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1.
Cardiovasc Pathol ; 39: 38-50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30623879

RESUMO

The traditional classification of congenital aortic arch abnormalities was described by James Stewart and colleagues in 1964. Since that time, advances in diagnostic imaging technology have led to better delineation of the vasculature anatomy and the identification of previously unrecognized and unclassified anomalies. In this manuscript, we review the existing literature and propose a series of modifications to the original Stewart classification of congenital aortic arch abnormalities to incorporate this new knowledge. In brief, we propose the following modifications: (1) In Group I, we further divide subgroup B into left arch atretic and right arch atretic; (2) In Group II, we add three more subgroups, including aberrant right innominate artery, "isolated" right innominate artery (RIA), "isolated" right carotid artery with aberrant right subclavian artery; (3) In Groups I, II, and III, we add a subgroup of absence of both ductus arteriosus; and (4) In Group IV, we add three subgroups, including circumflex retro-esophageal aorta arch, persistent V aortic arch, and anomalous origin of pulmonary artery from ascending aorta.


Assuntos
Aorta Torácica/anormalidades , Cardiopatias Congênitas/classificação , Terminologia como Assunto , Malformações Vasculares/classificação , Aorta Torácica/diagnóstico por imagem , Tomada de Decisão Clínica , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/terapia , Humanos , Valor Preditivo dos Testes , Prognóstico , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/terapia
2.
Reprod Sci ; 25(8): 1161-1167, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29463188

RESUMO

OBJECTIVE: Progesterone supplementation prevents preterm birth (PTB) in some high-risk women, but its mechanism of action is unknown. One-third of PTB is associated with preterm premature rupture of membranes (PPROMs). We have previously shown that progesterone inhibits basal and Tumor Necrosis Factor (TNF) α-induced apoptosis in an explant model of human fetal membranes. This study investigates the molecular mechanisms responsible for progesterone-mediated inhibition of apoptosis in fetal membranes. METHODS: Human fetal membranes were collected at elective cesarean at term (no labor, no infection; n = 6), washed, and pretreated with/without progesterone (125 ng/mL) for 24 hours. Thereafter, membranes were treated with/without TNFα (50 ng/mL) and/or progesterone for 48 hours, harvested, and homogenized. Apoptosis was determined by evaluating caspase-3, -8, and -9 activities. Expression of pro- BH3 interacting domain death against, Bc1-2 associated X protein (BID, BAX) and antiapoptotic proteins (X-linked inhibitor of apoptosis protein [XIAP], Bcl-2, FLICE inhibitory protein [FLIP]) were measured by Western blot. RESULTS: TNFα increased apoptosis (measured by caspase-3, -8, and -9 activities) in fetal membranes, and this effect was abrogated by progesterone. Under basal conditions, progesterone suppressed expression of the proapoptotic protein, BID, by 0.45 (0.14)-fold, and increased expression of the antiapoptotic proteins, Bcl-2 and XIAP; no change was seen in BAX or FLIP. In contrast, TNFα increased BID expression by 5.15 (2.92)-fold, which was prevented by pretreatment with progesterone. CONCLUSIONS: Progesterone inhibits apoptosis in fetal membranes by suppressing expression of the proapoptotic protein, BID (for both basal and TNFα-induced apoptosis), and upregulating expression of the antiapoptotic proteins, XIAP and Bcl-2 (under basal conditions only). These data provide a mechanism by which progesterone supplementation may prevent PPROM and PTB in some women at high risk.


Assuntos
Apoptose , Membranas Extraembrionárias/efeitos dos fármacos , Membranas Extraembrionárias/metabolismo , Progesterona/metabolismo , Humanos , Progesterona/farmacologia , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Fator de Necrose Tumoral alfa/farmacologia , Proteínas Inibidoras de Apoptose Ligadas ao Cromossomo X/metabolismo
3.
AJP Rep ; 7(2): e106-e110, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28611933

