Acute Fetal Distress Research Articles

An uncommon case of uterine rupture with retroperitoneal hematoma

Uterine rupture is a serious complication for both mother and child, occurring in 0.2 to 0.8% of attempts at vaginal delivery after cesarean section. A case of 29-year-old Moroccan woman, G2P2, with a previous caesarean section, was admitted to our emergency department at 38 weeks' gestation for acute fetal distress with complete cervical dilation. The delivery was imminent and done by vaginal route. The uterine revision objectified a uterine rupture. An immediate laparotomy was performed. The surgical exploration revealed uterine rupture on the right uterine edge with vascular pedicle lesion. More, we have found a huge hematoma of the right broad ligament diffusing into the right deep retroperitoneal space. The surgical management consisted of a total hysterectomy and packing of retroperitoneal hematoma. Removal of packing was performed on the fourth day after stabilization of clinical and biological parameters. Fortunately, the evolution was favorable under antibiotic therapy and massive transfusion. The patient was discharged from the hospital on the 10th postoperative day. The baby was doing well without any neurological sequelae.

Dengue infection during pregnancy in Burkina Faso: a cross-sectional study

BackgroundDengue fever is prevalent in the world; in recent years, several outbreaks occurred in West Africa. It affects pregnant women. We aimed to assess the consequences of dengue fever on pregnant women and their fetuses during dengue epidemic in Burkina Faso.MethodsWe conducted a cross-sectional study from November 1, 2015 to January 31, 2017 in 15 public and private health facilities in Ouagadougou, using secondary data. Immunochromatographic rapid test Duo detecting specific antibodies, immunoglobin M/G and /or dengue non structural antigen1 virus was used to diagnose dengue cases.ResultsOut of 399 (48%) women registered during the study period, 25 (6%) were pregnant. The average age of pregnant women was 30 years, with 18 and 45 years as extremes. The main symptoms were fever (92%) and headache (92%). Nine patients (36%) had severe dengue characterized by bleeding (16%), neurological symptoms (16%) and acute respiratory distress (8%). Eight (32%) of the 25 women had early miscarriage and 8 (32%) women gave birth to viable fetuses. Among those with viable babies, 5 (20%) presented post-partum hemorrhage and 3 (12%) presented early delivery. The main fetal complications included 3 cases of acute fetal distress (12%). One case of maternal death (4%) and 4 cases of neonatal mortality (44.5%) were notified.ConclusionDengue fever occurring during pregnancy increases maternal and neonatal mortality. Its severe complications require specific monitoring of pregnant women until delivery.

The effect of transient fetal bradycardia and other heart rate changes during and after external cephalic version on perinatal outcomes

ObjectivesTo evaluate the effect of transient fetal bradycardia and other heart rate changes during and after external cephalic version (ECV) on perinatal outcomes. To determine factors associated with a higher risk of occurrence of transient fetal bradycardia during and after ECV. Study designProspective study in 286 women after the 36th week of gestation with a fetus in breech presentation who have undergone an ECV attempt. The study analyses the incidence of transient fetal bradycardia during and immediately after ECV, the time interval to complete adjustment of fetal bradycardia, the factors associated with the occurrence of transient fetal bradycardia, cardiotocography (CTG) changes after ECV and perinatal outcomes. All the data were statistically analyzed. ResultsThe ECV was successful in 51 % (146/286). Transient fetal bradycardia occurred during and after ECV in 81 cases (28.3 %). A successful version was a factor significantly associated with fetal bradycardia (54; 37.0 % versus 27; 19.3 %; p < 0.01). Clinically significant hypotension of the mother was accompanied by transient fetal bradycardia in 12 cases (4.2 %). After the successful ECV there was no significant difference in the percentage of vaginal deliveries between subgroups with and without transient fetal bradycardia (85.2 % versus 83.7 %; p = 1.00). Nor in occurrence of acute fetal distress during labor (18.5 % versus 15.6 %; p = 0.65). In cases of a successful ECV transient CTG changes after ECV had no effect on the incidence of acute fetal distress during labor (23.5 % versus 15.7 %; p = 0.49). ConclusionsTransient fetal bradycardia and other heart rate changes during and immediately after ECV was not associated with a higher incidence of acute fetal distress during labor and did not affect perinatal outcomes. Higher occurrence of transient bradycardia after ECV was associated only with successful ECV. Transient hypotension of the mother as one of the causes of transient fetal bradycardia during ECV should be considered.

