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van Uden L, Tchirikov M. A Study of the Literature on Intrauterine Treatment Options for Chronic Placental Insufficiency with Intrauterine Growth Restriction Using Intrauterine Intravascular Amino Acid Supplementation. Life (Basel) 2023; 13:1232. [PMID: 37374014 DOI: 10.3390/life13061232] [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] [Received: 03/29/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Intrauterine growth retardation (IUGR) is a very serious prenatal condition with 3-5% incidence of all pregnancies. It results from numerous factors, including chronic placental insufficiency. IUGR is associated with an increased risk of mortality and morbidity and is considered a major cause of fetal mortality. Currently, treatment options are significantly limited and often result in preterm delivery. Postpartum, IUGR infants also have higher risks of disease and neurological abnormalities. METHODS The PubMed database was searched using the keywords "IUGR", "fetal growth restriction", "treatment", "management" and "placental insufficiency" for the period between 1975 and 2023. These terms were also combined together. RESULTS There were 4160 papers, reviews and articles dealing with the topic of IUGR. In total, only 15 papers directly dealt with a prepartum therapy of IUGR; 10 of these were based on an animal model. Overall, the main focus was on maternal intravenous therapy with amino acids or intraamniotic infusion. Treatment methods have been tested since the 1970s to supplement the fetuses with nutrients lacking due to chronic placental insufficiency in various ways. In some studies, pregnant women were implanted with a subcutaneous intravascular perinatal port system, thus infusing the fetuses with a continuous amino acid solution. Prolongation of pregnancy was achieved, as well as improvement in fetal growth. However, insufficient benefit was observed in infusion with commercial amino acid solution in fetuses below 28 weeks' gestation. The authors attribute this primarily to the enormous variation in amino acid concentrations of the commercially available solutions compared with those observed in the plasma of preterm infants. These different concentrations are particularly important because differences in the fetal brain caused by metabolic changes have been demonstrated in the rabbit model. Several brain metabolites and amino acids were significantly decreased in IUGR brain tissue samples, resulting in abnormal neurodevelopment with decreased brain volume. DISCUSSION There are currently only a few studies and case reports with correspondingly low case numbers. Most of the studies refer to prenatal treatment by supplementation of amino acids and nutrients to prolong pregnancy and support fetal growth. However, there is no infusion solution that matches the amino acid concentrations found in fetal plasma. The commercially available solutions have mismatched amino acid concentrations and have not shown sufficient benefit in fetuses below 28 weeks' gestation. More treatment avenues need to be explored and existing ones improved to better treat multifactorial IUGR fetuses.
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Affiliation(s)
- Lisa van Uden
- University Clinic of Obstetrics and Prenatal Medicine, Center of Fetal Surgery, University Medical Center Halle (Saale), Martin Luther University Halle-Wittenberg, Ernst-Grube Strasse 40, 06120 Halle (Saale), Germany
| | - Michael Tchirikov
- University Clinic of Obstetrics and Prenatal Medicine, Center of Fetal Surgery, University Medical Center Halle (Saale), Martin Luther University Halle-Wittenberg, Ernst-Grube Strasse 40, 06120 Halle (Saale), Germany
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2
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Peddi NC, Avanthika C, Vuppalapati S, Balasubramanian R, Kaur J, N CD. A Review of Cordocentesis: Percutaneous Umbilical Cord Blood Sampling. Cureus 2021; 13:e16423. [PMID: 34422463 PMCID: PMC8369974 DOI: 10.7759/cureus.16423] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 12/03/2022] Open
Abstract
We discuss the current indications, technical variation and procedure-related complications of percutaneous umbilical cord blood sampling (PUBS). The term PUBS is commonly used in the United States. Cordocentesis and funipuncture are equivalent terms. A needle guided by ultrasound is introduced into a blood vessel (usually the vein) of the umbilical cord to collect fetal specimen in PUBS. We conducted a literature search in PubMed indexed journals and analyzed all related articles on PUBS and cordocentesis. We chose this subject because it is a relatively new but convenient method that has both diagnostic and therapeutic value in fetal medicine. At present the only procedure that provides direct access to fetal circulation is PUBS. The most common clinical indication for PUBS is suspected fetal anemia. Other major indications for PUBS are the diagnosis of congenital infections, cytogenetic analysis, metabolic disorders, fetal growth restriction and hematologic disorders. Therapeutic applications of cordocentesis or puncture of the umbilical cord are in utero transfusions for rhesus alloimmunization and medication administration. PUBS also provides a direct assessment of fetal thyroid function diagnosing fetal thyroid disorders and helps administer therapy in utero. Literature demonstrates a low incidence of complications associated with percutaneous umbilical blood sampling. For PUBS, the true complication rate related to the method of sampling remains unclear. A few cases reported complications conducted PUBS for therapeutic purposes which naturally has a higher accident rate compared to diagnostic purposes. Although life-threatening complications are rare, there are potential risks that include bleeding from the puncture site, fetal bradycardia, vertical transmission of maternal infection. Therefore, PUBS should be performed at perinatal care centers by experienced physicians and the best time is between 17 to 40 weeks of gestation. There are three methods used to approach the umbilical cord that includes direct, indirect and free puncture. Anteriorly placed placenta allows an easier approach to the umbilical cord. The danger of abruption of placenta must be kept in mind while using this technique. The number of punctures should be limited to a maximum of 3 to reduce complications. According to a case series report, the mean time required for the procedure was 4 minutes with a fall in duration seen with increased experience. In conclusion, percutaneous blood sampling allows direct access to fetal circulation thus opening up new areas of prenatal diagnosis and therapy. PUBS is now a well-codified procedure. It is clear from our literature review that risks directly related to the technique are small. The indication of the procedure must be carefully chosen as the risk of complications of umbilical cord puncture is directly related to the severity of the condition. Complications such as bleeding and hematoma formation are related to duration and number of punctures which are operator-dependent. Thus, only highly trained personnel should conduct the procedure. The list of indications is extensive and growing. Nevertheless, this technique shows potential to open up new realms in the area of fetal medicine.
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Affiliation(s)
- Nikhil Chowdary Peddi
- Pediatrics, People's Education Society Institute of Medical Sciences and Research, Kuppam, IND
| | | | - Sravya Vuppalapati
- Pediatrics, People's Education Society Institute of Medical Sciences and Research, Kuppam, IND
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3
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Yadav RM, Gupta M, Dalvi A, Bargir UA, Hule G, Shabrish S, Aluri J, Kulkarni M, Kambli P, Uppuluri R, Seshadri S, Jagadeesh S, Suresh B, Raja J, Taur P, Malaischamy S, Ghosh P, Mahalingam S, Kadam P, Lashkari HP, Tamhankar P, Tamhankar V, Mithbawkar S, Bhattad S, Jhawar P, Makam A, Bansal V, Prasad M, Govindaraj G, Guhan B, Bharadwaj Tallapaka K, Desai M, Raj R, Madkaikar MR. Prenatal Diagnosis for Primary Immunodeficiency Disorders-An Overview of the Indian Scenario. Front Immunol 2020; 11:612316. [PMID: 33365035 PMCID: PMC7750517 DOI: 10.3389/fimmu.2020.612316] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/04/2020] [Indexed: 01/13/2023] Open
Abstract
Prenatal Diagnosis (PND) forms an important part of primary preventive management for families having a child affected with primary immunodeficiency. Although individually sparse, collectively this group of genetic disorders represents a significant burden of disease. This paper discusses the prenatal services available for affected families at various centers across the country and the challenges and ethical considerations associated with genetic counseling. Mutation detection in the index case and analysis of chorionic villous sampling or amniocentesis remain the preferred procedures for PND and phenotypic analysis of cordocentesis sample is reserved for families with well-characterized index case seeking PND in the latter part of the second trimester of pregnancy. A total of 112 families were provided PND services in the last decade and the presence of an affected fetus was confirmed in 32 families. Post-test genetic counseling enabled the affected families to make an informed decision about the current pregnancy.
