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1.
BJOG ; 127(3): 355-362, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31505103

RESUMO

OBJECTIVE: To define the predictive value (PV) of known prognostic factors of fetal infection with Cytomegalovirus following maternal primary infection <14 weeks of gestation, at different time points of pregnancy: the end of the second trimester; following prenatal magnetic resonance imaging (MRI) at 32 weeks of gestation; and using all ultrasound scans performed in the third trimester (US3rdT). DESIGN: A retrospective study. SETTING: Reference fetal medicine unit. POPULATION: Sixty-two fetuses infected <14 weeks of gestation. METHODS: We defined second-trimester assessment (STA) as the combination of ultrasound findings <28 weeks of gestation and fetal platelet count at cordocentesis. Three groups were defined: normal, extracerebral, and cerebral STA. MAIN OUTCOME MEASURES: For each group, the PV of STA alone, STA + MRI, and STA + US3rdT were assessed retrospectively. Outcome at birth and at follow-up were reported. RESULTS: The STA was normal, and with extracerebral and cerebral features, in 43.5, 42.0, and 14.5%, respectively. The negative PV of normal STA and MRI for moderate to severe sequelae was 100%. The residual risk was unilateral hearing loss in 16.7% of cases. Of pregnancies with cerebral STA, 44% were terminated. Following extracerebral STA, 48% of neonates were symptomatic and 30% had moderate to severe sequelae. In those cases, the positive and negative PV of MRI for sequelae were 33 and 73%, respectively. STA + US3rdT had a lower negative PV than MRI for symptoms at birth and for moderate to severe sequelae. Any false-positive findings at MRI were mostly the result of hypersignals of white matter. CONCLUSIONS: Serial assessment in the second and third trimesters by ultrasound and MRI is necessary to predict the risk of sequelae occurring in 35% of pregnancies following fetal infection in the first trimester of pregnancy. TWEETABLE ABSTRACT: Serial ultrasound prognostic assessment following fetal CMV infection in the 1st trimester is improved by MRI at 32 weeks.


Assuntos
Encéfalo/diagnóstico por imagem , Infecções por Citomegalovirus , Citomegalovirus/isolamento & purificação , Doenças Fetais , Imagem por Ressonância Magnética/métodos , Polimicrogiria , Complicações Infecciosas na Gravidez , Ultrassonografia Pré-Natal/métodos , Aborto Eugênico/estatística & dados numéricos , Adulto , Autopsia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Feminino , Doenças Fetais/etiologia , Doenças Fetais/patologia , França , Humanos , Lactente , Recém-Nascido , Masculino , Polimicrogiria/etiologia , Polimicrogiria/patologia , Valor Preditivo dos Testes , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Trimestres da Gravidez , Prognóstico
2.
Int J Pediatr Otorhinolaryngol ; 127: 109642, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479918

RESUMO

OBJECTIVE: Currently no established criteria exist to guide use of ex utero intrapartum treatment (EXIT) for fetal neck mass management. This study aims to correlate prenatal radiographic findings with incidence of ex utero intrapartum treatment and necessity of airway intervention at delivery. METHODS: We reviewed our EXIT experience between 2012 and 17. Furthermore, we performed a literature review of articles reporting incidences of fetal neck masses considered for EXIT. Articles that were included (1) discussed prenatal radiographic findings such as size, features, and evidence of compression and (2) reported extractable data on delivery outcomes and airway status. RESULTS: Ten cases at our institution were reviewed. Another 137 cases across 81 studies met inclusion criteria. These studies showed aerodigestive tract compression to be significantly associated with neck masses undergoing EXIT. Additionally, there was significantly higher incidence of airway intervention in cases where polyhydramnios, anatomic compression, and solid masses were seen on prenatal diagnostic imaging, while mass location and size did not correlate with airway intervention. CONCLUSION: With this data, we propose that any neck mass with anatomic compression on fetal imaging in the 3rd trimester should be considered for EXIT. When radiographic findings do not show compression but do display polyhydramnios or a solid neck mass (regardless of polyhydramnios), an airway surgeon should be available for perinatal airway assistance.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Doenças Fetais/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Feminino , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/etiologia , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Período Periparto , Gravidez , Centros de Atenção Terciária , Ultrassonografia Pré-Natal
3.
J Nippon Med Sch ; 86(4): 192-200, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484880

