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Maas AP, Eckrich J, Send T, Bernhardt M, Strieth S, Ernst BP. [Deforming endonasal mass during pregnancy]. HNO 2023; 71:323-327. [PMID: 36947200 PMCID: PMC10126015 DOI: 10.1007/s00106-023-01290-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
This article presents the case of a 33-year-old woman who consulted the authors' ENT clinic in the 39th week of pregnancy with recurrent epistaxis. A livid endonasal mass was found on the left side, subtotally displacing the nose and leading to deformation of the external nose. External biopsy provided no indications of malignancy. Postpartum CT of the paranasal sinuses revealed a mass destroying the cartilaginous nasal septum. Endoscopic resection of the finding was performed with preservation of the clinically sound nasal septal cartilage. Histopathological examination revealed a capillary hemangioma, which was classified as granuloma gravidarum due to its occurrence during pregnancy.
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Affiliation(s)
- A P Maas
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - J Eckrich
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - T Send
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - M Bernhardt
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
- Institut für Pathologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - B P Ernst
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Shi H, Chen L, Wang Y, Sun M, Guo Y, Ma S, Wang X, Jiang H, Wang X, Lu J, Ge L, Dong S, Zhuang Y, Zhao Y, Wei Y, Ma X, Qiao J. Severity of Anemia During Pregnancy and Adverse Maternal and Fetal Outcomes. JAMA Netw Open 2022; 5:e2147046. [PMID: 35113162 PMCID: PMC8814908 DOI: 10.1001/jamanetworkopen.2021.47046] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Anemia is the most widespread nutritional deficiency among pregnant females in the world. Despite numerous studies on anemia, evidence is limited about the association of severity of anemia with maternal and fetal health. OBJECTIVE To investigate the association between severity of anemia during pregnancy and risk of maternal and fetal adverse outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from China's Hospital Quality Monitoring System from January 1, 2016, to December 31, 2019, for pregnant females aged 15 to 49 years with birth outcomes reported at 1508 hospitals with maternity services in mainland China. EXPOSURES Anemia of varying severity during pregnancy was identified from daily standardized electronic inpatient discharge records using corresponding codes of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Mild anemia was defined as a hemoglobin concentration of 100 to 109 g/L (to convert g/L to g/dL, divide by 10.0); moderate anemia, as 70 to 99 g/L; and severe anemia, as less than 70 g/L. MAIN OUTCOMES AND MEASURES The main outcomes included 6 maternal outcomes (placental abruption, preterm birth, severe postpartum hemorrhage, shock, admission to the intensive care unit [ICU], and maternal mortality) and 3 neonatal outcomes (fetal growth restriction, malformation, and stillbirth). Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% CIs of these outcomes among pregnant females with varying severity of anemia. RESULTS Among 18 948 443 pregnant females aged 15 to 49 years (mean [SD] age, 29.42 [4.87] years), 17.78% were diagnosed with anemia during pregnancy, including 9.04% with mild anemia, 2.62% with moderate anemia, 0.21% with severe anemia, and 5.90% with anemia of unknown severity. Compared with no anemia, anemia severity during pregnancy was associated with increased risks of placental abruption (mild: adjusted OR [aOR], 1.36 [95% CI, 1.34-1.38]; moderate: aOR, 1.98 [95% CI, 1.93-2.02]; severe: aOR, 3.35 [95% CI, 3.17-3.54]), preterm birth (mild: aOR, 1.08 [95% CI, 1.07-1.08]; moderate: aOR, 1.18 [95% CI, 1.17-1.19]; severe: aOR, 1.36 [95% CI, 1.32-1.41]), severe postpartum hemorrhage (mild: aOR, 1.45 [95% CI, 1.43-1.47]; moderate: aOR, 3.53 [95% CI, 3.47-3.60]; severe: 15.65 [95% CI, 15.10-16.22]), and fetal malformation (mild: aOR, 1.15 [95% CI, 1.14-1.17]; moderate: aOR, 1.19 [95% CI, 1.16-1.21]; severe: aOR, 1.62 [95% CI, 1.52-1.73]). Compared with no anemia, moderate or severe anemia were associated with increased risks of maternal shock (moderate: aOR, 1.50 [95% CI, 1.41-1.60]; severe: aOR, 14.98 [95% CI, 13.91-16.13]), ICU admission (moderate: aOR, 1.08 [95% CI, 1.01-1.16]; severe: aOR, 2.88 [95% CI, 2.55-3.25]), maternal death (moderate: aOR, 0.45 [95% CI, 0.30-0.65]; severe: aOR, 1.56 [95% CI, 0.97-2.48], fetal growth restriction (moderate: aOR, 0.80 [95% CI, 0.78-0.82]; severe: aOR, 1.08 [95% CI, 1.00-1.17]), and stillbirth (moderate: aOR,0.79 [95% CI, 0.76-0.81]; severe: aOR, 1.86 [95% CI, 1.75-1.98]), and mild anemia was associated with decreased risks (maternal shock: aOR, 0.67 [95% CI, 0.63-0.71]; ICU admission: aOR, 0.80 [95% CI, 0.76-0.84]; maternal death: aOR, 0.37 [95% CI, 0.29-0.49]; fetal growth restriction: aOR, 0.79 [95% CI, 0.77-0.80]; stillbirth: aOR, 0.59 [95% CI, 0.58-0.61]) after adjusting for sociodemographic characteristics and other complications during pregnancy. CONCLUSIONS AND RELEVANCE The findings suggest that anemia during pregnancy is associated with maternal and fetal health outcomes and that mild anemia is associated with improved maternal and fetal survival and fetal growth. Further work is needed to validate the concentration of hemoglobin at which optimal maternal and fetal health are achieved.
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Affiliation(s)
- Huifeng Shi
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Lian Chen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Yuanyuan Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
| | - Mengxing Sun
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
| | - Yijie Guo
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Shang Ma
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Xiaoli Wang
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Hai Jiang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
| | - Xiaoxia Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Jie Lu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Lin Ge
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Shu Dong
- Department of Medical Affairs, Peking University Third Hospital, Beijing, China
| | - Yu Zhuang
- Department of Medical Affairs, Peking University Third Hospital, Beijing, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Yuan Wei
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Xudong Ma
- Department of Healthcare Quality Evaluation, Bureau of Medical Administration, National Health Commission of the People’s Republic of China, Beijing, China
| | - Jie Qiao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
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Magwali TL, Svisva A, Bowers T, Chiyaka F, Conway JD, Madzima B, Mambo V, Mangwiro A, Carmone AE. Applying the RE-AIM framework in a process evaluation of the introduction of the Non-Pneumatic Anti-Shock Garment in a rural district of Zimbabwe. PLoS One 2021; 16:e0251908. [PMID: 34015006 PMCID: PMC8136624 DOI: 10.1371/journal.pone.0251908] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 05/05/2021] [Indexed: 11/19/2022] Open
Abstract
The Non-Pneumatic Anti-Shock Garment (NASG) is a first aid tool that can halt and reverse hypovolemic shock secondary to obstetric hemorrhage. The World Health Organization recommended the NASG for use as a temporizing measure in 2012, but uptake of the recommendation has been slow, partially because operational experience is limited. The study is a process evaluation of the introduction of NASG in a public sector health facility network in rural Zimbabwe utilizing an adapted RE-AIM, categorizing observations into the domains of: reach, effectiveness, adoption, implementation and maintenance. The location of the study was Hurungwe district, where staff members of 34 health facilities at primary (31), secondary (2) and tertiary (1) levels of care participated. We found that all facilities became skilled in using the NASG, and that the NASG was used in 10 of 11 instances of severe hemorrhage. In the cases of hypovolemic shock where the NASG was used, there were no maternal deaths and no extreme adverse outcomes related to obstetric hemorrhage in the study period. Among the 10 NASG uses, the garment was used correctly in each case. Fidelity to processes was high, especially in regard to training and cascading skills, but revisions of the NASG rotation and replacement operating procedures were required to keep clean garments stocked. Clinical documentation was also a key challenge. NASG introduction dovetailed very well with pre-existing systems for obstetric emergency response, and improved clinical outcomes. Scale-up of the NASG in the Zimbabwean public health system can be undertaken with careful attention to mentorship, drills, documentation and logistics.
