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1.
Zhonghua Fu Chan Ke Za Zhi ; 56(2): 89-95, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33631879

RESUMO

Objective: To investigate the clinical outcomes of different treatment options on singleton short cervix and its influence factors. Methods: Totally 435 cases of singleton pregnancies who were diagnosed with short cervix (≤25 mm) between 12 to 33+6 gestational weeks in Peking University First Hospital from January 2018 to December 2018 were enrolled, including 21 cases with cervical length <10 mm, 414 cases with cervical length between 10 to 25 mm. The onset time was <24 gestational weeks in 106 cases, while 104 cases were at 24-29+6 gestational weeks and 225 cases of ≥30 gestational weeks. Gestational outcomes including delivery before 37 weeks, delivery before 34 weeks, neonatal birth weight (NBW) and adverse neonatal outcome (ANO) were compared among three treatment groups: rest group, progesterone group and cerclage group. Influence factors were also investigated. Results: (1) The incidence of short cervix in pregnancy was 7.07% (435/6 155), while 106 cases were at <24 gestational weeks (1.72%, 106/6 155), 104 cases (1.69%, 104/6 155) at 24-29+6 gestational weeks and 225 cases (3.66%, 225/6 155) at ≥30 gestational weeks. (2) In the group of cervical length <10 mm, rate of delivery before 37 and 34 weeks were 62% (13/21) and 57% (12/21) respectively. One case of progesterone treatment underwent miscarriage. Compared with rest group (n=8), delivery weeks [28.5 (25.0-40.0) vs 37.0 (28.0-40.0), P=0.020] and NBW [1 245 g (630-3 830 g) vs 2 648 g (1 560-3 830 g), P=0.028] were higher in cerclage group (n=9), while ANO was not statistically different (P>0.05). (3) In the group of cervical length ≥10 mm before 24 gestational weeks, the delivery weeks, incidence of delivery before 34 weeks, adjusted incidence of delivery before 37 weeks, NBW and ANO were not statistically different (P>0.05) among rest group (n=36), progesterone group (n=26) and cerclage group (n=34). In vitro fertilization (OR=11.97, 95%CI: 1.88-76.44, P=0.009), infection (OR=46.03, 95%CI: 5.12-413.58, P=0.001), sludge on sonography (OR=9.87, 95%CI: 1.69-57.60, P=0.011) and history of short cervix (OR=7.24, 95%CI: 1.04-50.24, P=0.045) were independent risk factors of preterm birth. (4) In the group of cervical length ≥10 mm and gestational weeks between 24-29+6, the delivery weeks, incidence of delivery before 37 weeks, incidence of delivery before 34 weeks, NBW and ANO were not statistically different (P>0.05) among rest group (n=52), progesterone group (n=34) and cerclage group (n=9). Infection was an independent risk factor of preterm birth (OR=56.40, 95%CI: 4.67-680.61, P=0.002). (5) Outcomes of 223 cases were relatively good in the group of cervical length ≥10 mm beyond 30 gestational weeks. The incidence of delivery before 34 weeks was 6.3% (14/223). The delivery weeks, incidence of delivery before 37 and 34 weeks, NBW and ANO were not statistically different (P>0.05) among 3 groups. Infection (OR=10.91, 95%CI: 2.21-53.96, P=0.003) and history of preterm birth (OR=8.63, 95%CI: 1.25-59.65, P=0.029) were independent risk factors of preterm birth. Conclusions: Short cervix is a common complication of pregnancy. Cervical cerclage is related with better outcome for patients with cervical length <10 mm. Neither progesterone nor cervical cerclage improves pregnancy outcome for >10 mm cervical length patients comparing with rest. Infection, sludge, in vitro fertilization, history of short cervix and history of preterm birth are independent risk factors of preterm birth in short cervix pregnancies.


