Good Perinatal Outcome Research Articles

Early procedure‐related complications of fetal blood sampling and intrauterine transfusion for fetal anemia

To review the procedure-related complication rates following fetal blood sampling and intrauterine red cell transfusion for anaemic fetuses at a single tertiary center. A retrospective study of 114 intrauterine transfusions. A single tertiary referral fetal medicine center at Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK. All cases (114) undergoing fetal blood sampling and intrauterine transfusion between January 2003 and May 2010. Early procedure-related complications (severe fetal bradycardia requiring either abandonment of the procedure or emergency delivery, fetal death, preterm labor or rupture of membranes) were investigated by review of computerized records and individual chart review. Live birth rate, perinatal mortality, procedure-related fetal bradycardia, preterm labor and procedure-related spontaneous rupture of membranes. The majority of cases (77.8%) were due to red cell alloimmunization, with anti-D being the commonest cause. The live birth rate was 93.5%, with a procedure-related fetal death rate of 0.9%. The preterm labor rate (<37 weeks' gestation) was 3.5% only occurring in patients undergoing multiple (>3) fetal transfusions. Complications in this series did not appear to be increased the earlier the gestation at which the first transfusion took place. Despite a reduction in the number of cases requiring intrauterine therapy for fetal anemia, contemporary outcomes appear to be good if not improving. It is important that the experience required to manage these cases should be concentrated in fewer centers to maximize good perinatal outcome.

Management of Pseudohypoparathyroidism Type 1a during Pregnancy and Labor: A Case Report

Pseudohypoparathyroidism is rare during pregnancy and poses multiple challenges related to its diagnosis and management during pregnancy. We hereby report a case of a young woman who was diagnosed to have type 1a pseudohypoparathyroidism. She was managed by multidisciplinary team and had good maternal and perinatal outcome. Management-related issues are discussed here in detail.

P10 Maternal death in Brazil last ten years: late maternal mortality rises

Objective: This study was undertaken to determine maternal and perinatal outcomes after expectant management of severe preeclampsia between 24 and 33 weeks’ gestation. Study design: This was a retrospective analysis of outcome in patients with severe preeclampsia between January, 2005 and December, 2009. Thirtysix patients with severe preeclampsia geatational aged 24-33 weeks were studied. Corticosteroids were administered. Perinatal and maternal complications (a composite maternal morbidities including HELLP syndrome, pulmonary edema, eclampsia, and renal insufficiency) were analyzed. Results: Mean of gestational aged was 30.7 weeks. The days of pregnancy prolongation were 5 days (range 2-22). There were five perinatal deaths (13.88%), four cases in those managed at < 28 weeks and one case in those managed at 28-30 weeks. Cesarean section rate was 94.44%. Maternal morbidities developed in four cases, two pulmonary edema, one placental abruption and one HELLP syndrome. There was no maternal death. Conclusion: Expectant management of severe preeclampsia at 24 to 33 weeks is associated with good perinatal outcome with a minimal risk for the mother. However, it should be done in the tertiary care center with close maternal and fetal monitoring.

Trends and correlates of good perinatal outcomes among singleton infants conceived through ART in the US, 2000-2005

