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2.
Ned Tijdschr Geneeskd ; 1642021 02 09.
Artículo en Holandés | MEDLINE | ID: mdl-33560604

RESUMEN

SARS-CoV-2 has rapidly spread worldwide since December 2019. Obviously, pregnant and lactating women will also be infected with SARS-CoV-2. Pregnant women, however, are a risk population for developing severe respiratory infections. Currently, the knowledge on potential risks and consequences of COVID-19 during pregnancy and lactation is limited. Available data show that pregnant women suffer from similar symptoms compared to non-pregnant patients. There is no evidence as yet that COVID-19 has a more serious course during pregnancy. Although pregnant women might suffer from a wide variety of symptoms, most of them are asymptomatic. Maternal SARS-CoV-2 infection might lead to adverse neonatal outcomes, such as prematurity or respiratory symptoms. There is currently no conclusive evidence of absence of intrauterine transmission of the virus; the virus has not been detected in breastmilk in most studies, although passage into breastmilk cannot be completely excluded.


Asunto(s)
Lactancia Materna , Transmisión Vertical de Enfermedad Infecciosa , Complicaciones Infecciosas del Embarazo/fisiopatología , Resultado del Embarazo , /transmisión , Portador Sano , Femenino , Humanos , Recién Nacido , Lactancia , Embarazo , Factores de Riesgo
3.
Medicine (Baltimore) ; 100(5): e23915, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592844

RESUMEN

BACKGROUND: In recent years, the incidence of ulcerative colitis (UC) is on the rise, and most of them are young adults. As the peak of the disease overlaps with the childbearing age, it has a great impact on the fertility of female patients. We, therefore, conduct a randomized and controlled trial to evaluate the efficacy and safety of mesalazine enteric-coated tablets combined with Kangfuxin Liquid (KFX) enema for the child-bearing period female with active UC. METHODS: In this randomized controlled study, a total of 236 eligible patients will be assigned to the experimental group (n = 118) or the control group (n = 118) in a 1:1 ratio. The control group will be taken mesalazine enteric-coated tablets combined with placebo enema and the experimental group will be taken mesalazine enteric-coated tablets combined with KFX enema. Participants will receive 8 weeks of intervention treatment and 3 months of maintenance treatment before pregnancy. The primary assessment is the Mayo score. Secondary outcomes include mucosal healing, faecal calprotectin (FC), Inflammatory Bowel Disease Quality (IBDQ), and pregnancy outcome. DISCUSSION: This study will provide evidence regarding the efficacy and safety of KFX enema used before pregnancy on halting active UC, reducing the relapse rate during pregnancy, improving pregnancy outcome, and the quality of life. TRIAL REGISTRATION: Chinese Clinical Trials Register identifier, ChiCTR2000039161, registered on October 20, 2020.


Asunto(s)
Antiinflamatorios no Esteroideos/administración & dosificación , Colitis Ulcerosa/tratamiento farmacológico , Enema/métodos , Materia Medica/administración & dosificación , Mesalamina/administración & dosificación , Complicaciones del Embarazo/tratamiento farmacológico , Adulto , Colitis Ulcerosa/complicaciones , Método Doble Ciego , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Complicaciones del Embarazo/etiología , Resultado del Embarazo , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Adulto Joven
5.
Med Clin North Am ; 105(2): 341-353, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33589107

RESUMEN

Management of women with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and obstetric antiphospholipid syndrome (APS) during pregnancy presents unique clinical challenges. Women with both RA and SLE can have disease flares during pregnancy, leading to pregnancy complications, such as preeclampsia, small-for-gestational-age infants, and preterm delivery. Disease should be under control prior to conception. Women with obstetric APS need to be anticoagulated during pregnancy. Many but not all antirheumatic medications can be used during pregnancy and lactation.


Asunto(s)
Síndrome Antifosfolípido , Artritis Reumatoide , Lupus Eritematoso Sistémico , Manejo de Atención al Paciente/métodos , Complicaciones del Embarazo , Síndrome Antifosfolípido/diagnóstico , Síndrome Antifosfolípido/terapia , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/terapia , Femenino , Humanos , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/terapia , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/terapia , Resultado del Embarazo , Embarazo de Alto Riesgo
6.
Medicine (Baltimore) ; 100(4): e23627, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530164

RESUMEN

BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is a common complication in the third trimester of pregnancy, which may result in premature delivery, fetal distress, stillbirth, and other adverse pregnancy outcomes. Ursodeoxycholic acid (UDCA) is a first-line treatment for ICP and has been controversial in improving adverse pregnancy outcomes. The purpose of this protocol is to systematically evaluate the effect of UDCA on pregnancy outcomes in patients with intrahepatic cholestasis during pregnancy. METHODS: To search the databases PubMed, Embase, Web of Science, the Cochrane Library, CNKI, WanFang, VIP, CBMDIsc by computer, then to include randomized controlled clinical studies on UDCA for treatment of intrahepatic cholestasis during pregnancy from the establishment of the database to October 1, 2020. Two researchers independently extract and evaluate the data of the included studies, and meta-analysis is conducted on the included literatures using RevMan5.3 software. RESULTS: This protocol evaluates the outcome of UDCA in improving ICP by incidence of postpartum hemorrhage in pregnant women preterm birth rates meconium contamination rate in amniotic fluid incidence of fetal distress scale of newborns scoring <7 in 5-min Apgar incidence of neonatal admission to neonatal intensive care unit. CONCLUSION: This protocol will provide an evidence-based basis for clinical use of UDCA in the treatment of intrahepatic cholestasis during pregnancy. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval was not required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605 / OSF.IO / BE67H.


