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1.
Medicina (Kaunas) ; 57(7)2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34203545

RESUMO

Coronavirus disease 2019 (COVID-19) has rapidly evolved into a worldwide pandemic causing a serious global public health problem. The risk of vertical transmission of SARS-CoV-2 is still debated, and the consequences of this virus on pregnant women and their fetuses remain unknown. We report a case of pregnancy complicated with hydrops fetalis that developed 7 weeks after recovery from a mild SARS-CoV-2 infection, leading to intrauterine death of the foetus. Evidence of SARS-CoV-2 placentitis was demonstrated by the presence of viral particles in the placenta identified by immunohistochemistry. As we excluded all possible etiological factors for non-immunologic hydrops fetalis, we believe that the fetal consequences of our case are related to vertical transmission of SARS-CoV-2 virus. To the best of our knowledge, this is the second reported case in the literature of COVID-19 infection complicated with hydrops fetalis and intrauterine fetal demise.


Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , Feminino , Morte Fetal/etiologia , Humanos , Hidropisia Fetal/etiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , SARS-CoV-2 , Natimorto
3.
N Engl J Med ; 385(5): 436-444, 2021 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-34320288

RESUMO

BACKGROUND: Primary cytomegalovirus (CMV) infection during pregnancy carries a risk of congenital infection and possible severe sequelae. There is no established intervention for preventing congenital CMV infection. METHODS: In this multicenter, double-blind trial, pregnant women with primary CMV infection diagnosed before 24 weeks' gestation were randomly assigned to receive a monthly infusion of CMV hyperimmune globulin (at a dose of 100 mg per kilogram of body weight) or matching placebo until delivery. The primary outcome was a composite of congenital CMV infection or fetal or neonatal death if CMV testing of the fetus or neonate was not performed. RESULTS: From 2012 to 2018, a total of 206,082 pregnant women were screened for primary CMV infection before 23 weeks of gestation; of the 712 participants (0.35%) who tested positive, 399 (56%) underwent randomization. The trial was stopped early for futility. Data on the primary outcome were available for 394 participants; a primary outcome event occurred in the fetus or neonate of 46 of 203 women (22.7%) in the group that received hyperimmune globulin and of 37 of 191 women (19.4%) in the placebo group (relative risk, 1.17; 95% confidence interval [CI] 0.80 to 1.72; P = 0.42). Death occurred in 4.9% of fetuses or neonates in the hyperimmune globulin group and in 2.6% in the placebo group (relative risk, 1.88; 95% CI, 0.66 to 5.41), preterm birth occurred in 12.2% and 8.3%, respectively (relative risk, 1.47; 95% CI, 0.81 to 2.67), and birth weight below the 5th percentile occurred in 10.3% and 5.4% (relative risk, 1.92; 95% CI, 0.92 to 3.99). One participant in the hyperimmune globulin group had a severe allergic reaction to the first infusion. Participants who received hyperimmune globulin had a higher incidence of headaches and shaking chills while receiving infusions than participants who received placebo. CONCLUSIONS: Among pregnant women, administration of CMV hyperimmune globulin starting before 24 weeks' gestation did not result in a lower incidence of a composite of congenital CMV infection or perinatal death than placebo. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Center for Advancing Translational Sciences; ClinicalTrials.gov number, NCT01376778.).


Assuntos
Infecções por Citomegalovirus/congênito , Imunoglobulinas Intravenosas/uso terapêutico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adulto , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/mortalidade , Infecções por Citomegalovirus/prevenção & controle , Método Duplo-Cego , Feminino , Morte Fetal/etiologia , Morte Fetal/prevenção & controle , Doenças Fetais/prevenção & controle , Humanos , Incidência , Lactente , Mortalidade Infantil , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Infusões Intravenosas , Gravidez , Falha de Tratamento
4.
Placenta ; 112: 97-104, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34329973

