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1.
Rozhl Chir ; 100(1): 27-31, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33691420

RESUMEN

INTRODUCTION: Endometriosis is defined as the presence of endometrial tissue, endometrial glands or endometrial stroma outside the uterine cavity causing chronic inflammatory response. The prevalence of abdominal wall endometriosis is less than 1%. Cesarean scar endometriosis is the most common type of abdominal wall endometriosis. Chronic lower abdominal pain amplified during menstruation and palpable mass in the area of scar are the main symptoms. Generally, surgical resection with negative resection margins offers the best chance for definitive treatment of abdominal wall endometriosis. CASE REPORT: The authors present two female patients in fertile age with chronic pain in the area of Cesarean scar. The preoperatively assumed endometriosis was histologically confirmed after complete surgical excision. CONCLUSION: Abdominal wall endometriosis is rare. However, it is a possible cause of constant lower abdominal pain, impacting quality of life of the patient.


Asunto(s)
Pared Abdominal , Endometriosis , Pared Abdominal/cirugía , Cesárea/efectos adversos , Cicatriz/etiología , Cicatriz/patología , Endometriosis/etiología , Endometriosis/patología , Endometriosis/cirugía , Femenino , Humanos , Embarazo , Calidad de Vida
2.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(2): 174-179, 2021 Feb.
Artículo en Chino | MEDLINE | ID: mdl-33729136

RESUMEN

OBJECTIVE: To explore high-risk factors of respiratory distress syndrome (RDS) and to compare the clinical efficacy of calf pulmonary surfactant (PS) combined with budesonide suspension and poractant alfa injection in the treatment of RDS in premature infants. METHODS: A retrospective analysis was conducted. Preterm infants who were born in the obstetrics department of Liaocheng People's Hospital and admitted to the neonatal intensive care unit (NICU) within 24 hours from July 2016 to July 2020 were enrolled. The clinical data of these patients including perinatal conditions, clinical features, therapeutic regimens of PS and outcomes were collected and analyzed. According to the diagnostic criteria of neonatal respiratory distress syndrome (NRDS), premature infants were divided into NRDS group and non-NRDS group. First, the clinical data of the two groups were compared to analyze the related factors of NRDS. Then the related factors of NRDS were confirmed by Logistic regression analysis. In addition, according to the trapeutic regimens of PS, the children were divided into calf PS combined with budesonide suspension group and poractant alfa injection group, and the efficacy of the two PS was compared. RESULTS: (1) A total of 1 690 preterm infants were included, including 297 preterm infants were diagnosed with NRDS which accounted for 17.6% of live preterm infants. There were significant differences in gender, gestational age (GA), birth parity, birth weight (BW), asphyxia of newborn, caesarean section, premature rupture of membrane, placental abruption, gestational diabetes and father's smoking addiction (maternal exposure to smoke during pregnancy) between NRDS group and non-NRDS group (male: 71.0% vs. 59.0%; GA: < 28 weeks was 4.1% vs. 0.1%, 28 weeks ≤ GA < 34 weeks was 70.0% vs. 29.9%, 34 weeks ≤ GA < 37 weeks was 25.9% vs.70.0%; birth parity: 2 (1, 3) vs. 2 (1, 3); BW: < 1 000 g was 4.1% vs. 0.4%, 1 000 g ≤ BW < 1 500 g was 31.3% vs. 6.5%, 1 500 g ≤ BW < 2 500 g was 51.5% vs. 58.9%, 2 500 g ≤ BW < 4 000 g was 12.8% vs. 33.1%, BW ≥ 4 000 g was 0.3% vs. 1.1%; asphyxia of newborn: 50.8% vs. 14.6%; caesarean section: 71.7% vs. 65.0%; premature rupture of membrane: 66.7% vs. 42.2%; premature rupture of fetal membranes: 11.4% vs. 5.2%; gestational diabetes: 12.1% vs. 7.0%; father's smoking addiction: 80.8% vs. 71.5%, all P < 0.05), but there was no significant difference in prenatal use of dexamethasone (DEX) between NRDS group and non-NRDS group (80.1% vs. 84.1%, P > 0.05). Binary multivariate Logistic regression analysis showed that GA, gender, cesarean section, premature rupture of membranes, gestational diabetes, father's smoking addiction and neonatal asphyxia were the risk factors of RDS [odds ratio (OR) and 95% confidence interval (95%CI) were 0.621 (0.557-0.693), 2.043 (1.478-2.825), 1.365 (1.036-1.797), 0.697 (0.506-0.961), 3.223 (1.906-5.449), 1.836 (1.261-2.673), 3.596 (2.622-4.933), all P < 0.05]. (2) A total of 160 patients diagnosed with grade III/IV NRDS were included to analyze the efficacy of PS. Among them, 42 cases were treated with calf PS combined with budesonide suspension, and 118 cases were treated with poractant alfa injection. Compared with the poractant alfa injection group, the total oxygen consumption time of the calf PS group was shorter [days: 9.0 (5.0, 19.0) vs. 13.0 (6.0, 26.0)], the hospitalization expenses were lower [ten thousand Yuan: 3.46 (2.88, 5.18) vs. 4.58 (3.08, 6.06)], and the incidence of bronchopulmonary dysplasia (BPD) was lower (11.9% vs. 28.8%), with statistically significant differences (all P < 0.05). CONCLUSIONS: In addition to GA, gender, cesarean section, premature rupture of membranes, gestational diabetes, and neonatal asphyxia, the father's smoking addiction (maternal smoke exposure during pregnancy) is an important risk factor of RDS in premature infants. The efficacy of prenatal use of DEX for prevention of RDS in preterm infants is affected by many factors, such as prenatal smoke exposure, timing of use, multiple fetuses, etc. Calf PS combined with budesonide suspension is better than poractant alfa injection in reducing the incidence of BPD.


