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1.
BMC Vet Res ; 19(1): 169, 2023 Sep 21.
Artículo en Inglés | MEDLINE | ID: mdl-37735392

RESUMEN

BACKGROUND: Parvoviruses are icosahedral, nonenveloped viruses with single-stranded DNA genomes of approximately 5 kb in length. In recent years, parvoviruses have frequently mutated and expanded their host range to cause disease in many wild animals by altering their tissue tropism. Animal infection mainly results in acute enteritis and inflammation of other organs. In this study, we used a viral metagenomic method to detect a novel parvovirus species in a red-crowned crane that died due to severe diarrhea in China. RESULTS: The presence of the viral genome in the kidney, lung, heart, liver, and intestine were confirmed by PCR. Histopathological examination of the intestine showed a large number of infiltrated inflammatory cells. The JL21/10 strain of the red-crowned crane parvovirus was first isolated from the intestine. Whole-genome sequence analysis showed that JL21/10 shared high identity with the red-crowned crane Parvovirinae strains yc-8 at the nucleotide level (96.61%). Phylogenetic analysis of the complete genome and NS1 gene revealed that the JL21/10 strain clustered with strains in chicken and revealed a close genetic relationship with the red-crowned crane parvovirus strains.The complete of VP2 gene analysis showed that JL21/10 shared identity with the red-crowned crane yc-8 strains (97.7%), chicken (55.4%),ducks(31.0%) and geese(30.1%) at the amino acid level. The result showed that red-crowned crane parvovirus may be cross-species transmission to chicken. However, There is little possibility of transmission to ducks and geese. CONCLUSION: This is the first isolation and identification of a parvovirus in red-crowned crane that was associated with severe diarrhea.


Asunto(s)
Infecciones por Parvoviridae , Parvovirus , Animales , Filogenia , Infecciones por Parvoviridae/veterinaria , Pollos , Patos , Gansos , China , Diarrea/veterinaria , Parvovirus/genética
2.
Microb Pathog ; 159: 105134, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34400283

RESUMEN

Aeromonas veronii (A. veronii, AV) strains are emerging zoonotic and aquatic pathogens, yet we know very little about their genomics. This study aims to utilize comparative genomics to investigate the intraspecific genetic diversity, differences in virulence factors and evolutionary mechanisms of A. veronii strains from diverse sources and to fundamentally demonstrate their pathogenic mechanisms. We conducted comparative genomics analysis of 39 A. veronii strains from different sources and found that 1993 core genes are shared by these strains and that these shared core genes may be necessary to maintain the basic characteristics of A. veronii. Additionally, phylogenetic relationship analysis based on these shared genes revealed that a distant relationship between the AMC34 strain and the other 38 strains but that, the genetic relationship among the 38 strains is relatively close, indicating that AMC34 may not belong to A. veronii. Furthermore, analysis of shared core genes and average nucleotide identity (ANI) values showed no obvious correlation with the location of A. veronii isolation and genetic relationship. Our research indicates the evolutionary mechanism of A. veronii from different sources and provides new insights for a deeper understanding of its pathogenic mechanism.


Asunto(s)
Aeromonas , Infecciones por Bacterias Gramnegativas , Aeromonas/genética , Aeromonas veronii/genética , Genómica , Humanos , Filogenia , Factores de Virulencia/genética
3.
BMC Vet Res ; 16(1): 80, 2020 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-32138728

