Delayed diagnosis and management of late second trimester intra-abdominal pregnancy / Philippine Journal of Obstetrics and Gynecology

@#Abdominal pregnancy resulting in lithopedion is a rare condition constituting only 0.0054% of all pregnancies. This is a case of a 48-year-old Gravida 6 Para 3 (3-0-2-2) who consulted at the emergency room for an ultrasound finding of abdominal pregnancy. The patient had previous imaging done which showed a live intrauterine pregnancy until her fourth ultrasound, showing fetal death in utero. After several months without passage of the products of conception, a repeat ultrasound showed an abdominal pregnancy. Diagnosis of abdominal pregnancies may be difficult, thus it is important to utilize other imaging modalities to confirm the diagnosis. The mainstay for treatment for abdominal pregnancies is laparotomy. However, due to the possible severe hemorrhage that may arise intraoperatively, preoperative and postoperative arterial embolization of feeding vessels may be performed, as was done in the case discussed.

A systematic approach to stillbirth examinationin a tertiary hospital

Background@#Stillbirth has a complex pathophysiology, hence the difficulty in arriving at a specific cause.@*Objectives@#The study aimed to identify the probable causes of stillbirth in a tertiary hospital based on gross examination of the placenta and the fetus, as well as, to identify the demographic profile of the stillbirths.

A systematic approach to stillbirth examination in a tertiary hospital

BACKGROUND: Stillbirth has a complex pathophysiology, hence the difficulty in arriving at a specific cause.OBJECTIVES: The study aimed to identify the probable causes of stillbirth in a tertiary hospital based on gross examination of the placenta and the fetus, as well as, to identify the demographic profile of the stillbirths.METHODS: A cross-sectional descriptive study was conducted among 29 stillbirths delivered in a tertiary hospital from March 2016 to September 2016. The probable causes of stillbirth were categorized as obstetrics complications, placental abnormalities, umbilical cord abnormalities, fetal malformations, infections, hypertensive disorders, medical complications, and undetermined causes.RESULTS: 86% of stillbirths in this study had a probable cause of death. Umbilical and placental abnormalities were the most probable causes (62% and 41%, respectively). The two most common identified cord abnormalities were short cord length (34%) and marginal insertion (23%), while small placenta (27%) was the most common for placental abnormalities.CONCLUSION: To be able to come up with the probable cause of stillbirth, the delivering physician or health personnel should always account the gross findings of the fetus and placenta after delivery.

Clinical characteristics and perinatal outcome of fetal hydrops

OBJECTIVE: To investigate the clinical characteristics of fetal hydrops and to find the antenatal ultrasound findings predictive of adverse perinatal outcome. METHODS: This is a retrospective study of 42 women with fetal hydrops who delivered in a tertiary-referral center from 2005 to 2013. Fetal hydrops was defined as the presence of fluid collection in > or =2 body cavities: ascites, pleural effusion, pericardial effusion, and skin edema. Predictor variables recorded included: maternal characteristics, gestational age at diagnosis, ultrasound findings, and identifiable causes. Primary outcome variables analyzed were fetal death and neonatal death. RESULTS: The mean gestational age at diagnosis was 29.3+/-5.4 weeks (range, 18 to 39 weeks). The most common identifiable causes were cardiac abnormality (10), followed by syndrome (4), aneuploidy (3), congenital infection (3), twin-to-twin transfusion syndrome (3), non-cardiac anormaly (2), chorioangioma (2), inborn errors of metabolism (1), and immune hydrops by anti-E antibody isoimmunization (1). Thirteen cases had no definite identifiable causes. Three women elected termination of pregnancy. Fetal death occurred in 4 cases. Among the 35 live-born babies, only 16 survived (54.0% neonatal mortality rate). Fetal death and neonatal mortality rate was not significantly associated with Doppler velocimetry indices or location of fluid collection, but increasing numbers of fluid collection site was significantly associated with a higher risk of neonatal death. CONCLUSION: The incidence of fetal hydrops in our retrospective study was 24.4 per 10,000 deliveries and the perinatal mortality rate was 61.9% (26/42). The number of fluid collection sites was the significant antenatal risk factor to predict neonatal death.