Asunto(s)
Surfactantes Pulmonares , Síndrome de Dificultad Respiratoria del Recién Nacido , Cesárea , Niño , Femenino , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Masculino , Embarazo , Surfactantes Pulmonares/uso terapéutico , Síndrome de Dificultad Respiratoria del Recién Nacido/tratamiento farmacológico , Estudios Retrospectivos
3.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(3): 254-258, 2021 Mar.
Artículo en Chino | MEDLINE | ID: mdl-33691918

RESUMEN

OBJECTIVE: To study the clinical features of very preterm small-for-gestational-age infants born by cesarean section due to severe preeclampsia. METHODS: Forty-two small-for-gestational-age infants who were admitted from August 2017 to July 2018 and were born due to severe preeclampsia were enrolled as the observation group. Forty very preterm infants who were born to healthy mothers since uterine contractions could not be suppressed were enrolled as the control group. Perinatal features, clinical manifestations of infection, complications, and clinical outcomes were analyzed for the two groups. RESULTS: Within 6 hours and 2-3 days after birth, the observation group had significantly lower white blood cell count (WBC), absolute neutrophil count (ANC), and platelet count (PLT) than the control group (P < 0.05). At 5-7 days after birth, there was no significant difference in WBC between the two groups (P > 0.05), while the observation group still had significantly lower ANC and PLT than the control group (P < 0.05). The observation group had a significantly higher C-reactive protein (CRP) level than the control group at 2-3 days and 5-7 days after birth (P < 0.05). The observation group had a significantly higher proportion of infants with severe infections than the control group (P < 0.05). The observation group had a significantly higher hemoglobin level than the control group within 6 hours after birth (P < 0.05). The observation group had a significantly higher incidence rate of bronchopulmonary dysplasia than the control group (P < 0.05). There was no significant difference between the two groups in the rate of pulmonary hemorrhage, intracranial hemorrhage, neonatal necrotizing enterocolitis, retinopathy of prematurity, and the rate of use of invasive ventilation, and clinical outcomes (P > 0.05). CONCLUSIONS: Very preterm small-for-gestational-age infants born due to severe preeclampsia have a high incidence rate of infection and severe conditions. Early manifestations include reductions in the infection indicators WBC, ANC, and PLT, and CRP does not increase significantly in the early stage and gradually increases at 2-3 days after birth. Most of these infants require invasive ventilation after birth, with bronchopulmonary dysplasia as the main complication. Clinical changes should be closely observed and inflammatory indicators should be monitored for early identification of infection, timely diagnosis, and timely adjustment of antibiotic treatment, so as to improve the outcome.


Asunto(s)
Displasia Broncopulmonar , Enfermedades del Prematuro , Preeclampsia , Cesárea , Femenino , Edad Gestacional , Humanos , Lactante , Recien Nacido Extremadamente Prematuro , Recién Nacido , Recién Nacido de muy Bajo Peso , Embarazo
4.
Ceska Gynekol ; 86(1): 40-45, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33752408

RESUMEN

OBJECTIVE: An analysis of ethical studies related to uterus transplantation in the treatment of absolute uterine factor infertility. METHODS: Literary research using the Web of Science, Google Scholar and Pubmed databases with the following keywords: absolute uterine factor infertility, ethics, deceased donor, living donor, and uterus transplantation. An analysis of articles published in impact and reviewed journals between 2000-2021. RESULTS: Uterus transplantation is a promising treatment method for women with absolute uterine factor infertility. In the experimental studies, an ultimate goal of this complex treatment was repeatedly achieved: childbirth through a caesarean section. An important milestone towards the application of uterus transplantation in human was the Montreal criteria of its ethical feasibility, published in 2012-2013. In 2012, the first uterus transplant study from a living donor started in Sweden and, in 2016, further studies were initiated worldwide. The first childbirth from the transplanted uterus in 2014 increased the interest of ethicists in various aspects of this experimental treatment, and this trend continues. Current ethical analyzes are focused particularly on the comparison of advantages and disadvantages related to the utilization of living and deceased donors of uterus; comparing ethical aspects of gestational surrogacy and uterus transplantation; uterus transplantation as an extremely radical form of assisted reproduction; its impact on adoptions; uterus transplantation in trans-gender women; the importance of establishing an international registry for uterus transplants; and other important ethical issues associated with this complex form of assisted reproduction. CONCLUSION: Uterus transplantation is still in an experimental stage. The ethical analysis of the individual steps of this comprehensive method in the treatment of female infertility should be carried out continuously, in connection with the gradually presented outcomes of ongoing scientific research studies.


