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1.
Cad Saude Publica ; 37(2): e00079120, 2021.
Artigo em Português | MEDLINE | ID: mdl-33729304

RESUMO

This study aimed to analyze the time trend in stillbirth rate (SBR) and the contribution by investigation to improving the definition of underlying cause of stillbirth in the city of São Paulo, Brazil, according to the place where the death certificate was issued. An ecological approach was used to analyze the trend in SBR by weight stratum (< 2,500g and ≥ 2,500g) and total deaths in the city in 2007-2017. Prais-Winsten generalized linear regression was used. The study of cases analyzed the underlying causes of stillbirth from 2012 to 2014, before and after the investigation, time of conclusion of the investigation, and redefinition of the underlying cause of stillbirths by type of issuer. In deaths with < 2,500g, there was an upward trend in SBR of 1.5% per year and a reduction (-1.3% per year) in stillbirths ≥ 2,500g. Total deaths presented a stable trend. In 2012-2014, 90% of deaths with ≥ 2,500g were investigated. After investigation, the underlying cause of death was redefined in 15% of the deaths, and not otherwise specified stillbirth (P95) represented 25% of the causes of death. The highest proportion of changes in the underlying cause of death occurred in deaths for which the death certificate was issued by the death certification review service (17%), while in health services the proportion was 10.6%. In conclusion, the SBR in deaths with ≥ 2,500g showed a downward trend. There was a significant redefinition of underlying causes, especially in those attested by the death certification review service. However, the redefinition was insufficient to expand the proportion of causes of death that would allow a better understanding of the mortality conditions.


Assuntos
Morte Fetal , Peso Corporal , Brasil/epidemiologia , Causas de Morte , Cidades , Morte Fetal/etiologia , Humanos
2.
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
3.
BMJ Case Rep ; 14(1)2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514616

RESUMO

A 31-year-old G3P2002 with history of two prior caesarean sections presented with influenza-like illness, requiring intubation secondary to acute respiratory distress syndrome. Investigations revealed intrauterine fetal demise at 30-week gestation.She soon deteriorated with sepsis and multiple organs impacted. Risks of the gravid uterus impairing cardiopulmonary function appeared greater than risks of delivery, including that of uterine rupture. Vaginal birth after caesarean was achieved with misoprostol and critical care status rapidly improved.Current guidelines for management of fetal demise in patients with prior hysterotomies are mixed: although the American College of Obstetricians and Gynecologists recommends standard obstetric protocols rather than misoprostol administration for labour augmentation, there is limited published data citing severe maternal morbidity associated with misoprostol use. This case report argues misoprostol-augmented induction of labour can be a reasonable option in a medically complex patient with fetal demise and prior hysterotomies.


Assuntos
Morte Fetal/etiologia , Trabalho de Parto Induzido/métodos , Trabalho de Parto/efeitos dos fármacos , Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem , Administração Intravaginal , Adulto , Parto Obstétrico/normas , Feminino , Humanos , Histerotomia/efeitos adversos , Intubação Intratraqueal/métodos , Misoprostol/farmacologia , Insuficiência de Múltiplos Órgãos/etiologia , Ocitócicos/farmacologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Terceiro Trimestre da Gravidez , /terapia , Resultado do Tratamento , Ruptura Uterina/prevenção & controle
4.
BMC Pregnancy Childbirth ; 21(1): 77, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33482762

RESUMO

BACKGROUND: Childbirth is a complex process, and checklists are useful tools to remember steps of such complex processes. The World Health Organization safe childbirth checklist is a tool used to improve the quality of care provided to women giving birth. The checklist was modified by Ministry of Health and was introduced to health centers in Ethiopia by the USAID Transform: Primary Health Care Activity. METHODS: A pre and post intervention study design with prospective data collection was employed. The availability of essential childbirth supplies and adherence of health care providers to essential birth practices were compared for the pre and post intervention periods. RESULTS: The pre and post intervention assessments were conducted in 247 and 187 health centers respectively. A statistically significant improvement from 63.6% pre intervention to 83.5% post intervention was observed in the availability of essential childbirth supplies, t (389.7) = - 7.1, p = 0.000. Improvements in adherence of health care providers to essential birth practices were observed with the highest being at pause point three (26.2%, t (306.3) = - 10.6, p = 0.000) followed by pause point four (21.1%, t (282.5) = - 8.0, p = 0.000), and pause point two (18.2%, t (310.8) = - 9.7, p = 0.000). The least and statistically non-significant improvement was observed at pause point one (3.3%, t (432.0) = - 1.5, p = 0.131). CONCLUSION: Improvement in availability of essential childbirth supplies and adherence of health care providers towards essential birth practices was observed after introduction of a modified World Health Organization safe childbirth checklist. Scale up of the use of the checklist is recommended.


