A non-hemorrhagic manifestation of vasa previa: a clinicopathologic case report.

BACKGROUND: The rare entity of vasa previa occurs when fetal vessels lying between the amniotic and chorionic membranes cross the cervical os. This report presents a case that was associated with vessel compression and concomitant adverse effects on fetal hemodynamics. CASE: A 23-year-old nulliparous woman at 36 weeks' gestation developed persistent, progressive severe variable decelerations several hours after spontaneous rupture of the membranes, resulting in a decision to perform a cesarean. At delivery, fetal vessels were noted in the membranes near the cervical os, leading into a marginally inserted cord. The decelerations were attributed to compression of the unprotected umbilical arteries by the fetal head. CONCLUSION: Vasa previa often results in fetal death and may be associated with fetal hemorrhage, but lack of bleeding does not exclude the existence of vasa previa. Altered fetal hemodynamics from varying degrees of vessel compression by the presenting part during labor may result in hypoxia and acidosis. A high index of suspicion is necessary to make the diagnosis and institute proper, timely management.

Intraligamentary pregnancy.

Intraligamentary pregnancy, although rare, tests the physician's acumen in diagnostic and therapeutic skills. Two cases illustrating this entity are presented, the first involves an 18-week fetus, the second a partial hydatidiform mole. Although their presentation and pathogenesis may be indistinguishable, their clinical course and management is different. To the best of our knowledge, this is the first reported case of an intraligamentary pregnancy involving a partial hydatidiform mole.

Spontaneous resolution of an isolated unilateral fetal pleural effusion: a case report.

Isolated pleural effusion is rare and occurs when varying degrees of fluid surround the fetal lung without concomitant hydrops. This article reports a case in which spontaneous resolution of an isolated fetal pleural effusion occurred four weeks following the third trimester sonographic diagnosis, without any morbidity or mortality to the fetus or neonate. The diagnosis and possible complications associated with fetal pleural effusions are also discussed, as well as a proposal for management when confronted with this entity.

Cardiopulmonary arrest in pregnancy: the role of caesarean section in the resuscitative protocol.

A 36-year-old black multipara at 32 weeks gestation was referred with apparent peripartal cardiomyopathy. Upon arrival, she was found to be in pulmonary edema; and shortly thereafter developed cardiopulmonary arrest. She failed to respond to initial attempts at cardiopulmonary resuscitation but subsequently responded after Caesarean section and pericardiocentesis. This case exemplifies the unique aspects of performing cardiopulmonary resuscitation on a gravid female in the latter part of pregnancy and that Caesarean section should be considered an integral part of the resuscitative protocol when standard protocols fail.

Ornithine transcarbamylase deficiency in pregnancy.

Women heterozygous for mutations at the ornithine transcarbamylase (OTC) locus may be at risk for hyperammonaemia and its untoward effects including coma and death in the postpartum period. We present the case of a pregnant woman heterozygous for OTC deficiency (McKusick 311250) whose past medical history was significant for two prior pregnancies complicated by postpartum hyperammonaemic coma. In the index pregnancy, increased levels of serum ammonium were noted during labour. Postpartum hyperammonaemia was averted by administration of oral sodium benzoate. Our experience demonstrates that in women at risk, perilous hyperammonaemia can be prevented through appropriate medical management.