morphine and Rupture--Spontaneous

To evaluate the impact of prolonged exposure to meconium-stained amniotic fluid (MSAF), in women with term pre-labor spontaneous rupture of membranes (PROM), on pregnancy outcome.. A retrospective cohort study of women who gave birth in a single university-affiliated tertiary medical center (2011-2019). Eligibility was limited to singleton pregnancies at term who presented with PROM. Women with MSAF were immediately induced and were compared to low-risk pregnant women with clear amniotic fluid (CAF) at admission who underwent induction of labor 24 h after rupture of membranes. All women were stratified into 4-time frame groups from rupture of membranes to delivery: T0: 0-7 h, T1: 8-13 h, T2: 14-18 h, and T3: > 18 h for the MSAF group. The time frames for the CAF were: T0 - 24-31 h, T1: 32-38 h, T2: 40-44 h, and T3: > 44 h. The maternal adverse composite outcome included any of the following: intrapartum fever (IPF), prolonged second stage (PSS), need for manual removal of suspected retained placenta, postpartum hemorrhage, and readmission within 45 days after delivery. The adverse composite neonatal outcome included one or more of the following: meconium aspiration syndrome, neonatal asphyxia, need for respiratory support, and intracranial hemorrhage.. Prolonged rupture of membranes in the presence of meconium does not affect maternal outcomes, however, prolonged exposure to meconium lead to an increased adverse neonatal outcome.

Topics: Amniotic Fluid; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Meconium Aspiration Syndrome; Placenta, Retained; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Retrospective Studies; Rupture, Spontaneous

A subcapsular hematoma of the liver is often found during autopsy in stillborn infants rather than clinically. It is usually asymptomatic unless ruptured; thus, the diagnosis is often delayed or missed. Rupture of a subcapsular hematoma in a premature neonate causes massive intraabdominal hemorrhage, which is associated with high mortality. Thus, early recognition and treatment to avoid rupture are imperative. We describe a case of life-threatening hemorrhage from a subcapsular hematoma of the liver during emergent laparotomy for mechanical obstruction in an 860 g premature neonate and discuss the appropriate preoperative preparation and anesthetic management for this case.

Topics: Blood Loss, Surgical; Emergencies; Fatal Outcome; Heart Arrest; Hematoma; Hemostasis, Surgical; Humans; Infant, Extremely Low Birth Weight; Infant, Extremely Premature; Infant, Newborn; Intestinal Obstruction; Intestine, Small; Intraoperative Complications; Laparotomy; Liver Diseases; Male; Meconium; Rupture, Spontaneous

To analyze the adequacy of prenatal care in a Birth Center and the causes associated with maternal and newborn transfers to the hospital.. Cross-sectional study of the care provided at the only Birth Center in Rio de Janeiro, from 2009 to 2014. Statistical analyzes were based on the χ2 test and Prevalence Ratio (PR).. Suitable prenatal care was predominant (42.8%) and there was no association (p = 0.55) with the transfers. Maternal transfer is caused by the ruptured amniotic sac (PR = 2.09, 95% CI 1.62-2.70) and altered fetal heart rates (PR = 3.06, 95% CI, 2.13-4.39). Newborn transfers are associated with the presence of meconium in the amniotic fluid (PR = 2.40, 95% CI 1.30-4.43); Apgar below 7 (PR = 5.33, 95% CI 2.65-10.73); and ventilatory assistance at birth (PR = 9.41, 95% CI 5.52-16.04).. Complications during intrapartum care are the causes associated with transfers.. Analisar a adequação da assistência pré-natal em Casa de Parto e as causas associadas com as transferências maternas e dos recém-nascidos para o hospital.. Estudo transversal dos atendimentos da única Casa de Parto, de 2009 a 2014, no Rio de Janeiro. As análises estatísticas foram pelo Teste χ2 e Razão de Prevalência (RP).. A assistência pré-natal adequada predominou (42,8%) e não houve associação (p=0,55) com as transferências. A transferência materna é causada pela bolsa amniótica rota (RP= 2,09; IC 95% 1,62-2,70) e batimentos cardíacos fetais alterados (RP= 3,06; IC 95% 2,13-4,39). As transferências do recém-nascido estão associadas com a presença de mecônio no líquido amniótico (RP= 2,40; IC 95% 1,30 - 4,43); Apgar abaixo de 7 (RP= 5,33; IC 95% 2,65-10,73) e assistência ventilatória ao nascer (RP= 9,41; IC 95% 5,52-16,04).. As intercorrências na assistência intraparto são as causas associadas com as transferências.. Analizar la adecuación de la asistencia prenatal en Casa de Parto y las causas asociadas con las transferencias maternas y de los recién nacidos para al hospital.. Investigación transversal de los atendimientos de la única Casa de Parto, de 2009 a 2014, en Río de Janeiro. Los análisis estadísticos fueron por el Test χ2 y Razón de Prevalencia (RP).. La asistencia prenatal adecuada predominó (42,8%) y no hubo asociación (p = 0,55) con las transferencias. La transferencia materna es causada por la bolsa amniótica ruta (RP = 2,09, IC 95% 1,62-2,70) y batimientos cardíacos fetales alterados (RP = 3,06, IC 95% 2,13-4,39). Las transferencias del recién nacido se asocian con la presencia de meconio en el líquido amniótico (RP = 2,40; IC 95% 1,30 - 4,43); Apgar abajo de 7 (RP= 5,33; IC 95% 2,65-10,73) y asistencia ventilatoria al nacer (RP=9,41; IC 95% 5,52-16,04).. Las intercurrencias en la asistencia intraparto son las causas asociadas con las transferencias.

