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Barber JA, Troedsson MH. Mummified fetus in a mare. J Am Vet Med Assoc 1996; 208:1438-40. [PMID: 8635994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A 12-year-old Arabian mare with a history of repeated early embryonic losses gave birth to a mummified fetus. The fetus was not the result of a pregnancy with twins. The mare had been given a progestogen throughout gestation and expelled the mummified fetus at about 325 days of gestation, 2 weeks after progestogen treatment was discontinued. We estimate that the size of the fetus was consistent with a fetal age of 5 months. The mare and mummified fetus illustrated that progestogen administration after 100 days of gestation can promote retention of a nonviable fetus. When the fetoplacental unit is incapable of producing progestogens in adequate amounts for pregnancy maintenance at that stage of gestation, then it is also unlikely to provide sufficient oxygen and nutrients to meet the needs of the growing fetus. Monitoring fetal viability would enable practitioners to prevent prolonged retention of a nonviable fetus.
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127
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Catanzarite VA, Mehalek KE, Wachtel T, Westbrook C. Sonographic diagnosis of traumatic and later recurrent uterine rupture. Am J Perinatol 1996; 13:177-80. [PMID: 8688111 DOI: 10.1055/s-2007-994320] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We report a case of traumatic transverse fundal uterine rupture with fetal death, followed by recurrent rupture during the subsequent (twin) pregnancy. Rupture was sonographically diagnosed within minutes of arrival at hospital following a motor vehicle accident in the first pregnancy and defined operative intervention, which was lifesaving for the mother. Rupture was again diagnosed sonographically in the second pregnancy based on extrusion of the bag of waters through the uterine incision without fetal distress. Emergency cesarean section was performed with good outcomes for both babies. Causes and clinical/sonographic diagnosis of uterine rupture are reviewed and obstetric management discussed. A high level of suspicion, early diagnosis, and expeditious management are keys to favorable outcome.
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128
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Ma OJ, Mateer JR, DeBehnke DJ. Use of ultrasonography for the evaluation of pregnant trauma patients. THE JOURNAL OF TRAUMA 1996; 40:665-8. [PMID: 8614056 DOI: 10.1097/00005373-199604000-00030] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The expeditious diagnosis and management of the pregnant trauma patient is essential for the survival of both the mother and fetus. The rapid trauma ultrasound examination, which has been accurately utilized by trauma surgeons and emergency physicians, may have a tremendous impact on the timely identification of acute intraperitoneal injuries and, potentially, on the evaluation of fetal viability in the pregnant trauma patient. This report describes our experience with the rapid trauma ultrasound examination in the management of three pregnant trauma patients and outlines the potential advantages and limitations of the procedure.
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129
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Pandya PP, Snijders RJ, Psara N, Hilbert L, Nicolaides KH. The prevalence of non-viable pregnancy at 10-13 weeks of gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 1996; 7:170-173. [PMID: 8705407 DOI: 10.1046/j.1469-0705.1996.07030170.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In an ultrasound screening study at 10-13 weeks of gestation involving 17,870 women, the prevalence of early pregnancy failure was 2.8% (501 cases), including 313 (62.5%) missed abortions and 188 (37.5%) anembryonic pregnancies. Lower gestation and higher maternal age were associated with a higher prevalence (chi 2 = 143.5; p < 0.001 and chi 2 = 53.3; p < 0.0001, respectively). The prevalence was higher in women with a history of vaginal bleeding (chi 2 = 141.5; p < 0.0001), but there was no significant association with previous pregnancy losses (chi 2 = 2.8), parity (chi 2 = 0.6) or cigarette smoking (chi 2 = 0.0). Recent evidence suggests that the most effective method of screening for chromosomal abnormalities is measurement of fetal nuchal translucency thickness at 10-13 weeks, and therefore ultrasound examination at this gestation is likely to become universally available. As shown in this study, an additional advantage of such a scan is the diagnosis of early pregnancy failure, which will be found in about 3% of patients examined. Elective evacuation of retained products of conception is likely to be more cost effective and potentially safer than emergency surgery in a patient presenting during miscarriage.
