Maternal and fetal effects of heroin addiction during pregnancy

Heroin addiction during pregnancy has been reported to be associated with adverse maternal and perinatal effects. In a study of a large obstetric service in Dallas, pregnancy outcome and health status of infants born to 24 heroin addicts were compared to those in a group of 100 unexposed women and their infants. Women who used heroin during pregnancy tended to use other substances (tobacco, alcohol, cocaine) more often than did controls. The frequency of preterm birth was increased significantly in women who abused heroin during pregnancy. Sexually transmitted diseases were not increased in frequency in pregnant heroin addicts as compared to women who did not use heroin during pregnancy. Heroin addicts had infants who were significantly shorter and lighter in weight than did controls. No significant differences in head circumference or frequency of congenital anomalies were observed.     

Maternal snoring during pregnancy is not associated with fetal growth restriction

A small number of studies have, thus far, evaluated the association between maternal snoring and fetal growth revealing conflicting results. No study has compared fetal growth between women with habitual snoring who snored before pregnancy and women with habitual snoring that started to snore during pregnancy.

Objectives: To examine the effect of maternal snoring on fetal outcome and to investigate the differences between “chronic snorers” and “new-onset snorers”. Methods: Women of singleton, uncomplicated, full-term pregnancies completed a questionnaire. Obstetric and labor records were reviewed. Newborn records were reviewed for gestational age, birth weight, Apgar score and gender. Results: 246 low risk women were studied. Mean BMI at the beginning of pregnancy was 22.3?±?3.5?kg/m². 32% reported habitual snoring. Of those, 26% were chronic snorers and 74% were new-onset snorers. Neither significant difference in fetal growth was found between snorers and non-snorers nor between chronic snorers and new-onset snorers. Increased rate of nulliparous women was found in new-onset snorers compared with both chronic snorers and non-snorers (54 vs. 25 and 29% respectively; p?=?0.001). Conclusions: In pregnant women with no apparent risk factors, maternal snoring does not affect fetal growth. No differences in maternal characteristics or fetal outcome were found between chronic snorers and new-onset snorers.     

Antepartum predictors of fetal distress in postterm pregnancy

The purpose of this study was to determine the efficacy of combining nonstress testing with ultrasound assessment of amniotic fluid volume for the antenatal evaluation of the postterm fetus. Postterm patients (884) were managed with amniotic fluid assessments and nonstress tests (including evaluation for variable and late decelerations) twice a week. There were no perinatal deaths or major neonatal morbidity. However, the antenatal testing sensitivity, specificity, negative, or positive predictive values were not improved by combining the two tests. Individually, amniotic fluid assessment was just as accurate a predictor of fetal well-being and was a significantly more sensitive test than the nonstress test. In addition, antenatal predictors of fetal distress and intrapartum signs of fetal distress were almost exclusively those reflective of umbilical cord compromise. These findings stress the importance of antenatal screening for signs of umbilical cord compromise as an early indication of potential fetal compromise. Although the results also suggest that amniotic fluid assessment is superior to the nonstress test, they do not conclusively support the use of amniotic fluid assessment as the sole parameter for postterm antenatal surveillance.     

Maternal and fetal hemodynamic effects of autologous blood donation during pregnancy.

OBJECTIVES: Our objectives were to describe the maternal and fetal hemodynamic impact of a 1 U acute blood loss during pregnancy and to compare the hemodynamic responses of pregnant women with those of nonpregnant controls. STUDY DESIGN: With Doppler techniques cardiac output and total peripheral vascular resistance were determined in 16 pregnant women in the third trimester and in 16 nonpregnant volunteers before and during orthostatic stress, before and after donation of 450 ml of whole blood. In pregnant women the fetal umbilical artery systolic/diastolic ratio was also determined. Data were subjected to multiple logistic regression analysis. RESULTS: In both groups orthostasis provoked significant decreases in cardiac output and increases in total peripheral vascular resistance. The hemodynamic effects of blood loss were less pronounced and did not significantly change the hemodynamic response to orthostasis in either group. Neither orthostasis nor blood loss caused significant changes in the umbilical systolic/diastolic ratio. CONCLUSION: These data support the hemodynamic safety of uncomplicated autologous blood donation during late pregnancy.     