Prenatal quality and clinical conditions of newborns exposed to syphilis

Introduction: Syphilis is a sexually transmitted disease caused by Treponema pallidum, and results in considerable morbidity and mortality. Congenital syphilis can lead to miscarriage, prematurity, bone deformities, hearing loss and other important clinical changes. Objective: To analyze prenatal quality and clinical conditions of newborns exposed to syphilis in a public maternity hospital in Rio Branco-Acre. Method: This is a cross-sectional study that included 92 mothers diagnosed with syphilis during pregnancy, attended from July to December 2017. Two pregnant women had fetal death, and the final sample consisted of 90 newborns exposed to syphilis. An interview with the postpartum woman was used, analysis of the pregnant woman's card and search for information from the pregnant woman's records and newborns. It was considered confirmed case of syphilis in pregnant woman: a) All pregnant women who presented non-treponemal reagent test with any titration and reagent treponemal test performed during prenatal care; b) Pregnant woman with reagent treponemal test and nonreactive or unreacted nontreponemal test, without previous treatment record. To characterize congenital syphilis we considered: a) newborn whose mother was not diagnosed with syphilis during pregnancy and who presented a nontreponemal test reactive with any titration at the time of delivery; b) child whose mother was not diagnosed with syphilis during pregnancy and had a non-treponemal test reagent at the time of delivery; c) newborns whose mother presented a reactive treponemal test and a nonreactive non-treponemal test at the moment of delivery, without previous treatment record. Results: Most newborns were born in normal delivery (65.5%), 17.8% had acute fetal distress and 11.2% required resuscitation maneuvers. Prematurity occurred in 10% of births and 12.2% of them were small for gestational age. Complete prenatal care was performed by 29.5% of the mothers, following the recommendations of the Ministry of Health of seven visits to the Health Unit and or Health Professional. From the 90 pregnant women, 79 had a reactive treponemal test when admitted to the maternity ward. 29.3% of them performed the treatment properly. In the analysis about the treatment of the sexual partner, it was reported that 58% did not adhere to syphilis treatment. Conclusion: The prenatal quality of pregnant women with syphilis was lower than that recommended by the Brazilian Ministry of Health, although there are few cases of syphilis as the primary outcome in newborns with childbirth with mothers diagnosed with syphilis. Prenatal, newborn, syphilis in pregnancy, congenital syphilis.

Perioperative Management and Outcomes After Cesarean Section—A Cross-Sectional Study From Rural Rwanda

BackgroundCesarean sections (c-sections), the most common surgical procedures performed worldwide, are essential in reducing maternal and neonatal deaths. There is a paucity of research studies on c-section care and outcomes in rural African settings. The objective of this study was to describe demographic characteristics, clinical management, and maternal and neonatal outcomes among women receiving c-sections at Kirehe District Hospital (KDH) in rural Rwanda. MethodsThis retrospective cohort study included all women aged ≥ 18 y residing in KDH catchment area who delivered by c-section at KDH between April 1 and September 30, 2017. Demographic and clinical characteristics of these women and their newborns were collected using patient interviews and medical chart extraction. Descriptive analyses were performed, and frequency and percentages are reported. ResultsOf the 621 women included in the study, 45.7% (n = 284) were aged 25-34 y; 42.2% (n = 262) were married; 67.5% (n = 419) had primary education; and 75.7% (n = 470) were farmers by occupation. Burundian refugees living in the nearby Mahama Refugee Camp comprised 13.7% (n = 85) of the study population. The most common indication for c-section was having undergone a c-section previously (31.9%, n = 198), followed by acute fetal distress (30.8%, n = 191). Among those with previous c-section as the sole indication for surgery, 85.4% presented as either urgent or emergent cases. Postoperatively, 67.7% spent less than 4 d at the hospital and 96.1% had no postoperative complications before discharge. Approximately 10% (59/572) of neonates were admitted to the neonatal unit, with the most common reason being neonatal infection (59.6%, n = 31). ConclusionsOur study found that previous delivery via c-section was the primary indication for c-section and that most of these cases were emergent or urgent on presentation. This study highlights the need for further research to explore the feasibility, safety, and appropriateness of vaginal birth after cesarean in rural district hospitals in sub-Saharan Africa.

