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1.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472804

RESUMO

Six days after a normal delivery, a 24-year-old woman with atraumatic lumbosacral pain radiating to the left groin was referred to the orthopaedic surgeon due to worsening pain and impossible load bearing on the left lower limb. Standard pelvic radiographs revealed an unstable displaced left neck of femur (NOF) fracture. A CT scanner and MRI showed diffuse osteopaenia of the left proximal femur and the corresponding acetabulum. A diagnosis of transient osteoporosis of the hip (TOH) complicated by a pathological displaced subcapital NOF fracture was established. The patient underwent total hip arthroplasty without complication and recovered excellent function after rehabilitation. Awareness of the differential diagnosis of TOH in pregnancy, a high index of suspicion and early MRI to make an early diagnosis and to prevent devastating fracture complications are mandatory.


Assuntos
Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Dor Lombar/diagnóstico , Osteoporose/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Artroplastia de Quadril , Feminino , Fraturas do Colo Femoral/etiologia , Fraturas do Colo Femoral/cirurgia , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/cirurgia , Humanos , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Osteoporose/complicações , Gravidez , Terceiro Trimestre da Gravidez , Tomografia Computadorizada por Raios X , Adulto Jovem
3.
J Comput Assist Tomogr ; 44(5): 780-783, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842059

RESUMO

INTRODUCTION: Vernix caseosa peritonitis (VCP) is a rare peripartum complication secondary to the introduction of fetal vernix into the maternal peritoneal cavity. Vernix caseosa peritonitis typically manifests a few hours to days after a cesarian section and is often initially misdiagnosed as a more common disease process resulting in delayed diagnosis. We report the computed tomography (CT) findings in 2 patients with VCP and reviewed the previously reported CT findings of VCP. CASES: Two patients, aged 17 and 24 years, presented with signs and symptoms of peritonitis within days of undergoing a cesarian section. In both cases, CT scans of the abdomen and pelvis demonstrated ascites and multiple small, well-defined, peripherally enhancing, cystic peritoneal nodules which were most prominent around the liver and became larger and more numerous over time. Antibiotic therapy was not effective, subsequent laparoscopic peritoneal biopsy demonstrated VCP, and patients were successfully treated with lavage and the addition of intravenous steroids. CONCLUSIONS: Vernix caseosa peritonitis is an underrecognized disorder that is most often mistaken for other more common causes of peritonitis. In the setting of peripartum peritonitis, the CT findings of ascites with multiple small, well-defined, peripherally enhancing, cystic peritoneal nodules, especially adjacent to the liver, which grow in size and number strongly suggests VCP.


Assuntos
Reação a Corpo Estranho/diagnóstico por imagem , Peritonite/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Verniz Caseoso , Abdome/diagnóstico por imagem , Adolescente , Adulto , Cesárea/efeitos adversos , Cistos/diagnóstico por imagem , Cistos/patologia , Cistos/cirurgia , Feminino , Reação a Corpo Estranho/patologia , Reação a Corpo Estranho/cirurgia , Humanos , Laparoscopia , Peritonite/patologia , Peritonite/cirurgia , Gravidez , Complicações na Gravidez/patologia , Complicações na Gravidez/cirurgia , Tomografia Computadorizada por Raios X , Verniz Caseoso/citologia , Verniz Caseoso/imunologia , Adulto Jovem
4.
PLoS One ; 15(6): e0235269, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32603339

