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1.
Taiwan J Obstet Gynecol ; 63(2): 234-237, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38485321

RESUMO

OBJECTIVE: With the development of diagnostic imaging, a new clinical entity called reversible cerebral vasoconstriction syndrome (RCVS), which is considered to be a cause of secondary headache, has emerged. We herein present two cases of RCVS with different patterns of clinical progression. CASE REPORT: Case 1 occurred during labor, whereas case 2 occurred after delivery. Neither case presnted thunderclap headache at the onset of symptoms. Hypertensive disorders of pregnancy did not occur during the pregnancy or the puerperium in either case. Neurological symptoms following mild headache (Case 1: coma; Case 2: paralysis of the right extremities) were observed. CONCLUSION: Even when a patient has no risk factors for RCVS and had no severe headache, it is important not to miss any of the neurological symptoms. Magnetic resonance imaging (MRI) strongly supports the diagnosis, even during pregnancy. In addition, the diagnosis should always be reviewed while excluding eclampsia.


Assuntos
Transtornos Cerebrovasculares , Vasoconstrição , Gravidez , Feminino , Humanos , Imageamento por Ressonância Magnética , Período Pós-Parto , Cefaleia
2.
Neonatology ; 118(3): 310-316, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33744873

RESUMO

INTRODUCTION: We aimed to evaluate the risk factors for mortality and neurodevelopmental impairment (NDI) among infants of 22-23 weeks' gestational age, which currently remain unclear. METHODS: This retrospective case-control study included 104 infants delivered at 22-23 weeks' gestation at Kagoshima City Hospital from 2006 to 2015. We compared 65 and 34 cases of survival to discharge and postnatal in-hospital death (5 excluded), respectively, and 26 and 35 cases with and without NDI, respectively, using maternal, prenatal, and postnatal records. A high rate of survivors' follow-up (61/65) was achieved in this study. RESULTS: The survival rate was 75.0% (21/28) and 62.0% (44/71) among infants born at 22 and 23 weeks' gestation, respectively. Infants who died weighed less (525.5 vs. 578 g, p = 0.04) and their intrauterine growth retardation (IUGR) rate (<5th percentile) was higher (14.7 vs. 1.5%, p = 0.02). Mortality was associated with an increased incidence of bradycardia on fetal heart rate monitoring (11.8 vs. 1.5%, p = 0.046), periventricular hemorrhagic infarction (PVHI; 32.4 vs. 6.2%, p = 0.001), necrotizing enterocolitis (NEC, surgery or drain tube; 14.7 vs. 0.0%, p = 0.004), and tension pneumothorax (29.4 vs. 6.2%, p = 0.004). There were significant differences in the proportion of PVHI (15.4 vs. 0%, p = 0.03) between infants with and without NDI. CONCLUSIONS: IUGR, bradycardia, PVHI, NEC, and tension pneumothorax were associated with neonatal mortality among infants born at 22-23 weeks' gestation. NDI at 36-42 months' chronological age was associated with PVHI.


Assuntos
Mortalidade Infantil , Doenças do Prematuro , Estudos de Casos e Controles , Feminino , Idade Gestacional , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Gravidez , Estudos Retrospectivos , Fatores de Risco
3.
Pediatr Int ; 63(4): 415-422, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32688450

RESUMO

BACKGROUND: In Japan, 44.3% of neonates are delivered in private clinics without an attending pediatrician. Obstetricians in the clinics must resuscitate asphyxiated neonates in unstable condition, such as respiratory failure, and they are frequently transferred to tertiary perinatal medical centers. There has been no study comparing the physiological status and prognosis of neonates transported by ambulance with those transported by helicopter. METHODS: Medical and transport records were used to compare the physiological status of neonates transported to Kagoshima City Hospital by land and those transported by air between January 1, 2013, and December 31, 2017. RESULTS: Data from 425 neonates transferred by land and 143 by air were analyzed. There were no significant differences between the two groups in mean gestational age, mean birthweight, fetal blood pH, Apgar score, or the Score for Neonatal Acute Physiology with Perinatal Extension-II (SNAPPE-II) on arrival to the tertiary center (16.3 ± 15.4 [95% confidence interval (CI): 13.2-17.7] vs 16.4 ± 15.4 [95% CI: 13.9-19.0], respectively; P = 0.999); both groups had SNAPPE-II score 10-19, indicating no difference in mortality risk. The times to starting first aid and to admission to the intensive care unit were significantly reduced in neonates transported by air than by land. In subgroup analysis of patients of a gestational age ≤28 weeks, all cases of severe intraventricular hemorrhage (IVH) were observed in the land transportation group. CONCLUSIONS: Neonatal transportation by air is as safe as land transportation, and time to first aid and intensive care are significantly reduced by transportation by air than by land. Air transport could also contribute to the prevention of IVH in neonatal transportation.