RESUMO

Background Monochorionic-triamniotic pregnancies are rare and fraught with complications. Case A case of monochorionic-triamniotic triplet pregnancy complicated by twin reversed arterial perfusion (TRAP) sequence is presented. The patient declined termination or selective fetal reduction. Triplet C was acardiac. At 24 weeks, triplet B developed polyhydramnios. At 30 weeks, polyhydramnios was seen in all three amniotic sacs, but without signs of fetal hydrops and with normal Doppler velocimetry measurements in the umbilical artery, middle cerebral artery, and ductus arteriosus of triplets A and B. At 32 2/7 weeks, the patient presented with preterm premature rupture of membranes and preterm labor. Two live male infants were delivered by cesarean delivery weighing 1,350 and 1,390 g, respectively; the acardiac fetus weighed 1,460 g. Pathology examination revealed a single placenta weighing1,250 g, with evidence of direct vascular connections between triplets A and C as well as between triplets A and B. Conclusion Monochorionic-triamniotic triplet pregnancy with TRAP sequence is rare. Although the risk of complications is high, such pregnancies can be managed conservatively in select cases.

4.
AJP Rep ; 7(2): e111-e115, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28611934

RESUMO

Objective This study aims to analyze the etiology and perinatal outcome of nonimmune hydrops fetalis (NIHF) in Southern China. Methods All cases with NIHF diagnosed antenatally from January 1, 2007 to December 31, 2014 were identified and analyzed. Results Total 482 cases of NIHF were identified during the study period. The most common cause of NIHF was hemoglobin (Hb) Bart's disease (61.8%), followed by chromosomal abnormalities (13.5%), idiopathic etiology (13.1%), cardiac abnormalities (6.4%), and others (5.2%). After 20 weeks' gestation, a total of 408 cases of NIHF presented, including Hb Bart's disease (279 cases), cardiac abnormalities (27 cases), and infection (7 cases). NIHF caused by chromosomal abnormalities mainly presented between 15 and 19 weeks' gestation. Of the 482 cases, 459 cases elected termination of pregnancy. The remaining 23 cases elected to continue their pregnancy. Among them, 14 (60.9%) resulted in intrauterine fetal death, 6 had neonatal death, 3 infants survived to 1 year of age. Of the three infants, one has cerebral palsy, and the remaining two are normal. Conclusions Hb Bart's disease is the most common cause of NIHF in Southern China. An effective prenatal screening and counseling program for thalassemia in this region may be the most effective way to lower the incidence NIHF.

5.
Chin Med J (Engl) ; 130(8): 920-928, 2017 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-28397721

RESUMO

BACKGROUND: Fetal brain development is a complicated process that continues throughout pregnancy. Fetal sulcus development has typical morphological features. Assessment of fetal sulcus development to understand the cortical maturation and development by prenatal ultrasound has become widespread. This study aimed to explore a reliable method to assess cortical sulcus and to describe the normal sonographic features of cortical sulcus development in the human fetus between 18 and 41 weeks of gestation. METHODS: A cross-sectional study was designed to examine the fetal cortical sulcus development at 18-41 weeks of gestation. Ultrasound was used to examine the insula, sylvian fissure (SF), parieto-occipital fissure (POF), and calcarine fissure (CF). Bland-Altman plots were used for assessing the concordance, and the intraclass correlation coefficient was used for assessing the reliability. RESULTS: SF images were successfully obtained in 100% of participants at 22 weeks of gestation, while the POF images and CF images could be obtained in 100% at 23 weeks of gestation and 24 weeks of gestation, respectively. The SF width, temporal lobe depth, POF depth, and the CF depth increased with the developed gestation. The width of uncovered insula and the POF angle decreased with the developed gestation. By 23 weeks of gestation, the insula was beginning to be covered. Moreover, it completed at 35 weeks of gestation. The intra- and inter-observer agreements showed consistent reproducibility. CONCLUSIONS: This study defined standard views of the fetal sulcus as well as the normal reference ranges of these sulcus measurements between 18 and 41 weeks of gestation. Such ultrasonographic measurements could be used to identify fetuses at risk of fetal neurological structural disorders.


