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1.
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
2.
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
3.
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
4.
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
5.
Natl Vital Stat Rep ; 69(4): 1-20, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32510316

RESUMO

Objectives-This report presents data on fetal cause of death by maternal age, maternal race and Hispanic origin, fetal sex, period of gestation, birthweight, and plurality. Methods-Descriptive tabulations of data collected on the 2003 U.S. Standard Report of Fetal Death are presented for fetal deaths occurring at 20 weeks of gestation or more for 2015-2017 in a reporting area of 34 states and the District of Columbia, in which less than 50% of deaths were attributed to Fetal death of unspecified cause (P95). Cause-of-death reporting in this area was based on the 2003 fetal death report revision and represents 60% of fetal deaths occurring in the United States during this time. Causes of death are processed in accordance with the International Classification of Diseases, 10th Revision. Results-Five selected causes account for 89.5% of fetal deaths in the reporting area: Fetal death of unspecified cause; Fetus affected by complications of placenta, cord and membranes; Fetus affected by maternal complications of pregnancy; Congenital malformations, deformations and chromosomal abnormalities; and Fetus affected by maternal conditions that may be unrelated to present pregnancy. Conclusions-Cause-of-fetal-death data reported on vital records enable new comparisons of maternal and fetal characteristics and provide information for a larger proportion of the country than other studies. While limited variation was seen among the selected causes across the maternal and fetal characteristics examined, many of the observed variations are consistent with associations that have been documented in the research literature.


Assuntos
Causas de Morte/tendências , Morte Fetal/etiologia , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Gravidez , Fatores de Risco , Estados Unidos/epidemiologia , Estatísticas Vitais
6.
J Card Surg ; 35(7): 1589-1596, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32484993

RESUMO

Cardiac disease is the leading cause of maternal mortality in the United Kingdom. Major causes of cardiac death in pregnant women include cardiomyopathies, myocardial infarction, ischemic heart disease, and aortic dissection. Uncorrected congenital heart disease and women who have had corrective or palliative surgery may have complicated pregnancies as well. Some women with significant cardiac disease are unable to meet the increased physiological demands of pregnancy. Of these, those who do not respond to medical treatment may require surgical correction such as coronary artery bypass grafting. The risk of cardiac operations for pregnant women is similar to that for nonpregnant women but the fetal mortality rate remains high. Contributing factors to high fetal mortality rates include timing, urgency of operation, and the fetal/fetoplacental response to cardiopulmonary bypass. The aim of this review is to summarize current evidence in utilizing the different management approaches of cardiac issues during pregnancy.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/métodos , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Ponte Cardiopulmonar , Ponte de Artéria Coronária , Tomada de Decisões , Feminino , Morte Fetal/etiologia , Humanos , Comunicação Interdisciplinar , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado da Gravidez , Adulto Jovem
7.
Cardiovasc Pathol ; 47: 107221, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32371340

RESUMO

Unexpected sudden cardiac death (SCD), sudden infant death syndrome (SIDS) and sudden intrauterine unexplained death (SIUD) are major unsolved, devastating forms of death that occur frequently. Obstructive sleep apnea (OSA) has been associated with increased cardiovascular and cerebrovascular morbidity and mortality, including sudden cardiac death (SCD). This editorial will review the pathology of SCD, including sudden infant death syndrome (SIDS) and sudden intrauterine unexplained death (SIUD); OSA with its cardiovascular consequences; the possible link between SCD and OSA, discussing the potential mechanisms underlying these two frequent, but yet overlooked pathologies. Finally, the possible preventive benefits of treating OSA and identifying patients at common risk for OSA and SCD and SIDS-SIUD to prevent unexpected deaths will be discussed. Post-mortem examination is of great importance in every case of SCD sine materia, with examination of the brainstem and cardiac conduction system on serial sections, when general autopsy fails, but it should be stressed that also the investigations of patients suffering from OSA should focus on the possibility of pathological findings in common with cases of SCD.