RESUMO

INTRODUCTION: Pregnant women with covid-19 are more likely to experience preterm birth. The virus seems to be associated with a wide range of placental lesions, none of them specific. METHOD: We collected cases of Covid-19 maternal infection during pregnancy associated with poor pregnancy outcomes, for which we received the placenta. We studied clinical data and described pathological findings of placenta and post-mortem examination of fetuses. We performed an immunohistochemical study and RT-PCR of SARS-Cov-2 on placenta samples. RESULTS: We report 5 cases of poor fetal outcome, 3 fetal deaths and 2 extreme premature neonates, one with growth restriction, without clinical and biological sign of SARS-Cov-2 infection. All placenta presented massive perivillous fibrin deposition and large intervillous thrombi associated with strong SARS-Cov-2 expression in trophoblast and SARS-CoV-2 PCR positivity in amniotic fluid or on placenta samples. Chronic histiocytic intervillositis was present in 4/5 cases. Placental ultrasound was abnormal and the sFLT1-PIGF ratio was increased in one case. Timing between mothers' infection and the poor fetal outcome was ≤10 days in 4 cases. The massive placental damage are directly induced by the virus whose receptors are expressed on trophoblast, leading to trophoblast necrosis and massive inflammation in villous chamber, in a similar way it occurs in diffuse alveolar damage in adults infected by SARS-Cov-2. DISCUSSION: SARS-Cov-2 can be associated to a rare set of placental lesions which can lead to fetal demise, preterm birth, or growth restriction. Stronger surveillance of mothers infected by SARS-Cov-2 is required.


Assuntos
COVID-19/complicações , Doenças Placentárias/etiologia , Nascimento Prematuro/etiologia , Natimorto , Adulto , COVID-19/diagnóstico , COVID-19/patologia , Feminino , Morte Fetal/etiologia , França , Humanos , Recém-Nascido , Masculino , Morte Perinatal/etiologia , Placenta/patologia , Placenta/virologia , Doenças Placentárias/diagnóstico , Doenças Placentárias/patologia , Doenças Placentárias/virologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/patologia , Resultado da Gravidez , Nascimento Prematuro/patologia , Nascimento Prematuro/virologia , SARS-CoV-2/fisiologia , Trofoblastos/patologia , Trofoblastos/virologia
5.
Cad Saude Publica ; 37(7): e00265920, 2021.
Artigo em Português | MEDLINE | ID: mdl-34287588

RESUMO

Although the Brazilian List of Avoidable Causes of Deaths (LBE in Portuguese), in its version for children under 5 years of age (LBE < 5), does not include stillbirths, some studies have used the list with or without adaptations. We present a proposal for adaptation of the LBE for stillbirths (LBE-OF in Portuguese) and the results of its application to stillbirths in the State of Rio de Janeiro, Brazil, in 2018, compared to the results with LBE < 5. We reviewed the categories from the 10th revision of the International Classification of Diseases (ICD-10) in the LBE < 5 and reassigned them in the avoidability groups, according to time of death in relation to delivery and the causes consistent with stillbirths. Conditions that did not elucidate the determinants of death were allocated as ill-defined causes. Stillbirths in the State of Rio de Janeiro, selected from the databases of the Mortality Information System (SIM in Portuguese), were classified according to LBE-OF and LBE < 5. When classifying the 2,585 stillbirths that occurred in the State of Rio de Janeiro in 2018, we found that according to LBE < 5, there were predominantly causes "reducible by adequate care in labor and delivery" (42.9%), while according to LBE-OF, the most frequent causes were "reducible by adequate care for during pregnancy" (43.6%). Ill-defined causes ranked second according to the LBE-OF (35.4%) and third according to LBE < 5. Some 30% of stillbirths changed groups and subgroups of avoidability, showing greater consistency with the profile of obstetric care. Although identifying a higher percentage of ill-defined causes, the LBE-OF is more consistent with the pathophysiology of fetal deaths. The inclusion of stillbirths in the SIM would be a positive step in monitoring and upgrading the investigation of causes of fetal death.


Assuntos
Morte Fetal , Classificação Internacional de Doenças , Brasil/epidemiologia , Causas de Morte , Criança , Pré-Escolar , Feminino , Morte Fetal/etiologia , Humanos , Assistência Médica , Gravidez
6.
Vet J ; 273: 105675, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34148598

RESUMO

The peripartum period is critical in equine medicine for maintaining healthy mares, and ensuring the delivery of healthy neonatal foals. The field of perinatal mortality in horses is continuously evolving, with several advances being recently made in causes of perinatal fetal and foal loss. This review details the main causes of perinatal loss in horses, through late pregnancy, parturition and the neonatal period. Recent advances in identification of infectious organisms and indicators of survival in neonatal foals will be discussed. Continued advances in reproductive and neonatal medicine will aid improved survival of foals through fewer pregnancy losses, and improved management of high-risk pregnancies and critically ill neonatal foals.


