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2.
Medicine (Baltimore) ; 99(4): e18877, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977892

RESUMO

RATIONALE: Posterior reversible encephalopathy syndrome (PRES), a rare neurologic disorder, manifests as headache, altered mental status, seizures, visual disturbances, and other focal neurologic signs with typically reversible clinical symptoms and image changes. Although the underlying mechanism remains unknown, a current theory indicates cerebral autoregulation failure as the primary cause. We report a case of PRES with stroke in an adult with intrauterine fetal death (IUFD). PATIENT CONCERNS: A 35-year-old Asian woman with twin pregnancy underwent cesarean section at 32 weeks of gestation because of IUFD. She presented with focal seizures and visual field defect 2 days after undergoing cesarean section. Her blood pressure and kidney, liver, and coagulation functions were normal without proteinuria. DIAGNOSIS: PRES was diagnosed based on a series of brain magnetic resonance imaging findings. Ischemic infarction in the right frontal lobe eventually developed to encephalomalacia. INTERVENTIONS: The patient received levetiracetam and valproate for seizure management. OUTCOMES: Five days after the onset, seizures were under control. All neurologic deficits completely improved after 21 days of admission. LESSONS: PRES can occur in women with IUFD without preeclampsia or eclampsia symptoms. Although most cases result in vasogenic edema of the brain and exhibit good prognosis, PRES can cause cytotoxic edema and permanently damage the brain.


Assuntos
Morte Fetal/etiologia , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Complicações na Gravidez/diagnóstico , Acidente Vascular Cerebral/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Cesárea , Eletrocorticografia , Feminino , Humanos , Síndrome da Leucoencefalopatia Posterior/complicações , Gravidez , Gravidez de Gêmeos , Convulsões/etiologia
3.
BJOG ; 127(6): 702-707, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31846206

RESUMO

OBJECTIVE: To evaluate the mode of delivery and stillbirth rates over time among women with obstetric fistula. DESIGN: Retrospective record review. SETTING: Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia and Ethiopia. POPULATION: A total of 4396 women presenting with obstetric fistulas for repair who delivered previously in facilities between 1990 and 2014. METHODS: Retrospective review of trends and associations between mode of delivery and stillbirth, focusing on caesarean section (CS), assisted vaginal deliveries and spontaneous vaginal deliveries. MAIN OUTCOME MEASURES: Mode of delivery, stillbirth. RESULTS: Out of 4396 women with fistula, 3695 (84.1%) delivered a stillborn baby. Among mothers with fistula giving birth to a stillborn baby, the CS rate (overall 54.8%, 2027/3695) rose from 45% (162/361) in 1990-94 to 64% (331/514) in 2010-14. This increase occurred at the expense of assisted vaginal delivery (overall 18.3%, 676/3695), which declined from 32% (115/361) to 6% (31/514). CONCLUSIONS: In Eastern and Central Africa, CS is increasingly performed on women with obstructed labour whose babies have already died in utero. Contrary to international recommendations, alternatives such as vacuum extraction, forceps and destructive delivery are decreasingly used. Unless uterine rupture is suspected, CS should be avoided in obstructed labour with intrauterine fetal death to avoid complications related to CS scars in subsequent pregnancies. Increasingly, women with obstetric fistula add a history of unnecessary CS to their already grim experiences of prolonged, obstructed labour and stillbirth. TWEETABLE ABSTRACT: Caesarean section is increasingly performed in African women with stillbirth treated for obstetric fistula.