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130
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Jauniaux E, Nicolaides KH. Placental lakes, absent umbilical artery diastolic flow and poor fetal growth in early pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 1996; 7:141-144. [PMID: 8776240 DOI: 10.1046/j.1469-0705.1996.07020141.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Uteroplacental insufficiency is a common cause of intrauterine growth retardation in the third trimester of pregnancy. We report a case in which placental vascular lesions, absent end-diastolic frequencies in the umbilical artery and high maternal serum levels of alpha-fetoprotein and human chorionic gonadotropin were observed from the beginning of the second trimester in a patient with a history of recurrent first- and second-trimester miscarriages. Fetal growth started to slow down from 14 weeks of gestation and no end-diastolic phase was found in the umbilical artery until 18 weeks of gestation, when the pregnancy was terminated. In apparently healthy women with or without a history of fetal death during the first half of pregnancy, the discovery of placental vascular lesions together with a high resistance to blood flow in the umbilical circulation should prompt early antepartum surveillance.
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131
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van Heijst AF, Nijhuis JG, Bult P, Hulsbergen-van de Kaa CA, Monnens LA, Semmekrot BA. Renal failure in the surviving monochorionic twin after death of the co-twin in utero. Pediatr Nephrol 1996; 10:51-4. [PMID: 8611356 DOI: 10.1007/bf00863443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Renal failure in the newborn infant is mainly determined by vascular causes. In this report we describe a patient with a particular vascular cause of renal failure. The patient was the product of a twin pregnancy in which the twin partner died in utero. In retrospect, the twins appeared to be monozygotic. As the pregnancy was studied carefully prenatally by ultrasound, we were able to observe the development of this condition, characterized by oliguria, oligohydramnios, and lung hypoplasia: the oligohydramnios sequence. After organ development had been normal initially, renal function was lost and the oligohydramnios sequence developed in the survivor after the co-twin had died in utero.
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133
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Scarano G, Della Monica M, Capece G, Lonardo F, Neri G, Maroteaux P. A case of short-rib syndrome without polydactyly in a stillborn: a new type? BIRTH DEFECTS ORIGINAL ARTICLE SERIES 1996; 30:95-101. [PMID: 9125350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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134
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Harrison SD, Nghiem HV, Shy K. Uterine rupture with fetal death following blunt trauma. AJR Am J Roentgenol 1995; 165:1452. [PMID: 7484584 DOI: 10.2214/ajr.165.6.7484584] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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135
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de Jong G, Muller LM. Perinatal death in two sibs with infantile cortical hyperostosis (Caffey disease). AMERICAN JOURNAL OF MEDICAL GENETICS 1995; 59:134-8. [PMID: 8588573 DOI: 10.1002/ajmg.1320590203] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We describe 2 sibs with lethal, prenatal-onset cortical hyperostosis. Antenatal sonographic diagnosis of the first sib was that of short limb dwarfism and thoracic dysplasia (nonspecific), possibly osteogenesis imperfecta. The second sib had a similar appearance on ultrasonography. The thickened, irregularly echodense diaphyses were an aid to diagnosis. Although sporadic cases and autosomal dominant inheritance have been described, an autosomal recessive cause for the lethal prenatal onset cases cannot be excluded.
