Relationship of placental grade to gestational age
| Autor: | Ruth A. Petrucha, Lawrence D. Platt |
|---|---|
| Rok vydání: | 1982 |
| Předmět: |
medicine.medical_specialty
Cephalometry Placenta Gestational Age Umbilical cord Fetus Pregnancy Fetal distress Medicine Humans Ultrasonography medicine.diagnostic_test business.industry Obstetrics Cephalopelvic disproportion Obstetrics and Gynecology Gestational age Subdural hemorrhage medicine.disease Fetal Tachycardia Surgery medicine.anatomical_structure Amniocentesis Female business |
| Zdroj: | American journal of obstetrics and gynecology. 144(6) |
| ISSN: | 0002-9378 |
| Popis: | tesis in a term infant. Lucy’ briefly mentioned injury to “fetal heart, brain, or lung” during intrauterine fetal blood transfusion for Rh disease, but no further details of brain injury were given. Creasman’ reported that injection of amniography dye into the brain of a 2% week fetus resulted in subdural hemorrhage and stillbirth. It seems likely that the relative infrequency of fetal brain trauma compared to trauma of the fetal chest, abdomen, extremity, and umbilical cord is due to both the protective effect of the cranial vault and the relative ease of manual identification of the head during amniocentesis. The present case represents an unusual picture for perinatal intracranial hemorrhage. Of the four major types of neonatal intracranial hemorrhage-periventricular, primary subarachnoid, subdural, and intracerebellar-the clinical presentation of this case most closely resembles a massive subdural hemorrhage. Predisposing factors include precipitate or prolonged delivery, severe cephalopelvic disproportion, irregular presentation, as in breech, face, or brow, and unusually rigid pelvic structures occurring in very young primiparous or elderly multiparous mothers. These factors were not present in this case since the infant was delivered via elective cesarean section with minimal trauma. Because no needle tract was found through the bone, it is possible that the needle did not directly lacerate the dura but distorted the cranial vault sufficiently to produce a hemorrhage. The unfortunate outcome of this case provides important lessons. Obtaining blood from an amniocentesis attempt and/or development of a fetal heart rate abnormality should alert the obstetrician to the possibility of fetal distress. Blood can be rapidly determined to be of fetal origin by the Kleihauer-Betke technique. Either fetal tachycardia or fetal blood obtained at amniocentesis in a term infant may justify immediate abdominal delivery. Even in a premature fetus likely to have immature lungs, the presence of both fetal blood obtained at amniocentesis and fetal heart rate abnormalities after amniocentesis would probably provide adequate evidence for emergency delivery and resuscitation.:’ Perhaps the most important issue concerns the routine use of amniocentesis to determine fetal pulmonary maturity prior to elective cesarean section. In this case, where ultrasonography confirmed dates at 23 weeks and the risk of iatrogenic prematurity with respiratory distress syndrome was extremely low, amniocentesis probably could have been safely avoided.* |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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