Assuntos
Ambulâncias , Hemorragia Cerebral , Índice de Apgar , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Gravidez , Transporte de Pacientes
4.
J Obstet Gynaecol Res ; 46(11): 2383-2389, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32924259

RESUMO

AIM: Periventricular leukomalacia (PVL) is an important cause of cerebral palsy in premature infants, and cystic PVL is the most serious form of the disease. The risk factors for cystic PVL in singleton fetuses at a gestational age of <35 weeks are unclear. METHODS: This study included 2013 singleton birth infants delivered at a gestational age of <35 weeks in Kagoshima City Hospital between 2006 and 2017. The findings for 30 infants with cystic PVL were compared with those for 63 matched control infants by gestational age and birth weight. RESULTS: The cystic PVL was associated with increased incidence of recurrent late deceleration (L/D) (43.4% vs. 15.9%, P = 0.004) and loss of variability (LOV) (10.0% vs. 0.0%, P = 0.03) in fetal heart rate monitoring and late-onset circulatory dysfunction (LCD) (33.3% vs. 11.1%, P = 0.02). Logistic regression analysis revealed that recurrent L/D (odds ratio [OR] = 3.57, 95% confidence interval [CI]: 1.29-10.15, P = 0.01) and LCD (OR = 3.41, 95% CI: 1.09-11.04, P = 0.03) were risk factors associated with cystic PVL. LOV was not included in the multivariate analysis as there were too few cases in both the cystic PVL and control groups. CONCLUSION: Recurrent L/D, LOV and LCD are strongly associated with cystic PVL. In cases of fetal acidosis related to recurrent L/D or loss of variability, cystic PVL may occur.


Assuntos
Leucomalácia Periventricular , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Leucomalácia Periventricular/epidemiologia , Gravidez , Fatores de Risco
5.
J Obstet Gynaecol Res ; 46(10): 2027-2035, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32779268

RESUMO

AIMS: Magnesium sulfate has neuroprotective effects in preterm infants. Whether other antepartum treatments interfere with the neuroprotective actions is not well known. This study aims to explore the impacts of antenatal administration of Magnesium sulfate or beta-2 adrenergic agonists as tocolytic agents on the developing brain in premature infants. METHODS: This is a retrospective cohort study in four tertiary perinatal centers in Japan. We collected data of pregnant women and infants born between 28 and 36 weeks for tocolytic agents, gestational age, sex, antenatal corticosteroid, fetal growth restriction, pathological chorioamnionitis, low umbilical arterial pH values (<7.1), multiple pregnancy, mode of delivery and institutions after excluding clinical chorioamnionitis, non-reassuring fetal status or major anomalies. Tocolytic agents were categorized into four groups: no-tocolysis, magnesium sulfate, beta-2 adrenergic agonists and the combination of them. We conducted multiple comparisons with multivariate analyses using generalized linear regression models to compare the prevalence of a poor perinatal outcome defined as infant's death, brain damage, particularly cerebral palsy and developmental delay. RESULTS: Among 1083 infants, 39% were no-tocolysis, 47% were magnesium sulfate, 41% were beta-2 adrenergic agonists and 27% were combination group, including the duplication. The incidence of poor perinatal outcome was decreased by magnesium sulfate (OR 0.27, 95% CI 0.10-0.72), but not changed significantly by beta-2 adrenergic agonists (OR 1.28, 95% CI 0.63-2.59) or the combination group (OR 2.24, 95% CI 0.67-7.54), compared with the no-tocolysis. CONCLUSION: The combination therapy for tocolysis with beta-2 adrenergic agonists diminished the magnesium sulfate neuroprotective action after adjusting for covariables.