Assuntos
Cerclagem Cervical/métodos , Colo do Útero/cirurgia , Complicações na Gravidez/cirurgia , Nascimento Prematuro/prevenção & controle , Adulto , Cerclagem Cervical/efeitos adversos , Colo do Útero/patologia , Feminino , Humanos , Incidência , Recém-Nascido , Gravidez , Complicações na Gravidez/patologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Progesterona/administração & dosagem , Técnicas de Sutura
2.
Eur J Endocrinol ; 184(3): 431-440, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33465046

RESUMO

Objective: Neonatal hyperthyroidism may be caused by a permanent non-autoimmune genetic disorder or, more frequently, by maternally transmitted high serum TRAb levels. Variable thyroid dysfunction may be observed in this second context. We aimed to evaluate the prevalence of neonatal non-autoimmune hyperthyroidism and of the different types of thyroid function in neonates with a high risk of hyperthyroidism due to maternal Graves' disease (GD). Design and methods: This observational cohort study included all neonates identified in the database of a single academic pediatric care center, over a period of 13 years, as having non-autoimmune hyperthyroidism or an autoimmune disorder with high TRAb levels (above 6 IU/L) transmitted by their mothers. Patients were classified as having neonatal hyperthyroidism, hypothyroidism, or euthyroidism with a permanent or transient disorder. Results: Two of the 34 consecutive neonates selected (6%) had permanent non-autoimmune hyperthyroidism due to germline (n = 1) or somatic (n = 1) mutations of the TSH receptor gene. The patients with high serum TRAb levels at birth had transient hyperthyroidism (n = 23), hypothyroidism (primary n = 2, central n = 3) or persistent euthyroidism (n = 4). Conclusion: These original findings highlight the need for careful and appropriate monitoring of thyroid function in the long term, not only for the rare patients with non-autoimmune neonatal hyperthyroidism, but also for repeat monitoring during the first month of life in neonates with maternally transmitted high TRAb levels, to ensure the early identification of thyrotoxicosis in more than two thirds of cases and to detect primary or central hypothyroidism, thereby potentially decreasing associated morbidity.


Assuntos
Doença de Graves/etiologia , Hipertireoidismo/congênito , Hipertireoidismo/epidemiologia , Doenças da Glândula Tireoide/congênito , Doenças da Glândula Tireoide/epidemiologia , Estudos de Coortes , Progressão da Doença , Feminino , Predisposição Genética para Doença , Doença de Graves/diagnóstico , Doença de Graves/epidemiologia , Doença de Graves/genética , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/genética , Lactente , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/genética , Doenças do Recém-Nascido/patologia , Masculino , Herança Materna , Triagem Neonatal , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/genética , Complicações na Gravidez/patologia , Prevalência , Prognóstico , Fatores de Risco , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/genética , Testes de Função Tireóidea
3.
BMC Pregnancy Childbirth ; 21(1): 99, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33516193

RESUMO

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


Assuntos
Corioamnionite/patologia , Vilosidades Coriônicas/patologia , Doenças Placentárias/patologia , Placenta/patologia , Complicações na Gravidez/patologia , Resultado da Gravidez , Adulto , Índice de Apgar , Estudos de Casos e Controles , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Gravidez , Adulto Jovem
4.
Arch Pathol Lab Med ; 145(1): 82-89, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33367657

