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1.
Medicina (Kaunas) ; 57(6)2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34200925

RESUMO

Background and Objectives: There is a clear evidence that pregnancy is associated with high production of sex hormones. During the first, second and third trimester of pregnancy, blood hormones levels increase gradually. Cells with affinity for sex hormones have been identified in different ocular tissues, such as: lid, lacrimal gland, meibomian gland, bulbar and palpebral conjunctivae, cornea, iris, ciliary body, lens, retina (retinal pigment epithelium) and choroid. This is why pregnancy is associated with changes at ocular level, involving anterior and posterior segments. Several clinical trials have been made trying to highlight changes in corneal biomechanics during pregnancy. By conducting this review, we want to evaluate both the changes in parameters that define corneal biomechanics and intraocular pressure values in pregnant. Materials and Methods: Following a systematic search in the literature related mainly to changes in corneal biomechanics during pregnancy, focusing on the paper published in the last decade, we included in a meta-analysis the cumulative results of three prospective comparative studies. Results: Important changes in corneal biomechanics (corneal hysteresis and corneal resistance factor) parameters were observed in women in the third trimester of pregnancy, but these variations were not statistically significant. Also, a decrease in intraocular pressure was mentioned in these women, but only the corneal compensation intraocular pressure showed a decrease with statistical significance. Conclusions: A decrease in corneal compensatory intraocular pressure was observed in pregnant women in the third trimester of pregnancy, but without other statistically significant changes resulting from the analysis of the other three parameters (corneal hysteresis, corneal resistance factor and Goldmann-correlated intraocular pressure).


Assuntos
Córnea , Tonometria Ocular , Fenômenos Biomecânicos , Feminino , Humanos , Pressão Intraocular , Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos
4.
BMC Pregnancy Childbirth ; 21(1): 505, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253173

RESUMO

BACKGROUND: Evidence on the outcome of SARS-CoV-2 infection in pregnancy is generally reassuring but yet not definitive. METHODS: To specifically assess the impact of SARS-CoV-2 infection in late pregnancy, we prospectively recruited 315 consecutive women delivering in a referral hospital located in Lombardy, Italy in the early phase of the epidemic. Restriction of the recruitment to this peculiar historical time period allowed to exclude infections occurring early in pregnancy and to limit the recall bias. All recruited subjects underwent a nasopharyngeal swab to assess the presence of Sars-Cov-2 using Real-time PCR. In addition, two different types of antibodies for the virus were evaluated in peripheral blood, those against the spike proteins S1 and S2 of the envelope and those against the nucleoprotein of the nucleocapsid. Women were considered to have had SARS-CoV-2 infection in pregnancy if at least one of the three assessments was positive. RESULTS: Overall, 28 women had a diagnosis of SARS-CoV-2 infection in pregnancy (8.9%). Women diagnosed with the infection were more likely to report one or more episodes of symptoms suggestive for Covid-19 (n = 11, 39.3%) compared to unaffected women (n = 39, 13.6%). The corresponding OR was 4.11 (95%CI: 1.79-9.44). Symptoms significantly associated with Covid-19 in pregnancy included fever, cough, dyspnea and anosmia. Only one woman necessitated intensive care. Pregnancy outcome in women with and without SARS-CoV-2 infection did not also differ. CONCLUSIONS: SARS-CoV-2 infection is asymptomatic in three out of five women in late pregnancy and is rarely severe. In addition, pregnancy outcome may not be markedly affected.