Assuntos
Tocólise , Tocolíticos , Agonistas Adrenérgicos beta , Encéfalo , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Japão , Sulfato de Magnésio , Gravidez , Estudos Retrospectivos
6.
J Obstet Gynaecol Res ; 44(2): 241-247, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28994162

RESUMO

AIM: Recent reports have shown lower levels of Clostridium and higher levels of Lactobacillales in the intestinal microbiota in preterm birth patients compared to term birth patients. However, the influence of probiotics on perinatal status has not been elucidated. The aim of our study was to evaluate the effects of probiotics on perinatal outcomes. METHODS: We retrospectively evaluated the effects of oral probiotics on perinatal outcome in patients at high risk of preterm birth. Probiotics containing Streptococcus faecalis, Clostridium butyricum and Bacillus mesentericus were administered for prophylaxis of bacterial vaginosis or treatment of constipation starting at 12.5 ± 4.1 weeks until delivery. Patients not administered probiotics were defined as the non-probiotics group. Between these two groups, perinatal outcomes including gestational age at birth, birth weight, chorioamnionitis or funisitis and preterm birth before 32 weeks were compared. In addition, multivariate regression analyses were performed to evaluate factors influencing preterm birth before 32 weeks, chorioamnionitis/funisitis and normal vaginal flora. RESULTS: The probiotics group showed longer gestation, higher birth weight, lower rates of chorioamnionitis and higher rates of normal vaginal flora compared to the non-probiotics group. Multivariate regression analysis showed that probiotics significantly suppressed preterm birth before 32 weeks and tended to suppress chorioamnionitis/funisitis. The adjusted odds ratios (95% confidence interval) for preterm birth before 32 weeks and chorioamnionitis/funisitis were 0.05 (0.01-0.71) and 0.07 (0.01-1.03), respectively. CONCLUSIONS: Oral probiotics containing Clostridium had a significant effect on the prevention of preterm birth before 32 weeks of gestation.


Assuntos
Constipação Intestinal/prevenção & controle , Nascimento Prematuro/prevenção & controle , Probióticos/uso terapêutico , Vaginose Bacteriana/prevenção & controle , Adulto , Peso ao Nascer/efeitos dos fármacos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Probióticos/administração & dosagem , Estudos Retrospectivos , Fatores de Risco
7.
J Obstet Gynaecol Res ; 44(1): 5-12, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29114962

RESUMO

We conducted a questionnaire survey on the current obstetric management of preterm labor (PL) and preterm premature rupture of the membranes (pPROM). The questionnaire covered approximately a third of all preterm deliveries and nearly half of the preterm deliveries before 32 gestational weeks. The diagnostic criterion for PL was either painful uterine contractions or cervical dilatation. Tocolytic agents were primarily used as long-term maintenance therapy. Intrauterine infection was clinically diagnosed at most responding institutions. Amniocentesis was performed for PL or pPROM at only a small number (10%) of institutions. Prenatal steroids were administered for PL or pPROM, if indicated, at approximately 40-60% of responding institutions. Prophylactic antibiotics to maintain pregnancy were administered for pPROM at approximately 90% and for PL at approximately 20% of institutions. Maintenance therapy with a tocolytic agent was used for pPROM at approximately 90% of institutions.


Assuntos
Amniocentese/estatística & dados numéricos , Ruptura Prematura de Membranas Fetais/terapia , Ginecologia , Trabalho de Parto Prematuro/terapia , Obstetrícia , Perinatologia , Sociedades Médicas , Tocolíticos/uso terapêutico , Adulto , Feminino , Ginecologia/estatística & dados numéricos , Humanos , Japão , Obstetrícia/estatística & dados numéricos , Perinatologia/estatística & dados numéricos , Gravidez , Estudos Retrospectivos , Sociedades Médicas/estatística & dados numéricos
8.
Pediatr Int ; 59(4): 438-442, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27696630

