Kenneth Leveno

Renal infection and pregnancy outcome

To evaluate the impact of renal infection on pregnancy outcome, we studied a group of pregnant women with asymptomatic renal bacteriuria and another group who had acute pyelonephritis. In 248 women with asymptomatic bacteriuria, infection was localized by the antibody-coated bacteria method. These women were prospectively matched with abacteriuric control subjects and we found no adverse effects of treated renal or bladder infection. Specifically, the number of women with hypertension and anemia in each group was similar, and infants born to these women were comparable regarding perinatal mortality, mean gestational age, and birth weight, as well as indices of maturity. A total of 487 women with acute pyelonephritis were evaluated in a case-control study and observations of the correlation of maternal anemia and pyelonephritis were confirmed. Women with antepartum infection had no increased adverse perinatal outcome; however, in some women with intrapartum infection, pyelonephritis appeared to have initiated premature labor. We concluded that treated renal infection, whether symptomatic or asymptomatic, does not significantly modify pregnancy outcome.

Fetal lung maturation in twin gestation

Clear amnionic fluid was collected at cesarean section and the lecithin/sphingomyelin (L/S) ratio was used to evaluate fetal lung maturation in 42 twin gestations. The L/S ratios of twin pairs were usually similar in both numerical value and predictive accuracy except when the greater L/S ratio from one member of a pair indicated borderline lung maturity. Twin fetal lung maturation was found to be independent of sex, zygosity, and birth weight discordance. Comparison of mean L/S ratios in twins to those of uncomplicated singleton pregnancies revealed that fetal lung maturation occurred several weeks earlier in twins.

Bacteremia and Septic Shock

Regardless of the site of infection, pathogenic microbes may enter the bloodstream and cause septic shock, which is a life-threatening syndrome characterized by hypotension, inadequate tissue perfusion, hypoxia, and metabolic acidosis. Circulatory insufficiency is initiated by bacteremia or by by-products of killed bacteria that cause cellular injury, activation of complement and coagulation, and release of vasoactive compounds. A presumptive diagnosis of septic shock is made when hypotension is preceded by chills and fever in association with tachycardia, tachypnea, oliguria, or mental obtundation.

Chapter 21 – Management

Publisher Summary Management of preeclampsia depends upon its severity as well as the gestational age at which it becomes clinically apparent. While in most cases, diagnosis is made by the appearance of new-onset gestational hypertension accompanied by proteinuria, observations over the last two decades—which are discussed in detail in other chapters— have emphasized the importance of endothelial cell injury and multiorgan dysfunction as integral parts of the preeclampsia syndrome. The basic management objectives for any pregnancy complicated by preeclampsia are: termination of pregnancy with the least possible trauma to mother and fetus, birth of an infant who subsequently thrives, and complete restoration of health to the mother. In certain women with preeclampsia, especially those at or near term, all three objectives are served equally well by induction of labor. One of the most important clinical questions for successful management is precise knowledge of the age of the fetus.