1
|
Walsh CJ, Micke K, Elfman H, Bock M, Harper T, Zaretsky M, Galan HL, Behrendt N, Putra M. Successful antenatal treatment of MAGED2-related Bartter syndrome and review of treatment options and efficacy. Prenat Diagn 2024; 44:172-179. [PMID: 38159268 DOI: 10.1002/pd.6508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/14/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
A new form of transient antenatal Bartter syndrome (aBS) was recently identified that is associated with the X-linked MAGED2 variant. Case reports demonstrate that this variant leads to severe polyhydramnios that may result in preterm birth or pregnancy loss. There is limited but promising evidence that amnioreductions may improve fetal outcomes in this rare condition. We report a woman with two affected pregnancies. In the first pregnancy, the patient was diagnosed with mild-to-moderate polyhydramnios in the second trimester that ultimately resulted in preterm labor and delivery at 25 weeks with fetal demise. Whole exome sequencing of the amniotic fluid sample resulted after the pregnancy loss and revealed a c.1337G>A MAGED2 variant that was considered diagnostically. The subsequent pregnancy was confirmed by chorionic villi sampling to also be affected by this variant. The pregnancy was managed with frequent ultrasounds and three amnioreductions that resulted in spontaneous vaginal delivery at 37 weeks and 6 days of a viable newborn with no evidence of overt electrolyte abnormalities suggesting complete resolution. A detailed review of the published cases of MAGED2-related transient aBS is provided. Our review focuses on individuals who received antenatal treatment. A total of 31 unique cases of MAGED2-related transient aBS were compiled. Amnioreduction was performed in 23 cases and in 18 cases no amnioreduction was performed. The average gestational age at delivery was significantly lower in cases without serial amnioreduction (28.7 vs. 30.71 weeks, p = 0.03). Neonatal mortality was seen in 5/18 cases without serial amnioreduction, and no mortality was observed in the cases with serial amnioreduction. In cases of second trimester severe polyhydramnios without identifiable cause, whole exome sequencing should be considered. Intensive ultrasound surveillance and serial amnioreduction is recommended for the management of MAGED2-related transient aBS.
Collapse
Affiliation(s)
- Caroline J Walsh
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kestutis Micke
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Hannah Elfman
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Margret Bock
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, Pediatric Nephrology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Teresa Harper
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael Zaretsky
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Henry L Galan
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nicholas Behrendt
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Manesha Putra
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, Section of Genetics and Metabolism, Children's Hospital Colorado, Aurora, Colorado, USA
| |
Collapse
|
2
|
Chen YS, He JF, Li DZ. Amnioreduction in cases of polyhydramnios: a low-risk procedure. Am J Obstet Gynecol MFM 2024; 6:101234. [PMID: 38000503 DOI: 10.1016/j.ajogmf.2023.101234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Affiliation(s)
- Yong-Shan Chen
- Prenatal Diagnosis Unit, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Jie-Fu He
- Prenatal Diagnosis Unit, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Jinsui Road 9, Zhujiang New Town, Guangzhou 510623, China.
| |
Collapse
|
3
|
Chalouhi GE, Guenuec A, Rameh G, Hamze H, Salomon LJ, Ville Y. Biplane mode for more precise intrauterine procedures. Am J Obstet Gynecol 2022; 226:215-219. [PMID: 34116039 DOI: 10.1016/j.ajog.2021.06.005] [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] [Received: 02/11/2021] [Revised: 05/14/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
The evolution of ultrasound and the introduction of 3- and 4-dimensional ultrasound techniques led to a shift in the perception and usage of ultrasound in fetal medicine. The biplane mode might help in multiple fetal procedures, including but not limited to basic intrauterine thoracocentesis, thoracoamniotic shunting, amnioreduction, amnioinfusion, cordocentesis, intraumbilical infusion, and umbilical cord coagulation, with a possible reduction in the complication rate. Despite its theoretical usefulness, more studies are required to assess the clinical importance of this technique.
