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Query: UMLS:C0085584 (encephalopathy)
 18,178 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Murless head extractor has been used since long time ago as a vector, extractor and head rotator through cesarean section diminishing the injury feto-maternal. From march to june 1991, 50 patients with cesarean section indication and with fetus in head presentation were gotten out using this way, analyzing 12 maternal parameters and 9 fetal. The most frequent indication of cesarean section was severe Preeclampsia 41%, third cesarean section 14.7%, fetal distress 14.7%, low reserve fetal 11.7%, PROM 8.8% and others 9.1%. The height of the head was at the first plane in 59.4%. The Apgar score at the minute was of 9 in 6.0%, of 8 in 60.6%, of 7 in 18.1%, of 6 in 12.1% of 4 in 3.3%. The Apgar score at five minutes was 9 in 84.8% and 8 in 12.1% for a total of 96.9%. An USG transfontanelar was practiced in 40 products from which 37 (92.5%) were normal and in 3 (7.5%) it was found: in one brain light edema and in two hypoxical encephalopathy (caused by severe Preeclampsia, chronic hypertension and superimposed preeclampsia and fetal distress due to cord around the neck. In the other ten cases USG was not used for another reasons. Maternal morbi-mortality and general due to extractor use, was not obtained not either fetal morbi-mortality. It was concluded that the head extractor is useful, does not increase the obstetrical injury and it is easily applied).
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PMID:[Evaluation of the Murless head extractor]. 147 10

Acute fatty liver of pregnancy is a potentially fatal disorder. We report a patient complicated by preeclampsia, coagulopathy, encephalopathy, and hepatorenal syndrome successfully managed by postpartum hepatic transplantation.
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PMID:Acute fatty liver of pregnancy associated with preeclampsia: management of hepatic failure with postpartum liver transplantation. 174 73

The clinical spectrum and outcome of neonatal convulsions within an obstetric hospital population were reviewed for the 5 years, 1978-82, inclusive. There were 156 convulsing neonates managed at the Mater Mothers Hospital (110 inborn, 46 outborn). The incidence of early neonatal convulsions for inborn babies was 3.0/1000 live births. Antenatal and perinatal risk factors were compared between the 156 convulsing infants and the 36,082 infants born during the same period who did not convulse. The leading risk factors for convulsions were prematurity, intra-uterine growth retardation, low 5 min Apgar score, pre-eclampsia, antepartum haemorrhage, twin pregnancy and breech presentation. The predominant seizure type was tonic in 28.6%, multifocal clonic in 27.2%, subtle in 18.4%, myoclonic in 15.0% and focal clonic in 8.8%. Mortality (31%) and long-term disability (43%) rates were high. Tonic seizures had the highest mortality and morbidity. Throughout the duration of the study period infants received increasingly thorough investigation. Causative factors were determined in 95% of convulsing infants, most frequent being hypoxic-ischaemic encephalopathy (40.3%) and cerebroventricular haemorrhage (30.5%). Follow-up data on 99 of the 107 survivors (93%) revealed severe disability in 25, moderate disability in eight and mild disability in 10. A poor long-term prognosis was associated with prolonged convulsions, tonic and multifocal clonic convulsions, convulsions due to asphyxia and cerebroventricular haemorrhage and an abnormal neurological examination at discharge.
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PMID:Clinical spectrum and outcome of neonatal convulsions. 321 7

Eclampsia occurring more than 48 hours postpartum has been observed in an unusual number of patients. From August 1977 to November 1982 at E. H. Crump Women's Hospital and Perinatal Center (Memphis), there were 132 documented cases of eclampsia, of which 36 (27%) occurred postpartum. Seventeen (47%) of these occurred more than 48 hours postpartum. Preeclampsia was diagnosed before the onset of convulsions in 12 patients, all of whom received intravenous magnesium sulfate postpartum. The mean duration of postdelivery magnesium sulfate therapy was 32 hours (range 24 to 72 hours). Headaches and visual disturbances were reported by all 17 patients before onset of convulsions. Physical and laboratory findings immediately after the convulsions were consistent with eclampsia. Treatment consisted primarily of intravenous magnesium sulfate. Neurologic consultation was obtained to rule out a neurologic disorder, and metabolic studies were also done. Electroencephalograms were done on 15 patients; eight of them showed patterns consistent with encephalopathy.
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PMID:Late postpartum eclampsia: an update. 664 9

