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AIUM Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:E20-E32. [PMID: 38224490 DOI: 10.1002/jum.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024]
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Kalbhenn J, Marx O, Müller-Peltzer K, Kunze M, Bürkle H, Bansbach J. [Pregnant women with COVID-19 ARDS on the intensive care unit]. DIE ANAESTHESIOLOGIE 2024; 73:385-397. [PMID: 38671334 PMCID: PMC11164748 DOI: 10.1007/s00101-024-01405-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 02/29/2024] [Accepted: 03/14/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease progression. Comorbidities, such as chronic arterial hypertension, diabetes mellitus, advanced maternal age and high body mass index, may predispose to severe disease. The management of pregnant COVID-19 patients on the intensive care unit (ICU) is challenging and requires careful consideration of maternal, fetal and ethical issues. OBJECTIVE Description and discussion of intensive care treatment strategies and perinatal anesthesiological management in patients with COVID-19 acute respiratory distress syndrome (CARDS). MATERIAL AND METHODS We analyzed the demographic data, maternal medical history, clinical intensive care management, complications, indications and management of extracorporeal membrane oxygenation (ECMO) and infant survival of all pregnant patients treated for severe CARDS in the anesthesiological ICU of a German university hospital between March and November 2021. RESULTS The cohort included 9 patients with a mean age of 30.3 years (range 26-40 years). The gestational age ranged from 21 + 3 weeks to 37 + 2 weeks. None of the patients had been vaccinated against SARS-CoV‑2. Of the nine patients seven were immigrants and communication was hampered by inadequate Central European language skills. Of the patients five had a PaO2/FiO2 index < 150 mm Hg despite escalated invasive ventilation (FiO2 > 0.9 and a positive end-expiratory pressure [PEEP] of 14 mbar) and were therefore treated with repeated prolonged prone positioning maneuvers (5-14 prone positions for 16 h each, a total of 47 prone positioning treatments) and 2 required treatment with inhaled nitric oxide and venovenous ECMO. The most common complications were bacterial superinfection of the lungs, urinary tract infection and delirium. All the women and five neonates survived. All newborns were delivered by cesarean section, two patients were discharged home with an intact pregnancy and two intrauterine fetal deaths were observed. None of the newborns tested positive for SARS-CoV‑2 at birth. CONCLUSION High survival rates are possible in pregnant patients with CARDS. The peripartum management of pregnant women with CARDS requires close interdisciplinary collaboration and should prioritize maternal survival in early pregnancy. In our experience, prolonged prone positioning, an essential evidence-based cornerstone in the treatment of ARDS, can also be safely used in advanced stages of pregnancy. Inhaled nitric oxide (iNO) and ECMO should be considered as life-saving treatment options for carefully selected patients. For cesarean section, neuraxial anesthesia can be safely performed in patients with mild CARDS if well planned but the therapeutic anticoagulation recommended for COVID-19 may increase the risk of bleeding complications, making general anesthesia a more viable alternative, especially in severe disease.
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Affiliation(s)
- J Kalbhenn
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinik Freiburg, Hugstetter Str. 55, Freiburg, Deutschland
| | - O Marx
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinik Freiburg, Hugstetter Str. 55, Freiburg, Deutschland
| | - K Müller-Peltzer
- Klinik für Radiologie, Universitätsklinik Freiburg, Freiburg, Deutschland
| | - M Kunze
- Klinik für Frauenheilkunde, Geburtshilfe und Perinatologie, Universitätsklinik Freiburg, Freiburg, Deutschland
| | - H Bürkle
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinik Freiburg, Hugstetter Str. 55, Freiburg, Deutschland
| | - J Bansbach
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinik Freiburg, Hugstetter Str. 55, Freiburg, Deutschland.
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Khalabazyane B, David R, Rashid R, Philips J. Navigating the Complexities of Symptomatic Hydronephrosis in Pregnancy. Cureus 2024; 16:e61240. [PMID: 38939245 PMCID: PMC11210578 DOI: 10.7759/cureus.61240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
The management of symptomatic hydronephrosis presents substantial challenges due to the absence of consensus within clinical guidelines concerning pain management, diagnostic approaches, therapeutic interventions, and follow-up protocols. This literature review focuses on complexities involving diagnostic challenges that arise from the difficulty in distinguishing physiological from pathological obstruction and treatment complexities that involve deciding on the most appropriate pain management medications and safe interventions while minimizing risks to both the mother and foetus. To address these challenges, a comprehensive search of electronic databases, including PubMed, Embase, and Google Scholar, was conducted for the terms "hydronephrosis", "hydronephrosis in pregnancy", "ionising radiation in pregnancy", and "safe analgesia in pregnancy". Moreover, Mendeley software was used to collect and organize the references. Diagnostic complexities involve selecting the appropriate imaging modality that balances accurate diagnosis with minimal radiation to the foetus. Ultrasound remains the first-line option. However, it has limitations in delineating the underlying aetiology. MRI avoids ionizing radiation but has restricted utility due to foetal movement artifacts. CT provides the highest diagnostic accuracy but raises foetal radiation exposure concerns, though ultra-low dose protocols (<1 mGy) are deemed acceptable by most guidelines. Management includes either a conservative approach, which is a safe option in the majority of cases, or intervention with a percutaneous nephrostomy or ureteric stent insertion, both with comparable symptom control. However, there is no consensus on the optimal frequency for drain changes to prevent rapid encrustation. Definitive procedures like ureteroscopy and percutaneous nephrolithotomies remain controversial. Most guidelines suggest limiting these interventions to specialist centres during the second trimester if required.
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Affiliation(s)
| | - Rotimi David
- Urology, Great Western Hospital National Health Service (NHS) Foundation Trust, Swindon, GBR
| | - Rahel Rashid
- General and Colorectal Surgery, Arrowe Park Hospital, Wirral, GBR
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Xie K, Cui C, Li X, Yuan Y, Wang Z, Zeng L. MRI-Based Clinical-Imaging-Radiomics Nomogram Model for Discriminating Between Benign and Malignant Solid Pulmonary Nodules or Masses. Acad Radiol 2024:S1076-6332(24)00207-1. [PMID: 38644089 DOI: 10.1016/j.acra.2024.03.042] [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: 02/29/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/23/2024]
Abstract
RATIONALE AND OBJECTIVES Pulmonary nodules or masses are highly prevalent worldwide, and differential diagnosis of benign and malignant lesions remains difficult. Magnetic resonance imaging (MRI) can provide functional and metabolic information of pulmonary lesions. This study aimed to establish a nomogram model based on clinical features, imaging features, and multi-sequence MRI radiomics to identify benign and malignant solid pulmonary nodules or masses. MATERIALS AND METHODS A total of 145 eligible patients (76 male; mean age, 58.4 years ± 13.7 [SD]) with solid pulmonary nodules or masses were retrospectively analyzed. The patients were randomized into two groups (training cohort, n = 102; validation cohort, n = 43). The nomogram was used for predicting malignant pulmonary lesions. The diagnostic performance of different models was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS Of these patients, 95 patients were diagnosed with benign lesions and 50 with malignant lesions. Multivariate analysis showed that age, DWI value, LSR value, and ADC value were independent predictors of malignant lesions. Among the radiomics models, the multi-sequence MRI-based model (T1WI+T2WI+ADC) achieved the best diagnosis performance with AUCs of 0.858 (95%CI: 0.775, 0.919) and 0.774 (95%CI: 0.621, 0.887) for the training and validation cohorts, respectively. Combining multi-sequence radiomics, clinical and imaging features, the predictive efficacy of the clinical-imaging-radiomics model was significantly better than the clinical model, imaging model and radiomics model (all P < 0.05). CONCLUSION The MRI-based clinical-imaging-radiomics model is helpful to differentiate benign and malignant solid pulmonary nodules or masses, and may be useful for precision medicine of pulmonary diseases.
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Affiliation(s)
- Kexin Xie
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210002, China
| | - Can Cui
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210002, China
| | - Xiaoqing Li
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210002, China
| | - Yongfeng Yuan
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210002, China
| | - Zhongqiu Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210002, China
| | - Liang Zeng
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210002, China.
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Davidson TM, Hieken TJ, Glasgow AE, Habermann EB, Yan Y. Pregnancy-associated melanoma: characteristics and outcomes from 2002 to 2020. Melanoma Res 2024; 34:175-181. [PMID: 38265469 PMCID: PMC10906198 DOI: 10.1097/cmr.0000000000000953] [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: 05/19/2023] [Accepted: 12/15/2023] [Indexed: 01/25/2024]
Abstract
Melanoma diagnosed within 1 year of pregnancy is defined as pregnancy-associated melanoma (PAM). No robust data on how pregnancy influences melanoma nor guidelines for PAM management exist. With IRB approval, female patients with a pathology-confirmed melanoma diagnosis within 1 year of pregnancy treated at our institution from 2000 to 2020 were identified. Controls from the cancer registry were matched 1 : 4 when available on decade of age, year of surgery (±5), and stage. We identified 83 PAM patients with median follow-up of 86 months. Mean age at diagnosis was 31 years. 80% AJCC V8 stage I, 2.4% stage II, 13% stage III, 4.8% stage IV. Mean Breslow thickness was 0.79 mm and 3.6% exhibited ulceration. The mean mitotic rate was 0.76/mm 2 . In terms of PAM management, 98.6% of ESD patients and 86.7% of LSD patients received standard-of-care therapy per NCCN guidelines for their disease stage. No clinically significant delays in treatment were noted. Time to treatment from diagnosis to systemic therapy for LSD patients was an average of 46 days (95% CI: 34-59 days). Comparing the 83 PAM patients to 309 controls matched on age, stage, and year of diagnosis, similar 5-year overall survival (97% vs. 97%, P = 0.95) or recurrence-free survival (96% vs. 96%, P = 0.86) was observed. The outcomes of PAM following SOC treatment at a highly specialized center for melanoma care were comparable to non-PAM when matched by clinical-pathologic features. Specialty center care is encouraged for women with PAM.
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Affiliation(s)
| | - Tina J. Hieken
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic
| | - Amy E. Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic
| | - Elizabeth B. Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic
- Division of Health Care Delivery Research, Mayo Clinic
| | - Yiyi Yan
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Lapinsky SE, Vasquez DN. Acute Respiratory Failure in Pregnancy. Crit Care Clin 2024; 40:353-366. [PMID: 38432700 DOI: 10.1016/j.ccc.2024.01.005] [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] [Indexed: 03/05/2024]
Abstract
Respiratory failure may affect up to 1 in 500 pregnancies, due to pregnancy-specific conditions, conditions aggravated by the pregnant state, or other causes. Management during pregnancy is influenced by altered maternal physiology, and the presence of a fetus influencing imaging, and drug therapy choices. Few studies have addressed the approach to invasive mechanical ventilatory management in pregnancy. Hypoxemia is likely harmful to the fetus, but precise targets are unknown. Hypocapnia reduces uteroplacental circulation, and some degree of hypercapnia may be tolerated in pregnancy. Delivery of the fetus may be considered to improve maternal respiratory status but improvement does not always occur.
