1
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Yu R, Zhou J, Zhu Q. Pregnancy complicated by severe osteogenesis imperfecta poses a challenge for the anaesthetist: A case report. J Int Med Res 2024; 52:3000605241260551. [PMID: 38863132 PMCID: PMC11179463 DOI: 10.1177/03000605241260551] [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] [Received: 02/02/2024] [Accepted: 05/22/2024] [Indexed: 06/13/2024] Open
Abstract
Pregnant women with severe osteogenesis imperfecta (OI) are uncommon, and there are limited data regarding anaesthesia for caesarean section in these high-risk individuals. The presence of anatomical and physiological abnormalities can pose technical challenges for the anaesthetist. This report describes the successful implementation of epidural anaesthesia in a parturient with severe OI. To our knowledge, this is the first documented use of ultrasound-assisted neuraxial anaesthesia and wrist blood pressure monitoring in such patients undergoing caesarean section. Understanding the pathophysiological changes associated with OI is crucial for ensuring safe administration of anaesthesia to these women.
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Affiliation(s)
- Rou Yu
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu 610041, Sichuan, China
| | - Jieshu Zhou
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu 610041, Sichuan, China
| | - Qing Zhu
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu 610041, Sichuan, China
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2
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Kao YT, Yen CC, Fan HC, Chen JK, Chen MS, Lan YW, Yang SH, Chen CM. In Utero Cell Treatment of Hemophilia A Mice via Human Amniotic Fluid Mesenchymal Stromal Cell Engraftment. Int J Mol Sci 2023; 24:16411. [PMID: 38003601 PMCID: PMC10670993 DOI: 10.3390/ijms242216411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Hemophilia is a genetic disorder linked to the sex chromosomes, resulting in impaired blood clotting due to insufficient intrinsic coagulation factors. There are approximately one million individuals worldwide with hemophilia, with hemophilia A being the most prevalent form. The current treatment for hemophilia A involves the administration of clotting factor VIII (FVIII) through regular and costly injections, which only provide temporary relief and pose inconveniences to patients. In utero transplantation (IUT) is an innovative method for addressing genetic disorders, taking advantage of the underdeveloped immune system of the fetus. This allows mesenchymal stromal cells to play a role in fetal development and potentially correct genetic abnormalities. The objective of this study was to assess the potential recovery of coagulation disorders in FVIII knockout hemophilia A mice through the administration of human amniotic fluid mesenchymal stromal cells (hAFMSCs) via IUT at the D14.5 fetal stage. The findings revealed that the transplanted human cells exhibited fusion with the recipient liver, with a ratio of approximately one human cell per 10,000 mouse cells and produced human FVIII protein in the livers of IUT-treated mice. Hemophilia A pups born to IUT recipients demonstrated substantial improvement in their coagulation issues from birth throughout the growth period of up to 12 weeks of age. Moreover, FVIII activity reached its peak at 6 weeks of age, while the levels of FVIII inhibitors remained relatively low during the 12-week testing period in mice with hemophilia. In conclusion, the results indicated that prenatal intrahepatic therapy using hAFMSCs has the potential to improve clotting issues in FVIII knockout mice, suggesting it as a potential clinical treatment for individuals with hemophilia A.
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Affiliation(s)
- Yung-Tsung Kao
- Department of Life Sciences, Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan;
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Health Research Institutes and National Chung Hsing University, Taichung 402, Taiwan;
| | - Chih-Ching Yen
- Department of Internal Medicine, Pulmonary Medicine Section, China Medical University Hospital, and China Medical University, Taichung 404, Taiwan;
| | - Hueng-Chuen Fan
- Department of Pediatrics, Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan;
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Miaoli 356, Taiwan
| | - Jen-Kun Chen
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Health Research Institutes and National Chung Hsing University, Taichung 402, Taiwan;
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli 350, Taiwan
| | - Ming-Shan Chen
- Department of Anesthesiology, Ditmanson Medical Foundation Chia-Yi Christion Hospital, Chia-Yi 600, Taiwan;
| | - Ying-Wei Lan
- Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45237, USA;
| | - Shang-Hsun Yang
- Department of Physiology, Institute of Basic Medical Sciences, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Chuan-Mu Chen
- Department of Life Sciences, Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan;
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Health Research Institutes and National Chung Hsing University, Taichung 402, Taiwan;
- The iEGG and Animal Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
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3
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Deguchi M, Tsuji S, Katsura D, Kasahara K, Kimura F, Murakami T. Current Overview of Osteogenesis Imperfecta. ACTA ACUST UNITED AC 2021; 57:medicina57050464. [PMID: 34068551 PMCID: PMC8151368 DOI: 10.3390/medicina57050464] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 12/18/2022]
Abstract
Osteogenesis imperfecta (OI), or brittle bone disease, is a heterogeneous disorder characterised by bone fragility, multiple fractures, bone deformity, and short stature. OI is a heterogeneous disorder primarily caused by mutations in the genes involved in the production of type 1 collagen. Severe OI is perinatally lethal, while mild OI can sometimes not be recognised until adulthood. Severe or lethal OI can usually be diagnosed using antenatal ultrasound and confirmed by various imaging modalities and genetic testing. The combination of imaging parameters obtained by ultrasound, computed tomography (CT), and magnetic resource imaging (MRI) can not only detect OI accurately but also predict lethality before birth. Moreover, genetic testing, either noninvasive or invasive, can further confirm the diagnosis prenatally. Early and precise diagnoses provide parents with more time to decide on reproductive options. The currently available postnatal treatments for OI are not curative, and individuals with severe OI suffer multiple fractures and bone deformities throughout their lives. In utero mesenchymal stem cell transplantation has been drawing attention as a promising therapy for severe OI, and a clinical trial to assess the safety and efficacy of cell therapy is currently ongoing. In the future, early diagnosis followed by in utero stem cell transplantation should be adopted as a new therapeutic option for severe OI.
