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Baldini GM, Lot D, Malvasi A, Di Nanni D, Laganà AS, Angelucci C, Tinelli A, Baldini D, Trojano G. Isthmocele and Infertility. J Clin Med 2024; 13:2192. [PMID: 38673465 PMCID: PMC11050579 DOI: 10.3390/jcm13082192] [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: 02/10/2024] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Isthmocele is a gynecological condition characterized by a disruption in the uterine scar, often associated with prior cesarean sections. This anatomical anomaly can be attributed to inadequate or insufficient healing of the uterine wall following a cesarean incision. It appears that isthmocele may impact a woman's quality of life as well as her reproductive capacity. The incidence of isthmocele can range from 20% to 70% in women who have undergone a cesarean section. This review aims to sum up the current knowledge about the effect of isthmocele on fertility and the possible therapeutic strategies to achieve pregnancy. However, currently, there is not sufficiently robust evidence to indicate the need for surgical correction in all asymptomatic patients seeking fertility. In cases where surgical correction of isthmocele is deemed necessary, it is advisable to evaluate residual myometrial thickness (RMT). For patients with RMT >2.5-3 mm, hysteroscopy appears to be the technique of choice. In cases where the residual tissue is lower, recourse to laparotomic, laparoscopic, or vaginal approaches is warranted.
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Affiliation(s)
- Giorgio Maria Baldini
- MOMO’ FertiLIFE, IVF Clinic, 76011 Bisceglie, Italy
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Dario Lot
- MOMO’ FertiLIFE, IVF Clinic, 76011 Bisceglie, Italy
| | - Antonio Malvasi
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Doriana Di Nanni
- Pathology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70125 Bari, Italy
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Childcare, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Cecilia Angelucci
- Gynecology and Obstetrics Clinic, University of Sassari, 07100 Sassari, Italy;
| | - Andrea Tinelli
- Department of Gynaecology and Obstetrics, “Veris Delli Ponti” Hospital, and CERICSAL (Centro di RIcerca Clinico SALentino), “Veris delli Ponti Hospital”, 73020 Lecce, Italy;
| | | | - Giuseppe Trojano
- Department of Maternal and Child, Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
- Madonna Delle Grazie Hospital ASM, 75100 Matera, Italy
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Alrifai N, Alhuneafat L, Jabri A, Khalid MU, Tieliwaerdi X, Sukhon F, Hammad N, Al-Abdouh A, Mhanna M, Siraj A, Sharma T. Pregnancy and Fetal Outcomes in Patients with Ehlers-Danlos Syndrome: A Nationally Representative Analysis. Curr Probl Cardiol 2023; 48:101634. [PMID: 36806636 DOI: 10.1016/j.cpcardiol.2023.101634] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Cardiovascular (CV) disease remains one of the leading causes of maternal morbidity and mortality globally. CV complications occur frequently in Ehlers-Danlos Syndrome (EDS). Pregnancy outcomes, however, are not well established in patients with EDS. We aim to evaluate pregnancy outcomes in this population compared to patients without EDS. METHODS We conducted a population-based, retrospective, cohort study using the national inpatient data sample to evaluate and compare pregnancy and fetal outcomes in patients with and without EDS, delivering between 2016 and 2019. Regression analysis was performed and adjusted for maternal age and race to compare maternal and fetal outcomes. RESULTS Of the total 5,887,050 births in our cohort, 1,016 were to patients with EDS. The EDS cohort was more likely to be older and white with multiple gestations and comorbidities, such as smoking, mitral valve prolapse, and chronic hypertension. When we adjusted for age and race, patients with EDS were more likely than those without EDS to require Cesarean-section, develop postpartum hemorrhage, experience intrauterine growth restriction, and deliver preterm. CONCLUSION In this nationally representative study, patients with EDS experienced higher rates of maternal complications, however, aortic aneurysmal rupture was not among them. Further studies regarding each type of EDS and its obstetric complications may aid in pre-pregnancy counseling, antenatal care, and formulating a multidisciplinary obstetric approach for this patient population. SHORT ABSTRACT Cardiovascular complications occur frequently in Ehlers-Danlos Syndrome (EDS). Pregnancy outcomes, however, are not well established in patients with EDS. We conducted a population-based, retrospective, cohort study using the national inpatient sample to compare pregnancy and fetal outcomes in patients with and without EDS, delivering between 2016 and 2019. Regression analysis was performed and adjusted for maternal age and race to compare both groups. Of the total 5,887,050 births in our cohort, 1,016 were to patients with EDS. The EDS cohort was more likely to be older, white and have multiple comorbidities, such as smoking, mitral valve prolapse, and chronic hypertension. When we adjusted for age and race, patients with EDS were more likely than those without EDS to require Cesarean-section, develop postpartum hemorrhage, experience intrauterine growth restriction, and deliver preterm. In this study, patients with EDS experienced higher rates of maternal complications, however, aortic aneurysmal rupture was not among them.
