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Cureus May 2023Introduction Dengue is caused by a virus from the Flaviviridae family. Although the literature on this disease is sparse, some studies have shown the effects of dengue...
Introduction Dengue is caused by a virus from the Flaviviridae family. Although the literature on this disease is sparse, some studies have shown the effects of dengue in the first trimester of pregnancy. However, the sample size in these studies is limited. Aims and objective The current study aimed to compare foetomaternal outcomes in pregnant patients with dengue in early (< 24 weeks) and late (> 24 weeks) pregnancy and find the prevalence and predictive factors for abortion in pregnant patients with dengue. Material and methods This retrospective study included all pregnant patients ( 62) admitted to the labour room over a period of six years from April 2016 to February 2022 and who were diagnosed with dengue anytime during pregnancy. Data were collected from their medical records and analysed. Differences between the two groups were assessed by the Chi-square test, Fisher's exact test, and Mann-Whitney U test. A value of less than 0.05 was considered significant. Results Out of a total of 62 patients, those with dengue at a gestational age of less than 24 weeks ( = 15) had more incidence of intrauterine growth restriction (55.6 vs 12.9%) ( value = 0.012) and oligohydramnios (66.7 vs 17.9%) ( value = 0.007). The incidence of abortion was 33.3%; among the patients at a gestational age of less than 12 weeks, 71.4% had an abortion. When the patients who had abortions were compared with those who did not, the factors predicting abortion were found to be a history of previous abortion ( value = 0.004), gestational age of less than 12 weeks ( value = 0.003), and decreased platelet count ( value = 0.03). Conclusion The effect of dengue infection in early pregnancy includes abortion, intrauterine growth restriction, and oligohydramnios, and these patients should be managed in a tertiary care hospital.
PubMed: 37303396
DOI: 10.7759/cureus.38740 -
Global Pediatric Health 2020Cloaca is a common excretory channel for the genital, urinary, and gastrointestinal tracts. It is considered a severe anorectal malformation caused by failed...
BACKGROUND
Cloaca is a common excretory channel for the genital, urinary, and gastrointestinal tracts. It is considered a severe anorectal malformation caused by failed partitioning of the genital, rectal, and urinary tracts.
METHODS
We report 5 infants with cloaca at birth who were identified prenatally by one or more of the following on prenatal ultrasound (US): ambiguous genitalia, a cystic pelvic/abdominal mass, hydronephrosis, ascites, a single umbilical artery, and oligohydramnios.
RESULTS
A cystic pelvic/abdominal mass and ambiguous genitalia were each observed in 3 cases by prenatal US. Ambiguous genitalia was observed in all 5 neonates at birth. There were 2 twin pregnancies (dichorionic/diamniotic and monochorionic/monoamniotic), with only 1 twin in a set affected with cloaca.
CONCLUSION
Pediatricians should be alert to the prenatal US findings that may raise suspicion of a persistent cloaca to improve both prenatal counseling and family preparation.
PubMed: 33015248
DOI: 10.1177/2333794X20958929 -
PLoS Medicine Feb 2023Existing data on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during late pregnancy is well established, providing assurance. However, the use of NSAIDs...
BACKGROUND
Existing data on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during late pregnancy is well established, providing assurance. However, the use of NSAIDs during early pregnancy remains inconclusive owing to conflicting findings on adverse neonatal outcomes as well as the limited data on adverse maternal outcomes. Therefore, we sought to investigate whether early prenatal exposure to NSAIDs was associated with neonatal and maternal adverse outcomes.
