Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.292
Filtrar
1.
Artigo em Inglês | MEDLINE | ID: mdl-33802696

RESUMO

There is growing literature about the SARS-CoV-2 pathogenetic effects exerted during pregnancy and whether vertical transmission or premature birth is possible. It is not well known whether changes in the immune system of pregnant women may lead to a marked susceptibility to infectious processes and the risk of adverse maternal and neonatal complications such as preterm birth, spontaneous abortion, hospitalization in an intensive care unit, transmission to the fetus or newborns, and fetal mortality are poorly understood. Along with this ongoing debate, it is not well defined whether, during pregnancy, the role of host susceptibility in producing a specific inflammatory response to SARS-CoV-2 may represent distinctive markers of risk of vertical transmission. Furthermore, SARS-CoV-2 impact on the vaginal microbiome has not yet been described, despite mounting evidence on its possible effect on the gastrointestinal microbiome and its influence on infectious diseases and preterm labor. This report describes the impact of SARS-CoV-2 on a twin pregnancy diagnosed with infection at the third trimester of gestation including tissue infections, inflammatory response, antibody production, cytokine concentration, and vaginal microbiome composition. We identified a pattern of cytokines including IL1-Ra, IL-9 G-CSF, IL-12, and IL-8 differently expressed, already associated with previously infected patients. We detected a similar concentration of almost all the cytokines tested in both twins, suggesting that the SARS-CoV-2-induced cytokine storm is not substantially impaired during the placental passage. The analysis of the vaginal microbiome did not show relevant signs of dysbiosis, similar to other healthy pregnant women and twin healthy pregnancies. The aim of this report was to analyze the immunological response against SARS-CoV-2 infection and virus tissue tropism in a twin pregnancy.


Assuntos
Complicações Infecciosas na Gravidez , Nascimento Prematuro , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa , Gravidez , Resultado da Gravidez , Gravidez de Gêmeos
2.
Am J Case Rep ; 22: e929489, 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743006

RESUMO

BACKGROUND The damage caused by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has been extensive. Pregnant women are a group requiring special attention in medicine given the anatomical and physiological changes that occur during pregnancy. Skin rash is commonly associated with pregnancy, with the most common form of an erythematous maculopapular rash being pruritic urticarial papules and plaques of pregnancy. Skin rash is also an increasingly reported initial presentation in patients with coronavirus disease 2019 (COVID-19), due to infection with SARS-CoV-2. CASE REPORT A 34-year-old woman with a diamniotic dichorionic twin pregnancy presented with clinical picture characterized by dermatological manifestations, namely an erythematous and papular skin rash associated with SARS-CoV-2 infection. A real-time reverse transcription-polymerase chain reaction (GeneFinder) test was positive for SARS-CoV-2 detection. CONCLUSIONS Ten months after the onset of this pandemic, there is no conclusive evidence indicating that pregnant women represent a sector more or less vulnerable to severe forms of COVID-19 than the general population. This report has highlighted the importance of performing a reliable diagnostic test for SARS-CoV-2 infection in patients who present with a skin rash, particularly pregnant women.


Assuntos
/diagnóstico , Eritema/virologia , Exantema/virologia , Complicações Infecciosas na Gravidez/diagnóstico , Adulto , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/virologia , Gravidez de Gêmeos
3.
Medicine (Baltimore) ; 100(3): e24009, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545996

RESUMO

RATIONALE: Torsion is the most common gynecologic emergency of the adnexal mass occurring during pregnancy. We report the clinical data of a case of twin pregnancy with adnexal torsion after in vitro fertilization (IVF) and embryo transfer, in which the patient underwent surgery for adnexal detorsion and experienced preterm delivery. One child died as a neonate, and the other child was diagnosed with hematological disease, which, to our knowledge, has not been reported previously. We also performed a systematic literature review to increase knowledge of the need for prompt surgical intervention. PATIENT CONCERNS: The patient was a 32-year-old pregnant woman, who presented to our center with acute onset of stabbing and non-radiating continuous lower left abdominal pain after urination, of 6 hours duration. DIAGNOSIS: Physical examination revealed that the lower abdominal tenderness was worse on the left side, and there were no signs of peritonitis. Transvaginal ultrasonographic examination indicated a multiloculated left ovary measuring 12.1 × 7.1 cm with sparse blood flow. The size of the largest cyst was 7.2 × 6.6 cm, the right ovary appeared normal, and two live fetuses were seen. INTERVENTIONS: laparoscopy was performed 1.5 hours later, which revealed a cystic and multilocular left ovary with a black purplish surface and thin wall. The left ovary and left fallopian tube had undergone 720° torsion (3 rotations), and detorsion was performed laparoscopy. OUTCOMES: The left adnexa recovered to near normal appearance 20 minutes postoperatively. The patient was discharged from hospital 5 days postsurgery, without complications. Unfortunately, the patient delivered two preterm babies at 30 weeks of gestation. CONCLUSIONS: We should be alert to the possible risk of adnexal torsion in pregnant women after IVF. Adnexal torsion necessitates prompt surgical intervention, detorsion and preserving ovarian function are the main treatment methods. Furthermore, the possibility of recurrence, and pregnancy outcomes for the patient, as well as newborn health, should be considered.