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Affiliation(s)
- Nada Alrifai
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Laith Alhuneafat
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ahmad Jabri
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA.
| | | | | | - Fares Sukhon
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Nour Hammad
- Department of Nephrology, University Hospitals Cleveland Medical Center, Cleveland, OH USA
| | - Ahmad Al-Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Mohammed Mhanna
- Department of Cardiovascular Medicine, University of Iowa, Iowa City, IA, USA
| | - Aisha Siraj
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Tarun Sharma
- Department of Rheumatology, Allegheny Health Network, Pittsburgh, PA, USA
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Roles of Two Small Leucine-Rich Proteoglycans Decorin and Biglycan in Pregnancy and Pregnancy-Associated Diseases. Int J Mol Sci 2021; 22:ijms221910584. [PMID: 34638928 PMCID: PMC8509074 DOI: 10.3390/ijms221910584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022] Open
Abstract
Two small leucine-rich proteoglycans (SLRP), decorin and biglycan, play important roles in structural–functional integrity of the placenta and fetal membranes, and their alterations can result in several pregnancy-associated diseases. In this review, we briefly discuss normal placental structure and functions, define and classify SLRPs, and then focus on two SLRPs, decorin (DCN) and biglycan (BGN). We discuss the consequences of deletions/mutations of DCN and BGN. We then summarize DCN and BGN expression in the pregnant uterus, myometrium, decidua, placenta, and fetal membranes. Actions of these SLRPs as ligands are then discussed in the context of multiple binding partners in the extracellular matrix and cell surface (receptors), as well as their alterations in pathological pregnancies, such as preeclampsia, fetal growth restriction, and preterm premature rupture of membranes. Lastly, we raise some unanswered questions as food for thought.
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Cherniad'ev SA, Mal'gina GB, Leshchinskaia AI, Erofeev EN, Bochegov VS, Makarov RA, Tarasova NV, Krokhaleva IM. [Multiple ruptures of major vessels and womb in a parturient woman with Ehlers-Danlos syndrome]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:153-158. [PMID: 34528600 DOI: 10.33529/angiq2021323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Presented herein is a clinical case report demonstrating uncontrolled development of fatal complications in a young parturient woman with vascular Ehlers-Danlos syndrome. The disease had not been known previously. In the third period of natural term delivery we revealed a complete linear vertical uterine rupture with a clinical picture of haemorrhagic shock. After hysterectomy we encountered sequential ruptures of the iliac veins, arteries, abdominal portion of the aorta and inferior vena cava. Attempts at restoring the integrity of vessels followed by ligation thereof, terminating in cutting of vascular walls, with the appearance of new sources of bleeding. The diagnosis was later on verified by the findings of autopsy and genetic typing.
