DOCSLIB.ORG

Perinatal/Neonatal Case Presentation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Perinatal/Neonatal Case Presentation Perinatal/Neonatal ..............Case Presentation Vernixuria: Another Sign of Uterine Rupture John Patrick O’Grady, MD CASE Michel Prefontaine, MD A 29-year-old G3 P2 was admitted at 37 weeks of gestation after Despina E. Hoffman, BA membrane rupture. She reported two prior cesarean deliveries. The initial surgery was performed for failure to progress. An elective repeat operation had been performed 4 years later. As documented by record review, both cesareans were uncomplicated, low, and Uterine rupture complicates approximately 1% of trials of labor after transverse operations. At the time of admission, fetal weight was cesarean. Classic signs and symptoms include loss of station, cessation of estimated at 3000 g. The clinical pelvimetry was normal. Following labor, vaginal bleeding, fetal distress, and abdominal pain. Other signs are counseling, a trial of vaginal delivery was planned. also possible. We report a case of uterine rupture at VBAC trial that includes The onset of labor was spontaneous. The rate of dilatation was an unusual clinical sign of uterine rupture: vernix caseosa observed in the normal, but descent of the presenting part proved tardy. Parenteral urine of the parturient. During labor, a bladder catheter was inserted to narcotics were the only labor analgesia. At 9 h after admission, a evaluate oliguria. Vernix caseosa and blood were found in the tubing. catheter was inserted into the parturient’s bladder to evaluate Prompt cesarean delivery followed. A tear extending from the original progressive oliguria. At that time, she did not complain of transverse scar into the bladder dome was found. Vernixuria is an additional discomforts that could be differentiated from those of normal labor. sign of uterine rupture. Concurrently, the fetal heart rate and the uterine contraction Journal of Perinatology (2003) 23, 351–352. doi:10.1038/sj.jp.7210897 pattern as recorded by external electronic monitoring devices were interpreted as normal. Combined abdominal – pelvic examination noted full cervical dilatation with a singleton, cephalic presenting fetus in a slightly deflexed OP presentation at À1 station. Vernix INTRODUCTION caseosa and frank blood were observed in the clear portion of the bladder catheter collection tubing. Prompt cesarean delivery under Potentially serious maternal or fetal complications occasionally general anesthesia followed. follow trials of labor after cesarean delivery (VBAC).1–4 Uterine At laparotomy, the fetus was noted to be partially extruded from rupture, the most serious complication, occurs in approximately the uterus. The vesicouterine space was obliterated by scarring. 0.5 to 0.8% of labor trials involving parturients with a prior low A tear extended from the original transverse myometrial scar into transverse cesarean scar. In 15 to 20% of rupture cases, potentially the dome of the bladder. The placenta remained implanted in the serious maternal or fetal morbidity occurs. Extension into major uterine fundus. A normal 2622 g fetus with Apgar scores of 7-8-9 at maternal vessels, the bladder, or severe myometrial tears may 1, 5, and 10 minutes, respectively, was delivered. The child necessitate blood transfusion, extensive reparative surgery, or even subsequently did well. hysterectomy. Severe asphyxial injury or death is rare, but remain The bladder and uterus were uneventfully repaired in layers. potential maternal/fetal risks. Herein, we report a case of uterine The patient was treated with antibiotics and 7 days of catheter rupture at VBAC trial that includes an unusual clinical sign of drainage. Transfusion was not required. No other complications uterine rupture: vernix caseosa observed in the urine of the ensued. parturient. COMMENT Uterine rupture is associated with prior uterine scars, abruptio Department Of Obstetrics & Gynecology, Baystate Medical Center, Springfield, MA, USA. placentae, Mu¨llerian abnormalities, multiparity, cocaine use, During a VBAC trial, vernix caseosa and blood were observed in Foley catheter drainage. At laparotomy, a uterine rupture extended into the bladder. multiple gestation, invasive trophoblastic disease, the administration of uterotonics, and, uncommonly, obstetrical Address correspondence and reprint requests to John Patrick O’Grady, MD, Department Of Obstetrics & Gynecology, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, manipulations such as version and extraction, forceps operations, 4–7 USA. or, rarely, external trauma. A focus of concern and controversy Journal of Perinatology 2003; 23:351–352 r 2003 Nature Publishing Group All rights reserved. 