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Affiliation(s)
- Stephen E Lapinsky
- Mount Sinai Hospital, Toronto, Interdepartmental Division of Critical Care Medicine, University of Toronto, 600 University Avenue, Toronto M5G1X5, Canada.
| | - Daniela N Vasquez
- ICU Head of Department, Sanatorio Anchorena, Tomás M. de Anchorena 1872, City of Buenos Aires, Argentina
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Ayyash M, Miller M, Smith N, Espy J, Kim SK. Management of small bowel obstruction in the third trimester. BMJ Case Rep 2024; 17:e255843. [PMID: 38442967 PMCID: PMC10916100 DOI: 10.1136/bcr-2023-255843] [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] [Indexed: 03/07/2024] Open
Abstract
Small bowel obstruction (SBO) in pregnancy is exceedingly rare. Management of SBO in the third trimester may pose particular challenges, as clinicians must determine whether or not the delivery of the fetus is indicated. In this report, we review the case of a patient in her mid-20's with no prior surgical history who presented with nausea and vomiting at 34 weeks of gestation and was ultimately diagnosed with an SBO. Following expectant management during the initial 4 days of inpatient admission, the patient subsequently underwent an exploratory laparotomy at 35 weeks without concurrent delivery. She was monitored for the remainder of her pregnancy with non-stress tests to evaluate fetal status and eventually underwent induction of labour at 39 weeks, resulting in a successful vaginal delivery. Herein, we review the challenges related to the diagnosis and management of SBO in pregnancy, as well as the maternal-fetal outcomes in the setting of SBO in the third trimester.
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Affiliation(s)
- Mariam Ayyash
- Department of Women's Health, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Madison Miller
- Department of Women's Health, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Nicolina Smith
- Department of Women's Health, Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Jeannette Espy
- Department of Women's Health, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Sun Kwon Kim
- Department of Women's Health, Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
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Albakri AA, Alzahrani MM, Alghamdi SH. Medical Imaging in Pregnancy: Safety, Appropriate Utilization, and Alternative Modalities for Imaging Pregnant Patients. Cureus 2024; 16:e54346. [PMID: 38500900 PMCID: PMC10945608 DOI: 10.7759/cureus.54346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/20/2024] Open
Abstract
This article reviews the existing literature on diagnostic and medical imaging of pregnant women, the risks and safety measures of different medical imaging modalities, and alternative modalities for imaging pregnant patients. Different medical imaging modalities such as MRI, CT scan, ultrasound, nuclear medicine, and X-ray imaging help to evaluate women with recognized or unrecognized pregnancies and identify any underlying complications among pregnant patients. Fetuses are more sensitive to radiation and the effects of medical imaging as compared to adults since they have a rapidly developing cell system. During cell proliferation, migration, and differentiation, fetuses suffer greatly from imaging radiation since they are developing under a dynamic system. To ensure safety, pregnant women should discuss the benefits and risks of medical imaging with their physicians. In addition, radiologists should not perform any medical imaging procedure without the patient's consent, unless the patient cannot make any sound decision. Fetal risks of medical imaging include slow growth and development of the fetus, abortion, malformations, impaired brain function, abnormal childhood growth, and neurological development. Diagnostic imaging procedures are necessary when a condition that needs medical evaluation arises during pregnancy such as appendicitis.
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Affiliation(s)
| | | | - Saeed H Alghamdi
- Interventional Radiology, King Fahad General Hospital, Al Baha, SAU
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Wei JL, Zhang L, Xu YL, Gan W, Qi M, Fu XW, Li X. Case-controlled study of tuberculosis in in-vitro fertilisation-embryo transfer and natural pregnancy. BMC Pregnancy Childbirth 2024; 24:77. [PMID: 38263003 PMCID: PMC10804702 DOI: 10.1186/s12884-024-06260-1] [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: 07/19/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE To improve the understanding of the clinical features and imaging characteristics of pregnant women with and without in-vitro fertilisation-embryo transfer combined with pulmonary tuberculosis (TB). METHODS A retrospective analysis was conducted involving 50 patients with pregnancy who had pulmonary TB and were admitted to the Third People's Hospital of Kunming (China) between 1 January 2017 and 31 December 2021. These patients were divided into an in-vitro fertilisation and embryo transfer (IVF-ET) conception group and a natural conception group according to the conception method. The clinical and imaging data were then collected and compared. RESULTS The mean age of the IVF-ET group (n = 13, 31.85 ± 5.84 years) was higher than in the natural conception group (n = 37, 27.05 ± 5.5 years). The proportions of fever, haematogenous TB and extrapulmonary TB in the IVF-ET group (92.31%, 84.62% and 76.92%, respectively) were higher than those in the natural conception group (40.54%,16.22%,27.03%,respectively). The percentage of patients with pregnancy who had intracranial TB (76.9%) in the IVF-ET group was higher than in the natural conception group (10.8%). The percentage of pregnancy terminations in the IVF-ET conception group (84.62%) was higher than in the natural conception group (48.65%). All the above results had statistically significant differences (p < 0.05). CONCLUSION Overall, IVF-ET conception combined with extensive pulmonary TB lesions lead to heavy systemic toxic symptoms, severe disease and poor pregnancy outcomes. Therefore, screening for TB prior to performing IVF-ET is recommended.
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Affiliation(s)
- Jia-Lu Wei
- Department of Radiology, The Third People's Hospital of Kunming/Yunnan Clinical Medical Center for Infectious Diseases, No. 319 of Wujing Street, Guandu District, Kunming, 650041, China
| | - Le Zhang
- Department of ICU, The Third People's Hospital of Kunming/Yunnan Clinical Medical Center for Infectious Diseases, Kunming, 650041, China
| | - Yan-Ling Xu
- Department of Radiology, The Third People's Hospital of Kunming/Yunnan Clinical Medical Center for Infectious Diseases, No. 319 of Wujing Street, Guandu District, Kunming, 650041, China
| | - Wei Gan
- Department of Radiology, The Third People's Hospital of Kunming/Yunnan Clinical Medical Center for Infectious Diseases, No. 319 of Wujing Street, Guandu District, Kunming, 650041, China
| | - Min Qi
- Department of Radiology, The Third People's Hospital of Kunming/Yunnan Clinical Medical Center for Infectious Diseases, No. 319 of Wujing Street, Guandu District, Kunming, 650041, China
| | - Xu-Wen Fu
- Department of Radiology, The Third People's Hospital of Kunming/Yunnan Clinical Medical Center for Infectious Diseases, No. 319 of Wujing Street, Guandu District, Kunming, 650041, China
| | - Xiang Li
- Department of Radiology, The Third People's Hospital of Kunming/Yunnan Clinical Medical Center for Infectious Diseases, No. 319 of Wujing Street, Guandu District, Kunming, 650041, China.
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Calado AM, Seixas F, Pires MDA. Updating an Overview of Teratology. Methods Mol Biol 2024; 2753:1-38. [PMID: 38285332 DOI: 10.1007/978-1-0716-3625-1_1] [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] [Indexed: 01/30/2024]
Abstract
In this chapter, the authors aim to update an overview of the principles of teratology, beginning with the definition of teratology, the critical point at which this process occurs, and some of the most common etiological agents that improve our understanding of teratology.Modern teratology has greatly improved in recent years with advances in new methods in molecular biology, toxicology, animal laboratory science, and genetics, increasing our knowledge of ambient influences. Nevertheless, there is a lot to do to reduce the influence of hazardous intervening agents, whether they target our genetics or not, that can negatively affect pregnancy and induce congenital development disorders, including morphological, biochemical, or behavioral defects.Certain agents might indeed be related to certain defects, but we have not been able to identify the cause of most congenital defects, which highlights the importance of finding and testing out new genetics techniques and conducting laboratory animal science to unravel the etiology and pathogenicity of each congenital defect.
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Affiliation(s)
- Ana Margarida Calado
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Fernanda Seixas
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Maria Dos Anjos Pires
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.
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Udine M, Loke YH, Goudar S, Donofrio MT, Truong U, Krishnan A. The current state and potential innovation of fetal cardiac MRI. Front Pediatr 2023; 11:1219091. [PMID: 37520049 PMCID: PMC10375913 DOI: 10.3389/fped.2023.1219091] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Fetal cardiac MRI is a rapidly evolving form of diagnostic testing with utility as a complementary imaging modality for the diagnosis of congenital heart disease and assessment of the fetal cardiovascular system. Previous technical limitations without cardiac gating for the fetal heart rate has been overcome with recent technology. There is potential utility of fetal electrocardiography for direct cardiac gating. In addition to anatomic assessment, innovative technology has allowed for assessment of blood flow, 3D datasets, and 4D flow, providing important insight into fetal cardiovascular physiology. Despite remaining technical barriers, with increased use of fCMR worldwide, it will become an important clinical tool to improve the prenatal care of fetuses with CHD.
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Affiliation(s)
- Michelle Udine
- Division of Cardiology, Children’s National Hospital, Washington, DC, United States
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Zaidi AK, Arif A, Butt M, Tebha SS, Ray I, Yosufi A, Dehgani-Mobaraki P. Coexistence of proboscis lateralis and multiple craniofacial, neurological, cardiac and spinal deformities: a one-of-a-kind case report. BMC Pediatr 2023; 23:70. [PMID: 36759785 PMCID: PMC9912482 DOI: 10.1186/s12887-023-03882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Proboscis lateralis (PL) is an uncommon congenital facial deformity marked by the protrusion of a primitive tubular structure made up of skin and soft tissue that generally emerges from the eye's medial canthus and is associated with some craniofacial deformities. We report the first case of PL with multiple craniofacial, neurological, cardiac, and spinal anomalies. CASE PRESENTATION A full-term female baby delivered by cesarean section cried immediately at birth. The mother reported having a normal pregnancy but has a history of x-ray during her first trimester. The baby was born with a rare presentation of proboscis lateralis which was accompanied by multiple anomalies, including but not limited to bilateral colpocephaly, corpus callosum agenesis, complex cyanotic congenital heart disease, and hemivertebra of the T10 body. CONCLUSION PL is an uncommon congenital condition that causes a variety of craniofacial abnormalities. Multiple additional defects affecting various organ systems should also be evaluated in a person diagnosed with PL.