Assuntos
Lista de Checagem/estatística & dados numéricos , Parto Obstétrico/normas , Serviços de Saúde Materna/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Complicações na Gravidez/prevenção & controle , Melhoria de Qualidade/organização & administração , Adulto , Etiópia , Feminino , Morte Fetal/prevenção & controle , Nível de Saúde , Humanos , Guias de Prática Clínica como Assunto , Gravidez , Estudos Prospectivos , Medição de Risco , Organização Mundial da Saúde
5.
Hum Reprod ; 36(4): 899-906, 2021 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-33346816

RESUMO

Coronavirus disease 2019 (COVID-19) is caused by infection of the respiratory tract by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which survives in the tissues during the clinical course of infection but there is limited evidence on placental infection and vertical transmission of SARS-CoV-2. The impact of COVID-19 in first trimester pregnancy remains poorly understood. Moreover, how long SARS-CoV-2 can survive in placenta is unknown. Herein, we report a case of a pregnant woman in the first trimester who tested positive for SARS-CoV-2 at 8 weeks of gestation, although her clinical course was asymptomatic. At 13 weeks of gestation, her throat swab tested negative for SARS-CoV-2 but viral RNA was detected in the placenta, and the Spike (S) proteins (S1 and S2) were immunolocalized in cytotrophoblast and syncytiotrophoblast cells of the placental villi. Histologically, the villi were generally avascular with peri-villus fibrin deposition and in some areas the syncytiotrophoblast layer appeared lysed. The decidua also had fibrin deposition with extensive leukocyte infiltration suggestive of inflammation. The SARS-CoV-2 crossed the placental barrier, as the viral RNA was detected in the amniotic fluid and the S proteins were detected in the fetal membrane. Ultrasonography revealed extensively subcutaneous edema with pleural effusion suggestive of hydrops fetalis and the absence of cardiac activity indicated fetal demise. This is the first study to provide concrete evidence of persistent placental infection of SARS-CoV-2 and its congenital transmission is associated with hydrops fetalis and intrauterine fetal demise in early pregnancy.


Assuntos
/diagnóstico , Morte Fetal , Placenta/virologia , Complicações Infecciosas na Gravidez/virologia , /isolamento & purificação , Infecções Assintomáticas , Evolução Fatal , Feminino , Humanos , Transmissão Vertical de Doença Infecciosa , Mães , Placenta/diagnóstico por imagem , Gravidez , Primeiro Trimestre da Gravidez
6.
Cardiovasc Pathol ; 50: 107295, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33002584

RESUMO

Congenital ventricular diverticulum is a rare anomaly with an unclear pathology. Here, we report a male fetus at 24 weeks of gestation, diagnosed with right ventricular diverticulum associated with tetralogy of Fallot and absent pulmonary valve. The diverticulum was located at the anterosuperior wall of the right ventricle and faced into the massive pulmonary regurgitation flow jet. Intrauterine fetal death from heart failure resulted at 26 weeks of gestation. An autopsy revealed significant subendocardial fibrosis in the diverticular wall without inflammatory cell infiltration. Clinical and pathologic features suggested that the regurgitative blood flow contributed to the formation of the right ventricular diverticulum.


Assuntos
Divertículo/congênito , Coração Fetal/anormalidades , Ventrículos do Coração/anormalidades , Hemodinâmica , Circulação Pulmonar , Valva Pulmonar/anormalidades , Tetralogia de Fallot/complicações , Autopsia , Divertículo/diagnóstico por imagem , Divertículo/fisiopatologia , Ecocardiografia Doppler em Cores , Evolução Fatal , Morte Fetal/etiologia , Coração Fetal/diagnóstico por imagem , Coração Fetal/fisiopatologia , Idade Gestacional , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/fisiopatologia , Ultrassonografia Pré-Natal
7.
Nature ; 589(7842): 442-447, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33361811