Assuntos
Tronco Encefálico/patologia , Morte Súbita Cardíaca/patologia , Morte Fetal/etiologia , Sistema de Condução Cardíaco/patologia , Apneia Obstrutiva do Sono/patologia , Morte Súbita do Lactente/patologia , Tronco Encefálico/imunologia , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Feminino , Morte Fetal/prevenção & controle , Sistema de Condução Cardíaco/imunologia , Humanos , Lactente , Recém-Nascido , Mediadores da Inflamação/imunologia , Gravidez , Prognóstico , Fatores de Risco , Apneia Obstrutiva do Sono/imunologia , Apneia Obstrutiva do Sono/mortalidade , Apneia Obstrutiva do Sono/terapia , Morte Súbita do Lactente/epidemiologia , Morte Súbita do Lactente/imunologia , Morte Súbita do Lactente/prevenção & controle
8.
Am J Obstet Gynecol ; 223(4): 576.e1-576.e8, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32335054

RESUMO

BACKGROUND: Postprocedural amniotic band disruption sequence is a condition that is associated with intrauterine interventions, and it is characterized by a constriction of the limbs or umbilical cord by fibrous strands, leading to edema, amputation, and/or fetal demise. OBJECTIVE: To evaluate the prevalence of, risk factors for, and the outcome of postprocedural amniotic band disruption sequence after fetoscopic laser surgery in twin-twin transfusion syndrome cases. STUDY DESIGN: All consecutive cases of twin-twin transfusion syndrome treated with fetoscopic laser coagulation of the vascular anastomoses at our center between January 2002 and March 2019 were included in the study. The occurrence of postprocedural amniotic band disruption sequence in these cases was recorded, and the potential risk factors were analyzed. RESULTS: Postprocedural amniotic band disruption sequence was detected, at birth, in 2.2% (15/672) of twin-twin transfusion syndrome cases treated with fetoscopic laser surgery, in both the recipients (10/15, 67%) and the donors (5/15, 33%). Postprocedural amniotic band disruption sequence primarily affected the lower extremities (11/15, 73%) and, less frequently, the upper extremities (2/15, 13%), both the upper and lower extremities (1/15, 7%), or the umbilical cord (1/15, 7%). Postprocedural amniotic band disruption sequence led to the amputation of toes in 5 of 15 cases (33%) and resulted in fetal demise because of constriction of the umbilical cord in 1 case (7%). The independent risk factors identified for postprocedural amniotic band disruption sequence were lower gestational age at laser surgery (odds ratio per week, 1.43; 95% confidence interval, 1.12-1.79; P=.003) and the presence of postprocedural chorioamniotic membrane separation on antenatal ultrasound examination (odds ratio, 41.66; 95% confidence interval, 5.44-319.25; P<.001). CONCLUSION: The prevalence of postprocedural amniotic band disruption sequence is low, but, when present, it may lead to severe consequences, with amputation of extremities or fetal demise occurring in more than one-third of the cases. Lower gestational age at the time of laser therapy and chorioamniotic membrane separation are independent risk factors for the postprocedural amniotic band disruption sequence.


Assuntos
Síndrome de Bandas Amnióticas/epidemiologia , Transfusão Feto-Fetal/cirurgia , Fetoscopia , Terapia a Laser , Complicações Pós-Operatórias/epidemiologia , Âmnio , Síndrome de Bandas Amnióticas/complicações , Síndrome de Bandas Amnióticas/fisiopatologia , Córion , Feminino , Morte Fetal/etiologia , Idade Gestacional , Humanos , Doença Iatrogênica , Extremidade Inferior , Complicações Pós-Operatórias/fisiopatologia , Gravidez , Prevalência , Fatores de Risco , Cordão Umbilical , Extremidade Superior
9.
PLoS One ; 15(4): e0230478, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32240197

