ABSTRACT
The authors exposed the problem of case of a dystocia due to hydrothorax and sub-cutaneous oedema which was complicated by a uterine rupture, diagnosed at 34 weeks amenorrhoea. Authors attempt to analyse the elements at hand to be able to prevent occurance of dystocia
Subject(s)
Humans , Female , Hydrops Fetalis/complications , Hydrothorax/complications , Uterine RuptureABSTRACT
Presentamos un caso de flutter auricular, con bloqueo auriculoventricular 2:1, asociado a hidrops en uno de los fetos de un embarazo gemelar triple, pesquisado por taquicardia fetal y confirmado con ecocardiografía a las 26 semanas de gestación. Iniciamos digoxina transplancetaria sin éxito por lo que agregamos flecainide al décimo tercer día, logrando conversión a ritmo sinusal y regresión del hidrops in útero. Se discute la utilidad del flecainide como primera línea para este tipo de pacientes y la necesidad de profilaxis antiarrítmica postnatal, considerando la favorable evolución en este período.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Anti-Arrhythmia Agents/administration & dosage , Anti-Arrhythmia Agents/therapeutic use , Atrial Flutter/complications , Atrial Flutter/diagnosis , Atrial Flutter/drug therapy , Hydrops Fetalis/complications , Hydrops Fetalis/diagnosis , Hydrops Fetalis/drug therapy , Pregnancy, Multiple , Arrhythmias, Cardiac , Drug Therapy, Combination , Digoxin/administration & dosage , Digoxin/therapeutic use , Echocardiography, Doppler , Flecainide/administration & dosage , Flecainide/therapeutic use , TwinsABSTRACT
A total of 300 pregnant women were screened for the presence of human parvovirus B19 IgG and IgM antibodies by an enzyme-linked immunosorbent assay (ELISA). Overall, 253 (84.3 percent) were found to be IgG-positive and IgM-negative (IgG+IgM-), 42 (14 percent) had neither IgG nor IgM antibodies (IgG-/IgM-) and 5 (1.7 percent) were both IgM- and IgG-positive (IgG+/IgM+). Maternal serology was performed routinely for cytomegalovirus, rubella, toxoplasmosis and syphilis. All IgG-/IgM- and IgG+/IgM+ women were followed until the time delivery, with venous blood samples taken monthly from each, one IgG-/IgM- mother seroconverted to IgG+/IgM- and B19 DNA was detected by nested polymerase chain reaction technique (PCR) in her serum. All babies born to IgG+/IgM+ mothers (and from the one who seroconverted) were IgG+IgM-, but no B19 DNA could be detected in their sera and no adverse effects were documented either by ultrasonographic examination or by detection of maternal serum alpha-fetoprotein. While 5 of the mothers delivered normal children at term, one gave birth to a premature (low-weight) baby who developed severe anemia and had convulsions. However, this mother was found to have toxoplasma-specif IgM. Our data indicate a low frequency of B19 infection in pregnancy in our region, at least during interepidemic periods. This appears to be partly due to high prevalence of prior infection among pregnant women. Recent B19 infection in 6 women did not lead to adverse fetal outcomes. This observation, however, in a small number of serologically positive patients, does not contradict the observations by others that recent infection does converg a risk for the fetus.