Assuntos
Encéfalo/embriologia , Desenvolvimento Fetal/fisiologia , Feto/embriologia , Ultrassonografia Pré-Natal/métodos , Adulto , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Gravidez
6.
PLoS One ; 11(8): e0160453, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27479123

RESUMO

PURPOSE: To evaluate the utility of urine protein/creatinine ratio (uPCR) measurements among healthy parturients at term we performed a prospective cohort study at a community teaching hospital. METHODS: Serial urine samples were collected. Ninety-three women contributed 284 urine samples. uPCRs were determined. Multiple imputation and paired sampled analysis was performed when appropriate. RESULTS: Two-thirds (63/93) of women had at least one measured uPCR ≥ 0.3. One-third (31/93) had a uPCR ≥ 0.3 at admission, including 39.1% (9/23) of women not in labor. Median (IQR) uPCRs increased during labor and after delivery: latent phase/no labor, 0.15 (0.06-0.32); active phase, 0.29 (0.10-0.58); early postpartum, 0.45 (0.18-1.36) (all p < 0.04). Median uPCRs were significantly < 0.3 in the latent phase and significantly > 0.3 in the immediate postpartum period (p < 0.01). Women who labored before cesarean delivery had the highest early postpartum uPCRs: median (IQR) 1.16 (0.39-1.80). A negative urine dipstick protein result did not exclude uPCR ≥ 0.3. uPCRs were similar when compared by method of urine collection. CONCLUSION: uPCR ≥ 0.3 is common among healthy women with uncomplicated pregnancies at term. uPCR increases during labor and is not a reliable measure of pathologic proteinuria at term or during the peripartum period.


Assuntos
Creatinina/urina , Trabalho de Parto , Proteínas/análise , Adulto , Cesárea , Demografia , Feminino , Hospitalização , Humanos , Período Pós-Parto , Gravidez , Estudos Prospectivos , Proteinúria/patologia , Proteinúria/urina , Adulto Jovem
7.
J Reprod Med ; 61(5-6): 295-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27424376

RESUMO

BACKGROUND: The incidence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection is increasing, and 0.5-4% of pregnant women are colonized. CASE: A 30-year-old pregnant woman at term presented with intractable headache 1 week after incision and drainage of a MRSA-positive axillary abscess. Imaging demonstrated a right-sided epidural abscess with midline shift and myositis of the overlying temporalis muscle. She underwent cesarean delivery followed by craniectomy of osteomyelitic bone and evacuation of the epidural abscess. CONCLUSION: Central nervous system abscess is rare but should be considered in patients with a history of MRSA infection and new neurologic signs or symptoms. Surgical evacuation and antibiotic therapy in combination with obstetrical care considering delivery timing based upon maternal stability and gestational age may produce excellent outcomes.


Assuntos
Abscesso Epidural/diagnóstico , Osteomielite/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Infecções Estafilocócicas/diagnóstico , Osso Temporal/patologia , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Staphylococcus aureus Resistente à Meticilina , Gravidez , Infecções Estafilocócicas/microbiologia
8.
J Ultrasound Med ; 35(4): 739-45, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26939599

RESUMO

OBJECTIVES: The purpose of this study was to describe the echocardiographic features and perinatal outcomes of congenital absence of the aortic valve diagnosed by first-trimester echocardiography. METHODS: This retrospective study assessed the feasibility of first-trimester echocardiography in detecting absence of the aortic valve. All cases of absence of the aortic valve diagnosed by first-trimester fetal echocardiography from January 2010 to December 2014 were identified at a single referral center using an established perinatal database. Demographic information, echocardiograms, perinatal outcomes, and autopsy reports were reviewed. Echocardiographic features were described. RESULTS: A total of 50,822 fetuses underwent first-trimester echocardiography during the study period. Ten cases of congenital absence of the aortic valve were diagnosed, for an overall incidence rate of 0.019%. The earliest gestational age at diagnosis was 11 weeks 6 days. The mean crown-lump length was 61.9 mm; mean gestational age was 12 weeks; and mean maternal body mass index ± SD was 21.2 ± 3.9 kg/m(2). Nine fetuses had increased nuchal translucency ranging from 2.4 to 12.4 mm (mean ± SD, 6.4 ± 3.6 mm). Color Doppler flow imaging revealed biphasic bidirectional flow in the ascending aorta and aortic arch and reversed flow in the ductus venosus during atrial systole in all cases. Reversed diastolic flow was present in the umbilical arteries and thoracic aorta. All cases had complex cardiac malformations as well as extracardiac abnormalities. CONCLUSIONS: Our study confirms that absence of the aortic valve is a rare cardiac defect that can be diagnosed by first-trimester fetal echocardiography. A "to-and-fro" flow pattern or biphasic bidirectional flow in the great arteries is a key echocardiographic feature in fetuses with absence of the aortic valve.