RESUMO

Successful pregnancies rely on adaptations within the mother1, including marked changes within the immune system2. It has long been known that the thymus, the central lymphoid organ, changes markedly during pregnancy3. However, the molecular basis and importance of this process remain largely obscure. Here we show that the osteoclast differentiation receptor RANK4,5 couples female sex hormones to the rewiring of the thymus during pregnancy. Genetic deletion of Rank (also known as Tnfrsf11a) in thymic epithelial cells results in impaired thymic involution and blunted expansion of natural regulatory T (Treg) cells in pregnant female mice. Sex hormones, in particular progesterone, drive the development of thymic Treg cells through RANK in a manner that depends on AIRE+ medullary thymic epithelial cells. The depletion of Rank in the mouse thymic epithelium results in reduced accumulation of natural Treg cells in the placenta, and an increase in the number of miscarriages. Thymic deletion of Rank also results in impaired accumulation of Treg cells in visceral adipose tissue, and is associated with enlarged adipocyte size, tissue inflammation, enhanced maternal glucose intolerance, fetal macrosomia, and a long-lasting transgenerational alteration in glucose homeostasis, which are all key hallmarks of gestational diabetes. Transplantation of Treg cells rescued fetal loss, maternal glucose intolerance and fetal macrosomia. In human pregnancies, we found that gestational diabetes also correlates with a reduced number of Treg cells in the placenta. Our findings show that RANK promotes the hormone-mediated development of thymic Treg cells during pregnancy, and expand the functional role of maternal Treg cells to the development of gestational diabetes and the transgenerational metabolic rewiring of glucose homeostasis.


Assuntos
Diabetes Gestacional/imunologia , Morte Fetal/etiologia , Receptor Ativador de Fator Nuclear kappa-B/metabolismo , Linfócitos T Reguladores/imunologia , Timo/imunologia , Adipócitos/patologia , Animais , Proliferação de Células , Diabetes Gestacional/etiologia , Diabetes Gestacional/metabolismo , Diabetes Gestacional/patologia , Células Epiteliais/imunologia , Feminino , Feto/imunologia , Feto/metabolismo , Feto/patologia , Glucose/metabolismo , Intolerância à Glucose/genética , Humanos , Gordura Intra-Abdominal/patologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Placenta/imunologia , Placenta/patologia , Gravidez , Receptor Ativador de Fator Nuclear kappa-B/deficiência , Receptor Ativador de Fator Nuclear kappa-B/genética , Linfócitos T Reguladores/citologia , Timo/citologia , Fatores de Transcrição/metabolismo
8.
PLoS One ; 15(12): e0244450, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382792

RESUMO

OBJECTIVES: To study Group B Streptococcus (GBS) isolates associated with different clinical syndromes: asymptomatic carriage in pregnant women, intrauterine fetal death (IUFD), and early onset disease (EOD) in the newborn. METHODS: GBS isolates were collected from asymptomatic pregnant women admitted for labor, IUFD cases, and neonates with EOD. Serotypes and antibiotic susceptibilities were determined. Multilocus sequence typing (MLST) was performed to assess genetic epidemiology. RESULTS: GBS carriage rate was 26.1% (280/1074). The dominant serotype among asymptomatic pregnant women was VI [98/240 women (40.8%)], followed by serotypes III, V and IV in 42/240 (17.5%), 30/240 (12.5%) and 28/240 (11.7%) women, respectively. The dominant serotype in IUFD cases was serotype VI [10/13 (76.9%)]. In contrast the prevalent serotype among EOD cases was III [16/19 (84.2%)]. ST-1 was associated with IUFD [7/13 (53.8%)], ST-17 was associated with serotype III and EOD in the newborn 14/19 (73.7%)]. Erythromycin and clindamycin resistance reached 36.8%, 7.7% and 20.0%among EOD, vaginal carriage and IUFD, respectively. CONCLUSIONS: Serotypes VI and ST-1 were dominant among asymptomatic pregnant women and in IUFD cases while EOD was associated with serotype III and ST-17. Invasive mechanisms thus may differ between IUFD and EOD in the newborn and virulence may be related to capsule serotype. Resistance rates to erythromycin and clindamycin were high in EOD cases.


Assuntos
Portador Sadio/diagnóstico , Morte Fetal , Sepse Neonatal/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus agalactiae/genética , Adulto , Idade de Início , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Portador Sadio/tratamento farmacológico , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Clindamicina/farmacologia , Clindamicina/uso terapêutico , Farmacorresistência Bacteriana Múltipla/genética , Eritromicina/farmacologia , Eritromicina/uso terapêutico , Feminino , Humanos , Recém-Nascido , Tipagem de Sequências Multilocus , Sepse Neonatal/tratamento farmacológico , Sepse Neonatal/epidemiologia , Sepse Neonatal/microbiologia , Polissacarídeos Bacterianos/genética , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Sorogrupo , Sorotipagem , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificação , Streptococcus agalactiae/patogenicidade , Virulência/genética , Adulto Jovem
10.
Cochrane Database Syst Rev ; 12: CD009599, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33336827