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Complicações do Trabalho de Parto/terapia , Fístula Retovaginal/terapia , Fístula Vesicovaginal/terapia , Adulto , África Central/epidemiologia , África Oriental/epidemiologia , Feminino , Morte Fetal , Humanos , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Resultado da Gravidez , Fístula Retovaginal/epidemiologia , Estudos Retrospectivos , Natimorto , Vácuo-Extração , Fístula Vesicovaginal/epidemiologia
5.
RECIIS (Online) ; 13(4): 863-876, out.-dez. 2019. ilus, tab
Artigo em Português | LILACS | ID: biblio-1047592

RESUMO

Este artigo se baseia em um estudo de série temporal sobre os óbitos fetais por malformações congênitas no estado do Maranhão relativo ao período de 2006 a 2016. Foram construídos indicadores epidemiológicos para estimar o risco de morte fetal e sua tendência ao longo da série estudada. Os dados são provenientes do Departamento de Informática do SUS e sua análise realizada por modelos de regressão linear. Foram registrados 17.843 óbitos fetais no período abordado pelo estudo, 528 dos quais decorrentes de malformações congênitas (2,96%). Observou-se uma tendência significativa de aumento do coeficiente de mortalidade fetal geral, correspondente a 6,99% (ß1=0,17; p=0,004) e do específico por malformações congênitas, equivalente a 5,13% (ß1=0,01; p=0,04). Os resultados deste estudo corroboram a tendência histórica dos serviços de saúde negligenciarem os óbitos fetais. É importante destacar que parte destes óbitos são preveníveis e potencialmente evitáveis. Desse modo, a implementação dos comitês de investigação de óbitos fetais e infantis e a sua vigilância adequada poderiam melhorar a assistência prestada tanto no pré-natal quanto no parto.


This article bases on a time series study about fetal deaths due to congenital malformations in the state of Maranhão, Brazil, occurred from 2006 to 2016. Epidemiological indicators were constructed to estimate the risk of fetal death and its trend throughout the series studied. The data were obtained in the Department of Informatics of SUS and analyzed by linear regression models. There were 17,843 fetal deaths during the analysed period, from which 528 were a direct result of congenital malformations (2.96%). A significant tendency towards an increase in the coefficient of general fetal mortality corresponding to 6.99% (ß1=0.17; p=0.004) and in the coefficient of specific fetal mortality due to congenital malformations equivalent to 5.13% (ß1=0.01; p=0.04) were observed. The end results of this study corroborate the historical trend toward negligence in Brazilian health centres with regard to fetal deaths. It is important to remark that some of these deaths can be presumed and potentially preventable. Thus, the implementation of the fetal and infant death investigation committees and their adequate surveillance could improve care during prenatal and delivery.


Este artículo se basa en un estudio de serie temporal acerca de muertes de fetos por malformaciones congénitas en el estado de Maranhão, Brasil, concerniente al periodo de 2006 a 2016. Se construyeron indicadores epidemiológicos para estimar el riesgo de la muerte fetal y su tendencia a lo largo de la serie estudiada. Los datos son provenientes del Departamento de Informática del SUS y fueron analizados por modelos de regresión lineal. Se registraron 17.843 muertes de fetos en el período estudiado, de los cuales 528 fueron resultado de malformaciones congénitas (2,96%). Se observó una tendencia significativa al aumento del coeficiente de mortalidad fetal general correspondiente a 6.99% (ß1=0,17; p=0,004) y del específico, por malformaciones congénitas, equivalente a 5,13% (ß1=0,01; p=0,04). Los resultados del estudio corroboran la tendencia histórica a la negligencia de los centros de salud brasileños con respecto a las muertes de los fetos. Por su importancia debemos destacar que parte de esas muertes son presumibles y pueden ser evitadas. De ese modo, la implementación de los comités de investigación de muertes de fetos y infantiles y su vigilancia adecuada podrían mejorar la asistencia prestada en el prenatal y en el parto.