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Affiliation(s)
- S A Cherniad'ev
- Department of Surgical Diseases and Cardiovascular Surgery of the Therapeutic and Preventive Faculty, Ural State Medical University of the RF Ministry of Public Health, Yekaterinburg, Russia
| | - G B Mal'gina
- Ural Scientific Research Institute of Mother and Child Care under the RF Ministry of Public Health, Yekaterinburg, Russia
| | - A Iu Leshchinskaia
- Department of Surgical Diseases and Cardiovascular Surgery of the Therapeutic and Preventive Faculty, Ural State Medical University of the RF Ministry of Public Health, Yekaterinburg, Russia
| | - E N Erofeev
- Ural Scientific Research Institute of Mother and Child Care under the RF Ministry of Public Health, Yekaterinburg, Russia
| | - V S Bochegov
- Department of Vascular Surgery, City Clinical Hospital #40, Yekaterinburg, Russia
| | - R A Makarov
- Ural Scientific Research Institute of Mother and Child Care under the RF Ministry of Public Health, Yekaterinburg, Russia
| | - N V Tarasova
- Ural Scientific Research Institute of Mother and Child Care under the RF Ministry of Public Health, Yekaterinburg, Russia
| | - Ia M Krokhaleva
- Department of Paediatric Surgery, Sverdlovsk Regional Pathologoanatomical Bureau, Yekaterinburg, Russia
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Stone J, Reed D. Maternal genetic diseases: potential concerns for mother and baby. Hum Genet 2019; 139:1173-1182. [PMID: 31729547 DOI: 10.1007/s00439-019-02086-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022]
Abstract
With advances in medical care, many women with genetic conditions previously known to decrease life expectancy are reaching childbearing age. Thus, it is important to understand the management of patients in the preconception, antepartum, and postpartum periods as they pose a unique challenge to the obstetrician. Most rare disorders lack well-established clinical guidelines for management in pregnancy. Existing data stem from case reports, case series, and expert opinion. We aim to summarize these recommendations and develop a clinical reference for managing reproductive age women with these conditions. We review recommendations for women with inborn errors in metabolism, connective tissue disorders, skeletal dysplasia, and selected single gene disorders. In all cases, it is crucial to employ a multidisciplinary team to optimize care for patients with rare disease before, during, and immediately after their pregnancies. The emphasis on expert consensus recommendations in the guidance of obstetric care is a signal that more studies are needed to determine best practices.
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Affiliation(s)
- Julie Stone
- Tufts Medical Center, 800 Washington Center, Boston, MA, 02111, USA
| | - Dallas Reed
- Tufts Medical Center, 800 Washington Center, Boston, MA, 02111, USA.
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Makatsariya A, Radetskaya L, Bitsadze V, Khizroeva J, Khamani N, Makatsariya N. Prenatal care and labor in patients with mesenchimal dysplasias (Marfan syndrome, Ehlers-Danlos syndrome, hereditary hemorrhagic telangiectasia). J Matern Fetal Neonatal Med 2018; 33:373-379. [PMID: 29938556 DOI: 10.1080/14767058.2018.1493102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Mesenchymal dysplasias or inherited connective tissue diseases are the group of diseases with deficiency of various components of connective tissue. Connective tissue disorders can affect different organs: skeleton, sight organ, skin, lungs, heart. But the most dangerous is vascular wall insufficiency leading to high risk of hemorrhage, especially during pregnancy and delivery due to hemodynamic and hormonal effects on the walls of the modified vessels.Aim: To evaluate the risk of complications during the pregnancy and delivery in patients with mesenchymal dysplasias.Study design: Fifty-six pregnancies in patients with mesenchymal dysplasias, including subclinical forms of diseases: 23 with Marfan syndrome (I group), 22 with Ehlers-Danlos syndrome (II group), and 11 with Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia) (III group) of the age from 18 to 36. The study included retrospective analysis (for the period from 1993 to 2005) and prospective study. Results of study showed high risk of life-threatening complications during pregnancy and delivery, especially the risk of hemorrhage and cardiovascular complications. In all the patients, we observed the progression of bleeding or development of bleeding in new localizations (epistaxis in 27 patients, easy brushing in 22, skin and mucosa telangiectasia in 20, gastrointestinal bleedings in 4, hemoptysis in 4, hematomas for minor traumas in 14, conjunctivas hemorrhages in 5).Conclusion: The pathogenesis of bleeding in such patients has mixed pattern: besides vascular wall pathology coagulation deficiency plays some role. The preferred delivery method for such patients is caesarean section. Deep vaginal ruptures and serious hemorrhage accompany vaginal delivery.
