Signs Of Fetal Distress Research Articles

Do We Really Need to Worry About Listeria in Newborn Infants?

Do We Really Need to Worry About Listeria in Newborn Infants?

Insufficient pain relief in vacuum extraction deliveries: a population‐based study

To investigate the pain relief used in association with vacuum extraction assisted deliveries and to identify risk factors for not receiving pain relief during the procedure. Retrospective birth register study. Nationwide study in Sweden. The study population consisted of all women (n=62568) with a singleton pregnancy who gave birth in gestational weeks 37(+0) to 41(+6) between 1999 and 2008 and were delivered by vacuum extraction. Register study with data from the Swedish Medical Birth Register. Epidural blockade, spinal blockade, pudendal nerve blockade, infiltration of the perineum, no pain relief. In all, 32.4% primiparas and 51.4% multiparas who had a vacuum-assisted delivery had this without potent pain relief such as epidural blockade, spinal blockade or pudendal nerve block. When infiltration was added as a method for pain relief, 18% were still delivered without pain relief. Multiparas were more likely than primiparas to be delivered without potent pain relief, odds ratio (OR) 2.29 95% confidence interval (CI) (2.20-2.38). Compared with women delivered by vacuum extraction due to prolonged labor, those with signs of fetal distress were more likely to be delivered without potent pain relief (OR) 1.74, 95% (CI) (1.68-1.81). A considerable number of women are delivered by vacuum extraction without pain relief. The high proportion might reflect that clinical staff do not always consider pain relief to be of high priority in vacuum extraction deliveries or that they fear impaired pushing forces.

Applicability of fetal renal artery Doppler values in determining pregnancy outcome and type of delivery in idiopathic oligohydramnios and polyhydramnios pregnancies

To investigate the relationship between fetal renal artery Doppler results and pregnancy outcomes in patients with idiopathic abnormal amniotic fluid indices. A total of 110 patients without signs of fetal distress were included in the study: 31 idiopathic oligohydramnios and 29 idiopathic polyhydramnios pregnancies (study group) and 50 normal pregnancies (controls). Doppler investigation of the umbilical artery (UA), middle cerebral artery (MCA), fetal descendant thoracic aorta (DTA) and fetal renal artery (RA) was performed in all patients. Fetal RA resistive index (RI) and pulsatile index (PI) values were measured. Values pertaining to type of birth, newborn weight and APGAR scores were compared. Average patient age, gravidity and week of pregnancy were 25 +/- 4, 1.6, and 37.4 +/- 1, respectively There were no statistically significant differences between the groups as far as UA S/D, MCA S/D, DTA S/D, DTA RI, DTA PI, and RA S/D measurements were concerned. However in the oligohydramnios group RA RI and RA PI values were significantly higher than the other two groups. Birth weight in the polyhydramnios group and cesarean section rate due to fetal distress in the oligohydramnios group were significantly higher In the oligohydramnios group, without affecting fetal distress parameters, Doppler USG evaluation identified an increase in the RA resistance. Also in that group, cesarean rate due to fetal distress during labor was significantly higher than in the remaining two groups. Due to the predictive potential of values of fetal renal artery Doppler of fetal outcome further large sample-sized studies on the subject ought to be carried out.

Indications for operative delivery between 1999-2010 and induction of labor and epidural analgesia on the risk of operative delivery – A population based Swedish register study

