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Moretti C, Gizzi C, Gagliardi L, Petrillo F, Ventura ML, Trevisanuto D, Lista G, Dellacà RL, Beke A, Buonocore G, Charitou A, Cucerea M, Filipović-Grčić B, Jeckova NG, Koç E, Saldanha J, Sanchez-Luna M, Stoniene D, Varendi H, Vertecchi G, Mosca F. A Survey of the Union of European Neonatal and Perinatal Societies on Neonatal Respiratory Care in Neonatal Intensive Care Units. Children (Basel) 2024; 11:158. [PMID: 38397269 PMCID: PMC10887601 DOI: 10.3390/children11020158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
(1) Background: Our survey aimed to gather information on respiratory care in Neonatal Intensive Care Units (NICUs) in the European and Mediterranean region. (2) Methods: Cross-sectional electronic survey. An 89-item questionnaire focusing on the current modes, devices, and strategies employed in neonatal units in the domain of respiratory care was sent to directors/heads of 528 NICUs. The adherence to the "European consensus guidelines on the management of respiratory distress syndrome" was assessed for comparison. (3) Results: The response rate was 75% (397/528 units). In most Delivery Rooms (DRs), full resuscitation is given from 22 to 23 weeks gestational age. A T-piece device with facial masks or short binasal prongs are commonly used for respiratory stabilization. Initial FiO2 is set as per guidelines. Most units use heated humidified gases to prevent heat loss. SpO2 and ECG monitoring are largely performed. Surfactant in the DR is preferentially given through Intubation-Surfactant-Extubation (INSURE) or Less-Invasive-Surfactant-Administration (LISA) techniques. DR caffeine is widespread. In the NICUs, most of the non-invasive modes used are nasal CPAP and nasal intermittent positive-pressure ventilation. Volume-targeted, synchronized intermittent positive-pressure ventilation is the preferred invasive mode to treat acute respiratory distress. Pulmonary recruitment maneuvers are common approaches. During NICU stay, surfactant administration is primarily guided by FiO2 and SpO2/FiO2 ratio, and it is mostly performed through LISA or INSURE. Steroids are used to facilitate extubation and prevent bronchopulmonary dysplasia. (4) Conclusions: Overall, clinical practices are in line with the 2022 European Guidelines, but there are some divergences. These data will allow stakeholders to make comparisons and to identify opportunities for improvement.
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Affiliation(s)
- Corrado Moretti
- Department of Pediatrics, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
| | - Camilla Gizzi
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
- Department of Neonatology and NICU, Ospedale Sant’Eugenio, 00144 Rome, Italy
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics, Ospedale Versilia, 55043 Viareggio, Italy;
| | - Flavia Petrillo
- Maternal and Child Department ASL Bari, Ospedale di Venere, 70131 Bari, Italy;
| | - Maria Luisa Ventura
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
| | - Daniele Trevisanuto
- Department of Woman’s and Child’s Health, University of Padova, 35122 Padova, Italy;
| | - Gianluca Lista
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
- Division of Pediatrics, Neonatal Intensive Care Unit and Neonatology, Ospedale dei Bambini “V.Buzzi”, ASST FBF SACCO, 20154 Milan, Italy
| | - Raffaele L. Dellacà
- TechRes Lab, Department of Electronics, Information and Biomedical Engineering (DEIB), Politecnico di Milano University, 20133 Milan, Italy;
| | - Artur Beke
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
- 1st Department of Obstetrics and Gynecology, Semmelweis University, 1085 Budapest, Hungary
| | - Giuseppe Buonocore
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
- Department of Pediatrics, Università degli Studi di Siena, 53100 Siena, Italy
| | - Antonia Charitou
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
- Department of Pediatrics, Rea Maternity Hospital, 17564 Athens, Greece
| | - Manuela Cucerea
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
- Neonatology Department, University of Medicine Pharmacy Sciences and Technology “George Emil Palade”, 540142 Târgu Mures, Romania
| | - Boris Filipović-Grčić
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
- Department of Pediatrics, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Nelly Georgieva Jeckova
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
- Department of Pediatrics, University Hospital “Majchin Dom”, 1483 Sofia, Bulgaria
| | - Esin Koç
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
- Division of Neonatology, Department of Pediatrics, School of Medicine, Gazi University, 06570 Ankara, Turkey
| | - Joana Saldanha
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
- Neonatology Division, Department of Pediatrics, Hospital Beatriz Ângelo, 2674-514 Loures, Portugal
| | - Manuel Sanchez-Luna
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
- Neonatology Division, Department of Pediatrics, Hospital General Universitario “Gregorio Marañón”, 28007 Madrid, Spain
| | - Dalia Stoniene
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
- Department of Pediatrics, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
| | - Heili Varendi
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
- Department of Paediatrics, University of Tartu, Tartu University Hospital, 50406 Tartu, Estonia
| | - Giulia Vertecchi
- Union of European Neonatal and Perinatal Societies (UENPS), 20143 Milan, Italy; (C.G.); (G.L.); (A.B.); (G.B.); (A.C.); (M.C.); (B.F.-G.); (N.G.J.); (E.K.); (J.S.); (M.S.-L.); (D.S.); (G.V.)
| | - Fabio Mosca
- Department of Pediatrics, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
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Daskalakis G, Pergialiotis V, Domellöf M, Ehrhardt H, Di Renzo GC, Koç E, Malamitsi-Puchner A, Kacerovsky M, Modi N, Shennan A, Ayres-de-Campos D, Gliozheni E, Rull K, Braun T, Beke A, Kosińska-Kaczyńska K, Areia AL, Vladareanu S, Sršen TP, Schmitz T, Jacobsson B. European guidelines on perinatal care: corticosteroids for women at risk of preterm birth. J Matern Fetal Neonatal Med 2023; 36:2160628. [PMID: 36689999 DOI: 10.1080/14767058.2022.2160628] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
of recommendationsCorticosteroids should be administered to women at a gestational age between 24+0 and 33+6 weeks, when preterm birth is anticipated in the next seven days, as these have been consistently shown to reduce neonatal mortality and morbidity. (Strong-quality evidence; strong recommendation). In selected cases, extension of this period up to 34+6 weeks may be considered (Expert opinion). Optimal benefits are found in infants delivered within 7 days of corticosteroid administration. Even a single-dose administration should be given to women with imminent preterm birth, as this is likely to improve neurodevelopmental outcome (Moderate-quality evidence; conditional recommendation).Either betamethasone (12 mg administered intramuscularly twice, 24-hours apart) or dexamethasone (6 mg administered intramuscularly in four doses, 12-hours apart, or 12 mg administered intramuscularly twice, 24-hours apart), may be used (Moderate-quality evidence; Strong recommendation). Administration of two "all" doses is named a "course of corticosteroids".Administration between 22+0 and 23+6 weeks should be considered when preterm birth is anticipated in the next seven days and active newborn life-support is indicated, taking into account parental wishes. Clear survival benefit has been observed in these cases, but the impact on short-term neurological and respiratory function, as well as long-term neurodevelopmental outcome is still unclear (Low/moderate-quality evidence; Weak recommendation).Administration between 34 + 0 and 34 + 6 weeks should only be offered to a few selected cases (Expert opinion). Administration between 35+0 and 36+6 weeks should be restricted to prospective randomized trials. Current evidence suggests that although corticosteroids reduce the incidence of transient tachypnea of the newborn, they do not affect the incidence of respiratory distress syndrome, and they increase neonatal hypoglycemia. Long-term safety data are lacking (Moderate quality evidence; Conditional recommendation).Administration in pregnancies beyond 37+0 weeks is not indicated, even for scheduled cesarean delivery, as current evidence does not suggest benefit and the long-term effects remain unknown (Low-quality evidence; Conditional recommendation).Administration should be given in twin pregnancies, with the same indication and doses as for singletons. However, existing evidence suggests that it should be reserved for pregnancies at high-risk of delivering within a 7-day interval (Low-quality evidence; Conditional recommendation). Maternal diabetes mellitus is not a contraindication to the use of antenatal corticosteroids (Moderate quality evidence; Strong recommendation).A single repeat course of corticosteroids can be considered in pregnancies at less than 34+0 weeks gestation, if the previous course was completed more than seven days earlier, and there is a renewed risk of imminent delivery (Low-quality evidence; Conditional recommendation).
