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Epidemiology of Fetal Death and Analysis of Causes According to CODAC Classification at Amath Dansokho Regional Hospital of Kedougou, Senegal

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Open Journal of Obstetrics and Gynecology 2023年第12期13卷 1909-1918页

作者： Mouhamadou Wade Mamour Gueye Abdoul Aziz Diouf Mouhamet Sene Khadim Faye Adjie Betty Faye Heyssam Ghais Amath Dansokho Regional Hospital of Kedougou Kedougou Senegal Gynecology and Obstetrics Department Cheikh Anta DIOP University Dakar Senegal

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.

关键词： Obstetrical Complications Fetal Death CODAC Classification

Thrombotic Thrombocytopenic Purpura in a Parturient Leading to Life-Threatening Thrombocytopenia and Neonatal Demise—A Case Report

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Maternal-fetal Medicine 2023年第2期5卷 119-122页

作者： Amnon A.Berger John J.Kowalczyk Philip E.Hess Yunping Li Department of Anesthesia Critical Care and Pain MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA 02215USA

Thrombocytopenia is common (up to 12%) in pregnancy;thrombotic thrombocytopenia is a rare cause of thrombocytopenia;however,it is immediately life-threatening to both mother and fetus and requires immediate intervention.This is compounded by the need to act on a presumptive diagnosis with high level of suspicion given the relatively long laboratory confirmation time.A 31-year-old gravida 3,para 1 parturient at 26 weeks of gestation presented to outside hospital with recent onset of easy bruising and blurry vision.A blood count was drawn and showed a platelet count of 19,000/μL.She was transferred to our institution for management where an initial diagnosis of preeclampsia with severe features was made based on thrombocytopenia and fetal growth restriction (fetal prognosis,especially in early pregnancy,low threshold of suspicion,early anesthesia involvement,and multi-disciplinary approach can facilitate diagnosis and timely intervention.In our case,it was likely lifesaving.

关键词： Thrombocytopenia Pregnancy Plasma exchange Preeclampsia Fetal Death von Willebrand factor Purpura thrombocytopenic idiopathic HELLP syndrome.

Single vs.Recurrent Episodes of Preeclampsia-population-based Epidemiological and Clinical Characteristics

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Maternal-fetal Medicine 2021年第3期3卷 190-196页

作者： Salvatore Andrea Mastrolia Boris Taran Eric Kachko Omer Mor Ruth Beer-Wiesel Tamar Eshkoli Doron Dukler Shayna Miodownik Offer Erez Department of Obstetrics and Gynecology Ospedale dei Bambini"Vittore Buzzi"University of MilanoMilano 20154Italy Department of Obstetrics and Gynecology Soroka University Medical CenterSchool of MedicineFaculty of Health SciencesBen Gurion University of the NegevBeer Sheva 84101Israel Clinical Research Center Soroka University Medical CenterBen Gurion University of the NegevBeer Sheva 84101Israel Medical School for International Health Faculty of Health SciencesBen-Gurion University of the NegevBeer-Sheva 84101Israel

Objective:The aims of this study were to determine the differences between women with single vs.recurrent episodes of preeclampsia in term of:(1)the outcome of the first pregnancy affected by preeclampsia;and(2)the perinatal outcomes of subsequent pregnancies.Methods:This population based retrospective cohort study included all multiparous patients with a singleton gestation who delivered at Soroka University Medical Center(Beer Sheva,Israel)from January 1988 until December 2012,meeting the inclusion criteria,those who had fetuses with chromosomal or anatomical abnormalities were exclude.Our cohort included 213,558 deliveries that met the inclusion criteria,of them 208,017 had normotensive pregnancies and 5541 had preeclampsia.The latter group was further divided into those who had a single episode of preeclampsia followed by normotensive gestations(n=3879),and women who had recurrent preeclampsia(n=1662).We used parametric and non-parametric statistics as appropriate.Results:(1)Women with recurrent preeclampsia had an increased rate of early((130/1662)7.8%vs.(171/3879)4.4%,P<0.001)and late((268/1662)16.1%vs.(438/3879)11.3%,P<0.001)preterm deliveries than a single episode of preeclampsia;(2)of interest,the rate of chronic hypertension is higher in the first pregnancy of those with a single preeclampsia episode(P<0.001),while women with recurrent preeclampsia developed It in the subsequent gestations(P<0.001);(3)the rate of small for gestational age neonates in the index pregnancy was higher in those with recurrent rather than a single episode of preeclampsia(single episode 450/3879,11.6%,recurrent preeclampsia 244/1662,14.7%,P=0.002);(4)patients with recurrent disease had an increased rate of cesarean deliveries in the subsequent pregnancies(P<0.001);and(5)patients who developed severe preeclampsia in the subsequent gestations had lower mean birthweight(P<0.001),a higher rate of perinatal mortality(P<0.001),and a lower Apgar score at 1 and 5 minutes(P<0.001),than those who developed mild preeclampsia in subsequen

