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Table 4 Clinical factors in subset of 11 patients with MPI

From: A proposed magnetic resonance imaging grading system for the spectrum of central neonatal parasagittal hypoxic–ischaemic brain injury

Pat Number

G A (weeks)

Age at scan

Gender

A/natal sonar

A/natal risk fact

Prolonged labour

Epidural

Delivery

HIE (grade)

BW (g)

A/S

1 min

A/S

5 min

Vent

Seizures

Postnatal Ultrasound

Post-natal or Follow-up MRI/CT

Other

007

38/40

6

1

Nil performed

HIV, Prior C/S X2 for CPD

1st and 2nd stage

Yes

C/S

3

3000

0

1

Bag and SIMV

Early and severe

Not recorded

Not recorded

Foetal decelerations/severe bradycardia. Prolonged labour followed by delay in C/S (40 min) Severe maternal blood loss during C/S

95

41/40

12

1

Normal 18-week scan

Post-mature Nil else

1st and 2nd stage

No

NVD

3

3500

4

5

Oxygen by NP

Early and severe

U/s on day 15 and at 3 months showed hypoxic–ischaemic brain injury

Not recorded

CPD in a primigravida. Neonatal anaemia required transfusion. LP on Day 5 was normal

109

38/40

6

1

Normal scan performed at local clinic

HIV on antiretroviral therapy

1st and 2nd stage

No

NVD with vacuum

3

4400

6

9

Oxygen by NP

Early and severe

Post-natal ultrasound was normal on day 2

CT scan demonstrated fronto-parietal cortical atrophy at 5 months age

Prolonged second stage with failed vaginal delivery of large baby. Required vacuum extraction with multiple attempts

149

38/40

9

0

Normal scan performed at local clinic

Nil

1st and 2nd stage

No

NVD

3

2500

4

8

Oxygen by NP

Early and severe

Not recorded

CT Scan confirmed hypoxic brain injury with basal ganglia and cortical involvement

CPD in a primigravida

Prolonged labour

Normal LP

150

41/40

7

1

Normal scan at 25 weeks—by radiologist

Hyper

Tension

Post-mature

2nd stage

Yes

C/S

3

3800

3

5

SIMV

Early and severe

Normal ultrasound on day 2

Not recorded

Decreased foetal movement, tachycardia and complex variable decelerations. Late Foetal bradycardia, maternal hypotension

177

40/40

7

0

Normal scan performed at local clinic

Prior intra-uterine death

2nd stage

No

NVD

With forceps

3

3400

3

5

Oxygen by NP

Early and severe

Not recorded

Not recorded

Severe delay in second stage—140 min. Intravenous Pitocin. Repeated forceps application needed to deliver. Cord found wrapped around neck

190

38/40

9

0

Normal scan performed at local clinic

Nil

1st and 2nd stage

No

NVD

3

3500

3

4

Oxygen by NP

Early and severe

Not recorded

Not recorded

Severe caput and moulding related to CPD

219

41/40

5

0

Normal scan performed at local clinic at 17 weeks

Maternal obesity BMI 45

1st and 2nd stage

No

NVD

3

2860

4

5

NCPAP

Early and severe

Post-natal ultrasound was normal

MRI showed diffuse severe cortical atrophy, white matter loss and corpus callosum thinning

Pitocin augmented delivery. Whole body cooling commenced at 2 h of life, continued for 72 h after delivery. Required intravenous inotropic support

229

40/40

5

0

Normal scan performed at local clinic

HIV positive on antiretroviral therapy

1st and 2nd stage

Yes

C/S

3

2260

2

3

Oxygen by NP

Early and severe

Not recorded

Not recorded

IUGR is suspected given the foetal weight and gestational age. HIV may be associated with chorioamnionitis. Prolonged first and second stage, augmented by oxytocin and epidural used

234

40/40

3

0

Normal scan performed at Clinic at 20 weeks

Nil

2nd stage

No

NVD

3

3430

6

7

Bag

Early and severe

U/S normal after birth. U/S on day 8 showed oedema

CT scan showed no features of metabolic or genetic disorders. Thin Corpus callosum

Prolonged second stage of labour

Foetal distress. MSL. Aspiration

297

38/40

2

1

Normal second trimester scan by ob/gynae

Nil

2nd stage

Yes

C/S

3

3130

1

3

Bag

Early and severe

U/S on day 1 was normal. U/S on day 3 showed oedema

MRI on day 15 showed APA changes

CT scan at 6 months showed no progressive changes

Prolonged 2nd stage. Foetal distress. Failed forceps extraction. Cephalhematoma. Head cooling done

  1. Regarding gender: 0 = female, 1 = male
  2. Pat patient, GA gestational age, A/natal antenatal, C/S caesarean section, NVD normal vaginal delivery, CPD cephalo-pelvic disproportion, Vent ventilation, MSL meconium-stained liquor, SIMV synchronised Intermittent Mandatory Ventilation, LP lumbar puncture, NCPAP Nasal continuous positive airway pressure