Faculty Bibliography

Background: A review of the English literature from 1980 to 2010 revealed only six gravidas managed by total parenteral nutrition (TPN) for at least 16 weeks of pregnancy. We found only two gravidas with obstruction due to malrotation, both managed surgically. Case: We report a unique case of bowel obstruction presenting in the second trimester due to congenital malrotation of the small intestine that was conservatively managed by prolonged TPN, with the delivery of a healthy term baby girl. Surgical correction was delayed until the patient was not pregnant. Conclusion: Intestinal obstruction in pregnancy is rare, and malrotation of the small bowel as the cause is extremely rare. This is the first case of intestinal obstruction in midtrimester in which prolonged TPN was employed when surgery was contraindicated. TPN may be considered if surgery cannot be performed, with an excellent outcome likely

Abstract This study evaluated in vitro immune responses to Escherichia coli lipopolysaccharide in maternal and fetal blood. Samples were concurrently obtained from maternal venipuncture and umbilical cord blood samples and cultured with the E. coli endotoxin, and cytokines were assayed. There were statistically significant correlations between maternal and fetal samples. This demonstrates maternal and fetal immune communication and mutual programming during pregnancy. Subclinical infection, which predisposes to premature labor, could be detectable from a maternal blood sample even if derived only from the fetal compartment. A maternal blood panel test might serve as a diagnostic screen for subclinical infection in patients at risk for preterm labor

Abstract The aims of this study were to evaluate the cardiac effects of subcutaneous terbutaline on the mother and fetus. Terbutaline was given in 250 or 500 mug doses to term gravidas not in labor. The mean arterial pressure (MAP), pulse, and uterine activity were measured. The fetal heart rate (FHR), accelerations, and decelerations were recorded. There were significant increases in maternal heart rate, FHR, and FHR accelerations, and a decrease in uterine basal activity after 500 mug, but not significantly after 250 mug of terbutaline. MAP was not significantly increased with either dose, although a small mean increase was observed. Terbutaline has a direct effect on the fetal heart apart from the effect of uterine relaxation.