Maternal and perinatal outcomes of minimally invasive fetal surgeries: experience from two reference centers in Rio de Janeiro, Brazil.

BACKGROUND: Concerns regarding high open surgery-related maternal morbidity have led to improvements in minimally invasive fetal surgeries. OBJECTIVE: To analyze the perinatal and maternal outcomes of minimally invasive fetal surgery performed in Rio de Janeiro, Brazil. DESIGN AND SETTING: Retrospective cohort study conducted in two tertiary reference centers. METHODS: This retrospective descriptive study was conducted using medical records from 2011 to 2019. The outcomes included maternal and pregnancy complications, neonatal morbidity, and mortality from the intrauterine period to hospital discharge. RESULTS: Fifty mothers and 70 fetuses were included in this study. The pathologies included twin-twin transfusion syndrome, congenital diaphragmatic hernia, myelomeningocele, lower urinary tract obstruction, pleural effusion, congenital upper airway obstruction syndrome, and amniotic band syndrome. Regarding maternal complications, 8% had anesthetic complications, 12% had infectious complications, and 6% required blood transfusions. The mean gestational age at surgery was 25 weeks, the mean gestational age at delivery was 33 weeks, 83% of fetuses undergoing surgery were born alive, and 69% were discharged from the neonatal intensive care unit. CONCLUSION: Despite the small sample size, we demonstrated that minimally invasive fetal surgeries are safe for pregnant women. Perinatal mortality and prematurity rates in this study were comparable to those previously. Prematurity remains the most significant problem associated with fetal surgery.

Maternal and perinatal outcomes of minimally invasive fetal surgeries: experience from two reference centers in Rio de Janeiro, Brazil

ABSTRACT BACKGROUND: Concerns regarding high open surgery-related maternal morbidity have led to improvements in minimally invasive fetal surgeries. OBJECTIVE: To analyze the perinatal and maternal outcomes of minimally invasive fetal surgery performed in Rio de Janeiro, Brazil. DESIGN AND SETTING: Retrospective cohort study conducted in two tertiary reference centers. METHODS: This retrospective descriptive study was conducted using medical records from 2011 to 2019. The outcomes included maternal and pregnancy complications, neonatal morbidity, and mortality from the intrauterine period to hospital discharge. RESULTS: Fifty mothers and 70 fetuses were included in this study. The pathologies included twin-twin transfusion syndrome, congenital diaphragmatic hernia, myelomeningocele, lower urinary tract obstruction, pleural effusion, congenital upper airway obstruction syndrome, and amniotic band syndrome. Regarding maternal complications, 8% had anesthetic complications, 12% had infectious complications, and 6% required blood transfusions. The mean gestational age at surgery was 25 weeks, the mean gestational age at delivery was 33 weeks, 83% of fetuses undergoing surgery were born alive, and 69% were discharged from the neonatal intensive care unit. CONCLUSION: Despite the small sample size, we demonstrated that minimally invasive fetal surgeries are safe for pregnant women. Perinatal mortality and prematurity rates in this study were comparable to those previously. Prematurity remains the most significant problem associated with fetal surgery.

Clinical and serological findings in pregnant women and newborns: patterns of coronavirus disease 2019 placental histopathology.

OBJECTIVE: The objective of this study was to evaluate the correlation between clinical and serological findings of pregnant women and newborns with patterns of histopathologic changes of the placenta diagnosed with coronavirus disease 2019. METHODS: A prospective descriptive study was conducted with pregnant women who were positive for SARS-CoV-2 by reverse transcription polymerase chain reaction or serology (IgG and IgM). Clinical analyses were performed using ELISA to detect anti-SARS-CoV-2 IgG and IgA antibodies using the S1 spike protein domain with the Euroimmun kit. Histopathologic analyses of placentas were performed by two expert pathologists. RESULTS: Maternal SARS-CoV-2 infection was associated with increased neonatal hospital length of stay (p=0.03), increased preterm birth (p=0.04), and Apgar score<7 at 1st min (p=0.00) and 5th min (p=0.02). Pregnant women with positive IgG and/or IgA at delivery had a higher incidence of placental histopathologic changes in addition to a greater likelihood of having an IgG-positive fetus (p<0.0001). Placentas with positive reverse transcription polymerase chain reaction for SARS-CoV-2 had a higher incidence of histopathologic changes such as maternal vascular hypoperfusion changes (p=0.00). CONCLUSION: Maternal SARS-CoV-2 infection was associated with adverse perinatal outcomes. Pregnant women with positive IgG at delivery had a higher incidence of placental histopathologic changes. Placentas with positive reverse transcription polymerase chain reaction for SARS-CoV-2 had a higher incidence of histopathologic changes such as maternal vascular hypoperfusion.