Topics: Adolescent; Adult; Amnion; Amniotic Fluid; Apgar Score; Birthing Centers; Chi-Square Distribution; Cross-Sectional Studies; Female; Heart Rate, Fetal; Humans; Infant, Newborn; Meconium; Mothers; Patient Transfer; Pregnancy; Prenatal Care; Rupture, Spontaneous; Young Adult

Intraperitoneal bowel perforation may occur in utero as a result of a variety of abnormalities and typically results in sterile meconium ascites, pseudocysts, and/or calcification in the fetus. On the other hand, extraperitoneal bowel perforation in intrauterine life is extremely rare. The object of this report is to present our experience of prenatal extraperitoneal rectal perforation, defining the clinical presentation, management, and progress.. Nine babies who were identified from 2 centers in the Republic of South Africa with fetal extraperitoneal rectal perforation are presented. The details of these babies were obtained retrospectively from the case notes.. All patients presented at or shortly after birth with air and meconium tracking below the pelvic floor manifesting as either an expanding, meconium-stained aerocele or with perirectal spreading sepsis. Where abdominal signs were present, laparotomy confirmed the extension of the meconium perforation into the peritoneal cavity. Management was by diverting colostomy, drainage of the perineal collection, and supportive therapy. A posterior approach to the rectum and excision of a fibrotic section of the lower rectal wall was performed in one case. One case developed rectal stenosis that was treated by dilatation before colostomy closure. In all the other cases, digital examination performed before colostomy closure ruled out significant narrowing. There was no mortality, and the site of the rectal perforation healed in all cases to leave good anorectal function after treatment.. Fetal extraperitoneal perforation is extremely rare, but the clinical features are easily recognizable, and when appropriate therapy is instituted, the outcome is likely to be good with normal anorectal function to be expected in the long-term. The exact cause of the condition is unknown.

Topics: Colostomy; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Infant, Newborn; Intensive Care, Neonatal; Laparotomy; Male; Meconium; Radiography, Abdominal; Rectal Diseases; Retrospective Studies; Rupture, Spontaneous; South Africa; Treatment Outcome

We report an unusual case of perforation of a congenital fibrosarcoma of the jejunum in utero and secondary meconium peritonitis. Prenatal ultrasound showed polyhydramnios and fetal ascites from 25 gestational weeks in the absence of other fetal congenital anomalies. A 2200 g baby girl was born at 34 weeks gestation, presenting with severe generalized edema and respiratory distress immediately after birth. Plain radiography revealed progressive abdominal distension and pneumoperitoneum. The baby subsequently underwent surgery at the age of one day. A perforation of the upper jejunum, which had resulted in meconium peritonitis, was discovered intraoperatively and the perforated section of the intestine was resected and anastomosed successfully. The postoperative course was uneventful. Pathological examination confirmed that the perforation was caused by rupture of a congenital fibrosarcoma originating from the jejunum. Rupture of a malignant tumor is an extremely rare cause of peritonitis in the fetus and neonate.

