ABSTRACT
UNLABELLED: Peripartum cardiomyopathy (PPCM) is a poorly characterized, rare form of cardiomyopathy. The etiology of PPCM is unknown, but viral, autoimmune, and idiopathic causes may contribute. The presentation is similar to other forms of congestive heart failure; the diagnosis of PPCM should not be considered until other causes of cardiac dysfunction are ruled out. Echocardiography is central to diagnosis. Early diagnosis and initiation of treatment are essential to optimize pregnancy outcome. Intensivists and anesthesiologists should be consulted to assist with management in complicated cases. Management of PPCM is essentially supportive. Prognosis is poor, although cardiac transplant is improving prognosis and should be considered when conventional therapy fails. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader will be able to understand the typical presentation of peripartum cardiomyopathy including adverse outcome predictors, to understand how to make the diagnosis of PPCM and how to manage it, and to understand the natural history of the disease.
Subject(s)
Cardiomyopathy, Dilated , Pregnancy Complications, Cardiovascular , Puerperal Disorders , Cardiomyopathy, Dilated/diagnosis , Cardiomyopathy, Dilated/etiology , Cardiomyopathy, Dilated/therapy , Cardiotonic Agents/therapeutic use , Diagnosis, Differential , Female , Heart Transplantation , Humans , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/etiology , Pregnancy Complications, Cardiovascular/therapy , Prognosis , Puerperal Disorders/diagnosis , Puerperal Disorders/etiology , Puerperal Disorders/therapy , Recurrence , Risk Factors , Ventricular Function, Left/physiologyABSTRACT
Sacrococcygeal teratoma is the most common fetal neoplasm, with an incidence of 1 in 40,000 births. Fetuses with this malformation are at risk for significant perinatal morbidity and mortality. We identified nine fetuses with sacrococcygeal teratomas that were diagnosed antenatally and managed at the University of North Carolina Hospitals over a 7-year period. We retrospectively reviewed the charts of mothers and infants and recorded data concerning perinatal and surgical management. Six infants survived the neonatal period. All infants diagnosed after 20 weeks' gestation survived. Fetal hydrops developed in three fetuses, all of whom died. Inadequate ventilation secondary to prematurity was a contributing factor in each lethal case. Diagnosis at an early gestational age, development of fetal hydrops, and premature delivery predicted a poor prognosis. When possible, we recommend that delivery be delayed to allow for fetal development. Stabilization of the infant should be attempted before resection of the teratoma.
Subject(s)
Fetal Diseases/diagnostic imaging , Spinal Neoplasms/diagnostic imaging , Teratoma/diagnostic imaging , Ultrasonography, Prenatal , Female , Fetal Diseases/therapy , Follow-Up Studies , Humans , Hydrops Fetalis/etiology , Infant, Newborn , Male , Pregnancy , Retrospective Studies , Sacrococcygeal Region , Spinal Neoplasms/congenital , Spinal Neoplasms/mortality , Spinal Neoplasms/surgery , Teratoma/congenital , Teratoma/mortality , Teratoma/surgeryABSTRACT
Sacrococcygeal teratoma is the most common fetal neoplasm, with an incidence of 1 in 40,000 births. Fetuses with this malformation are at risk for significant perinatal morbidity and mortality. We identified nine fetuses with sacrococcygeal teratomas that were diagnosed antenatally and managed at the University of North Carolina Hospitals over a 7-year period. We retrospectively reviewed the charts of mothers and infants and recorded data concerning perinatal and surgical management. Six infants survived the neonatal period. All infants diagnosed after 20 weeks' gestation survived. Fetal hydrops developed in three fetuses, all of whom died. Inadequate ventilation secondary to prematurity was a contributing factor in each lethal case. Diagnosis at an early gestational age, development of fetal hydrops, and premature delivery predicted a poor prognosis. When possible, we recommend that delivery be delayed to allow for fetal development. Stabilization of the infant should be attempted before resection of the teratoma.
Subject(s)
Fetal Diseases/diagnostic imaging , Spinal Neoplasms/diagnostic imaging , Spinal Neoplasms/surgery , Teratoma/diagnostic imaging , Teratoma/surgery , Ultrasonography, Prenatal , Female , Fetal Diseases/therapy , Follow-Up Studies , Humans , Infant, Newborn , Male , Pregnancy , Retrospective Studies , Sacrococcygeal Region , Spinal Neoplasms/congenital , Spinal Neoplasms/mortality , Teratoma/congenital , Teratoma/mortalityABSTRACT
Sacrococcygeal teratoma is the most common fetal neoplasm, with an incidence of 1 in 40,000 births. Fetuses with this malformation are at risk for significant perinatal morbidity and mortality. We identified nine fetuses with sacrococcygeal teratomas that were diagnosed antenatally and managed at the University of North Carolina Hospitals over a 7-year period. We reviewed retrospectively the charts of mothers and infants and recorded data concerning perinatal and surgical management. Six infants survived the neonatal period. All infants diagnosed after 20 weeks' gestation survived. Fetal hydrops developed in three fetuses, all of whom died. Inadequate ventilation secondary to prematurity was a contributing factor in each lethal case. Diagnosis at an early gestational age, development of fetal hydrops, and premature delivery predicted a poor prognosis. When possible, we recommend that delivery be delayed to allow for fetal development. Stabilization of the infant should be attempted before resection of the teratoma.