Eclampsia is a rare condition peculiar to pregnant and puerperal women, characterized by clinical pre-eclampsia (hypertension, proteinuria, edema) and generalized seizures. Three cases of eclamptic encephalopathy are reported: CT and MRI demonstrated transient abnormalities in the cortical and subcortical regions of the posterior areas of the brain - namely, parieto-occipital lobes - associated with occasional involvement of basal ganglia and/or brainstem. Pathogenesis is still unclear. Strict similarity with the pathological findings characterizing hypertensive encephalopathy suggests that a focal impairment in cerebral autoregulation may be the cause of vasodilation and fluid extravasation leading to hydrostatic edema; selective involvement of posterior areas could be explained by their lesser degree of adrenergic innervation supporting circulatory autoregulation mechanisms.
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PMID:Eclamptic encephalopathy: imaging and pathogenetic considerations. 940 96

Hypertension in pregnancy is defined by a systolic blood pressure > or = 140 mm Hg and a diastolic blood pressure of > or = 90 mm Hg or by a rise in blood pressure of systolic > or = 30 mm Hg and diastolic > or = 15 mm Hg. High blood pressures are found in 5-10% of all pregnancies. The outcome of pregnancy is influenced by the fact whether there occurs a proteinuria in addition to hypertension. While the prognosis of an isolated hypotension is good, the combination of hypertension and proteinuria leading to preeclampsia is the primary cause of maternal death in many countries and is responsible for 20-25% of perinatal mortality. A simple classification divides between chronic hypertension, preeclampsia, preeclampsia superimposed on chronic hypertension and transient hypertension. With chronic hypertension pregnancy outcome is determined by a preexisting nephropathy and the occurrence of a superimposed preeclampsia. Preeclampsia and superimposed preeclampsia are pregnancy induced multiorganic diseases, endangering both the mother and the fetus. Transient hypertension is a benign pathology, which occurs toward the end of pregnancy usually on the basis of a latent essential hypertension, which is laid open through pregnancy. While a severe chronic hypertension in pregnancy must be treated to prevent a hypertensive maternal encephalopathy, a less severe chronic hypertension should not be treated as the risk of a superimposed preeclampsia and the maternal and fetal outcome cannot be influenced by antihypertensive therapy. The incidence of preeclampsia is 3-5% in nulliparae and 0.5% in multiparae. Preeclampsia is a severe and dangerous pathology with an unknown etiology. Pregnancy termination is the only causal therapy. At present it is still recommended to terminate a severe preeclampsia after stabilizing the mother, irrespective of gestational age. In less severe preeclampsia occurring before 32 weeks of gestation, termination of pregnancy can be postponed under intensive monitoring and a prophylaxis with magnesium sulfate in order to accelerate the fetal lung maturation with glucocorticoids. A conservative management in the case of a HELLP-syndrome (Haemolyis, Elevated Liver enzymes, Low Platelets), which is a very severe form of preeclampsia, is not recommended because it hasn't been validated in prospective controlled studies. The most dangerous complication of preeclampsia is eclampsia, which is defined by general tonic-clonic convulsions before or after birth. The most effective prophylaxis of eclamptic attacks is the intravenous therapy with magnesium sulfate. A primary prohylaxis for preeclampsia doesn't exist. Treatment with low-dose aspirin in high-risk patients, i.e. after a severe preeclampsia, in cases of chronic hypertension, in cases of nephropathy and in cases with antiphospholipid-syndrome++ can be recommended. The prophylactic use of low-dose heparin, which has lead to a significant decreased incidence of preeclampsia in retrospective analysis, is now the object of a randomized, controlled trial in our hospital. All women who suffered from a preeclampsia should have a check-up after 3-6 months. Preexisting pathologies are found in up to 40% of patients, mostly in multiparae, i.e. chronic hypertension, nephropathy, endocrine pathologies, anomalies of blood coagulation and antiphospolipid-syndrome.
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PMID:[Hypertensive disorders in pregnancy]. 1054 28

