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1.
Mol Cell Neurosci ; 100: 103401, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31491533

RESUMO

Reelin plays important roles in regulating neuronal development, modulating synaptic function, and counteracting amyloid ß toxicity. A specific proteolytic cleavage (N-t cleavage) of Reelin abolishes its biological activity. We recently identified ADAMTS-3 (a disintegrin and metalloproteinase with thrombospondin motifs 3) as the major N-t cleavage enzyme in the embryonic and early postnatal brain. The contribution of other proteases, particularly in the postnatal brain, has not been demonstrated in vivo. ADAMTS-2, -3 and -14 share similar domain structures and substrate specificity, raising the possibility that ADAMTS-2 and -14 may cleave Reelin. We found that recombinant ADAMTS-2 protein expressed in cultured cell lines cleaves Reelin at the N-t site as efficiently as ADAMTS-3 while recombinant ADAMTS-14 hardly cleaves Reelin. The disintegrin domain is necessary for the Reelin-cleaving activity of ADAMTS-2 and -3. ADAMTS-2 is expressed in the adult brain at approximately the same level as ADAMTS-3. We generated ADAMTS-2 knockout (KO) mice and found that ADAMTS-2 significantly contributes to the N-t cleavage and inactivation of Reelin in the postnatal cerebral cortex and hippocampus, but much less in the cerebellum. Therefore, it was suggested that ADAMTS-2 can be a therapeutic target for adult brain disorders such as schizophrenia and Alzheimer's disease.

2.
Artigo em Inglês | MEDLINE | ID: mdl-31502338

RESUMO

Congenital hemangioma is a rare vascular tumor that develops prenatally, and a large congenital hemangioma may be accompanied by the Kasabach-Merritt phenomenon. We present a case of prenatally diagnosed fetal congenital hemangioma through ultrasound and maternal anti-Jr(a) antibody alloimmunization with elevated middle cerebral artery peak systolic velocity. To investigate fetal anemia and hemostatic condition, we performed percutaneous umbilical blood sampling, which revealed no symptom of either Kasabach-Merritt phenomenon or sensitization to anti-Jr(a) antibody. Consequently, pregnancy could be continued without further intervention. After birth, congenital hemangioma was found on the infant's left thigh, and Kasabach-Merritt phenomenon was not shown. Percutaneous umbilical blood sampling could provide precise information prenatally in case of congenital hemangioma with maternal alloimmunization.

3.
Fetal Diagn Ther ; : 1-7, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31434085

RESUMO

Only few studies have reported on Jra alloimmunization in pregnancy, and its clinical course remains unclear. We reviewed our cases to clarify the change in the peak systolic velocity of the middle cerebral artery (MCA-PSV) during pregnancy and the critical anti-Jra antibody titer to predict fetal anemia. We collected the data of pregnant women with anti-Jra antibody from two hospitals between 2010 and 2017. We extracted data on maternal information, number of intrauterine blood transfusions (IUT), trend of anti-Jra antibody titer, changes of MCA-PSV, and neonatal outcome. We had 16 cases. IUTs were performed in 6 fetuses with severe anemia between 27 and 32 weeks' gestation. The MCA-PSV did not increase more than 1.5 multiples of the median (MoM) after 32 weeks' gestation. No significant difference was found in the maximum titer between cases with IUT and those without IUT. All pregnancies but one delivered at term. No neonates developed severe anemia or jaundice. MCA-PSV did not increase higher than 1.5 MoM later during the pregnancy. A critical titer to predict fetal anemia did not exist. Spontaneous term delivery could be expected even in fetuses who underwent IUT before 32 weeks' gestation.