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Affiliation(s)
- Asiya Kamber Zaidi
- Research Fellow, Associazione Naso Sano, Perugia, Italy ,grid.415481.d0000 0004 1767 1900MGM Medical College Indore (MP), Indore, India
| | - Aabiya Arif
- grid.413093.c0000 0004 0571 5371Department of Medicine, Ziauddin University, Karachi, Pakistan
| | - Mehwish Butt
- grid.414695.b0000 0004 0608 1163Department of Neurosurgery and Neurology, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Sameer Saleem Tebha
- grid.414695.b0000 0004 0608 1163Department of Neurosurgery and Neurology, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Ishita Ray
- grid.415481.d0000 0004 1767 1900MGM Medical College Indore (MP), Indore, India
| | - Abubakr Yosufi
- Department of Research, Kabul University of Medical Sciences, Kabul, Afghanistan.
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Ami O, Maran JC, Cohen A, Hendler I, Zabukovek E, Boyer L. Childbirth simulation to assess cephalopelvic disproportion and chances for failed labor in a French population. Sci Rep 2023; 13:1110. [PMID: 36670300 PMCID: PMC9859818 DOI: 10.1038/s41598-023-28459-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Reducing failed labor and emergency cesarean section (CS) rates is an important goal. A childbirth simulation tool (PREDIBIRTH software and SIM37 platform) that evaluates a 5-min magnetic resonance imaging (MRI) assessment performed at 37 weeks of gestation was developed to enhance the consulting obstetrician's ability to predict the optimal delivery mode. We aimed to determine the potential value of this childbirth simulation tool in facilitating the selection of an optimal delivery mode for both mother and infant. A retrospective cohort study was performed on all patients referred by their obstetricians to our level 2 maternity radiology department between December 15, 2015 and November 15, 2016, to undergo MRI pelvimetry at approximately 37 weeks of gestation. The childbirth simulation software was employed to predict the optimal delivery mode based on the assessment of cephalopelvic disproportion. The prediction was compared with the actual outcome for each case. Including childbirth simulations in the decision-making process had the potential to reduce emergency CSs, inappropriately scheduled CSs, and instrumental vaginal deliveries by up to 30.1%, 20.7%, and 20.0%, respectively. Although the use of the simulation tool might not have affected the overall CS rate, consideration of predicted birthing outcomes has the potential to improve the allocation between scheduled CS and trial of labor. The routine use of childbirth simulation software as a clinical support tool when choosing the optimal delivery mode for singleton pregnancies with a cephalic presentation could reduce the number of emergency CSs, insufficiently justified CSs, and instrumental deliveries.
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Affiliation(s)
- Olivier Ami
- Ramsay Sante La Muette, 4 Rue de Sontay, 75116, Paris, France.
- Service de radiologie CHU Gabriel Montpied, Clermont Ferrand University Hospital, TGI -Institut Pascal, UMR 6602 UCA/CNRS/SIGMA Clermont Ferrand, Clermont Ferrand, France.
| | - Jean-Christophe Maran
- Service de radiologie CHU Gabriel Montpied, Clermont Ferrand University Hospital, TGI -Institut Pascal, UMR 6602 UCA/CNRS/SIGMA Clermont Ferrand, Clermont Ferrand, France
| | - Albert Cohen
- Réseau d'Imagerie Paris Nord, Paris, France
- Clinique de l'Estrée, ELSAN, Stains, France
| | - Israel Hendler
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Louis Boyer
- Service de radiologie CHU Gabriel Montpied, Clermont Ferrand University Hospital, TGI -Institut Pascal, UMR 6602 UCA/CNRS/SIGMA Clermont Ferrand, Clermont Ferrand, France
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European recommendations on practices in pediatric neuroradiology: consensus document from the European Society of Neuroradiology (ESNR), European Society of Paediatric Radiology (ESPR) and European Union of Medical Specialists Division of Neuroradiology (UEMS). Pediatr Radiol 2023; 53:159-168. [PMID: 36063184 PMCID: PMC9816178 DOI: 10.1007/s00247-022-05479-4] [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: 04/13/2022] [Revised: 06/27/2022] [Accepted: 08/01/2022] [Indexed: 01/24/2023]
Abstract
Pediatric neuroradiology is a subspecialty within radiology, with possible pathways to train within the discipline from neuroradiology or pediatric radiology. Formalized pediatric neuroradiology training programs are not available in most European countries. We aimed to construct a European consensus document providing recommendations for the safe practice of pediatric neuroradiology. We particularly emphasize imaging techniques that should be available, optimal site conditions and facilities, recommended team requirements and specific indications and protocol modifications for each imaging modality employed for pediatric neuroradiology studies. The present document serves as guidance to the optimal setup and organization for carrying out pediatric neuroradiology diagnostic and interventional procedures. Clinical activities should always be carried out in full agreement with national provisions and regulations. Continued education of all parties involved is a requisite for preserving pediatric neuroradiology practice at a high level.
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Appelman-Dijkstra NM, Pilz S. Approach to the patient: Management of parathyroid diseases across pregnancy. J Clin Endocrinol Metab 2022; 108:1505-1513. [PMID: 36546344 DOI: 10.1210/clinem/dgac734] [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: 09/08/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Taking care of patients with parathyroid disorders during pregnancy requires consideration of the physiological fundamental changes in bone and mineral metabolism occurring in these women. Diagnostic and therapeutic procedures regarding primary hyperparathyroidism (PHPT) and hypoparathyroidism significantly differ from the non-pregnant population. PHPT should preferably be cured by parathyroidectomy before pregnancy as in women with hypercalcemic PHPT, maternal and fetal pregnancy complications seem to increase according to the degree of hypercalcemia. Parathyroidectomy, if needed during pregnancy, is preferentially performed in the second trimester. Conservative treatment is recommended for milder cases and is mainly restricted to hydration with only limited evidence regarding drug treatment. Women with hypoparathyroidism can be informed that there are no major concerns regarding disease associated infertility and that the risk of pregnancy complications is low if the disease is properly managed. Regular active surveillance is recommended as requirements for calcium and active vitamin D may change during the course of pregnancy in either direction, with an overall trend for rather reduced doses. Any woman suffering from parathyroid disorders during pregnancy requires further surveillance in the postpartum period and during lactation, as there is an increased risk of hypercalcemia after delivery. Newborns of mothers with parathyroid diseases should, depending on disease severity, be carefully monitored for calcium levels in the first days (to weeks) after delivery as intrauterine exposure to hyper- or hypocalcemia may impact their postnatal regulation of calcium metabolism.
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Affiliation(s)
- Natasha M Appelman-Dijkstra
- Center for Bone Quality Leiden University Medical Center: Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Ece B, Aydın S, Kantarci M. Antenatal imaging: A pictorial review. World J Clin Cases 2022; 10:12854-12874. [PMID: 36569012 PMCID: PMC9782949 DOI: 10.12998/wjcc.v10.i35.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/17/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Today, in parallel with the use of imaging modalities increases in all fields, the use of imaging methods in pregnant women is increasing. Imaging has become an integral component of routine pregnancy follow-up. Imaging provides parents with an early opportunity to learn about the current situation, including prenatal detection of anomalies or diseases, etiology, prognosis, and the availability of prenatal or postnatal treatments. Various imaging modalities, especially ultrasonography, are frequently used for imaging both maternal and fetal imaging. The goal of this review was to address imaging modalities in terms of usefulness and safety, as well as to provide demonstrative examples for disorders. And this review provides current information on selecting a safe imaging modality to evaluate the pregnant and the fetus, the safety of contrast medium use, and summarizes major pathological situations with demonstrative sonographic images to assist radiologists and obstetricians in everyday practice.
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Affiliation(s)
- Bunyamin Ece
- Department of Radiology, Kastamonu University, Kastamonu 37150, Turkey
| | - Sonay Aydın
- Department of Radiology, Erzincan University, Erzincan 24142, Turkey
| | - Mecit Kantarci
- Department of Radiology, Erzincan University, Erzincan 24142, Turkey
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17
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Management of Pregnancy Associated Breast Cancer: a Review. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bilezikian JP, Silverberg SJ, Bandeira F, Cetani F, Chandran M, Cusano NE, Ebeling PR, Formenti AM, Frost M, Gosnell J, Lewiecki EM, Singer FR, Gittoes N, Khan AA, Marcocci C, Rejnmark L, Ye Z, Guyatt G, Potts JT. Management of Primary Hyperparathyroidism. J Bone Miner Res 2022; 37:2391-2403. [PMID: 36054638 DOI: 10.1002/jbmr.4682] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/11/2022]
Abstract
Since the last international guidelines were published in 2014 on the evaluation and management of primary hyperparathyroidism (PHPT), new information has become available with regard to evaluation, diagnosis, epidemiology, genetics, classical and nonclassical manifestations, surgical and nonsurgical approaches, and natural history. To provide the most current summary of these developments, an international group, consisting of over 50 experts in these various aspects of PHPT, was convened. This paper provides the results of the task force that was assigned to review the information on the management of PHPT. For this task force on the management of PHPT, two questions were the subject of systematic reviews using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. The full report addressing surgical and nonsurgical management of PHPT, utilizing the GRADE methodology, is published separately in this series. In this report, we summarize the results of that methodological review and expand them to encompass a much larger body of new knowledge that did not specifically fit the criteria of the GRADE methodology. Together, both the systematic and narrative reviews of the literature, summarized in this paper, give the most complete information available to date. A panel of experts then considered the last set of international guidelines in light of the newer data and assessed the need for their revision. This report provides the evidentiary background to the guidelines report. In that report, evidence from all task forces is synthesized into a summary statement and revised guidelines for the evaluation and management of PHPT. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- John P Bilezikian
- Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Shonni J Silverberg
- Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Francisco Bandeira
- Division of Endocrinology, University of Pernambuco Medical School Recife, Recife, Brazil
| | | | - Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Natalie E Cusano
- Division of Endocrinology, Department of Medicine, Lenox Hill Hospital, New York, NY, USA
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Anna Maria Formenti
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Milan, Italy
| | - Morten Frost
- Bone and Calcium Unit & Molecular Endocrinology Unit, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Jessica Gosnell
- Department of Surgery, University of California, San Francisco, CA, USA
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - Frederick R Singer
- Endocrine/Bone Disease Program, Saint John's Cancer Institute, Santa Monica, CA, USA
| | - Neil Gittoes
- Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital and University of Birmingham, Birmingham, UK
| | - Aliya A Khan
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Zhikang Ye
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - John T Potts
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Lv YT, Sun XJ, Chen Y, Ruan T, Xu GP, Huang JA. Epidemic characteristics of Mycoplasma pneumoniae infection: a retrospective analysis of a single center in Suzhou from 2014 to 2020. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1123. [PMID: 36388772 PMCID: PMC9652570 DOI: 10.21037/atm-22-4304] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/09/2022] [Indexed: 07/23/2023]
Abstract
BACKGROUND Mycoplasma pneumoniae (M. Pneumoniae) is a common pathogen of respiratory tract infections, but there is still a lack of detailed investigation on the large sample of M. Pneumoniae infection in the all age population. And patients with severe M. Pneumoniae pneumonia (SMPP) still have a certain risk of death. How to identify the clinical characteristics and population of patients with SMPP as soon as possible is still an urgent problem in clinical practice. METHODS Demographic characteristics, patient clinical information, and laboratory data of 81,131 patients with respiratory tract infections (RTIs) in the Affiliated Suzhou Hospital of Nanjing Medical University from 2014 to 2020 were retrospectively collected from all patient records. The serum particle agglutination (PA) test was used to determine M. Pneumoniae infection by detecting specific antibodies. The white blood cell count, the proportion of neutrophils and lymphocytes, C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels between children and adults with SMPP were compared by Student's t-test; other clinical features were analyzed by χ2 test or Fisher's exact test. RESULTS A total of 81,131 patients with RTIs were included, and 21,582 (26.60%) M. Pneumoniae immunoglobulin M (IgM)-positive patients were detected. From 2014 to 2020, the annual proportions of M. Pneumoniae RTIs were 23.60%, 28.18%, 38.08%, 27.05%, 23.44%, 25.26%, and 18.33%, respectively. In terms of seasonal distribution, April-June and September-November were the peak seasons of M. Pneumoniae infection each year. Children and women have a high proportion of M. Pneumoniae infection. The peak age of M. Pneumoniae infection was between 4 and 14 years old. There were 301 cases of SMPP, including 281 children and 20 adults (8 cases of pregnant women). Children and pregnant women accounted for a high proportion of SMPP. Children with SMPP had more extrapulmonary symptoms, multilobar infiltrates, and increased CRP and LDH levels compared with adults. CONCLUSIONS M. Pneumoniae infection has seasonal, sex, and age distribution trends. Children and pregnant women accounted for a high proportion of SMPP. Extrapulmonary symptoms, multilobar infiltrates, and increased CRP and LDH levels may be helpful to identify SMPP in children than in adults.
