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Turan S, Bucak M, Turan OM. Arterial and Venous Doppler in Evaluation of the "At-risk" Fetus. Clin Obstet Gynecol 2024:00003081-990000000-00174. [PMID: 39324941 DOI: 10.1097/grf.0000000000000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Our practice utilizes Doppler ultrasound as one of the most objective and effective methods to assess at-risk pregnancies. This review will discuss the application of arterial and venous Doppler techniques in assessing and managing various diseases and conditions for high-risk fetuses.
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Affiliation(s)
- Sifa Turan
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Maryland, Baltimore, Maryland
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Munoz JL, Benitez L, Buskmiller C, Nassr AA, Belfort MA, Cortes MS, Donepudi RV. Clinical Characteristics and Outcomes of Intrauterine Blood Transfusion (IUT) for Infectious Etiologies. Prenat Diagn 2024. [PMID: 39272224 DOI: 10.1002/pd.6671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 08/10/2024] [Accepted: 09/04/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE Congenital viral infection may result in fetal anemia and thrombocytopenia. While intrauterine blood transfusions (IUTs) are more commonly performed for Rh alloimmunization, reports using IUT for infection have varying success. Our primary objective was to characterize the outcomes of patients undergoing IUT for infectious etiologies at our center compared with Rh disease. STUDY DESIGN This was a case series of patients undergoing IUT from 2012-2023. Infectious etiologies were identified by maternal serologies and confirmed by amniotic fluid polymerase chain reactions (PCR). Clinical outcomes were obtained from electronic medical records. RESULTS During the study period, 70 patients underwent IUT, 34% (24/70) for Rh alloimmunization and 17% (12/70) for infection. Those with infectious etiologies were more likely to be diagnosed at earlier gestational ages (22 vs. 25 weeks, p = 0.04), with hydrops (75 vs. 33%, p = 0.03), and thrombocytopenia (27 ± 33 × 103 vs. 163 ± 112 × 103, p < 0.01). Perinatal death was significantly greater in cases of CMV (4/5, 80%) compared to parvovirus (1/7, 14%) or Rh alloimmunization (5/24, 21%) (p = 0.02). CONCLUSION Anemias and thrombocytopenias related to fetal infection may be indications for IUT. Compared with Rh alloimmunization, IUT in fetal infections was performed significantly earlier, and hydrops were more common at the time of IUT. In the case of CMV, greater rates of IUFD (80%) were observed. Patients should be counseled on the various outcomes by indication.
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Affiliation(s)
- Jessian L Munoz
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA
| | - Leticia Benitez
- BCNatal Fetal Medicine Research Center (Hospital Clinic and Hospital Sant Joan de Déu), University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cara Buskmiller
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA
| | - Ahmed A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA
| | - Magdalena Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA
| | - Roopali V Donepudi
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA
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Stafford IA, Workowski KA, Bachmann LH. Syphilis Complicating Pregnancy and Congenital Syphilis. N Engl J Med 2024; 390:242-253. [PMID: 38231625 DOI: 10.1056/nejmra2202762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Affiliation(s)
- Irene A Stafford
- From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McGovern Medical School at UT Health, Houston (I.A.S.); and the Department of Medicine, Division of Infectious Diseases, Emory University (K.A.W.), and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention - both in Atlanta (K.A.W., L.H.B.)
| | - Kimberly A Workowski
- From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McGovern Medical School at UT Health, Houston (I.A.S.); and the Department of Medicine, Division of Infectious Diseases, Emory University (K.A.W.), and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention - both in Atlanta (K.A.W., L.H.B.)
| | - Laura H Bachmann
- From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McGovern Medical School at UT Health, Houston (I.A.S.); and the Department of Medicine, Division of Infectious Diseases, Emory University (K.A.W.), and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention - both in Atlanta (K.A.W., L.H.B.)