4.
J Matern Fetal Neonatal Med ; : 1-6, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31409161

RESUMO

Purpose: To clarify the relationship between light vaginal bleeding (LVB) before physical examination-indicated cerclage (PEIC) and perinatal adverse outcomes. Methods: This was a retrospective cohort study involving 94 singleton pregnancies undergoing PEIC <26 weeks of gestation at a single perinatal medical center between 2008 and 2015. The primary outcome was set as spontaneous preterm birth (sPTB) <34 weeks of gestation. The secondary outcomes were set as the second-trimester loss prior to 22 weeks of gestation, sPTB before 28 weeks of gestation, sPTB before 37 weeks of gestation, and stillbirth or neonatal death. Relationships between LVB and adverse outcomes were evaluated using logistic regression analysis. Results: Preoperative LVB was detected in 16 cases (17.0%). Multivariate logistic regression analyses revealed that preoperative LVB was an independent risk factor for sPTB <34 weeks of gestation (adjusted odds ratio [aOR]: 8.42; 95% confidence interval [CI]: 1.72-41.1; p < .01), sPTB <28 weeks of gestation (aOR: 5.98; 95% CI: 1.67-21.4; p < .01) and perinatal death (aOR: 8.47; 95% CI: 1.11-64.5; p = .04). Conclusions: Vaginal bleeding prior to PEIC, even nonsignificant or self-limiting, is associated with sPTB before 28 or 34 weeks of gestation and perinatal death.

5.
J Obstet Gynaecol Res ; 45(9): 1821-1827, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31237754

RESUMO

AIM: The aim of the survey is to investigate current practice and complications of percutaneous umbilical cord blood sampling (PUBS) in Japan. METHODS: In this retrospective survey, data including perioperative information, indications, details of the procedure and procedure-related complications were collected for patients who underwent PUBS between 2012 and 2016 in Japanese perinatal care centers. RESULTS: One hundred and fifty-three patients underwent PUBS and a total of 223 procedures were analyzed in this study. Fetal anemia was the most common indication for PUBS, representing greater than 70% of all cases. Anemia specific to monochorionic twins, such as acute feto-fetal hemorrhage subsequent to single intrauterine fetal death (IUFD) and twin anemia-polycythemia sequence, were the leading causes of suspected fetal anemia. Maternal anesthetics were given during the procedure in 70% of cases. The PTC needle (Hakko, Japan) was most commonly used in the procedure. The most frequent complication was bleeding from the umbilical cord puncture site; however, it did not require immediate delivery during or after the procedure in any case. IUFD occurred in 11 (4.9%) procedures, 7 of which appeared to be related to the underlying fetal disease. The overall completion rate of the procedure was 97%. CONCLUSION: Percutaneous umbilical cord blood sampling was most commonly performed for the evaluation of fetal anemia, usually due to complications of monochorionic twins, followed by the measurement of fetal thyroid function. The safety and the completion rate of the procedure in Japan appear satisfactory.

6.
J Clin Neurosci ; 66: 138-143, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31088766

RESUMO

Short-segment temporary posterior spinal instrumentation has been widely used to treat thoracolumbar burst fractures. However, kyphosis recurrence without hardware failure has become a concern. Therefore, we investigated risk factors for kyphosis recurrence after short-segment temporary fixation for thoracolumbar burst fractures. Our prospective multicenter study involved 76 consecutive patients with thoracolumbar burst fractures who underwent short-segment temporary posterior fixation using ligamentotaxis with Schanz screws and without fusion. Patients were divided into two groups -kyphosis recurrence and no kyphosis recurrence- according to correction loss of the kyphotic angle. Clinical and radiographic data were examined to reveal the risk factors for postoperative kyphosis recurrence. After surgery, all patients experienced fracture union. Kyphotic deformity was reduced significantly, and maintenance of the reduced vertebra was successful. However, mean 9.1° loss of correction in kyphotic angle was observed. Statistical analysis revealed that a high ratio of canal compromise before surgery, as seen on computed tomography scanning, and a large preoperative kyphotic angle influenced kyphosis recurrence. In conclusion,short-segment temporary posterior fixation yields satisfactory results regarding reduction and maintenance of fractured vertebrae. However, correction loss after implant removal is associated with a high compromised canal ratio before surgery and a large preoperative kyphotic angle.

7.
Biochem Biophys Res Commun ; 514(3): 815-820, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31079931

RESUMO

Reelin is a large secreted protein that is essential for the development and function of the central nervous system. Dimerization and/or oligomerization is required for its biological activity, but the underlying mechanism is not fully understood. There are several widely used anti-Reelin antibodies and we noticed that their reactivity to monomeric or dimeric Reelin protein is different. We also found that their reactivity to Reelin in the solution or in fixed brain tissues also differs. Our results provide the information regarding how the N-terminal region of Reelin folds and contributes to the formation of higher order structure. We also provide a caveat that appropriate use of anti-Reelin antibody is necessary for quantitative analyses.

