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Sergi CM, Spencer D, Al-Jishi T. Stillbirth Investigations: An Iconographic and Concise Diagnostic Workup in Perinatal Pathology. J Lab Physicians 2023; 15:475-487. [PMID: 37780873 PMCID: PMC10539070 DOI: 10.1055/s-0043-1764485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/23/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Stillbirth is a dramatic event for the parents, health care team, and anyone close to the expectant parents. Multidisciplinary team (MDT) meetings are essential to improve communication in health care. We review the most frequent findings discussed at MDT meetings. Methods A PubMed search was conducted through December 2021 since the inception (1965) using clinical queries with the key terms "stillbirth" AND "investigation" AND "pathology" AND "human." The search strategy included reviews, meta-analyses, randomized controlled trials, clinical trials, and observational studies. This systematic review is based on, but not limited to, the search results. It is the experience of more than 30 years of pediatrics, obstetrics, and pathology staff. Results Two hundred and six articles were screened and complemented through the perusal of congressional activities and personal communications. Pathological findings following perinatal death can be divided into macroscopic, histologic, and placental findings. The placenta is crucial in fetal medicine and is key in determining the cause of stillbirth in a substantial number of events. Perinatal lung disease is essential to evaluate the response of newborns to extrauterine life and address newborns' outcomes appropriately. Conclusions Stillbirth remains one of the less explored areas of medicine, and we can determine the cause in a limited number of cases. Nevertheless, placental pathology is critical in the etiology discovery pathway. Accurate investigations and discussion of photography-supported findings are vital in promoting communication at MDT meetings.
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Affiliation(s)
- Consolato M. Sergi
- Department of Anatomic Pathology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Deborah Spencer
- Department of Pathology, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, United States
| | - Taher Al-Jishi
- Department of Obstetrics and Gynecology University of Ottawa, Ottawa, Ontario, Canada
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2
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David M, Hcini N, Mandelbrot L, Sibiude J, Picone O. Fetal and neonatal abnormalities due to congenital syphilis: a literature review. Prenat Diagn 2022; 42:643-655. [PMID: 35352829 DOI: 10.1002/pd.6135] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The recent recrudescence of syphilis among women of childbearing age is associated with an increasing number of cases of congenital syphilis. We aimed to summarize the fetal and neonatal abnormalities due to congenital syphilis infection, particularly signs amenable to prenatal diagnosis. METHODS Eligible studies were retrieved from the PubMed collection database. Articles focusing on postnatal and antenatal abnormalities covered the periods from 1969 to 2019 and 1975 to 2019, respectively. This review included cohort studies, case series and case reports reporting findings regarding congenital syphilis infections described before and/or after birth. Articles were reviewed by three experts in prenatal diagnosis, and all findings were classified as amenable or not amenable to prenatal diagnosis. RESULTS A total of 432 cases of congenital syphilis infection were reported. Abnormalities were described antenatally in 161 cases, postnatally in 319 cases, and in both the antenatal and postnatal periods in 57 cases. The most frequently reported signs amenable to prenatal diagnosis were abdominal abnormalities (hepatomegaly, splenomegaly, and bowel abnormalities), fetal growth restriction, and elevated middle cerebral artery peak systolic velocity in the context of ascites or atypical hydrops. Brain abnormalities were rare and never isolated. In the neonatal period, the most common abnormalities were hepatosplenomegaly, bone damage and skin lesions. CONCLUSION We found that no individual sonographic sign or pattern of signs is pathognomonic for fetal syphilis. In fetuses with ultrasound abnormalities suggestive of congenital infection, syphilis must be considered as part of the work-up. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marion David
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes Cedex, France
| | - Najeh Hcini
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, French Guyana. CIC Inserm 1424 et DFR Santé Université Guyane, ST Laurent du Maroni, France
| | - Laurent Mandelbrot
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes Cedex, France
- Université de Paris, Paris, France
- Inserm IAME-U1137, Paris, France
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- FHU Prema, Paris, France
| | - Jeanne Sibiude
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes Cedex, France
- Université de Paris, Paris, France
- Inserm IAME-U1137, Paris, France
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- FHU Prema, Paris, France
| | - Olivier Picone
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes Cedex, France
- Université de Paris, Paris, France
- Inserm IAME-U1137, Paris, France
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- FHU Prema, Paris, France
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3
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Siena G, Corrò M, Zanardello C, Foiani G, Romagnoli S, Ferré-Dolcet L, Milani C. A case report of a rapid development of fetal anasarca in a canine pregnancy at term. Vet Res Commun 2021; 46:597-602. [PMID: 34855120 DOI: 10.1007/s11259-021-09860-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
Abstract
A 5-year-old healthy pluriparous pregnant Flat-coated Retriever bitch was monitored by ultrasound on post-ovulation days 30 and 57: no deviation from normality picture were observed. On day 60, one of the three most caudal fetuses showed ultrasonographic signs of fetal anasarca: subcutaneous edema and anechoic fluid in thoracic and abdominal cavities. There was an increased volume of extra-fetal fluids. On day 64 a Cesarean section was performed and one of the seven pups that were delivered, a female, showed generalized subcutaneous edema and died soon after birth. She weighed 660 g, compared to a mean of 472 g for the other 6 normal fetuses. A total of 295, 40 and 27.5 mL of liquid were collected from subcutaneous tissue, abdominal and thoracic cavity, respectively. Liver showed sub-glissonian necrotic areas. Molecular analyses with PCR method for canine Herpesvirus, Parvovirus, Adenovirus, Leptospira interrogans, Chlamydia spp., Neospora caninum and Toxoplasma gondii from pools of organs (spleen, kidney and brain) and pleural effusion tested negative. This is the first reported case of fetal anasarca with a rapid onset diagnosed on day 60 post-ovulation just three days after observing a normal ultrasonographic pattern in Flat-coated Retriever. Ultrasonographic diagnosis of fetal anasarca is of primary importance when assisting parturition, due to its inherent risk of dystocia. Ultrasonographic monitoring in the immediate prepartum period may be useful in all breeds as it may help to detect ultrasonographic alterations occurring right before term such as anasarca.