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4
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Hüner B, Handke-Vesely A, Lato K, Korzoum A, Janni W, Reister F. Mother and child with osteogenesis imperfecta type III. Pregnancy management, delivery, and outcome. CASE REPORTS IN PERINATAL MEDICINE 2020. [DOI: 10.1515/crpm-2020-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Thanks to the advances of modern medicine it has become possible to reach a fertile age even in the case of serious illnesses, enabling those patients to realize their desire to have children. This is also the case with the extremely heterogeneous, often autosomal dominantly inherited osteogenesis imperfecta. Due to a disruption in collagen synthesis those patients are faced with multiple fractures, spinal deformities and a decrease in pulmonary capacity throughout the course of their lives, depending on the subtype and severity of the disease. Obstetricians as well as anesthetists face major interdisciplinary challenges in the case of a pregnancy in those patients because of pregnancy-associated risks like uterine rupture, preterm birth and postpartum hemorrhage as well as risks associated with the nature of osteogenesis imperfecta itself, like bone fractures, spinal deformities and decreased mobility in the course of the progressing pregnancy. Mode of delivery should be planned individually in order to minimize maternal morbidity and mortality. In cases in which the fetus is as well affected by the disease, this aspect must be taken into consideration when it comes to supervision of pregnancy and planning of the birth mode.
Case presentation
We report the case of a woman with osteogenesis imperfecta type III who spontaneously conceived a pregnancy with a fetus who was also affected by the genetic disease. This constellation has up to now been reported by only few sources and requires supervision by an experienced perinatal center.
Conclusions
Osteogenesis imperfecta is not an exclusion diagnosis for family planning and a successful delivery. Nevertheless, depending on the form of the disease, mother and child can be severely affected by the disturbed collagen synthesis. Each patient has to be individually advised and cared for with the specific risks due to the type of Osteogenesis imperfecta. In the case of type III, due to extreme scoliosis, pelvic deformity and small growth, only a primary cesarean section can be performed.
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Affiliation(s)
- Beate Hüner
- Department of Obstetrics and Gynecology , Ulm University , Prittwitzstr. 43 , Ulm , Baden-Württemberg , Germany
| | - Annette Handke-Vesely
- Department of Obstetrics and Gynecology , Ulm University , Ulm , Baden-Württemberg , Germany
| | - Krisztian Lato
- Department of Obstetrics and Gynecology , Ulm University , Ulm , Baden-Württemberg , Germany
| | - Andrea Korzoum
- Department of Obstetrics and Gynecology , Ulm University , Ulm , Baden-Württemberg , Germany
| | - Wolfgang Janni
- Department of Obstetrics and Gynecology , Ulm University , Ulm , Baden-Württemberg , Germany
| | - Frank Reister
- Department of Obstetrics and Gynecology , Ulm University , Ulm , Baden-Württemberg , Germany
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5
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Brizola E, Adami G, Baroncelli GI, Bedeschi MF, Berardi P, Boero S, Brandi ML, Casareto L, Castagnola E, Fraschini P, Gatti D, Giannini S, Gonfiantini MV, Landoni V, Magrelli A, Mantovani G, Michelis MB, Nasto LA, Panzeri L, Pianigiani E, Scopinaro A, Trespidi L, Vianello A, Zampino G, Sangiorgi L. Providing high-quality care remotely to patients with rare bone diseases during COVID-19 pandemic. Orphanet J Rare Dis 2020; 15:228. [PMID: 32867855 PMCID: PMC7456755 DOI: 10.1186/s13023-020-01513-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/19/2020] [Indexed: 01/08/2023] Open
Abstract
During the COVID-19 outbreak, the European Reference Network on Rare Bone Diseases (ERN BOND) coordination team and Italian rare bone diseases healthcare professionals created the "COVID-19 Helpline for Rare Bone Diseases" in an attempt to provide high-quality information and expertise on rare bone diseases remotely to patients and healthcare professionals. The present position statement describes the key characteristics of the Helpline initiative, along with the main aspects and topics that recurrently emerged as central for rare bone diseases patients and professionals. The main topics highlighted are general recommendations, pulmonary complications, drug treatment, trauma, pregnancy, children and elderly people, and patient associations role. The successful experience of the "COVID-19 Helpline for Rare Bone Diseases" launched in Italy could serve as a primer of gold-standard remote care for rare bone diseases for the other European countries and globally. Furthermore, similar COVID-19 helplines could be considered and applied for other rare diseases in order to implement remote patients' care.