RESUMO

Twin to twin transfusion syndrome (TTTS) is a major complication of monochorionic diamniotic (MD) twins, and its onset is known to be associated with placental vascular anastomoses and blood flow imbalance. In a typical case of TTTS, the recipient develops polyhydramnios, weight gain, cardiomegaly and hydrops fetalis in the uterus. In contrast, the donor develops oligohydramnios and intrauterine growth restriction. Recently, the significance of the renin-angiotensin-aldosterone system (RAAS) that transfers from the donor to the recipient has attracted interest in the fetal circulation of TTTS. The donor has decreased renal blood flow due to decreased circulating blood volume. For this reason, the secretion of RAAS hormones is augmented in the fetal kidneys of the donor. In TTTS, these RAAS hormones from the donor transfer to the recipient through the anastomosed vessels. In addition to excess preload, the recipient heart is exposed to excess afterload due to systemic vasoconstriction through RAAS hormones. Commonly occurring complications in the recipient include myocardial hypertrophy, atrioventricular valve regurgitation, and pulmonary valve stenosis or pulmonary atresia. Fetoscopic laser photocoagulation (FLP) has been introduced recently because neither mortality nor neurological morbidity have been satisfactorily improved with conventional treatment. FLP is a curative method that may improve the prognosis of TTTS. In Japan, this procedure has been performed frequently, and positive neurological outcomes have been achieved.


Assuntos
Transfusão Feto-Fetal , Feto/irrigação sanguínea , Volume Sanguíneo , Cardiomegalia/embriologia , Cardiomegalia/etiologia , Feminino , Doenças Fetais/etiologia , Doenças Fetais/fisiopatologia , Retardo do Crescimento Fetal/etiologia , Transfusão Feto-Fetal/diagnóstico por imagem , Transfusão Feto-Fetal/etiologia , Transfusão Feto-Fetal/patologia , Transfusão Feto-Fetal/terapia , Fetoscopia , Humanos , Terapia com Luz de Baixa Intensidade , Poli-Hidrâmnios/etiologia , Gravidez , Prognóstico , Estenose da Valva Pulmonar/embriologia , Estenose da Valva Pulmonar/etiologia , Circulação Renal , Sistema Renina-Angiotensina/fisiologia
4.
Medicine (Baltimore) ; 98(28): e16282, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305411

RESUMO

RATIONALE: Pain management is an essential part of good obstetrical care. The rapid onset of pain relief after combined spinal-epidural (CSE) analgesia may cause a transient imbalance in maternal catecholamine level, leading to uterine hyperactivity and fetal heart rate (FHR) abnormalities. How to manage the uterine basal tone and FHR abnormalities after labor analgesia still remains controversial. PATIENT CONCERNS: A 33-year-old nulliparous woman at 40 weeks' gestation underwent induction of labor after premature rupture of membranes. CSE analgesia was provided when the patient described her pain as the top on a scale of 10 during induction of labor with oxytocin infusion. DIAGNOSES: Uterine hypertonus and fetal bradycardia were diagnosed within 10 minutes after CSE analgesia. INTERVENTIONS: Oxytocin infusion and CSE analgesia were immediately suspended, and measures of staying in left lateral decubitus position and giving supplemental oxygen were attempted to resuscitating the baby. Because of suspicious fetal distress, the baby was rapidly delivered by emergency cesarean section. OUTCOMES: The Apgar score of the baby was 8 and 10 at 1 and 5 minutes after birth. Subsequent follow-up confirmed that both mother and baby were in good condition. LESSONS: The loss of the tocolytic effect of epinephrine after CSE analgesia and continuous oxytocin infusion may work together to form a totally synergistic function, finally leading to inevitable uterine hypertonus and fetal bradycardia. Both the obstetrical provider and anesthesiologist should carefully monitor all patients in the first 15 minutes after CES analgesia induction. Oxytocin administration in this critical period deserves attention. Additionally, intraprofessional collaboration is also necessary to ensure high quality and safe delivery for all childbearing women.


