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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intra-amniotic infection has been reported to be associated with intrapartum asphyxia; however, the criteria used to define asphyxia have been imprecise. In the present study of 123 women with intra-amniotic infection and 6769 women without infection, the mean umbilical artery pH was 7.28 in both groups. The frequency of acidemia (umbilical artery pH less than 7.20) was not significantly different between the infection group and controls (15 versus 10%; P = .12). Likewise, there was no significant difference between the groups when a lower umbilical artery pH value (less than 7.15) was used to define acidemia. None of the infants from infected mothers had metabolic acidemia with a pH of less than 7.15 and none had a pH of less than 7.00. Significantly more (P less than .05) infants in the infected group did have low 1-minute (20 versus 5%) and 5-minute (3 versus 1%) Apgar scores of 6 or less, criteria often used to define asphyxia. However, none of the newborns from the infected group had recently proposed criteria for the diagnosis of birth asphyxia (ie, leading to neurologic impairment) such as metabolic acidemia, seizures in the immediate newborn period, and low Apgar scores (3 or less). Birth asphyxia is rarely associated with intra-amniotic infection, and in the absence of other signs of fetal jeopardy such as an ominous fetal heart rate pattern, an immediate cesarean to prevent asphyxia does not appear justified once the diagnosis of chorioamnionitis is made.
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PMID:Intrapartum asphyxia in pregnancies complicated by intra-amniotic infection. 238 12

This study was undertaken to investigate whether physical assault was independently associated with an adverse obstetric outcome. 512 women examined at the low-risk prenatal clinic of the University of Texas Medical Branch in Galveston, Texas, were interviewed. The final cohorts consisted of 32 (7.3%) physically abused women and 352 (80.0%) control subjects without any abuse history. Demographic and socioeconomic differences were found to be insignificant among the respondents. Results revealed that women assaulted in the current pregnancy were twice as likely to have preterm labor as compared with those without assault history. In addition, crude odd ratios showed a twofold increased risk of chorioamnionitis in assault victims. No difference between abused and nonabused women was noted in the prevalence of preterm delivery, pregnancy-induced hypertension, cesarean section, meconium staining, infant birth weight, Apgar scores, intrauterine growth retardation, fetal distress, fetal death, neonatal seizures, sepsis, or admission to the intensive care unit. In conclusion, physical assault was associated with preterm labor and chorioamnionitis and screening for assault must be incorporated during routine prenatal care to identify women at risk of complications.
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PMID:Perinatal morbidity associated with violence experienced by pregnant women. 761 58

Morganella morganii is an opportunistic organism that leads to serious morbidity. It is an enteric organism commonly associated with immunocompromise and chronic urinary catheterization. We present a case of a healthy gravid individual who presented with chorioamnionitis and neonatal seizures associated with M. morganii. This organism, which causes severe morbidity, is fortunately rare in obstetrics and gynecology.
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PMID:Case of chorioamnionitis in an immunocompetent woman caused by Morganella morganii. 950 63

Placental specimens were reviewed from 73 singleton pregnancies of women whose offspring received electroencephalogram (EEG) studies in the neonate period. A group of 43 neonates (postconception age [PCA] 23-44 weeks) with electrically confirmed seizures in the immediate neonate period were compared with 30 healthy preterm and term infants of comparable PCA who had no electrographic seizures. Pathologic placental changes were separated: Group A consisted of chorioamnionitis, edema, meconium staining, and/or retroplacental hematoma. Group B consisted of abnormal villous maturation, infarction, and/or chronic villitis. Logistic regression analyses calculated the odds ratio of having Group A or Group B placental lesions in each neonate group as a function of increasing PCA. For the seizure group, the odds of having Group B with or without Group A placental lesions increased by a factor of 1.2 for each postconception week up to 43 weeks PCA. For a 15-week interval the odds of having Group B lesions for the seizure group increased by a factor of 12.1 (P < 0.007). Ratios were not significant for Group A lesions alone in the seizure group or for either Group B or Group A findings in the neonate group without seizures. Pathophysiologic events in utero leading to Group B rather than Group A findings are associated with electrically confirmed seizures in near-term and term infants. Group A lesions were considered more likely to have intrapartum or peripartum associations, whereas Group B lesions were considered more likely to have antepartum associations.
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PMID:Neonates with electrically confirmed seizures and possible placental associations. 968 83

The relation between clinical or histologic chorioamnionitis and early neonatal adverse neurologic outcome was investigated (n = 483). Histologic, but not clinical, evidence of chorioamnionitis was found to be a significant predictor of periventricular echodensity (odds ratio, 2.4; 95% CI, 1.8-3.2), echolucency (3.3; 1.9-5.6), ventriculomegaly (2.7; 1.8-4.2), intraventricular hemorrhage > or =3 (3.5; 2.4-5.2), and seizures (2.3; 1.4-3.7).
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PMID:Early neonatal brain injury in histologic chorioamnionitis. 1114 20

The limited available evidence supports a strong association of chorioamnionitis with neonatal encephalopathy and CP in the term infant. The association of chorioamnionitis with depressed Apgar scores or neonatal seizures and with CP is equivocal in the preterm infant. Different study results may be related to differences in study populations, perhaps specifically to differences in susceptibility by stages of neurologic development as well as differences in gene frequencies associated with inflammation and thrombophilia. We require further understanding of the normal roles of cytokines in brain development, pregnancy, and inflammatory homeostasis before clinical interventions directed at cytokines, their receptors, or the inflammatory process are considered.
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PMID:Chorioamnionitis and brain injury. 1251 38

