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Gică N, Botezatu R, Demetrian M, Vayna AM, Cimpoca-Raptis BA, Ciobanu AM, Gica C, Peltecu G, Panaitescu AM. Severe Neonatal Anemia Due to Spontaneous Massive Fetomaternal Hemorrhage at Term: An Illustrative Case with Suspected Antenatal Diagnosis and Brief Review of Current Knowledge. Medicina (Kaunas) 2021; 57:1285. [PMID: 34946230 PMCID: PMC8704460 DOI: 10.3390/medicina57121285] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
Fetomaternal hemorrhage is defined as transfer of fetal blood into placental circulation and therefore into maternal circulation during pregnancy, and represents an important contributor to intrauterine fetal demise and neonatal death. The condition is rarely diagnosed prenatally because clinical findings are often nonspecific, and it is unpredictable. In this paper we present an illustrative case of massive spontaneous fetomaternal hemorrhage where the diagnosis was highly suspected antenatally based on maternal reported reduced fetal movements, abnormal suggestive cardiotocographic trace, and increased peak systolic velocity in the fetal middle cerebral artery. We discuss obstetrical and neonatal management and review the current knowledge in the literature. Maintaining a high index of suspicion for this condition allows the obstetrician to plan for adequate diagnostic tests, arrange intrauterine treatment or delivery, and prepare the neonatal team.
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Affiliation(s)
- Nicolae Gică
- Carol Davila Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (R.B.); (B.A.C.-R.); (A.M.C.); (C.G.); (G.P.)
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Radu Botezatu
- Carol Davila Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (R.B.); (B.A.C.-R.); (A.M.C.); (C.G.); (G.P.)
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Mihaela Demetrian
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Ana Maria Vayna
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Brîndușa Ana Cimpoca-Raptis
- Carol Davila Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (R.B.); (B.A.C.-R.); (A.M.C.); (C.G.); (G.P.)
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Anca Marina Ciobanu
- Carol Davila Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (R.B.); (B.A.C.-R.); (A.M.C.); (C.G.); (G.P.)
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Corina Gica
- Carol Davila Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (R.B.); (B.A.C.-R.); (A.M.C.); (C.G.); (G.P.)
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Gheorghe Peltecu
- Carol Davila Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (R.B.); (B.A.C.-R.); (A.M.C.); (C.G.); (G.P.)
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Anca Maria Panaitescu
- Carol Davila Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (R.B.); (B.A.C.-R.); (A.M.C.); (C.G.); (G.P.)
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
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Cimpoca-Raptis BA, Ciobanu AM, Gica N, Peltecu G, Mitrea D, Panaitescu AM. Fetal Surveillance in Pregnancies with Myasthenia Gravis. Medicina (B Aires) 2021; 57:medicina57111277. [PMID: 34833495 PMCID: PMC8624595 DOI: 10.3390/medicina57111277] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022] Open
Abstract
Myasthenia gravis (MG) is an autoimmune condition, that commonly impacts adult women of reproductive age. Myasthenia gravis in pregnancy is rare, but the incidence is higher in different geographical areas. Pregnancies in mothers with MG can have an unfortunate outcome. Acetylcholine receptor antibodies may pass into the fetal circulation and can affect the fetal neuromuscular junction, generating transient MG or even fetal arthrogryposis. The 2016 and 2021 International Consensus Guidance for Management of Myasthenia Gravis issued by Myasthenia Gravis Foundation of America is lacking in recommendation for fetal surveillance for pregnancies in women with MG. The aim of this paper is to highlight fetal and neonatal complications in mothers with MG and to offer antenatal care insights. Close maternal and pregnancy monitoring can improve pregnancy outcome. Patients with MG should be encouraged to conceive, to avoid triggers for exacerbations of the disease during pregnancy and a multidisciplinary team should be established to ensure the optimal support and therapy.
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Affiliation(s)
- Brîndușa Ana Cimpoca-Raptis
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.C.-R.); (N.G.); (G.P.); (A.M.P.)
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Anca Marina Ciobanu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.C.-R.); (N.G.); (G.P.); (A.M.P.)
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
- Correspondence:
| | - Nicolae Gica
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.C.-R.); (N.G.); (G.P.); (A.M.P.)
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Gheorghe Peltecu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.C.-R.); (N.G.); (G.P.); (A.M.P.)
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Dan Mitrea
- Neuroaxis, Neurology Clinic, 011302 Bucharest, Romania;
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.C.-R.); (N.G.); (G.P.); (A.M.P.)
- Filantropia Clinical Hospital, 011132 Bucharest, Romania
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