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Leber AL. Maternal and congenital human cytomegalovirus infection: laboratory testing for detection and diagnosis. J Clin Microbiol 2024; 62:e0031323. [PMID: 38391188 PMCID: PMC11005381 DOI: 10.1128/jcm.00313-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Human cytomegalovirus (CMV) is the leading cause of congenital infection worldwide and the most common cause of non-genetic sensorineural hearing loss. As there is no vaccine or other specific intervention to prevent congenital CMV infection, there is a need to identify maternal and congenital infections with sensitive and specific testing as early as possible. There is no widely accepted practice for screening during pregnancy or in all newborns for identification of possible cases of congenital CMV. Currently, screening during pregnancy is limited to those identified as at risk followed by fetal and/or neonatal testing when congenital infection is suspected. This review focuses primarily on the current status of laboratory testing for diagnosis of maternal and congenital CMV infections. Primary maternal infection is best diagnosed using serologic testing, including CMV IgM, IgG, and avidity testing, while fetal infection should be assessed by nucleic acid amplification testing (NAAT) of amniotic fluid. Urine and saliva NAATs are the mainstay for diagnosis of congenital CMV in the first 3 weeks of life. Testing of dried blood spots can be useful for diagnosis of congenital CMV outside of the newborn period. The gaps in knowledge such as the prognostic value of viral loads in various sample types are addressed.
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Affiliation(s)
- Amy L. Leber
- Departments of Pathology and Laboratory Medicine and Pediatrics, Nationwide Children’s Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Chen CP. Genetic testing using fetal urine at vesicocentesis in case of fetal megacystis. Taiwan J Obstet Gynecol 2024; 63:257-259. [PMID: 38485327 DOI: 10.1016/j.tjog.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Institute of Clinical and Community Health Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Luewan S, Apaijai N, Chattipakorn N, Chattipakorn SC, Tongsong T. Fetal hemodynamic changes and mitochondrial dysfunction in myocardium and brain tissues in response to anemia: a lesson from hemoglobin Bart's disease. BMC Pregnancy Childbirth 2024; 24:141. [PMID: 38365664 PMCID: PMC10870590 DOI: 10.1186/s12884-023-06232-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/27/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE Whether or not the effects of anemia in the early phase, while the fetuses attempts to increase cardiac output to meet oxygen requirement in peripheral organs, is detrimental to the fetal developing vital organs is little-known. The objective of this is to compare prenatal cardiovascular changes and post-abortal cellular damages in the myocardium as a pumping organ and the brain as a perfused organ between anemic fetuses (using fetal Hb Bart's disease as a study model) in pre-hydropic phase and non-anemic fetuses. METHODS Fetuses affected by Hb Bart's disease and non-anemic fetuses at 16-22 weeks were recruited to undergo comprehensive fetal echocardiography. Cord blood analysis was used to confirm the definite diagnosis of fetal Hb Bart's disease and normal fetuses. Fetal cardiac and brain tissues were collected shortly after pregnancy termination for the determination of oxidative stress and mitochondrial function, including mitochondrial ROS production and mitochondrial membrane changes. RESULTS A total of 18 fetuses affected by Hb Bart's disease and 13 non-anemic fetuses were recruited. The clinical characteristics of both groups were comparable. The affected fetuses showed a significant increase in cardiac dimensions, cardiac function, cardiac output and brain circulation without deteriorating cardiac contractility and preload. However, in the affected fetuses, mitochondrial dysfunction was clearly demonstrated in brain tissues and in the myocardium, as indicated by a significant increase in the membrane potential change (p-value < 0.001), and a significant increase in ROS production in brain tissues, with a trend to increase in myocardium. The findings indicated cellular damage in spite of good clinical compensation. CONCLUSION The new insight is that, in response to fetal anemia, fetal heart increases in size (dilatation) and function to increase cardiac output and blood flow velocity to provide adequate tissue perfusion, especially brain circulation. However, the myocardium and brain showed a significant increase in mitochondrial dysfunction, suggesting cellular damage secondary to anemic hypoxia. The compensatory increase in circulation could not completely prevent subtle brain and heart damage.
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Affiliation(s)
- Suchaya Luewan
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nattayaporn Apaijai
- Cardiac Electrophysiology Research and Training Center (CERT), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center (CERT), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Cardiac Electrophysiology Research and Training Center (CERT), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Brar BK, Blakemore K, Hertenstein C, Miller JL, Miller KA, Shamseldin H, Maddirevula S, Hays T, Lianoglou B, Dukhovny S, Baker LA, Sparks TN, Wapner R, Alkuraya FS, Norton ME, Jelin AC. The utility of gene sequencing in identifying an underlying genetic disorder in prenatally suspected lower urinary tract obstruction. Prenat Diagn 2024; 44:196-204. [PMID: 37594370 DOI: 10.1002/pd.6425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Fetal megacystis generally presents as suspected lower urinary tract obstruction (LUTO), which is associated with severe perinatal morbidity. Genetic etiologies underlying LUTO or a LUTO-like initial presentation are poorly understood. Our objectives are to describe single gene etiologies in fetuses initially ascertained to have suspected LUTO and to elucidate genotype-phenotype correlations. METHODS A retrospective case series of suspected fetal LUTO positive for a molecular diagnosis was collected from five centers in the Fetal Sequencing Consortium. Demographics, sonograms, genetic testing including variant classification, and delivery outcomes were abstracted. RESULTS Seven cases of initially prenatally suspected LUTO-positive for a molecular diagnosis were identified. In no case was the final diagnosis established as urethral obstruction that is, LUTO. All variants were classified as likely pathogenic or pathogenic. Smooth muscle deficiencies involving the bladder wall and interfering with bladder emptying were identified in five cases: MYOCD (2), ACTG2 (2), and MYH11 (1). Other genitourinary and/or non-genitourinary malformations were seen in two cases involving KMT2D (1) and BBS10 (1). CONCLUSION Our series illustrates the value of molecular diagnostics in the workup of fetuses who present with prenatally suspected LUTO but who may have a non-LUTO explanation for their prenatal ultrasound findings.
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Affiliation(s)
- Bobby K Brar
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Karin Blakemore
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Christine Hertenstein
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jena L Miller
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kristen A Miller
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Hanan Shamseldin
- Department of Translational Genomics, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sateesh Maddirevula
- Department of Translational Genomics, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Thomas Hays
- Department of Pediatrics, Division of Neonatology, Columbia University Irving Medical Center, New York, New York, USA
| | - Billie Lianoglou
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Stephanie Dukhovny
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Linda A Baker
- Department of Urology, Division of Pediatric Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Teresa N Sparks
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Fowzan S Alkuraya
- Department of Translational Genomics, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mary E Norton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Angie C Jelin
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Munoz JL, Tounsi S, Buskmiller C, Cortes MS, Donepudi RV, Belfort MA, Nassr AA. Outcomes of fetal lower urinary tract obstruction based on timing of oligohydramnios onset. Prenat Diagn 2024; 44:131-137. [PMID: 38133549 DOI: 10.1002/pd.6493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/19/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Fetal Lower Urinary Tract Obstruction (LUTO) is associated with oligohydramnios and significant fetal morbidity, resulting in poor lung development and perinatal death. However, oligohydramnios may develop at different gestational periods, and the impact of timing on fetal outcomes remains unknown. Our objective was to characterize the impact onset of oligohydramnios had on prenatal outcomes. METHODS This study is a retrospective cohort study of all patients with a prenatal diagnosis of LUTO at our tertiary referral center from 2014 to 2023. All patients underwent detailed ultrasonography and interdisciplinary counseling and were subsequently delivered at our institution. Data were obtained from electronic medical records and complete extraction was required for final inclusion. RESULTS During the study time period, 93 patients met inclusion criteria of which 68 (73.1%) developed oligohydramnios during their pregnancy. 63 (93%) of these pregnancies resulted in livebirths with 28 (41.1%) perinatal deaths. Onset of oligohydramnios was earlier in pregnancies with perinatal death (23 vs. 28 weeks, p = 0.004) and associated with pulmonary hypoplasia. CONCLUSIONS Our data show the impact of oligohydramnios timing in pregnancy on pulmonary hypoplasia and ultimately perinatal death. This allows for detailed patient counseling on the impact oligohydramnios may have on pregnancies by the gestational age of onset.
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Affiliation(s)
- Jessian L Munoz
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Sarah Tounsi
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Cara Buskmiller
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Magdalena Sanz Cortes
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Roopali V Donepudi
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Ahmed A Nassr
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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Lawrence SM, Goshia T, Sinha M, Fraley SI, Williams M. Decoding human cytomegalovirus for the development of innovative diagnostics to detect congenital infection. Pediatr Res 2024; 95:532-542. [PMID: 38146009 PMCID: PMC10837078 DOI: 10.1038/s41390-023-02957-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023]
Abstract
Cytomegalovirus is the most common cause of congenital infectious disease and the leading nongenetic etiology of sensorineural hearing loss. Although most infected neonates are asymptomatic at birth, congenital cytomegalovirus infection is responsible for nearly 400 infant deaths annually in the United States and may lead to significant long-term neurodevelopmental impairments in survivors. The resulting financial and social burdens of congenital cytomegalovirus infection have led many medical centers to initiate targeted testing after birth, with a growing advocacy to advance universal newborn screening. While no cures or vaccines are currently available to eliminate or prevent cytomegalovirus infection, much has been learned over the last five years regarding disease pathophysiology and viral replication cycles that may enable the development of innovative diagnostics and therapeutics. This Review will detail our current understanding of congenital cytomegalovirus infection, while focusing our discussion on routine and emerging diagnostics for viral detection, quantification, and long-term prognostication. IMPACT: This review highlights our current understanding of the fetal transmission of human cytomegalovirus. It details clinical signs and physical findings of congenital cytomegalovirus infection. This submission discusses currently available cytomegalovirus diagnostics and introduces emerging platforms that promise improved sensitivity, specificity, limit of detection, viral quantification, detection of genomic antiviral resistance, and infection staging (primary, latency, reactivation, reinfection).
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Affiliation(s)
- Shelley M Lawrence
- University of Utah, College of Medicine, Department of Pediatrics, Division of Neonatology, Salt Lake City, UT, USA.
| | - Tyler Goshia
- Department of Bioengineering, University of California, San Diego, San Diego, CA, USA
| | | | - Stephanie I Fraley
- Department of Bioengineering, University of California, San Diego, San Diego, CA, USA
| | - Marvin Williams
- University of Oklahoma, College of Medicine, Department of Obstetrics and Gynecology, Division of Fetal-Maternal Medicine, Oklahoma City, OK, USA
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Che Y, Zhong J, Chen Y, Xie J, Wang R, Xu Y, Zha J, Zeng M, Chen H. A newborn with convulsions 12 days after birth was misdiagnosed as neonatal intracranial hemorrhage: Case report. Medicine (Baltimore) 2023; 102:e36675. [PMID: 38206725 PMCID: PMC10754593 DOI: 10.1097/md.0000000000036675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/24/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Cases with early diagnosis of neonatal tuberous sclerosis syndrome (TSC) are relatively seldom seen, and misdiagnosis of intracranial hemorrhage is even more rare. We retrospectively analyzed the clinical data of a case of neonatal tuberous sclerosis with atypical early symptoms and misdiagnosed as more common intracranial hemorrhage of the newborn. PATIENT CONCERNS The child was female and had no obvious cause of convulsion 12 days after birth. The local hospital was initially diagnosed as "neonatal intracranial hemorrhage, congenital heart disease," and still had convulsions after 5 days of treatment, so it was transferred to neonatal intensive care unit of our hospital. DIAGNOSIS After admission, cardiac color ultrasound, magnetic resonance imaging, and electroencephalogram were performed, and TSC was diagnosed in combination with clinical symptoms. However, no known pathogenic mutations such as TSC1 and TSC2 were detected by peripheral blood whole exon sequencing. INTERVENTION After a clear diagnosis, sirolimus, and vigabatrin were given. But there were still convulsions. Topiramate, valproic acid, and oxcarbazepine were successively added to the outpatient department for antiepileptic treatment, and vigabatrin gradually decreased. OUTCOME Up to now, although the seizures have decreased, they have not been completely controlled. CONCLUSIONS The TSC of neonatal tuberous sclerosis is different from that of older children. It is usually characterized by respiratory distress and arrhythmia, and may be accompanied by convulsions, but the activity between attacks is normal. However, neonatal intracranial hemorrhage can be caused by premature delivery, birth injury, hypoxia, etc. Its characteristics are acute onset, severe illness, and rapid progression. Consequently, the diagnosis of these 2 diseases should not only be based on medical imaging, but also be combined with their clinical characteristics. When the imaging features are inconsistent with the clinical diagnosis, a comprehensive evaluation should be made again. The timing and pattern of onset of neonatal convulsions can help in differential diagnosis. If there is cardiac rhabdomyoma, subependymal or cortical nodule, skin low melanoma, etc, the possibility of neonatal TSC should be considered, and the diagnosis should be made according to its diagnostic criteria to avoid or reduce misdiagnosis.