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Affiliation(s)
- Giulia Siena
- Department of Animal Medicine, Production and Health (MAPS), University of Padua, 35020, Legnaro, PD, Italy.
| | - Michela Corrò
- Istituto Zooprofilattico Sperimentale delle Venezie, 35020, Legnaro, PD, Italy
| | - Claudia Zanardello
- Istituto Zooprofilattico Sperimentale delle Venezie, 35020, Legnaro, PD, Italy
| | - Greta Foiani
- Istituto Zooprofilattico Sperimentale delle Venezie, 35020, Legnaro, PD, Italy
| | - Stefano Romagnoli
- Department of Animal Medicine, Production and Health (MAPS), University of Padua, 35020, Legnaro, PD, Italy
| | - Lluis Ferré-Dolcet
- Department of Animal Medicine, Production and Health (MAPS), University of Padua, 35020, Legnaro, PD, Italy.,San Marco Veterinary Clinic and Laboratory, Veggiano, PD, Italy
| | - Chiara Milani
- Department of Animal Medicine, Production and Health (MAPS), University of Padua, 35020, Legnaro, PD, Italy
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4
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Hasija VK, Mirza A, Khowaja WH, Asif S, Salat MS, Ariff S, Ahmad K. Clinical Profile and Predictors of Mortality in Neonates Born With Non-Immune Hydrops Fetalis: Experience From a Lower-Middle-Income Country. Cureus 2021; 13:e17830. [PMID: 34660039 PMCID: PMC8500813 DOI: 10.7759/cureus.17830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction Hydrops fetalis (HF) is a life-threatening condition in which a fetus has an abnormal collection of fluid in the tissue around the lungs, heart, abdomen, or under the skin. Based on its pathophysiology, it is classified into immune and non-immune types. With the widespread use of anti-D immunoglobulin, non-immune HF has become more common, with an incidence of one in 1,700-3,000 live births. A multitude of fetal diseases with various causes can lead to non-immune HF. Due to the recent advances in prenatal diagnostic and therapeutic interventions together with improved neonatal intensive care, the diagnosis and subsequent management of HF have been refined. However, HF is still associated with a high mortality rate. A recent assessment of the literature found that there is a lack of data on prognostic variables in neonates with HF from low- and middle-income countries. In light of this, we sought to establish the etiologic causes, predictors of mortality, and eventual fate of newborns born non-immune HF at the Aga Khan University Hospital, Karachi during the 10-year period spanning January 2009-December 2019 in this retrospective analysis. Methodology For this study, we collected data from the computerized database and patient record files at the hospital on all infants with non-immune HF. Demographic data, postnatal interventions, clinical and laboratory findings, outcomes, and the results of comparison between HF patients who died and those who survived were analyzed. Results The incidence of non-immune HF at our hospital was 0.62/1,000 live births during the period under study, with 33 newborn babies diagnosed with non-immune HF from a total of 53,033 live-born deliveries. An etiologic factor was discovered in 17 (51.5%) neonates with non-immune HF while 16 (48.4%) were classified as those with unidentified etiology. The most common causes were cardiovascular and genetic syndromes, which resulted in 100% mortality. The overall mortality rate was 67%. The need for mechanical ventilation, surfactant therapy, and prolonged hospitalization were identified as independent risk factors of mortality. Conclusion Our study proves that the need for mechanical ventilation [moderate to severe hypoxic respiratory failure (HRF)] and prolonged hospitalization are strong predictors of poor outcomes in neonates with non-immune HF. Therefore, severe hydrops causing significant mortality can be anticipated based on the patients' respiratory status and the need for escalated oxygen support.
