Fatal Fetal Outcome with the Combined Use of Valsartan and Atenolol

2001 ◽  
Vol 35 (7-8) ◽  
pp. 859-861 ◽  
Author(s):  
Gerald G Briggs ◽  
Michael P Nageotte
Keyword(s):  
Diabetes Mellitus ◽  
Amniotic Fluid ◽  
Fetal Death ◽  
Pulmonary Hypoplasia ◽  
Intrauterine Fetal Death ◽  
Direct Result ◽  
Chronic Hypertension ◽  
Amniotic Fluid Index ◽  
Female Fetus ◽  
Fetal Toxicity

OBJECTIVE: To report a case of anhydramnios, pulmonary hypoplasia, very small placenta, and fetal death in a pregnancy complicated by chronic hypertension and diabetes mellitus that had been treated through the first 24 weeks of gestation with valsartan and atenolol. CASE SUMMARY: A 40-year-old Hispanic woman with well-controlled chronic hypertension and diet-controlled type 2 diabetes mellitus was treated with valsartan and atenolol until pregnancy was diagnosed at 24 weeks' gestation. An ultrasound examination revealed normal fetal growth and anatomy but anhydramnios (amniotic fluid index 0). Valsartan was discontinued, and amniotic fluid volume normalized within two weeks. Intrauterine fetal death was documented at 33 weeks' gestation. Labor was induced, with the delivery of a stillborn female fetus with small, hypoplastic lungs (weight 41% of expected) and an extremely small, 148-g placenta (weight 48% of the 10th percentile for gestational age). DISCUSSION: The use of valsartan, a selective angiotensin II receptor antagonist (ARA), in human pregnancy has not been reported, but this class of agents would be expected to cause fetal toxicity similar to that observed with angiotensin-converting enzyme inhibitors. This toxicity includes reduced perfusion of the fetal kidneys, resulting in anuria, oligohydramnios, and subsequent pulmonary hypoplasia. The small hypoplastic lungs and very small placenta were probably a consequence of valsartan and atenolol combination therapy. CONCLUSIONS: Resolution of anhydramnios after discontinuing valsartan is evidence for ARA-induced fetal toxicity. The pulmonary hypoplasia observed in the stillborn infant was a direct result of the severe oligohydramnios. The cause of fetal death nine weeks later is uncertain, but because the woman's chronic hypertension and diabetes were well controlled, we believe the primary cause was chronic placental insufficiency resulting from the previous combination of valsartan and atenolol.

Amniotic fluid S100B protein in mid-gestation and intrauterine fetal death

The Lancet ◽  
2004 ◽  
Vol 364 (9430) ◽  
pp. 270-272 ◽  
Author(s):  
Pasquale Florio ◽  
Fabrizio Michetti ◽  
Matteo Bruschettini ◽  
Mario Lituani ◽  
Pierluigi Bruschettini ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Fetal Death ◽  
S100b Protein ◽  
Intrauterine Fetal Death

scholarly journals Letter: Alpha-fetoprotein in amniotic fluid in early normal pregnancy and intrauterine fetal death.

BMJ ◽  
1974 ◽  
Vol 3 (5933) ◽  
pp. 742-742 ◽  
Author(s):  
L Wisniewski ◽  
Z Skrzydlewski ◽  
J Orciuch
Keyword(s):  
Amniotic Fluid ◽  
Fetal Death ◽  
Normal Pregnancy ◽  
Alpha Fetoprotein ◽  
Intrauterine Fetal Death

scholarly journals Amniotic fluid disorders and the effects on prenatal outcome: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
H. Bakhsh ◽  
H. Alenizy ◽  
S. Alenazi ◽  
S. Alnasser ◽  
N. Alanazi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cohort Study ◽  
Amniotic Fluid ◽  
Retrospective Cohort ◽  
Fetal Outcome ◽  
Maternal Risk Factors ◽  
Amniotic Fluid Index ◽  
Maternal Risk ◽  
Vaginal Deliveries

