Studies of maternal amniotic fluid and serum at delivery have revealed the presence of toxic metals or deficiencies of essential metals associated with high-risk pregnancy. Essential and toxic metal levels were studied in 29 preeclamptic and 101 normal pregnancies. The authors grouped the samples according to the following gestation ages: 33-36 wk (48 normal and 10 preeclamptic) and 37-40 wk (53 normal and 19 preeclamptic). The metals studied were calcium, magnesium, zinc, selenium, copper, cadmium, and lead. Comparisons of the 33-36-wk gestation group showed significant differences between normal and preeclamptic amniotic fluid in levels of lead, calcium, magnesium, zinc, and selenium. There were also significant differences in levels of magnesium, copper, zinc, cadmium, and lead during the gestation period of 37-40 wk. The changes observed in calcium and lead levels were consistent with the results of animal studies in which investigators have found depressed calcium transport associated with subacute or chronic lead poisoning, resulting in a physical syndrome similar to preeclampsia.
Amniotic band syndrome (ABS) may result in fetal anomalies that vary in severity from minor to lethal. Although numerous conditions have been grouped with this diagnosis, a subset of this population will have no other intrauterine abnormalities other than isolated defects of the extremities. ABS may present as constriction rings and congenital amputation affecting the limbs and digits. Routine sonographic evaluation of the fetus in the second trimester can identify the major defects associated with ABS. Detailed evaluation of the fetal extremities, including views of the hands and feet, will increase the detection of minor defects.
detailed anatomic survey of the fetus by an experienced sonographer can detect a multitude of structural anomalies. Although relatively common in the neonate, an inguinoscrotal hernia is a condition that is rarely seen prenatally. In a male fetus, this abnormality typically appears in the third trimester as a complex scrotal mass. Active intestinal peristalsis within an enlarged scrotum is diagnostic of this condition. We report a case that involves the prenatal association between cystic fibrosis and a congenital inguinal scrotal hernia. Serial sonograms from 30 to 37 weeks' gestation provided the opportunity to follow both the abnormal bowel appearance and the progression of the hernia. Postnatal followup confirmed both diagnoses.
INTRODUCTION:Prepregnancy obesity (body mass index [BMI]≥30) has been consistently associated with maternal morbidity. The rate of morbid obesity (BMI≥40) appears to be increasing. This study investigated whether morbid obesity was associated with severe maternal morbidity in a population cohort.METHODS:Internal review board exemption was obtained. We identified 197,822 patients using the birth-certificate-based New York Statewide Perinatal Data System from 2010 to 2020. Women were divided into two categories, those with prepregnancy BMI <40 and those with prepregnancy BMI ≥40 (morbid obesity). The risk of severe maternal morbidity (maternal transfusion, intensive care unit admission, unplanned hysterectomy, and unplanned reoperation) was compared. We also compared the risk of cesarean delivery, hypertensive disorders of pregnancy, and gestational diabetes. Chi-square and t tests were used to compare categorical and continuous variables respectively.RESULTS:We identified 197,822 deliveries, of which 13,120 (6.63%) were complicated by maternal morbid obesity. Morbidly obese women had a significantly higher risk of severe morbidity (RR, 1.16; 95% CI, 1.003–1.33). The risk of intensive care unit admission was significantly increased (RR, 1.84; 95% CI, 1.35–2.53), but blood transfusion, unplanned hysterectomy, and unplanned reoperation were unchanged.CONCLUSION:Morbid obesity was associated with increased severe maternal morbidity specifically due to maternal intensive care unit admission. This may indicate a higher risk of severe medical complications and likely represents a higher risk of maternal mortality.
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