RESUMO

Many high-risk conditions of pregnancy are undetected until the time of delivery in low-income countries. We developed a point-of-care ultrasound training protocol for providers in rural Uganda to detect fetal distress or demise, malpresentation, multiple gestation, placenta previa, oligohydramnios and preterm delivery. This was a mixed-methods study to evaluate the 2-week training curriculum and trainees' ability to perform a standard scanning protocol and interpret ultrasound images. Surveys to assess provider confidence were administered pre-training, immediately after, and at 3-month follow up. Following lecture and practical demonstrations, each trainee conducted 25 proctored scans and were required to pass an observed structured clinical exam (OSCE). All images produced 8 weeks post course underwent blinded review by two ultrasound experts to assess image quality and to identify common errors. Key informant interviews further assessed perceptions of the training program and utility of point-of-care ultrasound. All interviews were audio recorded, transcribed, and reviewed by multiple readers using a content analysis approach. Twenty-three nurse/nurse midwives and two physicians from one district hospital and three health centers participated in the training curriculum. Confidence levels increased from an average of 1 point pre-course to over 6 points post-course for all measures (maximum of 7 points). Of 25 participants, 22 passed the OSCE on the first attempt (average score 89.4%). Image quality improved over time; the final error rate at week 8 was less than 5%, with an overall kappa of 0.8-1 for all measures between the two reviewers. Among the 12 key informant interviews conducted, key themes included a desire for more hands-on training and longer duration of training and challenges in balancing clinical duties with ability to attend training sessions. This study demonstrates that providers without previous ultrasound experience can detect high-risk conditions during labor with a high rate of quality and accuracy after training.


Assuntos
Enfermeiras Obstétricas/educação , Complicações na Gravidez/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Feminino , Humanos , Trabalho de Parto , Tocologia/educação , Obstetrícia/educação , Gravidez , População Rural , Triagem , Uganda , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/enfermagem
5.
J Clin Neurosci ; 77: 1-7, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32414621

RESUMO

Chiari Malformation type 1 (CM-I) is congenital or an acquired anomaly of the hind brain; develops when the cerebellar tonsils recede downwards below the foramen magnum. Recurrent post tussive suboccipital headache is the common presentation in a pregnant woman and the diagnosis is usually missed or delayed due to lack of formal understanding of this neurological pathology. Much has been written regarding presentation, morphology and the treatment of CM-I; however, little is known when the etiology is acquired or an iatrogenic in its evolution. Similarly, unknown is the progression of CM-I (diagnosed or undiagnosed) in pregnancy. The objective of this study is to elucidate the causes of progression of CM-I in pregnancy, and how this can be avoided. A detailed literature review has been conducted to find the case reports or case studies on association of CM-I in pregnancy; therefore, the risk factors regarding the progression have been sought. There is a lack of literature on timing, mode of anesthesia, and the management of CM-I. Moreover, authors have sought a questionnaire to screen these patients at pre-conception, intrapartum visits if, the initial diagnosis is delayed. Crucial points of concern including but not limited to the diagnosis, pre-conception counseling, timing of intervention during pregnancy, and mode of anesthesia, have been discussed in detail. In summary, a formal management algorithm has been proposed to avoid the rapid progression of this complex neurological pathology especially, in women of child bearing age and/or during pregnancy.


Assuntos
Malformação de Arnold-Chiari/diagnóstico por imagem , Progressão da Doença , Complicações na Gravidez/diagnóstico por imagem , Adulto , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/terapia , Tosse/complicações , Tosse/diagnóstico por imagem , Tosse/terapia , Parto Obstétrico/métodos , Feminino , Forame Magno/diagnóstico por imagem , Transtornos da Cefaleia Primários/complicações , Transtornos da Cefaleia Primários/diagnóstico por imagem , Transtornos da Cefaleia Primários/terapia , Humanos , Imagem por Ressonância Magnética/métodos , Gravidez , Complicações na Gravidez/terapia , Fatores de Risco
6.
Clin Nucl Med ; 45(7): e339-e341, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32433171

RESUMO

This 37-year-old woman was diagnosed with breast cancer during pregnancy. After multidisciplinary meeting, she was referred to our department for an FDG PET/CT for staging, and chemotherapy with weekly infusion of paclitaxel was initiated before childbirth. We estimated the fetal dose from the PET/CT procedure, and our results show that, if deemed necessary, this examination can reasonably be performed during pregnancy. The patient gave birth vaginally at term to an apparently healthy girl.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Fluordesoxiglucose F18 , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Complicações na Gravidez/diagnóstico por imagem , Adulto , Neoplasias da Mama/patologia , Feminino , Humanos , Estadiamento de Neoplasias , Gravidez , Complicações na Gravidez/patologia , Fatores de Tempo
8.
Am J Surg ; 219(5): 855-859, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32245608

