morphine and Pre-Eclampsia

There are five reported cases of fetal meconium peritonitis developing after episodes of maternal hepatitis. These cases demonstrate a potential association between severe maternal liver injury and subsequent fetal meconium peritonitis.. A 26-year-old primigravid woman developed acute liver failure 4 days after unilateral oophorectomy for ovarian torsion at 24 weeks of gestation. Her liver function gradually normalized with conservative management. She was readmitted for acute abdominal pain with elevated blood pressure at 29 weeks of gestation. An emergency cesarean delivery was performed for severe preeclampsia. Her neonate was noted to have a distended abdomen. Laparotomy and bowel resection were performed for meconium peritonitis and bowel perforation.. Fetal meconium peritonitis may develop after severe maternal liver disease. Thus, the latter may warrant heightened fetal surveillance.

Topics: Adult; Cesarean Section; Female; Humans; Hypertension, Pregnancy-Induced; Infant, Newborn; Intestinal Perforation; Liver Failure, Acute; Male; Meconium; Obstetric Surgical Procedures; Ovariectomy; Peritonitis; Pre-Eclampsia; Pregnancy

This is an unusual case in comparison to other sonographically described prenatal cases due to very early diagnosis and surgical intervention following prompt delivery. A 40-year-old pregnant, ultrasonography showed presence of cystic structure in the fetal abdomen that was consistent with intestinal dilatation. At 32 weeks' of gestation, repeat ultrasound showed collapse of the bowel dilatation along with the presence of hyperechogenic fluid in the fetal abdominal cavity. Cesarean section was performed. The clinical utility of this report is the recognition that meconium peritonitis (MP) may be diagnosed in the acute phase with typical ultrasound features, and should be considered in the differential diagnoses of cases presented with reduced fetal movements. Although it appears that morbidity and mortality in MP cases depend upon gestational age, this case report may help to manage similar cases for defining the appropriate delivery time and treatment modality after prenatal identification of the problem.

Topics: Abdomen; Adult; Diagnosis, Differential; Female; Fetal Diseases; Humans; Ileum; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Intestinal Volvulus; Male; Meconium; Peritonitis; Pre-Eclampsia; Pregnancy; Prenatal Diagnosis; Ultrasonography, Prenatal

As the patterns and frequency of maternal and clinical conditions and outcomes and gross and histological placental features and lesions vary with gestational age at delivery, we aimed to study the impact of these changes on the placental diagnosis, hoping to uncover potential novel clusters of gestational age-associated clinical and pathological diagnoses.. Retrospective statistical analysis of clinicoplacental database.. We analyzed 28 clinical (maternal and fetal) and 49 gross and microscopic placental variables from 3294 consecutively signed placentas received between 2001 and 2012, divided into three gestational age groups: 16-27 weeks, 697 cases; 28-36 weeks, 1365 cases; and 37+ weeks, in all 1232 cases.. Classical statistics by chi-squared and Fischer's tests, and the Ward agglomerative hierarchical clustering and multidimensional scaling techniques, were used.. The placental phenotypes clustered statistically significantly with severe preeclampsia in the second trimester; preterm premature rupture of membranes, placental abruption, and fetal growth restriction in the whole third trimester; and abnormally invasive placenta, thick meconium, maternal diabetes mellitus, and substance abuse in term pregnancies.. The applied statistical analyses made it possible to simultaneously compare the strength of clinicoplacental associations separately in three pregnancy intervals. Placental clinicopathological associations are strongest for the second trimester, i.e. severe preeclampsia and preterm ascending infection-related conditions, but were not significant for other pregnancy complications such as mild preeclampsia, chronic hypertension, diabetes mellitus, or umbilical cord compromise.