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136
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MacGregor SN, Tamura R, Sabbagha R, Brenhofer JK, Kambich MP, Pergament E. Isolated hyperechoic fetal bowel: significance and implications for management. Am J Obstet Gynecol 1995; 173:1254-8. [PMID: 7485332 DOI: 10.1016/0002-9378(95)91365-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objective of this study was to determine the significance of isolated hyperechoic fetal bowel. STUDY DESIGN Forty-five cases with prospective, ultrasonographic diagnosis of isolated hyperechoic fetal bowel were reviewed. Fetal variables, including aneuploidy, deoxyribonucleic acid studies for cystic fibrosis, congenital infection, growth retardation, and intrauterine death were reported. RESULTS Thirty-four of the 45 cases (76%) resulted in live-born infants without detected abnormalities. However, hyperechoic bowel was associated with cystic fibrosis in two cases (4%), congenital infection in two cases (4%), and fetal alcohol syndrome in one case. Termination of pregnancy was elected in three cases and intrauterine fetal death occurred in three cases (7%). Growth retardation was observed in five of 39 (13%) live-born infants. CONCLUSION Isolated hyperechoic fetal bowel is associated with significant pathologic disorders. Women whose fetuses are diagnosed as having isolated hyperechoic bowel should be offered additional prenatal diagnostic options, including maternal serologic studies for congenital infection, fetal karyotype, and deoxyribonucleic acid testing for cystic fibrosis. In addition, continuing ultrasonographic evaluation of fetal growth and antenatal biophysical assessment should be considered.
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137
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Jung V, Künzig HJ. [Hemorrhagic shock caused by intraperitoneal hemorrhage after amniocentesis]. Geburtshilfe Frauenheilkd 1995; 55:411-3. [PMID: 7557210 DOI: 10.1055/s-2007-1022812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
This case report its on a haemorrhagic shock developing after amniocentesis during early pregnancy. Initially caused by a lesion of a small subserous artery in the upper uterine fundal wall, the patient consequently developed a protracted haemorrhagic shock that required emergency treatment and surgery. Thirteen days later fetal death was diagnosed by ultrasonographic examination, apparently caused by an abnormality of the umbilical cord without any connection with the previous complication.
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138
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Erz W, Gonser M. [Doppler ultrasound of the middle cerebral artery: pre-final normalization of cerebrovascular circulation?]. Geburtshilfe Frauenheilkd 1995; 55:407-10. [PMID: 7557209 DOI: 10.1055/s-2007-1022811] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We report on the circulatory changes of a severely growth-retarded fetus at 26 weeks of gestation with intrauterine death after 6 days of observation and a birth weight of 480 g. On admission the fetus already showed signs of circulatory centralisation; furthermore, we found pulsation in the umbilical vein and diastolic reverse flow in the umbilical artery. During the days of observation this reverse flow increased and the compensatory phase of fetal circulatory centralisation was followed on the last day by a phase of circulatory decompensation with an apparently normal middle cerebral artery waveform, mimicking preterminal normalisation of fetal cerebral blood flow.
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139
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Levi CS. Prediction of early pregnancy failure on the basis of mean gestational sac size and absence of a sonographically demonstrable yolk sac. Radiology 1995; 195:873. [PMID: 7754026 DOI: 10.1148/radiology.195.3.7754026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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140
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Hately W, Case J, Campbell S. Establishing the death of an embryo by ultrasound: report of a public inquiry with recommendations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 1995; 5:353-357. [PMID: 7614144 DOI: 10.1046/j.1469-0705.1995.05050353.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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141
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Torres PJ, Gratacós E, Alonso PL. Umbilical artery Doppler ultrasound predicts low birth weight and fetal death in hypertensive pregnancies. Acta Obstet Gynecol Scand 1995; 74:352-5. [PMID: 7778426 DOI: 10.3109/00016349509024427] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Doppler ultrasound is nowadays common in the management of pregnancies complicated with hypertension, as an indirect assessment of fetal well-being. However, the value of abnormal umbilical artery Doppler results in predicting poor fetal outcome in hypertensive pregnancies has been studied in only a small number of patients. We designed a study to investigate the relation between abnormal umbilical artery Doppler velocimetry and fetal outcome in hypertensive pregnancies. DESIGN A prospective observational study over a 2-year period was performed at the Hospital Clinic, University of Barcelona. Pulsed Doppler examinations of the umbilical artery were performed in one hundred and seventy-two hypertensive pregnant women. The physicians managing the case were not aware of the Doppler results. The incidence of low birth weight and fetal death were considered as the main outcome measures. RESULTS When low birth weight was used as an end-point, abnormal resistance index showed a high specificity (95.16%), positive predictive value (83.33%), and negative predictive value (86.76%). Sensitivity was 62.5%. The absence of end-diastolic velocity predicted low birth weight in 100% of pregnancies and fetal death in 66.66%. All stillbirths had absence of end-diastolic velocity (sensitivity 100%). CONCLUSION This study demonstrates that umbilical artery Doppler velocimetry is a useful tool to assess fetal well being in hypertensive pregnancies.