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Affiliation(s)
- E Brizola
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - G Adami
- Rheumatology Unit, University of Verona, Verona, Italy
| | - G I Baroncelli
- Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - M F Bedeschi
- Medical Genetic Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - P Berardi
- Italian Osteogenesis Imperfecta Association (As.It.O.I), Olgiate Molgora (LC), Italy
| | - S Boero
- Department of Paediatric Orthopaedics, IRCCS Giannina Gaslini Institute, Children's Hospital, Genoa, Italy
| | - M L Brandi
- Department of Experimental Biochemical and Clinical Sciences, University of Florence and Fondazione FIRMO, Florence, Italy
| | - L Casareto
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - E Castagnola
- Infectious Disease Department, Giannina Gaslini Institute, IRCCS, Genoa, Italy
| | - P Fraschini
- Scientific Institute, IRCCS E. Medea, Bosisio Parini (LC), Italy
| | - D Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - S Giannini
- Department of Medicine, Clinica Medica 1, University of Padova and Regional Centre for Osteoporosis, Padua, Italy
| | - M V Gonfiantini
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - V Landoni
- Valduce Hospital - Villa Beretta Rehabilitation Centre, Lecco, Italy
| | - A Magrelli
- National Center for Drug, Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - G Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M B Michelis
- Department of Paediatric Orthopaedics, IRCCS Giannina Gaslini Institute, Children's Hospital, Genoa, Italy
| | - L A Nasto
- Department of Paediatric Orthopaedics, IRCCS Giannina Gaslini Institute, Children's Hospital, Genoa, Italy
| | - L Panzeri
- Italian Osteogenesis Imperfecta Association (As.It.O.I), Olgiate Molgora (LC), Italy
| | - E Pianigiani
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Scopinaro
- Italian Federation of Rare Diseases Patients Associations (UNIAMO FIMR), Rome, Italy
| | - L Trespidi
- Obstetrics and Gynecologic Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Vianello
- Respiratory Pathophysiology Division, University of Padua, Padua, Italy
| | - G Zampino
- Rare Diseases and Birth Defects Unit, Dipartimento di Scienza della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Sangiorgi
- Department of Rare Skeletal Disorders & CLIBI Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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6
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Chougui K, Addab S, Palomo T, Morin SN, Veilleux LN, Bernstein M, Thorstad K, Hamdy R, Tsimicalis A. Clinical manifestations of osteogenesis imperfecta in adulthood: An integrative review of quantitative studies and case reports. Am J Med Genet A 2020; 182:842-865. [PMID: 32091187 DOI: 10.1002/ajmg.a.61497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/03/2019] [Accepted: 01/03/2020] [Indexed: 12/16/2022]
Abstract
Osteogenesis imperfecta (OI) is a rare genetic disorder of the bones caused by a mutation in Type I collagen genes. As adults with OI are aging, medical concerns secondary to OI may arise. This integrative review sought to review, appraise, and synthesize the clinical manifestations faced by adults with OI. Four electronic bibliographic databases were searched. Published quantitative, qualitative, and mixed-methods studies, as well as case reports from 2000 to March 2019, addressing a clinical manifestation in adulthood, were reviewed. Eligible studies and case reports were subsequently appraised using the Mixed Methods Appraisal Tool and Case Report Checklist, respectively. Twenty quantitative studies and 88 case reports were included for review regardless of the varying methodological quality score. These studies collectively included 2,510 adults with different OI types. Several clinical manifestations were studied, and included: hearing loss, cardiac diseases, pregnancy complications, cerebrovascular manifestations, musculoskeletal manifestations, respiratory manifestations, vision impairment, and other clinical manifestations. Increased awareness may optimize prevention, treatment, and follow-up. Opportunities to enhance the methodological quality of research including better design and methodology, multisite collaborations, and larger and diverse sampling will optimize the generalizability and transferability of findings.
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Affiliation(s)
- Khadidja Chougui
- Nursing Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Psychology, Universite de Montreal, Montreal, Quebec, Canada
| | - Sofia Addab
- Nursing Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Telma Palomo
- Bone Densitometry, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,General Internal Medicine and Bone Metabolism Center, Montreal General Hospital, Montreal, Quebec, Canada
| | - Louis-Nicolas Veilleux
- Experimental Surgery, McGill University, Montreal, Quebec, Canada.,Motion Analysis Center, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
| | - Mitchell Bernstein
- Orthopedic Surgery, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Pediatric Surgery, McGill University, Montreal, Quebec, Canada
| | - Kelly Thorstad
- Nursing and Patient Services, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
| | - Reggie Hamdy
- Orthopedic Surgery, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Pediatric Surgery, McGill University, Montreal, Quebec, Canada
| | - Argerie Tsimicalis
- Nursing Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
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7
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Supraglottic Airway Rescue After Failed Fiberoptic Intubation in a Patient With Osteogenesis Imperfecta: A Case Report. A A Pract 2019; 13:7-9. [PMID: 30694815 DOI: 10.1213/xaa.0000000000000968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We describe the management of a pregnant patient with osteogenesis imperfecta with a history of numerous fractures, severe scoliosis, and anticipated difficult airway. Her pregnancy was complicated by progressive shortness of breath and a fetal diagnosis of osteogenesis imperfecta. Spine anatomy precluded neuraxial anesthesia. Cesarean delivery was performed under general anesthesia at 34 weeks. Immediately after awake fiberoptic intubation and induction of general anesthesia, capnography waveform was lost with rapid profound oxygen desaturation. A supraglottic airway device was placed, oxygenation maintained with supraglottic airway and positive pressure ventilation throughout case, and the baby was delivered with Apgars of 8 and 9.