多胎之一胎儿死亡的诊断及处理

多胎妊娠多胎之一胎儿死亡(sIUFD),存活胎儿的围产期患病率和死亡率均增加.多数胎儿死亡发生在妊娠早期,诊断主要靠早孕期超声检查提示多个孕囊,随后发现一个或多个孕囊消失.双绒毛膜双胎slUFD不会有胎儿之间的影响存在,可进行期待治疗.治疗应综合考虑病因、绒毛膜性、一胎死亡时间、母亲疾病等因素,根据母亲和胎儿具体情况作出决定.     

Hyperosmolar hyperglycemic state of pregnancy with intrauterine fetal demise and preeclampsia

Hyperosmolar hyperglycemic state (HHS) is a serious complication of uncontrolled hyperglycemia. Paralleling the obesity epidemic, the incidence of type 2 diabetes is increasing in a younger population. Therefore, obstetricians must be prepared to deal with the complications of this disease. We present a unique case of new-onset diabetes resulting in HHS. A 21-year-old G1P0 presented at 32 weeks 2 days with an intrauterine fetal demise. At presentation, she was noted to have hyperglycemia, hypertension, proteinuria, altered sensorium, and negative serum ketones. Management included an insulin drip, rehydration, and magnesium. Labor was induced without complications. HHS secondary to undiagnosed type 2 diabetes may become a more common entity in the pregnant population as obesity reaches epidemic proportions. The practitioner should have a high index of suspicion for HHS in obese patients presenting with hyperglycemia.     

Maternal arrhythmias during pregnancy

Introduction. An increased incidence of maternal cardiac arrhythmias is observed during pregnancy and they can range from clinically irrelevant isolated premature beats to debilitating supraventricular and ventricular tachycardias. Discussion. Management of arrhythmias during pregnancy is similar to that in non-pregnant patients. However, the presence of the foetus and the risk of teratogenicity, the haemodynamic changes, the effect of therapy on labour, delivery and lactation must be evaluated. Antiarrhythmic drug selection depends on the specific arrhythmia being treated and the cardiac condition of the mother. Although no drug is completely safe, most are well tolerated and can be given with relatively low risk. Some antiarrhythmic agents, such as propranolol, metoprolol, digoxin and quinidine, have been extensively tested during pregnancy and have proved to be safe; they should therefore, whenever possible, be used as a first-line. For supraventricular tachycardia, intravenous adenosine may be used to terminate the arrhythmia if vagal manoeuvres fail. If possible, drug therapy should be avoided during the first trimester of pregnancy. When drug treatment fails or is not indicated because of the haemodynamic instability of the patient, direct current cardioversion can be used. Conclusion. Most patients with arrhythmias during pregnancy can be treated with an excellent result.     

Maternal urinoma during pregnancy

Urinoma is peripelvic extravasation of urine seen as the squeal of urinary trauma or stones. Little is known about maternal urinoma during pregnancy. A 27-year-old primigravida presented with gradual worsening right flank pain at 21(5/7) weeks of gestation. She denied any past medicosurgical history. Initial work-up revealed cost-vertebral angle tenderness and mild hydronephrosis by ultrasonography. Her symptom worsened and follow-up ultrasonography was performed 48 h later, which showed worsened hydronephrosis with large perinephric fluid collection. A Double-J stent was placed under cystoscopy. After the placement, the patient's symptoms improved quickly. The stent was removed three weeks later. The patient delivered vaginally at 39 weeks of gestation without complication. Maternal urinoma during pregnancy developed in the right side of the kidney in five of six reported cases (83.3%), and all were seen in the second half of pregnancy. All showed flank pain as the initial presentation. Ultrasonography for diagnosis was used in half of the patients. Fifty percent underwent Double-J stent before delivery and 16.7% after delivery. All cases delivered at term and 33.3% underwent cesarean delivery. Maternal urinoma is an important differential diagnosis for flank pain during pregnancy. Double-J stent placement was the main management. Close monitoring of the symptom with serial ultrasonography may be the key for diagnosis.     

Maternal and fetal effects of chocolate consumption during pregnancy: a systematic review

Objectives: The purpose of this review is to explore the effects of chocolate consumption during pregnancy on fetus and mother herself.

