Large Meningioma Complicating Pregnancy

EDITORIAL COMMENT: This case report was accepted for publication because of the clinical lesson it delivers, namely that intracranial tumours, although rare in pregnancy, may as the authors state 'produce a wide variety of symptoms that are difficult to distinguish from the more common symptoms of pregnancy, including nausea, vomiting and headache'. This case suggests that examination of the optic fundi is essential in patients with neurological symptoms even when/especially when there is a history of psychiatric illness.     

Antecedents to and Outcomes of Rh(D) Isoimmunization: Mater Mothers Hospital, Brisbane, 1988–1995

Summary: We analyzed the antecedents and outcomes of Rh(D) isoimmunization in a local population. Forty-two Rh(D) isoimmunized women attending Mater Mothers Hospital for antenatal care were identified through the Mater Hospital Blood Bank database; their records were reviewed for variables including sensitizing events, obstetric interventions and pregnancy outcomes. In this group, 74% of women became sensitized despite receiving anti-D immune globulin, 17% did not receive anti-D appropriately and the others failed to attend for treatment of bleeding in pregnancy. Antenatal sensitization was implicated in 6 women (14%) and potentially responsible for isoimmunization in another 18. Over half of the 80 viable pregnancies in this study group required some form of obstetric intervention. Thirty pregnancies required amniocentesis and 1 in 3 babies underwent either intrauterine or exchange transfusion. Three fetal deaths occurred as a result of severe disease. This study offers information highlighting circumstances in which immunoprophylaxis guidelines have failed to impart protection against Rh(D) sensitization and the consequences of such failures.     

Drugs for obstetric conditions

For many reasons, including the fear of fetal anomaly, the recognition of pregnancy being a normal physiological process and maternal choice, few drugs are prescribed and used during pregnancy. Nevertheless, there are certain common obstetric conditions that are associated with significant maternal and perinatal morbidity and mortality where drugs play an important and necessary part in treatment. These conditions include termination of pregnancy, threatened preterm labour, induction of labour and post-partum haemorrhage. This chapter deals with the role of drug therapy in these obstetric scenarios. A large amount of obstetric clinical trial research has been dedicated to the management of these conditions.     

Antenatal Patterns of Uterine Activity in Low-Risk Women: A Longitudinal Study

Summary: There is a surprising lack of information on antenatal patterns of uterine activity in the normal obstetric population, with the majority of research having focussed on women at high-risk for preterm birth. We conducted a prospective longitudinal study to investigate patterns of uterine activity in women with singleton gestations at low-risk for preterm birth. Twenty pregnant women were recruited and their uterine activity was recorded using ambulatory tocodynamometry twice weekly throughout the latter half of pregnancy. The collected data were transmitted to a central receiving station for analysis. As gestation advanced there was a progressive increase in the median number of contractions detected per hour, peaking and stabilizing at 37–40 weeks (median of 0 contractions/hour at 20–24 weeks rising to 5.4 contractions/hour at 37–40 weeks). In those women with uterine activity, contraction duration and amplitude of deflection significantly increased as gestation advanced. There was a progressive increase in the number of higher amplitude contractions throughout the third trimester. Increasing parity was not associated with increasing antenatal uterine contraction frequency. No association between normal daily physical activity and uterine contraction frequency was evident throughout gestation. In normal human pregnancy there is a steady, progressive increase in the frequency, duration and amplitude of antenatal uterine activity throughout the latter half of gestation. The uterine contractile profile alters from one of a low amplitude, low frequency pattern in the second trimester to a higher amplitude, higher frequency pattern at term.     

Maternal Perception of Fetal Activity and Late Stillbirth Risk: Findings from the Auckland Stillbirth Study

Abstract: Background: Maternal perception of decreased fetal movements has been associated with adverse pregnancy outcomes, including stillbirth. Little is known about other aspects of perceived fetal activity. The objective of this study was to explore the relationship between maternal perception of fetal activity and late stillbirth (≥ 28 wk gestation) risk. Methods: Participants were women with a singleton, late stillbirth without congenital abnormality, born between July 2006 and June 2009 in Auckland, New Zealand. Two control women with ongoing pregnancies were randomly selected at the same gestation at which the stillbirth occurred. Detailed demographic and fetal movement data were collected by way of interview in the first few weeks after the stillbirth, or at the equivalent gestation for control women. Results: A total of 155/215 (72%) women who experienced a stillbirth and 310/429 (72%) control group women consented to participate in the study. Maternal perception of increased strength and frequency of fetal movements, fetal hiccups, and frequent vigorous fetal activity were all associated with a reduced risk of late stillbirth. In contrast, perception of decreased strength of fetal movement was associated with a more than twofold increased risk of late stillbirth (aOR: 2.37; 95% CI: 1.29–4.35). A single episode of vigorous fetal activity was associated with an almost sevenfold increase in late stillbirth risk (aOR: 6.81; 95% CI: 3.01–15.41) compared with no unusually vigorous activity. Conclusions: Our study suggests that maternal perception of increasing fetal activity throughout the last 3 months of pregnancy is a sign of fetal well‐being, whereas perception of reduced fetal movements is associated with increased risk of late stillbirth. (BIRTH 38:4 December 2011)     

Prolonged Induction to Delivery Time in Termination of Pregnancy Using 16,16-dimethyl-PGErmethyl ester (gemeprost) for Fetuses with a Neural Tube Defect or Hydrocephalus

Summary: A retrospective study is reported comparing the induction to delivery interval using gemeprost for termination of pregnancy, in the second trimester, in 3 groups of patients. It was observed that the mean induction to delivery interval was significantly longer in 75 pregnancies where there was a fetus with a neural tube defect and or hydrocephalus (31.7 hours) compared with 88 pregnancies with other fetal abnormalities (19.7 hours) and 84 pregnancies where there was an intrauterine death (113 hours). There was also an increase in the requirements for further intervention to obtain delivery in the group with a neural tube defect or hydrocephalus (n=33) compared with where there was an intrauterine fetal death (n=4) and other abnormality (n=14). We believe these results should be considered when counselling patients who have requested termination of pregnancy for fetal abnormalities.