Asunto(s)
Infertilidad Femenina , Trasplante de Órganos , Cesárea , Femenino , Humanos , Infertilidad Femenina/cirugía , Donadores Vivos , Embarazo , Útero
6.
Niger J Clin Pract ; 24(3): 335-340, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33723106

RESUMEN

Background: Postpartum hemorrhage (PPH) is one of the emergency situations of obstetrics practice that constitutes of 1 to 5% of vaginal and cesarean deliveries. Uterine atony is the number one cause of PPH and is responsible for at least 75% of PPH cases. Uterine compression sutures have been regarded as an effective method in PPH cases, as well as preserving fertility by preserving the uterus. Aims: The main purpose of this study was to report on our results with a new uterine compression suture technique that was developed by us. Subjects and Methods: In this study we included all women who needed uterine compression sutures because of uterine atony while cesarean section from January 2014 to December 2018. Fifteen cases with PPH with uterine atony were reported, who were treated with our uterine compression suture technique after conservative medical and uterine massage treatment failure. Results: All of the cases in this study were managed successfully namely none of the patients needed a hysterectomy or reoperation because of bleeding again. One week, one month, three months later all patients were followed up. Six months later 11 patients were examined, four patients lost to follow-up, but they were reached by phone since they were outside of the city, they reported no complaints. Ultrasound examination was performed to follow up patients. Short-term follow-up revealed no complications such as pyometra, endometritis, reoperation, amenorrhea, or uterine necrosis. Conclusions: We described our practice with our uterine compression suture that is easy to learn and apply. All of the cases that participated in our study showed improvement to the compression sutures, so no other surgical interventions were applied. The same suture technique was applied by only one physician. This is a feasible and easy way to stop bleeding in uterine atony and in uterine preservation, especially in rural areas when help may not be available in case of complications.


Asunto(s)
Hemorragia Posparto , Inercia Uterina , Cesárea , Femenino , Humanos , Madres , Hemorragia Posparto/cirugía , Embarazo , Técnicas de Sutura , Resultado del Tratamiento , Inercia Uterina/cirugía , Útero/cirugía
7.
Artículo en Inglés | MEDLINE | ID: mdl-33656138

RESUMEN

Congenital cytomegalovirus infection causes lethal diseases with neurological, visual, auditory and systemic injuries, including the hemophagocytic syndrome. Hemophagocytic lymphohistiocytosis (HLH) can be caused by primary hereditary immunological defects, as well as several infectious triggering factors, such as viruses, bacteria and fungus, among them the cytomegalovirus (CMV). Here we present the case report of a male newborn male, delivered by cesarean at term (gestation age of 39 weeks), weighing 3,250 g, with suffusion skin lesions spread throughout the body, anemia, generalized edema, hepatosplenomegaly, thrombocytopenia associated with grunts and difficulty breathing, treated with ganciclovir after receiving the diagnosis of congenital CMV infection. After a few days of hospitalization, the patient presented with high fever, persistent hepatosplenomegaly and pancytopenia, in addition to elevated ferritin and triglycerides, receiving the diagnosis of HLH treated with immunosuppressive therapy, corticosteroids and intravenous human immunoglobulin. The present case report highlights the importance for health professionals to carry out the investigation of congenital diseases, especially in developing countries, as well as their complications, such as HLH.


Asunto(s)
Infecciones por Citomegalovirus/congénito , Citomegalovirus/aislamiento & purificación , Linfohistiocitosis Hemofagocítica/diagnóstico , Administración Intravenosa , Corticoesteroides/administración & dosificación , Cesárea , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/tratamiento farmacológico , Femenino , Humanos , Inmunoglobulinas/administración & dosificación , Lactante , Recién Nacido , Linfohistiocitosis Hemofagocítica/complicaciones , Linfohistiocitosis Hemofagocítica/tratamiento farmacológico , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Resultado del Tratamiento
8.
Adv Exp Med Biol ; 1321: 45-51, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33656712

RESUMEN

COVID-19 is a fatal respiratory disease caused by a novel coronavirus that quickly became a pandemic. Pregnant women and neonates are two vulnerable groups in COVID-19 infections because the immune system weakens during pregnancy. The present review study was conducted to investigate the rate of vertical transmission in infants born to women with COVID-19 infections and to describe the characteristics of the affected infants. We conducted a search of the various scientific databases using relevant keywords. All English-language studies involving neonates born to women who had COVID-19 infections were included. The main outcomes were rates of vertical transmission and the characteristics of the affected newborns. Out of 13 selected studies, 103 newborns were involved. The rate of vertical transmission was 5.4%. Of the five infected newborns, four were full-term and one was preterm. All were born by Cesarean section. The clinical symptoms were vomiting, fever, lethargy, shortness of breath, and cyanosis. In four newborns, a chest x-ray showed evidence of pneumonia. The most common laboratory finding was leukocytosis and elevated creatine kinase levels. One newborn needed mechanical ventilation. All newborns recovered and were discharged. The findings of this review study showed that the prognosis of newborns of infected mothers was satisfactory, and clinical symptoms of infected neonates did not differ from adults and were nonspecific. Due to the low amount of data regarding this field, further studies with higher sample sizes are required for more definitive conclusions.