RESUMO

BACKGROUND: There have been few reports on the outcome of extracorporeal membrane oxygenation (ECMO) in newborn Japanese infants. METHODS: A review was carried out of 61 neonates with ECMO between January 1995 and December 2015 at a single center. ECMO was used in neonates with oxygenation index >20 after conventional treatment. Background factors, such as etiology, vascular access mode (veno-venous [VV] or veno-arterial [VA]), number of days with ECMO, and early ECMO (within 24 h after birth), were analyzed in relation to outcome with respect to survival to hospital discharge (SHD). RESULTS: Survival to hospital discharge was achieved in 35 infants (57%), while the remaining 26 died during hospital stay. Gestational age at birth was significantly higher and number of days with ECMO was significantly lower in SHD infants compared with those with adverse outcome (median, 4.0 vs 5.5 days, respectively; P = 0.008). The SHD rate was significantly higher for those with VV than VA vascular access mode (78%, 18/23 vs 45%, 17/38, respectively; P = 0.016), and for those with than without early ECMO (72%, 28/39 vs 32%, 7/22, respectively; P = 0.003). The SHD rate was relatively high in neonates with meconium aspiration syndrome (86%, 12/14), persistent pulmonary hypertension associated with hypoxic ischemic encephalopathy (75%, 6/8), and emphysema (80%, 4/5). On stepwise logistic regression analysis two independent factors of SHD were identified: early ECMO (OR, 9.63; 95%CI: 2.47-37.6) and ECMO length <8 days (OR, 8.05; 95%CI: 1.94-33.5). CONCLUSIONS: Neonates with early ECMO and those with ECMO duration <8 days may benefit from ECMO with respect to SHD.


Assuntos
Oxigenação por Membrana Extracorpórea , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Feminino , Mortalidade Hospitalar , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
9.
J Obstet Gynaecol Res ; 39(5): 922-5, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23510453

RESUMO

AIM: To clarify perinatal outcomes of monoamniotic (MM) twin pregnancies. MATERIAL AND METHODS: MM twins delivered in seven tertiary perinatal centers during the last decade were retrospectively evaluated. All pregnant women were scheduled to begin inpatient management at around 24 weeks of gestation and undergo a planned cesarean section beyond 32 weeks. Pregnancy outcomes, prevalence of fetal death and cord entanglement, perinatal mortality and neuromorbidity rate at discharge were examined. RESULTS: The study group comprised 38 MM twin pregnancies (76 fetuses). Cord entanglement was confirmed in 88% (30/34) of women, and fetal deaths occurred in nine women (eight were both fetal deaths, and one was single fetal death). The cord entanglement accounted for 65% (11/17) of the fetal deaths. The median gestational age at delivery was 31⁺³ weeks, but that for viable infants was 32⁺³ weeks; the median birth weight was 1642 g, the perinatal mortality rate was 2% (1/60), and the neuromorbidity rate was 8% (5/50). The overall survival rate was 75% (57/76). CONCLUSION: Perinatal outcomes in our study were relatively good irrespective of high frequency of cord entanglement. Close fetal monitoring may allow MM twin pregnancies to extend gestational age, which may contribute to reduce both fetal death and neonatal morbidity by immaturity, although the best delivery weeks remained undetermined.


Assuntos
Transfusão Feto-Fetal/epidemiologia , Cordão Nucal/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Gravidez de Gêmeos , Peso ao Nascer , Feminino , Transfusão Feto-Fetal/mortalidade , Humanos , Incidência , Recém-Nascido , Japão/epidemiologia , Cordão Nucal/mortalidade , Assistência Perinatal , Mortalidade Perinatal , Gravidez , Complicações Infecciosas na Gravidez/mortalidade , Resultado da Gravidez , Estudos Retrospectivos
10.
J Obstet Gynaecol Res ; 37(10): 1391-6, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21599804

RESUMO

AIM: To evaluate the methods of screening and prenatal diagnosis of vasa previa. MATERIAL AND METHODS: We reviewed cases of vasa previa in our hospital between January 2002 and December 2007. During this period, we visualized the site of cord insertion using transabdominal ultrasonography and observed the internal os using gray-scale transvaginal ultrasonography. A diagnosis of vasa previa was confirmed by transvaginal color Doppler imaging. RESULTS: We encountered 10 cases of vasa previa among 5131 deliveries. All cases had one or more known risk factors. In all of the four cases that underwent screening in the second trimester (i.e. between 20 and 25 weeks of gestation), the diagnosis was correct. Routine ultrasonography detected in only three of the other six cases of vasa previa that were referred to our hospital after 26 weeks of gestation. Of the other three cases referred after 26 weeks of gestation, in two cases vasa previa was detected by detailed examination using color Doppler transvaginal ultrasonography after fetal heart rate monitoring detected the presence of non-reassuring fetal status; in the remaining case, we were unable to make an antenatal diagnosis. Non-reassuring fetal status was seen on fetal heart rate monitoring in four of the five detected cases complicated by preterm labor. CONCLUSION: We consider that the best timing of antenatal screening for vasa previa is the second trimester. Non-reassuring fetal heart rate pattern without other possible causes warrants detailed examination of vasa previa.