Assuntos
Fertilização In Vitro/efeitos adversos , Complicações na Gravidez/cirurgia , Adulto , Feminino , Humanos , Gravidez , Complicações na Gravidez/etiologia , Gravidez de Gêmeos , Nascimento Prematuro/etiologia
4.
Medicine (Baltimore) ; 100(3): e24048, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546004

RESUMO

INTRODUCTION: Uterine rupture during pregnancy is a serious obstetric complication accompanied by a high incidence of maternal morbidity and mortality, and the presence of uterine scars is the main risk factor. In the present case, uterine rupture occurred in an unscarred uterus in a nonlaboring primigravida woman with adenomyosis and twin pregnancy in the third trimester. PATIENT CONCERNS: In this case, the patient suspected to have a history of endometriosis have got twin pregnancies following intracytoplasmic sperm injection, and complained of recurrent lower abdominal pain from 16 weeks to 29 weeks of gestation. DIAGNOSIS: After exploratory laparotomy, the patient was diagnosed with uterine rupture and adenomyosis. INTERVENTIONS: The patient was first administered expectant treatment such as antibiotics, tocolytics, and fluid replacement therapy. Symptoms then appeared repeatedly and worsened, followed by eventual peritoneal irritation, and exploratory laparotomy was performed. OUTCOMES: Two live female fetuses were extracted by cesarean section, and the uterine laceration was repaired. The mother recovered without any postoperative complications, and the babies were discharged after receiving one month of prematurity care without any postnatal complications. CONCLUSION: Adenomyosis and the conception of twins may lead to uterine rupture. For pregnant women with a history of adenomyosis with multiple gestations, close monitoring for signs of uterine rupture is necessary. Single-embryo transfer and multifetal pregnancy reduction should be recommended for infertile patients with adenomyosis.


Assuntos
Adenomiose/complicações , Complicações na Gravidez/etiologia , Gravidez de Gêmeos , Nascimento Prematuro/etiologia , Ruptura Uterina/etiologia , Adulto , Cesárea , Feminino , Humanos , Nascimento Vivo , Gravidez , Terceiro Trimestre da Gravidez , Ruptura Espontânea
5.
Medicine (Baltimore) ; 100(1): e24229, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429820

RESUMO

RATIONALE: Sirenomelia is a rare congenital malformation that threatens fetal survivals. The cases in which twin with sirenomelia and chromosomal abnormality have been seldomly reported. We reported a dichorionic twin case in which one twin had sirenomelia, the other twin had a normal phenotype, and they had different chromosomal abnormalities. PATIENT CONCERNS: The abnormal twin was found at 22 weeks by ultrasound. The sirenomelia fetus was complicated with a thoracic stenosis, enlarged rectum without anal opening, the absence of bilateral kidneys, a single umbilical artery, a single lower limb, the abnormal curvature of spine, double outlet of right ventricle, which were the indicatives of the chromosome detection. DIAGNOSIS: The copy number variation of the sirenomelia fetus was detected as a deletion of 4.8Mb in 11p11.12-11q11. The co-twin was found with del(Y)(q11.223q11.23), which was as the same as his father's. The mother had normal chromosome. The parents had normal phenotypes. It was firstly reported a microdeletion with sirenomelia fetus. INTERVENTIONS: There was no specific treatments for the twins. OUTCOMES: Intrauterine death of the sirenomelia fetus was found at 27 weeks and postnatal death after inevitable abortion happened to the co-twin. LESSONS: Prenatal ultrasound was responsible for recognizing sirenomelia, and the detailed ultrasound scanning and chromosome detection should be done for the co-twin. The etiology of sirenomelia remains unclear, and genetic detection is also necessary for its pathogenesis research.