RESUMO

BACKGROUND: Stillbirth is generally defined as a death prior to birth at or after 22 weeks' gestation. It remains a major public health concern globally. Antenatal interventions may reduce stillbirths and improve maternal and neonatal outcomes in settings with high rates of stillbirth. There are several key antenatal strategies that aim to prevent stillbirth including nutrition, and prevention and management of infections. OBJECTIVES: To summarise the evidence from Cochrane systematic reviews on the effects of antenatal interventions for preventing stillbirth for low risk or unselected populations of women. METHODS: We collaborated with Cochrane Pregnancy and Childbirth's Information Specialist to identify all their published reviews that specified or reported stillbirth; and we searched the Cochrane Database of Systematic Reviews (search date: 29 Feburary 2020) to identify reviews published within other Cochrane groups. The primary outcome measure was stillbirth but in the absence of stillbirth data, we used perinatal mortality (both stillbirth and death in the first week of life), fetal loss or fetal death as outcomes. Two review authors independently evaluated reviews for inclusion, extracted data and assessed quality of evidence using AMSTAR (A Measurement Tool to Assess Reviews) and GRADE tools. We assigned interventions to categories with graphic icons to classify the effectiveness of interventions as: clear evidence of benefit or harm; clear evidence of no effect or equivalence; possible benefit or harm; or unknown benefit or harm or no effect or equivalence. MAIN RESULTS: We identified 43 Cochrane Reviews that included interventions in pregnant women with the potential for preventing stillbirth; all of the included reviews reported our primary outcome 'stillbirth' or in the absence of stillbirth, 'perinatal death' or 'fetal loss/fetal death'. AMSTAR quality was high in 40 reviews with scores ranging from 8 to 11 and moderate in three reviews with a score of 7. Nutrition interventions Clear evidence of benefit: balanced energy/protein supplementation versus no supplementation suggests a probable reduction in stillbirth (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.39 to 0.94, 5 randomised controlled trials (RCTs), 3408 women; moderate-certainty evidence). Clear evidence of no effect or equivalence for stillbirth or perinatal death: vitamin A alone versus placebo or no treatment; and multiple micronutrients with iron and folic acid versus iron with or without folic acid. Unknown benefit or harm or no effect or equivalence: for all other nutrition interventions examined the effects were uncertain. Prevention and management of infections Possible benefit for fetal loss or death: insecticide-treated anti-malarial nets versus no nets (RR 0.67, 95% CI 0.47 to 0.97, 4 RCTs; low-certainty). Unknown evidence of no effect or equivalence: drugs for preventing malaria (stillbirth RR 1.02, 95% CI 0.76 to 1.36, 5 RCTs, 7130 women, moderate certainty in women of all parity; perinatal death RR 1.24, 95% CI 0.94 to 1.63, 4 RCTs, 5216 women, moderate-certainty in women of all parity). Prevention, detection and management of other morbidities Clear evidence of benefit: the following interventions suggest a reduction: midwife-led models of care in settings where the midwife is the primary healthcare provider particularly for low-risk pregnant women (overall fetal loss/neonatal death reduction RR 0.84, 95% CI 0.71 to 0.99, 13 RCTs, 17,561 women; high-certainty), training versus not training traditional birth attendants in rural populations of low- and middle-income countries (stillbirth reduction odds ratio (OR) 0.69, 95% CI 0.57 to 0.83, 1 RCT, 18,699 women, moderate-certainty; perinatal death reduction OR 0.70, 95% CI 0.59 to 0.83, 1 RCT, 18,699 women, moderate-certainty). Clear evidence of harm: a reduced number of antenatal care visits probably results in an increase in perinatal death (RR 1.14 95% CI 1.00 to 1.31, 5 RCTs, 56,431 women; moderate-certainty evidence). Clear evidence of no effect or equivalence: there was evidence of no effect in the risk of stillbirth/fetal loss or perinatal death for the following interventions and comparisons: psychosocial interventions; and providing case notes to women. Possible benefit: community-based intervention packages (including community support groups/women's groups, community mobilisation and home visitation, or training traditional birth attendants who made home visits) may result in a reduction of stillbirth (RR 0.81, 95% CI 0.73 to 0.91, 15 RCTs, 201,181 women; low-certainty) and perinatal death (RR 0.78, 95% CI 0.70 to 0.86, 17 RCTs, 282,327 women; low-certainty). Unknown benefit or harm or no effect or equivalence: the effects were uncertain for other interventions examined. Screening and management of fetal growth and well-being Clear evidence of benefit: computerised antenatal cardiotocography for assessing infant's well-being in utero compared with traditional antenatal cardiotocography (perinatal mortality reduction RR 0.20, 95% CI 0.04 to 0.88, 2 RCTs, 469 women; moderate-certainty). Unknown benefit or harm or no effect or equivalence: the effects were uncertain for other interventions examined. AUTHORS' CONCLUSIONS: While most interventions were unable to demonstrate a clear effect in reducing stillbirth or perinatal death, several interventions suggested a clear benefit, such as balanced energy/protein supplements, midwife-led models of care, training versus not training traditional birth attendants, and antenatal cardiotocography. Possible benefits were also observed for insecticide-treated anti-malarial nets and community-based intervention packages, whereas a reduced number of antenatal care visits were shown to be harmful. However, there was variation in the effectiveness of interventions across different settings, indicating the need to carefully understand the context in which these interventions were tested. Further high-quality RCTs are needed to evaluate the effects of antenatal preventive interventions and which approaches are most effective to reduce the risk of stillbirth. Stillbirth (or fetal death), perinatal and neonatal death need to be reported separately in future RCTs of antenatal interventions to allow assessment of different interventions on these rare but important outcomes and they need to clearly define the target populations of women where the intervention is most likely to be of benefit. As the high burden of stillbirths occurs in low- and middle-income countries, further high-quality trials need to be conducted in these settings as a priority.


