Vaginal bleeding patterns among rural highland Bolivian women: relationship to fecundity and fetal loss.

Among the most common reasons given for discontinued use of some contraceptive methods is a disturbance in the menstrual cycle, particularly changes in vaginal bleeding. Work to date suggests marked populational variation in menses duration, but few data have been collected from South America. This longitudinal study of non-contracepting Aymara women (n = 189 providing 837 non-truncated bleeding episodes) identified conceptions and fetal loss via urine tests for human chorionic gonadotropin and classified episodes accordingly to test the hypotheses that (a) vaginal bleeding patterns differ between lactating and non-lactating women, (b) duration of vaginal bleeding accompanying fetal loss differs from that of menstruation, (c) menses preceding a conception are longer than those not followed by a conception. Compared to published values, mean menses duration (3.5 days) in these women was relatively short. Menses duration was not significantly correlated with current age, age at menarche or first birth, parity, time postpartum, or menstrual segment length. Mean menses duration (not preceding a conception) was comparable for lactating and non-lactating women. Mean duration of fetal loss bleeding did not differ from that of menses. Pre-conception episodes were significantly longer than those not followed by conception. Thus, because the rate of conceptions was twice as great among lactating than non-lactating women, the mean duration of all menses (irrespective of conception) was significantly longer in lactating women. Bolivian, and perhaps other South American, women may be particularly disinclined to accept contraceptives (e.g., intrauterine devices) that modify an otherwise relatively brief menses duration. Therefore, a wide variety of contraceptive choices accompanied by population-specific informed counseling is essential. In addition, these findings suggest that studies of fecundability limited to non-lactating women may be biased toward those of relatively lower fecundity and that menses duration may be predictive of risk for some cancers.

First presentation of polymyositis postpartum following intrauterine fetal death.

We present a case of polymyositis (PM) following intrauterine fetal death. The first presentation of PM in the patient was during postpartum. The patient was referred to our hospital because of a fever of unknown cause 13 d after delivery of dead fetus at 32 weeks' gestation. PM was diagnosed based on the increased serum creatine phosphokinase level, typical electromyogram findings and characteristic muscle biopsy findings.

Parental origin and phenotype of triploidy in spontaneous abortions: predominance of diandry and association with the partial hydatidiform mole.

The origin of human triploidy is controversial. Early cytogenetic studies found the majority of cases to be paternal in origin; however, recent molecular analyses have challenged these findings, suggesting that digynic triploidy is the most common source of triploidy. To resolve this dispute, we examined 91 cases of human triploid spontaneous abortions to (1) determine the mechanism of origin of the additional haploid set, and (2) assess the effect of origin on the phenotype of the conceptus. Our results indicate that the majority of cases were diandric in origin because of dispermy, whereas the maternally-derived cases mainly originated through errors in meiosis II. Furthermore, our results indicate a complex relationship between phenotype and parental origin: paternally-derived cases predominate among "typical" spontaneous abortions, whereas maternally-derived cases are associated with either early embryonic demise or with relatively late demise involving a well-formed fetus. As the cytogenetic studies relied on analyses of the former type of material and the molecular studies on the latter sources, the discrepancies between the data sets are explained by differences in ascertainment. In studies correlating the origin of the extra haploid set with histological phenotype, we observed an association between paternal-but not maternal-triploidy and the development of partial hydatidiform moles. However, only a proportion of paternally derived cases developed a partial molar phenotype, indicating that the mere presence of two paternal genomes is not sufficient for molar development.

Aplasia cutis congenita in an infant of an initial triplet gestation: a case report.

Aplasia cutis congenita (ACC) is the clinical manifestation of an uncommon group of skin disorders. One postulated etiology is disseminated intravascular coagulation from release of thrombogenic maternal arising from placental injury or fetal demise. This leads to disruption of the ectodermal blood supply responsible for the skin defects. We present a neonate with group V ACC, one of an initial triplet gestation, associated with fetal demise at 14 weeks and formation of a fetus papyraceus. The practice of selective fetal reduction as a result of multiple gestation seen with the use of fertility drugs may in theory increase the incidence of group V ACC.

Síndrome dos anticorpos antifosfolipídeos e perda gestacional recorrente / Antiphospholipid antibody syndrome and recurrent fetal loss

Os anticorpos antifosfolipídeos estäo associados a fenômenos trombóticos (venosos e arteriais). Em mulheres a presença desses anticorpos tem sido associada a abortamentos espontâneos do primeiro trimestre assim como mortes fetais no segundo ou início do terceiro trimestre da gestaçäo. Seu diagnóstico é realizado através de sinais clínicos (tais como trombose recorrente ou perda gestacional) e pela presença de anticorpos antifosfolipídeos (anticorpos anticardiolipina ou anticoagulante lúpico). Diversos tratamentos têm sido propostos para as mulheres portadoras dessa síndrome durante a gestaçäo incluindo baixas doses de aspirina, predinisona, heparina e gama globulina com uma diminuiçäo na taxa de perdas gestacionais nessas pacientes.

Encefalomalacia multiquística asociada a muerte fetal de un gemelo / Fetal death of one twin associated with multicystic encephalomalacia in surviving twin

Introducción. La asociación entre daño cerebral en el gemelo sobreviviente de un embarazo donde sucede una muerte fetal fue descrita desde los años treintas; en la década de los sesentas se estableció la relación con cavitación extensa de la substancia blanca y el síndrome de transfusión fetal intrauterina. Casos clínicos. Se presentan 2 casos de leucomalacia multiquística en gemelos sobrevivientes de embarazos complicados con una muerte intrauterina en el tercer trimestre, que fueron detectatos en forma tardía al desarrollar crisis convulsivas y retardo global del desarrollo en el primer año de vida. Se muestran los hallazgos de tomografía axial computada. Conclusión. Se pone de manifiesto la importancia de una vigilancia estrecha de la vitalidad fetal en embarazos gemelares y la búsqueda intencionada de esta entidad en niños sobrevivientes de embarazos con historia de muerte intrauterina de un gemelo

The prevalence of non-viable pregnancy at 10-13 weeks of gestation.

