BACKGROUND Acute pancreatitis in pregnancy is a rare but serious condition that can lead to high maternal mortality and fetal loss.Instances of pregnancy complicated by severe acute pancreatitis,particularly with subs...BACKGROUND Acute pancreatitis in pregnancy is a rare but serious condition that can lead to high maternal mortality and fetal loss.Instances of pregnancy complicated by severe acute pancreatitis,particularly with subsequent respiratory and cardiac arrest,are rarely reported.CASE SUMMARY We present the case of a 35-year-old woman,at 36+5 weeks of gestation,who presented with paroxysmal epigastric pain accompanied by low back pain,nausea,and vomiting.According to the clinical symptoms,B-ultrasound imaging and biochemical indicators,the patient was diagnosed with acute pancreatitis and initially managed conservatively.However,3 hours after admission,the patient experienced respiratory and cardiac arrest,and the fetus died.In this case,the adverse outcomes occurred due to the lack of aggressive fluid resuscitation and an active surgical intervention.CONCLUSION Implementing aggressive fluid resuscitation to sustain tissue perfusion,alongside the proactive evaluation of pharmacological agents that suppress gastric acid secretion and inhibit pancreatic enzyme activity,may be beneficial in mitigating the risk of a severely adverse prognosis.Effective management of acute pancreatitis during pregnancy requires careful timing of surgical intervention,a thorough evaluation of the risks and benefits regarding the continuation or termination of pregnancy,and a focus on safeguarding both maternal and fetal health.展开更多
Introduction: The occurrence of intrauterine fetal death (IUFD) is a traumatic event not only for the mother and her family but also for the obstetric team. IUFD is a common event. Objective: the aim of our study is t...Introduction: The occurrence of intrauterine fetal death (IUFD) is a traumatic event not only for the mother and her family but also for the obstetric team. IUFD is a common event. Objective: the aim of our study is to describe the epidemiological, diagnostic and management aspects of IUFD at the Sylvanus Olympio University Teaching Hospital (CHU SO), Lomé. Methodology: It was a descriptive cross-sectional study with retrospective data collection process that concerned cases of IUFD from January 1st 2023 to December 31, 2023 at CHU SO. Results: The hospital prevalence of IUFD was 2.43%. The mean age of the mothers was 30.6 ± 6 years. The Multigestures represented 32.52% and primiparous women represented 29.72%. Pregnant women were referred in 88.11% of cases;47.55% had done at least 4 antenatal care visits and 4.20% had a history of IUFD. The etiological factors of IUFD were preeclampsia in 28.67% of cases, retroplacental hematoma in 28.67% and premature rupture of membranes in 4.55% of cases. Misoprostol was used for artificial induction of labor in 57.14% of cases and the delivery route was vaginal in 75.87% of cases. Conclusion: The frequency of IUFD is high and its reduction remains a challenge in low-income countries.展开更多
Objective: To identify the risk factors of intrapartal fetal death in a tertiary hospital in Yaoundé. Methods: It was a case-control study comparing 53 women who delivered with intrapartal fetal death to 106 wome...Objective: To identify the risk factors of intrapartal fetal death in a tertiary hospital in Yaoundé. Methods: It was a case-control study comparing 53 women who delivered with intrapartal fetal death to 106 women who delivered without intrapartal fetal death, carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon. Results: The risk factors of intrapartal fetal death identified at bivariate analysis were: maternal age <20 years (OR = 3.1;CI = 1.1 - 8.3), absence of regular income (OR = 2.4;CI = 1.2 - 4.7), single motherhood (OR = 2.9;CI = 1.5 - 5.7), illiteracy and primary level of education (OR = 4.7;CI = 1.9 - 11.5), referral (OR = 5.0;CI = 2.5 - 9.9), parity 0 and 1 (OR = 2.3;CI = 1.1 - 4.5), no antenatal care (OR = 9.2;CI = 2.4 - 35.6), number of