Subject(s)
Humans , Female , Pregnancy , Cohort Studies , Parvoviridae Infections/diagnosis , Parvoviridae Infections/transmission , Infectious Disease Transmission, Vertical , Parvovirus B19, Human , Pregnancy Complications, Infectious , Enzyme-Linked Immunosorbent Assay , Erythema Infectiosum/complications , Hydrops Fetalis/complications , Infant, Very Low Birth Weight , Maternal-Child Health Centers , Polymerase Chain Reaction , Prenatal CareABSTRACT
La transfusión fetal intrauterina es el tratamiento empleado en casos de isoinmunización severa por anti-D. Sin embargo, su eficacia se ve reducida en los casos muy severos de hidrops fetal de desarrollo temprano, antes de que la transfusión sea técnicamente posible de realizar. Objetivo: evaluar si el inicio temprano del tratamiento con gammaglobulina a altas dosis, seguida por transfusiones intrauterinas, reduce la severidad de la anemia fetal, el desarrollo de hidrops e incrementa la sobrevida fetal. Material y método: investigación clínica retrospectiva con controles concurrentes no aleatorizados: -Grupo gammaglobulina (grupo experimental): 16 pacientes que iniciaron el tratamiento con gammaglobulina antes de la semana 21 y luego complementaron con TIU luego de la semana 23. -Grupo TIU (grupo control): 31 pacientes que iniciaron TIU a una edad gestacional igual o menor a 25 semanas. Resultados: Ambos grupos fueron homogéneos en relación con el antecedente de muertes perinatales y títulos de anticuerpos anti-D. El número de hidrops fetal a la primera TIU y de muertes fetales fue significativamente superior en el Grupo TIU en comparación con el Grupo Gamma. El hematocrito fetal a la primera TIU y al nacimiento no fue diferente entre ambos grupos, aunque la proporción de fetos con anemia severa fue mayor en el Grupo TIU. Conclusión: Las evidencias sugieren que la terapéutica propuesta mejora la sobrevida fetal.
Subject(s)
Humans , Pregnancy , Infant, Newborn , Erythroblastosis, Fetal/mortality , Erythroblastosis, Fetal/therapy , gamma-Globulins/administration & dosage , Blood Transfusion, Intrauterine/methods , Fetal Mortality , Hydrops Fetalis/complicationsABSTRACT
Se presenta un caso de hidrops fetal no inmune provocado por una anemia hemolítica severa secundaria a una talasemia familiar pesquisada a las 28 semanas y que revierte luego de transfusión intravascular, TIV, practicada en nuestro servicio. Se analiza el diagnóstico, manejo prenatal y posterior evolución
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adult , Anemia, Hemolytic, Congenital/diagnosis , Hydrops Fetalis/complications , Thalassemia/diagnosis , Blood Transfusion , Clinical Evolution , Cordocentesis/statistics & numerical data , Genetic Diseases, Inborn/diagnosis , Hydrops Fetalis , Hydrops Fetalis/therapy , Thalassemia/complications , Ultrasonography, PrenatalABSTRACT
Se presentan 39 casos de Hidrops No Inmunológico estudiados en material de necropsia perinatal en el hospital "Pereira Rossell" y en la práctica privada en los 10 últimos años (1983-1992). Fueron excluídos los casos de hidrops fetal en productos gestacionales previables. Se determinó la etiología en 51 por ciento de los casos. Se analizan los resultados y se comparan con los hallazgos de la literatura. Este estudio subraya la importancia de la investigación clínica exhaustiva y la realización de la necropsia perinatal especializada en los casos de hidrops no inmune para determinar la patología subyacente
Subject(s)
Humans , Infant, Newborn , Hydrops Fetalis , Hydrops Fetalis/complications , Hydrops Fetalis/etiologyABSTRACT
Nonimmune hydrops fetalis is becoming a predominant form of fetal hydrops due to the declining incidence of immune hydrops fetalis triggered by Rh isoimmunization. Infantile polycystic kidney appeared to be related to hydrops fetalis whether it is causal or merely coincidental and may represent another entry to differential diagnoses. Infantile polycystic kidney was diagnosed by an elevated maternal serum alpha-fetoprotein (AFP) value coupled with an ultrasonographic abnormality scanned as a multicystic mass with ascites in the fetal abdomen antenatally. This study presents a case of infantile polycystic kidney that resulted in a stillborn baby with hydrops fetalis and extensive placental calcification; it was the first case in Korea in which nonimmune hydrops fetalis was associated with infantile polycystic kidney in consecutive siblings by autosomal recessive inheritance in one family. In addition, this paper comprehensively reviews the incidence, etiology, prenatal diagnosis and proper management of nonimmune hydrops fetalis.