The pathogenesis of intrauterine pneumonia. I. A critical review of the evidence concerning intrauterine respiratory-like movements.
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PNEUMONIC changes can be found the lungs of a substantial proportion of the fetuses which die utero the late stages of gestation. Similar alterations found the lungs of percentage of liveborn infants who for only a few hours or day. In the first instance it is certain, the second it is generally assumed that the process had its origin within the uterus. In additional number of both stillborn and liveborn infants, it may be demonstrated by microscopic examination that there is excessive quantity of sac contents within the lungs. The pathogenetic factors responsible for both intrauterine pneumonia and for excessive aspiration of contents have never been definitely established. still exit profound differences of opinion on every aspect of the process of intrauterine respiration. The following represent expert opinions on the question as to whether the fetus breathes or not. Snyder and Rosenfeld state that in the full-term fetus sponataneous rhythmic respiratory movements occur which may continue many hours. Davis and Potter maintain that amniotic fluid is normally aspirated into lungs as part of intrauterine respiratoy activity and concluded that an adquatic existence for the fetus is normal during intrauterine Windle has arrived at the opposite conclusion. In 1939 he wrote,One is tempted to entertain the false assumption that respiration at birth is a continuation of respiratory-like phenomena indulged normally throughout fetal life. This is contrary to fact. Sir Joseph Barcroft came to the same conclusion. There is during the second half of fetal life inhibition of the nervous mechanism responsible for respiratory movements. If there were not the fetus would be drowned before it was born.Cite
There has been a significant increase in the number of multiple pregnancies that are associated with a high risk of preterm delivery among Korean women. However, to date, delayed-interval delivery in women with multiple pregnancy is rare. We report a case of delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a dichorionic diamniotic twin pregnancy. The patient presented with vaginal leakage of amniotic fluid at 16 weeks of gestation and was diagnosed with a preterm premature rupture of membranes. Three days later, the first twin was delivered, but the neonate died soon after. The second twin remained in utero, and we decided to retain the fetus in utero to reduce the morbidity and mortality associated with a preterm birth. The patient was managed with antibiotics and tocolytics. Cervical cerclage was not performed. The second twin was delivered vaginally at 34 weeks and 5 days of gestation, 128 days after the delivery of the first-born fetus. This neonate was healthy and showed normal development during the 1-year follow-up period. Based on our experience with this case, we propose that delayed-interval delivery may improve perinatal survival and decrease morbidity in the second neonate in highly selected cases.
Twin Pregnancy
Cervical cerclage
Rupture of membranes
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In recent years, the evaluation of in utero exposure to drugs of abuse has been achieved by testing biological matrices coming from the fetus or newborn (eg, meconium, fetal hair, cord blood, neonatal urine), the pregnant or nursing mother (eg, hair, blood, oral fluid, sweat, urine, breast milk), or from both the fetus and the mother (placenta, amniotic fluid). Overall, these matrices have the advantage of noninvasive collection (with the exception of amniotic fluid) and early detection of exposure from different gestational periods. Matrices such as amniotic fluid, meconium, fetal hair, and maternal hair provide a long historical record of prenatal exposure to certain drugs and can account for different periods of gestation: amniotic fluid from the early pregnancy, meconium for the second and third trimester of gestation, fetal hair for the third, and finally maternal hair (when long enough) for the whole pregnancy. Placenta may reveal the passage of a substance from the mother to the fetus. Cord blood and neonatal urine are useful for determining acute exposure to drugs of abuse in the period immediately previous to delivery. Drug detection in maternal blood, oral fluid, and sweat accounts only for acute consumption that occurred in the hours previous to collection and gives poor information concerning fetal exposure. Different immunoassays were used as screening methods for drug testing in the above-reported matrices or as unique analytical investigation tools when chromatographic techniques coupled to mass spectrometry were not commonly available. However, in the last decade, both liquid and gas chromatography-mass spectrometric methodologies have been routinely applied after appropriate extraction of drugs and their metabolites from these biological matrices.
Drug Detection
Cord blood
Substance Abuse Detection
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Ultrasonographic examinations of seven pregnant cats with known breeding dates were made on successive days to establish the identifiable characteristics of pregnancy. Subsequent serial examinations were made to sonographically characterize normal feline prenatal development before 30 gestational days. An enlarged uterus, gestational sacs, and fetal poles were recognized as the features of early feline pregnancy and were first seen at 4, 11, and 15 days, respectively. Cardiac activity was detected earliest on gestational day 16, and recognizable feline fetal morphology appeared at day 26. Fetal membranes became apparent at as early as 21 days of gestation. Generalized fetal movements were first noted at day 28. Live and dead fetuses were compared in utero and marked differences were noted, with dead fetuses rapidly losing previously recognizable morphology. Determination of litter size in each cat could not be done accurately by ultrasound examination. It was concluded that the diagnosis and accurate dating of early pregnancy in the domestic feline may be accomplished with serial ultrasound evaluation.
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Hysterotomy
Umbilical artery
Twin Pregnancy
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Preliminary results on the diagnosis of sex in utero by analysis of cells from amniotic fluid are reported. Amniotic fluid was extracted from 20 subjects and was found to contain an adequate number of cells for diagnosis. Correct diagnosis of fetal sex was made in all cases. The only possibility of error with this technique is in rare cases of intersex, providing that the sample is not contaminated with maternal cells. The diagnosis can be made from the 12th week of gestation until term. Diagnosis of an aborted human fetus is also possible.
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Delayed-interval delivery is infrequent in twin gestation and more rare in triplet and quadruplet gestation. Coexistence of a triploid pregnancy with a normal fetus has not previously been reported to have resulted in survival of the normal fetus.A 26-year-old woman, gravida 2, para 0-0-1-0, was diagnosed with a quadruplet pregnancy. At 16 1/2 weeks' gestation she developed preeclampsia and severe hyperemesis. Ultrasound was consistent with partial molar pregnancy in quadruplet D. Quadruplet D died in utero, and the preeclampsia and hyperemesis resolved. At 19 5/7 weeks, spontaneous rupture of the membranes and preterm labor occurred, and quadruplet A, stillborn female weighing 260 g, was delivered. With the use of antibiotic therapy, tocolysis and bed rest, the remaining two fetuses were maintained in utero until 32 6/7 weeks' gestation, when quadruplet B, a 1,470-g female, and quadruplet C, a 1,700-g female, were delivered.This was the first reported case of surviving fetuses coexisting with a partial molar pregnancy. This case was also complicated by preterm delivery and successful delayed-interval birth in a quadruplet pregnancy.
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Abstract Epstein–Barr virus (EBV) infection in pregnancy and consequent fetal outcomes are rarely reported. The majority of cases described strongly support the possibility of transmission of this virus in utero and during delivery, resulting in stillbirth and/or congenital defects. We present a case of EBV reactivation in pregnancy that caused a severe symmetrical fetal growth restriction (FGR) and ultimately spontaneous fetal death. A 36‐year‐old woman, whose infection status was undetermined, was diagnosed with severe FGR at 24 weeks' gestation. The fetal karyotype was normal. EBV DNA was detected in the amniotic fluid and maternal immunoglobulin G antibodies were positive. At 30 weeks' gestation, the fetus died spontaneously. Placental examination found evidence of deciduitis and villitis. Reactivation of EBV infection appears to be related to FGR and warrants further research to determine the optimal management strategy in pregnancy.
Intrauterine growth restriction
Fetal death
Epstein–Barr virus infection
Amniocentesis
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Echogenicity
Transrectal ultrasonography
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