Assuntos
COVID-19/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Anosmia/fisiopatologia , Infecções Assintomáticas , COVID-19/fisiopatologia , Teste de Ácido Nucleico para COVID-19 , Teste Sorológico para COVID-19 , Tosse/fisiopatologia , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Humanos , Itália/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Prevalência , SARS-CoV-2 , Adulto Jovem
5.
Reprod Health ; 18(1): 136, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193196

RESUMO

BACKGROUND: Prenatal depression may have adverse health effects on mothers and their offspring. Perceived stress is an important risk factor for depression during pregnancy. Studies have shown that both perceived stress and depression may negatively influence birth outcomes. While 20% of pregnancies in Suriname, a middle-income Caribbean country located in northern South America, results in adverse birth outcomes, data on prenatal depression and its risk factors are lacking. This study aimed to assess the influence of perceived stress on depression during pregnancy in Surinamese women. METHODS: Survey data were used from 1143 pregnant women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study that addresses the impact of chemical and non-chemical environmental exposures in mother/child dyads in Suriname. The Edinburgh Depression Scale and Cohen Perceived Stress Scale were used to screen for probable depression (cut-off ≥ 12) and high stress (cut-off ≥ 20), respectively. The association between perceived stress and depression was examined using bivariate and multiple logistic regression analyses, adjusted for social support (including resilience) and maternal demographics. RESULTS: The prevalence of high perceived stress during the first two trimesters and the third trimester were 27.2% and 24.7% respectively. 22.4% of the participants had probable depression during first or second trimester and 17.6% during the third trimester. Women experiencing high stress levels during the first two trimesters had 1.92 increased odds (95% CI 1.18-3.11, p = 0.008) of having probable depression during the third trimester of pregnancy than those with low stress levels. Pregnant women with low individual resilience during early pregnancy (52.1%) had 1.65 (95% CI 1.03-2.63, p = 0.038) increased odds of having probable depression during later stages of pregnancy compared to those with high individual resilience. Low educational level (p = 0.004) and age of the mother (20-34 years) (p = 0.023) were significantly associated with probable depression during the third trimester. CONCLUSIONS: Early detection and management of stress and depression during pregnancy are important. Health education programs, targeting the reduction of stress during pregnancy, may help to reduce depression and its potential adverse health effects on the mother and child.


Assuntos
Depressão/epidemiologia , Complicações na Gravidez/psicologia , Gestantes/psicologia , Estresse Psicológico/epidemiologia , Adulto , Região do Caribe , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Suriname/epidemiologia , Adulto Jovem
6.
BMJ Case Rep ; 14(5)2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059548

RESUMO

A 31-year-old woman with a history of stillbirth due to placental abruption at 29 weeks' gestation and one first trimester miscarriage documented a continuous record of her perceived fetal movements from 28 to 38 weeks' gestation. Repeated ultrasound examinations confirmed a viable pregnancy, with normal growth, liquor volume and Doppler profile. She delivered a healthy male infant at 38 weeks and 3 days' gestation. The data collected give a detailed record of fetal activity in a healthy pregnancy. Perceived fetal activity increased as pregnancy progressed and was greatest in the evenings. We also found that clusters of movements, which have previously been reported as protective against stillbirth, were felt earlier on in pregnancy.


Assuntos
Movimento Fetal , Placenta , Adulto , Feminino , Humanos , Masculino , Gravidez , Primeiro Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Natimorto
7.
BMJ Case Rep ; 14(6)2021 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-34162616

RESUMO

This article presents an unusual case of appendicitis in pregnancy complicated by the novel coronavirus (SARS-CoV-2). The novel coronavirus has affected the way medicine is practised across most parts of the world with over 160 000 000 global cases to date. Tackling management of these cases is more complex when other pathological processes are ongoing. Appendicitis is a common occurrence in pregnancy, with most obstetric centres seeing about one or two cases a year. Though maternal morbidity and mortality are relatively unimpacted by this event, fetal loss and preterm labour are common sequelae. This case involves a 35-year-old woman presenting in her third trimester with abdominal pain and who went on to be diagnosed with concurrent appendicitis and SARS-CoV-2 infection. Although spinal anaesthesia would be most appropriate as it avoids aerosol generation, general anaesthetic techniques were indicated due to thrombocytopenia in this case. She underwent a successful appendicectomy, although preterm delivery was indicated as a result of maternal and fetal concerns.