RESUMO

CONTEXT.­: Women with diabetes have increased stillbirth risk. Although the underlying pathophysiological processes are poorly understood, stillbirth is frequently related to abnormal placental structure and function. OBJECTIVE.­: To investigate placental morphology and cellular characteristics in the placentas of women with diabetes who had stillbirths and stillbirths of unexplained cause. DESIGN.­: Placentas from women with uncomplicated live births, live births in women with diabetes, unexplained stillbirths, and stillbirths related to diabetes (n = 10/group) underwent clinical histopathologic assessment and were also investigated using immunohistochemical staining to quantify syncytial nuclear aggregates, proliferation, trophoblast area, vascularization, T cells, placental macrophages (Hofbauer cells), and the receptor for advanced glycation end products. RESULTS.­: Ki67+ cells were decreased in unexplained stillbirths compared with live births in women with diabetes. Both stillbirth groups had increased cytokeratin 7+/nuclear area compared with controls. Blood vessels/villi were decreased in unexplained stillbirth compared with live births from women with diabetes. Compared with uncomplicated controls, CD163+ macrophages were increased in live births in women with diabetes and unexplained stillbirths, and further increased in stillbirths related to diabetes. There was no change in CD3+ T cells or syncytial nuclear aggregates. Receptor for advanced glycation end products-positive cells were decreased in both stillbirth groups compared with diabetes-related live births. Co-localization of receptor for advanced glycation end products in macrophages was increased in both stillbirth groups compared with live birth groups. CONCLUSIONS.­: Stillbirths related to diabetes exhibit placental phenotypic differences compared with live births. Further investigation of these parameters may provide understanding of the pathologic mechanisms of stillbirth and aid the development of stillbirth prevention strategies.


Assuntos
Diabetes Mellitus , Placenta/patologia , Complicações na Gravidez/patologia , Natimorto , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Gravidez
5.
BMJ Case Rep ; 13(12)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33372016

RESUMO

Neurological manifestations of hypothyroidism include peripheral neuropathy and pituitary hyperplasia. However, these associations are rarely encountered during pregnancy. We report a case of a known hypothyroid with very high thyroid stimulating hormone (TSH) values (512 µIU/mL) in the second trimester. At 24 weeks she developed facial palsy and pituitary hyperplasia which responded to a combination of steroids and thyroxine. She had caesarean delivery at 35 weeks and 3 days gestation in view of pre-eclampsia with severe features and was discharged on oral antihypertensives and thyroxine. On follow-up at 5 months, TSH normalised and pituitary hyperplasia showed a greater than 50% reduction in size. To our knowledge, this is the first reported case of facial palsy and pituitary hyperplasia associated with hypothyroidism during pregnancy.


Assuntos
Paralisia Facial/etiologia , Hipotireoidismo/complicações , Hipotireoidismo/patologia , Hipófise/patologia , Complicações na Gravidez/patologia , Corticosteroides/uso terapêutico , Adulto , Anti-Hipertensivos/uso terapêutico , Cesárea , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Terapia de Reposição Hormonal , Humanos , Hiperplasia/diagnóstico por imagem , Hiperplasia/etiologia , Imagem por Ressonância Magnética , Hipófise/diagnóstico por imagem , Pré-Eclâmpsia/tratamento farmacológico , Pré-Eclâmpsia/cirurgia , Gravidez , Segundo Trimestre da Gravidez , Tireotropina/sangue , Tiroxina/administração & dosagem
6.
PLoS One ; 15(8): e0237738, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817701

RESUMO

This study assessed within-trial cost-effectiveness of a shared care program (SC, n = 339) for pregnancy outcomes compared to usual care (UC, n = 361), as implemented in a randomized trial of Chinese women with gestational diabetes (GDM). SC consisted of an individualized dietary advice and physical activity counseling program. The UC was a one-time group education program. The effectiveness was measured by number needed to treat (NNT) to prevent one macrosomia/large for gestational age (LGA) infant. The cost-effectiveness was measured by incremental cost-effectiveness ratio in terms of cost (2012 Chinese Yuan/US dollar) per case of macrosomia and LGA prevented. The study took both a health care system and a societal perspective. This study found that the NNT was 16/14 for macrosomia/LGA. The incremental cost for treating a pregnant woman was ¥1,877 ($298) from a health care system perspective and ¥2,056 ($327) from a societal perspective. The cost of preventing a case of macrosomia/LGA from the two corresponding perspectives were ¥30,032/¥26,278 ($4,775/$4,178) and ¥32,896/¥28,784 ($5,230/$4,577), respectively. Considering the potential severe adverse health and economic consequences of a macrosomia/LGA infant, our findings suggest that implementing this lifestyle intervention for women with GDM is an efficient use of health care resources.