Ultrasound Evaluation of the Cervix to Predict Failed Labor Induction.

Labor induction does not always result in vaginal delivery, and can expose both the mother and the fetus to the risks inherent to the induction procedure or a possible cesarean section. Transvaginal sonography (TVS) of the cervix is a useful tool to predict prematurity; in the present study, this tool was used to evaluate postterm induction. We evaluated the ultrasound characteristics of the cervix (cervical length, cervical funneling, internal os dilation, the presence or absence of the cervical gland area [CGA], and the morphological changes of the cervix as a result of applying fundal pressure) before the onset of labor induction among women with postterm pregnancy to identify the possible predictors of failed labor induction. The Bishop score (BS) was used for comparison purposes. Three groups were evaluated: successful versus unsuccessful induction; vaginal delivery versus cesarean delivery (excluding cases of acute fetal distress [AFD]); and vaginal delivery versus cesarean delivery (including cases of AFD). A fourth group including only the primiparous women from the three previous groups was also evaluated. Based on the studied characteristics and combinations of variables, a cervical length ≥ 3.0 cm and a BS ≤ 2 were the best predictors of induction failure. Although TVS is useful for screening for induction failure, this tool should not be used as an indication for cesarean section.

The Mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: A retrospective cohort study.

The prevalence of post-caesarean scar uterus, the most important risk factor of uterine rupture is increasing globally. Grand multiparity can also increase the risk of uterine rupture. The issue of grand multiparous with single post caesarean scar is poorly investigated.ObjectivesThe purpose of this study was to assess the factors associated with the mode of delivery of grand multiparous with post caesarean single uterine scar in low resources settings.Patients and MethodIt was a retrospective cohort study conducted from the 1st January to the 31st of May 2016, in three university teaching hospitals of the university of Yaoundé I in Cameroon. Grand multiparous (GMP) defined as parity ≥5 with single post-caesarean lower segment uterine scar admitted at a gestational age of 37 completed weeks and above were compared to grand multiparous without scar uterus at term. GMP with unknown scar were excluded. The mode of delivery and materno-fetal and neonatal outcome were investigated.ResultsWe included 33 GMP with single lower segment uterine scar and 120 GMP without uterine scar. Induction of labor and acute fetal distress were not related to having a scar or not in grand GMP, but augmentation of labor was less likely to be conducted in case of GMP with scar uterus(p = 0.08). The frequency of vaginal delivery was 75.8 and 87.5% in grand multiparous with and without uterine scar respectively (OR 0.17–1.16; P = 0.085), with one case of instrumental delivery in scarless group. However, single scar multiparity status increased by 2.42 folds the risk of delivery by caesarian section (P = 0.066). Cephalo-pelvic disproportion increased the indication of caesarian section by 12-fold in the GMP with scar group (p = 0.031), but mechanical dystocia related indications (CPD, macrosomia,) were present in only 4 cases out of 8 caesarian sections in the exposed group. The Apgar score at the fifth minute was better in the GMP with scar group. (p = 0.037).ConclusionGrand multiparous with single post-cesarean uterine scar should be given a chance of vaginal delivery in the absence added feto-maternal morbidity.

