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Muehlschlegel C, Kyriacou H, Al-Mohammad A, Foster-Davies LA, Simmons-Jones F, Oliver-Williams C. The risk of cardiovascular disease in women after miscarriage, stillbirth, and therapeutic abortion: a protocol for a systematic review and meta-analysis. Syst Rev 2020; 9:234. [PMID: 33028393 PMCID: PMC7542880 DOI: 10.1186/s13643-020-01444-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/31/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death in women, responsible for approximately a third of all female deaths. Pregnancy complications are known to be associated with a greater risk of incident CVD in mothers. However, the relationships between pregnancy loss due to miscarriage, stillbirth, or therapeutic abortion, and future maternal cardiovascular health are under-researched. This study seeks to provide an up-to-date systematic review and meta-analysis of the relationship between these three forms of pregnancy loss and the subsequent development of CVD. METHODS This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist (PRISMA) and the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) Checklist. A systematic search will be undertaken using publications identified in MEDLINE (PubMed), Scopus, Web of Knowledge, the CINAHL Nursing Database, and the Cochrane Library. The eligibility of each publication will be determined by predefined selection criteria. The quality of the included studies will be rated using the Newcastle-Ottawa Scale. Pooled measures of association will be computed using random-effects model meta-analyses. Between-study heterogeneity will be assessed using the I2 statistic and the Cochrane χ2 statistic. Small study effects will be evaluated for meta-analyses with sufficient studies through the use of funnel plots and Egger's test. DISCUSSION The results of this systematic review will discuss the long-term risks of multiple types of cardiovascular disease in women who have experienced miscarriage, stillbirth, and/or therapeutic abortion. It will contribute to the growing field of cardio-obstetrics as the first to consider the full breadth of literature regarding the association between all forms of pregnancy loss and future maternal cardiovascular disease. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number [CRD42020167587].
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Affiliation(s)
| | - Harry Kyriacou
- School of Clinical Medicine, University of Cambridge, Cambridge, England
| | | | | | | | - Clare Oliver-Williams
- Homerton College, University of Cambridge, Cambridge, England
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
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Hosier H, Farhadian SF, Morotti RA, Deshmukh U, Lu-Culligan A, Campbell KH, Yasumoto Y, Vogels CB, Casanovas-Massana A, Vijayakumar P, Geng B, Odio CD, Fournier J, Brito AF, Fauver JR, Liu F, Alpert T, Tal R, Szigeti-Buck K, Perincheri S, Larsen C, Gariepy AM, Aguilar G, Fardelmann KL, Harigopal M, Taylor HS, Pettker CM, Wyllie AL, Cruz CD, Ring AM, Grubaugh ND, Ko AI, Horvath TL, Iwasaki A, Reddy UM, Lipkind HS. SARS-CoV-2 infection of the placenta. J Clin Invest 2020; 130:4947-4953. [PMID: 32573498 PMCID: PMC7456249 DOI: 10.1172/jci139569] [Citation(s) in RCA: 318] [Impact Index Per Article: 79.5] [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] [Received: 04/24/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUNDThe effects of the novel coronavirus disease 2019 (COVID-19) in pregnancy remain relatively unknown. We present a case of second trimester pregnancy with symptomatic COVID-19 complicated by severe preeclampsia and placental abruption.METHODSWe analyzed the placenta for the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through molecular and immunohistochemical assays and by and electron microscopy and measured the maternal antibody response in the blood to this infection.RESULTSSARS-CoV-2 localized predominantly to syncytiotrophoblast cells at the materno-fetal interface of the placenta. Histological examination of the placenta revealed a dense macrophage infiltrate, but no evidence for the vasculopathy typically associated with preeclampsia.CONCLUSIONThis case demonstrates SARS-CoV-2 invasion of the placenta, highlighting the potential for severe morbidity among pregnant women with COVID-19.FUNDINGBeatrice Kleinberg Neuwirth Fund and Fast Grant Emergent Ventures funding from the Mercatus Center at George Mason University. The funding bodies did not have roles in the design of the study or data collection, analysis, and interpretation and played no role in writing the manuscript.
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MESH Headings
- Abortion, Therapeutic
- Abruptio Placentae/etiology
- Abruptio Placentae/pathology
- Abruptio Placentae/virology
- Adult
- Betacoronavirus/genetics
- Betacoronavirus/isolation & purification
- Betacoronavirus/pathogenicity
- COVID-19
- Coronavirus Infections/complications
- Coronavirus Infections/pathology
- Coronavirus Infections/virology
- Female
- Humans
- Microscopy, Electron, Transmission
- Pandemics
- Phylogeny
- Placenta/pathology
- Placenta/virology
- Pneumonia, Viral/complications
- Pneumonia, Viral/pathology
- Pneumonia, Viral/virology
- Pre-Eclampsia/etiology
- Pre-Eclampsia/pathology
- Pre-Eclampsia/virology
- Pregnancy
- Pregnancy Complications, Infectious/etiology
- Pregnancy Complications, Infectious/pathology
- Pregnancy Complications, Infectious/virology
- Pregnancy Trimester, Second
- RNA, Viral/genetics
- RNA, Viral/isolation & purification
- SARS-CoV-2
- Viral Load
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Affiliation(s)
- Hillary Hosier
- Department of Obstetrics, Gynecology, and Reproductive Sciences
| | | | | | - Uma Deshmukh
- Department of Obstetrics, Gynecology, and Reproductive Sciences
| | | | | | - Yuki Yasumoto
- Department of Comparative Medicine, Yale School of Medicine
| | - Chantal B.F. Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and
| | | | | | - Bertie Geng
- Department of Obstetrics, Gynecology, and Reproductive Sciences
| | | | - John Fournier
- Section of Infectious Diseases, Department of Medicine
| | - Anderson F. Brito
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and
| | - Joseph R. Fauver
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and
| | | | - Tara Alpert
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, Connecticut, USA
| | - Reshef Tal
- Department of Obstetrics, Gynecology, and Reproductive Sciences
| | | | | | | | | | | | | | | | - Hugh S. Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences
| | | | - Anne L. Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and
| | - Charles Dela Cruz
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | | | - Nathan D. Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and
| | - Albert I. Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, and
| | | | | | - Uma M. Reddy
- Department of Obstetrics, Gynecology, and Reproductive Sciences
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3
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Huang Y, Osborne D, Sibley CG. Sociodemographic factors associated with attitudes towards abortion in New Zealand. N Z Med J 2019; 132:9-20. [PMID: 31220061] [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: 06/09/2023]
Abstract
AIMS The present study examined the sociodemographic correlates of support for legalised abortion in New Zealand. METHOD Data (N=19,973) were from the 2016/17 New Zealand Attitudes and Values Study, a national longitudinal panel sample of New Zealand adults aged 18 and older. The survey measured support for legalised abortion (a) regardless of the reason and (b) when the woman's life is endangered, as well as (c) focal sociodemographic correlates. RESULTS Our sample expressed moderate-to-high support for legalised abortion regardless of the reason and high support for abortion when the woman's life is endangered. Being religious, living in a more deprived neighbourhood and having more children all correlated negatively with support for both measures of abortion. Men were less supportive of abortion for any reason but did not differ from women's support for legalised abortion when the woman's life is endangered. Furthermore, age correlated negatively with support for abortion for any reason, but positively with support for abortion when a woman's life is endangered. CONCLUSIONS A majority of our respondents expressed high levels of support for legalised abortion. Several sociodemographic factors were significantly associated with support for legalised abortion.
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Affiliation(s)
- Yanshu Huang
- PhD Student, School of Psychology, University of Auckland, Auckland
| | - Danny Osborne
- Associate Professor, School of Psychology, University of Auckland, Auckland
| | - Chris G Sibley
- Professor, School of Psychology, University of Auckland, Auckland
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4
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Modarressi T, Levine MA, Tchou J, Khan AN. Gestational Gigantomastia Complicated by PTHrP-Mediated Hypercalcemia. J Clin Endocrinol Metab 2018; 103:3124-3130. [PMID: 30032172 DOI: 10.1210/jc.2018-01181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/12/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT Gestational gigantomastia is an uncommon condition characterized by abnormal and excessive growth of breast tissue during an otherwise uncomplicated pregnancy. Gestational gigantomastia may be accompanied by hypercalcemia, which in some cases has been associated with elevated serum levels of PTHrP. The source of the PTHrP in these cases has been suggested to be the enlarged breasts. OBJECTIVE To describe the rapid resolution of hypercalcemia and normalization of serum PTHrP after elective termination of pregnancy, indicating that the placenta was the source of the PTHrP. DESIGN A retrospective analysis of clinical and biochemical data over a 2-year interval and review of literature. SETTING An academic medical center. PATIENT A 33-year-old G8P4 female who presented at week 8 of pregnancy with gestational gigantomastia and subsequently developed marked hypercalcemia at week 13. Serum levels of PTH were suppressed but circulating PTHrP was elevated. There was no history of hypercalcemia or significant breast growth during previous pregnancies. INTERVENTION Hypercalcemia was poorly responsive to IV saline, prednisone, calcitonin, and cinacalcet. She requested termination of pregnancy at week 20. RESULTS Serum levels of calcium, PTH, and PTHrP normalized within 48 hours of termination of pregnancy. CONCLUSION The rapid resolution of hypercalcemia after termination of pregnancy, despite persistent gigantomastia, provides evidence for a pathologic role of the placenta in the excess production of PTHrP, possibly through an as yet uncharacterized placenta-breast hormonal axis.