Topics: Abruptio Placentae; Adult; Cluster Analysis; Databases, Factual; Female; Fetal Growth Retardation; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Meconium; Phenotype; Placenta; Placenta Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Retrospective Studies; Substance-Related Disorders

Obstetric cholestasis is associated with maternal morbidity and adverse foetal outcomes. No information on local incidence is available. We present our experience with eight consecutive cases of obstetric cholestasis diagnosed between January 2003 and December 2005 in a regional hospital in Hong Kong. Three patients presented with pruritus without rash, three with impaired liver function, and two with elevated blood pressure postpartum. Meconium-stained liquor was present in five patients and four had spontaneous preterm delivery (between 34 and 36 weeks). The higher the bile acid level, the more marked the prematurity (correlation coefficient, -0.771; P=0.025). All those presenting with itchiness delivered preterm. Two patients developed pre-eclampsia. The rates of labour induction and abdominal delivery were both 38%. Heightened awareness among clinicians is required to recognise patients with obstetric cholestasis. Affected pregnancies are associated with meconium passage and prematurity. In our locality, affected women may also have an increased risk of pre-eclampsia. In affected women, the bile acid level is useful in assessing the risk of prematurity.

Topics: Adult; Bile Acids and Salts; Cesarean Section; Cholestasis, Intrahepatic; Female; Hong Kong; Hospitals; Humans; Hypertension; Incidence; Infant, Newborn; Liver Function Tests; Meconium; Obstetric Labor, Premature; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Premature Birth; Pruritus

The study was designed to investigate obstetric risk factors and pregnancy outcome of patients with pruritic urticarial papules and plaques of pregnancy (PUPPP).. A population-based study comparing all pregnancies of women with and without PUPPP was conducted. Deliveries occurred during the years 1988-2002 at the Soroka University Medical Center. A multivariable logistic regression model was constructed in order to find independent risk factors associated with PUPPP.. During a 15-year period, 159 197 deliveries took place. PUPPP complicated 42 (0.03%) of all pregnancies. Using a multivariable analysis, the following conditions were significantly associated with PUPPP: multiple pregnancies (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7-14.1), hypertensive disorders (OR = 2.2, 95% CI 1.1-4.7), and induction of labor (OR = 7.6, 95% CI 4.0-14.5). Higher rates of 5-minute Apgar scores lower than 7 (OR = 8.0, 95% CI 4.4-14.9) and of cesarean deliveries (OR = 2.9, 95% CI 1.5-5.6) were noted in the PUPPP as compared to the comparison group. While investigating other perinatal outcome parameters such as oligohydramnios, intrauterine growth restriction, meconium-stained amniotic fluid and perinatal mortality, no significant differences were observed between the groups.. Pruritic urticarial papules and plaques of pregnancy is a condition significantly associated with multiple pregnancies, hypertensive disorders, and induction of labor. Perinatal outcome is comparable to pregnancies without PUPPP.

Topics: Adult; Apgar Score; Cesarean Section; Female; Fetal Growth Retardation; Humans; Hypertension; Infant, Newborn; Logistic Models; Meconium; Obesity; Odds Ratio; Oligohydramnios; Parity; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pruritus; Risk Factors; Urticaria

To clarify electronic fetal heart rate (FHR) monitoring characteristics in pregnancies with preterm delivery before 32 weeks of gestation, using the late second-trimester nonstress test.. Among 953 children born from 1993 to 1996, we identified 100 singleton infants born before 32 weeks of gestation in whom second-trimester (24-27 weeks of gestation) electronic fetal monitoring (EFM) records were obtained. Individual components of the FHR patterns [baseline rate, baseline FHR variability, presence of acceleration (at least 10 beats/min for at least 10 s) and periodic or episodic deceleration (at least 25 beats/min for at least 15 s)] and birth characteristics were compared between pregnancy with or without second-trimester decelerations.. Among 100 infants, 65 had and 35 did not have second-trimester decelerations. There were no significant differences in gestational age at birth, birth weight, cord arterial blood pH, Apgar score and meconium staining between pregnancies with second-trimester decelerations and those without second-trimester decelerations. There were no significant differences in baseline rate and baseline variability between pregnancies with or without second-trimester decelerations. The number of accelerations in pregnancies with second-trimester decelerations was significantly more frequent than that in pregnancies without second-trimester decelerations (p < 0.001). There was a significant increase in the occurrence of premature rupture of the membranes (PROM; 60.0%) in pregnancies with second-trimester decelerations, when compared with events (37.1%) related to pregnancies without second-trimester decelerations (p < 0.05). There were no significant differences in the onset of breech presentation, cervical incompetency, preeclampsia and abnormal FHR pattern at birth between pregnancies with second-trimester decelerations and those without second-trimester decelerations. Pregnancies with PROM after second-trimester EFM were significantly more likely to have second-trimester decelerations than those without PROM (75.0 vs. 54.2%, p < 0.05).. Periodic or episodic decelerations during late second-trimester EFM were associated with an increased risk of the occurrence of PROM in pregnancies with preterm delivery before 32 weeks of gestation.