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Affiliation(s)
- George Daskalakis
- 1st department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Pergialiotis
- 1st department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Harald Ehrhardt
- Department of General Pediatrics and Neonatology, Justus-Liebig-University and Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany.,German Lung Research Center (DZL), Giessen, Germany
| | - Gian Carlo Di Renzo
- Center for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,PREIS International and European School of Perinatal, Neonatal and Reproductive Medicine, Florence, Italy.,Department of Obstetrics and Gynecology, I.M. Sechenov First State University of Moscow, Moscow, Russia
| | - Esin Koç
- Department of Neonatology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Králové, Hradec Kralove, Czech Republic
| | - Neena Modi
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.,Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, London, UK
| | - Diogo Ayres-de-Campos
- Medical School, Santa Maria University Hospital, Lisbon, Portugal.,European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Elko Gliozheni
- Department of Obstetrics and Gynaecology, Maternity Koco Gliozheni Hospital, Tirana, Albania
| | - Kristiina Rull
- Women's Clinic of Tartu University Hospital, Tartu, Estonia.,Department of Obstetrics and Gynaecology, University of Tartu, Tartu Estonia.,Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Thorsten Braun
- Department of Obstetrics and Division of 'Experimental Obstetrics', Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Artur Beke
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Katarzyna Kosińska-Kaczyńska
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Ana Luisa Areia
- Obstetrics Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Centre of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Coimbra, Portugal
| | - Simona Vladareanu
- Neonatology Clinic, Department of Obstetrics and Gynecology, Faculty of General Medicine, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Tanja Premru Sršen
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Thomas Schmitz
- Department of Obstetrics and Gynecology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Service de gynécologie-obstétrique, hôpital Robert-Debré, Université Paris Cité, Paris, France
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
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Gizzi C, Gagliardi L, Trevisanuto D, Ghirardello S, Di Fabio S, Beke A, Buonocore G, Charitou A, Cucerea M, Degtyareva MV, Filipović-Grčić B, Jekova NG, Koç E, Saldanha J, Luna MS, Stoniene D, Varendi H, Calafatti M, Vertecchi G, Mosca F, Moretti C. Variation in delivery room management of preterm infants across Europe: a survey of the Union of European Neonatal and Perinatal Societies. Eur J Pediatr 2023; 182:4173-4183. [PMID: 37436521 DOI: 10.1007/s00431-023-05107-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
The aim of the present study, endorsed by the Union of European Neonatal and Perinatal Societies (UENPS) and the Italian Society of Neonatology (SIN), was to analyze the current delivery room (DR) stabilization practices in a large sample of European birth centers that care for preterm infants with gestational age (GA) < 33 weeks. Cross-sectional electronic survey was used in this study. A questionnaire focusing on the current DR practices for infants < 33 weeks' GA, divided in 6 neonatal resuscitation domains, was individually sent to the directors of European neonatal facilities, made available as a web-based link. A comparison was made between hospitals grouped into 5 geographical areas (Eastern Europe (EE), Italy (ITA), Mediterranean countries (MC), Turkey (TUR), and Western Europe (WE)) and between high- and low-volume units across Europe. Two hundred and sixty-two centers from 33 European countries responded to the survey. At the time of the survey, approximately 20,000 very low birth weight (VLBW, < 1500 g) infants were admitted to the participating hospitals, with a median (IQR) of 48 (27-89) infants per center per year. Significant differences between the 5 geographical areas concerned: the volume of neonatal care, ranging from 86 (53-206) admitted VLBW infants per center per year in TUR to 35 (IQR 25-53) in MC; the umbilical cord (UC) management, being the delayed cord clamping performed in < 50% of centers in EE, ITA, and MC, and the cord milking the preferred strategy in TUR; the spotty use of some body temperature control strategies, including thermal mattress mainly employed in WE, and heated humidified gases for ventilation seldom available in MC; and some of the ventilation practices, mainly in regard to the initial FiO2 for < 28 weeks' GA infants, pressures selected for ventilation, and the preferred interface to start ventilation. Specifically, 62.5% of TUR centers indicated the short binasal prongs as the preferred interface, as opposed to the face mask which is widely adopted as first choice in > 80% of the rest of the responding units; the DR surfactant administration, which ranges from 44.4% of the birth centers in MC to 87.5% in WE; and, finally, the ethical issues around the minimal GA limit to provide full resuscitation, ranging from 22 to 25 weeks across Europe. A comparison between high- and low-volume units showed significant differences in the domains of UC management and ventilation practices. Conclusion: Current DR practice and ethical choices show similarities and divergences across Europe. Some areas of assistance, like UC management and DR ventilation strategies, would benefit of standardization. Clinicians and stakeholders should consider this information when allocating resources and planning European perinatal programs. What is Known: • Delivery room (DR) support of preterm infants has a direct influence on both immediate survival and long-term morbidity. • Resuscitation practices for preterm infants often deviate from the internationally defined algorithms. What is New: • Current DR practice and ethical choices show similarities and divergences across Europe. Some areas of assistance, like UC management and DR ventilation strategies, would benefit of standardization. • Clinicians and stakeholders should consider this information when allocating resources and planning European perinatal programs.
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Affiliation(s)
- Camilla Gizzi
- Department of Pediatrics and Neonatology, Ospedale Sandro Pertini, Rome, Italy.
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics, Ospedale Versilia, Viareggio, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Stefano Ghirardello
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sandra Di Fabio
- Department of Pediatrics, Ospedale San Salvatore, L'Aquila, Italy
| | - Artur Beke
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy
- 1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Giuseppe Buonocore
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy
- Department of Pediatrics, Università degli Studi di Siena, Siena, Italy
| | - Antonia Charitou
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy
- Department of Pediatrics, Rea Maternity Hospital, Athens, Greece
| | - Manuela Cucerea
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy
- Neonatology Department, University of Medicine Pharmacy Sciences and Technology "George Emil Palade", Târgu Mures, Romania
| | - Marina V Degtyareva
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy
- Department of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Boris Filipović-Grčić
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy
- Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, HR, Croatia
| | - Nelly Georgieva Jekova
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy
- Department of Pediatrics, University Hospital "Majchin Dom", Sofia, Bulgaria
| | - Esin Koç
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy
- Division of Neonatology, Department of Pediatrics, School of Medicine, Gazi University, Ankara, Turkey
| | - Joana Saldanha
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy
- Department of Pediatrics, Hospital de Santa Maria, Lisbon, Portugal
| | - Manuel Sanchez Luna
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy
- Neonatology Division, Department of Pediatrics, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - Dalia Stoniene
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy
- Department of Pediatrics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Heili Varendi
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy
- Department of Pediatrics, Tartu University Hospital, Tartu, Estonia
| | - Matteo Calafatti
- Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | - Giulia Vertecchi
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy
| | - Fabio Mosca
- Department of Pediatrics, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Corrado Moretti
- Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy
- Department of Pediatrics, Policlinico Umberto I, Sapienza University, Rome, Italy
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Beke A, Eros FR. Biostatistical evaluation of the effectiveness of fetal ultrasound diagnostics with application of new uncertainty factor and difficulty factor in cases of craniofacial malformations—gray zone in biostatistics for imaging procedures. Quant Imaging Med Surg 2023. [DOI: 10.21037/qims-22-1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Trevisanuto D, Gizzi C, Gagliardi L, Ghirardello S, Di Fabio S, Beke A, Buonocore G, Charitou A, Cucerea M, Degtyareva MV, Filipović-Grčić B, Georgieva Jekova N, Koç E, Saldanha J, Sanchez Luna M, Stoniene D, Varendi H, Vertecchi G, Mosca F, Moretti C. Neonatal Resuscitation Practices in Europe: A Survey of the Union of European Neonatal and Perinatal Societies. Neonatology 2022; 119:184-192. [PMID: 35051924 DOI: 10.1159/000520617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND We aimed to evaluate the policies and practices about neonatal resuscitation in a large sample of European hospitals. METHODS This was a cross-sectional electronic survey. A 91-item questionnaire focusing on the current delivery room practices in neonatal resuscitation domains was individually sent to the directors of 730 European neonatal facilities or (in 5 countries) made available as a Web-based link. A comparison was made between hospitals with ≤2,000 and those with >2,000 births/year and between hospitals in 5 European areas (Eastern Europe, Italy, Mediterranean countries, Turkey, and Western Europe). RESULTS The response rate was 57% and included participants from 33 European countries. In 2018, approximately 1.27 million births occurred at the participating hospitals, with a median of 1,900 births/center (interquartile range: 1,400-3,000). Routine antenatal counseling (p < 0.05), the presence of a resuscitation team at all deliveries (p < 0.01), umbilical cord management (p < 0.01), practices for thermal management (p < 0.05), and heart rate monitoring (p < 0.01) were significantly different between hospitals with ≤2,000 births/year and those with >2,000 births/year. Ethical and educational aspects were similar between hospitals with low and high birth volumes. Significant variance in practice, ethical decision-making, and training programs were found between hospitals in 5 different European areas. CONCLUSIONS Several recommendations about available equipment and clinical practices recommended by the international guidelines are already implemented by centers in Europe, but a large variance still persists. Clinicians and stakeholders should consider this information when allocating resources and planning European perinatal programs.