关键词： Cesarean section Fetal Death IUGR Pre-eclampsia Preterm delivery

Perinatal Morbidity, Mortality, and Neurodevelopmental Outcomes of Neonates with fetal Growth Restriction

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Open Journal of Obstetrics and Gynecology 2024年第3期14卷 321-333页

作者： Natsuki Tamashiro Shuko Chinen Yoshino Kinjyo Yukiko Chinen Tadatsugu Kinjo Keiko Mekaru Department of Obstetrics and Gynecology Graduate School of Medicine University of the Ryukyus Nishihara Japan

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.

关键词： Fetal Death fetal Growth Retardation Neurodevelopmental Disorders Perinatal Mortality Umbilical Artery Doppler Velocimetry

True Nodes of the Umbilical Cords of a Mono-Amniotic Pregnancy

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Open Journal of Obstetrics and Gynecology 2023年第2期13卷 259-264页

作者： Astou Coly Niassy Ibrahim Rahadat Aissatou Sankhare Marie-Edouard Faye Gynecology-Obstetrics Hospital Aristide Le Dantec Dakar Senegal

The incidence of twin pregnancies, has increased due to assisted reproductive technologies [1]. We note a doubling between 1970 and 2010 from less than 8‰ to nearly 16‰ of pregnancies (Pison et al., 2014;Pison et al., 2015) in developed countries [2] and 17‰ to 20‰ in sub-Saharan Africa. Monozygotic twins are the product of fertilization of a single egg by a single sperm, with the egg splitting into two within the first few days after fertilization. If the division takes place after the 8th day, the pregnancy is mono-chorionic mono-amniotic (less 1% of cases of monozygotic pregnancies) and represents 1 in 30,000 pregnancies. It is the development of two fetuses within the same amniotic sac, representing the rarest type of twin pregnancy (1% of monozygotic twin pregnancies) but being the one with the highest fetal and maternal morbidity. The main complication feared is coiling and knots of the umbilical cords responsible for abnormal heartbeat, fetal suffering and eventual Fetal Death. We report the case of in utero Fetal Death of twins from a mono choral mono amniotic pregnancy secondary to knots and coiling of the cord in order to discuss the diagnostic and therapeutic aspects.

关键词： Twin Pregnancy Fetal Death Coiling

Severe Trauma of Uterus and the Right Limb during a Road Accident at the Department of Obstetrics and Gynecology of the Teaching Hospital Souro Sanou of Bobo-Dioulasso: A Case Report and Review of Literature

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Open Journal of Obstetrics and Gynecology 2021年第12期11卷 1836-1842页

作者： Bambara Moussa Ouedraogo Issa Diallo Malick Yaro Biessan Komboïgo Evelyne Department of Obstetrics and Gynecology University Joseph Ki-Zerbo CUHSS Bobo-Dioulasso Burkina Faso Service of Obstetrics and Gynecology University Joseph Ki-Zerbo CHR-OHG Ouayigouya Burkina Faso Department of Surgery Teaching Hospital Souro Sanou Bobo-Dioulasso Burkina Faso Teaching Hospital Souro Sanou Bobo-Dioulasso Burkina Faso

The authors reported a case of trauma with uterus rupture at 35 weeks gestation with Fetal Death in uterus with a trauma of the right limb injuries during a serious road accident. Aim: the aim is to show the increasing of road accident with the motorized tricycle and their many risks for pregnant woman. Case Presentation: our patient was thrown from the back cargo of a motorized tricycle (three-wheeled vehicle) after a collision with a truck in a rural area from 150 km to Bobo-Dioulasso. She sustained a closed abdominal injury and a severe right lower limb open injury. At admission in our department in the Teaching Hospital, she was conscious, shocked with hemodynamic instability, including low blood pressure (75/52 mmHg), rapid heart rate (140 pulses per minute), rapid breath rate (40 per minute), and cold extremities. Abdominal examination was painful with uterine hypertonia, 28 cm height uterus, and no fetal heart heartbeat. A laparotomy in urgency revealed a rupture of the uterus fundus with a dead fetus. A conservative surgical treatment was performed. An open trauma to the right limb was managed by the orthopedists with a good outcome. Conclusion: Accident trauma during pregnancy is becoming more and more frequent with the increase in means of transport in urban and inter urban areas. The transport ways of the pregnant woman must take into account h