Assuntos
Apendicite , COVID-19 , Complicações Infecciosas na Gravidez , Adulto , Apendicectomia , Apendicite/complicações , Apendicite/diagnóstico , Apendicite/cirurgia , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , SARS-CoV-2
8.
BMJ Case Rep ; 14(6)2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167992

RESUMO

A male term neonate was admitted to the neonatal intensive care unit in the first hours of life with central cyanosis. Echocardiogram showed severe biventricular hypertrophy, markedly right-sided, tricuspid regurgitation, a patent foramen ovale and a closed ductus arteriosus (CDA). The mother recalled being treated with a single dose of intravenous diclofenac for low back pain 2 weeks earlier. The newborn was started on propranolol with symptomatic improvement and was discharged on day 10. At 1-month follow-up, he showed complete resolution of ventricular hypertrophy and suspended propranolol. In the literature, of the 22 cases of CDA after intrauterine exposure to diclofenac, 11 resolved in utero, 3 required ventilatory and inotropic support and 1 evolved to persistent pulmonary hypertension. In this case, a thorough anamnesis was key to identify the probable cause of an otherwise unexplained transient ventricular hypertrophy. This case also alerts to the fetal risks of non-steroidal anti-inflammatory drugs during the third trimester, requiring close monitoring.


Assuntos
Permeabilidade do Canal Arterial , Canal Arterial , Anti-Inflamatórios não Esteroides/efeitos adversos , Diclofenaco/efeitos adversos , Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/tratamento farmacológico , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Terceiro Trimestre da Gravidez
9.
Nutrients ; 13(6)2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34067270

RESUMO

BACKGROUND: Plasma albumin (ALB) reflects protein nutritional status in rats, but it is not clear whether it is associated with dietary protein insufficiency in pregnant women and/or their risk of low birth weight delivery. This study aimed to investigate whether maternal serum ALB redox state reflects maternal protein nutritional status and/or is associated with infant birth weights. METHODS: The relationship between the serum reduced ALB ratio and infant birth weight was examined in an observational study of 229 Japanese pregnant women. A rat model simulating fetal growth restriction, induced by protein-energy restriction, was used to elucidate the relationship between maternal nutritional status, maternal serum ALB redox state, and birth weight of the offspring. RESULTS: In the human study, serum reduced ALB ratio in the third trimester was significantly and positively correlated with infant birth weight. In the rat study, serum reduced ALB ratio and birth weight in the litter decreased as the degree of protein-energy restriction intensified, and a significant and positive correlation was observed between them in late pregnancy. CONCLUSIONS: Maternal serum reduced ALB ratio in the third trimester is positively associated with infant birth weight in Japanese pregnant women, which would be mediated by maternal protein nutritional status.


Assuntos
Peso ao Nascer , Fenômenos Fisiológicos da Nutrição Materna , Estado Nutricional , Albumina Sérica/análise , Adulto , Animais , Proteínas na Dieta/administração & dosagem , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Japão , Oxirredução , Gravidez , Terceiro Trimestre da Gravidez/sangue , Gestantes , Ratos , Ratos Wistar
10.
Acta Orthop Traumatol Turc ; 55(3): 196-200, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34100358

RESUMO

OBJECTIVE: This study aimed to determine the predictability of developmental dysplasia of the hip (DDH) in the prenatal period by means of evaluating fetal hips using the Graf method on obstetric ultrasonography (US) after the 34th week of gestation. METHODS: A total of 84 pregnant women (mean age = 27.04; age range = 19-46 years), who were referred to our radiology clinic for an obstetric US examination in the third trimester, and their fetuses were included in this study. In the obstetric US, alpha angles of both hips of the fetuses were measured based on Graf's method, and each case was assessed ultrasonographically by a second physician at 6-10 postnatal weeks. Prenatal and postnatal hips were then classified according to alpha angles as ≥ 60° or < 60°. The kappa coefficients between the diagnoses based on prenatal and postnatal alpha angles were calculated. RESULTS: According to the postnatal alpha angle, 77 fetuses were diagnosed to have type 1 right hip and 7 fetuses had type 2A right hip. The prenatal alpha angle provided the same results (77 type 1 and 7 type 2A right hips). Similarly, the postnatal alpha angle revealed type 1 left hip in 82 fetuses and type 2A left hip in 2 fetuses, which was the same as the diagnoses based on the prenatal alpha angles. There was a complete agreement between prenatal and postnatal alpha measurements for both the left and right hips (kappa = 1.00, P < 0.001). CONCLUSION: Evidence from this study has revealed that DDH can be identified by obstetric ultrasonographic examinations in the prenatal period.