Assuntos
Analgesia Obstétrica , Bradicardia/etiologia , Doenças Fetais/etiologia , Trabalho de Parto Induzido , Hipertonia Muscular/etiologia , Doenças Uterinas/etiologia , Adulto , Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Feminino , Humanos , Recém-Nascido , Ocitócicos , Ocitocina
5.
Curr Opin Anaesthesiol ; 32(3): 291-297, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31045636

RESUMO

PURPOSE OF REVIEW: The aim of this study was to review the current literature on anesthesia for predelivery procedures and to summarize recent findings on anesthesiological methods used. RECENT FINDINGS: Ex-utero intrapartum treatment (EXIT)-procedures are performed to secure the newborn's oxygenation in case of severe airway obstruction due to multiple conditions. A key feature of EXIT is continued intactness of the maternofetal circulation by uterine relaxation achieved by general anesthesia with high doses of anesthetic gases. A dose reduction may be achieved by combining inhaled anesthesia with propofol. After intrauterine transfusion the anesthesia team needs to be prepared for a potential need of emergency cesarean section. Temporary fetal endoluminal tracheal occlusion and laser coagulation for twin-to-twin transfusion syndrome may be either performed in monitored anesthesia care or neuraxial anesthesia. Neuraxial anesthesia also is a method of choice for fetal valvuloplasty and amniotic band release. Fetal myelomenigocele repair requires general anesthesia with tocolysis. SUMMARY: Predelivery procedures require a differentiated anesthesia approach depending on the invasiveness of the intervention. Anesthesia ranges from monitored care to neuraxial anesthesia and general anesthesia. Depending on the procedure uterine relaxation and fetal immobilization are crucial for technical success. Interdisciplinary consultation optimizes the anesthesia plan for complex procedures.


Assuntos
Anestesia Geral/métodos , Anestésicos Inalatórios/administração & dosagem , Doenças Fetais/terapia , Terapias Fetais/métodos , Bloqueio Nervoso/métodos , Obstrução das Vias Respiratórias/complicações , Anestesia Geral/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Doenças Fetais/etiologia , Terapias Fetais/efeitos adversos , Humanos , Planejamento de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Circulação Placentária , Gravidez
6.
Kobe J Med Sci ; 64(4): E157-E159, 2019 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-30728342

RESUMO

Fetal intestinal volvulus is a rare condition, and fetal diagnosis of this disease is still challenging, especially in primary cases not accompanied by other comorbidities, such as intestinal malformations. Herein, we report a case of fetal primary small bowel volvulus associated with acute gastric dilatation detected by ultrasonography. We speculate that the mechanism of acute gastric dilatation in our case was peristatic malfunction of the whole intestine caused by a strangulated ileus resulting from fetal intestinal volvulus. In conclusion, acute gastric dilatation detected by fetal ultrasound can indicate the fetal intestinal volvulus.


Assuntos
Doenças Fetais/etiologia , Dilatação Gástrica/complicações , Volvo Intestinal/etiologia , Ultrassonografia Pré-Natal , Doença Aguda , Adulto , Feminino , Doenças Fetais/diagnóstico por imagem , Humanos , Volvo Intestinal/diagnóstico por imagem , Masculino , Gravidez
7.
Artigo em Inglês | MEDLINE | ID: mdl-30718211

RESUMO

Fetal anemia has been known for many years as a dangerous complication of pregnancy. Its most common causes are maternal alloimmunization and parvovirus B19 infection, although it can be associated with many different pathological conditions including fetal aneuploidies, vascular tumors, and arteriovenous malformations of the fetus or placenta and inherited conditions such as alpha-thalassemia or genetic metabolic disorders. Doppler ultrasonographic assessment of the peak velocity of systolic blood flow in the middle cerebral artery for the diagnosis of fetal anemia and intravascular intrauterine transfusion for its treatment are the current practice standards. Live birth rates as high as 95% have been reported in recent years. The additional role of intravenous immunoglobulin therapy and the long-term consequences of the condition are the subjects of active ongoing research.


