Complications associated with the macrosomic fetus.

A retrospective study was done on 525 infants who weighed more than 4,500 g. The rates of grand multiparity, diabetes mellitus, pregnancy-induced hypertension, deliveries in women over 35 years of age, placenta previa and weight gain of more than 15 kg were higher than in a control group weighing 2,500-4,000 g. The rates of delivery with instruments and cesarean section were also significantly higher. The main indication for cesarean section in the study group was cephalopelvic disproportion, while in the control group it was repeat cesarean section. Rates of postpartum hemorrhage, shoulder dystocia, oxytocin augmentation of labor and tears in the birth canal far exceeded those in the control group. Maternal and fetal morbidity and perinatal mortality were significantly higher than in the control group. The complications were due to a difficult second stage of labor. Delivery of the macrosomic fetus by cesarean section is highly recommended except for the subgroup of women who already delivered a macrosomic child.

Uterine rupture during induced mid-trimester abortion.

Uterine rupture during induced mid-trimester abortion is infrequent. Often the diagnosis is established only after manual exploration of the uterus, exploratory laparotomy or even autopsy. It is crucial to establish the diagnosis rapidly and to offer efficient treatment, since the unexpected occurrence of this catastrophe adds to its inherent seriousness. Fourteen cases revealed by a Med-line search and two additional personal cases were reviewed. The most common complaint heralding the rupture was abdominal pain and secondary to it there were signs of blood loss, such as vaginal bleeding, decreased hematocrit level and decreased blood pressure. 72% of women with uterine rupture (10 out of 14) did not abort within 24 h after intra-amniotic injection, and 85% (11 out of 13) had large quantities of oxytocin administered for more than 12 h. The rupture occurred predominantly in the lower segment and there was no preference either for the right or left side of the uterus. It was shown that uterine rupture during mid-trimester induced abortion is not unique to women of high parity or old age. The major complications occurring in induced mid-trimester abortions are similar to those seen in patients who deliver in the third trimester.

PIP: Uterine rupture during induced midtrimester abortion is infrequent. Often the diagnosis is established only after manual exploration of the uterus, exploratory laparotomy, or even autopsy. It is crucial to establish, the diagnosis rapidly and to offer efficient treatment immediately to prevent further complications. 14 cases revealed by a Medline search and 2 additional personal cases were reviewed. The most common complaint accompanying the rupture was abdominal pain; secondary complaints were signs of blood loss, such as vaginal bleeding, decreased hematocrit level, and decreased blood pressure. 72% of women with uterine rupture (10 of 14) did not abort within 24 hours after intra-amniotic injection, and 85% (11 of 13) had large quantities of oxytocin administered for more than 12 hours. The rupture occurred predominantly in the lower segment and there was no preference either for the right or left side of the uterus. It was shown that uterine rupture during midtrimester induced abortion is not unique to women of high parity or old age. The major complications occurring in induced midtrimester abortions are similar to those seen in patients who deliver in the 3rd trimester.

Effect of folic acid supplementation on congenital malformations due to anticonvulsive drugs.

A study was conducted to determine the frequency of malformations among newborn infants of mothers receiving anticonvulsive therapy, with and without supplementation of folic acid. In the retrospective part of the study, the frequency of congenital malformations among the 66 newborn of 24 women who received anticonvulsive drugs without the supplementation of folic acid was 15% (10 children). The defects noted were congenital heart disease, cleft lip and palate, neural tube defects and skeletal abnormalities. Three out of the 10 children were stillborn or died immediately after delivery. In the prospective study of the 22 epileptic women with folic acid supplementation to their anticonvulsive regimen, 33 infants were born alive, without congenital malformations and of normal body weight. The teratogenic activity of anticonvulsant drugs seems to be mediated by interference with folic acid metabolism, and such activity might be influenced by hereditary and environmental factors. When an epileptic woman wishes to become pregnant, it is recommended that folic acid be added to her regimen.

Outcome of pregnancy in 31 triplet gestations.

The course of gestation and labor and the outcome of 31 triplet pregnancies were analyzed. Early diagnosis is very important for improving the rate of fetal salvage in multiple pregnancy. The outcome of triplet pregnancies was better in the group of patients with induced ovulation than in the group with spontaneous ovulation. The most frequent antenatal complications were preterm labor (97%), pregnancy-induced hypertension (46%), and anemia (20%). In this series the favorable results were due to earlier diagnosis, prolonged hospitalization, and planned delivery, usually by cesarean section.

The course of pregnancy in patients with artificial heart valves treated with dipyridamole.

Continuing improvements in cardiac surgery and a wider selection of young patients for prosthetic valve replacement mean that an increasing number of women of childbearing age will undergo such procedures and will also subsequently become pregnant. At present, most patients with prosthetic heart valves are treated with anticoagulant drugs for life. The main problem with anticoagulant therapy during pregnancy is fetal and maternal hemorrhage. Congenital anomalies have been described in infants born to mothers treated with coumarin derivatives during the first trimester of pregnancy. Dipyridamole is known to decrease the adhesiveness of platelets or their ability to aggregate. We report the successful outcome of four pregnancies in patients with Starr-Edwards prostheses who were treated with dipyridamole during their pregnancies.

The successful treatment of a case of primary sterility resulting from Fredrickson's Type V hyperlipemia and panhypopituitarism.

Successful treatment of primary sterility in a woman having the rare association of panhypopituitarism with Fredrickson's Type V hyperlipemia is described. Replacement therapy with l-thyroxine, prednisone and a low fat diet cleared the patient's blood of the excessive chylomicrons and very low density lipoproteins. Ovulation was induced with human gonadotrophins, and triplets (two normal girls and a boy) were born.

Uterus didelphys with a pregnancy in each horn. Case report.

A patient with uterus didelphys presented with a pregnancy in each horn which ended in the vaginal delivery of two infants who survived.

Cesarean section in a patient with a mitral valve prosthesis.

A successful cesarean section performed in a 24-year-old woman with rheumatic heart disease and a Starr-Edwards mitral valve prosthesis is reported. In the 33rd week of pregnancy, previous warfarin sodium therapy was discontinued and dipyridamole therapy instituted. Successful pregnancy and cesarean section in patients with mitral valve prostheses are possible with this regimen.

Congenital malformations due to anticonvulsive drugs.

A retrospective study of congenital malformations in the offspring of 20 women who received antiepileptic drugs during pregnancy is presented. Of 56 births, 9 children (16%) were born with malformations. Four children were born dead or died shortly after delivery. Congenital heart disease, cleft lip with or without cleft palate, neural tube defects, and skeletal abnormalities were the commonest anomalies found. One child had a recognizable pattern of multiple malformations. The increased perinatal mortality was mainly due to congenital malformations and spontaneous hemorrhage. The teratogenic activity of anticonvulsant drugs is mediated by interference with folic acid metabolism, and such activity might be influenced by hereditary and environmental factors. Bearing in mind the importance of anticonvulsant therapy in epilepsy, there is certainly need for an investigation of the problem in a larger and more representative birth population than that described.