Assuntos
Morte Fetal/prevenção & controle , Morte Perinatal/prevenção & controle , Cuidado Pré-Natal/métodos , Natimorto , Cardiotocografia , Feminino , Desenvolvimento Fetal , Humanos , Recém-Nascido , Mosquiteiros Tratados com Inseticida , Tocologia , Avaliação Nutricional , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto
11.
BMJ Open ; 10(12): e040716, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371028

RESUMO

OBJECTIVES: After introduction of a more proactive post-term induction practice, stillbirth rates have decreased substantially throughout the first decade of this century in Denmark. The aim was to follow up on induction and stillbirth rates in Denmark. DESIGN: Historical ecological study. PARTICIPANTS: We included all delivering women in Denmark during the period 2007-2018. INTERVENTION: Induction rates from 41 weeks of gestation. MAIN OUTCOME MEASURE: Stillbirth rates from 41+0 weeks. RESULTS: Of 739 570 delivered children, 179 734 (24.3%) were born from 41+0 weeks. The proportion of deliveries after 41 weeks which were induced increased from 25.4% in 2007 to 44.4% in 2012. From 2012 to 2015, the induction rates decreased from 44.4% to 39.4%. After 2015 rates were stable.During the same period, stillbirth rates decreased from 1.30 in 2007/2008 to 0.38 per 1000 newborn in 2011/12; -54%. From 2012, however, the rates were doubled from 0.38 per 1000 in 2011/2012 to 0.74 per 1000 in 2015/2018; RR 1.97 (95% CI 1.02 to 3.81), p=0.033.Changes in the included potential confounders cannot explain neither the substantial fall in stillbirth rates from 2007/2008 to 2011/2012, nor the doubling in stillbirth rates after 41 weeks since 2012.During the whole study period, the cumulated risk of intrauterine foetal death increased from week 41+0 to 41+6 from 0.16 to 1.25 per 1000 ongoing pregnancies or 7.8 folds. Going beyond 42 weeks further increased the risk to 2.46 per 1000 ongoing pregnancies. CONCLUSION: We found a consistent inverse correlation between the proportion of women with induction of labour after 41 weeks of gestation and the stillbirth rates during the same period and same gestational ages. This Danish update on post-term inductions and corresponding stillbirth rates thus confirm previous findings suggesting a causal link between these two parameters.


Assuntos
Natimorto , Dinamarca/epidemiologia , Feminino , Morte Fetal , Idade Gestacional , Humanos , Recém-Nascido , Trabalho de Parto Induzido , Gravidez , Natimorto/epidemiologia
12.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370964

RESUMO

A young third gravida was referred with prenatal diagnosis of factor XIII deficiency at 20 weeks of pregnancy for Medical Termination of Pregnancy (MTP). Her first baby, who was born by emergency Lower Segment Caesarean Section (LSCS) for fetal distress, had intracranial haemorrhage in the early neonatal period and was investigated elsewhere and diagnosed to have factor XIII deficiency. The child currently has global developmental delay and cerebral palsy. The mother had a second-degree consanguineous marriage and the couple were diagnosed to be carriers of factor XIII deficiency. She had lot of barriers to get prenatal diagnosis during the second pregnancy and it ended up in Intra Uterine Fetal Death (IUFD) at 27 weeks. During the current pregnancy, prenatal diagnosis (PND) was done only after the second trimester amniocentesis and the genetic mutation was F13 A1, Ex12, C.1687 G>A. Second trimester MTP in a previous scarred uterus was difficult as it is essential to avoid scar rupture. PND during the first trimester is ideal.