Assuntos
Análise Custo-Benefício , Diabetes Gestacional/economia , Glucose/metabolismo , Complicações na Gravidez/economia , Adulto , Peso ao Nascer/fisiologia , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/patologia , Exercício Físico/fisiologia , Feminino , Macrossomia Fetal , Educação em Saúde/normas , Estilo de Vida Saudável , Humanos , Recém-Nascido , Criança Pós-Termo , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/patologia , Resultado da Gravidez/epidemiologia
7.
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
8.
Lancet Diabetes Endocrinol ; 8(7): 572-581, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32559473

RESUMO

BACKGROUND: Maternal overweight and obesity might increase risks of adiposity and cardiovascular and metabolic diseases in offspring. We examined associations between maternal overweight and obesity severity and risk of cardiovascular diseases in young offspring. METHODS: In this population-based cohort study, we used data from live singleton births recorded in the Swedish Medical Birth Register. We calculated maternal BMI in early pregnancy from self-reported height and weight measurements at the first prenatal visit. We used multivariable Cox proportional hazards regression to estimate adjusted hazard ratios (HRs) and 95% CIs. We calculated the proportion of the associations mediated through known consequences of obesity that also predicted cardiovascular diseases and did family case-control analyses. FINDINGS: We identified 2 230 115 live singleton infants (without congenital malformations) in Sweden registered between Jan 1, 1992, and Dec 31, 2016. Overall, 1741 (0·08%) offspring were diagnosed with a cardiovascular disease between ages 1 and 25 years. Cardiovascular disease rates by maternal BMI categories were 0·57 per 10 000 child-years (BMI 18·5-24·9 kg/m2; normal weight), 0·61 per 10 000 child-years (25·0-29·9 kg/m2; overweight), 0·67 per 10 000 child-years (30·0-34·9 kg/m2; obesity grade I), 1·02 per 10 000 child-years (35·0-39·9 kg/m2; obesity grade II), and 1·38 per 10 000 child-years (≥40·0 kg/m2; obesity grade III). Compared with offspring of mothers with normal BMI, HRs of cardiovascular diseases were 1·10 (95% CI 0·97-1·25) for overweight, 1·16 (0·95-1·43) for obesity grade I, 1·84 (1·36-2·49) for obesity grade II, and 2·51 (1·60-3·92) for obesity grade III. Risks of cerebrovascular diseases increased with maternal obesity severity and were partly mediated through asphyxia-related neonatal complications. The sibling-cohort analysis also indicated a positive trend between maternal BMI and cardiovascular disease rates. INTERPRETATIONS: Our findings indicate that maternal obesity might be a risk factor for cardiovascular diseases in childhood and early adulthood. These results need to be replicated and possible underlying mechanisms identified. FUNDING: Swedish Research Council for Health, Working Life and Welfare.


Assuntos
Doenças Cardiovasculares/etiologia , Obesidade Materna/complicações , Sobrepeso/complicações , Complicações na Gravidez/etiologia , Irmãos , Adolescente , Adulto , Biomarcadores/análise , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/patologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/patologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Suécia/epidemiologia , Adulto Jovem
9.
BMC Womens Health ; 20(1): 114, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32487112