Assuntos
Animais Recém-Nascidos , Doenças dos Cavalos/etiologia , Doenças dos Cavalos/mortalidade , Aborto Animal/etiologia , Animais , Feminino , Morte Fetal/etiologia , Doenças dos Cavalos/epidemiologia , Cavalos , Humanos , Parto , Período Periparto , Gravidez , Natimorto/veterinária
7.
J Am Heart Assoc ; 10(12): e019713, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34098741

RESUMO

Background Tetralogy of Fallot with absent pulmonary valve is associated with high mortality, but it remains difficult to predict outcomes prenatally. We aimed to identify risk factors for mortality in a large multicenter cohort. Methods and Results Fetal echocardiograms and clinical data from 19 centers over a 10-year period were collected. Primary outcome measures included fetal demise and overall mortality. Of 100 fetuses, pregnancy termination/postnatal nonintervention was elected in 22. Of 78 with intention to treat, 7 (9%) died in utero and 21 (27%) died postnatally. With median follow-up of 32.9 months, no deaths occurred after 13 months. Of 80 fetuses with genetic testing, 46% had chromosomal abnormalities, with 22q11.2 deletion in 35%. On last fetal echocardiogram, at a median of 34.6 weeks, left ventricular dysfunction independently predicted fetal demise (odds ratio [OR], 7.4; 95% CI 1.3, 43.0; P=0.026). Right ventricular dysfunction independently predicted overall mortality in multivariate analysis (OR, 7.9; 95% CI 2.1-30.0; P=0.002). Earlier gestational age at delivery, mediastinal shift, left ventricular/right ventricular dilation, left ventricular dysfunction, tricuspid regurgitation, and Doppler abnormalities were associated with fetal and postnatal mortality, although few tended to progress throughout gestation on serial evaluation. Pulmonary artery diameters did not correlate with outcomes. Conclusions Perinatal mortality in tetralogy of Fallot with absent pulmonary valve remains high, with overall survival of 64% in fetuses with intention to treat. Right ventricular dysfunction independently predicts overall mortality. Left ventricular dysfunction predicts fetal mortality and may influence prenatal management and delivery planning. Mediastinal shift may reflect secondary effects of airway obstruction and abnormal lung development and is associated with increased mortality.


Assuntos
Ecocardiografia Doppler em Cores , Morte Fetal/etiologia , Coração Fetal/diagnóstico por imagem , Valva Pulmonar/diagnóstico por imagem , Tetralogia de Fallot/diagnóstico por imagem , Ultrassonografia Pré-Natal , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Canadá , Coração Fetal/anormalidades , Coração Fetal/fisiopatologia , Humanos , Valor Preditivo dos Testes , Prognóstico , Valva Pulmonar/anormalidades , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tetralogia de Fallot/complicações , Tetralogia de Fallot/mortalidade , Tetralogia de Fallot/fisiopatologia , Estados Unidos , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/mortalidade , Disfunção Ventricular Direita/fisiopatologia
8.
Pediatr Dev Pathol ; 24(5): 450-454, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34082613

RESUMO

An emerging complication of COVID-19 (SARS-CoV-2) infection is reported. A 23-year-old patient presented with high temperature and reduced fetal movements at 25 + 5/40 weeks of gestation. RT-PCR proved maternal COVID-19 infection. Ultrasound examination confirmed intrauterine death. Placenta histology showed necrosis of the villous trophoblast, associated with Chronic Histiocytic Intervillositis (CHI) and Massive Perivillous Fibrin Deposition (MPFD) with up to 90% - of the intervillous spaces being involved. Immunohistochemistry showed CD68 positive histiocytes in the intervillous spaces and the villous trophoblast was positive for the COVID-19 spike protein. RNA scope signal was indicative of the presence of the viral genome and active viral replication in the villous trophoblastic cells, respectively. MPFD is a gradually developing end-stage disease with various etiology, including autoimmune and alloimmune maternal response to antigens expressed at the feto-maternal interface and frequently accompanies chronic alloimmune villitis or histiocytic intervillositis. Covid-19 infection is associated with similar pattern of histological changes of the placenta leading to placental insufficiency and fetal death. This case report supports maternal- fetal vertical transmission of SARS-CoV-2 virus leading to placental insufficiency and fetal demise. MPFD and CHI appear to be the typical placental histology for SARS-CoV-2 virus infection associated fetal demise.