METHODS AND FINDINGS
We conducted a nationwide, population-based cohort study using Korea's National Health Insurance Service (NHIS) database with a mother-offspring cohort constructed and validated by the NHIS to include all live births in women aged 18 to 44 years between 2010 and 2018. We defined exposure to NSAIDs as at least two records of NSAID prescriptions during early pregnancy (first 90 days of pregnancy for congenital malformations and first 19 weeks for nonmalformation outcomes) and compared against three distinct referent groups of (1) unexposed, no NSAID prescription during the 3 months before pregnancy start to end of early pregnancy; (2) acetaminophen-exposed, at least two acetaminophen prescriptions during early pregnancy (i.e., active comparator); and (3) past users, at least two NSAID prescriptions before the start of pregnancy but no relevant prescriptions during pregnancy. Outcomes of interest were adverse birth outcomes of major congenital malformations and low birth weight and adverse maternal outcomes of antepartum hemorrhage and oligohydramnios. We estimated relative risks (RRs) with 95% CIs using generalized linear models within a propensity score (PS) fine stratification weighted cohort that accounted for various potential confounders of maternal sociodemographic characteristics, comorbidities, co-medication use, and general markers of burden of illness. Of 1.8 million pregnancies in the PS weighted analyses, exposure to NSAIDs during early pregnancy was associated with slightly increased risks for neonatal outcomes of major congenital malformations (PS-adjusted RR, 1.14 [CI, 1.10 to 1.18]) and low birth weight (1.29 [1.25 to 1.33]), and for maternal outcome of oligohydramnios (1.09 [1.01 to 1.19]) but not antepartum hemorrhage (1.05 [0.99 to 1.12]). The risks of overall congenital malformations, low birth weight, and oligohydramnios remained significantly elevated despite comparing NSAIDs against acetaminophen or past users. Risks of adverse neonatal and maternal outcomes were higher with cyclooxygenase-2 selective inhibitors or use of NSAIDs for more than 10 days, whereas generally similar effects were observed across the three most frequently used individual NSAIDs. Point estimates were largely consistent across all sensitivity analyses, including the sibling-matched analysis. Main limitations of this study are residual confounding by indication and from unmeasured factors.
CONCLUSIONS
This large-scale, nationwide cohort study found that exposure to NSAIDs during early pregnancy was associated with slightly higher risks of neonatal and maternal adverse outcomes. Clinicians should therefore carefully weigh the benefits of prescribing NSAIDs in early pregnancy against its modest, but possible, risk of neonatal and maternal outcomes, where if possible, consider prescribing nonselective NSAIDs for <10 days, along with continued careful monitoring for any safety signals.
Topics: Infant, Newborn; Female; Humans; Pregnancy; Acetaminophen; Cohort Studies; Oligohydramnios; Anti-Inflammatory Agents, Non-Steroidal; Republic of Korea; Live Birth; Obstetric Labor Complications; Hemorrhage
PubMed: 36848338
DOI: 10.1371/journal.pmed.1004183 -
Sensors (Basel, Switzerland) Jun 2022A fetal ultrasound (US) is a technique to examine a baby's maturity and development. US examinations have varying purposes throughout pregnancy. Consequently, in the... (Review)
Review
A fetal ultrasound (US) is a technique to examine a baby's maturity and development. US examinations have varying purposes throughout pregnancy. Consequently, in the second and third trimester, US tests are performed for the assessment of Amniotic Fluid Volume (AFV), a key indicator of fetal health. Disorders resulting from abnormal AFV levels, commonly referred to as oligohydramnios or polyhydramnios, may pose a serious threat to a mother's or child's health. This paper attempts to accumulate and compare the most recent advancements in Artificial Intelligence (AI)-based techniques for the diagnosis and classification of AFV levels. Additionally, we provide a thorough and highly inclusive breakdown of other relevant factors that may cause abnormal AFV levels, including, but not limited to, abnormalities in the placenta, kidneys, or central nervous system, as well as other contributors, such as preterm birth or twin-to-twin transfusion syndrome. Furthermore, we bring forth a concise overview of all the Machine Learning (ML) and Deep Learning (DL) techniques, along with the datasets supplied by various researchers. This study also provides a brief rundown of the challenges and opportunities encountered in this field, along with prospective research directions and promising angles to further explore.
Topics: Amniotic Fluid; Artificial Intelligence; Female; Humans; Infant, Newborn; Oligohydramnios; Pregnancy; Premature Birth; Prospective Studies
PubMed: 35746352
DOI: 10.3390/s22124570 -
The Journal of Maternal-fetal &... Dec 2023This study aimed to analyze the ultrasound characteristics of fetal congenital vertical talus (CVT) to provide a detailed basis for the prenatal diagnosis of CVT.
OBJECTIVE
This study aimed to analyze the ultrasound characteristics of fetal congenital vertical talus (CVT) to provide a detailed basis for the prenatal diagnosis of CVT.
METHODS
We retrospectively analyzed the ultrasonographic findings of fetuses with CVT confirmed by X-ray, surgery, or autopsy from 2010 to 2020. Clinical characteristics and ultrasonographic findings of CVT, including foot morphology, ossification center of the calcaneus and talus, associated deformities, and chromosomal test results, were recorded.
