Pregnancy associated with Friedreich ataxia

Article Abstract:

Patients with Friedreich ataxia (a rare hereditary degenerative disease of the nervous system) rarely reproduce, and little is known regarding pregnancy complications to which they may be prone. A case report is presented of a 22-year-old woman with Friedreich ataxia who had an uncomplicated pregnancy for the first 34 weeks, in spite of considerable weakness and disorders of movement. At that time, regular uterine contractions began; drug treatment led to the development of slurred speech, difficulty breathing, and cyanosis (a blue color due to insufficient oxygen). These symptoms were treated, and the patient recovered. At 38 weeks' gestation, she developed preeclampsia, a condition characterized by edema, high blood pressure, headache, and protein excretion. The patient underwent cesarean delivery for fetal distress. The female infant had no signs of Friedreich ataxia, and was discharged in good health with her mother on the 13th day after birth. Patients with Friedreich ataxia are kept alive longer than in previous years, with the result that problems associated with their pregnancies are more commonly encountered. Such patients should be counseled regarding the risk that their offspring may be affected, and that they will require careful monitoring throughout pregnancy. Drugs normally used to treat complications of pregnancy can produce serious side effects in these patients, since they may interact with defects already present. A brief discussion of such effects is presented. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Case studies, Physiological aspects, Pregnancy, Complications of, Pregnancy complications, Friedreich's ataxia

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Fetal acoustic stimulation as a possible adjunct to diagnostic obstetric ultrasound: a preliminary report

Article Abstract:

During pregnancy, diagnostic ultrasound procedures may need to be repeated when an inactive or sleeping fetus is in a position that is difficult to visualize. Acoustic (sound) stimulation can provoke the startle reflex in the fetus, and result in increased overall body movement. The experience of using acoustic stimulation with diagnostic ultrasound in 20 pregnant women is described in this article. Stimulation consisted of a three-second pulse of sound produced by an acoustic stimulator. The most common reason for use of acoustic stimulation was inaccessibility of the fetal head or heart. Fetal age ranged from 18 to 41 weeks. The overall success rate of being able to obtain a satisfactory ultrasound examination with this technique was 85 percent, with success being 94 percent for fetuses with gestational ages over 28 weeks. Most of the positive responses were obtained within 30 seconds, and the remainder occurred within 3 minutes. This preliminary study indicates that acoustic stimulation increases the success rate of diagnostic ultrasound. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sound, Ultrasonics in obstetrics, Startle reaction

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Ethical dilemmas in fetal echocardiography

Article Abstract:

Congenital heart diseases can now be detected as early as the 17th or 18th week of gestation. Ethical and medical questions arise from the technological ability to surgically repair these problems. In six cases of detected fetal heart disease, several factors were weighed: the age of the fetus, the severity of the disease, diagnosis and prognosis, treatment possibilities and the wishes of the parents and these factors were considered within the context of each case and were tested against the ethical principles of obstetrics. It was concluded that while respect for the parents' wishes and promotion of the infants' welfare is important, another ethically important factor is the availability of scarce medical resources, a factor which affects other people, not just the parents and fetus in question.

Evaluation, Fetal heart rate monitoring, Electronic fetal monitoring, Echocardiography, Medical ethics

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