Assuntos
COVID-19/virologia , Vilosidades Coriônicas/virologia , Fibrina/metabolismo , Complicações Infecciosas na Gravidez/virologia , SARS-CoV-2/patogenicidade , Adulto , Vilosidades Coriônicas/patologia , Feminino , Morte Fetal/etiologia , Histiócitos/virologia , Humanos , Placenta/patologia , Placenta/virologia , Gravidez , Complicações Infecciosas na Gravidez/patologia , RNA Viral
9.
Placenta ; 109: 72-74, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34034016

RESUMO

Whether early SARS-CoV-2 definitively increases the risk of stillbirth is unknown, though studies have suggested possible trends of stillbirth increase during the pandemic. This study of third trimester stillbirth does not identify an increase in rates during the first wave of the pandemic period, however investigation of the placental pathology demonstrates trends towards more vascular placental abnormalities.


Assuntos
COVID-19/epidemiologia , Doenças Placentárias/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Terceiro Trimestre da Gravidez , Natimorto/epidemiologia , Adulto , COVID-19/complicações , COVID-19/mortalidade , Causas de Morte , Feminino , Morte Fetal/etiologia , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Pandemias , Placenta/patologia , Doenças Placentárias/etiologia , Doenças Placentárias/patologia , Doenças Placentárias/virologia , Gravidez , Complicações Infecciosas na Gravidez/mortalidade , SARS-CoV-2/fisiologia , Estados Unidos/epidemiologia , Adulto Jovem
10.
Mod Pathol ; 34(9): 1704-1709, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34006935

RESUMO

Placental pathology in SARS-CoV-2-infected pregnancies seems rather unspecific. However, the identification of the placental lesions due to SARS-CoV-2 infection would be a significant advance in order to improve the management of these pregnancies and to identify the mechanisms involved in a possible vertical transmission. The pathological findings in placentas delivered from 198 SARS-CoV-2-positive pregnant women were investigated for the presence of lesions associated with placental SARS-CoV-2 infection. SARS-CoV-2 infection was investigated in placental tissues through immunohistochemistry, and positive cases were further confirmed by in situ hybridization. SARS-CoV-2 infection was also investigated by RT-PCR in 33 cases, including all the immunohistochemically positive cases. Nine cases were SARS-CoV-2-positive by immunohistochemistry, in situ hybridization, and RT-PCR. These placentas showed lesions characterized by villous trophoblast necrosis with intervillous space collapse and variable amounts of mixed intervillous inflammatory infiltrate and perivillous fibrinoid deposition. Such lesions ranged from focal to massively widespread in five cases, resulting in intrauterine fetal death. Two of the stillborn fetuses showed some evidence of SARS-CoV-2 positivity. The remaining 189 placentas did not show similar lesions. The strong association between trophoblastic damage and placenta SARS-CoV-2 infection suggests that this lesion is a specific marker of SARS-CoV-2 infection in placenta. Diffuse trophoblastic damage, massively affecting chorionic villous tissue, can result in fetal death associated with COVID-19 disease.


Assuntos
COVID-19/complicações , Morte Fetal/etiologia , Complicações Infecciosas na Gravidez/patologia , Trofoblastos/patologia , Adulto , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/virologia , SARS-CoV-2
12.
Vet J ; 272: 105660, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33941334

RESUMO

Porcine circovirus type 2 (PCV2) causes a variety of clinical conditions including PCV2-associated reproductive disease (PCV2-RD) characterized by late term abortions and mummifications. The generally accepted diagnostic triad includes the presence of reproductive disorders, the histopathological finding of myocarditis, and detection of moderate to high viral loads within the heart tissue. A new threshold of 109 PCV2 genome equivalents (GE)/g heart tissue is suggested to fulfil the third criterion using the diagnostic settings of quantitative real time PCR and in situ hybridization of 30 fetal heart tissues. The need to identify histopathological lesions in fetal heart tissue appears to be invalid or overestimated in confirming a diagnosis of PCV2-RD, at least at the individual fetus level. The highest viral loads (1012 GE/g tissue) were detected in autolyzed and mummified piglets and were identified as PCV2d, although concurrent detection of PCV2d + a and PCV2d + b also occurred.