RESUMEN

BACKGROUND: Duck circovirus (DuCV) is a potential immunosuppressive virus that causes feather disorders in young ducks. In this study, DuCV obtained from various species of ducks was investigated by polymerase chain reaction (PCR) in southern and southwestern China (Guangdong, Guangxi and Yunnan provinces) from 2018 to 2019. RESULTS: A total of 848 bursa samples were collected from dead Mulard, Cherry Valley Pekin, Muscovy and Mallard ducks from duck farms. The positivity rate of DuCV in the total sample was approximately 36.91%. We found that the prevalence of DuCV in Yunnan (43.09%) was higher than those in Guangxi (34.38%) and Guangdong (34.4%). However, the positivity rates of DuCV in the four duck species were not significantly different (P > 0.05). Nineteen randomly selected complete viral genomes were sequenced. The complete genomes of the DuCV were 1987 to 1995 nt in length, and were 81.7-99.3% homologous to the other 57 sequences in GenBank. Phylogenetic analyses based on the complete genomes of 76 DuCVs showed that the 19 novel DuCV sequences from Guangdong and Guangxi provinces mainly belonged to the DuCV-1 and DuCV-2 genetic groups, respectively. However, the two genotype groups coexisted in Yunnan Province. In addition, recombination analysis showed putative recombination sites in 3 strains in Yunnan that originated from strains Guangdong and Guangxi. Interestingly, the epidemiological investigation showed that Mulard ducks, Cherry Valley Pekin ducks and Muscovy ducks more than 4 weeks old were more susceptible to infection with the novel DuCV than ducks less than 4 weeks old. CONCLUSIONS: These data provide insight into the molecular epidemiology and genetic diversity of DuCVs circulating in southern and southwestern China for the first time.


Asunto(s)
Infecciones por Circoviridae/veterinaria , Circovirus/genética , Genoma Viral , Enfermedades de las Aves de Corral/virología , Animales , Bolsa de Fabricio/virología , China/epidemiología , Infecciones por Circoviridae/epidemiología , Circovirus/aislamiento & purificación , ADN Viral , Patos , Filogenia , Reacción en Cadena de la Polimerasa/veterinaria , Enfermedades de las Aves de Corral/epidemiología
4.
J Obstet Gynaecol Res ; 41(4): 646-9, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25345741

RESUMEN

Intrauterine devices (IUD) are the most common method of reversible birth control used worldwide. Adolescents infrequently have uterine perforation caused by IUD, hampering both the diagnosis and treatment. Herein, we report a case of uterine perforation in an 18-year-old primipara after insertion of an IUD that possessed memory function (AiMu MCu). The patient presented with vomiting and abdominal pain after insertion of an AiMu MCu IUD, was treated via laparoscopy and had a full recovery. The present case indicated that uterine perforation caused by an AiMu MCu IUD may occur as a rare complication and that uterine perforation can occur in an adolescent. Clinicians might consider a diagnosis of uterine perforation in an adolescent reporting vomiting and abdominal pain after IUD insertion. Laparoscopy could be a reasonable treatment option for such patients.


Asunto(s)
Dispositivos Intrauterinos/efectos adversos , Perforación Uterina/etiología , Adolescente , Femenino , Humanos , Laparoscopía , Resultado del Tratamiento , Perforación Uterina/cirugía
5.
BMC Vet Res ; 10: 128, 2014 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-24916952

RESUMEN

BACKGROUND: The European (EU) genotype of porcine reproductive and respiratory syndrome virus (Genotype-I PRRSV) has recently emerged in China. The coexistence of Genotype-I and -II PRRSV strains could cause seriously affect PRRSV diagnosis and management. Current vaccines are not able to protect against PRRSV infection completely and have inherent drawbacks. Thus, genetically engineered vaccines, including DNA vaccine and live vector engineered vaccines, have been developed. This study aimed to determine the enhanced immune responses of mice inoculated with a DNA vaccine coexpressing GP3 and GP5 of a Genotype-I PRRSV. RESULTS: To evaluate the immunogenicity of GP3 and GP5 proteins from European-type PRRSV, three DNA vaccines, pVAX1-EU-ORF3-ORF5, pVAX1-EU-ORF3 and pVAX1-EU-ORF5, were constructed, which were based on a Genotype-I LV strain (GenBank ID: M96262). BALB/c mice were immunized with the DNA vaccines; delivered in the form of chitosan-DNA nanoparticles. To increase the efficiency of the vaccine, Quil A (Quillaja) was used as an adjuvant. GP3 and GP5-specific antibodies, neutralizing antibodies and cytokines (IL-2, IL-4, IL-10 and IFN gamma) from the immunized mice sera, and other immune parameters, were examined, including T-cell proliferation responses and subgroups of spleen T-lymphocytes. The results showed that ORF3 and ORF5 proteins of Genotype-I PRRSV induced GP3 and GP5-specific antibodies that could neutralize the virus. The levels of Cytokines IL-2, IL-4, IL-10, and IFN-γ of the experimental groups were significantly higher than those of control groups after booster vaccination (P < 0.05). The production of CD3+CD4+ and CD3+CD8+ T lymphocyte was also induced. T lymphocyte proliferation assays showed that the PRRSV LV strain virus could stimulate the proliferation of T lymphocytes in mice in the experimental group. CONCLUSIONS: Using Quil A as adjuvant, Genotype-I PRRSV GP3 and GP5 proteins produced good immunogenicity and reactivity. More importantly, better PRRSV-specific neutralizing antibody titers and cell-mediated immune responses were observed in mice immunized with the DNA vaccine co-expressing GP3 and GP5 proteins than in mice immunized with a DNA vaccine expressing either protein singly. The results of this study demonstrated that co-immunization with GP3 and GP5 produced a better immune response in mice.


