morphine and Thrombosis

Meconium staining of the fetus and placenta is associated with increased neonatal mortality and asphyxia. Very often it is unclear whether the discharge of meconium is a cause or an effect of fetal distress. In the available literature there are no large epidemiological studies of pregnancy outcome with meconium-related lesions, even though this could be useful to improve our state of knowledge on this topic.. A case of umbilical cord vascular necrosis is described. A severely asphyxiated infant was delivered at 39 weeks' gestation by cesarean section due to alarming results of fetal heart rate monitoring and rupture of membranes with meconium-stained amniotic fluid. There was no meconium aspiration. We report a review of 15 similar cases. In the whole series, a linkage between umbilical cord vascular necrosis and evidence of remote meconium discharge always seems to be detectable. The pathophysiological mechanism is unknown.. It is still not clear why only a tiny percentage of cases with meconium-stained amniotic fluid develops umbilical cord lesions and poor pregnancy outcome. Further investigations are needed to explain why some meconium-stained newborns suffer severe neurological and other damage even without meconium aspiration.

Topics: Adult; Diastole; Female; Fetal Monitoring; Humans; Infant, Newborn; Male; Meconium; Pregnancy; Thrombosis; Umbilical Arteries; Umbilical Veins

Many pathologic features of the umbilical cord affect fetal well-being adversely. Excessively long or short umbilical cords may be the cause of hematomas and thrombosis of cord vessels and the placental surface, thus causing fetal death and/or thrombocytopenia. In other cases, fetal hypoxia and central nervous system damage are possible outcomes. Thrombosis is also frequently induced by velamentous insertion of the cord, as are hemorrhages when the membranous vessels rupture during parturition. Entangling and knotting of the cord, especially of excessively long cords, may lead to similar lesions and fetal death. It was recognized recently that prolonged meconium exposure to the surface of the cord can cause partial necrosis of umbilical vessels and cord ulceration. The noxious moiety of meconium also causes contraction of the umbilical vessels, leading to fetal hypoperfusion and hypoxia. A stricture at the fetal end of the cord and excessive spiralling of a very long umbilical cord are often present in cases of unexplained fetal demise, especially in early pregnancy. Less common abnormalities are obstruction of the circulation by amnionic bands and varices.

Topics: Aneurysm; Female; Fetal Diseases; Hematoma; Humans; Meconium; Pregnancy; Thrombosis; Torsion Abnormality; Umbilical Arteries; Umbilical Cord; Umbilical Veins

Amniotic fluid embolism (AFE) continues to be one of the most feared and devastating complications of pregnancy. A reliable diagnosis can be made only upon histological examination. A detection of AFE every now and then has a relevant implication on medico-legal aspects of intrapartum or post-partum maternal death. However, there are only isolated reports in the literature concerning the detection interval of amniotic fluid elements after their transfer into the lungs. The objective of this study was to determine how long after the onset of clinical symptoms the elements of amniotic fluid may be detectable in the pulmonary circulation. An autopsy, as well as a histological and toxicological examination of 29 women, who died intrapartum or post-partum were performed. AFE was diagnosed in seven women (25%). The maximum survival time of the women with AFE and also the detection interval of AF in the pulmonary vasculature was 36 h. In the lungs of the women who did not die of AFE, amniotic fluid components were not found. Thus, there is no evidence for a physiologic occurrence of AFE. In women who die some days or even weeks after delivery as a consequence of a haemorrhagic shock following post-partum genital bleeding ensuing from uterine atony, AFE should be considered as a cause of a coagulopathy.

Topics: Adult; Amniotic Fluid; Chorionic Villi; Embolism, Amniotic Fluid; Female; Forensic Pathology; Humans; Lung; Meconium; Mucins; Postmortem Changes; Pregnancy; Pulmonary Artery; Rupture; Shock, Hemorrhagic; Staining and Labeling; Subarachnoid Hemorrhage; Survival Analysis; Thrombosis; Time Factors; Uterus

To evaluate the immediate neonatal outcome and the presence of various placental lesions in 96 pregnancies with meconium-stained amniotic fluid.. The patients were divided into a group with acute (N = 41) and subacute and chronic (N = 55) meconium staining of the placenta. Apgar scores, arterial cord pH and admission to the neonatal intensive care unit (NICU) were determined in addition to the findings on gross and microscopic examination of the placentas.. Of the 53 live births with subacute and chronic meconium staining, 13% had Apgar Scores < or = 7 at 5 minutes compared to 7% with acute meconium staining. Similarly, a significantly lower umbilical artery pH was determined in the former group [(32%) versus (7%)], (p < 0.01). When 9 different pathologic lesions of the placenta were evaluated microscopically, the frequency of villous vascular thrombosis (25.4%), infarcts (38%), acute chorioamnionitis (20%), villous edema (9.1%) and villitis (14.5%) was significantly higher in the group with longer meconium exposure compared to the other group (2.4%), (9.7%), (7.3%), (0%), and 1 (2.4%), respectively. In addition, when tested for 4 different lesions, cases with acute meconium were less likely to have one or more lesions. When one or more placental lesions were found, NICU admission rate was significantly higher in the patients with subacute and chronic meconium.. Subacute and chronic meconium discharge is associated with significant placental lesions and an increased risk of adverse pregnancy outcome in the immediate neonatal period.

Topics: Acidosis; Adolescent; Adult; Female; Fetal Hypoxia; Humans; Meconium; Placenta; Placenta Diseases; Pregnancy; Pregnancy Outcome; Thrombosis; Time Factors

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

Topics: Amniotic Fluid; Embolism; Female; Humans; Infant, Newborn; Meconium; Pregnancy; Pulmonary Embolism; Thrombosis