ABSTRACT
BACKGROUND: Antenatal corticosteroids (ACSs) are recommended to all women at risk for preterm delivery; currently, there is controversy about the subsequent long-term neurocognitive sequelae. This systematic review summarizes the long-term neurodevelopmental outcomes after ACS therapy in animal models. METHODS: An electronic search strategy incorporating MeSH and keywords was performed using all known literature databases and in accordance with PRISMA guidance (PROSPERO CRD42019119663). RESULTS: Of the 669 studies identified, eventually 64 were included. The majority of studies utilized dexamethasone at relative high dosages and primarily involved rodents. There was a high risk of bias, mostly due to lack of randomization, allocation concealment, and blinding. The main outcomes reported on was neuropathological, particularly glucocorticoid receptor expression and neuron densities, and neurobehavior. Overall there was an upregulation of glucocorticoid receptors with lower neuron densities and a dysregulation of the dopaminergic and serotonergic systems. This coincided with various adverse neurobehavioral outcomes. CONCLUSIONS: In animal models, ACSs consistently lead to deleterious long-term neurocognitive effects. This may be due to the specific agents, i.e., dexamethasone, or the repetitive/higher total dosing used. ACS administration varied significantly between studies and there was a high risk of bias. Future research should be standardized in well-characterized models.
Subject(s)
Behavior, Animal/drug effects , Central Nervous System/drug effects , Dexamethasone/administration & dosage , Glucocorticoids/administration & dosage , Models, Animal , Animals , Dexamethasone/pharmacology , Female , Glucocorticoids/pharmacology , Humans , Pregnancy , Premature Birth/prevention & control , Prenatal Exposure Delayed EffectsABSTRACT
OBJECTIVE: We aimed to measure whether website-provided information about congenital diaphragmatic hernia (CDH) and fetal therapy for severe cases provides added value compared with clinical counseling of parents. METHODS: This is a single center study in 102 couples who earlier opted for fetoscopic endoluminal tracheal occlusion (FETO) because of isolated severe CDH. They were asked to fill out an anonymized web-based survey of 12 questions. Then, they were offered access to information on the web pages of the randomized Tracheal Occlusion to Accelerate Lung Growth (TOTAL) trial. One week later, their appreciation was measured again by a second questionnaire. RESULTS: Eighty-two (80%) parents completed the first questionnaire, and 48 (47%) completed the entire survey. Several items became more clear to the parents after reading the website, such as the length of hospital stay (23.2% prior to web information, 60.4% after; P = 0.004), maternal risk, or the requirement of fetal anesthesia for FETO (43.9% resp. 79.2%; P = <0.001). CONCLUSION: Complementing prenatal counseling on CDH and FETO by standardized information via website is perceived by parents as of added value. Maternal risks and the need for fetal medication need more clarification during the verbal counseling prior to prenatal interventions.
Subject(s)
Counseling/methods , Fetoscopy/education , Hernias, Diaphragmatic, Congenital , Information Storage and Retrieval , Internet , Mothers/education , Patient Education as Topic/methods , Adult , Data Collection , Female , Fetal Mortality , Fetoscopy/psychology , Hernia, Diaphragmatic/mortality , Hernia, Diaphragmatic/psychology , Hernia, Diaphragmatic/surgery , Humans , Pregnancy , Severity of Illness Index , Surveys and QuestionnairesSubject(s)
Abnormalities, Multiple/diagnosis , Diseases in Twins/diagnosis , Twins, Monozygotic , Urethra/abnormalities , Abortion, Induced/methods , Adult , Anal Canal/abnormalities , Dilatation, Pathologic/diagnosis , Female , Humans , Male , Pregnancy , Pregnancy Trimester, Second , Ultrasonography, PrenatalABSTRACT
OBJECTIVE: To document a rare case of coexisting endometriosis and mature cystic teratoma in the same ovary. DESIGN: Case report. SETTING: Gynecology unit in a tertiary training and teaching hospital in Cape Town, South Africa. PATIENT(S): A 30-year-old healthy nulligravida woman with a large ovarian tumor. INTERVENTION(S): After a basic examination, a diagnostic and management laparotomy was performed. A unilateral oophorectomy and staging laparotomy were performed. MAIN OUTCOME MEASURE(S): Final diagnosis of a complex ovarian tumor. RESULT(S): Histologic analysis confirmed endometriosis of the pelvis and concomitant compound pathology in the right ovary, which included endometriosis, mature teratoma, and mucinous cystadenoma. CONCLUSION(S): Co-existence of varied pathology in a single organ presents a challenge to the pathologist and the clinician. Accurate clinical (i.e., surgical) assessment and decisive histologic verification forms a critical part in this process. This case of coexisting endometriosis and teratoma in a single ovary is, to our knowledge, only the third case reported in literature.