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Affiliation(s)
- Yan-Tian Lv
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Respiratory and Critical Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Xiao-Jing Sun
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying Chen
- Department of Respiratory and Critical Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Ting Ruan
- Department of Respiratory and Critical Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Guo-Peng Xu
- Department of Respiratory and Critical Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Jian-An Huang
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
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Ismail H, Bradley AJ, Lewis JF. Cardiovascular Imaging in Pregnancy: Valvulopathy, Hypertrophic Cardiomyopathy, and Aortopathy. Front Cardiovasc Med 2022; 9:834738. [PMID: 35990938 PMCID: PMC9381830 DOI: 10.3389/fcvm.2022.834738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/20/2022] [Indexed: 11/20/2022] Open
Abstract
Pregnancy is associated with profound hemodynamic changes that are particularly impactful in patients with underlying cardiovascular disease. Management of pregnant women with cardiovascular disease requires careful evaluation that considers the well-being of both the woman and the developing fetus. Clinical assessment begins before pregnancy and continues throughout gestation into the post-partum period and is supplemented by cardiac imaging. This review discusses the role of imaging, specifically echocardiography, cardiac MRI, and cardiac CT, in pregnant women with valvular diseases, hypertrophic cardiomyopathy, and aortic pathology.
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22
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Abstract
Headache is a common presenting symptom in the ambulatory setting that often prompts imaging. The increased use and associated health care money spent in the setting of headache have raised questions about the cost-effectiveness of neuroimaging in this setting. Neuroimaging for headache in most cases is unlikely to reveal significant abnormality or impact patient management. In this article, reasons behind an observed increase in neuroimaging and its impact on health care expenditures are discussed. The typical imaging modalities available and various imaging guidelines for common clinical headache scenarios are presented, including recommendations from the American College of Radiology.
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Bollerslev J, Rejnmark L, Zahn A, Heck A, Appelman-Dijkstra NM, Cardoso L, Hannan FM, Cetani F, Sikjaer T, Formenti AM, Björnsdottir S, Schalin-Jäntti C, Belaya Z, Gibb F, Lapauw B, Amrein K, Wicke C, Grasemann C, Krebs M, Ryhänen E, Makay Ö, Minisola S, Gaujoux S, Bertocchio JP, Hassan-Smith Z, Linglart A, Winter EM, Kollmann M, Zmierczak HG, Tsourdi E, Pilz S, Siggelkow H, Gittoes N, Marcocci C, Kamenický P. European Expert Consensus on Practical Management of Specific Aspects of Parathyroid Disorders in Adults and in Pregnancy: Recommendations of the ESE Educational Program of Parathyroid Disorders. Eur J Endocrinol 2022; 186:R33-R63. [PMID: 34863037 PMCID: PMC8789028 DOI: 10.1530/eje-21-1044] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
This European expert consensus statement provides recommendations for the diagnosis and management of primary hyperparathyroidism (PHPT), chronic hypoparathyroidism in adults (HypoPT), and parathyroid disorders in relation to pregnancy and lactation. Specified areas of interest and unmet needs identified by experts at the second ESE Educational Program of Parathyroid Disorders (PARAT) in 2019, were discussed during two virtual workshops in 2021, and subsequently developed by working groups with interest in the specified areas. PHPT is a common endocrine disease. However, its differential diagnosing to familial hypocalciuric hypercalcemia (FHH), the definition and clinical course of normocalcemic PHPT, and the optimal management of its recurrence after surgery represent areas of uncertainty requiring clarifications. HypoPT is an orphan disease characterized by low calcium concentrations due to insufficient PTH secretion, most often secondary to neck surgery. Prevention and prediction of surgical injury to the parathyroid glands are essential to limit the disease-related burden. Long-term treatment modalities including the place for PTH replacement therapy and the optimal biochemical monitoring and imaging surveillance for complications to treatment in chronic HypoPT, need to be refined. The physiological changes in calcium metabolism occurring during pregnancy and lactation modify the clinical presentation and management of parathyroid disorders in these periods of life. Modern interdisciplinary approaches to PHPT and HypoPT in pregnant and lactating women and their newborns children are proposed. The recommendations on clinical management presented here will serve as background for further educational material aimed for a broader clinical audience, and were developed with focus on endocrinologists in training.
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Affiliation(s)
- Jens Bollerslev
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Section of Specialized Endocrinology, Department of Endocrinology, Medical Clinic, Oslo University Hospital, Oslo, Norway
- Correspondence should be addressed to J Bollerslev Email
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Alexandra Zahn
- Schön-Klinik Hamburg, Department of Endocrine Surgery, Hamburg, Germany
| | - Ansgar Heck
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Section of Specialized Endocrinology, Department of Endocrinology, Medical Clinic, Oslo University Hospital, Oslo, Norway
| | - Natasha M Appelman-Dijkstra
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Luis Cardoso
- Centro Hospitalar e Universitário de Coimbra, i3S – Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Fadil M Hannan
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Filomena Cetani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tanja Sikjaer
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anna Maria Formenti
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Sigridur Björnsdottir
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Camilla Schalin-Jäntti
- Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Zhanna Belaya
- The National Medical Research Centre for Endocrinology, Moscow, Russia
| | - Fraser Gibb
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Karin Amrein
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Corinna Wicke
- Thyroid Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Corinna Grasemann
- Division of Rare Diseases, Department of Pediatrics, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Eeva Ryhänen
- Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Özer Makay
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Turkey
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines, Sapienza University of Rome, Rome, Italy
| | - Sébastien Gaujoux
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris Descartes University, Cochin Hospital, Paris, France
| | - Jean-Philippe Bertocchio
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Nephrology Department, Boulevard de l’Hôpital, Paris, France
| | - Zaki Hassan-Smith
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Agnès Linglart
- Université de Paris Saclay, AP-HP, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphate, Filière OSCAR, Service d’Endocrinologie et Diabète de l’Enfant, Hôpital Bicêtre Paris Saclay, Le Kremlin Bicêtre, France
| | - Elizabeth M Winter
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Martina Kollmann
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Hans-Georg Zmierczak
- Reference Centre for Rare Bone, Calcium and Phosphate Disorders – University Hospital Ghent, Ghent, Belgium
| | - Elena Tsourdi
- Center for Healthy Aging, Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Heide Siggelkow
- Endokrinologikum Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Neil Gittoes
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Peter Kamenický
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphate, Le Kremlin-Bicêtre, France
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Lee MS, Fenstermaker MA, Naoum EE, Chong S, Van de Ven CJ, Bauer ME, Kountanis JA, Ellis JH, Shields J, Ambani S, Krambeck AE, Roberts WW, Ghani KR. Management of Nephrolithiasis in Pregnancy: Multi-Disciplinary Guidelines From an Academic Medical Center. Front Surg 2021; 8:796876. [PMID: 35028309 PMCID: PMC8751485 DOI: 10.3389/fsurg.2021.796876] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The management of nephrolithiasis during pregnancy can be stressful for urologists due to concerns for investigations and treatments that may pose risk of fetal harm, and unfamiliarity with optimal management of these complex patients. In response, we created multi-disciplinary evidence-based guidelines to standardize the care for obstetric patients presenting with flank pain and suspicion for nephrolithiasis. Methods: A multi-disciplinary team involving Urology, Obstetric Anesthesiology, Obstetrics and Gynecology, Diagnostic Radiology, and Interventional Radiology from a single academic medical center was assembled. A PubMed search was performed using keywords of pregnancy/antepartum, nephrolithiasis/calculi/kidney stones, ureteroscopy, non-obstetric surgery, complications, preterm delivery, MRI, computerized tomography, renal bladder ultrasound (RBUS), and anesthesia to identify relevant articles. Team members reviewed their respective areas to create a comprehensive set of guidelines. One invited external expert reviewed the guidelines for validation purposes. Results: A total of 54 articles were reviewed for evidence synthesis. Four guideline statements were constructed to guide diagnosis and imaging, and seven statements to guide intervention. Guidelines were then used to create a diagnostic and intervention flowchart for ease of use. In summary, RBUS should be the initial diagnostic study. If diagnostic uncertainty still exists, a non-contrast CT scan should be obtained. For obstetric patients presenting with a septic obstructing stone, urgent decompression should be achieved. We recommend ureteral stent placement as the preferred intervention if local factors allow. Conclusions: We present a standardized care pathway for the management of nephrolithiasis during pregnancy. Our aim is to standardize and simplify the clinical management of these complex scenarios for urologists.