RESUMO

BACKGROUND: Approximately one-third of the global stillbirth burden occurs during intrapartum period. The ability to assess obstetric parameters including effacement, dilatation, uterine contraction, decent, rupture of the uterus, and moulding of the foetal head are among the essential competencies required by obstetric service providers admitting women for labour in health facilities. Misdiagnosis of these conditions could result in unnecessary obstetric interventions and unfavourable obstetric outcomes including intrapartum stillbirth. This study aimed to assess associations between missed diagnosis plus complication of labour on admission and intrapartum stillbirth. METHODS: A case-control study using primary data from chart review of medical records of women who experienced intrapartum stillbirth in 20 public health centres and three public hospitals of Addis Ababa between 01 July 2010 and 30 June 2015 was conducted. Data were collected from charts of all cases meeting the inclusion criteria. Medical records of women with livebirths were randomly selected and reviewed from each public health facilities in two to one (2:1) control to case ratio. Accordingly, 728 cases of stillbirth out of 1,056 charts met the inclusion criteria whereas 1,551 controls out of 1,705 were also considered in the study. RESULTS: Proportionally, more women in the stillbirth group (39.4%) than in the livebirth group (30.2%) experienced ruptured membrane on admission, with the difference being statistically significant (OR 1.7, 95% CI 1.37-2.03). Significantly higher proportion of women in the intrapartum stillbirth group experienced FRH lower than 110/min, a result suggestive of foetal distress on admission. Proportionally, more women in the intrapartum stillbirth group (14.5%) than in the livebirth group (4.5%) had breech foetal presentation on admission for labour, the difference being statistically significant (aOR 3.26 95% CI 1.93-5.50). Intrapartum stillbirth was slightly higher among women with cervical dilatation 4cm or more on admission (OR 1.2, 95% CI 1.00-1.45). This could be owing to delay in seeking obstetric care or misdiagnosis of the condition, a situation that seeks more rigorous study to determine the underlying causal links. Diagnosis of foetal member was missed among more cases than controls where the difference was statistically significant (aOR 1.51, CI 1.03-2.19). CONCLUSION: Low FHR, non-vertex foetal presentations and ruptured cervical membrane were predictors of intrapartum stillbirth. Health facilities could avert unnecessary foetal loss by undertaking timely actions to manage obstetric emergencies on admission to labour.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Morte Fetal/etiologia , Instalações de Saúde/estatística & dados numéricos , Complicações do Trabalho de Parto/fisiopatologia , Natimorto/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Etiópia , Feminino , Morte Fetal/prevenção & controle , Coração Fetal/fisiologia , Monitorização Fetal/métodos , Humanos , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
10.
Indian J Pharmacol ; 52(1): 53-55, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32201448

RESUMO

During pregnancy, iron-deficiency anemia if untreated can affect the mother and child and hence iron is supplemented. Intolerance to oral iron therapy and malabsorption are common indications for parenteral iron therapy. The regularly used intravenous iron preparations are iron sucrose, sodium ferric gluconate, and iron dextran, of which iron sucrose has a satisfactory safety profile. We report a case of iron sucrose causing rare reaction with generalized edema in the mother, which was followed by intrauterine death. The oxidative stress due to immune-mediated mechanisms or adjuvant used in iron sucrose could cause mild rashes to severe anaphylactic reactions. This case report warns us toward the use of parenteral iron preparations in pregnant women, as one of the safe formulations could lead to an unusual fatal outcome in the fetus.


Assuntos
Hipersensibilidade a Drogas/etiologia , Óxido de Ferro Sacarado/efeitos adversos , Morte Fetal/etiologia , Hematínicos/efeitos adversos , Adulto , Anemia Ferropriva/tratamento farmacológico , Feminino , Humanos , Gravidez
11.
Taiwan J Obstet Gynecol ; 59(1): 1-7, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32039774

RESUMO

Electrical injuries can occur in pregnant women but currently their incidence is not completely known. Notwithstanding, those represent clinical important events such maternal and fetal death, which can be avoided if properly managed. The objective of this paper is to describe the results of electrical injury (high and low voltage), in pregnant women in scientific reports. A systematic search was performed with keywords "electrical injuries", "lightning injuries", "lightning strike", "pregnant women" and "pregnancy", using the databases: MedLine, Scielo, Lilacs, Clinical key, Web of Science, Scopus, Springer, Science Direct, Embase and Medic Latina. Filters like language, time, design and availability of text were not used. Descriptive analyses were carried out for variables such as maternal-fetal consequences, voltage and type of exposure, based on the reports identified. From the total 74 cases identified, 71.1% survived after the exposition. From the total live-births 28.6% did not show any alteration, 7.1% presented maceration and burns, while 64.3% had another outcome. Electric injury leads to fetal compromise and death in exposed pregnant women, mainly in the first hours after the injury. However, monitoring should be continued for the risk of complications such as placenta abruption, oligohydramnios and fetal distress. It is possible an underreporting of these events.