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Affiliation(s)
- Alexander Makatsariya
- Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Lyudmila Radetskaya
- Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Viktoriya Bitsadze
- Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Jamilya Khizroeva
- Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Nadin Khamani
- Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Natalya Makatsariya
- Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Chetty S, Norton ME. Obstetric care in women with genetic disorders. Best Pract Res Clin Obstet Gynaecol 2017; 42:86-99. [PMID: 28392223 DOI: 10.1016/j.bpobgyn.2017.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/07/2017] [Accepted: 03/10/2017] [Indexed: 01/04/2023]
Abstract
The management of pregnant women who are themselves affected with genetic diseases is an increasingly relevant and important issue. Improvements in early diagnosis and management of genetic disease, as well as advances in assisted reproductive technology have impacted pregnancy rates in a cohort of women who may not have otherwise been able to conceive. A multidisciplinary approach is key to the management of pregnant women with complex health conditions, including genetic diseases. Pertinent issues should be addressed in the preconception, antepartum, intrapartum and postpartum periods to optimize maternal and fetal health. Additionally, counseling regarding risk of inheritance in offspring and options for prenatal diagnosis should be reviewed if available. This reviews aims to help provide background and insight into the management strategies for various commonly encountered and complex genetic conditions in the setting of pregnancy.
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Affiliation(s)
- Shilpa Chetty
- Department of Obstetrics, Gynecology and Reproductive Sciences, 550 16th St, 7th Floor, University of California, San Francisco, CA 94143, USA.
| | - Mary E Norton
- Department of Obstetrics, Gynecology and Reproductive Sciences, 550 16th St, 7th Floor, University of California, San Francisco, CA 94143, USA
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8
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Baas AF, Spiering W, Moll FL, Page-Christiaens L, Beenakkers ICM, Dooijes D, Vonken EJPA, van der Smagt JJ, Knoers NV, Koenen SV, van Herwaarden JA, Sieswerda GT. Six uneventful pregnancy outcomes in an extended vascular Ehlers-Danlos syndrome family. Am J Med Genet A 2017; 173:519-523. [PMID: 28102592 DOI: 10.1002/ajmg.a.38033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/10/2016] [Indexed: 01/28/2023]
Abstract
Vascular Ehlers-Danlos Syndrome (vEDS) is caused by heterozygous mutations in COL3A1 and is characterized by fragile vasculature and hollow organs, with a high risk of catastrophic events at a young age. During pregnancy and delivery, maternal mortality rates up until 25% have been reported. However, recent pedigree analysis reported a substantial lower pregnancy-related mortality rate of 4.9%. Here, we describe an extended vEDS family with multiple uneventful pregnancy outcomes. In the proband, a 37-year-old woman, DNA-analysis because of an asymptomatic iliac artery dissection revealed a pathogenic mutation in COL3A1 (c.980G>A; p. Gly327Asp). She had had three uneventful vaginal deliveries. At the time of diagnosis, her 33-year-old niece was 25 weeks pregnant. She had had one uneventful vaginal delivery. Targeted DNA-analysis revealed that she was carrier of the COL3A1 mutation. Ultrasound detected an aneurysm in the abdominal aorta with likely a dissection. An uneventful elective cesarean section was performed at a gestational age of 37 weeks. The 40-year-old sister of our proband had had one uneventful vaginal delivery and an active pregnancy wish. Cascade DNA-screening showed her to carry the COL3A1 mutation. Computed Tomography Angiography (CTA) of her aorta revealed a type B dissection with the most proximal entry tear just below the superior mesenteric artery. Pregnancy was therefore discouraged. This familial case illustrates the complexity and challenges of reproductive decision-making in a potentially lethal condition as vEDS, and highlights the importance of a multidisciplinary approach. Moreover, it suggests that previous pregnancy-related risks of vEDS may be overestimated. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Annette F Baas
- Department of Medical Genetics, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Frans L Moll
- Department Vascular Surgery, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Lieve Page-Christiaens
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Ingrid C M Beenakkers
- Department of Anesthesiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Dennis Dooijes
