RESUMEN
OBJECTIVE: Monochorionic twins treated by fetoscopic laser coagulation (FLC) for twin-twin transfusion syndrome (TTTS) are at increased risk of neurodevelopmental impairment. Our aim was to evaluate the additional value of diffusion-weighted imaging (DWI) over fetal sonography and T2 magnetic resonance imaging (MRI) in the detection of acute ischemic cerebral lesions shortly following FLC. METHODS: This was a prospective cohort study of fetuses with TTTS treated by FLC. All fetuses underwent brain DWI and T2-MRI within 24-96 h after the procedure and a follow-up MRI at 30-32 weeks' gestation. All fetuses also had frequent ultrasound evaluation until delivery. RESULTS: Thirty pregnancies with TTTS were included in the study. Eight resulted in survival of only one twin after the procedure (Group A), while the other 22 pregnancies resulted in the survival of both twins (Group B), as assessed at the time of initial MRI. Two fetuses in Group A and four in Group B had evidence of transient bleeding in the germinal matrix. Three fetuses in Group B and none in Group A had diffuse ischemic changes in the white matter. One fetus died in utero 24 h after MRI. The other two fetuses in Group B demonstrated an acute infarct 24-48 h after the procedure. Subsequent scans at 28-29 and 32 weeks showed brain atrophy compatible with an old infarct. CONCLUSIONS: DWI can demonstrate cerebral damage immediately after FLC. Larger cohorts are needed to determine the role of fetal MRI in the prenatal assessment and follow-up of patients with TTTS.
Asunto(s)
Isquemia Encefálica/diagnóstico , Imagen de Difusión por Resonancia Magnética , Transfusión Feto-Fetal/cirugía , Fetoscopía/métodos , Coagulación con Láser/métodos , Láseres de Estado Sólido/uso terapéutico , Complicaciones Posoperatorias/diagnóstico , Infarto Encefálico/diagnóstico , Infarto Encefálico/diagnóstico por imagen , Infarto Encefálico/etiología , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/etiología , Femenino , Muerte Fetal/etiología , Transfusión Feto-Fetal/complicaciones , Transfusión Feto-Fetal/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Complicaciones Posoperatorias/diagnóstico por imagen , Embarazo , Estudios Prospectivos , Resultado del Tratamiento , Ultrasonografía PrenatalRESUMEN
BACKGROUND AND PURPOSE: Monochorionic twin pregnancies complicated by the IUFD of 1 twin are associated with substantial morbidity to the survivor twin. The aim of this study was to determine whether fetal sonography, T2 MR imaging, and DWI can diagnose acute cerebral lesions in the survivor of an MC twin pregnancy shortly after fetal death of the co-twin. MATERIALS AND METHODS: During the study period (2007-2010) 34 cases of single IUFD were evaluated. Group A included 6 cases complicated by spontaneous IUFD. Group B had 10 cases of fetal death shortly after treatment of severe TTTS. These were compared with group C, with 18 pregnancies treated by selective termination due to severe complications in MC pregnancies. RESULTS: Altogether 9/34 patients had abnormal prenatal cerebral findings. In group A, in 2/6 of pregnancies with spontaneous death, MR imaging showed findings of severe cerebral infarct, while cerebral damage was not evident by sonography. In another case, the surviving fetus was found to be hydropic on sonography, while MR imaging findings were normal. In group B, in 1/10 cases, cerebral infarct was demonstrated only by DWI. In 2 other cases, sonographic findings were normal, but MR imaging showed germinal matrix bleeding. In group C, in 1/18 cases, only DWI showed bilateral cerebral ischemia. In 2 other cases, MR imaging findings suggested germinal matrix bleeding and focal changes in the basal ganglia. In both cases, fetal sonographic findings were normal. CONCLUSIONS: In our study, early manifestations of cerebral ischemia in monochorionic twin pregnancies were better diagnosed with MR imaging, especially with DWI.