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Affiliation(s)
- Vinod K Hasija
- Pediatrics-Neonatal Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Adnan Mirza
- Pediatrics-Neonatal Medicine, Limerick University Maternity Hospital, Limerick, IRL.,Neonatal Fellowship Program/Neonatal Intensive Care Unit, Aga Khan University Hospital, Karachi, PAK
| | - Waqar H Khowaja
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK
| | - Sidra Asif
- Pediatrics, Aga Khan University Hospital, Karachi, PAK
| | | | - Shabina Ariff
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK
| | - Khalil Ahmad
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK
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5
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Tica OS, Gug C, Tica AA, Busuioc CJ, Amiri S, Tica I, Bică Brăiloiu G, Tica VI. A unique case of recurrent fetal cystic hygroma: first fetus with an inherited heteromorphism of chromosome 1 (1qh+) and the second fetus with 69XXX triploidy. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:935-940. [PMID: 33817737 PMCID: PMC8112748 DOI: 10.47162/rjme.61.3.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The authors report a unique recurrent septated cystic hygroma (CH), on two successive pregnancies, at five years interval. The chromosome analysis of the first fetus showed an increase in length of heterochromatin on the long arm of chromosome 1 – 1qh+, a chromosomal polymorphism inherited from mother, 46XX,1qh+,14ps+,21ps+. The karyotype of the second CH, with more severe ultrasound (US) imaging, showed a 69XXX triploidy. The patient took no risk and underwent each time a termination of pregnancy (TOP). The first karyotype is generally considered “normal”, although there are few reports linking 1qh+ with low fertility, but this was not the case, the patient having, from a previous marriage, a healthy boy and two TOPs. So, this “particular”, but “healthy” karyotype was not a cause for the first CH. The second karyotype highlights a possible causality between the 69XXX triploidy, usually associated with partial hydatidiform mole, and a more severe septated CH in the last fetus. Neither the CHs’ appearance nor their recurrence seemed to be family linked, as the two CHs had distinct genetic profiles. We recommend that, once CH is diagnosed, a careful US examination is compulsory for the determination of subcutaneous edema, ascites, pleural and pericardial effusions and cardiac or renal abnormalities; an early genetic work-up is mandatory, by chorionic villus sampling or amniocentesis. However, a “healthy” karyotype does not exclude a severe form, as in our first case of CH. Due to the very poor outcome of fetuses with CH, the patient must be thoroughly informed about the short and the long-term fetal prognosis.
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Affiliation(s)
- Oana Sorina Tica
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Romania; ; Department of Internal Medicine, Faculty of Medicine, Ovidius University of Constanţa, Romania;
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6
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Saldanha P. Hydropic placenta in a case of malaria. MGM JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/mgmj.mgmj_93_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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7
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Agarwal A, Agarwal S, Lalwani A, Najam R, Kumar A. Fetal bradyarrhythmia causing hydrops fetalis: A journey from fetal echo to autopsy. ULTRASOUND (LEEDS, ENGLAND) 2020; 28:266-270. [PMID: 36959892 PMCID: PMC10028386 DOI: 10.1177/1742271x20933996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/18/2020] [Indexed: 11/16/2022]
Abstract
Introduction Non-immune hydrops fetalis is a condition with poor fetal prognosis. The incidence of this clinical condition is increasing as compared to its iso-immune variant. The diagnosis of hydrops fetalis is straightforward; however, delineating the primary cause of non-immune hydrops fetalis requires a holistic approach and background knowledge of the entity. Case report We present a case of non-immune hydrops fetalis due to a rare functional cardiac disorder demonstrated by features of cardiac failure in the form of clinically significant tricuspid regurgitation detected on echocardiography. Fetal autopsy supported the diagnosis by excluding any structural anomaly. Discussion Non-immune hydrops fetalis may be due to structural and non-structural cardiac anomalies. Meticulous work-up is required to establish the diagnosis in such cases. Conclusion The case also highlights the systematic approach as well as the series of investigations required for the early diagnosis and management of such cases.
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Affiliation(s)
- Arjit Agarwal
- Department of Radiodiagnosis, Teerthanker Mahaveer Medical College &
Research Centre, Teerthanker Mahaveer University, Moradabad, India
- Arjit Agarwal, Teerthanker Mahaveer University
Medical College and Research Centre, A-46 Gandhi Nagar, Moradabad 244001, Uttar Pradesh,
India.
| | - Shubhra Agarwal
- Department of Obstetrics and Gynecology, Teerthanker Mahaveer Medical
College & Research Centre, Teerthanker Mahaveer University, Moradabad, India
| | - Astha Lalwani
- Department of Obstetrics and Gynecology, Teerthanker Mahaveer Medical
College & Research Centre, Teerthanker Mahaveer University, Moradabad, India
| | - Rehana Najam
- Department of Obstetrics and Gynecology, Teerthanker Mahaveer Medical
College & Research Centre, Teerthanker Mahaveer University, Moradabad, India
| | - Ashutosh Kumar
- Department of Obstetrics and Gynecology, Teerthanker Mahaveer Medical
College & Research Centre, Teerthanker Mahaveer University, Moradabad, India
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8
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Emiroğlu N, Yılmaz FH, Keçeci R, Yücel M, Gültekin ND, Altunhan H. Clinical characteristics and neonatal outcomes of liveborn newborns with hydrops fetalis treated in a tertiary level neonatal intensive care unit. Birth Defects Res 2020; 112:515-522. [PMID: 32212385 DOI: 10.1002/bdr2.1640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/06/2019] [Accepted: 12/17/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND This study was performed for examining the neonatal results and aetiological factors of neonates with hydrops fetalis (HF) and determining the factors affecting mortality. METHODS The medical records of liveborn neonates with HF who were admitted to a tertiary Neonatal Intensive Care Unit (NICU) in Konya, Turkey, between 2013 and 2019 were reviewed retrospectively. The demographic data, prenatal intervention, clinical findings, and results of the patients were recorded. RESULTS A total of 32.6% of the 46 liveborn HF infants had immune HF (IHF), while 67.4% had nonimmune HF (NIHF); there was prenatal diagnoses in 39 (84.7%) cases. Cordocentesis and blood transfusion (n = 14; 30.4%) were the prenatal diagnosis and treatment interventions with the highest rate. A total of 16 patients (34.7%) received in utero interventional treatment. It was determined that the mean gestational age was not associated with mortality; moreover, birthweight (BW), Apgar score and the need for mechanical ventilation affected mortality. CONCLUSION The prognosis changes according to different etiologies of HF. However, despite the developments in neonatal care, mortality is still high in HF infants.
