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1.
Arch Gynecol Obstet ; 310(1): 615-626, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38642127

RESUMO

Spontaneous previable rupture of membranes complicates approximately 0.4-0.7% of pregnancies and is associated with severe maternal and neonatal morbidity and mortality. Intra-amniotic inflammation is present in up to 94.4% of cases, most often caused by a bacterial infection. In comparison, the effectiveness of antibiotic therapy in its eradication reaches less than 17%. Inflammatory activity in the amniotic cavity disrupts the physiological development of the fetus with an increase in maternal, fetal, and neonatal inflammatory morbidity through the development of fetal inflammatory response syndrome, maternal chorioamnionitis, and neonatal sepsis. Amniopatch is an invasive therapeutic technique based on intra-amniotic administration of maternal hemoderivates in the form of thromboconcentrate and plasma cryoprecipitate to provide the temporary closure of the fetal membranes defect and secondary restitution of normohydramnios with correction of pressure-volume ratios. The supposed basis of this physical-mechanical action is the aggregation of coagulant components of amniopatch in the area of the defect with the formation of a valve cap. The background for the formulation of the hypothesis on the potential anti-infectious and anti-inflammatory action of non-coagulant components of amniopatch involved: i) clinical-academic and publishing outputs of the authors based on their many years' experience with amniopatch application in the treatment of spontaneous previable rupture of membranes (2008-2019), ii) the documented absence of clinically manifested chorioamnionitis in patients treated this way with a simultaneously reduced incidence of neonatal respiratory distress syndrome compared to expectant management (tocolysis, corticotherapy, antibiotic therapy). The non-coagulant components of plasma cryoprecipitate include mainly naturally occurring isohemagglutinins, albumin, and soluble plasma fibrinogen. Although these components of the amniopatch have not been attributed a significant therapeutic role, the authors assume that due to their opsonizing and aggregative properties, they can significantly participate in optimizing the intrauterine environment through the reduction in bacterial and cytokine charge in the amniotic fluid. The authors think these facts constitute a vital stimulus to future research-academic activity and, at the same time, an idea for reconsidering the therapeutic role of amniopatch as a tool for improving perinatal results of spontaneous previable ruptures of membranes.


Assuntos
Corioamnionite , Ruptura Prematura de Membranas Fetais , Fibrinogênio , Humanos , Gravidez , Feminino , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Ruptura Prematura de Membranas Fetais/terapia , Fibrinogênio/uso terapêutico , Corioamnionite/tratamento farmacológico , Anti-Inflamatórios/uso terapêutico , Recém-Nascido , Anti-Infecciosos/uso terapêutico , Fator VIII
2.
Bratisl Lek Listy ; 124(1): 25-28, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36519603

RESUMO

OBJECTIVES: Determining the mean deviation between estimated fetal weight (EFW) measured by ultrasound biometry and the real final birth weight and defining the factors influencing the accuracy of weight estimation. BACKGROUND: Estimated weight of the fetus before birth is valuable information for obstetricians particularlyin choosing the method, management, and timing of delivery. METHODS: The retrospective study analyzed 331 medical records of induced labor between January and June 2021. Fetal weight estimation was calculated using Hadlock formulas. The anamnestic data were obtained from medical records, namely: maternal age, maternal BMI, parity, date of the last ultrasonography (USG) before delivery, fetal presentation, placental location, EFW (including the physician's name performing the measurement, and time of the measurement), gestational age of the fetus, date of birth, fetal gender, neonatal weight and length. The correlations between the weight deviation and other factors were expressed using the Pearson and Phik (Φk) correlation coefficients. The Bland Altman method was used to visualize the correspondence between the two variables. The hypotheses were based on the acquired knowledge and then tested by Mann-Whitney U, Kruskal-Wallis, and ANOVA statistical tests, as required by the hypotheses and input data. RESULTS: The mean EFW in the studied group was 3,459 ± 435 g, and the mean actual birth weight was 3,508 ± 508 g. The mean absolute deviation between monitored weight parameters was 260.27 g. The mean real birth weight was higher compared to EFW by 4.873 g. A significant effect on EFW was observed for the following factors: time interval between sonographic weight estimation and delivery (less than 7 days), high maternal BMI (> 30 kg/m2), maternal age, and neonatal weight and length. The factors of fetal presentation, placental location, amniotic fluid volume, fetal gender, gestational age, parity, or those of examiner did not seem to impact EFW accuracy in our study. CONCLUSION: The time interval between sonographic weight estimation and delivery (shorter than 7 days), maternal BMI over 30 kg/m2, maternal age, neonatal weight and length are all factors significantly associated with the accuracy of ultrasound-based fetal weight estimation (Tab. 2, Ref. 13). Text in PDF www.elis.sk Keywords: ultrasound, biometry, fetal weight estimation.