Collapse
Affiliation(s)
- Gihad E Chalouhi
- Department of Obstetrics and Fetal Medicine, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France; Department of Obstetrics and Gynecology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon; Université de Paris, Paris, France
| | - Alexandra Guenuec
- Department of Obstetrics and Fetal Medicine, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France; Université de Paris, Paris, France
| | - Georges Rameh
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon
| | - Hassan Hamze
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon.
| | - Laurent J Salomon
- Department of Obstetrics and Fetal Medicine, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France; Université de Paris, Paris, France
| | - Yves Ville
- Department of Obstetrics and Fetal Medicine, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France; Université de Paris, Paris, France
| |
Collapse
|
4
|
Valiulienė G, Zentelytė A, Beržanskytė E, Navakauskienė R. Metabolic Profile and Neurogenic Potential of Human Amniotic Fluid Stem Cells From Normal vs. Fetus-Affected Gestations. Front Cell Dev Biol 2021; 9:700634. [PMID: 34336852 PMCID: PMC8322743 DOI: 10.3389/fcell.2021.700634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/21/2021] [Indexed: 12/04/2022] Open
Abstract
Human amniotic fluid stem cells (hAFSCs) possess some characteristics with mesenchymal stem cells (MSCs) and embryonic stem cells and have a broader differentiation potential compared to MSCs derived from other sources. Although hAFSCs are widely researched, their analysis mainly involves stem cells (SCs) obtained from normal, fetus-unaffected gestations. However, in clinical settings, knowledge about hAFSCs from normal gestations could be poorly translational, as hAFSCs from healthy and fetus-diseased gestations may differ in their differentiation and metabolic potential. Therefore, a more thorough investigation of hAFSCs derived from pathological gestations would provide researchers with the knowledge about the general characteristics of these cells that could be valuable for further scientific investigations and possible future clinical applicability. The goal of this study was to look into the neurogenic and metabolic potential of hAFSCs derived from diseased fetuses, when gestations were concomitant with polyhydramnios and compare them to hAFSCs derived from normal fetuses. Results demonstrated that these cells are similar in gene expression levels of stemness markers (SOX2, NANOG, LIN28A, etc.). However, they differ in expression of CD13, CD73, CD90, and CD105, as flow cytometry analysis revealed higher expression in hAFSCs from unaffected gestations. Furthermore, hAFSCs from “Normal” and “Pathology” groups were different in oxidative phosphorylation rate, as well as level of ATP and reactive oxygen species production. Although the secretion of neurotrophic factors BDNF and VEGF was of comparable degree, as evaluated with enzyme-linked immunosorbent assay (ELISA) test, hAFSCs from normal gestations were found to be more prone to neurogenic differentiation, compared to hAFSCs from polyhydramnios. Furthermore, hAFSCs from polyhydramnios were distinguished by higher secretion of pro-inflammatory cytokine TNFα, which was significantly downregulated in differentiated cells. Overall, these observations show that hAFSCs from pathological gestations with polyhydramnios differ in metabolic and inflammatory status and also possess lower neurogenic potential compared to hAFSCs from normal gestations. Therefore, further in vitro and in vivo studies are necessary to dissect the potential of hAFSCs from polyhydramnios in stem cell-based therapies. Future studies should also search for strategies that could improve the characteristics of hAFSCs derived from diseased fetuses in order for those cells to be successfully applied for regenerative medicine purposes.