antenatal visits <4 (OR = 4.2;CI = 2.1 - 8.6), antenatal care in a health center (OR = 3.8;CI = 1.9 - 7.5), antenatal care by a midwife (OR = 2.5;CI = 1.3 - 4.9) or a nurse (OR = 5.2;CI = 1.4 - 18.7), absence of malaria prophylaxis (OR = 10.6;CI = 2.9 - 39.5), absence of obstetrical ultrasound (OR = 4.7;CI = 1.9 - 10.9), prematurity (OR = 3.4;CI = 1.5 - 7.3), abnormal presentation (OR = 2.6;CI = 1.1 - 5.9), ruptured membranes at admission (OR = 2.7;CI = 1.3 - 5.4), ruptured membranes >12 hours at admission (OR = 5.1;CI = 2.5 - 10.3), stained amniotic fluid (OR = 4.8;CI = 2.4 - 9.7), labor lasting more than 12 hours (OR = 18.1;CI = 8.0 - 41.0), presence of maternal complications (OR = 4.7;CI = 2.2 - 10.3), and presence of fetal complications (OR = 48.6;CI = 18.3 - 129), particularly acute fetal distress (OR = 52.3;CI = (14.6 - 186), cord prolapse (OR = 12.1;CI = 3.3 - 43.4), and birth weight <2500 g (OR = 2.8;CI = 1.2 - 6.6). Conclusion: Close attention should be offered to pregnant women, so as to identify these risk factors and promptly provide an appropriate management.展开更多
Objective.Analysis of the cause of intrauterine death of one fetus of twin and to evaluate the outcome of conservative management of twin pregnancy with single fetal death. Method.A retrospective review was undertaken...Objective.Analysis of the cause of intrauterine death of one fetus of twin and to evaluate the outcome of conservative management of twin pregnancy with single fetal death. Method.A retrospective review was undertaken on PUMC hospital records of women who delivered twin between Jan. 1987 and Dec. 1998. Result.During the recent 12 years, 99 pregnant women were documented as twin pregnancies. Of the twin pregnancies during this period, 13 were complicated by a single intrauterine death. Four women suffered this complication during their first trimester. In the remain 9 cases one fetus died during second or third trimester. The cesarean section was given in three pregnant women soon after a single intrauterine death because of the survival fetal distress. No consumptive coagulopathy was apparent in all 13 pregnant women. It is wise that the pregnancy was managed conservatively, with regular coagulation parameters obtained. Conclusion.Our results support conservative management in twin pregnancies complicated by single fetal death.展开更多
Objectives: This paper aims to study the epidemiology and causes of fetal deaths in utero at Regional Hospital Amath Dansokho of Kedougou (RHADK). Methodology: This was a retrospective epidemiological study conducted ...Objectives: This paper aims to study the epidemiology and causes of fetal deaths in utero at Regional Hospital Amath Dansokho of Kedougou (RHADK). Methodology: This was a retrospective epidemiological study conducted at the Maternity Ward of the Regional Hospital Amath Dansokho of Kedougou from June 01, 2022 to June 30, 2023, including all patients seen for delivery care. Data were analyzed using Statistical Package for Social Science (SPSS 22, Windows version). The parameters studied were the frequency of in-utero fetal death, sociodemographic characteristics, pregnancy and delivery data, neonatal data and cause-of-death classification according to the Cause of Death and Associated Conditions (CODAC) classification. Results: We recorded 1628 deliveries, with 231 cases of in-utero fetal death, a frequency of 14.2%. Fetal death occurred most frequently in multiparous women (64.5%). The majority of patients (72.3%) were transferred. 51.9% of patients with fetal death had at least 3 antenatal visits. On admission, fetal heart rate was absent in 73.2% of patients. The etiology of in-utero fetal death was dominated by maternal factors (high blood pressure, anaemia and diabetes), which accounted for 36.9% of deaths, followed by placental pathologies (retroplacental haematoma) and intrapartum pathologies (uterine rupture, abnormal presentation). Conclusion: In-utero fetal death can be prevented, and is mainly due to direct obstetric complications. The focus should be on the prevention and management of hypertensive disorders and their complications during pregnancy, the fight against anaemia and, above all, the rapid and correct management of dystocia.展开更多