Assuntos
Placenta/diagnóstico por imagem , Cordão Umbilical/diagnóstico por imagem , Vasa Previa/diagnóstico por imagem , Adulto , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal
11.
J Obstet Gynaecol Res ; 33(5): 619-23, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17845318

RESUMO

AIM: This retrospective study was performed to reveal the natural history of cytomegalovirus (CMV) infected fetuses during the perinatal period and to find prenatal findings associated with poor outcomes. METHODS: 33 neonates with CMV infection, born after 30 weeks of gestation, were registered from a total of 12 414 infants between 1995 and 2003. Maternal and neonatal medical records were reviewed regarding fetal growth; abdominal signs including ascites and hepatosplenomegaly; cerebral signs including ventriculomegaly, microcephaly, and calcification; and fetal heart rate monitoring, for signs which may have been detected by the standard obstetric ultrasonography. Univariate and multivariate analyses were performed to test for any associations between these manifestations and poor outcomes such as death and neurological damages. RESULTS: Among the 33 infants, 6 died, 10 developed neurological damage including cerebral palsy (n = 8), epilepsy (n = 5), and hearing difficulties (n = 5), and the remaining 17 were normal. After adjusting for ganciclovir treatment and gender, death was 40-fold more likely associated with infants having abdominal signs (OR 40, 95%CI 4.6-930) than those without abdominal signs. Similarly, poor outcomes (death or neurological damage) were more likely associated with infants having either abdominal or cerebral signs (OR 39, 95%CI 3.8-1323). Fetal growth restriction and non-reassuring fetal heart rate patterns were not significantly associated with poor outcomes. CONCLUSION: The absence of abdominal signs guarantees the infant's survival. The presence of abdominal or cerebral signs is associated with poor outcomes, suggesting that these fetuses are possible candidates to receive in-utero therapy of congenital CMV infection.


Assuntos
Infecções por Citomegalovirus/congênito , Citomegalovirus/crescimento & desenvolvimento , Complicações Infecciosas na Gravidez/virologia , Antivirais/uso terapêutico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/patologia , Feminino , Ganciclovir/uso terapêutico , Humanos , Recém-Nascido , Masculino , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Estudos Retrospectivos
12.
J Obstet Gynaecol Res ; 32(5): 461-7, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16984512

RESUMO

AIM: This paper presents the serological and epidemiological background of the rubella-infected pregnant women following the rubella outbreak throughout Tokunoshima Island that occurred after the revision of the immunization law in Japan. METHODS: Twelve of 149 pregnant women managed in Miyagami Hospital were enrolled as having a high risk for congenital rubella infection. They were interviewed about their immunization history with rubella vaccine, the presence of rash, onset of rash, and the presence and timing of contact with rubella-infected patients. The obstetric histories were investigated for past rubella HI antibody titer. Nine of 12 women continued their pregnancy and delivered a baby. A serological test for rubella IgM antibody and a reversed transcription-nested PCR assay using umbilical cord blood and the newborn urine for virus genome detection were performed for all babies. We also enrolled all 309 mothers who delivered during the last 2 years in Miyagami Hospital, and retrospectively collected their rubella HI titers. RESULTS: Congenital rubella syndrome (CRS) and congenitally infected babies were born from 12 high-risk mothers. In our study, six pregnant women to be immunized by a catch-up program showed a lack of immunity to rubella. The remaining six women had low rubella immunity. Nine acquired rubella from members of their family, including their husband. The incidence of negative HI titer was 25% in women less than 25 years old who delivered during the last 2 years in this hospital. CONCLUSIONS: More intensive immunization should be considered to eradicate CRS completely in Japan.