ObjectivesThe aim of this study was to describe the distribution of indications for vacuum extraction (VE) and emergency cesarean section (EMCS) from 1999 to 2010. Furthermore, we investigated the association of induction of labor and epidural analgesia (EA) on the risk of operative delivery. Study designPopulation based register study with data from the Swedish Medical Birth Register during 1999–2010 including all 415230 primiparous women giving birth in gestational week 37+0 to 41+6. Main outcome measuresIndication for operative delivery as well as VE and EMCS. ResultsAmong the VE deliveries the indication “signs of fetal distress” increased while “multiple indications” decreased. For EMCS, “prolonged labor” increased steadily while “multiple indications” decreased. The total rate of induction of labor increased from 8.2% in 1999 to 11.9% in 2010, and was associated with an increased risk of both EMCS (OR 3.37) and VE (OR 1.5). The total rate of EA increased from 43.7% in 1999 to 49.8% in 2010, and was associated with a double risk for VE (OR=2.23) and with an increased risk of EMCS (OR=1.64). ConclusionThere have been changes in the distribution of indications for VE and EMCS during the study period. A growing number of mothers are being induced and more mothers receive EA. These factors seem to have influenced the rate of operative deliveries. Our findings underline the importance of carefully considering the advantages, disadvantages and risks with EA and induction of labor.

Obstetric cholestasis – an audit on its management and complications in Leeds

BackgroundThe complications associated with obstetric cholestasis (OC) are unclear. This means that the appropriate management of OC is also unclear and often not evidence based.Aims and objectivesTo audit current practices...

The influence of fetal head circumference on labor outcome: a population‐based register study

To investigate the association between postnatal head circumference and the occurrence of the three main indications for instrumental delivery, namely prolonged labor, signs of fetal distress and maternal distress. We also studied the association between postnatal fetal head circumference and the use of vacuum extraction and emergency cesarean section. Population-based register study. Nationwide study in Sweden. A total of 265 456 singleton neonates born to nulliparous women at term between 1999 and 2008 in Sweden. Register study with data from the Swedish Medical Birth Register. Prolonged labor, signs of fetal distress, maternal distress, use of vacuum extraction and emergency cesarean section. The prevalence of each outcome increased gradually as the head circumference increased. Compared with women giving birth to a neonate with average size head circumference (35 cm), women giving birth to an infant with a very large head circumference (39-41 cm) had significantly higher odds of being diagnosed with prolonged labor [odds ratio (OR) 1.49, 95% confidence interval (CI) 1.33-1.67], signs of fetal distress (OR 1.73, 95% CI 1.49-2.03) and maternal distress (OR 2.40, 95% CI 1.96-2.95). The odds ratios for vacuum extraction and cesarean section were thereby elevated to 3.47 (95% CI 3.10-3.88) and 1.22 (95% CI 1.04-1.42), respectively. The attributable risk proportion percentages associated with vacuum extraction and cesarean section were 46 and 39%, respectively among the cases exposed to a head circumference of 37-41 cm. Large fetal head circumference is associated with complicated labor and is etiological to a considerable proportion of assisted vaginal births and emergency cesarean sections.

Meconium aspiration syndrome - the experience of a tertiary center

BackgroundApproximately 5% of infants born with a meconium-stained amniotic fluid (MSAF) develop meconium aspiration syndrome (MAS). AimThe aims of this study were to analyse demographic data, morbidity and mortality associated with MAS and to identify possible risk factors. MethodsRetrospective chart review of newborns with MAS delivered at a tertiary center from January 1st, 1997 to December 31st, 2008. ResultsMAS was responsible for 1.4% of all Neonatal Intensive Care Unit (NICU) admissions, with a trend towards a decreasing incidence during the duration of the study, especially in the cases of thin meconium. Seventy two newborns were analysed during the study period: 55.6% (n = 40) were of the female gender, 62.5% were delivered by caesarean section, 93% had > 36 weeks of gestational age and 91.2% had a birth weight over 2500 g. Sixty-nine percent had an Apgar score < 7 at 1 minute and 23.6% an Apgar score < 7 at 5 minutes; foetal bradicardia was present in 26.4% of the newborns and tachycardia in 1.4%. The presence of meconium was associated with severe asphyxia and carried a bad prognosis with an increased risk of developing hypoxia (58.3%), need of mechanical ventilatory support (43.1%), respiratory and/or metabolic acidosis (30.6%), pulmonary hypertension (11.1%) and hypoxic ischemic encephalopathy (29.2%). The mortality rate was 2.8%. Thick meconium was associated with higher morbidity and mortality rates. ConclusionsThe number of admissions for MAS has been decreasing mostly because of a lower admission rate due to thin meconium; the number of cases with thick meconium has remained constant throughout the years. An Apgar score < 7 at 1 minute and signs of foetal distress during labour were associated with MAS. The MAS related morbidity remains significant.