Assuntos
Humanos , Anormalidades Congênitas/mortalidade , Mortalidade Fetal/tendências , Morte Fetal/etiologia , Cuidado Pré-Natal , Modelos Lineares , Estudos Retrospectivos , Estudos Ecológicos , Morte Fetal/prevenção & controle
7.
Medicine (Baltimore) ; 98(48): e18170, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31770267

RESUMO

RATIONALE: The umbilical cord is the way to exchange gas, supply nutrients, excrete metabolized. Thrombosis of the umbilical cord leads to fetal hypoxia, which jeopardizes fetal health and can cause fetal death. Umbilical vessel thrombosis, which is rarely reported, is difficult to detect prenatally. PATIENT CONCERNS: Both pregnant women had an unremarkable pregnancy course until a routine ultrasound scan in the third trimester showed a single umbilical artery. However, one umbilical vein and 2 umbilical arteries were seen during an ultrasound examination at 32 weeks. Case 2 had a better pregnancy outcome because of the timely discovery of this complication. DIAGNOSIS: Both cases were diagnosed as umbilical artery thrombosis. INTERVENTIONS: The first patient received no interventions until they reported decreased fetal movements and gradually disappear. The second patient underwent an emergency cesarean section. OUTCOMES: In Case 1, an emergency ultrasound examination showed intrauterine fetal death, and the patient vaginally delivered a stillborn child weighing 3300 g in a day. In Case 2, a female neonate weighing 2860 g was delivered by cesarean section, and exhibited Apgar scores of 10 and 10 at 1 and 5 minutes. CONCLUSION: In the late-term abortions, obstetricians should be vigilant if ultrasound imaging shows suspected umbilical vascular thrombosis or shows 1 umbilical artery when there had previously been 2. The fetus should be closely monitored and interventions implemented as early as possible to improve the prenatal detection rate of umbilical vessel thrombosis and avoid adverse pregnancy outcomes.


Assuntos
Cesárea/métodos , Intervenção Médica Precoce/métodos , Morte Fetal , Complicações Cardiovasculares na Gravidez , Trombose , Artérias Umbilicais , Adulto , Serviços Médicos de Emergência/métodos , Feminino , Morte Fetal/etiologia , Morte Fetal/prevenção & controle , Monitorização Fetal/métodos , Humanos , Recém-Nascido , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado da Gravidez , Natimorto , Trombose/complicações , Trombose/diagnóstico , Trombose/fisiopatologia , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/diagnóstico por imagem , Artérias Umbilicais/patologia
8.
JAMA ; 322(15): 1453-1454, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31613349
9.
S Afr Med J ; 109(9): 12723, 2019 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-31635598

RESUMO

BACKGROUND: Hypertensive disorders of pregnancy (HDP), including pre-eclampsia/eclampsia, account for significant maternal and fetal mortality globally and especially in South Africa. Objective. To formulate clinical guidelines for the management of HDP in order to substantially reduce the number of maternal deaths from HDP. Methods. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was used to formulate the guidelines and included six domains: scope and purpose; stakeholder involvement; rigour and development; clarity of presentation; applicability; and editorial independence. Recommendations. The guideline stipulates management strategies for all levels of care where women with hypertensive disorders in pregnancy are seen. It also has a detailed implementation plan. Conclusion. A clinical guideline that is of practical value has been formulated by a wide group of stakeholders. It is hoped that its dissemination and implementation by all doctors and nurses will reduce mortality and morbidity associated with HDP.


Assuntos
Morte Fetal/prevenção & controle , Hipertensão Induzida pela Gravidez/terapia , Morte Materna/prevenção & controle , Feminino , Mortalidade Fetal , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Mortalidade Materna , Gravidez , África do Sul
10.
Int J Gynaecol Obstet ; 147(3): 301-312, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493314