Portal hypertension in pregnancy

Objective: We aimed to revise the pregnancy and portal hypertension approach which is rarely seen together and may cause bleeding in esophageal varices. Case Report: A 35-year-old patient with portal hypertension at 38 weeks of gestation according to first trimestr ultrasonography (USG) was admitted to our clinic. At the age of 16, she was diagnosed with liver biopsy. She had had two vaginal births before. The patient did not have 2nd and 3rd trimester screening tests. The detailed USG was normal. The abdominal USG had a liver size of 14.5 cm. Hepatic venules and portal venous diameter were 8.2 mm at the level of the liver hilus. Spleen size was 14.5 cm. In the vicinity of the splenic hilus, the widest 13 mm diameter tortuous veins were observed. A council consisting of Gynecology, Gastroenterology and Neonatology team at 32nd week of pregnancy it was suggested that clinical and laboratory findings were closely followed and vaginal delivery was recommended unless there was an obstetric problem. The pregnancy was terminated by cesarean section because acute fetal distress developed when she was followed on the travay when she applied at 38th gestational week. Meconium 2420 gr 48 cm Apgar score 6/8 male baby was born. Conclusions: Portal hypertension is defined as elevation of blood pressure in the portal vein and its branches over 200-230 mmH2O. Portal hypertension and pregnancy can rarely be confronted. It increases the mortality and morbidity of the baby and the mother. Portal hypertension does not constitute a contraindication to pregnancy. During pregnancy, esophageal variceal bleeding, premature delivery, intrauterine growth restriction and fetal death can occur. In our case, we had a baby born with low birth weight who had cesarean section for an obstetric cause. As a result, the management of complications caused by portal hypertension during pregnancy is similar to that in non-pregnant patients, but a more intensive monitoring and follow-up is necessary.

Delivery Complications of the Single Fat Large Foetus (Macrosomia) with Teenagers at the Obstetrics and Gynaecology Department of the Donka National Hospital, University Teaching Hospital (CHU) of Conakry, Guinea

Objectives: The objectives of this work were to: 1) Calculate the delivery frequency of the large foetus with complications to teenagers; 2) Describe the epidemiological profile of these teenagers; 3) Identify the risk factors of the large foetus and to establish the maternal prognosis and foetus. Methodology: This was a prospective descriptive 6-month study performed at the Obstetrics and Gynaecology Department of the Donka National Hospital, CHU of Conakry, Guinea. We chose a regular amplitude of one year and we got the following slices: 16 years, 17 years, 18 years. Results: We recorded 14.23% (801/5629) teenage deliveries of which 9.4% (75/801) deliveries are single fat fetus and 93.3% (70/75) of them developed complications. The epidemiological profile was that of an 18 years old teenager (61.4%), single (58.6%), professional (44.3%), out of school (57.1%), primiparous (68.6%), having performed 3 - 4 CPN (47.1%), coming from home (65.7%) and carrying a full term pregnancy (100%) and having delivered by high way medical assistance (52.9%). Risk factors were dominated by the male foetus (75.7%). Maternal morbidity was dominated by cervico-perineal tears 28.6%. The recorded maternal mortality was 4.3%. The 3 cases of maternal deaths were caused by the hemorrhage. The APGAR score at the first minute was in 51.4% between 4 and 6; at the 5th minute in 80% between 7 and 10. The most common foetal complication was acute foetal distress 44.3%. Foetal lethality was 12.8%. Conclusion: Here, we demonstrated the teenage pregnancy and macrosomia in this area. We did not show how we can improve this situation based on the data; however, describing this situation may be of use as a fundamental data to make a better antenatal checkup and teenager-education.

Cojoined twins thoracoonfalophagus separation and liver bipartition (case report)

