ABSTRACT
Congenital LQTS is an often undetected inherited cardiac channel dysfunction and can be a reason for intrauterine fetal demise. It can present in utero as CTG and ultrasound abnormalities, i. e., bradycardia, ventricular tachycardia, or fetal hydrops. Diagnosis is made by CTG, echocardiography, or fMCG. Intrauterine therapy with a ß blocker and i. v. magnesium should be started. Our objective was to examine the current knowledge about diagnosis and treatment of LQTS and in particular to highlight the opportunity of vaginal birth under continuous intravenous magnesium therapy. Therefore, a thorough MEDLINE and Google Scholar search was conducted. Randomized controlled trials, meta-analyses, prospective and retrospective cohort trials, and case reports were considered. We showed the possibility of vaginal delivery under continuous magnesium therapy in a case of suspected fetal LQTS. A stepwise concept for diagnosis, monitoring, and peripartum management in low, intermediate, and high risk cases of fetal LQTS is presented. If risk is low or intermediate, a vaginal delivery under continuous monitoring is reasonable. Induction of labor at term should be evaluated.
Subject(s)
Labor, Induced , Long QT Syndrome , Humans , Female , Pregnancy , Long QT Syndrome/diagnosis , Long QT Syndrome/therapy , Long QT Syndrome/drug therapy , Infant, Newborn , Adult , Magnesium/administration & dosage , Fetal Diseases/drug therapy , Fetal Diseases/therapy , Fetal Diseases/diagnosis , Delivery, Obstetric , Perinatal Care/methodsABSTRACT
Supraventricular tachyarrhythmia (SVT) is the most common form of fetal tachyarrhythmias. The presentation can vary from ill-defined, non-sustained episodes of tachyarrhythmia to frank non-immune hydrops. The standard of care is transplacental therapy by treating the mother with oral antiarrhythmic drugs, followed by direct fetal therapy in refractory cases. We report a case of primigravida in her late 20s, who presented at 28.1 weeks of gestation with fetal hydrops and SVT. She was initially managed with oral digoxin and flecainide, but due to worsening hydrops, risk of fetal demise and extreme prematurity, further management by direct fetal therapy was given in terms of intramuscular digoxin and intraperitoneal flecainide. Following which, the fetus had a favourable outcome. This case highlights the possible role of direct fetal therapy in refractory cases of SVT.
Subject(s)
Fetal Diseases , Tachycardia, Supraventricular , Pregnancy , Female , Humans , Flecainide/therapeutic use , Fetal Diseases/diagnostic imaging , Fetal Diseases/drug therapy , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/drug therapy , Anti-Arrhythmia Agents/therapeutic use , Digoxin/therapeutic use , Hydrops Fetalis/diagnosis , Hydrops Fetalis/etiology , Hydrops Fetalis/drug therapy , Arrhythmias, Cardiac , Tachycardia/drug therapy , FetusABSTRACT
Mola hidatiforme parcial recorrente é evento em que há repetição da mola hidatiforme parcial. Há cerca de 100 casos relatados na literatura e dúvida se essa entidade pode evolver para neoplasia trofoblástica gestacional pós-molar. Apresenta-se relato de caso de paciente com recorrência de mola hidatiforme parcial em que houve aumento de embriopatia, bem como transformação maligna da mola parcial recorrente. Empregou-se quimioterapia com Methotrexate para induzir cura. Não obstante seja ocorrência rara, a importância deste relato encontra-se na evidência de neoplasia trofoblástica gestacional em recorrência de mola hidatiforme parcial, determinando vigilância hormonal rigorosa para detectar a malignização desses blastomas.