Assuntos
Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/epidemiologia , Primeiro Trimestre da Gravidez , Ultrassonografia Pré-Natal/estatística & dados numéricos , China/epidemiologia , Ecocardiografia/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Mortalidade Fetal , Humanos , Incidência , Gravidez , Resultado da Gravidez/epidemiologia , Prognóstico , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade
9.
Prenat Diagn ; 36(2): 117-26, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26573084

RESUMO

OBJECTIVE: We aim to determine the accuracy of first-trimester ultrasonography in detecting fetal limb abnormalities. METHODS: This is a retrospective study of all women undergoing fetal nuchal translucency (NT) assessment and detailed fetal anatomic survey in the first trimester at a single tertiary-care referral center in China. Fetal anatomy scans were repeated in the second trimester. Detection of fetal limb abnormalities was compared between first and second trimester anatomy scans and confirmed at delivery or at autopsy. RESULTS: Analyzed were 9438 fetuses from 9197 women (241 twin pairs). The incidence of fetal limb abnormalities was 0.38% (36/9438). Of these, 28 (77.8%) were diagnosed prenatally: 23 (63.9%) on first trimester scan and 5 (13.9%) on second trimester scan. Limb reduction defects (usually transverse limb deficiencies) were the most common limb defects identified in the first trimester (n = 12), followed by clubfoot (n = 4), skeletal dysplasia (n = 3), sirenomelia (n = 1), limb dysplasia (n = 1), malposition (n = 1), and syndactyly (n = 1). Nine fetuses with isolated limb abnormalities had normal NT, while 74.1% (20/27) of limb abnormalities that were associated with other abnormalities had increased NT. CONCLUSIONS: This study demonstrates that the majority of limb abnormalities detected prenatally [23/28 (82%)] can be identified in the first trimester, especially major limb defects; however, our numbers are small and still need larger cases for further investigation.


Assuntos
Deformidades Congênitas dos Membros/diagnóstico por imagem , Primeiro Trimestre da Gravidez , Ultrassonografia Pré-Natal/métodos , Adolescente , Adulto , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , China , Pé Torto Equinovaro/diagnóstico por imagem , Ectromelia/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Translucência Nucal , Gravidez , Estudos Retrospectivos , Sensibilidade e Especificidade , Sindactilia , Centros de Atenção Terciária , Adulto Jovem
10.
J Clin Ultrasound ; 43(6): 375-83, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25110859

RESUMO

OBJECTIVE: To describe changes in the Doppler waveforms of the fetal main pulmonary artery (MPA) throughout gestation and to assess their predictive value of neonatal respiratory distress syndrome (RDS). STUDY DESIGN: In the first phase of this study, we performed Doppler measurement of MPA acceleration time (AT), ejection time (ET), peak systolic velocity, end-diastolic velocity, mean velocity, pulsatility index, and resistance index in 288 healthy fetuses. In the second phase, we carried out these measurements in a prospective cohort of 52 pregnant women with impending preterm birth. RESULTS: In phase I, satisfactory fetal MPA Doppler recordings were collected in 284 of 288 (98.6%) normal fetuses. Significant and positive linear correlations were found between gestational age and AT, AT/ET ratio, peak systolic velocity, and mean velocity (p < 0.01), with the strongest correlations concerning AT (r = 0.898) and AT/ET ratio (r = 0.868). In phase II, satisfactory fetal MPA Doppler waveforms were obtained in 43 of 44 (97.7%) fetuses. Of these, 14 (32.6%) developed RDS and 29 did not. Using less than or equal to the fifth percentile as a gestational age-specific cutoff, AT alone could predict RDS with a sensitivity of 78.6% and a specificity of 89.7%. The AT/ET ratio could predict RDS with 71.4% sensitivity and 93.1% specificity. CONCLUSIONS: Fetal MPA Doppler velocimetry can reliably be obtained throughout gestation. AT and AT/ET ratios of the fetal MPA Doppler waveform may help identifying fetuses at risk of developing neonatal RDS.