Background: Cojoined twins are a rare phenomenon of monochorionic and monoamniotic twins. The incidence varies from 1 in 50,000 to 1 in 200,000 live births. Female fetuses are more commonly affected, with a ratio of men to women being 1:3, particularly in the thoracic type. The thoraco onfalophagus twins are joined and can share body part as the respiratory, cardiovascular and gastrointestinal systems, besides of thoracoabdominal wall. in the present case shared thoracoabdominal wall and livers and one of the twins has congenital complex cardiac malformation. These types of twins have better chances of survival if they are separated successfully. Methods: We present a rare case of male thoraco onfalóphagus twins successfully separated at 28 days old. We reviewed the postnatal study, the surgical technical aspects of the separation and the postoperative evolution of both twins. These twins are the product of primigesta of 22 years (G1P1001), without significant antecedents, with prenatal diagnosis of double gestation type Siameses thoraco onfalóphagus, the delivery was by caesarean section at 34 weeks of gestation for acute fetal distress. and we confirm that the Siameses are joined by the thoracoabdominal wall; Ultrasound studies and AngioCtScan showed that shared the visceras: heart and liver, the separation surgery was successfully performed with a multidisciplinary team of anesthesiologists, hepatobiliary surgeons, pediatric cardiovascular surgeons, plastic surgeons, pediatric surgeons, Results: The intraoperative findings, hearts and independent great vessels were seen, the pericardium, diaphragm and costal arches were shared, absence of sternum, the livers were joined by a bridge with an area of approximately 7 cm2 of parenchyma and maintained independence from the portal systems, A left portal branch coming from siamese 2 was common, veins cavas and suprahepatic veins as well as the biliary system were independent, there was a complex cardiac malformation in the Siames 1 (double exit route from the right ventricle, subvalvular and pulmonary valve stenosis, double-related ventricular septal defect) and malformation cardiac failure in the Siamese 2 (interatrial communication without hemodynamic repercussion), intestinal malrotation in the Siamese 1. Successful separation of the Cojoined twins was achieved through hepatic transection with ultrasonic dissector (CUSA), in addition to the use of monopolar and bipolar electrocautery, the shared portal vein was sutured; The separation of the thoracic and abdominal wall components described was carried out. In siamese 1 the total closure of the chest wall was not achieved and it was covered with a dermal patch that guarantees the posterior reconstruction, the abdominal wall was closed satisfactorily with lateral incisions of discharge. In siamese 2, satisfactory closure of the chest wall and abdominal wall with lateral discharge incisions was achieved. Conclusion: The management of cojoined twins together remains a medical challenge, due to multiple congenital anomalies associated, as in this case they lead to low success rate. The specialized and multidisciplinary integral management of these cojoined twins is necessary to guarantee success in terms of reducing complications and increasing survival. In this particular case, we performed the separation of thoracoonfalophagus and liver Bipartition succesfully and the current evolution is satisfactory, with emphasis on the subsequent correction of chest wall defects and associated cardiac congenital malformations.

Iron and Oxidative Status Following Routine Iron Supplementation: Reflection on Pregnancy Outcomes in a Cohort of Women in Kinshasa, DR Congo

Background: Anemia during pregnancy is associated with oxidative stress, which might expectedly provoke harmful consequences on maternal and perinatal outcomes. Use of iron in women during pregnancy improves maternal hematologic parameters, while likely to worsen oxidative status. Objectives: Our study thus aimed to assess adverse outcomes on all women having been routinely iron supplemented during pregnancy. Methods: This is a prospective observational cohort of 74 pregnant women with singleton pregnancy whose baseline iron and oxidative status along with variations throughout pregnancy have been recently assessed at university clinics of Kinshasa, DR Congo. Obstetrical adverse outcomes were assessed according to the diagnosis of anemia and oxidative stress considered at recruitment, at 28 - 32 weeks of gestation and at term. For statistical calculations, we used t-test, chi-square test, ANOVAR and regression, the significance being stated at p Results: Complications significantly associated with anemia at the beginning of pregnancy were acute fetal distress (OR = 3.9, p As of oxidative stress diagnosed at recruitment, significant associations were found with PROM (OR = 9, p Conclusion: Outcomes found significantly associated with oxidative stress seem to overlap those linked to anemic condition. Similarity between complications of anemia and that of oxidative stress is more observed at 28 - 32 weeks of gestation. This strongly suggests that major correction in both anemic and oxidative status should be initiated long before this landmark.