In an ultrasound screening study at 10-13 weeks of gestation involving 17,870 women, the prevalence of early pregnancy failure was 2.8% (501 cases), including 313 (62.5%) missed abortions and 188 (37.5%) anembryonic pregnancies. Lower gestation and higher maternal age were associated with a higher prevalence (chi 2 = 143.5; p < 0.001 and chi 2 = 53.3; p < 0.0001, respectively). The prevalence was higher in women with a history of vaginal bleeding (chi 2 = 141.5; p < 0.0001), but there was no significant association with previous pregnancy losses (chi 2 = 2.8), parity (chi 2 = 0.6) or cigarette smoking (chi 2 = 0.0). Recent evidence suggests that the most effective method of screening for chromosomal abnormalities is measurement of fetal nuchal translucency thickness at 10-13 weeks, and therefore ultrasound examination at this gestation is likely to become universally available. As shown in this study, an additional advantage of such a scan is the diagnosis of early pregnancy failure, which will be found in about 3% of patients examined. Elective evacuation of retained products of conception is likely to be more cost effective and potentially safer than emergency surgery in a patient presenting during miscarriage.

Premature centromere division: a possible manifestation of chromosome instability.

Retrospective analysis of "routine" chromosome preparations from 2 patients with Fanconi anemia and 2 others with ataxia-teleangiectasia showed increased chromosome breakage and a tendency to premature centromere division (PCD) with special reference to early separation of the large acrocentric (13-15) chromosomes. The findings suggest that PCD may be a manifestation of chromosome instability related to potential malignancy.

Overwhelming maternal sepsis due to a gas-forming Escherichia coli chorioamnionitis.

We report a case of a patient who developed fulminant sepsis and respiratory distress caused by a gas-forming Escherichia coli intrauterine infection following premature rupture of the membranes and fetal death. Such gas-forming infections are rare, and, when they occur, they are usually caused by Clostridium welchii. This patient was treated with antibiotics, ventilator support, and hysterectomy, and at follow-up was in good health.

Smoking and reproductive health: cigarette smoking as a risk factor in ectopic pregnancy.

To evaluate the association between ectopic pregnancy (EP) and smoking, a hospital based case-control study was undertaken. Also studied were other potential risk factors namely: PID, undernutrition, blood group 'O', the use of IUD, prior abnormal pregnancies and prior abdominal surgery. The investigation included 72 cases diagnosed at the University of Health Sciences, Kansas City, Missouri from January 1, 1976 through December 31, 1987 and 72 pair-matched controls selected from live-birth deliveries at the same hospital. Univariable McNemar analyses revealed four strong risk factors: having ever smoked (OR = 2.1, p = 0.04), previous EP (OR = 14.3, p = 0.0001), previous fetal loss (OR = 4, p = 0.04) and previous pelvic and abdominal surgery (OR = 6.3 p = 0.0001). A stepwise logistic regression analysis using parity, eversmoking, underweight and PID was performed. Only PID remained strongly associated with EP after the first step (p = 0.009).

Multicystic encephalomalacia in a surviving monochorionic twin.

From a recent monochorionic diamniotic twin pregnancy seen at this hospital, one of the twins died in utero at 37 weeks' gestation. The other twin, a male infant, was delivered by Cesarean section because of fetal distress, with resuscitation performed in the delivery room. The infant developed generalized tonic seizure shortly after stabilization, and was put on anticonvulsants. The initial brain echography was normal; follow-up echograms and CT scans performed at 8 and 12 days old, respectively, revealed diffuse low density over both side of cerebral hemisphere. At one month old, the infants's brain echogram showed diffuse cystic encephalomalacia. At four months, he was noted to be spastic and significantly delayed in neurodevelopment. Disseminated intravascular coagulation caused by fetal-to-fetal transfer of thromboplastic material from the dead fetus was considered as the most possible cause of the neurological complication in this patient. In addition, perinatal hypoxic-ischemic insult may also have been a superimposed, influencing factor.

Neonatal and infantile pulmonary hemorrhage: an autopsy study with clinical correlation.

We studied the clinicopathologic features of pulmonary hemorrhage in autopsied infants less than 1 year of age for a 12-month period. There were 70 liveborns (LB) and 24 stillborns (SB). The percentage of LB with pulmonary hemorrhage (PH), pulmonary interstitial emphysema (PIE), hyaline membrane disease (HMD), acute bronchopneumonia (ABP), congenital malformations (CM), and surgery (SUR) were analyzed according to weeks of estimated gestational age (EGA) and as an entire group. Overall, 74% of LB and 24% of SB had histologic evidence of PH. A semiquantitative evaluation of the extent of PH among the LB infants disclosed that hemorrhage involved less than one-third of the observed lung tissue in 42%, one-third to two-thirds of the lung was hemorrhagic in 15%, and the remaining 42% had more than two-thirds hemorrhagic lung parenchyma. A total of 31 clinical and pathologic factors were evaluated for their possible association or relationship to PH. Statistical analysis revealed that hyaline membranes and hemorrhage in other extrapulmonary sites were the only significant associations with PH. PH was more frequent in premature infants born between 24 and 39 weeks EGA and was always associated with multiple other conditions. Although the autopsy finding of hemorrhage in the lungs is relatively frequent in the population we studied, it appears that PH as a primary phenomenon in infants is extremely rare, if it occurs at all.