RESUMO

BACKGROUND: Optimal dose, interval, and administration route of misoprostol with added benefit of mifepristone for management of second trimester intrauterine fetal death (IUFD) are not established. OBJECTIVES: To assess effectiveness, safety, and acceptability of medical management of second trimester IUFD. SEARCH STRATEGY: Research databases from January 2006 to October 2018. SELECTION CRITERIA: Randomized controlled trials with IUFD cases at 14-28 weeks of gestation. DATA COLLECTION AND ANALYSIS: We screened and extracted data, assessed risk of bias, conducted analyses, and assessed overall certainty of the evidence. MAIN RESULTS: Sixteen trials from 1695 citations. When misoprostol is used alone, 400 µg is more effective than 200 µg (RR 0.78; 95% CI, 0.66-0.92, moderate certainty evidence); the sublingual route is more effective than the oral route (RR 0.88; 95% CI, 0.70-1.11, low certainty evidence). There may be little to no difference between the sublingual and vaginal route (RR 0.93; 95% CI, 0.85-1.03, low certainty evidence). Certainty of evidence related to mifepristone-misoprostol regimens and safety and acceptability is very low. CONCLUSIONS: Misoprostol 400 µg every 4 hours, sublingually or vaginally, may be effective. We cannot draw conclusions about safety and acceptability, or about the added benefits of mifepristone.


Assuntos
Abortivos não Esteroides/administração & dosagem , Abortivos Esteroides/administração & dosagem , Aborto Induzido/métodos , Morte Fetal , Mifepristona/administração & dosagem , Misoprostol/administração & dosagem , Aborto Induzido/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(9): 886-889, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31506147

RESUMO

OBJECTIVE: To investigate the short-term prognosis of the co-twin who survives after single intrauterine fetal demise (sIUFD). METHODS: A total of 52 infants who survived after sIUFD were enrolled as the case group, and 104 twins, matched for gestational age, from a pair of live-born twins without sIUFD were enrolled as the control group. Related clinical data were compared between the two groups. RESULTS: Among the 52 infants who survived after sIUFD, 42 (80.8%) were preterm infants, 13 (25.0%) had brain injury, and 3 (5.8%) died in the neonatal period. Compared with the control group, the case group had significantly higher incidence rates of meconium stained amniotic fluid/bloody amniotic fluid/polyhydramnios/hypamnion, torsion of cord/nuchal cord, and placenta previa/placenta abruption, as well as significantly higher incidence rates of birth asphyxia, anemia or polycythemia at birth, and coagulation disorder at birth (P<0.05). The case group also had significantly higher incidence rates of nosocomial infection and brain injury than the control group during hospitalization (P<0.05). CONCLUSIONS: There is an increase in the incidence rate of complications in the co-twin who survives after sIUFD. Prenatal evaluation and long-term follow-up should be performed for the surviving co-twin.


Assuntos
Recém-Nascido Prematuro , Resultado da Gravidez , Prognóstico , Feminino , Morte Fetal , Humanos , Recém-Nascido , Gravidez , Gêmeos
12.
Res Q Exerc Sport ; 90(4): 589-599, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31397647

RESUMO

Purpose: The role of a structured program of exercise training on the low-risk pregnancy in Iranian women undergoing in vitro fertilization (IVF) based on the reduction of gestational diabetes was examined. Method: A comparative quasi-experimental clinical trial with 170 IVF-pregnant women in two intervention and control groups was studied to monitor the training effect of physical activities in terms of walking, and aerobic, strength-conditioning, and relaxation exercises during pregnancy on the improvement of maternal and fetal health. Gestational diabetes as the main complication was evaluated with 2-h 75-g OGTT and FBS tests in 24-28 and 34- weeks' gestation, respectively. Other adverse maternal (e.g., preeclampsia, cesarean section, and preterm delivery) and neonatal (e.g., intrauterine growth retardation, low/high birth weight, and fetal death) outcomes were determined and analyzed by statistical and regression tests. Results: A significantly lower gestational diabetes and preeclampsia rate was found in the intervened IVF-pregnant women with the maintenance of an active lifestyle. Although there was no significant difference in other negative maternal and neonatal outcomes between the two groups, lower symptoms from these complications were recorded in IVF-pregnant women trained with regular exercise activities. Conclusion: Implementing the physical activity program by IVF-women during pregnancy is an effective intervention strategy in reducing the risk of adverse maternal and fetal outcomes.