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Affiliation(s)
- Nuriye Emiroğlu
- Department of Neonatology, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey
| | - Fatma Hilal Yılmaz
- Department of Neonatology, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey
| | - Ramazan Keçeci
- Department of Neonatology, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey
| | - Mehmet Yücel
- Department of Neonatology, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey
| | - Nazlı Dilay Gültekin
- Department of Neonatology, Van Training and Research Hospital, Health Sciences University, Van, Turkey
| | - Hüseyin Altunhan
- Department of Neonatology, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey
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9
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Dempsey E, Homfray T, Simpson JM, Jeffery S, Mansour S, Ostergaard P. Fetal hydrops – a review and a clinical approach to identifying the cause. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1719827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Esther Dempsey
- Molecular and Clinical Sciences, St George’s University of London, London, UK
| | - Tessa Homfray
- SW Thames Regional Genetics Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Steve Jeffery
- Molecular and Clinical Sciences, St George’s University of London, London, UK
| | - Sahar Mansour
- Molecular and Clinical Sciences, St George’s University of London, London, UK
- SW Thames Regional Genetics Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Pia Ostergaard
- Molecular and Clinical Sciences, St George’s University of London, London, UK
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10
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Mardy AH, Chetty SP, Norton ME, Sparks TN. A system-based approach to the genetic etiologies of non-immune hydrops fetalis. Prenat Diagn 2019; 39:732-750. [PMID: 31087399 DOI: 10.1002/pd.5479] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/11/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022]
Abstract
A wide spectrum of genetic causes may lead to nonimmune hydrops fetalis (NIHF), and a thorough phenotypic and genetic evaluation are essential to determine the underlying etiology, optimally manage these pregnancies, and inform discussions about anticipated prognosis. In this review, we outline the known genetic etiologies of NIHF by fetal organ system affected, and provide a systematic approach to the evaluation of NIHF. Some of the underlying genetic disorders are associated with characteristic phenotypic features that may be seen on prenatal ultrasound, such as hepatomegaly with lysosomal storage disorders, hyperechoic kidneys with congenital nephrosis, or pulmonary valve stenosis with RASopathies. However, this is not always the case, and the approach to evaluation must include prenatal ultrasound findings as well as genetic testing and many other factors. Genetic testing that has been utilized for NIHF ranges from standard chromosomal microarray or karyotype to gene panels and broad approaches such as whole exome sequencing. Family and obstetric history, as well as pathology examination, can yield additional clues that are helpful in establishing a diagnosis. A systematic approach to evaluation can guide a more targeted approach to genetic evaluation, diagnosis, and management of NIHF.
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Affiliation(s)
- Anne H Mardy
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
| | - Shilpa P Chetty
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
| | - Mary E Norton
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
| | - Teresa N Sparks
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
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11
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Park MS, Choi MS, Lee JH, Park SK. A case of Severe Hydrops Fetalis due to Anti-E Alloimmunization. NEONATAL MEDICINE 2016. [DOI: 10.5385/nm.2016.23.4.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Mi Seon Park
- Department of Pediatrics, Chosun University College of Medicine, Gwangju, Korea
| | - Min Seon Choi
- Department of Pediatrics, Chosun University College of Medicine, Gwangju, Korea
| | - Jae Hee Lee
- Department of Pediatrics, Chosun University College of Medicine, Gwangju, Korea
| | - Sang Kee Park
- Department of Pediatrics, Chosun University College of Medicine, Gwangju, Korea
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12
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Gimovsky AC, Luzi P, Berghella V. Lysosomal storage disease as an etiology of nonimmune hydrops. Am J Obstet Gynecol 2015; 212:281-90. [PMID: 25305402 DOI: 10.1016/j.ajog.2014.10.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/04/2014] [Accepted: 10/06/2014] [Indexed: 01/30/2023]
Abstract
We performed a systematic review of the literature to evaluate the incidence and types of lysosomal storage disorders (LSDs) in case series of nonimmune hydrops (NIH). PubMed and Ovid were reviewed for case series evaluating the workup of NIH diagnosed in utero or in the neonatal period in human subjects. Search terms were as follows: nonimmune hydrops, non immune hydrops, metabolic genetic disorders, and lysosomal storage disorders. The time period searched was 1979 through January 2014. Retrospective case series with at least 5 cases of fetal and/or neonatal NIH with its workup mentioned were identified. Idiopathic NIH was defined as NIH without an apparent cause after an initial workup. Exclusion criteria included studies published in languages other than English and review articles. The 3 authors screened all abstracts and manuscripts independently. Metaanalysis of Observational Studies in Epidemiology guidelines were followed. Fifty-four case series with 678 total cases of NIH were identified. The overall incidence of LSD was 5.2% (35 of 678) in all NIH cases that tested for any LSD and 17.4% (35 of 201) in idiopathic NIH cases. The 3 most common LSDs identified in cases of NIH, in order of decreasing incidence, were Mucopolysaccharidosis type VII, Gaucher's disease, and GM1-gangliosidosis. LSDs occur in 5.2% of all NIH cases and in 17.4% of idiopathic NIH cases and so should be screened for in this clinical scenario. Additionally, if a comprehensive LSD workup is completed on idiopathic cases, 29.6% of those would be reclassified as LSD. LSD testing does not only allow diagnosis but also ensures better counseling, appropriate management, and planning for possible early intervention. Moreover, their detection may aid in a prenatal diagnosis in subsequent pregnancies.