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Affiliation(s)
- Taher Modarressi
- Department of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael A Levine
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Tchou
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amna N Khan
- Department of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Section of Endocrinology, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
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Shepherd L, Marshall MF. Blanket Bans on Therapeutic Abortion and the Responsibilities of Hospitals as Moral Communities. Am J Bioeth 2018; 18:55-57. [PMID: 30040578 DOI: 10.1080/15265161.2018.1478046] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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IMAFUKU HITOMI, MIYAHARA YOSHIYA, EBINA YASUHIKO, YAMADA HIDETO. Ultrasound and MRI Findings of Twin Pregnancies with Complete Hydatidiform Mole and Coexisting Normal Fetus: Two Case Reports. Kobe J Med Sci 2018; 64:E1-E5. [PMID: 30282891 PMCID: PMC6192825] [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] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/15/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Both twin pregnancies with complete hydatidiform mole and coexisting normal fetus (CHMCF) and partial hydatidiform mole can be found in association with a live fetus and a placenta displaying a molar degeneration. Two cases of CHMCF using magnetic resonance imaging (MRI) for a diagnosis are reported. CASE In the first, CHMCF was suspected at 12 weeks of gestation. At 18 weeks of gestation, the existence of molar placenta and a sac separating from fetus and normal placenta was clearly depicted on MRI. At 19 weeks of gestations, she had termination of pregnancy because of a development of gestational trophoblastic neoplasia (GTN) and started chemotherapy. In the second case, CHMCF was suspected at 14 weeks of gestation. MRI demonstrated the existence of molar placenta and a sac separating from fetus and normal placenta. She chose induced abortion and there was no evidence of GTN during the 1 year-follow up period. Pathological examination in both cases was consistent with a complete hydration mole and a coexisting normal female fetus. CONCLUSION MRI was useful for an accurate diagnosis for CHMCF.
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Affiliation(s)
| | | | | | - HIDETO YAMADA
- Phone: +81-78-382-6000, Fax: +81-78-382-6019, E-mail:
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Tintara H, Voradithi P, Choobun T. Effectiveness of celecoxib for pain relief and antipyresis in second trimester medical abortions with misoprostol: a randomized controlled trial. Arch Gynecol Obstet 2018; 297:709-715. [PMID: 29327156 DOI: 10.1007/s00404-018-4653-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 01/04/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effectiveness of celecoxib for pain relief and antipyresis during second trimester abortion using sublingual misoprostol. METHODS Fifty-six pregnant women of gestational age 14-24 weeks were randomly assigned in a double-blind randomized controlled trial to receive 400 mg of celecoxib or placebo just before sublingual administration of misoprostol 400 µg every 6 h. Pain and body temperature (BT) were assessed every 1 h until the abortion or 24 h after the first dose of misoprostol. Pain was assessed using a 10-cm Visual Analog Scale (VAS). BT was measured with an infrared thermometer. RESULTS From January 2016 through September 2016, 28 patients were randomized into each study group. The mean VAS pain score at the completion of the abortion in the celecoxib group was significantly lower than in the placebo group (4.6 ± 2.8 vs. 7.3 ± 2.2) (p = 0.012). But 42.9% of patients in both groups experienced severe pain and needed equivalent amounts of morphine rescue. The overall mean BT in the celecoxib group was significantly lower than in the placebo group [- 0.09 (SD = 0.04)] (p = 0.017). The mean BTs at 1, 2 and 6 h after each repeated dose of misoprostol in the celecoxib group were also significantly lower than in the placebo group. CONCLUSIONS Single-dose 400 mg celecoxib had an inadequate beneficial effect on pain relief but significant antipyretic effect during second trimester abortions using sublingual misoprostol.
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Affiliation(s)
- Hatern Tintara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
| | - Peangpailin Voradithi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
| | - Thanapan Choobun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
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8
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Kníže M, Baraníková Z, Krejčová V, Fait T. Eating disorders in pregnancy. Ceska Gynekol 2018; 83:359-363. [PMID: 30848140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To highlight a problem of eating disorders in pregnancy and the need for interdisciplinary cooperation in these cases. DESIGN Case report. SETTING Department of Gynecology and Obstetrics, 2nd Faculty of Medicine, University hospital Motol, Prague. CASE REPORT We report the course of pregnancy in a 19-year-old woman with an atypical form of mental anorexia. The patient was repeatedly hospitalized for metabolic disruption. The pregnancy was finally terminated at the 27th week of pregnancy for fetal growth restriction of the fetus. CONCLUSION Despite the frequent irregularities of the menstrual cycle in eating disorders, a spontaneous conception is possible. The prognosis of pregnancy is uncertain and may endanger the mother and fetus. Management of pregnant women with eating disorders requires the cooperation of a perinatologist, internist, nutritional therapist, psychiatrist or psychologist.
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9
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Altınöz AE, Eşsizoğlu A, Sercan M, Yiğit D, Yıldız S. Evaluation of the Decision-making Capacity of Two Cases Planning to Undergo Uterine Evacuation. Turk Psikiyatri Derg 2018; 29:69-72. [PMID: 29730877] [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
Psychiatric disorders in the perinatal period can lead to a deterioration in one's judgment and decision-making ability. These disorders may cause sensitive and complex legal and ethical issues relating to psychiatric, obstetric, and neonatal care. Clinicians should ethically respect the autonomy of the individual, but at the same time, they must assess the individual's decision-making process with the use of forensic psychiatric and consultation-liaison psychiatric practice. While the literature related to mental disorders in pregnancy has been increasing, there is limited information regarding the medico-legal and ethical aspects of this topic. Herein, we present two cases who are pregnant and have psychiatric disorders, and we aim to discuss their evaluation process of uterine evacuation.
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Shih YH, Islam T, Hore SK, Sarwar G, Shahriar MH, Yunus M, Graziano JH, Harjes J, Baron JA, Parvez F, Ahsan H, Argos M. Associations between prenatal arsenic exposure with adverse pregnancy outcome and child mortality. Environ Res 2017; 158:456-461. [PMID: 28692928 PMCID: PMC5554459 DOI: 10.1016/j.envres.2017.07.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 07/01/2017] [Accepted: 07/03/2017] [Indexed: 05/19/2023]
Abstract
BACKGROUND Chronic arsenic exposure is a public health concern in many parts of the world, with elevated concentrations in groundwater posing a threat to millions of people. Arsenic is associated with various cancers and an array of chronic diseases; however, the relationship with adverse pregnancy outcomes and child mortality is less established. OBJECTIVES We evaluated associations between individual-level prenatal arsenic exposure with adverse pregnancy outcomes and child mortality in a pregnancy study among 498 women nested in a larger population-based cohort in rural Bangladesh. METHODS Creatinine-adjusted urinary total arsenic concentration, a comprehensive measure of exposure from water, food, and air sources, reflective of the prenatal period was available for participants. Self-reported pregnancy outcomes (livebirth, stillbirth, spontaneous/elective abortion) were ascertained. Generalized estimating equations, accounting for multiple pregnancies of participants, were used to estimate odds ratios and 95% confidence intervals in relation to adverse pregnancy outcomes. Vital status of livebirths was subsequently ascertained through November 2015. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals in relation to child mortality. RESULTS We observed a significant association between prenatal arsenic exposure and the risk of stillbirth (greater than median; adjusted OR = 2.50; 95% CI = 1.04, 6.01). We also observed elevated risk of child mortality (greater than median; adjusted HR = 1.92; 95% CI = 0.78, 4.68) in relation to prenatal arsenic exposure. CONCLUSIONS Prospective studies should continue to evaluate prenatal and early life health effects of arsenic exposure and arsenic remediation strategies for women of child-bearing age.
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Affiliation(s)
- Yu-Hsuan Shih
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, United States
| | | | - Samar Kumar Hore
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Mohammad Yunus
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Joseph H Graziano
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, United States
| | - Judith Harjes
- BioInformatics Service Center, Section of Biostatistics & Epidemiology, Department of Community & Family Medicine, Dartmouth Medical School, Lebanon, NH 03766, United States
| | - John A Baron
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Faruque Parvez
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, United States
| | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, Chicago, IL 60637, United States
| | - Maria Argos
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, United States.