Assuntos
Peso Fetal , Ultrassonografia Pré-Natal , Recém-Nascido , Feminino , Gravidez , Humanos , Peso ao Nascer , Estudos Retrospectivos , Ultrassonografia Pré-Natal/métodos , Placenta , Idade Gestacional , Ultrassonografia
3.
J Matern Fetal Neonatal Med ; 35(25): 9900-9906, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35513357

RESUMO

OBJECTIVE: To assess the use of amniopatch - intraamniotic application of maternal platelets and cryoprecipitate, in patients after spontaneous previable rupture of membranes (sPPPROM) in terms of its effect on the course and outcome of pregnancy in the largest cohort so far. Since the amniopatch is currently used only to treat patients with iatrogenic preterm rupture of membranes, aim of this study was to find out, if amniopatch could be also used in case of sPPPROM as a safe alternative to currently used expectant management and to compare the results with published data on expectant management. METHODS: The study included 53 patients with single-fetal pregnancy after sPPPROM who underwent amniopatch as an experimental method in the years 2008-2019. Authors evaluated individual characteristics for the whole group as well as a subgroup of live-born neonates who survived to discharge and abortions/live-born infants who did not survive to discharge. RESULTS: The mean time of sPPPROM was 19 + 3 gestational week (gw) and of amniopatch performance 22 + 0 gw. Across the group, the miscarriage rate was 33.96%, survival rate 66.03%, mortality rate after delivery 8.57%, survival rate to discharge 60.37%. The mean time of latency period was 5 + 3 gw in the total group, 7 + 1 gw in the group of live births who survived to discharge. We did not find any maternal/fetal complications related directly to amniopatch procedure. CONCLUSION: Amniopatch is a safe treatment alternative in patients with sPPPROM who require an active approach. It is associated with high percentage of a success rate in terms of duration of pregnancy and neonatal survival. In order to elucidate the possible mechanism of amniopatch effect in sPPPROM despite failure of complete sealing of membrane defect, authors give novel hypothesis of antimicrobial effect of amniopatch based on literature data.


Assuntos
Ruptura Prematura de Membranas Fetais , Gravidez , Recém-Nascido , Feminino , Humanos , Ruptura Prematura de Membranas Fetais/terapia , Ruptura Prematura de Membranas Fetais/etiologia , Plaquetas , Idade Gestacional , Resultado da Gravidez , Estudos Retrospectivos
4.
Bratisl Lek Listy ; 123(5): 326-333, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35420876

RESUMO

OBJECTIVES: To characterize the perinatal outcomes of pregnancies complicated by spontaneous previable premature rupture of membranes with a therapeutic intervention in the form of amniopatch (AP) at the 2nd Department of Obstetrics and Gynecology (2008‒2019). MATERIALS AND METHODS: The retrospective analysis of perinatal markers and early neonatal morbidity of pregnancies treated with amniopatch. Discussion comparison with the published papers of cases of spontaneous previable rupture of membranes managed expectantly. RESULTS: Out of the total number of pregnancies, 53 met the exclusion criteria, of which 35 were terminated by delivering a live newborn, 3 newborns died during the hospitalization. The following incidence of early complications has been reported in live births: 1) Bronchopulmonary dysplasia (10/35-28.57 %), 2) Newborn respiratory distress syndrome (25/35-71.42 %), 3) Neonatal sepsis (15/35-42.85 %), 4) Intraventricular hemorrhage (14/35-40 %), 5) Periventricular leukomalacia (3/35-8.57 %), 6). Necrotizing enterocolitis (2/35-5.71 %), 7) Retinopathy of prematurity (7/35-20 %) and 8) Foetal compression syndrome (16/35-45.71 %). In a discussion comparison with available publications of expectantly managed pregnancies, we observed a statistically significantly lower incidence of respiratory distress syndrome, retinopathy, and chorioamnionitis in our cohort along with a higher incidence of foetal compression defects. CONCLUSION: Amniopatch can be a therapeutic method for reducing the neonatal mortality associated with RDS, maternal infectious morbidity, and an alternative in patients, who require an active approach to such a compromised pregnancy (Tab. 12, Fig. 1, Ref. 50).