RESUMO

BACKGROUND: The presence of chronic deciduitis (CD) was determined in patients diagnosed with or without chronic endometritis (CE) before pregnancy. OBJECTIVE: To study the effect of CE on decidua in cases of miscarriage. METHODS: Decidual tissue was obtained from the patients who miscarried at the first pregnancy within a year after the diagnosis of the presence or absence of CE. The number and distribution pattern of plasma cells stained with CD138 in decidual tissue in 10 high-power fields (HPFs) was examined. The prevalence of CD diagnosed with four different grade; grade 0, no plasma cell in 10 HPFs, thus Non-CD;grade 1, rare single plasma cells; grade 2, rare clusters or more than 5 single cells total; and grade 3, many plasma cells with more than 5 clusters, were examined and compared between Non-CE and CE. RESULTS: The incidence rate of CD of grade2 + 3 was significantly higher in CE than Non-CE (53.8%; 7/13 vs. 0%; 0/13, P < 0.01). Presence of clusters or a number of plasma cells in 10 HPFs of decidua showed a sensitivity of 53.8%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 68.4% for the diagnosis of CE. CONCLUSION: Presence of clusters of plasma cells or five or more of plasma cells in decidua was found in more than half of CE, but not found in Non-CE. When CD with cluster or five or more of plasma cells is confirmed histologically in miscarriage decidual tissue, the presence of CE before the pregnancy should be suspected.


Assuntos
Aborto Habitual/epidemiologia , Decídua/patologia , Endometrite/complicações , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Aborto Habitual/etiologia , Aborto Habitual/patologia , Adulto , Doença Crônica , Endometrite/epidemiologia , Endometrite/patologia , Endométrio/patologia , Feminino , Humanos , Incidência , Masculino , Gravidez , Complicações na Gravidez/patologia , Taxa de Gravidez , Prevalência , Sensibilidade e Especificidade , Adulto Jovem
10.
Medicine (Baltimore) ; 99(22): e20280, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481396

RESUMO

INTRODUCTION: Subchorionic hematoma (SCH) is a rare type of intrauterine hematoma, usually with limited impact on fetuses and pregnant women. But massive hematoma causes significant space occupying effect, affects blood supply of the fetus and finally may lead to fetus demise. PATIENT CONCERNS: In this case report, we reported a 22-year-old pregnant woman presented to our hospital with complaint of irregular lower abdominal pain. DIAGNOSIS: Ultrasonography and magnetic resonance imaging confirmed an intrauterine mass with a compressed growth-restricted fetus. INTERVENTIONS: The patient underwent diseases induced labor after confirmation of fetus demise by ultrasonography. OUTCOMES: Histopathological examination of the mass revealed a SCH. CONCLUSION: Though small SCH can be found in quite a few pregnant women and is usually harmless, enormous hematoma can result in adverse pregnancy outcomes. It may be difficult, in some cases, to differentiate it from uterine tumors or placental tumors by means of ultrasonography and magnetic resonance imaging, especially when the mass is hyperechoic under ultrasonography. This case report stresses the importance of regular examinations of pregnant women.


Assuntos
Retardo do Crescimento Fetal/patologia , Hematoma/patologia , Complicações na Gravidez/patologia , Doenças Uterinas/patologia , Feminino , Hematoma/diagnóstico , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Ultrassonografia Pré-Natal , Doenças Uterinas/diagnóstico , Adulto Jovem
11.
Arch Gynecol Obstet ; 301(6): 1449-1454, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32377786

RESUMO

PURPOSE: Disease flare throughout gestation are not uncommon among women with inflammatory bowel diseases (IBD), and can substantially affect pregnancy outcomes. We aimed to evaluate the effect of prior pregnancy outcome on the risk of disease flare at subsequent pregnancy in women with IBD. METHODS: Women with IBD attending a multidisciplinary clinic for the preconception, antenatal and postnatal treatment were prospectively recruited during 2011-2018. RESULTS: Overall, 476 IBD women were followed during the study period. Of them, 69 (14.5%) had two pregnancies throughout follow-up period and constituted the study cohort. Among these 69 women, 48 (69.6%) had Crohn's disease and 21 (30.4%) ulcerative colitis. The median interpregnancy interval was 20 [11-32] months. Overall, 34 (49.3%) women experienced disease flare at the subsequent pregnancy. In multivariate analysis, active disease at conception (odds ratio [95% CI]: 25.65 (3.05, 25.52), P < 0.001) and history of disease flare at the previous pregnancy (odds ratio [95% CI]: 4.21 (1.10, 16.58), P < 0.001) were the only independent predictors of disease relapse in current gestation. Rates of hospitalization during pregnancy (14.7% vs. 0, P = 0.02) and preterm delivery (32.4% vs. 5.7%, P = 0.006) were higher, and neonatal birth weight was lower (median 3039 vs. 3300 g, P = 0.03), in those with disease flare as compared to those with maintained remission. CONCLUSION: History of disease relapse at previous gestation and periconception disease activity were found as important predictors of disease flare among IBD women. These data would facilitate adequate counseling and informed management decisions among reproductive-aged IBD women and their treating physicians.