Assuntos
Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/embriologia , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico por imagem , Ultrassonografia Doppler , Ultrassonografia Pré-Natal , Adulto , Velocidade do Fluxo Sanguíneo , Estudos de Coortes , Feminino , Feto , Idade Gestacional , Humanos , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
11.
Prenat Diagn ; 35(2): 103-7, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25201035

RESUMO

OBJECTIVE: To describe the incidence, prenatal diagnosis, and perinatal outcome in fetuses with congenital dacryocystocele. METHODS: All cases of congenital dacryocystocele diagnosed by prenatal ultrasound were identified using an established perinatal database. Prenatal ultrasound images were reviewed, and perinatal outcome was abstracted from the medical records. The correlation between the cyst size, gestational age, and prenatal and neonatal outcome was analyzed. RESULTS: The overall incidence of fetal dacryocystocele was 0.016% (75/456,202). Fifty-three cases (70.7%) had unilateral, and 22 (29.3%) had bilateral lesions. Lesions were seen more commonly among female fetuses with a female : male ratio 1.48 : 1. The average diameter of cysts size was 6.9 ± 1.9 mm (3.3-11 mm). There was a direct correlation between cyst size and gestational age. Among the 75 cases, 8 were lost to follow-up, 3 underwent elective termination of pregnancy. 58 resolved spontaneously before birth, and 6 were confirmed at birth. Two developed neonatal infection requiring antibiotic treatment. All 6 cases confirmed at birth resolved without surgical resection. CONCLUSIONS: Congenital dacryocystocele can be diagnosed by prenatal ultrasound. Such lesions typically resolve spontaneously in utero or in the early neonatal period. Thus, it should be considered as a developmental variant rather than a structural birth defect.


Assuntos
Cistos/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Obstrução dos Ductos Lacrimais/complicações , Adulto , China/epidemiologia , Cistos/congênito , Cistos/epidemiologia , Feminino , Doenças Fetais/epidemiologia , Doenças Fetais/etiologia , Humanos , Incidência , Obstrução dos Ductos Lacrimais/congênito , Obstrução dos Ductos Lacrimais/epidemiologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-Natal , Adulto Jovem
12.
J Clin Ultrasound ; 40(5): 301-5, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21952985

RESUMO

Diastematomyelia is a rare congenital disorder in which the spinal cord is divided longitudinally for part of its length. It can be accurately identified in the prenatal period by detailed sonographic examination of the spine. We report a case of diastematomyelia localized to spinal levels T6-T9 diagnosed prenatally at 31 weeks' gestation and review the existing literature on the diagnosis and management of this condition during pregnancy.


Assuntos
Defeitos do Tubo Neural/diagnóstico , Medula Espinal/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Aborto Terapêutico , Adulto , Diagnóstico Diferencial , Feminino , Idade Gestacional , Humanos , Imagem por Ressonância Magnética , Gravidez , Medula Espinal/anormalidades
13.
Reprod Sci ; 18(8): 713-22, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21421891

RESUMO

OBJECTIVE: Neutrophil gelatinase-associated lipocalin (NGAL) is a ubiquitous lipocalin that serves as a critical component of innate immunity and a transport shuttle for numerous substances (retinoids, arachidonic acid, prostaglandins, fatty acids, steroids, iron, and MMPs). Despite the well-documented association between intra-amniotic infection/inflammation (IAI) and preterm birth, NGAL expression in the uterus has not previously been examined. This study investigates NGAL expression at the maternal-fetal interface in vivo and in vitro. METHODS: Neutrophil gelatinase-associated lipocalin expression in term placenta with/without IAI was examined by immunohistochemistry. Trophoblast and decidual stromal cells were retrieved from elective cesarean, purified, and depleted of leukocytes. On days 1 (cytotrophoblast cells) and 4 (syncytiotrophoblast), cells were stimulated with/without interleukin 1ß (IL-1ß; 1 ng/mL), tumor necrosis factor α (TNF-α; 1 ng/mL), or lipopolysaccharide (LPS; 1 µg/mL). Neutrophil gelatinase-associated lipocalin messenger RNA (mRNA) and protein expression were measured by immunocytochemistry/Western blot and RT-qPCR, respectively. RESULTS: Under basal conditions, NGAL is expressed in trophoblast, but not decidua. Trophoblast NGAL is significantly upregulated in tissues with evidence of IAI vs controls. NGAL expression was increased after stimulation with all 3 pro-inflammatory mediators in day 1 (cytotrophoblast) but not day 4 cells (syncytiotrophoblast). IL-1ß and TNF-α (not LPS) upregulated NGAL gene expression in cytotrophoblast (not syncytiotrophoblast) cells. CONCLUSIONS: Intra-amniotic infection/inflammation is associated with increased expression of NGAL in trophoblast tissues in vivo. IL-1ß, TNF-α, and LPS stimulated NGAL in cytotrophoblast cells (not syncytiotrophoblast and decidua) in vitro. These data suggest that, in keeping with its role as a mediator of innate immunity, NGAL may have a central role to play in IAI-induced preterm birth.