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Affiliation(s)
- Reetika Malik Yadav
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leucocyte Biology, ICMR-National Institute of Immunohaematology, Mumbai, India
| | - Maya Gupta
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leucocyte Biology, ICMR-National Institute of Immunohaematology, Mumbai, India
| | - Aparna Dalvi
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leucocyte Biology, ICMR-National Institute of Immunohaematology, Mumbai, India
| | - Umair Ahmed Bargir
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leucocyte Biology, ICMR-National Institute of Immunohaematology, Mumbai, India
| | - Gouri Hule
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leucocyte Biology, ICMR-National Institute of Immunohaematology, Mumbai, India
| | - Snehal Shabrish
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leucocyte Biology, ICMR-National Institute of Immunohaematology, Mumbai, India
| | - Jahnavi Aluri
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leucocyte Biology, ICMR-National Institute of Immunohaematology, Mumbai, India
| | - Manasi Kulkarni
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leucocyte Biology, ICMR-National Institute of Immunohaematology, Mumbai, India
| | - Priyanka Kambli
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leucocyte Biology, ICMR-National Institute of Immunohaematology, Mumbai, India
| | - Ramya Uppuluri
- Department of Pediatric Hematology-Oncology, Blood Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Suresh Seshadri
- Department of Clinical Genetics & Genetic Counseling, Mediscan Systems, Chennai, India
| | - Sujatha Jagadeesh
- Department of Clinical Genetics & Genetic Counseling, Mediscan Systems, Chennai, India
| | - Beena Suresh
- Department of Clinical Genetics & Genetic Counseling, Mediscan Systems, Chennai, India
| | - Jayarekha Raja
- Department of Clinical Genetics & Genetic Counseling, Mediscan Systems, Chennai, India
| | - Prasad Taur
- Department of Immunology and Department of Pediatric Hemato-Oncology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | | | | | | | - Priya Kadam
- MedGenome Labs Private Limited, Bangalore, India
| | - Harsha Prasada Lashkari
- Department of Pediatrics, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, India
| | | | | | | | - Sagar Bhattad
- Division of Pediatric Immunology and Rheumatology, Department of Pediatrics, Aster CMI Hospital, Bangalore, India
| | - Prerna Jhawar
- Department of Fetal Medicine, Motherhood Hospital, Bangalore, India
| | - Adinarayan Makam
- Department of Fetal Medicine, Adi Advanced Centre for Fetal Care, Bangalore, India
| | - Vandana Bansal
- Fetal Medicine Department Surya Hospitals, Mumbai, India
| | | | - Geeta Govindaraj
- Department of Pediatrics, Government Medical College, Kozhikode, Calicut, India
| | - Beena Guhan
- Department of Pediatrics, Government Medical College, Kozhikode, Calicut, India
| | | | - Mukesh Desai
- Department of Immunology and Department of Pediatric Hemato-Oncology, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Revathi Raj
- Department of Pediatric Hematology-Oncology, Blood Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Manisha Rajan Madkaikar
- Center of Excellence for PIDs, Department of Pediatric Immunology and Leucocyte Biology, ICMR-National Institute of Immunohaematology, Mumbai, India
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Tanvisut R, Wanapirak C, Piyamongkol W, Sirichotiyakul S, Tongprasert F, Srisupundit K, Luewan S, Traisrisilp K, Jatavan P, Tongsong T. Cordocentesis-associated fetal loss and risk factors: single-center experience with 6650 cases. Ultrasound Obstet Gynecol 2020; 56:664-671. [PMID: 31975486 DOI: 10.1002/uog.21980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To identify procedural risk factors associated with fetal loss following cordocentesis and to determine the rate of cordocentesis-related fetal loss associated with the current cordocentesis protocol used in our institution. METHODS This was a retrospective cohort study of pregnancies that underwent midpregnancy cordocentesis in a single center (a tertiary hospital, teaching school), between 1992 and 2018, based on data retrieved from our prospective database. All consecutive cases were validated to retrieve those meeting the eligibility criteria, which included: singleton pregnancy without underlying maternal disease, normal fetus (no structural or chromosomal abnormality or severe disorder), gestational age between 16 and 24 weeks at the time of the procedure and availability of pregnancy outcome. Cases that resulted in termination of pregnancy were excluded. We assessed the effect of prior cordocentesis model training on the fetal-loss rate and procedure-related complications, and evaluated potential risk factors of fetal loss secondary to cordocentesis, including procedure difficulty, placenta penetration, prolonged bleeding, fetal bradycardia, puncture site and early gestational age at procedure. Pregnancy outcomes were compared between the study group and a control group of women, who did not undergo cordocentesis, selected randomly at a 1:1 ratio from our obstetric database. RESULTS A total of 10 343 procedures were performed during the study period, of which 6650 met the eligibility criteria and were included in the analysis. The fetal-loss rate in the first 60 procedures (early practice) of six operators (n = 360 procedures), who did not have prior model training, was significantly higher than that during the early practice of 18 operators (n = 1080 procedures) with prior model training (6.9% vs 1.6%; P < 0.001); whereas the fetal-loss rate in the next 60 procedures of practice was comparable between the two groups. After excluding the first 360 procedures of the groups without prior model training, the overall fetal-loss rate in pregnancies that underwent cordocentesis was significantly higher than that in the control group (1.6% vs 1.0%; P < 0.001). Considering the fetal-loss rate in the normal controls as background loss, the incremental cordocentesis-associated fetal-loss rate was 0.6%. Penetration of the placenta (odds ratio (OR), 2.65 (95% CI, 1.71-4.10)), prolonged bleeding from the puncture site (OR, 10.85 (95% CI, 5.27-22.36)) and presence of fetal bradycardia (OR, 3.32 (95% CI, 1.83-6.04)) during cordocentesis were independent risk factors associated with fetal loss. CONCLUSIONS Cordocentesis model training markedly reduces fetal loss during the early learning curve of practice. Thus, cordocentesis practice without prior model training should not be acceptable. Significant procedural risk factors for fetal loss secondary to cordocentesis are placental penetration, prolonged bleeding and fetal bradycardia. Cordocentesis-related fetal loss may be only 0.6%, much lower than the rate reported previously. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Tanvisut
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - C Wanapirak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - W Piyamongkol
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - S Sirichotiyakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - F Tongprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - K Srisupundit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - S Luewan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - K Traisrisilp
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - P Jatavan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - T Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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5
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Lee J, Lee MY, Won HS, Jang WK, Nam SH, Jeong SH, Choi H. Is fetal middle cerebral artery peak systolic velocity correlated with hemoglobin levels in cases of nonimmune fetal anemia? J Matern Fetal Neonatal Med 2020; 35:2889-2894. [PMID: 32878517 DOI: 10.1080/14767058.2020.1811668] [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: 10/23/2022]
Abstract
OBJECTIVES To establish whether a correlation exists between the fetal middle cerebral artery peak systolic velocity (MCA PSV) and fetal hemoglobin levels before intrauterine transfusion (IUT) in cases of severe fetal anemia. METHODS This was a single-center, retrospective study of data from 49 fetuses treated with IUT for fetal anemia between 2003 and 2018. Severe fetal anemia was suspected when MCA PSV was or exceeded 1.55 multiples of the median. RESULTS The causes of anemia were largely idiopathic, and the overall survival rate was 57%. MCA PSV and hemoglobin were correlated in all 34 fetuses with alloimmune fetal anemia, whereas the 15 fetuses with nonimmune causes showed no correlation. Of the 15 noncorrelated cases, twin pregnancy was most common, followed by idiopathic causes. All the twin pregnancies involved monochorionic twins. Fetal hydrops, especially ascites, was significantly associated with severe anemia. CONCLUSIONS Fetal MCA PSV may not be a reliable independent factor for the diagnosis of severe fetal anemia in nonimmune cases, and the presence of associated hydrops implies that the fetus is more likely to have severe fetal anemia than in a fetus without hydrops.
