The relationship between placental histopathology findings and perinatal outcome in preterm infants.

OBJECTIVE: To determine the correlation between placental histopathology findings and perinatal outcome in preterm infants. METHODS: Placental histopathology in 774 neonates delivered at 24-32 weeks between 1992 and 2000 was classified as follows: 254 (33%) had histological chorioamnionitis, 263 (34%) had coagulation-related lesions, 228 (30%) had vasculopathy. Perinatal outcome was compared between cases positive and negative for each histopathological classification. RESULTS: Histological chorioamnionitis occurred in 46% of cases with premature rupture of membranes and 45% with preterm labor. Positivity versus negativity for histological chorioamnionitis was associated with earlier presentation (191 vs. 205 days, p = 0.0001) and delivery (199 days vs. 209 days, p = 0.0001), increased risk of intraventricular hemorrhage (71% vs. 23%, p = 0.001, odds ratio (OR) 2.2), bronchopulmonary dysplasia (26% vs. 15%, p = 0.0001, OR 2), retinopathy (36% vs. 24%, p = 0.001, OR 1.8), neonatal sepsis (28% vs. 13%, p = 0.0001, OR 2.5) and neonatal death (12% vs. 7%, p = 0.012, OR 2). Vasculopathy versus no vasculopathy was associated with decreased birth weight (1245 g vs. 1341 g, p = 0.011), decreased Apgar score at 5 min (20% vs. 13%, p = 0.011, OR 1.7) and necrotizing enterocolitis (6% vs. 2%, p = 0.001, OR 4). Cases positive for coagulation-related lesions correlated only with necrotizing enterocolitis (5% vs. 2%, p = 0.02, OR 2.6). CONCLUSIONS: The presence of histological chorioamnionitis significantly increases the risk of earlier delivery and neonatal mortality. Vascular and coagulation placental findings increase the risk of necrotizing enterocolitis.

Clinical and pathologic correlates of stillbirths in a single institution.

BACKGROUND: To evaluate risk factors, placental and pathologic determinants of stillbirths. METHODS: A retrospective analysis of stillbirths > or = 25 weeks was performed. Clinical data was compared to a randomized control group. Statistical analysis included chi square test, student t test, and logistic regression. RESULTS: One hundred and fifteen stillbirths and 193 controls were analyzed. Maternal age, nulliparity, tobacco use, previous induced abortions, anticardiolipid antibodies, elevated maternal serum alpha feto protein, twins, and amniocentesis, were significantly associated with stillbirth. Logistic regression analysis showed only maternal age, tobacco use, small for gestational age (SGA), previous induced abortions, decreasing gestational age as independent significant variables. The stillbirth baby was 6.8 times more likely to be SGA and 11.9 times more likely to be preterm. Primary pathologic diagnoses were placental factors (37%), cord complications (28%), and fetal causes (15%), 17% had maternal risk factors only and 3% had no known risk factors. Diagnosis was suggested by pathology in 40% of cases. CONCLUSIONS: Stillbirth delivery is associated with older, nulliparous patients with prenatal complications resulting in intrauterine growth retardation and prematurity. Perinatal histopathologic examination is important in diagnosis. Utilizing an extensive testing protocol will reduce the diagnosis of unexplained stillbirth.

External cephalic version.

External cephalic version has been used periodically for centuries to manage breech presentations. As cesarean section rates have escalated in the last two decades, ways to curb this rise have been evaluated. By reducing the number of infants that arrive in labor in a malpresentation, it is possible to impact the overall cesarean section rate. External cephalic version is a safe, effective method when used in appropriate cases of breech presentation. A forward or backward roll can be accomplished in women at term with singleton gestations, adequate amniotic fluid, and reactive nonstress tests. Parity, fetal and placental position, and descent of the presenting part may all influence the success rate of the version.

Mitochondrial myopathy and preeclampsia associated with pregnancy.

Mitochondrial myopathy is characterized by weakness, exercise intolerance, and acidosis. Pregnancy has been reported to accelerate the disease process. This report discusses pregnancy and management of labor complicated by mitochondrial myopathy and the therapeutic dilemmas that arise when preeclampsia is diagnosed.

Pregnancy complicated by maternal spina bifida. A report of two cases.

Pregnancy occurred in two women who had undergone corrective surgery for meningomyelocele. Both women had urinary incontinence leading to urinary tract infections and, in one, to vulvitis urinosa. There is limited literature on maternal meningomyelocele and its complications.

Disseminated Kaposi's sarcoma in pregnancy: a manifestation of acquired immune deficiency syndrome.

The first case of acquired immune deficiency syndrome (AIDS) in pregnancy is reported. The patient, a drug addict, presented with lymphadenopathy, pulmonary infiltrates, and skin lesions of Kaposi's sarcoma, a tumor rarely found in young women in this country. The helper T-lymphocyte to suppressor T-lymphocyte ratio showed the profound inversion characteristic of this cell-mediated immune deficiency disease. Chemotherapy, a combination of doxorubicin, bleomycin, and vinblastine, was initiated during pregnancy. A growth-retarded infant was delivered vaginally. At four months of life, the infant had no apparent evidence of immune deficiency. Transplacental transmission of AIDS has not, as yet, been demonstrated. The social factors, clinical and laboratory features, and the controversies surrounding this new disease are discussed.