Nonimmune hydrops fetalis is becoming a predominant form of fetal hydrops due to the declining incidence of immune hydrops fetalis triggered by Rh isoimmunization. Infantile polycystic kidney appeared to be related to hydrops fetalis whether it is causal or merely coincidental and may represent another entry to differential diagnoses. Infantile polycystic kidney was diagnosed by an elevated maternal serum alpha-fetoprotein (AFP) value coupled with an ultrasonographic abnormality scanned as a multicystic mass with ascites in the fetal abdomen antenatally. This study presents a case of infantile polycystic kidney that resulted in a stillborn baby with hydrops fetalis and extensive placental calcification; it was the first case in Korea in which nonimmune hydrops fetalis was associated with infantile polycystic kidney in consecutive siblings by autosomal recessive inheritance in one family. In addition, this paper comprehensively reviews the incidence, etiology, prenatal diagnosis and proper management of nonimmune hydrops fetalis.
Adult ; Female ; Fetal Death/complications ; Fetal Diseases/*complications/pathology ; Human ; Hydrops Fetalis/*complications/pathology ; Pedigree ; Polycystic Kidney Diseases/*complications/pathology ; Pregnancy ; Recurrence

UNLABELLEDTo investigate the relationship between imbalance of cardiac autonomic nervous system and sudden death in fetuses of rats with intrahepatic cholestasis of pregnancy (ICP), the animal model of ICP was induced by hypodermic injection of 17-alpha-ethinylestradiol and progesterone. The electrocardiograms and frequency domain analysis of heart rate variability (HRV) including low frequency (LF), high frequency (HF) and the ratio between low and high frequencies (LF/HF) of fetal rats by the 21st day of gestation were evaluated with Chart 5 software of Powerlab biologic signal extracting and analyzing system.

RESULTS(1) The serum total bile acids (TBA) levels of pregnant rats were (78.5 +/- 4.5) micromol/L in Group ICP and (24.6 +/- 3.6) micromol/L in Group control; significant difference was noted between the two groups (P < 0.01). (2) In Group ICP, fetal rats arrhythmias appeared after (29.3 +/- 6.4) minutes' observation, and fetal rats died suddenly after (23.5 +/- 4.6) minutes' arrhythmias; However, the fetal rats in Group control all showed normal electrocardiograms over 90 minutes' continuous observation. (3) The values of LF and LF/HF of fetal rats in Group ICP within 20 minutes before fetal rats arrhythmias were significantly higher than those in Group control (LF 48.45 +/- 4.11 nu vs. 33.87 +/- 4.31 nu, and LF/HF 0.99 +/- 0.14 vs. 0.61 +/- 0.10, respectively, P < 0.01). (4) Dynamic power spectral analysis of HRV indicated that the values of LF and LF/HF of fetal rats in Group ICP increased progressively within 15 minutes before the sudden death of fetal rats. These demonstrated that autonomic imbalance in association with increased sympathetic activity has been strongly implicated in the pathophysiology of fetal arrhythmogenesis and sudden death in ICP. HRV analysis could be a useful tool for fetal surveillance, especially for ICP.

Animals ; Cholestasis, Intrahepatic ; physiopathology ; Death, Sudden ; etiology ; Electrocardiography ; Female ; Fetal Death ; etiology ; Heart Rate, Fetal ; Male ; Pregnancy ; Pregnancy Complications ; physiopathology ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo explore the factors associated with perinatal death of hepatic diseases in pregnancy (HDIP) and make feasible suggestions and measures for perinatal care of high risk patients.

METHODSThe 80 perinatal death cases of hepatic diseases in pregnancy (HDIP) during 1991-2000 in our hospital were analyzed retrospectively.

RESULTSThe perinatal mortality of HDIP in our hospital during the last 10 years was 17.99 approximately 65% was in utero death. Perinatal mortality was different between male (21.64%) and female (10.11%) (P<0.01). Compared first 5 years with last 5 years author found that the perinatal mortality of HDIP had no significant decrease (P>0.05). The perinatal mortality in city and suburbs had decreased, while in the floating population from other provinces the perinatal mortality had increased. The perinatal death was mainly caused by pregnancy induced hypertension (PIH) and asphyxia. But for the HBV carrier mothers the causes of death included umbilical cord problems, premature rupture of membrane and asphyxia.

CONCLUSIONSThe perinatal death mortality was increased by HDIP, deaths were essentially associated with pregnancy induced hypertension and asphyxia and the floating population and male gender were high risks. To enhance the management of HDIP or immigration, take effective therapies of hepatitis and improvement of resuscitation of newborns are critically important.

