Outcome of pregnancy in patients with organic heart disease in Taiwan.

A total of 122 pregnancies in 101 women with organic heart disease were reviewed. The incidence of organic heart disease in pregnant women was 0.25%. The ratio of rheumatic to congenital heart disease was 1.0 to 1.5. In the congenital heart disease group, IUGR was more frequent in the cyanotic group as were preterm births. Patients with cyanotic lesions had a significantly higher maternal mortality rate than those with acyanotic lesions. The cyanotic group without surgical correction had a significantly higher maternal mortality rate and more IUGR than those with correction. Congestive heart failure was the most common maternal complication, with a rate of 38.1%. The patients with good cardiac status control during pregnancy developed less IUGR, had fewer preterm births, less maternal morbidity and less maternal mortality than those in poor condition. Patients in functional classes I and II before pregnancy carried less risk of maternal morbidity than those in classes III and IV.

Meconium peritonitis-antenatal diagnosis by ultrasound.

Meconium peritonitis is usually the result of prenatal bowel obstruction with subsequent perforation, then the contents spread into the peritoneal cavity, which results in a sterile inflammatory reaction. The incidence ranges from 1/1500 to 1/2000, if without prenatal diagnosis and planned postnatal treatment, the mortality rate is as high as 62%. We describe three children, two with surgically, one with autoptically confirmed meconium peritonitis. All had abnormally prenatal ultrasonographic examinations. The first fetus showed a large 10 x 11 cm intra-abdominal mass with floating echogenic substances inside and with an echogenic rim. The second showed increased echogenicity with dilated bowel in abdominal cavity in one of the twin, and the third had an intra-abdominal cyst with several echogenic bands inside, fetal ascites was also noted. It is remarkable that the ultrasonographic findings were different in the three children. Two of the three children survived postoperation, one died 3 hours later after induction out at 31 weeks of gestational age due to multiple congenital anomalies.