OBJECTIVE: During 2000-2005, 271,270 assisted reproductive technology (ART) births occurred in the U.S.; of these 132,533 (48.9%) were singleton births. We analyzed data to evaluate trends in and correlates of the delivery of a term, normal birthweight singleton infant after ART.DESIGN: Retrospective analysis of National ART Surveillance System (NASS) data.MATERIALS AND METHODS: The outcome was defined as the delivery of a term (>37 weeks gestation), normal birthweight infant (> 2,500 grams). Data on all singleton infants born after ART during 2000-2005 and reported in NASS were assessed for trends using chi-square tests. Data from 2005 were examined for bivariate associations, and adjusted odds ratios (AOR) and 95% confidence intervals (95%CI) were computed using multiple logistic regression. Covariates included demographic characteristics, fertility history, infertility diagnosis, type of ART treatment, number of embryos transferred, and number of fetal hearts detected during pregnancy.RESULTS: From 2000 to 2005, the percentage of singleton ART births with a good outcome decreased from 83.6% to 82.9% (p=0.004). The odds of a good outcome were higher for women with one prior birth (AOR 1.25, 95%CI1.09-1.43), women whose reason for ART was male factor infertility (AOR 1.18, 95%CI1.08-1.28), and women who used their own fresh embryos rather than patient or donor thawed embryos (AOR 1.13, 95%CI1.03-1.23). The strongest effect was for the detection of 1 versus >1 fetal heart (AOR 1.79, 95%1.61-1.99).CONCLUSION: Birth history, certain fertility diagnoses, and embryo type affect pregnancy outcomes among ART singletons. Results indicate that singleton births resulting from singleton pregnancies do substantially better. Enhanced promotion of single embryo transfer would decrease the risk of adverse outcomes among ART singletons. OBJECTIVE: During 2000-2005, 271,270 assisted reproductive technology (ART) births occurred in the U.S.; of these 132,533 (48.9%) were singleton births. We analyzed data to evaluate trends in and correlates of the delivery of a term, normal birthweight singleton infant after ART. DESIGN: Retrospective analysis of National ART Surveillance System (NASS) data. MATERIALS AND METHODS: The outcome was defined as the delivery of a term (>37 weeks gestation), normal birthweight infant (> 2,500 grams). Data on all singleton infants born after ART during 2000-2005 and reported in NASS were assessed for trends using chi-square tests. Data from 2005 were examined for bivariate associations, and adjusted odds ratios (AOR) and 95% confidence intervals (95%CI) were computed using multiple logistic regression. Covariates included demographic characteristics, fertility history, infertility diagnosis, type of ART treatment, number of embryos transferred, and number of fetal hearts detected during pregnancy. RESULTS: From 2000 to 2005, the percentage of singleton ART births with a good outcome decreased from 83.6% to 82.9% (p=0.004). The odds of a good outcome were higher for women with one prior birth (AOR 1.25, 95%CI1.09-1.43), women whose reason for ART was male factor infertility (AOR 1.18, 95%CI1.08-1.28), and women who used their own fresh embryos rather than patient or donor thawed embryos (AOR 1.13, 95%CI1.03-1.23). The strongest effect was for the detection of 1 versus >1 fetal heart (AOR 1.79, 95%1.61-1.99). CONCLUSION: Birth history, certain fertility diagnoses, and embryo type affect pregnancy outcomes among ART singletons. Results indicate that singleton births resulting from singleton pregnancies do substantially better. Enhanced promotion of single embryo transfer would decrease the risk of adverse outcomes among ART singletons.

Maternal and Perinatal Outcome in Pregnancies Following Infertility

ABSTRACTContextGeneral practitioners as well as obstetricians are coming across a large number of pregnant women whose conceptions are following a period of infertility or treatment for the same. There is a controversy in the literature regarding the occurrence of adverse outcomes of pregnancy in such women.AimsTo assess the maternal and perinatal outcome in pregnancies that occurred after a period of infertility and to compare the outcome in spontaneous conceptions with the conceptions following treatment for infertilitySettings and DesignRetrospective analysis of hospital records of 200 pregnancies following infertility during the year 2009 in a tertiary care center in South India.Material and MethodsAll the women were divided into two groups,viz: Group 1—those who had history of infertility but conceived spontaneously and Group 2—those with history of infertility and conceived only after treatment for infertility. The main outcome measures were antenatal complications and adverse neonatal complications.Statistical analysisThe statistical package SSPS version 15.0. Chi-square and student ‘t’ test was used for nonparametric and parametric variables.ResultsThe incidence of hypertension was 60% and that of gestational diabetes was 7%. Obstetric complications included increased incidence of preterm labor (23.5%) and premature rupture of membranes (38%). There was no statistically significant difference in both groups though the medical complications especially hypertension was high in the pregnancies following spontaneous conceptions, i.e. untreated group. There was a greater demand for the NICU care mainly because of prematurity. The PNMR was (40/1000) less than the institutional rate of 72/1000 births.ConclusionsThere is increased incidence of hypertension premature rupture of membranes and preterm delivery in pregnancies following infertility. There is no significant statistical difference in the adverse pregnancy outcomes between spontaneous conception and those treated for infertility.Key MessagesPregnancies following infertility are at increased risk of developing hypertension and preterm labor and hence these women should be screened for the same and preventive measures to be undertaken to achieve good maternal and perinatal outcome.