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Affiliation(s)
- Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Camilla Gizzi
- Department of Pediatrics, Ospedale Sandro Pertini, Rome, Italy.,Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics, Ospedale Versilia, Viareggio, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Stefano Ghirardello
- Department of Pediatrics, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Sandra Di Fabio
- Department of Pediatrics, Ospedale San Salvatore, L'Aquila, Italy
| | - Artur Beke
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Giuseppe Buonocore
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Antonia Charitou
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, Rea Maternity Hospital, Athens, Greece
| | - Manuela Cucerea
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Neonatology Department, University of Medicine Pharmacy Sciences and Technology "George Emil Palade", Târgu Mures, Romania
| | - Marina V Degtyareva
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Boris Filipović-Grčić
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Nelly Georgieva Jekova
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, University Hospital "Majchin dom", Sofia, Bulgaria
| | - Esin Koç
- Division of Neonatology, Department of Pediatrics, School of Medicine, Gazi University, Ankara, Turkey.,1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Joana Saldanha
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, Hospital de Santa Maria, Lisbon, Portugal
| | - Manuel Sanchez Luna
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Neonatology Division, Department of Pediatrics, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - Dalia Stoniene
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Heili Varendi
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, Tartu University Hospital, Tartu, Estonia
| | - Giulia Vertecchi
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy
| | - Fabio Mosca
- Department of Pediatrics, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Corrado Moretti
- Union of European Neonatal and Perinatal Societies (UENPS), Pisa, Italy.,Department of Pediatrics, Policlinico Umberto I, Sapienza University, Rome, Italy
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6
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Laine K, Yli BM, Cole V, Schwarz C, Kwee A, Ayres-de-Campos D, Vayssiere C, Roth E, Gliozheni E, Savochkina Y, Ivanisevic M, Kalis V, Timonen S, Verspyck E, Anstaklis P, Beke A, Eriksen BH, Santo S, Kavsek G, Duvekot H, Dadak C. European guidelines on perinatal care- Peripartum care Episiotomy. J Matern Fetal Neonatal Med 2021; 35:8797-8802. [PMID: 34895000 DOI: 10.1080/14767058.2021.2005022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OF RECOMMENDATIONS1. Episiotomy should be performed by indication only, and not routinely (Moderate quality evidence +++-; Strong recommendation). Accepted indications for episiotomy are to shorten the second stage of labor when there is suspected fetal hypoxia (Low quality evidence ++-; Weak recommendation); to prevent obstetric anal sphincter injury in vaginal operative deliveries, or when obstetric sphincter injury occurred in previous deliveries (Moderate quality evidence +++-; Strong recommendation)2. Mediolateral or lateral episiotomy technique should be used (Moderate quality evidence +++-; Strong recommendation). Labor ward staff should be offered regular training in correct episiotomy techniques (Moderate quality evidence +++-; Strong recommendation).3. Pain relief needs to be considered before episiotomy is performed, and epidural analgesia may be insufficient. The perineal skin needs to be tested for pain before an episiotomy is performed, even when an epidural is in place. Local anesthetics or pudendal block need to be considered as isolated or additional pain relief methods (Low quality evidence ++-; Strong recommendation).4. After childbirth the perineum should be carefully inspected, and the anal sphincter palpated to identify possible injury (Moderate quality evidence +++-; Strong recommendation). Primary suturing immediately after childbirth should be offered and a continuous suturing technique should be used when repairing an uncomplicated episiotomy (High quality evidence ++++; Strong recommendation).
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Affiliation(s)
- Katariina Laine
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway.,Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | | | - Vanessa Cole
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, United Kingdom of Great Britain and Northern Ireland
| | | | | | | | | | | | | | | | | | - Vladimir Kalis
- Czech Society of Perinatology and Feto-Maternal Medicine
| | | | | | | | - Artur Beke
- Hungarian Society of Perinatology and Obstetric Anesthesiology
| | | | - Susana Santo
- Portuguese Society of Obstetrics and Maternal-Fetal Medicine
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7
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Mashamba MA, Tanser F, Afagbedzi S, Beke A. Multi Drug Resistant Tuberculosis Clusters in Mpumalanga Province, South Africa, 2013-2016: A Spatial Analysis. Trop Med Int Health 2021; 27:185-191. [PMID: 34873790 DOI: 10.1111/tmi.13708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify spatial clusters with unusually high levels of MDR-TB which are highly unlikely to have arisen by chance in Mpumalanga Province, South Africa. METHODS Home addresses of all MDR-TB patients were collected from four MDR-TB facilities from 2013 to 2016. We mapped all addresses, linking them to the nearest ward with population estimates. A spatial analysis was conducted using kernel density in ArcGIS to estimate and map the distribution of the disease and used Gertis-Ord Gi to test for significant clustering. RESULTS A total of 4,065 MDR-TB patients were mapped. Ten significant clusters (p-value < 0.05) were found across the province in six sub-districts: Mbombela, Nkomazi, Emalahleni, Govan Mbeki, Lekwa and Mkhondo. Mbombela has the highest number of significant clusters. The central region did not have any MDR-TB clusters. CONCLUSION There is clear evidence of MDR-TB clustering in Mpumalanga. This calls for concentrated TB prevention efforts and proper allocation of resources. Further investigations are needed to identify MDR-TB predictors.
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Affiliation(s)
- M A Mashamba
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa
| | - F Tanser
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK.,Africa Health Research Institute, KwaZulu-Natal, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - S Afagbedzi
- School of Public Health, Faculty of Health Sciences, University of Ghana, Ghana
| | - A Beke
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa
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8
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Nunes I, Dupont C, Timonen S, Ayres de Campos D, Cole V, Schwarz C, Kwee A, Yli B, Vayssiere C, Roth GE, Gliozheni E, Savochkina Y, Ivanisevic M, Janku P, Timonen S, Daskalakis G, Beke A, Santo S, Druškovič M, Duvekot JJ, Farr A, Dreyfus M. European Guidelines on Perinatal Care - Oxytocin for induction and augmentation of labor[Formula: see text]. J Matern Fetal Neonatal Med 2021; 35:7166-7172. [PMID: 34470113 DOI: 10.1080/14767058.2021.1945577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OF RECOMMENDATIONS1. Oxytocin for induction or augmentation of labor should not be started when there is a previous scar on the body of the uterus (such as previous classical cesarean section, uterine perforation or myomectomy when uterine cavity is reached) or in any other condition where labor or vaginal delivery are contraindicated. (Moderate quality evidence +++-; Strong recommendation).2. Oxytocin should not be started before at least 1 h has elapsed since amniotomy, 6 h since the use of dinoprostone (30 min if vaginal insert) and 4 h since the use of misoprostol (Low quality evidence ++- -; Moderate recommendation).3. Cardiotocography (CTG) should be performed and a normal pattern without tachysystole should be documented for at least 30 min before oxytocin is used. Continuous CTG, with adequate monitoring of both fetal heart rate and uterine contractions, should be maintained for as long as oxytocin is used, and thereafter until delivery (Low ++- - to moderate +++- quality evidence; Strong recommendation).4. For labor induction, at least 1-h should be allowed after amniotomy before oxytocin infusion is started, to evaluate whether adequate uterine contractility has meanwhile ensued. For augmentation of labor, if the membranes are intact and there are conditions for a safe amniotomy, the latter should be considered before oxytocin is started (Very low quality evidence +- --; Weak recommendation).5. Oxytocin should be administered intravenously using the following regimen: 5 IU oxytocin diluted in 500 mL of 0.9% normal saline (NaCl) (each mL contains 10 mIU of oxytocin), in an infusion pump at increasing rates, as shown in Table 1, until a frequency of 3-4 contractions per 10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality evidence ++ - -; Strong recommendation). If the frequency of contractions exceeds 5 in 10 min, the infusion rate should be reduced, even if a normal CTG pattern is present. With a non-reassuring CTG pattern, urgent clinical assessment by an obstetrician is indicated, and strong consideration should be given to reducing or stopping the oxytocin infusion. The minimal effective dose of oxytocin should always be used. (Low ++- - to Moderate +++- - quality evidence; Strong recommendation).[Table: see text]6. Use of oxytocin for induction and augmentation of labor should be regularly audited (Low quality evidence ++--; Strong recommendation).