Assuntos
Doenças Inflamatórias Intestinais/complicações , Complicações na Gravidez/etiologia , Adulto , Feminino , Humanos , Gravidez , Complicações na Gravidez/patologia , Resultado da Gravidez , Estudos Prospectivos , Recidiva , Exacerbação dos Sintomas
12.
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
14.
Artigo em Inglês | MEDLINE | ID: mdl-32312689

RESUMO

Elevated liver enzyme levels can sometimes be encountered in asymptomatic pregnant women. Similar to non-pregnant subjects, women with elevated gamma glutamyltransferase or alanine aminotransferase in early pregnancy have increased risk of subsequent complications, especially gestational diabetes mellitus. In non-pregnant subjects, the commonest cause of abnormal liver function currently is non-alcoholic fatty liver disease. Risk factors include obesity, diabetes, and the metabolic syndrome. It can progress to hepatocellular carcinoma through the development of steatohepatitis, and has become the leading cause for liver transplantation in women. Found in as many as 16-18% of pregnant women, it is associated with an increased risk of pregnancy complications and abnormal foetal growth, which predisposes the offspring to the same problem subsequently. This condition probably explains the majority of the cases of "idiopathic" abnormal liver function in pregnancy, and should be looked out for in high-risk women owing to its implications on their long-term health outcome.


Assuntos
Alanina Transaminase/sangue , Diabetes Gestacional/epidemiologia , Hepatopatia Gordurosa não Alcoólica/complicações , Complicações na Gravidez/epidemiologia , Diabetes Gestacional/etiologia , Feminino , Humanos , Testes de Função Hepática , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/patologia , Gravidez , Complicações na Gravidez/patologia , Resultado da Gravidez/epidemiologia , Fatores de Risco
15.
Anticancer Res ; 40(4): 1997-2001, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234889

RESUMO

BACKGROUND/AIM: The liver of pregnant women undergoes physiological and pathological changes and the changes in liver enzyme activity and release reflect changes in serum enzymatic activity. We aimed to assess the activity of alcohol dehydrogenase (ADH) isoenzymes, and aldehyde dehydrogenase (ALDH) in the sera of women with intrahepatic cholestasis of pregnancy (ICP), the most common pregnancy-related liver disease. PATIENTS AND METHODS: Serum samples were taken from 40 women with ICP in the second or third trimester of pregnancy. Serum samples were also obtained from 40 healthy pregnant women at the same time of pregnancy and 40 healthy non-pregnant women. Class I and II of ADH and ALDH activity was measured by a spectrofluorometric method. Class III, IV ADH and total ADH activity was measured by photometric methods. RESULTS: The total ADH activity was significantly higher in women with ICP than in healthy pregnant and non-pregnant women (about 42%). The median total activity of ADH was 1067 mU/l in women with ICP, 628 mU/l in healthy pregnant and 605 mU/l in non-pregnant women. A statistically significant increase in class I ADH isoenzymes was found in the sera of pregnant women with ICP. The median activity of this class in the ICP group increased about 62% and 80% in comparison to the healthy pregnant women and non-pregnant women, respectively. CONCLUSION: The activity of class I ADH isoenzymes in the sera of women with ICP is statistically significantly increased and may have a diagnostic significance.