Assuntos
Corioamnionite/imunologia , Lipocalinas/biossíntese , Neutrófilos/imunologia , Nascimento Prematuro/imunologia , Feminino , Humanos , Imuno-Histoquímica , Recém-Nascido , Recém-Nascido Prematuro , Lipocalinas/genética , Lipocalinas/imunologia , Gravidez , Regulação para Cima
14.
Prenat Diagn ; 31(4): 334-46, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21280058

RESUMO

OBJECTIVE: To describe the sonographic features and perinatal outcome of congenital vascular rings diagnosed prenatally at a single tertiary care institution. METHODS: All cases of congenital vascular rings diagnosed by prenatal ultrasound between July 2005 and December 2009 were identified at a single referral center using an established perinatal database. The diagnosis was confirmed by postnatal echocardiography for live-born infants or autopsy for terminated cases. RESULTS: The overall incidence of vascular ring during this 5-year period was 0.086% (81 cases among 94 321 women undergoing perinatal ultrasound examination). Forty-four cases had complete O-shaped (n = 3) or U-shaped (n = 41) vascular rings, and 37 cases had incomplete C-shaped vascular rings (vascular slings). The most common type of vascular ring seen in 50.6% (41/81) of cases was a right aortic arch with aberrant left subclavian artery. The second most common type was a left aortic arch with an aberrant right subclavian artery [39.5% (32/81)]. Chromosomal analysis was performed prenatally in 46 pregnancies, and six cases (13.0%) of fetal aneuploidy were identified. CONCLUSIONS: Congenital vascular rings can be diagnosed with prenatal ultrasound using the three-vessel trachea view and subsequent fetal echocardiography with particular attention to the relationship of the aortic arches, ductal arches, and the trachea.


Assuntos
Resultado da Gravidez/epidemiologia , Ultrassonografia Pré-Natal , Malformações Vasculares/diagnóstico por imagem , Aneurisma/diagnóstico por imagem , Aneurisma/patologia , Síndromes do Arco Aórtico/diagnóstico por imagem , Síndromes do Arco Aórtico/patologia , Anormalidades Cardiovasculares/diagnóstico por imagem , Anormalidades Cardiovasculares/patologia , Estudos de Casos e Controles , Estudos de Coortes , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/patologia , Feminino , Humanos , Recém-Nascido , Modelos Biológicos , Fenótipo , Gravidez , Prognóstico , Estudos Retrospectivos , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/patologia , Ultrassonografia Pré-Natal/estatística & dados numéricos , Malformações Vasculares/classificação , Malformações Vasculares/epidemiologia , Malformações Vasculares/patologia
15.
J Emerg Med ; 41(5): 503-6, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20813482

RESUMO

BACKGROUND: Spontaneous (non-traumatic) rupture of the spleen rarely occurs in the setting of a normal spleen, especially during pregnancy. OBJECTIVES: We report a case of spontaneous rupture of a normal spleen at 33.7 weeks gestation and review the literature with the aim of exploring the etiology, diagnosis, and management of this condition during pregnancy. CASE REPORT: A 30-year-old Chinese primigravida presented at 33.7 weeks gestation with acute onset of severe, constant left upper abdominal pain. She developed acute hypotension. Physical examination revealed diffuse abdominal tenderness with rebounding and guarding. An emergent cesarean delivery and abdominal exploration was performed. A non-viable male infant was delivered, and active bleeding was identified at the splenic hilum consistent with splenic rupture. A splenectomy was performed, and a consumptive coagulopathy was identified and treated. The patient had an uncomplicated postoperative course and was discharged home on postoperative day 15. CONCLUSION: Splenic rupture in pregnancy is a life-threatening complication. Early diagnosis and aggressive surgical intervention will allow for optimal maternal and perinatal outcome.