Asunto(s)
Complicaciones Infecciosas del Embarazo , Adulto , Cesárea , Femenino , Humanos , Lactante , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo , Mujeres Embarazadas
9.
Adv Exp Med Biol ; 1321: 287-298, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33656734

RESUMEN

The outbreak of the novel coronavirus 2019 (COVID-19) disease has been severe and a cause for major concern around the world. Due to immunological and physiological changes during pregnancy, pregnant women have a higher risk of COVID-19 morbidity and mortality. The aim of this study was to collect and integrate the results of previous studies to get an accurate representation and interpretation of the clinical symptoms, laboratory and radiological findings, and characteristics of pregnant women with COVID-19. We conducted a scientific search in main databases with a combination of related MESH terms and keywords. The outcomes included common clinical symptoms at the time of onset of the disease, common laboratory and radiological findings, the rates of vaginal delivery and Cesarean section, Cesarean section indications, maternal complications, and vertical transmission rates. A total of 51 studies comprising 571 pregnant women with COVID-19 pneumonia were included in the study. The most common symptoms were fever, cough, and dyspnea, respectively. Elevated C-reactive protein and ground-glass opacities were the most common laboratory and radiological findings of COVID-19 pneumonia, respectively. A total of 114 Cesarean sections were performed due to COVID-19-related concerns. There were 55 cases of intubation (11.6%) and 13 maternal deaths (2.3%). The vertical transmission rate was 7.9%. We conclude that the characteristics of pneumonia caused by COVID-19 in pregnant women do not appear to be different from those in the general population with COVID-19 infections. However, pregnant women with underlying diseases were more likely to develop COVID-19 than others, and, in those infected with the virus, the rate of Cesarean delivery and preterm birth increased.


Asunto(s)
Coronavirus , Complicaciones Infecciosas del Embarazo , Nacimiento Prematuro , Cesárea , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo , Nacimiento Prematuro/epidemiología
10.
Adv Exp Med Biol ; 1321: 299-307, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33656735

RESUMEN

In December 2019, a respiratory disease caused by a coronavirus called SARS-CoV-2 (COVID-19) began in Wuhan, China, and quickly became a pandemic. In such situations, pregnant women are suspected of being among the vulnerable groups. The aim of this study was to report clinical symptoms, laboratory findings, and obstetrical complications, maternal, fetal, and neonatal complications of COVID-19 infection in pregnant women. We searched the Cochrane library, MEDLINE/PubMed, and Web of Sciences from their inception to April 5, 2020. Any study involving pregnant women with COVID-19 which evaluated the effect of the disease on pregnancy outcomes and fetal and neonatal complications was included in the study. The outcomes were the symptoms and laboratory findings, obstetrical complications, mode of delivery, and maternal, fetal, and neonatal complications. The search resulted in 69 titles and abstracts, which were narrowed down to 12 studies involving 68 women. The three most common symptoms of patients were fever, cough, and fatigue. The most common laboratory findings were an increase in C-reactive protein (CRP) and lymphopenia. The most common obstetrical complication was preterm labor (33.3%). No maternal deaths were reported. The Cesarean section rate was 83.3% and the vertical transition rate was 2.23%. The findings showed that the clinical symptoms and laboratory measures of pregnant women affected by COVID-19 did not differ from the general population. In general, the prognosis of mothers who suffered from COVID-19 and their newborns was satisfactory. However, there is a need for further rigorous studies to confirm these findings as the pandemic progresses.


Asunto(s)
Complicaciones Infecciosas del Embarazo , Cesárea , China/epidemiología , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo
11.
J Med Case Rep ; 15(1): 143, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33741059

RESUMEN

BACKGROUND: There are limited data on cardiovascular complications of coronavirus disease 2019 in pregnancy, and there are only a few case reports on coronavirus disease 2019 related cardiomyopathy in pregnancy. Differentiation between postpartum cardiomyopathy and coronavirus disease 2019 related cardiomyopathy in pregnant women who develop severe acute respiratory syndrome coronavirus-2 infection during peripartum could be challenging. Here, we present a case of possible coronavirus disease 2019 related cardiomyopathy in a pregnant patient, followed by a discussion of potential differential diagnosis. CASE PRESENTATION: In this case report, we present the case of a young pregnant Iranian woman who developed heart failure with pulmonary edema after cesarean section. She was treated because of low left ventricular ejection fraction and impression of postpartum cardiomyopathy, and her severe dyspnea improved by intravenous furosemide. On day 3, she exhibited no orthopnea or leg edema, but she was complaining of severe and dry cough. Further evaluation showed severe acute respiratory syndrome coronavirus-2 infection. CONCLUSIONS: The possibility of severe acute respiratory syndrome coronavirus-2 infection should be considered in any pregnant woman who develops cardiomyopathy and pulmonary edema.


Asunto(s)
/diagnóstico , Cardiomiopatías/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Trastornos Puerperales/diagnóstico , Edema Pulmonar/diagnóstico , Adulto , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , Azitromicina/uso terapéutico , /terapia , Cardiomiopatías/tratamiento farmacológico , Cardiomiopatías/fisiopatología , Cesárea , Tos/fisiopatología , Diagnóstico Diferencial , Diuréticos/uso terapéutico , Disnea/fisiopatología , Ecocardiografía , Electrocardiografía , Femenino , Furosemida/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/fisiopatología , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Interferón beta/uso terapéutico , Pulmón/diagnóstico por imagen , Preeclampsia , Embarazo , Trastornos Puerperales/tratamiento farmacológico , Trastornos Puerperales/fisiopatología , Edema Pulmonar/tratamiento farmacológico , Edema Pulmonar/fisiopatología , Volumen Sistólico , Tomografía Computarizada por Rayos X
12.
Zhonghua Er Ke Za Zhi ; 59(4): 280-285, 2021 Apr 02.
Artículo en Chino | MEDLINE | ID: mdl-33775046