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Affiliation(s)
| | - Inês Nunes
- School of Medicine and Biomedical Sciences (ICBAS), University Hospital Center of Porto, CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Corinne Dupont
- University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE) INSERM U1290; AURORE Perinatal Network, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Susanna Timonen
- Finnish Society of Perinatology, Turku University Hospital, Turku University, Turku, Finland
| | | | | | | | - Christiane Schwarz
- Dept. Midwifery Science, University Lubeck, Institute for Health Sciences, Lubeck, Germany
| | - Anneke Kwee
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Branka Yli
- Delivery Deparment, Oslo University Hospital, Oslo, Norway
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse; UMR1295 CERPOP (Centre for Epidemiology and Population Health Research), Team SPHERE (Study of Perinatal, Paedriatric and Adolescent Health: Epidemiological Research and Evaluation) Toulouse III University, Toulouse, France
| | | | - Elko Gliozheni
- Albanian Association of Perinatology, Department of Obstetrics and Gynecology, University Hospital of Obstetrics and Gynaecology 'Koco Gliozheni', Tirana, Albania
| | - Yuliya Savochkina
- Bielorussian Society of Human Reproduction, 5th Minsk City Hospital and Belarus Medical Academy of Postgraduate Education, Minsk, Belarus
| | - Marina Ivanisevic
- Croatian Association of Perinatal Medicine, University Clinic for Obstetrics and Gynecology, School of Medicine, Zagreb, Croatia
| | - Petr Janku
- Czech Society of Perinatology and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, University Hospital Brno, Masaryk University Brno, Brno, Czech Republic; Department of Nursing and Midwifery, Masaryk University Brno, Czech Republic
| | - Susanna Timonen
- Finnish Society of Perinatology, Turku University Hospital, Turku University, Turku, Finland
| | - George Daskalakis
- Hellenic Society of Perinatal Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Artur Beke
- Hungarian Society of Perinatology and Obstetric Anesthesiology, Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Susana Santo
- Portuguese Society of Obstetrics and Maternal-Fetal Medicine, Santa Maria Hospital, University of Lisbon Medical School, Lisbon, Portugal
| | - Mirjam Druškovič
- Slovenia Medical Association - Society of Perinatal Medicine, Division of Obstetrics and Gynecology, UMC Ljubljana, Ljubljana, Slovenia
| | - J J Duvekot
- Dutch Society of Obstetrics and Gynecology, Department of Obstetrics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alex Farr
- Austrian Society for Pre- and Perinatal Medicine, Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Michel Dreyfus
- Societé Française de Medicine Perinatale, Service d'Obstétrique, Gynécologie et Médecine de la Reproduction, Centre Hospitalier Universitaire de Caen, Caen, France
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Simonyi A, Eros FR, Hajdu J, Beke A. Effectiveness of fetal ultrasound diagnostics in cardiac malformations and association with polyhydramnios and oligohydramnios. Quant Imaging Med Surg 2021; 11:2994-3004. [PMID: 34249629 DOI: 10.21037/qims-20-823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/17/2021] [Indexed: 11/06/2022]
Abstract
Background Examine the effectiveness of prenatal ultrasound diagnostics in the detection of cardiovascular malformations, and their association with polyhydramnios and oligohydramnios. Methods We examined the fetal ultrasonography and postnatal clinical/fetopathological data of 372 newborns/fetuses over a 7-year period in a tertiary centre. Fetal echocardiography was performed in cases of suspected US findings between 18-32 weeks. During the ultrasound the amniotic fluid amount was measured and the amniotic fluid index (AFI) or largest amniotic fluid pocket was determined. Results Prenatal ultrasonographic results and postnatal/fetopathological diagnosis were fully congruent in 236/372 cases (63.4%), and in 66/372 cases of cardiovascular anomalies (17.7%) the discovery was partial, while in 70/372 cases no fetal cardiovascular anomalies were diagnosed during pregnancy (18.8%) (false negative). Cardiovascular malformations were isolated in 255 cases, in 172 of which (67.5%) the results of prenatal ultrasonography and postnatal diagnostics were fully congruent. In 43 cases (16.9%) the prenatal discovery was partial, and in 40 cases (15.7%) there was no prenatal recognition of the malformation. Cardiovascular abnormalities were found as a part of multiple malformations in 76 cases. In 41 fetuses the cardiovascular malformation was associated with chromosomal abnormalities. Cardiovascular malformations were significantly associated with polyhydramnios. Although in some of the cardiovascular malformations the association rate with polyhydramnios was high (AVSD, double outlet right ventricle, tetralogy of Fallot), we found a moderate association rate (19.7%). The association with oligohydramnios was 8.57%. Conclusions Echocardiography plays an important role in the prenatal diagnostics. In cases of polyhydramnios and oligohydramnios, fetal echocardiography should be performed.
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Affiliation(s)
- Atene Simonyi
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Fanni Rebeka Eros
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Julia Hajdu
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.,Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | - Artur Beke
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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10
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Abstract
Nowadays, women's family planning intentions are postponed, and it is common that only later will the conditions be created for the woman to have children. Fortunately, in most cases, pregnancy is possible in this case, taking into account the increased genetic risk. However, this later childbirth may become impossible or significantly more difficult if we can detect sterility and infertility, and its genetic cause is revealed. Any procedure that can help to reduce the "aging" of society, the reproduction rate, must be treated as an important public health issue. It would be particularly important in cases where genetic causes can be detected in the background of female sterility and infertility. Endocrine causes, infections, immunological causes, psychic factors, stress, and weight problems may be among the causes of female infertility in addition to genetic causes and genetic developmental disorders. Infertility can also be caused by iatrogenic factors, previous interventions, and surgery. In this chapter we will discuss the diseases in which genetic factors play a role.
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Affiliation(s)
- Artur Beke
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
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11
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Beke A, Piko H, Haltrich I, Karcagi V, Rigo J, Molnar MJ, Fekete G. Study of patterns of inheritance of premature ovarian failure syndrome carrying maternal and paternal premutations. BMC Med Genet 2018; 19:113. [PMID: 29986653 PMCID: PMC6038184 DOI: 10.1186/s12881-018-0634-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 06/26/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Premature ovarian failure / primary ovarian insufficiency (POF/POI) associated with the mutations of the FMR1 (Fragile-X Mental Retardation 1) gene belongs to the group of the so-called trinucleotide expansion diseases. Our aim was to analyse the relationship between the paternally inherited premutation (PIP) and the maternally inherited premutation (MIP) by the examination of the family members of women with POF, carrying the premutation allele confirmed by molecular genetic testing. METHODS Molecular genetic testing was performed in the patients of the 1st Department of Obstetrics and Gynecology with suspected premature ovarian failure. First we performed the southern blot analyses and for the certified premutation cases we used the Repeat Primed PCR. RESULTS Due to POF/POI, a total of 125 patients underwent genetic testing. The FMR1 gene trinucleotide repeat number was examined in the DNA samples of the patients, and in 15 cases (12%) deviations (CGG repeat number corresponding to premutation or gray zone) were detected. In 6 cases out of the 15 cases the CGG repeat number fell within the range of the so-called gray zone (41-54 CGG repeat) (4.8%, 6/125), and the FMR1 premutation (55-200 CGG repeat) ratio was 7.2% (9/125). In 4 out of the 15 cases we found differences in both alleles, one was a premutation allele, and the other allele showed a repeat number belonging to the gray zone. Out of 15 cases, only maternal inheritance (MIP) was detected in 2 cases, in one case the premutation allele (91 CGG repeat number), while in the other case an allele belonging to the gray zone (41 CGG repeat number) were inherited from their mothers. In 10 out of 15 cases, the patient inherited the premutation allele only from the father (PIP). In 5 out of the 10 cases (50%) the premutation allele was inherited from the father, and the repeat number ranged from 55 to 133. Out of 125 cases, 9 patients had detectable cytogenetic abnormalities (7.2%). CONCLUSIONS The RP-PCR method can be used to define the smaller premutations and the exact CGG number. Due to the quantitative nature of the RP-PCR, it is possible to detect the mosaicism as well.