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Affiliation(s)
- Joohee Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Young Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won-Kyu Jang
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Republic of Korea
| | - So-Hyun Nam
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Hee Jeong
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Heehwa Choi
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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6
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Cai M, Lin N, Lin Y, Huang H, Xu L. Evaluation of chromosomal abnormalities and copy number variations in late trimester pregnancy using cordocentesis. Aging (Albany NY) 2020; 12:15556-15565. [PMID: 32805723 PMCID: PMC7467360 DOI: 10.18632/aging.103575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/09/2020] [Indexed: 01/30/2023]
Abstract
Because the numbers of detected fetal abnormalities increase as gestation progresses, we evaluated the safety and efficacy of cordocentesis for single nucleotide polymorphism (SNP) analysis tests in 754 women during third trimester pregnancy. Conventional karyotyping was performed on all fetuses, and Affymetrix CytoScan HD was used for SNP-array testing. In addition to the 24 cases with chromosomal abnormalities detected with conventional karyotyping analysis, the SNP-array test identified 56 (7.4%) cases with normal karyotypes but abnormal copy number variations (CNVs). Of those, 24 were pathogenic CNVs and 32 were of uncertain clinical significance. In 742 of the cases, there were abnormal sonographic findings, and cytogenetic abnormalities were detected in 76 cases (10.2%). The largest number of abnormalities involved multiple malformations (21.7%), followed by defects in the lymphatics or effusion (19.0%) or urogenital system (15.3%). The use of SNP-array test fully complemented chromosome karyotype analysis after late cordocentesis. It also improved the detection rate for fetal chromosomal abnormalities and was effective for preventing and controlling the occurrence of birth defects.
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Affiliation(s)
- Meiying Cai
- Department of the Prenatal Diagnosis Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Na Lin
- Department of the Prenatal Diagnosis Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Yuan Lin
- Department of the Prenatal Diagnosis Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Hailong Huang
- Department of the Prenatal Diagnosis Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Liangpu Xu
- Department of the Prenatal Diagnosis Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
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7
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Nemescu D, Tanasa IA, Stoian DL, Navolan DB, Vinturache AE. Conservative in utero treatment of fetal dyshormonogenetic goiter with levothyroxine, a systematic literature review. Exp Ther Med 2020; 20:2434-2438. [PMID: 32765729 PMCID: PMC7401841 DOI: 10.3892/etm.2020.8794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
Fetal goitrous hypothyroidism is a rare condition associated with important obstetrical, neonatal complications, and neurodevelopmental impairments. Prenatal treatment remains controversial, and the risk to benefit ratio must be accurately assessed and considered for individualized management. The objective of this review was to evaluate the feasibility, safety, and effectiveness of the conservative in utero treatment of fetal goitrous hypothyroidism. In total, 25 reports that met our inclusion criteria were selected and the management of 38 cases was analyzed. Prenatal diagnosis consisted mainly of ultrasonographic findings. Fetal thyroid status was assessed by cordocentesis. Prenatal treatment varied widely in terms of levothyroxine (LT4) route of administration, dosage, number of injections, and frequency. Although different regimens and routes of administration were proposed, they seem to have similar results regarding fetal goiter reduction and thyroid status at birth. At birth, most babies had hypothyroidism, but the long-term follow-up indicated a normal psycho-neuromotor development. Our data confirm the feasibility of conservative treatment with LT4 for fetal goitrous hypothyroidism. Further studies are needed to determine the optimal management of this disorder.
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Affiliation(s)
- Dragos Nemescu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy,700115 Iasi, Romania
| | - Ingrid Andrada Tanasa
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy,700115 Iasi, Romania
| | - Dana Liana Stoian
- Department of Endocrinology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dan Bogdan Navolan
- Department of Obstetrics and Gynecology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Angela Elena Vinturache
- Department of Obstetrics and Gynecology, Queen Elizabeth II Hospital, Grande Prairie, AB T8V 2E8, Canada
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8
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Faure-Bardon V, Millischer AE, Deloison B, Sonigo P, Grévent D, Salomon L, Stirnemann J, Nicloux M, Magny JF, Leruez-Ville M, Ville Y. Refining the prognosis of fetuses infected with Cytomegalovirus in the first trimester of pregnancy by serial prenatal assessment: a single-centre retrospective study. BJOG 2019; 127:355-362. [PMID: 31505103 DOI: 10.1111/1471-0528.15935] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To define the predictive value (PV) of known prognostic factors of fetal infection with Cytomegalovirus following maternal primary infection <14 weeks of gestation, at different time points of pregnancy: the end of the second trimester; following prenatal magnetic resonance imaging (MRI) at 32 weeks of gestation; and using all ultrasound scans performed in the third trimester (US3rdT). DESIGN A retrospective study. SETTING Reference fetal medicine unit. POPULATION Sixty-two fetuses infected <14 weeks of gestation. METHODS We defined second-trimester assessment (STA) as the combination of ultrasound findings <28 weeks of gestation and fetal platelet count at cordocentesis. Three groups were defined: normal, extracerebral, and cerebral STA. MAIN OUTCOME MEASURES For each group, the PV of STA alone, STA + MRI, and STA + US3rdT were assessed retrospectively. Outcome at birth and at follow-up were reported. RESULTS The STA was normal, and with extracerebral and cerebral features, in 43.5, 42.0, and 14.5%, respectively. The negative PV of normal STA and MRI for moderate to severe sequelae was 100%. The residual risk was unilateral hearing loss in 16.7% of cases. Of pregnancies with cerebral STA, 44% were terminated. Following extracerebral STA, 48% of neonates were symptomatic and 30% had moderate to severe sequelae. In those cases, the positive and negative PV of MRI for sequelae were 33 and 73%, respectively. STA + US3rdT had a lower negative PV than MRI for symptoms at birth and for moderate to severe sequelae. Any false-positive findings at MRI were mostly the result of hypersignals of white matter. CONCLUSIONS Serial assessment in the second and third trimesters by ultrasound and MRI is necessary to predict the risk of sequelae occurring in 35% of pregnancies following fetal infection in the first trimester of pregnancy. TWEETABLE ABSTRACT Serial ultrasound prognostic assessment following fetal CMV infection in the 1st trimester is improved by MRI at 32 weeks.