Assuntos
Aberrações Cromossômicas , Ectromelia/diagnóstico , Gravidez de Gêmeos , Ultrassonografia Pré-Natal , Adulto , Diagnóstico Diferencial , Ectromelia/diagnóstico por imagem , Ectromelia/genética , Feminino , Morte Fetal , Humanos , Gravidez , Segundo Trimestre da Gravidez
6.
Medicine (Baltimore) ; 100(1): e24239, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429826

RESUMO

RATIONALE: Subarachnoid hemorrhages (SAHs) from ruptured intracranial aneurysms are very rare during pregnancy. Management of ruptured intracranial aneurysms with SAH in pregnancy is often challenging because of the risks to the fetus and the mother. We present the first successful awake endovascular coiling of a dissected intracranial aneurysm in a third trimester twin pregnancy. PATIENT CONCERNS: A 28 years' old pregnant woman was admitted at the obstetric department of our hospital on account of very severe headaches associated with nausea and vomiting. DIAGNOSIS: Emergency obstetric ultrasound scan done confirmed 32 weeks' twin gestation, whereas magnetic resonance imaging established hemorrhage in the suprasellar cistern and the subarachnoid space. Magnetic resonance angiography revealed a dissected aneurysm in the ophthalmic segment of the left internal carotid artery. INTERVENTIONS: Awake cerebral angiography as well as embolization of the aneurysm with coils was done via the transarterial route and the twins were delivered via caesarean section at 37 weeks' gestation. OUTCOMES: Two years' follow-up indicated no complications and children as well as their mother are healthy. LESIONS: Awake endovascular coiling was very beneficial in our case because we avoided general anesthesia and the use of osmotic diuretics which are potentially hazardous during pregnancy.


Assuntos
Aneurisma Intracraniano/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico , Gravidez de Gêmeos , Hemorragia Subaracnóidea/diagnóstico , Ultrassonografia Pré-Natal , Adulto , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Embolização Terapêutica , Procedimentos Endovasculares , Feminino , Cefaleia/etiologia , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Angiografia por Ressonância Magnética , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/terapia , Terceiro Trimestre da Gravidez , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/terapia
7.
Rev Col Bras Cir ; 48: e20202671, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33503142

RESUMO

INTRODUCTION: twin-to-twin transfusion syndrome (TTTS), defined by combination of polyhydramnios-oligohydramnios, is the most prevalent (5%-35%) of the abnormalities due to placental vascular anastomoses and the most lethal (80%-100% mortality) if untreated. Fetoscopic laser ablation of abnormal vasculature using the Solomon technique is the gold standard approach. It consists of interrupting the intertwin blood flow. OBJECTIVES: to present our initial experience at the Fetal Surgery Service of the Hospital de Clinicas of the Federal University of Parana (HC-UFPR) and to compare our results with those reported in the literature. METHODS: we conducted a retrospective analysis of pregnancies who had undergone laser ablation, assessing data on Quintero's staging, gestational age at diagnosis and at the time of the procedure, placental position, immediate post-procedure survival, and survival after the neonatal period. We then compared these data with the most recent data available in the literature. RESULTS: we analyzed ten TTTS cases. The diagnosis was performed before the 26th week of pregnancy (median 20.8 weeks) and treatment occurred in a median of 9.5 days later. The distribution by the Quintero's staging was of three cases in stage II, five in stage III, and two in stage IV. In 50% of the gestations, at least one of the fetuses survived through the neonatal period. CONCLUSION: the treatment of TTTS in the HC-UFPR had a positive impact in the survival of the affected fetuses, although the results were worse than the ones reported in the literature, probably due to the delay in referencing the patients to our service, leading to a prolonged interval between diagnosis and treatment.


Assuntos
Transfusão Feto-Fetal/cirurgia , Fetoscopia , Fotocoagulação a Laser/métodos , Gêmeos Monozigóticos , Feminino , Transfusão Feto-Fetal/mortalidade , Idade Gestacional , Hospitais , Humanos , Gravidez , Resultado da Gravidez , Segundo Trimestre da Gravidez , Gravidez de Gêmeos , Estudos Retrospectivos , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento
8.
BMC Pregnancy Childbirth ; 21(1): 101, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33516175