Assuntos
Infecções por Circoviridae/veterinária , Circovirus , Complicações na Gravidez/veterinária , Doenças dos Suínos/diagnóstico , Doenças dos Suínos/virologia , Aborto Animal/diagnóstico , Aborto Animal/virologia , Animais , Infecções por Circoviridae/diagnóstico , Infecções por Circoviridae/patologia , Feminino , Morte Fetal/etiologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/virologia , Suínos , Doenças dos Suínos/patologia
13.
BJOG ; 128(11): 1775-1781, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33837600

RESUMO

OBJECTIVES: To evaluate the recurrence risk of stillbirth. DESIGN: Retrospective cohort study. SETTING AND POPULATION: All births 1992-2017, Alberta, Canada. METHODS: Retrospective cohort study. MAIN OUTCOME MEASURES: Stillbirth was defined as the death in utero of a fetus with gestational age ≥20 weeks or weighing ≥500 g. Stillbirths were further subdivided into those occurring before labour and those in labour. RESULTS: We identified 744 897 births from 308 478 women. Of these, 3698 women experienced a stillbirth and, of these, 97.7%, experienced only one. For women with a small-for-gestational- age stillbirth in the first birth, their risk of a subsequent antepartum stillbirth was increased substantially: 4.09%, relative risk (RR) 10.39, 95% CI 5.81-18.59. For women with a first birth appropriate-for-gestational-age stillbirth with no risk factors such as pregnancy induced hypertension, the risk with pre-existing diabetes mellitus or hypertension was also increased but to a much lesser degree (RR 2.46, 95% CI 1.23-4.91). For women who had experienced a first birth intrapartum stillbirth, the risk of another intrapartum stillbirth was very high (3.59%, RR 36.50, 95% CI 20.17-66.05). Most of these births also occurred prior to 24 weeks' gestation: 83% (10/12). CONCLUSIONS: The risk of recurrent antepartum stillbirth is low. The increase in risk in instances where the antepartum stillbirth was not growth-restricted is not clinically meaningful. Given the very low risk in any given gestational week, fetal surveillance is unlikely to be effective and may lead to unnecessary interventions. Intrapartum stillbirth has a very high recurrence risk but may not be preventable. TWEETABLE ABSTRACT: Stillbirth recurrence is rare.


Assuntos
Morte Fetal/etiologia , Cuidado Pré-Natal/estatística & dados numéricos , Natimorto/epidemiologia , Adulto , Alberta/epidemiologia , Feminino , Morte Fetal/prevenção & controle , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
14.
PLoS One ; 16(4): e0250734, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33901244

RESUMO

BACKGROUND: Most studies on chromosomal microarray analysis (CMA) and amniocentesis risks have not evaluated pregnancies with low risk for genetic diseases; therefore, the efficacy and safety of CMA and amniocentesis in this population are unclear. This study aimed to examine the benefits and risks of prenatal genetic diagnostic tests in pregnancies having low risk for chromosomal diseases. METHODS AND FINDINGS: In this retrospective study, we used clinical data from a large database of 30,830 singleton pregnancies at gestational age 16-23 weeks who underwent amniocentesis for karyotyping with or without CMA. We collected socio-demographic, medical and obstetric information, along with prenatal screening, CMA and karyotyping results. Fetal loss events were also analysed. CMA was performed in 5,837 pregnancies with normal karyotype (CMA cohort). In this cohort, 4,174 women had normal prenatal screening results and the risk for identifying genetic abnormalities with >10% risk for intellectual disability by CMA was 1:102, with no significant difference between maternal age groups. The overall post-amniocentesis fetal loss rate was 1:1,401 for the entire cohort (n = 30,830) and 1:1,945 for the CMA cohort (n = 5,837). The main limitation of this study is the relatively short follow-up of 3 weeks, which may not have been sufficient for detecting all fetal loss events. CONCLUSION: The low risk for post-amniocentesis fetal loss, compared to the rate of severe genetic abnormalities detected by CMA, suggests that even pregnant women with normal prenatal screening results should consider amniocentesis with CMA.