8.
J Orthop Surg (Hong Kong) ; 27(1): 2309499019825585, 2019 Jan-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30798712

RESUMO

PURPOSE:: The prevalence and distribution of air present in the leg in closed and low-grade open tibial shaft fractures are unknown on multidetector high-resolution computed tomography (CT). The purpose of this study was to determine the rate of surgical site infection (SSI) in cases where debridement was not performed in the area of air infiltration. METHODS:: Eighty-one closed and low-grade open tibial shaft fractures that underwent multidetector high-resolution CT on admission and were treated with an intramedullary nail were examined retrospectively. RESULTS:: Of the 36 Gustilo type I or II open fractures, all had local air around the fracture site (within 5 cm proximal and distal from the fracture center). Of these, 25 showed remote air (more than 5 cm away from the fracture center). The most frequent site of remote air was in the subcutaneous tissue, followed by the anterior compartment and deep posterior compartment. All open fractures were treated with local irrigation and debridement, regardless of the presence of remote air, followed by a reamed intramedullary nail. No SSI developed until bone union. Of the 45 closed fractures, 3 patients showed air in the leg on the CT. No debridement was performed for closed fractures. One patient who did not have air in the leg developed SSI. All fractures united eventually. CONCLUSIONS:: In low-grade open tibial shaft fractures, air can spread far from the fracture site. Even in closed tibial shaft fractures, air can be identified in the leg. The debridement of the area of air infiltration, however, is not necessary for prevention of SSI.

9.
Artigo em Inglês | MEDLINE | ID: mdl-30306664

RESUMO

AIM: This study aimed to evaluate the incidence of unexpected critical complications (UCC) in monochorionic diamniotic (MCDA) twin pregnancies according to ultrasonographic scan interval. METHODS: This retrospective single-center cohort study, conducted between January 2005 and April 2015, investigated the incidence of UCC in patients with MCDA twin pregnancies undergoing weekly ultrasound (Group A) and those undergoing biweekly ultrasound (Group B). We also examined the incidence of predictable critical complications according to ultrasound interval. RESULTS: Of all 385 cases, the total incidence of UCC was 20 (5.2%), including 14 cases of twin-twin transfusion syndrome and 6 cases of intrauterine fetal death. The incidence of UCC was 3.9% in Group A and 9.0% in Group B (P = 0.046). In contrast, the incidence of predictable critical complications was 6.7% in Group A and 9.0% in Group B (P = 0.440). CONCLUSION: The incidence of UCC in patients with MCDA twin pregnancies was significantly lower in patients undergoing weekly ultrasound. Our results suggest that weekly ultrasound evaluation for patients with MCDA pregnancy is more effective for early detection of UCC such as intrauterine fetal death and twin-twin transfusion syndrome ; however, further investigations are needed to determine whether weekly ultrasound evaluation can improve clinical outcomes.

10.
Artigo em Inglês | MEDLINE | ID: mdl-30191631

RESUMO

AIM: Since fetal therapy has been newly developed, objective evaluation of adverse events (AE), all harmful events that are not always related to the procedures, has not yet been adequately reported. We established new terminology and tried to re-evaluate it based on the Japanese prospective thoraco-amniotic shunting (TAS) study. METHODS: From the literature, all complications that occurred with all fetal therapies were identified as a basis for developing the terminology. Grading was set from 0 to 5. Grade 3 was defined as the need for invasive treatment, such as surgery. Grade 4 was defined as life-threatening, and Grade 5 was defined as death of the mother or fetus. Then, one series of TAS that we had already reported was re-evaluated, including 24 cases with 37 procedures and 200 opportunities those could be evaluated AE after procedures. RESULTS: Grade 4 preterm rupture of the membranes was reported in only 1 of 24 cases. Catheter displacement was reported in 7, 2 and 11 cases, of Grades 1, 2 and 3, respectively. It was found that the double-basket catheter had some association with catheter displacement, but it was clear that there were no life-threatening AE. CONCLUSION: Newly developed AE criteria are now available for fetal therapy. They will contribute to the objective evaluation of AE of new fetal therapies in the future.