RESUMO

BACKGROUND: The diagnosis of acute appendicitis (AA) in pregnancy remains challenging. We investigated which preoperative clinical factors are most predictive of AA in pregnant women. METHODS: 164 pregnant patients undergoing magnetic resonance imaging for suspected AA were retrospectively reviewed. Logistic regression was used to compare those with pathologically confirmed AA and those without. RESULTS: 28 patients (17.1%) had pathologically confirmed AA. 42.9% (n = 12) were perforated at the time of operation. Factors associated with AA included history of emesis (p = 0.005), migratory abdominal pain (p = 0.006), rebound tenderness (p = 0.01), elevated white blood cell count (p = 0.003), elevated Alvarado Score (p < 0.001), elevated neutrophil count (p = 0.021), and left shift (p = 0.001). As a screening test, a left shift with neutrophils >70% provided a sensitivity and negative predictive value of 100.0%. DISCUSSION: Every patient in our series with AA had a left shift. Neutrophil count and percentage should be considered in the diagnostic evaluation of these patients to better guide resource utilization and treatment.


Assuntos
Apendicite/sangue , Neutrófilos , Complicações na Gravidez/sangue , Doença Aguda , Adolescente , Adulto , Apendicectomia , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Feminino , Humanos , Perfuração Intestinal , Imagem por Ressonância Magnética , Valor Preditivo dos Testes , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade
9.
Am J Case Rep ; 21: e921299, 2020 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-32284523

RESUMO

BACKGROUND Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by autoantibody production leading to inflammation in multiple organs; it commonly affects young women in their child-bearing years. Clinical manifestations are diverse and range from mild arthritis to diffuse alveolar hemorrhage (DAH). DAH is a rare and devastating complication of SLE that carries a mortality rate of up to 50%, despite aggressive therapy. CASE REPORT A 21-year-old primigravida at 16 weeks gestation presents with a productive cough, rash, sore throat, and high-grade fever. Chest x-ray suggested multifocal pneumonia. Patient deteriorated despite antibiotics and intravenous (IV) fluids. She developed worsening anemia, leukopenia, and thrombocytopenia. Autoimmune workup was positive for Coombs, antinuclear antibody, anti-smith antibody, and hypocomplementemia. Skin biopsy was consistent with SLE. SLE vasculitis was suspected. She required mechanical intubation for rapid respiratory deterioration, with CT thorax suggesting ARDS. Bronchoscopy was done and confirmed DAH. Her course was further complicated with retinopathy and acute pancreatitis associated with SLE. She was treated with IV steroids, IV cyclophosphamide, and plasmapheresis, with significant clinical improvement and successful extubation. She delivered a healthy baby at 32 weeks gestation. CONCLUSIONS Early recognition and initiation of treatment is critical to survival in DAH and requires a high index of clinical suspicion. Treatment includes high-dose steroids, cyclophosphamide, and plasma exchange. Pregnancy increases the risk of adverse outcome in SLE. Seven cases of DAH in pregnant patients with SLE have been reported. Here, we report a catastrophic presentation of DAH, acute pancreatitis, and retinopathy in a pregnant patient with newly diagnosed SLE.


Assuntos
Lúpus Eritematoso Sistêmico/complicações , Insuficiência de Múltiplos Órgãos/etiologia , Complicações na Gravidez/etiologia , Vasculite/etiologia , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Pneumopatias/diagnóstico por imagem , Pneumopatias/etiologia , Pneumopatias/terapia , Lúpus Eritematoso Sistêmico/terapia , Insuficiência de Múltiplos Órgãos/terapia , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/terapia , Alvéolos Pulmonares/diagnóstico por imagem , Alvéolos Pulmonares/patologia , Vasculite/diagnóstico por imagem , Vasculite/terapia , Adulto Jovem
10.
J Neuroimmunol ; 343: 577235, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32279021