Assuntos
Transtornos Cromossômicos/diagnóstico , Análise em Microsséries/métodos , Adulto , Amniocentese/efeitos adversos , Aberrações Cromossômicas , Transtornos Cromossômicos/genética , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/genética , Bases de Dados Factuais , Feminino , Morte Fetal/etiologia , Idade Gestacional , Humanos , Cariotipagem , Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Fatores de Risco
15.
Eur J Obstet Gynecol Reprod Biol ; 260: 150-153, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33773261

RESUMO

The clinical management of intrauterine fetal demise (IUFD) in women with a previous cesarean delivery presents a dilemma for the obstetrician. With the current reluctance of obstetricians to perform vaginal birth after cesarean (VBAC) and the paucity of data to counsel women regarding maternal risks, management options are limited by physician's clinical experience and biases. In the setting of fetal demise, maternal safety becomes the primary concern. Medicolegal pressures may prevent physicians from attempting a trial of labor in this situation. In this review we will a focus on frequency of birth with IUFD after cesarean section (CS), we discuss the options (VBAC vs CS), different complications, methods for induction of vaginal birth as well as risk factors of vaginal birth and cesarean delivery.


Assuntos
Trabalho de Parto , Nascimento Vaginal Após Cesárea , Cesárea/efeitos adversos , Feminino , Morte Fetal/etiologia , Humanos , Parto , Gravidez , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea/efeitos adversos
16.
Cad Saude Publica ; 37(2): e00079120, 2021.
Artigo em Português | MEDLINE | ID: mdl-33729304

RESUMO

This study aimed to analyze the time trend in stillbirth rate (SBR) and the contribution by investigation to improving the definition of underlying cause of stillbirth in the city of São Paulo, Brazil, according to the place where the death certificate was issued. An ecological approach was used to analyze the trend in SBR by weight stratum (< 2,500g and ≥ 2,500g) and total deaths in the city in 2007-2017. Prais-Winsten generalized linear regression was used. The study of cases analyzed the underlying causes of stillbirth from 2012 to 2014, before and after the investigation, time of conclusion of the investigation, and redefinition of the underlying cause of stillbirths by type of issuer. In deaths with < 2,500g, there was an upward trend in SBR of 1.5% per year and a reduction (-1.3% per year) in stillbirths ≥ 2,500g. Total deaths presented a stable trend. In 2012-2014, 90% of deaths with ≥ 2,500g were investigated. After investigation, the underlying cause of death was redefined in 15% of the deaths, and not otherwise specified stillbirth (P95) represented 25% of the causes of death. The highest proportion of changes in the underlying cause of death occurred in deaths for which the death certificate was issued by the death certification review service (17%), while in health services the proportion was 10.6%. In conclusion, the SBR in deaths with ≥ 2,500g showed a downward trend. There was a significant redefinition of underlying causes, especially in those attested by the death certification review service. However, the redefinition was insufficient to expand the proportion of causes of death that would allow a better understanding of the mortality conditions.


Assuntos
Morte Fetal , Peso Corporal , Brasil/epidemiologia , Causas de Morte , Cidades , Morte Fetal/etiologia , Humanos
17.
Taiwan J Obstet Gynecol ; 60(2): 328-330, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33678336

RESUMO

OBJECTIVE: To present a rare case of endometriosis-related spontaneous hemoperitoneum in pregnancy (SHiP) with atypical subacute symptoms, which is likely to be mistaken as an infectious disease initially. CASE REPORT: A 35-year-old primigravid woman presented with diffuse lower abdominal pain and signs of peritoneal irritation for five days at 18 weeks' gestation, and the initial diagnosis was acute peritonitis. An abrupt deterioration with maternal shock and stillbirth of fetus was found in spite of close observation in emergent department. Emergent laparotomy was performed for delay-appeared hemoperitoneum. Bleeding from decidualized endometriotic tissue over posterior uterine surface was found, and hemostasis was achieved with uterine preservation. The patient recovered smoothly. CONCLUSION: SHiP is a serious obstetric complication of endometriosis with diagnostic difficulty. Its initial presentation may mimic infectious disease, so close monitoring for possible abrupt deterioration is crucial. Early detection and timely management are the key to avoid adverse pregnancy outcomes.