Assuntos
Displasia do Desenvolvimento do Quadril/diagnóstico , Feto/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Seguimentos , Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/etiologia , Articulação do Quadril/diagnóstico por imagem , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Terceiro Trimestre da Gravidez
11.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(5): 646-652, 2021 May 06.
Artigo em Chinês | MEDLINE | ID: mdl-34034406

RESUMO

Objective: To investigate the association of thallium exposure during pregnancy with pregnant blood pressure changing and hypertensive disorder complicating pregnancy(HDCP). Methods: A total of 3 240 pregnant women who had establish maternal health care manual in Ma'anshan Maternal and Child Health-Care Hospital and met the inclusion and exclusion criteria were included in this study between May 2013 and September 2014.We collected their general demographic characteristics and blood pressure through questionnaire and medical records. Meanwhile we measured serum thallium concentrations by experimental technology. We use multiple logistic regression to analyze the association between thallium exposure during pregnancy and HDCP. Mixed linear model were used to analyze the association between thallium concentration and maternal systolic blood pressure (SBP) or diastolic blood pressure(DBP) in different trimesters Results: The age of 3 240 pregnant woman was (26.61±3.64) years, and the detection rate of HDCP was 5.9%(191).The median (P25, P75) of thallium concentrations in first trimester, second trimester and third trimester were 62.96 (50.79, 77.04), 62.19 (50.87, 75.26), 48.84 (38.00, 66.00) ng/L, respectively. Multiple logistic regression results suggested after adjusting various confounding factors, the risk of HDCP in pregnant women with high concentrations of thallium (>77.04 ng/L) in the first trimester is 1.75 (95%CI:1.01-3.03) times higher than which with low concentrations(<50.82 ng/L). Mixed linear model results suggested there are positive correlation between thallium concentrations with maternal DBP in first trimester (ß=1.12, 95%CI: 0.39-1.85). Conclusion: Exposure to high levels of thallium during first trimester may increase the risk of HDCP, and the exposure of thallium may be effective to DBP of pregnant.


Assuntos
Hipertensão , Tálio , Adulto , Pressão Sanguínea , Criança , Feminino , Humanos , Exposição Materna , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Adulto Jovem
12.
BMC Pregnancy Childbirth ; 21(1): 365, 2021 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-33964891