Acardius acormus: una presentación atípica en el embarazo gemelar. Revisión de la literatura

Objetivo: presentar un caso de una gestación gemelar monocoriónica biamniótica con acardia fetal para revisar su diagnóstico y manejo.Presentación del caso: se reportó el caso de un feto acardius acormus en un embarazo gemelar monocoriónico biamniótico diagnosticado a la semana 21 + 4 días, por lo cual se realizó posterior seguimiento del caso.Metodología: se revisó la historia clínica y los resultados de ayudas diagnósticas de la paciente. Posteriormente, se realizó una búsqueda bibliográfica en las bases electrónicas PubMed y SciELO.Resultados: se llevó a cabo la revisión de la literatura con respecto a este caso poco frecuente y se encontraron 30 artículos relacionados. De éstos, se seleccionaron 15 en total: 9 artículos de revisión, 2 reportes de caso, 3 series de casos y 1 nota de epidemiología.Conclusiones: la acardia fetal es una de las complicaciones poco frecuentes de la gestación gemelar monocoriónica, cuya génesis y tasa de complicaciones se debe a las comunicaciones vasculares placentarias. El diagnóstico temprano y la vigilancia del caso presentado probablemente establecieron el buen desenlace perinatal.

Maternal Risks Factors and Delivery Outcome of Fetal Macrosomia in Zaria, Northern Nigeria

Although macrosomia may be associated with adverse maternal and perinatal outcome there is paucity of recent data regarding fetal macrosomia in our setting. This study was undertaken to document the prevalence and risk factors associated with fetal macrosomia and also to determine the maternal and perinatal outcome associated with the condition in Ahmadu Bello University Teaching Hospital Zaria, Nigeria. The study was a cross sectional comparative study that was carried out over a five year period (Jan 2001-Dec 2005). Case records of 207 mothers of macrosomic infants (cases) and records of 220 mothers of normal birth weight infants (control) were reviewed. Fetal characteristics such as sex, birth weight, and perinatal complications were also analyzed and compared between the two groups. The prevalence of fetal macrosomia from the study was 4.2%. There was strong association between diabetes mellitus, previous history of macrosomia, gestational age of > 40 weeks, male infant sex and a body mass index at booking of > 30 with fetal macrosomia. Maternal parity was found not to be significantly associated with fetal macrosomia. Labour was significantly prolonged, and there was associated prolonged hospital stay, primary postpartum haemorrhage and genital tract laceration in women with fetal macrosomia. The incidence of caesarean section was three times more in mothers with macrosomic infants compared to mothers with normal weighed infants. There was no maternal mortality recorded. The mean Apgar score at 1 and 5 minutes was not statistically different in the two groups. The stillbirth rate in the macrosomic infants was 4.8% compared with 2.3% among normal weighed babies. It can be concluded that macrosomia is a relatively common complication of pregnancy in our setting and is associated with maternal factors such as obesity, diabetes, previous macrosomia, prolonged pregnancy and adverse perinatal outcome. Identifying the risk factors to fetal macrosomia during antenatal period will be useful to plan appropriate delivery management to optimise good perinatal and maternal outcome.

Relevance of new recommendations on routine antenatal prevention of rhesus immunization: An appraisal based on a retrospective analysis of all cases observed in two French administrative areas of 3 million inhabitants

Objective To assess the potential impact of new guidelines recommending routine antenatal prophylaxis at 28 weeks of pregnancy on incidence, consequences and cost of rhesus immunization. Study design All rhesus immunizations of 224,500 ongoing pregnancies in two neighbouring administrative areas in France between 2000 and 2006 were enrolled in this retrospective study. To determine the aetiology of immunization and to specify when sensitization occurred, we searched sensitizing events between the last negative and the first positive red-cell antibody test results. Perinatal consequences and costing were also analyzed. Results From 138 rhesus negative women bearing anti-D antibodies, none had received routine prophylaxis at 28 weeks. 37% were primary immunizations and 63% were reactivating former immunization. 63% sensitizations occurred after unprovoked foetal-maternal haemorrhage, mostly after 28 weeks (54%). Twenty-five (18.1%) sensitizations resulted from inappropriate management of existing prophylaxis. Immigrants with previously acquired antibodies accounted for 10% of cases. There was no foetal demise and none born before 28 weeks among our 140 babies. Only 25% required intensive care, mostly those born to mothers reactivating immunization, with an overall good perinatal outcome. Systematic 28-week prophylaxis would have cost about €2.5 million to reduce overall cost of immunizations by €0.6 million. Conclusions The incidence of rhesus immunization in our population was low at 0.41‰. Routine antenatal prophylaxis could have avoided 54% of these immunizations but expected perinatal benefits are low, as newborns with the worst issue were born to mothers with unavoidable immunizations. Therefore the cost-effectiveness of this strategy is doubtful.

