Effect of mitral valve prosthetic surgery on the outcome of a growth-retarded fetus

Article Abstract:

Rheumatic fever can develop after bacterial infection with group A streptococci, and is characterized by fever and inflammation of tissues. In many cases, serious heart or kidney disease may follow. Rheumatic fever is often associated with permanent damage to the heart valves, which are structures that direct the flow of blood through the different compartments of the heart. One such valve abnormality usually caused by rheumatic fever is mitral stenosis, which is the narrowing of the mitral valve situated between the left atrium and left ventricle of the heart. Mitral stenosis may lead to the development of arrhythmias, or abnormal heart rhythms, and congestive heart failure, the inability of the heart to pump blood efficiently which causes congestion of the lungs. Surgery to repair the diseased valve can be performed during pregnancy without causing adverse effects on the fetus. A case is described of a 33-year-old woman who underwent surgery at 29 weeks gestation to replace an artificial mitral valve for the second time. The patient also had severe preeclampsia, which is characterized by high blood pressure, headaches, excretion of protein in the urine, and accumulation of body fluids in the lower limbs. In addition, the fetus was shown to have growth retardation, or slowing of growth. The operation required the use of cardiopulmonary bypass, in which the heart is bypassed by using a device that pumps blood while the operation is being performed on the heart. Within two minutes of starting the cardiopulmonary bypass, the heart rate of the fetus slowed and the fetus died. The presence of preeclampsia and fetal growth retardation, and the need for cardiopulmonary bypass during the operation, may have contributed to fetal death during surgery. The patient's heart valve operation was completed successfully and a day later, labor was induced to expel the fetus. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Surgery, Preeclampsia, Pregnancy, Complications of, Pregnancy complications, Mitral valve stenosis

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Vaginal ultrasonographic assessment of cervical length changes during normal pregnancy

Article Abstract:

The cervix, the neck of the uterus, secures the fetus during pregnancy. The shortening and dilatation of the cervix indicates the onset of labor or else an incompetent cervix. Accurate assessments of the character of the cervix are difficult since most of the cervix cannot be felt during internal examinations. Abdominal ultrasound imaging techniques have estimated the cervix to normally be between 1.2 and 2 inches long by the 33rd week of pregnancy. However, measurements can be distorted when the transabdominal approach is used. The actual length of the cervixes of 166 women was determined throughout pregnancy by means of transvaginal ultrasound, which uses a probe inserted into the vagina. The women all had uncomplicated pregnancies. The measurements were made by vaginal ultrasonography every five weeks between the 8th and 37th week of pregnancy. The longest cervical length was seen between 20 and 25 weeks of pregnancy. Accurate measurements made by transvaginal ultrasound can be used as a guide when assessing cervical length during pregnancy and confirming a diagnosis of premature labor or an incompetent cervix. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Measurement, Physiological aspects, Pregnancy, Cervix uteri, Prenatal ultrasonography, Ultrasonics in obstetrics

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Reverse end-diastolic flow in the middle cerebral artery: an agonal pattern in the human fetus

Article Abstract:

Death of human fetuses with severe intrauterine growth restriction (IUGR) may be predicted by a reversal of blood flow in the middle brain artery after initial reductions in flow. An ultrasound examination at 21 weeks' gestation of a hypertensive woman showed an IUGR fetus with no diastolic blood flow in the umbilical artery and an increased diastolic flow but very low pulse in the middle artery of the brain. The middle brain artery pulse continued to decrease until 29 weeks of pregnancy when a normal pulse was measured. At the same time, there was a reversal of blood flow in the umbilical artery. One week later, blood flow reversed in the middle brain artery as well, and the fetus died. Blood flow decreases in the brains of IUGR fetuses to protect the brain from growth restriction and lack of oxygen.

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