Assuntos
Exercício Físico/fisiologia , Fertilização In Vitro , Resultado da Gravidez , Adulto , Peso ao Nascer , Cesárea/estatística & dados numéricos , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/prevenção & controle , Feminino , Morte Fetal/prevenção & controle , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/prevenção & controle , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/prevenção & controle , Recém-Nascido Prematuro , Irã (Geográfico)/epidemiologia , Pessoa de Meia-Idade , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/prevenção & controle , Gravidez , Prevalência , Adulto Jovem
13.
Forensic Sci Int ; 302: 109888, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400617

RESUMO

INTRODUCTION: Pregnant women often suffer from negative fetal outcomes, despite wearing a seatbelt correctly. When restrained vehicle passengers are involved in a frontal collision without suffering from any injuries, the forces they experience are particularly concentrated in the chest because of the seatbelt. We analyzed the biomechanics of chest injuries sustained by restrained pregnant drivers and possible effects of these injuries on the fetus. MATERIAL AND METHODS: The Maternal Anthropometric Measurement Apparatus dummy, version 2B, representing a pregnant woman at 30 weeks of gestation, was used. Sled tests were performed for recreating frontal impact situations with vector velocity changes at impact speeds of 13, 26, and 40km/h. Overall kinematics of the dummy were examined using high-speed video imaging. Quantitative dummy responses, such as time course of acceleration of the sled and chest, pressure of the belt, and deflection of the chest (right and left) during impact were also measured. RESULTS: Although collision velocities were different, the distances of forward movement of the dummy were similar (121-129mm) owing to the safety devices. However, maximum deflection of the chest (35.4mm to the left and 15.7mm to the right) was obtained at a 26-km/h collision. Additionally, maximum deflection of 28.7mm to the left and 10.9mm to the right of the chest were obtained at 40km/h. CONCLUSIONS: Because the uterus enlarges and the fundus reaches the lower part of the rib cage during late pregnancy, we consider that the reason for negative fetal outcomes is partly owing to chest compression and subsequent applied forces on the uterus, even in minor to moderate frontal collisions. This knowledge may be useful for forensic scientists who determine the causes and mechanisms of a fetal death or the offenders' responsibilities for both maternal and fetal outcomes when the mother is involved in a frontal vehicle collision.


Assuntos
Acidentes de Trânsito , Cintos de Segurança/efeitos adversos , Traumatismos Torácicos/etiologia , Air Bags , Fenômenos Biomecânicos , Feminino , Morte Fetal , Humanos , Manequins , Gravidez , Pressão/efeitos adversos
14.
BMC Pregnancy Childbirth ; 19(1): 276, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382995

RESUMO

BACKGROUND: Implementation of high-quality national audits for perinatal mortality are needed to improve the registration of all perinatal deaths and the identification of the causes of death. This study aims to evaluate the implementation of a Regional Audit System for Stillbirth in Emilia-Romagna Region, Italy. METHODS: For each stillbirth (≥ 22 weeks of gestation, ≥ 500 g) occurred between January 1, 2014 to December 1, 2016 (n = 332), the same diagnostic workup was performed and a clinical record with data about mother and stillborn was completed. Every case was discussed in a multidisciplinary local audit to assess both the cause of death (ReCoDe classification) and the quality of care. Data were reviewed by the Regional Audit Group. Stillbirth rates, causes of death and the quality of care were established for each case. RESULTS: Total stillbirth rate was 3.09 per 1000 births (332/107,528). Late stillbirth rate was 2.3 per 1000 (251/107,087). Sixteen stillbirths were not registered by the Regional Birth Register. The most prevalent cause of death was placental disorder (33.3%), followed by fetal (17.6%), cord (14.2%) and maternal disorders (7.6%). Unexplained cases were 14%. Compared to local audits, the regional group attributed different causes of death in 17% of cases. At multivariate analysis, infections were associated with early stillbirths (OR 3.38, CI95% 1.62-7.03) and intrapartum cases (OR 6.64, CI95% 2.61-17.02). Placental disorders were related to growth restriction (OR 1.89, CI95% 1.06-3.36) and were more frequent before term (OR 1.86, CI95% 1.11-3.15). Stillbirths judged possibly/probably preventable with a different management (10.9%) occurred more frequently in non-Italian women and were mainly related to maternal disorders (OR 6.64, CI95% 2.61-17.02). CONCLUSIONS: Regional Audit System for Stillbirth improves the registration of stillbirth and allows to define the causes of death. Moreover, sub-optimal care was recognized, allowing to identify populations which could benefit from preventive measures.