Asunto(s)
Colagogos y Coleréticos/uso terapéutico , Colestasis Intrahepática/tratamiento farmacológico , Complicaciones del Embarazo/tratamiento farmacológico , Resultado del Embarazo/epidemiología , Atención Prenatal/métodos , Ácido Ursodesoxicólico/uso terapéutico , Femenino , Sufrimiento Fetal/epidemiología , Sufrimiento Fetal/etiología , Humanos , Incidencia , Recién Nacido , Metaanálisis como Asunto , Embarazo , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etiología , Proyectos de Investigación , Mortinato/epidemiología , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
7.
Viruses ; 13(2)2021 01 28.
Artículo en Inglés | MEDLINE | ID: mdl-33525328

RESUMEN

There have been reports of neurological abnormalities associated with the Zika virus (ZIKV), such as congenital Zika syndrome (CZS) in children born to mothers infected during pregnancy. We investigated how the immune response to ZIKV during pregnancy is primed and conduct a thorough evaluation of the inflammatory and cytotoxic profiles as well as the expression of CCR5 and CX3CR1. We compared the reactivity of T cells to ZIKV peptides in convalescent mothers infected during pregnancy. The child's clinical outcome (i.e., born with or without CZS) was taken to be the variable. The cells were stimulated in vitro with ZIKV peptides and evaluated using the ELISPOT and flow cytometry assays. After in vitro stimulation with ZIKV peptides, we observed a tendency toward a higher Interferon gamma (IFN-γ)-producing T cell responses in mothers who had asymptomatic children and a higher CD107a expression in T cells in mothers who had children with CZS. We found a higher frequency of T cells expressing CD107a+ and co-expressing CX3CR1+CCR5+, which is much clearer in the T cells of mothers who had CZS children. We suggest that this differential profile influenced the clinical outcome of babies. These data need to be further investigated, including the evaluation of other ZIKV peptides and markers and functional assays.


Asunto(s)
Receptor 1 de Quimiocinas CX3C/metabolismo , Complicaciones Infecciosas del Embarazo/inmunología , Receptores CCR5/metabolismo , Linfocitos T/inmunología , Infección por el Virus Zika/inmunología , Adulto , Estudios Transversales , Citotoxicidad Inmunológica , Femenino , Humanos , Lactante , Interferón gamma/metabolismo , Glicoproteínas de la Membrana Asociadas a los Lisosomas/metabolismo , Embarazo , Resultado del Embarazo , Linfocitos T/metabolismo , Adulto Joven , Virus Zika/inmunología
8.
Z Gastroenterol ; 59(2): 143-148, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33556973

RESUMEN

BACKGROUND: Neuroendocrine tumors (NET) diagnosed during pregnancy are extremely rare. This case report describes diagnosis and treatment of a metastasized pancreas NET that became symptomatic in the second trimester. CASE DESCRIPTION: A 33-year-old patient presented to the emergency department in the 19th week of pregnancy (WOP) with persistent diarrhea. Laboratory tests showed a pronounced hypercalcemia (3.53 mmol/l). Imaging revealed a mass in the pancreatic corpus/tail with extensive liver metastasis. Histologically, a NET (G2, SSTR-positive) with paraneoplastic parathormone-related-peptide secretion was found to be the cause of hypercalcemia. Under a treatment with octreotide, calcium values normalized and diarrhea stopped. After delivery of a healthy child (32.WOP via cesarean section) tumor progress was found. The pancreatic mass was resected completely, the liver metastases as far as possible. Postoperatively, in a CT scan, residual suspicious liver lesions could be found, and a palliative therapy with lanreotide was initiated. With this treatment, the patient has been asymptomatic for one year, and serum calcium remained normal. The child developed normally. DISCUSSION: This unusual case shows that even in extensively metastasized symptomatic NETs during pregnancy, there may be sufficient diagnostic and therapeutic options that allow for a continuation of pregnancy in close interdisciplinary cooperation under careful risk-benefit assessment for mother and child.


Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Diarrea/etiología , Hipercalcemia/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Tumores Neuroendocrinos/fisiopatología , Octreótido/uso terapéutico , Neoplasias Pancreáticas/fisiopatología , Adulto , Cesárea , Femenino , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/etiología , Hiperparatiroidismo/sangre , Hiperparatiroidismo/complicaciones , Recién Nacido , Neoplasias Hepáticas/patología , Metástasis de la Neoplasia , Tumores Neuroendocrinos/sangre , Neoplasias Pancreáticas/sangre , Neoplasias Pancreáticas/terapia , Proteína Relacionada con la Hormona Paratiroidea/sangre , Embarazo , Resultado del Embarazo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
9.
BMC Pregnancy Childbirth ; 21(1): 108, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33546624

RESUMEN

BACKGROUND: As pregnancy is a physiological prothrombotic state, pregnant women may be at increased risk of developing coagulopathic and/or thromboembolic complications associated with COVID-19. METHODS: Two biomedical databases were searched between September 2019 and June 2020 for case reports and series of pregnant women with a diagnosis of COVID-19 based either on a positive swab or high clinical suspicion where no swab had been performed. Additional registry cases known to the authors were included. Steps were taken to minimise duplicate patients. Information on coagulopathy based on abnormal coagulation test results or clinical evidence of disseminated intravascular coagulation (DIC), and on arterial or venous thrombosis, were extracted using a standard form. If available, detailed laboratory results and information on maternal outcomes were analysed. RESULTS: One thousand sixty-three women met the inclusion criteria, of which three (0.28, 95% CI 0.0 to 0.6) had arterial and/or venous thrombosis, seven (0.66, 95% CI 0.17 to 1.1) had DIC, and a further three (0.28, 95% CI 0.0 to 0.6) had coagulopathy without meeting the definition of DIC. Five hundred and thirty-seven women (56%) had been reported as having given birth and 426 (40%) as having an ongoing pregnancy. There were 17 (1.6, 95% CI 0.85 to 2.3) maternal deaths in which DIC was reported as a factor in two. CONCLUSIONS: Our data suggests that coagulopathy and thromboembolism are both increased in pregnancies affected by COVID-19. Detection of the former may be useful in the identification of women at risk of deterioration.


Asunto(s)
/epidemiología , Coagulación Intravascular Diseminada/epidemiología , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Hematológicas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Tromboembolia/epidemiología , Trombosis de la Vena/epidemiología , /virología , Comorbilidad , Coagulación Intravascular Diseminada/virología , Femenino , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/virología , Complicaciones Hematológicas del Embarazo/virología , Complicaciones Infecciosas del Embarazo/virología , Resultado del Embarazo , Tromboembolia/virología , Trombosis de la Vena/virología
10.
Lancet Public Health ; 6(2): e97-e105, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33516292

RESUMEN

BACKGROUND: Existing studies evaluating the association between maternal risk factors and specific infant outcomes such as birthweight, injury admissions, and mortality have mostly focused on single risk factors. We aimed to identify routinely recorded psychosocial characteristics of pregnant women most at risk of adverse infant outcomes to inform targeting of early intervention. METHODS: We created a cohort using administrative hospital data (Hospital Episode Statistics) for all births to mothers aged 15-44 years in England, UK, who gave birth on or after April 1, 2010, and who were discharged before or on March 31, 2015. We used generalised linear models to evaluate associations between psychosocial risk factors recorded in hospital records in the 2 years before the 20th week of pregnancy (ie, teenage motherhood, deprivation, pre-pregnancy hospital admissions for mental health or behavioural conditions, and pre-pregnancy hospital admissions for adversity, including drug or alcohol abuse, violence, and self-harm) and infant outcomes (ie, birthweight, unplanned admission for injury, or death from any cause, within 12 months from postnatal discharge). FINDINGS: Of 2 520 501 births initially assessed, 2 137 103 were eligible and were included in the birth outcome analysis. Among the eligible births, 93 279 (4·4%) were births to teenage mothers (age <20 years), 168 186 (7·9%) were births to previous teenage mothers, 51 312 (2·4%) were births to mothers who had a history of hospital admissions for mental health or behavioural conditions, 58 107 (2·7%) were births to mothers who had a history of hospital admissions for adversity, and 580 631 (27·2%) were births to mothers living in areas of high deprivation. 1 377 706 (64·5%) of births were to mothers with none of the above risk factors. Infants born to mothers with any of these risk factors had poorer outcomes than those born to mothers without these risk factors. Those born to mothers with a history of mental health or behavioural conditions were 124 g lighter (95% CI 114-134 g) than those born to mothers without these conditions. For teenage mothers compared with older mothers, 3·6% (95% CI 3·3-3·9%) more infants had an unplanned admission for injury, and there were 10·2 (95% CI 7·5-12·9) more deaths per 10 000 infants. INTERPRETATION: Health-care services should respond proactively to pre-pregnancy psychosocial risk factors. Our study demonstrates a need for effective interventions before, during, and after pregnancy to reduce the downstream burden on health services and prevent long-term adverse effects for children. FUNDING: Wellcome Trust.