RESUMO

BACKGROUND: Accurate estimation of fetal weight is important for prenatal care and for detection of fetal growth abnormalities. Prediction of fetal weight entails the indirect measurement of fetal biometry by ultrasound that is then introduced into formulae to calculate the estimated fetal weight. The aim of our study was to evaluate the accuracy of fetal weight estimation of Chinese fetuses in the third trimester using an automated three-dimensional (3D) fractional limb volume model, and to compare this model with the traditional two-dimensional (2D) model. METHODS: Prospective 2D and 3D ultrasonography were performed among women with singleton pregnancies 7 days before delivery to obtain 2D data, including fetal biparietal diameter, abdominal circumference and femur length, as well as 3D data, including the fractional arm volume (AVol) and fractional thigh volume (TVol). The fetal weight was estimated using the 2D model and the 3D fractional limb volume model respectively. Percentage error was defined as (estimated fetal weight - actual birth weight) divided by actual birth weight and multiplied by 100. Systematic errors (accuracy) were evaluated as the mean percentage error (MPE). Random errors (precision) were calculated as ±1 SD of percentage error. The intraclass correlation coefficient (ICC) was used to analyze the inter-observer reliability of the 3D ultrasound measurements of fractional limb volume. RESULTS: Ultrasound examination was performed on 56 fetuses at 39.6 ± 1.4 weeks' gestation. The average birth weight of the newborns was 3393 ± 530 g. The average fetal weight estimated by the 2D model was 3478 ± 467 g, and the MPE was 3.2 ± 8.9. The average fetal weights estimated by AVol and TVol of the 3D model were 3268 ± 467 g and 3250 ± 485 g, respectively, and the MPEs were - 3.3 ± 6.6 and - 3.9 ± 6.1, respectively. For the 3D TVol model, the proportion of fetuses with estimated error ≤ 5% was significantly higher than that of the 2D model (55.4% vs. 33.9%, p < 0.05). For fetuses with a birth weight < 3500 g, the accuracy of the AVol and TVol models were better than the 2D model (- 0.8 vs. 7.0 and - 2.8 vs. 7.0, both p < 0.05). Moreover, for these fetuses, the proportions of estimated error ≤ 5% of the AVol and TVol models were 58.1 and 64.5%, respectively, significantly higher than that of the 2D model (19.4%) (both p < 0.05). The inter-observer reliability of measuring fetal AVol and TVol were high, with the ICCs of 0.921 and 0.963, respectively. CONCLUSION: In this cohort, the automated 3D fractional limb volume model improves the accuracy of weight estimation in most third-trimester fetuses. Prediction accuracy of the 3D model for neonatal BW, particularly < 3500 g was higher than that of the traditional 2D model.


Assuntos
Peso Fetal , Feto/diagnóstico por imagem , Imageamento Tridimensional , Coxa da Perna/anatomia & histologia , Ultrassonografia Pré-Natal/métodos , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Software , Coxa da Perna/diagnóstico por imagem
13.
Cochrane Database Syst Rev ; 5: CD005547, 2021 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-33998661

RESUMO

BACKGROUND: Helminthiasis is an infestation of the human body with parasitic worms. It is estimated to affect 44 million pregnancies, globally, each year. Intestinal helminthiasis (hookworm infestation) is associated with blood loss and decreased supply of nutrients for erythropoiesis, resulting in iron-deficiency anaemia. Over 50% of the pregnant women in low- and middle-income countries (LMIC) suffer from iron-deficiency anaemia. Though iron-deficiency anaemia is multifactorial, hookworm infestation is a major contributory cause in women of reproductive age in endemic areas. Antihelminthics are highly efficacious, but evidence of their beneficial effect and safety when given during pregnancy has not been established. This is an update of a Cochrane Review last published in 2015. OBJECTIVES: To determine the effects of mass deworming with antihelminthics for soil-transmitted helminths (STH) during the second or third trimester of pregnancy on maternal and pregnancy outcomes. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) (8 March 2021) and reference lists of retrieved studies. SELECTION CRITERIA: We included all prospective randomised controlled trials evaluating the effect of administration of antihelminthics versus placebo or no treatment during the second or third trimester of pregnancy; both individual-randomised and cluster-randomised trials were eligible. We excluded quasi-randomised trials and studies that were only available as abstracts with insufficient information. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data, checked accuracy and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included a total of six trials (24 reports) that randomised 7873 pregnant women. All of the included trials were conducted in antenatal clinics within hospitals in LMICs (Uganda, Nigeria, Peru, India, Sierra Leone and Tanzania). Among primary outcomes, five trials reported maternal anaemia, one trial reported preterm birth and three trials reported perinatal mortality. Among secondary outcomes, included trials reported maternal worm prevalence, low birthweight (LBW) and birthweight. None of the included studies reported maternal anthropometric measures or infant survival at six months. Overall, we judged the included trials to be generally at low risk of bias for most domains, while the certainty of evidence ranged from low to moderate. Analysis suggests that administration of a single dose of antihelminthics in the second trimester of pregnancy may reduce maternal anaemia by 15% (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.72 to 1.00; I²= 86%; 5 trials, 5745 participants; low-certainty evidence). We are uncertain of the effect of antihelminthics during pregnancy on preterm birth (RR 0.84, 95% CI 0.38 to 1.86; 1 trial, 1042 participants; low-certainty evidence) or perinatal mortality (RR 1.01, 95% CI 0.67 to 1.52; 3 trials, 3356 participants; low-certainty evidence). We are uncertain of the effect of antihelminthics during pregnancy on hookworm (average RR 0.31, 95% CI 0.05 to 1.93; Tau² = 1.76, I² = 99%; 2 trials, 2488 participants; low-certainty evidence). Among other secondary outcomes, findings suggest that administration of antihelminthics during pregnancy may reduce the prevalence of trichuris (average RR 0.68, 95% CI 0.48 to 0.98; I²=75%; 2 trials, 2488 participants; low-certainty evidence) and ascaris (RR 0.24, 95% CI 0.19 to 0.29; I²= 0%; 2 trials, 2488 participants; moderate-certainty evidence). Antihelminthics during pregnancy probably make little or no difference to LBW (RR 0.89, 95% CI 0.69 to 1.16; 3 trials, 2960 participants; moderate-certainty evidence) and birthweight (mean difference 0.00 kg, 95% CI -0.03 kg to 0.04 kg; 3 trials, 2960 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS: The evidence suggests that administration of a single dose of antihelminthics in the second trimester of pregnancy may reduce maternal anaemia and worm prevalence when used in settings with high prevalence of maternal helminthiasis. Further data is needed to establish the benefit of antihelminthic treatment on other maternal and pregnancy outcomes. Future research should focus on evaluating the effect of these antihelminthics among various subgroups in order to assess whether the effect varies. Future studies could also assess the effectiveness of co-interventions and health education along with antihelminthics for maternal and pregnancy outcomes.


