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The role of ultrasound and MRI in diagnosing of obstetrics cardiac disorders: A systematic review. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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2
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Lesmes Heredia C, Comas Rovira M, Moreno Baró A, Pina Pérez S, Zamora Lapiedra M, Corona Martínez M. Elevated fetal middle cerebral artery peak systolic velocity in diabetes type 1 patient: a case report. CASE REPORTS IN PERINATAL MEDICINE 2021. [DOI: 10.1515/crpm-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Doppler measurement of fetal middle cerebral artery peak systolic velocity (MCA-PSV) is used to screen fetuses at risk of developing fetal anemia. This screening tool has demonstrated to be accurate to estimate the likelihood of fetal anemia and it has been used in the management of fetuses at this risk. It is rare to find in the literature cases of increased MCA-PSV in the absence of fetal anemia. We present the case of an elevated MCA-PSV in the absence of common causes of fetal anemia.
Case presentation
A 30-year-old woman at 21 weeks of gestation was referred to our unit with a left fetal renal agenesis and single umbilical artery diagnosis. The patient had a poorly controlled type 1 Diabetes with a booking HbA1C of 9.1%. At 31 weeks of gestation, MCA-PSV was raised (>1.5 multiples of the median) in the absence of any cause of fetal anemia and discrepancy of ventricular size with normal fetal heart function were seen. In a subsequent scan, thick interventricular septum was seen and hypertrophic cardiomyopathy (HC) was suggested. Follow-up ultrasonography showed a persistent MCA-PSV in a large for gestation age (LGA) fetus with HC. Due to the prenatal diagnosis of persistent elevated MCA-PSV in LGA fetus with diagnoses of HC in a poorly controlled type 1 diabetic patient labor was induced after fetal lung maturation. Biventricular hypertrophic cardiomyopathy was detected after birth.
Conclusions
HC may be an explanation for increased MCA-PSV without fetal anemia.
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Affiliation(s)
- Cristina Lesmes Heredia
- Obstetrics and Gynecology Department , Corporació Sanitària Parc Taulí , Sabadell , Catalunya , Spain
| | - Montserrat Comas Rovira
- Obstetrics and Gynecology Department , Corporació Sanitària Parc Taulí , Sabadell , Catalunya , Spain
| | - Anna Moreno Baró
- Obstetrics and Gynecology Department , Corporació Sanitària Parc Taulí , Sabadell , Catalunya , Spain
| | - Silvia Pina Pérez
- Obstetrics and Gynecology Department , Corporació Sanitària Parc Taulí , Sabadell , Catalunya , Spain
| | - Marc Zamora Lapiedra
- Obstetrics and Gynecology Department , Corporació Sanitària Parc Taulí , Sabadell , Catalunya , Spain
| | - Manuel Corona Martínez
- Obstetrics and Gynecology Department , Corporació Sanitària Parc Taulí , Sabadell , Catalunya , Spain
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Slaats RH, Schwach V, Passier R. Metabolic environment in vivo as a blueprint for differentiation and maturation of human stem cell-derived cardiomyocytes. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165881. [PMID: 32562698 DOI: 10.1016/j.bbadis.2020.165881] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 12/26/2022]
Abstract
Patient-derived human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) are increasingly being used for disease modeling, drug screening and regenerative medicine. However, to date, an immature, fetal-like, phenotype of hPSC-CMs restrains their full potential. Increasing evidence suggests that the metabolic state, particularly important for provision of sufficient energy in highly active contractile CMs and anabolic and regulatory processes, plays an important role in CM maturation, which affects crucial functional aspects of CMs, such as contractility and electrophysiology. During embryonic development the heart is subjected to metabolite concentrations that differ substantially from that of hPSC-derived cardiac cell cultures. A deeper understanding of the environmental and metabolic cues during embryonic heart development and how these change postnatally, will provide a framework for optimizing cell culture conditions and maturation of hPSC-CMs. Maturation of hPSC-CMs will improve the predictability of disease modeling, drug screening and drug safety assessment and broadens their applicability for personalized and regenerative medicine.