Asunto(s)
Anticuerpos Antivirales/sangre , Virus del Síndrome Respiratorio y Reproductivo Porcino/metabolismo , Proteínas Virales/inmunología , Vacunas Virales/inmunología , Adyuvantes Inmunológicos , Animales , Anticuerpos Neutralizantes/sangre , Proliferación Celular , Quitosano , Genotipo , Interferón gamma/sangre , Interleucina-2/sangre , Ratones , Ratones Endogámicos BALB C , Nanopartículas , Virus del Síndrome Respiratorio y Reproductivo Porcino/inmunología , Saponinas de Quillaja , Linfocitos T/fisiología , Vacunas de ADN/inmunología , Proteínas Virales/metabolismo
6.
J Obstet Gynaecol Res ; 39(1): 399-401, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22640265

RESUMEN

Corpus luteum hemorrhage may lead to a life-threatening intraperitoneal hemorrhage in women with bleeding disorders. A 17-year-old girl with aplastic anemia presented to the emergency ward with complaints of severe abdominal pain for the last 24h. On examination, she was noted to be pale with circulatory compromise. Transabdominal pelvic ultrasonography revealed a left complex adnexal mass, 6.9×5.1×5.1cm(3) in size, with a large anechoic area of fluid in the abdomen. On laparoscopic exploration, there was a massive hemoperitoneum (2.6L) with a ruptured corpus luteum on the surface of the left ovary. Hemostatic electric coagulation was successfully applied to the bleeding surface. The patient recovered without incident and was transferred to a special hospital for blood disease treatment one week after surgery. We concluded that corpus luteum hemorrhage in women with aplastic anemia can cause therapeutic difficulties. Laparoscopy is feasible for the management of a massive intraperitoneal hemorrhage secondary to a ruptured corpus luteum in such patients.


Asunto(s)
Anemia Aplásica/complicaciones , Cuerpo Lúteo , Hemoperitoneo/etiología , Hemorragia/complicaciones , Enfermedades del Ovario/etiología , Adolescente , Anemia Aplásica/cirugía , Femenino , Hemoperitoneo/cirugía , Hemorragia/cirugía , Humanos , Laparoscopía , Enfermedades del Ovario/cirugía , Resultado del Tratamiento
7.
Mar Pollut Bull ; 187: 114521, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36621299

RESUMEN

Human vibriosis, caused by pathogenic Vibrio spp., such as Vibrio parahaemolyticus, Vibrio cholerae and Vibrio vulnificus, has been increasing worldwide, mediated by increasing consumption of seafood. The present study was conducted to examine the global prevalence of V. vulnificus, V. parahaemolyticus and V. cholerae in fishes. We searched PubMed, Web of Science, Scopus, and CNKI for peer-reviewed articles and dissertations prior to December 31, 2021. A total of 24,831 articles were retrieved, and 82 articles contained 61 fish families were included. The global pooled prevalence of V. cholerae, V. parahaemolyticus and V. vulnificus in fishes was 9.56 % (95 % CI: 2.12-20.92), 24.77 % (95 % CI: 17.40-32.93) and 5.29 % (95 % CI: 0.38-13.61), respectively. Subgroup and meta-regression analyses showed that study-level covariates, including temperature, country, continent, origin and detection methods partly explained the between-study heterogeneity. These heterogeneities were underpinned by differences of the three Vibrio spp. in fishes at geographical and climatic scales. These results reveal a high global prevalence of pathogenic Vibrio spp. in fishes and highlight the need for implementation of more effective prevention and control measures to reduce food-borne infection in humans.