Recurrent partial hydatidiform mole is an event of repetitive partial hydatidiform mole. It has been reported around 100 cases in the literature and it is still unclear if this entity can evolve to postmolar gestational trophoblastic neoplasia. In this report, it is presented a case of recurrent partial hydatidiform mole with an increase in embriologic alterations, as well as malignization of recurrent partial hydatidiform mole. Chemotherapy with Methotrexate regimen was used to induce remission. Although rare, the importance of this report relies on the evidence of gestational trophoblastic neoplasia in recurrent partial hydatidiform mole, demanding straight hormonal surveillance to detect malignization of these tumors.
Subject(s)
Humans , Female , Gestational Trophoblastic Disease/drug therapy , Hydatidiform Mole , Uterine Neoplasms , Abortion, Induced , Fetal Diseases/drug therapy , Biomarkers/analysis , Recurrence , Trophoblastic NeoplasmsABSTRACT
No disponible
Subject(s)
Humans , Anesthesia/standards , Anesthesia , Anesthesiology/methods , Anesthesiology/trends , Fetal Diseases/drug therapy , Fetal Diseases/surgery , Obstetric Surgical Procedures/methodsABSTRACT
El lupus eritematoso sistémico (LES) es una de las patologías autoinmunes más frecuentes durante el embarazo, asociándose con distintas complicaciones fetales y neonatales, sobre todo cardíacas, secundario al traspaso de anticuerpos maternos a través de la placenta. Estos anticuerpos se unen a los cardiomioci-tos fetales, desencadenando una respuesta inflamatoria local que determina la aparición de lesiones que pueden ser permanentes y letales. Presentamos el caso de una paciente embarazada con LES, en la cual se observó en el feto la presencia de bloqueo aurículo-ventricular de primer grado y signos sugerentes de miocarditis. Estas complicaciones se caracterizan por un aumento en la morbimortalidad perinatal, por lo que las estrategias actuales están dirigidas a la detección precoz de éstas y también en la prevención de las mismas. Un tratamiento estándar aun es tema de investigación, pese a los reportes que muestran la efectividad de corticoides como la dexametasona. En embarazadas con anticuerpos anti-Ro positivo se recomienda efectuar ecocardiograma fetal seriados cada 1-2 semanas desde la semana 16, para detectar precozmente anomalías cardiacas sobre las cuales pudiese intervenirse.
Systemic lupus erythematosus (SLE) is one of the most common autoimmune disease during pregnancy, associated with various fetal and neonatal complications, especially heart disease, secondary to the transfer of maternal antibodies through the placenta. These antibodies bind to fetal cardiomyocytes, triggering a local inflammatory response that determines the appearance of lesions that may become permanent and deadly. We report a pregnant patient with SLE, in which was observed the presence of atrioventricular block of 1st degree and signs suggestive of myocarditis in the fetus. These complications are characterized by an increase in fetal and neonatal morbidity and mortality, so that current strategies are aimed at early detection of these and also in preventing them. A standard therapy for atrioventricular block is still matter of investigation, although corticosteroids like dexamethasone have been reported to be effective for associated cardiomyo-pathy. Serial echocardiograms and obstetric sonograms, performed at least every 1-2 weeks starting from the 16th week of gestational age, are recommended in anti-Ro/SSA-positive pregnant women to detect early fetal abnormalities that might be a target of preventive therapy.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adult , Atrioventricular Block/immunology , Atrioventricular Block , Fetal Diseases/immunology , Fetal Diseases , Lupus Erythematosus, Systemic/immunology , Antibodies, Antinuclear/analysis , Antibodies, Antinuclear/immunology , Dexamethasone/therapeutic use , Fetal Diseases/drug therapy , Myocarditis/immunology , Myocarditis , Pregnancy Outcome , Ultrasonography, PrenatalABSTRACT
Las arritmias fetales representan un motivo infrecuente de ingreso ala unidad de cuidados intensivos. Se presenta tres casos de gestantes entre 27 y 32 semanas, con el diagnóestico de taquiarritmias supraventriculares fetales sostenidas, que exhibían fracaso en el intento inicial de reversión con digoxina. Dos casos con taquicardia sapraventricular respondieron favorablemente cuando se asoció flecainida. Un feto hidrópico con aleteo auricular y bloqueo 2:1 no revirtió con la associón de flecainida ni amiodarona a la digoxina y requirió la interrupsión de la gestación en la 30 ª semana. El neonato presentó disfunción tiroidea transitória atribuída a la administración de amiodarona.