Objective: This study aimed to assess perinatal morbidity, mortality rates, and neurodevelopmental outcomes in the management of fetal growth restriction (FGR) at a single tertiary institute. Methods: Among 2465 deliv...Objective: This study aimed to assess perinatal morbidity, mortality rates, and neurodevelopmental outcomes in the management of fetal growth restriction (FGR) at a single tertiary institute. Methods: Among 2465 deliveries between 2013 and 2019, 109 cases of FGR were reviewed retrospectively for causes, indications for pregnancy termination, perinatal death, overall neonatal outcomes, and long-term prognosis. Results: Excluding FGR due to congenital anomalies (n = 17), the mortality rate was 3.3% (3/92). One neonate delivered at 23 weeks developed cerebral palsy (1.1%). Retinopathy of prematurity occurred in four neonates (4.3%). Neurodevelopmental disorders were present in six neonates (6.5%), all of whom were delivered at 32 - 38 weeks. Significantly lower gestational age at delivery, lower birth weight, and higher umbilical artery resistance indices were observed in neonates with neurodevelopmental disorders. Conclusions: Intact survival before 27 weeks of gestation at delivery with FGR is uncommon. Neurodevelopmental disorders may still develop after delivery at 32 - 38 weeks;consideration should be given to the timing of delivery usingfetal ductus venosus Doppler waveforms measurements to reduce neurodevelopmental disorders.展开更多
Objective: Fetal Alcohol Spectrum Disorders (FASDs) are common, often undiagnosed, lifelong developmental disorders that result from prenatal alcohol exposure. FASD is present at birth and typically identified around ...Objective: Fetal Alcohol Spectrum Disorders (FASDs) are common, often undiagnosed, lifelong developmental disorders that result from prenatal alcohol exposure. FASD is present at birth and typically identified around seven years of age. The most severe outcome in cases of FASD is mortality. The purpose of this scoping review is to 1) use a systematic review to provide an estimated mortality proportion for children with FASD, and 2) update a study published in 2014 by reviewing published reports of mortality in individuals diagnosed with FASD. Method: A search of PubMed, CINAHL, and Google Scholar for reports published between 2013 and 2023 on mortality in individuals with FASD. Results: Three population-based studies have reported on all-cause mortality rates, finding a combined mortality rate of 10.9%, a 2.63 fold (95% CI: 2.61 to 2.65) increase in mortality risk over the general population. Since 2016, this review identified only eight new cases meeting the study inclusion criteria. The reported causes of death were five cases of pneumonia, and one case each of failure to thrive and dehydration, intestinal dilatation and asphyxiation caused by overeating due to pica, and acute gastric volvulus. Discussion: While current research suggests a diagnosis of FASD is associated with a 2.6-fold increase in mortality risk, this is likely an underestimation, as most cases of FASD-related mortality go unreported. Globally, about 1 new case is reported every 15 months. However, in the United States alone, between 1752 to 4400 FASD related deaths occur annually. Our review suggests that FASD is rarely identified as a causal or contributing factor in deaths of children and adolescents, resulting in a substantial undercount of FASD-related deaths. Increased attention to the role of FASD in infant and child mortality case reviews, child death review committee reports, and mortality reviews is needed.展开更多