关键词： Road Accident Uterus Rupture Fetal Death Right Limb Injury Good Outcome

Parvovirus B19 and Pregnant Women: A Bibliographic Review

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Open Journal of Obstetrics and Gynecology 2021年第11期11卷 1543-1564页

作者： Majda Bouraddane Karima Warda Said Zouhair Laboratory of Microbiology-Virology Department of Biology Faculty of Medicine and Pharmacy University Cadi Ayyad Marrakech Morocco Laboratory of Bacteriology-Virology Avicenne Military Hospital Marrakech (HMA) Morocco

Primary infection with parvovirus B19 is an uncommon but serious and treatable cause of chronic anemia in immuno compromised hosts. Widely distributed, it is responsible for a wide range of clinical manifestations, the characteristics and outcome of which depend on the interaction between the viral properties and the physiological and immune status of the infected individuals. Infection during pregnancy can result in fetal anemia, abortion, and hydrops. Pregnancy does not appear to affect the course of the infection, but the infection may affect the pregnancy. The diagnosis of B19V can be made by serological and molecular investigation of the mother, fetus and newborn. In these conditions, it seemed necessary for us to answer in this article the various questions raised by the occurrence of a contagion and/or an infection with Parvovirus B19 during pregnancy. Our objective was to determine at first the nature and the main characteristics of Parvovirus B19 as well as its propagation during the pregnancy and to show its risk for the pregnant woman and her fetus. The importance of the subject is proven by the data on the spread and incidence of the virus. Worldwide, the focus on pregnancy is due to the additional potentially fatal effects on the fetus. This document covers the important aspects of a medical investigation: causes, symptoms, tests and diagnosis.

关键词： Parvovirus B19 Pregnant Women Clinical Manifestations Fetal Death Hydrops fetalis

Listeriosis Knowledge and Attitude among Pregnant Women Attending a Tertiary Health Institution, South Western Nigeria

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Advances in Infectious Diseases 2020年第2期10卷 64-75页

作者： Emelda E. Chukwu Francisca O. Nwaokorie Center for Infectious Disease Research Microbiology Department of the Nigerian Institute of Medical Research Yaba Nigeria Department of Medical Laboratory Sciences College of Medicine University of Lagos Lagos Nigeria

Background: Listeriosis affects immunosuppressed individual’s especially pregnant women. Maternal infections are usually mild for the woman, but may have devastating effects on the unborn child, including miscarriage, stillbirth, preterm labour and serious neonatal illness. WHO recommends that pregnant women should be educated to avoid foods with high risk of contamination. This study seeks to evaluate knowledge and practices predisposing to listeria infections during pregnancy. Methodology: This is a cross-sectional study on pregnant women, attending the antenatal clinic of Lagos University Teaching Hospital (LUTH) using semi structured questionnaires. The knowledge score of participants was collated and analyzed using SPSS version 26. Results: The mean age of the participants was 32.07 ± 5.6 years. Forty-three (30.7%) women have had previous miscarriages with the mean no of miscarriage of 1.54. Out of 147 participants, only 20 (13.6%) admitted having heard of listeriosis while 127 (86.4%) had never heard of listeriosis and none of the participants has ever been tested for listeriosis. The Overall knowledge score was poor, and this was irrespective of age and duration of pregnancy. However, women with graduate and/or postgraduate degrees were more likely to have heard of Listeriosis (X2 = 10.88, P = 0.028). Conclusion: Our study shows a low level of knowledge about this food-borne illness, which can lead to severe illnesses in pregnant women and their unborn child. It is necessarily to educate pregnant women on the risk of listeriosis. This would be a key factor in creating and implementing accurate measures of prevention and control.

关键词： Listeriosis Listeria monocytogenes Pregnant Women Fetal Death Nigeria