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8
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Long-Bellil L, Mitra M, Iezzoni LI, Smeltzer SC, Smith LD. Experiences and unmet needs of women with physical disabilities for pain relief during labor and delivery. Disabil Health J 2017; 10:440-444. [PMID: 28428112 DOI: 10.1016/j.dhjo.2017.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/24/2017] [Accepted: 02/19/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Childbirth is widely acknowledged as one of the most painful experiences most women will undergo in their lifetimes. Alleviating labor and delivery pain for women with physical disabilities can involve an additional level of complexity beyond that experienced by most women, but little research has explored their experiences. OBJECTIVE The purpose of this study was to explore the experiences of women with physical disabilities with respect to pain relief during labor and delivery with the goal of informing their care. METHODS Data were collected using semi-structured interviews with twenty-five women with physical disabilities from across the United States. RESULTS Women expressed specific preferences for the method of pain relief. Some confronted systemic barriers in exploring their options for pain relief, while others were given a choice. At times, anesthesiologists lacked knowledge and experience in caring for women with disabilities. Conversely, some women described how the administration of anesthesia was meticulously planned and attributed their positive labor and delivery experiences to this careful planning. CONCLUSIONS Advanced, individualized planning and evaluation of their options for pain relief was most satisfying to women and enabled them to make an informed choice. This approach is consistent with the recommendations of clinicians who have successfully provided pain relief during labor to women with complex physical disabilities. Clinicians who have successfully delivered babies of women with these and similar disabilities emphasize the importance of a team approach where the anesthesiologist and other specialists are involved early on in a woman's care.
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Affiliation(s)
- Linda Long-Bellil
- Center for Health Policy and Research, University of Massachusetts Medical School, 333 South Street, Shrewsbury, MA, 01545, United States.
| | - Monika Mitra
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, United States.
| | - Lisa I Iezzoni
- Harvard Medical School, The Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, Room 901B, Boston, MA, 02114, United States.
| | - Suzanne C Smeltzer
- Center for Nursing Research, Villanova University College of Nursing, 800 Lancaster Avenue, Villanova, PA, 190895, United States.
| | - Lauren D Smith
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, United States.
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9
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Ruiter-Ligeti J, Czuzoj-Shulman N, Spence AR, Tulandi T, Abenhaim HA. Pregnancy outcomes in women with osteogenesis imperfecta: a retrospective cohort study. J Perinatol 2016; 36:828-31. [PMID: 27442154 DOI: 10.1038/jp.2016.111] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/01/2016] [Accepted: 06/13/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Osteogenesis imperfecta (OI) is a rare genetic disorder characterized by defects in type I collagen that can pose serious complications during pregnancy. The aim was to evaluate maternal and fetal outcomes in pregnant women with OI. STUDY DESIGN This was a retrospective cohort study, using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. We examined the records of pregnant women with OI during the period 2003 to 2011. We evaluated antenatal complications and method of delivery among 295 women with OI, using unconditional logistic regression. RESULTS Of the total 7 287 994 births in our cohort, we encountered 295 deliveries among women with OI. The prevalence was 4 per 1 00 000 deliveries per year over the study period. Births to women with OI were more likely to be complicated by antepartum hemorrhage (odds ratio (OR) 2.01, 95% confidence interval (CI) 1.04 to 3.91), placenta abruption (OR 2.50, 95% CI 1.24 to 5.03), intrauterine growth restriction and small-for-gestational-age infants (OR 2.42, 95% CI 1.42 to 4.14), congenital malformation (OR 7.33, 95% CI 4.20 to 12.78) and preterm birth (OR 2.24, 95% CI 1.63 to 3.06). Seventy-five percent of women with OI delivered by cesarean section, and they had an increased rate of tubal sterilization at delivery (OR 1.67, 95% CI 1.18 to 2.36). No differences in rates of stress fracture and maternal death were found. CONCLUSION These findings suggest that there are increased risks to both mother and fetus in pregnancies complicated by OI.