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Friedman D, Lovig L, Halushka M, Clancy RM, Izmirly PM, Buyon JP. No histologic evidence of foetal cardiotoxicity following exposure to maternal hydroxychloroquine. Clin Exp Rheumatol 2017; 35:857-859. [PMID: 28598777 PMCID: PMC5657477] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/28/2017] [Indexed: 06/07/2023]
Abstract
It is currently recommended that hydroxychloroquine (HCQ) be maintained during pregnancy in patients with systemic lupus erythematosus. Recent data suggest that this Toll-like receptor inhibitor may also reduce the recurrence rate of anti-SSA/Ro associated congenital heart block (CHB). This case report describes a unique situation in which a CHB-afflicted, HCQ-exposed pregnancy was electively terminated. The heart did not reveal any characteristic features of cardiotoxicity, providing further evidence supporting the safety of foetal exposure to HCQ.
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Affiliation(s)
| | - Leif Lovig
- Paediatric Cardiology, Children's and Women's Physicians of Westchester LLP, Norwalk, CT, USA
| | - Marc Halushka
- Pathology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Robert M Clancy
- Medicine, Division of Rheumatology, New York University School of Medicine, New York, USA
| | - Peter M Izmirly
- Medicine, Division of Rheumatology, New York University School of Medicine, New York, USA
| | - Jill P Buyon
- Medicine, Division of Rheumatology, New York University School of Medicine, New York, NY, USA.
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Gong W, Liang L, Zheng DG, Zhong RS, Zhu YX, Wen YJ. A case report of fetal malignant immature mediastinal teratoma. CLIN EXP OBSTET GYN 2017; 44:496-498. [PMID: 29949307] [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: 06/08/2023]
Abstract
PURPOSE Fetal immature mediastinal teratoma is a rare disease. The pressure generated by the tumor mass can cause hydrops fetalis, pulmonary hypoplasia, pleural and peritoneal effusion, and polyhydramnios which cause the death of the fetus. Routine prenatal ultrasound has enabled accurate diagnosis. MATERIALS AND METHODS The authors report a 26-year-old patient, gravida 4 para 1, who was referred to this hospital, carrying a fetus with immature mediastinal teratoma. RESULTS At 27 weeks of gestation, a routine prenatal ultrasound suggested the fetus had a mass at the anterior mediastinum, accompanied by pulmonary hypoplasia, pleural and peritoneal effusion, subcutaneous edema of head and chest, and polyhydramnios. After the therapeutic abortion, the gross anatomy confirmed the mediastinal mass. The histological examination showed that the mass was a grade 2 immature teratoma. CONCLUSIONS The mother of the fetus had been exposed to plaster, paint, and paint-thinner in the first trimester of pregnancy, suggesting that these chemical contacts may be one of the causes of the disorder.
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14
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Gupta P, Huria A, Kaur D, Mehra R. Caesarian Scar Pregnancy- a Diagnostic Dilemma. JNMA J Nepal Med Assoc 2016; 54:88-90. [PMID: 27935931] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Caesarean scar pregnancy is one of the rarest forms of ectopic pregnancy. Transvaginal ultrasound and color flow Doppler provides a high diagnostic accuracy. A delay in diagnosis and treatment can lead to uterine rupture, major hemorrhage, hysterectomy and serious maternal morbidity and mortality. Early diagnosis can offer treatment options of avoiding uterine rupture and hemorrhage, thus preserving the uterus and future fertility. Primary health care provider should know about this rare entity, because if diagnosed timely, and referral to specialized centre is done without delay will definitely save maternal morbidity and mortality. Management plan should be individualized. Termination of pregnancy is the treatment of choice in the first trimester. Expectant treatment has a poor prognosis because of risk of rupture. In this case report we aim to discuss the associated diagnostic dilemma, most appropriate methods of diagnosis and management, with their implications in clinical practice.
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Affiliation(s)
- P Gupta
- Department of Gynecology and Obstetrics, Post Graduate Institute of Medical Sciences and Research, ESIC, Basaidarapur, New Delhi,India
| | - A Huria
- Department of Gynecology and Obstetrics, Government Medical College & Hospital, Chandigarh, India
| | - D Kaur
- Department of Gynecology and Obstetrics, Government Medical College & Hospital, Chandigarh, India
| | - R Mehra
- Department of Gynecology and Obstetrics, Post Graduate Institute of Medical Sciences and Research, ESIC, Basaidarapur, New Delhi,India
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Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, Kolenc M, Resman Rus K, Vesnaver Vipotnik T, Fabjan Vodušek V, Vizjak A, Pižem J, Petrovec M, Avšič Županc T. Zika Virus Associated with Microcephaly. N Engl J Med 2016; 374:951-8. [PMID: 26862926 DOI: 10.1056/nejmoa1600651] [Citation(s) in RCA: 1830] [Impact Index Per Article: 228.8] [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: 12/14/2022]
Abstract
A widespread epidemic of Zika virus (ZIKV) infection was reported in 2015 in South and Central America and the Caribbean. A major concern associated with this infection is the apparent increased incidence of microcephaly in fetuses born to mothers infected with ZIKV. In this report, we describe the case of an expectant mother who had a febrile illness with rash at the end of the first trimester of pregnancy while she was living in Brazil. Ultrasonography performed at 29 weeks of gestation revealed microcephaly with calcifications in the fetal brain and placenta. After the mother requested termination of the pregnancy, a fetal autopsy was performed. Micrencephaly (an abnormally small brain) was observed, with almost complete agyria, hydrocephalus, and multifocal dystrophic calcifications in the cortex and subcortical white matter, with associated cortical displacement and mild focal inflammation. ZIKV was found in the fetal brain tissue on reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay, with consistent findings on electron microscopy. The complete genome of ZIKV was recovered from the fetal brain.
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Affiliation(s)
- Jernej Mlakar
- From the Institute of Pathology, Faculty of Medicine (J. Mlakar, M. Popović, J. Mraz, A.V., J.P.), and the Institute of Microbiology and Immunology, Faculty of Medicine (M. Korva, M.P.-P., M. Kolenc, K.R.R., M. Petrovec, T.A.Z.), University of Ljubljana, and the Department of Perinatology, Division of Gynecology and Obstetrics (N.T., V.F.V.), and the Institute of Radiology (T.V.V.), University Medical Center Ljubljana - all in Ljubljana, Slovenia
| | - Misa Korva
- From the Institute of Pathology, Faculty of Medicine (J. Mlakar, M. Popović, J. Mraz, A.V., J.P.), and the Institute of Microbiology and Immunology, Faculty of Medicine (M. Korva, M.P.-P., M. Kolenc, K.R.R., M. Petrovec, T.A.Z.), University of Ljubljana, and the Department of Perinatology, Division of Gynecology and Obstetrics (N.T., V.F.V.), and the Institute of Radiology (T.V.V.), University Medical Center Ljubljana - all in Ljubljana, Slovenia
| | - Nataša Tul
- From the Institute of Pathology, Faculty of Medicine (J. Mlakar, M. Popović, J. Mraz, A.V., J.P.), and the Institute of Microbiology and Immunology, Faculty of Medicine (M. Korva, M.P.-P., M. Kolenc, K.R.R., M. Petrovec, T.A.Z.), University of Ljubljana, and the Department of Perinatology, Division of Gynecology and Obstetrics (N.T., V.F.V.), and the Institute of Radiology (T.V.V.), University Medical Center Ljubljana - all in Ljubljana, Slovenia
| | - Mara Popović
- From the Institute of Pathology, Faculty of Medicine (J. Mlakar, M. Popović, J. Mraz, A.V., J.P.), and the Institute of Microbiology and Immunology, Faculty of Medicine (M. Korva, M.P.-P., M. Kolenc, K.R.R., M. Petrovec, T.A.Z.), University of Ljubljana, and the Department of Perinatology, Division of Gynecology and Obstetrics (N.T., V.F.V.), and the Institute of Radiology (T.V.V.), University Medical Center Ljubljana - all in Ljubljana, Slovenia