Síndrome de aspiração meconial - experiência de um centro terciário

Background Approximately 5% of infants born with a meconium-stained amniotic fluid (MSAF) develop meconium aspiration syndrome (MAS). Aim The aims of this study were to analyse demographic data, morbidity and mortality associated with MAS and to identify possible risk factors. Methods Retrospective chart review of newborns with MAS delivered at a tertiary centre from January 1 st, 1997 to December 31 st, 2008. Results MAS was responsible for 1.4% of all Neonatal Intensive Care Unit (NICU) admissions, with a trend towards a decreasing incidence during the study duration, especially in the cases of thin meconium. Seventy two newborns were analysed during the study period: 55.6% (n = 40) were of the female gender, 62.5% were delivered by caesarean section, 93% had > 36 weeks of gestational age and 91.2% had a birth weight over 2500 g. Sixty-nine percent had an Apgar score < 7 at 1 minute and 23.6% an Apgar score < 7 at 5 minutes; foetal bradicardia was present in 26.4% of the newborns and tachycardia in 1.4%. The presence of meconium was associated with severe asphyxia and carried a bad prognosis with an increased risk of developing hypoxia (58.3%), need of mechanical ventilatory support (43.1%), respiratory and/or metabolic acidosis (30.6%), pulmonary hypertension (11.1%) and hypoxic ischemic encephalopathy (29.2%). The mortality rate was 2.8%. Thick meconium was associated with higher morbidity and mortality rates. Conclusion The number of admissions for MAS has been decreasing mostly because of a lower admission rate due to thin meconium; the number of cases with thick meconium has remained constant throughout the years. An Apgar score < 7 at 1 minute and signs of foetal distress during labour were associated with MAS. The MAS related morbidity remains significant.

Evaluation of normal values of reactive oxygen species and total antioxidant defenses on cord blood of full-term healthy infants with a bedside method

Aim. We measured in parallel and with a bedside equipment, the reference values of reactive oxygen species (ROS) and of total antioxidant defenses (TAD) in healthy full-term infants at birth on cord blood.Type of study. Population study of consecutive patients.Patients and methods. One hundred infants with gestational age 37–42 wks without signs of fetal distress or perinatal asphyxia. ROS and TAD were measured on cord blood – together with blood gas analysis – immediately after birth with a bedside equipment (FORM plus, Callegari 1930, Italy).Results. The average time to the end of the exams was 19 min (5–55 min). After outliers' exclusion, ROS resulted meanly 117 ± 58.2 U.F. and TAD 1.31 ± 0.45 mmol/l Trol.eq., being the ROS' value lower and that of TAD in the same range than those of adult people. No relationship was found between cesarean and vaginal delivery and between male and female sex.Conclusion. The normal full-term infants present low values of ROS but normal values of TAD when compared to adult people. We speculate this is a defensive mechanism, a sort of preparation of the fetus to face the partial pressure of oxygen of the room-air, increased with respect to that present in the womb.

Lactate dehydrogenase predicts hypoxic ischaemic encephalopathy in newborn infants: a preliminary study