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Affiliation(s)
- J Ruiter-Ligeti
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - N Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
| | - A R Spence
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
| | - T Tulandi
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - H A Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC, Canada.,Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
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10
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Management of osteogenesis imperfecta type I in pregnancy; a review of literature applied to clinical practice. Arch Gynecol Obstet 2016; 293:1153-9. [DOI: 10.1007/s00404-016-4012-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
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11
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Bellur S, Jain M, Cuthbertson D, Krakow D, Shapiro JR, Steiner RD, Smith PA, Bober MB, Hart T, Krischer J, Mullins M, Byers PH, Pepin M, Durigova M, Glorieux FH, Rauch F, Sutton VR, Lee B, Nagamani SC. Cesarean delivery is not associated with decreased at-birth fracture rates in osteogenesis imperfecta. Genet Med 2015; 18:570-6. [PMID: 26426884 PMCID: PMC4818203 DOI: 10.1038/gim.2015.131] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 08/14/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose Osteogenesis imperfecta (OI) predisposes to recurrent fractures. The moderate-to-severe forms of OI present with antenatal fractures and the mode of delivery that would be safest for the fetus is not known. Methods We conducted systematic analyses on the largest cohort of individuals (n=540) with OI enrolled to-date in the OI Linked Clinical Research Centers. Self-reported at-birth fracture rates were compared in individuals with OI types I, III, and IV. Multivariate analyses utilizing backward-elimination logistic regression model building were performed to assess the effect of multiple covariates including method of delivery on fracture-related outcomes. Results When accounting for other covariates, at-birth fracture rates did not differ based on whether delivery was by vaginal route or by cesarean section (CS). Increased birth weight conferred higher risk for fractures irrespective of the delivery method. In utero fracture, maternal history of OI, and breech presentation were strong predictors for choosing CS for delivery. Conclusion Our study, the largest to analyze the effect of various factors on at-birth fracture rates in OI shows that delivery by CS is not associated with decreased fracture rate. With the limitation that the fracture data were self-reported in this cohort, these results suggest that CS should be performed only for other maternal or fetal indications, but not for the sole purpose of fracture prevention in OI.
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Affiliation(s)
- S Bellur
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - M Jain
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - D Cuthbertson
- College of Medicine, University of South Florida, Tampa, Florida, USA
| | - D Krakow
- Department of Orthopedic Surgery, University of California, Los Angeles, California, USA.,Department of Human Genetics, University of California, Los Angeles, California, USA.,Department of Obstetrics and Gynecology, University of California, Los Angeles, California, USA
| | - J R Shapiro
- Department of Bone and Osteogenesis Imperfecta, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - R D Steiner
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, Oregon, USA.,Marshfield Clinic Research Foundation and University of Wisconsin, Marshfield and Madison, Wisconsin, USA
| | - P A Smith
- Shriners Hospitals for Children, Chicago, Illinois, USA
| | - M B Bober
- Division of Medical Genetics, Alfred I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - T Hart
- Osteogenesis Imperfecta Foundation, Gaithersburg, Maryland, USA
| | - J Krischer
- College of Medicine, University of South Florida, Tampa, Florida, USA
| | - M Mullins
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - P H Byers
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington, USA.,Department of Pathology, Division of Medical Genetics, University of Washington, Seattle, Washington, USA
| | - M Pepin
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington, USA.,Department of Pathology, Division of Medical Genetics, University of Washington, Seattle, Washington, USA
| | - M Durigova
- Department of Orthopedic Surgery, Shriners Hospital for Children and McGill University, Montreal, Québec, Canada
| | - F H Glorieux
- Department of Orthopedic Surgery, Shriners Hospital for Children and McGill University, Montreal, Québec, Canada
| | - F Rauch
- Department of Orthopedic Surgery, Shriners Hospital for Children and McGill University, Montreal, Québec, Canada
| | - V R Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Hospital, Houston, Texas, USA
| | - B Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Hospital, Houston, Texas, USA
| | | | - S C Nagamani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Hospital, Houston, Texas, USA
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12
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Dinges E, Ortner C, Bollag L, Davies J, Landau R. Osteogenesis imperfecta: cesarean deliveries in identical twins. Int J Obstet Anesth 2015; 24:64-8. [DOI: 10.1016/j.ijoa.2014.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/08/2014] [Accepted: 07/20/2014] [Indexed: 11/15/2022]
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13
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The collagenopathies: review of clinical phenotypes and molecular correlations. Curr Rheumatol Rep 2014; 16:394. [PMID: 24338780 DOI: 10.1007/s11926-013-0394-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Genetic defects of collagen formation (the collagenopathies) affect almost every organ system and tissue in the body. They can be grouped by clinical phenotype, which usually correlates with the tissue distribution of the affected collagen subtype. Many of these conditions present in childhood; however, milder phenotypes presenting in adulthood are increasingly recognized. Many are difficult to differentiate clinically. Precise diagnosis by means of genetic testing assists in providing prognosis information, family counseling, and individualized treatment. This review provides an overview of the current range of clinical presentations associated with collagen defects, and the molecular mechanisms important to understanding how the results of genetic testing affect medical care.