Context: The presence of conjoined twins is a rare occurrence during pregnancy. Today, early diagnosis is possible thanks to advances in imaging, particularly three-dimensional ultrasound, and the intervention of a tr...Context: The presence of conjoined twins is a rare occurrence during pregnancy. Today, early diagnosis is possible thanks to advances in imaging, particularly three-dimensional ultrasound, and the intervention of a trained operator. This antenatal diagnosis can be used to decide whether or not to continue the pregnancy. Cases presentation: Based on the authors’ experience, five (05) cases of conjoined twins were collected over a period of six years (01 January 2018-01 January 2023) in the maternity wards of the Angre’s Teaching Hospital (study location), whose diagnosis was sometimes unexpected in the delivery room. Among the five cases, we described three (03) thoraco-omphalopages and two (02) parapages, with a female predominance of 4/5. None were candidates for separation because they were stillborn or died on the first day of life. Conclusion: This series of cases highlights the different characteristics of conjoined twins and the poor fetal prognosis due to diagnostic difficulties and therapeutic possibilities that are practically non-existent in the African environment.展开更多
The fetal death In Uterus is relatively a common problem in developing countries. In Africa, the rate of deaths varies from one hospital to another. We wanted to evaluate the prevalence, to describe the epidemiologica...The fetal death In Uterus is relatively a common problem in developing countries. In Africa, the rate of deaths varies from one hospital to another. We wanted to evaluate the prevalence, to describe the epidemiological aspects, etiologies and maternal prognosis associated with fetal deaths in Uterus in 2017 at Sylvanus Olympio Teaching Hospital in Lomé. Patients and methods: This was a retrospective descriptive study conducted from January 1st to December 31st, 2017. We have included all pregnant cases received and treated on the spot for in uterus deaths as defined by the World Health Organization. Medical termination of pregnancy records, intrapartum deaths, less than 22 amenorrhea weeks’ pregnancies and complications of abortion were not included. Results: The fetal death rate in uterus was 3.64%. The multigravida and multiparous were respectively 49% and 41%;the referees were 51%, 28% evacuated;21% came on their own. The gestational age of 28 - 37 weeks was 39% and 17% had no prenatal consultation. The analysis has revealed that high blood pressure, preeclampsia, and retroplacental hematomas were the main etiologies associated with fetal deaths in uterus. Conclusion: In uterus fetal deaths remain common in our country. The main causes were hypertension disorders of pregnancy. There were also some unknown causes which could be related to economic or cultural reasons. For instance, autopsies of in uterus deaths and placental anatomopathology examination are not performed because of culture.展开更多
Background: Intrauterine fetal demise is the death of the fetus after twenty week of gestation but before the onset of labor. In more than 50% of cases, the etiology of antepartum fetal death is not known or cannot be...Background: Intrauterine fetal demise is the death of the fetus after twenty week of gestation but before the onset of labor. In more than 50% of cases, the etiology of antepartum fetal death is not known or cannot be determined. Several factors attributed to the risk of IUFD. This study aimed to determine the incidence of IUFD, as well as associated conditions. Method: This retrospective study enrolled all pregnant women who attending at KAUH between 2011 and 2015. Results: During the last five years 248 verified IUFD cases were reported, the mean age was 30.59. Saudi nationality represented by 27 %. PET was represented 17.7% and congenital malformation was represented by 7.3% as risk factors. Regarding the mode of delivery SVD was 58.9% followed by CS 28.6. Conclusion: Stillbirth is an unfavorable event, there are several factors (maternal, fetal & placenta) associated with IUFD. Providing good level of antenatal care helped in reducing IUFD incidence.展开更多