Asunto(s)
Vibriosis , Vibrio cholerae , Vibrio parahaemolyticus , Vibrio , Animales , Humanos , Salud Pública , Prevalencia , Alimentos Marinos , Vibriosis/epidemiología , Vibriosis/veterinaria , Peces
8.
Sci Total Environ ; 891: 164286, 2023 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-37230353

RESUMEN

Soil contamination with Cryptosporidium is a serious environmental and public health concern. In this systematic review and meta-analysis we estimated the global prevalence of Cryptosporidium contamination in soil and evaluated its association with climatic and hydrometeorological factors. PubMed, Web of Science, Science Direct, China National Knowledge Infrastructure, and Wanfang were searched from database inception up to 24 August 2022. The initial search identified 3220 studies, of which 14 met the inclusion criteria. The results were pooled using a random-effects model, and the statistical heterogeneity among the included studies was examined using Cochrane's Q test and I2 statistic. The estimated pooled global prevalence of Cryptosporidium in soil across all studies was 8.13 % (95 % confidence interval, 1.54-18.44). Meta-regression and subgroup analyses showed that Cryptosporidium prevalence in soil was significantly influenced by continent (p = 0.0002; R2 = 49.99 %), air pressure (p = 0.0154; R2 = 24.01 %), temperature (p = 0.0437; R2 = 14.53 %), and detection method (p = 0.0131; R2 = 26.94 %). These results highlight the need for increased surveillance of Cryptosporidium in soil and its risk factors to inform future development of environmental control interventions and public health policies.


Asunto(s)
Criptosporidiosis , Cryptosporidium , Humanos , Criptosporidiosis/epidemiología , Prevalencia , Factores de Riesgo , Suelo
9.
Front Immunol ; 14: 1196031, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37283741

RESUMEN

Swine acute diarrhoea syndrome coronavirus (SADS-CoV), which is a recently discovered enteric coronavirus, is the major aetiological agent that causes severe clinical diarrhoea and intestinal pathological damage in pigs, and it has caused significant economic losses to the swine industry. Nonstructural protein 5, also called 3C-like protease, cleaves viral polypeptides and host immune-related molecules to facilitate viral replication and immune evasion. Here, we demonstrated that SADS-CoV nsp5 significantly inhibits the Sendai virus (SEV)-induced production of IFN-ß and inflammatory cytokines. SADS-CoV nsp5 targets and cleaves mRNA-decapping enzyme 1a (DCP1A) via its protease activity to inhibit the IRF3 and NF-κB signaling pathways in order to decrease IFN-ß and inflammatory cytokine production. We found that the histidine 41 and cystine 144 residues of SADS-CoV nsp5 are critical for its cleavage activity. Additionally, a form of DCP1A with a mutation in the glutamine 343 residue is resistant to nsp5-mediated cleavage and has a stronger ability to inhibit SADS-CoV infection than wild-type DCP1A. In conclusion, our findings reveal that SADS-CoV nsp5 is an important interferon antagonist and enhance the understanding of immune evasion by alpha coronaviruses.


Asunto(s)
Alphacoronavirus , Coronavirus , Interferón Tipo I , Animales , Porcinos , Alphacoronavirus/genética , Alphacoronavirus/metabolismo , Coronavirus/metabolismo , Endopeptidasas , Interferón Tipo I/metabolismo
10.
Front Microbiol ; 14: 1235620, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37869659

RESUMEN

Seneca Valley virus (SVV), a member of the Picornaviridae family, may cause serious water blister diseases in pregnant sows and acute death in newborn piglets, which have resulted in economic losses in pig production. The 3C protease is a vital enzyme for SVV maturation and is capable of regulating protein cleavage and RNA replication of the virus. Additionally, this protease can impede the host's innate immune response by targeting the interferon pathway's principal factor and enhance virus replication by modulating the host's RNA metabolism while simultaneously triggering programmed cell death. This article reviews recent studies on SVV 3C functions, which include viral replication promotion, cell apoptosis modulation and host immune response evasion, and provides a theoretical basis for research on preventing and controlling SVV infection.