Assuntos
Álcool Desidrogenase/sangue , Aldeído Desidrogenase/sangue , Colestase Intra-Hepática/sangue , Fígado/enzimologia , Complicações na Gravidez/sangue , Adulto , Estudos de Casos e Controles , Colestase Intra-Hepática/enzimologia , Colestase Intra-Hepática/patologia , Feminino , Humanos , Isoenzimas/sangue , Fígado/patologia , Oxirredução , Gravidez , Complicações na Gravidez/enzimologia , Complicações na Gravidez/patologia , Espectrometria de Fluorescência
16.
Clin Dermatol ; 38(1): 105-112, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32197740

RESUMO

Any infectious illness presenting with an eruption in a pregnant patient may be associated with an increased risk of fetal loss. The viruses that can infect the placenta during maternal infection and can be transmitted to the fetus and cause congenital disease include the rubella virus, the measles virus, the varicella zoster virus, parvovirus B19, human cytomegalovirus, arboviruses, and hepatitis E virus type 1. In addition, some bacteria responsible for exanthematous diseases, like Treponema pallidum, can be transmitted during pregnancy from the mother to the fetus and cause fetal loss. All these infectious agents can cause typical and/or atypical exanthems whose etiologic diagnosis is sometimes difficult but important to determine, especially in pregnant women because of the potential risk to the fetus. In the last 20 years, we have extensively studied pityriasis rosea from the clinical and laboratory perspectives, demonstrating the pathogenic role of human herpesvirus (HHV)-6 and -7. We synthesize the available evidence that PR may be associated with active HHV-6/7 infection and therefore with complications during pregnancy and fetal loss. We have also summarized the emerging infectious illnesses of dermatologic interest that may represent life-threatening health conditions for the fetus: measles, rubella, arbovirus infection, and syphilis.


Assuntos
Infecções Bacterianas/complicações , Transmissão Vertical de Doença Infecciosa , Pitiríase Rósea/etiologia , Pitiríase Rósea/patologia , Complicações Infecciosas na Gravidez/etiologia , Complicações na Gravidez/etiologia , Complicações na Gravidez/patologia , Pele/patologia , Viroses/complicações , Feminino , Herpesvirus Humano 6 , Humanos , Gravidez , Infecções por Roseolovirus/complicações
17.
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
18.
PLoS One ; 15(2): e0228664, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32027702

RESUMO

BACKGROUND: Spontaneous abortions, intrauterine growth restriction, and preeclampsia are thought to be caused by defective placentation and are associated with increased risk of adverse outcomes in subsequent pregnancies. However, it is not known whether the recurrence of adverse outcomes is associated with the recurrence of placental pathology. We hypothesized that recurrent maternal vascular malperfusion (MVM) underlies the recurrence of adverse outcomes. METHODS: Using data from the National Collaborative Perinatal Project, we assessed the recurrence of pregnancy complications and MVM lesions (N = 3865), associations between a history of spontaneous abortions and MVM lesions or adverse outcomes in subsequent pregnancies (N = 8312), and whether the recurrence of pregnancy complications occurred independently of the presence of MVM lesions. RESULTS: The odds of an MVM lesion were higher for a woman who had had an MVM lesion in a previous pregnancy (aOR = 1.6; 95% CI 1.3-1.9), although this was marginally non-significant after adjusting for covariates such as gestational age, race and BMI. The odds of preeclampsia, a small-for-gestational-age infant, premature delivery and early pregnancy loss were 2.7-5.0 times higher if there had been that same adverse outcome in a previous pregnancy. A history of spontaneous abortions was associated with higher risk of a small-for-gestational-age baby (aOR = 2.4; 95% CI 1.7-3.4) and prematurity (aOR = 5.1; 95% CI 2.3-11.5 for extremely preterm), but not preeclampsia. The recurrence of adverse outcomes was significant when restricting analyses to women without MVM lesions. Similarly, associations between adverse outcomes and previous spontaneous abortions were significant when statistically controlling for the presence of MVM lesions, or excluding pregnancies with MVM lesions. CONCLUSIONS: Women with adverse outcomes in one pregnancy are at higher risk of complications in subsequent pregnancies. However, there is significant recurrence of adverse outcomes even in the absence of MVM.