RESUMEN

Objective: To explore the underlying genetic causes of neonatal encephalopathy complicated with perinatal asphyxia. Methods: From the neonates recruited to the Neonatal Genome Project of Children's Hospital of Fudan University between January 2016 and January 2019, 113 neonates with neonatal encephalopathy and acute peripartum or intrapartum event or Apgar score ≤7 were enrolled in this study. The clinical data, laboratory results, the findings of electroencephalograph and magnetic resonance imaging or head ultrasound, and the genetic information were retrospectively analyzed. Results: Of the 133 neonates with neonatal encephalopathy and acute peripartum or intrapartum event or Apgar score ≤7 scores, 77 (57.9%) were males, 56 (42.1%) were female, 56 (42.1%) were delivered via cesarean section, and 77(57.9%) were born by vaginal delivery. Among these cases, 68 (51.1%) were diagnosed of hypoxic ischemic encephalopathy, 25 (18.8%) had intracranial hemorrhage, 20 (15%) were related to genetic diseases, and 5 (3.8%) had sepsis without central nervous infection. A total of 20 cases with positive results by next-generation sequencing test were identified, including 19 cases with pathogenic variations and 1 case with variation of uncertain significance. These 20 cases included 4 cases with congenital myopathy (2 cases of MTM1 gene pathogenic variants, 1 case of ACTA1 and 1 case of RYR1 gene pathogenic variants), 4 cases with genetic syndrome (2 cases of CHD7 gene pathogenic variants, 1 case of PTN11 gene pathogenic variant, and 1 case of NSDHL gene pathogenic variant), 3 cases with metabolic disorders (1 case of OTC gene pathogenic variant, 1 case of MTHFR gene pathogenic variant, and 1 case of ALDH7A1 gene pathogenic variant), 2 cases with epileptic encephalopathy (1 case of KCNT1 and 1 case of PACS2 gene pathogenic variants), 1 case with congenital central hypoventilation syndrome (PHOX2B gene pathogenic variant) and 6 cases with copy-number pathogenic variations. Among these 20 cases, 8(40.0%) neonates were presented with persistent hypotonia, 7(35.0%) neonates with seizures, and 5(25.0%) neonates with congenital malformation. Genetic counseling and further follow-up were performed or suggested for these 20 cases; 4 neonates were deceased, 10 neonates underwent palliative care, and 6 neonates were improved after supportive care and their further follow-up plan were performed in clinics. Conclusions: Genetic diseases are not rare in neonates with neonatal encephalopathy complicated with perinatal hypoxia event. The common causes in these neonates include congenital myopathy, metabolic disorders, genetic syndrome, and epilepsy encephalopathy.


Asunto(s)
Cesárea , Hipoxia-Isquemia Encefálica , 3-Hidroxiesteroide Deshidrogenasas , Niño , Femenino , Genotipo , Humanos , Hipoxia , Hipoxia-Isquemia Encefálica/genética , Recién Nacido , Masculino , Proteínas del Tejido Nervioso , Fenotipo , Canales de potasio activados por Sodio , Embarazo , Estudios Retrospectivos
13.
Zhonghua Er Ke Za Zhi ; 59(4): 294-298, 2021 Apr 02.
Artículo en Chino | MEDLINE | ID: mdl-33775048

RESUMEN

Objective: To analyze the clinical characteristics and treatment of tricuspid valve prolapse caused by chordal rupture complicated with persistent pulmonary hypertension in neonates. Methods: The clinical data of a male neonate with tricuspid valve prolapse complicated with persistent pulmonary hypertension admitted to the Neonatal Intensive Care Unit of Children's Hospital of Hebei Province in November 2018 was analyzed retrospectively. Related literature up to September 2020 was searched with the strategy of "(neonate OR newborn) AND (tricuspid valve prolapse) AND (rupture OR necrosis) AND (papillary muscle OR chordae tendineae) AND (pulmonary hypertension)" in Wanfang, CNKI and PubMed database in Chinese and English. The characteristics of the disease were summarized. Results: A male full-term neonate was admitted due to presenting severe cyanosis for 9 hours. He was born by caesarean section and presented severe cyanosis and dyspnea at 10 min of ages, unresponsive to the positive airway pressure resuscitation. After 9 hours of mechanical ventilation, there was no improvement. Thus he was transferred to Children's Hospital of Hebei Province. On admission, the initial blood gas analysis showed an arterial partial pressure of oxygen of 22.5 mmHg (1 mmHg=0.133 kPa). The echocardiography revealed prolapsed anterior leaflet of tricuspid valve, severe tricuspid regurgitation (TR) and pulmonary artery hypertension, and right to left shunt via a patent foramen ovale. The arterial duct was closed. The chest X-ray was normal. The boy was treated with nitric oxide, milrinone, and continued mechanical ventilation initially. Addition of prostacyclin analog (treprostinil) on day 3 led to significant improvement of pulmonary blood flow, oxygenation, and stabilization, so that the extracorporeal membrane oxygenation therapy was avoided. At 11 months after birth, the boy underwent cardiac surgery. At surgery, the rupture of chordal tendineae in anterior leaflet of tricuspid valve was found. Tricuspid annuloplasty, valvuloplasty and repair of patent foramen ovale were successfully performed. The follow-up echocardiogram at postoperative 3 months showed only mild tricuspid insufficiency. The boy was well at last follow-up at 22 months of age with normal cognitive skill development. According to literature, 20 cases of papillary muscle or chordae tendineae rupture in neonates had been reported in 12 English papers. Among the total 21 neonates, there were 12 male infants and only one premature infant with gestational age of 33 weeks. They presented with profound cyanosis soon after birth. All of them received endotracheal intubation and mechanical ventilation. Other treatments included inhalation of nitric oxide, intravenous milrinone, vasoactive drugs, diuretics and prostacyclin, etc. Extracorporeal membrane oxygenation (ECMO) was used in 6 infants as a bridge to surgical treatment. Two cases reported earlier death of cardiopulmonary failure without operation and the rest 19 survived after surgery. The followed surgery or autopsy revealed that all of them had tricuspid valve prolapse, rupture of papillary muscle or chordae tendineae. Conclusions: The severe TR resulting from rupture of papillary muscle or chordate tendineae in neonates is rare and could cause severe hypoxemia. Early recognition, adequate cardiopulmonary support to stabilize the hemodynamic status and timely surgery can significantly reduce the mortality.