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Affiliation(s)
- Matthew S. Lee
- Department of Urology, University of Michigan, Ann Arbor, MI, United States
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Michael A. Fenstermaker
- Department of Urology, University of Michigan, Ann Arbor, MI, United States
- Kaiser Permanente Group, Department of Urology, Washington, DC, United States
| | - Emily E. Naoum
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Suzanne Chong
- Department of Radiology, Indiana University, Indianapolis, IN, United States
| | - Cosmas J. Van de Ven
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States
| | - Melissa E. Bauer
- Department of Anesthesiology, Duke University, Durham, NC, United States
| | - Joanna A. Kountanis
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - James H. Ellis
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - James Shields
- Department of Interventional Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Sapan Ambani
- Department of Urology, University of Michigan, Ann Arbor, MI, United States
| | - Amy E. Krambeck
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - William W. Roberts
- Department of Urology, University of Michigan, Ann Arbor, MI, United States
| | - Khurshid R. Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, United States
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Mahato A, Joshi R, Harish S, Paliwal D. Fluorodeoxyglucose positron emission tomography-computed tomography in a pregnant woman with carcinoma breast. World J Nucl Med 2021; 20:374-376. [PMID: 35018153 PMCID: PMC8686741 DOI: 10.4103/wjnm.wjnm_98_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/29/2021] [Indexed: 12/03/2022] Open
Abstract
A 35-year-old female with a 15-week period of gestation was detected with locally advanced cancer of the left breast. She was suggested to undergo a medical termination of pregnancy (MTP) followed by invasive Oncological imaging - Contrast enhanced computed tomography (CECT) chest–abdomen–pelvis/fluorodeoxyglucose positron emission tomography-CT (FDG PET-CT) for staging the disease. However, to avoid the risk of iatrogenic novel coronavirus 2019 infection to the patient, on her request, the hospital admission was carried out after the oncological workup and thus PET-CT was conducted before the MTP. FDG PET-CT revealed FDG avid primary in the left breast along with extensive metastases to liver and skeletal lesions. The developing fetus also showed physiological FDG uptake. The patient has undergone an MTP and is presently under treatment for metastatic breast cancer. The case report illustrates the radiation safety guidelines on fetal radiation exposure, steps to decrease fetal radiation exposure, and illustration of fetal FDG uptake.
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Affiliation(s)
- Abhishek Mahato
- Department of Nuclear Medicine and PET-CT, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
| | - Richa Joshi
- Department of Nuclear Medicine and Surgical Oncology, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
| | - S Harish
- Department of Nuclear Medicine and Surgical Oncology, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
| | - Dharmesh Paliwal
- Department of Nuclear Medicine and Surgical Oncology, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
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Primary Hyperparathyroidism in Pregnancy: Literature Review of the Diagnosis and Management. J Clin Med 2021; 10:jcm10132956. [PMID: 34209340 PMCID: PMC8268799 DOI: 10.3390/jcm10132956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Parathyroid disease is uncommon in pregnancy. During pregnancy, multiple changes occur in the calcium regulating hormones which may make the diagnosis of primary hyperparathyroidism more challenging. Close monitoring of serum calcium during pregnancy is necessary in order to optimize maternal and fetal outcomes. In this review, we will describe the diagnosis and management of primary hyperparathyroidism during pregnancy. Methods: We searched MEDLINE, CINAHL, EMBASE and Google scholar bases from 1 January 1990 to 31 December 2020. Case reports, case series, book chapters and clinical guidelines were included in this review. Conclusions: Medical management options for primary hyperparathyroidism during pregnancy are severely limited due to inadequate safety data with the various potential therapies available, and surgery is advised during the 2nd trimester of pregnancy in the presence of severe hypercalcemia (calcium adjusted for albumin greater than 3.0 mmol/L (12.0 mg/dL)). Hypercalcemia should be avoided during pregnancy in order to minimize maternal and fetal complications.
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Vandecaveye V, Amant F, Lecouvet F, Van Calsteren K, Dresen RC. Imaging modalities in pregnant cancer patients. Int J Gynecol Cancer 2021; 31:423-431. [PMID: 33649009 PMCID: PMC7925814 DOI: 10.1136/ijgc-2020-001779] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/13/2022] Open
Abstract
Cancer during pregnancy is increasingly diagnosed due to the trend of delaying pregnancy to a later age and probably also because of increased use of non-invasive prenatal testing for fetal aneuploidy screening with incidental finding of maternal cancer. Pregnant women pose higher challenges in imaging, diagnosis, and staging of cancer. Physiological tissue changes related to pregnancy makes image interpretation more difficult. Moreover, uncertainty about the safety of imaging modalities, fear of (unnecessary) fetal radiation, and lack of standardized imaging protocols may result in underutilization of the necessary imaging tests resulting in suboptimal staging. Due to the absence of radiation exposure, ultrasound and MRI are obvious first-line imaging modalities for detailed locoregional disease assessment. MRI has the added advantage of a more reproducible comprehensive organ or body region assessment, the ability of distant staging through whole-body evaluation, and the combination of anatomical and functional information by diffusion-weighted imaging which obviates the need for a gadolinium-based contrast-agent. Imaging modalities with inherent radiation exposure such as CT and nuclear imaging should only be performed when the maternal benefit outweighs fetal risk. The cumulative radiation exposure should not exceed the fetal radiation threshold of 100 mGy. Imaging should only be performed when necessary for diagnosis and likely to guide or change management. Radiologists play an important role in the multidisciplinary team in order to select the most optimal imaging strategies that balance maternal benefit with fetal risk and that are most likely to guide treatment decisions. Our aim is to provide an overview of possibilities and concerns in current clinical applications and developments in the imaging of patients with cancer during pregnancy.
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Affiliation(s)
- Vincent Vandecaveye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium .,Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Frédéric Amant
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium.,Center for Gynecological Oncology, Academic Medical Centre Amsterdam-University of Amsterdam and The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Frédéric Lecouvet
- Department of Radiology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Kristel Van Calsteren
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Raphaëla Carmen Dresen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
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Zou YZ, Yang JP, Zhou XJ, Li K, Li XM, Song CH. Bochdalek hernia masquerading as severe acute pancreatitis during the third trimester of pregnancy: A case report. World J Clin Cases 2020; 8:4660-4666. [PMID: 33083431 PMCID: PMC7559646 DOI: 10.12998/wjcc.v8.i19.4660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/12/2020] [Accepted: 08/25/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The occurrence of a diaphragmatic hernia during the third trimester of pregnancy is rare; to our knowledge, there has only been a single case report related to congenital Bochdalek hernia complicated with mild acute pancreatitis during pregnancy. Nonspecific symptoms and lack of experience due to its rarity make the diagnosis of this condition very challenging. We report a case of diaphragmatic hernia accompanied by mild acute pancreatitis in the third trimester of pregnancy, which was misdiagnosed as severe acute pancreatitis.
CASE SUMMARY A 19-year-old woman presented at gestation of 31+2 weeks with continuous distension pain for 3 d in the left lumbar region of no obvious cause. Ultrasonographic findings of left ureterectasis, with nonspecific lumbago and abdominal pain, led to the misdiagnosis of renal colic. Increased serum amylase and/or lipase levels indicated acute pancreatitis. Following the treatment of pancreatitis, her condition deteriorated. The patient was finally diagnosed with a diaphragmatic hernia complicated with mild acute pancreatitis on magnetic resonance imaging at our hospital. Caesarean section was performed at gestation of 31+6 weeks, followed by hernia repair, and the pancreatitis was treated sequentially. The patient was discharged in good condition 20 d after the surgery.
CONCLUSION In this case, surgical treatment was not the same as that for non-pregnant diaphragmatic hernia repair. It is important to first perform a cesarean section before commencing the therapy.
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Affiliation(s)
- Yun-Zhi Zou
- Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jin-Pu Yang
- Department of Gastroenterology, the First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Xiao-Jiang Zhou
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Ke Li
- Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Mei Li
- Clinical Research Center, Xiamen University, Xiamen 361102, Fujian Province, China
| | - Cong-Hua Song
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Moin T, Ramsay B, Mckeown B, Astall E, Tapuria N. Ruptured ovarian dermoid cyst - an unusual cause for peritonitis in pregnancy: a case report. JRSM Open 2020; 11:2054270417744502. [PMID: 32551131 PMCID: PMC7278314 DOI: 10.1177/2054270417744502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Computed tomography scanning could be safely used in later pregnancy to aid diagnosis and target management of the acute abdomen.
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Affiliation(s)
- Thajammul Moin
- Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough PE3 9GZ, UK
| | - Bruce Ramsay
- Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough PE3 9GZ, UK
| | - Barbara Mckeown
- Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough PE3 9GZ, UK
| | - Elizabeth Astall
- Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough PE3 9GZ, UK
| | - Niteen Tapuria
- Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough PE3 9GZ, UK
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30
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Chen S, Liao E, Cao D, Gao Y, Sun G, Shao Y. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. J Med Virol 2020; 92:1556-1561. [PMID: 32222119 PMCID: PMC7228212 DOI: 10.1002/jmv.25789] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 01/08/2023]
Abstract
The aim is to evaluate pregnant women infected with coronavirus disease 2019 (COVID‐19) and provide help for clinical prevention and treatment. All five cases of pregnant women confirmed COVID‐19 were collected among patients who admitted to the Maternal and Child Hospital of Hubei Province between January 20 and February 10, 2020. All patients, aging from 25 to 31 years old, had the gestational week from 38th weeks to 41st weeks. All pregnant women did not have an antepartum fever but developed a low‐grade fever (37.5℃‐38.5℃) within 24 hours after delivery. All patients had normal liver and renal function, two patients had elevated plasma levels of the myocardial enzyme. Unusual chest imaging manifestations, featured with ground‐grass opacity, were frequently observed in bilateral (three cases) or unilateral lobe (two cases) by computed tomography (CT) scan. All labors smoothly processed, the Apgar scores were 10 points 1 and 5 minutes after delivery, no complications were observed in the newborn. Pregnancy and perinatal outcomes of patients with COVID‐19 should receive more attention. It is probable that pregnant women diagnosed with COVID‐19 have no fever before delivery. Their primary initial manifestations were merely low‐grade postpartum fever or mild respiratory symptoms. Therefore, the protective measures are necessary on admission; the instant CT scan and real‐time reverse‐transcriptase polymerase‐chain‐reaction assay should be helpful in early diagnosis and avoid cross‐infection on the occasion that patients have fever and other respiratory signs. Pregnant woman with COVID‐19.