Assuntos
Anemia/terapia , Transfusão de Sangue Intrauterina/métodos , Doenças Fetais/terapia , Imunoglobulinas Intravenosas/uso terapêutico , Anemia/diagnóstico , Anemia/etiologia , Transfusão de Sangue Intrauterina/efeitos adversos , Feminino , Sangue Fetal/diagnóstico por imagem , Sangue Fetal/metabolismo , Doenças Fetais/diagnóstico , Doenças Fetais/etiologia , Humanos , Gravidez , Ultrassonografia Doppler , Ultrassonografia Pré-Natal
8.
Nat Commun ; 10(1): 282, 2019 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-30655546

RESUMO

Failure of neural tube closure results in severe birth defects and can be induced by high glucose levels resulting from maternal diabetes. MARCKS is required for neural tube closure, but the regulation and of its biological activity and function have remained elusive. Here, we show that high maternal glucose induced MARCKS acetylation at lysine 165 by the acetyltransferase Tip60, which is a prerequisite for its phosphorylation, whereas Sirtuin 2 (SIRT2) deacetylated MARCKS. Phosphorylated MARCKS dissociates from organelles, leading to mitochondrial abnormalities and endoplasmic reticulum stress. Phosphorylation dead MARCKS (PD-MARCKS) reversed maternal diabetes-induced cellular organelle stress, apoptosis and delayed neurogenesis in the neuroepithelium and ameliorated neural tube defects. Restoring SIRT2 expression in the developing neuroepithelium exerted identical effects as those of PD-MARCKS. Our studies reveal a new regulatory mechanism for MARCKS acetylation and phosphorylation that disrupts neurulation under diabetic conditions by diminishing the cellular organelle protective effect of MARCKS.


Assuntos
Diabetes Mellitus Experimental/complicações , Doenças Fetais/patologia , Lisina Acetiltransferase 5/metabolismo , Substrato Quinase C Rico em Alanina Miristoilada/metabolismo , Defeitos do Tubo Neural/patologia , Sirtuína 2/metabolismo , Transativadores/metabolismo , Acetilação , Animais , Glicemia/metabolismo , Linhagem Celular , Diabetes Mellitus Experimental/sangue , Diabetes Mellitus Experimental/induzido quimicamente , Embrião de Mamíferos , Estresse do Retículo Endoplasmático , Feminino , Doenças Fetais/sangue , Doenças Fetais/etiologia , Humanos , Lisina Acetiltransferase 5/genética , Masculino , Camundongos Endogâmicos C57BL , Camundongos Knockout , Mitocôndrias/patologia , Substrato Quinase C Rico em Alanina Miristoilada/genética , Defeitos do Tubo Neural/etiologia , Neurulação , Fosforilação , Gravidez , Gravidez em Diabéticas/sangue , Sirtuína 2/genética , Estreptozocina/toxicidade , Transativadores/genética
9.
Gynecol Endocrinol ; 35(4): 280-286, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30614304

RESUMO

Pheochromocytoma during pregnancy is rare but potentially harmful to the mother and fetus. Fetal risks are mainly determined by the vasoconstrictive effects of maternal catecholamine on uteroplacental circulation, because the fetus is protected from the direct effects of high catecholamine levels at the placental interface. Uteroplacental insufficiency may lead to spontaneous abortion, fetal growth restriction, premature delivery, and fetal hypoxia, followed by fetal distress and/or birth asphyxia. Adrenalectomy is recommended during the second trimester. When a diagnosis is made during the late second or third trimester, appropriate medical treatment until term and planned delivery with concurrent or delayed adrenalectomy can result in good fetal outcomes. Moreover, when adrenalectomy is planned after delivery, there is concern regarding the potential of antihypertensive drugs to be transferred to breast milk. It is generally known that early detection and proper treatment of pheochromocytoma during pregnancy decrease maternal and fetal mortality. However, in recent case series, antenatal maternal pheochromocytoma diagnosis did not significantly decrease the risk of fetal and neonatal mortality and morbidity, contrary to the maternal death and complication rates. Although intrauterine ischemia and hypoxia due to uteroplacental insufficiency can affect the long-term outcomes of neonates, no systematic studies have been performed.