A hypertensive emergency is a situation in which uncontrolled hypertension is associated with acute end-organ damage. Most patients presenting with hypertensive emergency have chronic hypertension, although the disorder can present in previously normotensive individuals, particularly when associated with pre-eclampsia or acute glomerulonephritis. The pathophysiological mechanisms causing acute hypertensive endothelial failure are complex and incompletely understood but probably involve disturbances of the renin-angiotensin-aldosterone system, loss of endogenous vasodilator mechanisms, upregulation of proinflammatory mediators including vascular cell adhesion molecules, and release of local vasoconstrictors such as endothelin 1. Magnetic resonance imaging has demonstrated a characteristic hypertensive posterior leucoencephalopathy syndrome predominantly causing oedema of the white matter of the parietal and occipital lobes; this syndrome is potentially reversible with appropriate prompt treatment. Generally, the therapeutic approach is dictated by the particular presentation and end-organ complications. Parenteral therapy is generally preferred, and strategies include use of sodium nitroprusside, beta-blockers, labetelol, or calcium-channel antagonists, magnesium for pre-eclampsia and eclampsia; and short-term parenteral anticonvulsants for seizures associated with encephalopathy. Novel therapies include the peripheral dopamine-receptor agonist, fenoldapam, and may include endothelin-1 antagonists.
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PMID:Hypertensive emergencies. 1105 14

The aim of the study was to identify maternal risk factors for perinatal asphyxia in Malawi. Records of 100 mothers who delivered neonates with Apgar scores less than 6 at 5 minutes of birth during March to September 1998 were analyzed. The majority of the mothers were primigravidas (79%) and were within the normal childbearing ages of 20 to 34 years (61.2%). Sixty-one percent of the mothers started antenatal care at 20 to 28 weeks' gestation. Sixty-five percent of the mothers developed obstetric and medical problems that contributed to perinatal asphyxia, and of these, 12 mothers (18.5%) had more than one problem. The problems were premature labor and delivery (21%), preeclampsia (10%), cephalopelvic disproportion (8%), breech presentation (12%), prolonged second stage (11%), fetal distress (7%), cord prolapse (4%), antepartum hemorrhage (2%), prolonged rupture of membranes (1%), and malaria (1%). Forty-six percent had assisted deliveries, and these were cesarean section (18%), vacuum extraction (14%), breech delivery (12%), and forceps delivery (2%). Eighty-one percent of the neonates were admitted to the neonatal nursery, and of these, 56 neonates (67.1%) developed complications; the most common was hypoxic ischemic encephalopathy (38 neonates; 67.9%). Thirty-three percent of the neonates died within 6 days postdelivery. Morbidity and mortality related to perinatal asphyxia can be reduced if staff are knowledgeable and skilled in basic neonatal resuscitation and necessary equipment is available. Mothers should be encouraged to report early for antepartum and intrapartum care for adequate surveillance. The quality of neonatal care, with a focus on thermoregulation and infection prevention, needs to be improved.
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PMID:Risk factors for perinatal asphyxia at Queen Elizabeth Central Hospital, Malawi. 1127 Nov 18

To evaluate prenatal and perinatal risk factors for early neonatal seizures, we conducted a case-control study including 100 newborns with neonatal seizures in the first week of life and 204 controls randomly selected from a list of healthy newborns born in the same hospital during the study period. Generalized tonic seizures were the most common seizures observed (29%), although the majority of newborns (71%) experienced more than one type of seizure. The most frequent presumed etiology of neonatal seizures was hypoxic-ischemic encephalopathy (30%). A history of epilepsy in first-degree relatives was found only for cases. Neonatal seizures were found to be associated with maternal disease in the 2 years before pregnancy, mother's weight gain > 14 kg during pregnancy, placental pathology, preeclampsia, low birthweight, low gestational age, and jaundice in the first 3 days of life. The need for cardiopulmonary resuscitation was found only for cases (37%). The causal pathways for neonatal seizures often begin before birth, and some of the factors identified may be preventable.
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PMID:Prenatal and perinatal determinants of neonatal seizures occurring in the first week of life. 1157 4

Neonatal venous sinus thrombosis is a well-recognized, but infrequently diagnosed, cause of neonatal encephalopathy. Previous reports have tended to omit reference to the importance of maternal factors in predisposing the infant to this condition. This report, in which eight patients with neonatal venous sinus thrombosis are presented, will reveal a strong association between pre-eclampsia, prothrombotic disorders, and neonatal venous sinus thrombosis. Contrary to previously published reports, there is a high likelihood of neurodevelopmental residua after this condition.
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PMID:Pre-eclampsia: a predisposing factor for neonatal venous sinus thrombosis? 1158 81


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