Enzyme leakage as a result of hypoxia-ischaemia induced cell damage in affected organs is seen together with hypoxic ischaemic encephalopathy (HIE) after perinatal asphyxia. To investigate whether plasma lactate dehydrogenase [LDH], alanine aminotransferase [ALT] and aspartate aminotransferase [AST] during the first 12 h after birth predict HIE and adverse neurodevelopment outcome in newborn term infants with intra-partum signs of foetal distress. Enzymes were measured within 12 h post partum in newborn infants with differing degree of HIE (n = 41) and in infants with signs of foetal distress during birth (n = 205) without HIE (non-HIE group). All infants were randomized into two groups. One group (n = 123) was used for calculation of cut off limits for the enzymes studied and the other group (n = 123) was used for calculation of the predictive value of the enzymes for detection of HIE. Using ROC curves, a cut off level of 1049 U/L for [LDH] was the best predictor of HIE (sensitivity 100% and specificity 97%) but also for long term outcome after HIE. [LDH] is a good predictor of HIE during the first 12 h after birth. This result is of clinical interest offering a potential inexpensive and safe prognostic marker in newborn infants with perinatal asphyxia.

Association between serum interleukin-1β levels and perinatal asphyxia

Objective: Asphyxia is a major cause of acute mortality and chronic neurologic disability in neonates. We sought to define the predictive values of serum concentrations of interleukin-1β in newborns with perinatal asphyxia to see if there is a relation between interleukin-1β (IL-1β) levels to the short term neurological deficit. Methods: This was a prospective (case-control) study conducted between June 2007 and July 2008, at the Neonatal Intensive Care Unit, Ghaem Hospital, Mashhad, Iran. Serum IL-1β levels were measured at birth, 24 and 48 h post-partum in 38 consecutive uninfected neonates with perinatal asphyxia(blood pH< 7.2, low Apgar score , signs of fetal distress) and 41 randomly selected healthy newborns (normal infants free of a postnatal clinical event during the first weeks of life). Receiver-operating characteristic (ROC) curves were used for the determination of thresholds for the asphyxiated group versus healthy neonate group. Results: A total of 79 infants were studied. Serum interleukin-1β concentrations in the infants who developed hypoxic-ischemic encephalopathy was 6 folds higher as compared to values in the normal infants (p< 0.006) and 5-folds higher compared to infants with asphyxia who did not subsequently develop hypoxic-ischemic encephalopathy (p< 0.006). There was also a significant relationship between serum IL-1Β and outcome at the time of discharge. Conclusions: Serum levels of IL-1Β are increased substantially in neonates with asphyxia, and this is most pronounced in neonates with poorer prognosis.

Maternal Allopurinol During Fetal Hypoxia Lowers Cord Blood Levels of the Brain Injury Marker S-100B

It has been suggested that early postnatal administration of allopurinol, a xanthine oxidase inhibitor, might reduce perinatal brain damage because of intrapartum asphyxia. This double-blind randomized pilot study investigated whether maternal treatment with allopurinol in a population of pregnant women in late labor with signs of fetal hypoxia would reduce fetal cord serum concentrations of non-protein-bound iron, or other free radicals and S-100, a protein marker of central nervous system damage. The subjects of the study were 53 women in labor (54 fetuses) at >36 weeks' gestation, and who had signs of fetal distress (indicated by abnormal or nonreassuring fetal heart rate tracing or fetal scalp pH of 2 mg/L for allopurinol and/or >4 mg/L for oxypurinol), and significantly higher compared with fetal arterial cord concentrations. Therapeutic concentrations were also found in the cord blood of 15 allopurinol-treated newborns. However, 12 had sub-therapeutic levels. For this reason, 3 treatment groups were created: therapeutic allopurinol (n = 15), sub-therapeutic allopurinol (n = 12), and placebo (n = 27). The therapeutic allopurinol group had significantly lower plasma S-100B concentrations compared with the subtherapeutic allopurinol and placebo groups (P < 0.01 for both). Moreover, the concentration of non-protein-bound iron was significantly less in therapeutic allopurinol cord blood cord samples than that in the subtherapeutic allopurinol and placebo groups (P < 0.05 for both). The investigators believe that this is the first study to demonstrate that maternal allopurinol/oxypurinol can cross the placenta during fetal hypoxia, and that therapeutic concentrations can reduce serum levels of markers associated with brain asphyxia. These findings should be confirmed in a larger study using higher doses.