Assuntos
Placentação/fisiologia , Resultado da Gravidez , Adulto , Feminino , Humanos , Placenta/patologia , Circulação Placentária , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/patologia , Recidiva , Estudos Retrospectivos
19.
Ann Epidemiol ; 41: 21-27, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31928895

RESUMO

PURPOSE: Maternal body mass index (BMI) is inversely associated with gastroschisis, but a causal relationship has not been established. As data demonstrating that a change in exposure status is related to a change in the frequency of the outcome can add to the evidence for causality, we conducted a case-control study of change in maternal BMI, assessed using interpregnancy change in BMI (IPC-BMI), and gastroschisis. METHODS: Data for 258 gastroschisis cases and 2561 controls were obtained from the Texas Birth Defects Registry and vital records (2006-2012). Logistic regression was used to estimate the adjusted association between IPC-BMI and gastroschisis. RESULTS: The continuous IPC-BMI variable was inversely associated with gastroschisis (adjusted odds ratio [aOR] = 0.90, 95% confidence interval [CI]: 0.86, 0.95). When assessed as a six-level categorical variable, with weight stable women as the referent, the odds of gastroschisis were higher following a BMI decrease of greater than 1 unit (aOR = 1.37, 95% CI: 0.91, 2.06) and lower after a BMI increase of ≥3 units (aOR = 0.62, 95% CI: 0.42, 0.94). CONCLUSIONS: Our findings suggest that maternal change in BMI is associated with gastroschisis and, thus, add to the epidemiological evidence that can be used to inform our understanding of the relationship between BMI and gastroschisis.


Assuntos
Índice de Massa Corporal , Gastrosquise/epidemiologia , Obesidade/epidemiologia , Complicações na Gravidez/epidemiologia , Ganho de Peso/fisiologia , Perda de Peso/fisiologia , Adulto , Estudos de Casos e Controles , Feminino , Gastrosquise/patologia , Humanos , Obesidade/complicações , Gravidez , Complicações na Gravidez/patologia , Fatores de Risco , Texas/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
20.
Sci China Life Sci ; 63(6): 898-904, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31701403

RESUMO

We conducted a retrospective cohort study of 9,552 women experiencing their second delivery between 2014 and 2016 at the International Peace Maternity and Child Health Hospital to investigate the association between the interpregnancy interval (IPI) and adverse perinatal outcomes. With the 12-23-mon IPI as the reference category, logistic regression analyzes were used to examine associations between different IPIs (<12, 12-23, 24-59, 60-119, and ≥120 mon) and perinatal outcomes (gestational diabetes mellitus, premature membrane rupture, gestational hypertension, preterm birth, low birth weight, and macrosomia). Compared with the 12-23-mon IPI category, women with longer IPIs had a higher risk of adverse perinatal outcomes, and those with an IPI ≥120 mon had the highest risk of gestational diabetes mellitus and premature membrane rupture (adjusted odds ratio (OR) 1.76, 95% confidence interval (CI) 1.32-2.35 and adjusted OR 2.03, 95% CI 1.53-2.67, respectively). These results indicate that a longer IPI is associated with a higher risk of adverse perinatal outcomes and an IPI of ≥120 mon appears to be independently associated with a higher risk of gestational diabetes mellitus and premature membrane rupture.


Assuntos
Intervalo entre Nascimentos , Resultado da Gravidez , Adulto , Diabetes Gestacional/patologia , Feminino , Idade Gestacional , Ganho de Peso na Gestação , Humanos , Hipertensão Induzida pela Gravidez/patologia , Recém-Nascido de Baixo Peso , Recém-Nascido , Idade Materna , Razão de Chances , Gravidez , Complicações na Gravidez/patologia , Nascimento Prematuro/patologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
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