- Department of Medical Genetics, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Evert-Jan P A Vonken
- Department of Radiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Jasper J van der Smagt
- Department of Medical Genetics, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Nine V Knoers
- Department of Medical Genetics, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Steven V Koenen
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Joost A van Herwaarden
- Department Vascular Surgery, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Gertjan Tj Sieswerda
- Department of Cardiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
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Riambau V, Böckler D, Brunkwall J, Cao P, Chiesa R, Coppi G, Czerny M, Fraedrich G, Haulon S, Jacobs M, Lachat M, Moll F, Setacci C, Taylor P, Thompson M, Trimarchi S, Verhagen H, Verhoeven E, ESVS Guidelines Committee, Kolh P, de Borst G, Chakfé N, Debus E, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Document Reviewers, Kolh P, Black J, Busund R, Björck M, Dake M, Dick F, Eggebrecht H, Evangelista A, Grabenwöger M, Milner R, Naylor A, Ricco JB, Rousseau H, Schmidli J. Editor's Choice – Management of Descending Thoracic Aorta Diseases. Eur J Vasc Endovasc Surg 2017; 53:4-52. [DOI: 10.1016/j.ejvs.2016.06.005] [Citation(s) in RCA: 598] [Impact Index Per Article: 85.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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10
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The collagenopathies: review of clinical phenotypes and molecular correlations. Curr Rheumatol Rep 2014; 16:394. [PMID: 24338780 DOI: 10.1007/s11926-013-0394-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Genetic defects of collagen formation (the collagenopathies) affect almost every organ system and tissue in the body. They can be grouped by clinical phenotype, which usually correlates with the tissue distribution of the affected collagen subtype. Many of these conditions present in childhood; however, milder phenotypes presenting in adulthood are increasingly recognized. Many are difficult to differentiate clinically. Precise diagnosis by means of genetic testing assists in providing prognosis information, family counseling, and individualized treatment. This review provides an overview of the current range of clinical presentations associated with collagen defects, and the molecular mechanisms important to understanding how the results of genetic testing affect medical care.
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Naing BT, Watanabe A, Tanigaki S, Ono M, Iwashita M, Shimada T. Presymptomatic genetic analysis during pregnancy for vascular type Ehlers-Danlos syndrome. Int Med Case Rep J 2014; 7:99-102. [PMID: 24971038 PMCID: PMC4069127 DOI: 10.2147/imcrj.s59879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The vascular type of Ehlers–Danlos syndrome (EDS), EDS type IV (Online Mendelian Inheritance in Man [MIM] #130050) is characterized by thin, translucent skin, easy bruising, and arterial, intestinal, and/or uterine fragility during pregnancy, which may lead to sudden death. It is an autosomal dominant inherited disorder caused by type III procollagen gene (COL3A1: MIM #120180) mutations. Approximately 50% of the COL3A1 mutations are inherited from an affected parent, and 50% are de novo mutations. Each child of an affected individual has a 50% chance of inheriting the mutation and developing the disorder. Pregnant women with vascular EDS are at an increased risk of uterine and arterial rupture during the peripartum period, with high maternal morbidity and mortality rates. We report the first case of an asymptomatic 35-year-old woman at a risk of complications of vascular EDS who underwent presymptomatic evaluation during pregnancy. The sequencing results of both her brother and mother had a one-base-pair deletion, resulting in Glutamate at position 730 changing to Lysine and causing a frame shift and premature termination codon at 61 amino acids from the mutation position (p. Glu730Lysfs*61) on exon 32 of COL3A1. This deletion caused frameshift, leading to a premature termination codon (TAG) at 181 nucleotides downstream in exon 35, which could not be detected by previous total RNA (ribonucleic acid) method. Thus, she was at risk of complications of vascular EDS, and diagnostic testing was employed at 8 weeks of pregnancy to minimize the risk of developing vascular EDS-related complications. The negative presymptomatic diagnostic result allowed the patient to choose normal delivery at term. Vascular EDS is a serious disorder, with high mortality, especially in high-risk women with vascular EDS during pregnancy. The presymptomatic genetic testing of vascular EDS during pregnancy for a high-risk family can help with the early establishment of preventive measures.