Ursodeoxycholic acid administration from the first trimester in case of a severe early-onset intrahepatic cholestasis of pregnancy

Abstract Intrahepatic cholestasis of pregnancy is characterized by pruritus, raised maternal liver enzymes and bile acids. It usually presents in the third trimester and rarely before 25 weeks. Ursodeoxycholic acid is the most promising therapy to alleviate symptoms and prevent fetal risk. However, its administration has been restricted for the last trimester as its embryotoxic effect is undetermined. We report here a case of an extremely rare, severe obstetric cholestasis with early onset treated by ursodeoxycholic acid from the 9th week of pregnancy, the earliest ever reported in the literature. The treatment was well tolerated. At the 32nd week urgent caesarean section was performed due to intolerable symptoms, worsening laboratory results and signs of fetal distress. A healthy newborn was delivered. It is concluded that ursodeoxycholic acid in case of a severe early-onset intrahepatic cholestasis may be started in the early pregnancy to improve maternal condition and prevent fetal complications.

Isolated fetal umbilical vein varix—prenatal sonographic diagnosis and suggested management

To present our experience with fetuses with umbilical vein varix (UVV), to investigate possible risk factors and to suggest a management scheme of evaluation. A study of 14 pregnancies complicated with isolated UVV was performed. Data collected included sonographic characteristics of the UVV, pregnancy outcome including induction of labour, mode of delivery, birthweight, and neonatal complications. UVV was diagnosed at a median gestational age of 27.5 weeks' gestation (range: 22-34 weeks). The average diameter of the UVV at diagnosis was 10.6 mm (range: 8-15 mm), and the maximal diameter during follow-up was 12.8 mm (range: 10-18 mm). The median gestational age at delivery was 36.1 weeks (range: 34-40 weeks), with an average birthweight of 2834 g (range: 1725-3715 g). Five women underwent emergent cesarean section. In fetuses with turbulent flow in the UVV there was a tendency to larger maximal sizes of the UVV, earlier gestational age at delivery and smaller birthweight. There were no cases of fetal or neonatal demise. We suggest that fetuses with UVV should be followed weekly from diagnosis to 28 weeks, and twice a week afterwards. Induction of labour should be considered at 36-37 weeks' gestation or at signs of fetal distress.

Developing a systems approach to prevent meconium aspiration syndrome: lessons learned from multinational studies

Passage of fetal bowel movement (meconium) is common (in about one out of six births), and in some the staining of the amniotic fluid is a sign of fetal distress. Inhalation of meconium (aspiration syndrome, in upto one out of five to eight such births) just before or at birth may be preventable by a coordinated approach by well-trained and informed birth attendants. Respiratory failure secondary to meconium aspiration syndrome (MAS) remains a major cause of morbidity and mortality in the neonatal population. Infants with hypoxemic respiratory failure because of MAS, persistent pulmonary hypertension of the newborn and pneumonia/sepsis have an increased survival with extracorporeal membrane oxygenation (ECMO). Other treatment options earlier limited to inotropic support, continuous airway pressure (CPAP), conventional ventilatory management, respiratory alkalosis, paralysis and intravenous vasodilators have been replaced by synchronized intermittent mandatory ventilation (SIMV), high-frequency oscillatory ventilation (HFOV), surfactant and inhaled nitric oxide (iNO). HFOV has been advocated for use to improve lung inflation while potentially decreasing lung injury through volutrauma. Other reports describe the enhanced efficacy of HFOV when combined with iNO. Subsequent to studies reporting that surfactant deficiency or inactivation may contribute to neonatal respiratory failure, exogenous surfactant therapy has been implemented with apparent success. Recent studies have shown that iNO therapy in the neonate with hypoxemic respiratory failure can result in improved oxygenation and decreased need for ECMO. However, these innovative interventions are costly, require a sophisticated infrastructure and are not universally accessible. In this paper, a context of systems-approach for prenatal, natal and postnatal management of babies delivered through meconium stained amniotic fluid (MSAF) so that adverse outcomes are minimized and the least number of babies require innovative ventilatory support is described. Previously reported data from a single urban perinatal center (Philadelphia, PA, USA), over a 6-year period (1995-2000), demonstrated that 14.5% (3370/23175 of live births babies were delivered with MSAF. These data also showed that 4.6% of babies (155/3370) with MSAF sustained MAS. Overall, 26% of babies (40/155) with MAS needed ventilatory support (or 0.17% of all live births); of these, only 20% (8/40 or 0.035% of live births) needed innovative ventilatory support. None died or needed ECMO. These data describe the components for a systems approach to prevent and manage adverse outcomes related to MSAF at the regional level II or III perinatal center. Replication of a similar strategy may be more relevant to cost containment and be a safer approach for neonates at risk for MAS-related respiratory failure. This paper assess the evidence for pivotal steps needed to prevent MAS and ensuing neonatal death and disease in the context of diverse perinatal health services.