Asunto(s)
Hipertensión Pulmonar , Válvula Tricúspide , Cesárea , Niño , Cuerdas Tendinosas , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Embarazo , Estudios Retrospectivos , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/cirugía
14.
BMC Pregnancy Childbirth ; 21(1): 247, 2021 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-33761892

RESUMEN

BACKGROUND: Coronavirus disease (COVID-19) has been associated with adverse pregnancy outcomes. Due to the lack of effective treatments for COVID-19, it becomes imperative to assess the geographical differences and trends in the current clinical care and outcomes of COVID-19 in pregnant women. METHODS: A PubMed search was performed to screen articles reporting therapeutics and outcomes of confirmed COVID-19 in pregnant women prior to August 27, 2020. We performed searches, quality assessments of eligible studies, extracted and reported data according to PRISMA guidelines. Meta-analyses and cumulative meta-analyses of proportions were performed for estimating each outcome and their pattern over time respectively. RESULTS: One thousand two hundred thirty nine pregnant women with COVID-19 from 66 studies were analyzed. In case series analysis reflecting average-risk patients, the proportion of oxygen support, antibiotics, antivirals, and plasma therapy administration except for hydroxychloroquine was substantially higher in Asian studies (55, 78, 80, 6, and 0%) compared to the US (7, 1, 12, 0, and 7%) or European (33, 12, 14, 1, and 26%) studies, respectively. The highest preterm birth and the average length of hospital stay (35%, 11.9 days) were estimated in Asian studies compared to the US studies (13%, 9.4 days) and European studies (29%, 7.3 days), respectively. Even in case reports reflecting severe cases, the use of antivirals and antibiotics was higher in Asian studies compared to the US, Latin American, and European studies. A significant decline in the use of most therapeutics along with adverse outcomes of COVID-19 in pregnant women was observed. CONCLUSIONS: Geographical differences in therapeutic practice of COVID-19 were observed with differential rates of maternal and clinical outcomes. Minimizing the use of some therapeutics particularly antibiotics, antivirals, oxygen therapy, immunosuppressants, and hydroxychloroquine by risk stratification and careful consideration may further improve maternal and clinical outcomes.


Asunto(s)
Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , /terapia , Hidroxicloroquina/uso terapéutico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Respiración Artificial , Adulto , Asia/epidemiología , Cesárea , Europa (Continente)/epidemiología , Femenino , Humanos , Inmunización Pasiva , Recién Nacido , América Latina/epidemiología , Tiempo de Internación , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Resultado del Embarazo , Nacimiento Prematuro , Resultado del Tratamiento , Estados Unidos/epidemiología , Adulto Joven
15.
BMJ Case Rep ; 14(3)2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33727296

RESUMEN

A 31-year-old pregnant woman presented with symptomatic COVID-19, which was complicated by progressive hypoxaemia requiring intensive care and emergent delivery by caesarean section. Afterward, she was successfully supported with mechanical ventilation and prone positioning and ultimately recovered. We review literature regarding complications of COVID-19 affecting pregnancy and evidence-based treatment strategies.


Asunto(s)
/terapia , Cesárea , Posicionamiento del Paciente/métodos , Complicaciones Infecciosas del Embarazo/terapia , Respiración Artificial/métodos , Adulto , Femenino , Humanos , Embarazo , Posición Prona
16.
Medicine (Baltimore) ; 100(10): e25075, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725898

RESUMEN

RATIONALE: Pituitary tumor apoplexy (PTA) is a rare clinical syndrome which requires urgent diagnosis and treatment due to its life-threatening consequences. Management of undiagnosed pituitary tumor before pregnancy is a problem during pregnancy. PATIENT CONCERNS: We reported a case with PTA which was not diagnosed before pregnancy presenting with vomiting associated with hyponatremia during the third trimester. After supplying the sodium the patient presented with dysarthria and hemiplegia. DIAGNOSES: MRI examination showed PTA accompanied with extrapontine myelinolysis (EPM). INTERVENTIONS: The patient was given hydrocortisone according to the symptoms gradually to taper off dose, at the same times oral levothyroxine therapy (25µg/day) was given. OUTCOMES: The patient delivered a healthy baby via cesarean section at hospital at 38 + 1 week of gestation. We performed MRI examination regularly and the tumor regressed significantly 8 months postpartum. LESSONS: We reported a case as PTA associated with EPM. Headache during pregnancy is often nonspecific, so careful medical history inquiry is very important.