| | - Mateja Poljšak-Prijatelj
- From the Institute of Pathology, Faculty of Medicine (J. Mlakar, M. Popović, J. Mraz, A.V., J.P.), and the Institute of Microbiology and Immunology, Faculty of Medicine (M. Korva, M.P.-P., M. Kolenc, K.R.R., M. Petrovec, T.A.Z.), University of Ljubljana, and the Department of Perinatology, Division of Gynecology and Obstetrics (N.T., V.F.V.), and the Institute of Radiology (T.V.V.), University Medical Center Ljubljana - all in Ljubljana, Slovenia
| | - Jerica Mraz
- From the Institute of Pathology, Faculty of Medicine (J. Mlakar, M. Popović, J. Mraz, A.V., J.P.), and the Institute of Microbiology and Immunology, Faculty of Medicine (M. Korva, M.P.-P., M. Kolenc, K.R.R., M. Petrovec, T.A.Z.), University of Ljubljana, and the Department of Perinatology, Division of Gynecology and Obstetrics (N.T., V.F.V.), and the Institute of Radiology (T.V.V.), University Medical Center Ljubljana - all in Ljubljana, Slovenia
| | - Marko Kolenc
- From the Institute of Pathology, Faculty of Medicine (J. Mlakar, M. Popović, J. Mraz, A.V., J.P.), and the Institute of Microbiology and Immunology, Faculty of Medicine (M. Korva, M.P.-P., M. Kolenc, K.R.R., M. Petrovec, T.A.Z.), University of Ljubljana, and the Department of Perinatology, Division of Gynecology and Obstetrics (N.T., V.F.V.), and the Institute of Radiology (T.V.V.), University Medical Center Ljubljana - all in Ljubljana, Slovenia
| | - Katarina Resman Rus
- From the Institute of Pathology, Faculty of Medicine (J. Mlakar, M. Popović, J. Mraz, A.V., J.P.), and the Institute of Microbiology and Immunology, Faculty of Medicine (M. Korva, M.P.-P., M. Kolenc, K.R.R., M. Petrovec, T.A.Z.), University of Ljubljana, and the Department of Perinatology, Division of Gynecology and Obstetrics (N.T., V.F.V.), and the Institute of Radiology (T.V.V.), University Medical Center Ljubljana - all in Ljubljana, Slovenia
| | - Tina Vesnaver Vipotnik
- From the Institute of Pathology, Faculty of Medicine (J. Mlakar, M. Popović, J. Mraz, A.V., J.P.), and the Institute of Microbiology and Immunology, Faculty of Medicine (M. Korva, M.P.-P., M. Kolenc, K.R.R., M. Petrovec, T.A.Z.), University of Ljubljana, and the Department of Perinatology, Division of Gynecology and Obstetrics (N.T., V.F.V.), and the Institute of Radiology (T.V.V.), University Medical Center Ljubljana - all in Ljubljana, Slovenia
| | - Vesna Fabjan Vodušek
- From the Institute of Pathology, Faculty of Medicine (J. Mlakar, M. Popović, J. Mraz, A.V., J.P.), and the Institute of Microbiology and Immunology, Faculty of Medicine (M. Korva, M.P.-P., M. Kolenc, K.R.R., M. Petrovec, T.A.Z.), University of Ljubljana, and the Department of Perinatology, Division of Gynecology and Obstetrics (N.T., V.F.V.), and the Institute of Radiology (T.V.V.), University Medical Center Ljubljana - all in Ljubljana, Slovenia
| | - Alenka Vizjak
- From the Institute of Pathology, Faculty of Medicine (J. Mlakar, M. Popović, J. Mraz, A.V., J.P.), and the Institute of Microbiology and Immunology, Faculty of Medicine (M. Korva, M.P.-P., M. Kolenc, K.R.R., M. Petrovec, T.A.Z.), University of Ljubljana, and the Department of Perinatology, Division of Gynecology and Obstetrics (N.T., V.F.V.), and the Institute of Radiology (T.V.V.), University Medical Center Ljubljana - all in Ljubljana, Slovenia
| | - Jože Pižem
- From the Institute of Pathology, Faculty of Medicine (J. Mlakar, M. Popović, J. Mraz, A.V., J.P.), and the Institute of Microbiology and Immunology, Faculty of Medicine (M. Korva, M.P.-P., M. Kolenc, K.R.R., M. Petrovec, T.A.Z.), University of Ljubljana, and the Department of Perinatology, Division of Gynecology and Obstetrics (N.T., V.F.V.), and the Institute of Radiology (T.V.V.), University Medical Center Ljubljana - all in Ljubljana, Slovenia
| | - Miroslav Petrovec
- From the Institute of Pathology, Faculty of Medicine (J. Mlakar, M. Popović, J. Mraz, A.V., J.P.), and the Institute of Microbiology and Immunology, Faculty of Medicine (M. Korva, M.P.-P., M. Kolenc, K.R.R., M. Petrovec, T.A.Z.), University of Ljubljana, and the Department of Perinatology, Division of Gynecology and Obstetrics (N.T., V.F.V.), and the Institute of Radiology (T.V.V.), University Medical Center Ljubljana - all in Ljubljana, Slovenia
| | - Tatjana Avšič Županc
- From the Institute of Pathology, Faculty of Medicine (J. Mlakar, M. Popović, J. Mraz, A.V., J.P.), and the Institute of Microbiology and Immunology, Faculty of Medicine (M. Korva, M.P.-P., M. Kolenc, K.R.R., M. Petrovec, T.A.Z.), University of Ljubljana, and the Department of Perinatology, Division of Gynecology and Obstetrics (N.T., V.F.V.), and the Institute of Radiology (T.V.V.), University Medical Center Ljubljana - all in Ljubljana, Slovenia
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Khosla D, Rai B, Patel FD, Sreedharanunni S, Dey P, Sharma SC. Primitive neuroectodermal tumor of the uterine cervix diagnosed during pregnancy: a rare case with review of literature. J Obstet Gynaecol Res 2015; 40:878-82. [PMID: 24738134 DOI: 10.1111/jog.12238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Primitive neuroectodermal tumors of the cervix are very rare. A 28-year-old pregnant woman presented with a cervical mass. The tumor was staged as IB2. The biopsy from tumor was suggestive of malignant small round cell tumor. She then underwent termination of pregnancy followed by radical hysterectomy. Based on morphologic and immunohistochemical profile, a diagnosis of peripheral primitive neuroectodermal tumor of the cervix was made. The patient received adjuvant chemotherapy and radiotherapy. The patient is alive and disease-free 33 months post-surgery. The present case highlights the importance of keeping primitive neuroectodermal tumors in the differential diagnosis of small cell neoplasms of the uterine cervix. Pregnancy should not be a barrier to early detection and treatment of this potentially aggressive tumor. The optimal treatment methods have not yet been established because of the rarity of the tumor.
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MESH Headings
- Abortion, Therapeutic
- Adult
- Biopsy
- Cervix Uteri/pathology
- Chemoradiotherapy, Adjuvant
- Diagnosis, Differential
- Early Detection of Cancer
- Female
- Humans
- Hysterectomy
- Neoplasm Staging
- Neuroectodermal Tumors, Primitive, Peripheral/diagnosis
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- Neuroectodermal Tumors, Primitive, Peripheral/surgery
- Neuroectodermal Tumors, Primitive, Peripheral/therapy
- Pregnancy
- Pregnancy Complications, Neoplastic/diagnosis
- Pregnancy Complications, Neoplastic/pathology
- Pregnancy Complications, Neoplastic/surgery
- Pregnancy Complications, Neoplastic/therapy
- Treatment Outcome
- Uterine Cervical Neoplasms/diagnosis
- Uterine Cervical Neoplasms/pathology
- Uterine Cervical Neoplasms/surgery
- Uterine Cervical Neoplasms/therapy
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17
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Gupta K, Venkatesan B, Chandra T, Rajeswari K, Devi TKR. Amniotic band syndrome with sacral agenesis and umbilical cord entrapment: A case report emphasizing the value of evaluation of umbilical cord. J Radiol Case Rep 2015; 9:12-9. [PMID: 25926929 PMCID: PMC4395011 DOI: 10.3941/jrcr.v9i3.2115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Amniotic band syndrome is a rare congenital disorder caused by entrapment of fetal parts by fibrous amniotic bands in utero. The congenital anomalies seen in this syndrome vary widely and defects may be isolated or multiple and do not follow a specific pattern. Asymmetric distribution of defects is the hallmark of this syndrome. The diagnosis is difficult to make on ultrasound and relies on identification of amniotic bands. We report a case of amniotic band syndrome with sacral agenesis diagnosed on routine antenatal ultrasound scan in the second offspring of a recently diagnosed diabetic mother. The associated features were entrapment of umbilical cord, caudal adhesions and lower limb anomalies. Medical termination of pregnancy was done and all the fetal anomalies as well as umbilical cord abnormalities were confirmed. The importance of meticulous scanning to evaluate for amniotic bands and the umbilical cord in addition to the fetal structures is emphasized.