Third trimester fetoscopic laser ablation of type II vasa previa

Vasa previa is associated with increased perinatal morbidity and mortality because of fetal exsanguination at time of membrane rupture. We report our experience in the treatment of type II vasa previa via in utero laser ablation in the third trimester. Two cases of type II vasa previa were identified via endovaginal ultrasound in the second trimester and treated via third trimester fetoscopic laser ablation. In case 1, fetoscopic laser ablation of the vasa previa was performed without complication at 28 3/7 weeks' gestation as a prophylactic measure. The patient delivered at 33 3/7 weeks' gestation after rupture of membranes without sequelae with good perinatal outcome. In case 2, expectant management of twins with a vasa previa was planned. However, significant cervical shortening and funneling was documented at 30 5/7 weeks', and the risk of membrane rupture was deemed relatively high. As a therapeutic alternative to outright preterm delivery, the patient underwent uncomplicated laser ablation of the vasa previa. Delivery occurred at 34 3/7 weeks' after rupture of membranes, and the twins did well. We suggest that type II vasa previa can be definitively treated in utero by laser photocoagulation in the third trimester. Ablation of the vasa previa may be performed prophylactically or as a therapeutic measure to delay delivery if symptoms of preterm labor and/or cervical shortening develop.

Pregnancy and perinatal outcomes after assisted reproduction: a comparative study

Dear Editor, We welcomed the paper by Allen et al. [1] which provides reassurance about the rate of congenital malformations in babies delivered after assisted reproductive technology (ART). Their data are in close agreement with previous research [2], where an increased risk of placenta previa after in vitro fertilisation (IVF) was identified. As Allen et al. note, however, the true incidence of stillbirth and miscarriage after IVF remains unknown, because the scope of their investigation did not include all IVF pregnancies (i.e., only deliveries known to have good perinatal outcomes were sampled). While their study did achieve a questionnaire return rate of 65% from these parents of IVF children, the study design could not identify common demographic or clinical characteristics among the non-responders. From a public health perspective, information on this important sub-group of IVF patients would be highly informative. As Allen et al. [1] correctly note, the impact of IVF on the course of pregnancy is not yet fully understood. For example, anecdotal reports of mature stillbirths in IVF patients who go beyond 40 weeks gestation have been frustrating to assess systematically. It is hoped that future epidemiologic studies will address this issue. In the meantime, we agree with others [3, 4] that in the absence of standardised protocols for the obstetric management of pregnancies conceived with IVF, it is prudent for such gestations to be regarded as high-risk.

The placenta as a barrier to high conjugated bilirubin levels – - The case of an unexpected good maternal and perinatal outcome after acute hepatitis E infection in an HIV positive woman

Introduction: Hepatitis E virus (HEV) infection in pregnancy results in high rates of preterm labour, antepartum haemorrhage, poor fetal outcomes, intrauterine fetal deaths and maternal mortality. Case: A 32 year old G1/P0 HIV-positive Nigerian woman presented at the 27th week of gestation with abdominal pain and jaundice. The ultrasonographic evaluation showed a normal sized fetus, normal umbilical and cerebral Doppler values, but an oligohydramnios. The fetal heart rate showed a decreased variability. Blood pressure and urine test was normal. The initial labs showed normal platelets but signs of beginning liver failure (ALT 1683 U/l [10–35 U/l], total bilirubin 43mg/dl [0–1.2mg/dl] and haemolysis (haptoglobin &lt;5mg/dl [30–200mg/dl], figure 1). The patient was hospitalised with the diagnosis of beginning liver failure of unknown origin and anti-HIV treatment was stopped. HEV RNA, initially negative, seroconverted on day 17. Betamethasone i.m. 2×12mg was given. Due to an increased HIV load of 106 copies/ml antiviral therapy was restarted and NFV was exchanged for tenofovir (TDF). With this regimen liver enzymes and haemolysis normalized. A scheduled caesarean section for prevention of vertical transmission of HIV infection was performed at week 36. The fetal outcome was excellent (Apgar-Score 9/10/10, pH: 7.31, total bilirubin level: 7.9mg/dl). Now, 9 months after birth, the child is still developing normal. HIV and hepatitis serologies are negative. Discussion: The unexpected good perinatal outcome underlines in our view the clinical importance of the placenta as an efficient barrier to even high conjugated bilirubin levels. Interdisciplinary team-work was crucial in the management of this case.