Assuntos
Traumatismos por Eletricidade/fisiopatologia , Morte Fetal/etiologia , Sofrimento Fetal/etiologia , Lesões Pré-Natais/fisiopatologia , Traumatismos por Eletricidade/complicações , Feminino , Humanos , Exposição Materna/efeitos adversos , Gravidez , Lesões Pré-Natais/etiologia
12.
Taiwan J Obstet Gynecol ; 59(1): 99-104, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32039809

RESUMO

OBJECTIVE: To study two major molecular alterations in spontaneous abortions (SA) with unexplained etiology - fetal genomic anomalies and the endometrial expression of main angiogenic factors VEGFA/VEGFR2 and chemokines SDF-1/CXCR4. MATERIALS AND METHODS: Whole genome copy number analysis by arrayCGH or Next Generation Sequencing (NGS) was applied for detection of fetal genomic imbalances. The abortive decidua of SA without fetal aneuploidies was further investigated for expression levels of the abovementioned factors using real time PCR analysis. A total of 30 abortive materials were collected from spontaneous abortions after exclusion of known predisposing factors. RESULTS: In 21 of 30 spontaneous abortions (70%), genomic anomalies were discovered by whole genome copy number analysis. Numerical anomalies were detected in 90% of aberrant cases, and in 10% - structural aberrations were revealed. An increased expression for essential factors of angiogenesis was identified in spontaneous abortions' tissues - 3.44 times for VEGFA and 10.29 times for VEGFR2. We found an average of 14 times increase in the expression levels of SDF-1 and 3.21 times for its receptor CXCR4. CONCLUSION: We could suggest the occurrence of increased angiogenesis in SA without fetal aneuploidies, compared to the control tissues, which could lead to increased oxidative stress and fetal loss.


Assuntos
Aborto Espontâneo/genética , Indutores da Angiogênese/metabolismo , Feto/irrigação sanguínea , Adulto , Aneuploidia , Quimiocina CXCL12/metabolismo , Aberrações Cromossômicas/embriologia , Variações do Número de Cópias de DNA , Decídua/metabolismo , Feminino , Morte Fetal/etiologia , Expressão Gênica , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Neovascularização Patológica/genética , Estresse Oxidativo/genética , Gravidez , Receptores CXCR4/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/metabolismo
13.
Obstet Gynecol Clin North Am ; 47(1): 183-196, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32008668

RESUMO

Because of the critical role that placental structure and function plays during pregnancy, abnormal placental structure and function is closely related to stillbirth: when an infant dies before birth. However, understanding the role of the placental and specific lesions is incomplete, in part because of the variation in definitions of lesions and in classifying causes of stillbirths. Nevertheless, placental abnormalities are seen more frequently in stillbirths than live births, with placental abruption, chorioamnionitis, and maternal vascular malperfusion most commonly reported. Critically, some placental lesions affect the management of subsequent pregnancies. Histopathological examination of the placenta is recommended following stillbirth.


Assuntos
Descolamento Prematuro da Placenta/diagnóstico , Morte Fetal/etiologia , Placenta/patologia , Complicações na Gravidez , Natimorto , Feminino , Idade Gestacional , Humanos , Gravidez
14.
J Pediatr Surg ; 55(5): 938-943, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32061362

RESUMO

BACKGROUND: Trauma is the leading cause of non-obstetric death in pregnancy. While maternal management is defined, few studies have examined the effects on the fetus. METHODS: Following IRB approval, all pregnant females (2010-2017) at a level-1 trauma center were retrospectively reviewed. Maternal and fetal demographics, interventions, and clinical outcomes were analyzed. RESULTS: There were 188 pregnancies in 5654 females. Maternal demographics were 26 ±â€¯7 years old, gestational age at trauma 21 ±â€¯12 weeks, 81% blunt mechanism, and maternal mortality 6%. Forty-one (22%) fetuses were immediately affected by the trauma including 20 (11%) born alive, 12 (7%) fetal demise, and 9 (5%) stillbirths. Of those that initially survived (n = 20), 5 (25%) expired during neonatal hospitalization. Two mothers returned immediately after trauma discharge with stillbirths for an overall infant mortality of 14% (n = 26). There were 84 patients with complete data to delivery including the 41 born at trauma and 43 born on a subsequent hospitalization. Those born at the time of trauma had significantly more delivery/neonatal complications and worse outcomes. Overall trauma burden to the fetus (preterm delivery, stillbirth, delivery/neonatal complication, or long-term disability) was 66% (56/84). CONCLUSIONS: Trauma during pregnancy has significant immediate mortality and delayed effects on the unborn fetus. This study has uncovered a previously hidden burden and mortality of trauma during pregnancy. LEVEL OF EVIDENCE: Level III.