OP13.02: Important to differentiate between fetal and neonatal populations

The outcome of infants with congenital anomalies has primarily been based on available data from liveborns. However, fetal and neonatal populations are not comparable. This study evaluates the outcome for fetuses from the time of prenatal diagnosis. Cases with a prenatal diagnosis of duodenal obstruction, gastroschisis and omphalocele were followed prospectively from the time of the diagnosis, through pregnancy and birth and into the postnatal period. Of 29 fetuses with duodenal obstruction 4 (14%) died in utero in the third trimester; none of these 4 had any significant associated anomalies. Twenty-one of the 29 fetuses (72%) survived, but only six had no associated anomalies including normal karyotype and a normal development during the postnatal period. The overall survival of 64 fetuses with gastroschisis was 87.5%. All survivors had a favourable outcome. However, signs of fetal distress were found in the third trimester in 22% (13/60), leading to emergency Cesarean sections. Of 90 fetuses with omphalocele 21 (23%) survived but only 8 (9%) without sequelae. The rate of abnormal karyotype, mainly trisomy 18, and other lethal associated anomalies was high in fetuses with omphalocele. Fetal and neonatal populations are different. In general, a diagnosis made prenatally reflects a more severe condition with a higher risk for an abnormal karyotype and the spectrum of associated fetal anomalies, syndromes, sequences etc., than a newborn with the same diagnosis would have had. The earlier the diagnosis is made the higher the risk. In addition a certain anomaly, such as duodenal obstruction, in itself may increase the risk for intrauterine fetal death and/or increased risk for adverse outcome during delivery. The detailed knowledge of the spectra of anomalies and the consequences is important for the counselling and to prevent some risks.

Procalcitonin for the diagnosis of early-onset neonatal sepsis: A multilevel probabilistic approach

ObjectivesTo compare the accuracy of procalcitonin (PCT) in early-onset neonatal sepsis (EOS) using standard cut-off values and a multilevel probabilistic approach. Design and methodsA retrospective study of PCT was performed in 149 newborns at risk of EOS, including preterm or prolonged rupture of membranes, chorioamnionitis or maternal infection, GBS colonization and signs of fetal distress. PCT values were analysed according to time of assay, i.e. at birth and at 24 and 48 h. We estimated sensitivity, specificity, positive (LR+) and negative likelihood ratio (LR−), diagnostic odds ratio (DOR) and number needed to diagnose (NND) using traditional and optimal (derived from ROC analysis) PCT cut-off values. ResultsUsing optimal cut-off, the LR+, DOR and NND at birth were 10, 18.9 and 2.2, at 24 h they were 5.3, 11.2 and 2.1, and at 48 h they were 5.6, 18.1 and 1.7, respectively. The multilevel analysis generated three post-test probabilities for each time of assay. At 24 h post-test probabilities of EOS were 78% for PCT >90, 11% for PCT 10.1–90 and 3% for PCT <10.1 mg/L, respectively. Similar results were found in the other time points, with a wide range of intermediate PCT concentrations that did not change the post-test probability. ConclusionsThe multilevel probabilistic approach was more effective in assessing the diagnostic power of PCT in EOS, showing that a wide range of intermediate PCT values was not able to discriminate between presence and absence of infection.

