Abnormal pregnancy sonogram and chromosomal anomalies: four years' experience with rapid karyotyping

Over a four-year period, 140 pregnancies with different malformations detected by ultrasound were examined cytogenetically. Gestational age ranged from 13 to 36 weeks. Twenty-six fetuses (18.6 per cent) had abnormal karyotypes, including trisomies, triploidy, monosomy X, and structural anomalies. Similar malformations were found in fetuses with different chromosomal anomalies, indicating that the types of malformations are not specific for particular chromosomal anomalies. Chromosomal analysis was performed on amniotic fluid culture and by direct karyotyping of placental biopsies. Direct karyotyping is suggested to be the most rapid approach, especially if sonographic anomalies are detected close to the 24th week of gestation, shortly before delivery, and in cases of significant oligohydramnios.     

Management of pregnancy and labour in cases diagnosed with major fetal malformation

PURPOSE OF REVIEW: To explore the obstetrical management of pregnancies with severe fetal malformations, taking into account the rapid improvement in ultrasound technology and interventional possibilities. RECENT FINDINGS: Unique studies using modern ultrasound techniques describe the evolution of spina bifida and the subsequent varying development of hydrocephalus. In addition, the dilated fetal stomach is shown to be an ominous sign of complications in cases of gastroschisis. Such complications can be decreased by prenatal supervision using cardiotocography, which detects signs of fetal distress. Recent studies confirm previous findings that caesarean section does not improve the outcome in cases of fetal gastroschisis or spina bifida. SUMMARY: Recent research has demonstrated the development of severe fetal malformations. New studies have shown the positive effects of fetal supervision in cases of gastroschisis. Furthermore, caesarean section is not beneficial compared with vaginal delivery in such cases. Fetal surgery is still undergoing rapid development and has the potential to improve outcome in the near future.     

Psychological aspects of ultrasound examinations during pregnancy

The acceptability of ultrasound examinations during pregnancy has been documented in many studies. Yet there is little empirical evidence for the postulated psychological benefits of ultrasound examinations. Although seeing the baby is most often rated as a moving experience, there are no proven long-term effects of ultrasound visualization on bonding with the fetus or on pregnant women's health-related maternal behaviour. There is evidence to support the notion that attenuated anxiety and stress immediately following the examination are likely artefactual - a reflection of increased anxiety before real-time scan. Review of the literature indicates no evidence as to whether antenatal detection of fetal abnormalities leads to improvement in coping or only prolongs the phase of psychological stress and mourning. This articles provides an overview of current research on psychological effects of prenatal ultrasound examination.     

The limbo of motherhood: Women's experiences of major challenges to cope with the first pregnancy

Introductionpregnancy is a unique health experience which is influenced by various factors, particularly culture and social context.Aim of studyto explore women's perception regarding major challenges of adaptation with first pregnancy based on culture and social context.Designa qualitative content analysis was used for data gathering and analysis. Data were collected through unstructured in-depth interviews.Settingthe study was conducted in public health clinics in Hamadan city, an urban area in southwest of Iran from July to December 2016.Participantsnineteen healthy primigravidas were recruited using a purposive sampling method and interviewed in the third trimester of pregnancy.Findingsthe two main categories extracted: imposing the motherhood role on oneself and negative feelings toward pregnancy. The feeling of being in limbo during pregnancy suggests that the everyday experiences of the participants were filled with challenges and short-term tensions, fears, and limitations of pregnancy overwhelmed the participants with negative feelings. As a result, they experienced doubt due to their inexperience in the acceptance of the responsibility of pregnancy and motherhood.Key conclusions and implications for practiceone of the challenges of adaptation to pregnancy is the experience of negative feelings toward physiological changes and sense of uncertainty toward accepting motherhood responsibilities. Thus, the provision of suitable interventions during the prenatal period to reduce negative feelings and improve women's self-sufficiency in adaptation to pregnancy seems necessary.     

Hydronephrosis during pregnancy: four cases of hydronephrosis causing symptoms during pregnancy

Hydronephrosis during pregnancy is a physiological phenomenon in the majority of pregnant women after the 20th week of pregnancy; normally it gives rise to no symptoms. Four cases of hydronephrosis causing symptoms during pregnancy are described, where ureteral colic has been the reason for hospitalization. An evaluation is given of the indications and the methods of treatment, including the employment of an indwelling ureteral catheter.     