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Affiliation(s)
- Siyu Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - E Liao
- Department of Obstetrics and Gynecology, Maternal and Child Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dongmei Cao
- Department of Obstetrics and Gynecology, Maternal and Child Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ying Gao
- Department of Obstetrics and Gynecology, Maternal and Child Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guoqiang Sun
- Department of Obstetrics and Gynecology, Maternal and Child Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yong Shao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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31
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Feasibility of free-breathing T1-weighted 3D radial VIBE for fetal MRI in various anomalies. Magn Reson Imaging 2020; 69:57-64. [PMID: 32171775 DOI: 10.1016/j.mri.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES In magnetic resonance (MR) fetal imaging, the image quality acquired by the traditional Cartesian-sampled breath-hold T1-weighted (T1W) sequence may be degraded by motion artifacts arising from both mother and fetus. The radial VIBE sequence is reported to be a viable alternative to conventional Cartesian acquisition for both pediatric and adult MR, yielding better image quality. This study evaluated the role of radial VIBE in fetal MR imaging and compared its image quality and motion artifacts with those of the Cartesian T1W sequence. MATERIALS AND METHODS We included 246 pregnant women with 50 lesions on 1.5-T MR imaging. Image quality and lesion conspicuity were evaluated by two radiologists, blinded to the acquisition schemes used, using a five-point scale, where a higher score indicated a better trajectory method. Mixed-model analysis of variance and interobserver variability assessment were performed. RESULTS The radial VIBE sequence showed a significantly better performance than conventional T1W imaging in the head and neck, fetal body, and placenta region: 3.92 ± 0.88 vs 3 ± 0.74, p < 0.001, 3.8 ± 0.94 vs 3.15 ± 0.87, p < 0.001, and 4.17 ± 0.63 vs 3.12 ± 0.72, p < 0.001, respectively. Additionally, fewer motion artifacts were observed in all regions with the radial VIBE sequence (p < 0.01). Of 50 lesions, 49 presented better lesion conspicuity on radial VIBE images than on T1W images (4.34 ± 0.91 vs 3.48 ± 1.46, p < 0.001). CONCLUSION For fetal imaging, the radial VIBE sequences yielded better image quality and lesion conspicuity, with fewer motion artifacts, than conventional breath-hold Cartesian-sampled T1W sequences.
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32
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Anderson M, Goldman RH. Occupational Reproductive Hazards for Female Surgeons in the Operating Room. JAMA Surg 2020; 155:243-249. [DOI: 10.1001/jamasurg.2019.5420] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Matilda Anderson
- Western Health Surgical Department, Victoria, Australia
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Rose H. Goldman
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Cambridge Health Alliance, Department of Medicine, Cambridge, Massachusetts
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Azab M, Bharadwaj S, Jayaraj M, Hong AS, Solaimani P, Mubder M, Yeom H, Yoo JW, Volk ML. Safety of endoscopic retrograde cholangiopancreatography (ERCP) in pregnancy: A systematic review and meta-analysis. Saudi J Gastroenterol 2019; 25:341-354. [PMID: 31744939 PMCID: PMC6941455 DOI: 10.4103/sjg.sjg_92_19] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIMS Endoscopic retrograde cholangiopancreatography (ERCP) is a technically challenging procedure rarely associated with severe postprocedure complications. Hormonal changes during pregnancy promote cholelithiasis, but there are limited clinical data available on the outcomes of ERCP in pregnant women. ERCP techniques without irradiation were recently introduced as potential alternative. We performed a systematic review and meta-analysis to assess the safety of ERCP in pregnancy and to compare outcomes of radiation versus nonradiation ERCP. MATERIALS AND METHODS A systematic search of PubMed, Medline/Ovid, Web of Science, and Google Scholar through April 18th, 2018 using PRISMA and MOOSE guidelines identified 27 studies reporting the outcomes of ERCP in pregnancy. Random effects pooled event rate and 95% confidence intervals (CIs) were estimated. Heterogeneity was measured by I2, and meta-regression analysis was conducted. Adverse outcomes were divided into fetal, maternal pregnancy-related, and maternal nonpregnancy-related. RESULTS In all, 27 studies reporting on 1,307 pregnant patients who underwent ERCP were identified. Median age was 27.1 years. All results were statistically significant (P < 0.01). The pooled event rate for overall adverse outcomes was 15.9% (95% CI = 0.132-0.191) in all studies combined, 17.6% (95% CI = 0.109-0.272) in nonradiation ERCP (NR-ERCP) subgroup and 21.6% (95% CI = 0.154-0.294) in radiation ERCP subgroup. There was no significant difference in the pooled event rate for fetal adverse outcomes in NR-ERCP 6.2% (95% CI = 0.027-0.137) versus 5.2% (95% CI = 0.026-0.101) in radiation ERCP group. There was no significant difference in maternal pregnancy-related adverse outcome event rate between NR-ERCP (8.4%) (95% CI = 0.038-0.173) and radiation ERCP (7.1%) (95% CI = 0.039-0.125). Maternal nonpregnancy-related adverse outcome event rate in NR-ERCP was 7.6% (95% CI = 0.038-0.145), which was half the event rate in radiation ERCP group of 14.9% (95% CI = 0.102-0.211). CONCLUSIONS ERCP done by experienced endoscopists is a safe procedure during pregnancy. Radiation-free techniques appear to reduce the rates of nonpregnancy-related complications, but not of fetal and pregnancy-related complications.
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Affiliation(s)
- Mohamed Azab
- Department of Gastroenterology and Hepatology, Loma Linda University Medical Center, California, USA,Address for correspondence: Dr. Mohamed Azab, Department of Gastroenterology, Loma Linda University School of Medicine, 11234 Anderson Street, MC 1503A, Loma Linda, California - 92354, USA. E-mail:
| | - Shishira Bharadwaj
- Department of Gastroenterology and Hepatology, Loma Linda University Medical Center, California, USA
| | - Mahendran Jayaraj
- Department of Gastroenterology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Annie S. Hong
- Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Pejman Solaimani
- Department of Gastroenterology and Hepatology, Loma Linda University Medical Center, California, USA
| | - Mohamad Mubder
- Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Hyeyoung Yeom
- Department of School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Michael L. Volk
- Department of Gastroenterology and Hepatology, Loma Linda University Medical Center, California, USA
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34
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Hanu C, Loeliger BW, Panyutin IV, Maass-Moreno R, Wakim P, Pritchard WF, Neumann RD, Panyutin IG. Effect of Ionizing Radiation from Computed Tomography on Differentiation of Human Embryonic Stem Cells into Neural Precursors. Int J Mol Sci 2019; 20:ijms20163900. [PMID: 31405104 PMCID: PMC6720494 DOI: 10.3390/ijms20163900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/06/2019] [Accepted: 08/09/2019] [Indexed: 12/13/2022] Open
Abstract
We studied the effect of radiation from computed tomography (CT) scans on differentiation of human embryonic stem cells (hESCs) into neuronal lineage. hESCs were divided into three radiation exposure groups: 0-dose, low-dose, or high-dose exposure. Low dose was accomplished with a single 15 mGy CT dose index (CTDI) CT scan that approximated the dose for abdominal/pelvic CT examinations in adults while the high dose was achieved with several consecutive CT scans yielding a cumulative dose of 500 mGy CTDI. The neural induction was characterized by immunocytochemistry. Quantitative polymerase chain reaction (qPCR) and Western blots were used to measure expression of the neuronal markers PAX6 and NES and pluripotency marker OCT4. We did not find any visible morphological differences between neural precursors from irradiated and non-irradiated cells. However, quantitative analyses of neuronal markers showed that PAX6 expression was reduced following exposure to the high dose compared to 0-dose controls, while no such decrease in PAX6 expression was observed following exposure to the low dose. Similarly, a statistically significant reduction in expression of NES was observed following high-dose exposure, while after low-dose exposure, a modest but statistically significant reduction in NES expression was only observed on Day 8 of differentiation. Further studies are warranted to elucidate how lower or delayed expression of PAX6 and NES can impact human fetal brain development.
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Affiliation(s)
- Christine Hanu
- Department of Radiology and Imaging Sciences, Clinical Center, NIH, 10 Center Dr., Bethesda, MD 20892, USA
| | - Burk W Loeliger
- Department of Radiology and Imaging Sciences, Clinical Center, NIH, 10 Center Dr., Bethesda, MD 20892, USA
| | - Irina V Panyutin
- Department of Radiology and Imaging Sciences, Clinical Center, NIH, 10 Center Dr., Bethesda, MD 20892, USA
| | - Roberto Maass-Moreno
- Department of Radiology and Imaging Sciences, Clinical Center, NIH, 10 Center Dr., Bethesda, MD 20892, USA
| | - Paul Wakim
- Biostatistics and Clinical Epidemiology Service, Clinical Center, NIH, 10 Center Dr., Bethesda, MD 20892, USA
| | - William F Pritchard
- Department of Radiology and Imaging Sciences, Clinical Center, NIH, 10 Center Dr., Bethesda, MD 20892, USA
| | - Ronald D Neumann
- Department of Radiology and Imaging Sciences, Clinical Center, NIH, 10 Center Dr., Bethesda, MD 20892, USA
| | - Igor G Panyutin
- Department of Radiology and Imaging Sciences, Clinical Center, NIH, 10 Center Dr., Bethesda, MD 20892, USA.
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35
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Tokue H, Tokue A, Tsushima Y, Kameda T. Risk factors for massive bleeding based on angiographic findings in patients with placenta previa and accreta who underwent balloon occlusion of the internal iliac artery during cesarean section. Br J Radiol 2019; 92:20190127. [PMID: 31317769 DOI: 10.1259/bjr.20190127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We evaluated the risk factors for massive bleeding based on angiographic findings in patients with placenta previa and accreta who underwent balloon occlusion of the internal iliac artery (BOIA) during cesarean section. METHODS We performed a retrospective analysis using the clinical records of 42 patients with placenta previa and accreta who underwent BOIA during cesarean section between 2006 and 2017 in Gunma university hospital. We reviewed incidence of collateral arteries to the uterus on the initial aortography. We evaluated the visualization of the ovarian artery arising directly from the abdominal aorta, round ligament artery arising from the external iliac artery/inferior epigastric artery, and the iliolumbar artery. In addition, the clinical characteristics were reviewed. Patients with an estimated blood loss during delivery of >2500 ml, >4 packed red blood cell transfusions, uterine artery embolization after delivery, or hysterectomy were defined as the massive bleeding group. We compared between the massive and non-massive bleeding groups. RESULTS 20 patients (48%) had a massive bleeding. No procedure-related severe complications were observed. The massive and non-massive bleeding groups differed in terms of operation time (p < 0.001), hysterectomy (p < 0.001), post-operative hospital stay (p < 0.05), and visualization of round ligament arteries to the uterus [15/20 (75%) patients, p < 0.01]. CONCLUSION The incidence of collateral blood supply from a round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section. ADVANCES IN KNOWLEDGE Angiographic visualization of collateral circulation from the round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section.
