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Laoreti A, Sala V, Casati D, Faiola S, Spaccini L, Cetin I, Lanna MM. Amnioreduction for Polyhydramnios in a Consecutive Series at a Single Center: Indications, Risks and Perinatal Outcomes. CHILDREN (BASEL, SWITZERLAND) 2024; 11:502. [PMID: 38671719 PMCID: PMC11048928 DOI: 10.3390/children11040502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
Pregnancies complicated by severe polyhydramnios are associated with a high rate of underlying fetal anomaly. Amnioreduction may be offered to alleviate maternal symptoms. This is a retrospective study of amnioreductions performed on singleton and twin gestations complicated by symptomatic polyhydramnios between 2010 and 2023 at our tertiary referral center. The indications, procedural techniques and pregnancy and neonatal outcomes were retrieved from an archive database and reviewed with the use of the maternal and child medical record chart, the hospital electronic clinical discharge report and telephone recalls. Our study comprised 86 pregnancies, 65 singletons and 21 twin pregnancies. Fetal anomalies were identified in 79% of cases, mainly gastrointestinal obstructive anomalies; 9.3% of cases were idiopathic. The median gestational age at first amnioreduction was 32.5 weeks, and peri-procedural complications were rare (1 case of placental abruption and 2 cases of preterm delivery). The median gestational age at delivery was 36.5 weeks, with a median prolongation of the pregnancy from the time of first drain until birth of 30 days. Preterm labor < 37 weeks occurred in 48.8% of procedures, with 26.7% of patients delivering before 34 weeks and pPROM < 36 weeks recorded in 23.2% of cases. In conclusion, amnioreduction offered to alleviate maternal symptoms is a reasonably safe procedure with a low complication rate. These pregnancies necessitate management in a tertiary referral center because of their need for a multidisciplinary approach both prenatally and postnatally.
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Affiliation(s)
- Arianna Laoreti
- Fetal Therapy Unit “U. Nicolini”, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.C.); (S.F.); (M.M.L.)
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
| | - Valentina Sala
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
| | - Daniela Casati
- Fetal Therapy Unit “U. Nicolini”, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.C.); (S.F.); (M.M.L.)
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
| | - Stefano Faiola
- Fetal Therapy Unit “U. Nicolini”, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.C.); (S.F.); (M.M.L.)
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
| | - Luigina Spaccini
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
- Clinical Genetic Service, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy
| | - Irene Cetin
- Fondazione IRCCS Ca’ Granda, Hospital Maggiore Policlinico, University of Milan, 20122 Milan, Italy;
| | - Mariano M. Lanna
- Fetal Therapy Unit “U. Nicolini”, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.C.); (S.F.); (M.M.L.)
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
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Gerli MFM, Calà G, Beesley MA, Sina B, Tullie L, Sun KY, Panariello F, Michielin F, Davidson JR, Russo FM, Jones BC, Lee DDH, Savvidis S, Xenakis T, Simcock IC, Straatman-Iwanowska AA, Hirst RA, David AL, O'Callaghan C, Olivo A, Eaton S, Loukogeorgakis SP, Cacchiarelli D, Deprest J, Li VSW, Giobbe GG, De Coppi P. Single-cell guided prenatal derivation of primary fetal epithelial organoids from human amniotic and tracheal fluids. Nat Med 2024; 30:875-887. [PMID: 38438734 PMCID: PMC10957479 DOI: 10.1038/s41591-024-02807-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/05/2024] [Indexed: 03/06/2024]
Abstract
Isolation of tissue-specific fetal stem cells and derivation of primary organoids is limited to samples obtained from termination of pregnancies, hampering prenatal investigation of fetal development and congenital diseases. Therefore, new patient-specific in vitro models are needed. To this aim, isolation and expansion of fetal stem cells during pregnancy, without the need for tissue samples or reprogramming, would be advantageous. Amniotic fluid (AF) is a source of cells from multiple developing organs. Using single-cell analysis, we characterized the cellular identities present in human AF. We identified and isolated viable epithelial stem/progenitor cells of fetal gastrointestinal, renal and pulmonary origin. Upon culture, these cells formed clonal epithelial organoids, manifesting small intestine, kidney tubule and lung identity. AF organoids exhibit transcriptomic, protein expression and functional features of their tissue of origin. With relevance for prenatal disease modeling, we derived lung organoids from AF and tracheal fluid cells of congenital diaphragmatic hernia fetuses, recapitulating some features of the disease. AF organoids are derived in a timeline compatible with prenatal intervention, potentially allowing investigation of therapeutic tools and regenerative medicine strategies personalized to the fetus at clinically relevant developmental stages.