Asunto(s)
Salud Mental/estadística & datos numéricos , Resultado del Embarazo/epidemiología , Factores Socioeconómicos , Adolescente , Adulto , Inglaterra/epidemiología , Femenino , Humanos , Vigilancia de la Población , Embarazo , Embarazo en Adolescencia/psicología , Nacimiento Prematuro , Características de la Residencia/estadística & datos numéricos , Factores de Riesgo , Conducta Autodestructiva/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Violencia/estadística & datos numéricos , Adulto Joven
11.
Zhonghua Fu Chan Ke Za Zhi ; 56(1): 19-26, 2021 Jan 25.
Artículo en Chino | MEDLINE | ID: mdl-33486924

RESUMEN

Objective: To investigate the impact of a previous cesarean delivery on pregnancy outcomes of in vitro fertilization and frozen-thawed embryo transfer (FET). Methods: The clinical data of 1 179 patients who received in vitro fertilization and FET in Tianjin Central Hospital of Gynecology Obstetrics from January 2014 to May 2019 and had a history of the previous delivery were retrospectively analyzed. The patients were divided into four groups according to different previous delivery history and the number of embryo transferred: group A (single embryo transfer group with cesarean delivery history, n=338), group B (single embryo transfer group with vaginal delivery history, n=78), group C (double embryo transfer group with cesarean delivery history, n=444), and group D (double embryo transfer group with vaginal delivery history, n=319). The 1∶1 propensity score based on age, body mass index (BMI), infertility duration, basal FSH, basal LH, number of oocytes retrieved and high-quality embryo rate was used to match group A and B (caliper value=0.15), group C and D (caliper value=0.05), and group A and C (caliper value=0.01) respectively to reduce the influence of selection bias. The clinical pregnancy outcomes of patients were compared. Results: (1) Group A and group B were single embryo transfer groups with a total of 77 pairs of matched patients. There were no statistically significant differences in clinical pregnancy rate [42.9% (33/77) vs 45.5% (35/77)], miscarriage rate, preterm birth rate, and neonatal birth weight (all P>0.05). (2) Group C and group D were double embryo transfer groups with a total of 304 pairs of matched patients. The clinical pregnancy rate [42.4% (129/304)] and twin pregnancy rate [9.5% (29/304)] of Group C were significantly lower than those of Group D [53.0% (161/304), 15.5% (47/304) respectively; both P<0.05). There were no statistically significant in miscarriage rate, preterm birth rate and neonatal birth weight between the two groups (all P>0.05). (3) Groups A and C matched 318 pairs of patients. The two groups had no statistical significances in clinical pregnancy rate [38.4% (122/318) vs 45.6% (145/318)], miscarriage rate and preterm birth rate (all P>0.05), but the twin pregnancy rate in group C was significantly higher than that of group A [11.3% (36/318) vs 0.3% (1/318), P<0.01). (4) The occurrence of the low-birth-weight infant were related to gestational age (OR=0.41, 95%CI: 0.32-0.54) and twin pregnancy (OR=4.44, 95%CI: 1.93-10.21), and the occurrence of macrosomia was related to BMI (OR=1.18, 95%CI: 1.06-1.32). Moreover, the previous delivery method was not related to the neonatal birth weight (P>0.05). Conclusions: Patients with different delivery histories receive FET therapy, the pregnancy outcomes of single embryo transfer are not significantly different, and the success rate of double embryo transfer in patients with a cesarean delivery history is low. The neonatal birth weight is not related to the history of the cesarean section. It is recommended that patients with a cesarean delivery history choose elective single embryo transfer to ensure the success rate and to reduce the risk.


Asunto(s)
Cesárea/efectos adversos , Transferencia de Embrión/métodos , Fertilización In Vitro , Resultado del Embarazo , Cesárea/estadística & datos numéricos , Criopreservación , Transferencia de Embrión/efectos adversos , Femenino , Humanos , Recién Nacido , Embarazo , Índice de Embarazo , Nacimiento Prematuro , Estudios Retrospectivos
12.
Zhonghua Fu Chan Ke Za Zhi ; 56(1): 58-63, 2021 Jan 25.
Artículo en Chino | MEDLINE | ID: mdl-33486929

RESUMEN

Objective: To conduct a systematic review of the association of levothyroxine treatment with pregnancy outcomes in euthyroid women who are thyroid autoantibody positive. Methods: Medline, Excerpta Medica (EMBASE), Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), Wanfang data and VIP database were searched from inception until Jan. 28, 2020. All published randomized controlled trials assessing the association of levothyroxine treatment with pregnancy outcomes in euthyroid women with thyroid autoantibody-positive were included. STATA 11.0 and RevMan 5.3 softwares were used to perform this Meta-analysis. Results: A total of 6 studies met the inclusion criteria, with 2 188 women randomized. Meta-analysis showed that there was no significantly association between miscarriage (OR=0.85, 95%CI: 0.65-1.11, P=0.234) and preterm birth (OR=0.79, 95%CI: 0.54-1.16, P=0.224) with levothyroxine treatment. Conclusions: Levothyroxine therapy could not reduce the risk of miscarriage and preterm birth in euthyroid women with thyroid autoantibody-positive. Therefore, levothyroxine should be used with caution for these pregnant women.