Topics: Adult; Apgar Score; Birth Weight; Breech Presentation; Female; Fetal Blood; Fetal Membranes, Premature Rupture; Fetal Monitoring; Gestational Age; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infant, Premature; Meconium; Obstetric Labor, Premature; Pre-Eclampsia; Pregnancy; Uterine Cervical Incompetence

Urinary meconium index (UMI) was determined in 538 cases of pregnant women by spectrophotometry (265 cases were in late pregnancies 229 in the first stage of delivery, and 44 in the second stage). The results indicated that most of those having positive UMI were high-risk pregnancies (P less than 0.01). The UMI index of the meconium contaminated amniotic fluid was higher than the non-contaminated amniotic fluid (P less than 0.01), and patients with lower Apgar score had higher rate of positive UMI. In consecutive measuring, , We found that the rate of neonatal asphyxia was highest in those with a UMI of falling type, and then in the rising type. It showed that measurement of maternal UMI is of value in monitoring high-risk pregnancies.

Topics: Female; Fetal Monitoring; Humans; Meconium; Pre-Eclampsia; Pregnancy; Risk Factors

Estimation of the alkaline phosphates isoenzymes in paired maternal serum and amniotic fluids in term uncomplicated pregnancies and in patients with pre-eclampsia, showed poor correlation coefficients between the levels of both heat stable and heat labile isoenzymes. There was a statistically significant fall in AF (P less than .05) HSAP in pre-eclampsia and a highly significant rise of HLAP in meconial liquor. It is concluded that the poor correlation between the levels of HSAP in maternal serum and amniotic fluid (despite their common source of origin), the normal levels of HLAP in maternal serum in the presence of significantly high levels of HSAP in maternal serum in the presence of significantly diminished levels in amniotic fluid point to a state of relatively diminished permeability of the chorioamniotic membranes to the alkaline phosphatase isoenzymes in Nigerians.

Topics: Alkaline Phosphatase; Amniotic Fluid; Female; Humans; Isoenzymes; Meconium; Nigeria; Pre-Eclampsia; Pregnancy

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

The levels of urinary estriol (U-E3), serum leucine aminopeptidase (LSP) and heat stable alkaline phosphatase (HSAP) were determined in toxemic and normal pregnancies. The significance of differences was established by weekly estimation of the parameters for both groups after the 28th week of gestation. Assayed values were classified into 4 types (type I-IV) by the mean values for 3 serial 24h assays and 3 patterns (pattern a-c) observed with these three determinations. The distribution rate for each type and pattern was examined according to the following: Severe toxemia, low birth weight, meconium staining at parturition and low apgar score groups. For U-E3, the incidence of the low value type (type IV) and the descending pattern (pattern c) both increased linearly in all the above groups. These findings suggest the clinical applicability of U-E3 as a reasonable indicator for evaluating intrauterine fetal well being because of the close correlation to the listed conditions. Thus these biochemical parameters should be considered in the antepartum fetal management of third trimester toxemic pregnancies.