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Affiliation(s)
- Artur Beke
- 1st Department of Obstetrics and Gynecology, Semmelweis University, Baross u. 27, Budapest, 1428, Hungary.
| | - Henriett Piko
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Iren Haltrich
- 2nd Department of Pediatrics, Semmelweis University fekete, Budapest, Hungary
| | - Veronika Karcagi
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Janos Rigo
- 1st Department of Obstetrics and Gynecology, Semmelweis University, Baross u. 27, Budapest, 1428, Hungary
| | - Maria Judit Molnar
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - György Fekete
- 2nd Department of Pediatrics, Semmelweis University fekete, Budapest, Hungary
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12
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Eros FR, Simonyi A, Tidrenczel Z, Szabo I, Rigo J, Beke A. Efficacy of Prenatal Ultrasound in Craniospinal Malformations According to Fetopathological and Postnatal Neonatological, Pathological Results. Fetal Pediatr Pathol 2018; 37:166-176. [PMID: 29737917 DOI: 10.1080/15513815.2018.1461282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Our objective is to examine the effectiveness of prenatal ultrasound diagnosis of craniospinal malformations compared to postnatal neonatological and pathological findings. METHODS Over a 7-year period, we preformed approximately 82.500 prenatal ultrasounds of 26.827 pregnancies. We detected 290 fetuses with 351 craniospinal malformations. RESULTS Craniospinal abnormalities were found as a part of multiplex malformations in 84/290 cases: in 47/84 cases (55.95%) there was complete concurrence between prenatal and postnatal results. In 15/290 fetuses the craniospinal malformation was associated with chromosomal abnormalities. In 9/15 (60%) of these fetuses, malformations were fully diagnosed with ultrasound. Isolated craniospinal malformations occurred in 191/290 cases, in 162/191 (84.82%) the results of prenatal ultrasonography and postnatal or post abortion examinations showed complete concurrence. In addition to the 290 fetuses with craniospinal malformations, there were an additional 17 who were thought by ultrasound to have a craniospinal malformation, which could not be documented after birth (false positives). CONCLUSIONS Prenatal ultrasound accurately diagnosed 218/290 (75,17%) craniospinal abnormalities, and partially defined the abnormalities in 9.66%, failed to detect abnormalities in 15.17%, with an approximate 0.06% false detection rate.
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Affiliation(s)
- Fanni Rebeka Eros
- a Semmelweis University , 1st Department of Obstetrics and Gynecology , Budapest , Hungary
| | - Atene Simonyi
- a Semmelweis University , 1st Department of Obstetrics and Gynecology , Budapest , Hungary
| | - Zsolt Tidrenczel
- a Semmelweis University , 1st Department of Obstetrics and Gynecology , Budapest , Hungary.,b Medical Centre Hungarian Defence Forces , Department of Obstetrics and Gynecology , Budapest , Hungary
| | - Istvan Szabo
- a Semmelweis University , 1st Department of Obstetrics and Gynecology , Budapest , Hungary
| | - Janos Rigo
- a Semmelweis University , 1st Department of Obstetrics and Gynecology , Budapest , Hungary
| | - Artur Beke
- a Semmelweis University , 1st Department of Obstetrics and Gynecology , Budapest , Hungary
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13
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Affiliation(s)
| | - A Beke
- School of Health Systems and Public Health; University of Pretoria
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14
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Beke A, Eros FR, Pete B, Szabo I, Gorbe E, Rigo J. Efficacy of prenatal ultrasonography in diagnosing urogenital developmental anomalies in newborns. BMC Pregnancy Childbirth 2014; 14:82. [PMID: 24564681 PMCID: PMC3936834 DOI: 10.1186/1471-2393-14-82] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Showing a prevalence rate of 0.5-0.8%, urogenital malformations discovered in newborns is regarded relatively common. The aim of this study is to examine the efficacy of ultrasound diagnostics in detecting developmental disorders in the urogenital system. METHODS We have processed the prenatal sonographic and postnatal clinical details of 175 urogenital abnormalities in 140 newborns delivered with urogenital malformation according to EUROCAT recommendations over a 5-year period between 2006 and 2010. The patients were divided into three groups; Group 1: prenatal sonography and postnatal examinations yielded fully identical results. Group 2: postnatally detected urogenital changes were partially discovered in prenatal investigations. Group 3: prenatal sonography failed to detect the urogenital malformation identified in postnatal examinations. Urogenital changes representing part of certain multiple disorders associated with chromosomal aberration were investigated separately. RESULTS Prenatal sonographic diagnosis and postnatal results completely coincided in 45%, i.e. 63/140 of cases in newborns delivered with urogenital developmental disorders. In 34/140 cases (24%), discovery was partial, while in 43/140 patients (31%), no urogenital malformation was detected prenatally. No associated malformations were observed in 108 cases, in 57 of which (53%), the results of prenatal ultrasonography and postnatal examinations showed complete coincidence. Prenatally, urogenital changes were found in 11 patients (10%), whereas no urogenital disorders were diagnosed in 40 cases (37%) by investigations prior to birth. Urogenital disorders were found to represent part of multiple malformations in a total of 28 cases as follows: prenatal diagnosis of urogenital malformation and the findings of postnatal examinations completely coincided in three patients (11%), partial coincidence was found in 22 newborns (79%) and in another three patients (11%), the disorder was not detected prenatally. In four newborns, chromosomal aberration was associated with the urogenital disorder; 45,X karyotype was detected in two patients, trisomy 9 and trisomy 18 were found in one case each. CONCLUSION In approximately half of the cases, postnatally diagnosed abnormalities coincided with the prenatally discovered fetal urogenital developmental disorders. The results have confirmed that ultrasonography plays an important role in diagnosing urogenital malformations but it fails to detect all of the urogenital developmental abnormalities.
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Affiliation(s)
- Artur Beke
- 1st Department of Obstetrics and Gynecology, Semmelweis University, Baross u, 27,, 1088 Budapest, Hungary.
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15
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Beke A, Piko H, Haltrich I, Csomor J, Matolcsy A, Fekete G, Rigo J, Karcagi V. Molecular cytogenetic analysis of Xq critical regions in premature ovarian failure. Mol Cytogenet 2013; 6:62. [PMID: 24359613 PMCID: PMC3914679 DOI: 10.1186/1755-8166-6-62] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/03/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND One of the frequent reasons for unsuccessful conception is premature ovarian failure/primary ovarian insufficiency (POF/POI) that is defined as the loss of functional follicles below the age of 40 years. Among the genetic causes the most common one involves the X chromosome, as in Turner syndrome, partial X deletion and X-autosome translocations. Here we report a case of a 27-year-old female patient referred to genetic counselling because of premature ovarian failure. The aim of this case study to perform molecular genetic and cytogenetic analyses in order to identify the exact genetic background of the pathogenic phenotype. RESULTS For premature ovarian failure disease diagnostics we performed the Fragile mental retardation 1 gene analysis using Southern blot technique and Repeat Primed PCR in order to identify the relationship between the Fragile mental retardation 1 gene premutation status and the premature ovarion failure disease. At this early onset, the premature ovarian failure affected patient we detected one normal allele of Fragile mental retardation 1 gene and we couldn't verify the methylated allele, therefore we performed the cytogenetic analyses using G-banding and fluorescent in situ hybridization methods and a high resolution molecular cytogenetic method, the array comparative genomic hybridization technique. For this patient applying the G-banding, we identified a large deletion on the X chromosome at the critical region (ChrX q21.31-q28) which is associated with the premature ovarian failure phenotype. In order to detect the exact breakpoints, we used a special cytogenetic array ISCA plus CGH array and we verified a 67.355 Mb size loss at the critical region which include total 795 genes. CONCLUSIONS We conclude for this case study that the karyotyping is definitely helpful in the evaluation of premature ovarian failure patients, to identify the non submicroscopic chromosomal rearrangement, and using the array CGH technique we can contribute to the most efficient detection and mapping of exact deletion breakpoints of the deleted Xq region.