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Arredondo Montero J, Bronte Anaut M, Caballero Martínez MC, Fernández Seara MP, Martín-Calvo N. Congenital cytomegalovirus infection with brainstem hemorrhage and polymicrogyria: Necropsic and histopathological findings. Congenit Anom (Kyoto) 2022; 62:248-253. [PMID: 35941838 PMCID: PMC9805181 DOI: 10.1111/cga.12488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/18/2022] [Accepted: 07/19/2022] [Indexed: 01/07/2023]
Abstract
Congenital cytomegalovirus (CMV) infection can cause severe neurological sequelae or even fetal death. We present a 17-year-old pregnant woman with fetal CMV infection, leading to voluntary termination of pregnancy. Fetopsy demonstrated a brainstem hemorrhage and focal polymicrogyria. CMV inclusions were observed in the lung, liver, thyroid, pancreas, kidneys, adrenal, placenta, and central nervous system. Intracranial hemorrhage is a rare finding in the context of congenital CMV infection, with isolated brainstem hemorrhage being an exceptional form of presentation. Polymicrogyria appears to be a more frequent finding, although its actual incidence is unknown. Future studies are needed to determine the causal association.
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Affiliation(s)
- Javier Arredondo Montero
- Pediatric Surgery Department, Hospital Universitario de Navarra, Pamplona, Spain.,Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | | | | | | | - Nerea Martín-Calvo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Health institute Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria de Navarra, IdiSNA, Pamplona, Spain
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Lanna MM, Fabbri E, Zavattoni M, Doneda C, Toto V, Izzo G, Casati D, Faiola S, Cetin I. Severe fetal symptomatic infection from human cytomegalovirus following non-primary maternal infection: report of two cases. Fetal Diagn Ther 2021; 49:36-40. [PMID: 34969040 DOI: 10.1159/000521711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/23/2021] [Indexed: 11/19/2022]
Abstract
Introduction Human cytomegalovirus (HCMV) is the most common congenital infection, expecially severe after a maternal primary infection; sequelae in neonates born to mothers experiencing a non-primary infection have been already reported. Hereby, two cases of severe fetal HCMV disease in seroimmune gravidas referred to our Unit are described. Cases presentation Case 1 A fetus at 21 weeks' gestation with signs of anemia and brain abnormalities at ultrasound (US), described at magnetic resonance (MR) imaging as ependymal irregularity and bilateral asymmetric parenchimal thinning; amniotic fluid sample was positive for HCMV although the woman had a previous immunity; after termination of pregnancy, autopsy demonstrated a thicken layer of disorganized neurons on the right cortical plate, while on the left there was a morphological pattern coherent with polymicrogyria. Case 2 A fetus at 20 weeks' gestation with anemia, moderate atrio-ventricular insufficiency, hepatosplenomegaly but no major cerebral lesions. Fetal blood was positive for HCMV, although unexpected for pre-pregnancy maternal immunity, and intrauterine transfusion was needed. A cesarean section at 34 weeks gestation was performed due to worsening condition of the fetus, who had a birthweight of 2210 grams, needed platelet transfusions but MR examination and clinical evaluation were normal. Conclusion The impact of non-primary maternal infection on pregnancy outcome is unknown and fetal brain damage in HCMV seroimmune transmitter-mothers can occur as a consequence of maternal re-infection or reactivation for a hypotetic different role of HCMV-primed CD4+ or CD8+ T-cells in fetal brain, with progressive brain lesions coexistent in the first case and with severe unexpected anemia in the second case. A previous maternal HCMV immunity should not exempt to test anemic fetuses for such infection, nor to consider a potential transplacental transmission.