11.
J Obstet Gynaecol Res ; 44(9): 1747-1751, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29992662

RESUMO

AIM: To examine the intrapartum cesarean delivery rate following failure of induction of labor (IOL) as well as risk factors associated with failed IOL among nulliparous women of advanced maternal age (AMA). METHODS: This was a retrospective cohort study conducted at a single perinatal care center. We retrospectively reviewed the medical records of nulliparous AMA women (aged 35 years or older) with singleton vertex pregnancy who underwent IOL at term. Data regarding maternal baseline characteristics and pregnancy course, including complications during pregnancy and maternal status at time of IOL, were collected. Rate of emergency cesarean section (eCS) as well as risk factors associated with failed IOL were investigated by means of logistic regression analysis. RESULTS: Among 234 women included in this study, 103 (44%) had failed IOL and delivered by eCS. Hypertensive disorder during pregnancy (adjusted odds ratio [aOR], 2.01; 95% confidence interval [CI], 1.0-4.12; P = 0.025) and unfavorable cervical status (aOR, 1.92; 95% CI, 1.08-3.41; P = 0.038) were identified as independent risk factors for failed IOL. CONCLUSION: IOL failed in 44% of nulliparous AMA women. Hypertensive disorder and immature cervical status should be considered as independent risk factors for eCS among such women.

12.
J Obstet Gynaecol Res ; 44(6): 1057-1062, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29607579

RESUMO

AIM: To examine the predictive value of ultrasound parameters for antepartum non-reassuring fetal status (NRFS) in fetal growth restriction (FGR) cases after late preterm. METHODS: Retrospective review of singleton FGR cases before 37 weeks gestation who delivered after 34 weeks gestation was performed. The association between ultrasound parameters that was assessed from 34 to 36 weeks gestation and the development of antepartum NRFS that was diagnosed by nonstress test and biophysical profile was analyzed by using multivariate Cox proportional hazards analyses. RESULTS: A total of 214 patients were included in final data analyses. Antepartum NRFS occurred in 23 cases (10.7%) including five cases of placental abruption. Lower standard deviation (SD) of estimated fetal weight (EFW), lower cerebroplacental ratio (CPR) and the presence of oligohydramnios were independently associated with antepartum NRFS. The prevalence of antepartum NRFS was highest (50.4%) in the group of EFW ≤-2.5 SD with CPR ≤1.45. CONCLUSION: Ultrasound parameters of lower SD of EFW, lower CPR and oligohydramnios were predictive for antepartum NRFS in FGR after late preterm.


Assuntos
Descolamento Prematuro da Placenta/diagnóstico por imagem , Retardo do Crescimento Fetal/diagnóstico por imagem , Hipóxia Fetal/diagnóstico por imagem , Peso Fetal , Oligo-Hidrâmnio/diagnóstico por imagem , Ultrassonografia Pré-Natal/normas , Adulto , Feminino , Humanos , Gravidez , Estudos Retrospectivos
13.
J Obstet Gynaecol Res ; 44(7): 1221-1227, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29673002

RESUMO

AIM: To elucidate the incidence of and risk factors for severe hypertensive disorders (HD) and related maternal complications in uncomplicated twin pregnancies that reached 36 weeks' gestation. METHODS: We conducted a prospective cohort study of twin pregnancies delivered after 36 weeks' gestation. Cases of twin-twin transfusion syndrome, twin anemia-polycythemia sequence, malformed fetuses, monoamniotic twins, selective reduction, fetal therapy and HD or fetal death before 35 weeks' gestation were excluded. The study's primary outcome was the incidence of severe maternal complications, including severe HD, eclampsia, placental abruption, HELLP (hemolysis, elevated liver enzyme and low platelet) syndrome, pulmonary edema and cerebrovascular disease. Perinatal factors associated with the primary outcome were identified using a multivariate logistic regression model. RESULTS: In 330 enrolled women, the number of cases with the primary outcome was 28 (8.5%; 95% confidence interval 5.9-12.0), including 25 cases of severe HD and each one case of placental abruption, HELLP syndrome and eclampsia. The rate of severe maternal complications significantly increased with gestational age, demonstrating 1.2% at 36 weeks, 3.9% at 37 weeks and 6.4% at 38 weeks. Only gestational proteinuria was identified as the independent risk factor for severe maternal complications (adjusted odds ratio 17.1 [95% confidence interval 6.71-45.4]). CONCLUSION: Severe maternal HD and related complications increased from late preterm to early term; particularly, patients with gestational proteinuria were at high risk.