独眼畸形通常由于胚胎两眼原基未完全分离或者前脑中部发育障碍,导致两侧原始视泡向中线融合引发,是前脑无裂畸形相关面部畸形中最严重的一种表现。报告1例妊娠16周独眼畸形死胎病例,该例孕妇妊娠14+3周时行胎儿颈后透明层检查发现头颅...独眼畸形通常由于胚胎两眼原基未完全分离或者前脑中部发育障碍,导致两侧原始视泡向中线融合引发,是前脑无裂畸形相关面部畸形中最严重的一种表现。报告1例妊娠16周独眼畸形死胎病例,该例孕妇妊娠14+3周时行胎儿颈后透明层检查发现头颅内异常液性暗区,妊娠终止后引产儿面部可见单眼眶及其上方的前额鼻肉柱,经基因组拷贝数变异测序(copy number variation sequencing,CNV-seq)分析发现染色体三倍体变异、嵌合比约32%的X染色体嵌合重复以及嵌合比约32%的Y染色体嵌合缺失。独眼畸形的病因具有异质性,目前其发病机制尚未明确,妊娠期影像学检查和产前诊断为常用检查方法,在诊断后应尽早终止妊娠,减轻孕妇身心损害及社会医疗经济负担。展开更多
The objective is to report a clinical case of vaginal cesarean section performed to expel a dead fetus in scarred uterus. For this indication, vaginal hysterectomy constitutes an alternative to vaginal expulsion with ...The objective is to report a clinical case of vaginal cesarean section performed to expel a dead fetus in scarred uterus. For this indication, vaginal hysterectomy constitutes an alternative to vaginal expulsion with a high risk of uterine rupture and to classic abdominal cesarean section with risk of significant surgical trauma, particularly adhesions. However, this surgical technique, described since the 19th century, remains unknown to many practitioners and few publications exist on the subject throughout the world. Considered obsolete by some practitioners, it retains all its advantages in the practice of modern obstetrics. We report this case of expulsion of fetal death on a tri-scarred uterus performed by vaginal cesarean section at the Health District Reference Health Center (District Hospital) of Commune I in Bamako, Mali in a 37-year-old patient with a pregnancy of 27 weeks of amenorrhea.展开更多
文摘BACKGROUND Acute pancreatitis in pregnancy is a rare but serious condition that can lead to high maternal mortality and fetal loss.Instances of pregnancy complicated by severe acute pancreatitis,particularly with subsequent respiratory and cardiac arrest,are rarely reported.CASE SUMMARY We present the case of a 35-year-old woman,at 36+5 weeks of gestation,who presented with paroxysmal epigastric pain accompanied by low back pain,nausea,and vomiting.According to the clinical symptoms,B-ultrasound imaging and biochemical indicators,the patient was diagnosed with acute pancreatitis and initially managed conservatively.However,3 hours after admission,the patient experienced respiratory and cardiac arrest,and the fetus died.In this case,the adverse outcomes occurred due to the lack of aggressive fluid resuscitation and an active surgical intervention.CONCLUSION Implementing aggressive fluid resuscitation to sustain tissue perfusion,alongside the proactive evaluation of pharmacological agents that suppress gastric acid secretion and inhibit pancreatic enzyme activity,may be beneficial in mitigating the risk of a severely adverse prognosis.Effective management of acute pancreatitis during pregnancy requires careful timing of surgical intervention,a thorough evaluation of the risks and benefits regarding the continuation or termination of pregnancy,and a focus on safeguarding both maternal and fetal health.
文摘Introduction: The occurrence of intrauterine fetal death (IUFD) is a traumatic event not only for the mother and her family but also for the obstetric team. IUFD is a common event. Objective: the aim of our study is to describe the epidemiological, diagnostic and management aspects of IUFD at the Sylvanus Olympio University Teaching Hospital (CHU SO), Lomé. Methodology: It was a descriptive cross-sectional study with retrospective data collection process that concerned cases of IUFD from January 1st 2023 to December 31, 2023 at CHU SO. Results: The hospital prevalence of IUFD was 2.43%. The mean age of the mothers was 30.6 ± 6 years. The Multigestures represented 32.52% and primiparous women represented 29.72%. Pregnant women were referred in 88.11% of cases;47.55% had done at least 4 antenatal care visits and 4.20% had a history of IUFD. The etiological factors of IUFD were preeclampsia in 28.67% of cases, retroplacental hematoma in 28.67% and premature rupture of membranes in 4.55% of cases. Misoprostol was used for artificial induction of labor in 57.14% of cases and the delivery route was vaginal in 75.87% of cases. Conclusion: The frequency of IUFD is high and its reduction remains a challenge in low-income countries.