Assuntos
Neoplasias das Glândulas Suprarrenais/terapia , Doenças Fetais/etiologia , Feocromocitoma/terapia , Complicações Neoplásicas na Gravidez/terapia , Neoplasias das Glândulas Suprarrenais/complicações , Feminino , Humanos , Recém-Nascido , Feocromocitoma/complicações , Gravidez
11.
J Matern Fetal Neonatal Med ; 32(21): 3589-3594, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29681182

RESUMO

Objective: Metabolic disorders are a pandemic and increasing health problem. Women of childbearing age may also be affected, thus an abnormal metabolism may interfere with pregnancy short- and long-term outcomes, harming both mother and child. In the context of an abnormal maternal and intrauterine metabolic milieu the development of fetal organs, including pancreas, may be affected. Aim: To investigate the effects of pregnancy metabolic disorders on the morphology of pancreatic Langerhans islets in human late-third trimester stillborn fetuses. Methods: Samples from fetal pancreas underwent a quantitative histological evaluation to detect differences between pregnancy with (cases, n = 9) or without (controls, n = 6) abnormal metabolism. Results: Results show that the islets size increases in fetuses from dysmetabolic pregnancies and that this increment is related to both beta-cell hyperplasia and hypertrophy. Moreover, according to pregnancy and fetal metabolic disorders, a threshold of abnormal size of the islets has been identified. Above this threshold the size of fetal pancreatic Langerhans islets should be considered excessively increased. Conclusion: The study suggests that an accurate fetal pancreas analysis supplies an important tool in stillborn fetus, to discover metabolic disturbances that should be kept in mind and managed in future pregnancies.


Assuntos
Doenças Fetais/etiologia , Feto/patologia , Ilhotas Pancreáticas/patologia , Doenças Metabólicas/patologia , Pancreatopatias/etiologia , Complicações na Gravidez/patologia , Adulto , Estudos de Casos e Controles , Tamanho Celular , Diabetes Gestacional/patologia , Feminino , Doenças Fetais/patologia , Humanos , Hiperplasia/diagnóstico , Hiperplasia/patologia , Hipertrofia/diagnóstico , Hipertrofia/etiologia , Pancreatopatias/patologia , Gravidez
12.
J Obstet Gynaecol Res ; 45(2): 461-465, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30255653

RESUMO

Vitamin K deficiency in pregnant women causes intracranial hemorrhage (ICH) in fetuses. Fetal ICH frequently causes life-threatening and persistent neurological damage. However, indicators for preventing fetal ICH are not established. Two pregnant women developed long-term eating disorders caused by psychosis. They were administered intravenous fluid and vitamin supplementation, excluding vitamin K. The intracranial low-hypoechoic area on fetal ultrasound was suggestive of fetal ICH due to vitamin K deficiency. Their neonates showed severe developmental delay. Laboratory analysis revealed a normal prothrombin time, but elevated protein induced by vitamin K absence II. Pregnant women who have eating disorders more than 3 weeks could develop fetal ICH due to maternal subclinical vitamin K deficiency. Illness duration and protein induced by vitamin K absence II of pregnant woman may be indicators for vitamin K administration to prevent fetal intracranial hemorrhage.


Assuntos
Anemia Neonatal/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Doenças Fetais/etiologia , Hemorragias Intracranianas/etiologia , Efeitos Tardios da Exposição Pré-Natal/etiologia , Deficiência de Vitamina K/complicações , Adulto , Pré-Escolar , Feminino , Doenças Fetais/diagnóstico por imagem , Humanos , Recém-Nascido , Hemorragias Intracranianas/diagnóstico por imagem , Gravidez
13.
Ultrasound Obstet Gynecol ; 53(5): 655-662, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30084123