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Affiliation(s)
- Banyar Than Naing
- Department of Biochemistry and Molecular Biology, Nippon Medical School, Tokyo, Japan
| | - Atsushi Watanabe
- Department of Biochemistry and Molecular Biology, Nippon Medical School, Tokyo, Japan ; Division of Clinical Genetics, Nippon Medical School Hospital, Tokyo, Japan
| | - Shinji Tanigaki
- Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan
| | - Masae Ono
- Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan
| | - Mitsutoshi Iwashita
- Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan
| | - Takashi Shimada
- Department of Biochemistry and Molecular Biology, Nippon Medical School, Tokyo, Japan ; Division of Clinical Genetics, Nippon Medical School Hospital, Tokyo, Japan
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12
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Pregnancy-related deaths and complications in women with vascular Ehlers–Danlos syndrome. Genet Med 2014; 16:874-80. [DOI: 10.1038/gim.2014.53] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/15/2014] [Indexed: 11/08/2022] Open
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13
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Dubruc E, Dupuis-Girod S, Khau Van Kien P, Denis-Belicard E, Chirossel C, Fokstuen S, Touraine R, Plauchu H. [Pregnancy and Ehlers-Danlos vascular syndrome: patients' care and complications]. ACTA ACUST UNITED AC 2012; 42:159-65. [PMID: 23040267 DOI: 10.1016/j.jgyn.2012.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 08/01/2012] [Accepted: 08/17/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Elhers-Danlos vascular syndrome type IV (EDS4) is a hereditary pathology of the connective tissue responsible for an increased risk of lethal arterial, uterine and digestive complications during and after pregnancy. PATIENTS AND METHODS We describe the obstetrical care, the nature and frequency of complications related to pregnancy of patients with EDS4 and their relatives. RESULTS Twenty-seven pregnancies were studied including 23 deliveries, 18 vaginal deliveries and five caesarean, no maternal death and two major life-threatening complications (8.7%) were recorded which could be directly linked to EDS4 (rupture of the biscupid valve pillar after vaginal delivery and a rupture of the caecum after a prophylactic caesarean). Ten deliveries underwent epidural anesthesia without complication. Six perineal injuries (33.3%) were observed. CONCLUSION Pregnancy in patient with EDS4 needs obstetrical cares in a special unit's motivated medical team with intensive care and surgical disponibilities.
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Affiliation(s)
- E Dubruc
- Service de génétique, hôpital Louis-Pradel, hospices civils de Lyon, 28, avenue Doyen-Lépine, 69500 Bron, France.
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Management of pregnancy in women with genetic disorders, Part 1: Disorders of the connective tissue, muscle, vascular, and skeletal systems. Obstet Gynecol Surv 2012; 66:699-709. [PMID: 22186601 DOI: 10.1097/ogx.0b013e31823cdd50] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
UNLABELLED Due to early diagnosis and increasingly effective medical advances, the number of women with various genetic syndromes who are undergoing pregnancy is increasing, and this represents an important issue for providers of obstetric care. Each year more women with genetic disease reach childbearing age. Advances in assisted reproductive technology have enabled pregnancy in a cohort of woman who may experience impaired fertility due to their underlying diagnosis. Management of these women requires coordination of care by healthcare providers from multiple specialties to optimize outcomes. Potentially serious medical issues specific to each diagnosis often exist in the preconception, antepartum, intrapartum, and postpartum periods, all of which must be recognized to allow timely diagnosis and treatment. The fetus may also face issues related to risk for inheritance of the genetic disorder itself, as well as risks related to the chronic disease status of the mother. This article will explore the issues faced by women with various genetic disorders that may affect connective tissue, muscular, vascular, and skeletal systems. TARGET AUDIENCE Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES After the completing the CME activity, physicians should be better able to classify the cardiovascular manifestations observed in Marfan syndrome and Ehlers-Danlos, evaluate prenatal diagnostic options and limitations for various genetic syndromes, assess the risks to the fetus in women with various genetic syndromes. Determine whether there is a preferred mode of delivery for pregnant patients with various genetic syndromes described in this paper.