0743-8346/03 $25 www.nature.com/jp 351 O’Grady et al. Vernixuria: Another Sign of Uterine Rupture in recent years has been the risk of rupture in pregnancies chosen large fragments of vernix is a clinical sign of normal, advanced for VBAC trials.1–5 gestation. In our case, the appearance of easily identified vernix There are various signs and symptoms associated with uterine particles accompanied by gross hematuria in the tubing of the rupture. Classically, these include loss of station of the presenting bladder catheter were the principal clinical signs of uterine rupture. part, an altered uterine contour, cessation of labor, uterine These observations with the concomitant finding of a high, hypertonus, vaginal bleeding, fetal distress, and abdominal pain. malpositioned presenting part led to the prompt laparotomy. However, when the medical records from actual rupture cases are Fortunately, primary uterine repair was possible despite extension reviewed, these classic signs are quite variable in occurrence.5 of the tear into the maternal bladder. Fetal morbidity proved Infrequently, as in our case, minimal maternal or fetal signs and inconsequential. symptoms may be present despite a serious rupture.3 Even Trials of labor on a previous uterine scar continue to involve a intrauterine pressure recordings may appear normal despite small, but real, risk of serious maternal morbidity.3 The rupture. In some instances, an abnormal fetal heart electronic observation of vernix caseosa in a urine specimen obtained at tracing may be the only clinical sign of injury. catheterization can now be added to the previously described signs The severity of fetal and maternal morbidity from a uterine of uterine rupture. rupture varies from inconsequential to fatal injury. Important factors include the extent of the myometrial injury and associated hemorrhage, the degree of placental separation, and any extension of the tear into adjacent structures. Once the diagnosis is strongly References suspected, prompt laparotomy is mandatory. At surgical 1. Rageth JC, Juzi C, Grossenbacher H. Delivery after previous cesarean: A risk exploration, the infant is delivered and primary uterine repair is evaluation. Obstet Gynecol 1999;93:332–7. performed unless hemorrhage or severe injury force hysterectomy. 2. Flamm BL, Goings JR, Liu Y, Wolde-Tsadik G. Elective repeat cesarean Vernix caseosa is a waxy white-to-tan-colored substance that delivery versus trial of labor: A prospective multicenter study. Obstet Gynecol progressively coats the fetal skin in the third trimester. 1994;83:927–32. Histologically, vernix contains large numbers of fetal skin cells 3. Yap SOW, Kim ES, Laros RK. Maternal and neonatal outcomes after uterine embedded in a lipid matrix. Biochemically, the matrix contains rupture in labor. Am J Obstet Gynecol 2001;184:1576–81. sterol esters, free steroids, cholesterol, triglycerides, and waxes, 4. Zelop CM, Shipp TD, Repke JT, Cohen A, Caughey AB, Lieberman E. Uterine largely of sebaceous cell origin. The vernix coating of fetal skin rupture during induced and augmented labor in gravid women with one functions as a highly effective water barrier. Physiologically, this is prior cesarean delivery. Am J Obstet Gynecol 1999;181:882–6. believed to protect the developing epidermal cells from the potential 5. Phelan JP. Uterine rupture. Clin Obstet Gynecol 1990;33:432–7. adverse effects of prolonged exposure to amniotic fluid, while 6. Plauche WC, Von Almen W, Muller R. Catastrophic uterine rupture. Obstet Gynecol 1984;64:792–7. promoting normal skin cornification. With advancing gestation, 7. Hibbard JU, Ismail MA, Wang Y, Te C, Karrison T, Ismail MA. Failed vaginal minute fragments of vernix pass into the amniotic fluid resulting birth after a cesarean section: How risky is it? I. Maternal morbidity. Am J in its characteristic turbidity. This process of vernix passage into Obstet Gynecol 2001;184:1365–73. amniotic fluid is aided by surfactants from the fetal lung that 8. Narendran V, Wickett RR, Pickens WL, Hoath SB. Interaction between 8 progressively appear in the amniotic fluid. The presence of marked pulmonary surfactant and vernix: a potential mechanism for induction of turbidity in an amniotic fluid sample with the visualization of amniotic fluid turbidity. Pediatr Res 2000;48:120–4. 352 Journal of Perinatology 2003; 23:351–352.