11.
Sci Total Environ ; 851(Pt 1): 158168, 2022 Dec 10.
Artículo en Inglés | MEDLINE | ID: mdl-35988599

RESUMEN

There is a growing concern regarding the potential adverse impact of Toxoplasma gondii contamination of the marine environment on marine wildlife and public health. Terrestrial runoff is a significant route for dissemination of T. gondii oocysts from land to sea. Yet, the influence of terrestrial runoff on T. gondii prevalence in marine animals in China is largely unknown. To address this concern, we examined the presence of T. gondii in marine oysters Crassostrea spp., rockfish Sebastes schlegelii (S. schlegelii), fat greenling fish Hexagrammos otakii (H. otakii), and Asian paddle crab Charybdis japonica (C. japonica) using a PCR assay targeting T. gondii B1 gene. A total of 1920 samples were randomly collected, in Jan-Dec 2020, from terrestrial runoff areas (TRA, TRB, and TRC) and non-terrestrial runoff area (Grape bay) in Weihai, China. T. gondii prevalence in TRB and TRC was 6.04 % and 5.83 %, respectively, which was higher than 2.29 % detected in the non-terrestrial runoff area. The highest prevalence was detected in Crassostrea spp., and a correlation was observed between T. gondii prevalence and weight of Crassostrea spp. The temperature, but not precipitation, significantly correlated with T. gondii prevalence. Understanding the fate of T. gondii delivered to oceans by terrestrial runoff is critical for predicting future disease risks for marine wildlife and humans.


Asunto(s)
Toxoplasma , Animales , Animales Salvajes , Organismos Acuáticos , Humanos , Océanos y Mares , Oocistos
13.
Huan Jing Ke Xue ; 41(6): 2646-2652, 2020 Jun 08.
Artículo en Zh | MEDLINE | ID: mdl-32608779

RESUMEN

In this study, the geochemical characteristics and ecological risks of heavy metals in the sediments of a river-lake system were comprehensively identified and the spatial distribution was analyzed. Meanwhile, the potential sources of heavy metals in the sediments were apportioned using the positive matrix factorization model (PMF). The elements Cd, Cu, and Zn were identified as the main pollutants in the sediments of the river-lake system; in particular, Cd indicated an ecological risk. Compared with receiving lakes, the river is more polluted and poses a more significant risk. Spatial analysis of the lake suggested that the entrance of rivers had a relatively higher pollution degree and risk, indicating that rivers may be an important channel to transfer pollutants into the lake. PMF modelling showed that the heavy metals in the sediments were mainly associated with human activities (55.7%), including industrial emissions (20.3%), fertilizer application (19.5%), and aquaculture (15.9%).

14.
Medicine (Baltimore) ; 99(17): e19743, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32332613

RESUMEN

INTRODUCTION: The implantation of a gestational sac within the scar of a previous caesarean delivery is defined as caesarean scar pregnancy (CSP), which is classified into two types: CSP I and CSP II. CSP II is life threatening, and no clear consensus for CSP II management exists. PATIENT CONCERNS: A 31-year-old woman, gravida 1, para 1, with a previous caesarean delivery due to macrosomia, presented with an estimated 45 days of amenorrhea. The patient presented to the emergency department with vaginal bleeding for 1 day and no abdominal pain. DIAGNOSES: An ultrasound examination was performed demonstrating a viable fetus that was embedded in the caesarean scar area and was bulging through the wall of the uterus into the bladder without contact with the uterine cavity or cervical canal. A diagnosis of type II caesarean scar pregnancy was made. INTERVENTIONS: Local lauromacrogol was used to reduce the gestational sac blood supply. Suction curettage was performed under the guidance of abdominal ultrasound 24 h later, and the amount of bleeding was 20 mL. The response to the treatment was monitored by serial beta-human chorionic gonadotropin (ß-hCG). OUTCOMES: Patient was followed up with ß-hCG weekly levels which became <10 mIU/mL after 4 weeks of treatment. CONCLUSION: Ultrasound-guided local lauromacrogol injection combined with suction curettage may be a safer and novel therapeutic method.