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Affiliation(s)
- Rolf H Slaats
- Department of Applied Stem Cell Technologies, TechMed Centre, University of Twente, Drienerlolaan 5, 7500AE Enschede, the Netherlands
| | - Verena Schwach
- Department of Applied Stem Cell Technologies, TechMed Centre, University of Twente, Drienerlolaan 5, 7500AE Enschede, the Netherlands
| | - Robert Passier
- Department of Applied Stem Cell Technologies, TechMed Centre, University of Twente, Drienerlolaan 5, 7500AE Enschede, the Netherlands; Department of Anatomy and Embryology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands.
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Asoglu MR, Gabbay-Benziv R, Turan OM, Turan S. Exposure of the developing heart to diabetic environment and early cardiac assessment: A review. Echocardiography 2018; 35:244-257. [DOI: 10.1111/echo.13811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Mehmet R. Asoglu
- ObstetricsGynecology & Reproductive Sciences; University of Maryland School of Medicine; Baltimore MD USA
| | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology; Hillel Yaffe Medical Center; Hadera Israel
| | - Ozhan M. Turan
- ObstetricsGynecology & Reproductive Sciences; University of Maryland School of Medicine; Baltimore MD USA
| | - Sifa Turan
- ObstetricsGynecology & Reproductive Sciences; University of Maryland School of Medicine; Baltimore MD USA
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Liu X, Zhu M, Streiff C, Sahn DJ, Ashraf M. Image-Derived Assessment of Left Ventricular Mass in Fetal Myocardial Hypertrophy by 4-Dimensional Echocardiography: An In Vitro Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:943-949. [PMID: 27036164 DOI: 10.7863/ultra.15.05043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/17/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES This study tested the accuracy of new 4-dimensional fetal echocardiography to evaluate left ventricular (LV) mass in an experimental model of fetal myocardial hypertrophy. METHODS Ten fresh rabbit hearts were studied. Fetal myocardial hypertrophy was simulated by fixing different amounts of myocardial tissue to the LV epicardium. A small latex balloon was mounted on vinyl tubing and fixed within each LV cavity. The proximal end of the tube was attached to a pulsatile pump apparatus. The pump was calibrated to deliver stroke volumes of 2 and 4 mL at stroke rates of 60 and 120 beats per minute (bpm). Four-dimensional data were acquired and analyzed with quantification software. Reference values for LV mass were determined by the displacement method. RESULTS Echo-derived measurements of LV mass showed good correlations with reference values at all stroke rates and stroke volumes: at 2 mL and 60 bpm, r = 0.95; at 2 mL and 120 bpm, r = 0.95; at 4 mL and 60 bpm, r = 0.93; and at 4 mL and 120 bpm, r = 0.95 (P< .01 for all values). There was also excellent interobserver (r = 0.98; mean difference of -0.32 g; -4.4% of the mean) and intraobserver (r = 0.98; mean difference of -0.28 g; -3.8% of the mean) agreement. CONCLUSIONS In this controlled in vitro study, high-resolution 4-dimensional echocardiography was shown to accurately assess LV mass and have the potential to evaluate fetal myocardial hypertrophy.
