American journal of perinatology
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We studied 16 women, at 32 weeks' or more gestation who required magnesium sulfate (MgSO4) therapy for preterm labor or preeclampsia. A 60-minute Doppler fetal heart rate (FHR) tracing, analyzed by the Oxford Sonicaid System 8000, was obtained for 1 hour before and 2 hours after each patient received intravenous MgSO4 therapy. Maternal serum Mg2+ levels were obtained at the second monitoring session. ⋯ Reduced short-term and overall variability occurred in all cases with maternal serum Mg2+ levels more than 4.6 mg/dL. Therapeutic maternal serum Mg2+ levels are linked with decreases in long-term and short-term FHR variability and acceleration counts. These findings should be considered when evaluating resting FHR baseline of patients thus treated.
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Case Reports
Labor and delivery complicated by acute mitral regurgitation due to ruptured chordae tendineae.
Acute mitral regurgitation due to ruptured chordae tendineae is a dramatic and life-threatening clinical situation. Rarely does this complication occur during pregnancy. ⋯ Delivery was uneventful and successful and was followed by open heart surgery 5 days later. A review of the literature on chordae tendineae rupture and resulting mitral regurgitation during pregnancy is presented.
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Randomized Controlled Trial Clinical Trial
Effects of single dose calcium gluconate infusion in hypocalcemic preterm infants.
We conducted a prospective, double-blind study of 43 preterm infants to examine the effect of a single calcium gluconate infusion as therapy for neonatal hypocalcemia on serum calcium concentrations and hypocalcemic signs in preterm infants with low total serum calcium concentrations. Total and ionized serum calcium was measured and signs of irritability, jitteriness, and twitching were scored (scale 0-9) by blinded observers before and after receiving one dose of either calcium gluconate (100 mg/kg) or placebo (normal saline). ⋯ Of the infants with hypocalcemic signs, the average score of hypocalcemic signs decreased in the 11 calcium-treated infants; the 12 infants with hypocalcemic signs showed no change of hypocalcemic signs following treatment with placebo. We conclude from this study that a single dose of calcium gluconate (100 mg/kg) in hypocalcemic preterm infants raise total and ionized serum calcium and decrease clinical signs of hypocalcemia.
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The shape of the volume-pressure (V/P) curve indicates alveolar collapse if it is convex to the pressure axis and indicates overdistension if it is concave. Positive end-expiratory pressure (PEEP) should either improve or decrease compliance and oxygenation in neonates ventilated for respiratory distress syndrome (RDS), depending on predominance of either alveolar collapse or overdistension. To test this hypothesis, we determined quasistatic V/P curves in 13 preterm neonates and characterized their shape by an alveolar distension index (ADI) at PEEP levels of 2, 4, and 6 cm H2O. ⋯ An increased PEEP in neonates with alveolar collapse (ADI less than 1) decreased AaDO2 more (12 vs 10 mm Hg/cm PEEP, not significant) and decreased compliance less (3 vs 17%/cm PEEP; P < 0.05) than in those neonates with alveolar overdistension (ADI more than 1). Conversely, a decreased PEEP in neonates with alveolar overdistension increased compliance more (19 vs 5%; not significant) and increased AaDO2 less (7 vs 26 mm Hg; P < .01) than in those with alveolar collapse. AaDO2 and compliance changes after PEEP alterations were significantly correlated to the ADI before PEEP alterations (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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A 16-year-old primigravida woman presented in advanced labor with a singleton breech presentation. Vaginal delivery was considered to be possible, but entrapment at the level of the fetal thorax occurred. The Zavanelli maneuver was attempted unsuccessfully. ⋯ Repositioning of the mother facilitated delivery. The fetus survived without any complications. This case illustrates the lack of scientific data to support decision-making in the case of patients presenting with breech presentation late in labor, as well as the unconventional steps sometimes needed in these situations.