Asunto(s)
Cesárea/efectos adversos , Cicatriz/complicaciones , Legrado por Aspiración/métodos , Adulto , Cesárea/métodos , Femenino , Humanos , Polidocanol/uso terapéutico , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Complicaciones del Embarazo/cirugía , Ultrasonografía/métodos
16.
Zhongguo Gu Shang ; 30(12): 1118-1126, 2017 Dec 25.
Artículo en Zh | MEDLINE | ID: mdl-29457434

RESUMEN

OBJECTIVE: To compare efficacy and safety of minimally invasive sinus tarsal approach versus conventional L-shaped lateral approach in treating calcaneal fractures. METHODS: The studies concerning about randomized controlled trial and non-randomized controlled trial of minimally invasive sinus tarsal approach versus conventional L-shaped lateral approach in treating calcaneal fractures from the time of creating database to March, 2017 were searched from PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMbase, ISI Web of Knowledge databases, VIP, CNKI, CBM and Wan Fang. The literatures which screened by randomized controlled trial and non- randomized controlled trial were extracted and performed quality assessment by two people. Meta analysis were performed by RevMan 5.3 software and GRADE system were used to evaluate quality. RESULTS: Four randomized controlled trial and 4 non-randomized controlled trial were included, totally 493 patients. Meta-analysis results showed compared with conventional L-shaped lateral approach, minimally invasive sinus tarsal approach had shorter operative time [MD=-5.41, 95%CI(-6.71, -4.12), P<0.000 01], lower incidence of postoperative complications[OR=0.10, 95%CI(0.05, 0.21), P<0.000 01], and higher AOFAS score [MD=-3.09, 95%CI(-1.72, 4.46), P<0.000 01] at the final follow-up. Böhler angle in conventional L-shaped lateral approach was better than that of minimally invasive sinus tarsal approach [MD=-0.80, 95%CI(-1.45, -0.14), P<0.05]. While there were no significant differences in postoperative Gissanes angle [MD=0.35, 95%CI(-0.77, 1.47), P>0.05] and Maryland score[MD=2.12, 95%CI(-0.71, 4.95), P>0.05] between two groups. CONCLUSIONS: Minimally invasive sinus tarsal approach and conventional L-shaped lateral approach has similar clinical effect for the treatment of calcaneal fractures. However, minimally invasive sinus tarsal approach has advantages of shorter operation time, lower incidence of complication and better safety. For the limited quantity of the original studies, operative approach should be chosen according to the patient.


Asunto(s)
Calcáneo/lesiones , Fracturas Óseas/cirugía , Traumatismos del Tobillo , Fijación Interna de Fracturas , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
17.
Zhongguo Yi Liao Qi Xie Za Zhi ; 29(1): 57-9, 2005 Jan.
Artículo en Zh | MEDLINE | ID: mdl-15875698

RESUMEN

This paper is to explore the reasonable applications of automatic exposure control in computed radiography, and to improve the quality of CR images. It is very important to select a suitable KV value in automatic exposure control in computed radiography. At the same time, a suitable ionization chamber, correct density compensation and necesary post-processing should be selected.


Asunto(s)
Procesamiento de Imagen Asistido por Computador , Intensificación de Imagen Radiográfica/métodos , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Automatización , Niño , Preescolar , Femenino , Cabeza/diagnóstico por imagen , Humanos , Lactante , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Control de Calidad , Dosis de Radiación , Radiografía Torácica , Tomografía Computarizada por Rayos X/normas
19.
Iran J Public Health ; 43(1): 120-2, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26060689

RESUMEN

Most fetal heart rate patterns can be interpreted accurately so that management decisions can be made correctly. How-ever, few fetal heart rate patterns are so ambiguous that the obstetricians cannot interpret them precisely. A 27-year-old woman at 38 weeks' gestation in her first pregnancy was admitted with heavy vaginal bleeding and decrease in fetal movements. Fetal status was indeterminate according to an indefinite fetal heart rate tracing with regular decelerations. After emergent cesarean delivery, a ruptured vasa previa, traversing the fetal membrane, unsupported by either the umbilical cord or placental tissue, was clearly identified. Treatment decision-making is challenging in such patient with indefinite fetal heart rate pattern because limited data exist to guide management. Well-designed studies are needed to clarify the uncertainty about the effect of indefinite fetal heart rate pattern on clinical outcomes.

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