RESULTS
Thirteen patients diagnosed with CVT by prenatal ultrasound were confirmed postpartum. Nine cases were bilateral, and four were unilateral. Under two-dimensional ultrasound, 13/13 cases had abnormal foot morphology, and 10 of 13 cases (76.9%) showed that the ossification center of the talus moved downward, and the calcaneus moved laterally. Under three-dimensional ultrasound, 11 cases (84.6%) presented a "rocking chair" appearance, and two cases did not obtain satisfactory three-dimensional image due to oligohydramnios and fetal position. In this group of cases, two cases (15.4%) were isolated CVT, and the other 11 cases (84.6%) were complicated with other abnormalities. Eleven cases of non-isolated CVT and 1 case of isolated CVT were induced, and another patient with isolated CVT had undergone postnatal surgery, which had been followed up for 8 years and recovered well.
CONCLUSIONS
The combination of fetal foot morphology, ossification center position of the calcaneus and talus, and three-dimensional ultrasound can provide a reliable diagnosis of CVT. Furthermore, we should pay more attention to the evaluation of other systemic and chromosomal abnormalities in CVT cases.
Topics: Female; Humans; Pregnancy; Flatfoot; Retrospective Studies; Prenatal Diagnosis; Talus; Ultrasonography, Prenatal
PubMed: 36948222
DOI: 10.1080/14767058.2023.2192323 -
Cureus Jun 2023Obesity has become a growing pandemic with a significant increase in incidence in recent years. The complications associated with pregnancy in obese patients can lead to...
Obesity has become a growing pandemic with a significant increase in incidence in recent years. The complications associated with pregnancy in obese patients can lead to increased morbidity and mortality in pregnant women. A 41-year-old morbidly obese female with primary hypertension and 32.4 weeks pregnant, presented with severe oligohydramnios, breech presentation, and a history of previous lower segment cesarean section (LSCS). The patient experienced abdominal pain, lower backache, and leaking per vaginal, and a decision was made to perform LSCS. Challenges were encountered during the procedure related to anesthesia management and the need for specialized equipment and additional assistants. A multidisciplinary approach was chosen for managing this patient with the special role of anesthetists. Intra-operative and post-operative management was crucial for a successful recovery. Obesity during pregnancy presents unique challenges for healthcare providers, and it is necessary to increase resources and prepare skilfully to manage these patients effectively.
PubMed: 37416027
DOI: 10.7759/cureus.39958 -
Journal of Perinatal Medicine Jul 2022To analyze the role of viral infections as etiology of stillbirths in Mexico and their epidemiological impact in the context of the global Every Newborn Initiative.
OBJECTIVES
To analyze the role of viral infections as etiology of stillbirths in Mexico and their epidemiological impact in the context of the global Every Newborn Initiative.
METHODS
A comprehensive literature search was performed in electronic databases related to stillbirth and viral infections published prior to January 19th 2021. Stillbirths records and causes from National Mexican databases, during 2008-2019 period were also computed.
RESULTS
Only two articles with a direct relationship between viral infection and stillbirth were found, and one article with an indirect serological association was identified. During the analyzed period there were 198,076 stillbirths, with a National stillbirth rate (SBR) ranging from 6.9 to 6.5 between 2008 and 2014, with a subsequent increase to reach 7.7 in 2019. Only 19 cases were attributed to viral causes and a specific virus was identified in 11. The main causes of early stillbirth were a fetus with premature rupture of membranes and light for gestational age, and for late stillbirth these were fetus affected by oligohydramnios and slow fetal growth. The percentage classified as unspecified deaths varied from 34.4-41.9%.
CONCLUSIONS
In Mexico, there has been an increase in SBR during last years, but the goals of the Every Newborn Initiative is met. More than 14,500 stillbirths with at least 5,100 unspecified cases have been reported per year, and only 11 cases were attributable to a specific virus, highlighting the serious underestimation of cases and the need of implementation of routine viral diagnosis methods to improve the care of this global health problem.
Topics: Female; Gestational Age; Global Health; Humans; Infant, Newborn; Mexico; Pregnancy; Stillbirth; Virus Diseases
PubMed: 35377975
DOI: 10.1515/jpm-2021-0348 -
Molecular Genetics & Genomic Medicine Jun 2023Wolf-Hirschhorn syndrome (WHS) is a congenital malformation syndrome with poor prognosis. It is associated with a heterozygous deletion of chromosome 4p16.3. Adequate... (Review)
Review
OBJECTIVE
Wolf-Hirschhorn syndrome (WHS) is a congenital malformation syndrome with poor prognosis. It is associated with a heterozygous deletion of chromosome 4p16.3. Adequate knowledge of prenatal phenotypes and proper prenatal counseling are essential for intrauterine diagnosis.