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Affiliation(s)
- V Faure-Bardon
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - A-E Millischer
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Radiology, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - B Deloison
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - P Sonigo
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Radiology, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - D Grévent
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Radiology, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - L Salomon
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - J Stirnemann
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - M Nicloux
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Neonatal Intensive Care Unit, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - J-F Magny
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Neonatal Intensive Care Unit, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - M Leruez-Ville
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Y Ville
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
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9
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Kunochova I, Papcun P, Krizko M, Gabor M, Alfoldi M, Ferianec V. The value of cordocentesis in current management of intrauterine patient. ACTA ACUST UNITED AC 2019; 120:563-565. [PMID: 31379177 DOI: 10.4149/bll_2019_091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Analyzing the clinical group to evaluate current indications for cordocenteses, their complications and data obtained in further pregnancy management. METHODS Retrospective analysis evaluated 92 cordocenteses (diagnostic and therapeutic) performed during the period of 2007‒2018. These were performed between 17 and 36 weeks of gestation under ultrasound guidance by a specialist at 2nd Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University. RESULTS Out of 92 procedures, 78 were diagnostic and 14 were therapeutic. The diagnostic cordocentesis was successful in 97.4 % and intrauterine therapy was successful in 85.7 %. There were 2 (2.56 %) diagnostic cordocenteses complicated by fetal demise and 2 (14 %) intrauterine demises in therapeutic cordocentesis. The pathological karyotype was detected in 14.5 %. Aneuploidia was present in 4 cases (44.4 %), mosaicism in 4 cases (44.4 %) and triploidia in one case (11.1 %). CONCLUSION Despite of novel molecular genetic technique cordocentesis still plays unreplaceable role in current prenatal diagnosis and treatment. The risk of complications of cordocentesis increases depending on the severity of fetal pathology in pathologic pregnancies. In some situations it can be used as a useful tool for original fetal diagnosis and therapy (Tab. 3, Ref. 20).
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10
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Someya M, Sasahara J, Yamamoto S, Sawada A, Nishikawa M, Ishii K. Prenatally diagnosed congenital hemangioma with elevated middle cerebral artery peak systolic velocity mimicking the Kasabach-Merritt phenomenon: A case report. J Obstet Gynaecol Res 2019; 45:2456-2460. [PMID: 31502338 DOI: 10.1111/jog.14121] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/25/2019] [Indexed: 12/13/2022]
Abstract
Congenital hemangioma is a rare vascular tumor that develops prenatally, and a large congenital hemangioma may be accompanied by the Kasabach-Merritt phenomenon. We present a case of prenatally diagnosed fetal congenital hemangioma through ultrasound and maternal anti-Jr(a) antibody alloimmunization with elevated middle cerebral artery peak systolic velocity. To investigate fetal anemia and hemostatic condition, we performed percutaneous umbilical blood sampling, which revealed no symptom of either Kasabach-Merritt phenomenon or sensitization to anti-Jr(a) antibody. Consequently, pregnancy could be continued without further intervention. After birth, congenital hemangioma was found on the infant's left thigh, and Kasabach-Merritt phenomenon was not shown. Percutaneous umbilical blood sampling could provide precise information prenatally in case of congenital hemangioma with maternal alloimmunization.
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Affiliation(s)
- Masayuki Someya
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Jun Sasahara
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Satoshi Yamamoto
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Akihisa Sawada
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masanori Nishikawa
- Department of Radiology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Keisuke Ishii
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
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11
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Anastasio HB, Mardis R, Khalifeh A, Baxter J, Berghella V, Al-Kouatly HB. Time advantage of HemoCue versus traditional complete blood count during cordocentesis. J Matern Fetal Neonatal Med 2019; 34:1914-1918. [PMID: 31409164 DOI: 10.1080/14767058.2019.1651275] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES During cordocentesis, a significant risk factor for adverse outcome is procedure length. One of the greatest contributors to total procedure length is the time that elapses between obtaining a fetal sample and receiving the results of the complete blood count (CBC) from the hospital laboratory. We aimed to evaluate whether there is an advantage to using a point of care hemoglobinometer (HemoCue) compared with traditional CBC during cordocentesis, measured in time elapsing between obtaining fetal sample, and available result. Secondarily we aimed to compare accuracy of HemoCue in relation to traditional CBC. METHODS A prospective cohort study was conducted on women undergoing cordocentesis and fetal transfusion for suspected fetal anemia from July 2016 to July 2018 at an urban academic medical center. Fetal blood samples were obtained during cordocentesis, and concurrently sent for traditional CBC, as well as immediately analyzed at bedside using a HemoCue machine. The time elapsing between the obtained fetal sample and availability of results with HemoCue versus traditional CBC were recorded. Primary outcome was time elapsed between obtaining fetal sample and result available for HemoCue versus traditional CBC. Secondary outcome was comparison of HemoCue and CBC hemoglobin values for accuracy. RESULTS Forty-five fetal samples were compared using CBC and HemoCue. Sixteen cordocentesis procedures were performed on 10 patients during the study period. Use of HemoCue was associated with a significantly shorter time to yield a fetal hemoglobin result, compared to traditional CBC (1.5 versus 5.5 min, p = .0001). Results yielded by the HemoCue highly correlated to those yielded by traditional CBC (R = 0.96). CONCLUSIONS Use of HemoCue during cordocentesis is associated with a 4-min time advantage over traditional CBC. Hemoglobin results yielded by HemoCue and traditional CBC are highly correlated.KEY MESSAGEUse of a point-of-care hemoglobinometer is associated with a time advantage of 4 min over traditional complete blood count during cordocentesis. This represents a potentially modifiable risk factor for procedure length, and thus procedure complications.
