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Medicina (Kaunas, Lithuania) Sep 2023Doppler findings of persistent reverse end-diastolic flow (PREDF) in a fetal middle cerebral artery (MCA) are a very rare sonographic finding and are a marker of poor...
Doppler findings of persistent reverse end-diastolic flow (PREDF) in a fetal middle cerebral artery (MCA) are a very rare sonographic finding and are a marker of poor fetal condition. This finding often leads to intrauterine fetal death or early neonatal death. Reverse end-diastolic flow in the middle cerebral artery is an advanced hemodynamic event. Fetal cerebral circulation normally has a high impedance; in the event of fetal hypoxemia, impedance decreases, resulting in the central redistribution of blood flow to vital organs, which maintains the oxygen delivery to the brain. Reverse flow in the middle cerebral arteries describes the loss of this autoregulatory process. PREDF is a sequence that occurs due to increased extracranial or intracranial pressure. Previous case reports mentioned intracranial hemorrhage, fetal growth restriction, fetal anemia, and fetal hepatic abnormalities as problems leading to PREDF. This condition presumably arises due to cerebral edema associated with severe hypoxemia. We reported Doppler findings of PREDF MCA in a 33-year-old female patient at 30 weeks gestation who was referred to the hospital with severe preeclampsia accompanied by fetal growth restriction and oligohydramnios. A cesarean section was performed due to severe preeclampsia and a low bishop score. Hypotheses on various etiologies and their association with intrauterine/neonatal death as well as the best management still require further investigation.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Adult; Middle Cerebral Artery; Fetal Growth Retardation; Cesarean Section; Perinatal Death; Pre-Eclampsia; Fetal Death; Ultrasonography, Prenatal; Blood Flow Velocity
PubMed: 37763767
DOI: 10.3390/medicina59091648 -
Diagnostics (Basel, Switzerland) Sep 2023Fetal biliary lithiasis is a benign condition characterized by the presence of gallstones in the gallbladder of a developing fetus. It is typically detected incidentally...
Fetal biliary lithiasis is a benign condition characterized by the presence of gallstones in the gallbladder of a developing fetus. It is typically detected incidentally during a routine obstetric echography. The incidence of this condition varies from 0.03% to 2.3%. In most cases, fetal cholelithiasis resolves spontaneously and has an excellent prognosis. However, there are certain risk factors that may contribute to its development. Maternal factors that increase the risk of fetal cholelithiasis include placental abruption, elevated estrogen levels, narcotic use, diabetes, enteral nutrition, and specific medications, such as ceftriaxone, furosemide, and prostaglandin E2. Fetal factors that can contribute to the condition include Rhesus or ABO blood group incompatibility, congenital anomalies affecting the cardiovascular, gastrointestinal, or urinary systems, twin pregnancies with the fetal demise of one twin, genetic anomalies such as trisomy 21, chromosomal aberrations, cystic fibrosis, growth restriction, oligohydramnios, hepatitis, or idiopathic causes. Usually, the gallstones spontaneously resolve before or after birth without requiring specific treatment. However, in rare instances, complications can arise, such as the formation of biliary sludge, inflammation of the gallbladder (cholecystitis), or obstruction of the bile ducts. If complications occur or if the gallstones persist after birth, further evaluation and management may be necessary. Treatment options can include medication, minimally invasive procedures, or, in severe cases, surgical removal of the gallbladder.
PubMed: 37761267
DOI: 10.3390/diagnostics13182900 -
Journal of Education and Health... 2023Sirenomelia is an extremely uncommon congenital deformity in which neonate has fused lower limbs associated with various visceral malformations including urogenital and...
Sirenomelia is an extremely uncommon congenital deformity in which neonate has fused lower limbs associated with various visceral malformations including urogenital and gastrointestinal tract, pulmonary hypoplasia, and potter's facies. The prevalence is 0.8 to 1 per 100,000 newborns. About 300 cases were recorded till date. We describe a case of 31-year G4P1L1A2 with previous lower segment caesarean section with gestational age of 22 weeks 5 days with anomaly scan suggestive of single live intrauterine pregnancy of 21 weeks 5 days with bilateral renal agenesis with placenta previa and no demonstrable amniotic fluid pocket seen. Her pregnancy was uneventful without any medical disorder, drug history, and no congenital anomaly in the family. Termination of pregnancy done by emergency hysterotomy and delivered anomalous foetus with fused lower limb with absent toes, low set ears, absent left ear ostium, imperforate anus, and absent external genitalia. Sirenomelia is fatal congenital anomaly with unclear etiology. Early antenatal diagnosis and termination of pregnancy is the treatment.