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Adur J, DSouza-Li L, Pedroni MV, Steiner CE, Pelegati VB, de Thomaz AA, Carvalho HF, Cesar CL. The severity of Osteogenesis imperfecta and type I collagen pattern in human skin as determined by nonlinear microscopy: proof of principle of a diagnostic method. PLoS One 2013; 8:e69186. [PMID: 23869235 PMCID: PMC3711916 DOI: 10.1371/journal.pone.0069186] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 06/09/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The confirmatory diagnosis of Osteogenesis Imperfecta (OI) requires invasive, commonly bone biopsy, time consuming and destructive methods. This paper proposes an alternative method using a combination of two-photon excitation fluorescence (TPEF) and second-harmonic generation (SHG) microscopies from easily obtained human skin biopsies. We show that this method can distinguish subtypes of human OI. METHODOLOGY/PRINCIPAL FINDINGS Different aspects of collagen microstructure of skin fresh biopsies and standard H&E-stained sections of normal and OI patients (mild and severe forms) were distinguished by TPEF and SHG images. Moreover, important differences between subtypes of OI were identified using different methods of quantification such as collagen density, ratio between collagen and elastic tissue, and gray-level co-occurrence matrix (GLCM) image-pattern analysis. Collagen density was lower in OI dermis, while the SHG/autofluorescence index of the dermis was significantly higher in OI as compared to that of the normal skin. We also showed that the energy value of GLCM texture analysis is useful to discriminate mild from severe OI and from normal skin. CONCLUSIONS/SIGNIFICANCE This work demonstrated that nonlinear microscopy techniques in combination with image-analysis approaches represent a powerful tool to investigate the collagen organization in skin dermis in patients with OI and has the potential to distinguish the different types of OI. The procedure outlined in this paper requires a skin biopsy, which is almost painless as compared to the bone biopsy commonly used in conventional methods. The data presented here complement existing clinical diagnostic techniques and can be used as a diagnostic procedure to confirm the disease, evaluate its severity and treatment efficacy.
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Affiliation(s)
- Javier Adur
- Biophotonic Group, Optics and Photonics Research Center (CEPOF), Institute of Physics "Gleb Wataghin," State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil.
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15
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Chen CP, Lin SP, Su YN, Chern SR, Su JW, Wang W. Prenatal diagnosis of recurrent autosomal dominant osteogenesis imperfecta associated with unaffected parents and paternal gonadal mosaicism. Taiwan J Obstet Gynecol 2013; 52:106-9. [DOI: 10.1016/j.tjog.2013.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2012] [Indexed: 12/11/2022] Open
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16
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Osteogenesis imperfecta type IV: prenatal molecular diagnosis and genetic counseling in a pregnancy carried to full term with favorable outcome. Taiwan J Obstet Gynecol 2013; 51:271-5. [PMID: 22795107 DOI: 10.1016/j.tjog.2012.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To present molecular diagnosis and genetic counseling for osteogenesis imperfecta (OI) type IV in a pregnancy carried to term with favorable outcome. CASE REPORT A 34-year-old, primigravid woman was referred for genetic counseling in the second trimester because of advanced maternal age and a positive family history of OI type IV. Her husband had a weight of 40 kg and a height of 145 cm. Her husband had normal sclerae, moderate short stature and osteopenia, and had sustained multiple fractures with minimal trauma since childhood. The husband and his relatives including his mother, aunt, uncle, sister and nephew had suffered from OI type IV. Molecular analysis of the affected individuals in the family revealed a G to T change at position c.2197 (c.2197G>T, GGT>TGT) of the exon 37 in the COL1A2 gene leading to a change of glycine at codon 733 to cysteine (G733C). Cytogenetic analysis of cultured amniocytes revealed a karyotype of 46,XY. Molecular analysis of uncultured amniocytes revealed a missense mutation of G733C in COL1A2. Level II ultrasound at 23 weeks of gestation revealed significant shortness of the limbs. Small stature for gestation age was obvious in the third trimester. At 37 weeks of gestation, a fetal ultrasound showed curvature of the femurs. A cesarean section was performed at 38 weeks of gestation, and a male baby was delivered uneventfully. The baby had normal sclerae, a body weight of 2190 g (< 5(th) centile) and a body length of 46 cm (< 5(th) centile). X-rays showed thin clavicles and short curved femurs but no bony fractures. No fractures were noted at the age of 1 month. CONCLUSION The present case adds to previous examples of favorable outcome in pregnancies with non-lethal forms of OI.