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Affiliation(s)
- Yuanyuan Che
- Department of Neurology, Children’s Hospital of Jiangxi Province, Nanchang, China
| | - Jianmin Zhong
- Department of Neurology, Children’s Hospital of Jiangxi Province, Nanchang, China
| | - Yong Chen
- Department of Neurology, Children’s Hospital of Jiangxi Province, Nanchang, China
| | - Jihua Xie
- Department of Neurology, Children’s Hospital of Jiangxi Province, Nanchang, China
| | - Ruiyan Wang
- Department of Neurology, Children’s Hospital of Jiangxi Province, Nanchang, China
| | - Yuxin Xu
- Department of Neurology, Children’s Hospital of Jiangxi Province, Nanchang, China
| | - Jian Zha
- Department of Neurology, Children’s Hospital of Jiangxi Province, Nanchang, China
| | - Miao Zeng
- Department of Neurology, Children’s Hospital of Jiangxi Province, Nanchang, China
| | - Hui Chen
- Department of Neurology, Children’s Hospital of Jiangxi Province, Nanchang, China
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Delabaere A, Guerard M, Cahierc R, Bouvier D, Pereira B, Gallot D. Accuracy of a portable hemoglobinometer (HemoCue) to measure fetal hemoglobin values during in utero transfusion. J Matern Fetal Neonatal Med 2023; 36:2266092. [PMID: 37840223 DOI: 10.1080/14767058.2023.2266092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/27/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES The current recommended treatment for severe fetal anemia is in utero transfusion (IUT). During this procedure, the evaluation of the necessary volume of transfused blood is based on regular measurement of fetal hemoglobin (FHb) concentration. The gold standard measurement is performed in the biology laboratory. A rapid medical test such as HemoCue® is an effective way to predict FHb concentration. It would reduce the time to obtain results and therefore the procedure duration. To evaluate the accuracy of HemoCue® to measure FHb during IUT, we compared Hb levels obtained by HemoCue® and by our biology laboratory. METHODS This retrospective study involved all pregnant women who had undergone an IUT in the university hospital of Clermont-Ferrand, France, during the period from 1 January 2010 to 6 June 2021. The FHb level was evaluated by two methods, a rapid medical test, HemoCue®, and a standard method in the biology laboratory. RESULTS We obtained 244 pairs of results from HemoCue® and our laboratory, of 90 IUT procedures. The correlation between the two sets of results was excellent, with Lin's concordance correlation coefficient of 0.979. However, we established that the measurements were not significantly modified by IUT number, puncture time, cause of fetal anemia, estimated fetal weight, gestational age, and delay between two IUT or middle cerebral artery peak systolic velocity values. CONCLUSION Our results allowed to extend the relevance of FHb measurements by HemoCue® during IUT.
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Affiliation(s)
- Amélie Delabaere
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Maeva Guerard
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Equipe "Translational approach to epithelial injury and repair", Université Clermont Auvergne, CNRS, Inserm, GReD, Clermont-Ferrand, France
| | - Romain Cahierc
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Damien Bouvier
- Equipe "Translational approach to epithelial injury and repair", Université Clermont Auvergne, CNRS, Inserm, GReD, Clermont-Ferrand, France
- Biochemistry and Molecular Biology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- University Hospital of Clermont-Ferrand, Biostatistics Unit, the Clinical Research and Innovation Direction, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Denis Gallot
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Equipe "Translational approach to epithelial injury and repair", Université Clermont Auvergne, CNRS, Inserm, GReD, Clermont-Ferrand, France
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Wang Z, Ma B, Nie F. Prenatal diagnosis of fetal pericardial rhabdomyoma resulting in fetal death. Int J Cardiovasc Imaging 2023; 39:2483-2485. [PMID: 37776385 DOI: 10.1007/s10554-023-02954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/07/2023] [Indexed: 10/02/2023]
Abstract
We present a case of huge pericardial rhabdomyoma that progressed into the pericardial cavity, resulting in fetal death. Fetal ultrasound and neonatal echocardiography provide excellent diagnostic methods for fetal rhabdomyoma. When established, antenatal diagnosis enables a focused, specialized, and multidisciplinary approach with individual case management, potentially reducing perinatal morbidity and mortality.
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Affiliation(s)
- Zhen Wang
- Ultrasound Medicine Center, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu Province, 730030, China
| | - Bin Ma
- Ultrasound Medicine Center, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu Province, 730030, China
| | - Fang Nie
- Ultrasound Medicine Center, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu Province, 730030, China.
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Li ZQ, Kang WL, Tang SJ, Mao Y, Fang T, Jiang JJ, Li XH. Effect of maternal age on foetal chromosomal defects: an investigation based on non-invasive prenatal testing. J OBSTET GYNAECOL 2023; 43:2287125. [PMID: 38069630 DOI: 10.1080/01443615.2023.2287125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND This study aimed to evaluate the value of non-invasive prenatal testing (NIPT) in the prenatal screening of foetal aneuploidy-associated diseases at different gestational ages. METHODS Briefly, cell-free foetal DNAs were extracted from plasma first, followed by DNA sequencing and bioinformatics analyses for chromosome aneuploidy (T21, T18, and T13), sex chromosome aneuploidy (SCA), and microdeletion/microduplication. Subsequently, the positive results were subject to karyotype analyses. RESULTS The pregnant women included in this study were divided into six groups, and the results, such as chromosome diagnoses, and clinical phenotypes, were collected for data analyses. According to the results of the data analysis, the positivity rates of foetal chromosomal abnormalities in pregnant women under 20, 20-24, 25-29, 30-34, 35-39, and >40 years old were 0%, 0.17%, 0.25%, 0.27%, 0.60%, and 1.66%, respectively. The positive predictive value (PPV) in the 20-24 years group was 41.67%, that in the 25-29 years group was 62.5%, that in the 30-34 years group was 66.67%, that in the 35-39 years group was 90.74%, and that in the >40 years group was 90.32%. CONCLUSION Overall, NIPT detection in elderly pregnant women has excellent clinical application value in reducing the incidence of either birth defects or abortion caused by invasive chromosome examination.
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Affiliation(s)
- Zhi-Qiang Li
- The Laboratory of Clinical Genomics, Hefei KingMed Diagnostics Ltd, Hefei, China
| | - Wei-Ling Kang
- The Laboratory of Clinical Genomics, Hefei KingMed Diagnostics Ltd, Hefei, China
| | - Si-Jie Tang
- The Aoyang Cancer Institute, Affiliated Aoyang Hospital of Jiangsu University, Suzhou, China
| | - Yuan Mao
- The Laboratory of Clinical Genomics, Hefei KingMed Diagnostics Ltd, Hefei, China
| | - Ting Fang
- The Laboratory of Clinical Genomics, Hefei KingMed Diagnostics Ltd, Hefei, China
| | - Jia-Jia Jiang
- The Aoyang Cancer Institute, Affiliated Aoyang Hospital of Jiangsu University, Suzhou, China
| | - Xiao-Hua Li
- The Laboratory of Clinical Genomics, Hefei KingMed Diagnostics Ltd, Hefei, China
- The Aoyang Cancer Institute, Affiliated Aoyang Hospital of Jiangsu University, Suzhou, China
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Penikis AB, Zhou AL, Sferra SR, Engwall-Gill AJ, Miller JL, Baschat AA, Blakemore KJ, Kunisaki SM. Serial lung mass volume ratios as prognostic indicators of neonatal respiratory morbidity in fetal pulmonary malformations. Am J Obstet Gynecol MFM 2023; 5:101128. [PMID: 37572880 DOI: 10.1016/j.ajogmf.2023.101128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Several studies have shown that the congenital pulmonary airway malformation volume ratio is a useful prognosticator of neonatal outcome in prenatally diagnosed lung lesions. However, there remains a lack of consensus on which congenital pulmonary airway malformation volume ratio values have the best predictive value because of operator dependence, inherent changes in lung lesion size throughout gestation, and the widespread use of maternal steroids. OBJECTIVE This study sought to determine the association between serial congenital pulmonary airway malformation volume ratio measurements and neonatal outcomes among fetuses with lung malformations. STUDY DESIGN This was a retrospective cohort study of fetuses with a prenatally diagnosed lung malformation managed at 2 major fetal centers from January 2010 to December 2021. Prenatal variables, including prospectively measured congenital pulmonary airway malformation volume ratio measurements (initial, maximum, and final), were analyzed. The results were correlated with 3 outcome measures, namely surgical resection before 30 days of life, a need for supplemental O2 at birth, and endotracheal intubation at birth. Statistical analyses were performed using receiver operating characteristic curve analyses, Welch 2 sample t tests, and multivariable logistic regressions (P<.05). RESULTS There were 123 fetuses with isolated lung lesions identified. Eight (6.5%) had hydrops. The mean initial congenital pulmonary airway malformation volume ratio was 0.67±0.61 cm2 at 22.9±3.9 weeks' gestation. The mean maximum congenital pulmonary airway malformation volume ratio was 1.08 ± 0.94 cm2 at 27.0 ± 4.0 weeks' gestation. The mean final congenital pulmonary airway malformation volume ratio was 0.58±0.60 cm2 at 33.2±4.1 weeks' gestation. At a mean gestational age at delivery of 38.3±2.6 weeks, 15 (12.2%) underwent neonatal lung resection for symptomatic disease. In a multivariable regression, all 3 congenital pulmonary airway malformation volume ratio measurements showed a significant correlation with neonatal lung resection (P<.001). Optimal congenital pulmonary airway malformation volume ratio cutoffs were established based on an initial congenital pulmonary airway malformation volume ratio of ≥0.8 cm2, maximum congenital pulmonary airway malformation volume ratio of ≥1.5 cm2, and a final congenital pulmonary airway malformation volume ratio of ≥1.3 cm2 with associated areas under the curve of 0.89, 0.97, and 0.93, respectively. The final congenital pulmonary airway malformation volume ratio had the highest specificity for predicting surgical lung resection in the early postnatal period. CONCLUSION Measuring congenital pulmonary airway malformation volume ratios throughout pregnancy in fetuses with pulmonary malformations has clinical value for prenatal counseling and planning care transition after delivery. Fetuses with a final congenital pulmonary airway malformation volume ratio of more than 1.3 cm2 are likely to require neonatal surgery and therefore should be delivered at tertiary care centers with a neonatal intensive care unit and pediatric surgical expertise.
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Affiliation(s)
- Annalise B Penikis
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Penikis, Ms Zhou, and Drs Sferra and Kunisaki)
| | - Alice L Zhou
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Penikis, Ms Zhou, and Drs Sferra and Kunisaki)
| | - Shelby R Sferra
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Penikis, Ms Zhou, and Drs Sferra and Kunisaki)
| | - Abigail J Engwall-Gill
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI (Dr Engwall-Gill)
| | - Jena L Miller
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Drs Miller, Baschat, and Blakemore)
| | - Ahmet A Baschat
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Drs Miller, Baschat, and Blakemore)
| | - Karin J Blakemore
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Drs Miller, Baschat, and Blakemore)
| | - Shaun M Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Penikis, Ms Zhou, and Drs Sferra and Kunisaki).
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Tataj‐Puzyna U, Baranowska B, Szlendak B, Szabat M, Węgrzynowska M. Parental experiences of prenatal education when preparing for labor and birth of infant with a lethal diagnosis. Nurs Open 2023; 10:6817-6826. [PMID: 37391910 PMCID: PMC10495705 DOI: 10.1002/nop2.1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/29/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023] Open
Abstract
AIM The aim of this study was to describe the unique experiences of parents facing a Life Limiting Fetal Conditions (LLFC) diagnosis, who chose to continue with their pregnancy, as they prepare for childbirth through individual and group prenatal education. DESIGN A qualitative study. METHODS We employed the phenomenological approach and the Colaizzi strategy to analyse semi-structured interviews. Thirteen persons were interviewed. The participants were couples (n = 6) and women (n = 7) who received LLFC and were preparing for birth. RESULTS We described three main paths of prenatal education chosen by parents with LLFC: 'Searching for normality' concerned people participating in conventional prenatal classes (AC) who tried to avoid confronting the situation they faced; 'Searching for communitas' concerned the participation in special AC selected for the opportunity of sharing experiences; 'Searching for an individual way' concerned people who resorted to individual preparation for childbirth, often as a result of delayed planning. Parents should have a choice of various paths of birth preparation, that best meet their preferences.