Assuntos
Surtos de Doenças , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Rubéola (Sarampo Alemão)/epidemiologia , Adulto , Anticorpos Antivirais/sangue , Feminino , Humanos , Imunização , Imunoglobulina M/sangue , Recém-Nascido , Japão/epidemiologia , Gravidez , RNA Viral/sangue , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rubéola (Sarampo Alemão)/congênito , Rubéola (Sarampo Alemão)/imunologia , Vacina contra Rubéola , Vírus da Rubéola/genética , Vírus da Rubéola/imunologia
13.
Am J Perinatol ; 22(4): 181-7, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15906211

RESUMO

We evaluated an association of nonreassuring fetal heart rate (FHR) patterns and subsequent cerebral palsy (CP) in pregnancies with intrauterine bacterial infection. Among 10,030 infants born during 1995 to 2000, 139 were complicated with acute intrauterine bacterial infection in labor. The FHR patterns 2 hours immediately before delivery were interpreted according to the guidelines of the National Institute of Child Health and Human Development. The correlations between the FHR patterns and umbilical blood gases, as well as FHR patterns and CP were studied. Statistics included unpaired t test, contingency table with chi (2) and Fisher test, and one-way analysis of variance with Bonferroni/Dunn test. Fifteen infants (11%) developed CP at 2 years or older. Nonreassuring FHR patterns including recurrent late deceleration, severe variable deceleration, and prolonged deceleration occurred in 24% of pregnancies with intrauterine infection. Incidence of CP was not different according to the FHR deceleration patterns or umbilical pH values. Multiple logistic regression analysis revealed that fetal tachycardia (OR, 11; 95% CI, 1.8 to 67) and lower gestational age (< 34 weeks; OR, 9.4; 95% CI, 0.96 to 93) was associated with CP in intrauterine infection. Nonreassuring FHR patterns were increased in intrauterine infection. CP occurred more frequently and was associated with tachycardia and lower gestational age, but not with FHR deceleration patterns or acidemia, suggesting different pathophysiology from acute hypoxia-ischemia.


Assuntos
Paralisia Cerebral/fisiopatologia , Corioamnionite/epidemiologia , Doenças Fetais/epidemiologia , Frequência Cardíaca Fetal , Complicações do Trabalho de Parto/epidemiologia , Paralisia Cerebral/epidemiologia , Feminino , Sangue Fetal/química , Idade Gestacional , Humanos , Modelos Logísticos , Razão de Chances , Gravidez , Fatores de Risco
14.
Am J Obstet Gynecol ; 191(1): 380-1, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15295401

RESUMO

We report a case of maternal malignant lymphoma transferred to the fetus during pregnancy. A 29-year-old woman developed lymphoma at 29 weeks' gestation, and her infant developed malignant lymphoma at 8 months. Immunohistochemical examinations revealed lymphoid cells of similar characteristics in the maternal, placental, and infant tissues.


Assuntos
Transmissão Vertical de Doenças Infecciosas , Linfoma de Células B/etiologia , Complicações Neoplásicas na Gravidez , Adulto , Evolução Fatal , Feminino , Humanos , Imuno-Histoquímica , Hibridização in Situ Fluorescente , Fígado/metabolismo , Linfoma de Células B/imunologia , Placenta/patologia , Gravidez , Complicações Neoplásicas na Gravidez/imunologia
15.
Fetal Diagn Ther ; 19(2): 187-90, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-14764968

RESUMO

INTRODUCTION: Regarding its pathogenesis, discordant development in early gestation, as well as vascular anastomoses between twins are postulated to be required for the establishment of the twin-reversed arterial perfusion (TRAP) sequence. However, first trimester findings associated with this complication have not yet been reported. CASE: A discordant monochorionic twin was revealed upon examination of a 24-year-old primigravida at 11 weeks' gestation. Cystic masses were identified on the back of the smaller twin, later followed by the appearance of skin edema and pericardial effusion, indicating cardiac failure. Subsequently, despite diagnosis of fetal demise at 15 weeks the lower body was shown to have further developed and the heartbeats appeared again, resulting in an acardia anceps or hemicardia. No remarkable change was observed in the larger normal twin. CONCLUSION: This occurrence was considered consistent with the current hypothesis regarding the pathogenesis of the acardiac anomaly. First trimester discordancy in a monochorionic twin gestation is considered to represent an early manifestation of TRAP sequence.