Assuntos
Dor Abdominal/etiologia , Endometriose/complicações , Hemoperitônio/etiologia , Complicações na Gravidez/etiologia , Dor Abdominal/cirurgia , Adulto , Feminino , Morte Fetal/etiologia , Hemoperitônio/cirurgia , Humanos , Gravidez , Complicações na Gravidez/cirurgia , Segundo Trimestre da Gravidez
18.
Sci Rep ; 11(1): 6737, 2021 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-33762593

RESUMO

To describe the prevalence and spectrum of cardio-pathogenic variants in singleton fetuses after unexplained intrauterine fetal death (IUFD). DNA from post-mortem fibroblastic tissue samples of 16 fetuses after unexplained IUFD was retrieved at two tertiary university hospitals for clinical exome sequencing with subsequent filtering of 122 cardio-specific genes to elucidate underlying cardio-pathogenic variants. In total, we included 12 (75%) male and four (25%) female fetuses who were stillborn at a median gestational age of 34+6 (23+2-40+5) weeks. In two (12.5%) fetuses no cardio-pathogenic variants were found. In 14 (87.5%) fetuses, overall 33 variants were detected in 22 cardio-specific genes, involving 14 (63.63%) genes associated with cardiomyopathy, six (27.27%) arrhythmogenic susceptibility genes and two (9.09%) arrhythmia and cardiomyopathy associated genes. Among the 33 variants, five (15.2%) were classified as likely benign according to the American College of Medical Genetics and Genomics; 28 (84.8%) variants were considered as variants of uncertain significance. Compared to a cohort of explained IUFDs, the cases with and without fetal variants in cardiac genes differed not significantly regarding maternal age, previous history of stillbirth, time of stillbirth or fetal sex. Unexplained stillbirth may be caused by cardio-genetic pathologies, yet a high number of variants of uncertain significance merit a more detailed post-mortem examination including family segregation analysis.


Assuntos
Cardiomiopatias/complicações , Cardiomiopatias/genética , Morte Fetal/etiologia , Variação Genética , Natimorto/epidemiologia , Áustria/epidemiologia , Feminino , Predisposição Genética para Doença , Humanos , Projetos Piloto , Gravidez , Estudos Retrospectivos
19.
Pediatr Dev Pathol ; 24(3): 241-245, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33593145

RESUMO

Heterotopic liver tissue in the umbilical cord is rare, and the outcome is quite unpredictable based on the few reported cases. We present a case of heterotopic liver nodule in the umbilical cord of a midtrimester fetus who died in utero. Although such association has only been reported once, heterotopic nodular tissue in the umbilical cord must be regarded as a potential cause of fetal demise by a mechanism analogous to the more common umbilical cord abnormalities resulting in umbilical vessel compromise.


Assuntos
Coristoma/patologia , Morte Fetal/etiologia , Fígado/patologia , Cordão Umbilical/anormalidades , Cordão Umbilical/patologia , Feminino , Humanos , Gravidez , Artéria Umbilical Única/patologia
20.
Pediatr Dev Pathol ; 24(3): 246-251, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33617361

RESUMO

Optimal management of intrauterine infection to avoid serious adverse perinatal outcomes entails prompt administration of antibiotics and consideration of early delivery of the fetus to remove the focus of infection. We report an unusual case of preterm chorioamnionitis which did not improve with sensitive antibiotics, or delivery of the fetus, and ultimately required an emergency hysterectomy to save the mother's life. Interestingly, subsequent histopathological analysis of the post-hysterectomy specimen did not reveal myometrial necrosis or infectious microorganisms. The placental pathological examination, on the other hand, showed evidence of necrotising chorioamnionitis accompanied by a rarely reported lesion: acute villitis with abundant intravascular Escherichia coli, a finding which is strongly associated with fetal demise and adverse maternal outcomes.


Assuntos
Corioamnionite/microbiologia , Vilosidades Coriônicas/microbiologia , Infecções por Escherichia coli/complicações , Sepse/microbiologia , Corioamnionite/patologia , Vilosidades Coriônicas/patologia , Feminino , Morte Fetal/etiologia , Humanos , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/patologia
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