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Affiliation(s)
| | - Barbara Baranowska
- Department of MidwiferyCentre of Postgraduate Medical EducationWarsawPoland
| | | | | | - Maria Węgrzynowska
- Department of MidwiferyCentre of Postgraduate Medical EducationWarsawPoland
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Jaeggi E, Kulasingam V, Chen J, Fan CPS, Laskin C, Hamilton RM, Hiraki LT, Silverman ED, Sepiashvili L. Maternal Anti-Ro Antibody Titers Obtained With Commercially Available Immunoassays Are Strongly Associated With Immune-Mediated Fetal Heart Disease. Arthritis Rheumatol 2023; 75:1556-1565. [PMID: 36996277 DOI: 10.1002/art.42513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE Anti-Ro antibody-positive mothers are frequently referred for serial echocardiography due to the fetal risk of developing heart block and endocardial fibroelastosis. Little is known why only some and not all offspring develop these cardiac manifestations of neonatal lupus (CNL). This prospective study examined associations between anti-Ro antibody titers and fetal CNL. METHODS Antibody-positive mothers referred since 2018 for fetal echocardiography at risk of CNL (group 1; n = 240) or with CNL (group 2; n = 18) were included. Maternal antibody titers were measured with a chemiluminescent immunoassay (CIA). Additional testing on diluted serum samples was used to quantify anti-Ro 60 antibody titers above the analytical measuring range (AMR) of the standard CIA (≥1,375 chemiluminescent units [CU]). RESULTS Among 27 total mothers with a fetal diagnosis of CNL, all displayed anti-Ro 60 antibody titers that exceeded the AMR of the CIA at least 10-fold. Of 122 mothers in group 1 who underwent additional anti-Ro 60 antibody testing, event rates of CNL (n = 9) were 0% (0 of 45) among mothers with anti-Ro 60 antibody titers from 1,375-10,000 CU, 5% (3 of 56) among mothers with titers from 10,000-50,000 CU, but 29% (6 of 21) among mothers with titers >50,000 CU (odds ratio 13.1, P = 0.0008). Of mothers in group 2 with a primary diagnosis of CNL, 0% (0 of 18 mothers) had anti-Ro 60 antibody titers <10,000 CU, 44% (8 of 18 mothers) had titers from 10,000-50,000 CU, and 56% (10 of 18 mothers) had titers >50,000 CU. CONCLUSION CNL is associated with substantially higher anti-Ro antibody titers than are obtained using a standard CIA. Enhancing the assay measuring range allows an improved specificity of identifying pregnancies at risk of CNL.
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Affiliation(s)
- Edgar Jaeggi
- Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Vathany Kulasingam
- Division of Clinical Biochemistry, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jack Chen
- Department of Laboratory Medicine & Pathobiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Chun-Po Steve Fan
- Rogers Computational Program, Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Carl Laskin
- Department of Medicine, Mount Sinai Hospital, New York, New York
| | - Robert M Hamilton
- Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Linda T Hiraki
- Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Earl D Silverman
- Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lusia Sepiashvili
- Department of Laboratory Medicine & Pathobiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Prenatal Screening and Diagnosis Group, Birth Defect Prevention and Control Professional Committee. [Guideline for the application of chromosomal microarray analysis in prenatal diagnosis (2023)]. Zhonghua Fu Chan Ke Za Zhi 2023; 58:565-75. [PMID: 37599253 DOI: 10.3760/cma.j.cn112141-20230327-00146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
After the promulgation of the first edition of expert consensus on the application of chromosomal microarray analysis (CMA) technology in prenatal diagnosis in 2014, after 8 years of clinical and technical development, CMA technology has become a first-line diagnosis technology for fetal chromosome copy number deletion or duplication abnormalities, and is widely used in the field of prenatal diagnosis in China. However, with the development of the industry and the accumulation of experience in case diagnosis, the application of CMA technology in many important aspects of prenatal diagnosis, such as clinical diagnosis testimony, data analysis and genetic counseling before and after testing, needs to be further standardized and improved, so as to make the application of CMA technology more in line with clinical needs. The revision of the guideline was led by the National Prenatal Diagnostic Technical Expert Group, and several prenatal diagnostic institutions such as Peking Union Medical College Hospital were commissioned to write, discuss and revise the first draft, which was discussed and reviewed by all the experts of the National Prenatal Diagnostic Technical Expert Group, and was finally formed after extensive review and revision. This guideline is aimed at the important aspects of the application of CMA technology in prenatal diagnosis and clinical diagnosis, from the clinical application of evidence, test quality control, data analysis and interpretation, diagnosis report writing, genetic counseling before and after testing and other work specifications are elaborated and introduced in detail. It fully reflects the integrated experience, professional thinking and guidance of the current Chinese expert team on the prenatal diagnosis application of CMA technology. The compilation of the guideline for the application of CMA technology in prenatal diagnosis will strive to promote the standardization and advancement of prenatal diagnosis of fetal chromosome diseases in China.
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Yan L, Cao J, Zhang Y, Liu Y, Zou J, Lou B, Zhuang D, Li H. Prenatal diagnosis to identify compound heterozygous variants in PKDCC that causes rhizomelic limb shortening with dysmorphic features in a fetus from China. BMC Med Genomics 2023; 16:190. [PMID: 37592254 PMCID: PMC10433562 DOI: 10.1186/s12920-023-01631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Rhizomelic limb shortening with dysmorphic features (RLSDF) has already been a disorder of the rare autosomal recessive skeletal dysplasia, just having a few reported cases. RLSDF is caused by protein kinase domain containing, cytoplasmic(PKDCC)gene variants. In this study, we describe the clinical features and potential RLSDF molecular etiology in a fetus from China. METHODS Genomic DNA (gDNA) extracted from the fetal muscle tissue and parents' peripheral blood was subjected to chromosomal microarray analysis (CMA) and trio-based whole exome sequencing (Trio-WES). The candidate pathogenic variants were verified by using Sanger sequencing. RESULTS Trio-WES identified two compound heterozygous variants in PKDCC, c.346delC (p.Pro117Argfs*113) and c.994G > T (p.Glu332Ter), inherited from the father and mother, respectively. Both variants are classified as pathogenic according to American College of Medical Genetics and Genomics guidelines. CONCLUSIONS We reported the first prenatal case of RLSDF caused by PKDCC in the Chinese population. Our findings extended the variation spectrum of PKDCC and emphasized the necessity of WES for the early diagnosis of skeletal dysplasia and other ultrasound structural abnormalities in fetuses.
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Affiliation(s)
- Lulu Yan
- The Central Laboratory of Birth Defects Prevention and Control, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, 315000, China
| | - Juan Cao
- Department of Obstetrics, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, 315000, China
| | - Yuxin Zhang
- The Central Laboratory of Birth Defects Prevention and Control, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, 315000, China
| | - Yingwen Liu
- The Central Laboratory of Birth Defects Prevention and Control, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, 315000, China
| | - Jinghui Zou
- Department of Obstetrics, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, 315000, China
| | - Biying Lou
- Ningbo University School of Medicine, Ningbo, Zhejiang, 315000, China
| | - Danyan Zhuang
- The Central Laboratory of Birth Defects Prevention and Control, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, 315000, China
| | - Haibo Li
- The Central Laboratory of Birth Defects Prevention and Control, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, 315000, China.
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董 淼, 姜 梅. [Clinical Efficacy and Nursing Care of Fetal Intrauterine Blood Transfusion: Previous Experience Review]. Sichuan Da Xue Xue Bao Yi Xue Ban 2023; 54:843-847. [PMID: 37545084 PMCID: PMC10442628 DOI: 10.12182/20230760504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Indexed: 08/08/2023]
Abstract
Objective To summarize the clinical efficacy and nursing experience of intrauterine blood transfusion (IUT) treatment for fetal anemia cases. Methods The clinical data of 4 fetal anemia cases receiving IUT in Beijing Obstetrics and Gynecology Hospital, Capital Medical University between 2020 and 2022 were collected. Four pregnant women aged 24-38 years were included in the study. They carried fetuses with anemia of unknown causes. The four pregnant women developed anxiety after they were informed of the diagnosis of fetal anemia. One-on-one psychological counseling before the IUT procedure and one-on-one companionship over the course of the surgery were provided for the pregnant women. In addition, they were closely monitored for blood transfusion reactions. Postprocedural observation of the puncture site and 24-hour monitoring of the newborns were also conducted. Results The four pregnant women underwent 1-3 times of IUT in the second and third trimesters, with the minimum gestational age at the time of IUT being 25 + weeks and the blood transfusion volume being 20-107 mL/time. Two pregnant women experienced irregular uterine contractions during IUT in the third trimester. Other than that, all other IUT treatments were successful. After IUT, there was a significant improvement in fetal hemoglobin, peak systolic velocity of the middle cerebral artery (MCA-PSV), and cardiothoracic area ratio. One case did not give birth in our hospital and the outcome of the fetus was not known. The other three fetuses achieved good outcomes. Conclusion Positive preprocedural psychological counseling for pregnant women, close intraoprocedural and postprocedural pregnancy monitoring, and the prevention of maternal and fetal complications are the key to improving the clinical efficacy of IUT and achieving a good fetal outcome.
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Affiliation(s)
- 淼 董
- 首都医科大学附属北京妇产医院/北京妇幼保健院 特需门诊 (北京 100026)Specialist Consultation Outpatient Service, Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
| | - 梅 姜
- 首都医科大学附属北京妇产医院/北京妇幼保健院 特需门诊 (北京 100026)Specialist Consultation Outpatient Service, Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
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Joshi D, Stellon M, Antony K, Beninati M, Luks FI, Puricelli M, Lobeck IN. Indications, Resource Allocation, and Outcomes Associated with Ex-Utero Intrapartum Treatment Procedures: A North American Fetal Therapy Network Survey. Fetal Diagn Ther 2023; 50:376-386. [PMID: 37339615 PMCID: PMC10614236 DOI: 10.1159/000531615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/13/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Neonates with cardiorespiratory compromise at delivery are at substantial risk of hypoxic neurologic injury and death. Though mitigation strategies such as ex-utero intrapartum treatment (EXIT) exist, the competing interests of neonatal beneficence, maternal non-maleficence, and just distribution of resources require consideration. Due to the rarity of these entities, there are few systematic data to guide evidence-based standards. This multi-institutional, interdisciplinary approach aims to elucidate the current scope of diagnoses that might be considered for such treatments and examine if treatment allocation and/or outcomes could be improved. METHODS After IRB approval, a survey investigating diagnoses appropriate for EXIT consultation and procedure, variables within each diagnosis, occurrence of maternal and neonatal adverse outcomes, and instances of suboptimal resource allocation in the last decade was sent to all North American Fetal Treatment Network center representatives. One response was recorded per center. RESULTS We received a 91% response rate and all but one center offer EXIT. Most centers (34/40, 85%) performed 1-5 EXIT consultations per year and 17/40 (42.5%) centers performed 1-5 EXIT procedures in the last 10 years. The diagnoses with the highest degree of agreement between centers surveyed to justify consultation for EXIT are head and neck mass (100%), congenital high airway obstruction (90%), and craniofacial skeletal conditions (82.5%). Maternal adverse outcomes were noted in 7.5% of centers while neonatal adverse outcomes in 27.5%. A large percentage of centers report cases of suboptimal selection for risk mitigation procedures and several centers experienced adverse neonatal and maternal outcomes. CONCLUSION This study captures the scope of EXIT indications and is the first to demonstrate the mismatch in resource allocation for this population. Further, it reports on attributable adverse outcomes. Given suboptimal allocation and adverse outcomes, further examination of indications, outcomes, and resource use is justified to drive evidence-based protocols.
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Affiliation(s)
- Devashish Joshi
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA,
| | - Michael Stellon
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kathleen Antony
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michael Beninati
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Francois I Luks
- Department of Surgery, Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Michael Puricelli
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Inna Neyman Lobeck
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Nigro G, Muselli M. Prevention of Congenital Cytomegalovirus Infection: Review and Case Series of Valaciclovir versus Hyperimmune Globulin Therapy. Viruses 2023; 15:1376. [PMID: 37376675 PMCID: PMC10302477 DOI: 10.3390/v15061376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Cytomegalovirus (CMV) is the most common cause of congenital infections in developed countries because is capable of infecting the fetus after both primary and recurrent maternal infection, and because the virus may be spread for years through infected children. Moreover, CMV is the most serious congenital infection associated with severe neurological and sensorineural sequelae, which can occur at birth or develop later on. Hygienic measures can prevent CMV transmission, which mainly involve contact with children under 3 years of age and attending a nursery or daycare. In animal and human pregnancies, many observational and controlled studies have shown that CMV-specific hyperimmune globulin (HIG) is safe and can significantly decrease maternal-fetal transmission of CMV infection and, mostly, the occurrence of CMV disease. Recently, valaciclovir at the dosage of 8 g/day was also reported to be capable of decreasing the rates of congenital infection and disease. However, comparing the results of our two recent case series, the infants born to women treated with HIG showed significantly lower rates of CMV DNA positivity in urine (9.7% vs. 75.0%; p < 0.0001) and abnormalities after follow-up (0.0% vs. 41.7%; p < 0.0001). The implementation of CMV screening would enable primary prevention via hygiene counseling, improve the understanding and awareness of congenital CMV infection, and increase the knowledge of the potential efficacy of preventive or therapeutic HIG or antiviral administration.
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Affiliation(s)
- Giovanni Nigro
- Non-Profit Association Mother-Infant Cytomegalovirus Infection (AMICI), 00198 Rome, Italy
| | - Mario Muselli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
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Ashwal E, Blaser S, Leckie A, Kajal D, Krishnan P, Chong K, Roifman M, Toi A, Chitayat D. Anterior extension of the choroid plexus into the frontal horns of the fetal lateral cerebral ventricles: Prenatal findings and postnatal outcome. Prenat Diagn 2023; 43:756-762. [PMID: 36946677 DOI: 10.1002/pd.6344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To evaluate the short- and long-term outcome of fetuses with evidence of extension of the choroid plexus into the frontal horns. METHODS This is a retrospective cohort study of fetuses diagnosed with isolated choroid plexi extending into the frontal horns. Fetuses with major central nervous system anomalies were excluded. Ultrasound and fetal/postnatal magnetic resonance imaging (MRI) were evaluated. Postnatal outcomes, including developmental assessment, were obtained. RESULTS Twenty nine fetuses were diagnosed with choroid plexus extension (22 unilateral and 7 bilateral). Gestational age at diagnosis was 19.3 weeks. Three cases (10.3%) presented with nonspecific extra-CNS findings. At presentation, 8/29 (28%) cases had single/multiple choroid plexus cysts (CPC). Twenty-six (89.6%) cases underwent antenatal MRI. On MRI, four cases had punctate susceptibility weighted imaging (SWI) foci suggesting trace hemosiderin and two cases had ventriculomegaly. Antenatal follow-up demonstrated resolution of the choroid plexus extension in 90% (18/20). Gestational age at delivery was 39.6 weeks. All had normal neurologic examinations within 24 h of life. Postnatal MRI studies were notable for deep venous differences in seven cases. Long-term clinical outcome was assessed in 14 cases with a median follow-up of 1.75 years, with normal neurodevelopment reported in 13/14 (92.8%). CONCLUSIONS Most fetuses with an anterior extension of the choroid plexus as the sole sonographic finding had favorable outcomes.