Arterial ischemic infarction occurring around the time of birth is an increasingly recognized cause of neurological disability in children. The rate of arterial infarction in neonates is as high as the annual incidence of large-vessel ischemic stroke in adults. Factors contributing to this increased risk of stroke among neonates include complications that occur before, during, and after delivery. Maternal conditions that have been associated with perinatal stroke in the fetus include prothrombotic disorders, cocaine abuse, and placental complications such as chorioamnionitis and placental vasculopathy. In many cases, the placenta is suspected to be the underlying embolic source for perinatal stroke, although data on placental pathology is often lacking. During the delivery process, an infant may develop a cervical arterial dissection that leads to stroke. Several conditions in the neonatal period predispose to perinatal stroke including prothrombotic disorders, congenital heart disease, meningitis, and systemic infection. Perinatal stroke may present with neonatal seizures during the first weeks of life or may be asymptomatic until months later when the infant is first noted to have pathological handedness. The outcome of perinatal stroke is variable and depends on severity, anatomic localization, and other factors not yet well characterized. As many as 50% of infants with documented stroke recognized in the newborn period do not develop a hemiparesis. The incidence, clinical presentation, pathogenesis, risk factors, and outcome of this increasingly recognized disorder are reviewed.
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PMID:Perinatal arterial stroke: understanding mechanisms and outcomes. 1634 98

Three hundred-forty-eight out of a regional population of 1272 newborn infants were randomly chosen and followed neurologically until age of two years to study the epidemiology of neurodevelopmental disorders, and to reveal the main factors influencing outcome. The most frequent neonatal pathologies were low Apgar scores - 45 (3.5%), neonatal sepsis - 28 (2.2%), neonatal seizures - 26 (2.0%), neonatal sepsis complicated with bacterial meningitis - 13 (1.0%), traumatic injury of peripheral nerves - 7 (0.6%), intracranial hemorrhages - 4 (0.3%) and CNS malformations - 3 (0.2%). At the age of 24 months abnormal development was identified in 29 cases (8.5%) of children, comprising global developmental delay in five (1.5%), unclassified motor problems (hypotonia without ataxia) in four (1.2%), cerebral palsy in three (0.9%), behavioral/sleep disorders in 12 (3.5%) and epilepsy in five (1.5%). The most significant single risk factors for abnormal neurodevelopmental outcome were maternal age, chorioamnionitis, gestational age <37 weeks, pathological delivery, and a low (<5) Apgar score at 5min after birth. Coexistence of several risk factors increased the probability of an adverse outcome.
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PMID:Epidemiology of neurodevelopmental disorders in 2 years old Georgian children. Pilot study - population based prospective study in a randomly chosen sample. 1968 48

Ischemic perinatal stroke is a serious potential complication of delivery. In utero infection may be responsible for an underestimated proportion of perinatal stroke. Limited literature identifies objective evidence of ischemic perinatal stroke as a consequence of uterine infection. The authors report a neonate with ischemic stroke and documented findings of severe chorioamnionitis with umbilical vein thrombosis. A term neonate, after uneventful pregnancy and delivery, presented on the third day of life with seizures. Investigations for metabolic, electrolyte, infectious, and hypercoaguability derangements were normal. Extensive acute infarction in the left middle cerebral artery territory was diagnosed by magnetic resonance imaging (MRI). Placental histopathology confirmed the presence of chorioamnionitis. On follow-up assessments, mild residual neurologic deficits have persisted. Chorioamnionitis has been correlated with ischemic perinatal stroke. In addition to the recognized inflammatory cascade of in utero infection, umbilical vein thrombosis with subsequent ''paradoxical'' embolization may represent one mechanism responsible for this association.
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PMID:Ischemic perinatal stroke secondary to chorioamnionitis: a histopathological case presentation. 1995 47

Chorioamnionitis (CA) is defined as an infection that can affect amniotic fluid, placenta and uterus. The chorioamnionitis is present in 10-40% of cases of maternal peripartum fever and in 50% of preterm labor. Diagnosis is based on the presence of maternal fever (>38 degrees C) at least 2 of these conditions: maternal leukocytosis (> 15,000 cells/mmc), maternal tachycardia, fetal tachycardia, stained or foul smelling amniotic fluid, uterine tenderness. Obstetric risk factors include nulliparity, presence of stained amniotic fluid, the excessive duration of labor, the presence of pathogens in the genital tract (eg, Gonorrhea, GBS, EC), and the frequency of digital vaginal examinations. In suspicion of CA membranes and placenta are usually sent for histological examination performance, but the diagnosis of CS is not always confirmed by histological or microbiological exams. Early administration of broad-spectrum antibiotic therapy reduces both maternal and neonatal morbidity. The standard treatment by the administration of ampicillin and gentamicin have been shown to be safe and effective. Common maternal complications include bacteremia to septic shock, cesarean section, uterine atony with hemorrhage, pelvic abscess, maternal coagulopathy, thromboembolism and wound infections. The risk of neonatal sepsis, low seizures, low Apgar score at 5 minutes increased in the newborn. Cardiotocographic fetal monitoring should be continued during labor in cases of suspected chorioamnionitis with recourse to caesarean section as soon as signs of severe fetal distress.
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PMID:[Chorioamnionitis in the delivery room]. 2109 85


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