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Affiliation(s)
- Xin Liu
- Oregon Health and Science University, Portland, Oregon USADepartment of Ultrasound, First Central Hospital of Baoding, Baoding, China
| | - Meihua Zhu
- Oregon Health and Science University, Portland, Oregon USA
| | - Cole Streiff
- Oregon Health and Science University, Portland, Oregon USA
| | - David J Sahn
- Oregon Health and Science University, Portland, Oregon USA
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Elmekkawi SF, Mansour GM, Elsafty MSE, Hassanin AS, Laban M, Elsayed HM. Prediction of Fetal Hypertrophic Cardiomyopathy in Diabetic Pregnancies Compared with Postnatal Outcome. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2015; 8:39-43. [PMID: 26664250 PMCID: PMC4667560 DOI: 10.4137/cmwh.s32825] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/26/2015] [Accepted: 11/02/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to estimate the accuracy of prenatal assessment of interventricular septum (IVS) thickness, right myocardial wall thickness (RMWT), and left myocardial wall thickness (LMWT) by two-dimensional (2D) ultrasound for the prediction of perinatal mortality and postnatal diagnosis of hypertrophic cardiomyopathy (HCM) among diabetic pregnant women. SUBJECTS AND METHODS A total of 120 diabetic pregnant women at 35 weeks or more were enrolled in this study from January 1, 2012, to June 30, 2014, at Ain Shams Maternity Hospital, Cairo, Egypt. The 2D ultrasound was done once for all the participants at the time of recruitment; IVS thickness, RMWT, and LMWT were measured. The glycosylated hemoglobin (HbA1c) levels of the participants were recorded. Neonatal assessment including postnatal echocardiography was done after 48 hours. Postnatal results were compared with the prenatal predictive results. RESULTS Higher thickness values for IVS, RMW, and LMW were obtained in the uncontrolled diabetic cases (HbA1c > 6.5%) than in the controlled diabetic cases (HbA1c < 6.5%; P < 0.01). Of the included 120 neonates, 10 (8.3%) were stillborn, 99 (82.5%) had a five-minute Apgar score ≥7, and 4 (3.3%) had a five-minute Apgar score ≤3. The four neonates with severe neonatal distress died after admission to neonatal intensive care unit within one week after delivery. Out of 110 live-born neonates, 4 (3.6%) neonates had a low ejection fraction (EF) (<50%) due to HCM; of them 2 (1.8%) died within one week after delivery, while 2 (1.8%) survived. Another two (1.8%) neonates died from severe respiratory distress syndrome. A cutoff value of ≥4.5 mm for prenatal IVS thickness was predictive of neonatal distress due to HCM with a sensitivity of 82%, specificity of 68%, and diagnostic accuracy of 72%. A cutoff value of <1.18 for the ratio of IVS thickness to LMWT had a sensitivity of 82%, specificity of 72%, and diagnostic accuracy of 74% for the prediction of neonatal distress due to HCM. In this study, 8 of the 10 fetuses with intrauterine demise and the 2 neonates who died within one week after delivery due to heart failure had a prenatal IVS thickness of ≥4.5 mm, while 7 of the 10 fetuses with intrauterine demise and the 2 neonates who died postnatal from heart failure had a prenatal IVS thickness to LMWT ratio of ≤1.18. CONCLUSION A prenatal IVS thickness of ≥4.5 mm or an IVS/LMWT ratio of ≤1.18 seems to be predictive of HCM and is associated with almost twofold higher risk of intrauterine fetal death and almost threefold higher risk of possibly relevant perinatal mortality.
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Affiliation(s)
- Sherif F Elmekkawi
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | - Ghada M Mansour
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | | | - Alaa S Hassanin
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | - Mohamed Laban
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
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Topcuoglu S, Karatekin G, Yavuz T, Arman D, Kaya A, Gursoy T, Ovalı F. The relationship between the oxidative stress and the cardiac hypertrophy in infants of diabetic mothers. Diabetes Res Clin Pract 2015; 109:104-9. [PMID: 25934526 DOI: 10.1016/j.diabres.2015.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 03/23/2015] [Accepted: 04/15/2015] [Indexed: 11/23/2022]
Abstract
Recently, oxidative stress was suggested to play a role in maternal and fetal complications of diabetic pregnancies. The aim of this study is to evaluate the global oxidant and antioxidant status in infants of diabetic mothers (IDM) via measurement of total antioxidant capacity (TAC) and total oxidant status (TOS) and to determine their association with the clinical and cardiac manifestations of gestational diabetes on infants. Forty five infants constituted the IDM group, 51 infants born to non diabetic mothers served as the control group. Umbilical cord blood was drawn from IDM and controls for TAC and TOS measurement. Echocardiographic measurements were performed in the first three days of life. Infants of diabetic mother had significantly higher TAC (p=0.024), TOS (p=0.03) and oxidative stress index (OSI, p=0.04) levels compared to controls. Hemoglobin values were correlated to TOS (r=0.310, p=0.03) and OSI (r=0.310, p=0.03). Maternal HbA1c values were also correlated to TOS (r=0.576, p=0.001) and OSI (r=0.606, p<0.001). Systolic and diastolic interventicular septum measurements, and left ventricular mass were also correlated with TOS (r=0.330, p=0.02; r=0.453, p=0.002; r=0.404, p=0.006, respectively) and OSI (r=0.330, p=0.02; r=0.300, p=0.04, r=0.300; p=0.04, respectively). Oxidant-antioxidant balance is disturbed in favor of oxidants in IDM despite compensatory increase in TAC. The degree of oxidative stress is related to the severity of myocardial and hematological involvement in IDM in the first days of life and maternal glycemic control.