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Affiliation(s)
- Thulani Leslie Magwali
- Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
- * E-mail: (AEC); (TLM)
| | | | | | | | | | - Bernard Madzima
- Maternal Health Program, Zimbabwe Ministry of Health, Harare, Zimbabwe
| | - Violet Mambo
- Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
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Ajepe AA, Okunade KS, Sekumade AI, Daramola ES, Beke MO, Ijasan O, Olowoselu OF, Afolabi BB. Prevalence and foetomaternal effects of iron deficiency anaemia among pregnant women in Lagos, Nigeria. PLoS One 2020; 15:e0227965. [PMID: 31971986 PMCID: PMC6977715 DOI: 10.1371/journal.pone.0227965] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 01/04/2020] [Indexed: 01/05/2023] Open
Abstract
Anaemia in pregnancy is a major health problem and an important cause of adverse foetomaternal outcomes in developing countries. Iron deficiency is the cause of the overwhelming majority of the cases of anaemia in pregnancy. Iron deficiency anaemia (IDA) has been linked with adverse foetal and maternal outcomes. This study investigated the prevalence of IDA and evaluated its effects on foetomaternal outcomes among parturients in Lagos, Nigeria. This was a cross-sectional study that enrolled 220 women aged 15–49 years with singleton gestation at term, between May 1, 2016, and March 31, 2017. Participants were selected by systematic sampling and baseline data were collected through interviews. Venous blood samples were obtained to measure haemoglobin and serum ferritin concentrations, and the associations between IDA (defined as anaemia and iron deficiency) and pregnancy outcomes were examined. A P-value <0.05 was considered as statistically significant. The prevalence of IDA was 12.3%. Routine antenatal iron supplementation (adjusted odds ratio 0.18, 95% confidence interval 0.07–0.46; P = 0.001) and interpregnancy interval of at least 2 years (adjusted odds ratio 0.20, 95% confidence interval 0.05–0.97; P = 0.021) have significant association with IDA. Iron deficiency anaemia was not significantly associated with adverse perinatal outcomes but there were significant associations with increased risk of blood transfusion (P = 0.001) and maternal infectious morbidities such as puerperal pyrexia (P = 0.041) and wound infection (P = 0.020). IDA is still a fairly common condition among parturients in Lagos and it’s mostly associated with maternal peripartum morbidities. Adequate pregnancy spacing through the use of effective contraception and routine antenatal iron supplementations in pregnancy is a recommended preventive measure against IDA and its adverse sequelae. Future studies should adopt the use of transferrin saturation (TSAT) in compliment with serum ferritin assay as a more sensitive marker of iron deficiency.
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Affiliation(s)
| | - Kehinde Sharafadeen Okunade
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
- * E-mail:
| | | | | | - Mary Olufunmilayo Beke
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olaolopin Ijasan
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olusola Festus Olowoselu
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Bukola Bosede Afolabi
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
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Abstract
Pregnancy in women with sickle cell disease (SCD) is associated with increased maternal and fetal morbidity and mortality. Outcomes vary widely owing to methodological limitations of clinical studies, but overall, hypertensive disorders of pregnancy, venothromboembolism, poor fetal growth, and maternal and perinatal mortality are increased globally. Few therapeutic interventions have been explored other than prophylactic and selective transfusion therapy. Unfortunately, existing data are limited, and it remains unclear whether prophylactic use of chronic transfusions will improve pregnancy outcomes. Management of pregnant women with SCD is best accomplished with a multidisciplinary team that includes a sickle cell expert and an obstetrician familiar with high-risk pregnancies. Women with SCD should have individualized care plans that outline management of acute pain and guidelines for transfusion therapy. Neonates require close monitoring for neonatal abstinence syndrome and hemolytic disease of the newborn. Ideally all young women with SCD will have a "reproductive life plan" developed as a component of preconception counseling and health promotion. Research leading to improved pregnancy management focused on diminishing adverse maternal and neonatal outcomes is overdue. International collaborations should be considered to improve subject recruitment and foster timely completion of clinical trials. Additional therapeutic interventions outside of transfusion therapy should be explored.
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Affiliation(s)
- Kim Smith-Whitley
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA
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Auerbach M. New paradigms and therapies for iron replacement in iron deficiency anemia. Clin Adv Hematol Oncol 2018; 16:712-715. [PMID: 30543585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Michael Auerbach
- Auerbach Hematology and Oncology, Baltimore, Maryland, Georgetown University School of Medicine, Washington, DC
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Gebreamlak B, Dadi AF, Atnafu A. High Adherence to Iron/Folic Acid Supplementation during Pregnancy Time among Antenatal and Postnatal Care Attendant Mothers in Governmental Health Centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical Negative Binomial Poisson Regression. PLoS One 2017; 12:e0169415. [PMID: 28129344 PMCID: PMC5271309 DOI: 10.1371/journal.pone.0169415] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 06/15/2016] [Accepted: 12/17/2016] [Indexed: 11/24/2022] Open
Abstract
Background Iron deficiency during pregnancy is a risk factor for anemia, preterm delivery, and low birth weight. Iron/Folic Acid supplementation with optimal adherence can effectively prevent anemia in pregnancy. However, studies that address this area of adherence are very limited. Therefore, the current study was conducted to assess the adherence and to identify factors associated with a number of Iron/Folic Acid uptake during pregnancy time among mothers attending antenatal and postnatal care follow up in Akaki kality sub city. Methods Institutional based cross-sectional study was conducted on a sample of 557 pregnant women attending antenatal and postnatal care service. Systematic random sampling was used to select study subjects. The mothers were interviewed and the collected data was cleaned and entered into Epi Info 3.5.1 and analyzed by R version 3.2.0. Hierarchical Negative Binomial Poisson Regression Model was fitted to identify the factors associated with a number of Iron/Folic Acid uptake. Adjusted Incidence rate ratio (IRR) with 95% confidence interval (CI) was computed to assess the strength and significance of the association. Result More than 90% of the mothers were supplemented with at least one Iron/Folic Acid supplement from pill per week during their pregnancy time. Sixty percent of the mothers adhered (took four or more tablets per week) (95%CI, 56%—64.1%). Higher IRR of Iron/Folic Acid supplementation was observed among women: who received health education; which were privately employed; who achieved secondary education; and who believed that Iron/Folic Acid supplements increase blood, whereas mothers who reported a side effect, who were from families with relatively better monthly income, and who took the supplement when sick were more likely to adhere. Conclusion Adherence to Iron/Folic Acid supplement during their pregnancy time among mothers attending antenatal and postnatal care was found to be high. Activities that would address the above mentioned factors were highly recommended to ensure the sustainability of mothers’ adherence to the supplement.
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Affiliation(s)
| | - Abel Fekadu Dadi
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Azeb Atnafu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sviggum HP, Gill LA, Traynor KD. Velamentous Umbilical Cord Insertion and Ruptured Fetal Vessel: A Cause of Fetal-Maternal Hemorrhage: A Case Report. J Reprod Med 2016; 61:598-600. [PMID: 30226732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Fetal hemorrhage is rare but can result in rapid fetal compromise. Abnormally located fetal vessels within the membranes increase the risk for their rupture and subsequent hemorrhage. The classic example of this is vasa previa. CASE We present a case of acute fetal hemorrhage resulting from a ruptured fetal vessel. During induction of labor, significant fetal heart rate deceleration occurred, coinciding with acute vaginal bleeding and amniotomy. A depressed, live female neonate was delivered by emergency cesarean section. Examination of the placenta revealed a velamentous cord insertion and a ruptured fetal vessel coursing through the chorioamniotic membranes. Neonatal resuscitation included red blood cell transfusion for hypotension and low hematocrit. The neonate made a full recovery. CONCLUSION Acute fetal hemorrhage from the rupture of aberrant fetal vessels often coincides with rupture of membranes. Identifying ruptured fetal vessels abnormally coursing through the chorioamniotic membranes on examination of the placenta provides supporting evidence for suspected fetal hemorrhage.
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Barillari G, Springolo F, Pasca S, Del Fabro A, Marchesoni D. Caesarean surgery or vaginal delivery in a pregnant woman with homozygous FXI deficiency and FXI level <1%? This is the question! Minerva Ginecol 2016; 68:476-477. [PMID: 27302213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Giovanni Barillari
- Center for Hemorrhagic and Thrombotic Diseases, University Hospital of Udine, Udine, Italy -
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John CO, Korubo K, Ogu R, Mmom CF, Mba AG, Chidiadi EA, Akani C. Management of aplastic anaemia in pregnancy in a resource poor centre. Pan Afr Med J 2016; 24:277. [PMID: 28154632 PMCID: PMC5267852 DOI: 10.11604/pamj.2016.24.277.9880] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/10/2016] [Indexed: 11/11/2022] Open
Abstract
Aplastic anaemia occurring in pregnancy is a rare event with life threatening challenges for both mother and child. We present a successful fetomaternal outcome despite the challenges in the management of this rare condition in a tertiary but resource poor centre. This is case of a 37 year old Nigerian woman G6P0+5managed with repeated blood transfusions from 28 weeks of gestation for bone marrow biopsy confirmed aplastic anaemia following presentation with weakness and gingival bleeds. She had a cesarean section at 37 weeks for pre-eclampsia and oligohydraminous with good feto-maternal outcome. She was managed entirely with fresh whole blood and received 21 units. Aplastic Anaemia in Pregnancy is a rare event with poor feto maternal prognosis. Successful management is possible with good multi-disciplinary approach and availability of supportive comprehensive obstetric care.
