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Reference values for Doppler indices of the umbilical and fetal middle cerebral arteries in uncomplicated third trimester pregnancy  [PDF]
S Paudel,B Lohani,G Gurung,MA Ansari,P Kayastha
Journal of Institute of Medicine , 2010, DOI: 10.3126/joim.v32i3.4953
Abstract: Introduction: The purpose of this study was to categorize new reference ranges for measurements of commonly used umbilical artery and fetal middle cerebral artery Doppler indices (Pulsatility Index, Resistance Index, and Systolic: Diastolic ratio) in uncomplicated third trimester pregnancy. Methods: This was a prospective cross sectional study involving 101 singleton uncomplicated pregnancies of 30 to 37 weeks of gestation. Umbilical artery indices were obtained from free floating loop and middle cerebral Doppler indices were obtained from the proximal third of the artery with flow towards the probe. Regression equations were used to categorize reference ranges and percentile fitted Normograms were obtained for all the parameters. Results: Among 101 singleton pregnancies between 30 and 37 weeks of gestation, 65 (64.35%) were primigravida women and 36 (34.65%) were multigravida. Mean maternal age was 23.12years (range 16 to 35 years). Maximum number of pregnancies (18.81%) was at 34 weeks of gestation. The established percentiles of Doppler indices showed a continuous reduction of all the measured indices as pregnancy increases (p<0.0001). Conclusions: Reference ranges were obtained for the middle cerebral artery and umbilical artery Doppler indices. These ranges are consistent with similar studies done by other authors. Keywords: Doppler study; fetal Middle cerebral artery; pulsatility index; resistance index; systolic; diastolic ratio; umbilical artery DOI: http://dx.doi.org/10.3126/joim.v32i3.4953 Journal of Institute of Medicine , December, 2010; 32:3 5-13
HEMODYNAMIC DOPPLER PARAMETERS IN THE FETUS FETOPLACENTAL UNIT WITH INTRAUTERINE GROWTH RESTRICTIONWITHIN PREGNANCY INDUCED HYPERTENSION  [PDF]
Snezana Stamenovic,Miodrag Radovic
Acta Medica Medianae , 2005,
Abstract: Based on the spectral analysis of Doppler velocity waveform in uteroplacental and fetoplacental circulation, a Doppler parameters diagnostic efficiency was examined in fetus prenatal detection with intrauterine growth restriction (IUGR) within Pregnancy Induced Hypertension (PIH) and their respiratory menace.A prospective analysis was performed in 141 third-trimester pregnancies. The control group included 65 normal pregnancies and the expeimental group included 76 high-risk pregnancies, which was divided into three sub-groups, namely, 31 with IUGR within PIH, 24 with PIH only and 21 with IUGR only. The uterine artery was examined in uteroplacental circulation and umbilical artery was examined in fetoplacental circulation. Perinatal outcome and birth weight were recorded in each case.Uteroplacental circulation analysis showed statistically higer values of Pourcelot resistance index Ri in uterine artery in IUGR within PIH pregnancies. Statistically higher pulsatility index in umbilical artery was recorded in IUGR pregnancies compared to the control group and PIH subgroup. Higher values of pulsatility index were particulary noticed in IUGR within PIH subgroup. Doppler parameters in uteroplacental and fetoplacental circulation showed a significant negative correlation in relation to Apgar score of the newborn.In combination with biophysical profile and CTG, Doppler parameters diagnostic efficiency is increased on the evaluation of the fetus respiratory menace with IUGR and PIH.