Assuntos
Dor Abdominal/diagnóstico , Complicações na Gravidez/diagnóstico , Ruptura Esplênica/diagnóstico , Doença Aguda , Adulto , Feminino , Humanos , Gravidez , Ruptura Espontânea/diagnóstico , Choque Hemorrágico/etiologia , Natimorto
16.
Rev Obstet Gynecol ; 4(3-4): 99-102, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22229061

RESUMO

Pulmonary hypoplasia is a rare congenital disorder; most cases occur in association with other congenital abnormalities, including congenital diaphragmatic hernia, oligohydramnios, and/or skeletal deformities. The authors report a case of unilateral pulmonary hypoplasia diagnosed prenatally and confirmed at autopsy.

17.
Reprod Sci ; 17(6): 532-9, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20360593

RESUMO

OBJECTIVE: Progesterone supplementation prevents preterm birth (PTB) in some high-risk women, but its mechanism of action is not known. One third of PTB is associated with preterm premature rupture of membranes (PPROM). We hypothesize that progesterone may block proinflammatory cytokine-induced apoptosis of fetal membrane, thereby preventing PPROM and PTB. METHODS: Fetal membranes were collected at elective repeat cesarean at term (no labor, no infection [n = 12]), washed, and cultured with/ without progesterone (125-500 ng/mL), 17alpha-hydroxyprogesterone caproate (125-500 ng/mL [17P]), or medroxyprogesterone acetate (10(-7)-10( -6) mol/L [MPA]) for 24 hours. Membranes were then treated with/without lipopolysaccharide ([LPS] 100 ng/mL) or tumor necrosis factor alpha ([TNF-alpha] 50 ng/ mL) for 24 to 72 hours, harvested, and homogenized. Apoptosis was determined by evaluating caspase-3, -8, and -9 activities. Caspase activity in relative light units was measured on a luminometer and corrected for total protein. RESULTS: Both TNF-alpha and LPS significantly increased caspase-3, -8, and -9 activity in term fetal membranes in a time-dependent fashion. Progesterone, 17P, and MPA significantly reduced TNF-alpha, but not LPS, induced caspase-3 activity. Interestingly, progesterone and MPA, but not 17P, also inhibited basal caspase-3 activity. CONCLUSION: Progesterone inhibits basal and TNF-alpha-induced apoptosis in term fetal membranes. This novel observation may explain in part the mechanism by which progesterone supplementation prevents PPROM and PTB in some high-risk women. The effect of progesterone on the basal levels of apoptosis suggests that this mechanism may also be important for normal labor at term.


Assuntos
Apoptose/efeitos dos fármacos , Membranas Extraembrionárias/efeitos dos fármacos , Nascimento Prematuro/prevenção & controle , Progesterona/farmacologia , Progestinas/farmacologia , Fator de Necrose Tumoral alfa/toxicidade , Células Cultivadas , Membranas Extraembrionárias/citologia , Feminino , Ruptura Prematura de Membranas Fetais/prevenção & controle , Humanos , Gravidez , Progesterona/uso terapêutico , Progestinas/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidores
18.
Am J Obstet Gynecol ; 200(2): 203.e1-11, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19185102

RESUMO

OBJECTIVE: The objective of the study was to evaluate the fetal renal artery impedance in the context of inflammation-associated preterm birth. STUDY DESIGN: We conducted a prospective Doppler assessment of the fetal renal artery impedance in 70 singleton fetuses. The study group consisted of 56 premature fetuses (median, 28.1 [interquartile range, 25.3-30.6] weeks at enrollment). Gestational age (GA) reference ranges were generated based on fetuses with uncomplicated pregnancies (n = 14). Doppler studies included renal artery pulsatility index (PI), resistance index (RI), systolic/diastolic (S/D) ratio, and presence or absence of end-diastolic blood flow. Proteomic profiling (surface-enhanced laser desorption ionization time-of-flight) was used for assessment of intraamniotic inflammation and biomarker peak corresponding to beta2-microglubin. Data were interpreted in relationship to amniotic fluid index (AFI), cord blood interleukin (IL)-6 and erythropoietin (EPO) levels. The cardiovascular and metabolic profiles of the neonates were investigated in the first 24 hours of life. RESULTS: Fetuses delivered by mothers with intraamniotic inflammation had higher cord blood IL-6 but not EPO levels. Fetal inflammation did not affect either renal artery PI, RI, S/D ratio, or end-diastolic blood flow. Neonates delivered in the context of intraamniotic inflammation had higher serum blood urea nitrogen levels, which correlated significantly with AF IL-6 levels. The renal artery RI and SD ratio were inversely correlated with the AFI independent of GA, cord blood IL-6, and status of the membranes. CONCLUSION: The fetus is capable of sustaining normal renal artery impedance despite inflammation. Resistance in the renal vascular bed affects urine output independent of inflammation.


