ABSTRACT
The dysgnathia complex (agnathia-otocephaly) (AO) is a lethal malformation that consists of congenital absence of the lower jaw with union or close approximation of the lower ears on the front of the neck, microstomia, and hypoglossia. We present a novel case of agnathia-otocephaly with associated organomegaly and the use of postmortem 3-D computed tomographic rendering.
Subject(s)
Abnormalities, Multiple/diagnostic imaging , Ear/abnormalities , Fetus/diagnostic imaging , Mandible/abnormalities , Maxillofacial Abnormalities/diagnostic imaging , Tomography, X-Ray Computed , Adult , Ear/diagnostic imaging , Fatal Outcome , Female , Gestational Age , Humans , Image Processing, Computer-Assisted/methods , Mandible/diagnostic imaging , Polyhydramnios/diagnosis , Polyhydramnios/etiology , Pregnancy , SyndromeABSTRACT
OBJECTIVE: The purpose of this study was to define the indications and outcomes of emergent cesarean deliveries. STUDY DESIGN: We analyzed prospectively collected singleton maternal and neonatal data from January 1, 1998, to December 31, 2004 of all such cesarean deliveries that were performed. A case-control analysis was performed by matching emergent cesarean deliveries with the next 2 acute cesarean deliveries. RESULTS: There were 126 emergent cesarean deliveries (1:159 deliveries). There were no significant differences in identifiable obstetric or chronic medical risk factors between the 2 groups. Compared with the control subjects, the subjects with emergent cesarean deliveries had an increased risks of cesarean delivery for non-reassuring fetal heart rate (P < .0001; odds ratio, 12.0), cord prolapse (P < .0001), and suspected uterine rupture (P < .0001); in addition, greater risk of a low 1-minute Apgar score (P < .001; odds ratio, 19.5) and low 5-minute Apgar score (P < .001; odds ratio, 10.4), acute respiratory distress of infant (P < .001; odds ratio, 4.21), and infant intubations (P < .0001; odds ratio, 8.1). CONCLUSION: These data demonstrate that most emergent cesarean deliveries develop during labor in low-risk women and cannot be anticipated by prelabor factors. The outcomes demonstrate that infants are at risk in these clinical situations and suggest that strategies to improve performance in these clinical situations are important.
Subject(s)
Cesarean Section , Emergency Medical Services , Apgar Score , Case-Control Studies , Female , Heart Rate, Fetal , Humans , Infant, Newborn , Intubation , Pregnancy , Prolapse , Prospective Studies , Respiratory Distress Syndrome, Newborn , Risk Factors , Umbilical Cord , Uterine RuptureABSTRACT
OBJECTIVE: To provide a comprehensive review of urinary tract infections (UTIs) during pregnancy. All aspects of UTIs, including epidemiology, pathogenesis, resistance, clinical features, diagnosis, treatment, and prevention, were reviewed. DATA SOURCES: MEDLINE (1966-August 2003) and Cochrane Library searches were performed using the key search terms urinary tract infection, pyelonephritis, cystitis, asymptomatic bacteriuria, and resistance. STUDY SELECTION AND DATA EXTRACTION: All article abstracts were evaluated for relevance. Only articles pertaining to pregnancy were included. The majority of published literature were review articles; the number of original clinical studies was limited. DATA SYNTHESIS: UTIs are the most common bacterial infections during pregnancy. They are characterized by the presence of significant bacteria anywhere along the urinary tract. Pyelonephritis is the most common severe bacterial infection that can lead to perinatal and maternal complications including premature delivery, infants with low birth weight, fetal mortality, preeclampsia, pregnancy-induced hypertension, anemia, thrombocytopenia, and transient renal insufficiency. Enterobacteriaceae account for 90% of UTIs. The common antibiotics used are nitrofurantoin, cefazolin, cephalexin, ceftriaxone, and gentamicin. CONCLUSIONS: Therapeutic management of UTIs in pregnancy requires proper diagnostic workup and thorough understanding of antimicrobial agents to optimize maternal outcome, ensure safety to the fetus, and prevent complications that lead to significant morbidity and mortality in both the fetus and the mother.