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Jamard A, Le Hello C, Simonet T, Dreyfus M. [Vascular Ehlers-Danlos syndrome and pregnancy: an obstetrical specific support]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2012; 41:676-8. [PMID: 22522144 DOI: 10.1016/j.jgyn.2012.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 01/04/2012] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
Abstract
The Ehlers-Danlos syndrome (EDS) is a rare inheritable disease, characterised by a defect in collagen synthesis. Various types have been described and the type IV or vascular type is the most severe characterised by vascular, gastrointestinal and gynaecologic complications. We describe in a case report the specific obstetrical support we applied to avoid the most frequent complications such as early spontaneous abortions, pre-term delivery, tearing of perineum, uterine and vascular rupture and hard healing. Pregnancy is very risky in women with vascular EDS. Combination of multidisciplinary support and advice of the rare vascular disease national reference centre may reduce the morbi-mortality rate, including celiprolol long-term treatment.
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Affiliation(s)
- A Jamard
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Caen-FEH, Caen cedex, France.
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Wu Z, Aron AW, Macksoud EE, Iozzo RV, Hai CM, Lechner BE. Uterine dysfunction in biglycan and decorin deficient mice leads to dystocia during parturition. PLoS One 2012; 7:e29627. [PMID: 22253749 PMCID: PMC3258236 DOI: 10.1371/journal.pone.0029627] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 12/01/2011] [Indexed: 02/05/2023] Open
Abstract
Cesarean birth rates are rising. Uterine dysfunction, the exact mechanism of which is unknown, is a common indication for Cesarean delivery. Biglycan and decorin are two small leucine-rich proteoglycans expressed in the extracellular matrix of reproductive tissues and muscle. Mice deficient in biglycan display a mild muscular dystrophy, and, along with mice deficient in decorin, are models of Ehlers-Danlos Syndrome, a connective tissue anomaly associated with uterine rupture. As a variant of Ehlers-Danlos Syndrome is caused by a genetic mutation resulting in abnormal biglycan and decorin secretion, we hypothesized that biglycan and decorin play a role in uterine function. Thus, we assessed wild-type, biglycan, decorin and double knockout pregnancies for timing of birth and uterine function. Uteri were harvested at embryonic days 12, 15 and 18. Nonpregnant uterine samples of the same genotypes were assessed for tissue failure rate and spontaneous and oxytocin-induced contractility. We discovered that biglycan/decorin mixed double-knockout dams displayed dystocia, were at increased risk of delayed labor onset, and showed increased tissue failure in a predominantly decorin-dependent manner. In vitro spontaneous uterine contractile amplitude and oxytocin-induced contractile force were decreased in all biglycan and decorin knockout genotypes compared to wild-type. Notably, we found no significant compensation between biglycan and decorin using quantitative real time PCR or immunohistochemistry. We conclude that the biglycan/decorin mixed double knockout mouse is a model of dystocia and delayed labor onset. Moreover, decorin is necessary for uterine function in a dose-dependent manner, while biglycan exhibits partial compensatory mechanisms in vivo. Thus, this model is poised for use as a model for testing novel targets for preventive or therapeutic manipulation of uterine dysfunction.
