RESUMO
Hematologic conditions in reproductive-age women can complicate pregnancy and the neonatal period. Affected pregnancies have a higher risk of severe morbidity and mortality. Coagulation factor changes that occur in the normal state of pregnancy can delay detection and recognition of a bleeding disorder in cases without an apparent bleeding history, thus hindering the appropriate management during gestation and the neonatal period. In addition, unique maternal immunologic changes occur during pregnancy, which are meant to protect the fetus who shares paternal antigens. Rarely, derangement of the maternal immune system may result in alloimmunization against fetal platelet antigens, leading to the development of fetal and/or neonatal thrombocytopenia. Bleeding and platelet disorders pose significant risk of intracranial hemorrhage for the fetus and newborn that is associated with significant morbidity and mortality. We discuss contemporary diagnosis and management of rare bleeding and platelet disorders in pregnancy and their effect on the neonatal period.
Assuntos
Doenças do Recém-Nascido , Complicações Hematológicas na Gravidez/epidemiologia , Trombocitopenia , Feminino , Feto , Hemorragia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/terapia , Gravidez , Cuidado Pré-Natal , Trombocitopenia/diagnóstico , Trombocitopenia/terapiaAssuntos
Frequência Cardíaca Fetal/efeitos dos fármacos , Doenças do Recém-Nascido/induzido quimicamente , Trabalho de Parto Induzido , Sulfato de Magnésio/administração & dosagem , Complicações na Gravidez , Tocolíticos/administração & dosagem , Adulto , Cardiotocografia , Feminino , Humanos , Recém-Nascido , Sulfato de Magnésio/efeitos adversos , Complicações do Trabalho de Parto/tratamento farmacológico , Guias de Prática Clínica como Assunto/normas , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico , Tocolíticos/efeitos adversosAssuntos
Cardiotocografia/normas , Retardo do Crescimento Fetal/diagnóstico , Frequência Cardíaca Fetal , National Institute of Child Health and Human Development (U.S.)/normas , Complicações do Trabalho de Parto/diagnóstico , Feminino , Frequência Cardíaca Fetal/fisiologia , Humanos , Recém-Nascido , Gravidez , Estados UnidosAssuntos
Cardiotocografia/normas , Ruptura Uterina/diagnóstico , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Ruptura Uterina/cirurgiaAssuntos
Cardiotocografia , Frequência Cardíaca Fetal , Desaceleração , Feminino , Humanos , GravidezAssuntos
Acrocefalossindactilia/diagnóstico por imagem , Ossos Faciais/anormalidades , Ossos Faciais/diagnóstico por imagem , Crânio/anormalidades , Crânio/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adulto , Diagnóstico Precoce , Feminino , Humanos , Medição da Translucência Nucal , GravidezRESUMO
OBJECTIVE: The purpose of this study was to determine the incidence of trisomy 18 in women who are <35 years old and who have sonographically detected isolated choroid plexus cyst. STUDY DESIGN: A meta-analysis of prospective trials that were published in the English language between 1990 and 2000 was performed. Each trial met the following inclusion criteria: (1) prospective trial, (2) total population screened during the study period reported, (3) maternal age (either numeric or descriptive) reported, and (4) pregnancy/neonatal outcomes reported. An isolated choroid plexus cyst for the purpose of this study was defined as absence of sonographically detected structural abnormalities and normal serum analyte screens, if reported. RESULTS: Eight trials met the criteria and were used for analysis. A total of 106,732 women were screened through articles that were published between 1990 and 2000. The total number of fetuses with choroid plexus cysts that were identified in second-trimester scans were 1,235 (incidence, 1.2%). The incidence of isolated choroid plexus cysts in women who were <35 years old was 1.0% (n = 1,017 women). There were no cases of trisomy 18 in women with isolated choroid plexus cyst who were <35 years old. Four structural abnormalities were noted on postnatal examination; all four neonates had normal karyotypes. CONCLUSION: There is no evidence that detection of isolated choroid plexus cyst in women who are <35 years of age increases the risk of trisomy 18. Therefore, amniocentesis is not warranted because of the inherent risk of pregnancy loss that is associated with the procedure. Better algorithms are needed to screen women who have a low risk for trisomy 18.