Load more

Recommended publications
  • Association Between First Caesarean Delivery and Adverse Outcomes In
    Hu et al. BMC Pregnancy and Childbirth (2018) 18:273 https://doi.org/10.1186/s12884-018-1895-x RESEARCHARTICLE Open Access Association between first caesarean delivery and adverse outcomes in subsequent pregnancy: a retrospective cohort study Hong-Tao Hu1†, Jing-Jing Xu1†, Jing Lin1, Cheng Li1, Yan-Ting Wu2, Jian-Zhong Sheng3, Xin-Mei Liu4,5* and He-Feng Huang2,4,5* Abstract Background: Few studies have explored the association between a previous caesarean section (CS) and adverse perinatal outcomes in a subsequent pregnancy, especially in women who underwent a non-indicated CS in their first delivery. We designed this study to compare the perinatal outcomes of a subsequent pregnancy in women who underwent spontaneous vaginal delivery (SVD) or CS in their first delivery. Methods: This retrospective cohort study included women who underwent singleton deliveries at the International Peace Maternity and Child Health Hospital from January 2013 to December 2016. Data on the perinatal outcomes of all the women were extracted from the medical records. Multivariate logistic regression was conducted to assessed the association between CS in the first delivery and adverse perinatal outcomes in the subsequent pregnancy. Results: CS delivery in the subsequent pregnancy was more likely for women who underwent CS in their first birth than for women with previous SVD (97.3% versus 13.2%). CS in the first birth was also associated with a significantly increased risk of adverse outcomes in the subsequent pregnancy, especially in women who underwent a non- indicated CS. Adverse perinatal outcomes included pregnancy-induced hypertension [adjusted odds ratio (OR), 95% confidence interval (CI): 2.20, 1.59–3.05], gestational diabetes mellitus (1.82, 1.57–2.11), gestational anaemia (1.27, 1.
    [Show full text]
  • Managing the Risk of Uterine Rupture During a Trial of Labor After Cesarean Section
    Managing the Risk of Uterine Rupture During a Trial of Labor After Cesarean Section By NORCAL Mutual Insurance Company Introduction While a successful vaginal birth after cesarean section (VBAC) is associated with less morbidity and mortality than repeat cesarean section (C-section), an unsuccessful VBAC is associated with a small but significant risk of uterine rupture that can result in death or serious injury to both the mother and the infant.1 When a trial of labor after C-section (TOLAC) ends in uterine rupture, emergency C-section, and the delivery of an infant with brain injuries, there is a good chance that the child’s This article originally appeared in the parents will file a lawsuit, or at least September 2011 issue of Claims Rx. It consider it. It should be noted that has been edited by Drs. Mark Zakowski, a plaintiff’s attorney is supposed to Patricia Dailey and Stephen Jackson prove duty (responsibility of the to meet the educational needs of physicians involved), negligence anesthesiologists, and is reprinted, as (care provided was below the changed, with permission. ©Copyright standard of care) and causation 2011, NORCAL Mutual Insurance Co. (negligence led to the injury) All Rights Reserved. Reproduction as well as injury. However, the permissible with written permission plaintiffs probably won’t focus on and credit. whether the standard of care was met, and their attorney might not either. In these types of cases, the degree of the infant’s brain injuries tends to over- shadow other liability issues. This can carry through to trial because juries are generally biased toward severely brain-injured infants and the parents who must provide for them.