Assuntos
Paralisia Cerebral/etiologia , Deficiências do Desenvolvimento/etiologia , Deficiência do Fator XIII/diagnóstico , Hemorragias Intracranianas/genética , Aborto Induzido , Amniocentese , Deficiência do Fator XIII/complicações , Deficiência do Fator XIII/genética , Deficiência do Fator XIII/prevenção & controle , Fator XIIIa/genética , Feminino , Morte Fetal , Testes Genéticos , Humanos , Lactente , Recém-Nascido , Hemorragias Intracranianas/complicações , Gravidez , Recidiva
13.
Medicine (Baltimore) ; 99(51): e23166, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371061

RESUMO

ABSTRACT: To identify the risk factors associated with velamentous cord insertion (VCI) and investigate the association between adverse pregnancy outcomes and VCI in singleton pregnancies and those with vasa previa.A total of 59,976 single cases admitted from Qinhuangdao Maternal and Child Health Hospital and Qinhuangdao Beidaihe Hospital from January 2004 to January 2014 were included in this study. We retrospectively analyzed the perinatal complications, neonatal complications, and the clinical features, as well as the Color Doppler ultrasonography findings of the velamentous placenta and placenta previa.We reviewed the clinical data of 59,976 women with singleton pregnancies delivered in Qinhuangdao Maternal and Child Health Hospital and Qinhuangdao Beidaihe Hospital from January 2004 to January 2014. Risk factors and the risks of adverse pregnancy outcomes including admission to a neonatal unit, fetal death, preterm delivery, low birth weight of <2500 g, the infant being small for its gestation age, low Apgar scores (<7) at 1 and 5 minute were evaluated separately among women with and without VCI by means of logistic regression analyses.The prevalence of velamentous umbilical cord insertion was 0.84%, and the prevalence of vasa previa was 0.0017%. The independent risk factors for VCI were nulliparity, obesity, fertility problems, placenta previa, and maternal smoking. VCI was associated with a 1.83-, 2.58-, 3.62-, and 1.41-fold increase in the risk of retention in the neonatal unit, preterm delivery (<37 gestation weeks), low birth weight, and small-for-gestational age, compared to pregnancies involving normal cord insertion. Of the women with VCI, 16.1% underwent emergency cesarean section compared to 8.9% (P < .001) of women without VCI.The prevalence of VCI was 0.84% in singletons. The results suggest that VCI is a moderate risk condition resulted in increased risks of prematurity and impairment of fetal growth.


Assuntos
Placenta Prévia/epidemiologia , Resultado da Gravidez/epidemiologia , Cordão Umbilical/patologia , Vasa Previa/epidemiologia , Adulto , Índice de Apgar , China/epidemiologia , Feminino , Morte Fetal/etiologia , Humanos , Recém-Nascido de Baixo Peso , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Placenta Prévia/diagnóstico por imagem , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal , Cordão Umbilical/diagnóstico por imagem , Vasa Previa/diagnóstico , Adulto Jovem
14.
Rev. iberoam. fertil. reprod. hum ; 37(3/4): 0-0, jul.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-199278

RESUMO

INTRODUCCIÓN: La pérdida del embarazo que ocurre tras las veinte semanas de gestación, se denomina muerte fetal (MF); es un evento que causa un gran impacto psicoemocional en la pareja afectada. La literatura médica afirma que, en casi la mitad de estos casos, no hay una causa conocida. Las causas principales están relacionadas son: síndrome antifosfolípido obstétrico (SAF), otras alteraciones inmunológicas (OIA), otros factores que pueden causar infarto placentario por coagulación, rotura prematura de membranas, preeclampsia y trombosis en la circulación útero-placentaria. MÉTODOS: Revisamos cuidadosamente la historia clínica y los estudios inmunológicos de una cohorte de 38 pacientes que han sufrido MF. RESULTADOS: Treinta y ocho pacientes (edades 36-42 años) fueron estudiadas. En más de la mitad de los pacientes (57 %) se diagnosticó SAF. El hipotiroidismo autoinmune (26 %), el anticuerpo antinuclear (24 %) comprendió el grupo de OIA. Once de 38 pacientes mostraron diferentes mutaciones de trombofilias. La hiperhomocisteinemia estuvo presente en el 53 % de los pacientes. CONCLUSIÓN: Las alteraciones inmunológicas y la trombofilia se asociaron con una proporción significativa de nuestros casos de MF. El diagnóstico de las causas evitables es necesario para evitar complicaciones obstétricas en embarazos futuros


