Contributed by Antonio Alvarez-Mendoza MD, Terry L. Fox, MD and Dale S. Huff, MD
Published on line in August 1997
A 31 years old white female gravida IV, para III, had history of smoking one pack of cigarettes per day. Her first two daughters were delivered in 1984 and 1993 respectively. They are alive and well. Her third pregnancy, in 1995 was complicated by oligohydramnios and intrauterine growth retardation. At 20 weeks gestation, an ultrasound showed normal amniotic fluid volume and kidneys. At 35 weeks, she delivered a female neonate that was 30 weeks size and died by 30 hrs. of age due to respiratory insufficiency. No autopsy was performed.
The proposita was a male neonate product of the fourth pregnancy. At 21 weeks oligohydramnios was first noted. Subsequent ultrasound studies showed normal kidneys and no bladder was visualized. An amniocentesis study showed 46,XY karyotype and no evidence of infection. At 28 weeks late decelerations were noted, and labor was induced for a non-reassuring non-stress test and a biophysical profile of 4/8. This baby was vaginally delivered at 28 3/7 weeks of gestation. He had poor oxygenation requiring mechanical ventilation, hypotension, and no urine production. He died at 23 hrs of age. An autopsy was performed.