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Affiliation(s)
- Mattia Francesco Maria Gerli
- Department of Surgical Biotechnology, Division of Surgery and Interventional Science, University College London, London, UK.
- Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Giuseppe Calà
- Department of Surgical Biotechnology, Division of Surgery and Interventional Science, University College London, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Max Arran Beesley
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Beatrice Sina
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Politecnico di Milano, Milan, Italy
| | - Lucinda Tullie
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Stem Cell and Cancer Biology Laboratory, The Francis Crick Institute, London, UK
| | - Kylin Yunyan Sun
- Department of Surgical Biotechnology, Division of Surgery and Interventional Science, University College London, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Francesco Panariello
- Armenise/Harvard Laboratory of Integrative Genomics, Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
| | - Federica Michielin
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Joseph R Davidson
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Francesca Maria Russo
- Department of Development and Regeneration, Woman and Child and UZ Leuven Clinical Department of Obstetrics and Gynaecology, KU Leuven, Leuven, Belgium
| | - Brendan C Jones
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Dani Do Hyang Lee
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Savvas Savvidis
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Theodoros Xenakis
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ian C Simcock
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | | | - Robert A Hirst
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Department of Development and Regeneration, Woman and Child and UZ Leuven Clinical Department of Obstetrics and Gynaecology, KU Leuven, Leuven, Belgium
| | | | - Alessandro Olivo
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Simon Eaton
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Stavros P Loukogeorgakis
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Davide Cacchiarelli
- Armenise/Harvard Laboratory of Integrative Genomics, Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
- Department of Translational Medicine, University of Naples Federico II, Naples, Italy
- Genomics and Experimental Medicine Program, Scuola Superiore Meridionale, Naples, Italy
| | - Jan Deprest
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Department of Development and Regeneration, Woman and Child and UZ Leuven Clinical Department of Obstetrics and Gynaecology, KU Leuven, Leuven, Belgium
| | - Vivian S W Li
- Stem Cell and Cancer Biology Laboratory, The Francis Crick Institute, London, UK
| | | | - Paolo De Coppi
- Great Ormond Street Institute of Child Health, University College London, London, UK.
- Department of Development and Regeneration, Woman and Child and UZ Leuven Clinical Department of Obstetrics and Gynaecology, KU Leuven, Leuven, Belgium.
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
- Medical and Surgical Department of the Fetus, Newborn and Infant, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy.
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
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Walsh CJ, Micke K, Elfman H, Bock M, Harper T, Zaretsky M, Galan HL, Behrendt N, Putra M. Successful antenatal treatment of MAGED2-related Bartter syndrome and review of treatment options and efficacy. Prenat Diagn 2024; 44:172-179. [PMID: 38159268 DOI: 10.1002/pd.6508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/14/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
A new form of transient antenatal Bartter syndrome (aBS) was recently identified that is associated with the X-linked MAGED2 variant. Case reports demonstrate that this variant leads to severe polyhydramnios that may result in preterm birth or pregnancy loss. There is limited but promising evidence that amnioreductions may improve fetal outcomes in this rare condition. We report a woman with two affected pregnancies. In the first pregnancy, the patient was diagnosed with mild-to-moderate polyhydramnios in the second trimester that ultimately resulted in preterm labor and delivery at 25 weeks with fetal demise. Whole exome sequencing of the amniotic fluid sample resulted after the pregnancy loss and revealed a c.1337G>A MAGED2 variant that was considered diagnostically. The subsequent pregnancy was confirmed by chorionic villi sampling to also be affected by this variant. The pregnancy was managed with frequent ultrasounds and three amnioreductions that resulted in spontaneous vaginal delivery at 37 weeks and 6 days of a viable newborn with no evidence of overt electrolyte abnormalities suggesting complete resolution. A detailed review of the published cases of MAGED2-related transient aBS is provided. Our review focuses on individuals who received antenatal treatment. A total of 31 unique cases of MAGED2-related transient aBS were compiled. Amnioreduction was performed in 23 cases and in 18 cases no amnioreduction was performed. The average gestational age at delivery was significantly lower in cases without serial amnioreduction (28.7 vs. 30.71 weeks, p = 0.03). Neonatal mortality was seen in 5/18 cases without serial amnioreduction, and no mortality was observed in the cases with serial amnioreduction. In cases of second trimester severe polyhydramnios without identifiable cause, whole exome sequencing should be considered. Intensive ultrasound surveillance and serial amnioreduction is recommended for the management of MAGED2-related transient aBS.