OP19.06: Predicting neonatal prognosis in 40 fetuses with isolated congenital diaphragmatic hernia using the “ultrasonographic fetal lung volume to body weight ratio”

Background: CCAM is an uncommon pathology that involves proliferation of terminal respiratory bronchioles. The diagnosis is often made in the prenatal period using ultrasound. The antenatal diagnosis has become more frequent with increasing sonographer training and higher resolution ultrasound imaging platforms. Methods: This was a retrospective analysis of all fetuses of CCAM diagnosed antenatally that were born in our department during last three years. The ultrasound diagnosis was confirmed by prenatal MRI scan in all cases. Results: In a 3-years period, 14 cases of fetal CCAM were reffered for further management. All the lesions were noted to be unilateral CCAMs. The gestational age at diagnosis was 16–22 weeks. Two cases were diagnosed as CCAM type I (14%), 5 CCAM type II (36%) and 7 CCAM type III (50%). In two cases diagnostic type of CCAM was different from US and MRI investigations. The lesions were usually complicated by varying degrees of mediastinal sfift (78%). Severe hydrops fetalis was present in two cases only (14%). All the fetuses had normal karyotype. Termination of pregnancy was performed in three cases. Spontaneous regression of the sonographic appearances during pregnancy was observed in 46% (5/11) cases. All cases had good perinatal outcome (91% after postnatally surgery). Conclusions: The postnatal outcome of fetal CCAM is better than previously assumed, probably because of the detection ob subtle lesions and the high rate of prenatal spontaneous resolution of such tumors. Supported by grant VZ FNM 00064203/6202.

Hypothyroidism complicating pregnancy.

In this report we describe 26 pregnancies complicated by hypothyroidism cared for over 6.5 years at AIIMS, New Delhi. In 2 women hypothyroidism was diagnosed during pregnancy; others were diagnosed before pregnancy and continued to receive thyroxine replacement therapy throughout pregnancy. The thyroxine treatment needed readjustment in 7 (26.9%) pregnancies to maintain euthyroidism. Maternal complications included anaemia (23.0%), pregnancy induced hypertension (26.9%), postpartum haemorrhage (7.7%), intrauterine growth retardation (15.4%), postdatism (30.8%), and deficient lactation (19.2%). Perinatal mortality was 3.9%. No case of stillbirth occurred probably because of intensive fetal monitoring and timely termination of pregnancies on evidence of intrauterine fetal compromise. One neonatal death occurred due to fetal thyrotoxicosis. In these cases close surveillance during pregnancy is needed to maintain optimum thyroid hormone concentration, and intensive fetal monitoring is required to achieve a good perinatal outcome.

Macrosomía fetal. Resultados obstétricos y neonatales

Objective A longitudinal descriptive retrospective study was performed of neonates weighing more than 3,999 g born in the Obste trics and Gynecology Service of the University Maternity Hospital of the Canary Islands (Spain) from January 1 st, 1992 to December 31 st, 2002. Subjects and methods Data were taken from the medical records of mothers and newborn infants. Statistical analysis was performed of 2,037 newborns weighing 4,000 g or more. Subsequently, the following variables were analyzed: age at delivery, parity, gestational age, pregnancy-related conditions, onset and route of delivery, sex of the infant, Apgar score, fetal artery pH, intensive care unit admission, fetal and neonatal mortality, hemorrhagic complications, and birth canal trauma. These data were compared with those in a control group of infants weighing less than 4,000 g at birth and delivered in the same period. Results The incidence of macrosomia was 5.3%. Most of the mothers (79.4%) were aged between 17 and 34 years old and 54.4% were multiparous. Three-quarters (74.6%) of deliveries were at term, with spontaneous onset in 66.7% and normal delivery in 64.1%. Most of the newborns were boys (67.3%) with good perinatal outcomes. In the macrosomic group, birth canal trauma was found in 74.07%, pregnancy-related conditions in 25.97%, hemorrhagic complications in 2.95%, and shoulder dystocia in 2.061%. Conclusions In tables 1, 2, 3 and 4 are related the final data. Statistically significant differences with p less than 0.001 are demonstrated in the following data: older age of 34 years at the time of delivery, multiparity, gestation chronological prolonged, male fetal gender, delivery induction, rates of cesaran section, neonatal income in intensive care unit, and extended perinatal mortality.