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Affiliation(s)
- Eran Ashwal
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Susan Blaser
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, Division of Neuroradiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Leckie
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Dilkash Kajal
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Pradeep Krishnan
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, Division of Neuroradiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karen Chong
- Department of Obstetrics and Gynecology, The Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Maian Roifman
- Department of Obstetrics and Gynecology, The Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ants Toi
- Department of Radiology, Mount Sinai Hospital, University of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - David Chitayat
- Department of Obstetrics and Gynecology, The Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Petpichetchian C, Carpineta L, Brown R. Cerebral Lateral Ventricular Asymmetry: Normal Variant or an Indicator of Underlying Pathology. Fetal Diagn Ther 2023; 50:179-186. [PMID: 37231824 DOI: 10.1159/000531091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Isolated lateral ventricular asymmetry has been associated with a favorable prognosis; however, prenatal evaluations in existing studies have been conducted using ultrasonography (US). This study aimed to describe the magnetic resonance imaging (MRI) findings, progression of ventricular asymmetry, and perinatal outcomes in fetuses prenatally diagnosed with isolated ventricular asymmetry. METHODS This retrospective study included patients who underwent MRI for isolated fetal ventricular asymmetry at a tertiary center between January 2012 and January 2020. Information, including pregnancy history, US, MRI findings, and perinatal outcomes, was obtained from medical records. RESULTS The study cohort included 17 women with fetal ventricular asymmetry but without ventriculomegaly at the time of index US. Mild ventriculomegaly subsequently developed in 13 patients; 12 of them showed spontaneous resolution before delivery. MRI identified low-grade intraventricular hemorrhage (IVH) in 13 fetuses. Postnatally, 12 newborns underwent neonatal cranial US where two of them showed evidence of germinal matrix hemorrhage. Both newborns appeared normal at birth without neonatal complications. CONCLUSION MRI identified low-grade IVH in most fetuses with isolated ventricular asymmetry. These fetuses were also likely to develop mild ventriculomegaly with spontaneous resolution. Although perinatal outcomes appeared good, careful follow-up in both prenatal and postnatal periods is warranted.
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Affiliation(s)
- Chusana Petpichetchian
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand,
- Department of Obstetrics and Gynecology and Maternal Fetal Medicine, McGill University Health Centre, Montreal, Québec, Canada,
| | - Lucia Carpineta
- Department of Radiology, McGill University Health Centre, Montreal, Québec, Canada
| | - Richard Brown
- Department of Obstetrics and Gynecology and Maternal Fetal Medicine, McGill University Health Centre, Montreal, Québec, Canada
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Safa N, Yanchar N, Puligandla P, Sewitch M, Baird R, Beaunoyer M, Campbell N, Chadha R, Griffiths C, Jones S, Kaur M, Le-Nguyen A, Nasr A, Piché N, Piper H, Prasil P, Romao RLP, VanHouwelingen L, Wales P, Guadagno E, Emil S. Treatment and Outcomes of Congenital Ovarian Cysts A Study by the Canadian Consortium for Research in Pediatric Surgery (CanCORPS). Ann Surg 2023; 277:e1130-e1137. [PMID: 35166261 PMCID: PMC10082055 DOI: 10.1097/sla.0000000000005409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We conducted a multicenter study to assess treatments and outcomes in a national cohort of infants with congenital ovarian cysts. SUMMARY BACKGROUND DATA Wide variability exists in the treatment of congenital ovarian cysts. The effects of various treatment strategies on outcomes, specifically ovarian preservation, are not known. METHODS Female infants diagnosed with congenital intra-abdominal cysts between 2013 and 2017 at 10 Canadian pediatric surgical centers were retrospectively evaluated. Sonographic characteristics, median time to cyst resolution, incidence of ovarian preservation, and predictors of surgery were evaluated. Subgroup analyses were performed in patients with complex cysts and cysts ≥40 mm in diameter. RESULTS The study population included 189 neonates. Median gestational age at diagnosis and median maximal prenatal cyst diameter were 33 weeks and 40 mm, respectively. Cysts resolved spontaneously in 117 patients (62%), 14 (7%) prenatally, and the remainder at a median age of 124 days. Intervention occurred in 61 patients (32%), including prenatal aspiration (2, 3%), ovary sparing resection (14, 23%), or oophorectomy (45, 74%). Surgery occurred at a median age of 7.4weeks. Independent predictors of surgery included postnatal cyst diameter ≥40 mm [odds ratio (OR) 6.19, 95% confidence interval (CI) 1.66-35.9] and sonographic complex cyst character (OR 63.6, 95% CI 10.9-1232). There was no significant difference in the odds of ovarian preservation (OR 3.06, 95% CI 0.86 -13.2) between patients who underwent early surgery (n = 22) and those initially observed for at least 3 months (n = 131). CONCLUSIONS Most congenital ovarian cysts are asymptomatic and spontaneously resolve. Early surgical intervention does not increase ovarian preservation.
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Affiliation(s)
- Nadia Safa
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Natalie Yanchar
- Division of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Pramod Puligandla
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Maida Sewitch
- Division of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Robert Baird
- Division of Pediatric Surgery Children's Hospital of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mona Beaunoyer
- Divisions of Pediatric Surgery and Pediatric Urology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Niamh Campbell
- Division of Pediatric Surgery, Center Hospitalier Universitaire Sainte-Justine Universite de Montreal, Montreal, Quebec, Canada
| | - Rati Chadha
- Division of Maternal Fetal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Griffiths
- Division of Pediatric Surgery, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Jones
- Division of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Manvinder Kaur
- Division of Pediatric Surgery, Children's Hospital London Health Sciences Center, Western University, London, Ontario, Canada
| | - Annie Le-Nguyen
- Divisions of Pediatric Surgery and Pediatric Urology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ahmed Nasr
- Division of Pediatric Surgery, Children's Hospital London Health Sciences Center, Western University, London, Ontario, Canada
| | - Nelson Piché
- Divisions of Pediatric Surgery and Pediatric Urology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hannah Piper
- Division of Pediatric Surgery Children's Hospital of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pascale Prasil
- Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Rodrigo L P Romao
- Division of Pediatric Surgery, Center Hospitalier Universitaire Sainte-Justine Universite de Montreal, Montreal, Quebec, Canada
| | - Lisa VanHouwelingen
- Division of Pediatric Surgery, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Paul Wales
- Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Sherif Emil
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
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Sparks TN, Dugoff L. How to choose a test for prenatal genetic diagnosis: a practical overview. Am J Obstet Gynecol 2023; 228:178-186. [PMID: 36029833 PMCID: PMC9877133 DOI: 10.1016/j.ajog.2022.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/29/2022] [Accepted: 08/05/2022] [Indexed: 01/28/2023]
Abstract
Establishing the diagnosis of a fetal genetic disease in utero expands decision-making opportunities for individuals during pregnancy and enables providers to tailor prenatal care and surveillance to disease-specific risks. The selection of prenatal genetic tests is guided by key details from fetal imaging, family and obstetrical history, suspected diagnoses and mechanisms of disease, an accurate understanding of what abnormalities each test is designed to detect, and, at times, the gestational age at which testing is initiated. Pre- and posttest counseling, by or in conjunction with providers trained in genetics, ensure an accurate understanding of genetic tests, their potential results and limitations, estimated turnaround time for results, and the clinical implications of their findings. As prenatal diagnosis and testing options continue to expand rapidly, it is increasingly important for obstetrical providers to understand how to choose appropriate genetic testing and contextualize the clinical implications of their results.
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Affiliation(s)
- Teresa N Sparks
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA; Institute for Human Genetics, University of California, San Francisco, San Francisco, CA.
| | - Lorraine Dugoff
- Divisions of Reproductive Genetics and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Mappa I, De Vito M, Flacco ME, di Mascio D, D'Antonio F, Rizzo G. Prenatal predictors of adverse perinatal outcome in congenital cytomegalovirus infection: a retrospective multicenter study. J Perinat Med 2023; 51:102-110. [PMID: 35993868 DOI: 10.1515/jpm-2022-0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/07/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To identify predictors of adverse perinatal outcome in congenital cytomegalovirus (CMV) infection. METHODS In a multicenter study fetuses with congenital CMV infection diagnosed by PCR on amniotic fluid and normal prenatal imaging at the time of diagnosis were included. Primary outcome was the occurrence of structural anomalies at follow-up ultrasound or prenatal magnetic resonance imaging (MRI). Secondary outcomes were the occurrence of anomalies detected exclusively postnatally and the rate of symptomatic infection. RESULTS One hundred and four fetuses with congenital CMV were included in the study. Anomalies were detected at follow-up ultrasound or MRI in 18.3% (19/104) cases. Additional anomalies were found after birth in 11.9% (10/84) of cases and 15.5% (13/85) of newborns showed clinical symptoms related to CMV infection. There was no difference in either maternal age (p=0.3), trimester (p=0.4) of infection and prenatal therapy (p=0.4) between fetuses with or whiteout anomalies at follow-up. Conversely, median viral load in the amniotic fluid was higher in fetuses with additional anomalies at follow-up (p=0.02) compared to those without. At multivariate logistic regression analysis, high viral load in the amniotic fluid, defined as ≥100,000 copies/mL was the only independent predictor for the occurrence of anomalies detected exclusively at follow-up ultrasound assessment or MRI, with an OR of 3.12. CONCLUSIONS Viral load in the amniotic fluid is a strong predictor of adverse perinatal outcome in congenital CMV infection. The results of this study emphasize the importance of adequate follow up even in case of negative neurosonography to better predict postnatal adverse outcomes of infected newborns, especially in amniotic fluid high viral load.