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Affiliation(s)
- Sevilay Topcuoglu
- Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey.
| | - Guner Karatekin
- Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Taner Yavuz
- Pediatric Cardiology, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Didem Arman
- Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Ayşem Kaya
- Section of Biochemistry, Institute of Cardiology, Istanbul University, Istanbul, Turkey
| | - Tugba Gursoy
- Koc University, School of Medicine, Istanbul, Turkey
| | - Fahri Ovalı
- Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
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Hill MG, Sekhon MK, Reed KL, Anderson CF, Borjon ND, Tardiff JC, Barber BJ. Intrauterine Treatment of a Fetus with Familial Hypertrophic Cardiomyopathy Secondary to MYH7 Mutation. Pediatr Cardiol 2015; 36:1774-7. [PMID: 26337809 PMCID: PMC4655206 DOI: 10.1007/s00246-015-1250-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/04/2015] [Indexed: 11/28/2022]
Abstract
There is no clear consensus on optimal management of fetuses affected by familial hypertrophic cardiomyopathy (HCM). Intrauterine treatment of the condition has not been attempted in any standardized fashion. We report the case of a fetus treated by maternal propranolol during the third trimester after septal hypertrophy and diastolic dysfunction was diagnosed on fetal echocardiogram. The pregnancy went successfully to term, and fetal septal hypertrophy was noted to improve prior to delivery.
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Affiliation(s)
- Meghan G Hill
- Department of Obstetrics and Gynecology, The University of Arizona, College of Medicine, 1501 N. Campbell Ave, 8th Floor, Tucson, AZ, 85724, USA.
| | - Mehtab K Sekhon
- Department of Obstetrics and Gynecology, The University of Arizona, College of Medicine, 1501 N. Campbell Ave, 8th Floor, Tucson, AZ, 85724, USA
| | - Kathryn L Reed
- Department of Obstetrics and Gynecology, The University of Arizona, College of Medicine, 1501 N. Campbell Ave, 8th Floor, Tucson, AZ, 85724, USA
| | - Caroline F Anderson
- Department of Obstetrics and Gynecology, The University of Arizona, College of Medicine, 1501 N. Campbell Ave, 8th Floor, Tucson, AZ, 85724, USA
| | - Nydia D Borjon
- Department of Obstetrics and Gynecology, The University of Arizona, College of Medicine, 1501 N. Campbell Ave, 8th Floor, Tucson, AZ, 85724, USA
| | - Jil C Tardiff
- Department of Obstetrics and Gynecology, The University of Arizona, College of Medicine, 1501 N. Campbell Ave, 8th Floor, Tucson, AZ, 85724, USA
| | - Brent J Barber
- Department of Obstetrics and Gynecology, The University of Arizona, College of Medicine, 1501 N. Campbell Ave, 8th Floor, Tucson, AZ, 85724, USA
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Barros FSB, Rolo LC, Rocha LA, Martins WP, Nardozza LMM, Moron AF, Da Silva Costa F, Araujo Júnior E. Reference ranges for the volumes of fetal cardiac ventricular walls by three-dimensional ultrasound using spatiotemporal image correlation and virtual organ computer-aided analysis and its validation in fetuses with congenital heart diseases. Prenat Diagn 2014; 35:65-73. [DOI: 10.1002/pd.4480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/28/2014] [Accepted: 08/10/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Fernanda Silveira Bello Barros
- Department of Obstetrics, Paulista School of Medicine; Federal University of São Paulo (EPM-UNIFESP); São Paulo SP Brazil
| | - Liliam Cristine Rolo
- Department of Obstetrics, Paulista School of Medicine; Federal University of São Paulo (EPM-UNIFESP); São Paulo SP Brazil
| | - Luciane Alves Rocha
- Department of Obstetrics, Paulista School of Medicine; Federal University of São Paulo (EPM-UNIFESP); São Paulo SP Brazil
| | - Wellington P. Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School; University of São Paulo (DGO-FMRP-USP); Ribeirão Preto-SP Brazil
| | | | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine; Federal University of São Paulo (EPM-UNIFESP); São Paulo SP Brazil
| | - Fabrício Da Silva Costa
- Department of Perinatal Medicine and Obstetrics and Gynecology, Royal Women's Hospital; University of Melbourne, Melbourne; Melbourne Victoria Australia