Assuntos
Idade Gestacional , Hipertensão Induzida pela Gravidez/epidemiologia , Gravidez de Gêmeos , Adolescente , Adulto , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
14.
J Obstet Gynaecol Res ; 44(5): 831-839, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29436080

RESUMO

The aim of this study was to review fetoscopic laser photocoagulation (FLP), which ablates placental vascular anastomoses to treat twin-twin transfusion syndrome (TTTS). A review of studies reporting on the procedures, outcomes, complications and nonconventional applications of FLP for TTTS was conducted. FLP has been established as the primary treatment for monochorionic twin pregnancy associated with TTTS at 16-26 weeks. FLP is the only therapy that directly addresses the underlying pathophysiology. The recent technique modification of FLP, referred to as the 'Solomon technique', induces selective coagulation to connect the anastomoses ablation sites and has been introduced to reduce residual anastomoses. The perinatal survival following FLP improved significantly with advances in the technique after its introduction. The recent survival rates of both twins and at least one twin are 70% and more than 90%, respectively. However, there is still an 11-14% risk of long-term neurodevelopment impairment. The premature rupture of membranes that leads to preterm labor is a common complication after FLP. FLP is a valuable treatment option for feto-fetal transfusion syndrome in triplets and for TTTS after 26 weeks. FLP for selective intrauterine growth restriction may be potentially beneficial when accompanied by abnormal Doppler findings and oligohydramnios. FLP is the optimal treatment option for TTTS at 16-26 weeks of gestation. FLP appears to be applicable in triplets, TTTS after 26 weeks and cases of selective intrauterine growth restriction with abnormal Doppler findings and oligohydramnios. FLP is the most common and successful fetal intervention. Improvement in the neurodevelopmental outcomes after FLP is a future focus.


Assuntos
Doenças em Gêmeos , Ruptura Prematura de Membranas Fetais/etiologia , Transfusão Feto-Fetal/cirurgia , Fetoscopia/métodos , Idade Gestacional , Fotocoagulação a Laser/métodos , Trabalho de Parto Prematuro/etiologia , Avaliação de Resultados (Cuidados de Saúde) , Gravidez de Gêmeos , Feminino , Fetoscopia/efeitos adversos , Humanos , Fotocoagulação a Laser/efeitos adversos , Gravidez
15.
Fetal Diagn Ther ; 2018 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-29462812

RESUMO

INTRODUCTION: We aimed to clarify the survival rate without brain abnormalities (BA) after fetoscopic laser photoco-agulation (FLP) for monochorionic diamniotic twin gestations (MCDA) with selective intrauterine growth restriction (sIUGR) accompanied by abnormal umbilical artery (UA) Doppler waveforms and isolated oligohydramnios in the sIUGR twin. MATERIALS AND METHODS: This retrospective study included 52 cases that underwent FLP. The main outcome was survival rate without BA of the twins at age 28 days. BA was defined as severe intraventricular hemorrhage and periventricular leukomalacia on postnatal ultrasonography. RESULTS: Median gestational age at FLP was 20 (16-24) weeks. Ten cases were classified as type III based on Doppler for the UA. For all cases, including 20 cases of anterior placenta, FLP was completed without major intraoperative complications. Amnioinfusion was required in 49 cases for better fetoscopic visualization. Fetal loss occurred in 29 sIUGR twins and two larger twins, whereas one larger twin experienced neonatal death. Survival rates without BA were 44% (n = 23) for sIUGR twins and 94% (n = 49) for the larger twins. DISCUSSION: FLP for MCDA with sIUGR presenting with oligohydramnios in the sIUGR twin might be considered a prenatal treatment option.