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Affiliation(s)
- Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Marika De Vito
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | | | - Daniele di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco D'Antonio
- Centre for Fetal Care and High-risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chiety, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
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24
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Miyoshi T, Maeno Y, Matsuda T, Ito Y, Inamura N, Kim KS, Shiraishi I, Kurosaki K, Ikeda T, Sago H. Neurodevelopmental outcome after antenatal therapy for fetal supraventricular tachyarrhythmia: 3-year follow-up of multicenter trial. Ultrasound Obstet Gynecol 2023; 61:49-58. [PMID: 36350016 DOI: 10.1002/uog.26113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/30/2022] [Accepted: 10/20/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Although many studies have supported the efficacy of transplacental treatment for fetal supraventricular tachyarrhythmia, the long-term neurodevelopmental outcome after antenatal antiarrhythmic treatment is not well understood. The aim of this study was to investigate the prognosis and neurodevelopmental outcome at 36 months of corrected age and the incidence of tachyarrhythmia after birth, following protocol-defined antenatal therapy for fetal supraventricular tachyarrhythmia. METHODS This was a 3-year follow-up study of a multicenter trial that evaluated the efficacy and safety of protocol-defined transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL). The primary endpoints were mortality and neurodevelopmental impairment (NDI) at 36 months of corrected age. NDI was defined as any of the following outcomes: cerebral palsy, bilateral blindness, bilateral deafness or neurodevelopmental delay. Neurodevelopmental delay was evaluated using appropriate developmental quotient scales, mainly the Kyoto Scale of Psychological Development, or examination by pediatric neurologists. The detection rate of tachyarrhythmia at birth and at 18 and 36 months of corrected age was also evaluated as the secondary endpoint. In addition, the association of NDI at 36 months with perinatal and postnatal factors was analyzed. RESULTS Of 50 patients enrolled in the original trial, one withdrew consent and in two there was fetal death, leaving 47 patients available for enrollment in this follow-up study. Of these, 45 cases were available for analysis after two infants were lost to follow-up. The mortality rate was 2.2% (1/45) during a median follow-up of 3.2 (range, 2.1-9.4) years. The infant died at the age of 2.1 years. Another infant had missing neurodevelopmental assessment data. In the remaining 43 infants, at 36 months of corrected age, NDI was detected in 9.3% (4/43) overall and in two of three (66.7%) cases with fetal hydrops with subcutaneous edema. Cerebral palsy was noted in two infants with severe subcutaneous edema or ascites at an early gestational age. Neurodevelopmental delay was found in two infants with severe congenital abnormalities (one with tuberous sclerosis and the other with heterotaxy syndrome). Tachyarrhythmia was present in 31.9% (15/47) cases in the neonatal period and decreased to 8.9% (4/45) and 4.5% (2/44) at 18 and 36 months of corrected age, respectively. The median ventricular rate at diagnosis was significantly higher in infants with NDI compared to those without (265 vs 229 bpm; P = 0.003). In infants with NDI, compared to those without, fetal hydrops with subcutaneous edema at diagnosis was more common (50.0% vs 2.6%; P = 0.019) and the duration of fetal effusion was longer (median, 10.5 vs 0 days; P = 0.013). Postnatal arrhythmia and physical development abnormalities were not associated with NDI. CONCLUSIONS This multicenter 3-year follow-up study is the first to demonstrate the long-term mortality and morbidity of infants born following protocol-defined transplacental treatment for fetal SVT and AFL. NDI was associated with the presence of fetal hydrops with subcutaneous edema at diagnosis and longer duration of fetal effusion. Neurodevelopmental delay was detected only in infants with severe congenital abnormalities. Therefore, in infants that have undergone antenatal treatment for fetal tachyarrhythmia and in which there are no comorbidities, the risk of NDI is low. However, in those with fetal hydrops with subcutaneous edema and/or associated severe congenital abnormalities, the risk for long-term neurologic morbidity might be considered somewhat increased. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Miyoshi
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center, Suita, Japan
- Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Y Maeno
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - T Matsuda
- Department of Pediatrics, Yonaha Okanoue Hospital, Kuwana, Japan
| | - Y Ito
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - N Inamura
- Department of Pediatric Cardiology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - K-S Kim
- Department of Cardiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - I Shiraishi
- Department of Pediatric Cardiology, NCVC, Suita, Japan
| | - K Kurosaki
- Department of Pediatric Cardiology, NCVC, Suita, Japan
| | - T Ikeda
- Department of Obstetrics and Gynecology, Mie University, Tsu, Japan
| | - H Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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25
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Avram CM, Caughey AB, Norton ME, Sparks TN. Cost-Effectiveness of Exome Sequencing versus Targeted Gene Panels for Prenatal Diagnosis of Fetal Effusions and Non-Immune Hydrops Fetalis. Am J Obstet Gynecol MFM 2022; 4:100724. [PMID: 35995366 PMCID: PMC9938838 DOI: 10.1016/j.ajogmf.2022.100724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Although exome sequencing has a greater overall diagnostic yield than targeted gene panels in the evaluation of nonimmune hydrops fetalis and fetal effusions, the cost-effectiveness of this approach is not known. OBJECTIVE This study aimed to evaluate the costs and outcomes of targeted gene panels vs exome sequencing for prenatally diagnosed nonimmune hydrops fetalis and fetal effusions when next-generation sequencing is pursued following nondiagnostic standard nonimmune hydrops fetalis evaluations, including karyotype or chromosomal microarray. STUDY DESIGN A decision-analytical model was designed using TreeAge Pro to compare 10 genetic testing strategies, including a single test only (RASopathy, metabolic, or nonimmune hydrops fetalis-targeted gene panel or exome sequencing), sequential testing (RASopathy panel followed by nonimmune hydrops fetalis panel, metabolic panel followed by nonimmune hydrops fetalis panel, RASopathy panel followed by exome sequencing, metabolic panel followed by exome sequencing, and nonimmune hydrops fetalis panel followed by exome sequencing), and no additional genetic testing. Our theoretical cohort included cases with normal karyotype and/or microarray and excluded cases of alloimmunization and congenital viral infections. As nonimmune hydrops fetalis and fetal effusions can present throughout gestation, whereas pregnancy management options vary depending on gestational age, outcomes were calculated for 3 time intervals: 10 to 18, 18 to 22, and >22 weeks of gestation. The primary outcome was incremental cost per quality-adjusted life year. Additional outcomes included termination of pregnancy, stillbirth, neonatal death, and neonates born with mild, moderate, and severe or profound disease phenotypes. The cost-effectiveness threshold was $100,000 per quality-adjusted life year. RESULTS Among women <18 weeks of gestation, exome sequencing alone was the dominant strategy associated with the lowest costs ($221 million) and the highest quality-adjusted life years (10,288). Strategies with exome sequencing alone or as a sequential test resulted in more terminations but fewer stillbirths, neonatal deaths (NNDs), and affected infants than strategies without exome sequencing. Among women between 18 and 22 weeks of gestation, exome sequencing alone was also associated with the lowest costs ($188 million) and the highest quality-adjusted life years (8734), and similar trends were observed in pregnancy outcomes. Among patients >22 weeks of gestations, when termination was not available, exome sequencing was associated with lower costs ($300 million) and the highest quality-adjusted life years (8492). Exome sequencing was cost-effective up to a cost per test of $50,451 at <18 weeks of gestation, $50,423 at 18 to 22 weeks of gestation, and $9530 at >22 weeks of gestation. Targeted genetic panels and exome sequencing were cost-effective strategies compared with no additional genetic testing. CONCLUSION For cases of nonimmune hydrops fetalis and fetal effusions with nondiagnostic karyotype or microarray, next-generation sequencing was cost-effective compared with a strategy without additional genetic testing. For those that undergo next-generation sequencing, exome sequencing was the cost-effective strategy compared with all other testing strategies using targeted gene panels, leading to lower costs and fewer adverse perinatal outcomes. Exome sequencing was cost-effective in a setting without the option for pregnancy termination. These data supported the routine use of exome sequencing when next-generation sequencing is pursued for establishing a genetic diagnosis underlying otherwise unexplained nonimmune hydrops fetalis and fetal effusions.
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Affiliation(s)
- Carmen M Avram
- Duke University Medical Center, Durham, NC (Carmen M. Avram, MD).
| | - Aaron B Caughey
- Oregon Health & Science University, Portland, OR (Aaron B. Caughey, MD, PhD)
| | - Mary E Norton
- University of California, San Francisco, San Francisco, CA (Mary E. Norton, MD, Teresa N. Sparks, MD, MAS)
| | - Teresa N Sparks
- University of California, San Francisco, San Francisco, CA (Mary E. Norton, MD, Teresa N. Sparks, MD, MAS)
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26
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Pécheux O, Willame A, Martinez De Tejada B. [Cytomegalovirus screening during pregnancy : an ongoing debate still in 2022]. Rev Med Suisse 2022; 18:1961-1966. [PMID: 36259702 DOI: 10.53738/revmed.2022.18.800.1961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Cytomegalovirus infection remains the main congenital infectious cause of abnormal development, notably neurological or auditory. In case of early maternal infection, vertical transmission is lower than later in pregnancy, but fetal/neonatal sequelae are more frequent and severe. Until recently, there was no available treatment to prevent transmission and complications and only preventive measures were recommended. Based on a recent literature review, we will discuss the possible indication for CMV screening before conception and/or in the first trimester of pregnancy, in order to improve patient's information, prevention and treatment.
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Affiliation(s)
- Océane Pécheux
- Service d'obstétrique, Département de la femme, l'enfant et l'adolescent, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Alexia Willame
- Service d'obstétrique, Département de la femme, l'enfant et l'adolescent, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Begoña Martinez De Tejada
- Service d'obstétrique, Département de la femme, l'enfant et l'adolescent, Hôpitaux universitaires de Genève, 1211 Genève 14
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Wade J, Johnson SM, Burkhardt I, Egloff A, Thomas J, Guy E, Demirjian A. Discordant Congenital Toxoplasmosis and Cytomegalovirus Infection in Dichorionic Diamniotic Twins. Pediatr Infect Dis J 2022; 41:e377-e382. [PMID: 35797707 DOI: 10.1097/inf.0000000000003610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Toxoplasmosis and cytomegalovirus (CMV) congenital infection present with similar clinical pictures. Both infections have long-term sequelae that can be mitigated by early detection and treatment. Coinfection is uncommonly reported. METHODS Dichorionic diamniotic twins born at 35 weeks of gestation were investigated for congenital infections due to abnormalities on the antenatal scan at 31 weeks of gestation. Antenatal investigations were delayed due to late booking and delay in maternal investigations. In the neonatal period, they suffered discordant symptoms and were both investigated for Toxoplasma gondii infection. This diagnosis was confirmed in twin 2 but proved difficult in twin 1 who had a weakly positive polymerase chain reaction with inconclusive serology. Twin 1 was also diagnosed with congenital CMV, further complicating the clinical picture. Toxoplasmosis can cause long-term sequelae, and definitive diagnosis requires serology at 12 months of age; in view of this, treatment for congenital toxoplasmosis was initiated in both twins. Twin 1 was also treated for congenital CMV. RESULTS Due to limitations in serological investigations in neonates, diagnosing congenital toxoplasmosis can be challenging, and initiating treatment may be warranted in suspected cases, given the risk of infective complications. Discordant presentations between twins are known in congenital toxoplasmosis and CMV, but coinfection has rarely been reported without concurrent immunocompromise. A high index of suspicion should be maintained in the twin of an infected neonate, and the possibility of multiple infections should be considered. Multidisciplinary working is crucial in reaching a diagnosis and treating appropriately.
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Gao B, Zhang L, Wei Q. An unexplained fetal intracranial hemorrhage with extensive and multifocal hemorrhagic lesions: A case report. Medicine (Baltimore) 2022; 101:e29335. [PMID: 35758363 PMCID: PMC9276342 DOI: 10.1097/md.0000000000029335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/01/2022] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Fetal intracranial hemorrhage (ICH) is an extremely rare complication of pregnancy, with subsequent neurological sequelae or fetal death. The diagnosis of fetal ICH is primarily based on ultrasound or magnetic resonance imaging. PATIENT CONCERNS An asymptomatic woman at 31 weeks of gestation was referred for a detailed anomaly scan because routine fetal ultrasonography showed suspected fetal ICH. DIAGNOSES Fetal ICH with extensive and multifocal hemorrhagic lesions was diagnosed by ultrasound and magnetic resonance imaging imaging and finally confirmed by postmortem examination. INTERVENTIONS The woman opted for pregnancy termination after medical consultation. Labor was induced by mifepristone and rivanol infusion. OUTCOMES The patient delivered a stillborn male infant weighing 1522 g. We tried our best to screen the possible etiology contributing to fetal ICH; unfortunately, no evidence of obvious causes or predisposing factors was identified. LESSONS Medically unexplained massive fetal ICH may cause an unfavorable prognosis, and prompt termination of pregnancy is appropriate, although there is no consensus on the optimal mode of delivery.
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29
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Kielaite D, Paliulyte V. Parvovirus (B19) Infection during Pregnancy: Possible Effect on the Course of Pregnancy and Rare Fetal Outcomes. A Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58050664. [PMID: 35630081 PMCID: PMC9144227 DOI: 10.3390/medicina58050664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
Infection caused by human parvovirus B19 (B19) often has mild yet wide-ranging clinical signs, with the course of disease usually defined as benign. Particularly prevalent in the population of young children, the virus is commonly transmitted to the parents, especially to susceptible mothers. During pregnancy, particularly the first and second trimesters, parvovirus infection can lead to pathology of the fetus: anemia, heart failure, hydrops, and disorders of physical and neurological development. In severe cases, the disease can result in fetal demise. This article presents a rare case of manifestation of B19 infection during pregnancy. At the 27th week of gestation, a sudden change in fetal movement occurred in a previously healthy pregnancy. The examination of both fetus and the mother revealed newly formed fetal subdural hematoma of unknown etiology and ventriculomegaly. Following extensive examination to ascertain the origin of fetal pathology, a maternal B19 infection was detected. Due to worsening fetal condition, a planned cesarean section was performed to terminate the pregnancy at 31 weeks of gestation. A preterm male newborn was delivered in a critical condition with congenital B19 infection, hydrocephalus, and severe progressive encephalopathy. The manifestation and the origin of the fetal condition remain partially unclear. The transplacental transmission of maternal B19 infection to the fetus occurs in approximately 30% of cases. The main method for diagnosing B19 infection is Polymerase Chain Reaction (PCR) performed on blood serum. In the absence of clinical manifestations, the early diagnosis of B19 infection is rarely achieved. As a result, the disease left untreated can progress inconspicuously and cause serious complications. Treatment strategies are limited and depend on the condition of the pregnant woman and the fetus. When applicable, intrauterine blood transfusion reduces the risk of fetal mortality. It is crucial to assess the predisposing factors of the infection and evaluate signs of early manifestation, as this may help prevent the progression and poor outcomes of the disease.
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Affiliation(s)
- Dovile Kielaite
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Correspondence:
| | - Virginija Paliulyte
- Center of Obstetrics and Gynecology, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 08661 Vilnius, Lithuania;
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30
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Safa N, Yanchar N, Puligandla P, Sewitch M, Baird R, Beaunoyer M, Butter A, Campbell N, Chadha R, Griffiths C, Jones S, Kaur M, Le-Nguyen A, Nasr A, Piché N, Piper H, Prasil P, Romao R, VanHouwelingen L, Wales P, Guadagno E, Emil S. Differentiating congenital ovarian cysts from other abdominal cystic lesions in female infants: A study by the Canadian Consortium for Research in Pediatric Surgery (CanCORPS). J Pediatr Surg 2022; 57:877-882. [PMID: 35090716 DOI: 10.1016/j.jpedsurg.2021.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The origin of congenital abdominal cysts in the female fetus often dictates management. While most arise from the ovary and are often managed non-operatively, some are non-ovarian and are frequently removed. We analyzed a national sample of female infants with congenital abdominal cysts to elucidate prenatal and postnatal factors associated with the diagnosis of a non-ovarian cyst. METHODS A retrospective cohort study of female infants who were prenatally diagnosed with abdominal cysts between 2013 and 2017 at 10 Canadian pediatric surgical centres was performed. Clinical characteristics, pre- and postnatal sonographic findings, and cyst trajectories were compared between patients with proven ovarian etiology and those with cysts arising from other organs. RESULTS Of 185 infants with prenatally diagnosed abdominal cysts, 22 (12%) were non-ovarian, five of which had clear non-ovarian organ of origin on prenatal ultrasound. Comparison of the other 17 cysts with 163 congenital ovarian cysts showed the following factors to be associated with a non-ovarian origin: earlier gestational age at diagnosis (23.5 vs 33.5 weeks, p <0.001), smaller diameter on first prenatal ultrasound (15.8 vs. 39.7 mm, p <0.001), change in sonographic character from simple to complex (87% vs 22%, p <0.001), and postnatal sonographic characteristics of complex cyst (87% vs. 48%, p = 0.004). CONCLUSION Clear organ of origin, diagnosis earlier in gestation, smaller initial prenatal cyst diameter, and sonographic cyst character change differentiate congenital non-ovarian cysts from their ovarian counterparts. These characteristics may be used to guide diagnosis and management.