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Affiliation(s)
- Hiroyuki Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Gunma, Japan
| | - Azusa Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Gunma, Japan
| | - Yoshito Tsushima
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Gunma, Japan
| | - Takeshi Kameda
- Department of Obstetrics and Gynecology, Gunma University Hospital, Gunma, Japan
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36
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DiMarco AN, Meeran K, Christakis I, Sodhi V, Nelson-Piercy C, Tolley NS, Palazzo FF. Seventeen Cases of Primary Hyperparathyroidism in Pregnancy: A Call for Management Guidelines. J Endocr Soc 2019; 3:1009-1021. [PMID: 31065618 PMCID: PMC6497920 DOI: 10.1210/js.2018-00340] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/11/2019] [Indexed: 12/17/2022] Open
Abstract
Context The risks of primary hyperparathyroidism (pHPT) to pregnant women and their fetuses appear to increase commensurate with serum calcium levels. The management strategy for pHPT must be adapted in pregnancy and should reflect the severity of hypercalcemia. However, no guidelines exist to assist clinicians. Methods The experience of a high-volume multidisciplinary endocrine surgical service in treating a consecutive series of pregnant women with pHPT referred for parathyroidectomy is presented and data are compared with a nonpregnant cohort with pHPT. A review of pHPT and pregnancy outcomes in the literature is provided. Results Seventeen pregnant women and 247 age range-matched nonpregnant women with pHPT were referred for surgery over 11 years. Mean serum calcium level was higher in the pregnant cohort (2.89 vs 2.78 mmol/L; P = 0.03). Preoperative localization with ultrasound succeeded in eight pregnant women (47%) and sestamibi scanning did in two of six (33% imaged preconception), compared with 84 (34%) and 102 (42%) control subjects, respectively (not significant). Parathyroidectomy was performed under general anesthesia between 12 and 28 weeks' gestation with no adverse pregnancy outcomes resulting. Cure rate was 100% vs 96% in controls. Conclusion pHPT in pregnancy is a threat to mother and child. Medical management may be appropriate in mild disease, but in moderate to severe disease, parathyroidectomy under general anesthesia in the second trimester is safe. Localization using ionizing radiation/MRI is unnecessary, because surgical intervention in a high-volume multidisciplinary setting has excellent outcomes. Guidelines on the topic would assist clinicians.
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Affiliation(s)
- Aimee Natasha DiMarco
- Department of Surgery and Cancer, Imperial College, London, United Kingdom.,Department of Endocrine Surgery, Hammersmith Hospital, London, United Kingdom
| | - Karim Meeran
- Department of Medicine, Imperial College, London, United Kingdom.,Department of Endocrinology, Imperial College National Health Service Trust, London, United Kingdom
| | - Ioannis Christakis
- Department of Endocrine and General Surgery, Kings' College Hospital, London, United Kingdom
| | - Vinpreet Sodhi
- Department of Anaesthesia, Imperial College National Health Service Trust, London, United Kingdom
| | - Catherine Nelson-Piercy
- Department of Obstetric Medicine, Guy's and St. Thomas' Foundation Trust, London, United Kingdom.,Department of Obstetric Medicine, Imperial College National Health Service Trust, London, United Kingdom
| | - Neil Samuel Tolley
- Department of Surgery and Cancer, Imperial College, London, United Kingdom.,Department of Endocrine Surgery, Hammersmith Hospital, London, United Kingdom
| | - Francesco Fausto Palazzo
- Department of Surgery and Cancer, Imperial College, London, United Kingdom.,Department of Endocrine Surgery, Hammersmith Hospital, London, United Kingdom
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Obstetric patients' perspectives on functional magnetic neuroimaging research in pregnant women. Arch Womens Ment Health 2019; 22:115-118. [PMID: 29687161 PMCID: PMC6500439 DOI: 10.1007/s00737-018-0846-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/04/2018] [Indexed: 12/14/2022]
Abstract
Magnetic resonance neuroimaging (MRI) studies of healthy pregnant women could identify key mechanisms of spontaneous health behavior changes observed in expectant mothers as novel intervention targets, but are currently unprecedented. As balancing potential benefits of research with unknown risks, including participant perceptions of risk, is foundational to ethical conduct, we surveyed a convenience obstetric sample to understand pregnant women's perspectives on this issue. Respondents were 76 pregnant women (modal age of 30-39 years; 64% multiparous) presenting for obstetric care from April to June 2016 at privately and publicly funded clinics at an urban academic medical center in the Midwestern USA. Following a written description about functional magnetic resonance neuroimaging (fMRI) and its known and unknown risks, women were queried on their willingness to participate in a hypothetical study involving fMRI during pregnancy, and specific concerns about doing so, if hesitant or unwilling. Willingness to participate was "yes" (28.4%, n = 21), "maybe" (28.4%, n = 21), and "no" (43.2%, n = 32). Among those responding "maybe" or "no" (n = 53, 73.6%), 11 women (20.7%) articulated concern about the fetus. Other concerns expressed were time commitment (n = 11, 20.7%) and discomfort being in an MRI machine (n = 4; 7.5%). Pregnant women may be open to participating in research involving MRI provided concerns about fetal health, time, and personal comfort are addressed.
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Abstract
Stroke in pregnant women has a mortality rate of 1.4 deaths per 100,000 deliveries. Vascular malformations are the most common cause of hemorrhagic stroke in this population; preeclampsia and other risk factors have been identified. However, nearly a quarter of strokes have an undeterminable cause. Spontaneous intracranial hemorrhage (ICH) is less frequent but results in significant morbidity. The main objective of this study is to review the literature on pregnant patients who had a spontaneous ICH. A systematic review of the literature was conducted on PubMed and the Cochrane library from January 1992 to September 2016 following the PRISMA guidelines. Studies reporting pregnant patients with spontaneous intraparenchymal hemorrhage (IPH), subarachnoid hemorrhage (SAH), and subdural hemorrhage (SDH) were selected and included if patients had non-structural ICH during pregnancy or up to 6 weeks postpartum confirmed by imaging. Twenty studies were included, and 43 patients identified. Twenty-two patients (51.3%) presented with IPH, 15 patients (34.8%) with SAH, and five patients (11.6%) with SDH. The most common neurosurgical management was clinical in 76.7% of patients, and cesarean section was the most common obstetrical management in 28% of patients. The most common maternal outcome was death (48.8%), and fetal outcomes were evenly distributed among term delivery, preterm delivery, and fetal or neonatal death. Spontaneous ICH carries a high maternal mortality with IPH being the most common type, most frequently presenting in the third trimester. Diagnosis and management do not differ for the parturient compared to the non-pregnant woman.
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39
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Tang P, Wang J, Song Y. Characteristics and pregnancy outcomes of patients with severe pneumonia complicating pregnancy: a retrospective study of 12 cases and a literature review. BMC Pregnancy Childbirth 2018; 18:434. [PMID: 30390683 PMCID: PMC6215647 DOI: 10.1186/s12884-018-2070-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/22/2018] [Indexed: 12/26/2022] Open
Abstract
Background Pneumonia during pregnancy has been proven to be associated with increased maternal and fetal morbidity and mortality. The management of severe pneumonia in gravid patients is even more challenging. Thus, we summarized the characteristics and pregnancy outcomes of these patients and explored the probable risk factors and predictive factors for pneumonia during pregnancy and the appropriate timing of delivery in severe pneumonia patients. Methods A retrospective cohort study was conducted with 12 patients who were diagnosed with severe pneumonia complicating pregnancy at Peking Union Medical College Hospital between January 2010 and June 2017. The clinical features, treatment strategies, and pregnancy outcomes were collected from medical records and telephone calls. Results All 12 patients were in their late second or third trimester. The patients had a higher prevalence of anemia (50%) and preeclampsia (25%) than ordinary pregnant women. Delayed diagnoses were not uncommon. Two mothers died in our series, resulting in a mortality rate of 17%. Two intrauterine deaths were observed. Elective delivery was not performed in any of the four patients in their second trimester. Six of the seven patients who presented after 28 weeks of gestation and had live fetuses underwent emergency deliveries. Preterm births (6/7) and cesarean sections (5/7) were the two leading adverse outcomes in newborns. Conclusions Anemia, advanced gestational age, and preeclampsia might be associated with the severity of pneumonia. Chest radiographs should be taken as soon as pneumonia is highly suspected to facilitate an early diagnosis. High incidences of adverse fetal outcomes were observed; thus, termination of the pregnancy is recommended for patients in their third trimester when respiratory function deteriorates progressively. However, it might be reasonable to continue pregnancy for those in their first or second trimester.
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Affiliation(s)
- Pingping Tang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangshan Wang
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingna Song
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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40
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Warsza B, Richter B. Internal Hernia in Pregnant Woman after Roux-en-Y Gastric Bypass Surgery. J Radiol Case Rep 2018; 12:9-16. [PMID: 29875982 DOI: 10.3941/jrcr.v12i1.3257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Laparoscopic Roux-en-Y gastric bypass has become the most common obesity surgery procedure worldwide over the last two decades. Many patients undergoing the procedure are women of reproductive age. This carries a risk for developing gastric bypass-related complications during pregnancy. One of the potentially serious risks is an internal hernia. We present a patient in the third trimester of pregnancy with an internal hernia following a laparoscopic Roux-en-Y gastric bypass for morbid obesity. We discuss the importance of computed tomography (CT) in the diagnosis of an internal hernia and review key CT findings including compression of the superior mesenteric vein, which proved to be crucial in diagnosing the internal hernia in this patient.
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Affiliation(s)
- Bogna Warsza
- Department of Radiology, Haugesund hospital Helse Fonna, Haugesund, Norway
| | - Blazej Richter
- Department of Radiology, Haugesund hospital, University of Bergen, Norway
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41
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Hayes SN, Kim ESH, Saw J, Adlam D, Arslanian-Engoren C, Economy KE, Ganesh SK, Gulati R, Lindsay ME, Mieres JH, Naderi S, Shah S, Thaler DE, Tweet MS, Wood MJ. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e523-e557. [PMID: 29472380 PMCID: PMC5957087 DOI: 10.1161/cir.0000000000000564] [Citation(s) in RCA: 695] [Impact Index Per Article: 115.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented.