Adolescent ; Adult ; Cause of Death ; Female ; Fetal Death ; epidemiology ; Fetal Distress ; etiology ; mortality ; Humans ; Infant Mortality ; Infant, Newborn ; Liver Diseases ; complications ; mortality ; Male ; Pre-Eclampsia ; complications ; mortality ; Pregnancy ; Pregnancy Complications ; mortality ; Retrospective Studies ; Sex Factors

Thirty-eight pregnant inpatients with acute pancreatitis (AP) were retrospectively reviewed from 2006 to 2012 in our hospital. The incidence of pregnancy-associated AP was 2.27‰. Most (78.95%) of the attack occurred in the third trimester. The median of APACHE II score was 6 and severe AP accounted for 31.58% (12 cases). Primary diseases were absent in most cases (57.89%). The most common clinical presentations were abdominal pain (89.47%) and vomiting (68.42%). Pleural effusion and ascites were found only in the third trimester. Elevated white blood cell count, amylase and lipase were commonly found in biochemical examinations. Eleven cases required intensive care in ICU and 21 cases received caesarean section. There were 2 maternal deaths and 12 fetal losses including 4 abortions. It is concluded that AP is a rare entity in pregnancy. The incidence of pancreatitis increases with the gestational age. However, the severity is not necessarily related with the pregnancy trimesters. The diagnosis is based on clinical presentations, laboratory tests and imaging examinations. Although the treatment strategy of a pregnant woman with pancreatitis is similar to the general non-pregnant patient with AP, a multidisciplinary team consisting of gastroenterologist, gastrointestinal surgeon, radiologist, obstetrician, and ICU doctor should be set up.
Adult ; Female ; Fetal Death ; diagnosis ; Humans ; Longitudinal Studies ; Maternal Death ; Pancreatitis ; complications ; diagnosis ; therapy ; Pregnancy ; Pregnancy Complications ; diagnosis ; therapy ; Retrospective Studies ; Treatment Outcome ; Young Adult

Thrombophilia refers to inherited or acquired hemostatic disorders that result in a predisposition to blood clot formation. When combined with the hypercoagulable state that is characteristic of pregnancy, there is an increased risk of severe and recurrent pregnancy complications. Activated protein C resistance caused by factor V Leiden (FVL) mutation is known to be the most common cause of inherited thrombophilia in Caucasian population. FVL mutation has been related to pregnancy complications associated with hypercoagulation, e.g. miscarriage, intrauterine fetal demise, placental abruption, and intrauterine growth retardation. Although the FVL mutation is easily detected using molecular DNA techniques, patients who are heterozygous for this disorder often remain asymptomatic until they develop a concurrent prothrombotic condition. Because there are potentially serious effects of FVL mutation for pregnancy, and because effective treatment strategies exist, early detection and treatment of this condition might be considered.
Abortion, Spontaneous ; Abruptio Placentae ; Activated Protein C Resistance ; DNA ; Factor V ; Female ; Fetal Death ; Fetal Growth Retardation ; Hemostatic Disorders ; Humans ; Pregnancy Complications ; Pregnancy ; Pregnant Women ; Thrombophilia

Estriol excreation was studied in 216 normal and 61 pathologic pregnancies. The 95% fiducial limits of the normal excretion of estriol, within which 95% out of 100 future determinations in normal pregnancies are expected to fall, were established. The estriol curve in normal pregnancy in this study agrees well in its general shape with those presented by previous investigators who used different chemical methods of determination. The estriol values in pathologic pregnancies with preeclampsia. intrauterine fetal death and antepartum hemorrage have been analyzed. The clinical significance of estriol determinations during pregnancy was discussed.
Estriol/urine* ; Female ; Fetal Death/urine ; Human ; Pre-Eclampsia/urine ; Pregnancy* ; Pregnancy Complications/urine* ; Uterine Hemorrhage/urine

*Cesarean Section ; *Fetal Death ; *Labor Presentation ; *Pregnancy Complications, Hematologic ; *Scotland ; *Umbilical Cord ; *Vital Statistics ; *Infant, Newborn ; *Pregnancy