RESUMO

BACKGROUND: Monozygotic twins are nearly identical in genotype and phenotype because monozygotic twins arise from one fertilized oocyte. In all cases of discordant karyotype in monozygotic twins, trisomy 21 accounts for about one in 385,000. Monozygotic twins discordant for Robertsonian translocation trisomy 21 of the der (21;21)(q10;q10), in which the additional chromosome originates from the father is rare. CASE PRESENTATION: A 28-year-old parous woman, G3P1A0, came to our institution for a dating scan at 8 weeks of gestation. The transvaginal ultrasound examination demonstrated a monochorionic diamniotic pregnancy. She and her husband were healthy, with no family history of trisomy 21 or other congenital diseases. The ultrasound examination of nuchal translucency thickness was discordant in twins at 13 weeks (twin A, NT 1.4 mm with CRL being 65 mm; twin B, NT 7.8 mm with CRL being 69 mm). At 17+ 4 weeks, twin A was normal, but ventricular septal defect and the hypoplastic left heart was detected in twin B. The deepest vertical pocket was 18 mm in twin A (oligohydramnios) and 102 mm in Twin B (polyhydramnios). The bladder in twin A was absent. Ultrasound findings indicated TTTS Stage II. Amniocentesis was performed for the two fetuses. The karyotyping results revealed 46, XX in twin A but 46,XX,+ 21,der (21;21)(q10;q10) in twin B. For twin B, the parents opted for selective fetal termination by radiofrequency ablation. The procedure was uneventful. At 40+ 5 weeks, twin A was born with a birth weight of 4120 g by vaginal delivery. CONCLUSIONS: The early detection of discordant karyotype and twin-to-twin transfusion syndrome is beneficial to the early intervention. In monozygotic twins with a discordant anomaly, the discordant karyotype should be considered.


Assuntos
Amniocentese , Síndrome de Down/genética , Transfusão Feto-Fetal/genética , Gravidez de Gêmeos/genética , Gêmeos Monozigóticos/genética , Adulto , Cromossomos Humanos Par 21/genética , Síndrome de Down/diagnóstico , Feminino , Transfusão Feto-Fetal/diagnóstico , Humanos , Recém-Nascido , Cariotipagem , Medição da Translucência Nucal , Oligo-Hidrâmnio , Gravidez , Redução de Gravidez Multifetal , Ultrassonografia Pré-Natal
11.
Harefuah ; 160(1): 13-18, 2021 Jan.
Artigo em Hebraico | MEDLINE | ID: mdl-33474873

RESUMO

INTRODUCTION: Preterm labor is defined as delivery before 37 weeks of gestation. Up to 17% of twin pregnancy are preterm. Arabin cervical pessary has been proven as preventing preterm labor in singleton pregnancies. The benefit of it in twin pregnancy is controversial. OBJECTIVES: The purpose of this study was to compare the rate of preterm delivery in twin gestation with short cervical length in Israel- one center utilized the combined treatment of Arabin cervical pessary and vaginal progesterone (study group) and the others utilized vaginal progesterone approach (control group). METHODS: Multi-center retrospective cohort study, including "Shamir", "Wolfson", "Shaare Zedek" and "Galilee" medical centers, between the years 2012-2016. Inclusion criteria were twin gestations and short cervical length (<25mm) between 16-28 weeks' gestation. RESULTS: The study group included 68 women, the control group 78 women. The study group had shorter cervical length at intervention in comparison to the control group (13.6 ± 5.9 vs. 16.5 ± 5.7, respectively, p = .002). The treatment started later for the study group compared to the control group (23.2 +2.2 vs 22.6 +3.0). CONCLUSIONS: Despite having shorter cervical length at recruitment, the rate of spontaneous delivery < 34-weeks' gestation was similar in both groups (36.8 vs. 37.2%, respectively). DISCUSSION: Considering the conclusion in this research it seems that the combination of the mechanical effect of the pessary by embracing the cervix, keeping the cervical mucus, bending it in a way that the pressure is towards the anterior cervical wall together with the progestative effect which increases the estrogen/progesterone ratio, creating uterine quiescence and keeping the structural connective tissue of the cervix have an added benefit. It seems that the combined use of Arabin cervical pessary and vaginal progesterone in twin pregnancy with short cervical length have a synergic effect which may have a benefit in preventing preterm labor. The combination of cervical pessary and progesterone does not negatively affect twin pregnancy outcome and does not cause preterm birth.


Assuntos
Gravidez de Gêmeos , Nascimento Prematuro , Administração Intravaginal , Colo do Útero/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Israel , Pessários , Gravidez , Nascimento Prematuro/prevenção & controle , Progesterona , Estudos Retrospectivos
12.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(1): 37-42, 2021 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33476535