Assuntos
Anemia Ferropriva/prevenção & controle , Anti-Helmínticos/administração & dosagem , Enteropatias Parasitárias/tratamento farmacológico , Complicações Hematológicas na Gravidez/prevenção & controle , Complicações Parasitárias na Gravidez/tratamento farmacológico , Solo/parasitologia , Albendazol/administração & dosagem , Anemia Ferropriva/parasitologia , Viés , Feminino , Helmintíase/tratamento farmacológico , Helmintíase/transmissão , Humanos , Compostos de Ferro/administração & dosagem , Mortalidade Perinatal , Gravidez , Complicações Hematológicas na Gravidez/parasitologia , Complicações Parasitárias na Gravidez/etiologia , Resultado da Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
J Infect Dev Ctries ; 15(4): 463-469, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-33956644

RESUMO

INTRODUCTION: The objective of the study was to compare the clinical characteristics and pregnancy outcomes of asymptomatic and symptomatic pregnant women with confirmed COVID-19 in the third trimester. METHODOLOGY: Forty-one patients were enrolled in this study from two COVID-19 designated hospitals in Wuhan. Patients underwent chest CT scans for screening and were divided into two groups based on pneumonia-related syndromes. The clinical characteristics and pregnancy outcomes were reviewed and compared. RESULTS: Among the sample of pregnant women infected with SARS-CoV-2 in the third trimester, there was no mortality or severe complications in the mothers nor newborns. Nearly 40% of the patients in the study were asymptomatic. The most common pneumonia-related symptom in symptomatic pregnant patients was cough. Asymptomatic patients had a significantly shorter duration of hospitalisation and a lower rate of positive RT-PCR testing compared with symptomatic patients. There was no statistically significant difference in antibody test results between asymptomatic and symptomatic patients during hospitalisation, while the positive rate of IgM antibody testing was significantly lower in asymptomatic patients during follow-up. CONCLUSIONS: Clinical manifestation of pregnant women infected with SARS-CoV-2 were atypical and concealed. Screening of possible COVID-19 patients should be strengthened, through serial or combined testing of laboratory testing or radiological testing, before pregnant women are admitted to hospital.