OP02.04: Prenatal intervention in fetuses with severe congenital diaphragmatic hernia and congenital cystic adenomatoid malformation

Objectives: The natural history of echogenic lung lesions such as congenital cystic adenomatoid malformation (CCAM) and pulmonary sequestration (PS) has been altered by the advent of antenatal ultrasonography. Initial reports were characterized by a high incidence of adverse features (hydrops) and a poor outcome and did not accord with recent experience. Our purpose was to review the evolution and outcome of these lesions in our series. Methods: A retrospective review was conducted on fetuses diagnosed antenatally in the Fetal Medicine Unit of Hospital Vall d Hebron in Barcelona, Spain, between 2001 and 2007. A computer search identified all referred cases, and the records of these patients were examined to determine the pregnancy outcome. Results: In a 6-year period, 34 fetuses with echogenic lung lesions were referred for further management. The median age at diagnosis was 23 (range, 20–41) weeks. The lesion was on the right side in 19 (55%) and 15 (45%). All cases were unilateral. One case was diagnosed as CCAM type I (3%), 14 CCAM type II (41%) 11 CCAM type III (32%), 3 PS (8.8%) and five were mixed PS/CCAM (15%). All the fetuses had no associated anomalies and normal karyotype except one (47 XX+18). Termination of pregnancy was performed in seven cases of CCAM. In all cases histologic examination showed definitive diagnostic features of CCAM. In two cases diagnostic type of CCAM was changed from CCAM type II to type I and from CCAM type III to type II. Mediastinal shift was present in 16 fetuses (47%). Severe signs of fetal distress (hydrops) were present in three (8.8%). Because of hydrops, antenatal intervention was performed in two fetuses (thoracoamniotic shunting) and it was resolved. During the course of the pregnancy 70.5% (24/34) cases reduced in size or resolved spontaneously. All cases had good perinatal outcome. Conclusions: Most cases of prenatally diagnosed echogenic lung lesions had a good outcome. This review has positively influenced the counseling of women with this diagnosis.

OP02.03: Maternal hyperoxygenation test in fetuses with congenital diaphragmatic hernia and correlations with neonatal respiratory function

Objectives: The natural history of echogenic lung lesions such as congenital cystic adenomatoid malformation (CCAM) and pulmonary sequestration (PS) has been altered by the advent of antenatal ultrasonography. Initial reports were characterized by a high incidence of adverse features (hydrops) and a poor outcome and did not accord with recent experience. Our purpose was to review the evolution and outcome of these lesions in our series. Methods: A retrospective review was conducted on fetuses diagnosed antenatally in the Fetal Medicine Unit of Hospital Vall d Hebron in Barcelona, Spain, between 2001 and 2007. A computer search identified all referred cases, and the records of these patients were examined to determine the pregnancy outcome. Results: In a 6-year period, 34 fetuses with echogenic lung lesions were referred for further management. The median age at diagnosis was 23 (range, 20–41) weeks. The lesion was on the right side in 19 (55%) and 15 (45%). All cases were unilateral. One case was diagnosed as CCAM type I (3%), 14 CCAM type II (41%) 11 CCAM type III (32%), 3 PS (8.8%) and five were mixed PS/CCAM (15%). All the fetuses had no associated anomalies and normal karyotype except one (47 XX+18). Termination of pregnancy was performed in seven cases of CCAM. In all cases histologic examination showed definitive diagnostic features of CCAM. In two cases diagnostic type of CCAM was changed from CCAM type II to type I and from CCAM type III to type II. Mediastinal shift was present in 16 fetuses (47%). Severe signs of fetal distress (hydrops) were present in three (8.8%). Because of hydrops, antenatal intervention was performed in two fetuses (thoracoamniotic shunting) and it was resolved. During the course of the pregnancy 70.5% (24/34) cases reduced in size or resolved spontaneously. All cases had good perinatal outcome. Conclusions: Most cases of prenatally diagnosed echogenic lung lesions had a good outcome. This review has positively influenced the counseling of women with this diagnosis.