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Affiliation(s)
- Hannah B Anastasio
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Rachel Mardis
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Adeeb Khalifeh
- Division of Maternal-Fetal Medicine, Einstein Healthcare Network, Philadelphia, PA, USA
| | - Jason Baxter
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Huda B Al-Kouatly
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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12
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Sasahara J, Ishii K, Fujikawa E, Mitsuda N. Current status of percutaneous umbilical cord blood sampling in Japan. J Obstet Gynaecol Res 2019; 45:1821-1827. [PMID: 31237754 DOI: 10.1111/jog.14047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/03/2019] [Indexed: 11/29/2022]
Abstract
AIM The aim of the survey is to investigate current practice and complications of percutaneous umbilical cord blood sampling (PUBS) in Japan. METHODS In this retrospective survey, data including perioperative information, indications, details of the procedure and procedure-related complications were collected for patients who underwent PUBS between 2012 and 2016 in Japanese perinatal care centers. RESULTS One hundred and fifty-three patients underwent PUBS and a total of 223 procedures were analyzed in this study. Fetal anemia was the most common indication for PUBS, representing greater than 70% of all cases. Anemia specific to monochorionic twins, such as acute feto-fetal hemorrhage subsequent to single intrauterine fetal death (IUFD) and twin anemia-polycythemia sequence, were the leading causes of suspected fetal anemia. Maternal anesthetics were given during the procedure in 70% of cases. The PTC needle (Hakko, Japan) was most commonly used in the procedure. The most frequent complication was bleeding from the umbilical cord puncture site; however, it did not require immediate delivery during or after the procedure in any case. IUFD occurred in 11 (4.9%) procedures, 7 of which appeared to be related to the underlying fetal disease. The overall completion rate of the procedure was 97%. CONCLUSION Percutaneous umbilical cord blood sampling was most commonly performed for the evaluation of fetal anemia, usually due to complications of monochorionic twins, followed by the measurement of fetal thyroid function. The safety and the completion rate of the procedure in Japan appear satisfactory.
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Affiliation(s)
- Jun Sasahara
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Keisuke Ishii
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Eri Fujikawa
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Nobuaki Mitsuda
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
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13
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Tchirikov M, Saling E, Bapayeva G, Bucher M, Thews O, Seliger G. Hyperbaric oxygenation and glucose/amino acids substitution in human severe placental insufficiency. Physiol Rep 2019. [PMID: 29536649 PMCID: PMC5849598 DOI: 10.14814/phy2.13589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In the first case, the AA and glucose were infused through a perinatal port system into the umbilical vein at 30 weeks' gestation due to severe IUGR. The patient received daily hyperbaric oxygenation (HBO, 100% O2) with 1.4 atmospheres absolute for 50 min for 7 days. At 31+4 weeks' gestation, the patient gave birth spontaneously to a newborn weighing 1378 g, pH 7.33, APGAR score 4/6/intubation. In follow‐up examinations at 5 years of age, the boy was doing well without any neurological disturbance or developmental delay. In the second case, the patient presented at 25/5 weeks' gestation suffering from severe IUGR received HBO and maternal AA infusions. The cardiotocography was monitored continuously during HBO treatment. The short‐time variations improved during HBO from 2.9 to 9 msec. The patient developed pathologic CTG and uterine contractions 1 day later and gave birth to a hypotrophic newborn weighing 420 g. After initial adequate stabilization, the extremely preterm newborn unfortunately died 6 days later. Fetal nutrition combined with HBO is technically possible and may allow the prolongation of the pregnancy. Fetal‐specific amino‐acid composition would facilitate the treatment options of IUGR fetuses and extremely preterm newborn.
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Affiliation(s)
- Michael Tchirikov
- Center of Fetal Surgery, University Clinic of Obstetrics and Fetal Medicine, University Medical Center Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Erich Saling
- Saling Institute of Perinatal Medicine, Berlin, Germany
| | - Gauri Bapayeva
- National Research Center for Mother and Child Health, Nazarbayev University, Astana, Republic of Kazakhstan
| | - Michael Bucher
- Center of HBO, University Clinic of Anesthesiology, University Medical Center Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Oliver Thews
- Institute of Physiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Gregor Seliger
- Center of Fetal Surgery, University Clinic of Obstetrics and Fetal Medicine, University Medical Center Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
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14
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Inan C, Sayin NC, Gurkan H, Erzincan SG, Uzun I, Sutcu H, Atli E, Varol F. Unusual facio-upper arm band of a fetus mimicking amniotic band syndrome. J Obstet Gynaecol Res 2019; 45:927-930. [PMID: 30656803 DOI: 10.1111/jog.13905] [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] [Received: 07/11/2018] [Accepted: 12/08/2018] [Indexed: 11/27/2022]
Abstract
Amniotic band syndrome can lead to a wide spectrum of congenital abnormalities including orofacial and visceral defects. It is associated with malformations in truncal, craniofacial regions and the limbs, whereas it sometimes may imitate some genetic disorders. Here, we present an atypical case mimicking amniotic band syndrome with a facio-upper arm band that was having multiple fetal structural abnormalities including scoliosis, bilateral cleft lip and palate, upper limb abnormality, unilateral anophthalmia with contralateral microphthalmia, left hypertrophic kidney and severe ventriculomegaly.
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Affiliation(s)
- Cihan Inan
- Faculty of Medicine, Department of Obstetrics and Gynecology, Trakya University, Edirne, Turkey
| | - N Cenk Sayin
- Faculty of Medicine, Department of Obstetrics and Gynecology, Trakya University, Edirne, Turkey
| | - Hakan Gurkan
- Faculty of Medicine, Department of Medical Genetics, Trakya University, Edirne, Turkey
| | - Selen G Erzincan
- Faculty of Medicine, Department of Obstetrics and Gynecology, Trakya University, Edirne, Turkey
| | - Isil Uzun
- Faculty of Medicine, Department of Obstetrics and Gynecology, Trakya University, Edirne, Turkey
| | - Havva Sutcu
- Faculty of Medicine, Department of Obstetrics and Gynecology, Trakya University, Edirne, Turkey
| | - Engin Atli
- Faculty of Medicine, Department of Medical Genetics, Trakya University, Edirne, Turkey
| | - Fusun Varol
- Faculty of Medicine, Department of Obstetrics and Gynecology, Trakya University, Edirne, Turkey
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15
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Abstract
RATIONALE Mesalazine and its prodrug sulfasalazine are both used for inflammatory bowel disease. Sulfasalazine has been associated with hematological side-effects such as aplastic and hemolytic anemia in patients, but also in fetuses after intrauterine exposure. To our knowledge, we describe the first case of a fetus with severe anemia, and subsequent hydrops, where this drug was found at concentrations in the fetus corresponding to those in the mother and most likely responsible for the fetal condition. PATIENT CONCERNS A uniparous woman was referred at 31 weeks of gestation due to a hydropic fetus with massive ascites and cardiomegaly. DIAGNOSES The patient had Crohn's disease and was thus treated with 4 g mesalazine daily. The fetus had severe anemia with an initial hemoglobin level of 51 g/L. INTERVENTIONS The maternal medication was discontinued and four intrauterine erythrocyte transfusions were given during three weeks. Plasma samples were drawn from mother and fetus during cordocentesis for later analysis of mesalazine. OUTCOMES A healthy baby was born after 37 full weeks of gestation. Plasma levels of mesalazine were non-conspicuous in neither mother nor fetus. The mesalazine half-life in the fetus (37 h) was half that of the mother (80 h), both considerably longer than previously reported (about 19 h). LESSONS A causal relationship must be suspected between the fetal anemia and the maternal use of mesalazine. This fetal side-effect should be considered in pregnant women on mesalazine (and its prodrug sulfasalazine).