Assuntos
Infecções Assintomáticas , COVID-19/etiologia , Complicações Infecciosas na Gravidez/etiologia , Resultado da Gravidez , Adulto , Teste para COVID-19 , Cesárea , Feminino , Hospitalização , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Masculino , Gravidez , Terceiro Trimestre da Gravidez
15.
J Am Coll Radiol ; 18(5S): S189-S198, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33958112

RESUMO

The Appropriateness Criteria for the imaging screening of second and third trimester fetuses for anomalies are presented for fetuses that are low risk, high risk, have had soft markers detected on ultrasound, and have had major anomalies detected on ultrasound. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Diagnóstico por Imagem , Sociedades Médicas , Feminino , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Pesquisa , Ultrassonografia , Estados Unidos
16.
Eur J Obstet Gynecol Reprod Biol ; 262: 28-35, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33989941

RESUMO

Pregnancy related transient osteoporosis of the hip (PR-TOH) is a rare condition that manifests with sudden pain located in the groin region, anterior thigh and buttocks. It is a benign and in the majority of cases self-limiting disease, related to bone marrow oedema. It occurs during the third trimester of pregnancy or less frequently during the post-partum period. Hip movements are usually restricted by pain and it often becomes a non-obstetric indication for Caesarean delivery. Here, we report a case of unilateral PR-TOH diagnosed by magnetic resonance imaging (MRI) and a literature review.


Assuntos
Osteoporose , Complicações na Gravidez , Cesárea , Feminino , Articulação do Quadril , Humanos , Imageamento por Ressonância Magnética , Gravidez , Terceiro Trimestre da Gravidez
17.
Medicine (Baltimore) ; 100(21): e26145, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032766

RESUMO

RATIONALE: Choriocarcinoma is a highly aggressive tumor. It occurs infrequently during pregnancy. The management of choriocarcinoma during pregnancy poses several challenges. PATIENT CONCERNS: At 34 weeks of gestation, a 21-year-old primigravida was transferred to the emergency room for cephalgia, reduced fetal movements, and left intra-atrial intracavitary thrombus. DIAGNOSIS: Choriocarcinoma in the third trimester with lung and brain metastases, pulmonary vein thrombosis (PVT), and systemic thrombosis. INTERVENTION: An emergency cesarean section was performed. Subsequently, low-molecular-weight heparin anticoagulation combined with multiagent chemotherapy was administered. OUTCOME: A 1.59 kg live female was born. Multiagent chemotherapy combined with anticoagulation led to complete regression of the cerebral and pulmonary lesions and the dissolution of pulmonary vein thrombus. At the 11-month follow-up, the patient remained in complete remission without complications, and her child was disease-free. LESSONS: This is the first case of gestational choriocarcinoma with PVT. Our case suggests that conservative therapy can be the first choice for small, asymptomatic PVT secondary to choriocarcinoma.


Assuntos
Coriocarcinoma/complicações , Coriocarcinoma/tratamento farmacológico , Veias Pulmonares , Neoplasias Uterinas/complicações , Neoplasias Uterinas/tratamento farmacológico , Trombose Venosa/tratamento farmacológico , Trombose Venosa/etiologia , Anticoagulantes/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/secundário , Cesárea , Coriocarcinoma/secundário , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Neoplasias Pulmonares/secundário , Gravidez , Terceiro Trimestre da Gravidez , Indução de Remissão , Adulto Jovem
18.
Placenta ; 109: 72-74, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34034016

RESUMO

Whether early SARS-CoV-2 definitively increases the risk of stillbirth is unknown, though studies have suggested possible trends of stillbirth increase during the pandemic. This study of third trimester stillbirth does not identify an increase in rates during the first wave of the pandemic period, however investigation of the placental pathology demonstrates trends towards more vascular placental abnormalities.