Asunto(s)
Isquemia Encefálica/embriología , Isquemia Encefálica/patología , Imagen de Difusión por Resonancia Magnética/métodos , Muerte Fetal/patología , Embarazo Gemelar , Diagnóstico Prenatal/métodos , Femenino , Humanos , Masculino , Embarazo , Reproducibilidad de los Resultados , Medición de Riesgo , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To evaluate pregnancy outcome and ultrasound diagnosis in patients with histologically-confirmed placental chorioangioma. STUDY DESIGN: Placentas with histological diagnosis of chorioangioma were identified and medical charts were reviewed for findings of ultrasound examinations. Pregnancy outcomes were compared with all singleton deliveries without chorioangioma in the same time period. MAIN OUTCOME MEASURES: Primary outcome was Neonatal Intensive Care Unit admission rate. Secondary outcome was ultrasound detection rate of chorioangioma. RESULTS: Among 14,725 singleton deliveries, 23 placentas were diagnosed with chorioangioma (0.16%). The control group included all singleton deliveries without chorioangioma (n = 14702). Neonates in the study group were more likely to be admitted to the Neonatal Intensive Care Unit (OR = 4.45) and to have smaller birth weight (p = 0.006). Only 2 of 7 larger chorioangiomas (≥ 2 cm) with available ultrasound reports were identified by ultrasound (29% detection rate). All cases demonstrated normal fetal growth and wellbeing. CONCLUSION: Chorioangiomas are not always identified by routine prenatal sonography. Even in the absence of ultrasonic abnormalities, neonatal morbidity, as measured by NICU admission rate, is increased.
Asunto(s)
Hemangioma/diagnóstico por imagen , Enfermedades Placentarias/diagnóstico por imagen , Complicaciones Neoplásicas del Embarazo/diagnóstico por imagen , Ultrasonografía Prenatal , Adulto , Peso al Nacer , Femenino , Hemangioma/diagnóstico , Hemangioma/patología , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Placenta/diagnóstico por imagen , Enfermedades Placentarias/diagnóstico , Enfermedades Placentarias/patología , Embarazo , Complicaciones Neoplásicas del Embarazo/patología , Resultado del Embarazo , Estudios RetrospectivosRESUMEN
OBJECTIVE: The placenta weight/birthweight (PW/BW) ratio has been shown to be associated with certain long-term fetal outcomes; however, its association with short-term outcomes has not received much attention. Our aim was to assess the correlation between the PW/BW ratio and short-term adverse obstetrics outcomes in full-term, appropriate-for-gestational-age (AGA) newborns. DESIGN: Retrospective cohort study analysis using data from the McGill Obstetrical and Neonatal Database. SETTING: McGill University Health Centre in Montreal Canada. POPULATION: AGA neonates. METHODS: Three groups of full-term AGA neonates were created, according to their PW/BW ratio (high, normal and low), to be compared. Our primary outcome was the admission rate to the neonatal intensive care unit (NICU), and secondary outcomes included an Apgar score < 7 at 5 minutes, cord PH < 7.0, cord base excess (BE) ≤ 12, respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), occurrence of apnoea episodes, breech presentation at delivery, caesarean section rate and status in discharge home. A logistic regression model was instituted to investigate the predictors for adverse obstetrics outcomes. MAIN OUTCOME MEASURE: Admission to the NICU. RESULTS: Compared with the group with normal PW/BW ratios, the high PW/BW ratio group was associated with increased rates of admission to the NICU, of Apgar scores < 7 at 5 minutes, of breech presentation and caesarean section. On the contrary, the low PW/BW ratio group showed decreased rates of NICU admission, breech presentation and caesarean section. CONCLUSIONS: A high PW/BW ratio is significantly correlated with short-term adverse perinatal outcomes. This ratio may be used as a new and simple warning sign to predict the possibility of short-term health risks for newborns.
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Peso al Nacer/fisiología , Placenta/anatomía & histología , Adulto , Puntaje de Apgar , Presentación de Nalgas , Cesárea/estadística & datos numéricos , Cuidados Críticos/estadística & datos numéricos , Conducto Arterioso Permeable/etiología , Femenino , Edad Gestacional , Humanos , Concentración de Iones de Hidrógeno , Recién Nacido , Masculino , Tamaño de los Órganos , Mortalidad Perinatal , Embarazo , Resultado del Embarazo , Síndrome de Dificultad Respiratoria del Recién Nacido/etiología , Estudios Retrospectivos , Nacimiento a Término/fisiologíaRESUMEN
OBJECTIVE: To establish updated placental percentile nomograms in a large North American population for singleton and twin gestations for the use of researchers and clinicians. STUDY DESIGN: Data was extracted from our computerized registry; McGill Obstetrics and Neonatal Database (MOND). The registry includes all the obstetrical data on all deliveries at the McGill University, including placental weight, placental pathologies, maternal and perinatal complications. 20,635 singleton deliveries and 527 twin deliveries were included. Placental weight, gestational age at delivery, birth weight and gender were retrieved. Tables and figures for the 3rd,10th,25th, 50th, 75th 90th, and 97th percentile of placental weight by gestational age, placental weight by birth weight and placental to birth weight ratio by gestational age were produced. RESULTS: Tables and figures are presented for placental percentiles curves according to gestational age, gestational weight and gender for singleton and twin deliveries. In addition, tables and figures are presented for the ratio of placental weight to birth weight. CONCLUSIONS: Population percentile curves have been produced for placental weight and for the ratio of placental weight to birth weight to for singleton and twin deliveries.