Asunto(s)
Autoanticuerpos/sangre , Hipotiroidismo/tratamiento farmacológico , Nacimiento Prematuro/prevención & control , Tirotropina/sangre , Tiroxina/uso terapéutico , Autoanticuerpos/fisiología , China , Femenino , Humanos , Recién Nacido , Embarazo , Complicaciones del Embarazo , Resultado del Embarazo , Nacimiento Prematuro/sangre , Nacimiento Prematuro/epidemiología , Tiroxina/administración & dosificación , Tiroxina/efectos adversos , Tiroxina/sangre , Resultado del Tratamiento
13.
BMC Pregnancy Childbirth ; 21(1): 95, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33514327

RESUMEN

BACKGROUND: A bicornuate uterus often results in infertility. While reconstructive procedures may facilitate pregnancy, spontaneous abortion or serious pregnancy complications may occur. We present a case of a bicornuate uterus with spontaneous conception after Strassman metroplasty; however, life-threatening complications during pregnancy occurred. CASE PRESENTATION: A 38-year-old woman with a history of infertility presented for prenatal care at 6 weeks of gestation. She had conceived spontaneously after four failed in vitro fertilization and embryo transfer (IVF-ET) procedures, Strassman metroplasty for a complete bicornuate uterus, and two postoperative IVF-ET pregnancies that ended in embryo arrest. This pregnancy was uneventful until the patient presented with massive vaginal bleeding at 28 weeks of gestation and was diagnosed with placenta previa and placenta percreta. Bleeding was controlled after emergency Caesarean section and delivery of a healthy neonate. However, severe adhesions were noted as well as a rupture along the metroplasty scar. Two days later, on removal of the intrauterine gauze packing, severe hemorrhage resumed, and the uterus did not respond to oxytocin, hemabate, or carbetocin. Emergency hysterectomy was required. CONCLUSIONS: Reconstructive surgical procedures for complete bicornuate uterus may allow patients to achieve spontaneous pregnancies. However, potential intrapartum complications include placenta implantation and postpartum hemorrhage, and the latter may be exacerbated as the uterus does not contract or respond to oxytocin or prostaglandin drugs. Patients should be counseled on the risks associated with pregnancy after Strassman metroplasty, and clinicians must be aware of potential severe complications.


Asunto(s)
Placenta Accreta/cirugía , Complicaciones del Embarazo/cirugía , Anomalías Urogenitales/cirugía , Hemorragia Uterina/diagnóstico , Útero/anomalías , Útero/cirugía , Aborto Espontáneo/etiología , Adulto , Cesárea/efectos adversos , Femenino , Edad Gestacional , Humanos , Histerectomía , Recién Nacido , Placenta Previa/cirugía , Embarazo , Resultado del Embarazo , Segundo Trimestre del Embarazo , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Hemorragia Uterina/etiología , Hemorragia Uterina/cirugía
14.
BMC Pregnancy Childbirth ; 21(1): 99, 2021 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-33516193

RESUMEN

BACKGROUND: Chorangiosis is a vascular change involving the terminal chorionic villi in the placenta. It results from longstanding, low-grade hypoxia in the placental tissue, and is associated with such conditions as intrauterine growth restriction (IUGR), diabetes, and gestational hypertension in pregnancy. Chorangiosis rarely occurs in normal pregnancies. However, its prevalence is 5-7% of all placentas from infants admitted to newborn intensive care units. The present study was aimed at determining the association of chorangiosis with pregnancy complications and perinatal outcomes. METHODS: In this case-control study, 308 chorangiosis cases were compared with 308 controls (with other diagnoses in pathology) in terms of maternal, placental, prenatal, and neonatal characteristics derived from the medical records of participants retrospectively. R and SPSS version 22 software tools were used, and the statistical significance level was considered 0.05 for all the tests. RESULTS: Preeclampsia, diabetes mellitus, maternal hemoglobin, maternal hematocrit, C/S, oligohydramnios, fetal anomaly, dead neonates, NICU admissions were significantly higher in the chorangiosis group OR = 1.6, 3.98, 1.68, 1.92, 2.1, 4.47, 4.22, 2.9, 2.46, respectively (p-value< 0.05 for all). Amniotic fluid index, birth weight, cord PH amount, 1st, and 5th Apgar score was lower in the chorangiosis group OR = 0.31, 1, 0.097, 0.83, 0.85, respectively (p-value< 0.05 for all). Moreover, fundal placenta, retro placental hemorrhage, perivillous fibrin deposition, calcification, and acute chorioamnionitis were higher in the chorangiosis group OR = 2.1, 11.8, 19.96, 4.05, and 6.38 respectively, (p-value< 0.05). There was a high agreement between the two pathologists, and the power of the study was estimated at 99%. CONCLUSION: Although chorangiosis is an uncommon condition, it is associated with a higher incidence of perinatal and neonatal morbidity and mortality. Therefore, it should be considered an important clinical sign of adverse pregnancy outcomes and should be reported in the pathology evaluation.