RESUMO

Diagnosis and treatment of anti-NMDAR encephalitis during pregnancy are challenging. We report a case of anti-NMDAR encephalitis in a 28-year-old, 24 weeks pregnant woman. Her brain magnetic resonance imaging was normal, but arterial spin labeling (ASL) showed increased cerebral blood flow in the right insula and temporal area. She was successfully treated with emergent cesarean section and immunotherapies including intravenous immunoglobulin, steroids, and rituximab. The newborn was healthy and she recovered fully. Early suspicion and proper management is important in treatment of anti-NMDAR encephalitis during pregnancy. ASL can help diagnosing anti-NMDAR encephalitis during pregnancy.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico por imagem , Neuroimagem/métodos , Complicações na Gravidez/diagnóstico por imagem , Adulto , Encefalite Antirreceptor de N-Metil-D-Aspartato/tratamento farmacológico , Feminino , Humanos , Fatores Imunológicos/uso terapêutico , Gravidez , Complicações na Gravidez/tratamento farmacológico , Terceiro Trimestre da Gravidez , Marcadores de Spin
12.
Rev. esp. anestesiol. reanim ; 67(4): 215-218, abr. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-ET5-1118

RESUMO

Los déficits motores de miembros inferiores durante el embarazo y el puerperio son relativamente frecuentes. Se atribuyen habitualmente a complicaciones asociadas a las técnicas neuroaxiales que son realizadas por el anestesiólogo. Pero existen otras posibles causas, como la osteoporosis transitoria de caderas. La osteoporosis transitoria del embarazo es una patología infrecuente y autolimitada de origen desconocido. La complicación más severa que puede presentar son las fracturas patológicas, fundamentalmente en las articulaciones de carga. Esta patología suele presentarse en el tercer trimestre del embarazo y cursa con dolor e impotencia funcional del miembro inferior afecto. Presentamos el caso de una mujer de 35 años, gestante de 40+3 semanas que inicia trabajo de parto. Se coloca catéter epidural normofuncionante y finalmente se decide cesárea por parto estacionado; 48h después comienza con impotencia funcional en miembro inferior izquierdo y dolor. Se realiza RM donde se descarta hematoma epidural y se objetiva osteopenia de caderas, siendo diagnosticada de osteoporosis transitoria el embarazo


Motor deficits of lower limbs during pregnancy and the puerperium are relatively frequent. They are usually attributed to complications which are associated with neuroaxial techniques performed by the anesthesiologist. But there are other possible causes, such as transient osteoporosis of the hips. Transient osteoporosis of pregnancy is a rare and self-limited pathology of unknown etiology. The most severe complication that can occur are pathological fractures, mainly in the load joints. This pathology usually occurs in the third trimester of pregnancy and is showed up with pain and functional impotence of the lower limb affected. We present the case of a 35-year-old woman, 40+3 weeks of pregnancy who starts labour. Normally functioning epidural catheter is placed and finally cesarean section is decided because failure to progress; 48h later the patient begins with functional impotence and pain in the lower left limb. MRI is performed, epidural hematoma is ruled out and osteopenia of the hips is proved. The patient is diagnosed with transient osteoporosis of pregnancy


Assuntos
Humanos , Feminino , Gravidez , Adulto , Osteoporose/diagnóstico por imagem , Doenças Ósseas Metabólicas/diagnóstico por imagem , Quadril/fisiopatologia , Cesárea , Complicações na Gravidez/diagnóstico por imagem , Terceiro Trimestre da Gravidez , Imagem por Ressonância Magnética , Período Pós-Parto , Analgesia Epidural/efeitos adversos
13.
Can Assoc Radiol J ; 71(3): 396-402, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32157904

RESUMO

The use of diagnostic imaging studies in the emergency setting has increased dramatically over the past couple of decades. The emergency imaging of pregnant and lactating patients poses unique challenges and calls upon the crucial role of radiologists as consultants to the referring physician to guide appropriate use of imaging tests, minimize risk, ensure timely management, and occasionally alleviate unwarranted trepidation. A clear understanding of the risks and benefits involved with various imaging tests in this patient population is vital to achieve this. This review discusses the different safety and appropriateness issues that could arise with the use of ionizing radiation, iodinated-, and gadolinium-based contrast media and radiopharmaceuticals in pregnant and lactating patients. Special considerations such as trauma imaging, safety concerns with magnetic resonance imaging and ultrasound, management of claustrophobia, contrast extravasation, and allergic reactions are also reviewed. The consent process for these examinations has also been described.