RESUMO

OBJECTIVE: To evaluate the effect of fetal growth restriction (FGR) at term on fetal and neonatal cardiac geometry and function. METHODS: This was a prospective study of 87 pregnant women delivering at term, comprising 54 normally grown and 33 FGR pregnancies. Fetal and neonatal conventional and spectral tissue Doppler and two-dimensional speckle tracking echocardiography were performed a few days before and within hours after birth. Fetal cardiac geometry, global myocardial deformation and performance and systolic and diastolic function were compared between normal and FGR pregnancies before and after birth. RESULTS: Compared with normally grown fetuses, FGR fetuses exhibited more globular ventricular geometry and poorer myocardial deformation and cardiac function (left ventricular (LV) sphericity index (SI), 0.54 vs 0.49; right ventricular (RV) SI, 0.60 vs 0.54; LV torsion, 1.2 °/cm vs 3.0 °/cm; LV isovolumetric contraction time normalized by cardiac cycle length, 121 ms vs 104 ms; interventricular septum early diastolic myocardial peak velocity/atrial contraction myocardial diastolic peak velocity ratio, 0.60 vs 0.71; P < 0.01 for all). The poorest perinatal outcomes occurred in FGR fetuses with the most impaired cardiac functional indices. When compared with normally grown neonates, FGR neonates showed persistent alteration in cardiac parameters (LV-SI, 0.53 vs 0.50; RV-SI, 0.54 vs 0.44; LV torsion, 1.1 °/cm vs 1.4 °/cm; LV myocardial performance index (MPI'), 0.52 vs 0.42; P < 0.01 for all). Paired comparison of fetal vs neonatal cardiac indices in FGR demonstrated that birth was associated with a significant improvement in some, but not all, cardiac indices (RV-SI, 0.60 vs 0.54; RV-MPI', 0.49 vs 0.39; P < 0.001 for all). CONCLUSIONS: Compared with normal pregnancies, FGR fetuses and neonates at term exhibit altered cardiac indices indicative of myocardial impairment that reflect adaptation to placental hypoxemia and alterations in hemodynamic load around the time of birth. Elucidating potential mechanisms that contribute to the alterations in perinatal cardiac adaptation in FGR could improve management and aid the development of better therapeutic strategies to reduce the risk of adverse pregnancy outcome. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Ecocardiografia Doppler/estatística & dados numéricos , Ecocardiografia/estatística & dados numéricos , Retardo do Crescimento Fetal/diagnóstico por imagem , Coração Fetal/diagnóstico por imagem , Ultrassonografia Pré-Natal/estatística & dados numéricos , Adulto , Ecocardiografia/métodos , Ecocardiografia Doppler/métodos , Feminino , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/etiologia , Doenças Fetais/patologia , Retardo do Crescimento Fetal/patologia , Retardo do Crescimento Fetal/fisiopatologia , Coração Fetal/patologia , Coração Fetal/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/embriologia , Ventrículos do Coração/patologia , Humanos , Hipóxia/complicações , Hipóxia/diagnóstico por imagem , Hipóxia/embriologia , Recém-Nascido , Estudos Longitudinais , Doenças Placentárias/diagnóstico por imagem , Doenças Placentárias/patologia , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Nascimento a Termo/fisiologia , Ultrassonografia Pré-Natal/métodos
14.
Minerva Ginecol ; 71(2): 97-112, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30318879

RESUMO

The diagnosis and management of fetal anemia has been at the forefront of advances in the fields of fetal physiology, immunology, fetal imaging, and fetal therapy among others. Alloimmunization and parvovirus infection are the leading cause of fetal anemia in the United States. The middle cerebral artery peak systolic velocity (MCA-PSV) diagnoses fetal anemia. Its discovery is considered one of the most important achievements in fetal medicine. Accumulation of experience in recent years as well as refinement of surgical techniques have led to safer invasive procedures. It is expected that long term follow-up of affected pregnancies, continues to reflect all these improvements in care. It is also expected that treatment of other less common causes of fetal anemia becomes more frequently reported and that the management principles of fetal anemia are successfully applied to other fetal pathologies.


Assuntos
Anemia/terapia , Doenças Fetais/terapia , Terapias Fetais/métodos , Anemia/diagnóstico , Anemia/etiologia , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/etiologia , Humanos , Artéria Cerebral Média/metabolismo , Gravidez , Cuidado Pré-Natal/métodos
15.
Obstet Gynecol ; 132(6): e228-e248, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30461693

RESUMO

Pregestational diabetes mellitus represents one of the most challenging medical complications of pregnancy because of the need for frequent monitoring and adjustment of medications as well as the potential for maternal and fetal complications. This document provides an overview of the current understanding of pregestational diabetes mellitus and suggests management guidelines during pregnancy. Because few well-designed studies have been performed, many of the guidelines are based on expert and consensus opinion. This document has been updated to reflect current data on pregestational diabetes. This Practice Bulletin is updated with summary information to counsel and manage women with pregestational diabetes before and during pregnancy, more recent literature reflecting experience with continuous subcutaneous insulin infusion during pregnancy, an expanded section on the role of oral hypoglycemic agents in pregnancy, and the option of long-acting reversible contraception during the postpartum period.