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17
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Uncomplicated vaginal delivery in two consecutive pregnancies carried to term in a woman with osteogenesis imperfecta type I and bisphosphonate treatment before conception. Taiwan J Obstet Gynecol 2012; 51:305-7. [DOI: 10.1016/j.tjog.2012.04.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2012] [Indexed: 11/18/2022] Open
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Management of pregnancy in women with genetic disorders, Part 1: Disorders of the connective tissue, muscle, vascular, and skeletal systems. Obstet Gynecol Surv 2012; 66:699-709. [PMID: 22186601 DOI: 10.1097/ogx.0b013e31823cdd50] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
UNLABELLED Due to early diagnosis and increasingly effective medical advances, the number of women with various genetic syndromes who are undergoing pregnancy is increasing, and this represents an important issue for providers of obstetric care. Each year more women with genetic disease reach childbearing age. Advances in assisted reproductive technology have enabled pregnancy in a cohort of woman who may experience impaired fertility due to their underlying diagnosis. Management of these women requires coordination of care by healthcare providers from multiple specialties to optimize outcomes. Potentially serious medical issues specific to each diagnosis often exist in the preconception, antepartum, intrapartum, and postpartum periods, all of which must be recognized to allow timely diagnosis and treatment. The fetus may also face issues related to risk for inheritance of the genetic disorder itself, as well as risks related to the chronic disease status of the mother. This article will explore the issues faced by women with various genetic disorders that may affect connective tissue, muscular, vascular, and skeletal systems. TARGET AUDIENCE Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES After the completing the CME activity, physicians should be better able to classify the cardiovascular manifestations observed in Marfan syndrome and Ehlers-Danlos, evaluate prenatal diagnostic options and limitations for various genetic syndromes, assess the risks to the fetus in women with various genetic syndromes. Determine whether there is a preferred mode of delivery for pregnant patients with various genetic syndromes described in this paper.
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20
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Lyra TG, Pinto VAF, Ivo FAB, Nascimento JDS. Osteogenesis imperfecta in pregnancy. Case report. Rev Bras Anestesiol 2011; 60:321-4. [PMID: 20682164 DOI: 10.1016/s0034-7094(10)70040-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 02/03/2010] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Osteogenesis Imperfecta is a rare condition, especially in obstetric patients. It has an estimated prevalence of 1/10,000 in the general population, and 1/25,000 to 30,000 in obstetric patients. The objective of this report was to present a rare case of a pregnant woman with Osteogenesis Imperfecta undergoing cesarean section. CASE REPORT This is a 23 years old gravida on the 38th week, admitted to the maternity ward with loss of amniotic fluid and contractions for four hours, associated with the absence of fetal movements for four days. The patient had a mild form of Osteogenesis Imperfecta without other comorbidities. She was not taking any medication, and she did not have prenatal follow-up. The patient underwent spinal anesthesia in the L(3)-L(4) space, median approach, with a single puncture with a 27G Quincke needle and the administration of hyperbaric 0.5% bupivacaine (10 mg) and morphine (60 microg). She was discharged in the second postoperative day without complaints. CONCLUSIONS Fertility is preserved, especially in those patients with type I of the disease, and pregnancy can be carried to term. Delivery is usually surgical due to pelvic deformities in the gravida, cephalopelvic disproportion, and increased incidence of abnormal fetal presentation. The importance of the anesthesiologist in the surgical team relies on the perioperative management and the choice of the most appropriate anesthetic technique for each patient.
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Affiliation(s)
- Ticiana Goyanna Lyra
- Maternidade de Referência Professor José Maria de Magalhães Netto, CET/SBA of the Santa Casa de Misericórdia da Bahia, Salvador, BA.
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Abstract
UNLABELLED Intrauterine fracture is an extremely rare finding, but can occur as the result of maternal trauma, osteogenesis imperfecta (OI), or theoretically other metabolic/structural abnormalities. Increased clinical awareness of the diagnosis and optimal management of these cases can lead to more positive outcomes for the patient and her child. Blunt abdominal trauma late in gestation increases the risk of fetal skull fracture, while a known diagnosis of OI or other abnormalities leading to decreased fetal bone density creates concern for long bone fracture. Biochemical and genetic tests can aid in the prenatal diagnosis of OI, while ultrasound is the best overall imaging modality for identifying fetal fracture of any etiology. When fetal fracture is diagnosed radiologically, specific management is recommended to promote optimal outcomes for mother and fetus, with special consideration given to the mother with OI. With the exception of fetal fractures due to lethal conditions, cesarean delivery is recommended in most cases, especially when fetal or maternal well-being cannot be assured. When a patient presents with risk factors for intrauterine fracture, careful evaluation via thorough history-taking, ultrasonography of the entire fetal skeleton, and laboratory tests should be performed. Heightened awareness of intrauterine fracture allows better postpartum management, whether for simple fracture care or for long-term care of patients with OI or genetic/metabolic abnormalities. TARGET AUDIENCE Obstetricians & Gynecologist, Family Physicians. LEARNING OBJECTIVES After completion of this educational activity, the reader will be able to compare x-ray, ultrasound modalities and MRI and their utility in diagnosing fetal fracture. Formulate a differential diagnosis for fetal fracture. Propose a delivery plan for a patient whose fetus has a prenatally diagnosed fetal fracture.
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Abstract
Although cesarean deliveries frequently are performed for anomalous fetal conditions, available data do not always support a fetal benefit from this delivery management. The literature on cesarean delivery for anomalous infants reports insufficient information on comorbid neonatal conditions, so these complications are unknown in this population of newborns. In a minority of cases, a cesarean delivery is reasonable to prevent dystocia or optimize outcome. Areas for future investigation include prospective, randomized, controlled trials of prelabor cesarean compared with vaginal deliveries for myelomeningocele and anterior abdominal wall defects. The rarity of other lesions likely precludes randomized controlled trials.