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Bhagwanjee S, Muckart DJ, Hodgson RE, Naidoo J. Fatal foetal outcome from diabetic ketoacidosis in pregnancy. Anaesth Intensive Care 1995; 23:234-7. [PMID: 7793605 DOI: 10.1177/0310057x9502300225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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143
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144
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Raga F, Ballester MJ, Strasser J, Bonilla-Musoles F. [Extra-amniotic pregnancy. Diagnosis with transvaginal color Doppler]. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 1995; 16:29-32. [PMID: 7709217 DOI: 10.1055/s-2007-1003234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
We report on the early diagnosis of two cases of extraamniotic pregnancy in the first trimester using transvaginal colour Doppler. The flow alterations in trophoblastic and corpus luteum vessels were of low diagnostic significance.
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145
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Tadmor O, Nitzan M, Rabinowitz R, Skomorovsky Y, Aboulafia Y, Diamant YZ. Prediction of second trimester intrauterine growth retardation and fetal death in a discordant twin by first trimester measurements. Case report and review of the literature. Fetal Diagn Ther 1995; 10:17-21. [PMID: 7710675 DOI: 10.1159/000264186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Ultrasound examination at 9 weeks of gestation in a 34-year-old primigravida showed a twin pregnancy, with discrepancy in the sizes of the two gestational sacs, whereas the crown-rump lengths and fetal heart rates were virtually identical-the result being an abnormal sac size/crown-rump length ratio (early oligohydramnios). By 14 weeks discordant heart rates and umbilical artery flow velocities were detected, the discordance between the twins increasing as pregnancy progressed. Biparietal diameters, femoral lengths, and abdominal circumferences were also progressively discordant, and at 28 weeks the smaller twin had no heart beat. At 30 weeks the patient was delivered of a live 1,350-gram infant and a 400-gram dead fetus. This case suggests, in contradistinction to several previous reports, that fetal discordance in twin pregnancies (and perhaps intrauterine growth retardation in general) may be present as early as the first trimester.
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146
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Tongsong T, Wanapirak C, Srisomboon J, Sirichotiyakul S, Polsrisuthikul T, Pongsatha S. Transvaginal ultrasound in threatened abortions with empty gestational sacs. Int J Gynaecol Obstet 1994; 46:297-301. [PMID: 7805999 DOI: 10.1016/0020-7292(94)90409-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine whether transvaginal ultrasound criteria alone can distinguish viable from non-viable gestational sacs at a single examination. METHOD A prospective descriptive study was undertaken and analysis performed on 211 pregnancies complicated by threatened abortion and empty gestation sacs diagnosed by transvaginal ultrasound. The main outcome measure was the final diagnosis of viable or non-viable gestation on subsequent transvaginal sonography. RESULTS The study shows that a single transvaginal ultrasound examination is useful in differentiating viable from non-viable gestation sacs. The mean sac diameter (MSD) was found to be the most useful criterion for determining non-viability. An MSD of > or = 17 mm that lacked an embryo and an MSD of > or = 13 mm without visible yolk sac were reliable predictors of non-viable gestation sacs at a single examination with 100% specificity and 100% positive predictive value. An MSD > or = 13 mm without visible yolk sac was the most sensitive criterion. Using MSD criteria, 73% of non-viable gestations could be reliably identified without any false-positive diagnoses. Deformed shape, low position and thin decidual reaction are strong indicators of non-viable gestations but are not 100% accurate. There is still a significant proportion of empty sacs, where no accurate distinction between viable and non-viable can be made according to one criterion at a single examination and in these cases serial examinations should be carried out before any active management is advocated. CONCLUSION In most cases, transvaginal sonographic criteria alone can distinguish viable from non-viable empty gestational sacs at a single examination.