Assuntos
Glicemia/metabolismo , Doenças Fetais/diagnóstico , Hipoglicemiantes/uso terapêutico , Insulinas/uso terapêutico , Gravidez em Diabéticas/diagnóstico , Gravidez em Diabéticas/terapia , Parto Obstétrico , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Cetoacidose Diabética/etiologia , Nefropatias Diabéticas/etiologia , Retinopatia Diabética/etiologia , Dieta , Aconselhamento Diretivo , Exercício , Feminino , Doenças Fetais/etiologia , Humanos , Gravidez , Gravidez em Diabéticas/sangue
16.
Prenat Diagn ; 38(13): 983-993, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30238473

RESUMO

Partial amniotic carbon dioxide insufflation (PACI) involves insufflating the amniotic sac with carbon dioxide (CO2 ) and, in some cases, draining some of the amniotic fluid. The creation of a gaseous intra-amniotic compartment improves visualization, even in the presence of limited bleeding, and creates the work space required for complex fetoscopic procedures. Clinically, PACI is mostly used to perform fetoscopic myelomeningocele (MMC) repair, enabling a minimally invasive alternative to open fetal surgery. However, evidence of the fetal safety of PACI is limited. Previous animal experiments in sheep demonstrate that PACI induces fetal hypercapnia and acidosis with largely unknown short and longer term implications. In this review, we examine the literature for the physiological effects of intrauterine insufflation pressure, duration, humidity, and the role of maternal hyperventilation on fetal physiology and well-being.


Assuntos
Âmnio , Fetoscopia/métodos , Feto/cirurgia , Insuflação/métodos , Meningomielocele/cirurgia , Acidose/etiologia , Animais , Dióxido de Carbono/efeitos adversos , Feminino , Doenças Fetais/etiologia , Fetoscopia/efeitos adversos , Humanos , Umidade , Hipercapnia/etiologia , Insuflação/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Gravidez , Pressão , Respiração Artificial/métodos , Ovinos , Fatores de Tempo
17.
Prenat Diagn ; 38(12): 964-970, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30207389

RESUMO

OBJECTIVE: Because the literature on the predictive value of fetal urinalysis is controversial in fetuses with lower urinary tract obstruction, we determined the best model of fetal urine biochemical markers correlated with long-term postnatal renal function based on glomerular filtration rate (GFR). METHOD: This retrospective study concerned 89 fetuses with lower urinary tract obstruction and their renal function after 10 years of age. We correlated fetal urine biochemical markers (total protein, ß2-microglobulin, sodium, chloride, glucose, calcium, and phosphorus) with GFR at 10 to 30 years of age in 89 patients with posterior urethral valves. We defined five stages of chronic kidney disease (CKD). RESULTS: Of the 89 patients, 18 (20%) are 20 years old or over. Postnatal renal function was good in 67.4% (GFR > 60 mL/min/1.73 m2 ) and poor in 17% (GFR < 30 mL/min/1.73 m2 ). All fetal urine markers differed between CKD stage 1 + 2 and CKD stage 4 + 5 (P < 0.001). ß2-microblobulin showed an 87% sensitivity for a 72% specificity. A combination of ß2-microglobulin and chloride gave the best results (93% sensitivity and 71% specificity) versus amniotic fluid volume (80% sensitivity and 73% specificity). CONCLUSION: Fetal urine biochemistry predicts long-term (10-30 years) postnatal renal function.


Assuntos
Doenças Fetais/urina , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/urina , Obstrução Uretral/urina , Microglobulina beta-2/urina , Biomarcadores/urina , Criança , Cloretos/urina , Feminino , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/etiologia , Taxa de Filtração Glomerular , Humanos , Masculino , Oligo-Hidrâmnio/diagnóstico por imagem , Oligo-Hidrâmnio/etiologia , Valor Preditivo dos Testes , Gravidez , Prognóstico , Insuficiência Renal Crônica/congênito , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Obstrução Uretral/congênito , Obstrução Uretral/diagnóstico por imagem , Obstrução Uretral/etiologia , Urinálise
18.
Lancet Child Adolesc Health ; 2(9): 666-676, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30119760

RESUMO

Perinatal stroke encompasses a heterogeneous group of focal neurological injuries early in brain development that probably affects more than 5 million people worldwide. Many such injuries are symptomatic in the first days of life, including neonatal arterial ischaemic stroke, cerebral sinovenous thrombosis, and neonatal haemorrhagic stroke. The remaining focal neurological injuries usually present later in the first year with motor asymmetry, such as arterial presumed perinatal ischaemic stroke, periventricular venous infarction, and presumed perinatal haemorrhagic stroke. The numerous sequelae of these injuries include hemiparesis (cerebral palsy), epilepsy, and cognitive, language, and behavioural challenges. In this Review we summarise each perinatal stroke disease, examining the epidemiology, pathophysiology, acute management, and outcomes, including the effect on parents and families, and emerging therapies to mitigate these lifelong morbidities.