METHOD
We retrospectively analyzed 11 prenatal cases of WHS diagnosed using low-depth whole-genome sequencing (copy number variation sequencing) performed at our hospital from May 2017 to September 2022 and reviewed their prenatal ultrasound reports in detail. We also analyzed WHS cases (including prenatal and postnatal) with abnormal prenatal ultrasound findings in the published literature over the past 20 years.
RESULTS
Among the 11 fetuses with a prenatal diagnosis of WHS in our hospital, four cases showed abnormal prenatal ultrasound findings, including shrunken kidneys, ventricular septal defect, a small stomach, fetal growth restriction (FGR), enlarged posterior fossa, and soft ultrasonic markers. Our four cases were combined with 114 published WHS cases with prenatal ultrasound abnormalities from other medical institutions. Of the 118 cases, 59.3% (70 of 118) were multiple malformations. The most frequent ultrasound features observed in all 118 cases were FGR (76.3%, 90 of 118), followed by facial anomalies (28.8%, 34 of 118), central nervous system anomalies (27.1%, 32 of 118), and soft ultrasound markers (23.7%, 28 of 118). Other less common phenotypes included cardiac anomalies (19.5%, 23 of 118), genitourinary anomalies (19.5%, 23 of 118), increased NT/NF (12.7%, 15 of 118), skeletal anomalies (11.9%, 14 of 118), a single umbilical artery (10.2%, 12 of 118), gastrointestinal anomalies (9.3%, 11 of 118), oligohydramnios (8.5%, 10 of 118), cystic hygroma (5.1%, six of 118), hydrops/pleural effusion/ascites (2.5%, three of 118), and polyhydramnios (2.5%, three of 118).
CONCLUSION
This study improved our understanding of the prenatal presentation of WHS by analyzing prenatal ultrasound abnormalities. The timely identification of prenatal ultrasound abnormalities can provide accurate consultation for pregnant women, improve the prenatal detection of WHS, and enable early prenatal management and intervention of WHS.
Topics: Female; Humans; Pregnancy; Wolf-Hirschhorn Syndrome; Retrospective Studies; DNA Copy Number Variations; Chromosome Deletion; Phenotype; Fetal Growth Retardation
PubMed: 36849216
DOI: 10.1002/mgg3.2155 -
Frontiers in Pediatrics 2020The widespread use of obstetric ultrasonography has increased the detection rate of antenatal hydronephrosis. Although most cases of antenatal hydronephrosis are... (Review)
Review
The widespread use of obstetric ultrasonography has increased the detection rate of antenatal hydronephrosis. Although most cases of antenatal hydronephrosis are transient, one third persists and becomes clinically important. Ultrasound has made differential diagnosis possible to some extent. Ureteropelvic junction type hydronephrosis (UPJHN) is one of the most common cause of persistent fetal hydronephrosis and occurs three times more in male fetuses. It is usually sporadic and unilateral. However, when bilateral kidneys are involved and presents with severe hydronephrosis, the prognosis may be poor. Typical ultrasound findings of UPJHN is hydronephrosis without hydroureter. The size and appearance of the fetal bladder is usually normal without thickening of the bladder wall. Several grading systems are developed and increasingly being used to define the severity of prenatal hydronephrosis and provides much more information about prediction of postnatal renal prognosis. If fetal urinary tract dilation is detected; laterality, severity of hydronephrosis, echogenicity of the kidneys, presence of ureter dilation should be assessed. Bladder volume and emptying, sex of the fetus, amniotic fluid volume, and presence of associated malformations should be evaluated. Particularly the ultrasonographic signs of renal dysplasia, such as increased renal parenchymal echogenicity, thinning of the renal cortex, the presence of cortical cysts, and co-existing oligohydramnios should be noticed. Unfortunately, there is no reliable predictor of renal function in UPJHN cases. Unilateral hydronephrosis cases suggesting UPJHN are mostly followed up conservatively. However, the cases with bilateral involvement are still difficult to manage. Timing of delivery is also controversial.
PubMed: 33014923
DOI: 10.3389/fped.2020.00492