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine; Federal University of São Paulo (EPM-UNIFESP); São Paulo SP Brazil
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Van Mieghem T, Hodges R, Jaeggi E, Ryan G. Functional echocardiography in the fetus with non-cardiac disease. Prenat Diagn 2013; 34:23-32. [DOI: 10.1002/pd.4254] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/23/2013] [Accepted: 10/07/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Tim Van Mieghem
- Fetal Medicine Unit, Mount Sinai Hospital; University of Toronto; Toronto Canada
| | - Ryan Hodges
- Fetal Medicine Unit, Mount Sinai Hospital; University of Toronto; Toronto Canada
| | - Edgar Jaeggi
- Fetal Cardiac Program, Pediatric Cardiology, Hospital for Sick Children; University of Toronto; Toronto Canada
| | - Greg Ryan
- Fetal Medicine Unit, Mount Sinai Hospital; University of Toronto; Toronto Canada
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Appleton K, Barnard J, Jantz AK, Pooh R, Comas-Gabriel C. The Role of Ultrasound in the Diagnosis of Complications Associated with Maternal Diabetes. ACTA ACUST UNITED AC 2013. [DOI: 10.5005/jp-journals-10009-1325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT
Gestational diabetes mellitus (GDM) is defined as glucose intolerance that begins or is first recognized during pregnancy. Numerous clinical factors are associated with an increased likelihood of GDM, such as increasing age, obesity, ethnicity, family history of diabetes and past obstetric history. There is a well-documented relationship between maternal hyperglycemia and increased rate of macrosomia, cesarean section, stillbirth, fetal congenital malformations, shoulder dystocia, hypoglycemia, hyperbilirubinemia, pre-eclampsia, preterm delivery, childhood obesity, and increased risk of maternal development of type 2 DM later on in her life. This case-based review is designed to provide health care workers a framework on using various ultrasound imaging modalities in early detection of the effects of gestational diabetes, and the specific conditions and/or anomalies seen in diabetic pregnancies.
How to cite this article
Appleton K, Barnard J, Jantz AK, Pooh R, Comas-Gabriel C, Kupesic-Plavsic S. The Role of Ultrasound in the Diagnosis of Complications Associated with Maternal Diabetes. Donald School J Ultrasound Obstet Gynecol 2013;7(4):506-515.
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Fouda UM, Abou ElKassem MM, Hefny SM, Fouda RM, Hashem AT. Role of fetal echocardiography in the evaluation of structure and function of fetal heart in diabetic pregnancies. J Matern Fetal Neonatal Med 2012; 26:571-5. [PMID: 23176302 DOI: 10.3109/14767058.2012.743521] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To detect the structural and functional changes of fetal hearts in diabetic pregnancies by using Doppler echocardiography. METHODS This prospective study included 119 pregnant women divided into three groups. Group 1 included 47 pregnant patients with pre-existing diabetes mellitus (DM), group 2 included 40 patients with gestational diabetes and group 3 included 32 non-diabetic pregnant women. M-mode echocardiography was used to measure the thickness of the fetal ventricular walls and interventricular septum. The mitral and tricuspid early (E) and late (A) diastolic velocities and the ventricular shortening fraction were measured. RESULTS HbA1c % was significantly lower in gestational diabetes group compared with the pre-existing diabetes group. The interventricular septum was significantly thicker in the pre-existing diabetes group compared with other groups. Tricuspid and mitral E/A ratios were significantly lower in the pre-existing diabetes group compared with gestational diabetes and control groups. Moreover, there were no significant differences in the tricuspid and mitral E/A ratios between gestational diabetes group and the control group. The right and left ventricular shortening fractions were similar in the three groups. CONCLUSION Fetuses of women with well-controlled gestational diabetes lack the diastolic dysfunction that is present in fetuses of women with pre-existing diabetes.
