Meconium-stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity

The purpose of this study was to determine whether meconium-stained amniotic fluid is a marker for microbial invasion of the amniotic cavity. Amniocentesis was performed on 707 patients presenting with preterm labor and intact membranes. Meconium-stained amniotic fluid was present in 4.2% (30/707) of patients with preterm labor. The prevalence of positive amniotic fluid cultures was significantly higher in women with meconium-stained amniotic fluid than in women with clear fluid (33% [10/30] vs 11% [75/677]; p = 0.001; odds ratio = 4.01; 95% confidence interval = 1.6 to 9.4). Patients with meconium-stained amniotic fluid were also more likely to have failed tocolysis and delivered a preterm neonate more frequently than patients with clear fluid (83% [25/30] vs 38% (258/677); p = 0.0001; odds ratio = 8.1; 95% confidence interval = 2.9 to 24.4). We conclude that meconium-stained amniotic fluid is a risk factor for microbial invasion of the amniotic cavity and preterm delivery in women with preterm labor and intact membranes.     

Intraamniotic infection with Haemophilus influenzae report of a case and review of the literature

We report a rare case of intraamniotic infection with Haemophilus influenzae in a woman presenting with preterm premature rupture of membranes. Review of the literature identified 7 cases of intraamniotic infection with Haemophilus influenzae in patients with preterm premature rupture of membranes or with preterm labor and intact membranes.     

Clinical significance, prevalence, and natural history of thrombocytopenia in pregnancy-induced hypertension

The purpose of this study was to establish the prevalence and clinical significance of thrombocytopenia in pregnancy-induced hypertension (PIH). Thrombocytopenia, defined as a platelet count less than 100,000/mm3 was found in 11.6% of all patients with PIH. Logistic regression analysis was used to assess the relative contribution of thrombocytopenia, proteinuria, and the degree of hypertension to maternal and perinatal outcome. Thrombocytopenia was the principal contributor to the occurrence of abdominal pain, liver dysfunction, the presence of schistocytes in the peripheral smear, proteinuria, fetal distress, and the requirement for blood transfusions. Thrombocytopenia was also associated with a higher incidence of preterm delivery and intrauterine growth retardation. The nadir platelet count occurred within 48 hours of delivery in 56.7% (21 of 37) of cases. The median number of days for recovery of the thrombocytopenia was 2.0 days (range, 0 to 8 days). In five patients thrombocytopenia preceded the clinical manifestations of PIH. We conclude that thrombocytopenia is an independent and important risk factor for the occurrence of maternal and perinatal complications in PIH.     

The prevalence and clinical significance of intraamniotic infection with Candida species in women with preterm labor

Summary Intraamniotic infection is considered a major etiologic factor of preterm birth. Positive amniotic fluid cultures are rarely contaminated with Candida species. The presence of this microorganism is associated with a poor pregnancy outcome. Out of 773 transabdominal amniocenteses performed in women presenting with preterm labor and intact membranes, 77 patients (9.9%) had positive amniotic fluid cultures and in 5 women (6.5%) Candida species were identified. On the other hand, 625 amniocenteses were performed in women with preterm premature rupture of membranes and 178 (28%) had positive cultures. Only in 4 patients was Candida isolated (2.2%) (P=0.13 Fisher’s exact test). The importance of early and accurate diagnosis of intraamniotic infection with Candida is pointed out. A transabdominal amniocentesis for microbiological examination is suggested for every woman presenting with preterm labor or preterm premature rupture of membranes and especially for those who conceived with a retained IUD or cervical cerclage.     

Management and outcome of multiple pregnancies complicated by the antenatal death of one fetus

Over a 15-year period, infants from 1,192 multiple gestations were delivered at Soroka Medical Center, Beer Sheva, Israel. In 21 patients the pregnancy was complicated by the antenatal death of one fetus. In 2 of the 4 cases of monochorionic placenta, both twins died in utero within a short time, while in the 17 cases of dichorionic placenta there was no second fetal death. It seems that in cases of monochorionic placenta, the surviving twin is exposed to a more dangerous environment, and death can occur imminently. The management protocol should be based, if possible, on the type of placentation.     

Severe Takayasu's arteritis in pregnancy: the role of central hemodynamic monitoring

Maternal cardiovascular complications have been attributed to the dramatic hemodynamic changes associated with labor and delivery in patients with Takayasu's arteritis. The role of central hemodynamic monitoring in the management of a pregnant patient with severe Takayasu's arteritis is discussed.     

Abortion caused by electrical current

Summary A case of electrical accident in a pregnant woman at 9 weeks of gestation is described. No fetal heart activity was noted immediately after the injury, and spontaneous abortion occurred two days later.