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Abstract
As the information obtained from previable fetal and stillbirth autopsies is used not only to explain the loss to the parents, but for future pregnancy planning, general pathologists need to be comfortable in dealing with these autopsies. The importance of an adequate fetal examination has been emphasized in a recent policy on the subject by the American Board of Pathology http://www.abpath.org/FetalAutopsyPoli'cy.pdf. This second review paper covers the approach to hydrops fetalis. The approach to the nonanomalous and anomalous fetus was covered in the first part of this series.
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14
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Bellini C, Donarini G, Paladini D, Calevo MG, Bellini T, Ramenghi LA, Hennekam RC. Etiology of non-immune hydrops fetalis: An update. Am J Med Genet A 2015; 167A:1082-8. [DOI: 10.1002/ajmg.a.36988] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 12/28/2014] [Indexed: 01/30/2023]
Affiliation(s)
- Carlo Bellini
- Neonatal Intensive Care Unit; Department of Intensive Care; Gaslini Institute; Genoa Italy
| | - Gloria Donarini
- Fetal Medicine and Surgery Unit; Gaslini Institute; Genoa Italy
| | - Dario Paladini
- Fetal Medicine and Surgery Unit; Gaslini Institute; Genoa Italy
| | - Maria Grazia Calevo
- Department of Epidemiology; Biostatistics and Committees; Gaslini Institute; Genoa Italy
| | - Tommaso Bellini
- Neonatal Intensive Care Unit; Department of Intensive Care; Gaslini Institute; Genoa Italy
| | - Luca A Ramenghi
- Neonatal Intensive Care Unit; Department of Intensive Care; Gaslini Institute; Genoa Italy
| | - Raoul C Hennekam
- Department of Pediatrics; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
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15
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Etiology and outcome of hydrops fetalis: report of 62 cases. Pediatr Neonatol 2014; 55:108-13. [PMID: 24094760 DOI: 10.1016/j.pedneo.2013.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 06/11/2013] [Accepted: 07/03/2013] [Indexed: 01/30/2023] Open
Abstract
AIM We aimed to define the etiologic and prognostic factors in live-born infants with hydrops fetalis (HF) in our tertiary neonatal intensive care unit over a 10-year period. METHODS Medical records of newborn infants with HF during 2002-2011 were reviewed retrospectively. Demographic data, prenatal interventions, clinical and laboratory findings, outcomes, and the results of postmortem examinations were analyzed. RESULTS During the study period, 62 newborn infants with HF were identified from 16,200 live-born deliveries and the incidence of HF was 3.8/1000 live births in our hospital. Twenty-eight infants (45.2%) had immune HF, whereas 34 (54.8%) had nonimmune HF. An etiologic factor could be identified in 24 (70.5%) infants with nonimmune HF. Lymphatic dysplasias comprised the majority (23.5%) of the infants with nonimmune HF. Mortality rate was 50%. The presence of two or more serous cavity effusions and gestational age were independently associated with the risk of mortality. CONCLUSION Despite the improvements in neonatal care, mortality rate in infants with HF is still high. Gestational age and the extent of serous cavity determine the risk of mortality. Timely and advanced prenatal or postnatal new therapeutic strategies may alter this fatal outcome in appropriate patients.
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Iskender C, Tarım E, Yalcınkaya C. Prenatal diagnosis of right diaphragmatic eventration associated with fetal hydrops. J Obstet Gynaecol Res 2012; 38:858-62. [DOI: 10.1111/j.1447-0756.2011.01831.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Chen I, Chandra S, Singh A, Kumar M, Jain V, Turnell R. Successful outcome with intrauterine transfusion in non-immune hydrops fetalis secondary to congenital syphilis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:861-865. [PMID: 21050519 DOI: 10.1016/s1701-2163(16)34658-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Congenital syphilis is rare, but the incidence has increased over the last few years in Alberta. Previous reports of fetal hydrops secondary to syphilis are few and have not demonstrated the application of middle cerebral artery peak systolic velocity (MCA PSV) to monitor for fetal anemia, or reported successful management with intrauterine transfusion. CASE A 17-year-old primigravida at 28 weeks' gestational age with positive syphilis serology and fetal hydrops was treated with high-dose intravenous penicillin. An elevated MCA PSV suggested fetal anemia. Successful intrauterine cordocentesis and transfusion of packed red blood cells led to resolution of fetal hydrops. The fetus delivered spontaneously at 35 weeks' gestation with no clinical signs of congenital syphilis. CONCLUSION Syphilitic hydrops may be successfully managed with high dose intravenous penicillin, measurement of MCA PSV, and intrauterine transfusion.