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42
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Three-dimensional magnetic resonance pelvimetry: A new technique for evaluating the female pelvis in pregnancy. Eur J Radiol 2018; 102:208-212. [DOI: 10.1016/j.ejrad.2018.03.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/12/2018] [Accepted: 03/16/2018] [Indexed: 11/24/2022]
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43
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Burton KR, Park AL, Fralick M, Ray JG. Risk of early-onset breast cancer among women exposed to thoracic computed tomography in pregnancy or early postpartum. J Thromb Haemost 2018; 16:876-885. [PMID: 29450965 DOI: 10.1111/jth.13980] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Indexed: 01/08/2023]
Abstract
Essentials Tests for pulmonary embolism expose women to low-dose radiation. 5859 pregnancies had a thoracic computed tomography (T-CT) vs. 1.3 million who did not. The adjusted hazard ratio for breast cancer was 1.17 (95% confidence interval 0.80-1.70). The long-term risk of breast cancer among women who had a T-CT remains unknown. SUMMARY Background The risk of breast cancer may be higher with direct exposure to ionizing radiation from thoracic computed tomography (CT) during pregnancy or the postpartum. We evaluated the short-term risk of maternal breast cancer after exposure to thoracic CT during these periods. Methods We completed a retrospective population-based cohort study of all deliveries between 1995 and 2014 using universal healthcare databases in the province of Ontario, Canada. The main exposure was thoracic CT in pregnancy or ≤ 42 days postpartum. The passive exposure was ventilation-perfusion scintigraphy (VQ) scan in pregnancy or ≤ 42 days postpartum. Each was compared to pregnancies unexposed to thoracic CT or VQ scan. The primary study outcome was newly diagnosed breast cancer starting 366 days post-index delivery date. Results A total of 5859 pregnancies were exposed to thoracic CT, 4075 to VQ scan and 1 292 059 to neither. Starting from 1 year after the index delivery, the median duration of follow-up was 5.9, 7.3 and 11.1 years, respectively. A total of 10 129 women were diagnosed with breast cancer, of whom 9039 (89.2%) were aged ≤ 50 years. There were 27 new cases of breast cancer (7.1 per 10 000 person-years) following thoracic CT vs. 10 080 (7.0 per 10 000 person-years) among the unexposed, an adjusted hazard ratio (HR) of 1.17 (95% confidence interval [CI], 0.80-1.70). Following VQ scan exposure, the incidence rate of breast cancer was 7.0 per 10 000 person-years, an adjusted HR of 1.23 (95% CI 0.81-1.87), compared with the unexposed cohort. Conclusion Exposure to thoracic CT during pregnancy or the postpartum was not associated with an increased short-term risk of maternal breast cancer. The long-term risk should be studied.
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Affiliation(s)
- K R Burton
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - A L Park
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - M Fralick
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - J G Ray
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, ON, Canada
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44
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45
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Berk-Krauss J, Liebman TN, Stein JA. Pregnancy and Melanoma: Recommendations for Clinical Scenarios. Int J Womens Dermatol 2018; 4:113-115. [PMID: 29872687 PMCID: PMC5986258 DOI: 10.1016/j.ijwd.2017.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 12/13/2022] Open
Abstract
Managing pregnant patients with a history of melanoma or with a melanoma diagnosis can be daunting and confusing for dermatologists. We present three clinical scenarios that raise questions about the safety of pregnancy in patients with a history of melanoma, skin biopsies during pregnancy, and excisions and sentinel lymph node biopsies during pregnancy. Our recommendations incorporate the most up-to-date clinical data to help guide clinicians when faced with pigmented lesions and melanoma in a pregnant patient.
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Affiliation(s)
- Juliana Berk-Krauss
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY.,Yale University School of Medicine, New Haven, CT
| | - Tracey N Liebman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
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46
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Valovska MTI, Pais VM. Contemporary best practice urolithiasis in pregnancy. Ther Adv Urol 2018; 10:127-138. [PMID: 29560029 DOI: 10.1177/1756287218754765] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/31/2017] [Indexed: 01/10/2023] Open
Abstract
Urolithiasis is the most common nonobstetric complication in the gravid patient. The experience can provoke undue stress for the mother, fetus, and management team. The physiologic changes of pregnancy render the physical exam and imaging studies less reliable than in the typical patient. Diagnosis is further complicated by the need for careful selection of imaging modality in order to maximize diagnostic utility and minimize obstetric risk to the mother and ionizing radiation exposure to the fetus. Ultrasound remains the first-line diagnostic imaging modality in this group, but other options are available if results are inconclusive. A trial of conservative management is uniformly recommended. In patients who fail spontaneous stone passage, treatment may be temporizing or definitive. While temporizing treatments have classically been deemed the gold standard, ureteroscopic stone removal is now acknowledged as a safe and highly effective definitive treatment approach. Ultimately, a multidisciplinary, team-based approach involving the patient, her obstetrician, urologist, radiologist, and anesthesiologist is needed to devise a maximally beneficial management plan.
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Affiliation(s)
| | - Vernon M Pais
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire 03756-1000, USA
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47
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Abstract
Trauma is the leading non-obstetric cause of death during pregnancy and approximately 6-8% of all pregnancies are complicated by injury, both accidental and intentional. The initial evaluation and management of the injured pregnant patient often requires a multidisciplinary, collaborative team to provide the optimal outcome for both mother and fetus. It is important to recognize that even minor mechanisms of injury may result in poor outcomes for both fetus and mother. Injured pregnant patients meeting admission criteria experience a progressive increase in the number of complications as well as the number of patients that require delivery. There exists opportunity to identify patients who require admission and provide supportive measures that may reduce the complications of prematurity. Patients that are admitted may benefit from a multidisciplinary approach including on-going care from obstetricians or maternal-fetal medicine physicians. Placental abruption is the most common pregnancy complication, and may occur with even minor mechanisms of injury. Increasing severity of trauma increases the frequency of abruption, admission, delivery, and fetal demise.
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Affiliation(s)
- Christopher Kevin Huls
- Department of Obstetrics and Gynecology, University of Arizona College of Medicine, Banner University Medical Center, Phoenix, AZ.
| | - Corey Detlefs
- Department of Surgery, University of Arizona College of Medicine, Banner University Medical Center, Phoenix, AZ
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48
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Prabhu M, Eckert LO, Belfort M, Babarinsa I, Ananth CV, Silver RM, Stringer E, Meller L, King J, Hayman R, Kochhar S, Riley L. Antenatal bleeding: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2017; 35:6529-6537. [PMID: 29150058 PMCID: PMC5710989 DOI: 10.1016/j.vaccine.2017.01.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/13/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Malavika Prabhu
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.
| | - Linda O Eckert
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Michael Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA; Department of Obstetrics and Gynecology, Texas Children's Hospital, Houston, TX, USA
| | - Isaac Babarinsa
- Sidra Medical and Research Center/Weill Cornell Medicine-Qatar/Women's Hospital, Qatar
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Physicians, Columbia University, New York, NY, USA; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Elizabeth Stringer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, NC, USA
| | - Lee Meller
- Gloucestershire Hospitals NHS Foundation Trust, UK
| | - Jay King
- SanofiPasteur, Swiftwater, PA, USA
| | - Richard Hayman
- Department of Obstetrics and Gynaecology, Gloucestershire Hospital, Gloucester, UK
| | - Sonali Kochhar
- Global Healthcare Consulting, India; Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Laura Riley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
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49
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Pierce T, Hovnanian M, Hedgire S, Ghoshhajra B. Imaging of Cardiovascular Disease in Pregnancy and the Peripartum Period. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:94. [PMID: 29134367 DOI: 10.1007/s11936-017-0593-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OPINION STATEMENT Cardiovascular disease is an important cause of morbidity and mortality during pregnancy and the postpartum period. During pregnancy, the cardiovascular system undergoes extensive hemodynamic, hormonal, and microstructural changes which may exacerbate a preexisting underlying cardiovascular condition or predispose to cardiovascular complications not typically seen in young healthy women. Such conditions include spontaneous coronary artery dissection, atherosclerotic coronary artery disease, and peripartum cardiomyopathy. When evaluating this patient population, the diagnostic strategy should be tailored to specifically assess this distinct disease spectrum. The choice of imaging techniques must also consider potential risks to both the mother and child; a unique challenge of diagnostic imaging during pregnancy. The risk of radiation from radiography, computed tomography, and nuclear medicine imaging; iodinated and gadolinium-based contrast media for computed tomography and magnetic resonance imaging respectively; and heat deposition from sonography are of special importance during pregnancy. A thorough understanding of pregnancy-specific cardiovascular complications and the capabilities and risks of available diagnostic imaging modalities is crucial to appropriately manage the pregnant patient.
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Affiliation(s)
- Theodore Pierce
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Founders 216, Boston, MA, 02114, USA.
| | - Meline Hovnanian
- Department of Cardiothoracic Radiology, Mount Sinai School of Medicine - BISLR, 1000 Tenth Avenue, New York, NY, 10019, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Brian Ghoshhajra
- Division of Cardiovascular Imaging, Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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50
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Gill MM, Sia W, Hoskinson M, Niven E, Khurana R. The use of PET/CT in pregnancy: A case report of malignant parathyroid carcinoma and a review of the literature. Obstet Med 2017; 11:45-49. [PMID: 29636815 DOI: 10.1177/1753495x17724950] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/23/2017] [Indexed: 12/11/2022] Open
Abstract
Positron emission tomography scanning is not commonly performed in pregnancy but can be done if required. Fetal doses of radiation can be minimized, and our case exemplifies the safe application of positron emission tomography/computed tomography in pregnancy. A 38-year-old woman in her first ongoing pregnancy presented at 28 weeks' gestation with symptomatic hypercalcemia. Given a history of parathyroid carcinoma, recurrence was suspected. Ultrasound and magnetic resonance imaging failed to locate the lesion. However, positron emission tomography/computed tomography identified a culprit supraclavicular lymph node. This was excised under local anesthesia resulting in normalization of parathyroid hormone and calcium levels. A term, healthy baby was delivered. The literature provides support that the use of positron emission tomography/computed tomography is acceptable when indicated, and there are modifications to protocols that can further limit risk.
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Affiliation(s)
| | - Winnie Sia
- 1Department of Medicine, University of Alberta, Edmonton, Canada.,2Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada
| | - Michael Hoskinson
- 3Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Erin Niven
- 4Diagnostic Imaging, Alberta Health Services, Edmonton, Canada
| | - Rshmi Khurana
- 1Department of Medicine, University of Alberta, Edmonton, Canada.,2Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada
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