INTRODUCTION: Pregnancy loss that occurs after the twenty weeks of gestation, termed foetal death (FD), is a rare event of pregnancy causing great psycho-emotional impact on the affected couple. Medical literature states that in nearly half of these cases, there is no known cause. Leading, causes are related to obstetric antiphospholipid syndrome (APS), other immunological alterations (OIA), other factors that may cause clotting placental infarction, premature rupture of membranes, preeclampsia, and thrombosis in the utero-placental circulation with subsequent FD. METHODS: We carefully reviewed the complete medical records and immunological studies of a cohort of 38 patients that have suffered FD. RESULTS: Thirty-eight patients (ages 36 - 42 years) were studied. In more than half of the patients (57%) APS was diagnosed. Autoimmune hypothyroidism (26%), antinuclear antibody (24%) comprised the group of OIA. Eleven out of 38 patients showed different thrombophilia mutations. Hyperhomocysteinemia was present in 53% of patients. CONCLUSION: Immunological alterations and thrombophilia were associated with a significant proportion of our FD cases. Diagnosis of preventable causes of FD is necessary in order to avoid any obstetric complications in future pregnancies


Assuntos
Humanos , Masculino , Gravidez , Adulto , Morte Fetal/etiologia , Complicações na Gravidez/etiologia , Fatores de Risco , Síndrome Antifosfolipídica/complicações , Doenças do Sistema Imunitário/complicações , Trombose/complicações , Trombofilia/complicações , Estudos de Coortes
15.
Medicine (Baltimore) ; 99(42): e21839, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080668

RESUMO

RATIONALE: Cloacal malformation (CM) is a serious type of anorectal and urogenital tract malformation. However, prenatal ultrasound (US) detection of CM is challenging. In this paper, we reported a rare case of CM prenatally diagnosed by US and magnetic resonance imaging (MRI), as well as reviewed the prenatal US and MRI characteristics of CM in the literature. PATIENT CONCERNS: A 30-year-old pregnant woman complained of cystic mass in the fetal abdomen detected by prenatal US. DIAGNOSIS: Fetus CM. INTERVENTIONS: The fetus was diagnosed as fetal CM by US and MRI, then the pregnant woman received a drug-induced labor treatment. After the neonate was delivered, the measurement was performed on the weight, length, head circumference, abdomen circumference, and bilateral thigh circumference. OUTCOMES: A female dead neonate was delivered from the vagina of the gravida, showing congenital anus absence. Prenatal ultrasound demonstrated right kidney duplication, hydronephrosis, and right ureteral dilatation. Meanwhile, prenatal MRI showed a cystic cavity, double collecting systems of right kidney, right ureteral dilatation, and right rectum dilatation. In addition, general parameters are as follows: weight: 2280 g; length: 39 cm; head circumference: 26.3 cm; abdomen circumference: 31 cm; right thigh circumference: 17 cm, and left thigh circumference: 18 cm. LESSONS: US combined with MRI can not only provide reliable evidence for fetal CM in the third trimester but also offer crucial information to the pregnant women to establish clinic treatment programs as early as possible.


Assuntos
Cloaca/anormalidades , Diagnóstico Pré-Natal/métodos , Adulto , Feminino , Morte Fetal , Humanos , Imagem por Ressonância Magnética , Gravidez , Ultrassonografia Pré-Natal
16.
Sci Rep ; 10(1): 18126, 2020 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-33093582

RESUMO

This systematic review and meta-analysis aimed to evaluate the impact of COVID-19 on pregnant women. We searched for qualified studies in PubMed, Embase, and Web of Science. The clinical characteristics of pregnant women with COVID-19 and their infants were reported as means and proportions with 95% confidence interval. Eleven studies involving with 9032 pregnant women with COVID-19 and 338 infants were included in the meta-analysis. Pregnant women with COVID-19 have relatively mild symptoms. However, abnormal proportions of laboratory parameters were similar or even increased, compared to general population. Around 30% of pregnant women with COVID-19 experienced preterm delivery, whereas the mean birth weight was 2855.9 g. Fetal death and detection of SARS-CoV-2 were observed in about 2%, whereas neonatal death was found to be 0.4%. In conclusion, the current review will serve as an ideal basis for future considerations in the treatment and management of COVID-19 in pregnant women.


Assuntos
Infecções por Coronavirus/patologia , Morte Perinatal/etiologia , Pneumonia Viral/patologia , Nascimento Prematuro/etiologia , Betacoronavirus/isolamento & purificação , Peso ao Nascer , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Feminino , Morte Fetal/etiologia , Humanos , Recém-Nascido , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Gravidez
17.
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
18.
J Perinat Med ; 48(9): 950-958, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-32975205

RESUMO

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.