16.
J Perinat Med ; 46(9): 1040-1047, 2018 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-29267174

RESUMO

OBJECTIVE: To clarify and compare if the neurological outcomes of fetal growth restriction (FGR) cases with abnormal cord insertion (CI) are associated with a higher risk of a poor neurological outcome in subjects aged 3 years or less versus those with normal CI. METHODS: A multicenter retrospective cohort study was conducted among patients with a birth weight lower than the 3rd percentile, based on the standard reference values for Japanese subjects after 22 weeks' gestation, who were treated at a consortium of nine perinatal centers in Japan between June 2005 and March 2011. Patients whose birth weights were less than the 3rd percentile and whose neurological outcomes from birth to 3 years of age could be checked from their medical records were analyzed. The relationship between abnormal CI and neurological outcomes was analyzed. Univariate and multivariate models of multivariate logistic regression were employed to estimate the raw and odds ratio (OR) with 95% confidence intervals comparing marginal (MCI) and velamentous cord insertion (VCI) to normal CI. RESULTS: Among 365 neonates, 63 cases of MCI and 14 cases of VCI were observed. After excluding 24 cases with neonatal or infant death from the total FGR population, the assessment of the outcomes of the infants aged 3 years or younger showed the following rates of neurological complications: 7.3% (n=25) for cerebral palsy, 8.8% (n=30) for developmental disorders, 16.7% (n=57) for small-for-gestational-age short stature (SGA), 0.6% (n=2) for impaired hearing, 0.9% (n=3) for epilepsy, 1.2% (n=4). The ORs (95% confidence intervals) based on multivariate analysis were as follows: cerebral palsy=10.1 (2.4-41.5) in the VCI group and 4.3 (1.6-11.9) in the MCI group, developmental disorders=6.7 (1.7-26) in the VCI group and 3.9 (1.1-14.2) in the single umbilical artery (SUA) group, 5.1 (1.4-18.7) for birth weight <1000 g and 2.8 (1.2-6.7) for placental weight <200 g. CONCLUSIONS: The present results indicate that growth-restricted fetuses diagnosed with a birth weight below the 3rd percentile exhibiting abnormal umbilical CI are at a high risk for poor neurological outcomes, including cerebral palsy and/or developmental disorders.

17.
J Obstet Gynaecol Res ; 44(2): 217-222, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29094431

RESUMO

AIM: The aim of this study was to determine the effect of maternal age on emergency cesarean section (CS) during labor, and to identify the independent risk factors for emergency CS. METHODS: This was a retrospective cohort study using data from 2009 to 2014 from a tertiary perinatal care center in Japan. Inclusion criteria were maternal age ≥ 35 years, nulliparous singleton pregnancy at term and a cephalic presentation without indication of elective CS at onset of labor. The primary outcome was rate of emergency CS, while independent risk factors were elucidated using multivariate logistic regression analysis. RESULTS: Of 953 women, 199 (20.9%) delivered by emergency CS. Rates of emergency CS were 18.3% (129/706) in women aged 35-39 years and 28.3% (70/247) in those aged ≥ 40 years (P < 0.01). Adjusted odds ratios (95% confidence intervals) of independent risk factors were 1.50 (1.03-2.18) for maternal age ≥ 40 years, 1.51 (1.06-2.17) for body mass index ≥ 25 kg/m2 , 2.22 (1.24-3.98) for hypertensive disorder during pregnancy, 3.43 (1.31-8.95) for large-for-date fetus and 4.64 (3.23-6.69) for induction of labor. CONCLUSIONS: The rate of intrapartum emergency CS in older nulliparous women at term was approximately 21%. Induction of labor should be recognized as a significant factor for emergency CS.