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Affiliation(s)
- Usama M Fouda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Zielinsky P, Piccoli AL. Myocardial hypertrophy and dysfunction in maternal diabetes. Early Hum Dev 2012; 88:273-8. [PMID: 22445568 DOI: 10.1016/j.earlhumdev.2012.02.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
Abstract
Diabetes in pregnancy, both pre-gestational and gestational, is a frequent cause of fetal myocardial hypertrophy, partly due to fetal hyperinsulinism. In fetal life, cardiac function may be impaired, especially during diastole, as a result of decreased left ventricular distensibility and altered left atrial dynamics secondary to myocardial hypertrophy. In neonates, the hypertrophy is a transient disorder, with spontaneous regression of the increased myocardial thickness during the first months of life. Nevertheless, cardiac hypertrophy may be associated with neonatal cardiomegaly and respiratory distress secondary to poor left ventricular compliance. The development of a number of new echocardiographic parameters discussed in this article, and primarily based on the pathophysiological consequences of myocardial hypertrophy, highlight an area of research priority: the assessment of diastolic function in fetuses of diabetic mothers with (and without) myocardial hypertrophy. A score for grading the severity of fetal diastolic dysfunction in these fetuses is proposed.
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Affiliation(s)
- Paulo Zielinsky
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil.
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Fesslova V, Mongiovì M, Pipitone S, Brankovic J, Villa L. Features and outcomes in utero and after birth of fetuses with myocardial disease. Int J Pediatr 2010; 2010:628451. [PMID: 20976307 PMCID: PMC2952816 DOI: 10.1155/2010/628451] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 06/26/2010] [Accepted: 08/07/2010] [Indexed: 11/17/2022] Open
Abstract
Objectives. Ninety-one fetuses with dilated or hypertrophic cardiomyopathy (DCM, HCM) and myocarditis were studied. Results. Group 1 "DCM" included 19 fetuses: 13 with hydrops (FH) and 5 with associated extracardiac anomalies (ECAs) (15.8%). Group 2 "Myocarditis" included twelve fetuses, having 11 with FH. Group 3 "HCM" included sixty fetuses: 26 had associated ECAs, 17 had maternal diabetes, and 17 were "idiopathic"; however, in one case, a metabolic disorder was found postnatally, and 4 had familiarity for HCM. Outcomes. Ten cases opted for termination of pregnancy. Two cases with DCM and 1 with HCM were lost at follow-up. Out of the cases that continued pregnancy, with known follow-up, mortality was 68.75% in Group 1, 63.6% in Group 2, and 31.3% in Group 3 (the majority with severe ECAs). Surviving cases with DCM and myocarditis improved, 2 with HCM worsened, 6 remained stable, and 26 improved or normalized. Conclusions. Our data show more severe prognosis in DCM and myocarditis and forms with severe associated ECAs.
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Affiliation(s)
- Vlasta Fesslova
- Center of Fetal Cardiology, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese, 20097 Milan, Italy
| | - Maurizio Mongiovì
- Department of Pediatric Cardiology, “Casa del Sole” Hospital, 90136 Palermo, Italy
| | - Salvatore Pipitone
- Department of Pediatric Cardiology, “Casa del Sole” Hospital, 90136 Palermo, Italy
| | - Jelena Brankovic
- Center of Fetal Cardiology, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese, 20097 Milan, Italy
| | - Laura Villa
- First Obstetric and Gynecologic Clinic, University of Milan, 20122 Milan, Italy
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Köşüş A, Köşüş N, Turhan NÖ. Assessment of cardiomyopathy in fetuses of women with false positive oral glucose loading test. Eur J Obstet Gynecol Reprod Biol 2010; 154:37-9. [PMID: 20855145 DOI: 10.1016/j.ejogrb.2010.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 07/28/2010] [Accepted: 08/25/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate fetal asymmetric septal hypertrophy in women with a false positive oral glucose loading test (OGL). STUDY DESIGN OGL was applied to 79 pregnant women at gestational age between 24 and 28 weeks. The first study group consisted of patients with a normal OGL. Cases having glucose levels above 130 mg/dL after 50 g OGL but a normal 100g oral glucose tolerance test (OGTT) formed a second group. M-mode echocardiography was then performed. Fetal septal and left ventricular posterior wall (LVPW) thicknesses in Group 1 and Group 2 were compared. RESULTS Mean septal and LVPW thickness was slightly higher in the second group but there was no statistically significant difference between the two groups. CONCLUSIONS Although statistically not significant, there is some increase in septal and ventricular wall thickness in cases with high OGL but normal OGTT. The study also provides evidence of the absence of prominent septal and ventricular thickening in these cases with minimal glucose intolerance.