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Affiliation(s)
- Caroline J Walsh
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kestutis Micke
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Hannah Elfman
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Margret Bock
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, Pediatric Nephrology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Teresa Harper
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael Zaretsky
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Henry L Galan
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nicholas Behrendt
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Manesha Putra
- The University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, Section of Genetics and Metabolism, Children's Hospital Colorado, Aurora, Colorado, USA
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Chen YS, He JF, Li DZ. Amnioreduction in cases of polyhydramnios: a low-risk procedure. Am J Obstet Gynecol MFM 2024; 6:101234. [PMID: 38000503 DOI: 10.1016/j.ajogmf.2023.101234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Affiliation(s)
- Yong-Shan Chen
- Prenatal Diagnosis Unit, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Jie-Fu He
- Prenatal Diagnosis Unit, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Jinsui Road 9, Zhujiang New Town, Guangzhou 510623, China.
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Soni S, Paidas Teefey C, Gebb JS, Khalek N, Neary K, Miller K, Moldenhauer JS. Amnioreduction vs expectant management in pregnancies with moderate to severe polyhydramnios. Am J Obstet Gynecol MFM 2023; 5:101192. [PMID: 37858792 DOI: 10.1016/j.ajogmf.2023.101192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/20/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The rate of polyhydramnios is higher in pregnancies complicated by congenital anomalies. These pregnancies have higher rates of peripartum complications. Amnioreduction is offered to relieve maternal symptoms such as dyspnea, abdominal and respiratory discomfort, and other issues like satiety. OBJECTIVE This study aimed to report the rates of amnioreduction and its associated complications in pregnancies with moderate to severe polyhydramnios secondary to fetal anomalies. We also sought to determine if amnioreduction provided additional benefits, including prolongation of pregnancy and a decrease in the rates of peripartum morbidities associated with moderate to severe polyhydramnios. STUDY DESIGN This was a retrospective review of anomalous singleton pregnancies with moderate to severe polyhydramnios that were evaluated and delivered at a single center between 2013 and 2021. Peripartum outcomes were compared between pregnancies that underwent amnioreduction and those that were expectantly managed. Mann-Whitney U tests were used to compare continuous variables and Fisher's exact tests were used for categorical variables. A multiple regression model was created to understand the effects of amnioreduction on gestational age at delivery. RESULTS A total of 218 singleton pregnancies met the inclusion criteria of moderate to severe polyhydramnios in the study period. Of those, 110 patients (50.5%) underwent amnioreduction and 108 patients (49.5%) opted for expectant management. A total of 147 procedures were performed at a median gestational age of 32.5 weeks and a median of 1900 mL of amniotic fluid was removed per procedure. Complications occurred in 10.9% (n=16) of procedures, including preterm delivery within 48 hours in 5.4% cases (n=8). The median amniotic fluid index was higher in the amnioreduction group than in the expectant group (38.9 cm vs 35.5 cm; P<.0001). Patients who underwent amnioreduction had an earlier median gestational age at delivery (36.3 weeks vs 37.0 weeks; P=.048), however, the rates of spontaneous preterm delivery were similar. A higher percentage of women in the amnioreduction group had vaginal delivery (49.4% vs 30.5%; P=.01) and lower rates of uterine atony (2.4% vs 13.7%; P=.006). In the multiple linear regression analysis, the gestational age at delivery positively correlated with gestational age at amnioreduction after controlling for amniotic fluid volume (P<.0001; 95% confidence interval, 0.34-0.71). In addition, the patients in the amnioreduction group were twice as likely to have a vaginal delivery (P=.02). CONCLUSION Amnioreduction in the setting of moderate-severe polyhydramnios has a reasonably low rate of complications but does not provide any benefits in terms of prolonging the pregnancy. The procedure may increase the likelihood of vaginal delivery and lower the rates of uterine atony.