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Affiliation(s)
- Celestine Osita John
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Kaladada Korubo
- Department of Haematology & Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Rosemary Ogu
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Chigozirim Faith Mmom
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Alpheus Gogo Mba
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Ezenwa-Ahanene Chidiadi
- Department of Haematology & Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Chris Akani
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
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Wang X, Zhang C, Liang M, Zhang X, Wang J, Zhang X. [Analysis of risk factors for adverse perinatal outcomes in women with pancytopenia]. Zhonghua Fu Chan Ke Za Zhi 2015; 50:931-936. [PMID: 26887878] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore the pregnancy outcomes of women with pancytopenia and the risk factors for the adverse perinatal outcomes. METHODS A total of 106 pregnant women with pancytopenia were admitted to Peking University People's Hospital from Jan. 2005 to Sep. 2014. The clinical data and the pregnancy outcomes were reviewed retrospectively to investigate the risk factors for the adverse perinatal outcomes. RESULTS (1 ) Eighty-four patients were found pancytopenia before pregnancy while 22 were found for the first time during pregnancy. Sixty-four patients were diagnosed as aplastic anemia; 30 as myelodysplastic syndrome; 2 as paroxysmal nocturnal hemoglobinuria; 4 as hypersplenism, and 1 as anti-phospholipid syndrome. Diagnoses of the remaining 5 patients were uncertain. (2) Sixty-nine patients received at least one time blood transfusion before delivery. (3) As for the complications, nine women developed gestational diabetes; twenty-two suffered severe preeclampsia (SPE); two were diagnosed as anemic heart disease and three experienced respiratory tract infection. The postpartum blood loss ranged from 50 ml to 3 800 ml, with the median of 400 ml. And six women had the blood loss more than 1 000 ml. The gestational age at delivery ranged from 24 weeks to 40 weeks, with the median of 37.0 weeks. (4) Thirty-one patients suffered adverse perinatal outcomes, including 3 cases of intrauterine death, 4 therapeutic labor induction before 28 gestational weeks, 6 premature delivery before 34 weeks. There were 2 neonates complicated with intracranial hemorrhage, 2 with neonatal respiratory distress syndrome, 3 with hypoxic-ischemic encephalopathy, 2 with severe asphyxia and death, and 14 with small for gestational age. Among the patients with adverse perinatal outcomes, 26 women received blood transfusion during pregnancy and 17 developed SPE. The maximum and the minimum value of their white cell count (WBC), hemoglobin concentration (Hb) and blood platelet count (BPC) were (4.9±1.4)×10(9)/L, (2.9±0.8)×10(9)/L, (88.6±14.9) g/L, (57.9±14.5) g/L, (47.7±27.4)×10(9)/L and (11.9±12.3)×10(9)/L, respectively. For those patients without adverse perinatal outcomes, 43 received blood transfusion during pregnancy and 5 developed SPE. The maximum and the minimum value of their WBC, Hb and BPC were (5.2±1.5)×10(9)/L, (3.2±0.9)×10(9)/L, (101.4±16.2) g/L, (71.9 ± 14.5) g/L, (52.3 ± 24.0) × 10(9)/L and (19.0±12.1) × 10(9)/L, respectively. The multivariate regression analyses indicated that SPE, Hb less than 70 g/L and BPC less than 20×10(9)/L were the independent risk factors for the poor perinatal outcomes in pregnant women with pancytopenia (P<0.05). CONCLUSIONS The incidence of adverse perinatal complications increased dramatically in pregnant women with pancytopenia. Concurrent SPE, minimum Hb less than 70 g/L and minimum BPC less than 20 × 10(9)/L may be the independent risk factors for the adverse perinatal outcomes.
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MESH Headings
- Anemia, Aplastic/diagnosis
- Anemia, Aplastic/pathology
- Antiphospholipid Syndrome/diagnosis
- Antiphospholipid Syndrome/pathology
- China/epidemiology
- Delivery, Obstetric
- Diabetes, Gestational/diagnosis
- Diabetes, Gestational/epidemiology
- Female
- Gestational Age
- Humans
- Infant, Newborn
- Labor, Induced
- Pancytopenia/diagnosis
- Pancytopenia/epidemiology
- Platelet Count
- Postpartum Hemorrhage/epidemiology
- Pre-Eclampsia/epidemiology
- Pregnancy
- Pregnancy Complications, Hematologic/diagnosis
- Pregnancy Complications, Hematologic/pathology
- Pregnancy Complications, Hematologic/therapy
- Pregnancy Outcome/epidemiology
- Premature Birth/epidemiology
- Retrospective Studies
- Risk Factors
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Affiliation(s)
- Xueyan Wang
- Department of Obstetrics, Peking University People's Hospital, Beijing 100044, China
| | - Chao Zhang
- Department of Obstetrics, Peking University People's Hospital, Beijing 100044, China; zc_pkuph @126.com
| | - Meiying Liang
- Department of Obstetrics, Peking University People's Hospital, Beijing 100044, China
| | - Xiaohong Zhang
- Department of Obstetrics, Peking University People's Hospital, Beijing 100044, China
| | - Jianliu Wang
- Department of Obstetrics, Peking University People's Hospital, Beijing 100044, China
| | - Xia Zhang
- Department of Obstetrics, Peking University People's Hospital, Beijing 100044, China
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12
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Abstract
Pregnancy-associated venous thromboembolism (VTE) is a leading cause of maternal mortality, but is relatively uncommon. It is clear that the antepartum and postpartum periods have different magnitudes of risk and distinct risk factors for VTE and therefore must be considered separately. Absolute daily risks of VTE must be understood and explored when deciding to prescribe antepartum or postpartum thromboprophylaxis and must also be balanced against the downsides of prophylaxis. When the risks for VTE and bleeding are both low, other burdens of thromboprophylaxis must be weighed in and a decision made after an individualized patient values- and patient preferences-based discussion. Risk stratification is essential to ensure that the practicing clinician strikes the right balance.
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Affiliation(s)
- Marc Rodger
- Ottawa Blood Disease Centre, Ottawa Hospital, Clinical Epidemiology Program, Ottawa Hospital Research Institute, and Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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13
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Butina EV, Zaĭtseva GA, Isaeva NV. [The detection of thrombocyte-bound IgG in patients with throbocytopenia]. Klin Lab Diagn 2014; 59:23-25. [PMID: 25884076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The article presents the mode of detection of anti-thrombocyte auto-antibodies using flow cytometry technique. The values of IgG conjugated with thrombocytes are established in healthy persons. The rate of frequency of auto-antibodies to thrombocytes is analyzed in patients with primarily diagnosed immune thrombocytopenia, with relapse of disease and after therapy of immune thrombocytopenia. The carried out studies demonstrate that flow cytometry technique has a high sensitivity to detect thrombocyte-related antibodies and can be applied under examination of patients with thrombocytopenia.
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14
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Shin JE, Lee Y, Kim SJ, Shin JC. Association of severe thrombocytopenia and poor prognosis in pregnancies with aplastic anemia. PLoS One 2014; 9:e103066. [PMID: 25058151 PMCID: PMC4110015 DOI: 10.1371/journal.pone.0103066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 08/26/2013] [Accepted: 06/27/2014] [Indexed: 11/29/2022] Open
Abstract
Purpose We sought to estimate the risks of adverse obstetric outcomes and disease outcomes associated with severe thrombocytopenia in pregnant women with aplastic anemia (AA). Methods In a retrospective study, we compared demographics, clinical characteristics, laboratory results, and outcomes between severe thrombocytopenia (ST) and non-severe thrombocytopenia (non-ST) groups comprising pregnant women with AA. Results Of 61 AA patients, 43 (70%) were diagnosed as AA before pregnancy and 18 (30%) were AA during pregnancy. The ST group exhibited lower gestational age at nadir of platelet count (26.0 versus 37.0 weeks, p<0.001) and at delivery (37.3 versus 39.1 weeks, p = 0.008), and a higher rate of bleeding gums (33.8 versus 7.7%, p = 0.015) than the non-ST group. In addition, the ST group exhibited more transfusions during pregnancy (72.7 versus 15.4%, p<0.001) and postpartum period (45.0 versus 2.7%, p<0.001), and more bone marrow transplant after delivery (25.0 versus 0.0%, p<0.001) than the non-ST group. The ST group had a higher odds ratio of composite disease complications (OR, 9.63; 95% CI, 2.82–32.9; p<0.001) and composite obstetric complications (OR, 6.78; 95% CI, 2.11–21.8; p = 0.001) than the non-ST group. Conclusions Severe thrombocytopenia is more associated with obstetric and disease complications than is non-severe thrombocytopenia in pregnant women with AA.