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Affiliation(s)
- Nadia Safa
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Natalie Yanchar
- Division of Pediatric Surgery, Alberta Children's Hospital, University of Calgary,Calgary, Alberta, Canada
| | - Pramod Puligandla
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Maida Sewitch
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine and Health Sciences,Montreal, Quebec, Canada
| | - Robert Baird
- Division of Pediatric Surgery, Children's Hospital of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mona Beaunoyer
- Division of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Andreana Butter
- Division of Pediatric Surgery, Children's Hospital London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Niamh Campbell
- Division of Pediatric Surgery, IWK Health Sciences Centre, Dalhousie University,Halifax, Nova Scotia, Canada
| | - Rati Chadha
- Division of Maternal Fetal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Griffiths
- Division of Pediatric Surgery, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Jones
- Division of Pediatric Surgery, Children's Hospital London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Manvinder Kaur
- Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Annie Le-Nguyen
- Division of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Ahmed Nasr
- Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Nelson Piché
- Division of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Hannah Piper
- Division of Pediatric Surgery, Children's Hospital of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pascale Prasil
- Division of Pediatric Surgery, Centre Hospitalier de l'Universite Laval, Quebec, Quebec, Canada
| | - Rodrigo Romao
- Division of Pediatric Surgery, IWK Health Sciences Centre, Dalhousie University,Halifax, Nova Scotia, Canada
| | - Lisa VanHouwelingen
- Division of Pediatric Surgery, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Paul Wales
- Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Sherif Emil
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
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Phelps AJD, Bisson CM, Ouyang DW. A Case of Dropped Beats: Management of a Common Fetal Arrhythmia. Neoreviews 2022; 23:e272-e278. [PMID: 35362039 DOI: 10.1542/neo.23-4-e272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Alexandra J D Phelps
- Advocate Lutheran General Hospital Department of Obstetrics and Gynecology, Park Ridge, IL
| | - Courtney M Bisson
- NorthShore University Health System/University of Chicago Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Evanston, IL
| | - David W Ouyang
- NorthShore University Health System/University of Chicago Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Evanston, IL
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Leung J, Reid HD, Morgan J, Kadyk H, Havener G, Marin M. Notes from the Field: Congenital Varicella Syndrome Case — Illinois, 2021. MMWR Morb Mortal Wkly Rep 2022; 71:390-392. [PMID: 35271562 PMCID: PMC8911996 DOI: 10.15585/mmwr.mm7110a5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
Fetal and neonatal dysfunctions include rare serious disorders involving abnormal thyroid function during the second half of gestation, which may persist throughout life, as for most congenital thyroid disorders, or be transient, resolving in the first few weeks of life, as in autoimmune hyperthyroidism or hypothyroidism and some cases of congenital hypothyroidism (CH) with the thyroid gland in situ. Primary CH is diagnosed by neonatal screening, which has been implemented for 40 years in developed countries and should be introduced worldwide, as early treatment prevents irreversible neurodevelopmental delay. Central CH is a rarer entity occurring mostly in association with multiple pituitary hormone deficiencies. Other rare disorders impair the action of thyroid hormones. Neonatal Graves' disease (GD) results from the passage of thyrotropin receptor antibodies (TRAbs) across the placenta, from mother to fetus. It may affect the fetuses and neonates of mothers with a history of current or past GD, but hyperthyroidism develops only in those with high levels of stimulatory TRAb activity. The presence of antibodies predominantly blocking thyroid-stimulating hormone receptors may result in transient hypothyroidism, possibly followed by neonatal hyperthyroidism, depending on the balance between the antibodies present. Antithyroid drugs taken by the mother cross the placenta, treating potential fetal hyperthyroidism, but they may also cause transient fetal and neonatal hypothyroidism. Early diagnosis and treatment are key to optimizing the child's prognosis. This review focuses on the diagnosis and management of these patients during the fetal and neonatal periods. It includes the description of a case of fetal and neonatal autoimmune hyperthyroidism.
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Affiliation(s)
- Juliane Léger
- Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Pediatric Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Paris, France
- Université de Paris; NeuroDiderot, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Clemence Delcour
- Université de Paris; NeuroDiderot, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
- Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Gynecology and Obstetric Department, Paris, France
| | - Jean-Claude Carel
- Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Pediatric Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Paris, France
- Université de Paris; NeuroDiderot, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
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Wierzbowski KA, Wing SE, Brown BP, Martinez ML, Golomb MR. Fetal Cerebral Sinovenous Thrombosis and Dural Sinus Malformation. Pediatr Neurol 2022; 126:89-93. [PMID: 34763246 DOI: 10.1016/j.pediatrneurol.2021.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fetal cerebral sinovenous thrombosis (CSVT) and dural sinus malformation (DSM) are rare types of fetal cerebral venous pathology that are becoming increasingly recognized as fetal imaging advances. Fetal DSMs are a common source of fetal CSVT, although CSVT may occur without a DSM. The literature on these disorders is limited. METHODS Cases of fetal CSVT and DSM were identified retrospectively through a query of the Indiana University Health fetal imaging archive from 2007 to 2021. RESULTS Seven cases were identified, all of whom were alive at birth. A DSM was present in six. Treatments after birth included enoxaparin sodium (3), embolization (3), and shunt placements (1). Five cases had documented regression or complete resolution of the thrombus and/or malformation. One was lost to follow-up, one died from complications of hydrocephalus at nine months, one was receiving physical and occupational therapy at last follow-up at three months, one had concern for autism and mild gait abnormality at 21 months, two had concern for speech delay (18 months and 24 months), and one had normal development at most recent follow-up (four years). CONCLUSIONS Positive short-term outcomes may occur for some cases of fetal CSVT and DSM. However, risk factors and best treatments are not clear, and long-term outcome data are limited. There is a need for further study.
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Affiliation(s)
- Katherine A Wierzbowski
- Division of Child Neurology, Department of Neurology, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana
| | - Sarah E Wing
- Division of Child Neurology, Department of Neurology, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana
| | - Brandon P Brown
- Department of Radiology and Imaging Sciences, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana
| | - Mesha L Martinez
- Department of Radiology and Imaging Sciences, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana
| | - Meredith R Golomb
- Division of Child Neurology, Department of Neurology, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana.
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Périllaud-Dubois C, Belhadi D, Laouénan C, Mandelbrot L, Picone O, Vauloup-Fellous C. Current practices of management of maternal and congenital Cytomegalovirus infection during pregnancy after a maternal primary infection occurring in first trimester of pregnancy: Systematic review. PLoS One 2021; 16:e0261011. [PMID: 34860861 PMCID: PMC8641894 DOI: 10.1371/journal.pone.0261011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Congenital CMV infection is the first worldwide cause of congenital viral infection but systematic screening of pregnant women and newborns for CMV is still debated in many countries. OBJECTIVES This systematic review aims to provide the state of the art on current practices concerning management of maternal and congenital CMV infection during pregnancy, after maternal primary infection (PI) in first trimester of pregnancy. DATA SOURCES Electronically searches on databases and hand searches in grey literature. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS Primary outcome was listing biological, imaging, and therapeutic management interventions in two distinct populations: population 1 are pregnant women with PI, before or without amniocentesis; population 2 are pregnant women with congenitally infected fetuses (after positive amniocentesis). Secondary outcome was pregnancy outcome in population 2. RESULTS Out of 4,134 studies identified, a total of 31 studies were analyzed, with 3,325 pregnant women in population 1 and 1,021 pregnant women in population 2, from 7 countries (Belgium, France, Germany, Israel, Italy, Spain and USA). In population 1, ultrasound (US) examination frequency was 0.75/month, amniocentesis in 82% cases, maternal viremia in 14% and preventive treatment with hyperimmune globulins (HIG) or valaciclovir in respectively 14% and 4% women. In population 2, US examination frequency was 1.5/month, magnetic resonance imaging (MRI) in 44% cases at 32 weeks gestation (WG), fetal blood sampling (FBS) in 24% at 28 WG, and curative treatment with HIG or valaciclovir in respectively 9% and 8% patients. CONCLUSIONS This systematic review illustrates management of maternal and congenital CMV during pregnancy in published and non-published literature, in absence of international consensus. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019124342.
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Affiliation(s)
- Claire Périllaud-Dubois
- Département de Virologie, AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Paris, France
- Université de Paris, INSERM UMR1137, IAME, Paris, France
- GRIG, Groupe de Recherche sur les Infections pendant la Grossesse, Paris, France
- * E-mail:
| | - Drifa Belhadi
- Université de Paris, INSERM UMR1137, IAME, Paris, France
- Department of Epidemiology, Biostatistic and Clinical Research, AP-HP, Hôpital Bichat, Paris, France
| | - Cédric Laouénan
- Université de Paris, INSERM UMR1137, IAME, Paris, France
- Department of Epidemiology, Biostatistic and Clinical Research, AP-HP, Hôpital Bichat, Paris, France
| | - Laurent Mandelbrot
- Université de Paris, INSERM UMR1137, IAME, Paris, France
- GRIG, Groupe de Recherche sur les Infections pendant la Grossesse, Paris, France
- AP-HP, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France
| | - Olivier Picone
- Université de Paris, INSERM UMR1137, IAME, Paris, France
- GRIG, Groupe de Recherche sur les Infections pendant la Grossesse, Paris, France
- AP-HP, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France
| | - Christelle Vauloup-Fellous
- GRIG, Groupe de Recherche sur les Infections pendant la Grossesse, Paris, France
- Laboratoire de Virologie, AP-HP.Université Paris-Saclay, Hôpital Paul Brousse, Villejuif, France
- Université Paris-Saclay, INSERM U1193, Villejuif, France
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Shapira D, Cleper R. [DISTENDED FETAL BLADDER]. Harefuah 2021; 160:797-800. [PMID: 34957714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Distended fetal bladder, also known as fetal megacystis, usually points to lower urinary tract obstruction (LUTO) which is most commonly caused by posterior urethral valves (PUV) in the male fetus. We present a short case-series of fetal megacystis without oligohydramnion where primary vesicoureteral reflux (VUR) was the leading aetiology. These cases also displayed a high rate of kidney dysplasia with early-onset renal dysfunction. By contrast, late-onset diagnosis of isolated megacystis, i.e without significant renal parenchymal or upper urinary tract abnormalities, had a surprisingly benign postnatal course with spontaneous resolution after birth. Our case series also display the associated risk for extra-renal malformations and specifically neuro-cognitive developmental abnormalities which should be sought on genetic and imaging evaluation.
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Affiliation(s)
- Dana Shapira
- Pediatric Nephrology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Roxana Cleper
- Pediatric Nephrology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
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Fragoso MBT, Ferreira RC, Tenório MCDS, Moura FA, de Araújo ORP, Bueno NB, Goulart MOF, de Oliveira ACM. Biomarkers of Inflammation and Redox Imbalance in Umbilical Cord in Pregnancies with and without Preeclampsia and Consequent Perinatal Outcomes. Oxid Med Cell Longev 2021; 2021:9970627. [PMID: 34795845 PMCID: PMC8595010 DOI: 10.1155/2021/9970627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/16/2021] [Accepted: 10/11/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To compare redox imbalance and inflammation biomarkers in umbilical cords from pregnancies with and without preeclampsia (PE) and to analyse their relationships with perinatal outcomes. METHODS A controlled cross-sectional study was conducted in Maceió, Alagoas, Brazil, that involved pregnant women with PE and a group of women without the disease, through the application of a standardized questionnaire. After delivery, umbilical cord samples were collected to measure antioxidant defense, products from oxidative damage, and inflammation biomarkers such as myeloperoxidase (MPO), interleukin- (IL-) 6, IL-8, IL-10, and tumor necrosis factor-alpha (TNF-α). Statistical analyses were performed using Stata version 13.0 software and IBM Statistical Package for the Social Sciences (SPSS) 20.0, adopting a 95% confidence level (α = 0.05), with the chi-square test, the Wilcoxon-Mann-Whitney test, and the multinomial and Poisson regression tests. RESULTS One hundred PE pregnant women and 50 women without the disease were studied. The umbilical cords from PE pregnancies showed higher levels of reduced glutathione (GSH) (p ≤ 0.001), glutathione peroxidase (GPx) (p = 0.016), and malondialdehyde (MDA) (p = 0.028) and lower levels of IL-6 (p = 0.030) and TNF-α (p ≤ 0.001) than the other group, with some associations among these biomarkers with perinatal outcomes. CONCLUSION The higher levels of GSH and GPx, in addition to the lower levels of IL-6 and TNF-α, found in the PE umbilical cord, may result from adaptive mechanisms to maintain the oxidative and inflammatory balance; however, despite these changes, the damage to the cell membranes was not minimized, as the MDA level was higher in women with PE than in women without the disease. This implies that a redox imbalance is present, confirming that other physiological and adaptive mechanisms are being activated to preserve foetal health. Therefore, the present work unveils an important role of the umbilical cord in controlling redox imbalance and inflammation in PE pregnancies. Our results reinforce the necessity for continuous research on GSH as a protective compound for the perinatal outcome, especially in PE women.