Clinical and serological findings in pregnant women and newborns: patterns of coronavirus disease 2019 placental histopathology

SUMMARY OBJECTIVE: The objective of this study was to evaluate the correlation between clinical and serological findings of pregnant women and newborns with patterns of histopathologic changes of the placenta diagnosed with coronavirus disease 2019. METHODS: A prospective descriptive study was conducted with pregnant women who were positive for SARS-CoV-2 by reverse transcription polymerase chain reaction or serology (IgG and IgM). Clinical analyses were performed using ELISA to detect anti-SARS-CoV-2 IgG and IgA antibodies using the S1 spike protein domain with the Euroimmun kit. Histopathologic analyses of placentas were performed by two expert pathologists. RESULTS: Maternal SARS-CoV-2 infection was associated with increased neonatal hospital length of stay (p=0.03), increased preterm birth (p=0.04), and Apgar score<7 at 1st min (p=0.00) and 5th min (p=0.02). Pregnant women with positive IgG and/or IgA at delivery had a higher incidence of placental histopathologic changes in addition to a greater likelihood of having an IgG-positive fetus (p<0.0001). Placentas with positive reverse transcription polymerase chain reaction for SARS-CoV-2 had a higher incidence of histopathologic changes such as maternal vascular hypoperfusion changes (p=0.00). CONCLUSION: Maternal SARS-CoV-2 infection was associated with adverse perinatal outcomes. Pregnant women with positive IgG at delivery had a higher incidence of placental histopathologic changes. Placentas with positive reverse transcription polymerase chain reaction for SARS-CoV-2 had a higher incidence of histopathologic changes such as maternal vascular hypoperfusion.

Resultados perinatais de cirurgias fetais minimamente invasivas: experiência de dois centros de referência / Perinatal results of minimally invasive fetal surgeries: the experience of two reference centers

Objetivo: Analisar os resultados perinatais das cirurgias fetais minimamente invasivas realizadas em dois centros de referências no Rio de Janeiro ­ Brasil. Metodologia: Foi realizado estudo descritivo retrospectivo através de revisão de prontuários entre 2011 e 2019. Os desfechos analisados foram complicações maternas, complicações durante a gestação, morbidade e mortalidade neonatal. Complicações maternas foram consideradas todas as complicações anestésicas, complicações infecciosas e/ou necessidade de hemotransfusão. Resultados: Foram incluídas 50 gestantes, sendo 20 gestações múltiplas, totalizando 70 fetos. As patologias fetais incluídas foram: síndrome de transfusão feto-fetal (STFF), hérnia diafragmática congênita (HDC), mielomeningocele (MMC), obstrução do trato urinário inferior (OTUI), derrame pleural e síndrome de obstrução congênita da via aérea superior e síndrome de banda amniótica. A média de idade das gestantes foi de 33 anos, e 72% não tinham comorbidades. Antibiotico profilático foi realizado em 82% das cirurgias e 72% das pacientes receberam tocólise. A idade gestacional média no momento da cirurgia foi de 25 semanas e o tempo médio de cirurgia foi de 80 minutos. Em relação às complicações maternas, 8% tiveram complicações anestésicas, 12% tiveram complicações infecciosas e 6% necessitaram de hemotransfusão. No momento da cirurgia, 22% das gestantes tiveram algum tipo de complicação e 72% tiveram complicações anteparto após a cirurgia. A idade gestacional média no parto foi de 33 semanas, 83% nasceram vivos e 69% tiveram alta da UTI neonatal. Conclusão: Apesar da pequena amostra, os nossos resultados são semelhantes aos descritos na literatura internacional. A prematuridade é uma das principais complicações encontradas em nosso estudo.

Objective: To analyze the perinatal results of minimally invasive fetal surgeries performed in 2 reference centers in Rio de Janeiro ­ Brazil. Methodology: It was a retrospective descriptive study based on the analysis of medical records between 2011 and 2019. Outcomes were maternal complications, pregnancy complications, neonatal morbidity and neonatal mortality. Results: Fifty patients were included, 20 were multiple pregnancy, totaling 70 fetuses. The pathologies included were Twin-twin Transfusion Syndrome (TTTS), Congenital Diaphragmatic Hernia (CDH), Myelomeningocele (MMC), Lower Urinary Tract Obstruction, Pleural Effusion, Congenital Upper Airway Obstruction Syndrome (CHAOS) and Amniotic Band Syndrome. The mean age of patients was 33 years and 72% had no comorbidity. A total of 82% received prophylactic antibiotics, 72% received tocolysis. Mean gestational age at surgery was 25 weeks and mean surgery time was 80 minutes. Regarding maternal complications, 8% had anesthetic complications, 12% had infectious complications and 6% required blood transfusion. A total of 22.0% of surgeries had intraoperative complications and 76.6% had antepartum complications after surgery. The mean gestational age at delivery was 33 weeks, 82.9% of fetuses undergoing surgery were born alive and 75.7% were discharged from the NICU. Conclusion: Although our small sample, the results found are compatible with those shown at the literature. Prematurity was one of the main problems found in our study.