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Placentación , Embarazo Múltiple , Estudios Transversales , Parto Obstétrico , Femenino , Desarrollo Fetal/fisiología , Edad Gestacional , Gráficos de Crecimiento , Humanos , Recién Nacido , Masculino , Nomogramas , Tamaño de los Órganos , Placenta/anatomía & histología , Embarazo , Embarazo Múltiple/fisiología , GemelosRESUMEN
BACKGROUND: Chemotherapy destroys primordial follicles and can lead to ovarian atrophy. Although reports indicate that apoptosis is the mechanism responsible for follicle loss, additional pathways can be involved. This study investigates the damage in human ovaries after administration of non-sterilizing doses of chemotherapy. METHODS: In a blind study, pathological changes in ovarian tissue harvested for cryopreservation were evaluated. The study group comprised young non-sterile cancer patients, previously exposed to chemotherapy who were (mean +/- SD), when compared with non-exposed patients. RESULTS: Thirty-five cancer patients aged 28.7 +/- 6.74; 17 were previously exposed to non-sterilizing chemotherapy and 18 were not. In all samples, primordial follicles were present. In previously exposed patients, damage to cortical blood vessel and proliferation of small vessels was observed. The cortex showed focal areas of fibrosis with disappearance of follicles (sensitivity 76%, positive predictive value 75% for <37 years old patients). Older patients, not exposed to chemotherapy (5/7) showed similar pathological changes. CONCLUSIONS: Injury to blood vessels and focal ovarian cortical fibrosis are aspects of ovarian damage caused by chemotherapy. These findings indicate a potential additional mechanism of damage to the direct apoptotic effect of chemotherapy on follicles. The possibility that these changes are involved in ageing ovaries should be further investigated.
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Antineoplásicos/efectos adversos , Neoplasias/tratamiento farmacológico , Ovario/patología , Adulto , Antineoplásicos/uso terapéutico , Vasos Sanguíneos/efectos de los fármacos , Vasos Sanguíneos/patología , Femenino , Fibrosis , Humanos , Ovario/irrigación sanguínea , Ovario/efectos de los fármacosRESUMEN
Vitamin B6 is often prescribed for the treatment of nausea and vomiting of pregnancy (NVP), at much higher doses than initially recommended. Large doses of vitamin B6 have been associated with cases of neuropathy. We set out to assess whether higher than standard doses of vitamin B6 during the first trimester of pregnancy were associated with a risk of maternal adverse events, major malformations, miscarriages or low birth weight. This was a prospective comparative observational study. The study group included women who were exposed to >50 mg/day of vitamin B6 during the first trimester; the control group included pregnant women with a non-teratogen exposure. A total of 192 pregnancies were followed-up. The mean dose of B6 used in the study group was 132.3 mg/day (median 110 mg/day, range 50 - 510 mg/day), for a mean period of 9 +/- 4.2 weeks. In this group (n = 96), there were 91 live births, one major malformation and the mean birth weight was 3,542 +/- 512 g. There were no statistical differences in the study endpoints between the vitamin B6 and the control groups. Within the limits of our sample size, higher than standard doses of vitamin B6 do not appear to be associated with an increased risk for major malformations.