文摘Objective: To identify the risk factors of intrapartal fetal death in a tertiary hospital in Yaoundé. Methods: It was a case-control study comparing 53 women who delivered with intrapartal fetal death to 106 women who delivered without intrapartal fetal death, carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon. Results: The risk factors of intrapartal fetal death identified at bivariate analysis were: maternal age <20 years (OR = 3.1;CI = 1.1 - 8.3), absence of regular income (OR = 2.4;CI = 1.2 - 4.7), single motherhood (OR = 2.9;CI = 1.5 - 5.7), illiteracy and primary level of education (OR = 4.7;CI = 1.9 - 11.5), referral (OR = 5.0;CI = 2.5 - 9.9), parity 0 and 1 (OR = 2.3;CI = 1.1 - 4.5), no antenatal care (OR = 9.2;CI = 2.4 - 35.6), number of antenatal visits <4 (OR = 4.2;CI = 2.1 - 8.6), antenatal care in a health center (OR = 3.8;CI = 1.9 - 7.5), antenatal care by a midwife (OR = 2.5;CI = 1.3 - 4.9) or a nurse (OR = 5.2;CI = 1.4 - 18.7), absence of malaria prophylaxis (OR = 10.6;CI = 2.9 - 39.5), absence of obstetrical ultrasound (OR = 4.7;CI = 1.9 - 10.9), prematurity (OR = 3.4;CI = 1.5 - 7.3), abnormal presentation (OR = 2.6;CI = 1.1 - 5.9), ruptured membranes at admission (OR = 2.7;CI = 1.3 - 5.4), ruptured membranes >12 hours at admission (OR = 5.1;CI = 2.5 - 10.3), stained amniotic fluid (OR = 4.8;CI = 2.4 - 9.7), labor lasting more than 12 hours (OR = 18.1;CI = 8.0 - 41.0), presence of maternal complications (OR = 4.7;CI = 2.2 - 10.3), and presence of fetal complications (OR = 48.6;CI = 18.3 - 129), particularly acute fetal distress (OR = 52.3;CI = (14.6 - 186), cord prolapse (OR = 12.1;CI = 3.3 - 43.4), and birth weight <2500 g (OR = 2.8;CI = 1.2 - 6.6). Conclusion: Close attention should be offered to pregnant women, so as to identify these risk factors and promptly provide an appropriate management.
文摘Objective.Analysis of the cause of intrauterine death of one fetus of twin and to evaluate the outcome of conservative management of twin pregnancy with single fetal death. Method.A retrospective review was undertaken on PUMC hospital records of women who delivered twin between Jan. 1987 and Dec. 1998. Result.During the recent 12 years, 99 pregnant women were documented as twin pregnancies. Of the twin pregnancies during this period, 13 were complicated by a single intrauterine death. Four women suffered this complication during their first trimester. In the remain 9 cases one fetus died during second or third trimester. The cesarean section was given in three pregnant women soon after a single intrauterine death because of the survival fetal distress. No consumptive coagulopathy was apparent in all 13 pregnant women. It is wise that the pregnancy was managed conservatively, with regular coagulation parameters obtained. Conclusion.Our results support conservative management in twin pregnancies complicated by single fetal death.
文摘Objectives: This paper aims to study the epidemiology and causes of fetal deaths in utero at Regional Hospital Amath Dansokho of Kedougou (RHADK). Methodology: This was a retrospective epidemiological study conducted at the Maternity Ward of the Regional Hospital Amath Dansokho of Kedougou from June 01, 2022 to June 30, 2023, including all patients seen for delivery care. Data were analyzed using Statistical Package for Social Science (SPSS 22, Windows version). The parameters studied were the frequency of in-utero fetal death, sociodemographic characteristics, pregnancy and delivery data, neonatal data and cause-of-death classification according to the Cause of Death and Associated Conditions (CODAC) classification. Results: We recorded 1628 deliveries, with 231 cases of in-utero fetal death, a frequency of 14.2%. Fetal death occurred most frequently in multiparous women (64.5%). The majority of patients (72.3%) were transferred. 51.9% of patients with fetal death had at least 3 antenatal visits. On admission, fetal heart rate was absent in 73.2% of patients. The etiology of in-utero fetal death was dominated by maternal factors (high blood pressure, anaemia and diabetes), which accounted for 36.9% of deaths, followed by placental pathologies (retroplacental haematoma) and intrapartum pathologies (uterine rupture, abnormal presentation). Conclusion: In-utero fetal death can be prevented, and is mainly due to direct obstetric complications. The focus should be on the prevention and management of hypertensive disorders and their complications during pregnancy, the fight against anaemia and, above all, the rapid and correct management of dystocia.