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Affiliation(s)
- Jae Eun Shin
- Department of Obstetrics and Gynecology, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Young Lee
- Department of Obstetrics and Gynecology, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Sa Jin Kim
- Department of Obstetrics and Gynecology, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Jong Chul Shin
- Department of Obstetrics and Gynecology, College of Medicine, the Catholic University of Korea, Seoul, Korea
- * E-mail:
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15
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Drobinskaia AN, Nadeeva AP, Zhukova VA, Pasman NM, Karpov MA, Teliatnikova NV. [Placental morphology in inherited thrombophilia]. Arkh Patol 2014; 76:33-36. [PMID: 25306608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To study placental morphological changes in inherited thrombophilia. SUBJECT AND METHODS A morphometric method was used to examine placentas from 37 patients divided into 3 groups: 1) 13 pregnant women with verified inherited thrombophilia; 2) 14 pregnant women with inherited thrombophilia and signs of placental inflammatory manifestations (basal deciduitis, intervillositis, placentitis); 3) 10 women with normal pregnancy (a control group). RESULTS In inherited thrombophilia, the placentas exhibited morphological manifestations of chronic placental insufficiency as pathological immaturity with a predominance of intermediate differentiated villi and as dissociated maturity of cotyledones, with a substantial reduction in the specialized terminal villi, excessive intervillous fibrinoid formation and villous immuring, evolving pseudoinfarctions, fewer capillaries in the terminal villi, and their increased stromal proportion. At the same time, no significant differences were found in the morphological pattern in inherited thrombophilia concurrent with placental inflammatory changes. CONCLUSION In inherited thrombophilia, there is chronic placental insufficiency caused by delayed development of the shaggy chorion.
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16
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Soundararajan LP, Howe DT. Starry sky liver in twin anemia-polycythemia sequence. Ultrasound Obstet Gynecol 2014; 43:597-599. [PMID: 24339130 DOI: 10.1002/uog.13276] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 09/14/2013] [Accepted: 09/17/2013] [Indexed: 06/03/2023]
Affiliation(s)
- L P Soundararajan
- Wessex Maternal Fetal Medicine Unit, University Hospitals Southampton, NHS Foundation Trust, Southampton, UK
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17
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Kiran N, Zubair A, Khalid H, Zafar A. Morphometrical analysis of intervillous space and villous membrane thickness in maternal anaemia. J Ayub Med Coll Abbottabad 2014; 26:207-211. [PMID: 25603679] [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: 06/04/2023]
Abstract
BACKGROUND Anaemia in pregnancy is linked with an increased risk of preterm delivery, low birth weight, perinatal and maternal mortality and it is related with variable histo-morphological changes in placenta which show a reflection for the poor foetal outcome. The objective of this study is to assess the micro-morphometery of intervillous space and villous membrane of placenta in anaemic mothers. METHODS This case control study was carried out at Army Medical College, National University of Sciences and Technology Islamabad in collaboration with Department of Obstetrics and Gynaecology, Military Hospital, Rawalpindi, Pakistan, from December 2011 to November 2012. A total of 75 placentas were included, that were divided into study and control group. In control group (n = 15) placentas were taken from mothers having normal haemoglobin levels and study group (n = 60) included placentas from anaemic mothers having haemoglobin less than 11g/dl. Study group was subdivided into three groups, i.e., mildly (10.0-10.9 g/dl), moderately (7.0-9.9 g/dl) and severely (< 7 g/dl) anaemic group. Three representative sections were taken from placenta, i.e., one close to umbilical cord (A), one from periphery (C) and one midway between A and C (B).Ocular micro-meter was used to measure intervillous space and villous membrane thickness. RESULTS Intervillous space was prominent in study groups (41.26 ± 16.33 ìm) as compared to control group (15.98 ± 3.81 ìm) (p < 0.05). Thickness of villous membrane was significantly less in study group as compared to control group (2.97 ± 0.70) (p < 0.05). CONCLUSION The present study showed wide intervillous space and thin villous membrane in study group as compared to control group reflecting adaptive changes in response to hypoxiain maternal anaemia.
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Affiliation(s)
- Nazma Kiran
- Department of Pathology, Army Medical College, Rawalpindi, Pakistan.
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18
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Trifonov I, Uzunova J, Gavrilova T. [Ovarian vein thrombophlebitis during pregnancy--with a contribution of one clinical case]. Akush Ginekol (Sofiia) 2014; 53 Suppl 1:43-46. [PMID: 25510042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Ovarian vein thrombosis (OVT) is a rare, but serious condition that affects mostly postpartum women but may also be associated with pelvic inflammatory disease, malignancies and pelvic surgical procedures. Concerning ovarian vein thrombosis in earlier stages of pregnancy there are only very few case reports. The authors consider this rare but potentially deadly disease and describe the clinical case study.
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19
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20
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Skrzypczak J, Jasiński P, Wirstlein P, Goździewicz T, Rajewski M. [Histologic changes in placenta and chorion of women with antiphospholipid syndrome and inherited thrombophilia]. Ginekol Pol 2011; 82:652-663. [PMID: 22379924] [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: 05/31/2023] Open
Abstract
BACKGROUND The aim of the study was a histologic evaluation of placentas and chorions from pregnancies complicated by antiphospholipid syndrome (APS) and inherited thrombophilia in women treated with anticoagulants and in a group of women without the anticoagulant treatment. MATERIAL 24 placentas from 18 patients with acquired and inherited thrombophilia and 23 chorions from 19 miscarriages in women with the same diagnosis were included in the study There were 33 chorions from miscarriages from healthy women and 25 placentas from uneventful pregnancies in the control group. Biopsies from placentas and chorions were stained with eosin and hematoxylin and evaluated for the presence of villous thrombosis, fibrin deposits, intraplacental hematomas, thrombosis in fetal circulation and other histological findings. RESULTS In the placentas from pregnancies complicated with APS and inherited thrombophilia, the presence of fibrin deposits in the basal and villous plate, stasis in the fetal circulation and thrombosis in the villous plate and villous vessels, were statistically more frequent (p < 0,001) comparing with physiological pregnancies. In the material from miscarriages the presence of fibrin deposits was statistically more common (p < 0,001) in women with thrombophilia. The number of physiological findings in placentas of women treated with anticoagulants in pregnancy and in the non-treated ones, whose pregnancies resulted in fetal demise, were not statistically different. CONCLUSIONS 1. Fibrin deposits between villi and villous plate are the most recognizable features in placentas and chorions from APS pregnancies 2. In women with APS impaired trophoblast invasion seems to be the most likely cause of recurrent miscarriages 3. Anticoagulant therapy does not prevent either fibrin deposits collection or other placental changes
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Affiliation(s)
- Jana Skrzypczak
- Klinika Rozrodczości, Katedra Ginekologii, Połoznictwa i Onkologii Ginekologicznej Uniwersytetu Medycznego w Poznaniu, Polska.
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21
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Habek D. Multiple intraplacental hematomas--Kline's hemorrhage. Acta Clin Croat 2011; 50:423-425. [PMID: 22384780] [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: 05/31/2023] Open
Abstract
A rare clinical case of intraplacental intervillous hemorrhage (Kline's hemorrhage) is presented. After delivery of a premature newborn (810 g/35 cm) in 27th week of uncomplicated pregnancy, peripartum observation of the premature placenta (270 g, 16 x 16 x 1.8) suggested multiple intraplacental cavernae with semifluid blood and fresh coagula and fresh marginal (partial) placental abruption. The possible etiologic causes of recent microembolism include thrombophilia, microangiopathy diseases, antiphospholipid syndrome, disseminated intravascular coagulopathy and severe preeclampsia.
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Affiliation(s)
- Dubravko Habek
- University Department of Obstetrics and Gynecology, Sveti Duh University Hospital, Zagreb, Croatia.
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22
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Abstract
Acquired haemophilia A is an auto-immune disease caused by an inhibitory antibody to factor VIII. The pattern of bleeding varies but patients remain at risk of life threatening bleeding until the inhibitor has been eradicated. The cornerstones of management are; rapid and accurate diagnosis, control of bleeding, investigation for an underlying cause and eradication of the inhibitor by immunosuppression. Patients should always be managed jointly with a specialist centre even if they present without significant bleeding. Despite an extensive literature, few controlled data are available and treatment guidelines are based on expert opinion. To treat bleeds recombinant factor VIIa and activated prothrombin complex concentrate are equally efficacious but both are superior to factor VIII or desmopressin. Immunosuppression should be started as soon as the diagnosis is made. Commonly used regimens are steroids alone or combined with cytotoxic agents. Rituximab is being used more widely but current evidence does not suggest that it improves outcomes or reduces side effects.