Assuntos
Emergências , Feto/efeitos da radiação , Lactação/efeitos dos fármacos , Complicações na Gravidez/diagnóstico por imagem , Exposição à Radiação/prevenção & controle , Proteção Radiológica/métodos , Ferimentos e Lesões/diagnóstico por imagem , Meios de Contraste/efeitos adversos , Feminino , Humanos , Transtornos Fóbicos/prevenção & controle , Gravidez , Compostos Radiofarmacêuticos/efeitos adversos , Gestão da Segurança
14.
Taiwan J Obstet Gynecol ; 59(1): 28-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32039796

RESUMO

OBJECTIVE: To compare pregnancy outcomes resulting from the use of cervical cerclage for different indications and investigate factors that might influence the clinical effects of cervical cerclage. MATERIALS AND METHODS: This was a retrospective study of pregnant women who received cervical cerclage in The Women's Hospital, Zhejiang University School of Medicine, China. Patients were divided into three groups: a history-indicated group; an ultrasound-indicated group and a physical examination-indicated group. The pregnancy outcomes of the three groups were then compared. Univariate and multivariate logistic regression analysis were performed to assess the independent risk factors. RESULTS: Statistical differences were evident when the history-indicated group and the ultrasound-indicated group were compared with the physical examination-indicated group for gestational age at delivery [37.3(33.3-38.9), 35.4(28.9-38.4) vs. 26.1 (24.3-28.4) weeks, respectively, P < 0.05], percentage of cases delivered at < 28 weeks of gestation (13.4%, 20.3% vs. 74.3%, respectively, P < 0.05), percentage of cases delivered at < 37 weeks of gestation (42.7%, 54.2% vs. 91.4%, respectively, P < 0.05) and fetal survival rate (88.4%, 81.4% vs. 40.0%, respectively, P < 0.05). The history-indicated group and the ultrasound-indicated group were similar with regards to these outcomes. The independent risk factors affecting the clinical effects of cervical cerclage include age, body mass index (BMI), history of prior preterm birth and second-trimester loss, C-reactive protein (CRP) >5 mg/L and cervical dilation ≥3 cm (P < 0.05). CONCLUSION: Pregnancy outcomes were similar when compared between history-indicated and ultrasound-indicated cerclage. Serial cervical surveillance is beneficial for pregnant with a history of cervical insufficiency, and the placement of cervical cerclages in response to ultrasonographically detected shortening of the cervical length is a medically acceptable alternative to the use of history-indicated cerclage.


Assuntos
Cerclagem Cervical/estatística & dados numéricos , Complicações na Gravidez/cirurgia , Nascimento Prematuro/cirurgia , Incompetência do Colo do Útero/cirurgia , Adulto , Colo do Útero/diagnóstico por imagem , Colo do Útero/cirurgia , China , Feminino , Idade Gestacional , Humanos , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Resultado da Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Ultrassonografia Pré-Natal , Incompetência do Colo do Útero/diagnóstico por imagem
15.
Radiol Clin North Am ; 58(2): 347-361, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044011

RESUMO

Pelvic pain in the first trimester is nonspecific, with causes including pregnancy complications, pregnancy loss, and abnormal implantation, and symptom severity ranges from mild to catastrophic. Ultrasonography is the imaging modality of choice and essential to evaluate for the location of pregnancy, either intrauterine or not. If there is an intrauterine pregnancy, ultrasonography helps assess viability. If there is not an intrauterine pregnancy, ultrasonography helps assess for abnormal implantation, which accounts for a high percentage of maternal morbidity and mortality.