Objective: To investigate the clinical characteristics and maternal and fetal prognosis of pregnant women with acute fatty liver of pregnancy (AFLP). Methods: The clinical data of 86 AFLP pregnant women admitted to the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to August 2022 were collected, and their general data, clinical characteristics, laboratory tests and maternal and fetal outcomes were retrospectively analyzed. Results: (1) General information: the age of the 86 pregnant women with AFLP was (30.8±5.4) years, and the body mass index was (21.0±2.5) kg/m². There were 50 primiparas (58.1%, 50/86) and 36 multiparas (41.9%, 36/86). There were 64 singleton pregnancies (74.4%, 64/86) and 22 twin pregnancies (25.6%, 22/86). (2) Clinical characteristics: the main complaints of AFLP pregnant women were gastrointestinal symptoms, including epigastric pain (68.6%, 59/86), nausea (47.7%, 41/86), anorexia (46.5%, 40/86), vomiting (39.5%, 34/86). The main non-gastrointestinal symptoms were jaundice of skin and/or scleral (54.7%, 47/86), edema (38.4%, 33/86), fatigue (19.8%, 17/86), bleeding tendency (16.3%, 14/86), polydipsia or polyuria (14.0%, 12/86), skin itching (8.1%, 7/86), and 17.4% (15/86) AFLP pregnant women had no obvious symptoms. (3) Laboratory tests: the incidence of liver and kidney dysfunction and abnormal coagulation function in AFLP pregnant women was high, and the levels of blood ammonia, lactate dehydrogenase and lactic acid were increased, and the levels of hemoglobin, platelet and albumin decreased. However, only 24 cases (27.9%, 24/86) of AFLP pregnant women showed fatty liver by imageology examination. (4) Pregnancy outcomes: ① AFLP pregnant women had a high incidence of pregnancy complications, mainly including renal insufficiency (95.3%, 82/86), preterm birth (46.5%, 40/86), hypertensive disorders in pregnancy (30.2%, 26/86), gestational diabetes mellitus (36.0%, 31/86), fetal distress (24.4%, 21/86), pulmonary infection (23.3%, 20/86), disseminated intravascular coagulation (16.3%, 14/86), multiple organ dysfunction syndrome (16.3%, 14/86), hepatic encephalopathy (9.3%, 8/86), and intrauterine fetal death (2.3%, 2/86). ② Treatment and outcome of AFLP pregnant women: the intensive care unit transfer rate of AFLP pregnant women was 66.3% (57/86). 82 cases were improved and discharged after treatment, 2 cases were transferred to other hospitals for follow-up treatment, and 2 cases (2.3%, 2/86) died. ③ Neonatal outcomes: except for 2 cases of intrauterine death, a total of 106 neonates were delivered, including 39 cases (36.8%, 39/106) of neonatal asphyxia, 63 cases (59.4%, 63/106) of neonatal intensive care unit admission, and 3 cases (2.8%, 3/106) of neonatal death. Conclusions: AFLP is a severe obstetric complication, which is harmful to mother and fetus. In the process of clinical diagnosis and treatment, attention should be paid to the clinical manifestations and laboratory tests of pregnant women, early diagnosis and active treatment, so as to improve maternal and fetal outcomes.
Pregnancy ; Infant, Newborn ; Female ; Humans ; Adult ; Retrospective Studies ; Premature Birth/epidemiology* ; Pregnancy Complications/diagnosis* ; Fatty Liver/diagnosis* ; Fetal Death ; Stillbirth

BACKGROUND: Although HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is a serious medical complications including coagulopathy, hypertension, hepatic and renal failures, and pulmonary edema in pregnant women, the data about HELLP syndrome were rarely reported in the medical journal in Korea. METHODS: Nineteen cases of HELLP syndrome were retrospectively studied out of 16,910 pregnant women from January 1998 to March 2004 at Uijongbu St. Mary's Hospital. We analyzed incidence, clinical symptoms, laboratory findings, maternal and clinical complications and clinical course of HELLP syndrome. RESULTS: The incidence of HELLP syndrome was 0.27% (19/16,910) in total pregnant women and 4.15% (19/458) in women with preeclampsia. All patients had evidence of hemolysis and serum aspartate aminotransferase level >or= 70 IU/L, and platelet counts complications included acute renal failure (n=3), pulmonary edema (n=2), disseminated intravascular coagulopathy (n=2), postpartum bleeding (n=4). There was no maternal death. Fetal complications included placental disruption (n=2), and intrauterine growth retardation (n=5). Fetal death occurred in 2 cases. CONCLUSION: This data suggest that HELLP syndrome is not uncommon in women with preeclampsia and it represents poor maternal and fetal outcomes. Therefore, in order to decrease maternal and fetal morbidities, cooperation between internists and obstetric doctors is very important.
Acute Kidney Injury ; Aspartate Aminotransferases ; Female ; Fetal Death ; Fetal Growth Retardation ; HELLP Syndrome* ; Hemolysis ; Hemorrhage ; Humans ; Hypertension ; Incidence* ; Korea ; Liver ; Maternal Death ; Platelet Count ; Postpartum Period ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Pregnant Women* ; Pulmonary Edema ; Renal Insufficiency ; Retrospective Studies

Holoprosencephaly (HPE) and polycystic kidney disease (PKD) are genetically heterogeneous anomalies which can make up part of various syndromes or chromosomal anomalies. Due to the rapid lethality prognosis, early and precise prenatal diagnosis would be of great value. This case report describes extensive PKD involvement, already present in utero, in a patient with HPE and subdural effusion visible by MR imaging. The detailed anatomic information obtained by the MR imaging can guide the surgical planning and can aid antenatal counseling.
Adult ; Female ; Fetal Death ; Holoprosencephaly/complications/*diagnosis/embryology/pathology ; Humans ; Magnetic Resonance Imaging/*methods ; Polycystic Kidney Diseases/complications/*diagnosis/embryology/pathology ; Pregnancy ; Prenatal Diagnosis/*methods