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Affiliation(s)
- P W Collins
- Arthur Bloom Haemophilia Centre, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
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23
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Nikolov A, Mihova M. [Hyperimmunoglobulin E syndrome (Job's syndrome)]. Akush Ginekol (Sofiia) 2011; 50:55-59. [PMID: 22482162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Job's syndrome (Hyperimmunoglobulin E syndrome) is a rare congenital immune deficiency condition, manifested by local and system changes. A case of successful pregnancy in patient, suffering from this rare disease is presented. The possible complications during the course of pregnancy, delivery and puerperal period and therapeutic alternatives during pregnancy are discussed.
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24
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Barinova IV, Krivova IS, Barabanov VM, Savel'ev SV, Petrukhin VA, Burumkulova FF, Shidlovskaia NV. [Diabetic fetopathy in gravida with autoimmune hemolytic anemia complicated by steroid diabetes]. Arkh Patol 2010; 72:39-40. [PMID: 20369585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The authors made a clinicoanatomic analysis of fetal death in a 32-year-old diabetic gravida at 34-35 weeks gestational age. Fetal autopsy identified the characteristic signs of fetopathy: macrosomy, cardiomegaly, hepatomegaly, and brain weight reduction. Histological analysis revealed minute foci of leukomalacia with glial proliferation in the cerebral hemispheres; adipose and hyaline drop degeneration of cardiomyocytes in the heart, that of hepatocytes in the liver, the proximal renal tubular epithelial cells; hemorrhages in the respiratory portions of the lung. The pancreas displayed inflammation foci, hypertrophy and hyperplasia of the islets of Langerhans. Immunohistochemical studies identified cells with enlarged nuclei among the beta and alpha-cells. The placenta showed a large mass with pronounced changes. It has been demonstrated that steroid diabetes may lead to the development of diabetic fetopathy and placental changes, which are typical of maternal diabetes.
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25
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Lockwood CJ, Paidas M, Murk WK, Kayisli UA, Gopinath A, Huang SJ, Krikun G, Schatz F. Involvement of human decidual cell-expressed tissue factor in uterine hemostasis and abruption. Thromb Res 2009; 124:516-20. [PMID: 19720393 DOI: 10.1016/j.thromres.2009.07.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 07/06/2009] [Accepted: 07/07/2009] [Indexed: 11/15/2022]
Abstract
Vascular injury increases access and binding of plasma-derived factor VII to perivascular cell membrane-bound tissue factor (TF). The resulting TF/VIIa complex promotes hemostasis by cleaving pro-thrombin to thrombin leading to the fibrin clot. In human pregnancy, decidual cell-expressed TF prevents decidual hemorrhage (abruption). During placentation, trophoblasts remodel decidual spiral arteries into high conductance vessels. Shallow trophoblast invasion impedes decidual vascular conversion, producing an inadequate uteroplacental blood flow that elicits abruption-related placental ischemia. Thrombin induces several biological effects via cell surface protease activated receptors. In first trimester human DCs thrombin increases synthesis of sFlt-1, which elicits placental ischemia by impeding angiogenesis-related decidual vascular remodeling. During pregnacy, the fibrillar collagen-rich amnion and choriodecidua extracellular matrix (ECM) provides greater than additive tensile strength and structural integrity. Thrombin acts as an autocrine/paracrine mediator that degrades these ECMs by augmenting decidual cell expression of: 1) matrix metalloproteinases and 2) interleukin-8, a key mediator of abruption-associated decidual infiltration of neutrophils, which express several ECM degrading proteases. Among the cell types at the maternal fetal interface at term, TF expression is highest in decidual cells indicating that this TF meets the hemostatic demands of labor and delivery. TF expression in cultured term decidual cells is enhanced by progestin and thrombin suggesting that the maintenance of elevated circulating progesterone provides hemostatic protection and that abruption-generated thrombin acts in an autocrine/paracrine fashion on decidual cells to promote hemostasis via enhanced TF expression.
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Affiliation(s)
- C J Lockwood
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06520, USA
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26
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Affiliation(s)
- E S Guvendag Guven
- SSK Ankara Women's' Health and Maternity Teaching Hospital, Ankara, Turkey.
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27
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Zhang C, Liang MY, Wang SM. [Clinical analysis of bicytopenia and pancytopenia during pregnancy]. Zhonghua Fu Chan Ke Za Zhi 2009; 44:488-491. [PMID: 19957545] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the diagnosis, management, pregnancy outcome and prognosis of bicytopenia or pancytopenia during pregnancy. METHODS Retrospective chart review was conducted on 24 pregnancies who were found bicytopenia or pancytopenia during pregnancy for the first time. The diagnoses were reconfirmed. The management and pregnancy outcome were collected. And the prognoses were followed. RESULTS According to the clinical data and laboratory findings, the latter including complete blood cell count, reticulocyte count, peripheral smear, serum folate and vitamin B12 level, autoimmune antibody screening, bone marrow smear and biopsy, thirteen patients were diagnosed as having chronic aplastic anemia (CAA), six as having myelodysplastic syndromes (MDS), two as having megaloblastic anemia (MA), one as having paroxysmal nocturnal hemoglobinuria (PNH), one as having Evan's syndrome and one as having acute leukemia. The management basically consisted of supportive transfusions. Six patients suffered pregnancy complications including four with severe preeclampsia (one with intracranial hemorrhage and one with intrauterine death concomitantly) and two with gestational diabetes. The delivery ages of the 21 patients were term or nearly term with all good neonatal outcomes. Postpartum follow-up showed the two patients with MA achieved complete remission, the one with PNH had mild anemia and that with Evan's syndrome had mild thrombocytopenia. The patient with acute leukemia died of recurrence six months postpartum. Of the thirteen patients with CAA, two achieved complete remission, six partial remission, four no remission and one was lost follow-up. Of the 6 patients with MDS, one achieved partial remission, four no remission, and one transformed into acute monocytic leukemia, then refused chemotherapy and was lost follow-up. CONCLUSIONS CAA may be one of the most common causes of bicytopenia or pancytopenia during pregnancy, MDS may be the second. Diagnosis should be made as soon as possible through appropriate and reasonable laboratory examinations. Most patients could achieve good pregnancy outcomes through supportive management. The maternal prognosis may vary widely depending on the causes.
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Affiliation(s)
- Chao Zhang
- Department of Obstetrics, Peking University People's Hospital, Beijing 100044, China
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28
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Christova R, Lisichkov T, Chernev T. [Autoimmune thrombocitopenic purpura in pregnancy]. Akush Ginekol (Sofiia) 2009; 48:42-46. [PMID: 20225496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The author deals with haematologists' and obstetricians' current views on acquired ATP in children and adults, characterised by a transient, acute or chronic decrease in platelets count (<50.109/l) due to premature destruction by the reticuloendothelial system. The most common questions arising in connection with this disease are: what is autoimmune thrombocytopenic purpura; is there any correlation between pregnancy and ATP; what are its symptoms; does pregnancy itself affect the autoimmune disease. If is of utter importance for women with ATP to be aware of the risks these symptoms pose both on the health of the mother and the foetus. Obstetricians and gynaecologists seldom object to pregnancy in women with ATP. Nevertheless, it is essential to point out that additional monitoring and therapy are needed. There is no medical evidence that supports the notion of terminating pregnancy due to ATP. Assessment is made only by an obstetrician, haematologist and pediatrician working in close collaboration. This collaborative work must be present throughout the whole pregnancy, delivery and puerperium. The treatment necessary for women with ATP aims to establish platelet count over 50.000 ppm when approaching the end of pregnancy, preferably between 80.000 ppm - 100.000 ppm taking into account vagina or surgical delivery as well as the administration of anaesthetic. Delivery management must be decided entirely on obstetrics consideration, but not on ATP ones. Pregnant women with ATP must be monitored and treated with caution by a highly specialised medical team.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Adult
- Blood Platelets/pathology
- Delivery, Obstetric
- Female
- Humans
- Platelet Count
- Pregnancy
- Pregnancy Complications, Hematologic/diagnosis
- Pregnancy Complications, Hematologic/drug therapy
- Pregnancy Complications, Hematologic/pathology
- Prognosis
- Purpura, Thrombocytopenic, Idiopathic/diagnosis
- Purpura, Thrombocytopenic, Idiopathic/drug therapy
- Purpura, Thrombocytopenic, Idiopathic/pathology
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29
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Castiglione F, Buccoliero AM, Garbini F, Gheri CF, Mecacci F, Moncini D, Rossi Degl'Innocenti D, Taddei GL. Placental findings in pregnancy-associated haemolytic uremic syndrome: clinicomorphological study of three cases. Pathologica 2008; 100:451-453. [PMID: 19475885] [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: 05/27/2023] Open
Abstract
Acute renal failure occurring in pregnancy or postpartum is often associated with preeclampsia, HELLP syndrome or haemolytic uremic syndrome: differential diagnosis may be difficult due to the overlapping symptoms of these syndromes. We report our experience on diagnosis, management and outcome of women with pregnancy associated haemolytic uremic syndrome, focusing on placental features.