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Affiliation(s)
- Artur Beke
- 1st Department of Obstetrics and Gynecology, Semmelweis University, Baross u, 27, 1088 Budapest, Hungary.
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Belics Z, Fekete T, Beke A, Szabó I. Prenatal ultrasonographic measurement of the fetal iliac angle during the first and second trimester of pregnancy. Prenat Diagn 2011; 31:351-5. [PMID: 21413034 DOI: 10.1002/pd.2690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 11/06/2010] [Accepted: 11/11/2010] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this study was to present our results of the sonographic measurement of the fetal iliac angle during the first and second trimesters of pregnancy. METHODS A total of 2168 fetal iliac angle measurements were performed in a transverse section of the fetal pelvis. The iliac angle measurements were compared in fetuses with trisomy 21 (n = 52) and fetuses with normal karyotype (n = 1980). The sensitivity, specificity, positive predictive value, negative predictive value and false positive rate in trisomy 21 fetuses were compared for multiple cut-off value. Statistical significance for measurements was estimated for trisomy 21. RESULTS A total of 2064 fetuses had adequate images for satisfactory measurement of the iliac wing angle and 1831 patients asked for a genetic invasive procedure. Of the fetuses with chromosomal aberrations, only the fetuses with trisomy 21 were included in the investigation. The risk of trisomy 21 in our population was 1 of 39. In the euploid fetuses, the mean iliac wing angle was 63.72°. The mean iliac wing angle in the fetuses with trisomy 21 was 90.32°, significantly higher than those seen in fetuses with normal karyotype. CONCLUSION The proven larger iliac wing angle in neonates with Down syndrome can be demonstrated sonographically during the pregnancy, especially in the first and second trimesters. This marker may be useful in prenatal screening or exclusion of trisomy 21.
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Affiliation(s)
- Zoran Belics
- 1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
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Achoki TN, Shilumani C, Beke A. Effectiveness of community participation in tuberculosis control. S Afr Med J 2009; 99:722-724. [PMID: 20128269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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Beke A, Joó J, Csaba A, Lázár L, Bán Z, Papp C, Tóth-Pál E, Papp Z. Incidence of Chromosomal Abnormalities in the Presence of Fetal Subcutaneous Oedema, Such as Nuchal Oedema, Cystic Hygroma and Non-Immune Hydrops. Fetal Diagn Ther 2009; 25:83-92. [DOI: 10.1159/000201946] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 04/07/2008] [Indexed: 11/19/2022]
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Hajdú J, Marton T, Kozsurek M, Pete B, Csapó Z, Beke A, Papp Z. Prenatal Diagnosis of Abnormal Course of Umbilical Vein and Absent Ductus Venosus – Report of Three Cases. Fetal Diagn Ther 2007; 23:136-9. [DOI: 10.1159/000111594] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 11/10/2006] [Indexed: 12/14/2022]
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Gávai M, Hupuczi P, Berkes E, Beke A, Hruby E, Murber A, Urbancsek J, Papp Z. Spinal anesthesia for cesarean section in a woman with Kartagener’s syndrome and a twin pregnancy. Int J Obstet Anesth 2007; 16:284-7. [PMID: 17408950 DOI: 10.1016/j.ijoa.2006.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 11/01/2006] [Indexed: 11/23/2022]
Abstract
Kartagener's syndrome is an inherited disease characterized by a triad of symptoms: bronchiectasis, situs inversus and sinusitis resulting from defective cilial motility. There are few reports in the literature regarding the optimum anesthetic technique in patients with Kartagener's syndrome. The main anesthetic considerations are related to the respiratory system and increased risk of infection. We report the case of a woman with Kartagener's syndrome and a twin pregnancy conceived by in-vitro fertilization-embryo transfer, who underwent cesarean section under spinal anesthesia. Despite recurrent pulmonary problems, the twin pregnancy resulted in a successful outcome. This was facilitated by a close working relationship between the obstetrician, anesthesiologist and patient.
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Affiliation(s)
- M Gávai
- I. Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
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Papp C, Ban Z, Szigeti Z, Csaba A, Beke A, Papp Z. Role of second trimester sonography in detecting trisomy 18: a review of 70 cases. J Clin Ultrasound 2007; 35:68-72. [PMID: 17206726 DOI: 10.1002/jcu.20290] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE To investigate the role of second-trimester sonographic examination in the prenatal diagnosis of trisomy 18. METHODS Out of 22,150 fetal chromosomal analyses performed between 1990 and 2004, 70 trisomy 18 fetuses were found. The sonographic findings of this aneuploidy were analyzed. RESULTS The average maternal age was 32.4 years; the average gestational age was 19.5 weeks. Major anomalies were seen in 61 (87.1%) of the 70 fetuses with trisomy 18; among these, cardiac anomalies were the most common (47.1%), with a 27.1% incidence of ventricular septal defects. Anomalies of the central nervous system were seen in 35.7% of cases; abnormal head shape was the most frequently detected anomaly in this group (12.9%). Fifty-six (80%) of the fetuses had at least 1 minor anomaly; of these, choroid plexus cyst was the most common (38.6%). Increased nuchal fold thickness was detected in 17.1% of cases. CONCLUSION The vast majority of trisomy 18 fetuses have sonographically detectable abnormalities in the second trimester. Both the 87.1% frequency of major anomalies and the 80% frequency of minor anomalies are substantially higher than multiple biochemical marker tests could achieve. It was also demonstrated that fetal echocardiography plays a pivotal role in the diagnosis of trisomy 18.
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Affiliation(s)
- Csaba Papp
- Semmelweis Univeristy, Baross u. 27, Budapest 1088, Hungary
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Hajdu J, Beke A, Marton T, Hruby E, Pete B, Papp Z. Congenital heart diseases in twin pregnancies. Fetal Diagn Ther 2006; 21:198-203. [PMID: 16491003 DOI: 10.1159/000089303] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Accepted: 03/03/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To find connection between the type of congenital heart malformations and twin pregnancies. METHOD Retrospective analysis of data of fetal cardiology database between 1 January 1996 and 30 November 2003. RESULTS In single pregnancies 455 and in twin pregnancies 31 severe congenital heart malformations were diagnosed prenatally. In monozygotic twin pregnancies 36% of heart malformations were pulmonary stenosis and 45% endocardial fibroelastosis, which is significantly higher than in single pregnancies. In dizygotic twin pregnancies Ebstein malformation was significantly more frequent than in single pregnancies. With the exception of Ebstein malformation in dichorionic and dizygotic twin pregnancies the cardiac malformations were similar to the ones in single pregnancies. CONCLUSIONS The twin pregnancy alone can be considered as indication for fetal echocardiography. The type of congenital heart malformations detected in monochorial twin pregnancies was different from those found in single, dizygotic or dichorionic twin pregnancies. Chorionicity seems to be more important than zygosity.
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Affiliation(s)
- J Hajdu
- Semmelweis University, 1st Department of Obstetrics and Gynecology, Budapest, Hungary.
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Abstract
OBJECTIVE This study was conducted to evaluate the diagnostic value of different sonographic signs of fetuses with Turner syndrome in the first and second trimesters of pregnancy. METHODS Between 1990 and 2004, Turner syndrome was found in 69 of 22,150 fetal karyotypings. Congenital anomalies detected by sonography were analyzed. RESULTS Of the 514 (2.3%; 514/22,150) chromosome aberrations that were diagnosed, 69 Turner syndrome cases were found (13.4%; 69/514). Twenty-four fetuses had a 45,X karyotype (34.8%), and 45 fetuses were mosaic (65.2%). Forty-seven fetuses (68.1%; 47/69) showed symptoms on sonography. A substantial proportion of fetuses with Turner syndrome showed early-onset signs that could be detected in the first trimester (29.8%;14/69). The most common findings with sonography were hygroma colli (26.1%; 18/69), fetal hydrops (11.6%; 8/69), cardiac defects (13%; 9/69), and increased nuchal translucency (13%; 9/69). Among heart defects, coarctation of the aorta was the most common (44.4% of all cardial defects). Soft markers were also detected with relatively high frequency (23.2%; 16/69). CONCLUSIONS The diagnosis of severe Turner syndrome is possible in early pregnancy. A search for soft markers during second-trimester sonography and extensive use of echocardiography may increase the detection rate of Turner syndrome.