Methods: Randomized controlled trials/quasi-experimental/observational/controlled before and after studies involving chocolate/cocoa/cacao consumption (irrespective of type or dose, composition, exposure period, and method of administration) among pregnant women/animals; and measuring any outcome (beneficial or harmful) related to fetus or mother after chocolate exposure were included. Databases searched were PubMed, Web of Science and Scopus; between April and May 2017. Risk of bias within each human randomized controlled trial (RCT) and animals’ experimental studies was evaluated by “The Cochrane Collaboration’s tool” and SYRCLE’s tool respectively.

Results: Fourteen human studies including a total of 6639 participants and nine animal studies were selected. Outcome variables investigated in human studies were maternal blood pressure, fetal heart rate, and striae gravidarum. Animal studies explored chocolate-induced teratogenicity and fetal metabolic derangements. Ten out of these 23 studies reported chocolate to be “beneficial”; five studies reported adverse effects, whereas eight studies declared chocolate as “neutral”.

Conclusions: Maternal chocolate intake has acute stimulatory effects on fetal reactivity and chronic blood pressure reducing effect in mothers. Chocolate is nonteratogenic and does not affect reproductive indices. Metabolic derangements in offsprings born to chocolate fed dams have been reported. Pregnant females must be careful about consumption of cocoa and chocolate. Future studies should be planned, keeping in view heterogeneities identified across the selected studies in this review.     

Maternal and embryonal/fetal beta-endorphin concentrations during the first trimester of pregnancy

In this study, we have determined the beta-endorphin concentrations in the plasma of 11 cases during the first 3 months of pregnancy, as well as the corresponding products of conception, collected by hysterosuction, during the course of voluntary abortion. The purpose of this study is to compare the values obtained by the analysis of maternal plasma and the material collected by hysterosuction. The beta-endorphin concentrations were obtained by radioimmunologic methods using a kit which allows a separation from beta-lipotropin. The specimens obtained by hysterosuction (8 +/- 1.7 pmol/l) showed significantly higher levels of beta-endorphin than those observed in the maternal plasma (2.6 +/- 0.3 pmol/l). Thus, already in the earliest gestational period, the data are consistent with a feto-placental origin for this opioid peptide.     

Maternal and neonatal outcome in a monochorionic twin pregnancy complicated by single intrauterine demise

Single fetal death in monochorionic pregnancies is believed to be associated with increased risk of perinatal morbidity and mortality for the living twin and risk of coagulopathy affecting the mother. In this report we present a case of single intrauterine death in a monochorionic twin gestation diagnosed in the 28th week of pregnancy.     

Maternal anxiety and fetal movement patterns in late pregnancy

Objective: To determine whether maternal anxiety affects fetal movement patterns in the third trimester of pregnancy.

Methods: The inclusion criteria were a state of good health and a singleton pregnancy between 36 and 40 weeks. Thirty healthy pregnant women were included. The Beck Anxiety Inventory (BA) questionnaire with 21 self-reported items validated for the Brazilian population was applied. The women were asked to record the number of minutes taken to perceive 10 fetal movements once a day for one week. Anxiety symptoms were rated as moderate or severe according to the BAI total score.

Results: The mean BAI score was 20.8 (SD?=?10.2) and the mean time to count 10 fetal movements was 24.3?min (SD?=?6.6?min). The BAI items significantly associated with moderate or severe maternal anxiety were numbness or tingling, fear of the worst happening, terrified, feeling of choking, fear of losing control and fear of dying. There was a statistically significant negative correlation between the total BAI score and the mean time of 10 perceived fetal movements (p?<?0.0001; rho?=??0.70; 95% CI for rho ?0.84 to ?0.45).

Conclusions: Maternal anxiety seems to affect fetal movement patterns in late pregnancy and is associated with the mother’s increased perception of fetal activity.     

Legionnaire's disease complicating pregnancy: a case report with intrauterine fetal demise

OBJECTIVE: Legionnaire's disease complicating pregnancy is an unusual event that can seriously compromise both the mother and the fetus. CASE REPORT: We describe one case of such association, with an unfavourable intrauterine fetal outcome, secondary to acute placental insufficiency, related to infection. DISCUSSION: It is important in these high risk pregnancies complicated by acute pneumonia to take into consideration the diagnosis, as early as possible, and the appropriate treatment or the careful monitoring of fetal wellbeing.