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Affiliation(s)
- F Castiglione
- Department of Human Pathology and Oncology, University of Florence, School of Medicine, Florence, Italy.
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30
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Rathod KB, Jaiswal KN, Shrivastava AC, Shrikhande AV. Study of placenta in sickle cell disorders. INDIAN J PATHOL MICR 2007; 50:698-701. [PMID: 18306531] [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: 05/26/2023] Open
Abstract
Remarkable changes are seen on gross and microscopic examination of placenta of patients with sickle cell disorders, hence the present study was undertaken to find out the pathological changes seen in the placenta of sickle cell disorder patients, as compared to control and to study the effect of maternal sickling on the fetus. It includes total 73 cases, of which 10 were of control group and 63 were from patients with sickle cell disorders, which included 47 sickle cell trait (AS) and 16 sickle cell disease (SS) patients. In group II, 9 (14.28%) patients with SS pattern developed complications during pregnancy, in the form of vaso-occlusive and hemolytic crises. Pregnancy induced hypertension was seen in 4 (25%) out of 16 SS and 11 (23.40%) of the 47 AS patients. Urinary tract infection (UTI) was seen in 6 (37.5%) out of 16 SS and 8 (17.02%) out of 47 AS patients. Placentae in sickle cell disorders showed pathological changes in the form of infarction, calcification, sickled red blood cells and hemorrhage in intervillous spaces, increased syncytial knots, fibrinoid necrosis, stromal fibrosis, hyalinised villi and compensatory proliferation of trophoblastic cells.
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31
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Abstract
A cervical varix during pregnancy is a very rare complication. It can lead to hemorrhage and may result in significant morbidity. Furthermore, appropriate management has not yet been established. We present a case of a cervical varix with placenta previa totalis. A 30-year-old woman with placenta previa totalis also had a cervical varix without bleeding. At 32 weeks' gestation, massive hemorrhage from the cervical varix occurred. A vaginal pack controlled the bleeding, and a cesarean section was subsequently carried out because of uncontrollable uterine contractions. A 1655 g female infant was delivered; the estimated blood loss was 1814 mL. The cervical varix decreased dramatically in size. In conclusion, presented herein is a rare case of a cervical varix, which had a successful outcome.
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Affiliation(s)
- Yukiyo Kumazawa
- Division of Obstetrics and Gynecology, Department of Reproductive and Developmental Medicine, Akita Unviersity School of Medicine, Akita, Japan.
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32
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Hanaoka M, Tsukimori K, Hojo S, Abe Y, Mutou T, Muta K, Iwasa A, Yao T, Nakano H. B-Cell Lymphoma During Pregnancy Associated with Hemophagocytic Syndrome and Placental Involvement. ACTA ACUST UNITED AC 2007; 7:486-90. [PMID: 17875240 DOI: 10.3816/clm.2007.n.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of B-cell lymphoma during pregnancy associated with hemophagocytic syndrome and placental involvement. A 33-year-old Japanese woman developed pancytopenia, hepatosplenomegaly, and a high-grade fever for 2 weeks at 23 weeks of gestation. The demonstration of hemophagocytes in her bone marrow confirmed the diagnosis of hemophagocytic syndrome. She was referred at 25 weeks of gestation for evaluation of hemophagocytic syndrome. The screening for infection and autoimmune disease was negative. Clinical manifestation suggested malignant lymphoma as the underlying cause of hemophagocytic syndrome, but we could not confirm any lymphoma involvement in the bone marrow aspiration. Glucocorticoid therapy did not arrest the hemophagocytic process. Her general status worsened, and reduction of amniotic fluid was noted. At 28 weeks of gestation, we performed a Cesarean section because of fetal distress. Microscopic examination of placental specimen revealed diffuse infiltration of large, atypical lymphoid cells involving the intervillous space. Using immunohistochemical study, we made the diagnosis of B-cell lymphoma. R-CHOP (rituximab/cyclophosphamide/doxorubicin/vincristine/prednisone) chemotherapy was administered on the eighth postpartum day. After 2 cycles of R-CHOP chemotherapy, hematopoiesis became normal and hepatosplenomegaly almost completely disappeared. After 6 cycles of R-CHOP, the patient received autologous peripheral-blood stem cell transplantation, and she is currently in complete remission 1 year after diagnosis. The infant did well, without clinical or laboratory manifestations of malignant lymphoma. In cases with suspected malignancy associated with hemophagocytic syndrome during pregnancy, it is important to verify placental microscopic examination for evaluating the causative disease of hemophagocytic syndrome.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Cesarean Section
- Female
- Fetal Distress/diagnosis
- Fetal Distress/pathology
- Fetal Distress/therapy
- Gestational Age
- Humans
- Lymphohistiocytosis, Hemophagocytic/diagnosis
- Lymphohistiocytosis, Hemophagocytic/pathology
- Lymphohistiocytosis, Hemophagocytic/therapy
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Peripheral Blood Stem Cell Transplantation
- Placenta/pathology
- Pregnancy
- Pregnancy Complications, Hematologic/diagnosis
- Pregnancy Complications, Hematologic/pathology
- Pregnancy Complications, Hematologic/therapy
- Pregnancy Complications, Neoplastic/diagnosis
- Pregnancy Complications, Neoplastic/pathology
- Pregnancy Complications, Neoplastic/therapy
- Transplantation, Autologous
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Affiliation(s)
- Mio Hanaoka
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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33
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Abstract
The purpose of this article is to review the histopathologic findings in the placenta of women with a known thrombophilic mutation. The findings range from normal to severe pathologic features including decidual vasculopathy, placental infarctions, syncytial knotting, maternal floor infarction, fetal thrombotic vasculopathy, vasculitis, and chronic villitis. They are, however, not pathognomonic of thrombophilic states, nor are necessarily markers of perinatal damage. The prospective evaluation of cases with known thrombophilic mutations and the application of tissue microarray examination of the placenta may allow identification of major histopathologic features and molecular parameters associated with maternal and/or fetal thrombophilic states. This may assist clinicians in their consultation with patients and optimize management in future pregnancies.
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Affiliation(s)
- Maria Rosaria Raspollini
- Department of Human Pathology and Oncology, University of Florence School of Medicine, Florence, Italy
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34
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Pavlova TV, Petrukhin VA, Zhiliaeva OD, Nadezhdin SV. [Placental morphology in pregnancy complicated with iron-deficiency anemia]. Arkh Patol 2007; 69:31-2. [PMID: 17642189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Iron-deficiency anemia in pregnant females negatively affects pregnancy, delivery, neonatal infants. Anemia-caused placental changes found during pregnancy are characterized by imbalance between the processes of adaptation and dysadaptation in response to the developed hypoxia in the pregnant-placenta-fetus system and placental tissue ischemia. When iron-deficiency anemia had developed before pregnancy, placental morphological changes show the signs of chronic placental insufficiency. The developed therapy for anaemia with Ferro-Folgama corrects all the elements of the pregnant-placenta-fetus system.
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35
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Hauth EA, Tötsch M, Forsting M. [Thecal fibroma of the ovary in the first trimester of pregnancy]. ROFO-FORTSCHR RONTG 2007; 179:312-4. [PMID: 17325999 DOI: 10.1055/s-2006-927347] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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36
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Abstract
Three patients with pregnancy-induced pancytopenia also exhibited variable features of sideroblastic anemia and amegakaryocytic thrombocytopenia. Treatment with anti-thymocyte globulin proved highly effective in two cases and a spontaneous remission occurred in the third. This illness is distinct from the more commonly reported incidental association of pregnancy with classic aplastic anemia. Its differentiation from myelodysplasia is also emphasized.
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Affiliation(s)
- Ethan A Natelson
- Methodist Academic Medicine Associates, The Methodist Hospital, Houston, Texas 77030, USA.
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37
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Bernathova M, Jaschke W, Pechlahner C, Zelger B, Bodner G. Primary angiosarcoma of the breast associated Kasabach–Merritt syndrome during pregnancy. Breast 2006; 15:255-8. [PMID: 16000250 DOI: 10.1016/j.breast.2005.04.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [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: 10/10/2004] [Revised: 04/10/2005] [Accepted: 04/13/2005] [Indexed: 10/25/2022] Open
Abstract
Primary angiosarcoma of the breast is a rare aggressive tumour of unknown etiology. A frequent clinical presentation is a painful palpable smooth mass or diffuse enlargement of the breast without a palpable mass but with purple discolouration of the overlying skin with apparent bruising. An uncommon clinical presentation of an angiosarcoma is spontaneous bleeding due to disseminated intravascular coagulation (DIC) by consumption coagulopathy, known as the Kasabach-Merritt syndrome. Imaging characteristics of a breast angiosarcoma are limited to a few radiological reports. We report a case of a young pregnant woman with a bleeding angiosarcoma of the breast and associated Kasabach-Merritt syndrome and describe the sonographic and MRI findings.