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Affiliation(s)
- Mariano Matteo Lanna
- Fetal Therapy Unit "U. Nicolini", Children's Hospital Vittore Buzzi, Milan, Italy
- Department of Women Mother and Neonate, Children's Hospital Vittore Buzzi, Milan, Italy
| | - Elisa Fabbri
- Department of Women Mother and Neonate, Children's Hospital Vittore Buzzi, Milan, Italy
| | - Maurizio Zavattoni
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Doneda
- Pediatric Radiology and Neuroradiology Department, Children's Hospital Vittore Buzzi, Milan, Italy
| | - Valentina Toto
- Pathology Division, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Giana Izzo
- Pediatric Radiology and Neuroradiology Department, Children's Hospital Vittore Buzzi, Milan, Italy
| | - Daniela Casati
- Fetal Therapy Unit "U. Nicolini", Children's Hospital Vittore Buzzi, Milan, Italy
- Department of Women Mother and Neonate, Children's Hospital Vittore Buzzi, Milan, Italy
| | - Stefano Faiola
- Fetal Therapy Unit "U. Nicolini", Children's Hospital Vittore Buzzi, Milan, Italy
- Department of Women Mother and Neonate, Children's Hospital Vittore Buzzi, Milan, Italy
| | - Irene Cetin
- Department of Women Mother and Neonate, Children's Hospital Vittore Buzzi, Milan, Italy
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Salazar-Sanchez C, Llancarí P, Novoa RH, Ventura W. Severe fetal anaemia caused by congenital cytomegalovirus infection. BMJ Case Rep 2021; 14:e244585. [PMID: 34645629 PMCID: PMC8515478 DOI: 10.1136/bcr-2021-244585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/04/2022] Open
Abstract
A 22-year-old pregnant woman was referred to our fetal medicine unit due to severe fetal growth restriction at 26 weeks of gestation. An extensive detailed ultrasound revealed signs of bilateral periventricular hyperechogenicity, suggesting fetal infection potentially due to cytomegalovirus (CMV). Doppler ultrasound showed a high peak systolic velocity in the middle cerebral artery. Percutaneous umbilical cord blood sampling confirmed fetal CMV infection and severe fetal anaemia. We present this case to highlight the importance of fetal anaemia, which can be fatal regardless of whether it is associated with generalised oedema or hydrops fetalis.
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Affiliation(s)
| | - Pedro Llancarí
- Department of Obstetrics and Perinatology, Instituto Nacional Materno Perinatal, Lima, Peru
| | - Rommy H Novoa
- Department of Obstetrics and Perinatology, Instituto Nacional Materno Perinatal, Lima, Peru
| | - Walter Ventura
- Department of Obstetrics and Perinatology, Instituto Nacional Materno Perinatal, Lima, Peru
- Fetal Medicine Unit, Grupo CERAS, Clínica Anglo Americana, Lima, Peru
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Murlewska J, Sylwestrzak O, Poszwa P, Respondek-Liberska M. The effect of nuchal umbilical cord on fetal cardiac and cerebral circulation-cross-sectional study. J Perinat Med 2021; 49:590-595. [PMID: 33567478 DOI: 10.1515/jpm-2020-0316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/10/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The subject of our analysis is the influence of umbilical cord collision around the fetal neck on the fetal heart function and cerebral circulation. METHODS Our study was carried out on a group of 115 fetuses from single pregnancies with physiological course, during the 15th to 40th week of pregnancy. In our analysis, we examined the following parameters: Tei index for right ventricle, Tei index for left ventricle with Tei index components: isovolumetric contraction time, isovolumetric relaxation time, ejection time and cardiothoracic area ratio, middle cerebral artery peak systolic velocity (PS MCA), middle cerebral artery pulsatility index (PI MCA). Gestational age in our study was: 28+2±34. The study group of patients with fetal umbilical cord around neck group (fUCAN) included 38 fetuses (20 males, 18 females). The control group of patients with no fetal umbilical cord around neck group (NfUCAN) included 77 fetuses (43 males, 34 females). RESULTS In our study, we found no significant differences in the values obtained: Tei LV in fUCAN: 0.5±0.1 vs. in NfUCAN: 0.5±0.1; p=0.42), Tei RV in fUCAN: 0.5±0.2 vs. in NfUCAN: 0.4±0.1; (p=0.2). Tricuspid valve regurgitation-TR was observed with the following frequency: fUCAN: 7/38, 18% vs. NfUCAN: 13/77, 17%; p=0.8. MCA PS in study fUCAN group was significantly higher than in NfUCAN (40.2±11.5 vs. 32.5±9.5; p=0.003), although other hemodynamic and clinical variables did not differ between the study and control groups. CONCLUSIONS The fetal nuchal umbilical cord collision did not affect the fetal heart function expressed as Tei index, at the time of fetal heart examination (at mean gestational age 29+4 weeks). The fUCAN group presented elevated PS MCA, which was not related to other hemodynamic and clinical variables between the study and control groups.
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Affiliation(s)
- Julia Murlewska
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | | | - Przemysław Poszwa
- Institute of Materials Technology, Poznan University of Technology, Poznan, Poland
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.,Department of Diagnoses and Prevention Fetal Malformations, Medical University of Lodz, Lodz, Poland
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