RESUMO

OBJECTIVE: To study the influence of twin pregnancy by assisted reproductive technology (ART) versus twin pregnancy by spontaneous conception (SC) on neonatal outcomes. METHODS: A retrospective analysis was performed for the clinical data of 3 356 live twins with a gestational age of ≥24 weeks who were born in Nanjing Maternal and Child Health Hospital from 2017 to 2019, with 2 006 twins (1 003 pairs) in the ART group and 1 350 (675 pairs) in the SC group. The two groups were compared in terms of the mother's general information and pregnancy comorbidities and the general information, diseases, and outcomes of neonates. RESULTS: Compared with the SC group, the ART group had a significantly higher maternal age (P < 0.05) and significantly higher rates of primiparity, cesarean section, and cervical cerclage (P < 0.05). Compared with the SC group, the ART group had significantly higher incidence rates of maternal pregnancy comorbidities including hypertension, gestational diabetes, and postpartum hemorrhage (P < 0.05). Compared with the SC group, the ART group had a significantly lower mean gestational age of neonates (P < 0.05) and a significantly higher proportion of very-low-birth-weight infants (6.8% vs 5.8%, P < 0.05), while ART did not increase the risks of preterm birth and low Apgar score. There were no significant differences between the two groups in the mortality rate of neonates and the incidence rates of neonatal diseases including respiratory distress syndrome, stage II/III necrotizing enterocolitis, bronchopulmonary dysplasia, and grade III-IV intracranial hemorrhage (P > 0.05). CONCLUSIONS: Compared with twin pregnancy by SC, twin pregnancy by ART does not increase the neonatal mortality rate and risk of adverse outcomes.


Assuntos
Gravidez de Gêmeos , Nascimento Prematuro , Cesárea , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Técnicas de Reprodução Assistida , Estudos Retrospectivos
13.
Placenta ; 105: 7-13, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33497931

RESUMO

INTRODUCTION: Recent reports suggest SARS-CoV-2, the virus causing COVID-19, may be transmittable from pregnant mother to placenta and fetus, albeit rarely. The efficacy of vertical transmission of SARS-CoV-2 critically depends on the availability of its receptor, ACE2, in the placenta. In the present study, we tested the hypothesis that placental ACE2 expression is oxygenation-dependent by studying the expression of ACE2 and associated cell entry regulators in the monochorionic twin anemia-polycythemia (TAPS) placenta, a model of discordant placental oxygenation. METHODS: We performed a retrospective comparative immunohistochemical, immunofluorescence and Western blot analysis of ACE2, TMPRSS2 and Cathepsin B expression in anemic and polycythemic territories of TAPS placentas (N = 14). RESULTS: ACE2 protein levels were significantly higher in the anemic twin territories than in the corresponding polycythemic territories, associated with upregulation of the key ACE2-related cell entry regulators, TMPRSS2 and Cathepsin B, immunolocalized to villous trophoblastic and stromal cells. Cellular colocalization of ACE2 and TMPRSS2, suggestive of functionality of this cell entry axis, was demonstrated by double immunofluorescence studies. DISCUSSION: Placental hypoxia is associated with upregulation of ACE2 expression, concomitant with increased expression of its key cell entry proteases. ACE2-regulated placental functions, both infection- and non-infection related, may be highly oxygenation-dependent.


Assuntos
Anemia/metabolismo , Doenças Fetais/metabolismo , Hipóxia/metabolismo , Placenta/metabolismo , Policitemia/metabolismo , Gravidez de Gêmeos , Adulto , Anemia/complicações , Anemia/patologia , Estudos de Casos e Controles , Estudos de Coortes , Doenças em Gêmeos/metabolismo , Doenças em Gêmeos/patologia , Feminino , Doenças Fetais/patologia , Humanos , Hipóxia/complicações , Hipóxia/patologia , Imuno-Histoquímica , Recém-Nascido , Masculino , Placenta/patologia , Policitemia/complicações , Policitemia/patologia , Gravidez , Gravidez de Gêmeos/metabolismo , Estudos Retrospectivos , Serina Endopeptidases/metabolismo , Regulação para Cima
14.
Diabetes Res Clin Pract ; 171: 108623, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33316314

RESUMO

AIMS: To evaluate the influence of gestational diabetes mellitus (GDM) on the perinatal outcomes of twin pregnancies and its impact on fetal growth profiles of twin offspring from 6 weeks to 12 months of corrected age. METHODS: A longitudinal cohort study was conducted among pregnant women with twins and their twin offspring. All information on perinatal outcomes and child growth trajectories from 6 weeks to 12 months of corrected age were obtained and analyzed using a general linear model and logistic regression models. RESULTS: GDM was not correlated with adverse perinatal outcomes of twin pregnancies; however, in monochorionic diamniotic (MCDA), but not dichorionic diamniotic (DCDA) twin pregnancies, GDM was correlated with gestational hypertension disorder and a fetus being small for gestational age (OR, 2.68; 95% CI 1.16-6.04 and OR, 0.35; 95% CI 0.16-0.76, respectively). In both MCDA and DCDA groups, GDM was positively associated with a higher risk of childhood overweight at 6 months of corrected age (2.32 [1.05, 5.09] and 2.00 [1.13, 3.53]). CONCLUSIONS: GDM had a greater impact on MCDA twin pregnancies in terms of maternal gestational hypertension disease and small for gestational age of newborns. Additionally, twin offspring exposed to GDM had a higher risk of being overweight at 6 months of corrected age irrespective of chorionicity. CLINICAL TRIAL REGISTRATION: ChiCTR-OOC-16008203.