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Affiliation(s)
- Maria Bernathova
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
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38
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Jarvenpaa J, Pakkila M, Savolainen ER, Perheentupa A, Jarvela I, Ryynanen M. Evaluation of Factor V Leiden, Prothrombin and Methylenetetrahydrofolate Reductase Gene Mutations in Patients with Severe Pregnancy Complications in Northern Finland. Gynecol Obstet Invest 2006; 62:28-32. [PMID: 16514238 DOI: 10.1159/000091814] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [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: 10/10/2005] [Accepted: 01/19/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thrombosis in placenta may lead to severe pregnancy complications. Most important inherited thrombophilias are factor V Leiden mutation, prothrombin mutation, and methylenetetrahydrofolate reductase mutation. The aim of our research was to evaluate the prevalence of inherited thrombophilias in severe pregnancy complications and in normal pregnancies. MATERIAL AND METHODS The study subjects with severe preeclampsia, intrauterine growth restriction, placental abruption or fetal death were collected during the period 1999-2004 from Oulu University Hospital. We also collected during the same period voluntary parturients with normal pregnancy outcome as the control group. FVL, FII, and MTHFR gene mutations of the patients and controls were analyzed. RESULTS We found a significant difference in the prevalence of FVL mutation between the groups. There were 9.5% FVL mutations in the study group compared to 1.8% in the control group; the observed difference between prevalences was 7.7% (95% CI 2.0-13.4). No statistical difference was found in the FII or MTHFR mutations between the groups. All FV and FII mutations were heterozygous and all the MTHFR mutations homozygous. CONCLUSION Women with thrombophilia have a risk for severe pregnancy complications. Randomized controlled trials are needed to assess the influence of low-molecular-weight heparin in pregnant women with thrombophilia.
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Affiliation(s)
- J Jarvenpaa
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
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39
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Abstract
Antiphospholipid syndrome is an autoimmune disorder characterized by the association between antiphospholipid antibodies and venous or arterial thrombosis or obstetric complications. In spite of the recent progresses, many aspects of this disease remain unclear. In this review, we briefly focus on the most important advances in the pathophysiology, diagnosis and treatment of this condition.
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Affiliation(s)
- Massimo Franchini
- Servizio di Immunoematologia e Trasfusione, Azienda Ospedaliera di Verona, Piazzale Ludovico Scuro, 37134 Verona, Italy.
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40
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Affiliation(s)
- Aman Coonar
- Cardiothoracic Surgery, 6th Floor East Wing, Lambeth Palace Road, St. Thomas' Hospital, London SE1 7EH, UK.
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41
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Fietz T, Arnold R, Massenkeil G, Rieger K, Reufi B, Thiel E, Knauf WU. Altered growth characteristics of cord blood cells after in vivo exposure to maternal acute myeloid leukemia and chemotherapy. Acta Haematol 2005; 114:121-4. [PMID: 16103638 DOI: 10.1159/000086588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Accepted: 11/09/2004] [Indexed: 11/19/2022]
MESH Headings
- Adult
- Antigens, CD34/biosynthesis
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Cells, Cultured
- Colony-Forming Units Assay
- Female
- Fetal Blood/cytology
- Granulocyte Precursor Cells/metabolism
- Granulocyte Precursor Cells/pathology
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/physiopathology
- Leukocyte Common Antigens/biosynthesis
- Leukocytes, Mononuclear/cytology
- Leukocytes, Mononuclear/metabolism
- Leukocytes, Mononuclear/pathology
- Maternal Exposure/adverse effects
- Pregnancy
- Pregnancy Complications, Hematologic/pathology
- Pregnancy Complications, Hematologic/physiopathology
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Affiliation(s)
- T Fietz
- Department of Hematology, Oncology and Transfusion Medicine, Campus Benjamin Franklin, Berlin, Germany.
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42
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Abstract
Antiphospholipid syndrome is a distinct disorder with the clinical features of recurrent thrombosis in the venous or arterial circulation and fetal losses. Its serological marker is the presence of antiphospholipid antibodies in the blood of these patients. The relation between the presence of antibodies against anionic phospholipids and thromboembolic complications is well established over the last 25 years but the pathophysiology of the syndrome is largely unclear. Even after all these years, there is a persisting debate about the specificity and sensitivity of the assays for the detection of antiphospholipid antibodies. We now accept that antibodies to beta2-glycoprotein I rather than to anionic phospholipids are the major pathological antibodies, although there is no clear consensus on how the presence of these antibodies correlates with the different clinical manifestations of the syndrome. In this review, we discuss the current methods of detection of the antibodies and our insight into the pathobiology of the syndrome. We propose a mechanism for describing how the presence of anti-beta2-glycoprotein I antibodies relates to the different clinical manifestations observed.
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Affiliation(s)
- P G de Groot
- Department of Haematology, University Medical Center Utrecht, Utrecht, The Netherlands.
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43
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Bose P, Black S, Kadyrov M, Weissenborn U, Neulen J, Regan L, Huppertz B. Heparin and aspirin attenuate placental apoptosis in vitro: implications for early pregnancy failure. Am J Obstet Gynecol 2005; 192:23-30. [PMID: 15671997 DOI: 10.1016/j.ajog.2004.09.029] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Live birth rates are increased by treatment with heparin and aspirin in cases of poor pregnancy outcome such as antiphospholipid syndrome. Both drugs may attenuate miscarriage by inhibiting aberrant coagulation or by modulating trophoblast apoptosis. Here we assessed their roles in trophoblast apoptosis in vitro. STUDY DESIGN BeWo cells and placental villi were cultured in sera from women with successful or failing in vitro fertilization, with and without heparin or aspirin. Apoptosis was assessed by using DNA laddering, cytokeratin 18 neoepitope formation, Bcl-2, and caspase 7 expression. RESULTS In BeWo cells, sera from in vitro fertilization failure increased trophoblast apoptosis, whereas heparin and aspirin reversed these effects. In villous trophoblast, heparin increased Bcl-2 and cytokeratin 18 protein expression. Heparin and aspirin inhibited DNA laddering. CONCLUSION Heparin and aspirin modulate trophoblast apoptosis suggesting a direct impact on trophoblast biology, thus providing an additional mechanism to explain the clinical benefits of heparin and aspirin on recurrent pregnancy loss.
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Affiliation(s)
- Patrick Bose
- Department of Anatomy II, University Hospital RWTH, Aachen, Germany
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44
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Trampont P, Roudier M, Andrea AM, Nomal N, Mignot TM, Leborgne-Samuel Y, Ravion S, Clayton J, Mary D, Elion J, Decastel M. The placental-umbilical unit in sickle cell disease pregnancy: A model for studying in vivo functional adjustments to hypoxia in humans. Hum Pathol 2004; 35:1353-9. [PMID: 15668892 DOI: 10.1016/j.humpath.2004.07.003] [Citation(s) in RCA: 21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The placental-umbilical unit in sickle cell disease (SCD) pregnancy was used to explore hypoxia in vivo, an important factor in the pathophysiology of this disease. Gross examination and microscopic analysis of the placentas, taken immediately after delivery, indicate good concordance between maturity and term as controls, but higher frequency of vascular injuries such as excess syncytial knots, excess fibrin deposits, congestion and villous necroses. Unexpectedly, neither leukocyte recruitment nor alteration in extraplacental membrane was observed, suggesting the absence of inflammation. Additionally, interleukin (IL)-6 and IL-8 concentrations, measured by enzyme-linked immunosorbent assay (ELISA), were similar in the placental maternal blood from controls and SCD. There were also no significant differences found in IL-6 vein blood concentrations between controls and SCD, IL-8 being not detected. Immunostaining of umbilical vein endothelium in SCD pregnancies showed redistribution of PECAM-1 (CD31), von Willebrand factor (vWF), and P-selectin to the cell surface, controls exhibiting the classical pattern. Staining quantification indicated increases in vWF (+36.2%; P=.006) and vascular endothelial growth factor (VEGF) expression (+96.0%; P=.006) over control, but a reduction in endothelial nitric oxide synthase (eNOS) (-45.5%; P=.029). These results document, for the first time, direct functional adjustments in response to hypoxia in human in vivo. The mechanism for these changes has not been clearly established, but it may reflect increased tolerance to SCD hypoxic conditions and hypoxia in general.