Assuntos
Aborto Espontâneo/epidemiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Morte Fetal , Morte Perinatal , Pneumonia Viral/complicações , Complicações Infecciosas na Gravidez/virologia , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco
19.
Medicine (Baltimore) ; 99(39): e22499, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991490

RESUMO

INTRODUCTION: The clinical treatment is complicated for patients with placenta previa who must terminate pregnancy due to fetal malformation, death, or inevitable abortion in the second trimester. It is difficult to manage excessive bleeding during pregnancy termination; and those patients face risks of removing the uterus, infection and other complications. PATIENT CONCERNS: Two patients had placenta previa in the second trimester. Both cases had to terminate pregnancy. Case 1 patient had intrauterine fetal death. Case 2 patient had life-threatening vaginal bleeding. Both patients had bleeding and their cervix was not mature during vaginal delivery. DIAGNOSIS: After hospitalization, placenta previa was confirmed by magnetic resonance imaging for case 1 patient. Placenta previa was confirmed by ultrasound examination for case 2 patient. Both patients had to terminate pregnancy. INTERVENTIONS: We designed a new procedure using a cervical ripening balloon to reduce the risks during pregnancy termination for patients with placenta previa. A cervical ripening balloon was inserted through the placenta and placed between the fetus and placenta; external force was applied to keep the cervical ripening balloon pressing against the placenta that covers the cervical os. The cervical ripening balloon dilated the cervix, quickly reduced bleeding, and induced vaginal delivery during pregnancy termination for patients with placenta previa. This method was applied to 2 patients with placenta previa who must terminate pregnancy. OUTCOMES: Using the new method, both patients had a successful pregnancy termination and vaginal delivery with minimal bleeding. Total time from the balloon placement to the end of the delivery was about 3 hours. The procedure only used a cervical ripening balloon without uterine artery embolization needed. The fetus was delivered through the vagina; and the uterus was fully retained. There was no postpartum infection. CONCLUSION: This new method using a cervical ripening balloon could be a quick and effective way to reduce the risks during pregnancy termination for patients with placenta previa. It is especially helpful in emergency situations with minimal requirements of personnel and equipment. Our study showed great potential of this new utilization of a cervical ripening balloon, and is worthy of further research.


Assuntos
Aborto Induzido , Técnicas Hemostáticas/instrumentação , Placenta Prévia , Hemorragia Uterina/terapia , Adulto , Feminino , Morte Fetal , Humanos , Gravidez , Segundo Trimestre da Gravidez
20.
S Afr Med J ; 110(7): 667-670, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32880345

RESUMO

BACKGROUND: Trauma in pregnancy poses a unique challenge to clinicians. Literature on this topic is limited in South Africa (SA). OBJECTIVES: To review our institution's experience with the management of trauma in pregnancy in a developing-world setting. METHODS: This study was based at Grey's Hospital, Pietermaritzburg, SA. All pregnant patients who were admitted to our institution following trauma between December 2012 and December 2018 were identified from the Hybrid Electronic Medical Registry (HEMR). RESULTS: During the 6-year study period, 2 990 female patients were admitted by the Pietermaritzburg Metropolitan Trauma Service (PMTS), of whom 89 were pregnant. The mean age of these patients was 25.64 (range 17 - 43) years. The mechanism of injury was road traffic crash (RTC) in 39, stab wounds (SW) in 19, assault other than SW or gunshot wounds (GSW) in 19, GSW in 8, snake bite in 5, impalement in 1, dog bite in 1, hanging in 1, sexual assault in 1 and a single case of a patient being hit by a falling object. A subset of patients sustained >1 mechanism of injury. Thirty patients were managed operatively. The mean time of gestation was 19.16 (5 - 36) weeks. Three patients died, and there were 16 fetal deaths (including 3 lost after the mother's death). Forty-five fetuses were recorded as surviving at discharge, while 25 fetal outcomes were not specifically recorded. There were 2 threatened miscarriages and/or patients with vaginal bleeding, 1 positive pregnancy test with no recorded outcome and no premature births as a result of trauma. CONCLUSIONS: Trauma in pregnancy is relatively uncommon and mostly due to a RTC or deliberately inflicted trauma. Fetal outcome is largely dependent on the severity of the maternal injury, with injuries requiring laparotomy leading to a high fetal mortality rate.


Assuntos
Complicações na Gravidez/epidemiologia , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Feminino , Morte Fetal , Humanos , Gravidez , Complicações na Gravidez/cirurgia , África do Sul/epidemiologia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Centros de Traumatologia , Ferimentos e Lesões/cirurgia , Adulto Jovem
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