Assuntos
Diabetes Gestacional/fisiopatologia , China , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido , Estudos Longitudinais , Gravidez , Resultado da Gravidez , Gravidez de Gêmeos , Estudos Prospectivos
15.
Zhonghua Fu Chan Ke Za Zhi ; 55(12): 823-829, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33355756

RESUMO

Objective: To analyze the perioperative maternal complications of twin-twin transfusion syndrome (TTTS) after fetolascopic laser photocoagulation (FLP). Methods: A retrospective study was conducted among 182 cases with TTTS received FLP in Shanghai First Maternity and Infant Hospital from January 2010 to December 2018. The types, incidence and related factors of perioperative maternal complications as well as the changes of maternal laboratory parameters before and after FLP were analyzed. Results: The age of 182 TTTS pregnant women was (29.8±3.9) years old, body mass index (BMI) before pregnancy was (21.3±2.9) kg/m2. The median gestational week of FLP treatment was 22.0 weeks, the preoperative cervical length was (34.1±9.0) mm, and the median preoperative maximum vertical pocket was 12.0 cm. During the perioperative period of FLP treatment, 22 cases (12.1%, 22/182) presented maternal complications, among which 4 cases (2.2%, 4/182) presented severe postoperative maternal complications, including 3 cases of pulmonary edema and 1 case of pulmonary embolism accompanied with right cardiac insufficiency. There were 18 cases (9.9%, 18/182) of common maternal complications during the perioperative period, including 6 cases (3.3%, 6/182) of intraoperative hemorrhage, 5 cases (2.7%, 5/182) of intraoperative amniotic fluid leakage into the pelvic cavity, 5 cases (2.7%, 5/182) of premature rupture of membrane 72 hours after the operation, 1 case (0.5%, 1/182) of inevitable abortion, and 1 case (0.5%, 1/182) of infection. The analysis of related risk factors found that maternal complications were only related to BMI before pregnancy, and the BMI of TTTS pregnant women with complications was lower than that of those without complications, the difference was statistically significant (P<0.01). The hemoglobin level, hematocrit and albumin level of TTTS pregnant women were significantly decreased at 4-6 hours and 24 hours after FLP respectively, compared with those before surgery (P<0.01), and there were no significant correlations with the amount of amniodrainage during surgery (P>0.05 for all). Conclusions: The overall incidence of perioperative maternal complications in the treatment of TTTS by FLP is not high, among which the serious complications mainly include pulmonary edema and pulmonary embolism. Timely correction of maternal hemodilution that may occur in TTTS pregnant women could achieve a good prognosis after FLP.


Assuntos
Ruptura Prematura de Membranas Fetais/etiologia , Transfusão Feto-Fetal , Fetoscopia/métodos , Fotocoagulação a Laser/métodos , Gravidez de Gêmeos , Adulto , China/epidemiologia , Feminino , Transfusão Feto-Fetal/cirurgia , Fetoscopia/efeitos adversos , Idade Gestacional , Humanos , Recém-Nascido , Fotocoagulação a Laser/efeitos adversos , Lasers , Masculino , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Gêmeos Monozigóticos
16.
J Pregnancy ; 2020: 6859157, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33029401