    [Show full text]
  • Managing Complications in Pregnancy and Childbirth Fetal
    IMPAC FEtal distress in labour WHO Home | Reproductive Health Home | HRP | What's new | Resources | Contact | Search Department of Reproductive Health and Research (RHR), World Health Organization z Abbreviations Managing Complications in Pregnancy and Childbirth z Index A guide for midwives and doctors z List of diagnoses z MCPC Home Section 2 - Symptoms Clinical principles Rapid initial assessment Fetal distress in labour Talking with women and their families Emotional and psychological support PROBLEMS Emergencies z Abnormal fetal heart rate (less than 100 or more than 180 beats per minute). General care principles Clinical use of blood, blood products and z Thick meconium-stained amniotic fluid. replacement fluids Antibiotic therapy Anaesthesia and analgesia GENERAL MANAGEMENT Operative care principles z Prop up the woman or place her on her left side. Normal Labour and childbirth Newborn care principles z Stop oxytocin if it is being administered. Provider and community linkages ABNORMAL FETAL HEART RATE Symptoms BOX S-7 Abnormal fetal heart rate Shock Vaginal bleeding in early pregnancy z A normal fetal heart rate may slow during a contraction but usually recovers to normal as Vaginal bleeding in later pregnancy and soon as the uterus relaxes. labour z A very slow fetal heart rate in the absence of contractions or persisting after contractions is Vaginal bleeding after childbirth suggestive of fetal distress. Headache, blurred vision, convulsions or loss of consciousness, elevated blood z A rapid fetal heart rate may be a response to maternal fever, drugs causing rapid maternal pressure heart rate (e.g. tocolytic drugs), hypertension or amnionitis. In the absence of a rapid maternal Unsatisfactory progress of Labour heart rate, a rapid fetal heart rate should be considered a sign of fetal distress.
    [Show full text]
  • Gtg-No-20B-Breech-Presentation.Pdf
    Guideline No. 20b December 2006 THE MANAGEMENT OF BREECH PRESENTATION This is the third edition of the guideline originally published in 1999 and revised in 2001 under the same title. 1. Purpose and scope The aim of this guideline is to provide up-to-date information on methods of delivery for women with breech presentation. The scope is confined to decision making regarding the route of delivery and choice of various techniques used during delivery. It does not include antenatal or postnatal care. External cephalic version is the topic of a separate RCOG Green-top Guideline No. 20a: ECV and Reducing the Incidence of Breech Presentation. 2. Background The incidence of breech presentation decreases from about 20% at 28 weeks of gestation to 3–4% at term, as most babies turn spontaneously to the cephalic presentation. This appears to be an active process whereby a normally formed and active baby adopts the position of ‘best fit’ in a normal intrauterine space. Persistent breech presentation may be associated with abnormalities of the baby, the amniotic fluid volume, the placental localisation or the uterus. It may be due to an otherwise insignificant factor such as cornual placental position or it may apparently be due to chance. There is higher perinatal mortality and morbidity with breech than cephalic presentation, due principally to prematurity, congenital malformations and birth asphyxia or trauma.1,2 Caesarean section for breech presentation has been suggested as a way of reducing the associated perinatal problems2,3 and in many countries in Northern Europe and North America caesarean section has become the normal mode of breech delivery.
    [Show full text]
  • Skin Eruptions Specific to Pregnancy: an Overview
    DOI: 10.1111/tog.12051 Review The Obstetrician & Gynaecologist http://onlinetog.org Skin eruptions specific to pregnancy: an overview a, b Ajaya Maharajan MBBS DGO MRCOG, * Christina Aye BMBCh MA Hons MRCOG, c d Ravi Ratnavel DM(Oxon) FRCP(UK), Ekaterina Burova FRCP CMSc (equ. PhD) aConsultant in Obstetrics and Gynaecology, Luton and Dunstable University Hospital, Lewsey Road, Luton, Bedfordshire LU4 0DZ, UK bST5 in Obstetrics and Gynaecology, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK cConsultant Dermatologist, Buckinghamshire Health Care, Mandeville Road, Aylesbury, Buckinghamshire HP21 8AL, UK dConsultant Dermatologist, Skin Cancer Lead for Bedford Hospital, Bedford Hospital NHS Trust, South Wing, Kempston Road, Bedford MK42 9DJ, UK *Correspondence: Ajaya Maharajan. Email: [email protected] Accepted on 31 January 2013 Key content Learning objectives Pregnancy results in various physiological skin changes. To understand the physiological skin changes in pregnancy. As a consequence, some common dermatoses can present more To identify the skin conditions that require appropriate referral. frequently in pregnant women. In addition, there are a number To be able to take a history, to diagnose the skin eruptions unique to of skin eruptions unique to pregnancy. pregnancy, undertake appropriate investigations and first-line The aetiology of physiological skin changes in pregnancy is management, and understand the criteria for referral to a uncertain but is thought to be due to hormonal and physical dermatologist. changes of pregnancy. Keywords: atopic eruption of pregnancy / intrahepatic cholestasis The four dermatoses of pregnancy are: atopic eruption of pregnancy / pemphigoid gestastionis / polymorphic eruption of of pregnancy, pemphigoid gestationis, polymorphic pregnancy / skin eruptions eruption of pregnancy and intrahepatic cholestasis of pregnancy.