Cesarean section rate and pattern of indications in a tertiary care maternity hospital in Kashmir: A cross-sectional analytical study

Background: WHO advises that lower segment cesarean section (LSCS) rates should not be more than 15%. A caesarean section (CS) is a life-saving surgical procedure when certain complications arise during pregnancy and labour. However, it is a major surgery and is associated with immediate maternal and peri-natal risks and may have implications for future pregnancies. Worldwide, CS rates increased up to 3 times in 14 years, from 6.7% in 1990 to 19.1% in 2014. Objectives: To determine the rate of LSCS deliveries and pattern of indications for LSCS in a tertiary care maternity hospital in Kashmir. Methodology: An observational study was carried out where in all the pregnant females who delivered in the month of December in a tertiary care hospital were enrolled in the study. The mode of delivery was ascertained and in case of LSCS, the primary indication for LSCS was noted down. Results: In our study total number of deliveries were 1823 including 663 (36.36%) vaginal deliveries and 1160 (63.63%) LSCS. The commonest indication of LSCS was previous caesarean section in 37.2% followed by acute fetal distress (21.6%) and cephalo pelvic disproportion (CPD) 10.6%. Conclusion: The LSCS rate in our study is very high compared to the WHO standards and previous LSCS is the commonest indication followed by AFD and CPD. It is an eye opener to health care policy makers and other stakeholders, to formulate the guidelines for the absolute indications of Caesarean section.

A successful conservative management of ruptured subcapsular hepatic hematoma with pre-eclampsia

Ruptured subcapsular hematoma of the liver is a rare complication of pregnancy, commonly associated with pre-eclampsia or HELLP syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome). We report a case of a 32-year-old woman, with no particular antecedents, admitted to our emergency department at 32 weeks of amenorrhea, for pre-eclampsia with epigastralgia. The liver ultrasound performed at admission was normal. In the presence of acute fetal distress, a caesarean section with midline vertical incision was performed urgently. The surgical exploration revealed massive haemoperitoneum with ruptured subcapsular hepatic hematoma. The management consisted of hepatic packing with massive transfusion. Removal of packing was performed on the fourth day after stabilization and regression of hepatic encephalopathy. Fortunately, the evolution was favorable and the patient was discharged after 4 weeks of hospital stay in stable condition. The ruptured subcapsular hematoma of the liver remains a very challenging situation and potentially life-threatening condition.

A rare cause of postpartum hemorrhage: the genital thrombus

We report the case of a 30-year old primiparous patient, having given birth to a 3500g boy by cesarean section due to acute fetal distress. Two hours after childbirth, the patient had bilateral painful ecchymotic vulvar swelling suggesting post-partum thrombus of the vulva. Given the clinical stability of the size of this hematoma, the absence of unbearable pain and the stable hemodynamic status, conservative medical treatment (ice bag + NSAIDs). Output was favorable with progressive decrease in the size of the hematoma until disappearance 8 weeks after delivery. Thrombus or genital hematoma is a rare but potentially very serious post-partum haemorrhagic complication. There are four major types of genital hematomas: hematoma of the vulva, vulvo-vaginal hematoma, vaginal hematoma and pelvic-abdominal hematoma. The contributing factors are primiparity, instrumental extractions, toxaemia of pregnancy, twin pregnancies and vulvovaginal varicose veins. It is essential to suspect it in patients with pain and/or internal postpartum hemorrhage, and, if any doubt exists, to perform vulvovaginal inspection. Early treatment is necessary and should be associated with hemodynamic resuscitation, first-line surgery and percutaneous radiologic arterial embolization in case of failure of surgery.

CLINICAL, SUB-CLINICAL CHARACTERISTICS AND MANAGEMENT OF ACUTE FETAL DISTRESS AT MATERNITY DEPARTMENT OF HUE CENTRAL HOSPITAL

Objective: Examination ofclinical, sub-clinical characteristics and attitudes of management of acute fetal distress at Maternity Department, Hue Central Hospital. Methods and Material: Descriptive cross sectional study on 208 acute fetal distress patients at Maternity Department of Hue Central Hospital from 06/2016 – 03/2017. Results: DIP II: 35.6% and Apgar score after birth &lt; 7: 4.1%, variability &lt; 5 bpm: 7.2%, and Apgar score after birth &lt; 7: 6.7%. Dark green amniotic fluid: 25.0% and increase after birth. Apgar score/1 minute &lt; 7: 1.9%, Apgar/5 minutes &lt; 7: 0.5%. Medical treatment: infusion, oxygen, lying on the left side are the most used methods. Management of obstetric use including caesarean (94.2%), Forceps (1.5%), natural childbirth (4.3%). Conclusions: Follow Monitoring changes and amniotic fluid color are very valuable in the diagnosis of acute fetal distress. Treatment of acute fetal distress is a combination of medical and obstetric treatment. Key words: Acute fetal distress, green amniotic fluid, cardiotocography