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147
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Goldstein SR. Embryonic death in early pregnancy: a new look at the first trimester. Obstet Gynecol 1994; 84:294-7. [PMID: 8041550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the frequency of pregnancy loss following successful development of anatomical embryonic landmarks identified with endovaginal ultrasound. METHODS Two hundred thirty-two women with positive urinary pregnancy tests and no antecedent history of vaginal bleeding had endovaginal sonography performed at the initial visit and at subsequent visits as indicated clinically. The presence of anatomical and embryonic structures (gestational sac, yolk sac, embryo) and cardiac activity was recorded. Patients were followed until delivery unless sonographic evidence of nonviability was seen or spontaneous loss occurred. RESULTS Twenty-seven losses occurred during the embryonic period, four losses occurred in the fetal period, and there were 201 live births. If a gestational sac developed, subsequent loss of viability in the embryonic period occurred in 11.5%; loss rates were 8.5% with a yolk sac, 7.2% for an embryo up to 5 mm, 3.3% for an embryo of 6-10 mm, and 0.5% for an embryo larger than 10 mm. No pregnancies were lost between 8.5 and 14 menstrual weeks. The fetal loss rate after 14 weeks was 2.0%. CONCLUSIONS The rate of early pregnancy loss decreases successively with gestational age and is virtually complete by the end of the embryonic period (70 days after onset of the last menstrual period). Subsequent pregnancy losses in the fetal period occur between 14 and 20 weeks. This pattern of early pregnancy death suggests a period of embryonic loss distinct from one of fetal loss. Based on these data, the physiologic significance of the traditional boundary of the first trimester as an appropriate dividing time line for early pregnancy may be questioned.
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148
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Macfarlane JS. Embryonic mortality in cattle. Vet Rec 1994; 134:636. [PMID: 7802841 DOI: 10.1136/vr.134.24.636-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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149
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Sharma AK, Haldar A, Phadke SR. Post mortem radiography of perinatal deaths: an aid to genetic counselling. Indian Pediatr 1994; 31:702-6. [PMID: 7896399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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150
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Pauli RM, Reiser CA, Lebovitz RM, Kirkpatrick SJ. Wisconsin Stillbirth Service Program: I. Establishment and assessment of a community-based program for etiologic investigation of intrauterine deaths. AMERICAN JOURNAL OF MEDICAL GENETICS 1994; 50:116-34. [PMID: 8010345 DOI: 10.1002/ajmg.1320500204] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Although stillbirth is a common event, few programs have previously been established for the comprehensive etiologic investigation of intrauterine death. Fewer still have been prospective, unbiased in ascertainment, and consistent in protocol utilization. The Wisconsin Stillbirth Service Program was established in 1983 as a unique model for the investigation of the causes of stillbirth. This community-based, University-supported model for health care delivery is here described. Through it more than a thousand infants have been etiologically investigated. We demonstrate that a community-based program of stillbirth assessment can succeed, that compliance with recommended protocols is high and that a specific primary cause of fetal death can be demonstrated in about 40% of referrals. A majority of the established causes of intrauterine death are fetal etiologies. Furthermore, it appears that there are no substantial referral biases. Lack of such biases, together with the prospective, protocol driven nature of the program provides a unique population upon which to base estimates of the frequency of various etiologic diagnoses and classes and categories of cause.
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