Study of Umbilical Cord in Pregnancy Induced Hypertension  [cached]
Alka Udainia,C D Mehta
National Journal of Medical Research , 2013,
Abstract: Introduction: Fetal outcome is already compromised in pregnancy induced hypertension (PIH) and it is adversely affected by abnormality in umbilical cord, so purpose of this study to early diagnosis of latter would give an insight into the former. Methodology: The study on umbilical cord insertion in pregnancy induced hypertension (PIH) was carried out by dissection method in Government Medical College Surat. The attachment of umbilical cord on placenta was examined after careful dissection of membranes in 75 cases of PIH and 25 cases of normotensive pregnancy. Results: It was noted that Eccentric insertion of umbilical cord is the commonest type of insertion in PIH group (70.67%). Next common type of insertion is Central insertion 12% in PIH group. Marginal insertion is found in 14.67% cases in PIH group. No case of Velamentous (Membranous) insertion is found in normotensive while 2.66% cases are found in PIH. Whereas PIH group shows both dispersal and magistral type of distribution, in mild PIH 95% placenta shows dispersal type and 5% shows magistral type distribution, but in severe PIH 91.43% placenta show dispersal type and 8.57% placenta show magistral type of distribution. [Natl J of Med Res 2013; 3(1.000): 66-69]
Hemoperitoneum Caused by Placenta Percreta in the Third Trimester of Pregnancy
Roya Faraji Darkhaneh,Maryam Asgharnia,Sohrab Aghazadeh
Iranian Journal of Medical Sciences , 2009,
Abstract: The placental adhesive disorders such as placenta accreta andplacenta percreta are the rare causes of serious obstetric hemorrhages.They are associated with high maternal morbidity andmortality. Placenta percreta is usually diagnosed in the thirdtrimester of pregnancy as a massive postpartum hemorrhagewhen an attempt to remove the placenta reveals lack of acleavage plane. Here we report an unusual presentation of placentapercreta as hemoperitoneum and hemorrhagic shock inthe third trimester of pregnancy. A 33-year-old woman wasadmitted to hospital at the 35th weeks of gestation with abdominalpain and hemorrhagic shock. Laparotomy was immediatelyperformed because of intra-abdominal bleeding. Uponinspection, a posterior laceration of the uterus was noted.Pathologic investigation of the uterus showed placenta percreta.The patient recovered uneventfully. Spontaneous ruptureof the uterus can be occured in the absence of uterinetrauma. In the differential diagnosis of a pregnant woman presentingwith hypotension, abdominal pain, and fetal death, ruptureof the uterus caused by placenta percreta should be considered.Rapid diagnosis, blood transfusion, and emergency laparotomyare the key steps in successful management.
Cervicovaginal Infections During Third Trimester of Pregnancy
Sakine Moaiedmohseni,Laleh Bashardoost,Maryam Abbasi
Journal of Family and Reproductive Health , 2012,
Abstract: Objective: This study was conducted in order to assess the prevalence of different cervicovaginalinfections during pregnancy.Materials and methods:Totally 110 healthy pregnant women with complaints of vaginal symptoms intheir third trimester of pregnancy were checked for vaginal candidiasis,bacterial vaginosis, vaginaltrichomoniasis, streptococcus β hemoliticus,gonorrhea, syphilis, and infection by chlamydia trachomatisand HIV.Results:Among 110 studied women and mostly nullipara, the mean age was 25.2 years. All of them hadat least one symptom including discharge,itching or burning of vagina. Among them 39(35.5%) hadvaginal and endocervical infection identified by laboratory tests including candidiasis 26.4%, bacterialvaginosis 8% and streptococcus β hemoliticus 5.3 %. Gonorrhea and trichomoniasis were not seen.Three of the patients had positive IgG antibody for chlamydia trachomatis. None of them had serologicalpositive test for syphilis and HIV.Conclusion: Symptomatic pregnant women need to be actively searched for infections. Besidesspeculum examination as an easy to carry out clinical test and if needed laboratory exams must be usedto choose the best treatment.
Prevalence of Group B Streptococcus Vaginal Colonization in The Third Trimester of Pregnancy.
MR Nazer,E Rafiei Alavi,E Nazer,M Khamechi
Journal of Shahid Sadoughi University of Medical Sciences , 2011,
Abstract: Introduction: Group B Strepococcus(GBS) is one of the most important causes of neonatal infections including septicemia and meningitis. It also plays an important role in maternal infections such as chorioamnionitis, pyelonephritis, metritis and post partum infection. The present study was carried out to find the prevalence of GBS in pregnant women with 28 to 38 weeks gestational age. Methods: In this study, 100 pregnant women referring to the obstetrical clinic of Asalian Hospital in Khorramabad city in the third trimester of pregnancy (after explaining the study, getting informed consent and demographic informations) were tested for GBS by taking a vaginal sample. The sample was taken by sterile cotton swab. The swabs were placed in transport media, transported to the central Lab, and were inoculated in blood agar. Then all samples were analyzed for the presence of GBS. Results: In this study, the prevalence of positive vaginal GBS culture in pregnant women was 14% (CI: 7.2-20.8%). No significant correlation were found between this positive culture and maternal age, gestational age, abortion status, diabetes mellitus and pregnancy induced hypertension, while a significant correlation was found between positive cultures and parity. Conclusion: As the colonization rate of GBS in pregnant women of Khorramabad is high, routine culture-based screening is recommended for all pregnant women in third trimester of pregnancy.