Asunto(s)
Corioamnionitis/patología , Vellosidades Coriónicas/patología , Enfermedades Placentarias/patología , Placenta/patología , Complicaciones del Embarazo/patología , Resultado del Embarazo , Adulto , Puntaje de Apgar , Estudios de Casos y Controles , Femenino , Humanos , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Embarazo , Adulto Joven
15.
Medicine (Baltimore) ; 100(2): e24196, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33466195

RESUMEN

ABSTRACT: This retrospective study was designed to explore the recovery of uterine and ovarian function in patients with complete placenta previa (PP) after caesarean delivery (CD). 136 complete placenta previa patients (group completed placenta previa) and 140 patients without complete PP (group non-PP, control group) were included in this study from Jan 2016 to Dec 2018. Subgroup analysis of patients with complete PP was made to determine the impact of different hemostatic methods used during CD on the recovery of uterine function. There were no statistically significant differences between the 2 groups in postpartum menstrual cycle changes, ovarian hormone, and uterine vascular supply as measured by pulsatility index and systolic/diastolic ratio (P > .05). However, the group with complete PP had a reduced endometrial thickness (0.47 ±â€Š0.11 vs 0.50 ±â€Š0.12, P < .001), a lower uterine resistance index at 42nd days (0.84 ±â€Š0.03 vs 0.90 ±â€Š0.03, P < .001), and a delayed resumption menstruation (7.07 ±â€Š2.61 vs 5.31 ±â€Š2.16, P < .001) when compared with control group. Subgroup analysis showed that RI index of all subgroups in completed PP group was lower, endometrial thickness was thinner and the time to menstrual recovery was longer than that of non-PP group. In conclusion, the endometrial thickness and blood supply at 42nd days, not ovarian function, maybe affected after CD in patients with complete PP.


Asunto(s)
Cesárea/métodos , Ovario/anomalías , Placenta Previa/fisiopatología , Recuperación de la Función/fisiología , Útero/anomalías , Adulto , Cesárea/efectos adversos , Femenino , Humanos , Ovario/fisiopatología , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , Útero/fisiopatología
16.
Rev Col Bras Cir ; 48: e20202671, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33503142

RESUMEN

INTRODUCTION: twin-to-twin transfusion syndrome (TTTS), defined by combination of polyhydramnios-oligohydramnios, is the most prevalent (5%-35%) of the abnormalities due to placental vascular anastomoses and the most lethal (80%-100% mortality) if untreated. Fetoscopic laser ablation of abnormal vasculature using the Solomon technique is the gold standard approach. It consists of interrupting the intertwin blood flow. OBJECTIVES: to present our initial experience at the Fetal Surgery Service of the Hospital de Clinicas of the Federal University of Parana (HC-UFPR) and to compare our results with those reported in the literature. METHODS: we conducted a retrospective analysis of pregnancies who had undergone laser ablation, assessing data on Quintero's staging, gestational age at diagnosis and at the time of the procedure, placental position, immediate post-procedure survival, and survival after the neonatal period. We then compared these data with the most recent data available in the literature. RESULTS: we analyzed ten TTTS cases. The diagnosis was performed before the 26th week of pregnancy (median 20.8 weeks) and treatment occurred in a median of 9.5 days later. The distribution by the Quintero's staging was of three cases in stage II, five in stage III, and two in stage IV. In 50% of the gestations, at least one of the fetuses survived through the neonatal period. CONCLUSION: the treatment of TTTS in the HC-UFPR had a positive impact in the survival of the affected fetuses, although the results were worse than the ones reported in the literature, probably due to the delay in referencing the patients to our service, leading to a prolonged interval between diagnosis and treatment.


Asunto(s)
Transfusión Feto-Fetal/cirugía , Fetoscopía , Coagulación con Láser/métodos , Gemelos Monocigóticos , Femenino , Transfusión Feto-Fetal/mortalidad , Edad Gestacional , Hospitales , Humanos , Embarazo , Resultado del Embarazo , Segundo Trimestre del Embarazo , Embarazo Gemelar , Estudios Retrospectivos , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del Tratamiento
17.
Artículo en Inglés | MEDLINE | ID: mdl-33445657