Diagnóstico prenatal del síndrome de Jarcho-Levin

El síndrome de Jarcho-Levin es una rara entidad heterogénea caracterizada por dismorfia facial, extremidades de tamaño normal con cuello y tronco corto, múltiples anomalías vertebrales en todos los niveles de la columna vertebral y defectos costales. El síndrome se ha clasificado en 2 fenotipos clínicos principales, según la extensión y distribución de las anomalías esqueléticas, el patrón de herencia y el pronóstico. El diagnóstico ecográfica prenatal se caracteriza por la presencia de costillas desplegadas a partir de cuerpos vertebrales torácicos fusionados. Debido a la rareza de esta condición, existe un número limitado de informes en la literatura científica y muy pocos se diagnostican prenatalmente. Es un caso de síndrome de Jarcho-Levin en una mujer de 16 años con embarazo de 31 semanas y sin antecedentes patológicos prominentes. La ecografía reveló feto único con datos biométricos compatibles con 27 semanas. Se observó columna vertebral acortada con deformidad extrema y escoliosis moderada, canal medular ancho, segmentación de cuerpos vertebrales en las áreas torácicas y lumbares inferiores, aumento de la distancia intervertebral con tórax corto y estrecho, cuello corto hiperflexionado y occipucio que parecía fusionarse con las vértebras cervicales. Se realizó cesárea debido a sufrimiento fetal agudo, obteniendo recién nacido masculino. El examen físico mostró circunferencia cefálica normal, tórax corto, cuello corto y rígido, cifoescoliosis torácica con restricción del patrón respiratorio y abdomen abultado. No se observaron alteraciones faciales o craneales. Después de 4 días, el recién nacido muere debido a falla respiratoria aguda.

Factores relacionados a partos por cesárea en el Hospital II EsSalud de Huánuco

Introducción: El objetivo del presente estudio fue determinar la frecuencia de las cesáreas en el Hospital II EsSalud - Huánuco e identificar los factores relacionados a su ocurrencia. Métodos: Diseño descriptivo transversal. La variable dependiente fue “tipo de parto” y las variables independientes incluyeron características clínicas y no clínicas. Para la obtención de los datos se utilizaron las historias clínicas. Se realizó un análisis bivariado de las variables clínicas, usando la prueba chi-cuadrado y la prueba exacta de Fisher; además, se asoció con razón de prevalencia (RP); el análisis estadístico de la variable no clínica se realizó con la correlación de Pearson. Resultados: La tasa de cesárea obtenida fue de 37,16%, encontrándose asociación entre cesárea y las variables cesárea previa [p=0,000; RP: 2,81 (IC: 2,12-3,72)], presentación fetal [p=0,034; RP: 2,14 (IC: 1,37-3,34)], desprendimiento prematuro de placenta [p=0,039; RP: 2,61 (IC: 1,73-3,94)], sufrimiento fetal agudo [p=0,000; RP: 2,68; (IC: 1,99-3,60)], ruptura prematura de membrana [p=0,011; RP: 1,76 (IC: 1,20-2,58)], placenta previa (p=0,013; RP: 2,71 (IC: 1,92-3,82)] y disturbio de líquido amniótico (p=0,012; RP: 1,90 (IC: 1,26-2,88)]; no siendo estadísticamente significativas las variables macrosomía fetal, hipertensión inducida por el embarazo, tratamiento por infertilidad, embarazo múltiple y condilomatosis. La variable no clínica “médico” no fue significativa. Conclusiones: La tasa de cesárea en el Hospital II EsSalud- Huánuco fue de 37,16%; los factores relacionados a cesárea fueron cesárea previa, presentación fetal, desprendimiento prematuro de placenta, sufrimiento fetal agudo, ruptura prematura de membrana, placenta previa y disturbio de líquido amniótico.