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Affiliation(s)
- Aydin Köşüş
- Dept of ObGyn, Fatih University, Faculty of Medicine, Ankara, Turkey
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16
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Tonni G, Centini G, Taddei F. Can 3D Ultrasound and Doppler Angiography of Great Arteries Be Included in Second Trimester Ecocardiographic Examination? A Prospective Study on Low-Risk Pregnancy Population. Echocardiography 2009; 26:815-22. [DOI: 10.1111/j.1540-8175.2008.00874.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
OBJECTIVE To identify the presence of ventricular diastolic dysfunction by tissue Doppler in fetuses of diabetic mothers, with or without septal hypertrophy, in comparison to fetuses of nondiabetic mothers. METHODS A contemporary transverse study in fetuses with a gestational age between 25 weeks to term, studying diastolic function by assessment using tissue Doppler and pulsed wave Doppler of the atrioventricular diastolic flow. The mothers of the fetuses all had previous or gestational diabetes, and were referred to the Fetal Cardiology Unit of the Institute of Cardiology in Porto Alegre, Brazil. We analysed variance with the Student-Neumann-Keuls post hoc test. An alfa of 0.05 was considered significant for statistical analysis. RESULTS The mean myocardial velocities of the E'and A' waves at the mural mitral annulus, in fetuses of diabetic mothers with myocardial hypertrophy, were, respectively, 7.00 plus or minus 1.6 centimetres per second, and 10.24 plus or minus 3.3 centimetres per second. In the fetuses of diabetic mothers group without myocardial hypertrophy, the comparable values were 7.19 plus or minus 2.4 centimetres per second and 10.77 plus or minus 3.77 centimetres per second, respectively. In the control group, they were 4.81 plus or minus 0.85 centimetres per second and 8.01 plus or minus 2.2 centimetres per second. The difference between the velocities in fetuses of diabetic mothers and in fetal normal mothers was statistically significant (p less than 0.05). Statistically significant differences were also observed in E' and A' diastolic waves at the aortic mitral annulus, as well as for the tricuspid annulus when tissue Doppler assessment was carried out in the same sample. The mean ratio between the E and E' of mitral and tricuspid waves in the control fetuses of normal mothers was significantly higher than in fetuses of diabetic mothers. CONCLUSION Pulsed tissue Doppler, when used in fetuses of diabetic mothers and compared with fetuses of nondiabetic mothers, shows evidence of impaired diastolic function, independently of the presence of myocardial hypertrophy.
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Yinon Y, Yagel S, Hegesh J, Weisz B, Mazaki-Tovi S, Lipitz S, Achiron R. Fetal cardiomyopathy--in utero evaluation and clinical significance. Prenat Diagn 2007; 27:23-8. [PMID: 17154225 DOI: 10.1002/pd.1612] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To describe the prenatal diagnosis and outcome of fetal cardiomyopathy (CM). METHODS The charts, photographs and videotapes of all fetuses with CM, who were assessed during pregnancy at two referral centers, were reviewed. RESULTS The diagnosis of CM was established in 12 fetuses. All had structurally normal hearts, and all cases were diagnosed after 23 weeks of gestation, following normal early fetal echocardiogram. Three clusters of fetal CM appeared: Familial--two sib fetuses of a mother, who is a second generation of CM. Both had dilated CM and pathological findings were consistent with the diagnosis of endocardial fibroelastosis. Secondary--CM that was induced by another factor. Idiopathic--six cases of CM without an underlying specific etiology. Three women elected to terminate their pregnancy. Among the nine who delivered, four had a favorable outcome with normal cardiac function at the age of 1 month, in which three belonged to the secondary category, and five cases were complicated by fetal/infant death. CONCLUSIONS CM may develop during fetal life and might be diagnosed by prenatal echocardiography. Normal cardiac findings in a midtrimester fetus do not exclude subsequent development of CM. Detailed prenatal sonographic examination may aid in determining the neonatal outcome.