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Affiliation(s)
- Csaba Papp
- First Department of Obstetrics and Gynecology, Semmelweis University, Faculty of Medicine, H-1088 Budapest, Baross ut 27, Hungary.
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Abstract
OBJECTIVE The purpose of this study was to investigate the role of second-trimester sonographic examination in the prenatal diagnosis of trisomy 13. METHODS Of 22,150 fetal chromosome analyses, 28 fetuses with trisomy 13 were found between 1990 and 2004. Sonographic findings of this aneuploidy were analyzed in this study. RESULTS The average maternal age was 32.4 years; the average gestational age was 19.5 weeks. There was an 89.3% (n = 25) total prevalence of sonographic abnormalities in fetuses with trisomy 13 in this series. Major (structural) malformations were seen in 23 cases (82.1%), whereas minor anomalies were detected on sonography in 16 cases (57.1%). Although in 2 fetuses 1 minor anomaly was the only sonographic sign of trisomy 13, other cases with minor anomalies (87.5% [n = 14]) were multiplex malformations, in which combinations of major and minor anomalies were detected on sonography. The most frequently seen structural abnormalities were central nervous system and facial anomalies (64.3% [n = 18]). Among central nervous system anomalies, ventriculomegaly and holoprosencephaly were seen most frequently. Cardiovascular anomalies were detected in 53.6% (n = 15) of the fetuses with trisomy 13. This high frequency underlines the importance of echocardiography in diagnosing this aneuploidy. Among minor anomalies, increased nuchal translucency (21.4%) and echogenic bowel (17.9%) were the most common findings. CONCLUSIONS Second-trimester sonographic examination is capable of showing anomalies that are characteristic of trisomy 13; thus, the scan can indicate whether fetal karyotyping is advisable. Incorporation of careful assessment of the fetal cardiovascular system by sonography certainly increases the detection rate of trisomy 13.
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Affiliation(s)
- Csaba Papp
- First Department of Obstetrics and Gynecology, Semmelweis University, Faculty of Medicine, Baross ut 27, H-1088 Budapest, Hungary.
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Belics Z, Beke A, Csabay L, Szabó I, Papp Z. Sonographic measurement of the fetal iliac angle in trisomy 21, 18 and 13. Fetal Diagn Ther 2003; 18:47-50. [PMID: 12566776 DOI: 10.1159/000066384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2001] [Accepted: 05/02/2002] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether iliac wing angle measurement in second trimester fetuses is a useful sonographic marker for the detection of trisomy 21, 18 and 13. METHODS During the period between September 1998 and September 2001, 406 fetal iliac angle measurements were performed in women in the second trimester of their pregnancies. The iliac angle measurements in fetuses with trisomy 21 (n = 25), trisomy 18 (n = 10) and trisomy 13 (n = 5) were compared with iliac angle measurement in fetuses with normal karyotypes (n = 333). RESULTS The mean iliac wing angle in the fetuses with trisomy 21 was 92.67 and 79.35 degrees and 74 degrees in fetuses with trisomy 18 and 13 (the mean iliac wing angle in the healthy fetuses was 70.09 degrees ). CONCLUSION The proven larger iliac wing angle in neonates with Down's syndrome can be demonstrated sonographically during the pregnancy, especially during the second trimester, and may be useful in prenatal screening of trisomy 21. The sonographic measurement of the fetal iliac angle cannot be used as a marker for trisomy 18 and 13. We have shown that fetuses with trisomy 18 and 13, on average, have iliac angles only a few degrees larger than healthy fetuses.
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Affiliation(s)
- Zoran Belics
- Semmelweis University, First Department of Obstetrics and Gynecology, Budapest, Hungary.
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Abstract
The authors summarize the perinatal effects of the main genetic disorder groupings. Diseases of autosomal dominant inheritance are usually less severe and postnatal life is possible. Diseases of autosomal recessive inheritance are serious in most cases, causing severe symptoms in postnatal life. Diseases of X-linked recessive inheritance manifest themselves in male embryos and may be mild or serious; the more severe forms may influence the perinatal outcome. Diseases of X-linked dominant inheritance occur less frequently and manifest themselves in both sexes: in some cases the life expectancy is not favorable. Chromosomal anomalies, unbalanced rearrangements and autosomal trisomies may cause severe multiplex malformation syndromes and mental retardation. The diseases are serious in most cases and intrauterine mortality is high. Conversely, in cases of numerical differences of the sex chromosomes perinatal mortality does not increase remarkably, except in X-monosomy. Diseases of multifactorial origin lead to isolated malformations, but many civilization diseases originate from similar causes. In a few cases, severe diseases (i.e. congenital heart defects and neural tube defects) occur which may influence the outcome of the pregnancy. In terms of teratogenic effects, taking medication or undergoing X-ray examination or infections during early pregnancy indicates only a small risk in most cases. The authors emphasize that genetic centers significantly influence the perinatal outcome of pregnancies with their complex activity and their role in prenatal diagnostics.
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Affiliation(s)
- A Beke
- 1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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Rigó J, Nagy B, Fintor L, Tanyi J, Beke A, Karádi I, Papp Z. Maternal and neonatal outcome of preeclamptic pregnancies: the potential roles of factor V Leiden mutation and 5,10 methylenetetrahydrofolate reductase. Hypertens Pregnancy 2000; 19:163-72. [PMID: 10877984 DOI: 10.1081/prg-100100132] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the potential perinatal effects of Factor V Leiden mutation and 5,10 methylenetetrahydrofolate reductase C677T polymorphism in preeclamptic women. STUDY DESIGN One hundred twenty preeclamptic women (N = 120) and 101 healthy pregnant controls (N = 101) were recruited and evaluated for frequency of Leiden and 5,10 methylenetetrahydrofolate reductase (MTHFR) mutations using polymerase chain reaction (PCR). Perinatal outcomes were then recorded and analyzed for all study participants and their neonates. RESULTS Laboratory analysis yielded 22 (18.33%) heterozygous carriers of Factor V Leiden mutation among preeclamptic women and 3 (2.97%) heterozygous carriers among the healthy controls; differences between the two groups were found to be statistically significant [p < 0.001, the relative risk (RR) = 6.17, 95% confidence interval (95% CI) = 1.90-20.02]. Homozygous MTHFR mutations were found in 8 of 120 (6.67%) preeclamptic women and in 6 of the 101 (5.94%) healthy controls evaluated. Among preeclamptic women, episodes of hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome were reported in 7 of 22 (31.81%) of those with Factor V Leiden mutation and in 11 of 98 (11.22%) of those who were negative for the mutation. Group differences were determined to be statistically significant (p < 0.015, RR = 2.83, 95% CI = 1.24-6. 48). Perinatal indicators collected from the two groups included frequency of intrauterine growth retardation, birth weight, and gestational age. No statistically different perinatal outcomes were found between Factor V Leiden positive and negative preeclamptic women. In addition, MTHFR gene polymorphism did not appear to be correlated with the development of preeclampsia. CONCLUSION Although the frequency of Factor V Leiden mutation appears to be significantly higher among preeclamptic women, the mechanism of pathogenesis and potential influence on perinatal outcomes is not yet well understood. Relatively high rates of HELLP syndrome among those with Factor V Leiden mutation suggest that this thrombogene mutation may play a significant role in hemostatic system activation. Our results suggest that the role of MTHFR polymorphism and other factors such as folic acid supplementation will require more extensive analysis in controlling worldwide morbidity and mortality associated with this important maternal condition.