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Affiliation(s)
- Shelly Soni
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer).
| | - Christina Paidas Teefey
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer)
| | - Juliana S Gebb
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer)
| | - Nahla Khalek
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer)
| | - Kayla Neary
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer)
| | - Kendra Miller
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer)
| | - Julie S Moldenhauer
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer)
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Jha P, Raghu P, Kennedy AM, Sugi M, Morgan TA, Feldstein V, Pōder L, Penna R. Assessment of Amniotic Fluid Volume in Pregnancy. Radiographics 2023; 43:e220146. [PMID: 37200220 DOI: 10.1148/rg.220146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Amniotic fluid (AF) is an integral part of the fetal environment and is essential for fetal growth and development. Pathways of AF recirculation include the fetal lungs, swallowing, absorption through the fetal gastrointestinal tract, excretion through fetal urine production, and movement. In addition to being a marker for fetal health, adequate AF is necessary for fetal lung development, growth, and movement. The role of diagnostic imaging is to provide a detailed fetal survey, placental evaluation, and clinical correlation with maternal conditions to help identify causes of AF abnormalities and thereby enable specific therapy. Oligohydramnios prompts evaluation for fetal growth restriction as well as genitourinary issues, including renal agenesis, multicystic dysplastic kidneys, ureteropelvic junction obstruction, and bladder outlet obstruction. Premature preterm rupture of membranes should also be clinically excluded as a cause of oligohydramnios. Clinical trials evaluating amnioinfusion are underway as a potential intervention for renal causes of oligohydramnios. Most cases of polyhydramnios are idiopathic, with maternal diabetes being a common cause. Polyhydramnios prompts evaluation for fetal gastrointestinal obstruction and oropharyngeal or thoracic masses, as well as neurologic or musculoskeletal anomalies. Amnioreduction is performed only for maternal indications such as symptomatic polyhydramnios causing maternal respiratory distress. Polyhydramnios with fetal growth restriction is paradoxical and can occur with maternal diabetes and hypertension. When these maternal conditions are absent, this raises concern for aneuploidy. The authors describe the pathways of AF production and circulation, US and MRI assessment of AF, disease-specific disruption of AF pathways, and an algorithmic approach to AF abnormalities. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Priyanka Jha
- From the University of California San Francisco, 505 Parnassus Ave, San Francisco, Calif (P.J., P.R., M.S., T.A.M., V.F., L.P.); University of Utah Hospital, Salt Lake City, Utah (A.M.K.); and Inland Imaging, Seattle, Wash (R.P.)
| | - Preethi Raghu
- From the University of California San Francisco, 505 Parnassus Ave, San Francisco, Calif (P.J., P.R., M.S., T.A.M., V.F., L.P.); University of Utah Hospital, Salt Lake City, Utah (A.M.K.); and Inland Imaging, Seattle, Wash (R.P.)
| | - Anne M Kennedy
- From the University of California San Francisco, 505 Parnassus Ave, San Francisco, Calif (P.J., P.R., M.S., T.A.M., V.F., L.P.); University of Utah Hospital, Salt Lake City, Utah (A.M.K.); and Inland Imaging, Seattle, Wash (R.P.)
| | - Mark Sugi
- From the University of California San Francisco, 505 Parnassus Ave, San Francisco, Calif (P.J., P.R., M.S., T.A.M., V.F., L.P.); University of Utah Hospital, Salt Lake City, Utah (A.M.K.); and Inland Imaging, Seattle, Wash (R.P.)
| | - Tara A Morgan
- From the University of California San Francisco, 505 Parnassus Ave, San Francisco, Calif (P.J., P.R., M.S., T.A.M., V.F., L.P.); University of Utah Hospital, Salt Lake City, Utah (A.M.K.); and Inland Imaging, Seattle, Wash (R.P.)
| | - Vickie Feldstein
- From the University of California San Francisco, 505 Parnassus Ave, San Francisco, Calif (P.J., P.R., M.S., T.A.M., V.F., L.P.); University of Utah Hospital, Salt Lake City, Utah (A.M.K.); and Inland Imaging, Seattle, Wash (R.P.)
| | - Liina Pōder
- From the University of California San Francisco, 505 Parnassus Ave, San Francisco, Calif (P.J., P.R., M.S., T.A.M., V.F., L.P.); University of Utah Hospital, Salt Lake City, Utah (A.M.K.); and Inland Imaging, Seattle, Wash (R.P.)
| | - Rubal Penna
- From the University of California San Francisco, 505 Parnassus Ave, San Francisco, Calif (P.J., P.R., M.S., T.A.M., V.F., L.P.); University of Utah Hospital, Salt Lake City, Utah (A.M.K.); and Inland Imaging, Seattle, Wash (R.P.)