Assuntos
Dor Aguda/diagnóstico por imagem , Dor Pélvica/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Primeiro Trimestre da Gravidez , Gravidez Ectópica/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Diagnóstico Diferencial , Feminino , Humanos , Gravidez
16.
Radiol Clin North Am ; 58(2): 363-380, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044012

RESUMO

Abdominal pain is a common occurrence in pregnant women and may have a variety of causes, including those that are specific to pregnancy (eg, round ligament pain in the first trimester) and the wide range of causes of abdominal pain that affect men and women who are not pregnant (eg, appendicitis, acute cholecystitis). Noncontrast magnetic resonance (MR) imaging is increasingly performed to evaluate pregnant women with abdominal pain, either as the first-line test or as a second test following ultrasonography. The imaging appearance of causes of abdominal pain in pregnant women are reviewed with an emphasis on noncontrast MR imaging.


Assuntos
Abdome Agudo/diagnóstico por imagem , Dor Aguda/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Complicações na Gravidez/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Pelve/diagnóstico por imagem , Gravidez
17.
Radiol Clin North Am ; 58(2): 431-443, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044016

RESUMO

There are various complications that can occur in the postpartum period, including pain, bleeding, and infection. These include complications related to cesarean section, postpartum hemorrhage and hematomas, bladder injury, torsion and uterine dehiscence, and rupture. It is important the radiologist is aware of these entities and the associated imaging features to help guide timely and appropriate management.


Assuntos
Cesárea/efeitos adversos , Complicações na Gravidez/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Período Periparto , Período Pós-Parto , Gravidez , Transtornos Puerperais/diagnóstico por imagem
18.
Radiol Clin North Am ; 58(2): 445-462, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044017

RESUMO

Radiological guided intervention techniques are discussed in obstetric and gynecologic patients. Fallopian tube recanalization, postpartum hemorrhage control, techniques of treating uterine leiomyomas, pelvic congestion treatment, and the use of percutaneous and transvaginal ultrasonography-guided aspirations and biopsy are covered. These techniques use basic radiological interventional skills and show how they are adapted for use in the female pelvis.


Assuntos
Embolização Terapêutica/métodos , Doenças Urogenitais Femininas/diagnóstico por imagem , Doenças Urogenitais Femininas/terapia , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/terapia , Ultrassonografia de Intervenção/métodos , Feminino , Doenças Urogenitais Femininas/patologia , Ginecologia , Humanos , Biópsia Guiada por Imagem/métodos , Obstetrícia , Gravidez , Complicações na Gravidez/patologia
19.
BMC Med Imaging ; 20(1): 19, 2020 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066402

RESUMO

BACKGROUND: The torsion of normal adnexa is rare during pregnancy, especially in the third trimester. Nonspecific symptoms and signs as well as the limitations of ultrasound (US) make the diagnosis difficult, resulting in the loss of adnexa and fetal compromise. The magnetic resonance imaging (MRI) features of the torsion of normal adnexa are not classically described during pregnancy and only reported in a few cases. We find some different MRI features of the torsion of normal adnexa in late pregnancy and its diagnosis and treatment values are discussed in our report. CASE PRESENTATION: A 27-year-old woman at 31 + 5 weeks' gestation presented to the emergency department with a three-day history of the left lower abdominal pain. US discovered a mass of 87 × 61 mm in the left abdomen, but did not show whether the mass originated from the left ovary or the uterus. MRI showed the left ovary was increased in size to 82 × 42 × 85 mm with peripheral follicles. On fat-suppressed T2-weighted images, the signal intensity of the lesion was significantly decreased compared with the right ovary. The adjacent fallopian tube was found to be thickened. The radiologists diagnosed ovary infarction secondary to adnexal torsion. With the provisional diagnosis of adnexal torsion, the patient was taken to surgery. The left adnexal torsion was found during surgery. There was extensive hemorrhage and necrosis, so a left salpingo-oophorectomy was performed. The histopathology confirmed an extensively hemorrhagic fallopian tube and ovary with partial necrosis. CONCLUSION: We believe MRI is helpful where US is indeterminate in diagnosis of the torsion of normal adnexa in advanced pregnancy. We found that aside from hyperintensity on fat-saturated T1-weighted images, the low signal intensity on T2-weighted images can also reflect adnexal hemorrhage in conjunction with the torsion of normal adnexa.