文摘Objective: This study aimed to assess perinatal morbidity, mortality rates, and neurodevelopmental outcomes in the management of fetal growth restriction (FGR) at a single tertiary institute. Methods: Among 2465 deliveries between 2013 and 2019, 109 cases of FGR were reviewed retrospectively for causes, indications for pregnancy termination, perinatal death, overall neonatal outcomes, and long-term prognosis. Results: Excluding FGR due to congenital anomalies (n = 17), the mortality rate was 3.3% (3/92). One neonate delivered at 23 weeks developed cerebral palsy (1.1%). Retinopathy of prematurity occurred in four neonates (4.3%). Neurodevelopmental disorders were present in six neonates (6.5%), all of whom were delivered at 32 - 38 weeks. Significantly lower gestational age at delivery, lower birth weight, and higher umbilical artery resistance indices were observed in neonates with neurodevelopmental disorders. Conclusions: Intact survival before 27 weeks of gestation at delivery with FGR is uncommon. Neurodevelopmental disorders may still develop after delivery at 32 - 38 weeks;consideration should be given to the timing of delivery usingfetal ductus venosus Doppler waveforms measurements to reduce neurodevelopmental disorders.
文摘Objective: Fetal Alcohol Spectrum Disorders (FASDs) are common, often undiagnosed, lifelong developmental disorders that result from prenatal alcohol exposure. FASD is present at birth and typically identified around seven years of age. The most severe outcome in cases of FASD is mortality. The purpose of this scoping review is to 1) use a systematic review to provide an estimated mortality proportion for children with FASD, and 2) update a study published in 2014 by reviewing published reports of mortality in individuals diagnosed with FASD. Method: A search of PubMed, CINAHL, and Google Scholar for reports published between 2013 and 2023 on mortality in individuals with FASD. Results: Three population-based studies have reported on all-cause mortality rates, finding a combined mortality rate of 10.9%, a 2.63 fold (95% CI: 2.61 to 2.65) increase in mortality risk over the general population. Since 2016, this review identified only eight new cases meeting the study inclusion criteria. The reported causes of death were five cases of pneumonia, and one case each of failure to thrive and dehydration, intestinal dilatation and asphyxiation caused by overeating due to pica, and acute gastric volvulus. Discussion: While current research suggests a diagnosis of FASD is associated with a 2.6-fold increase in mortality risk, this is likely an underestimation, as most cases of FASD-related mortality go unreported. Globally, about 1 new case is reported every 15 months. However, in the United States alone, between 1752 to 4400 FASD related deaths occur annually. Our review suggests that FASD is rarely identified as a causal or contributing factor in deaths of children and adolescents, resulting in a substantial undercount of FASD-related deaths. Increased attention to the role of FASD in infant and child mortality case reviews, child death review committee reports, and mortality reviews is needed.
文摘Context: The presence of conjoined twins is a rare occurrence during pregnancy. Today, early diagnosis is possible thanks to advances in imaging, particularly three-dimensional ultrasound, and the intervention of a trained operator. This antenatal diagnosis can be used to decide whether or not to continue the pregnancy. Cases presentation: Based on the authors’ experience, five (05) cases of conjoined twins were collected over a period of six years (01 January 2018-01 January 2023) in the maternity wards of the Angre’s Teaching Hospital (study location), whose diagnosis was sometimes unexpected in the delivery room. Among the five cases, we described three (03) thoraco-omphalopages and two (02) parapages, with a female predominance of 4/5. None were candidates for separation because they were stillborn or died on the first day of life. Conclusion: This series of cases highlights the different characteristics of conjoined twins and the poor fetal prognosis due to diagnostic difficulties and therapeutic possibilities that are practically non-existent in the African environment.
