Seminars in perinatology
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It is widely believed in neonatology and obstetrics that there are situations in which it is inappropriate to attempt newborn resuscitation, and other times when newborn resuscitation is obligatory despite parental refusal. In each case, an ethical justification for the decision needs to be identified. ⋯ It specifically addresses the issue of extreme prematurity, including an analysis of current recommendations, the data, relevant rights of patient and parents, and a discussion of the relative merits of withholding resuscitation vs providing resuscitation and possibly withdrawing intensive care later. In addition to extreme prematurity, the considerations presented are also relevant to a wider spectrum of newborn problems, including Trisomy 13, Trisomy 18, and severe congenital anomalies.
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Preterm birth is the leading cause of perinatal morbidity and mortality in the United States. The risk of preterm birth is inversely proportional to the length of the cervix on transvaginal sonography. ⋯ The pessary may represent an easy and safe intervention in the treatment of a short cervix diagnosed in the midtrimester. Further research is merited to evaluate the role of the cervical pessary as an alternative treatment for a short cervix or for women at high risk for preterm birth.
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Recent technological advances in fetal magnetic resonance imaging (MRI) and increased reliability of MRI in depicting abnormalities and lesions, especially in the central nervous system, are increasingly bringing up challenging issues with regard to accurate diagnosis. There are also pitfalls not only attributable to image acquisition but also in clinical interpretation. The misinterpretation of findings because of insufficient knowledge about fetal brain development as visualized by MRI may also be regarded as an important limitation of fetal MRI. We provide an overview of the most common pitfalls experienced in fetal MRI in routine practice, demonstrate how to identify some of the factors that lead to imaging misinterpretation, and suggest ways to tackle these problems, with an emphasis on MR techniques and image calibration.
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Pre-eclampsia affects 3 to 8% of all pregnancies. In the USA, pre-eclampsia remains a leading cause of maternal morbidity and mortality, comprising 17% of maternal deaths in advanced gestations in 1999. ⋯ Equally important are the adverse effects on the maternal hematologic, cardiovascular and pulmonary, neurologic, renal, and gastrointestinal system. This article aims to review complications of pre-eclampsia as they impact on the cardiovascular and pulmonary systems.
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Seminars in perinatology · Jun 2009
ReviewAbruptio placentae and disseminated intravascular coagulopathy.
Abruptio placentae is an important cause of vaginal bleeding in the latter half of pregnancy. The key factor in the pathophysiology is hemorrhage at the decidual-placental interface. Small episodes may escape clinical detection, but severe grades impact significantly on fetal and maternal morbidity and mortality, with the most frequent complications being fetal death, severe maternal shock, disseminated intravascular coagulopathy, and renal failure. ⋯ The diagnosis is essentially made on the clinical picture that includes vaginal bleeding (usually dark blood), abdominal pain, and uterine contractions. The essence of management is restoration of circulating volume followed by delivery of the fetus and placenta, most often by cesarean section when the diagnosis is clear and the fetus alive and viable. Aggressive resuscitation and expeditious vaginal delivery are the goals when the fetus is dead.