Intrapartum course of fetuses with isolated hypoplastic left heart syndrome

Article Abstract:

Hypoplastic left heart syndrome, a congenital defect in which the heart develops abnormally with left ventricular outflow tract obstruction, has been considered a fatal condition. However, many infants with this disorder can now be treated with surgery and heart transplantation. Surgery is associated with a 61 percent one-year survival rate after the first procedure, which is palliative, and a 40 percent long-term survival rate after the second procedure, which is reconstructive. Transplantation is associated with a three-year survival rate of 80 percent. To learn more about the outcome of affected infants, the medical records were reviewed for 13 fetuses with this diagnosis. There were no other structural malformations and all fetuses were candidates for surgical repair. The disorder had been diagnosed at least two weeks before delivery, which took place just before 39 weeks of gestation, on average. Labor was spontaneous in five patients and was induced in six; two patients underwent cesarean section. The baseline fetal heart rate pattern was normal in all patients who delivered vaginally except one. Apgar scores (a measure of physical function in the newborn) were no lower than 8 at five minutes. The infants all survived to undergo the first reconstructive surgery, which was performed between the first and nineteenth day of life. A discussion is presented of the hypoplastic left heart syndrome. When the condition is diagnosed prior to birth, an abortion should be considered; if aborted, the fetus should be examined for associated chromosomal anomalies, which, if present, may indicate an increase risk for abnormalities in future pregnancies. Babies born with hypoplastic left heart syndrome are not at particularly high risk during the period surrounding their delivery, and specialized, high-risk care is not necessary at this time. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Labor (Obstetrics), Hypoplastic left heart syndrome

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Patient attitude toward home uterine activity monitoring

Article Abstract:

Early diagnosis and treatment improves the outcome of pregnancies complicated by preterm labor. Patient-perceived signs and symptoms of labor are often unreliable, and a new home monitoring device that measures, records and transmits uterine contraction patterns via the telephone to perinatal nurses has proved useful in diagnosing early labor. With home monitoring, nurses are also available 24 hours a day to assess the patient-perceived signs and symptoms of preterm labor. Attitudes towards home monitoring were evaluated among 40 private patients at risk for preterm delivery. The patients used the Term Guard monitor and the Tokos Perinatal Nursing Service for preterm labor surveillance beginning at the 24th week of pregnancy. Twenty-seven women (67.5 percent) responded to the survey after delivery. Most of the patients (81 percent) felt the device and nursing service helped their pregnancies and would recommend the program to others. Eighty-five percent would consider using the program in subsequent pregnancies. Although 41 percent of the patients felt the device was an intrusion into their life styles, no patient thought that the device was depersonalizing. For 78 percent of the women, the monitor helped them recognize uterine contraction and understand the symptoms of preterm labor. Almost 60 percent of the women did not feel the contractions recorded on the monitor. Most (65 percent) realized the benefit of 24-hour nursing in reducing the number of hospital visits and unnecessary calls to the obstetrician. All patients appreciated the value of home monitoring and daily nursing contact and believed it helped improve the outcome of their pregnancy. Overall, home monitoring of uterine contractions in high-risk patients was well-tolerated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Equipment and supplies, Diagnosis, Premature labor, Obstetrics, Patient monitoring, Physiologic monitoring, Obstetrical equipment

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Management of the pregnant patient with a cerebral venous angioma: a report of two cases

Article Abstract:

A cerebral venous angioma is a malformation of the veins in the brain. Angiomas that involve cerebral arteries are more likely to cause seizures and bleeding than those involving veins. In many cases, venous angiomas do not cause any noticeable symptoms and are discovered by accident during computed tomography (CT scans) or magnetic resonance imaging (MRI) of the brain. The cases of two pregnant women with cerebral venous angiomas are described. The first case involved a 25-year-old pregnant woman who was being treated with carbamazepine for seizures. Two years prior to her pregnancy she was diagnosed as having a cerebral venous angioma. The woman continued to take carbamazepine and remained free of seizures throughout her pregnancy. The pregnancy was normal and there were no signs of bleeding inside the brain. At week 40 of pregnancy she gave birth to a healthy 7.7-pound baby. The second case was that of a 32-year-old woman who had been diagnosed with a cerebral venous angioma five years before she became pregnant. She did not have seizures or bleeding in the brain. She was able to complete a normal pregnancy and deliver a healthy baby weighing 8.4 pounds at week 41 of pregnancy. These cases show that women with cerebral venous angiomas can have normal pregnancies and have normal, healthy babies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Abnormalities, Physiological aspects, Pregnant women, Brain, Blood vessels, Cerebrovascular disease, Cerebrovascular disorders, Angioma

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