PubMed: 37727419
DOI: 10.4103/jehp.jehp_160_23 -
Boletin Medico Del Hospital Infantil de... 2023Acute fetal distress (AFD) is a condition that requires timely diagnosis because it generates hypoxia, acidosis, and even intrauterine death. This study aimed to...
BACKGROUND
Acute fetal distress (AFD) is a condition that requires timely diagnosis because it generates hypoxia, acidosis, and even intrauterine death. This study aimed to determine lactate and pH values in the umbilical cord in full-term newborns (NBs) with a history of AFD.
METHODS
We conducted a cross-sectional study in full-term NBs of mothers with at least one perinatal, neonatal, or gasometric AFD antecedent. Neonatal morbidity was considered: if 1-min Apgar ≤ 6, or advanced neonatal maneuvers, or neonatal intensive care unit (NICU) admissions were necessary. The cutoff points were lactate > 4mmol/L and pH < 7.2.
RESULTS
Of 66 NBs, 33.3% of mothers presented at least one antecedent for developing AFD; 22.7% presented hypertensive pregnancy disease, 13.6% oligohydramnios, and 63.6% other factors. Perinatally, 28.7% required advanced neonatal resuscitation maneuvers and 7.5% admission to the NICU. In the gasometry, the lactate and pH values for the neonatal morbidity of the NBs' group were 4.726 ± 1.401 and 7.293 ± 0.056, respectively, versus 2.240 ± 0.318 and 7.359 ± 0.022 (p < 0.05) for the group without associated neonatal morbidity.
CONCLUSIONS
Lactate values in the umbilical cord increased by 25%, and pH decreased by one percent in NBs with a history of AFD and associated morbidity.
Topics: Female; Pregnancy; Infant, Newborn; Humans; Lactic Acid; Cross-Sectional Studies; Fetal Distress; Resuscitation; Hypertension; Hydrogen-Ion Concentration
PubMed: 37703551
DOI: 10.24875/BMHIM.23000033 -
Medicine Aug 2023Most extremely preterm infants (EPIs), who were born before 28 weeks of gestation, with pulmonary air leak syndrome (ALS) are symptomatic, often severe, and require...
Most extremely preterm infants (EPIs), who were born before 28 weeks of gestation, with pulmonary air leak syndrome (ALS) are symptomatic, often severe, and require drainage. EPIs with severe air leak syndrome (sALS) that require tube drainage or needle aspiration are at high risk of morbidities and mortality. This study aimed to investigate perinatal characteristics, morbidities, and mortality in EPIs with sALS, and to estimate the risk of mortality according to gestational age (GA). A prospective cohort study conducted from 2013 to 2020 compiled the Korean Neonatal Network database to evaluate the incidence, perinatal characteristics, and outcomes of sALS in EPIs born before 28 weeks of gestation. Among 5666 EPIs, the incidence of sALS was 9.4% and inversely related to GA. From this cohort, we compared 532 EPIs with sALS to 1064 EPIs without sALS as controls, matching the subjects by GA and birth weight. Preterm premature rupture of membranes, oligohydramnios, resuscitation after birth, low Apgar scores, repeated surfactant administration, persistent pulmonary hypertension of the newborn, and pulmonary hemorrhage were associated with the development of pneumothorax. The sALS group required a higher fraction of inspired oxygen and more invasive respiratory support at both 28 days of life and 36 weeks of postmenstrual age. The sALS group had a higher incidence of bronchopulmonary dysplasia and major brain injury. The mortality rate was higher in the sALS group than in the control group (55.3% vs 32.5%, P < .001), and the ALS group had a 1.7 times risk of mortality than the control group. More attention should be paid to sALS in EPIs because the frequency of sALS increased as GA decreased, and the risk of mortality was more significant at lower GA.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Cohort Studies; Infant, Extremely Premature; Prospective Studies; Risk Factors; Salts; Sodium Chloride; Sodium Chloride, Dietary; Lung Diseases; Syndrome
PubMed: 37653823
DOI: 10.1097/MD.0000000000034759 -
International Journal of Molecular... Oct 2023Preeclampsia (PE) is a major complication of pregnancy with an incidence rate of 2‑8% and is a leading cause of maternal mortality and morbidity. The various...