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Affiliation(s)
- Innie Chen
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB
| | - Sujata Chandra
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB; Division of Maternal-Fetal Medicine, University of Alberta, Edmonton AB
| | - Ameeta Singh
- Division of Infectious Diseases, University of Alberta, Edmonton AB
| | - Manoj Kumar
- Division of Neonatal Intensive Care, University of Alberta, Edmonton AB
| | - Venu Jain
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB; Division of Maternal-Fetal Medicine, University of Alberta, Edmonton AB
| | - Roger Turnell
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB; Division of Maternal-Fetal Medicine, University of Alberta, Edmonton AB
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Taweevisit M, Thorner PS. Hydrops fetalis in the stillborn: a series from the central region of Thailand. Pediatr Dev Pathol 2010; 13:369-74. [PMID: 20233068 DOI: 10.2350/09-12-0771-oa.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to analyze the cause of hydrops fetalis (HF) among fetal deaths in the central region of Thailand. Autopsy reports diagnosed as HF from 1999 to 2008 at King Chulalongkorn Memorial Hospital were retrieved, and the pathologic findings, clinical information, fetal ultrasonographic studies, and laboratory investigations were reviewed. There were 78 stillborn autopsies during this 10-year period; the mean gestational age was 28 weeks. The causes of fetal hydrops were identified in 88.5%; no cases of immune hydrops were detected. Anemia was the predominant cause of HF (n = 33; 42.2%): related to homozygous α-thalassemia (n = 17; 21.8%), twin-twin transfusion syndrome (n = 8; 10.2%), hemoglobin H (n = 3; 3.8%), lung hemorrhage (n = 1; 1.3%), adrenal hemorrhage (n = 1; 1.3%), and 3 cases of unspecified etiology (3.8%). Other causes of high-output failure included mass lesions resulting in vascular shunting (n = 2; 2.6%) and 1 case each (1.3% each) of maternal diabetes mellitus, intestinal lymphangiectasia, and Beckwith-Wiedemann syndrome. Causes resulting in low-output cardiac failure were congenital heart disease (n = 16; 20.5%) and thoracic space-occupying lesions (n = 7; 9%). The remaining causes included fetal infection (n = 5; 6.4%), congenital abnormalities suggestive of a chromosomal or genetic basis (n = 2; 2.6%), and 1 case (1.3%) of placental vascular thrombosis. Nine cases (11.5%) had no identifiable cause. Thus, the most common cause of HF in this series was homozygous α-thalassemia, reflecting the geographic location of this series.
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Affiliation(s)
- Mana Taweevisit
- Department of Pathology, Chulalongkorn University, Pathumwan, Bangkok, 10330 Thailand.
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19
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Bellini C, Hennekam RC, Fulcheri E, Rutigliani M, Morcaldi G, Boccardo F, Bonioli E. Etiology of nonimmune hydrops fetalis: A systematic review. Am J Med Genet A 2009; 149A:844-51. [DOI: 10.1002/ajmg.a.32655] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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20
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Marshall AC, Levine J, Morash D, Silva V, Lock JE, Benson CB, Wilkins-Haug LE, McElhinney DB, Tworetzky W. Results ofin uteroatrial septoplasty in fetuses with hypoplastic left heart syndrome. Prenat Diagn 2008; 28:1023-8. [DOI: 10.1002/pd.2114] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Armstrong R, Fryer A, Pisipati S, Jesudason E. Evaluating the association between congenital cystic adenomatoid malformation of the lung and abdominal wall laxity. Clin Dysmorphol 2007; 16:77-80. [PMID: 17351348 DOI: 10.1097/mcd.0b013e328014724e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a male fetus with congenital cystic adenomatoid malformation of the lung, who was treated by laser with resolution of hydrops. Postnatally, the infant had the typical abdominal wall laxity and undescended testes characteristic of prune-belly syndrome. The sonographic diagnosis of cystic adenomatoid malformation was confirmed histologically after postnatal resection. The relationship between cystic adenomatoid malformation and prune-belly syndrome is evaluated through analysis of the present and previously reported cases. We show that there does appear to be a true association between cystic adenomatoid malformation and prune-belly syndrome. We also, however, demonstrate that the traditional explanation (cystic adenomatoid malformation-related hydrops causes ascitic abdominal distension resulting in prune-belly syndrome) is unlikely to be straightforwardly correct.
