Introduction: Regarding its pathogenesis, discordant development in early gestation, as well as vascular anastomoses between twins are postulated to be required for the establishment of the twin-reversed arterial perfusion (TRAP) sequence. However, first trimester findings associated with this complication have not yet been reported. Case: A discordant monochorionic twin was revealed upon examination of a 24-year-old primigravida at 11 weeks’ gestation. Cystic masses were identified on the back of the smaller twin, later followed by the appearance of skin edema and pericardial effusion, indicating cardiac failure. Subsequently, despite diagnosis of fetal demise at 15 weeks the lower body was shown to have further developed and the heartbeats appeared again, resulting in an acardia anceps or hemicardia. No remarkable change was observed in the larger normal twin. Conclusion: This occurrence was considered consistent with the current hypothesis regarding the pathogenesis of the acardiac anomaly. First trimester discordancy in a monochorionic twin gestation is considered to represent an early manifestation of TRAP sequence.
Magnesium sulfate has been used for some time in the United States to prevent eclampsia. It dilates cerebral blood vessels and can reduce ischemia by preventing cerebral vasospasm. If eclampsia is in fact a result of cerebral ischemia, the calcium-channel blocker nimodipine, a specific cerebral vasodilator, would seem to be an ideal alternative treatment. Nimodipine can be given orally, has little toxicity, and lowers blood pressure. This unblinded trial randomized women with severe preeclampsia, for whom delivery had been decided on, to receive either 60 mg of nimodipine by mouth every 4 hours or a 6-g loading dose of magnesium sulfate followed by an infusion of 2 g per hour. An alternative was to administer 4 g at the outset to be followed by an infusion of 1 g per hour. Treatment continued for up to 24 hours antepartum. Participants were accessed from 14 centers in 8 countries. The 819 women randomized to receive nimodipine and the 831 given magnesium sulfate were comparable demographically and clinically, except for slightly higher baseline systolic blood pressure in the magnesium sulfate group. Mean arterial pressure fell by 8% on average within 1 hour of the start of treatment, and the reduction was maintained at 3 hours. Nimodipine-treated patients were significantly likelier to have a seizure than those given magnesium (2.6% vs. 0.8%). The crude relative risk of a seizure with nimodipine was 3.0. The majority of seizures in this group and all those in the magnesium sulfate group occurred in the antepartum period. The group difference in seizure risk was significant only in the postpartum period. Women given magnesium more often required hydralazine to control blood pressure and more frequently had postpartum bleeding. In addition, respiratory problems were more numerous in these patients. Rates of eclampsia were 1.4% in the nimodipine group and 0.5% in women given magnesium sulfate. This study shows that magnesium sulfate is a more effective means of preventing eclampsia in women with severe preeclampsia than is nimodipine. The findings suggest that eclampsia might be a result of cerebral overperfusion rather than decreased blood flow. ABSTRACTUsing caffeine while pregnant reportedly increases the risk of both spontaneous abortion and low birth weight. Caffeine augments catecholamine release from the renal medulla, possibly causing constriction of uteroplacental vessels and consequent fetal hypoxia. It also is possible that caffeine directly affects the fetal cardiovascular system, resulting in tachycardia and other arrhythmias. This prospective follow-up study sought information on coffee drinking from 18,478 women bearing singleton pregnancies. Participants completed questionnaires before their first antenatal visit, at approximately 16 weeks' gestation.The overall risk of stillbirth (defined as delivery of a dead fetus at 28 weeks' gestation or later) was 4.4 per 1000, and the risk of infant death during the first year of life was 4.0 per 1000. Stillbirths increased with the number of cups of coffee dr...
This study was performed to correlate cervicovaginal fluid and umbilical cord plasma level of IL-6 and IL-8 in patients with premature rupture of the membranes (PROM) and to see the effect of antibiotics on those concentrations. As a part of a randomized controlled trial of treatment in PROM with antibiotics, cervicovaginal fluid was sampled before delivery for measurement of IL-6 and IL-8 and for bacteria from 36 patients less than 36 weeks of gestation. Umbilical cord plasma was also collected. Concentrations of IL-6 and IL-8 were measured by an ELISA. Neonatal infections were noted in a total of 9 cases, including bacteria detection (Escherichia coli 2 cases, GBS and Streptococcus constellata) in 4 cases. Correlation between IL-6 in cervicovaginal fluid and in cord plasma (r = 0.881, p < 0.0001) was stronger than that of IL-8 (r = 0.469, p < 0.01). The difference of concentrations in IL-6 and IL-8 was not significant between cases with (n = 20) and without (n = 16) ampicillin. Our observation indicates that the measurement of IL-6 concentrations in cervicovaginal fluid is a useful marker for PROM patients who are more likely to develop neonatal infection and the antibiotic treatment does not necessarily produce their beneficial effects on fetuses at the risk of infection.
This study was designed to elucidate the effects of meluadrine tartrate on oxytocin-induced uterine contraction and maternal hemodynamics in unanesthetized, chronically instrumented pregnant goats. After the administration of meluadrine tartrate or ritodrine hydrochloride to pregnant goats, changes in heart rate (HR), arterial blood pressure (AOP), and arterial blood pH and gasses (P(O2) and P(CO2)) in the mother, as well as changes in intrauterine pressure (IUP) and uterine arterial blood flow (UBF), were measured. The escalating administration of meluadrine tartrate (0.03, 0.1, 0.3 and 1 micro g. kg(-)(1). min(-)(1)) or ritodrine hydrochloride (1, 3, 10 and 30 microg. kg(-)(1). min(-)(1)) to the maternal femoral vein caused a marked and similar inhibition in oxytocin-induced uterine contraction (a rise in IUP). By these escalating dosings, maternal HR was increased dose-dependently in both treatment groups; however, the degree of the HR increase in the meluadrine tartrate-treatment group was significantly less than that in the ritodrine hydrochloride-treatment group. Furthermore, the degree of the UBF decrease in the meluadrine tartrate-treatment group was significantly less than that in the ritodrine hydrochloride-treatment group. The present study suggests that meluadrine tartrate has a mild influence on the maternal cardiovascular function relative to the effects of ritodrine taking the potent efficacy on oxytocin-induced uterine contraction into account.
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