    [Show full text]
  • Cord Prolapse
    CLINICAL PRACTICE GUIDELINE CORD PROLAPSE CLINICAL PRACTICE GUIDELINE CORD PROLAPSE Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and the Clinical Strategy and Programmes Division, Health Service Executive Version: 1.0 Publication date: March 2015 Guideline No: 35 Revision date: March 2017 1 CLINICAL PRACTICE GUIDELINE CORD PROLAPSE Table of Contents 1. Revision History ................................................................................ 3 2. Key Recommendations ....................................................................... 3 3. Purpose and Scope ............................................................................ 3 4. Background and Introduction .............................................................. 4 5. Methodology ..................................................................................... 4 6. Clinical Guidelines on Cord Prolapse…… ................................................ 5 7. Hospital Equipment and Facilities ....................................................... 11 8. References ...................................................................................... 11 9. Implementation Strategy .................................................................. 14 10. Qualifying Statement ....................................................................... 14 11. Appendices ..................................................................................... 15 2 CLINICAL PRACTICE GUIDELINE CORD PROLAPSE 1. Revision History Version No.
    [Show full text]
  • Maternal and Fetal Outcomes of Spontaneous Preterm Premature Rupture of Membranes
    ORIGINAL CONTRIBUTION Maternal and Fetal Outcomes of Spontaneous Preterm Premature Rupture of Membranes Lee C. Yang, DO; Donald R. Taylor, DO; Howard H. Kaufman, DO; Roderick Hume, MD; Byron Calhoun, MD The authors retrospectively evaluated maternal and fetal reterm premature rupture of membranes (PROM) at outcomes of 73 consecutive singleton pregnancies com- P16 through 26 weeks of gestation complicates approxi- plicated by preterm premature rupture of amniotic mem- mately 1% of pregnancies in the United States and is associ- branes. When preterm labor occurred and fetuses were at ated with significant risk of neonatal morbidity and mor- tality.1,2 a viable gestational age, pregnant patients were managed Perinatal mortality is high if PROM occurs when fetuses aggressively with tocolytic therapy, antenatal corticos- are of previable gestational age. Moretti and Sibai 3 reported teroid injections, and antenatal fetal testing. The mean an overall survival rate of 50% to 70% after delivery at 24 to gestational age at the onset of membrane rupture and 26 weeks of gestation. delivery was 22.1 weeks and 23.8 weeks, respectively. The Although neonatal morbidity remains significant, latency from membrane rupture to delivery ranged despite improvements in neonatal care for extremely pre- from 0 to 83 days with a mean of 8.6 days. Among the mature newborns, neonatal survival has improved over 73 pregnant patients, there were 22 (30.1%) stillbirths and recent years. Fortunato et al2 reported a prolonged latent phase, low infectious morbidity, and good neonatal out- 13 (17.8%) neonatal deaths, resulting in a perinatal death comes when physicians manage these cases aggressively rate of 47.9%.