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Affiliation(s)
- Sverker Ek
- Department of Obstetrics and Gynecology, Center of Fetal Medicine, Karolinska University Hospital
| | - Staffan Rosenborg
- Clinical Pharmacology, Karolinska University Laboratory and Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Wilson RD, Gagnon A, Audibert F, Campagnolo C, Carroll J. Interventions et techniques de diagnostic prénatal visant l'obtention d'un prélèvement fœtal à des fins diagnostiques : Risques et avantages pour la mère et le fœtus. J Obstet Gynaecol Can 2017; 38:S688-S703. [PMID: 28063574 DOI: 10.1016/j.jogc.2016.09.071] [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: 11/26/2022]
Abstract
OBJECTIF Offrir aux fournisseurs de soins de maternité et à leurs patientes des lignes directrices factuelles contemporaines en ce qui concerne les services de counseling traitant des risques et des avantages maternels propres à la tenue des interventions diagnostiques prénatales orientées par échographie (et/ou des techniques permettant l'établissement d'un diagnostic génétique) nécessaires dans les cas où il a été établi pendant la période prénatale que la grossesse serait exposée à des risques, ainsi qu'en ce qui concerne la prise de décisions subséquentes quant à la prise en charge de la grossesse (questions abordant des aspects tels que le niveau du fournisseur de soins obstétricaux, la surveillance prénatale, le lieu où devraient se dérouler les soins et l'accouchement, et la décision de poursuivre ou d'interrompre la grossesse). La présente directive clinique se limite aux services de counseling traitant des risques et des avantages maternels, et aux décisions en matière de prise en charge de la grossesse pour les femmes qui nécessitent (ou qui envisagent) la mise en œuvre d'une intervention ou d'une technique effractive orientée par échographie aux fins de l'établissement d'un diagnostic prénatal. POPULATION DE PATIENTES Femmes enceintes identifiées, à la suite de la mise en œuvre de protocoles établis de dépistage prénatal (taux sériques maternels ± imagerie, résultats d'analyse de l'ADN acellulaire indiquant des risques élevés, résultats anormaux au moment de l'imagerie fœtale diagnostique ou antécédents familiaux de troubles héréditaires), comme étant exposées à un risque accru d'anomalie génétique fœtale. Ces femmes pourraient nécessiter ou demander des services de counseling au sujet des risques et des avantages pour la grossesse de la tenue d'une intervention effractive orientée par échographie visant à déterminer l'étiologie, le diagnostic, et/ou la pathologie de possibles anomalies fœtales. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans Medline, PubMed et The Cochrane Library jusqu'en juin 2014 au moyen d'un vocabulaire contrôlé (« prenatal diagnosis », « amniocentesis », « chorionic villi sampling », « cordocentesis ») et de mots clés (« prenatal screening », « prenatal genetic counselling », « post-procedural pregnancy loss rate ») appropriés. Les résultats ont été restreints aux analyses systématiques, aux études observationnelles et aux essais comparatifs randomisés / essais cliniques comparatifs publiés en anglais entre janvier 1985 et juin 2014. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'en juin 2014. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. VALEURS La qualité des résultats a été évaluée au moyen des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs (Tableau 1). AVANTAGES, DéSAVANTAGES ET COûTS: Consentement éclairé de la patiente, transfert des connaissances, évaluation du risque génétique prénatal, soulagement de l'anxiété, création d'anxiété, défense des droits, compréhension du dépistage fœtal, limites du dépistage fœtal, choix en matière de prise en charge de la grossesse, complication de la grossesse ou fausse couche, soins opportuns et améliorés pour l'accouchement d'un enfant présentant une morbidité reconnue. RECOMMANDATIONS.
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Karimzad Hagh J, Liehr T, Ghaedi H, Mossalaeie MM, Alimohammadi S, Inanloo Hajiloo F, Moeini Z, Sarabi S, Zare-Abdollahi D. Prenatal Diagnosis of Mosaic Tetrasomy 18p in a Case without Sonographic Abnormalities. Int J Mol Cell Med 2017; 6:61-65. [PMID: 28868271 PMCID: PMC5568194] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/22/2016] [Indexed: 11/22/2022]
Abstract
Small supernumerary marker chromosomes (sSMC) are still a major problem in clinical cytogenetics as they cannot be identified or characterized unambiguously by conventional cytogenetics alone. On the other hand, and perhaps more importantly in prenatal settings, there is a challenging situation for counseling how to predict the risk for an abnormal phenotype, especially in cases with a de novo sSMC. Here we report on the prenatal diagnosis of a mosaic tetrasomy 18p due to presence of an sSMC in a fetus without abnormal sonographic signs. For a 26-year-old, gravida 2 (para 1) amniocentesis was done due to consanguineous marriage and concern for Down syndrome, based on borderline risk assessment. Parental karyotypes were normal, indicating a de novo chromosome aberration of the fetus. FISH analysis as well as molecular karyotyping identified the sSMC as an i(18)(pter->q10:q10->pter), compatible with tetrasomy for the mentioned region. Cordocentesis was done due to normal sonography and the results from amniocentesis were confirmed. The parents opted for pregnancy termination and post mortem examination now noted, low anterior hairline, large philtrum, low-set posteriorly rotated malformed ears with prominent antihelix, lower limbs joint contracture and digital anomalies, including long and narrow toes with clinodactyly of the 1st and 5th toes and postaxial polydactyly of one hand. De novo i(18p) can be considered as a special case in the sense that the major relevant phenotypes mentioned for it, i.e. feeding difficulties, abnormalities in muscle tone and developmental/mental retardation, cognitive and behavioral characteristics, recurrent otitis media and seizures, are mostly postnatal. This emphasizes the necessity to determine the nature of a de novo euchromatic marker chromosome, especially in cases with normal ultrasound result and the suitability of a cordocentesis in order to better predicting the pregnancy outcome and parental counseling.