RESUMO

Despite several efforts globally, the problem of perinatal mortality remained an unsolved agenda. As a result, it continued to be an essential part of the third sustainable development goals to end preventable child deaths by 2030. With a rate of 33 per 1000 births, Ethiopia has the highest level of perinatal mortality in the world. Thus, determining the magnitude and identifying the determinants are very crucial for evidence-based interventions. A community-based longitudinal study was conducted in Southwest Ethiopia among 3474 pregnant women to estimate the magnitude of perinatal mortality. Then, a case-control study among 120 cases and 360 controls was conducted to identify the determinants of perinatal mortality. Data were collected by using an interviewer-administered questionnaire and analyzed by using SPSS version 20. Multivariate logistic regression analysis was used to identify variables having a significant association with perinatal mortality at p < 0.05. The perinatal mortality rate was 34.5 (95% CI: 28.9, 41.1) deaths per 1000 births. Attending ≥4 ANC visits (AOR = 0.46; 95% CI: 0.23, 0.91), having good knowledge on key danger signs (AOR = 0.27; 95% CI: 0.10, 0.75), and having a skilled attendant at birth (AOR = 0.34; 95% CI: 0.19, 0.61) were significantly associated with a reduction of perinatal mortality. Being a primipara (AOR = 3.38; 95% CI: 1.90, 6.00), twin births (AOR = 5.29; 95% CI: 1.46, 19.21), previous history of perinatal mortality (AOR = 3.33; 95% CI: 1.27, 8.72), and obstetric complication during labor (AOR = 4.27; 95% CI: 2.40, 7.59) significantly increased perinatal mortality. In conclusion, the magnitude of perinatal mortality in the study area was high as compared to the national target for 2020. Care during pregnancy and childbirth and conditions of pregnancy and labor were identified as determinants of perinatal mortality. Hence, interventions need to focus on increasing knowledge of danger signs and utilization of skilled maternity care. Special emphasis needs to be given to mothers with a previous history of perinatal mortality, twin pregnancies, and having obstetric complications.


Assuntos
Assistência Perinatal , Mortalidade Perinatal , Estudos de Casos e Controles , Competência Clínica , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Conhecimento , Modelos Logísticos , Estudos Longitudinais , Masculino , Complicações do Trabalho de Parto , Paridade , Gravidez , Gravidez de Gêmeos , Fatores de Risco , Inquéritos e Questionários
17.
Rev Bras Ginecol Obstet ; 42(10): 669-671, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33129222

RESUMO

The present report describes the case of a 31-year-old primigravida, with dichorionic twins at 31 weeks. She presented with history of myalgia, jaundice, and abdominal discomfort. No flu-like symptoms as fever or cough. She was not aware of exposure to COVID-19. Normal blood pressure and O2 saturation. Laboratory tests showed platelet count of 218,000 mm3, alanine aminotransferase (ALT) 558 IU and serum creatinine 2.3 mg/dl. Doppler ultrasound in one twin was compatible with brain sparing. Partial hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome was the hypothesis, and a cesarean section was performed. On day 2, the white-cell count reached 33,730, with decreased consciousness and mild respiratory distress. Tomography revealed both lungs with ground-glass opacities. Swab for COVID-19 polymerase chain reaction (PCR) was positive. Thrombocytopenia in patients with COVID-19 appears to be multifactorial, similar to what occurs in preeclampsia and HELLP syndrome. We assume that the synergism of these pathophysiological mechanisms could accelerate the compromise of maternal conditions and could be a warning to the obstetric practice.


Assuntos
Infecções por Coronavirus/diagnóstico , Síndrome HELLP/diagnóstico , Pneumonia Viral/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Resultado da Gravidez , Adulto , Cesárea/métodos , Técnicas de Laboratório Clínico , Diagnóstico Diferencial , Feminino , Idade Gestacional , Humanos , Pandemias , Gravidez , Gravidez de Gêmeos , Trombocitopenia/diagnóstico , Ultrassonografia Pré-Natal
18.
PLoS One ; 15(9): e0239477, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956426

RESUMO

OBJECTIVE: Report maternal, fetal and neonatal complications associated with single intrauterine fetal death (sIUFD) in monochorionic twin pregnancies. DESIGN: Prospective observational study. SETTING: UK. POPULATION: 81 monochorionic twin pregnancies with sIUFD after 14 weeks gestation, irrespective of cause. METHODS: UKOSS reporters submitted data collection forms using data from hospital records. MAIN OUTCOME MEASURES: Aetiology of sIUFD; surviving co-twin outcomes: perinatal mortality, central nervous system (CNS) imaging, gestation and mode of delivery, neonatal outcomes; post-mortem findings; maternal outcomes. RESULTS: The commonest aetiology was twin-twin transfusion syndrome (38/81, 47%), "spontaneous" sIUFD (22/81, 27%) was second commonest. Death of the co-twin was common (10/70, 14%). Preterm birth (<37 weeks gestation) was the commonest adverse outcome (77%): half were spontaneous and half iatrogenic. Only 46/75 (61%) cases had antenatal CNS imaging, of which 33 cases had known results of which 7/33 (21%) had radiological findings suggestive of neurological damage. Postnatal CNS imaging revealed an additional 7 babies with CNS abnormalities, all born at <36 weeks, including all 4 babies exhibiting abnormal CNS signs. Major maternal morbidity was relatively common, with 6% requiring ITU admission, all related to infection. CONCLUSIONS: Monochorionic twin pregnancies with single IUD are complex and require specialist care. Further research is required regarding optimal gestation at delivery of the surviving co-twin, preterm birth prevention, and classifying the cause of death in twin pregnancies. Awareness of the importance of CNS imaging, and follow-up, needs improvement.