    [Show full text]
  • Fetal Distress Condition Twin-To-Twin Transfusion Syndrome (TTTS)
    Fetal Distress Condition Twin-to-Twin Transfusion Syndrome (TTTS) Twice as many babies Description die from TTTS and TTTS or Twin-to-Twin Transfusion Syndrome is a disease of the placenta. It affects other fetal syndromes pregnancies with monochorionic (shared placenta) multiples when blood passes than from SIDS disproportionately from one baby to the other through connecting blood vessels within (Sudden Infant Death their shared placenta. One baby, the recipient twin, gets too much blood overloading his or Syndrome) each year; her cardiovascular system, and may die from heart failure. The other baby, the donor twin yet more people are or stuck twin, does not get enough blood and may die from severe anemia. Left untreated, mortality rates near 100%. aware of SIDS. The cause of TTTS is attributed to unbalanced flow of blood through vascular channels that connect the circulatory systems of each twin via the common placenta. The shunting of blood through the vascular communications leads to a net flow of blood from one twin (the donor) to the other twin (the recipient). The donor twin develops oligohydramnios (low amniotic fluid) and poor fetal growth, while the recipient twin develops polyhydramnios (excess amniotic fluid), heart failure, and hydrops. If left untreated, the pregnancy may be lost due to lack of blood getting to the smaller twin, fluid overload and heart failure in the larger twin, and/or preterm (early) labor leading to miscarriage of the entire pregnancy. Some general treatment approaches consist of using laser energy to seal off the blood vessels that shunt blood between the fetuses.
    [Show full text]
  • Term Pregnancy with Umbilical Cord Prolapse
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Available online at www.sciencedirect.com Taiwanese Journal of Obstetrics & Gynecology 51 (2012) 375e380 www.tjog-online.com Original Article Term pregnancy with umbilical cord prolapse Jian-Pei Huang a,b,*, Chie-Pein Chen a,c, Chih-Ping Chen a,d, Kuo-Gon Wang a,c, Kung-Liahng Wang a,b,d a Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan b Mackay Medicine, Nursing and Management College, Taipei, Taiwan c Division of High Risk Pregnancy, Mackay Memorial Hospital, Taipei, Taiwan d Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan Accepted 10 March 2011 Abstract Objective: To investigate the incidence, management, and perinatal and long-term outcomes of term pregnancies with umbilical cord prolapse (UCP) at Mackay Memorial Hospital, Taipei, from 1998 to 2007. Materials and Methods: For this retrospective study, we reviewed the charts, searched a computerized birth database, and contacted the families by telephone to acquire additional follow-up information. Results: A total of 40 cases of UCP were identified among 40,827 term deliveries, an incidence of 0.1%. Twenty-six cases (65%) were delivered by emergency cesarean section (CS). Of the neonates, 18 had an Apgar score of <7 at 1 minute, 10 of these scores being sustained at 5 minutes after birth, and three infants finally died. Eleven UCPs occurred at the vaginal delivery of a second twin, and nine with malpresentation. All of the infants who had good perinatal outcomes also had good long-term outcomes.
    [Show full text]
  • Outcome of Infants Born with Nuchal Cords MAJ William F
    Outcome of Infants Born with Nuchal Cords MAJ William F. Miser, MC, USA Fort Sill, Oklahoma Background. The effect o f a nuchal cord on the out­ as often in the nuchal cord group (18.6% as compared come of delivery is controversial. The purposes of this with 9.6%, P < .01). Despite this finding, there was studv were to investigate the frequency o f nuchal cords no significant difference in the number of operative de­ and determine the effect that nuchal cords have on the liveries or in Apgar scores at 1 and 5 minutes between neonate. the two groups. There were no perinatal deaths associ­ Methods. In a retrospective, case-control study, 706 ated with nuchal cords. Infants born with nuchal cords consecutive infant deliveries in a community hospital weighed less than those in the control group (3345 g were evaluated. Sixteen deliveries that were compli­ compared with 3468 g, P < .01). There were also cated by the umbilical cord entangled around an ex­ significantly fewer largc-for-gestational-age and mac- tremity or by a prolapsed cord were excluded from fur­ rosomic infants born in the nuchal cord group. Com­ ther analysis. The study group consisted of the 167 plications such as jaundice, hypoglycemia, sepsis, and deliveries (23.7%) complicated by a nuchal cord. The respiratory problems were not increased in the postna­ remaining 523 deliveries were used as the control tal period because o f a nuchal cord. group. Conclusions. This study suggests that nuchal cords are Results. There were no significant differences found in common and are rarely associated with significant mor­ maternal age, race, parity, prepregnancy weight, or bidity or mortality in neonates.