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Affiliation(s)
- Shannon E G Hamrick
- Department of Pediatrics, Emory University, Emory Children's Center, 2015 Uppergate Drive, Atlanta, GA 30322, USA.
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Parasuraman R, Taylor MJO, Liversedge H, Gilg J. Pregnancy management in type III maternal osteogenesis imperfecta. J OBSTET GYNAECOL 2008; 27:619-21. [PMID: 17896267 DOI: 10.1080/01443610701546292] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- R Parasuraman
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
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Litos M, Michala S, Brown R. Osteogenesis imperfecta and pregnancy. Eur J Obstet Gynecol Reprod Biol 2008; 136:126-7. [PMID: 17045730 DOI: 10.1016/j.ejogrb.2006.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Revised: 08/13/2006] [Accepted: 09/05/2006] [Indexed: 10/24/2022]
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Coors ME, Townsend SF. Supporting Pregnant Women through Difficult Decisions: A Case of Prenatal Diagnosis of Osteogenesis Imperfecta. THE JOURNAL OF CLINICAL ETHICS 2006. [DOI: 10.1086/jce200617309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Rudlof B, Scheel G, Jacquet M. [Anesthesia for cesarean section in a patient with Lobstein's syndrome]. Anaesthesist 2006; 55:655-9. [PMID: 16528521 DOI: 10.1007/s00101-006-1006-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We report on a 21-year-old woman with a severe form of Lobstein's syndrome, who underwent a Cesarean section. The following issues are discussed: the risk of sustaining fractures during positioning, fractures by automatic blood pressure measurement, an almost always existing latex allergy, a susceptibility for malignant hyperthermia, potential cardiac defect, difficult endotracheal intubation, lowering of the conus medullaris to an area usually used for spinal puncture, severe spinal deformities resulting in difficult puncture, hemorrhagic diathesis, and unpredictability of the expansion of local anesthetics in the vertebral canal. In this case the procedure could be carried out in spinal anesthesia without encountering major problems.
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Affiliation(s)
- B Rudlof
- Zentralinstitut für Anästhesie, Kliniken St. Antonius, Vogelsangstrasse 106, 42109 Wuppertal.
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Abstract
Musculoskeletal anomalies are not uncommon in prenatal life. They can be either sporadic or part of chromosomal syndromes causing prenatal morbidity and mortality. The prenatal diagnosis of musculoskeletal anomalies is based on information assembled from various imaging modalities and from biochemical and genetic workups. The prenatal diagnosis can serve as a prognostic tool and in counseling the parents. Among the imaging methods, ultrasonography is the most popular and cost effective in observing and following fetal development from the very early stages of gestation. Transvaginal sonography can detect and identify most of the normal and the specific pathologic changes very close to the stage of their embryogenic development. From a practical point of view, early detailed transvaginal sonography screening at 14 to 15 weeks of gestation is very useful while late detection at 20 to 23 weeks of gestation may provide some additional information in low-risk pregnancies. Very early screening, even during the ninth week, may be indicated in high-risk pregnancies. Additional genetic counseling is recommended when abnormal findings are suspected. We summarize the diagnostic approach and the information available for the most common musculoskeletal anomalies.
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Affiliation(s)
- David Keret
- Department of Pediatric Orthopaedics, Dana Children's Hospital, and the Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
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Di Lieto A, Pollio F, De Falco M, Iannotti F, Mascolo M, Somma P, Staibano S. Collagen content and growth factor immunoexpression in uterine lower segment of type IA osteogenesis imperfecta: Relationship with recurrent uterine rupture in pregnancy. Am J Obstet Gynecol 2003; 189:594-600. [PMID: 14520241 DOI: 10.1067/s0002-9378(03)00468-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate collagen content and platelet-derived growth factor, vascular endothelial growth factor, and connective tissue growth factor expression in the myometrium of the uterine lower segment from a patient with type IA osteogenesis imperfecta with recurrent uterine rupture and to evaluate the existence of a relationship between the rare recurrent uterine rupture and the tissue disorders of type IA osteogenesis imperfecta. STUDY DESIGN Collagen content and platelet-derived growth factor, vascular endothelial growth factor, and connective tissue growth factor expression in the uterine lower segment were assessed in the patient with type IA osteogenesis imperfecta and in eight otherwise healthy ("control") patients. RESULTS Type IA osteogenesis imperfecta contained less total collagen amount, with no difference in type III collagen expression and showed increased levels of platelet-derived growth factor and vascular endothelial growth factor in myometrial smooth muscle cells. No difference was observed in connective tissue growth factor expression. CONCLUSION These findings confirm the diminished collagen amount in myometrium from osteogenesis imperfecta and show the presence of additional pathogenetic mechanisms. A relationship is hypothesized between the underlying myometrial biochemical modifications and the recurrent uterine rupture.
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Affiliation(s)
- Andrea Di Lieto
- Department of Obstetrical-Gynaecological, University Federico II of Naples, Naples, Italy.
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