Topics: Female; Fetal Diseases; Fibrosarcoma; Humans; Jejunal Neoplasms; Meconium; Peritonitis; Rupture, Spontaneous

A case of congenital immature gastric teratoma along with spontaneous gastric perforation in a 1-day-old boy is presented. The clinical features are similar to those of meconium peritonitis. Coincidentally, the child had an arachnoid cyst at 25 months of age. To the best of the authors knowledge, this case of congenital immature gastric teratoma associated with gastric perforation mimicking meconium peritonitis, is the first description in the English-language literature.

Topics: Diagnosis, Differential; Humans; Infant; Male; Meconium; Peritonitis; Rupture, Spontaneous; Stomach Neoplasms; Teratoma; Ultrasonography, Prenatal

Topics: Adult; Fatal Outcome; Female; Fetal Distress; Humans; Meconium; Necrosis; Pregnancy; Rupture, Spontaneous; Umbilical Cord; Umbilical Veins

Congenital rupture of the scrotum caused by meconium peritonitis occurred in a newborn with clinical findings of the Beckwith-Wiedemann syndrome. Ruptured omphalocele and jejunal atresia were present. Surgical repair 3 hours after birth was successful.

Topics: Genital Diseases, Male; Humans; Infant, Newborn; Male; Meconium; Peritonitis; Rupture, Spontaneous; Scrotum

The case of a neonate presenting with respiratory distress who had an incarcerated Bochdalek hernia with perforation and meconium peritonitis and pleuritis is reported. The patient had an associated jejunal atresia in an incarcerated segment of intestine, which undoubtedly contributed to the obstruction, strangulation, and perforation in the incarcerated hernia. Gastrointestinal complications attributable to the hernia are most unusual in the neonate, and aggressive preoperative resuscitation and stabilization with the earliest possible surgical intervention are imperative features in management.

Topics: Female; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Intestinal Atresia; Jejunum; Meconium; Peritonitis; Pleurisy; Radiography; Rupture, Spontaneous

Antenatal appendicular perforation leading to localized meconium peritonitis and intestinal obstruction is reported in a premature neonate. The baby was successfully treated by a limited ileocaecal resection.

Topics: Appendicitis; Female; Fetal Diseases; Humans; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Pregnancy; Rupture, Spontaneous

Topics: Genital Diseases, Male; Humans; Infant, Newborn; Male; Meconium; Peritonitis; Rupture, Spontaneous; Scrotum

Topics: Adult; Female; Fetal Diseases; Humans; Infant, Newborn; Intestinal Perforation; Intestine, Small; Meconium; Peritonitis; Pregnancy; Prenatal Diagnosis; Rupture, Spontaneous; Ultrasonography

Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Ischemia; Meconium; Peritonitis; Radiography; Rupture, Spontaneous; Stomach; Stomach Rupture

Topics: Female; Humans; Ileum; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Pregnancy; Rupture, Spontaneous

Apparently spontaneous neonatal intestinal perforation may be difficult to diagnose if the condition is not kept in mind. It may present with free perforation or with the late effects of meconium peritonitis. Five cases are described. There is a high mortality associated with bacterial peritonitis, and the importance of early diagnosis and energetic resuscitation is underlined.

Topics: Colonic Diseases; Female; Humans; Ileum; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Jejunum; Male; Meconium; Peritonitis; Rupture, Spontaneous; Stomach Rupture

Topics: Actinobacillus Infections; Anemia, Hemolytic; Animals; Animals, Newborn; Contracture; Diarrhea; Entropion; Female; Hernia; Horse Diseases; Horses; Joint Diseases; Meconium; Pregnancy; Rupture, Spontaneous; Tendons; Urachus; Urinary Bladder Diseases