Assuntos
Ruptura Prematura de Membranas Fetais , Síndrome do Desconforto Respiratório , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Ruptura Prematura de Membranas Fetais/terapia , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Conduta Expectante
5.
Ginekol Pol ; 93(9): 742-749, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35072241

RESUMO

OBJECTIVES: Processing of available information on TAPS with a focus on the evaluation of the most sensitive and most specific prenatal diagnostic test. MATERIAL AND METHODS: Retrospective analysis of available publications on TAPS with their meta-analytical processing through available electronic medical databases. Evaluation of the most sensitive and specific prenatal diagnostic test with graphical processing of sensitivity and specificity values ​​depending on the TAPS diagnostic criteria used. RESULTS: In total, we found 165 available articles, the oldest from 2007 and the most recent from 2020. Based on the available articles, we evaluated the determination of MCA-PSV with a sensitivity of 83% and a specificity of up to 100% for the currently generally accepted diagnostic criterion TAPS - Delta MCA-PSV > 0.5MoM as the most sensitive and specific method of prenatal diagnosis. CONCLUSIONS: The serial determination of MCA-PSV represents the most sensitive and specific prenatal diagnostic test to date (2020) based on available knowledge. Serial measurement of the MCA-PSV since gestational week 20 every two weeks until delivery represents a potential TAPS screening test for all monochorionic pregnancies. The late, or postnatal diagnosis of TAPS can have serious consequences in the form of intrauterine death of the foetus(es) and increased perinatal mortality and morbidity.


Assuntos
Anemia , Transfusão Feto-Fetal , Policitemia , Anemia/diagnóstico , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Artéria Cerebral Média/diagnóstico por imagem , Policitemia/complicações , Policitemia/diagnóstico , Gravidez , Gravidez de Gêmeos , Diagnóstico Pré-Natal , Estudos Retrospectivos , Gêmeos Monozigóticos , Ultrassonografia Pré-Natal/métodos
6.
Ceska Gynekol ; 86(3): 184-188, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34167311

RESUMO

OBJECTIVE: To describe the case of ectopic pregnancy in the scar after caesarean section and its successful treatment using the technique of sonographically controlled vacuum aspiration. CASE REPORT: The case of a 35-year-old patient with a history of two caesarean sections referred by a district gynecologist in the 6th week of pregnancy with suspected pathological localization of pregnancy in a scar after a previous caesarean section. The procedure for the diagnosis and treatment of ectopic pregnancy in the scar after previous caesarean sections has been successfully resolved using sonographically controlled vaginal vacuum aspiration. CONCLUSION: Caesarean scar pregnancy occurs as a complication of previous caesarean section or other uterine instrumental performances. The use of the sonographically controlled vacuum aspiration technique appears to be a successful method of treating pregnancy in a scar after a caesarean section.


Assuntos
Gravidez Ectópica , Curetagem a Vácuo , Adulto , Cesárea/efeitos adversos , Cicatriz/diagnóstico por imagem , Cicatriz/etiologia , Feminino , Humanos , Gravidez , Gravidez Ectópica/diagnóstico por imagem , Gravidez Ectópica/etiologia , Gravidez Ectópica/terapia , Ultrassonografia de Intervenção , Curetagem a Vácuo/efeitos adversos
7.
Ceska Gynekol ; 86(2): 133-139, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34020562

RESUMO

OBJECTIVE: The aim of this review article is to provide a practical and concise overview of diagnosis and management of pregnancy with fetal lower urinary tract obstruction. METHODS: Review of literature and current studies. CONCLUSION: Proper diagnosis and management of isolated fetal lower urinary tract obstruction with oligohydramnios allows appropriate implementation of intrauterine treatment in indicated cases. The treatment is a prevention of pulmonary hypoplasia and also improves renal function; this  finally contributes to the improvement of overall perinatal morbidity and mortality.


Assuntos
Doenças Fetais , Obstrução Uretral , Feminino , Doenças Fetais/diagnóstico , Humanos , Gravidez , Diagnóstico Pré-Natal , Ultrassonografia Pré-Natal , Obstrução Uretral/diagnóstico , Obstrução Uretral/etiologia , Obstrução Uretral/terapia
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