Assuntos
Líquido Amniótico/imunologia , Artéria Renal/diagnóstico por imagem , Resistência Vascular/imunologia , Adulto , Amniocentese , Feminino , Ruptura Prematura de Membranas Fetais/imunologia , Feto , Hemodinâmica , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Trabalho de Parto Prematuro/imunologia , Gravidez , Nascimento Prematuro/imunologia , Estudos Prospectivos , Artéria Renal/imunologia , Ultrassonografia Doppler , Adulto Jovem
19.
Rev Obstet Gynecol ; 1(2): 61-8, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18769658

RESUMO

Respiratory distress syndrome (RDS) remains a major cause of perinatal morbidity and mortality in premature infants. To avoid iatrogenic RDS, The American College of Obstetricians and Gynecologists (ACOG) recommends that obstetricians confirm fetal pulmonary maturity prior to elective delivery less than 39 weeks' gestation. However, ACOG based such recommendations primarily on studies carried out prior to the routine use of antenatal corticosteroids to accelerate lung maturity and the liberal use of ultrasound to confirm gestational age. Recent studies suggest that testing for fetal lung maturity at more advanced gestational ages is neither reliable nor cost effective. This article reviews the current literature on the use of amniocentesis to confirm fetal lung maturity prior to elective delivery at 36 to 39 weeks' gestation.

20.
Am J Obstet Gynecol ; 198(4): 426.e1-9, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18395034

RESUMO

OBJECTIVE: The objective of the study was to test the hypothesis that inflammation modulates fetal erythroblastosis and/or the release of nucleated red blood cells (NRBCs) independent of hypoxia or fetal stress. We sought to determine whether fetal inflammation is associated with an elevation in neonatal NRBC count in the setting of inflammation-associated preterm birth. STUDY DESIGN: The relationships between peripheral NRBC count, histological chorioamnionitis, umbilical cord interleukin (IL)-6, erythropoietin (EPO), cortisol, and acid-base status were analyzed in 68 preterm singletons, born to mothers who had an amniocentesis to rule out infection. Proteomic profiling of amniotic fluid identified presence of intraamniotic inflammation according to established parameters. NRBC counts were assessed within 1 hour of birth. Early-onset neonatal sepsis (EONS) was established based on hematological and microbiological indices. IL-6, EPO, and cortisol levels were measured by immunoassays. Fetal acid-base status was determined within 10 minutes of delivery. Parametric or nonparametric statistics were used. RESULTS: Fetuses with EONS (n = 19) were delivered at earlier gestational ages (mean +/- SD: 27.1 +/- 2.8 weeks, P = .001) and more often by mothers with intraamniotic inflammation (P = .022) and histological chorioamnionitis (P < .001). Neonates with EONS had higher absolute NRBC counts (P = .011). NRBC counts were directly correlated with cord blood IL-6 levels (P < .001) but not with EPO, cortisol or parameters of acid-base status levels regardless of EONS status. These relationships remained following correction for gestational age, diabetes, intrauterine growth restriction, and steroid exposure. CONCLUSION: In the setting of inflammation-associated preterm birth and in the absence of hypoxia, elevations in NRBCs in the early neonatal period may be a direct response of exposure to inflammatory mediators in utero.


Assuntos
Corioamnionite/imunologia , Eritroblastos/metabolismo , Sofrimento Fetal/sangue , Nascimento Prematuro/imunologia , Sepse/imunologia , Adulto , Corioamnionite/sangue , Eritroblastose Fetal/sangue , Eritroblastose Fetal/imunologia , Contagem de Eritrócitos , Feminino , Humanos , Hipóxia/sangue , Hipóxia/imunologia , Recém-Nascido , Mediadores da Inflamação , Masculino , Gravidez , Nascimento Prematuro/sangue , Sepse/sangue
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