Abstract Background The amniotic fluid is a protective liquid present in the amniotic sac. Two types of amniotic fluid disorders have been identified. First refers to polyhydramnios, which is an immoderate volume of amniotic fluid with an Amniotic Fluid Index (AFI) greater than 24 cm. Second includes oligohydramnios, which refers to decreased AFI i.e., less than 5 cm. This study aims to; a) identify the maternal risk factors associated with amniotic fluid disorders, b) assess the effect of amniotic fluid disorders on maternal and fetal outcome c) examine the mode of delivery in pregnancy complicated with amniotic fluid disorders. Methods A comparative retrospective cohort study design is followed. Sample of 497 pregnant women who received care at King Abdullah bin Abdul-Aziz University Hospital (KAAUH) between January 2017 to October 2019 was included. Data were collected from electronic medical reports, and was analyzed using descriptive statistics. Association of qualitative variables was conducted by Chi-square test, where p-value < 0.05 was considered statistically significant. Results Among the collected data, 2.8% of the cases had polyhydramnios and 11.7% patients had oligohydramnios. One case of still born was identified. A statically significant association was found between polyhydramnios and late term deliveries (P = 0.005) and cesarean section (CS) rates (P = 0.008). The rate of term deliveries was equal in normal AFI and oligohydramnios group (P = 0.005). Oligohydramnios was mostly associated with vaginal deliveries (P = 0.008). Oligohydramnios and polyhydramnios were found to be associated with diabetes mellitus patients (P = 0.005), and polyhydramnios with gestational diabetes patients (P = 0.052). Other maternal chronic diseases showed no effect on amniotic fluid index, although it might cause other risks on the fetus. Conclusion Diabetes mellitus and gestational diabetes are the most important maternal risk factors that can cause amniotic fluid disorders. Maternal and fetal outcome data showed that oligohydramnios associated with gestational age at term and low neonatal birth weight with high rates of vaginal deliveries, while polyhydramnios associated with gestational age at late term and high birth weight with higher rates of CS.

The Influence of Hyperglycemia on the Outcome of Diabetic Pregnancies

2018 ◽  
Vol 25 (2) ◽  
pp. 215-221
Author(s):  
Alin Albai ◽  
Nicoleta Lupascu ◽  
Simona Popescu ◽  
Bogdan Timar ◽  
Ovidiu Potre ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Distress Syndrome ◽  
Fetal Death ◽  
Scientific Literature ◽  
Intrauterine Fetal Death ◽  
Fetal Mortality ◽  
Careful Monitoring ◽  
Neonatal Hypoglycemia ◽  
Entire Pregnancy ◽  
Complications And Mortality

Abstract At the beginning of the last century, the association between diabetes mellitus and pregnancy was credited with a high risk of complications and mortality. However, nowadays, such issue no longer bears such a pessimistic approach. Planning the pregnancy during a period of optimal metabolic control and careful monitoring of the pregnant woman significantly reduces maternal and fetal mortality. The most important aspects of fetal pathology are: intrauterine fetal death, congenital malformations, growing disorders (macrosomia or delays in growing), neonatal hypoglycemia, respiratory distress syndrome, hypertrophic cardiomyopathy etc. The fetus’s viability is significantly impacted if a quality maternal glycemic control is not obtained at least 3 months prior to birth, as well as throughout the entire pregnancy term (particularly during the first 10 weeks, term during which organogenesis is completed). This systematic review of scientific literature aims to summarize the pathogenic ways in which hyperglycemia may influence the fetus of women with Diabetes Mellitus.

Intrauterine Fetal Death and the Isolation of Echovirus 27 from Amniotic Fluid

1988 ◽  
Vol 158 (2) ◽  
pp. 501-502 ◽  
Author(s):  
J. L. Nielsen ◽  
G. K. Berryman ◽  
G. D. V. Hankins
Keyword(s):  
Amniotic Fluid ◽  
Fetal Death ◽  
Intrauterine Fetal Death

scholarly journals Reference Ranges of Amniotic Fluid Index in Late Third Trimester of Pregnancy: What Should the Optimal Interval between Two Ultrasound Examinations Be?