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Affiliation(s)
- Yoav Yinon
- Department of Obstetric and Gynecology, the Chaim Sheba Medical Center, Tel- Hashomer, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
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19
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Wong ML, Wong WHS, Cheung YF. Fetal myocardial performance in pregnancies complicated by gestational impaired glucose tolerance. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:395-400. [PMID: 17330321 DOI: 10.1002/uog.3957] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To determine fetal myocardial performance in pregnancies complicated by mild gestational impaired glucose tolerance (GIGT). METHODS Ultrasound examinations were performed in 37 pregnant women with mild GIGT (36 did not require insulin) and in 44 controls at 18-24, 26-30 and 34-37 weeks of gestation. The thickness of the fetal ventricular walls and interventricular septum were measured by M-mode echocardiography. Using conventional Doppler echocardiography, the mitral and tricuspid early (E) and late (A) diastolic velocities and the ventricular myocardial performance index (MPI) were determined. RESULTS The fetuses of women with GIGT had a greater abdominal circumference (P = 0.02), a larger amniotic fluid index (P = 0.03), and a tendency to be heavier (P = 0.058) at the third scan. There were no significant differences in myocardial thickness, mitral and tricuspid E and A velocities, and E/A ratios between study and control groups. The left and right ventricular MPIs, while similar between the two groups in the first and second scans, had decreased significantly by late gestation in the GIGT fetuses (P for trend = 0.018 and 0.014, respectively) and were significantly lower than those of the control group (P = 0.002 and 0.0008, respectively). CONCLUSIONS Fetuses of women with mild GIGT lack the ventricular hypertrophy and diastolic dysfunction that is common in fetuses of diabetic mothers, and they have a decreased MPI late in gestation. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- M L Wong
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong, China
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20
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Plasencia W, Eguiluz I, Barber M, Martín A, Molo C, Martínez-Sopena J, Castro N, García-Hernández J. Miocardiopatía hipertrófica. Manejo durante el embarazo y el parto. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2004. [DOI: 10.1016/s0210-573x(04)77327-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Piacenza JM, Kirkorian G, Audra PH, Mellier G. Hypertrophic cardiomyopathy and pregnancy. Eur J Obstet Gynecol Reprod Biol 1998; 80:17-23. [PMID: 9758254 DOI: 10.1016/s0301-2115(98)00076-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The case of a young primiparous woman with defibrillator-assisted familial hypertrophic cardiomyopathy (HCM) has led us to review the literature on this pathology, which is exceptional because of its scarcity and the originality of the problems encountered. To our knowledge, this is the first observation ever reported of defibrillator-assisted activation during pregnancy in a woman with HCM. Several questions raised from this particular case, e.g. what are the risks caused by pregnancy in these patients, what is the impact of therapeutics, does the activation of an internal defibrillator involve particular risks, what is the best disposition for delivery and what are the risks for fetuses? We have tried to ask all of these questions, using as exhaustive a literature review as possible.
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Affiliation(s)
- J M Piacenza
- Hospital Edouard Herriot, Gynecologie Obstetrique, Lyon, France
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22
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Abstract
Fetal echocardiography has provided a means for the detailed assessment of cardiac structure and function from early prenatal life. Indications for a fetal echocardiographic examination and the potential implications for individuals caring for newborns with cardiac malformations are discussed.
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Affiliation(s)
- D J Penny
- Department of Cardiology, Royal Children's Hospital, Parkville, Victoria, Australia
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