A retrospective cohort study of maternal and perinatal risk factors on intrauterine fetal death / 대한산부인과학회지

OBJECTIVES: The purpose of this study was to investigate the clinical characteristics and the risk factors of Intrauterine fetal death (IUFD). METHODS: We did retrospective review and investigated the risk factors from medical records of the 62 pregnancies with IUFD between January 2000 and December 2007. Also we statistically analyzed that maternal and perinatal risk factors compared with 3,887 live-birth pregnancies. RESULTS: The overall incidence of IUFD was 1.57%. The age distribution of mother with IUFD was between 21 to 41, and was highest in the 30 to 34 year old age group (41.94%). There were 29 cases (46.78%) with nulliparous and 5 cases (8.06%) with previous IUFD. IUFD was the most prevalent (48.39%) at 20-29 weeks of gestation and the sex ratio of male versus female fetus was 1.03:1. Most of cases (80.64%) were delivered vaginally (spontaneous labor: 62.90%, labor induction: 17.74%), and laparotomy was 19.35%. Risk factors were maternal obesity, infection, placental abnormality, advanced maternal age (> or =35), and unexplained cause in that order. 50 cases included more than two risk factors. The risk analysis showed statistically significant risk in preeclampsia (OR 2.733; 95% CI 1.408-5.306) and placental abruption (OR 5.190; 95% CI 2.165-12.441). CONCLUSION: Identification of risk factors for IUFD assists the clinician in performing a risk assessment for each patient. Clinicians need to be able to assess each patient's risk for IUFD and to have a low threshold to evaluate fetal growth in at-risk pregnancies.

The Clinical Study of Fetal Death in Utero / 대한주산의학회잡지

OBJECTIVE: To investigate the clinical characteristics and etiologic factors of pregnancies with fetal death in utero (FDIU). METHODS: Retrospective review of medical records of 184 pregnancies with FDIU between March 1996 and March 2006 was conducted and descriptive analysis was done. Medical records were unavailable in 14 cases which were excluded in the analysis of etiology and diagnostic evaluation. RESULTS: The overall incidence was 1.31%. There was no significant difference in the yearly incidence during the study period. Age distribution of FDIU was between 18 and 44 and the incidence was highest in 25~29 year-old age group. The risk analysis showed statistically significant risk in the age group under 25 (OR, 2.455) and 25~29 (OR, 1.590) compared to 30~34 year-old age group. The risk of age group beyond 35 has a tendency to increase but was not statistically significant. FDIU was the most prevalent (38.58%) among pregnancies less than 29 weeks of gestation. Most of cases were delivered vaginally (86.5%). Etiologic factors included unexplained causes (37.1%), fetal factors (29.4%), placental and cord factors (18.2%) and maternal factors (15.3%). Autopsy was done in 128 cases (75.3%) and placental pathology was examined in 148 cases (87.1%). Among the workups done, autopsy and placental pathology were the most informative. CONCLUSION: Despite the advance of prenatal care, the incidence of FDIU was steady throughout the study period. The etiology of the largest proportion was unexplained. Once FDIU is diagnosed, prompt delivery should be done and appropriate diagnostic tests should be offered to aid in next pregnancy.

Clinical Study for Fetal Death in Utero / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the incidence, causes and maternal complications in cases of fetal death in utero (FDIU). METHODS: This is a clinical study of 224 cases of FDIU among 10,582 deliveries at 00 University Hospital during January 1990 to December 2004. All the clinical informations were obtained by reviewing medical records retrospectively. RESULTS: The average incidence of FDIU was 2.1%. The mean age of mothers with FDIU was 28.5 years old. The mean gestational age was 30.4 weeks and mean weight of dead fetus was 1442 gm. The causes of FDIU were placenta abuptio (14.3%), severe preeclampsia (13.4%), congenital anomalies (9.4%), severe intrauterine growth restriction (IUGR, 9.4%), nuchal cord (6.7%), chrioamnionitis (5.8%). However the causes of FDIU were largely unknown (18.8%). The modes of delivery were induced labor (65.2%), laparotomy (26.8%), spontaneous labor (8.0%). The most common indication of laparotomy was placenta abuptio (36.7%). There were 66 cases (29.5%) with maternal complications and common complications were hemorrhage (11.2%), fever (8.5%), DIC (5.8%). The incidence of hypofibrinogenemia (<150 mg/dL) was 14.3%. CONCLUSION: The most common suspected causes of FDIU were placenta abruptio, severe preeclampsia and the causes could not be determined in 42 cases (18.8%). The proper prenatal care should be taken of fetuses on the basis of risk factors of antepartum and intrapartum so that unnecessary intrauterine fetal death might be able to be prevented.

