia Neonatorum; Congenital Abnormalities; Female; Fetal Growth Retardation; Glucose; Hematologic Diseases; Hemorrhage; Humans; Hypoglycemia; Hypothermia; Infant Care; Infant Food; Infant, Newborn; Infant, Newborn, Diseases; Infant, Small for Gestational Age; Lung Diseases; Meconium; Pregnancy; Respiratory Distress Syndrome, Newborn; Terminology as Topic; Water-Electrolyte Balance

Meconium staining of the placenta and/or fetal body was present at birth in 10.3 per cent of 42,000 live-born infants, but present disproportionately in 18.1 per cent of 788 neonatal deaths. The neonatal mortality rate was 3.3 per cent in the stained group and 1.7 per cent in the nonstained group. Among infants who died, the incidence of erythroblastosis was quadrupled and that of cardiovascular malformation was doubled in the stained group. Meconium staining was associated with a decrease in the expected frequency of hyaline membranes and atelectasis even in premature infants; hypotheses for this phenomenon were presented. Meconium staining of the fetus or placenta requires several hours of exposure. As a hypothesis, the observed increase of deaths in stained neonates may be related to the stresses of cumulative or chronic hypoxia which may occur after the initial passage of meconium if delivery is prolonged.?23AUTHOR

Topics: Amniotic Fluid; Autopsy; Birth Weight; Congenital Abnormalities; Erythroblastosis, Fetal; Female; Fetal Diseases; Hemorrhage; Humans; Hyaline Membrane Disease; Hypoxia; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Obstetric Labor Complications; Placenta; Pneumonia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Pulmonary Atelectasis; Time Factors

Topics: Anti-Bacterial Agents; Australia; Erythroblastosis, Fetal; Female; Fetal Diseases; Fetal Heart; Hemorrhage; Hospitals; Humans; Hypnotics and Sedatives; Injections, Intravenous; Labor, Induced; Maternal Health Services; Meconium; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Pregnancy Complications, Infectious; Private Practice; Radiography; Thromboembolism; Urinary Tract Infections

Topics: Asphyxia; Blood Transfusion; Color; Cyanosis; Female; Fetofetal Transfusion; Fetomaternal Transfusion; Gestational Age; Heart Defects, Congenital; Hematocrit; Hemorrhage; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lung Diseases; Meconium; Oxygen Inhalation Therapy; Placenta Diseases; Positive-Pressure Respiration; Pregnancy; Resuscitation; Skin Manifestations

Topics: Afibrinogenemia; Amniotic Fluid; Blood Coagulation Disorders; Female; Fibrinolysis; Fibrinolytic Agents; Gestational Age; Hemorrhage; Humans; Meconium; Placenta; Pregnancy; Pregnancy Complications; Thrombosis; Uterus

Topics: Amnion; Blood Group Incompatibility; Cesarean Section; Extraembryonic Membranes; Female; Gestational Age; Hemorrhage; Humans; Iron-Dextran Complex; Meconium; Microscopy, Electron; Obstetric Labor, Premature; Pregnancy; Rh-Hr Blood-Group System; Skin; Trophoblasts

Topics: Adrenal Gland Diseases; Congenital Abnormalities; Emergencies; Esophagus; Hemorrhage; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Obstruction; Meconium; Peritonitis; Radiography