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OB: For LSRFrom: art fougner, md (evsono@pipeline.com)Wed Feb 14 11:52:28 2001
Luis - what's your take on this? in the Society for MFM edition of Gray Journal - 0144 NEONATAL CEREBRAL INFARCTION: CLINICAL ASSOCIATIONS Paul Ogburn Jr.1 Sarosh Rana, MD2 Diana Danilenko, MD2 Robert Johnson, MD3 1Mayo Clinic, Obstetrics/Gynecology, Rochester, MN; 2Mayo Clinic, Obstetrics/Gynecology, Rochester, MN; 3Mayo Clinic, Neonatology, Rochester, MN OBJECTIVE: To describe clinical situations associated with neonatal cerebral infarction (NCI). STUDY DESIGN: The neonatal database of a single tertiary center was searched for NCI (years 1992 to 1999; total deliveries greater than 12,000). Maternal and infant records were reviewed to confirm the diagnosis of NCI and evaluate clinical associations. RESULTS: Seven cases of NCI were discovered and reviewed. Four of these cases were associated with the use of cervical ripening agents (3 misoprostol and 1 PGE2 gel) as part of labor induction protocols that also included oxytocin. All 4 cases were primigravidas with male infants with gestational ages ranging from 36 to 415/7 weeks. NCI were diagnosed by CT scans showing unilateral middle cerebral artery distribution cerebral infarctions in 2 infants and bilateral lesions in 2 infants. Apgar scores were 7, 9, 9, and 9 at 5 minutes for these infants. Clinical signs of NCI were seizures starting 12 to 31 hours after birth. The case associated with PGE2 gel had maternal HELLP syndrome and a fever to 38.7°C (with fetal tachycardia to 210 beats/min). The 3 cases associated with misoprostol had used vaginal doses ranging from 25 µg (×2) to 50 µg (×4); all had episodes of uterine hyperstimulation in labor. The 3 remaining cases of NCI had various associations including (1) stillbirth in term-size infant with no prenatal care delivered in emergency room; (2) postpartum streptococcus meningitis; and (3) preterm delivery at 27 weeks’ gestation. CONCLUSION: The most common clinical associations for NCI was induction of labor in primigravidas at or near term in which cervical ripening agents were used (most often misoprostol). this may dampen the ardor somewhat. art
-- art fougner, md
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