Asunto(s)
Mielinólisis Pontino Central/diagnóstico , Apoplejia Hipofisaria/diagnóstico , Neoplasias Hipofisarias/diagnóstico , Complicaciones Neoplásicas del Embarazo/diagnóstico , Cesárea , Quimioterapia Combinada , Disartria/etiología , Femenino , Cefalea/tratamiento farmacológico , Cefalea/etiología , Hemiplejía/tratamiento farmacológico , Hemiplejía/etiología , Humanos , Hidrocortisona/administración & dosificación , Hiponatremia/diagnóstico , Hiponatremia/tratamiento farmacológico , Hiponatremia/etiología , Imagen por Resonancia Magnética , Mielinólisis Pontino Central/tratamiento farmacológico , Mielinólisis Pontino Central/etiología , Apoplejia Hipofisaria/sangre , Apoplejia Hipofisaria/tratamiento farmacológico , Apoplejia Hipofisaria/etiología , Hipófisis/diagnóstico por imagen , Neoplasias Hipofisarias/sangre , Neoplasias Hipofisarias/complicaciones , Embarazo , Tercer Trimestre del Embarazo , Sodio/administración & dosificación , Tiroxina/administración & dosificación , Resultado del Tratamiento , Vómitos/tratamiento farmacológico , Vómitos/etiología , Adulto Joven
17.
Artículo en Inglés | MEDLINE | ID: mdl-33753426

RESUMEN

BACKGROUND: The impact of COVID-19 on pregnant inflammatory bowel disease (IBD) patients is currently unknown. Reconfiguration of services during the pandemic may negatively affect medical and obstetric care. We aimed to examine the impacts on IBD antenatal care and pregnancy outcomes. METHODS: Retrospective data were recorded in consecutive patients attending for IBD antenatal care including outpatient appointments, infusion unit visits and advice line encounters. RESULTS: We included 244 pregnant women with IBD, of which 75 (30.7%) were on biologics in whom the treatment was stopped in 29.3% at a median 28 weeks gestation. In addition, 9% of patients were on corticosteroids and 21.5% continued on thiopurines. The care provided during 460 patient encounters was not affected by the pandemic in 94.1% but 68.2% were performed via telephone (compared with 3% prepandemic practice; p<0.0001). One-hundred-ten women delivered 111 alive babies (mean 38.2 weeks gestation, mean birth weight 3324 g) with 12 (11.0%) giving birth before week 37. Birth occurred by vaginal delivery in 72 (56.4%) and by caesarean section in 48 (43.6%) cases. Thirty-three were elective (12 for IBD indications) and 15 emergency caesarean sections. Breast feeding rates were low (38.6%). Among 244 pregnant women with IBD, 1 suspected COVID-19 infection was recorded. CONCLUSION: IBD antenatal care adjustments during the COVID-19 pandemic have not negatively affected patient care. Despite high levels of immunosuppression, only a single COVID-19 infection occurred. Adverse pregnancy outcomes were infrequent.


Asunto(s)
/complicaciones , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Enfermedades Inflamatorias del Intestino/epidemiología , Atención Prenatal/estadística & datos numéricos , Corticoesteroides/uso terapéutico , Adulto , Alopurinol/análogos & derivados , Alopurinol/uso terapéutico , Productos Biológicos/uso terapéutico , Lactancia Materna/estadística & datos numéricos , /epidemiología , Cesárea/estadística & datos numéricos , Parto Obstétrico/estadística & datos numéricos , Femenino , Edad Gestacional , Humanos , Enfermedades Inflamatorias del Intestino/virología , Embarazo , Resultado del Embarazo/epidemiología , Estudios Retrospectivos , Reino Unido/epidemiología , Privación de Tratamiento
18.
Arch. argent. pediatr ; 119(1): 18-24, feb. 2021. tab, ilus
Artículo en Inglés, Español | LILACS, BINACIS | ID: biblio-1147062

RESUMEN

Introducción. A nivel mundial, hay una tendencia ascendente en nacimientos prematuros y cesáreas. El objetivo fue describir edad gestacional (EG), vía de parto, distribución en días y horarios, y relación entre la vía de parto y el momento del nacimiento en dos instituciones privadas.Población y métodos. Estudio prospectivo, transversal, analítico.Resultados. Se incluyeron los 1500 nacidos vivos entre 9-2017 y 8-2018 (1465 embarazadas). El 99,4 % fueron embarazos controlados; el 66,8 % terminaron por cesárea. La causa fue cesárea previa en el 36,4 %, falta de progresión y descenso en el 18,9 % y elección materna en el 9,2 %. El peso promedio al nacer fue de 3232 g ± 561,1 g y la mediana de EG, 39 semanas (rango 38-40) por fecha de última menstruación. El 88,2 % fueron nacidos de término y, de los prematuros, el 76,1 % fueron pretérminos tardíos. Los nacidos de término temprano tuvieron mayor índice de cesáreas (p < 0,001). Los nacimientos por cesárea en días hábiles fueron 849/1201 (el 74,5 %) y, en los días de fin de semana y feriados, 173/299 (el 57,9 %, p < 0,001). Se encontró una relación estadísticamente significativa entre el horario de nacimiento y la realización de cesárea.Conclusiones. La mediana de EG fue 39 semanas. La cesárea fue la vía de nacimiento más frecuente. Los nacimientos se produjeron, predominantemente, de lunes a viernes entre las 8 y las 21 h. El 82,9 % de los nacimientos por cesárea ocurrieron en días de semana laborables