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Affiliation(s)
- Ruth Armstrong
- Cheshire and Merseyside Medical Genetics Service, Department of Clinical Genetics Department of Paediatric Surgery, Royal Liverpool Children's Hospital (Alder Hey) Division of Child Health, University of Liverpool, Liverpool, UK
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22
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Lee JS, Yu Q, Shin JT, Sebzda E, Bertozzi C, Chen M, Mericko P, Stadtfeld M, Zhou D, Cheng L, Graf T, MacRae CA, Lepore JJ, Lo CW, Kahn ML. Klf2 is an essential regulator of vascular hemodynamic forces in vivo. Dev Cell 2007; 11:845-57. [PMID: 17141159 DOI: 10.1016/j.devcel.2006.09.006] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Revised: 07/27/2006] [Accepted: 09/11/2006] [Indexed: 10/23/2022]
Abstract
Hemodynamic responses that control blood pressure and the distribution of blood flow to different organs are essential for survival. Shear forces generated by blood flow regulate hemodynamic responses, but the molecular and genetic basis for such regulation is not known. The transcription factor KLF2 is activated by fluid shear stress in cultured endothelial cells, where it regulates a large number of vasoactive endothelial genes. Here, we show that Klf2 expression during development mirrors the rise of fluid shear forces, and that endothelial loss of Klf2 results in lethal embryonic heart failure due to a high-cardiac-output state. Klf2 deficiency does not result in anemia or structural vascular defects, and it can be rescued by administration of phenylephrine, a catecholamine that raises vessel tone. These findings identify Klf2 as an essential hemodynamic regulator in vivo and suggest that hemodynamic regulation in response to fluid shear stress is required for cardiovascular development and function.
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MESH Headings
- Anemia/physiopathology
- Animals
- Arteriovenous Malformations/physiopathology
- Blood Flow Velocity
- Blood Vessels/cytology
- Blood Vessels/drug effects
- Blood Vessels/physiology
- Cells, Cultured
- Embryo, Mammalian/cytology
- Embryo, Mammalian/metabolism
- Embryo, Nonmammalian
- Endothelium, Vascular/cytology
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/metabolism
- Gene Expression Regulation, Developmental
- Genes, Lethal
- Heart Failure
- Integrases/metabolism
- Kruppel-Like Transcription Factors/genetics
- Kruppel-Like Transcription Factors/physiology
- Mice
- Mice, Knockout
- Mice, Transgenic
- Microfilament Proteins/genetics
- Microfilament Proteins/physiology
- Muscle Proteins/genetics
- Muscle Proteins/physiology
- Muscle, Smooth/cytology
- Muscle, Smooth/drug effects
- Muscle, Smooth/metabolism
- Myocardium/cytology
- Myocardium/metabolism
- Phenylephrine/pharmacology
- Polymerase Chain Reaction
- Promoter Regions, Genetic
- Receptor, TIE-2/genetics
- Receptor, TIE-2/physiology
- Stress, Mechanical
- Transcription, Genetic
- Umbilical Veins/cytology
- Umbilical Veins/drug effects
- Umbilical Veins/metabolism
- Zebrafish/embryology
- Zebrafish/metabolism
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Affiliation(s)
- John S Lee
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Zankl A, Osterheld MC, Vial Y, Beurret N, Meuli R, Meagher-Villemure K, Roth-Kleiner M. Right-sided diaphragmatic eventration: a rare cause of non-immune hydrops fetalis. Neonatology 2007; 92:14-8. [PMID: 17596732 DOI: 10.1159/000098412] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 09/18/2006] [Indexed: 11/19/2022]
Abstract
We report 2 cases of non-immune hydrops fetalis (NIHF) in which autopsy findings revealed an association with right-sided congenital diaphragmatic eventration (CDE). Both patients born at 30 weeks of gestation presented with severe generalized skin oedema, pleural effusions and ascites. They both died shortly after birth of cardiorespiratory insufficiency due to lung hypoplasia and low output heart failure. The right thoracic cavity was filled with the membranous but intact right diaphragm covering the herniated visceral organs including parts of the liver, small bowel and colon surrounded by voluminous ascites. In similar fashion to the situation seen in congenital diaphragmatic hernia (CDH), the displaced visceral organs led to impaired lung growth resulting in important lung hypoplasia and obstructed venous return. Extravascular liquid accumulation was probably further aggravated by hypoproteinaemia secondary to liver dysfunction resulting from the venous congestion and cardiac failure. In summary, CDE is a rare condition resulting from impaired ingrowth of muscle fibres into the diaphragm during the first trimester. Prenatal differentiation of CDE from CDH is a real challenge. The association of CDE and NIHF has not been previously described.
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Affiliation(s)
- A Zankl
- Division of Neonatology, Department of Pediatrics, University Hospital of Lausanne, Lausanne, Switzerland
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25
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Abstract
BACKGROUND The placenta provides a 'diary' of the pregnancy. The information provided from pathological assessment of the placenta may provide important clinical information for both the mother and the neonate. AIMS To develop tools to ensure histopathological assessment of appropriate placentas and uniform provision of clinical history to pathologists to enable clinicopathological assessment. METHODS A placenta information form was devised that included the following clinical criteria: gestational age, prolonged rupture of membranes at term, suspected maternal/fetal bacterial or viral infection, swabs taken for culture, intrauterine growth restriction, perinatal death, pre-eclampsia, essential hypertension, diabetes, placenta praevia, multiple pregnancy and cytogenetics. A table was introduced into the midwifery placenta policy indicating clinical criteria for microbiology, histopathological or cytogenetic assessment. A colourful reminder poster was designed and placed in the delivery suite and education sessions were provided. Six-month review periods were performed prior to and following the two interventions. RESULTS The number of placentas submitted for histopathological examination (and meeting the inclusion criteria) increased from 41 (120/296) to 61% (161/266) following the initial interventions and to 82% (262/319) with the introduction of the reminder poster and education sessions. Clinically relevant placental pathology was found in 55 (64%) of cases in these time intervals. Comprehensive clinical history on the pathology report improved from 45 to 98% over the assessment time. CONCLUSIONS Valuable information on a pregnancy can be provided by ensuring histopathological examination of appropriate placentas with the simple introduction of placental information sheets, updated midwifery policy, education sessions and a colourful reminder poster.
