Third-trimester fetal death in triplet pregnancies

Article Abstract:

In Denmark in the last 10 years, 89 sets of triplets were born later than the 25th week of pregnancy. Death of a fetus in the last three months of pregnancy occurred in 15 triplet pregnancies, and accounted for 17 deaths before birth. Of these 15 pregnancies, six more babies died after birth and 22 babies survived. In four cases, the pregnancy was thought to involve twins rather than triplets, and was correctly diagnosed only at delivery. Conception was spontaneous in eight cases; augmented by assisted fertilization and embryo transfer in two cases; and aided by stimulation of ovulation in five cases. The average age of the mothers was 27.8 years, and ranged from 17 to 38 years. Seven women had previous pregnancies, whereas the triplet pregnancy was the first for eight mothers. Complications of the triplet pregnancies included hydramnios, an excessive amount of amniotic fluid, in three cases; abnormalities in blood pressure in three cases; and anemia, or decreased oxygen-carrying capacity of the blood, in nine cases. All deliveries occurred before the end of the normal nine-month pregnancy period. Of 11 triplet pregnancies, death of the fetus was detected at an average of 32.2 weeks and delivery occurred at an average of 32.6 weeks. Delivery was by cesarean section in nine of the 11 triplet pregnancies. The pregnancies could have been continued after fetal death in three cases, but immediate delivery was necessary in eight cases. Fetal death resulted from abnormalities in the placenta, fetal growth retardation, abnormal development of the brain or spinal cord, umbilical cord problems, and water accumulation. The death of a fetus should not be the only indication for delivery. The fetus should be continually monitored in cases of severe prematurity and stable in utero conditions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Pregnancy, Multiple, Multiple pregnancy, Triplets

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Universal prenatal hepatitis B testing: is it cost effective?

Article Abstract:

Pregnant women who are carriers of the hepatitis B virus, which can cause severe liver damage, can transmit the virus to their fetuses during pregnancy. Transmission via pregnancy is the most common mode of hepatitis B transmission, responsible for 40 percent of the infections in Asian populations. In an effort to prevent the transmission of hepatitis B during pregnancy, in 1984 it was suggested that all high-risk pregnant women be screened for hepatitis B antigens. In 1988 this recommendation was extended to all pregnant women. The cost-effectiveness of this new policy is reviewed. The screening of women not at risk has shown that the disease is unlikely to occur in hepatitis B antigen-negative pregnancies. Furthermore the benefit of protecting contacts from hepatitis B carriers has not been established. On the other hand, the implications of not treating an infant infected by hepatitis B (either a fulminant infection or a chronic carrier state) must be considered. It is argued that medical resources are not unlimited and rational medical policies must be implemented. It is not justified to spend $180,000 to prevent one infant from developing fulminant hepatitis or chronic carrier state, a cost 15 times higher than the cost of preventing a case of infant hepatitis B in high-risk women. The author suggests limiting screening to high-risk women only, until an inexpensive hepatitis B vaccine becomes available. (Consumer Summary produced by Reliance Medical Information, Inc.)

Finance, Testing, Disease transmission, Medical screening, Health screening, Hepatitis B, Hepatitis B virus, Carrier state (Communicable diseases)

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Fetomaternal bleeding as a cause of recurrent fetal morbidity and mortality

Article Abstract:

The consequences of significant fetomaternal bleeding (transfer of blood from the fetus to the mother via the placenta) can cause damage or death to the fetus. In such cases, the mother's body mounts an immune response against the fetal red blood cells, attacking and destroying them. The case report is presented of a woman who lost three pregnancies as a result of fetomaternal bleeding. (A child had been born as a result of the patient's first pregnancy, fathered by a different man from the other four.) Her fifth pregnancy, completed with careful monitoring of fetal health and extent of fetomaternal bleeding, was successful. The cause of this condition is not known; however, it is not usually associated with recurrent fetal death. Methodological concerns in testing for fetomaternal bleeding are discussed. Women with a history of unexplained transfer of fetal blood should be monitored during pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fetal diseases

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