Collapse
Affiliation(s)
- Giedrė Valiulienė
- Department of Molecular Cell Biology, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Aistė Zentelytė
- Department of Molecular Cell Biology, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Elizabet Beržanskytė
- Department of Molecular Cell Biology, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Rūta Navakauskienė
- Department of Molecular Cell Biology, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
5
|
Erfani H, Diaz-Rodriguez GE, Aalipour S, Nassr A, Rezaei A, Gandhi M, Mendez-Figueroa H, Aagaard KM, Shamshirsaz AA. Amnioreduction in cases of polyhydramnios: Indications and outcomes in singleton pregnancies without fetal interventions. Eur J Obstet Gynecol Reprod Biol 2019; 241:126-128. [PMID: 31160132 DOI: 10.1016/j.ejogrb.2019.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate indications, pregnancy outcomes, and risk of adverse events following amnioreduction procedures in singleton gestations. STUDY DESIGN Study of all amnioreduction procedures performed on singleton gestations complicated by polyhydramnios between January 2011 and June 2018 at our tertiary and regional referral fetal center. Clinical indications for amnioreduction procedures were categorized as either maternal shortness of breath, perceived abdominal tightness, or preterm uterine contractions with or without cervical change. Our primary outcome(s) of interest were: preterm premature rupture of membranes (PPROM), placental abruption, chorioamnionitis and/or preterm delivery, each in isolation or as a composite. RESULTS Among 358 patients who underwent amnioreduction in the study period, 251 arose from cases of twin-twin transfusion syndrome (TTTS) and 74 were singletons undergoing additional fetal intervention procedures. Each of the remaining 33 patients underwent a median number of one [range 1-12] amnioreductions over the antepartum interval, yielding a total of 66 amnioreduction procedures. Among the study cohort, there were no instances of PPROM, placental abruption, chorioamnionitis or preterm delivery within the 12 h following the procedure but 10.6% experienced preterm delivery within 48 h of amnioreduction. CONCLUSION Our data suggests that among singleton gestations, there was a low risk for preterm delivery in close proximity to the procedure and none experienced rupture of membranes, placental abruption, sepsis, fetal demise or neonatal death. This data may be used in counseling of potential candidates for amnioreduction with singleton pregnancies and symptomatic polyhydramnios.
Collapse
Affiliation(s)
- Hadi Erfani
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Gian Esteban Diaz-Rodriguez
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Soroush Aalipour
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Ahmed Nassr
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt
| | - Atefeh Rezaei
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Manisha Gandhi
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Hector Mendez-Figueroa
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Kjersti M Aagaard
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Alireza A Shamshirsaz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States.
| |
Collapse
|
6
|
Khazaei S, Jenabi E. The association between polyhydramnios and the risk of placenta abruption: a meta-analysis. J Matern Fetal Neonatal Med 2019; 33:3035-3040. [PMID: 30624999 DOI: 10.1080/14767058.2019.1566898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: The results of studies about the effect of polyhydramnios on the risk of placental abruption are a controversy. This study was conducted to determine the association between polyhydramnios and the risk of placental abruption.Methods: PubMed, Scopus, and Web of Science were searched in September 2017 along with references from meta-analyses and reviews. We assessed publication bias using the rank correlation test (Begg's test) and the regression asymmetry test (Egger's test). The studies' heterogeneity was measured by the Q-statistic and I-squared (I2) tests. The random-effects model was conducted to obtain pooled odds ratio (OR) as a measure of the association between polyhydramnios and the risk of placental abruption.Results: A total of 10 studies were included in this meta-analysis with a sample of 198,359 participants. There was a significant association between polyhydramnios and the risk of placental abruption [OR: 1.93 (95% CI: 1.23-2.63)].Conclusions: The present study is the first meta-analysis that reported polyhydramnios is a risk factor for placental abruption.
Collapse
Affiliation(s)
- Salman Khazaei
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ensiyeh Jenabi
- Pediatric Developmental Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
7
|
Kim A, Economidis MA, Stohl HE. Placental abruption after amnioreduction for polyhydramnios caused by chorioangioma. BMJ Case Rep 2018; 2018:bcr-2017-222399. [PMID: 29507014 DOI: 10.1136/bcr-2017-222399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Placental chorioangioma is the most common type of a benign placental tumour that occurs in 1% of pregnancies. A large chorioangioma is associated with adverse pregnancy outcomes. We present a case of placental abruption necessitating preterm delivery after multiple amnioreductions for polyhydramnios caused by a large chorioangioma. If antenatal diagnosis of a significant chorioangioma is made as the cause of polyhydramnios, caution should be taken when performing rapid amnioreductions.
Collapse
Affiliation(s)
- Angela Kim
- Department of Obstetrics and Gynecology, Harbor UCLA Medical Center, Torrance, California, USA
| | - Megan A Economidis
- Department of Obstetrics and Gynecology, Harbor UCLA Medical Center, Torrance, California, USA
| | - Hindi E Stohl
- Department of Obstetrics and Gynecology, Harbor UCLA Medical Center, Torrance, California, USA
| |
Collapse
|