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Affiliation(s)
- Alison L Kent
- Department of Neonatology, The Canberra Hospital, Australian National University Medical School, Australian Capital Territory, Australia.
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26
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Nuovo GJ, Cooper LD, Bartholomew D. Histologic, infectious, and molecular correlates of idiopathic spontaneous abortion and perinatal mortality. ACTA ACUST UNITED AC 2005; 14:152-8. [PMID: 16106196 DOI: 10.1097/01.pas.0000176769.18423.37] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to analyze the placental and neonatal tissues in fatal cases for a wide variety of infectious agents and cytokine expression. Placentas and corresponding neonatal tissues in 21 consecutive cases of idiopathic spontaneous abortion or perinatal death, before or within 2 days of birth, were tested for an infectious agent. The controls included 10 consecutive cases of fetal and placental tissues from therapeutic abortions, 5 placentas from unremarkable childbirths, and 11 placentas from cases of spontaneous abortion or perinatal death of known cause (ruptured uterus, placenta abruption, prolapsed cord). An intrauterine infection was noted in 16 of 21 (76%) of the placentas associated with neonatal mortality; in each case, the same infectious agent was found in the neonatal tissues, primarily the spleen. The most common infectious agent was enterovirus/coxsackie virus (10 cases); the histologic findings in the placenta were nonspecific. There was strong expression of TNF-alpha in the placenta and spleen of each of the cases of intrauterine infection and in none of the 26 controls. It is concluded that in utero infection and the associated cytokine up-regulation are responsible for many cases of unexplained fetal and neonatal loss.
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Affiliation(s)
- Gerard J Nuovo
- Department of Pathology, Ohio State University Medical Center, Columbus, OH 43210, USA.
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27
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Rodríguez MM, Bruce JH, Jiménez XF, Romaguera RL, Bancalari E, García OL, Ferrer PL. Nonimmune hydrops fetalis in the liveborn: series of 32 autopsies. Pediatr Dev Pathol 2005; 8:369-78. [PMID: 16010481 DOI: 10.1007/s10024-005-8089-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Accepted: 02/18/2005] [Indexed: 10/25/2022]
Abstract
Nonimmune hydrops fetalis (NIHF) or generalized soft tissue edema and cavity effusions may be due to cardiovascular diseases, congenital infections, genitourinary malformations, thoracic masses, placental conditions, chromosomal abnormalities, and idiopathic. We report 32 cases of NIHF from among 429 neonates who underwent autopsies (incidence 7.45%). Sixteen cases (50%) had cardiovascular disease; all were due to low output cardiac failure; 7 had structural congenital heart disease. Three of the children with congenital heart disease also had chromosomal abnormalities: 2 had trisomy 18 and 1 had Noonan syndrome. Among myocardial conditions were five subjects with cardiomyopathies (1 of each of the following types): oncocytic, dilated, endocardial fibroelastosis, cardiac glycogenosis, and carnitine deficiency; 3 had myocarditis, and 1 had cardiac rhabdomyomas. Congenital infections were due to cytomegalovirus in 3 cases, bacteria in 2, and parvovirus in 1. The mechanism of NIHF in these cases might be a combination of decreased myocardial contractility due to myocarditis and fetal anemia. Genitourinary diseases were present in 5 newborns: Two had congenital nephrotic syndrome, 1 had VACTER association, 1 had prune-belly syndrome, and 1 had urogenital sinus malformation. Intrathoracic lesions were found in 2 babies (pulmonary sequestration and diaphragmatic hernia). One twin died of volume overload due to twin transfusion syndrome. Only 2 newborns were classified as idiopathic. Our study shows that cardiovascular diseases that lead to heart failure or impaired venous return are more common in the liveborn (50%), whereas congenital infections are more common in the stillborn with NIHF.
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Affiliation(s)
- María M Rodríguez
- Department of Pathology, Division of Pediatric Pathology, University of Miami, Jackson Memorial Medical Center, Miami, FL 33136, USA.
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Becker S, Hofbeck M, Kendziorra H, Wallwiener D, Mielke G. Double-chamber right ventricle associated with severe fetal cardiac failure. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 23:411-413. [PMID: 15065199 DOI: 10.1002/uog.1027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Fetal cardiac defects leading to intrauterine cardiac failure and subsequent fetal hydrops are rare. We report an unusual case of a double-chamber right ventricle leading to progressive fetal cardiac insufficiency and hydrops. The patient was first managed conservatively. Delivery by Cesarean section was performed for a pathological fetal heart-rate tracing at 28 weeks of gestation. The newborn died 4 h postpartum due to generalized cardiac insufficiency.
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Affiliation(s)
- S Becker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany.
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29
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Current Awareness in prenatal diagnosis. Prenat Diagn 2002. [DOI: 10.1002/pd.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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