Assuntos
Morte Fetal , Gêmeos Monozigóticos , Adulto , Corioamnionite/epidemiologia , Feminino , Retardo do Crescimento Fetal/etiologia , Retardo do Crescimento Fetal/mortalidade , Transfusão Feto-Fetal/mortalidade , Transfusão Feto-Fetal/terapia , Idade Gestacional , Humanos , Incidência , Lactente , Mortalidade Infantil , Recém-Nascido , Nascimento Vivo , Masculino , Malformações do Sistema Nervoso/diagnóstico por imagem , Malformações do Sistema Nervoso/embriologia , Malformações do Sistema Nervoso/epidemiologia , Mortalidade Perinatal , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Redução de Gravidez Multifetal , Gravidez de Gêmeos , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Prospectivos , Transtornos Puerperais/epidemiologia , Reino Unido/epidemiologia
19.
Zhonghua Fu Chan Ke Za Zhi ; 55(9): 627-632, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32957751

RESUMO

Objective: To investigate the clinical characteristics and outcomes of monochorionic monoamniotic (MCMA) twin pregnancy. Methods: The clinical data of 60 MCMA twin pregnant women who were terminated in Peking University Third Hospital from January 2011 to December 2019 were collected, and the general clinical data, prenatal examination and pregnancy outcomes were analyzed retrospectively. Results: The age of 60 MCMA twin pregnant women was (31.0±4.1) years old, among which 44 cases were primiparas (73%, 44/60) and 16 cases were multiparas (27%, 16/60). Fifty-eight cases were diagnosed as MCMA twin pregnancy prenatally and were confirmed after delivery. Median ultrasonic diagnosis of gestational age was 12 weeks (range: 8-30 weeks). In the 60 MCMA twin pregnancies, 6 cases were conjoined twins, 5 cases were complicated with twin reversed arterial perfusion sequence (TRAPS), and 10 cases were diagnosed as other fetal malformation by prenatal ultrasound examination. Among the 60 MCMA twin pregnant women, 19 cases had spontaneous abortion or induced abortion due to fetal malformation, fetal death or other reasons within 28 weeks of pregnancy, 41 cases entered the perinatal period, a total of 70 newborns survived. The main cause of perinatal fetal or neonatal death was fetal dysplasia. Conclusions: There is a high incidence of fetal abnormality and perinatal mortality in MCMA twin pregnancy. Accurate early diagnosis, enhanced management and monitoring during pregnancy, and individualized treatment are the keys to improve MCMA twin pregnancy outcomes.


Assuntos
Âmnio/diagnóstico por imagem , Placenta/diagnóstico por imagem , Gravidez de Gêmeos , Gêmeos Monozigóticos , Ultrassonografia Pré-Natal/métodos , Adulto , Âmnio/fisiopatologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Mortalidade Perinatal , Placenta/fisiopatologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
20.
Rev Med Liege ; 75(7-8): 489-493, 2020 Jul.
Artigo em Francês | MEDLINE | ID: mdl-32779895

RESUMO

Prenatal diagnosed congenital infection by Enterovirus is rarely described in the literature. A few casereports describe severe abnormalities observed by ultrasound that have led to spontaneous intrauterine demise or early death of the newborn. We report the case of a dichorionic diamniotic twin pregnancy. At 24 weeks of gestation, the second trimester ultrasound examination shows cardiac, brain and abdominal abnormalities in one of the fetuses. The other fetus has a normal appearance. "Standard" serological tests conducted on the mother are negative and amniocentesis reveals no genetic abnormality. After birth, Reverse Transcription Polymerase Chain Reaction (PCR) on samples of blood, ascites and stool reveals to be positive for Enterovirus in both newborns. Both are viable and exhibit severe brain abnormalities with severe neurological sequelae such as cerebral palsy, visual and hearing impairment. This case report illustrates the difficulty of prenatal diagnosis of congenital Enterovirus infection and informs about its possible neurological sequelae.


Assuntos
Infecções por Enterovirus , Enterovirus , Doenças Fetais , Gravidez de Gêmeos , Feminino , Humanos , Recém-Nascido , Gravidez , Ultrassonografia Pré-Natal
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...