Assuntos
Morte Fetal/etiologia , Natimorto/epidemiologia , Ferimentos e Lesões/complicações , Adulto , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Gravidez , Complicações na Gravidez , Nascimento Prematuro/etiologia , Sistema de Registros , Estudos Retrospectivos , Centros de Traumatologia , Índices de Gravidade do Trauma , Ferimentos e Lesões/mortalidade , Adulto Jovem
15.
BMC Cardiovasc Disord ; 20(1): 27, 2020 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959127

RESUMO

BACKGROUND: TAB2 is an activator of MAP 3 K7/TAK1, which is required for the IL-1 induced signal pathway. Microdeletions encompassing TAB2 have been detected in various patients with congenital heart defects (CHD), indicating that haploinsufficiency of TAB2 causes CHD. To date, seven variants within TAB2 were reported associated with CHD, only two of them are nonsense mutations. CASE PRESENTATION: Here we describe a three-generation Chinese family that included five CHD patients with heart valvular defects, such as mitral or tricuspid valves prolapse or regurgitation, and aortic valve stenosis or regurgitation. Our proband was a pregnant woman presenting with mitral, tricuspid, and aortic defects; her first child experienced sudden cardiac death at the age of 2 years. Whole-exome sequencing of the proband revealed a novel nonsense variant in TAB2 (c.C446G, p.S149X), which results in the elimination of the majority of C-terminal amino acids of TAB2, including the critical TAK1-binding domain. The variant was identified in five affected patients but not in the eight unaffected family members using Sanger sequencing and was classified as "pathogenic" according to the latest recommendation on sequence variants laid out by the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. CONCLUSION: We described a family with CHD caused by a novel TAB2 nonsense mutation. Our study broadens the mutation spectrum of TAB2; to the best of our knowledge, this is the first report of a pathogenic mutation within TAB2 in a Chinese population.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Códon sem Sentido , Genes Dominantes , Cardiopatias Congênitas/genética , Adulto , Grupo com Ancestrais do Continente Asiático/genética , Criança , Pré-Escolar , China , Análise Mutacional de DNA , Morte Súbita Cardíaca/etiologia , Feminino , Morte Fetal/etiologia , Predisposição Genética para Doença , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/etnologia , Hereditariedade , Humanos , Lactente , Masculino , Linhagem , Fenótipo , Gravidez , Fatores de Risco , Sequenciamento Completo do Exoma
16.
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
17.
Fetal Diagn Ther ; 47(2): 156-164, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31505487

RESUMO

BACKGROUND: Rare causes of fetal anemia requiring intrauterine transfusion (IUT) are challenging for fetal medicine specialists. OBJECTIVES: The aim of this study was to describe the perinatal patterns and prognosis in a consecutive series of fetuses transfused for fetal anemia of rare or unknown etiology, and to propose a protocol of investigation for fetal anemia of undetermined cause and for the management of subsequent pregnancies. METHOD: We conducted a retrospective descriptive study on fetuses transfused for severe anemia of rare or unknown etiology managed in our national referral center (Centre National de Référence d'Hémobiologie Périnatale) and born between 2010 and 2017. RESULTS: During the study period, 584 IUT were performed in 253 fetuses. Among those IUT, 23 (3.9%) were performed for a rare or unknown cause of anemia in 13 fetuses (5.1% of transfused fetuses). The median gestational age at diagnosis was 26 weeks of gestation (WG; range 21-33). Hemoglobin levels ranged from 1.6 to 9.1 g/dL (0.18-0.83 multiples of median) before the first IUT. The fetuses received between 1 and 6 IUT (39% received at least 2 IUT). The definitive etiologies for central anemia were: congenital syphilis, neonatal poikilocytosis, type II congenital dyserythropoietic anemia (CDA), and neonatal hemochromatosis. There was 1 case with suspected type I CDA and 1 with suspected Diamond-Blackfan anemia. There was 1 case of peripheral anemia, secondary to cerebral hemorrhages of different ages, related to a variant of the COL4A1 gene. In 6 fetuses corresponding to 4 mothers, no precise diagnosis was found despite a complete workup. In our series, there were 8 live births, 4 terminations of pregnancy, and 1 intrauterine fetal death. CONCLUSIONS: Fetal anemia of rare or unknown diagnosis represents 5% of all transfused fetuses in our cohort. Fetal and neonatal anemias can be recurrent in further pregnancies, with variable expressivity.