Assuntos
Doenças Fetais/epidemiologia , Retardo do Crescimento Fetal/epidemiologia , Doenças Placentárias/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Qualidade da Assistência à Saúde , Natimorto/epidemiologia , Adulto , África ao Sul do Saara/etnologia , África do Norte/etnologia , Causas de Morte , Auditoria Clínica , Europa Oriental/etnologia , Feminino , Morte Fetal/etiologia , Humanos , Índia/etnologia , Itália/epidemiologia , Análise Multivariada , Morte Perinatal/etiologia , Gravidez , Complicações na Gravidez/epidemiologia , Fatores de Risco , Cordão Umbilical
15.
BMC Pregnancy Childbirth ; 19(1): 311, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455300

RESUMO

BACKGROUND: Monochorionic multifetal pregnancies are at increased risk of adverse perinatal outcome because of placental vascular anastomoses. We present a case of multicystic encephalomalacia and gastrointestinal injury in two surviving fetuses following single fetal death in first trimester and subsequent fetofetal transfusion syndrome in a monochorionic triplet pregnancy. CASE PRESENTATION: A 31-year-old nulliparous woman had a spontaneous monochorionic triamniotic triplet pregnancy. Three live fetuses with single placenta were seen at 8-week ultrasound scan. One fetus demised at 11 weeks and 3 days of gestation. Dilated echogenic bowel and ascites were found in one surviving fetus at 23 weeks of gestation. At 28 weeks of gestation, the pregnancy was complicated by fetofetal transfusion syndrome in which discordant amniotic fluid volumes were found. Two days later, emergency Caesarean section was performed because of worsening of fetal Doppler and biophysical profile. One baby was found to have jejunal atresia requiring surgery at 4 days old. He had periventricular leukomalacia and intracranial haemorrhage, but subsequent normal neurological development. Another baby had gastric perforation requiring surgery at 2 days old. He was confirmed to have multicystic encephalomalacia by cranial ultrasound and magnetic resonance imaging. He suffered from developmental delay, epilepsy and cerebral palsy. CONCLUSION: This case alerts the obstetricians the possible hypoxic-ischemic injury to the survivors of monochorionic triplet pregnancy after the co-triplet death in the first trimester and fetofetal transfusion syndrome. Antenatal assessment and postnatal follow-up are important for these high-risk multiple pregnancies.


Assuntos
Encefalomalacia/etiologia , Transfusão Feto-Fetal/etiologia , Trato Gastrointestinal/lesões , Gravidez de Trigêmeos , Adulto , Cesárea , Feminino , Morte Fetal , Humanos , Gravidez , Resultado da Gravidez , Primeiro Trimestre da Gravidez
16.
Medicine (Baltimore) ; 98(34): e16883, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441864