Velamentous Cord Insertion – A Case Report

Normally the umbilical cord is inserted into the central portion of placenta; at times the cord is inserted distally from the margin; onto the fetal membranes, called velamentous insertion. After the insertion the umbilical vessels traverse unsupported for a variable distance between amnion and chorion before reaching the placenta. These vessels can get compressed and torn especially in labour resulting in acute fetal distress and at times fetal death. We report a case where the cause of fetal distress during labour was compression of these vessels. There is a strong case of finding out site of cord insertion when the antenatal cases are undergoing routine sonography. Once abnormal insertion is detected then these pregnancies should be monitored closely as the chances of both antenatal and intranatal complications are higher in such pregnancies.

Spontaneous Sigmoid Colon Rupture Secondary to Endometriosis in the Third Trimester of Pregnancy

Background: Endometriosis is a common benign gynecologic condition. When it occurs during pregnancy, the symptoms typically lessen. Endometriosis-associated, spontaneous sigmoid-colon rupture in pregnancy is extremely rare and requires a surgical solution. Case: A woman 30½ weeks pregnant developed an acute abdomen and fetal distress. During a cesarean section, a ruptured sigmoid colon was discovered and a colostomy was placed. Results: Postoperatively, this patient developed exudative bilateral pleural effusions that required thoracentesis. Conclusions: Endometriosis is a rare cause of sigmoid-colon perforation in pregnancy and can occur even when there is no history of endometriosis. (J GYNECOL SURG 34:40)

Study of fetal heart rate abnormalities observed on cardiotocography in Lubumbashi: about a cases followed at the Lubumbashi University Clinic and the General Hospital of the Cinquantenaire

L'usage du cardiotocographe (CTG) est très récent à Lubumbashi mais aucune étude approfondie n'est encore menée pour dégager son impact sur la morbi-mortalité périnatale. L'objectif de cette étude est de déterminer la fréquence des anomalies du rythme cardiaque fœtal (RCF), d'en rechercher les facteurs associés afin de proposer une prise en charge appropriée. Il s'agit d'une étude descriptive transversale réalisée durant 19 mois (de mars 2015 à décembre 2016) chez 411 parturientes. En présence des anomalies pathologiques du RCF, la sensibilité et la valeur prédictive positive de l'examen cardiotocographique, dans le dépistage de la souffrance fœtale aigue étaient respectivement de 82,95 et 45,35%. Les anomalies du RCF étaient retrouvées chez deux parturientes sur cinq. Les décélérations étaient les plus fréquentes de toutes les anomalies du RCF observées (50,8%) avec une prédominance remarquable des décélérations tardives (22,1% de toutes les anomalies). Les facteurs associés aux anomalies pathologiques du RCF étaient le travail prolongé (OR = 14,64, IC = 3,91-54,81), la chorioamniotite (OR = 14,56, IC = 3,83-55,34), l'anémie chronique maternelle (OR = 4,99, IC = 1,48-16,85), La primiparité (OR = 2,69, IC = 1,49-4,85), la prématurité (OR = 2,90, IC = 1,51-5,54) et la grossesse prolongée (OR = 3,22, IC = 1,38-7,52). Le Retard de Croissance Intrautérin et l'hypertension artérielle étaient associés particulièrement aux tracés plats et aux décélérations tardives (OR = 7,79, IC = 2,50-24,30 et OR = 2,74, IC = 1,31-5,72). Le CTG est un outil de dépistage de la souffrance fœtale aigue mais avec un taux élevé de faux positifs (55%); il convient de lui associer les autres moyens de dépistage de la souffrance fœtale aigue de seconde ligne en vue de réduire ce taux. Les facteurs associés aux anomalies pathologiques du RCF sont souvent à l'origine des causes de la souffrance fœtale aigue et exigent ainsi une analyse rigoureuse des tracés du CTG.