Introduction. There is a worldwide growing trend of preterm births and C-sections. Our objective was to describe gestational age (GA), mode of delivery, day and time distribution, and the relation between the mode of delivery and the time of birth in two private facilities.Population and methods. Prospective, cross-sectional, analytical study.Results. A total of 1500 live newborn infants were included between September 2017 and August 2018 (1465 pregnant women). Of these, 99.4 % had received antenatal care; 66.8 % of pregnancies ended via C-section. The reason was a previous C-section in 36.4 %, lack of progression and descent in 18.9 %, and maternal choice in 9.2 %. The average birth weight was 3232 g ± 561.1 g and the median GA was 39 weeks (range: 38-40) based on the date of the last menstrual period; 88.2 % were term births and, among preterm births, 76.1 % corresponded to late preterm babies. Early term births showed a higher rate of C-sections (p < 0.001). There were 849/1201 (74.5 %) C-sections on weekdays and 173/299 (57.9 %, p < 0.001) on weekends and holidays. A statistically significant relation was observed between the time of birth and the performance of a C-section.Conclusions. The median GA was 39 weeks. C-sections were the most common mode of delivery. Births occurred predominantly Mondays through Fridays between 8 a.m. and 9 p.m.; 82.9 % of C-sections took place on weekdays.


Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Cesárea , Edad Gestacional , Factores de Tiempo , Recien Nacido Prematuro , Estudios Transversales , Estudios Prospectivos , Parto
19.
Heart Surg Forum ; 24(1): E019-E021, 2021 01 14.
Artículo en Inglés | MEDLINE | ID: mdl-33635242

RESUMEN

Pneumonia caused by coronavirus disease 2019 (COVID-19) is a highly contagious disease. Unfortunately, research on extracorporeal membrane oxygenation (ECMO) assisted treatments for patients with COVID-19 infection is limited. In this case study, a patient who was in late pregnancy (35+2 weeks of pregnancy) and suffering from severe COVID-19 was extremely irritable during ECMO-assisted treatment after she underwent a cesarean section. Her Richmond Agitation Sedation Scale (RASS) score reached +3. Nevertheless, the patient successfully was treated with a continuous single/combined application of propofol, midazolam, dexmedetomidine, hibernation mixture, and other drugs for several days (maintaining RASS -2 to -4) and provided with anti-infection, mechanical ventilation, nutritional support, fluid balance under hemodynamic monitoring, liver support, and other organ function support treatments. ECMO-assisted sedation strategy for patients was introduced and discussed in this case to provide a certain reference for the clinical diagnosis and treatment of such patients.


Asunto(s)
/terapia , Cesárea , Dexmedetomidina/administración & dosificación , Oxigenación por Membrana Extracorpórea , Hipnóticos y Sedantes/administración & dosificación , Midazolam/administración & dosificación , Propofol/administración & dosificación , Terapia Combinada , Femenino , Fluidoterapia , Humanos , Monitoreo Fisiológico , Apoyo Nutricional , Embarazo , Respiración Artificial
20.
Z Geburtshilfe Neonatol ; 225(1): 55-59, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33601452

RESUMEN

OBJECTIVE: Caesarean rates have increased rapidly for various reasons recently. One of the important reasons among these is medicolegal problems. Our aim with this study was to preoperatively predict abdominal adhesion density by combining the scar tissue morphology formed in the post-caesarean Pfannenstiel incision line and the skin color scoring of the patients. MATERIAL AND METHODS: Patients who had undergone one caesarean section previously, completed their terms (37-39 weeks) and were under 35 years old were included in the study. Skin color scoring of the patients was performed using the Fitzpatrick skin color scale. Intra-abdominal adhesion scoring of the participant patients was performed using Nair's adhesion scoring system. RESULTS: The change in abdominal adhesion scores was evaluated based on the Fitzpatrick color scale. Adhesion scores per the Nair intra-abdominal adhesion scoring system were found to be 0.04±0.209 in the FP1 group, 0.35±0.662 in the FP2 group, 1.58±0.923 in the FP3 group, and 2.33±0.577 in the FP4 group (p<0.05). These results showed a significant increase in adhesion density with increasing skin color darkness. Based on these results, it was observed that the abdominal adhesion scores and the frequency of depressed skin scar were significantly increased with increasing Fitzpatrick scores (p<0.05). CONCLUSION: The aim of this study was to increase the prediction rates by adding the skin color scoring to the scar tissue characteristics, which have been used in previous studies. The results of this study indicate that the combination of these two parameters may be more effective in predicting intra-abdominal adhesions. Nevertheless, there is a need for studies with a much higher number of patients and multiple parameters to be able to predict intra-abdominal adhesion density preoperatively with greater accuracy.


Asunto(s)
Cesárea Repetida/efectos adversos , Cesárea/efectos adversos , Cicatriz/etiología , Pigmentación de la Piel , Adherencias Tisulares/etiología , Adulto , Cicatriz/patología , Femenino , Edad Gestacional , Humanos , Valor Predictivo de las Pruebas , Embarazo , Adherencias Tisulares/diagnóstico
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