Assuntos
Transfusão Feto-Fetal/diagnóstico por imagem , Gravidez Múltipla , Gêmeos , Adulto , Pré-Escolar , Feminino , Transfusão Feto-Fetal/patologia , Humanos , Masculino , Gravidez , Primeiro Trimestre da Gravidez , Ultrassonografia
16.
Am J Obstet Gynecol ; 190(1): 118-23, 2004 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-14749646

RESUMO

OBJECTIVE: Our purpose was to evaluate the clinical validity of electronic fetal heart rate monitoring to detect fetal acidemia and to evaluate the prevalence of cerebral palsy in unselected low-risk pregnancies. STUDY DESIGN: We selected two secondary and two tertiary level institutions in which 10,030 infants were born. Among them, 5546 of the pregnancies were low-risk pregnancies by antepartum evaluation. The fetal heart rate patterns were interpreted according to the guidelines of the National Institute of Child Health and Human Development. The correlations between the fetal heart rate pattern and umbilical blood gases and the fetal heart rate pattern and cerebral palsy were studied. Spastic cerebral palsy was diagnosed at > or =1 year by pediatric neurologists. Statistics included unpaired t test, contingency table with chi(2) and Fisher tests, and one-way analysis of variance with Bonferroni/Dunn test. RESULTS: On the basis of the severity of decelerations, frequency of decelerations, and decreased variability, umbilical pH, and Po(2) level were decreased accordingly, and incidence of pH<7.1 was increased. Sensitivity and false-positive rate of nonreassuring fetal heart rate patterns for fetal acidemia were 63% and 89%. There were nine cerebral palsy cases: six of the cases were preexisting asphyxia before monitoring was initiated, two of the cases were cytomegaloviral infections, and one of the cases was a maternal amniotic fluid embolism. CONCLUSION: In low-risk pregnancies, intrapartum fetal heart rate monitoring was useful to detect fetal acidemia. Cerebral palsy caused by intrapartum asphyxia was restricted to unavoidable accidents under continuous fetal heart rate monitoring.


Assuntos
Ácidos/sangue , Gasometria , Paralisia Cerebral/epidemiologia , Monitorização Fetal , Frequência Cardíaca Fetal , Trabalho de Parto , Paralisia Cerebral/etiologia , Paralisia Cerebral/virologia , Infecções por Citomegalovirus/complicações , Reações Falso-Positivas , Feminino , Hipóxia Fetal/complicações , Humanos , Japão/epidemiologia , Gravidez , Prevalência , Fatores de Risco , Sensibilidade e Especificidade
17.
J Soc Gynecol Investig ; 10(4): 189-93, 2003 May.
Artigo em Inglês | MEDLINE | ID: mdl-12759146

RESUMO

OBJECTIVE: In fetal sheep, we found that the augmentation of cardiac contractility by beta-adrenergic receptor (beta-AR) stimulation was reduced after exposure to long-term hypoxia. However, cyclic adenosine monophosphate (cAMP) production after beta-AR stimulation was higher in long-term hypoxic fetal sheep than in normoxic ones. Therefore, we studied the potential role of changes in myocardial protein kinase A (PKA) activity and troponin I (TnI) isoforms in fetal and nonpregnant sheep exposed to approximately 112 days of hypoxia at high altitude (3820 m). METHODS: Resting and maximally stimulated (by cAMP) PKA activity was measured by phosphorylation of the artificial peptide, Kemptide. Specificity was confirmed by inhibition with PKI, a specific PKA inhibitor. For TnI isoforms, sodium dodecyl sulfate-polyacrylamide gel electrophoresis was used to resolve the proteins. We used monoclonal anti-cardiac TnI antibody (clone C5), which also cross-reacted with slow skeletal muscle TnI, to identify TnI isoforms. RESULTS: For the fetal hearts, resting PKA activity was significantly higher in the high-altitude group than the control group, but total PKA activity was not different between the normoxic and hypoxic groups. In the adult hearts, no significant difference was observed in either resting or total PKA activity between normoxic and hypoxic groups. For both the fetal and adult sheep, the predominant TnI was the cardiac isoform, and hypoxic exposure produced no change in the TnI isoform composition. CONCLUSIONS: Neither a reduction in PKA activity nor a change in TnI isoforms could explain the reduction in beta-receptor augmentation of cardiac contractility in fetal sheep exposed to long-term hypoxia.