Subject(s)
Pregnancy , Adult , Humans , Male , Female , Anti-Arrhythmia Agents/therapeutic use , Fetal Diseases/drug therapy , Tachycardia, Supraventricular/drug therapy , Amiodarone/therapeutic use , Digoxin/therapeutic use , Fetal Diseases , Flecainide/therapeutic use , Treatment Outcome , Tachycardia, SupraventricularABSTRACT
Las arritmias fetales representan un motivo infrecuente de ingreso ala unidad de cuidados intensivos. Se presenta tres casos de gestantes entre 27 y 32 semanas, con el diagnóestico de taquiarritmias supraventriculares fetales sostenidas, que exhibían fracaso en el intento inicial de reversión con digoxina. Dos casos con taquicardia sapraventricular respondieron favorablemente cuando se asoció flecainida. Un feto hidrópico con aleteo auricular y bloqueo 2:1 no revirtió con la associón de flecainida ni amiodarona a la digoxina y requirió la interrupsión de la gestación en la 30 ¬ semana. El neonato presentó disfunción tiroidea transitória atribuída a la administración de amiodarona. (AU)
Subject(s)
Pregnancy , Adult , Humans , Male , Female , Tachycardia, Supraventricular/drug therapy , Fetal Diseases/drug therapy , Anti-Arrhythmia Agents/therapeutic use , Tachycardia, Supraventricular/diagnostic imaging , Fetal Diseases/diagnostic imaging , Digoxin/therapeutic use , Amiodarone/therapeutic use , Flecainide/therapeutic use , Treatment OutcomeABSTRACT
The purpose is to study the prophylactic and therapeutic effect of the traditional Chinese Medicine (TCM)-Jinyebaidu (JYBD) to guinea pig cytomegalovirus (GPCMV) intrauterine infection. The virus-free female and male guinea pigs were screened with nest-polymerase chain reaction (N-PCR). After inbred, pregnant guinea pigs were selected and divided into 3 groups randomly: 5 guniea pigs of the blank control group were not given either GPCMV or JYBD. 31 guniea pigs of the positive control group were inoculated 1 mL (10(7) TCID50) suspension of GPCMV intraperitoneal. 10 guniea pigs of the experimental group were inoculated GPCMV firstly and then perfused stomach with JYBD for 14 days (Dosage in accordance with the modulus of the weight ratio of human to guniea pig). The effects of JYBD on the intrauterine infection of GPCMV were observed. The results showed that JYBD could decrease the maternal infection rate from 100% (31/31) to 50% (5/10) (P < 0.001), the intrauterine infection rate from 100% (72/72) to 75% (21/28) (P < 0.001), and the rate of abnormal outcome of pregnancy from 64.4% (29/45) to 25.0% (7/28) (P < 0.001), the infective symptoms being relieved. It can be concluded that traditional Chinese medicine- JYBD can prevent and treat (GPCMV intrauterine infection, and can be expected a prophylactic drug for HCMV intrauterine infection.