Assuntos
COVID-19/epidemiologia , Doenças Placentárias/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Terceiro Trimestre da Gravidez , Natimorto/epidemiologia , Adulto , COVID-19/complicações , COVID-19/mortalidade , Causas de Morte , Feminino , Morte Fetal/etiologia , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Pandemias , Placenta/patologia , Doenças Placentárias/etiologia , Doenças Placentárias/patologia , Doenças Placentárias/virologia , Gravidez , Complicações Infecciosas na Gravidez/mortalidade , SARS-CoV-2/fisiologia , Estados Unidos/epidemiologia , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-33801299

RESUMO

The aim of this study is to observe the morphological and postural changes to the foot that take place during pregnancy and the puerperium. Method: In this descriptive, observational, longitudinal study, we analysed 23 pregnant women, with particular attention to morphological and postural aspects of the foot, at three time points during and after pregnancy: in weeks 9-13 of gestation, weeks 32-35 of gestation and weeks 4-6 after delivery. The parameters considered were changes in foot length, the Foot Posture Index (FPI) and the Hernández Corvo Index, which were analysed using a pedigraph and taking into account the Body Mass Index (BMI). The same procedure was conducted in each review. Results: The statistical analyses obtained for each foot did not differ significantly between the three measurement times. A pronator-type footprint was most frequently observed during the third trimester of pregnancy; it was predominantly neutral during the postpartum period. Statistically significant differences between the measurement times were obtained in the right foot for cavus vs. neutral foot type (between the first and third trimesters and also between the first trimester and the puerperium) (in both cases, p < 0.0001). Conclusions: Foot length increases in the third trimester and returns to normal in the puerperium. According to FPI findings, the third trimester of pregnancy is characterised by pronation, while the posture returns to neutrality during the postpartum period. During pregnancy, the plantar arch flattens, and this persists during the puerperium. The incidence of cavus foot increases significantly in the third trimester and in the puerperium.


Assuntos
, Período Pós-Parto , Feminino , Pé/fisiologia , Humanos , Estudos Longitudinais , Postura , Gravidez , Terceiro Trimestre da Gravidez
20.
Int J Mol Sci ; 22(5)2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33803239

RESUMO

Previously, we demonstrated the expression of apelin and G-protein-coupled receptor APJ in human placenta cell lines as well as its direct action on placenta cell proliferation and endocrinology. The objective of this study was to examine the effect of apelin on placenta apoptosis in BeWo cells and villous explants from the human third trimester of pregnancy. The BeWo cells and villous explants were incubated with apelin (2 and 20 ng/mL) alone or with staurosporine for 24 to 72 h. First, we analysed the dose- and time-dependent effect of apelin on the expression of apoptotic factors on the mRNA level by real-time PCR and on the protein level using Western blot. Next, we checked caspase 3 and 7 activity by Caspase-Glo 3/7, DNA fragmentation by the Cell Death Detection ELISA kit and oxygen consumption by the MitoXpress-Xtra Oxygen Consumption assay. We found that apelin increased the expression of pro-survival and decreased proapoptotic factors on mRNA and protein levels in both BeWo cells and villous explants. Additionally, apelin inhibited caspase 3 and 7 activity and DNA fragmentation in staurosporine-induced apoptosis as also attenuated oxidative stress by increasing extracellular oxygen consumption. The antiapoptotic effect of apelin in BeWo cells was mediated by the APJ receptor and mitogen-activated protein kinase (ERK1/2/MAP3/1) and protein kinase B (AKT). The obtained results showed the antiapoptotic effect of apelin on trophoblast cells, suggesting its participation in the development of the placenta.


Assuntos
Apelina/farmacologia , Apoptose/efeitos dos fármacos , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Placenta/metabolismo , Terceiro Trimestre da Gravidez , Caspase 3/metabolismo , Caspase 7/metabolismo , Linhagem Celular Tumoral , MAP Quinases Reguladas por Sinal Extracelular , Feminino , Humanos , Gravidez , Proteínas da Gravidez/metabolismo
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