Assuntos
Proteínas Quinases Dependentes de AMP Cíclico/metabolismo , Coração Fetal/fisiopatologia , Feto/fisiopatologia , Hipóxia/enzimologia , Miocárdio/enzimologia , Ovinos/fisiologia , Troponina I/metabolismo , Altitude , Animais , Feminino , Gravidez , Isoformas de Proteínas , Distribuição Aleatória , Ovinos/embriologia
18.
J Periodontol ; 74(12): 1764-70, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14974817

RESUMO

BACKGROUND: Threatened premature labor (TPL) often results in preterm birth (PB). The aim of the present study was to evaluate the associations of periodontal and general health conditions with TPL and PB in relation to serum cytokine levels and the composition of subgingival plaque. METHODS: Eighty-eight women were enrolled in the study. Systemic conditions were assessed, and subgingival plaque samples obtained for bacterial analysis. Periodontal examinations included assessments of plaque, gingivitis, clinical attachment level, probing depth, and bleeding on probing. Serum cytokine levels also were analyzed. Gestational age at delivery was recorded, and the mothers were divided into a TPL or non-TPL group, and into a non-TPL-TB (term birth), non-TPL-PB, TPL-TB, or TPL-PB group, accordingly. RESULTS: Forty subjects were classified as TPL and 18 as TPL-PB. There were significant differences between the TPL and non-TPL subjects in several of the systemic and periodontal parameters and serum cytokine levels. Significant differences were observed between the TPL-TB and TPL-PB groups in the percentage of Tannerella forsythensis (Tf, formerly Bacteroides forsythus), and the serum interleukin (IL)-8 and IL-1beta levels. Significant negative correlations between the gestational age at delivery and several periodontal parameters and serum IL-8 and IL-1beta levels, and significant positive correlations between periodontal status and serum IL-8 and IL-1beta levels, were observed. CONCLUSIONS: The TPL women revealed worsened periodontal conditions and elevated serum IL-8 and IL-1beta levels compared to the non-TPL women. The elevated levels of serum IL-8 and IL-1beta could have affected the maintenance of the proper uterine-fetus relationship, resulting in premature uterine contractions.


Assuntos
Citocinas/sangue , Trabalho de Parto Prematuro/etiologia , Doenças Periodontais/complicações , Adulto , Análise de Variância , Bacteroides/isolamento & purificação , Placa Dentária/microbiologia , Feminino , Idade Gestacional , Nível de Saúde , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Interleucina-1/sangue , Interleucina-6/sangue , Interleucina-8/sangue , Masculino , Trabalho de Parto Prematuro/sangue , Doenças Periodontais/sangue , Índice Periodontal , Gravidez , Estatísticas não Paramétricas , Fator de Necrose Tumoral alfa/análise
19.
J Soc Gynecol Investig ; 9(6): 335-41, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12445597

RESUMO

OBJECTIVE: We studied the effect of long-term, high-altitude hypoxia on cardiac myosin, actin, and troponin T (TnT) isoforms and Ca(2+)- and Mg(2+)-activated myofibrillar adenosine triphosphatase (ATPase) activities in fetal and adult sheep. METHODS: We exposed pregnant (beginning at day 30 of gestation) and nonpregnant sheep to high altitude (3820 m) for 110 days. Myosin, actin, and TnT isoforms were analyzed by Western analysis. In purified myofibrillar preparations, Ca(2+)(-) and Mg(2+)-ATPase activities were measured by the appearance of inorganic phosphate after the addition of NaATP and various concentrations of either calcium or magnesium to the reaction mixture. RESULTS: We found no change in myosin, actin, or TnT isoform composition after exposure to long-term hypoxia in either fetal or adult sheep. However, Mg(2+)-activated myofibrillar ATPase activity decreased significantly in the right ventricle of both fetus and adult after hypoxic exposure. There was also a significant maturational increase in both Ca(2+)- and Mg(2+)-ATPase activity in control animals. CONCLUSION: The decrease in Mg(2+)-activated myofibrillar ATPase activity might affect the decrease in cardiac contractility previously noted in the right ventricle of fetal sheep after exposure to long-term hypoxia. Likewise, the increase in Ca(2+)- and Mg(2+)-activated ATPase activities from the fetus to adult could partially explain the previously found maturational increase in cardiac contractility.


Assuntos
Proteínas Contráteis/análise , Feto/metabolismo , Hipóxia/metabolismo , Miocárdio/química , Actinas/análise , Altitude , Animais , Western Blotting , ATPase de Ca(2+) e Mg(2+)/análise , Cálcio/administração & dosagem , ATPases Transportadoras de Cálcio/análise , Eletroforese em Gel de Poliacrilamida , Feminino , Idade Gestacional , Magnésio/administração & dosagem , Miofibrilas/enzimologia , Miosinas/análise , Gravidez , Ovinos , Troponina T/análise
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