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Affiliation(s)
- Kanika Gupta
- Department of Radiodiagnosis, ESI Medical College and PGIMSR, Chennai, Tamil Nadu, India
| | | | - Tushar Chandra
- Department of Radiology, Medical College of Wisconsin, Milwaukee, USA
| | - Kathiah Rajeswari
- Department of Pathology, ESI Medical College and PGIMSR, Chennai, Tamil Nadu, India
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18
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Sano M, Matsumoto M, Terada H, Wang H, Kurihara Y, Wada N, Yamamoto H, Kira Y, Tachibana D, Koyama M. Increased annexin A2 expression in the placenta of women with acute worsening of preeclampsia. Osaka City Med J 2014; 60:87-93. [PMID: 25803884] [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
BACKGROUND The aims of present study were to investigate the expression of Annexin A2 in the placenta of patients with preeclampsia (PE) and correlate these data with acute worsening of clinical symptoms. METHODS Placentas were collected from uncomplicated normal pregnancies (n = 9), PE cases without emergency termination of pregnancy (group 1, n = 6), and PE cases with acute worsening of symptoms necessitating immediate pregnancy termination (group 2, n = 7). Immunohistochemistry data were analyzed quantitatively, and placental mRNA expression was measured by Real-time PCR. RESULTS Group 2 had a significantly shorter interval between diagnosis and pregnancy termination compared with group 1 (p = 0.002). Birth weight and placental weight in group 2 were significantly lower compared with the normal group (p = 0.006 and p = 0.03, birth weight and placental weight, respectively), whereas there were no differences in gestational age at delivery between the three groups or the severity of high blood pressure and proteinuria between the PE groups. Placental expression of Annexin A2 as determined by immunohistochemistry was significantly higher in both PE groups compared with the uncomplicated pregnancy group (p < 0.001 and p < 0.001, groups 1 and 2, respectively). Placental Annexin A2 mRNA expression was significantly elevated in group 2 compared with the normal group (p = 0.002) but did not change in group 1. CONCLUSIONS This study is the first to demonstrate increased placental Annexin A2 mRNA expression during the acute phase of PE. Immunohistochemical staining of placental Annexin A2 was high, regardless of PE phase. These findings suggest that worsening of PE might alter Annexin A2 expression at the transcription level.
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19
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Montes-Hernández D, López-Franco A, Hernández-Valencia M. [Cornual ectopic pregnancy]. Ginecol Obstet Mex 2014; 82:641-645. [PMID: 25412559] [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
This paper reports the case of a 16-year old patient, with menstrual delay of 9 weeks, with positive pregnancy test, who went to the hospital due to expulsion of organized material, as well as pain colic type in hypogastrium. It was carried out laparotomy, finding ectopic pregnancy in right horn, being carried out miometrial incision and trophoblast aspiration, with presence of multiple endometriosic focuses in later face of uterus. In later pregnancies, there are not studies about the solidity of the scar after the horn resection and uterine breaks have been described in the second and third trimester.
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Van Dijk MG, García-Rojas M, Contreras X, Krumholz A, García SG, Díaz-Olavarrieta C. Treating patients with severe preeclampsia and eclampsia in Oaxaca, Mexico. Salud Publica Mex 2014; 56:426-427. [PMID: 25604285] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
| | | | - Xipatl Contreras
- Mexico Office, Population Council, México, Distrito Federal, México
| | - Abigail Krumholz
- Mexico Office, Population Council, México, Distrito Federal, México
| | - Sandra G García
- Mexico Office, Population Council, México, Distrito Federal, México
| | - Claudia Díaz-Olavarrieta
- Research Center for Health Population, Instituto Nacional de Salud Pública, México, Distrito Federal, México,
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Dominguez F, Moreno-Moya JM, Lozoya T, Romero A, Martínez S, Monterde M, Gurrea M, Ferri B, Núñez MJ, Simón C, Pellicer A. Embryonic miRNA profiles of normal and ectopic pregnancies. PLoS One 2014; 9:e102185. [PMID: 25013942 PMCID: PMC4094496 DOI: 10.1371/journal.pone.0102185] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 11/12/2013] [Accepted: 06/16/2014] [Indexed: 12/27/2022] Open
Abstract
Our objective was to investigate the miRNA profile of embryonic tissues in ectopic pregnancies (EPs) and controlled abortions (voluntary termination of pregnancy; VTOP). Twenty-three patients suffering from tubal EP and twenty-nine patients with a normal ongoing pregnancy scheduled for a VTOP were recruited. Embryonic tissue samples were analyzed by miRNA microarray and further validated by real time PCR. Microarray studies showed that four miRNAs were differentially downregulated (hsa-mir-196b, hsa-mir-30a, hsa-mir-873, and hsa-mir-337-3p) and three upregulated (hsa-mir-1288, hsa-mir-451, and hsa-mir-223) in EP compared to control tissue samples. Hsa-miR-196, hsa-miR-223, and hsa-miR-451 were further validated by real time PCR in a wider population of EP and control samples. We also performed a computational analysis to identify the gene targets and pathways which might be modulated by these three differentially expressed miRNAs. The most significant pathways found were the mucin type O-glycan biosynthesis and the ECM-receptor-interaction pathways. We also checked that the dysregulation of these three miRNAs was able to alter the expression of the gene targets in the embryonic tissues included in these pathways such as GALNT13 and ITGA2 genes. In conclusion, analysis of miRNAs in ectopic and eutopic embryonic tissues shows different expression patterns that could modify pathways which are critical for correct implantation, providing new insights into the understanding of ectopic implantation in humans.
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Affiliation(s)
- Francisco Dominguez
- Fundación IVI, Instituto Universitario IVI, INCLIVA, Valencia, Spain
- INCLIVA Biomedical Research, Valencia, Spain
- * E-mail:
| | | | | | | | | | | | | | | | | | - Carlos Simón
- Fundación IVI, Instituto Universitario IVI, INCLIVA, Valencia, Spain
| | - Antonio Pellicer
- Fundación IVI, Instituto Universitario IVI, INCLIVA, Valencia, Spain
- Hospital Universitario LaFe, Valencia, Spain
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Alonso-Lázaro N, Bustamante-Balén M, Pous-Serrano S, Braithwaite-Flores A, Ponce-Romero M, Argüello-Viudez L, García-Granero E, Pons-Beltrán V. Insertion of self-expanding metal stent for treatment of malignant obstruction in a pregnant woman. Rev Esp Enferm Dig 2014; 106:216-219. [PMID: 25007020] [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: 06/03/2023]
Abstract
Colorectal cancer (CRC) is the second most frequent cancer both in incidence and mortality in women, especially in those over 60 years of age. Diagnosis in women at gestational age is rare, so its incidence during pregnancy is low. However, an increase in its diagnosis is expected during the next years because of the raise in the average age of pregnancy.In most cases, the diagnosis is delayed because symptoms related to CRC can be attributed to pregnancy itself. Up to 30 % of CRC cases may present as an intestinal obstruction. In this situation, the main objective is to solve the clinical emergency in the safest way for mother and fetus, together with performing an accurate diagnostic approach to offer the best possible therapeutic management knowing the limitations and difficulties related to pregnancy. The self-expanding metallic stent (SEMS) can be particularly useful in colon obstruction in a pregnant patient with CRC because it allows solving the acute condition providing time to perform a more accurate staging study and to prepare the patient for surgery, thus reducing both post-surgical morbidity and mortality.We report on the case of a patient who early in the second trimester of pregnancy presented with an acute colonic obstruction due to CRC which was successfully managed with the placement of a self-expanding metal stent.
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23
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Trifonov I, Uzunova J. [Successful full-term pregnancy in the Herlyn-Werner-Wunderlich syndrome: a case report and review of literature]. Akush Ginekol (Sofiia) 2014; 53 Suppl 2:42-45. [PMID: 25510053] [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
Herlyn-Werner-Wunderlich Syndrome results in a doubling of the internal genitalia accompanied by unilateral gynatresia (with hemi-hematokolpos, hemi-hematometra and/or hemi-hematosalpings) and ipsilateral renal agenesis. The authors considered the case of a successful full-term pregnancy in one uterus after pregnancy failure in the other imposed surgical removal of the same.
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Aydin H, Yanik S, Tug E, Ahsen H, Geckinli B, Senol S, Karaman A, Yilmaz F, Boran C. Craniorachischisis, gastroschisis, and a branchial sinus defect: a case report. Genet Couns 2014; 25:237-240. [PMID: 25059025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Boynukalin FK, Baykal C. Prenatal diagnosis of multiple fetal anomalies in naphthalene-addicted pregnant women: a case report. CLIN EXP OBSTET GYN 2014; 41:217-218. [PMID: 24779257] [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: 06/03/2023]
Abstract
BACKGROUND Naphthalene is one of the abused inhalants. It has been associated with acute and chronic health problems. To the authors' knowledge, prenatal exposure to naphthalene has never been discussed in humans. CASE The authors discuss a case of naphthalene-addicted pregnant women with multiple fetal anomalies. At 15 weeks gestation, ultrasound screening demostrated multiple fetal anomalies: anencephaly, scoliosis, diffuse subcutaneous edema, flexion contracture of lower extremities, and hypoplastic left ventricle. Four weeks later obstetrical ultrasonography revealed that there was no fetal cardiac activity. The patient had a medical abortion. CONCLUSION A stronger knowledge basis regarding naphthalene-related fetal anomaly is required to ensure accurate direct link, however the probability of naphthalene-related fetal anomaly must be considered.
