RESUMO
BACKGROUND: Women with spinal cord injuries are at risk for autonomic hyperreflexia during labor. CASE: A 36-year-old woman, gravida 4, para 2, abortus 1, with a spinal cord injury and a positive antibody screen result had had a previous pregnancy complicated by autonomic hyperreflexia during labor. Autonomic hyperreflexia did not occur during serial amniocenteses and fetal transfusions for isoimmunization or intrapartum. CONCLUSION: Intrauterine procedures and vaginal delivery were accomplished without autonomic hyperreflexia in this pregnancy. Intrauterine procedures and vaginal delivery might be done safely in women with histories of autonomic hyperreflexia.
Assuntos
Disreflexia Autonômica/terapia , Complicações na Gravidez/terapia , Traumatismos da Medula Espinal/terapia , Adulto , Transfusão de Sangue Intrauterina , Doença Crônica , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Masculino , Assistência Perinatal , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal , Vértebras TorácicasAssuntos
Sofrimento Fetal/fisiopatologia , Monitorização Fetal/métodos , Frequência Cardíaca Fetal/fisiologia , Oligo-Hidrâmnio , Adulto , Âmnio , Cesárea , Feminino , Sofrimento Fetal/etiologia , Humanos , Recém-Nascido , Infusões Parenterais , Trabalho de Parto Induzido , Masculino , Oligo-Hidrâmnio/diagnóstico , Oligo-Hidrâmnio/fisiopatologia , Gravidez , Ultrassonografia Pré-NatalAssuntos
Acidentes por Quedas , Bradicardia/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Frequência Cardíaca Fetal , Adulto , Bradicardia/etiologia , Cesárea , Ecocardiografia Doppler em Cores , Feminino , Doenças Fetais/etiologia , Monitorização Fetal/instrumentação , Humanos , GravidezRESUMO
An automated amniotic fluid surfactant-albumin ratio (SAR) test was performed as a screening test for pregnancies requiring fetal pulmonary maturity testing. Of the 178 neonates delivered within 3 days of the testing, respiratory distress syndrome (RDS) developed in 21 (11.8%) and transient tachypnea of the newborn infant (TTN) in 11 (6.1%). A positive test was defined as one which predicted RDS or TTN. Sensitivity was interpreted as the proportion of neonates with RDS or TTN detected by SAR less than 70 mg/gm. Sensitivity was 90.7% with a specificity of 76.1%. The positive predictive value was 45.3%; the negative predictive value 97.4%. The interassay coefficient of variability was 3.5%. The SAR test has proven to be a rapid, precise laboratory tool. Our combined testing protocol uses the SAR as an initial screening test with the lecithin/sphingomyelin ratio used as backup if the SAR did not predict maturity (SAR < 70 mg/gm). This protocol has markedly lowered the use of lecithin/sphingomyelin ratios while maintaining necessary clinical accuracy.