Assuntos
Traumatismo Cerebrovascular/complicações , Doenças Fetais/etiologia , Acidente Vascular Cerebral/etiologia , Isquemia Encefálica/complicações , Hemorragia Cerebral/complicações , Doenças Fetais/diagnóstico , Doenças Fetais/terapia , Humanos , Recém-Nascido , Trombose Intracraniana/complicações , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
19.
Obstet Gynecol ; 132(3): 763-772, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30095760

RESUMO

Infertility is a disease that affects up to 15.5% of reproductive-aged couples. Until the birth of the first neonate born from in vitro fertilization (IVF) in 1978, many infertile couples did not have an opportunity to conceive a biological child. Over the past 40 years, access to and effectiveness of IVF have increased; currently 1.7% of births in the United States result from IVF. As with any medical intervention, potential risk exists. In the case of IVF, both maternal risks (ovarian stimulation, oocyte retrieval, and subsequent pregnancy) and fetal risks that vary based on maternal age and fetal number must be considered. Importantly, risk quantification varies by comparison group, which is typically either spontaneous conception in a fertile couple or assisted non-IVF conception in an infertile couple. It must also be considered compared with the alternative of not undergoing IVF, which may mean not having a biological child. Although increased compared with spontaneous conception, absolute maternal-fetal-assisted reproductive technology risks are low and can be minimized by optimizing ovarian stimulation and transferring a single embryo. In this article, we aim to summarize maternal and fetal risk associated with use of assisted reproductive technology. The review focuses on ovarian stimulation and procedural risks as well as adverse perinatal outcomes among resultant singleton and twin pregnancies in young women and women of advanced maternal age.


Assuntos
Técnicas de Reprodução Assistida/efeitos adversos , Anormalidades Congênitas/etiologia , Feminino , Doenças Fetais/etiologia , Humanos , Infertilidade Feminina/complicações , Idade Materna , Gravidez , Gravidez Múltipla
20.
Eur J Obstet Gynecol Reprod Biol ; 228: 203-208, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30007247

RESUMO

BACKGROUND: Intrauterine conditions may be important in the development of cerebral palsy in the child. The hormone, human chorionic gonadotropin (hCG), is synthesized in the placenta, and hCG plays an important role in placental angiogenesis and development. Thus, maternal hCG concentrations may be an indicator of placental function and thereby the intrauterine environment for the offspring. We studied the associations of maternal concentrations of hCG during pregnancy with cerebral palsy in the child. METHODS: We performed a case-control study nested within a cohort of 29,948 pregnancies in Norway during 1992-1994. Cases were all women within the cohort who gave birth to a singleton child with cerebral palsy diagnosed before five years of age (n = 63). Controls were a random sample of women with a singleton child without cerebral palsy (n = 182). RESULTS: The adjusted odds ratio (OR) for cerebral palsyin the child was 0.78 (95% CI: 0.55-1.10) per log-transformed unit of maternal hCG in the 1 st trimester, and the OR was 1.42 (95% CI: 0.94-2.16) in the 2nd trimester. Thus, women who did not have high hCG concentrations in the 1 st trimester and low hCG concentrations in the 2nd trimester, had increased risk for giving birth to a child with cerebral palsy. Adjustments were made for pregnancy week of serum sampling, maternal age and parity. CONCLUSIONS: The abnormal hCG concentrations in pregnancies with cerebral palsy in the offspring, could suggest placental factors as causes of cerebral palsy.


Assuntos
Paralisia Cerebral/sangue , Gonadotropina Coriônica/sangue , Doenças Fetais/sangue , Adolescente , Adulto , Estudos de Casos e Controles , Paralisia Cerebral/etiologia , Feminino , Doenças Fetais/etiologia , Humanos , Placentação , Gravidez , Adulto Jovem
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