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Affiliation(s)
| | - Thomas Liehr
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Jena, Germany, Iran.
| | - Hamid Ghaedi
- Department of medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Shohreh Alimohammadi
- Endometrium and Endometriosis Research Center, Faculty of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran.
| | | | - Zahra Moeini
- Parseh Pathobiology & Genetics Laboratory, Tehran, Iran.
| | - Sadaf Sarabi
- Parseh Pathobiology & Genetics Laboratory, Tehran, Iran.
| | - Davood Zare-Abdollahi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Corresponding author: Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
E-mails: &
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18
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Mari G, Norton ME, Stone J, Berghella V, Sciscione AC, Tate D, Schenone MH. Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: the fetus at risk for anemia--diagnosis and management. Am J Obstet Gynecol 2015; 212:697-710. [PMID: 25824811 DOI: 10.1016/j.ajog.2015.01.059] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We sought to provide evidence-based guidelines for the diagnosis and management of fetal anemia. METHODS A systematic literature review was performed using MEDLINE, PubMed, EMBASE, and the Cochrane Library. The search was restricted to English-language articles published from 1966 through May 2014. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion. Evidence reports and published guidelines were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology was used for defining the strength of recommendations and rating the quality of evidence. Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence. RESULTS AND RECOMMENDATIONS We recommend the following: (1) middle cerebral artery peak systolic velocity (MCA-PSV) measured by ultrasound Doppler interrogation be used as the primary technique to detect fetal anemia; (2) amniotic fluid delta OD450 not be used to diagnosis fetal anemia; (3) MCA-PSV assessment be reserved for those patients who are at risk of having an anemic fetus (proper technique for MCA-PSV evaluation includes assessment of the middle cerebral artery close to its origin, ideally at a zero degree angle without angle correction); (4) if a fetus is deemed at significant risk for severe fetal anemia (MCA greater than 1.5 multiples of the median or hydropic), fetal blood sampling be performed with preparation for an intrauterine transfusion, unless the pregnancy is at a gestational age when the risks associated with delivery are considered to be less than those associated with the procedure; (5) if a fetus is deemed at significant risk for severe fetal anemia, the patient be referred to a center with expertise in invasive fetal therapy; (6) MCA-PSV be considered to determine the timing of a second transfusion in fetuses with anemia, and, alternatively, a predicted decline in fetal hemoglobin may be used for timing the second procedure; and (7) pregnancies with a fetus at significant risk for fetal anemia be delivered at 37-38 weeks of gestation unless indications develop prior to this time.
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Maeda K, Imoto I, Kaji T, Yoshida Y, Nakayama S, Irahara M. Case of non-mosaic trisomy 20 in amniotic fluid cultures without anomalies in the fetus: cytogenetic discrepancy between amniocytes and fetal blood. J Obstet Gynaecol Res 2014; 41:141-4. [PMID: 25164874 DOI: 10.1111/jog.12488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/21/2014] [Accepted: 04/28/2014] [Indexed: 11/27/2022]
Abstract
We report a case of non-mosaic trisomy 20 detected prenatally by amniocentesis during the 16th week of pregnancy. Fetal blood sampling showed a normal karyotype and no fetal, neonatal or infant abnormalities were observed. Amniotic fluid cell karyotyping revealed a trisomy 20 (47,XY,+20) with 100% trisomic cells (38/38); however, a subsequent cordocentesis revealed a normal male karyotype. Moreover, a follow-up ultrasonographic examination did not reveal any major congenital malformations, and a healthy male infant was delivered subsequently at an appropriate gestational age without obvious anomalies. Cytogenetic analysis of blood lymphocytes from the infant revealed a normal karyotype, but cultured cells from the term placenta showed a mosaic karyotype 47,XY,+20/46,XY with 88% trisomic cells (44 of 50). Furthermore, no anomalies or developmental delays were observed in the neonatal period, thus suggesting two possibilities: confined placental mosaicism with the presence of normal and abnormal cell lineages, or generalized mosaicism affecting a limited number of tissues in both the placenta and fetus.
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Affiliation(s)
- Kazuhisa Maeda
- Shikoku Medical Center for Children and Adults, General Perinatal Medical Center, Zentsuji, Japan; Department of Obstetrics and Gynecology, Tokushima University Hospital, Tokushima, Japan
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20
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Abstract
OBJECTIVE We sought to review indications, technical aspects, risks, and recommendations for fetal blood sampling (FBS). METHODS A systematic review was performed using MEDLINE, PubMed, EMBASE, and Cochrane Library using the terms "fetal blood sampling," "percutaneous umbilical blood sampling," and "cordocentesis." The search was restricted to English-language articles published from 1966 through July 2012. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries also were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document. Evidence reports and guidelines published by organizations or institutions such as the National Institutes of Health, Agency for Health Research and Quality, American Congress of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. Grade (Grading of Recommendations Assessment, Development, and Evaluation) methodology was employed for defining strength of recommendations and rating quality of evidence. Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence. RESULTS AND RECOMMENDATIONS Ultrasound-guided FBS is the only procedure that provides direct access to the fetal circulation. When invasive testing is planned for suspected severe fetal anemia or thrombocytopenia, we recommend FBS as the procedure of choice, with availability of immediate transfusion if confirmed. We recommend against the use of FBS for indications in which other less invasive, and therefore lower risk, alternatives are available. The overall success rate of FBS is high, and blood samples can be obtained in >98% of patients. We suggest that counseling for FBS include discussion about the potential risk of FBS that may include, but may not be limited to: bleeding from puncture site (20-30%); fetal bradycardia (5-10%); pregnancy loss (≥1.3%, depending on indication, gestational age, and placental penetration); and vertical transmission of hepatitis or human immunodeficiency virus. We recommend that FBS be performed by experienced operators at centers with expertise in invasive fetal procedures when feasible.
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Balkan M, Fidanboy M, İsi H, Akbaş H, Kalkanli S, Alp MN, Budak T. A case of complete tetraploidy in amniocentesis with normal karyotype in subsequent cordocentesis. J Pediatr Genet 2012; 1:243-6. [PMID: 27625831 DOI: 10.3233/pge-12039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/15/2022]
Abstract
We report a case of complete tetraploidy in amniotic fluid culture obtained at 17 wk of pregnancy. Amniocentesis was performed in this pregnancy because of a high-risk maternal serum screening result and abnormal ultrasound findings. Amniotic fluid was cultured in two flasks. Growth was very slow in one culture with no growth in the other. Harvest was possible after 3 wk, which revealed tetraploidy in all studied plates. Subsequent cordocentesis was performed to confirm the diagnoses of amniocentesis. Chromosomal analysis of the cordocentesis revealed a normal karyotype with 46,XY. A healthy male infant was born at term. This case illustrates that abnormal karyotypes in poor growth cultures could be misleading and should be confirmed by another technique, such as cordocentesis.