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7
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Alajjuri OA, Samaha ME, Honemeyer U, Mohammed G, Mousa NA. Balancing Benefits and Risks of Indomethacin in the Management of Antenatal Bartter Syndrome: A Case Report. Front Med (Lausanne) 2022; 9:870503. [PMID: 35847797 PMCID: PMC9276994 DOI: 10.3389/fmed.2022.870503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/27/2022] [Indexed: 12/16/2022] Open
Abstract
Background Bartter syndrome, a very rare inherited renal tubular disorder, characterized by urinary salt wastage, hypokalemia, polyuria, and metabolic alkalosis, may manifest antenatally as severe isolated polyhydramnios. Indomethacin is known to reduce salt wastage and subsequent polyhydramnios during pregnancy; however, it reduces the Ductus Arteriosus diameter among other potential complications, such as inhibition of gastrointestinal perfusion and increasing the risk of renal toxicity. Case A 36-year-old multigravida presented with severe isolated polyhydramnios at 30 weeks of gestation. Based on a history of a previous pregnancy affected with Bartter syndrome, indomethacin was initiated. Amniotic fluid volume and Ductus Arteriosus diameter were monitored. As evidence lacks on optimal dose and duration of indomethacin, multiple-dose adjustments were made to reduce the amniotic fluid volume while maintaining normal Ductus Arteriosus diameter. Progressive polyhydramnios led to Cesarean section at 34+ weeks of gestation resulting in a healthy fetus diagnosed with Bartter syndrome in the early neonatal period. Conclusion We share our experience in the adjustment of the dose and duration of Indomethacin therapy in the treatment of severe polyhydramnios associated with antenatal Bartter syndrome. Amniotic fluid index, Ductus Arteriosus diameter, and umbilical artery doppler work together as key indicators to guide the success and safety of the therapy.
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Affiliation(s)
- Omar Ala' Alajjuri
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Mayar Essam Samaha
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Ulrich Honemeyer
- New Medical Center (NMC) Royal Hospital Sharjah, Sharjah, United Arab Emirates
| | - Ghada Mohammed
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Noha A. Mousa
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- *Correspondence: Noha A. Mousa
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Shamshirsaz AA, Aalipour S, Stewart KA, Nassr AA, Furtun BY, Erfani H, Sundgren NC, Cortes MS, Donepudi RV, Lee TC, Mehta DK, Kravitz ES, Asl NM, Espinoza J, Belfort MA. Perinatal characteristics and early childhood follow up after ex-utero intrapartum treatment for head and neck teratomas by prenatal diagnosis. Prenat Diagn 2021; 41:497-504. [PMID: 33386645 DOI: 10.1002/pd.5894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/09/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ex utero intrapartum treatment (EXIT) is utilized for safe delivery when a baby has a compromised airway. The purpose of this retrospective study was to examine the indications and outcomes of 11 children presenting with airway occluding oropharyngeal and cervical teratomas. METHODS Study of all children with an airway occluding teratoma delivered via EXIT (2001-2018) in our unit. Primary outcomes included survival and tracheostomy at discharge. Data are reported using descriptive statistics as median (range) and rate (%). RESULTS We performed 45 EXIT procedure performed between January 2001 and April 2018. Of these, eleven were for cervical and/or upper airway teratoma. Ten (91%) cases had associated polyhydramnios, two (18%) developed nonimmune hydrops, and eight (72%) delivered preterm. Six (45.5%) were performed as an emergency. Estimated blood loss was 1000 ml (500, 1000). The neonatal mortality rate was 18% (2/11) and 33% (3/9) of the survivors were discharged with a tracheostomy. CONCLUSION EXIT is a reasonable option for delivery of babies with an occlusive upper airway mass. Neonatal survival depends on individualized factors but may be as high as 82% in those with teratoma.
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Affiliation(s)
- Alireza A Shamshirsaz
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Soroush Aalipour
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Kelsey A Stewart
- Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ahmed A Nassr
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.,Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Egypt
| | - Betul Y Furtun
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Hadi Erfani
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Nathan C Sundgren
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Magdalena S Cortes
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Roopali V Donepudi
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Timothy C Lee
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Deepak K Mehta
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Elizabeth S Kravitz
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Nazli M Asl
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Jimmy Espinoza
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Michael A Belfort
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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