Topics: Alkaline Phosphatase; Apgar Score; Birth Weight; Estriol; Female; Humans; Infant, Newborn; Leucyl Aminopeptidase; Meconium; Pre-Eclampsia; Pregnancy

Values of carcinoembryonic antigen (CEA) were measured by radioimmunoassay in 100 pregnant women divided into 4 groups. In group 1 (49 normal pregnancies) and 2 (17 pre-eclamptic pregnancies), the estimation of CEA was done in maternal vein blood, umbilical cord blood and in amniotic fluid. In group 3 (20 normal pregnancies) CEA was measured separately in blood of the two umbilical vessels as well as in maternal vein blood. In group 4 (14 pregnancies with small-for-date infants) CEA was estimated in umbilical cord blood. The values in amniotic fluid of normal and pre-eclamptic pregnancies were more than 20 times higher than in the other two compartments. A significant correlation was found between the amniotic fluid and umbilical cord blood values (r = 0.500; P < 0.05), as well as between the values in umbilical artery and vein (r = 0.792; P < 0.001). Thus, it is thought that CEA is transferred from the amniotic cavity to the umbilical cord while a part of CEA perhaps is produced by the placenta. Umbilical cord blood values of small-for-date fetuses do not differ significantly from the normal. On the contrary, significantly lower values were obtained in umbilical cord blood and in amniotic fluid of pre-eclamptic women as compared to the normal, but this finding is not useful clinically because of the large standard deviation.

Topics: Amniotic Fluid; Carcinoembryonic Antigen; Female; Fetal Blood; Fetal Distress; Humans; Infant, Newborn; Meconium; Pre-Eclampsia; Pregnancy; Radioimmunoassay; Umbilical Arteries; Umbilical Veins

Sixty-six patients with chronic hypertension were cared for during a total of 72 pregnancies. Patients were treated at home primarily by greater than or equal to 4 hours of bed rest daily in the left recumbent position. Only patients whose diastolic blood pressures remained greater than 110 mmHg were treated with hydralazine (Apresoline, Ciba). With this plan of treatment there were only 3 perinatal deaths for an uncorrected perinatal mortality of 4.1% (1.4% corrected). Twenty-nine percent of the patients had babies that were small for gestational age, 13.8% had positive oxytocin challenge tests, and 36.8% developed superimposed preeclampsia. When compared with the outcome of previous pregnancies, the program of bed rest lowered perinatal mortality from 16.8 to 8.8%. Thus, it is suggested that bed rest together with the avoidance of diuretics and the judicious use of hydralazine results in the most favorable fetal outcome.

Topics: Bed Rest; Birth Weight; Chronic Disease; Female; Fetal Death; Humans; Hydralazine; Hypertension; Infant Mortality; Infant, Newborn; Infant, Small for Gestational Age; Meconium; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular

Over the last 4 years at Los Angeles County-University of Southern California Medical Center, Women's Hospital, clinical interest in antepartum fetal monitoring has increased considerably. As a result of approximately 1,500 tests in some 600 patients at high risk for placental insufficiency, we have reached several conclusions regarding the methods for antepartum fetal monitoring, criteria for interpretation of the results obtained, and the role of antepartum monitoring information in clinical management. In this paper, the results of "stress" monitoring (monitoring in the presence of uterine contractions) are presented. The term "oxytocin challenge test" is used in reference to "stressed" monitoring even though sometimes the contractions were spontaneous, or without oxytocin stimulation.

Topics: Cesarean Section; Electrocardiography; Estriol; Female; Fetal Death; Fetal Heart; Heart Rate; Hemoglobinopathies; Humans; Labor, Obstetric; Meconium; Monitoring, Physiologic; Obstetric Labor, Premature; Oxytocin; Phonocardiography; Placenta Diseases; Placenta Previa; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Pregnancy, Prolonged; Prenatal Diagnosis; Ultrasonography; Uterus

Topics: Amniocentesis; Amniotic Fluid; Anemia, Sickle Cell; Bilirubin; Birth Weight; Blood; Color; Coloring Agents; Delivery, Obstetric; Embryonic and Fetal Development; Erythroblastosis, Fetal; Female; Gestational Age; Humans; Hyperbilirubinemia; Infant, Newborn; Meconium; Oxazines; Placenta Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Prospective Studies; Respiratory Distress Syndrome, Newborn; Staining and Labeling; Vagina

Topics: Amniotic Fluid; Female; Fetal Diseases; Fetal Heart; Germany, West; Gestational Age; Humans; Maternal-Fetal Exchange; Meconium; Obstetric Labor Complications; Placenta Diseases; Pre-Eclampsia; Pregnancy; Umbilical Cord