Fetal blood sampling during pregnancy with use of a needle guided by ultrasound: a study of 606 consecutive cases

Because of various prenatal diagnoses, 606 fetal blood samplings were carried out in 562 pregnancies from the gestational week 17 to 38 with use of a 20-gauge needle guided by ultrasound. The procedure was performed on outpatients under local anesthesia and without medication before or after the procedure. Pure fetal blood was obtained at the first attempt in 588 cases. A second attempt was necessary in 18 cases. Maternal blood contamination was never present. Amniotic fluid dilution was noted in 15 cases. At the beginning of our experience only three cords could not be punctured. The duration of the procedure was less than 10 minutes in 90% of cases. Fifty-eight pregnancies were terminated after consideration of the results of the diagnosis, and 504 pregnancies were continued. The complications found in these pregnancies were premature delivery (5%), growth retardation (8%), in utero death (1.1%), and spontaneous abortion (0.8%). In the future this new procedure could replace fetoscopy and initiate an important field of new investigations.     

Obese women's experiences of encounters with midwives and physicians during pregnancy and childbirth

Objective

to describe obese women's experiences of encounters with midwives and physicians during pregnancy and childbirth.

Design

a qualitative study using a phenomenological approach. Data were collected by means of interviews that were tape-recorded.

Setting

the women's homes or at a hospital in western Sweden.

Participants

10 women with body mass index >30, three primiparous and seven multiparous, who had given birth at a hospital in western Sweden in the period between October 2006 and September 2007 were interviewed four to six weeks after childbirth.

Findings

the meaning of being both obese and pregnant is living with a constant awareness of the body, and its constant exposure to the close observation and scrutiny of others. It involves negative emotions and experiences of discomfort. Feelings of discomfort increase as a result of humiliating treatment, whilst affirmative encounters alleviate discomfort and provide a sense of wellbeing.

Conclusion and implications for practice

obese pregnant women are a vulnerable group because obesity is highly visible. Caregivers tend to focus on providing care to obese patients somatically, but are additionally in need of knowledge about care from the woman's point of view. Many obese women have negative experiences of health care that they have to overcome. It is necessary to individualise care for obese pregnant women, which involves taking time to give the women an opportunity to tell their own story. Caregivers have to promote health but it has to be done honestly and respectfully. In order to avoid judgemental attitudes and causing increased suffering for obese pregnant women, midwives and physicians need to be conscious of, reflect upon and verbalise their own attitudes and power.     

High-risk pregnancy in beta-thalassemia major women. Report of three cases

Reproductive failure is common in beta-thalassemia major patients because of endocrine damage resulting from iron overload. Here 3 full-term pregnancies following spontaneous ovulation in 2 splenectomized beta-thalassemia major women are reported. The main echocardiographic parameters, such as left ventricular end-diastolic and end-systolic diameters, fractional shortening and ejection fraction, were within the normal range before pregnancy, but worsened during gestation, and 1 patient developed pre-congestive heart failure. Deferoxamine therapy was continued throughout 2 pregnancies, while in the other it was stopped after 8 weeks: no abnormalities were noted in the children. Thanks to the currently applied therapies, an increased number of pregnancies may now be expected in beta-thalassemia major women: it is important to find out more about the pregnancy-related problems and their management in these patients.     

妊娠合并肺栓塞15例临床分析

目的分析妊娠合并肺栓塞临床特点及妊娠结局。 方法收集广州医科大学附属第三医院妇产科2010年3月至2014年1月收治的15例妊娠合并肺栓塞患者的临床资料,对其一般情况、临床症状、辅助检查、治疗措施及妊娠结局进行回顾性分析。 结果(1)发病时间：妊娠早期1例,妊娠中期6例,妊娠晚期2例,剖宫产术后产褥期6例。(2)终止妊娠方式：剖宫产8例,剖宫取胎术5例,利凡诺引产1例,自然流产1例。(3)结局：孕妇死亡4例,存活11例;健康足月儿6例,早产儿3例,死胎6例。 结论提高对妊娠合并肺栓塞疾病的认识,尽早确诊和治疗,改善其妊娠结局。     

Syrian women's perceptions and experiences of ultrasound screening in pregnancy: implications for antenatal policy

Ultrasound scanning is firmly embedded in antenatal maternity care around the world. This paper reports on a qualitative study carried out in 2003 of 30 Syrian women's perceptions and experiences of routine ultrasound in pregnancy. It was part of a larger study of the experiences of pregnancy and childbirth of 500 women from Damascus and its suburbs who had recently given birth to healthy newborns. The women had had multiple scans during pregnancy and accepted its use uncritically nearly all the time. The scans gave them reassurance that the baby was healthy, the pregnancy was progressing well and allowed them to learn the sex of the baby. The women also reacted positively to the antenatal educational messages that were conveyed using scans. However, we found the excessive use of this technology worrying. We believe private doctors, who attend 80% of pregnant women, use ultrasound primarily to attract women to their clinics and increase their income. We recommend that maternity care in Syria should be better regulated; that women and their doctors should be made aware of the essential components of antenatal care; that notional guidelines for antenatol care should be developed and that Syrian women should be empowered to ask questions about pregnancy and childbirth and the care they receive.