Asunto(s)
Antieméticos/administración & dosificación , Resultado del Embarazo , Vitamina B 6/administración & dosificación , Adulto , Antieméticos/efectos adversos , Peso al Nacer , Femenino , Humanos , Embarazo , Primer Trimestre del Embarazo , Vitamina B 6/efectos adversosRESUMEN
Adequate ovarian response, essential for successful IVF, cannot be accurately predicted. This study retrospectively reviewed all patients undergoing IVF from 1998 to 2001. Inclusion criteria were age <41 years at treatment onset and a basal day 3 serum FSH concentration <12 IU/l. Women with FSH
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Hormona Folículo Estimulante/sangre , Infertilidad Femenina/terapia , Hormona Luteinizante/sangre , Inducción de la Ovulación/métodos , Índice de Embarazo , Adulto , Biomarcadores/sangre , Estudios de Cohortes , Estradiol/sangre , Femenino , Humanos , Infertilidad Femenina/sangre , Valor Predictivo de las Pruebas , Embarazo , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
QUESTION: I read in a Motherisk Update that angiotensin-converting enzyme (ACE) inhibitors are contraindicated during pregnancy. Many women, however, do not know they are pregnant for quite some time after conception. One of my patients was taking ACE inhibitors for 3 to 4 months while she was pregnant. How should I advise her? ANSWER: The deleterious effects ACE inhibitors have on fetuses were seen only after exposure during the second and third trimesters and were mostly secondary to renal damage. These effects can be reversed, as described in this Motherisk Update.
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Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Oligohidramnios/inducido químicamente , Efectos Tardíos de la Exposición Prenatal/prevención & control , Ramipril/efectos adversos , Adulto , Femenino , Humanos , Recién Nacido , Embarazo , Segundo Trimestre del EmbarazoRESUMEN
UNLABELLED: The main aim of this study was to assess the obstetric complications for those pregnancies that are complicated by ovarian hyperstimulation syndrome (OHSS) and continue beyond the first trimester. We checked also for other related serious events that occurred during the first trimester. METHODS: We included only patients whose pregnancies continued beyond the first trimester and compared them with IVF-treated patients displaying moderate ovarian response. RESULTS: We studied 165 patients with OHSS (101 singletons and 64 twins) and 156 IVF control patients (85 singletons and 71 twins). Two serious complications, gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH), were noted in both groups. However, the incidence of these two complications did not differ significantly between the groups. In the OHSS group, GDM presented with an incidence of 9.9% for singletons and 9.4% for twins, and 12.9% and 7.0%, respectively, for the control group. PIH presented as 6.9% for singletons and 10.9% for twins in the OHSS group, and 8.2% and 7.0%, respectively, for the control groups. During the first trimester laparoscopies for suspected ovarian torsion were performed in 13 patients, and in 10 patients the diagnosis were confirmed. CONCLUSIONS: Although patients with OHSS-complicated pregnancies previously reported a relatively high risk of GDM and PIH, the occurrence rates do not differ from a matched control group of normally responding patients who conceived after IVF.
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Síndrome de Hiperestimulación Ovárica/complicaciones , Síndrome de Hiperestimulación Ovárica/epidemiología , Complicaciones del Embarazo/epidemiología , Resultado del Embarazo , Adulto , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Embarazo , Primer Trimestre del Embarazo , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Factores de Riesgo , GemelosRESUMEN
P-450 aromatase inhibitors, designed for suppressing estradiol production, were first approved for the treatment of advanced breast cancer. Recent studies have provided evidence that aromatase inhibitors may be effective in the short term for induction of ovulation and in the long-term for treatment of endometriosis. Based on current data, the role of aromatase inhibitors in the management of various gynecological conditions may soon be widely determined.
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Inhibidores de la Aromatasa/uso terapéutico , Enfermedades de los Genitales Femeninos/tratamiento farmacológico , Endometriosis/tratamiento farmacológico , Antagonistas de Estrógenos/uso terapéutico , Femenino , Humanos , Inducción de la OvulaciónRESUMEN
Group B Streptococcus (GBS) is a common inhabitant of the maternal genital and gastrointestinal tracts, and colonizes approximately 20% of pregnant women. About 50% of infants born to colonized women will become colonized at birth. Early onset GBS disease affects 5/1000 newborns, and is related to a 5-16% mortality rate and severe morbidity. Selective intra-partum chemoprophylaxis can prevent most cases of GBS early-onset disease. In 1996, the federal Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recommended either a culture-based or risk-based approach for prevention of early onset GBS disease. Understanding the epidemiology of the disease and comparing efficacy of the two prevention strategies may elucidate the dispute surrounding this issue. Accordingly, new recommendations from the CDC and the ACOG were published, and their implementation in Israel should now be considered.