RESUMEN

(1) Background: A considerable number of systematic reviews, with substantial heterogeneity regarding their methods and included populations, on the impact of COVID-19 on infected pregnant women and their neonates, has emerged. The aim was to describe the obstetric-perinatal and neonatal outcome of infected pregnant women and their newborns during the COVID-19 pandemic; (2) Methods: Three bibliographical databases were searched (last search: September 10, 2020). Quality assessment was performed using the AMSTAR-2 tool. Primary outcomes included mode of delivery, preterm delivery/labor, premature rupture of membranes (PROM/pPROM) and abortions/miscarriages. Outcomes were mainly presented as ranges. A separate analysis, including only moderate and high-quality systematic reviews, was also conducted. The protocol was registered with PROSPERO (CRD42020214447); (3) Results: Thirty-nine reviews were analyzed. Reported rates, regarding both preterm and term gestations, varied between 52.3 and 95.8% for cesarean sections; 4.2-44.7% for vaginal deliveries; 14.3-63.8% specifically for preterm deliveries and 22.7-32.2% for preterm labor; 5.3-12.7% for PROM and 6.4-16.1% for pPROM. Maternal anxiety for potential fetal infection contributed to abortion decisions, while SARS-CoV-2-related miscarriages could not be excluded. Maternal ICU admission and mechanical ventilation rates were 3-28.5% and 1.4-12%, respectively. Maternal mortality rate was <2%, while stillbirth, neonatal ICU admission and mortality rates were <2.5%, 3.1-76.9% and <3%, respectively. Neonatal PCR positivity rates ranged between 1.6% and 10%. After accounting for quality of studies, ranges of our primary outcomes remained almost unchanged, while among our secondary outcomes, maternal ICU admission (3-10%) and mechanical ventilation rates (1.4-5.5%) were found to be relatively lower; (4) Conclusions: Increased rates of cesarean sections and preterm birth rates were found, with iatrogenic reasons potentially involved. In cases of symptomatic women with confirmed infection, high maternal and neonatal ICU admission rates should raise some concerns. The probability of vertical transmission cannot be excluded. Further original studies on women from all trimesters are warranted.


Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo , Resultado del Embarazo , Adulto , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Pandemias , Embarazo , Nacimiento Prematuro/virología
18.
Ecotoxicol Environ Saf ; 211: 111915, 2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-33461015

RESUMEN

BACKGROUND: The few studies that examined the association between residential greenness and birth outcomes have produced inconsistent results, and the underlying mechanisms of these associations remain unclear. OBJECTIVES: We examined the mediation and interaction effects of particulate matter (PM) air pollution on the relationship between greenness exposure during the first and third trimesters of pregnancy and birth outcomes, including preterm birth (PTB), term low birth weight (TLBW), small for gestational age (SGA), birth weight (BW), and head circumference (HC). METHODS: We conducted a retrospective cohort study on 16,184 singleton live births between 2010 and 2012 in Taiwan. Residential greenness was estimated based on the normalized difference vegetation index (NDVI), and the PM information during the first and third trimesters was estimated through hybrid kriging land use regression and ordinary kriging interpolation methods. Multiple regression analyses were performed to evaluate the associations between greenness exposure and birth outcomes. We estimated the mediating effects of PM associated with greenness exposure on birth outcomes through causal mediation analyses. We also examined the potential multiplicative and additive interactions between greenness exposure and PM and their effects on birth outcomes. RESULTS: The first trimester NDVI exposure was associated with reduced risks for PTB, TLBW, and SGA, which had an adjusted OR (aOR) of 0.93 (95% CI: 0.89-0.97), 0.91 (95% CI: 0.83-0.99), and 0.95 (95% CI: 0.91-1.00), respectively, per 0.1 unit increase in multi-pollutant models. The causal mediation analysis showed that PM mediated approximately 5-19% of the association between first and third trimester greenness and PTB and mediated approximately 15-37% of the association between greenness and SGA. We identified multiplicative interactions in log scale between first trimester PM10 and NDVI exposure for SGA (aORinteraction = 0.92, p = 0.03) and HC (estimateinteraction = 1.47, p = 0.04). CONCLUSIONS: This study revealed beneficial associations between residential greenness and birth outcomes, including PTB, TLBW, and SGA. The associations were partly mediated by a reduction in exposure to PM air pollution. SUMMARY: The beneficial effects of greenness on PTB and SGA are partly mediated by a reduction in exposure to PM air pollution.


Asunto(s)
Contaminación del Aire/estadística & datos numéricos , Exposición Materna/estadística & datos numéricos , Resultado del Embarazo/epidemiología , Adulto , Contaminantes Atmosféricos/análisis , Femenino , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Material Particulado/análisis , Embarazo , Nacimiento Prematuro , Estudios Retrospectivos , Taiwán
19.
BMC Pregnancy Childbirth ; 21(1): 75, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33482755