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Affiliation(s)
- Marilene Brandão Tenório Fragoso
- Instituto de Química e Biotecnologia (IQB/UFAL), Rede Nordeste de Biotecnologia (RENORBIO), Universidade Federal de Alagoas, Campus A. C. Simões, BR 104 Norte, Km. 96.7, Tabuleiro dos Martins, CEP 57.072-970 Maceió, Alagoas, Brazil
| | - Raphaela Costa Ferreira
- Programa de Pós-graduação em Ciências da Saúde, ICBS, Universidade Federal de Alagoas, Campus A. C. Simões, BR 104 Norte, Km. 96.7, Tabuleiro dos Martins, CEP 57.072-970 Maceió, Alagoas, Brazil
| | - Micaely Cristina dos Santos Tenório
- Instituto de Química e Biotecnologia (IQB/UFAL), Rede Nordeste de Biotecnologia (RENORBIO), Universidade Federal de Alagoas, Campus A. C. Simões, BR 104 Norte, Km. 96.7, Tabuleiro dos Martins, CEP 57.072-970 Maceió, Alagoas, Brazil
| | - Fabiana Andréa Moura
- Faculdade de Nutrição, Universidade Federal de Alagoas, Campus A. C. Simões, BR 104 Norte, Km. 96.7, Tabuleiro dos Martins, CEP 57.072-970 Maceió, Alagoas, Brazil
| | - Orlando Roberto Pimentel de Araújo
- Instituto de Química e Biotecnologia (IQB/UFAL), Programa de Pós-graduação Em Química e Biotecnologia, Universidade Federal de Alagoas, Campus A. C. Simões, BR 104 Norte, Km. 96.7, Tabuleiro dos Martins, CEP 57.072-970 Maceió, Alagoas, Brazil
| | - Nassib Bezerra Bueno
- Faculdade de Nutrição, Universidade Federal de Alagoas, Campus A. C. Simões, BR 104 Norte, Km. 96.7, Tabuleiro dos Martins, CEP 57.072-970 Maceió, Alagoas, Brazil
| | - Marília Oliveira Fonseca Goulart
- Instituto de Química e Biotecnologia (IQB/UFAL), Rede Nordeste de Biotecnologia (RENORBIO), Universidade Federal de Alagoas, Campus A. C. Simões, BR 104 Norte, Km. 96.7, Tabuleiro dos Martins, CEP 57.072-970 Maceió, Alagoas, Brazil
- Programa de Pós-graduação em Ciências da Saúde, ICBS, Universidade Federal de Alagoas, Campus A. C. Simões, BR 104 Norte, Km. 96.7, Tabuleiro dos Martins, CEP 57.072-970 Maceió, Alagoas, Brazil
- Instituto de Química e Biotecnologia (IQB/UFAL), Programa de Pós-graduação Em Química e Biotecnologia, Universidade Federal de Alagoas, Campus A. C. Simões, BR 104 Norte, Km. 96.7, Tabuleiro dos Martins, CEP 57.072-970 Maceió, Alagoas, Brazil
| | - Alane Cabral Menezes de Oliveira
- Faculdade de Nutrição, Universidade Federal de Alagoas, Campus A. C. Simões, BR 104 Norte, Km. 96.7, Tabuleiro dos Martins, CEP 57.072-970 Maceió, Alagoas, Brazil
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Souganidis E, Chen A, Friedlaender E. Symptomatic Persistent Fetal Ovarian Cysts. Pediatr Emerg Care 2021; 37:e672-e674. [PMID: 32796350 DOI: 10.1097/pec.0000000000002209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Vomiting in young infants is a common presentation to the pediatric emergency department with a broad differential diagnosis. We present 2 cases seen in our emergency department of infant females with symptomatic complex ovarian cysts who presented with vomiting. The first case study describes a patient with a prenatally diagnosed ovarian cyst that was being followed with serial ultrasounds by general surgery. The second case study describes a patient with reportedly normal prenatal ultrasounds with a subsequent diagnosis of a large complex ovarian cyst. These cases were selected to review pertinent imaging findings, discuss management decisions, and expand the differential of vomiting in the young female infants.
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Affiliation(s)
| | - Aaron Chen
- Children's Hospital of Philadelphia, Philadelphia, PA
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Bruni V, Spoleti CB, La Barbera A, Dattilo V, Colao E, Votino C, Bellacchio E, Perrotti N, Giglio S, Iuliano R. A Novel Splicing Variant of COL2A1 in a Fetus with Achondrogenesis Type II: Interpretation of Pathogenicity of In-Frame Deletions. Genes (Basel) 2021; 12:genes12091395. [PMID: 34573377 PMCID: PMC8467821 DOI: 10.3390/genes12091395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/08/2023] Open
Abstract
Achondrogenesis type II (ACG2) is a lethal skeletal dysplasia caused by dominant pathogenic variants in COL2A1. Most of the variants found in patients with ACG2 affect the glycine residue included in the Gly-X-Y tripeptide repeat that characterizes the type II collagen helix. In this study, we reported a case of a novel splicing variant of COL2A1 in a fetus with ACG2. An NGS analysis of fetal DNA revealed a heterozygous variant c.1267-2_1269del located in intron 20/exon 21. The variant occurred de novo since it was not detected in DNA from the blood samples of parents. We generated an appropriate minigene construct to study the effect of the variant detected. The minigene expression resulted in the synthesis of a COL2A1 messenger RNA lacking exon 21, which generated a predicted in-frame deleted protein. Usually, in-frame deletion variants of COL2A1 cause a phenotype such as Kniest dysplasia, which is milder than ACG2. Therefore, we propose that the size and position of an in-frame deletion in COL2A1 may be relevant in determining the phenotype of skeletal dysplasia.
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Affiliation(s)
- Valentina Bruni
- Medical Genetics Unit, Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (V.B.); (C.B.S.); (V.D.); (E.C.); (N.P.)
| | - Cristina Barbara Spoleti
- Medical Genetics Unit, Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (V.B.); (C.B.S.); (V.D.); (E.C.); (N.P.)
| | - Andrea La Barbera
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences “Mario Serio”, University of Florence, 50121 Florence, Italy;
| | - Vincenzo Dattilo
- Medical Genetics Unit, Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (V.B.); (C.B.S.); (V.D.); (E.C.); (N.P.)
| | - Emma Colao
- Medical Genetics Unit, Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (V.B.); (C.B.S.); (V.D.); (E.C.); (N.P.)
| | | | - Emanuele Bellacchio
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Nicola Perrotti
- Medical Genetics Unit, Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (V.B.); (C.B.S.); (V.D.); (E.C.); (N.P.)
| | - Sabrina Giglio
- Unit of Medical Genetics, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy;
| | - Rodolfo Iuliano
- Medical Genetics Unit, Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (V.B.); (C.B.S.); (V.D.); (E.C.); (N.P.)
- Correspondence: ; Tel.: +39-0961-3695182
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Düppers AL, Bohnhorst B, Bültmann E, Schulz T, Higgins‐Wood L, von Kaisenberg CS. Severe fetal brain damage subsequent to acute maternal hypoxemic deterioration in COVID-19. Ultrasound Obstet Gynecol 2021; 58:490-491. [PMID: 34319630 PMCID: PMC8441859 DOI: 10.1002/uog.23744] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 05/15/2023]
Affiliation(s)
- A. L. Düppers
- Department of Obstetrics, Gynecology and Reproductive MedicineHannover Medical SchoolHannoverGermany
| | - B. Bohnhorst
- Department of Pediatric Pneumology, Allergology and NeonatologyHannover Medical SchoolHannoverGermany
| | - E. Bültmann
- Institute of Diagnostic and Interventional NeuroradiologyHannover Medical SchoolHannoverGermany
| | - T. Schulz
- Department of VirologyHannover Medical SchoolHannoverGermany
| | - L. Higgins‐Wood
- Department of Obstetrics, Gynecology and Reproductive MedicineHannover Medical SchoolHannoverGermany
| | - C. S. von Kaisenberg
- Department of Obstetrics, Gynecology and Reproductive MedicineHannover Medical SchoolHannoverGermany
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42
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Donepudi R, Shamshirsaz AA, Espinoza J, Sanz-Cortes M, Belfortv MA, Nassr AA. Peritoneal-amniotic shunt in management of urinary ascites complicating fetal lower urinary tract obstruction. Ultrasound Obstet Gynecol 2021; 58:320-322. [PMID: 32770819 DOI: 10.1002/uog.22170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- R Donepudi
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - M Sanz-Cortes
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | | | - A A Nassr
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
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43
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Fu J, Yao R, Yong W. A case report of prenatal diagnosis of fetal alloimmune thrombocytopenia: A CARE-compliant article. Medicine (Baltimore) 2021; 100:e26092. [PMID: 34128846 PMCID: PMC8213323 DOI: 10.1097/md.0000000000026092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Fetal alloimmune thrombocytopenia (FAIT) is a serious life-threatening disease caused by platelet-antigen incompatibility between the mother and fetus. FAIT can lead to fetal thrombocytopenia, intracranial hemorrhage (ICH), fetal death and severe neurological disorders after birth. Noninvasive prenatal diagnosis technology has not been widely used in China, and thus few cases of FAIT can be diagnosed prenatally. In this study, we report a case of prenatal diagnosis and treatment of FAIT. PATIENT CONCERNS A 29-year-old female was admitted at 32 weeks' gestational age (GA). Fetal ultrasound at 32 weeks' GA showed a hemorrhagic focus area in the left lateral ventricle and the sign of severe fetal anemia. Hence, fetal umbilical cord puncture was ordered to identify the etiology. DIAGNOSES The fetal cord blood test revealed a normal hemoglobin level but severe fetal thrombocytopenia (platelet count, 23 × 109/L). Antibodies of human platelet antigens and human leukocyte antigens between mother and fetus were positive, and thus the diagnosis of FAIT was confirmed. INTERVENTIONS The patient refused intravenous immunoglobulin (IVIG) therapy owing to financial consideration. She was treated with dexamethasone acetate tablets (Xianju Company, China) 0.75 mg twice a day until delivery and cesarean section was performed at 34 weeks' GA. The newborn received postnatal anti-platelet antibody treatment. OUTCOMES The platelet count of the newborn progressively decreased until the third day after birth and it increased to normal level after postnatal treatment. The neonatal cerebral ultrasound showed the area of hemorrhage was in the process of absorption. During the postnatal one-year follow-up, the neonate showed normal developmental milestones and had no abnormal signs of neurological symptoms. LESSONS For FAIT, the fetal umbilical cord puncture can be carried out by skilled fetal medical teams. Dexamethasone acetate tablets can be an alternative choice for patients from underdeveloped areas.
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Affiliation(s)
- Jing Fu
- Reproductive Medicine Center
| | - Ruojin Yao
- Department of Obstetrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenjing Yong
- Department of Obstetrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Kunochová I, Gábor M, Jr Križko M, Alföldi M, Totka A, Ferianec V. Fetal lower urinary tract obstruction: a current overview of intrauterine diagnosis and treatment. Ceska Gynekol 2021; 86:133-139. [PMID: 34020562 DOI: 10.48095/cccg2021133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this review article is to provide a practical and concise overview of diagnosis and management of pregnancy with fetal lower urinary tract obstruction. METHODS Review of literature and current studies. CONCLUSION Proper diagnosis and management of isolated fetal lower urinary tract obstruction with oligohydramnios allows appropriate implementation of intrauterine treatment in indicated cases. The treatment is a prevention of pulmonary hypoplasia and also improves renal function; this finally contributes to the improvement of overall perinatal morbidity and mortality.
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45
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Gravenhorst VD, Schneider HE, Müller MJ, Krause U, Felke B, Paul T. [Fetal ECG and arrhythmias]. Herzschrittmacherther Elektrophysiol 2021; 32:152-157. [PMID: 33825056 DOI: 10.1007/s00399-021-00758-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Abstract
The normal fetal heart rate ranges between 110 und 180 beats per minute (bpm). Intrauterine arrhythmias are not an uncommon finding. Fetal echocardiography (ECG) allows for correct diagnosis of the arrhythmia, which is prerequisite for decision making and treatment. Most fetal rhythm disturbances are the result of premature atrial contractions and are of little clinical significance. Intrauterine bradycardias (heart rate < 110 bpm) result from sinus node dysfunction, complete AV block and nonconducted atrial bigeminy. Isolated complete heart block related to maternal anti-SSA/Ro or SSB/La auto-antibodies is irreversible in almost all fetuses. Anti-inflammatory therapy and chronotropic medication may improve outcome. Newborn babies often require pacemaker implantation to augment cardiac output. Intrauterine tachycardias (heart rate > 180 bpm) are most commonly related to supraventricular tachycardia and atrial flutter. Specific antiarrhythmic medication is available to stop the arrhythmia and to prevent hemodynamic deterioration.