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Shripad Hebbar ◽  
Lavanya Rai ◽  
Prashant Adiga ◽  
Shyamala Guruvare
Keyword(s):  
Diabetes Mellitus ◽  
Amniotic Fluid ◽  
Gestational Age ◽  
Local Population ◽  
Low Risk ◽  
Reference Ranges ◽  
Third Trimester ◽  
Amniotic Fluid Index ◽  
Percentile Curves ◽  
Biophysical Profile

Background. Amniotic fluid index (AFI) is one of the major and deciding components of fetal biophysical profile and by itself it can predict pregnancy outcome. Very low values are associated with intrauterine growth restriction and renal anomalies of fetus, whereas high values may indicate fetal GI anomalies, maternal diabetes mellitus, and so forth. However, before deciding the cut-off standards for abnormal values for a local population, what constitutes a normal range for specific gestational age and the ideal interval of testing should be defined.Objectives. To establish reference standards for AFI for local population after 34 weeks of pregnancy and to decide an optimal scan interval for AFI estimation in third trimester in low risk antenatal women.Materials and Methods. A prospective estimation of AFI was done in 50 healthy pregnant women from 34 to 40 weeks at weekly intervals. The trend of amniotic fluid volume was studied with advancing gestational age. Only low risk singleton pregnancies with accurately established gestational age who were available for all weekly scan from 34 to 40 weeks were included in the study. Women with gestational or overt diabetes mellitus, hypertensive disorders of the pregnancy, prelabour rupture of membranes, and congenital anomalies in the foetus and those who delivered before 40 completed weeks were excluded from the study. For the purpose of AFI measurement, the uterine cavity was arbitrarily divided into four quadrants by a vertical and horizontal line running through umbilicus. Linear array transabdominal probe was used to measure the largest vertical pocket (in cm) in perpendicular plane to the abdominal skin in each quadrant. Amniotic fluid index was obtained by adding these four measurements. Statistical analysis was done using SPSS software (Version 16, Chicago, IL). Percentile curves (5th, 50th, and 95th centiles) were constructed for comparison with other studies. Cohen’sdcoefficient was used to examine the magnitude of change at different time intervals.Results. Starting from 34 weeks till 40 weeks, 50 ultrasound measurements were available at each gestational age. The mean (standard deviation) of AFI values (in cms) were 34 W: 14.59 (1.79), 35 W: 14.25 (1.57), 36 W: 13.17 (1.56), 37 W: 12.48 (1.52), 38 W: 12.2 (1.7), and 39 W: 11.37 (1.71). The 5th percentile cut-off was 8.7 cm at 40 weeks. There was a gradual decline of AFI values as the gestational age approached term. Significant drop in AFI was noted at two-week intervals. AFI curve generated from the study varied significantly when compared with already published data, both from India and abroad.Conclusion. Normative range for AFI values for late third trimester was established. Appreciable changes occurred in AFI values as gestation advanced by two weeks. Hence, it is recommended to follow up low risk antenatal women every two weeks after 34 weeks of pregnancy. The percentile curves of AFI obtained from the present study may be used to detect abnormalities of amniotic fluid for our population.

scholarly journals Persistence of SARS-CoV-2 in the first trimester placenta leading to vertical transmission and fetal demise from an asymptomatic mother

2020 ◽  
Author(s):  
Prajakta Shende ◽  
Pradip Gaikwad ◽  
Manisha Gandhewar ◽  
Pawankumar Ukey ◽  
Anshul Bhide ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Amniotic Fluid ◽  
Vertical Transmission ◽  
Early Pregnancy ◽  
Fetal Death ◽  
Clinical Course ◽  
First Trimester ◽  
Intrauterine Fetal Death ◽  
Fetal Membranes ◽  
Fetal Demise

Coronaviruses infect the respiratory tract and are known to survive in these tissues during the clinical course of infection. However, how long can SARS-CoV-2 survive in the tissues is hitherto unknown. Herein, we report a case where the virus is detected in the first trimester placental cytotrophoblast and syncytiotrophoblasts five weeks after the asymptomatic mother cleared the virus from the respiratory tract. This first trimester placental infection was vertically transmitted as the virus was detected in the amniotic fluid and fetal membranes. This congenitally acquired SARS-CoV-2 infection was associated with hydrops and fetal demise. This is the first study providing concrete evidences towards persistent tissue infection of SARS-CoV-2, its congenital transmission in early pregnancy leading to intrauterine fetal death.

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