RESUMEN

BACKGROUND: The amniotic fluid is a protective liquid present in the amniotic sac. Two types of amniotic fluid disorders have been identified. First refers to polyhydramnios, which is an immoderate volume of amniotic fluid with an Amniotic Fluid Index (AFI) greater than 24 cm. Second includes oligohydramnios, which refers to decreased AFI i.e., less than 5 cm. This study aims to; a) identify the maternal risk factors associated with amniotic fluid disorders, b) assess the effect of amniotic fluid disorders on maternal and fetal outcome c) examine the mode of delivery in pregnancy complicated with amniotic fluid disorders. METHODS: A comparative retrospective cohort study design is followed. Sample of 497 pregnant women who received care at King Abdullah bin Abdul-Aziz University Hospital (KAAUH) between January 2017 to October 2019 was included. Data were collected from electronic medical reports, and was analyzed using descriptive statistics. Association of qualitative variables was conducted by Chi-square test, where p-value < 0.05 was considered statistically significant. RESULTS: Among the collected data, 2.8% of the cases had polyhydramnios and 11.7% patients had oligohydramnios. One case of still born was identified. A statically significant association was found between polyhydramnios and late term deliveries (P = 0.005) and cesarean section (CS) rates (P = 0.008). The rate of term deliveries was equal in normal AFI and oligohydramnios group (P = 0.005). Oligohydramnios was mostly associated with vaginal deliveries (P = 0.008). Oligohydramnios and polyhydramnios were found to be associated with diabetes mellitus patients (P = 0.005), and polyhydramnios with gestational diabetes patients (P = 0.052). Other maternal chronic diseases showed no effect on amniotic fluid index, although it might cause other risks on the fetus. CONCLUSION: Diabetes mellitus and gestational diabetes are the most important maternal risk factors that can cause amniotic fluid disorders. Maternal and fetal outcome data showed that oligohydramnios associated with gestational age at term and low neonatal birth weight with high rates of vaginal deliveries, while polyhydramnios associated with gestational age at late term and high birth weight with higher rates of CS.


Asunto(s)
Parto Obstétrico/estadística & datos numéricos , Oligohidramnios/fisiopatología , Polihidramnios/fisiopatología , Resultado del Embarazo/epidemiología , Adulto , Diabetes Gestacional/fisiopatología , Femenino , Humanos , Recién Nacido , Oligohidramnios/epidemiología , Polihidramnios/epidemiología , Embarazo , Estudios Retrospectivos , Adulto Joven
20.
BMC Pregnancy Childbirth ; 21(1): 74, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33482764

RESUMEN

BACKGROUND: The current study aimed to estimate the prevalence of alcohol use identified as a risk factor during pregnancies by the antenatal care providers, resulting in live births in British Columbia (BC) and to examine associations between alcohol use, adverse neonatal outcomes, and pregnancy complications. METHODS: This population-based cross-sectional study utilized linked obstetrical and neonatal records within the BC Perinatal Data Registry (BCPDR), for deliveries that were discharged between January 1, 2015 and March 31, 2018. The main outcome measures were alcohol use identified as a risk factor during pregnancy, associated maternal characteristics, pregnancy complications, and adverse neonatal outcomes. Estimates for the period and fiscal year prevalence were calculated. Chi-square tests were used to compare adverse neonatal outcomes and pregnancy complications by alcohol use during pregnancy identified as a risk factor. Logistic regression was used to examine the association between alcohol use identified as a risk factor during pregnancy and adverse neonatal outcomes and pregnancy complications, after adjusting for identified risk factors. RESULTS: A total of 144,779 linked records within the BCPDR were examined. The period prevalence of alcohol use during pregnancy identified as a risk factor was estimated to be 1.1% and yearly prevalence was 1.1, 1.1, 1.3 and 0.9% from the 2014/2015 to 2017/2018 fiscal years, respectively. Alcohol use identified as a risk factor was associated with younger maternal age, fewer antenatal visits, being primiparous, a history of mental illness, substance use and smoking. Neonates with alcohol use during pregnancy identified as a risk factor had greater odds of being diagnosed with: "low birth weight (1000-2499g)" (ICD-10: P07.1; aOR = 1.25; 95% CI: 1.01, 1.53), "other respiration distress of newborn" (ICD-10: P22.8; aOR = 2.57; 95% CI: 1.52, 4.07), "neonatal difficulty in breastfeeding" (ICD-10: P92.5; aOR = 1.97; 95% CI: 1.27, 2.92) and "feeding problems, unspecified" (ICD-10: P92.9; aOR = 2.06; 95% CI: 1.31, 3.09). CONCLUSIONS: The prevalence of alcohol use during pregnancy identified as a risk factor was comparable to previous estimates within the BCPDR. Identified prenatal alcohol exposure was associated with notable differences in maternal and neonatal characteristics and adverse neonatal outcomes. More consistent, thorough screening and prevention efforts targeting alcohol use in pregnancy are urgently needed in Canada.


Asunto(s)
Trastornos Relacionados con Alcohol/epidemiología , Complicaciones del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Adulto , Colombia Británica/epidemiología , Estudios Transversales , Femenino , Humanos , Recién Nacido , Edad Materna , Vigilancia de la Población , Embarazo , Nacimiento Prematuro/epidemiología , Factores de Riesgo
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