Subject(s)
Cytomegalovirus , Cytomegalovirus Infections/drug therapy , Drugs, Chinese Herbal/therapeutic use , Fetal Diseases/drug therapy , Fetal Diseases/prevention & control , Fetal Diseases/virology , Phytotherapy , Pregnancy Complications, Infectious/drug therapy , Random AllocationABSTRACT
Se presenta un caso de taquicardia supraventricular fetal, diagnosticado a las 33 semanas de embarazo y tratado en forma exitosa con asociación de drogas antiarrítmicas, logrando un embarazo a término. Se comenta frecuencia de la patología, su diagnóstico y alternativas terapéuticas
Subject(s)
Humans , Female , Pregnancy , Adult , Fetal Diseases/drug therapy , Tachycardia, Supraventricular/drug therapy , Anti-Arrhythmia Agents/administration & dosage , Heart Defects, Congenital/diagnosis , Maternal-Fetal ExchangeABSTRACT
OBJETIVO: Avaliar a forma de apresentaçäo, diagnóstico e tratamento das taquiarritmias supraventriculares fetais, através do relato de uma série de casos acompanhados em um centro terciário de cardiologia fetal. MÉTODOS: Säo descritos 25 casos de taquiarritmia supraventricular diagnosticados intra-útero, no período de janeiro/89 a outubro/97, em uma populaçäo compreendendo 3117 gestantes. RESULTADOS: Foram diagnosticados 17 casos taquiarritmia supraventricular e 8 casos de flutter atrial fetal. As idades gestacionais variam de 26 a 40 semanas. Doze fetos apresentavam hidropisia no momento do diagnóstico (6 com taquicardia supraventricular (TSV) e 6 com flutter atrial). Quatro fetos com TSV apresentavam cardiopatias estruturais (dois casos de anomalia de Ebstein e dois com comunicaçäo interventricular). Todos os fetos foram internados na Unidade de Cardiologia Fetal para monitorizaçäo e tratamento. Entre os 17 fetos com TSV, 12 apresentaram reversäo da arritmia após administraçäo de digoxina, mas esta medida näo foi eficaz em nenhum paciente com flutter. Dois pacientes com TSV e seis com necessitaram interrupçäo da gestaçäo para cardioversäo elétrica pós-natal. A mortalidade foi de 3/17 no grupo da TSV (incluindo dois pacientes com anomalia de Ebstein) e de 0/8 no grupo com flutter. CONCLUSÄO: As taquiarritmias supraventriculares fetais säo enventos raros na populaçäo geral. Entretanto, podem provocar insuficiência cardíaca e óbito intrauterino. Como a resposta ao tratamento é satisfatória, tornam-se de extrema importância o diagnóstico precoce e o tratamento adequado.
Subject(s)
Humans , Female , Pregnancy , Anti-Arrhythmia Agents/therapeutic use , Fetal Diseases/diagnosis , Fetal Diseases/drug therapy , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/drug therapy , Adenosine/therapeutic use , Amiodarone/therapeutic use , Digoxin/therapeutic use , Electrocardiography , Medical Records , Sotalol/therapeutic use , Ultrasonography, PrenatalABSTRACT
Gestante de 34 semanas foi encaminhada para ecocardiografia fetal por bradicardia e hidropsia fetal ao ultrassom obstétrico. A anatomia cardíaca mostrou-se normal, porém, foi diagnosticado bloqueio atrioventricular total com freqüência ventricular de 22 bpm e freqüência atrial de 101 bpm. Através de cordocentese, injetou-se na veia umbilical 0,06µg de isoproterenol, elevando-se a freqüência ventricular para 40bpm e a atrial para 171bpm. A utilizaçäo de simpaticomiméticos diretamente na veia umbilical fetal é um procedimento relativamente simples e, em muitos casos, pode evitar a hidropsia e o óbito
Subject(s)
Humans , Female , Adult , Isoproterenol/therapeutic use , Heart Block/drug therapy , Fetal Diseases/drug therapy , Hydrops Fetalis/etiology , Heart Block/complicationsABSTRACT
Os autores utilizam a dosagem da 17-OH-Progesterona e delta-4-androstenediona no líquido amniótico para rastrear a ocorrência de hiperplasia congênita da supra-renal em cinco fetos com risco da doença. Os casos foram estudados no pós-natal e confirmaram o acerto do diagnóstico pré-natal em todos os casos, caracterizando o teste como adequado no rastreamento da doença.