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Sonalkar S, Hou MY, Borgatta L. Administration of the etonogestrel contraceptive implant on the day of mifepristone for medical abortion: a pilot study. Contraception 2013; 88:671-3. [PMID: 24028749 DOI: 10.1016/j.contraception.2013.07.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 07/22/2013] [Accepted: 07/24/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We sought to determine satisfaction and continuation rates of the contraceptive implant when placed on the initial visit for first-trimester medical abortion. STUDY DESIGN In this pilot study, we placed the implant within 15 min of mifepristone administration. We assessed satisfaction with implant placement timing, 1-year implant continuation and abortion completion. RESULTS We enrolled 20 participants. Sixteen (80%) returned for follow-up, and all had complete abortion. At 1 year, of 16 participants contacted, 14 (87.5%) were satisfied with implant insertion timing, and 14 (87.5%) continued the implant. CONCLUSIONS Initiation of the contraceptive implant on the initial visit for medical abortion resulted in high satisfaction and continuation rates. IMPLICATIONS This pilot study provides important groundwork for future larger studies to assess initiation of the contraceptive implant on the day of mifepristone for medical abortion.
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Affiliation(s)
- Sarita Sonalkar
- Department of Obstetrics and Gynecology, Boston University Medical Center.
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27
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Neyazi SM. Placenta percreta and uterine rupture at 16 weeks. Saudi Med J 2013; 34:753-756. [PMID: 23860897] [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: 06/02/2023] Open
Abstract
Placenta percreta is a complication of pregnancy with significant morbidity and mortality rates. Spontaneous uterine rupture in early pregnancy due to placenta percreta is rare. We report a case of this life-threatening complication occurring at the sixteenth week of gestation. The patient presented with signs of shock, acute abdomen, and evidence of hemoperitoneum. The pregnancy was viable with a normal ultrasound appearance that created some confusion and there was a dilemma in the diagnosis of this case. Various obstetric and surgical causes were taken into consideration. The patient was taken to the operating room immediately for exploratory laparotomy. She was found to have fundal uterine rupture, which was managed by uterine repair. This patient had prior cesarean section and dilatation and curettage; factors well known to predispose for placenta percreta. Here, we emphasize the importance of a fast decision and surgical intervention to save a patient's life in cases of uterine rupture.
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Affiliation(s)
- Salwa M Neyazi
- Department of Obstetrics and Gynecology, College of Medicine, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
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28
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Hoeltzenbein M, Stieler K, Panse M, Wacker E, Schaefer C. Allopurinol Use during Pregnancy - Outcome of 31 Prospectively Ascertained Cases and a Phenotype Possibly Indicative for Teratogenicity. PLoS One 2013; 8:e66637. [PMID: 23840514 PMCID: PMC3686712 DOI: 10.1371/journal.pone.0066637] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 03/04/2013] [Accepted: 05/08/2013] [Indexed: 11/25/2022] Open
Abstract
Allopurinol is a purine analogue that inhibits xanthine oxidase. It is mainly used for the treatment of hyperuricemia in patients with gout or tumor lysis syndrome. Experience with allopurinol in pregnancy is scarce. In 2011, Kozenko et al. reported on a child with multiple malformations after maternal treatment with allopurinol throughout pregnancy. Possible teratogenicity of allopurinol was proposed due to the similarity of the pattern of malformations in children with mycophenolate embryopathy. A possible common mechanism of both drugs, i.e. disruption of purine synthesis, was discussed. We report on the outcome of 31 prospectively ascertained pregnancies with allopurinol exposure at least during first trimester. Pregnancy outcomes were 2 spontaneous abortions, 2 elective terminations of pregnancy and 27 live born children. The overall rate of major malformations (3.7%) and of spontaneous abortions (cumulative incidence 11%, 95%-CI 3–40) were both within the normal range. However, there was one child with severe malformations including microphthalmia, cleft lip and palate, renal hypoplasia, low-set ears, hearing deficit, bilateral cryptorchidism, and micropenis. The striking similarity of the anomalies in this child and the case described by Kozenko et al. might be considered as a signal for teratogenicity. Thus, we would recommend caution with allopurinol treatment in the first trimester, until further data are available.
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Affiliation(s)
- Maria Hoeltzenbein
- Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy, Charité Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Katja Stieler
- Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mary Panse
- Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Evelin Wacker
- Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christof Schaefer
- Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy, Charité Universitätsmedizin Berlin, Berlin, Germany
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Roux I, Das M, Fernandez H, Deffieux X. Pregnancy after endometrial ablation. A report of three cases. J Reprod Med 2013; 58:173-176. [PMID: 23539888] [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: 06/02/2023]
Abstract
BACKGROUND Pregnancies after endometrial ablation (EA) are rare and are associated with high morbidity, especially in the second and third trimesters. CASE We report 3 cases of pregnancy after EA in which severe complications occurred during the first trimester. The first case concerns an unexpected pregnancy after EA in a 50-year-old woman. Hysterectomy via laparotomy was needed because of heavy bleeding and severe anemia. Pathology showed a complete hydatidiform mole without invasion. Ultrasound-guided in situ methotrexate injection could be a nonsurgical alternative to terminate an intrauterine pregnancy after EA when the pregnancy is located within uterine synechiae, as shown by the second case. The third case presented as an accreta placentation mimicking hyperplastic myometrial invasion in a 46-year-old patient. CONCLUSION Because of the high morbidity of these pregnancies that could still occur after EA, patients need contraception after EA, and concomitant hysteroscopic sterilization should be proposed at the same time.
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Affiliation(s)
- Isabelle Roux
- Department of Obstetrics and Gynecology and Reproductive Medicine, Antoine Beclere Hospital, Clamart, France
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Kirk E, McDonald K, Rees J, Govind A. Intramural ectopic pregnancy: a case and review of the literature. Eur J Obstet Gynecol Reprod Biol 2013; 168:129-33. [PMID: 23375906 DOI: 10.1016/j.ejogrb.2012.12.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/11/2012] [Accepted: 12/13/2012] [Indexed: 12/20/2022]
Abstract
An intramural ectopic is a rare type of ectopic pregnancy in which the gestational sac is implanted within the myometrium, separate from the endometrial cavity and Fallopian tubes. There are only 53 cases in the published literature. We report a case of intramural ectopic pregnancy treated surgically and review the published data on this rare type of ectopic pregnancy, with respect to aetiology, diagnosis and management.
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Affiliation(s)
- Emma Kirk
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, Sterling Way, London N18 1QX, United Kingdom.
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31
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Mghaieth F, Ayari J, Mbarki S, Mizouni H, Sfar E, Mourali MS, Mnif E, Chelli H, Mechmeche R. [Acute myocardial infarction during pregnancy complicated by acute adrenal failure]. Tunis Med 2012; 90:897-898. [PMID: 23247794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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32
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Miloudi N, Gharbi W, Ben Abid S, Bayar R, Arfa N, Khalfallah MT. [Digestive cancer in pregnancy]. Tunis Med 2012; 90:751-752. [PMID: 23096522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Maulard A, Bonneau C, Selleret L, Atallah D, Rouzier R. [Cancer and pregnancy]. Rev Prat 2012; 62:954-959. [PMID: 23236867] [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: 06/01/2023]
Abstract
To diagnose cancer during pregnancy is a terrible event for the patient and her family and a complex situation for physicians. The management of this clinical situation should be as standardized as possible, most similar to management that would be offered without pregnancy. Except in rare cases, termination of pregnancy is not justified by the cancer itself, because it does not improve the prognosis. Hormone therapy, targeted therapy, chemotherapy in the first trimester, and radiotherapy are most of the time contra-indicated. During the 2nd and 3rd trimesters, management will follow the usual recommendations with surgery and chemotherapy. The delivery term depends on the date of discovery of cancer but is beyond 35 weeks of gestation in the majority of cases. It is at best scheduled between the oncologist and obstetrician to minimize fetal or obstetrical risks. A network exists to help physicians and patients: www.cancer-et-grossesse.fr.