Assuntos
Cesárea/estatística & dados numéricos , Trabalho de Parto Induzido/estatística & dados numéricos , Idade Materna , Paridade , Adulto , Feminino , Idade Gestacional , Humanos , Gravidez , Estudos Retrospectivos
18.
J Med Ultrason (2001) ; 45(2): 337-340, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28725980

RESUMO

We describe the case of a neonate who was prenatally diagnosed at a gestational age of 36 weeks with premature constriction of the ductus arteriosus. Blood from the thin ductus arteriosus flowed toward the pulmonary artery. Severe tricuspid regurgitation was also observed. We subsequently confirmed rupture of the tricuspid papillary muscle after birth. Cardiotonic drugs and nitric oxide were administered immediately at birth for pulmonary hypertension, and this therapy was continued until the seventh postnatal day. Emergency tricuspid valve repair was unnecessary, because there were no signs of severe circulatory insufficiency. This case suggests a relationship between prenatally diagnosed premature constriction of the ductus arteriosus and tricuspid papillary muscle rupture in neonates.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Canal Arterial/diagnóstico por imagem , Músculos Papilares/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Ultrassonografia Pré-Natal , Ecocardiografia , Feminino , Humanos , Recém-Nascido , Gravidez , Ruptura Espontânea
19.
J Med Ultrason (2001) ; 45(1): 99-102, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28451775

RESUMO

AIM: This study aimed to investigate the impact of placental migration on the definitive prepartum diagnosis of patients with placenta previa (PP) and low-lying placenta (LLP) after late preterm. METHODS: This was a retrospective cohort study of singleton pregnancies with PP and LLP diagnosed at 30-33 weeks of gestation. We assessed the rate of changes in transvaginal ultrasonographic measurements of placental position during the period from 34 to 38 weeks of gestation. RESULTS: A total of 127 cases (82 of PP, 45 of LLP) were included. The PP group comprised 34 cases with complete PP and 48 with partial and marginal PP. The diagnosis of complete PP was changed to partial or marginal PP in two (5.9%) cases. Concerning cases with partial and marginal PP, 14 (29.2%) were eventually revised to LLP and four (8.3%) ultimately normalized. Among the patients with LLP, placental position was normalized in 23 (51.1%). Overall, a revision in diagnosis after late preterm was required in 48 cases (37.8%). Among the 93 patients who did not have complete PP, 46 (49.5%) needed revisions of their placental diagnosis. CONCLUSIONS: Repeated evaluations of placental position by ultrasonography after late preterm could be of significant value in selecting the most appropriate mode of delivery.


Assuntos
Placenta Prévia/diagnóstico por imagem , Terceiro Trimestre da Gravidez , Ultrassonografia Pré-Natal , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Adulto Jovem
20.
J Obstet Gynaecol Res ; 44(2): 223-227, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29027307

RESUMO

AIM: Iatrogenic premature rupture of membrane (PROM) is one of the major complications related to fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS). However, amniotic fluid leakage (AFL) sometimes spontaneously disappears. This study evaluated the incidence and clinical characteristics of transient AFL after FLP. METHODS: We retrospectively reviewed pregnancies that underwent FLP for TTTS at a single center. Patients with apparent AFL within 2 weeks after FLP were divided into two groups: transient AFL, defined by the disappearance of fluid leakage within a week; and PROM, if AFL persisted continuously for more than a week or premature birth occurred, including miscarriage, within a week of the first symptom of AFL. RESULTS: Among 201 monochorionic twin pregnancies that underwent FLP during the study period, nine patients (4.5%) were diagnosed with AFL within a week after FLP. Four patients (2.0%) were classified as transient AFL and five as PROM. Median gestational age at FLP was not significantly different between the groups; operative time in the PROM group was significantly longer (P = 0.01). The surgery to delivery interval and median gestational age at delivery were greater in the transient AFL group (87.8 vs 17.6 days, P = 0.01; 32.5 vs 23.6 weeks, P = 0.01, respectively). CONCLUSIONS: The incidence of transient AFL after FLP was 2%. Perinatal outcomes of transient AFL might be better than that of PROM.


Assuntos
Ruptura Prematura de Membranas Fetais/etiologia , Transfusão Feto-Fetal/cirurgia , Fetoscopia/efeitos adversos , Fotocoagulação a Laser/efeitos adversos , Adulto , Feminino , Fetoscopia/métodos , Idade Gestacional , Humanos , Fotocoagulação a Laser/métodos , Gravidez , Gravidez de Gêmeos , Remissão Espontânea , Estudos Retrospectivos
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