Topics: Amniocentesis; Amniotic Fluid; Anemia, Sickle Cell; Antibody Formation; Female; Fetal Diseases; Gestational Age; Humans; Hypertension; Infant, Newborn; Meconium; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Complications, Hematologic; Pregnancy in Diabetics; Rh-Hr Blood-Group System

Topics: Apgar Score; Arrhythmias, Cardiac; Birth Weight; Cesarean Section; Female; Fetal Death; Fetal Diseases; Fetal Heart; Gestational Age; Heart Rate; Hospitals, Community; Humans; Infant Mortality; Infant, Newborn; Labor, Obstetric; Maryland; Meconium; Monitoring, Physiologic; Obstetric Labor Complications; Pre-Eclampsia; Pregnancy; Retrospective Studies; Uterine Inertia

Topics: Amniocentesis; Amniotic Fluid; Blood Urea Nitrogen; Cholesterol; Epithelial Cells; Epithelium; Female; Fetal Death; Humans; Meconium; Methods; Placenta Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Vernix Caseosa

Topics: Abruptio Placentae; Amnion; Amniotic Fluid; Apgar Score; Endoscopy; Erythroblastosis, Fetal; Female; Fetal Death; Fetal Diseases; Fetoscopy; Humans; Hypoxia; Meconium; Placenta Previa; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

Topics: Age Factors; Amnion; Amniotic Fluid; Endoscopy; Female; Fetoscopy; Gestational Age; Humans; Labor, Induced; Meconium; Parity; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

Topics: Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Magnesium; Magnesium Sulfate; Maternal-Fetal Exchange; Meconium; Pre-Eclampsia; Pregnancy

Topics: Alkaline Phosphatase; Amniotic Fluid; Anencephaly; Apgar Score; Bilirubin; Blood Transfusion; Chromatography, Paper; Chromatography, Thin Layer; Erythroblastosis, Fetal; Female; Fetus; Humans; Infant, Newborn; Jaundice; Liver Function Tests; Maternal-Fetal Exchange; Meconium; Polyhydramnios; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Rh-Hr Blood-Group System; Spectrophotometry; Transaminases; Urobilin; Urobilinogen

Topics: Amniotic Fluid; Bile Pigments; Bilirubin; Birth Weight; Cesarean Section; Defecation; Female; Humans; Infant, Newborn; Intestinal Absorption; Jaundice, Neonatal; Maternal-Fetal Exchange; Meconium; Pre-Eclampsia; Pregnancy; Time Factors

Topics: Anemia; Erythroblastosis, Fetal; Female; Fetal Diseases; Fetal Heart; Humans; Meconium; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Pregnancy, Prolonged

Topics: Amniotic Fluid; Cesarean Section; Female; Fetal Death; Fetal Diseases; Humans; Infant Mortality; Labor, Induced; Meconium; Methods; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

Topics: 17-Ketosteroids; Adrenal Glands; Birth Weight; Chorionic Gonadotropin; Chromatography, Thin Layer; Dehydroepiandrosterone; Estriol; Feces; Female; Humans; Infant, Newborn; Male; Meconium; Pre-Eclampsia; Pregnancy; Umbilical Arteries; Umbilical Veins

Topics: Adolescent; Adult; Alkalosis; Amniotic Fluid; Blood Chemical Analysis; Female; Fetal Death; Fetal Diseases; Humans; Hydrogen-Ion Concentration; Hypoxia; Infant Mortality; Infant, Newborn; Meconium; Pre-Eclampsia; Pregnancy

Topics: Amniotic Fluid; Endoscopy; Erythroblastosis, Fetal; Female; Fetal Diseases; Humans; Infant Mortality; Maternal-Fetal Exchange; Meconium; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

Topics: Acid-Base Equilibrium; Acidosis; Amniotic Fluid; Blood Chemical Analysis; Blood Gas Analysis; Female; Fetus; Humans; Hydrogen-Ion Concentration; Lactates; Meconium; Oximetry; Pre-Eclampsia; Pregnancy