Preeclampsia (PE) is a major complication of pregnancy with an incidence rate of 2‑8% and is a leading cause of maternal mortality and morbidity. The various consequences of severe preeclampsia for the fetus, neonate and child include intrauterine growth retardation (IUGR), fetal hypoxia, oligohydramnios, intrauterine fetal demise, increased perinatal mortality and morbidity, neurodevelopmental disorders and even irreversible brain damage (cerebral palsy). A number of studies have demonstrated that differences in maternal serum concentrations of angiogenic factors between preeclampsia and normotensive pregnancies can be used as biomarkers, either alone or in combination with other markers, to predict the development of PE. The presence in the maternal circulation of two proteins of placental origin, placental growth factor (PlGF) and soluble fms‑like tyrosine kinase 1 (sFlt‑1), has been shown to be of clinical value, as the sFlt‑1/PlGF ratio appears to be the optimal predictive tool for the development of PE. The measurement of their concentration in maternal serum in screening models, serves as predictive marker for the development of PE or IUGR later in gestation. However, further research is required to improve its clinical applicability and provide guidelines for its use worldwide to achieve more consistent clinical management of women with PE.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Fetal Growth Retardation; Placenta; Placenta Growth Factor; Pre-Eclampsia
PubMed: 37594116
DOI: 10.3892/ijmm.2023.5292 -
Advanced Biomedical Research 2023COVID-19 is the leading cause of the recent pandemic in the globe. This disease might have different effects on the maternal and fetal outcomes in pregnancy. The aim of...
BACKGROUND
COVID-19 is the leading cause of the recent pandemic in the globe. This disease might have different effects on the maternal and fetal outcomes in pregnancy. The aim of this study was to assess these outcomes in pregnant women with COVID-19 infections in different trimesters.
MATERIALS AND METHODS
This is a prospective cohort study that was performed in February 2020 to August 2021 in Isfahan on 430 pregnant women with definite diagnosis of COVID-19 infection admitted to our medical centers. The included cases were followed based on the gestational age in which they were diagnosed with COVID-19 infection. Patients were divided into three groups (first, second, and third trimesters) based on COVID-19 infection.
RESULTS
The frequency of requiring mechanical ventilation was higher in mothers with COVID-19 in the second trimester ( = 0.049) and the frequency of PIH was significantly higher in mothers with COVID-19 in the third trimester compared to other women ( = 0.009). Fetal growth restriction (FGR) was also observed in 22 patients (5.3%) that was mostly observed with COVID-19 in the third trimester ( = 0.012). Oligohydramnios and fetal distress leading to C/S were observed in 19 patients (4.6%) and 12 patients (2.9%), respectively. The majority of maternal mortality was among cases with COVID-19 infection in the third trimester (44.4%).
CONCLUSION
We observed higher maternal and fetal complications in women especially those in the third trimester. Our results were in line with the findings of previous studies. Women with COVID-19 infection in the third trimester had highest frequencies of preterm labor and FGR.
PubMed: 37564445
DOI: 10.4103/abr.abr_173_22 -
The Journal of Maternal-fetal &... Dec 2023To compare neonatal outcomes between multiples and singletons among very low birth weight infants, this was a prospective cohort study that was conducted by collecting...
OBJECTIVE
To compare neonatal outcomes between multiples and singletons among very low birth weight infants, this was a prospective cohort study that was conducted by collecting data registered in the Korean Neonatal Network database.
METHODS
From January 2013 to December 2016, there were 8265 infants in the Korean Neonatal Network database, and 2958 of them were from multiples. Among them, 2636 infants were twins, 308 infants were triplets, and 14 infants were quadruplets. Maternal and neonatal variables including and mortality major morbidity were compared. Finally, the predicted rates of major morbidity between singletons and multiples.
RESULTS
Multiples had higher gestational age, birth weight, Apgar score at 5 min, rates of cesarean section and artificial reproductive technology but lower maternal hypertension, oligohydramnios, chorioamnionitis rates and Clinical Risk Index for Babies scores II without base excess than the singletons. In univariate analysis, multiples had a lower incidence of respiratory distress syndrome, bronchopulmonary dysplasia, and sepsis. The mortality rate was not significantly different for overall gestational ages except for those born at ≤26 weeks of gestation. In multivariate logistic analysis, the incidences of intraventricular hemorrhage (grade ≥3), and retinopathy of prematurity requiring treatment were significantly higher than the singletons.
CONCLUSIONS
Mortality was not significantly different between multiples and singletons according to overall gestational age, except for multiples born at ≤26 weeks. A significant higher risk of intraventricular hemorrhage and retinopathy of prematurity requiring treatment was found in multiples. A new strategy to improve the mortality of immature multiples born at ≤26 weeks of gestation should be developed.
Topics: Infant, Newborn; Infant; Pregnancy; Humans; Female; Pregnancy, Multiple; Cohort Studies; Cesarean Section; Retinopathy of Prematurity; Prospective Studies; Retrospective Studies; Infant, Very Low Birth Weight; Birth Weight; Gestational Age; Hemorrhage; Republic of Korea; Infant Mortality
PubMed: 37558283
DOI: 10.1080/14767058.2023.2245530