Pre-eclampsia complicated by severe hyponatraemia

A 41-year-old woman was diagnosed with pre-eclampsia at 35 weeks gestation. She was treated with antihypertensives but, unfortunately, her condition became complicated by severe hyponatraemia. Her sodium levels rapidly dropped to 125 mmol/L. The cause for the hyponatraemia was the syndrome of inappropriate antidiuretic hormone secretion. She was initially managed with fluid restriction, but an emergency caesarean section was necessary in view of fetal distress. Her sodium levels returned to normal within 48 hours of delivery.Pre-eclampsia is rarely associated with hyponatraemia. A low maternal sodium level further increases the mother’s risk for seizures during this state. Additionally, the fetal sodium rapidly equilibrates to the mother’s and may result in fetal tachycardia, jaundice and polyhdraminios. All these factors may necessitate an emergency fetal delivery.

Fetal Tachycardia in the Delivery Room: Fetal Distress, Supraventricular Tachycardia, or Both?

Background Supraventricular tachycardia (SVT) is seldom considered a cause for fetal tachycardia; commoner etiologies including maternal fever and fetal distress are usually envisaged. Fetal arrhythmia can be missed as a diagnosis, potentially leading to suboptimal management. Cases Three cases are described where detection of fetal tachycardia >200 beats per minute (bpm) at 36, 40, and 38 weeks gestation resulted in emergency cesarean section for presumed fetal distress. Retrospective review of the cardiotocograph in two cases revealed baseline heart rates 120 to 160 bpm, with loss of trace associated with auscultated rates over 200 bpm. The diagnosis of SVT was not initially considered and made later when the infants required cardioversion at the age of 3 weeks, 2 days, and 8 days, respectively. The 36-week infant required noninvasive ventilation for prematurity. Conclusion SVT should be actively considered in the differential diagnosis of fetal tachycardia. Unrecognized fetal SVT may result in avoidable caesarean for suspected fetal distress, with potential prematurity-related problems. The cardiotocograph can be helpful if showing contact loss associated with rapid heart rate auscultation. The antenatal detection of fetal SVT is important as it can allow anticipation and prevention of neonatal SVT, which is potentially life-threatening if not detected and treated promptly.

Early-Onset Neonatal listeriosis –A Case Report

A 25-year-old primigravida in her 30 weeks of gestation presented with fever and some flu-like symptoms. There was minimal vaginal discharge. Keeping in view the possibility of chorioamnionitis a prompt intravenous infusion of antibiotics was instituted with continuous external monitoring of fetal heart rate. An emergency cesarean section was performed 3 hours later for persistent fetal tachycardia suggestive of fetal distress. A preterm baby girl was born with evidence of respiratory distress requiring ventilatory support. Listeria monocytogenes was isolated from newborn’s blood culture, tracheal secretions and the placental swab, confirming neonatal listeriosis. Cerebro-spinal fluid examination did not reveal evidence of meningitis. Prompt laboratory diagnosis and aggressive antibiotic treatment led to complete recovery of the infant from septicemia. This represents the first reported case of early-onset neonatal listeriosis in Malaysia

Neonate Born to a Mother with a Diagnosis of Suspected Intra-Amniotic Infection versus COVID-19 or Both

A diagnosis of intra-amniotic infection is typically made based on clinical criteria, including maternal intrapartum fever and one or more of the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. The diagnosis can also be made in patients with an isolated fever of 39°C, or greater, without any other clinical risk factors present. Coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, has been noted to have varying signs and symptoms over the course of the disease including fever, cough, fatigue, anorexia, shortness of breath, sputum production, and myalgia. In this report, we detail a case of a newborn born to a mother with a clinical diagnosis of intra-amniotic infection with maternal fever and fetal tachycardia, who was then found to be SARS-CoV-2 positive on testing. Due to the varying presentation of COVID-19, this case illustrates the low threshold needed to test mothers for SARS-CoV-2 in order to prevent horizontal transmission to neonates and to healthcare providers.

Treatment of Permanent Junctional Reciprocating Tachycardia in a Preterm Neonate: Case Report

Permanent junctional reciprocating tachycardia (PJRT) is most often observed in infants and children and can lead to incessant tachycardia. PJRT is usually refractory to medical treatment. Tachycardia may infrequently occur in the fetus in which case fetal tachycardia transplacental treatment should be started immediately. Term delivery is recommended for fetuses with tachycardia in the absence of significant clinical compromise to avoid complications of preterm birth. Herein, a 36-week preterm neonate presented with PJRT. He had tachycardia in the fetal period and was treated with digoxin, amiodaron, and esmolol therapy after birth without undergoing the catheter ablation procedure.

Desaceleraciones variables [Variable decelerations]

<p>Paciente femenina de 22 años con gestación de 38 semanas. Acude con historia de salida espontánea de líquido transvaginal en su casa, asociado a contracciones uterinas de 6 horas de evolución. Al llegar al hospital, con 3 centímetros de dilatación, 80% de borramiento, cefálico, membranas ovulares rotas, líquido meconial. Monitoreo fetal realizado en el cuarto de urgencias (figura 1) evidencia desaceleraciones profundas de tipología variable, variabilidad disminuida y taquicardia fetal hacia el final del trazo (más de diez minutos). Se realizó cesárea de urgencia, obteniéndose un producto de sexo masculino, APGAR 6/8, de 3200g, con triple circular de cordón al cuello. Evolución satisfactoria post parto.</p><p>22-year-old female patient with a 38-week gestation. She comes with history of spontaneous leakage of transvaginal fluid at home, associated with uterine contractions of 6 hours of evolution. On arrival at the hospital, with 3 centimeters of dilation, 80% effacement, cephalic, ruptured ovular membranes, meconial fluid. Fetal monitoring performed in the emergency room (Figure 1) shows deep decelerations of variable typology, decreased variability and fetal tachycardia towards the end of the line (more than ten minutes). An emergency caesarean section was performed, obtaining a male product, APGAR 6/8, of 3200g, with a triple circular cord around the neck. Satisfactory postpartum evolution.</p>

The value of amniotic fluid analysis in patients with suspected clinical chorioamnionitis

Objective To assess the value of incorporating amniotic fluid (AF) analysis in the management of patients with clinical chorioamnionitis. Methods This was a retrospective cohort study of all women carrying a singleton fetus and managed at our center between 2000 and 2009. We included only those women suspected of chorioamnionitis based on one or more of the following: (1) uterine tenderness, (2) maternal fever, (3) maternal and/or fetal tachycardia and (4) purulent discharge. The management was deemed to be justified if (1) pregnancy was terminated <24 weeks and histology confirmed chorioamnionitis; (2) delivery was performed expeditiously after initial assessment and histology confirmed chorioamnionitis; (3) delivery was delayed for 2–7 days and the patient completed a course of antenatal steroids before 34 weeks; and (4) delivery was delayed ≥7 days and histology was not indicative of chorioamnionitis, or delivery occurred after 37 weeks. Univariate and logistic regression analyses were used as appropriate. Results Of the 77 women with suspected chorioamnionitis, AF analysis was performed in 43 (55.8%) cases, and the management was justified in 63 (81.8%) cases based on the aforementioned criteria. Stepwise regression analysis confirmed AF analysis as a predictor of justified management. The rates of composite morbidity, neonatal sepsis, neonatal death and admissions to neonatal intensive care unit were lower in the justified management group. Conclusion Incorporation of AF analysis into clinical assessment does improve the management of suspected chorioamnionitis.