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Affiliation(s)
- Mahmut Balkan
- Department of Medical Biology and Genetics, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Mehmet Fidanboy
- Department of Medical Biology and Genetics, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Hilmi İsi
- Department of Medical Biology and Genetics, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Halit Akbaş
- Department of Medical Biology and Genetics, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Sevgi Kalkanli
- Department of Medical Biology and Genetics, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - M Nail Alp
- Department of Medical Biology and Genetics, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Turgay Budak
- Department of Medical Biology and Genetics, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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Chaiworapongsa T, Romero R, Berry SM, Hassan SS, Yoon BH, Edwin S, Mazor M. The role of granulocyte colony-stimulating factor in the neutrophilia observed in the fetal inflammatory response syndrome. J Perinat Med 2011; 39:653-66. [PMID: 21801092 PMCID: PMC3382056 DOI: 10.1515/jpm.2011.072] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Fetal neutrophilia is present in two-thirds of cases with the fetal inflammatory response syndrome (FIRS). The mechanisms responsible for this finding have not been elucidated. Granulocyte colony-stimulating factor (G-CSF) is the primary physiologic regulator of neutrophil production and plays a key role in the rapid generation and release of neutrophils in stressful conditions (i.e., infection). The objective of this study was to determine: 1) whether FIRS was associated with changes in fetal plasma G-CSF concentrations; and 2) if fetal plasma G-CSF concentrations correlated with fetal neutrophil counts, chorioamnionitis, neonatal morbidity/mortality and cordocentesis-to-delivery interval. STUDY DESIGN Percutaneous umbilical cord blood sampling was performed in a population of patients with preterm labor (n=107). A fetal plasma interleukin-6 (IL-6) concentration >11 pg/mL was used to define FIRS. Cord blood G-CSF was measured by a sensitive and specific immunoassay. An absolute neutrophil count was determined and corrected for gestational age. Receiver operating characteristic (ROC) curve, survival analysis and Cox proportional hazard model were employed. RESULTS 1) G-CSF was detected in all fetal blood samples; 2) fetuses with FIRS had a higher median fetal plasma G-CSF concentration than those without FIRS (P<0.001); 3) a fetal plasma G-CSF concentration ≥134 pg/mL (derived from an ROC curve) was associated with a shorter cordocentesis-to-delivery interval, a higher frequency of chorioamnionitis (clinical and histological), intra-amniotic infection, and composite neonatal morbidity/mortality than a fetal plasma concentration below this cut-off; and 4) a fetal plasma G-CSF concentration ≥134 pg/mL was associated with a shorter cordocentesis-to-delivery interval (hazard ratio 3.2; 95% confidence interval 1.8-5.8) after adjusting for confounders. CONCLUSIONS 1) G-CSF concentrations are higher in the peripheral blood of fetuses with FIRS than in fetuses without FIRS; and 2) a subset of fetuses with FIRS with elevated fetal plasma G-CSF concentrations are associated with neutrophilia, a shorter procedure-to-delivery interval, chorio-amnionitis and increased perinatal morbidity and mortality.
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Affiliation(s)
- Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI, USA
| | | | - Sonia S. Hassan
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Bo Hyun Yoon
- Seoul National University College of Medicine, Seoul, Korea
| | | | - Moshe Mazor
- Ben Gurion University, Soroka Medical Center, Beer Sheva, Israel
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Romero R, Alpay Savasan Z, Chaiworapongsa T, Berry SM, Kusanovic JP, Hassan SS, Yoon BH, Edwin S, Mazor M. Hematologic profile of the fetus with systemic inflammatory response syndrome. J Perinat Med 2011; 40:19-32. [PMID: 21957997 PMCID: PMC3380620 DOI: 10.1515/jpm.2011.100] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [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: 06/03/2011] [Accepted: 07/19/2011] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The fetal inflammatory response syndrome (FIRS) is associated with impending onset of preterm labor/delivery, microbial invasion of the amniotic cavity and increased perinatal morbidity. FIRS has been defined by an elevated fetal plasma interleukin (IL)-6, a cytokine with potent effects on the differentiation and proliferation of hematopoietic precursors. The objective of this study was to characterize the hematologic profile of fetuses with FIRS. STUDY DESIGN Fetal blood sampling was performed in patients with preterm prelabor rupture of membranes and preterm labor with intact membranes (n=152). A fetal plasma IL-6 concentration ≥ 11 pg/mL was used to define FIRS. Hemoglobin concentration, platelet count, total white blood cell (WBC) count, differential count, and nucleated red blood cell (NRBC) count were obtained. Since blood cell count varies with gestational age, the observed values were corrected for fetal age by calculating a ratio between the observed and expected mean value for gestational age. RESULTS 1) The prevalence of FIRS was 28.9% (44/152); 2) fetuses with FIRS had a higher median corrected WBC and corrected neutrophil count than those without FIRS (WBC: median 1.4, range 0.3-5.6, vs. median 1.1, range 0.4-2.9, P=0.001; neutrophils: median 3.6, range 0.1-57.5, vs. median 1.8, range 0.2-13.9, P<0.001); 3) neutrophilia (defined as a neutrophil count >95th centile of gestational age) was significantly more common in fetuses with FIRS than in those without FIRS (71%, 30/42, vs. 35%, 37/105; P<0.001); 4) more than two-thirds of fetuses with FIRS had neutrophilia, whereas neutropenia was present in only 4.8% (2/42); 5) FIRS was not associated with detectable changes in hemoglobin concentration, platelet, lymphocyte, monocyte, basophil or eosinophil counts; and 6) fetuses with FIRS had a median corrected NRBC count higher than those without FIRS. However, the difference did not reach statistical significance (NRBC median 0.07, range 0-1.3, vs. median 0.04, range 0-2.3, P=0.06). CONCLUSION The hematologic profile of the human fetus with FIRS is characterized by significant changes in the total WBC and neutrophil counts. The NRBC count in fetuses with FIRS tends to be higher than fetuses without FIRS.
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Affiliation(s)
- Roberto Romero
- Perinatology Research Branch, Eunice Kennedy Shriver, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Detroit, MI 48201, USA.
| | - Zeynep Alpay Savasan
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, MI, USA
| | | | - Juan Pedro Kusanovic
- Department of Obstetrics and Gynecology, Pontificia Universidad Católica de Chile, Santiago, Chile,Center for Perinatal Research, Sótero del Río Hospital, Santiago, Chile
| | - Sonia S. Hassan
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Bo Hyun Yoon
- Seoul National University College of Medicine, Seoul, Korea
| | | | - Moshe Mazor
- Department of Obstetrics and Gynecology, Soroka Medical Center, Ben Gurion University of Negev, Beer Sheva, Israel
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Giannoulis C, Zournatzi B, Giomisi A, Diza E, Tzafettas I. Toxoplasmosis during pregnancy: a case report and review of the literature. Hippokratia 2008; 12:139-143. [PMID: 18923664 PMCID: PMC2504397] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Although toxoplasmosis is considered harmless for a non-pregnant woman, it is potentially harmful during pregnancy, especially at first trimester. The aim of this study is to increase our alertness and monitoring in case of toxoplasmosis during pregnancy, given that when diagnosed it can be effectively treated.We present a case of a healthy 26 years old adult woman, found with toxoplasmosis during the 13th week of pregnancy. The role of frequent maternal and fetus immunological tests, PCR-tests of the amniotic fluid and ultrasound screening of the fetus throughout pregnancy was of great value. The patient was treated with spiramycin (1 grx3) from the 16th week of pregnancy. The patient was subjected to cesarean delivery at the 36th week of pregnancy due to preterm contractions and history of previous cesarean delivery. The newborn was a healthy girl with a birth weight of 2880 gr. A two-year follow up of the baby revealed no medical condition. Maternal infections are a serious medical condition during pregnancy. Toxoplasmosis when diagnosed on time and treated properly can lead to healthy offspring.
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Affiliation(s)
- C Giannoulis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece
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