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Affiliation(s)
- Paul Trampont
- UMR-S458 INSERM Université des Antilles et de la Guyane, Paris, France
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45
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Abstract
Hypercoagulability leading to placental thrombosis has been implicated in severe pregnancy complications. We compared the perinatal outcome in women with severe preeclampsia, intrauterine growth retardation (IUGR) and severe abruptio placentae and multiple acquired and inherited thrombophilias (study group, n=22) to matched women with similar complications and single thrombophilia (control group, n=22). Gestational age at delivery and birth weight were significantly lower in the study group compared to the control group (p<0.01) and among the study women with severe preeclampsia and IUGR. Severe pregnancy complications may occur earlier during pregnancy and more seriously affect perinatal outcome in women with multiple thrombophilias.
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Affiliation(s)
- Michael J Kupferminc
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
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46
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Abstract
The aim of this study was to test the hypothesis that placental vascular lesions of the fetal circulation are caused by fetal thrombophilic mutations. The study included 64 newborns of women with one or more of the following pregnancy complications: preeclampsia, placental abruption, and intrauterine growth restriction. The most prevalent inherited thrombophilias--factor V Leiden, factor II (prothrombin) G20210A, and homozygosity for methyltetrahydrofolate reductase C677T--were examined in maternal blood and fetal umbilical cord blood. One pathologist reviewed all of the slides for fetal vascular lesions. Associations between fetal thrombotic vasculopathy and fetal thrombophilia were tested for using Fisher's exact test; Z scores and gestational age were compared using the Student t-test. Fetal thrombophilic mutations were diagnosed in 19 of 64 newborns, 15 of whom had coexistent maternal thrombophilia. There was no statistical difference in the prevalence of thrombotic lesions of the fetal circulation between newborns with and without thrombophilia. The combination of maternal and fetal thrombophilia was also not associated with increased fetal vascular lesions. The results indicate that fetal thrombophilia alone, even in the context of maternal underperfusion, is not associated with fetal vascular lesions of the placenta, although it may represent an underlying risk factor for lesions triggered by other process(es).
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Affiliation(s)
- Ilana Ariel
- Department of Pathology, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
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47
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Alkazaleh F, Viero S, Simchen M, Walker M, Smith G, Laskin C, Windrim R, Kingdom J. Ultrasound diagnosis of severe thrombotic placental damage in the second trimester: an observational study. Ultrasound Obstet Gynecol 2004; 23:472-476. [PMID: 15133798 DOI: 10.1002/uog.1044] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To screen women with uteroplacental insufficiency between 18 and 26 weeks' gestation for sonographic evidence of destructive placental lesions, to observe the effect of low molecular-weight heparin (LMWH) in these cases, and to compare the outcome with similar but untreated controls. METHODS We screened 180 women at high risk for placental damage using 16-week maternal serum screening (alpha-fetoprotein and human chorionic gonadotropin), placental shape and texture, and uterine artery Doppler waveforms at the 18-20-week level II examination. Serial gray-scale examinations of placental texture were performed at 22, 24 and 26 weeks. LMWH was offered to women with ultrasound evidence of destructive placental lesions in the absence of intrauterine growth restriction and/or pre-eclampsia. RESULTS We prospectively identified six women (3.3%) with abnormal maternal serum screening and uterine artery Doppler in whom abnormal placental texture (echogenic cystic lesions) suggestive of destructive lesions in the placental parenchyma was found either at the 18-20-week ultrasound examination (n = 4), or by 26 weeks of gestation (n = 2). All six received LMWH and had live births (gestational age at delivery, 33-37 weeks; birth weight, 1000-3200 g). A further 14 women were referred with similar multiparameter evidence of placental damage at or after 26 weeks, outside the screening study. All had significant fetal growth restriction and were therefore not offered heparin. In 9/14 cases there was a perinatal death. Ischemic and/or thrombotic placental pathology was confirmed in each case, but no maternal thrombophilia disorders were identified in the 20 women. CONCLUSIONS Integrated biochemical and ultrasound testing of placental function at 16-20 weeks of gestation, followed by serial placental gray-scale ultrasound, may be an effective method of identifying a subset of pregnancies at high risk of adverse pregnancy outcome due to destructive lesions in the placental parenchyma. This strategy of identifying thrombo-occlusive placental lesions before the development of pregnancy complications may prove useful in the design of trials to study the effectiveness of LMWH in the prevention of clinical complications resulting from thrombo-occlusive placental disease.
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Affiliation(s)
- F Alkazaleh
- Placenta Clinic, Maternal-Fetal Medicine Division, Mount Sinai Hospital, University of Toronto, Ontario, Canada
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48
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Morssink LP, Santema JG, Willemse F. Thrombophilia is not associated with an increase in placental abnormalities in women with intra-uterine fetal death. Acta Obstet Gynecol Scand 2004; 83:348-50. [PMID: 15005781 DOI: 10.1111/j.0001-6349.2004.00388.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to investigate whether women with thrombophilia and intrauterine fetal death have a higher incidence of placental lesions as compared with those without thrombophilia. METHOD In a case-control study comprising 50 women with an obstetrical history of intrauterine fetal death, placental histology comparison was made between those with thrombophilia and those without thrombophilia. RESULTS Of the women who had an intrauterine fetal death, eight (16%) had a thrombophilia factor. There were no differences in birth weight, gestational age and parity or in placental volume and weight between the eight women with and the 42 women without thrombophilia. There was no statistically significant difference between placentas of the women with and those without thrombophilia. CONCLUSION In a group of women who had an obstetrical history of intrauterine fetal death, those with thrombophilia do not have a difference in placental histological lesions compared with the women without a thrombophilia factor. Future thrombophilia research should be focused on placental bed specimens.
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Affiliation(s)
- Leonard P Morssink
- Department of Obstetrics and Gynecology, Medical Center Leeuwarden, the Netherlands.
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49
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Schlembach D, Beinder E, Zingsem J, Wunsiedler U, Beckmann MW, Fischer T. Association of maternal and/or fetal factor V Leiden and G20210A prothrombin mutation with HELLP syndrome and intrauterine growth restriction. Clin Sci (Lond) 2003; 105:279-85. [PMID: 12725641 DOI: 10.1042/cs20030073] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [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: 02/20/2003] [Revised: 04/16/2003] [Accepted: 05/02/2003] [Indexed: 11/17/2022]
Abstract
This study was conducted to investigate the association of maternal and/or fetal factor V Leiden (FVL) and G20210A prothrombin mutation with HELLP syndrome. FVL and G20210A prothrombin mutation were determined using PCR. Sixty-three pregnant women, 36 of them diagnosed with HELLP syndrome, were included in the study. Overall, 68 children were born as a result of these pregnancies and blood sampling was possible in 28 out of 39 children from HELLP patients and 25 out of 29 children from the control women. The prevalence of a maternal FVL was elevated 2-fold in HELLP patients compared with the control women [six out of 36 (16.7%) compared with two out of 27 (7.4%); P =0.282]. None of the HELLP patients and only one woman in the control group was found to be positive for the G20210A prothrombin mutation (P =0.251). The fetal carrier frequency was four out of 28 compared with three out of 25 for FVL (P =0.811), and two out of 28 compared with one out of 25 for G20210A prothrombin mutation (P =0.629). Intrauterine growth restriction (IUGR) was significantly higher in fetuses found to be positive for a thrombophilic mutation (P =0.022). IUGR occurred in seven out of ten fetuses with a thrombophilic mutation compared with 11 out of 43 in fetuses without a mutation. The prevalence of FVL, but not of the G20210A prothrombin mutation, seems to be elevated in women with HELLP syndrome. A fetal thrombophilic mutation does not contribute significantly to the clinical features of the HELLP syndrome. Our results demonstrate a fetal contribution to IUGR. Fetal thrombophilic mutations may lead to placental microthrombosis, which consecutively could lead to a disturbed fetoplacental blood flow and thus cause growth restriction.
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Affiliation(s)
- Dietmar Schlembach
- Department of Obstetrics and Gynaecology, University of Erlangen-Nuremberg, Universitaetsstrasse 21-23, 91054 Erlangen, Germany.
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50
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Abstract
Throughout the last century, there has been a marked decline in obstetric maternal deaths, resulting in an increase in the proportion of nonobstetric deaths among pregnant women. Trauma, in particular, has become a leading cause of maternal death. We report the case of a 20-year-old primigravid woman who was involved in a motor vehicle crash at 36 weeks gestation. The woman developed abruptio placentae, followed by disseminated intravascular coagulation, adult respiratory distress syndrome, and shock, and died the day after the crash. Widespread pulmonary embolization by chorionic villi was identified at autopsy. This report discusses traumatic maternal deaths, with emphasis on the differences in injury pattern observed in pregnant trauma victims in comparison with other adults. It is important that the pathologist be aware of these problems so that an accurate cause of death can be identified in cases of maternal death after trauma. Also discussed is the relationship between trauma and placental abruption and the mechanism of death in the patient. To the authors' knowledge, this is the first reported case of extensive embolism of chorionic villi to the lungs after trauma.
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