Prospective Randomized Study of Oxytocin Discontinuation After the Active Stage of Labor is Established

Prolonged episodes of labor induction or augmentation with oxytocin may make induction less effective and increase the risk of complications. This prospective study enrolled 342 pregnant women having labor induced, and randomly assigned them to either continue on oxytocin until the time of delivery (n = 174) or to stop receiving oxytocin at the start of the active phase of labor, defined as 5 cm of cervical dilation and regular contractions at 3-minute intervals (n = 168). All participants had a live fetus in cephalic presentation and an ultrasound-estimated fetal weight of less than 4000 g. Induction was carried out for a variety of reasons at 37–42 weeks' gestation. The 2 treatment groups did not differ significantly in maternal age, gestational age, incidence of nulliparity, or indications for induction. Both the duration of the active phase of labor and the length of the second stage were longer in the oxytocin-discontinued group, but the differences between groups were not statistically significant. Uterine hyperstimulation, based on 6 or more contractions in 10-minute intervals, was observed significantly more often in the oxytocin-continued group (P < 0.05). The overall rates of cesarean delivery were 6.9% for women in the oxytocin-continued group and 4.8% in the oxytocin-discontinued group (P > 0.05). In both groups, the indications for cesarean delivery were fetal distress and nonprogressive labor. No significant group differences in birth weight or signs of fetal distress were noted. These findings show that discontinuing oxytocin infusion once active labor is established is both effective and safe. This approach may be especially useful in developing countries where the conditions for fetal monitoring and emergency cesarean delivery are less readily available.

Fetal complications after placement of an intrauterine pressure catheter: A report of two cases and review of the literature

Background. Uterine contractions during labor can be monitored by external tocodynamometry or by the use of an intrauterine pressure catheter (IUPC). Since an IUPC measures the frequency of contractions as well as their strength and duration, it is thought to be more accurate than external tocodynamometry. However, limited evidence on this subject suggests that IUPC may not improve maternal or perinatal outcomes. Moreover, the use of IUPC may cause fetal complications.Cases. We describe the placement of an IUPC during induction of labor with oxytocin in two cases, one presenting with a singleton pregnancy and the other a twin pregnancy. After introduction of the IUPC, both cases were complicated by blood loss and signs of fetal distress on cardiotocography. An emergency cesarean section was performed in both cases. In the first case, extramembranous placement of the IUPC was observed, whereas in the second case, the IUPC had lacerated an arteriovenous anastomosis in the membranes, resulting in perinatal death.Conclusion. Placement of an intrauterine pressure catheter instead of external tocodynamometry has a small risk for serious fetal complications.

Pregnancies associated with primary adrenal insufficiency

To provide a framework for the clinical presentation, evolution, treatment, and outcome of the unusual association between primary adrenal insufficiency (AI) during pregnancy and life-threatening complications for the mother and fetus. Case reports. Pregnant women with AI treated in the Endocrine and Diabetes Department, Hospital Universitario de Maternidad y Neonatología, Córdoba, Argentina. Three pregnant women with AI. Review of hospital records. Clinical, laboratory features, treatment, and outcome. Two women with AI were diagnosed before conception, and one was diagnosed during gestation. Two of the cases were associated with other autoimmune diseases. Two newborns were born with signs of fetal distress, and one passed away hours later. Poor outcome was related to low compliance with treatment. AI is often overlooked during pregnancy because of its rarity and pregnancy-like symptoms. Nevertheless, other autoimmune diseases, hyponatremia, metabolic acidosis, nausea and vomiting, and orthostatic hypotension that does not improve with usual treatment or persists after first trimester should evoke a diagnosis of AI. If diagnosis and treatment are properly managed, pregnancy, labor, and delivery may occur without complications. If not, AI is associated with high maternal and fetal morbidity and mortality.