    [Show full text]
  • Vernix-Monoacylglycerol Reduces LPS-Induced Inflammatory Markers in Human Enterocytes in Vitro
    Articles | Basic Science Investigation BCFA-enriched vernix-monoacylglycerol reduces LPS-induced inflammatory markers in human enterocytes in vitro Yuanyuan Yan1, Zhen Wang2, Donghao Wang2, Peter Lawrence2, Xingguo Wang1, Kumar S.D. Kothapalli3, Jacelyn Greenwald2, Ruijie Liu1, Hui Gyu Park3 and J. Thomas Brenna3 BACKGROUND: Excess vernix caseosa produced by the fetal The high concentration of BCFA led us to propose that skin appears as particles suspended in the amniotic fluid in vernix is important for development of the gastrointestinal late gestation, is swallowed by the fetus, and is found tract (6). The anti-inflammatory effects of some fatty acids are throughout the newborn gastrointestinal tract as the first well known from studies dating to the 1970s on cardiovas- organisms are arriving to colonize the gut. Lipid-rich vernix cular disease and many other conditions. The long-chain contains an unusually high 29% branched chain fatty acids polyunsaturated fatty acids (LCPUFA), docosahexaenoic acid (BCFA). BCFAs reduce the incidence of necrotizing enteroco- (DHA, 22:6(n-3)), and eicosapentaenoic acid (EPA, 20:5(n- litis in an animal model, and were recently found predomi- 3)), are best studied for the anti-inflammatory and proresol- nantly in the sn-2 position of human milk triacylglycerols. ving properties of their eicosanoid and docosanoid products Nothing is known about the influence of vernix BCFA on (7–9). Fatty acids in their monoacylglyceride (MAG) form are proinflammatory markers in human enterocytes. incorporated into mixed micelles for normal fat absorption. METHODS: We investigated the effect of vernix- MAGs are a GRAS (generally recognized as safe) ingredient monoacylglycerides (MAGs) (enriched with 30% BCFA) on for food applications.
    [Show full text]
  • Meconium Aspiration: Case Report Marinković N* and Aleksić I Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade
    Clinical Case Reports and Reviews Case Report ISSN: 2059-0393 Meconium aspiration: Case report Marinković N* and Aleksić I Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade Abstract Introduction: Aspiration of amniotic fluid has clinical significance as a cause of disease and mortality of new-borns, but also has a forensic significance due to numerous steps that need to be determined in the establishing of medical malpractice. Case Report: Female new-born, born in the 40th week of pregnancy by emergency C-section with green amniotic fluid. Immediately upon the C-section, without heart function, with limpness, cyanotic, without tone and reflex. Heavily aspirated with green liquid content in the apparatus, cardiopulmonary reanimation started immediately, achieved heart rhythm with bradycardia. On the X-ray image, lungs bilaterally have small grainy confluating shadows. Auscultation on the lungs shows symmetrical breathing with bilateral pops. Despite the nasal oxygen therapy, the death has occurred during transport to the appropriate medical institution. Forensic autopsy has shown no foreign content in the external nasal and oral cavities, oesophagus, trachea and bronchi are free from foreign content. Lung tissue with reduced aeration, with flat, medium bloody cross-section with red spots; when pressure is exerted, no content comes out from the bronchi. Pathohistological examination of tissue taken during autopsy has shown the presence of foreign content in the alveoli and bronchi, mostly consisting of squamous cells and mucus, with occasional dark irregular grainy formations, fresh bleeding and presence of neutrophils in alveolar area (HE, Alcian blue, Pan cytokeratin). Based on the autopsy results, data from the medical documents and chemical-toxicological analysis, it has been concluded that this was a violent death caused by asphyxiation due to aspiration of amniotic fluid and meconium.
    [Show full text]