RESUMO

Previous adverse pregnancy outcomes (APO) in women with hereditary thrombophilia have emerged as new indications for prophylactic use of low-molecular-weight heparin (LMWH) during pregnancy. Recent meta-analysis conducted to establish if LMWH may prevent recurrent placenta-mediated pregnancy complications point to important therapeutic effect but these findings are absolutely not universal. Furthermore, previous studies regarding LMWH prophylaxis for APO in women with inherited thrombophilia were performed in high risk patients with previous adverse health outcomes in medical, family and/or obstetric history. Therefore, the aim of this study was to investigate the effects of LMWH prophylaxis on pregnancy outcomes in women with inherited thrombophilias regardless of the presence of previous adverse health outcomes in medical, family, and obstetric history.Prospective analytical cohort study included all referred women with inherited thrombophilia between 11 and 15 weeks of gestation and followed-up to delivery. Patients were allocated in group with LWMH prophylaxis (study group) and control group without LWMH prophylaxis. The groups were compared for laboratory parameters and Doppler flows of umbilical artery at 28 to 30th, 32nd to 34th and 36th to 38th gestational weeks (gw), and for obstetric and perinatal outcomes.The study group included 221 women and control group included 137 women. Mean resistance index of the umbilical artery Ri in 28 to 30, 32 to 34, and 36 to 38 gw were significantly higher in the control group compared to study group (0.71 ±â€Š0.02 vs 0.69 ±â€Š0.02; 0.67 ±â€Š0.03 vs 0.64 ±â€Š0.02; and 0.67 ±â€Š0.05 vs 0.54 ±â€Š0.08, respectively). Intrauterine fetal death (IUFD) and miscarriages were statistically significantly more frequent in control group compared to the patients in study (P < .001). The frequencies of fetal growth restriction (FGR) and APO were significantly higher in the control group compared to the study group (P = .008 and P < .001, respectively). In a multivariate regression model with APO as a dependent variable, only Ri was detected as a significant protective factor for APO, after adjusting for age and LMWH prophylaxis (P < .001).We have demonstrated better perinatal outcomes in women with LMWH prophylaxis for APO compared to untreated women.


Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Complicações Hematológicas na Gravidez/tratamento farmacológico , Trombofilia/tratamento farmacológico , Aborto Espontâneo/prevenção & controle , Adulto , Estudos de Casos e Controles , Feminino , Morte Fetal/prevenção & controle , Retardo do Crescimento Fetal/prevenção & controle , Humanos , Recém-Nascido , Nascimento Vivo/epidemiologia , Gravidez , Estudos Prospectivos
17.
Science ; 365(6449): 118-119, 2019 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-31296753
18.
Ital J Pediatr ; 45(1): 85, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319890

RESUMO

BACKGROUND: Turner syndrome (45,X), accounts for 1-2% of conceptions which typically miscarry early in the first trimester. Cases detected prenatally often present with cystic hygroma, which is an ultrasound marker for aneuploidy generally, but Turner syndrome particularly. In this study, we report a second trimester intrauterine fetal demise (IUFD), complicated by a marked cystic hygroma and bilateral syndactyly of the fingers and toes. CASE PRESENTATION: A 25-year-old woman presented for her first prenatal visit at 22-week gestation with IUFD. Color Doppler ultrasound revealed a septated nuchal lymphatic hygroma and hydrops fetalis, characterized by edema of the whole body, substantial pleural effusion and abdominal fluid. Pregnancy was further complicated by oligohydramnios. Following labor induction, a stillborn female baby was delivered at 22 weeks gestation. Autopsy confirmed the presence of huge nuchal cystic hygroma (10 cm × 10 cm × 6 cm) and generalized edema. Bilateral, partial syndactyly involving digits 2-5 of the fingers and toes were also observed. Chromosomal analysis revealed a 45,X karyotype. CONCLUSIONS: We investigated an unusual case of severe septated nuchal cystic hygroma associated with bilateral syndactyly of the fingers and toes in a stillborn infant with Turner syndrome. Although cystic hygroma has been frequently reported in 45,X the severity is marked in this case. In addition, syndactyly is not a typical complication of Turner syndrome. This case emphasizes the importance of early ultrasound in pregnancy.