Assuntos
Anemia/terapia , Transfusão de Sangue Intrauterina , Doenças Fetais/terapia , Aborto Induzido , Anemia/sangue , Anemia/diagnóstico , Anemia/etiologia , Biomarcadores/sangue , Transfusão de Sangue Intrauterina/efeitos adversos , Feminino , Morte Fetal/etiologia , Doenças Fetais/sangue , Doenças Fetais/diagnóstico , Doenças Fetais/etiologia , Hemoglobina Fetal/metabolismo , Idade Gestacional , Humanos , Nascimento Vivo , Gravidez , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
18.
Am J Perinatol ; 37(5): 534-542, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-30919394

RESUMO

OBJECTIVE: This study aimed to identify the frequency of potentially preventable causes of stillbirth in a large heterogeneous population. STUDY DESIGN: This is a retrospective study of all stillbirth cases between January 2011 and December 2016 at a single tertiary medical center. Deliveries resulting from a nonviable fetus prior to 24 weeks of gestation, intrapartum fetal death, and incomplete stillbirth workup were excluded. Potentially preventable stillbirth was defined as that of a nonanomalous fetus that most likely resulted from one or more of the following: (1) placental-mediated complications, (2) postterm pregnancy, (3) monochorionicity-associated complications, (4) cholestasis of pregnancy, (5) preventable or treatable infections, and (6) isoimmunization. RESULTS: During the study period, 312 stillbirths were identified, 228 of which met the inclusion criteria. Of the 110 cases with a recognized cause, 47 (20.6%) were potentially preventable. The most common causes were placental-mediated complications and preventable or treatable infections, accounting for 75 and 9% of all potentially preventable causes, respectively. There were no recognizable maternal risk factors for potentially preventable stillbirth. CONCLUSION: One-fifth of all causes of stillbirth are potentially preventable. Due to the significant contribution of placental-mediated complications to preventable stillbirth, close sonographic surveillance and timely delivery may decrease risk substantially.


Assuntos
Morte Fetal/prevenção & controle , Complicações Cardiovasculares na Gravidez , Complicações Infecciosas na Gravidez , Natimorto , Feminino , Morte Fetal/etiologia , Feto/irrigação sanguínea , Idade Gestacional , Humanos , Placenta/irrigação sanguínea , Gravidez , Complicações na Gravidez , Estudos Retrospectivos
19.
Pan Afr Med J ; 37: 125, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33425158

RESUMO

Mirror syndrome or Ballantyne syndrome is a rare disease, characterized by the association between fetal anasarca and maternal generalized edema. This may be complicated by pre-eclampsia. The purpose of this study was to highlight the diagnostic and therapeutic features of this severe clinical entity, which, despite its rarity, should be suspected. We here report the clinical case of a 35-year-old parturient woman at 26 weeks of amenorrhea presenting to the Emergency Department with idiopathic mirror syndrome whose progression was rapidly marked by the occurrence of intrauterine fetal death and remission of maternal clinical-biological symptoms, once uterine vacuity was obtained. Indeed, a specific treatment in uterus is necessary, although in some severe idiopathic cases, only uterine vacuity can improve maternal and fetal prognosis.


Assuntos
Edema/diagnóstico , Morte Fetal/etiologia , Hidropisia Fetal/diagnóstico , Complicações na Gravidez/diagnóstico , Adulto , Progressão da Doença , Feminino , Humanos , Gravidez , Síndrome
20.
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
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