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Affiliation(s)
- J Rigó
- 1st Department of Obstetrics and Gynecology, Semmelweis University Medical School, Budapest, Hungary
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Abstract
UNLABELLED The authors present the results of their follow-up studies of data from the last four years on patients with congenital ventriculomegaly. OBJECTIVE To study the psychomotor and mental developmental outcome of neonates with congenital ventriculomegaly diagnosed prenatally. In addition, patients were also classified into subgroups with subgrouping based on the etiology and complications of congenital ventriculomegaly and on the absence of ventriculoperitoneal shunt placement, and the findings compared between the different subgroups. METHODS Level 3 fetal ultrasonography was used for the prenatal diagnosis of congenital ventriculomegaly in 30 infants. Using neurological examination and the modified Brunet-Lézine infant test performed postnatal follow-up of motor and sensory development and intelligence, respectively. RESULTS The results show thirteen symptomless, well-developing patients, ten moderately handicapped patients and seven severely handicapped patients. Newborns with isolated, moderate ventriculomegaly have the best outcome.
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Affiliation(s)
- A Beke
- 1st Department of Obstetrics and Gynecology, Semmelweis University Medical School, Budapest, Hungary
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Beke A, Nagy B, Bán Z, Tóth-Pál E, Csaba A, Papp Z. [Pre- and perinatal aspects of hemophilia A and B]. Orv Hetil 2000; 141:721-7. [PMID: 10803014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Authors investigate in a retrospective study obstetrical and genetical data in 20 years period of 149 pregnancies of patients turning to genetical counselling because of haemophilia A and B. In case of heterozygote mother there have been fetal determination of sex, and in case of male fetus, there have been DNA examination in 23 of the 35 cases. In case of sick male fetus the couple made a decision on keeping the pregnancy or not, knowing well the genetical risk. Haemophilia A occurred in case of 135 pregnancies (98 pregnancies of 55 heterozygote mothers, and 37 pregnancies from 20 sick fathers). Haemophilia B occurred in case of 14 pregnancies (9 pregnancies of 3 heterozygote mothers, and 5 pregnancies from 4 sick fathers). In case of haemophilia A heterozygote pregnant women there were 32 proven male fetuses, and in 22 cases there have been DNA examinations. In 16 cases there have been artificial abortions (in 10 cases proven disease by DNA examination), and 4 sick male newborns were born from the 16 deliveries (the disease was proven during pregnancy by DNA examination). One male newborn (healthy) was born from the 3 proven male fetuses of haemophilia B heterozygote pregnant women, in 2 cases there have been artificial abortions (in one case on the basis of DNA diagnostics). In cases of heterozygote mothers (haemophilia A and B altogether) the ration of the spontaneous abortions was 13.1%. The rations of the premature deliveries (8.2%) and the Caesarean sections (8.2%) were not higher than the national average. The ration of the bleeding complications during pregnancy was 18.7%, in 2.7% of the cases transfusion was necessary. In case of sickness of the father (in heterozygote female fetuses the haemostasis may change from the fetal side) the ration of the bleeding complications during pregnancy was 18.2%. In connection with delivery, obstetrical bleeding complications occurred in 12.2%, atonia in 2%, abrasion after delivery in 4.1, transfusion in 10.2% in cases both of haemophilia A and B heterozygote mothers. From the neonatological complications in one case there was cerebral haemorrhage, and in one case bleeding from the umbilical stump. (Both newborns were male with haemophilia.) In connection with delivery there was no haematoma developing on the skull of the newborns, there was no need of giving transfusion. In case of sickness of the fathers the ration of the instrumental uterine examination was 6.7%, there were no neonatological and other obstetrical complications.
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Affiliation(s)
- A Beke
- Semmelweis Egyetem Budapest
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Abstract
The purpose of this study is to establish whether there is any connection between neonatal morbidity and speech perception and comprehension in children of pre-school age who have previously been treated as newborn infants in an intensive care unit. The test applied is a method invented in Hungary for the analysis of global hearing, speech perception and comprehension. The authors summarize the results of their follow-up studies of 52 children with respiratory disorders as newborns, some of whom were born as pre-term and some as full-term newborns with asphyxia. The children have been put into three groups according to their maturity and their birthweight. Newborns with hearing loss and mental retardation were excluded from this study. Of the various neonatal factors the results show: complications of delivery, birthweight, hypoxia, persistent ductus arteriosus, duration of ventilation and complications of respiratory treatment are found to be correlated to perception and comprehension. Incidences of poor achievement obtained in the most characteristic subtests have been compared among the different groups of newborns. The intelligence level of pre-school children is found to be closely correlated to speech perception and comprehension.
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Affiliation(s)
- A Beke
- First Department of Obstetrics and Gynaecology, Semmelweis University Medical School, Budapest, Hungary
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Abstract
A nation-wide survey of pain relief in childbirth in Hungary was carried out in 1993. Information was provided on 104 137 deliveries in 98 units. The frequencies of different methods of pain relief for vaginal delivery were as follows: systemic opiates in 7387 cases (8.3%), epidural analgesia in 4611 cases (5.2%) and inhalational analgesia (nitrous oxide) in 4470 cases (5%). Epidural analgesia was available in 36 units (36.7%). For 71 744 vaginal deliveries (80.5%) no pain relief was provided at all. For caesarean section (n = 13240) the rate of spinal or epidural anaesthesia was 36.7%. It was concluded that despite an increasing rate of pain relief in labour elsewhere, the numbers of epidurals are still rather low in Hungary.
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Affiliation(s)
- A Beke
- Department of Obstetrics and Gynaecology, Semmelweis University Medical School, Budapest, Hungary
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Beke A, Rigo J, Szabo I, Papp Z. Is there a fetal brain-sparing effect in pre-eclampsia? Ultrasound Obstet Gynecol 1997; 9:429. [PMID: 9239832 DOI: 10.1046/j.1469-0705.1997.09060429.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Beke A, Rigó J, Paulin F. [Effect of preeclampsia on neonatal morbidity]. Orv Hetil 1995; 136:1999-2003. [PMID: 7566931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In this study the outcome of two groups of premature infants born by caesarean section were compared from 52 hypertensive mothers with severe pre-eclampsia and from 30 normotensive mothers. The indication of caesarean section in pre-eclampsia was: proteinuria (> 500 mg/24 h), high blood pressure (> 160/100 mmHg), abnormal cardiotocogram and abnormality in flowmetry (fetal distress). Every infant was premature as well as in the control group. Significantly smaller mean birthweight and longer nursing-time in neonatal intensive care unit (NICU) were found in the pre-eclamptic group. Neonatal illnesses and complications are more frequent in the pre-eclamptic group. The time of ventilation was also longer. There are more early neurological disorders in the pre-eclamptic group than in the control one. The authors can establish that pre-eclamptic toxemia increases the morbidity in the neonatal period. This is due to the chronic intrauterine fetal distress as well as the retardation.
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Affiliation(s)
- A Beke
- Semmelweis Orvostudományi Egyetem I. Szülészeti és Nögyógyászati Klinika
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Takács G, Beke A, Fedák L. [Gynecologic and obstetric anesthesia in Hungary 1993]. Orv Hetil 1995; 136:1259-62. [PMID: 7596582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Authors publish findings of a nationwide survey of pain relief in childbirth in Hungary carried out during the year of 1993. Informations were provided on 104,137 deliveries in 98 units. At 71,744 vaginal deliveries (81%) not any types of pain relief were used. The frequency ot different types of pain reliefs at vaginal deliveries were as follows: systemic opioids at 7387 cases (8.3%), epidural analgesia at 4611 cases (5.2%) and inhalational analgesia (nitrous oxide) at 4470 cases (5.0%). The availability of epidural analgesia at 62 units was absent. The rate of spinal--epidural analgesia at Cesarean sections was 37% (n = 13,240). At gynaecological laparotomies (n = 18,219) the rate of general anaesthesia was 98%, this rate at vaginal hysterectomies was 56.8% (n = 1568). Authors conclude that the rate of pain relief in labour in Hungary is unreasonably low. The reason of it is the lack of anaesthetists and also the traditional view, which does not recognize the importance of the pain relief in labour.
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Affiliation(s)
- G Takács
- I. sz. Szülészeti és Nögyógyászatí Klinika, Semmelweis Orvostudományi Egyetem, Budapest
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Hervei S, Hovanyovszky S, Beke A. [Glucose content of blood preparations]. Orv Hetil 1991; 132:1732-3. [PMID: 1866172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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