Clinical Study for Intrauterine Fetal Death / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate intrauterine fetal death and to elucidate the etiology of intrauterine fetal death. METHODS: This is a clinical study of 153 cases of fetal death in utero (FDIU) among 11,866 deliveries at Holy Family Hospital during Mar. 1995 to Feb. 2002. RESULTS: 1. The average incidence of FDIU was 1.29%. 2. The age distribution of mother with FDIU was between 16 to 45 year old and was highest in the 25 to 29 year old age group (45%). 3. The parity of mothers with FDIU was the highest in nulliparous group (58.5%) and there was a decreased tendency with high parity. 4. There were 80 cases (52.1%) with previous history of abortion and 8 cases (5.2%) with previous history of FDIU. 5. The highest incidence rate of FDIU was shown at 20~24 weeks of gestation (36.6%) and in the fetus weighted less than 1,000 gm (56%), and the sex ratio of male versus female fetus was 1.29:1. 6. The mode of delivery FDIU was labor induction (54.3%), laparotomy (15.2%), spontaneous labor (30.4%). The indication for laparotomy were placental abruption, previous cesarean section state, twin and maternal death. As the gestational age and fetal weight decreased, the mean time interval from start of labor induction to fetal expulsion and the variety of labor induction became increase. 7. The etiology factors of FDIU was unexplained causes (44%), congenital anomaly (17%), cord complication (14%) in order. CONCLUSION: The proper antenatal care should be taken of fetuses on the basis of risk factors of antepartum and intrapartum so that unnecessary intrauterine fetal death might be able to be prevented.

A Case of Multiple Placental Chorioangioma Combined with Oligohydramnios / 대한산부인과학회잡지

Chorioangioma is the most common benign tumor of the placenta and associated with adverse perinatal outcome. The prevalence of chorioangioma of the placenta is about 1 percent. The most placental chorioangioma has no clinical significance. But the uncommon large (greater than 5 cm in diameter) chorioangioma may produce both maternal and fetal complications, such as polyhydramnios, preterm labor, fetal heart failure, hydrops fetalis, fetal growth restriction, fetal microangiopathic hemolytic anemia, fetal thrombocytopenia, toxemia of pregnancy, maternal thrombocytopenia, and maternal coagulopathy. The ultrasonography and Color Doppler are used for diagnosis of these lesions. If chorioangioma is suspected, Color Doppler study is informative to confirm the presence of the vascular channels. We report a case of multiple chorioangioma combined with oligohydramnios and discuss the noxious effects of this benign tumor on the mother and the fetus.

A Clinical Analysis of Intrauterine Fetal Death / 대한주산의학회잡지

OBJECTIVE: To evaluate the causes, methods of delivery, and maternal complications in cases of fetal death in utero(FDIU) at Samsung Medical Center. METHODS: There were 92 cases of FDIU among 25,195 deliveries at Samsung Medical Center during 7 years from 1994 to 2001. In these cases, perinatal autopsy and placental biopsy was performed in 35 and 71 cases, respectively. All the clinical informations were obtained by reviewing medical records retrospectively. RESULTS: The overall incidence of FDIU was 0.37%. Most of FDIU occurred in 25 to 29 years old group(43.5%). Recurrence rate of FDIU was 3.3%. Most of FDIU were low birth weight(79.3%) and preterm(79.6%). The modes of delivery were induced labor(68.5%), laparotomy(18.5%), and the spontaneous delivery(13.0%). The causes of FDIU were chorioamnionitis(15.2%), placental abruption(14.1%), severe preeclampsia(11.9%), congenital and chromosomal anomaly(6.5%), but it was unexplained in 27.2%. There were 25 cases with maternal complications and the most common complications were intra-/postpartum fever(18.5%), postpartum hemorrhage(8.7%) and DIC(8.7%). CONCLUSION: The causes of FDIU could not be determined in only about 1/4 cases at Samsung Medical Center. Since FDIU recurred in 3.3%, thorough studies including perinatal autopsy and chromosomal study must be made on stillborn infants and placenta to determine the recurrent causes.