Assuntos
Doenças dos Anexos/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Anormalidade Torcional/diagnóstico por imagem , Doenças dos Anexos/cirurgia , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Gravidez , Complicações na Gravidez/cirurgia , Terceiro Trimestre da Gravidez , Salpingo-Ooforectomia , Anormalidade Torcional/cirurgia , Resultado do Tratamento
20.
JAMA Netw Open ; 3(1): e1919940, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995213

RESUMO

Importance: Prenatal maternal stress is increasingly associated with adverse outcomes in pregnant women and their offspring. However, the association between maternal stress and human fetal brain growth and metabolism is unknown. Objective: To identify the association between prenatal maternal psychological distress and fetal brain growth, cortical maturation, and biochemical development using advanced 3-dimensional volumetric magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H-MRS). Design, Setting, and Participants: This cohort study prospectively recruited pregnant women from low-risk obstetric clinics in Washington, DC, from January 1, 2016, to April 17, 2019. Participants were healthy volunteers with a normal prenatal medical history, no chronic or pregnancy-induced physical or mental illnesses, and normal results on fetal ultrasonography and biometry studies. Fetal brain MRI studies were performed at 2 time points between 24 and 40 weeks' gestation. Exposures: Prenatal maternal stress, anxiety, and depression. Main Outcomes and Measures: Volumes of fetal total brain, cortical gray matter, white matter, deep gray matter, cerebellum, brainstem, and hippocampus were measured from 3-dimensional reconstructed T2-weighted MRI scans. Cortical folding measurements included local gyrification index, sulcal depth, and curvedness. Fetal brain N-acetylaspartate, creatine, and choline levels were quantified using 1H-MRS. Maternal stress, depression, and anxiety were measured with the Perceived Stress Scale (PSS), Edinburgh Postnatal Depression Scale (EPDS), Spielberger State Anxiety Inventory (SSAI), and Spielberger Trait Anxiety Inventory (STAI). Results: A total of 193 MRI studies were performed in 119 pregnant women (67 [56%] carrying male fetuses and 52 [44%], female fetuses; maternal mean [SD] age, 34.46 [5.95] years) between 24 and 40 gestational weeks. All women were high school graduates, 99 (83%) were college graduates, and 100 (84%) reported professional employment. Thirty-two women (27%) had positive scores for stress, 31 (26%) for anxiety, and 13 (11%) for depression. Maternal trait anxiety was associated with smaller fetal left hippocampal volume (STAI score: -0.002 cm3; 95% CI, -0.003 to -0.0008 cm3; P = .004). Maternal anxiety and stress were associated with increased fetal cortical gyrification in the frontal lobe (ß for SSAI score: 0.004 [95% CI, 0.001-0.006; P = .002]; ß for STAI score: 0.004 [95% CI, 0.002-0.006; P < .001]; ß for PSS score: 0.005 [95% CI, 0.001-0.008; P = .005]) and temporal lobe (ß for SSAI score: 0.004 [95% CI, 0.001-0.007; P = .004]; ß for STAI score: 0.004 [95% CI, 0.0008-0.006; P = .01]). Elevated maternal depression was associated with decreased creatine (EPDS score: -0.04; 95% CI, -0.06 to -0.02; P = .005) and choline (EPDS score: -0.03; 95% CI, -0.05 to -0.01; P = .02) levels in the fetal brain. Conclusions and Relevance: This study found that the prevalence of maternal psychological distress in healthy, well-educated, and employed pregnant women was high, underappreciated, and associated with impaired fetal brain biochemistry and hippocampal growth as well as accelerated cortical folding. These findings appear to support the need for routine mental health surveillance for all pregnant women and targeted interventions in women with elevated psychological distress.


Assuntos
Encéfalo/crescimento & desenvolvimento , Córtex Cerebral/diagnóstico por imagem , Desenvolvimento Fetal/fisiologia , Substância Cinzenta/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Estresse Psicológico/patologia , Adulto , Estudos de Coortes , Feminino , Humanos , Imageamento Tridimensional/métodos , Recém-Nascido , Imagem por Ressonância Magnética/métodos , Gravidez , Complicações na Gravidez/psicologia , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Estresse Psicológico/diagnóstico por imagem
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