Zeitschrift für Geburtshilfe und Neonatologie
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The "perinatal asphyxia" is regarded to be one of the causes of cerebral palsy, though in the very most of the children with cerebral palsy there is found no hypoxia during labour. It should be mentioned, that the definition of "perinatal" and "asphyxia" neither are unic nor concret. And also there is no correlation between nonreassuring fetal heart rate patterns and acidosis in fetal blood with the incidence of cerebral palsy. ⋯ There is a great probability of a pre(and post-)natal origin of brain injury (for instance a periventricular leucomalacia found after birth) which leads to cerebral palsy. Short after labour signs of a so called "asphyxia" may occur in addition to this preexisting injury and misrepresent the cause of cerebral palsy. Finally the prepartal injury may cause both: Cerebral palsy and hypoxia.
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The early detection of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) is the basic condition for immediate therapeutic management, which mainly leads to prompt delivery. The classical symptoms despite the typical laboratory evaluation (hemolysis, elevated liver enzymes, low platelets) are epigastric or right upper quadrant pain and nausea and vomiting; the classical signs of preeclampsia (proteinuria and hypertension) may be absent in 20%. The differential diagnostic problems of HELLP syndrome arise in relation to the mimicry-symptomatic: upper abdomen pain can imitate gastroenterologic diseases (e.g. cholelithiasis, appendicitis), the elevated liver enzymes combined with hyperbilirubinemia liver diseases (e.g. viral hepatitis) and thrombocytopenia in combination with hemolytic anemia, neurological symptoms and renal failure other similar pathogenetic disorders due to the category of thrombotic microangiopathies. ⋯ Interdisciplinary detours and delay are the consequences of this differential diagnostic problems, which could imply deleterious effects on the mother and the fetus, until the final diagnosis is clear. Therefore all pregnant women with upper abdomen pain irrespective of symptoms of preeclampsia should be considered to have HELLP syndrome and immediate laboratory evaluation has to be done. If there is any doubt a interdisciplinary consultation is required!
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Z Geburtshilfe Neonatol · Mar 1996
Review[Significance of intrapartum hypoxia for cerebral long-term morbidity].
Congenital brain damage is not equivalent with birth associated brain damage. The majority of congenital brain lesions are prenatal in origin. There is a smooth transition of hypoxemia and acidemia in fetal blood related to the physiological birth stress and fetal hypoxia resulting in tissue damage. ⋯ Brain damage caused by birth hypoxia usually result in spastic cerebral palsy. Even today in the majority of cerebral palsy cases the actual cause remains unclear. Increased attention should be directed towards the differentiation between disturbances developing in late pregnancy and primary intrapartal hypoxia.
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The use of regional analgesia and anesthesia in obstetrics has been established since the end of the 19th century. According to an agreement between German societies of anesthesiologists and obstetricians, regional anesthesia may be performed by both anesthesiologists and obstetricians under certain preconditions. At the RWTH Aachen hospital, the responsibility for different anesthetic techniques is divided between anesthesiologists and obstetricians in order to reduce legal risks. ⋯ The failure rate of caudal anesthesia was higher than that of lumbar epidural anesthesia. Blood pressure falls exceeding 20 percent of baseline were only seen in the epidural group (incidence 0.9 to 1.5 percent). The incidence of fetal bradycardia and the overall complication rate were similar in both groups.