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Affiliation(s)
- Amandine Maulard
- Université Pierre-et-Marie-Curie Paris-6, hôpital Tenon, gynécologie-obstétrique et médecine de la reproduction, 75970 Paris Cedex 20, France
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Manjunatha YC, Sonwalkar P. Spontaneous antepartum vesicouterine fistula causing severe oligohydramnios in a patient with a previous cesarean delivery. J Ultrasound Med 2012; 31:1294-1296. [PMID: 22837297 DOI: 10.7863/jum.2012.31.8.1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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de Bennetot M, Rabischong B, Aublet-Cuvelier B, Belard F, Fernandez H, Bouyer J, Canis M, Pouly JL. Fertility after tubal ectopic pregnancy: results of a population-based study. Fertil Steril 2012; 98:1271-6.e1-3. [PMID: 22818285 DOI: 10.1016/j.fertnstert.2012.06.041] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [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: 04/11/2012] [Revised: 06/12/2012] [Accepted: 06/14/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the reproductive outcome after an ectopic pregnancy (EP) based on the type of treatment used, and to identify predictive factors of spontaneous fertility. DESIGN Observational population based-study. SETTING Regional sistry. PATIENT(S) One thousand sixty-four women registered from 1992 to 2008. INTERVENTION(S) Laparoscopic (radical or conservative), or medical treatment. MAIN OUTCOME MEASURE(S) Epidemiologic characteristics, clinical presentation, treatments performed, reproductive outcome, recurrence. RESULT(S) The 24-month cumulative rate of intrauterine pregnancy (IUP) was 67% after salpingectomy, 76% after salpingostomy, and 76% after medical treatment. IUP rate was lower after radical treatment compared with conservative treatments in univariable analysis. In multivariate analysis, IUP rate was significantly lower for patients >35 years old or with history of infertility or tubal disease. For them, IUP rate was significantly higher after conservative treatment compared with salpingectomy. The 2-year cumulative rate of recurrences was 18.5% after salpingostomy or salpingectomy and 25.5% after medical treatment. History of infertility or of previous live birth would be protective, in contrast to history of voluntary termination of pregnancy. CONCLUSION(S) Conservative strategy seems to be preferred, whenever possible, to preserve patients' fertility without increasing the risk of recurrence. The choice between conservative treatments does not rely on subsequent fertility, but more likely on their own indications and therapeutic effectiveness. Risk factors of recurrence could be considered for secondary prevention.
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Affiliation(s)
- Marianne de Bennetot
- Department of Obstetrics and Gynecology, Pôle de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Estaing, Clermont-Ferrand, France
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36
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Kihara M, Usui H, Tanaka H, Inoue H, Matsui H, Shozu M. Complicating preeclampsia as a predictor of poor survival of the fetus in complete hydatidiform mole coexistent with twin fetus. J Reprod Med 2012; 57:325-328. [PMID: 22838249] [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: 06/01/2023]
Abstract
OBJECTIVE To examine whether preeclampsia is a predictive factor for fetal prognosis in complete hydatidiform mole coexistent with twin fetus (CHMCF). STUDY DESIGN We performed a retrospective chart review for 17 cases of definitive CHMCF managed in our hospital between 1991 and 2011. RESULTS Fifteen patients chose expectant management and the remaining 2 selected termination of the pregnancy. During expectant management 6 patients displayed hypertension with proteinuria, representing preeclampsia, by the 2nd trimester (11-24 weeks) and the other 9 did not (nonpreeclamptic). No babies from preeclamptic mothers survived, with 5 intrauterine fetal deaths at 16-29 weeks and 1 neonatal death at 22 weeks. By contrast, 5 babies from 9 nonpreeclamptic mothers (1 preterm delivery at 29 weeks and 4 term deliveries) survived, while 4 pregnancies were lost by spontaneous abortion at 11-19 weeks. Low-risk gestational trophoblastic neoplasia (GTN) eventually occurred in both preeclamptic (4 of 6) and nonpreeclamptic (4 of 11) cases. Complicating preeclampsia correlated significantly with fetal demise and an increasing trend in serum hCG level but not with postmolar GTN. CONCLUSION Complicating preeclampsia predicts poor survival of the fetus, but not subsequent GTN, in CHMCF.
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Affiliation(s)
- Maki Kihara
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
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Li SL, Luo G, Norwitz ER, Wang C, Ouyang S, Wen HX, Xia X, Yao Y. Prenatal diagnosis of diastematomyelia: a case report and review of the literature. J Clin Ultrasound 2012; 40:301-305. [PMID: 21952985 DOI: 10.1002/jcu.20869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 06/21/2011] [Indexed: 05/31/2023]
Abstract
Diastematomyelia is a rare congenital disorder in which the spinal cord is divided longitudinally for part of its length. It can be accurately identified in the prenatal period by detailed sonographic examination of the spine. We report a case of diastematomyelia localized to spinal levels T6-T9 diagnosed prenatally at 31 weeks' gestation and review the existing literature on the diagnosis and management of this condition during pregnancy.
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Affiliation(s)
- Sheng-Li Li
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Affiliated to Southern Medical University, China.
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38
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Wang Y, Ma CH, Qiao J, Chen XN, Liu P. Efficacy of local aspiration in the conservative treatment of live interstitial pregnancy coexisting with live intrauterine pregnancy after in vitro fertilization and embryo transfer. Chin Med J (Engl) 2012; 125:1345-1348. [PMID: 22613613] [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: 06/01/2023] Open
Abstract
BACKGROUND Heterotopic pregnancy (HP) is defined as a pregnancy in which one or more embryos is viably implanted in the uterus while the other is implanted elsewhere as an ectopic pregnancy. The occurrence of HP rises dramatically with the increased use of assisted reproductive technology. HP of interstitial pregnancy is one special situation which needs more concern. Here we evaluate the efficacy of local aspiration and instillation of hyperosmolar glucose in the treatment of live interstitial pregnancy complicated with live intrauterine pregnancy after in vitro fertilization and embryo transfer. METHODS Five female patients were diagnosed with live interstitial pregnancies complicated with intrauterine pregnancies. They were treated with transvaginal ultrasound-guided aspiration of interstitial pregnancy and instillation of hyperosmolar glucose at the Center for Reproductive Medicine of Peking University Third Hospital from January 1st, 2008 to May 30th, 2011. RESULTS Gemmule embryos in all 5 cases were aspirated successfully and there was no abdominal hemorrhage, threatened abortion or infection in any of the cases. The sac of interstitial pregnancy continued to progress after aspiration and stopped growing between 11 to 20 weeks. By the 30th week of pregnancy, 80% of the interstitial masses had disappeared. Four cases have delivered and one is still in on-going pregnancy. All of the four cases underwent cesarean section and there were nothing special detected in the corner of the uterus. CONCLUSION Local aspiration and instillation of hyperosmolar glucose may be an effective way to treat live interstitial pregnancy when coexisting with a live intrauterine pregnancy.
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Affiliation(s)
- Yang Wang
- Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
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39
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Grapsa D, Mavrigiannaki P, Kleanthis C, Hasiakos D, Vitoratos N, Kondi-Pafiti A. Autopsy findings in fetuses with cystic hygroma: a literature review and our center's experience. CLIN EXP OBSTET GYN 2012; 39:369-373. [PMID: 23157047] [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: 06/01/2023]
Abstract
PURPOSE OF INVESTIGATION To report our experience of autopsied cases of fetal cystic hygroma (CH) and discuss the role of fetal autopsy in genetic counseling. METHODS A review of autopsy reports at our institution revealed 18 cases of fetal CH over a 10-year period (from 2000 to 2010). The clinical data, results of cytogenetic analysis and prenatal ultrasound findings were also retrieved and compared to the autopsy findings. RESULTS Fetal death was due to intrauterine death in eight cases, therapeutic abortion in eight cases and spontaneous abortion in two cases. Cytogenetic analysis was available in 12 cases, and the results showed an abnormal karyotype in seven cases (5 cases of Turner syndrome and 2 cases of trisomy 21). The mean size of CH was 5.4 cm. Other malformations or findings suggestive of the cause of fetal death were diagnosed in 10/18 cases (55.6%). The most common autopsy findings were hydrops and central nervous system anomalies. The autopsy findings were in agreement with the prenatal ultrasound findings in 13/18 cases (72.2%), while in five cases (27.8%) additional findings were detected during autopsy. The most common placental abnormalities were infarcts and calcifications. CONCLUSION In addition to prenatal diagnostic studies, fetal autopsy and pathologic examination of fetal and placental tissues may help to establish the exact cause of death and disclose important information as to the presence of various fetal malformations or placental abnormalities.
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Affiliation(s)
- D Grapsa
- Pathology Laboratory 22nd Clinic of Obstetrics and Gynecology, University of Athens, Areteion Hospital, Athens, Greece
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40
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Valeeva RM, Gaĭsin IR, Shilina LV, Vavilkina ZV, Smirnova ES, Nikolaeva NB, Kir'ianov NA. [Cardiac angiosarcoma in a pregnant women]. Kardiologiia 2012; 52:93-95. [PMID: 22839677] [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: 06/01/2023]
Abstract
We present a case of cardiac angiosarcoma in a pregnant women. Clinical manifestations of angiosarcoma were unspecific and progressed rapidly as hemopericardium, cardiac tamponade, heart failure, fever, chest pain. Pregnancy was interrupted at 22-nd week. The patient died in 6 months after appearance of first symptoms.