Assuntos
Hidropisia Fetal/diagnóstico por imagem , Linfangioma Cístico/diagnóstico por imagem , Sindactilia/diagnóstico por imagem , Síndrome de Turner/diagnóstico por imagem , Adulto , Feminino , Morte Fetal , Humanos , Oligo-Hidrâmnio/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Gravidez , Diagnóstico Pré-Natal , Ultrassonografia Pré-Natal
19.
Med J Aust ; 211(3): 134-141, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31271467

RESUMO

Infections in pregnancy represent a challenging and often underappreciated area of concern for many specialists and general practitioners and can cause serious sequelae. Antenatal status should be highlighted on pathology request forms, as this serves to alert the laboratory of the need to store serum for an extended period. Prior antenatal specimens can be forwarded to other laboratories to enable testing in parallel with the more recent sample. Women with a confirmed, potentially vertically transmissible infection should be referred to a specialist with expertise in the management of perinatal infections. Cytomegalovirus infection is the most common congenital infection. Women who care for young children are at greater risk of exposure to the virus. Preventive steps including hand hygiene and avoiding contact with children's urine, mucous and saliva are recommended for all pregnant women. The incidence of parvovirus B19 infection in pregnancy is unknown. This infection is highly contagious and may result in fetal loss; particularly in the first half of pregnancy, pregnant women should avoid contact with adults or children who may have an infection.


Assuntos
Infecções por Citomegalovirus/complicações , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/métodos , Antivirais/uso terapêutico , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/prevenção & controle , Feminino , Morte Fetal/etiologia , Humanos , Incidência , Infecções por Parvoviridae/epidemiologia , Parvovirus B19 Humano/isolamento & purificação , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Fatores de Risco
20.
Medicine (Baltimore) ; 98(23): e15788, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169678

RESUMO

Data based on forensic autopsy in neonates and infants in China are rare in the literature. The purpose of this study is to evaluate the characteristics of fetal, neonatal, and infant death and to determine the main cause of death among them.A retrospective analysis of fetal and infant forensic autopsies referred to the Tongji Forensic Medical Center (TFMC) in Hubei, central China, during a 16-year period between January 1999 and December 2014, was performed.In this period, there were 1111 males and 543 females; the total male-to-female ratio (MFR) was 2.05:1. There were 173 fetal and infant autopsies conducted, comprised of 43 fetal, 84 neonatal (<28 days) and 46 infant (4 weeks to 1 year) cases. The annual case number ranged from 5 in 2004 to 18 in 2014 (annual mean of 10.8). MFR was 1.75:1. About 94% of these deaths (163/173) resulted from natural causes, 6 cases (3.5%) were accidental deaths, and 4 (2.3%) resulted from homicide (4 abandoned babies). Among fetuses, the most common causes of death were placental and umbilical cord pathologies (28%, 12/43), followed by intrapartum asphyxia resulting from amniotic fluid aspiration (AFA) or meconium aspiration syndrome (MAS) (18.6%, 8/43), congenital malformation (14%, 6/43), and intrapartum infection (9.3%, 4/43). A majority of neonatal deaths (66.7%, 56/84) died within 24 hours of birth. The main causes of neonatal death were asphyxia resulting from AFA, MAS, or hyaline membrane disease, and congenital malformation. The main causes of infant (1-12 months) death were infectious diseases, including pneumonia, meningitis, and viral brainstem encephalitis.This study was the 1st retrospective analysis of autopsies of fetal, neonatal, and infant death in TFMC and central China. We delineate the common causes of early demise among cases referred for autopsy, and report a male preponderance in this population. Our data observed that placental and/or umbilical cord pathology, asphyxia due to AFA, and/or MAS, and pneumonia were the leading causes of fetal, neonatal, and infant death, respectively. And it can inform clinical practitioners about the underlying causes of some of the most distressing cases in their practices.


Assuntos
Morte Fetal/etiologia , Doenças Fetais/mortalidade , Morte do Lactente/etiologia , Doenças do Recém-Nascido/mortalidade , Morte Perinatal/etiologia , Asfixia Neonatal/mortalidade , Autopsia , Causas de Morte , China , Feminino , Patologia Legal , Humanos , Lactente , Recém-Nascido , Masculino , Síndrome de Aspiração de Mecônio/mortalidade , Pneumonia/mortalidade , Gravidez , Estudos Retrospectivos
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