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Affiliation(s)
- Verena D Gravenhorst
- Klinik für Kinder- und Jugendmedizin, Pädiatrische Kardiologie, Intensivmedizin und Pneumologie, Kinderherzklinik/Überregionales EMAH-Zentrum, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - Heike E Schneider
- Klinik für Kinder- und Jugendmedizin, Pädiatrische Kardiologie, Intensivmedizin und Pneumologie, Kinderherzklinik/Überregionales EMAH-Zentrum, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Matthias J Müller
- Klinik für Kinder- und Jugendmedizin, Pädiatrische Kardiologie, Intensivmedizin und Pneumologie, Kinderherzklinik/Überregionales EMAH-Zentrum, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Ulrich Krause
- Klinik für Kinder- und Jugendmedizin, Pädiatrische Kardiologie, Intensivmedizin und Pneumologie, Kinderherzklinik/Überregionales EMAH-Zentrum, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Barbara Felke
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Thomas Paul
- Klinik für Kinder- und Jugendmedizin, Pädiatrische Kardiologie, Intensivmedizin und Pneumologie, Kinderherzklinik/Überregionales EMAH-Zentrum, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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46
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Schoeneberg LA, Zakaria D, Bolin EH, Eble BK, Miquel-Verges F, Sandlin AT, Bornemeier RA. A Fetal Presentation of a Ruptured Right Ventricular Diverticulum. Pediatr Cardiol 2021; 42:978-980. [PMID: 33725147 DOI: 10.1007/s00246-021-02572-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Abstract
Ruptured diverticula and ventricular aneurysms are rare in the fetus, with a limited number of case reports published previously. Additional fetal complications secondary to these ventricular wall abnormalities can be seen. Interventional measures can be considered and attempted either in utero or postnatally to improve the chance of survival. We present a case of a ruptured diverticulum in a fetus and the clinical course.
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Affiliation(s)
- Laura A Schoeneberg
- Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA.
| | - Dala Zakaria
- Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA
| | - Elijah H Bolin
- Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA
| | - Brian K Eble
- Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA
| | - Franscesca Miquel-Verges
- Department of Pediatrics (Neonatology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA
| | - Adam T Sandlin
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA
| | - Renee A Bornemeier
- Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA
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Morrison JL, Ayonrinde OT, Care AS, Clarke GD, Darby JRT, David AL, Dean JM, Hooper SB, Kitchen MJ, Macgowan CK, Melbourne A, McGillick EV, McKenzie CA, Michael N, Mohammed N, Sadananthan SA, Schrauben E, Regnault TRH, Velan SS. Seeing the fetus from a DOHaD perspective: discussion paper from the advanced imaging techniques of DOHaD applications workshop held at the 2019 DOHaD World Congress. J Dev Orig Health Dis 2021; 12:153-167. [PMID: 32955011 DOI: 10.1017/s2040174420000884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Advanced imaging techniques are enhancing research capacity focussed on the developmental origins of adult health and disease (DOHaD) hypothesis, and consequently increasing awareness of future health risks across various subareas of DOHaD research themes. Understanding how these advanced imaging techniques in animal models and human population studies can be both additively and synergistically used alongside traditional techniques in DOHaD-focussed laboratories is therefore of great interest. Global experts in advanced imaging techniques congregated at the advanced imaging workshop at the 2019 DOHaD World Congress in Melbourne, Australia. This review summarizes the presentations of new imaging modalities and novel applications to DOHaD research and discussions had by DOHaD researchers that are currently utilizing advanced imaging techniques including MRI, hyperpolarized MRI, ultrasound, and synchrotron-based techniques to aid their DOHaD research focus.
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Affiliation(s)
- Janna L Morrison
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Oyekoya T Ayonrinde
- Fiona Stanley Hospital, Murdoch, WA, Australia
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Alison S Care
- The Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Geoffrey D Clarke
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Jack R T Darby
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Justin M Dean
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- The Department of Obstetrics and Gynecology, Monash University, Melbourne, Victoria, Australia
| | - Marcus J Kitchen
- School of Physics and Astronomy, Monash University, Melbourne, Victoria, Australia
| | | | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
| | - Erin V McGillick
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- The Department of Obstetrics and Gynecology, Monash University, Melbourne, Victoria, Australia
| | - Charles A McKenzie
- Department of Medical Biophysics, Western University, London, ON, Canada
- Lawson Health Research Institute and Children's Health Research Institute, London, ON, Canada
| | - Navin Michael
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
| | - Nuruddin Mohammed
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Suresh Anand Sadananthan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
| | - Eric Schrauben
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Timothy R H Regnault
- Lawson Health Research Institute and Children's Health Research Institute, London, ON, Canada
- Department of Obstetrics and Gynecology, Western University, London, ON, Canada
- Department of Physiology and Pharmacology, Western University, London, ON, Canada
| | - S Sendhil Velan
- Singapore Bioimaging Consortium, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
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48
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Romero R, Pacora P, Kusanovic JP, Jung E, Panaitescu B, Maymon E, Erez O, Berman S, Bryant DR, Gomez-Lopez N, Theis KR, Bhatti G, Kim CJ, Yoon BH, Hassan SS, Hsu CD, Yeo L, Diaz-Primera R, Marin-Concha J, Lannaman K, Alhousseini A, Gomez-Roberts H, Varrey A, Garcia-Sanchez A, Gervasi MT. Clinical chorioamnionitis at term X: microbiology, clinical signs, placental pathology, and neonatal bacteremia - implications for clinical care. J Perinat Med 2021; 49:275-298. [PMID: 33544519 PMCID: PMC8324070 DOI: 10.1515/jpm-2020-0297] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Clinical chorioamnionitis at term is considered the most common infection-related diagnosis in labor and delivery units worldwide. The syndrome affects 5-12% of all term pregnancies and is a leading cause of maternal morbidity and mortality as well as neonatal death and sepsis. The objectives of this study were to determine the (1) amniotic fluid microbiology using cultivation and molecular microbiologic techniques; (2) diagnostic accuracy of the clinical criteria used to identify patients with intra-amniotic infection; (3) relationship between acute inflammatory lesions of the placenta (maternal and fetal inflammatory responses) and amniotic fluid microbiology and inflammatory markers; and (4) frequency of neonatal bacteremia. METHODS This retrospective cross-sectional study included 43 women with the diagnosis of clinical chorioamnionitis at term. The presence of microorganisms in the amniotic cavity was determined through the analysis of amniotic fluid samples by cultivation for aerobes, anaerobes, and genital mycoplasmas. A broad-range polymerase chain reaction coupled with electrospray ionization mass spectrometry was also used to detect bacteria, select viruses, and fungi. Intra-amniotic inflammation was defined as an elevated amniotic fluid interleukin-6 (IL-6) concentration ≥2.6 ng/mL. RESULTS (1) Intra-amniotic infection (defined as the combination of microorganisms detected in amniotic fluid and an elevated IL-6 concentration) was present in 63% (27/43) of cases; (2) the most common microorganisms found in the amniotic fluid samples were Ureaplasma species, followed by Gardnerella vaginalis; (3) sterile intra-amniotic inflammation (elevated IL-6 in amniotic fluid but without detectable microorganisms) was present in 5% (2/43) of cases; (4) 26% of patients with the diagnosis of clinical chorioamnionitis had no evidence of intra-amniotic infection or intra-amniotic inflammation; (5) intra-amniotic infection was more common when the membranes were ruptured than when they were intact (78% [21/27] vs. 38% [6/16]; p=0.01); (6) the traditional criteria for the diagnosis of clinical chorioamnionitis had poor diagnostic performance in identifying proven intra-amniotic infection (overall accuracy, 40-58%); (7) neonatal bacteremia was diagnosed in 4.9% (2/41) of cases; and (8) a fetal inflammatory response defined as the presence of severe acute funisitis was observed in 33% (9/27) of cases. CONCLUSIONS Clinical chorioamnionitis at term, a syndrome that can result from intra-amniotic infection, was diagnosed in approximately 63% of cases and sterile intra-amniotic inflammation in 5% of cases. However, a substantial number of patients had no evidence of intra-amniotic infection or intra-amniotic inflammation. Evidence of the fetal inflammatory response syndrome was frequently present, but microorganisms were detected in only 4.9% of cases based on cultures of aerobic and anaerobic bacteria in neonatal blood.
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Affiliation(s)
- Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
- Detroit Medical Center, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Florida International University, Miami, FL, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Division of Obstetrics and Gynecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Department of Obstetrics and Gynecology, Sótero del Río Hospital, Santiago, Chile
| | - Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Bogdan Panaitescu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Eli Maymon
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Susan Berman
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - David R. Bryant
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Kevin R. Theis
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
- Perinatal Research Initiative in Maternal, Perinatal and Child Health, Wayne State University School of Medicine, Detroit, MI, USA
| | - Gaurav Bhatti
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Chong Jai Kim
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Bo Hyun Yoon
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sonia S. Hassan
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Office of Women’s Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Chaur-Dong Hsu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ramiro Diaz-Primera
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Julio Marin-Concha
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Kia Lannaman
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ali Alhousseini
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Hunter Gomez-Roberts
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Aneesha Varrey
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Angel Garcia-Sanchez
- Department of Obstetrics, Gynecology, and Pediatrics, University of Salamanca, Salamanca, Spain
| | - Maria Teresa Gervasi
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Italy
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49
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Souabni SA, Habib BE, Oubahha I, Baqali JE, Aboulfalah A, Soummani A. [Severe neonatal thrombocytopenia due to maternal alloimmunization: case report and literature review]. Pan Afr Med J 2021; 38:67. [PMID: 33889233 PMCID: PMC8028367 DOI: 10.11604/pamj.2021.38.67.26353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 11/11/2022] Open
Abstract
Prior to 1970, maternal alloimmunization was the leading cause of perinatal death. Currently, it has become rarer thanks to screening and monitoring in high-risk pregnancies. The advent of transcranial doppler has been a turning point in the monitoring of these pregnancies, as it is a reliable, non-invasive method for the diagnosis of fetal anemia. This helps clinicians decide whether or not to perform intrauterine transfusion. Anti-D immunoprophylaxis has also played an important role in preventing fetal and neonatal hemolytic anemia and its administration is currently well codified. Adequate management helps to avoid the effects of alloimmunization on the fetus and newborn as well as to reduce the risks of alloimmunization in subsequent pregnancies. We here report a case of severe fetomaternal rhesus (Rh) alloimmunization during unmonitored pregnancy complicated by fetoplacental anasarca.
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Affiliation(s)
- Sara Ait Souabni
- Université Cadi Ayyad, Faculté de Médecine et de Pharmacie de Marrakech, Marrakech, Maroc
| | - Belhaddad El Habib
- Service de Gynécologie-Obstétrique, CHU Med VI Marrakech, Marrakech, Maroc
| | - Ihsane Oubahha
- Université Cadi Ayyad, Faculté de Médecine et de Pharmacie de Marrakech, Marrakech, Maroc
| | - Jihane El Baqali
- Université Cadi Ayyad, Faculté de Médecine et de Pharmacie de Marrakech, Marrakech, Maroc
| | - Abderrahim Aboulfalah
- Université Cadi Ayyad, Faculté de Médecine et de Pharmacie de Marrakech, Marrakech, Maroc
| | - Abderraouf Soummani
- Université Cadi Ayyad, Faculté de Médecine et de Pharmacie de Marrakech, Marrakech, Maroc
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50
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Vila Real D, Nogueira R, Sá J, Godinho C. Prenatal diagnosis of Bardet-Biedl syndrome: a multidisciplinary approach. BMJ Case Rep 2021; 14:e238445. [PMID: 33419754 PMCID: PMC7799144 DOI: 10.1136/bcr-2020-238445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 01/11/2023] Open
Abstract
Bardet-Biedl syndrome (BBS) is a rare ciliopathic human genetic disorder with mainly an autosomal recessive inheritance. BBS phenotype develops over the years and diagnosis is usually made in late childhood or early adulthood. Prenatal diagnosis is rare in the absence of family history or consanguinity. We present a prenatal case without a family history of inherited diseases or consanguinity. Mid-trimester ultrasound revealed hyperechogenic kidneys and postaxial polydactyly putting us on track of BBS. The fetopathology supported this diagnosis and the whole-exome sequencing confirmed the hypothesis. Our case illustrates how high-resolution obstetric scan, detailed observation of fetal features and application of gene sequencing technology contribute to elucidate the aetiology of rare, yet disabling and incurable disease, with the particular setting of negative family history.
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Affiliation(s)
- Daniela Vila Real
- Obstetrics and Gynecology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Rosete Nogueira
- Pathology, CGC Genetics Centro de Genetica Clinica, Porto, Portugal
- Surgical Sciences Domain, Life and Health Sciences Research Domain (ICVS) School of Medicine University of Minho, Braga, Portugal
| | - Joaquim Sá
- Genetics, CGC Genetics-Unilabs, Porto, Portugal
| | - Cristina Godinho
- Obstetrics and Gynecology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
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