文摘The fetal death In Uterus is relatively a common problem in developing countries. In Africa, the rate of deaths varies from one hospital to another. We wanted to evaluate the prevalence, to describe the epidemiological aspects, etiologies and maternal prognosis associated with fetal deaths in Uterus in 2017 at Sylvanus Olympio Teaching Hospital in Lomé. Patients and methods: This was a retrospective descriptive study conducted from January 1st to December 31st, 2017. We have included all pregnant cases received and treated on the spot for in uterus deaths as defined by the World Health Organization. Medical termination of pregnancy records, intrapartum deaths, less than 22 amenorrhea weeks’ pregnancies and complications of abortion were not included. Results: The fetal death rate in uterus was 3.64%. The multigravida and multiparous were respectively 49% and 41%;the referees were 51%, 28% evacuated;21% came on their own. The gestational age of 28 - 37 weeks was 39% and 17% had no prenatal consultation. The analysis has revealed that high blood pressure, preeclampsia, and retroplacental hematomas were the main etiologies associated with fetal deaths in uterus. Conclusion: In uterus fetal deaths remain common in our country. The main causes were hypertension disorders of pregnancy. There were also some unknown causes which could be related to economic or cultural reasons. For instance, autopsies of in uterus deaths and placental anatomopathology examination are not performed because of culture.
文摘Background: Intrauterine fetal demise is the death of the fetus after twenty week of gestation but before the onset of labor. In more than 50% of cases, the etiology of antepartum fetal death is not known or cannot be determined. Several factors attributed to the risk of IUFD. This study aimed to determine the incidence of IUFD, as well as associated conditions. Method: This retrospective study enrolled all pregnant women who attending at KAUH between 2011 and 2015. Results: During the last five years 248 verified IUFD cases were reported, the mean age was 30.59. Saudi nationality represented by 27 %. PET was represented 17.7% and congenital malformation was represented by 7.3% as risk factors. Regarding the mode of delivery SVD was 58.9% followed by CS 28.6. Conclusion: Stillbirth is an unfavorable event, there are several factors (maternal, fetal & placenta) associated with IUFD. Providing good level of antenatal care helped in reducing IUFD incidence.
文摘独眼畸形通常由于胚胎两眼原基未完全分离或者前脑中部发育障碍,导致两侧原始视泡向中线融合引发,是前脑无裂畸形相关面部畸形中最严重的一种表现。报告1例妊娠16周独眼畸形死胎病例,该例孕妇妊娠14+3周时行胎儿颈后透明层检查发现头颅内异常液性暗区,妊娠终止后引产儿面部可见单眼眶及其上方的前额鼻肉柱,经基因组拷贝数变异测序(copy number variation sequencing,CNV-seq)分析发现染色体三倍体变异、嵌合比约32%的X染色体嵌合重复以及嵌合比约32%的Y染色体嵌合缺失。独眼畸形的病因具有异质性,目前其发病机制尚未明确,妊娠期影像学检查和产前诊断为常用检查方法,在诊断后应尽早终止妊娠,减轻孕妇身心损害及社会医疗经济负担。
文摘The objective is to report a clinical case of vaginal cesarean section performed to expel a dead fetus in scarred uterus. For this indication, vaginal hysterectomy constitutes an alternative to vaginal expulsion with a high risk of uterine rupture and to classic abdominal cesarean section with risk of significant surgical trauma, particularly adhesions. However, this surgical technique, described since the 19th century, remains unknown to many practitioners and few publications exist on the subject throughout the world. Considered obsolete by some practitioners, it retains all its advantages in the practice of modern obstetrics. We report this case of expulsion of fetal death on a tri-scarred uterus performed by vaginal cesarean section at the Health District Reference Health Center (District Hospital) of Commune I in Bamako, Mali in a 37-year-old patient with a pregnancy of 27 weeks of amenorrhea.