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41
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Ahonen J, Nuutila M. [HELLP syndrome--severe complication during pregnancy]. Duodecim 2012; 128:569-577. [PMID: 22506319] [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: 05/31/2023]
Abstract
HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is a severe microcirculatory disturbance during pregnancy, associated with pre-eclampsia, but it may occur also without it. In HELLP maternal morbidity and mortality have increased. Typical complications include coagulation disorder, acute respiratory failure, acute renal failure, infections, central nervous system symptoms, hepatic failure and bleeding, and premature ablation of the placenta. The only effective means to treat the syndrome during pregnancy is termination of pregnancy.
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42
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Chávez-Corral DV, Aguilar Torres CR, Levario-Carrillo M, Alcalá-Sánchez I, Fierro-Murga R, Arámbula-Almanza J, García-Mendoza A. [Sirenomelia apus. Case report]. Ginecol Obstet Mex 2011; 79:501-507. [PMID: 21966849] [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: 05/31/2023]
Abstract
We report a case of Sirenomelia. The mother began prenatal care in the second trimester. Transabdominal ultrasound was determined anhydramnios, cardiac abnormalities and lumbosacral spine. We obtained a single fetus of 21 weeks' gestation with fused lower extremities from the hip to finish in a stump without the presence of feet. Heart with transposition of the great vessels, among other birth defects. It was classified as symelia, Apodi apus, monopodio sirenoide, siren ectropodia, type VI. It is important to diagnose early, because it is a serious and deadly disorder.
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43
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Morales García V, Bautista Gómez E, Vásquez Santiago E, Santos Pérez U. [Partial molar pregnancy. A case report and literature review]. Ginecol Obstet Mex 2011; 79:432-435. [PMID: 21966838] [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: 05/31/2023]
Abstract
We report the case of a 17 year old patient with partial molar pregnancy and coexistent live fetus of 13 gestational weeks diagnosed by ultrasound, which required the termination of pregnancy for maternal decompensation.
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Affiliation(s)
- Víctor Morales García
- Servicio de Ginecología, Hospital General Dr. Aurelio Valdivieso, Oaxaca de Juárez, México.
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Owerczuk A, Dabrowski S, Basiński A, Preis K, Zieliński D, Łopaciński T, Raniszewska E. [Primary pulmonary hypertension in pregnancy--a case report]. Ginekol Pol 2011; 82:533-536. [PMID: 21913432] [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
Primary pulmonary arterial hypertension, so called idiopathic pulmonary arterial hypertension (IPAH), is a rare and progressive disease with poor prognosis. Pregnancy in patients with this condition is hazardous and makes the prognosis significantly worse. According to WHO, IPAH is a contraindication to pregnancy because of high risk of maternal death and WHO advises to discuss termination in the event of pregnancy Below we describe a case of a young woman at 16 weeks pregnancy with severe decompensated primary pulmonary hypertension. The patient was admitted to our department because of increasing dyspnoea and swollen legs occurring from 14th week of pregnancy. In the past the patient had been diagnosed with pulmonary hypertension, which had been defined during differential diagnostics as primary pulmonary hypertension. Echocardiographic examination over the last 4 years revealed stable mean pulmonary artery pressure (PAP) of about 50 mmHg. The patient was treated efficiently with sildenafil for the last 2 years, but the therapy was discontinued after finding pregnancy. On admission it was established that pregnancy should be terminated. Other reasons of circulatory decompensation, such as pulmonary embolism, cardiac tamponade or pulmonary diseases, were excluded.
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Affiliation(s)
- Adam Owerczuk
- Kliniczny Oddział Ratunkowy, Uniwersyteckie Centrum Kliniczne, Gdański Uniwersytet Medyczny, Polska.
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Shen O, Rabinowitz R, Yagel S, Avnet H. Omega-shaped anomaly of the umbilical artery: association with chromosome 18q deletion. J Ultrasound Med 2011; 30:581-582. [PMID: 21460161 DOI: 10.7863/jum.2011.30.4.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Madsen BS, Havelund T. [HELLP in the second trimester in a patient with antiphospholipid syndrome]. Ugeskr Laeger 2011; 173:357-358. [PMID: 21276403] [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: 05/30/2023]
Abstract
The syndrome of haemolysis, elevated liver enzymes and low platelets (HELLP) is estimated to occur in 0.01-0.2% of pregnancies and is considered a severe form of preeclampsia. It is associated with considerable risk of maternal and foetal mortality. HELLP syndrome associated with antiphospholipid syndrome is known to occur early in the pregnancy. We report a case of severe HELLP syndrome complicated by multiple hepatic infarctions and portal vein thrombosis in the second trimester in a patient with antiphospholipid syndrome.
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47
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Petrova EV, Nekrasova ES, Voronin DV. [Prenatal ultrasonic diagnosis and pregnancy outcome in cases of fetal cystic hygroma]. Vopr Onkol 2011; 57:517-520. [PMID: 22191246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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48
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Papakonstantinou E, Liapis A, Kairi-Vassilatou E, Iavazzo C, Kleanthis CK, Kondi-Pafiti A. Virilizing ovarian Krukenberg tumor in a 27-year-old pregnant woman. A case report and literature review. EUR J GYNAECOL ONCOL 2011; 32:331-333. [PMID: 21797128] [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]
Abstract
A case is reported of a 27-year-old pregnant woman with ovarian tumors, measuring 12 cm and 11.5 cm in the greatest diameter, discovered during investigation for virilization symptoms. Termination of the pregnancy at the 22nd week of gestation and tumorectomy with both adnexa were performed, with the provisional diagnosis of arrhenoblastoma. Pathological examination of the tumors showed typical Krukenberg neoplasms and subsequent upper GI tract endoscopy revealed a gastric cancer that was excised. The pathological examination revealed a diffuse type gastric adenocarcinoma with signet ring morphology, similar to ovarian tumors. In any case of ovarian tumor with unusual hormonal manifestations, in addition to hormonally active sex cord-stromal neoplasms, metastatic ovarian tumors must be considered as well, especially in cases of bilateral tumors.
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Manolakos E, Peitsidis P, Eleftheriades M, Dedoulis E, Ziegler M, Orru S, Liehr T, Petersen MB. Prenatal detection of full monosomy 21 in a fetus with increased nuchal translucency: molecular cytogenetic analysis and review of the literature. J Obstet Gynaecol Res 2010; 36:435-40. [PMID: 20492403 DOI: 10.1111/j.1447-0756.2009.01140.x] [Citation(s) in RCA: 14] [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] [Indexed: 11/26/2022]
Abstract
Full monosomy 21 is an extremely rare chromosomal disorder. A 38-year-old woman attended a first trimester scan. Ultrasound (U/S) imaging of the fetus at 12 weeks of gestation showed features of increased nuchal translucency measurement (12 mm). Chorionic villi sampling (CVS) was performed after genetic counseling. At 16 weeks of gestation the fetus showed U/S characteristics of severe intrauterine growth restriction, generalized edema and hydrothorax. Cytogenetic examination was performed using quantitative fluorescent polymerase chain reaction analysis, standard Giesma banding and fluorescent in situ hybridization analysis. Non-mosaic full monosomy 21 was detected and the parents opted to terminate the pregnancy. Microsatellite analysis demonstrated maternal origin of the single chromosome. This case represents one of the few cases of prenatally diagnosed full monosomy 21 confirmed only by CVS, in which the parental origin of the single chromosome was determined.
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van Oppenraaij RHF, Nik H, Heathcote L, McPartland JL, Turner MA, Quenby S, Steegers EAP, Exalto N. Compromised chorionic villous vascularization in idiopathic second trimester fetal loss. Early Hum Dev 2010; 86:469-72. [PMID: 20615635 DOI: 10.1016/j.earlhumdev.2010.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 04/09/2010] [Accepted: 06/03/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND For normal fetal growth and development a well-developed chorionic villous vascularization is essential. AIM The aim of this study is to investigate whether idiopathic second trimester fetal loss is associated with an underdeveloped chorionic villous vascularization. METHODS 38 placentas after late miscarriage, classified as idiopathic fetal loss (IFL, n=16) or as fetal loss due to intrauterine infection (IUI, n=22) were collected. After CD34 immunohistochemical staining the villous stromal area, number of villous vessels, vascular area and vascular area density (central, peripheral and total) were measured in randomly selected immature intermediate villi. RESULTS The mean gestational age was 19+4 weeks for the IFL group and 20+6 weeks for the IUI group. After controlling for gestational age, we found no differences in fetal weight, placental weight, villous stromal area, number of vessels and central vascular features. The mean peripheral vascular area and peripheral vascular area density were, after adjusting for gestational age, reduced in the IFL group. CONCLUSION Idiopathic second trimester fetal loss is associated with a reduced peripheral chorionic villous vascularization. We hypothesize that in these cases, placentation is already disturbed in first trimester of pregnancy, leading to a reduced materno-fetal interface in second trimester, thus to early postplacental fetal hypoxia and fetal death.
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Affiliation(s)
- R H F van Oppenraaij
- Department of Obstetrics and Gynecology, Division Obstetrics and Prenatal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
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