RESUMEN
OBJECTIVE: To assess perinatal and long-term outcomes for pregnancies complicated by early onset, severe fetal growth restriction with absent or reverse end-diastolic flow velocity waveform (AREDF) in the umbilical artery. METHODS: A retrospective cohort study of 36 singleton pregnancies with AREDF when the estimated fetal weight (EFW) is less than 501 g at presentation. RESULTS: At presentation, the median gestational age and EFW were 24 (18-29) weeks and 364 (167-496) g, respectively. The median interval between presentation and live birth or diagnosis of intrauterine fetal death (IUFD) was 13 (0-60) days. Delivery was for IUFD in 19 cases (53%), fetal indications in 13 cases (36%) and maternal indications in four cases (11%). Caesarean section (CS) was performed for the 17 live births of which 10 (59%) were by classical CS. Of the total cohort, five infants survived to hospital discharge giving an overall perinatal survival rate of 14%. All survivors had short-term morbidity. The cognitive function in four children was assessed as normal at two years of age. One survivor had developmental delay. None of the surviving children had any evidence of cerebral palsy. CONCLUSION: The overall perinatal survival rate for pregnancies complicated by early onset, severe growth restriction with an EFW of < 501 g and AREDF is low. When delivery occurs for fetal indications, the majority of these women require classical CS. Short-term neonatal morbidity is high though none of the survivors had cerebral palsy.
Asunto(s)
Retardo del Crecimiento Fetal/diagnóstico por imagen , Ultrasonografía Prenatal , Arterias Umbilicales/diagnóstico por imagen , Adolescente , Adulto , Cesárea/estadística & datos numéricos , Preescolar , Discapacidades del Desarrollo/epidemiología , Discapacidades del Desarrollo/etiología , Femenino , Retardo del Crecimiento Fetal/mortalidad , Retardo del Crecimiento Fetal/patología , Mortalidad Fetal , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Recién Nacido de muy Bajo Peso , Masculino , Embarazo , Segundo Trimestre del Embarazo , Queensland/epidemiología , Estudios Retrospectivos , Arterias Umbilicales/patología , Adulto JovenAsunto(s)
Presentación de Nalgas , Pelvis/anatomía & histología , Femenino , Humanos , Embarazo , Estudios RetrospectivosRESUMEN
The severe acute respiratory syndrome (SARS) is a highly contagious infection caused by a newly discovered strain of coronavirus (SARS-CoV). Infants born to pregnant women with SARS did not appear to acquire the infection through vertical transmission. Some newborn infants, however, developed severe intrauterine growth retardation and life-threatening gastrointestinal complications. It is now known that the clinical course and prognosis are different between paediatric and adult SARS patients. Young children (< 12 years), in general, run a less aggressive clinical course than do teenage and adult patients. Thus far, no fatalities have been reported in the paediatric age group (< or =18 years). This review describes the current understanding of the clinical manifestations, diagnostic tests, immunological profiles, patient management and outcomes of SARS-CoV infection in the paediatric population.
Asunto(s)
Síndrome Respiratorio Agudo Grave , Adolescente , Niño , Preescolar , Femenino , Retardo del Crecimiento Fetal/virología , Enfermedades Gastrointestinales/virología , Humanos , Lactante , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Embarazo , Radiografía Torácica , Síndrome Respiratorio Agudo Grave/diagnóstico , Síndrome Respiratorio Agudo Grave/terapia , Síndrome Respiratorio Agudo Grave/transmisión , Tomografía Computarizada por Rayos XRESUMEN
Severe acute respiratory syndrome (SARS) is a newly discovered infectious disease caused by a novel coronavirus. During the community outbreak in Hong Kong, 5 liveborn infants were born to pregnant women with SARS. A systematic search for perinatal transmission of the SARS-associated coronavirus, including serial reverse transcriptase-polymerase chain reaction assays, viral cultures, and paired serologic titers, failed to detect the virus in any of the infants. In addition, none of the infants developed clinical, radiologic, hematologic, or biochemical evidence suggestive of SARS. One preterm infant developed jejunal perforation and another developed necrotizing enterocolitis with ileal perforation shortly after birth. This case series is the first report to describe the clinical course of the first cohort of liveborn infants born to pregnant women with SARS.
Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa , Complicaciones Infecciosas del Embarazo/virología , Síndrome Respiratorio Agudo Grave/transmisión , Adulto , Antiinflamatorios/efectos adversos , Antiinflamatorios/uso terapéutico , Antivirales/efectos adversos , Antivirales/uso terapéutico , Cesárea , Estudios de Cohortes , Brotes de Enfermedades , Enterocolitis Necrotizante/etiología , Femenino , Retardo del Crecimiento Fetal/etiología , Hong Kong/epidemiología , Humanos , Enfermedades del Íleon/etiología , Recién Nacido , Recien Nacido Prematuro , Perforación Intestinal/etiología , Enfermedades del Yeyuno/etiología , Masculino , Metilprednisolona/efectos adversos , Metilprednisolona/uso terapéutico , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Síndrome de Dificultad Respiratoria del Recién Nacido/complicaciones , Ribavirina/efectos adversos , Ribavirina/uso terapéutico , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo/aislamiento & purificación , Síndrome Respiratorio Agudo Grave/tratamiento farmacológico , Síndrome Respiratorio Agudo Grave/epidemiologíaRESUMEN
OBJECTIVE: This study was undertaken to evaluate the pregnancy and perinatal outcomes of pregnant women with severe acute respiratory syndrome (SARS). STUDY DESIGN: All pregnant women (12) who presented with SARS in Hong Kong between February 1 and July 31, 2003, were included. The pregnancy and perinatal outcomes were collected. Evidence of perinatal transmission of virus was assessed with the SARS-associated coronavirus reverse-transcriptase polymerase chain reaction on cord blood, placenta tissue, and subsequent follow-up of the neonate on serology. RESULTS: Three deaths occurred among the 12 patients, giving a case fatality rate of 25%. Four of the 7 patients (57%) who presented in the first trimester had spontaneous miscarriage. Four of the 5 patients who presented after 24 weeks were delivered preterm. Two mothers recovered without delivery, but their ongoing pregnancies were complicated by intrauterine growth restriction. No newborn infant had clinical SARS and all investigations were negative for SARS. CONCLUSION: SARS during pregnancy is associated with high incidences of spontaneous miscarriage, preterm delivery, and intrauterine growth restriction. There is no evidence of perinatal SARS infection among infants born to these mothers.