OP10.08: Is uterine artery blood flow volume correlated to placental site in normal human pregnancies?

one case was lost to follow-up. Of the remaining 16 pregnancies, 15 women delivered at term and all the infants were healthy. The remaining case delivered a stillborn fetus at 28 week due to an E. coli intrauterine infection. The cause of death was considered unrelated to the PSC. Discussion: According to this series, PSCs are associated with a good perinatal outcome. In contrast with umbilical cord cysts, it is unlikely that PSCs can jeopardize fetal wellbeing, despite continuous growth during pregnancy in some of them. Owing to the close proximity to the umbilical cord in most cases, PSCs should be clearly differentiated from umbilical cord cysts, which carry a poorer prognosis.

Impétigo herpetiforme recurrente: manejo exitoso con ciclosporina

Impetigo Herpetiformis is a high-risk gestational skin disease that represents a risk for both the mother and offspring. Its management is based on multisystemic support and maternal steroid therapy. When these measures are insufficient to control the disease, the association of ciclosporine to the treatment has been proposed. We report a 24 year-old woman with a 16 weeks pregnancy, that presented with Impetigo Herpetiformis. The disease was refractory to the use of steroids, the patient had a metabolic decompensation and a dehydration with electrolyte imbalance. Therefore, treatment with ciclosporine was initiated and a rapid regression of the lesions was observed. Gestation was maintained, with a good perinatal outcome.

Perinatal outcomes, blood pressure patterns and risk assessment of superimposed preeclampsia in mild chronic hypertensive pregnancy

Objective Assessment of perinatal outcomes, blood pressure (BP) patterns and risk of superimposed preeclampsia in a population with mild chronic hypertension. Study design We investigated 223 pregnant women with mild chronic hypertension and 200 controls. Twenty-four-hour BP monitoring longitudinally in pregnancy and Doppler assessment of uterine arteries at 24 weeks’ gestation were performed. Perinatal outcomes were recorded. Results Superimposed preeclampsia occurred in 28.4% of hypertensive women, with an increased rate of small-for-gestational age babies (30.7% versus 8.9%), a lower birth weight (2587.75 ± 832.97 versus 3167.35 ± 536.3; p < 0.001) and a higher rate of caesarean sections (69.2% versus 35.5%) than controls. According to the ROC curve, the mean 24-h blood pressure (diastolic 78 mmHg [S.E.: 0.95; SP: 0.89] and systolic 121 mmHg [S.E.: 0.88; SP: 0.92]) and the mean resistance index of the uterine arteries of 0.52 (S.E.: 0.69; SP: 0.87) are better prognostic values for predicting superimposed preeclampsia. Conclusions In women with chronic hypertension in the second trimester 24-h blood pressure monitoring and Doppler velocimetry of the uterine artery are able to detect those at risk of superimposed preeclampsia. In women with circulatory adaptation to pregnancy, a good perinatal outcome is expected with proper obstetric care.

Good perinatal outcome in selective vaginal breech delivery at term

To compare perinatal outcome in groups of planned vaginal breech delivery, elective cesarean section with the fetus in breech presentation, and planned vaginal delivery with the fetus in cephalic presentation in a university hospital with a tradition of managing breech deliveries by the vaginal route. A cohort study from a 7-year period 1995-2002, including 590 planned vaginal deliveries with a term (> 37 weeks) singleton fetus in breech presentation, 396 elective cesarean sections with a term singleton fetus in breech presentation, and 590 control women intending vaginal delivery with a singleton term fetus in cephalic presentation. The Apgar scores were lower in the group of planned vaginal breech delivery, but in other outcome measures there were no significant intergroup differences. The overall neonatal morbidity was small (1.2% vs. 0.5% vs. 0.3% in the respective study groups) if compared to a recently published randomized multicenter study. Selective vaginal breech deliveries may be safely undertaken in units having a tradition of vaginal breech deliveries.