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Affiliation(s)
- Zhiping Wu
- Department of Pediatrics, Women and Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Abraham W. Aron
- Department of Pediatrics, Women and Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Elyse E. Macksoud
- Department of Pediatrics, Women and Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Renato V. Iozzo
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Chi-Ming Hai
- Department of Molecular Pharmacology, Physiology, and Biotechnology, Brown University, Providence, Rhode Island, United States of America
| | - Beatrice E. Lechner
- Department of Pediatrics, Women and Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- * E-mail:
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Park JK. Ehlers-Danlos Syndrome Type IV and the Management of Its Vascular Complication. Vasc Specialist Int 2011. [DOI: 10.5758/kjves.2011.27.2.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jong Kwon Park
- Department of Surgery, Inje University College of Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
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Hammond R, Oligbo N. Ehlers Danlos Syndrome Type IV and pregnancy. Arch Gynecol Obstet 2011; 285:51-4. [PMID: 21538010 DOI: 10.1007/s00404-011-1899-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 03/24/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A case report is presented of a 23-year-old patient who was diagnosed with Ehlers Danlos syndrome (EDS) Type IV (vascular type) in the 23rd week of her second pregnancy. EDS Type IV has one of the highest mortality rates for pregnant women of any condition with significant morbidity if the mother survives. DISCUSSION Current literature is presented and supports the necessity for close monitoring of mother and child in a specialist unit with involvement of a multi-disciplinary team. There is no agreed consensus on the mode or timing of delivery but recent literature is supportive of delivery by caesarean section at 32 weeks. CONCLUSION This case report demonstrates a successful outcome for both mother and child with a planned delivery at 34 weeks by caesarean section and emphasises the importance of strategic planning for complicated deliveries and the effectiveness of good communication networks. Patients with EDS Type IV should be counselled about the potential risks for both themselves and the child to enable them to make informed decisions about their obstetric care.
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Affiliation(s)
- Rebecca Hammond
- James Paget Hospital, Lowestoft Road, Gorleston, Norfolk, NR31 6LA, UK.
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Ioscovich A, Grisaru-Granovsky S, Halpern S, Shapiro Y. Peripartum anesthetic management of a patient with brittle cornea syndrome. Arch Gynecol Obstet 2011; 283 Suppl 1:49-52. [PMID: 21258811 DOI: 10.1007/s00404-011-1838-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Accepted: 01/07/2011] [Indexed: 12/19/2022]
Abstract
Brittle cornea syndrome (BCS) is a rare autosomal recessive disease that affects the connective tissue. The syndrome is caused by genetic changes in the 4.7-Mb interval between the D16S3423 and D16S3425 markers on the 16q24 chromosome and mutations in the Zinc-Finger 469 gene (ZNF469). BCS is characterized by thin and fragile cornea that tends to perforate spontaneously or as a result of minor trauma to the eye. In addition, the patient usually suffers from hearing loss, mental retardation, hyperextensibility of skin and joints, as well as varying degrees of scoliosis. This phenotypical expression presents an interesting challenge to anesthetic care. We briefly present the perioperative management of a patient with BCS who underwent three cesarean sections.
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Affiliation(s)
- A Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Centre, Hebrew University, POB 3235, 91031, Jerusalem, Israel.
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Shields LBE, Rolf CM, Davis GJ, Hunsaker JC. Sudden and unexpected death in three cases of Ehlers-Danlos syndrome type IV. J Forensic Sci 2010; 55:1641-5. [PMID: 20707836 DOI: 10.1111/j.1556-4029.2010.01521.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ehlers-Danlos syndrome (EDS) type IV is a connective tissue disorder characterized by the inability to produce sufficient amounts of collagen or a defect in the structure of collagen. The most serious complications include a rupture of a viscus or vascular rupture with or without mural dissection. Death may result from internal hemorrhage. This report describes three cases of sudden and unexpected death caused by EDS type IV. Two cases involved hemothorax as a result of dissection of the subclavian artery and aorta, respectively. The third case represented spontaneous pulmonary rupture and hemorrhage. A detailed family history should be sought, and additional specimens collected to confirm the diagnosis, including skin fibroblasts for collagen testing and blood for DNA testing. The forensic pathologist should consider the possibility of EDS type IV upon discovery of spontaneous visceral or arterial rupture and should alert the family members of this hereditary and potentially fatal condition.
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Affiliation(s)
- Lisa B E Shields
- Medicolegal Research Associate, Norton Neuroscience Institute, 210 E. Gray Street, Suite 1105, Louisville, KY, USA
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Ohkuchi A, Matsubara S, Takahashi K, Inoue S, Saito T, Mitsuhashi T, Yamagata T, Takahashi N, Watanabe A, Shimada T, Suzuki M. Ehlers-Danlos type IV in pregnancy with a history of myocardial infarction. J Obstet Gynaecol Res 2009; 35:797-800. [DOI: 10.1111/j.1447-0756.2009.01015.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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