Assessment of the Value of Rescreening for Syphilis in the Third Trimester of Pregnancy  [PDF]
Rodney K. Edwards,Margaret Bennett,Carrie Langstraat,Daina Greene
Infectious Diseases in Obstetrics and Gynecology , 2006, DOI: 10.1155/idog/2006/56504
Abstract: Objectives. Our aim is evaluating the need for repeating tests for syphilis on pregnant women in the third trimester. Study design. A single-center retrospective cohort study was performed on all women delivering 7/03–6/04. Results. During the study interval, 2244 women delivered at our hospital. Of those women having available records and attending at least one prenatal visit, 1940 (98.9%) were screened for syphilis at the first prenatal visit. Of the 1627 women beginning prenatal care prior to 27 weeks and delivering after 32 weeks, 1377 (84.6%) were rescreened in the third trimester. No cases of syphilis were identified with either the initial (upper limit of 95% CI 0.24%) or repeat (upper limit of 95% CI 0.34%) screening. Conclusions. In our obstetric population, syphilis is so uncommon that mandated prenatal screening on more than one occasion seems unjustified and laws requiring repeated screening should be reevaluated.
Antenatal Diagnosis of Isolated Total Arhinia in the Second Trimester of Pregnancy  [PDF]
D. Leroy, E. Slachmuylder, M. Popijn, M. Cassart, A. Massez, N. D'Haene, J. Désir, A. Vandermaelen, C. Daelemans, G. Ceysens, C. Donner
Open Journal of Obstetrics and Gynecology (OJOG) , 2016, DOI: 10.4236/ojog.2016.67055
Abstract: Congenital arhinia is a very rare condition especially when it is isolated. Most of arhinia are identified after birth and only five prenatal cases are described in the literature. Generally, arhinia is associated with other malformations mainly craniofacial anomalies. Genetics aberrations are uncommon. Our case was diagnosed in the second trimester of pregnancy and we found no associated anomaly except for a single umbilical artery. Autopsy confirmed the diagnosis and neuropathology analysis revealed the absence of olfactory bulbs and tracts.
Association of Second and Third Trimester Weight Gain in Pregnancy with Maternal and Fetal Outcomes  [PDF]
Michele Drehmer, Bruce Bartholow Duncan, Gilberto Kac, Maria Inês Schmidt
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0054704
Abstract: Objective To investigate the association between weekly weight gain, during the second and third trimesters, classified according to the 2009 Institute of Medicine (IOM/NRC) recommendations, and maternal and fetal outcomes. Methods Gestational weight gain was evaluated in 2,244 pregnant women of the Brazilian Study of Gestational Diabetes (Estudo Brasileiro do Diabetes Gestacional – EBDG). Outcomes were cesarean delivery, preterm birth and small or large for gestational age birth (SGA, LGA). Associations between inadequate weight gain and outcomes were estimated using robust Poisson regression adjusting for pre-pregnancy body mass index, trimester-specific weight gain, age, height, skin color, parity, education, smoking, alcohol consumption, gestational diabetes and hypertensive disorders in pregnancy. Results In fully adjusted models, in the second trimester, insufficient weight gain was associated with SGA (relative risk [RR] 1.72, 95% confidence interval [CI] 1.26–2.33), and excessive weight gain with LGA (RR 1.64, 95% CI 1.16–2.31); in third trimester, excessive weight gain with preterm birth (RR 1.70, 95% CI 1.08–2.70) and cesarean delivery (RR 1.21, 95% CI 1.03–1.44). Women with less than recommended gestational weight gain in the 2nd trimester had a lesser risk of cesarean deliveries (RR 0.82, 95% CI 0.71–0.96) than women with adequate gestational weight gain in this trimester. Conclusion Though insufficient weight gain in the 3rd trimester was not associated with adverse outcomes, other deviations from recommended weight gain during second and third trimester were associated with adverse pregnancy outcomes. These findings support, in part, the 2009 IOM/NRC recommendations for nutritional monitoring during pregnancy.
Group A Streptococcal Toxic Shock Syndrome Developing in the Third Trimester of Pregnancy  [PDF]
Nancy F. Crum,Helen M. Chun,Thomas G. Gaylord,Braden R. Hale
Infectious Diseases in Obstetrics and Gynecology , 2002, DOI: 10.1155/s1064744902000248
Abstract: Background: Group A streptococcal (GAS) toxic shock syndrome (TSS) is an uncommon, but life-threatening infection during pregnancy and should be considered in rapid onset of shock.Most cases described in the literature have occurred in the puerperium.We report a case of GAS TSS occurring during the third trimester of pregnancy in a previously healthy woman.
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