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Menon R, Richardson L, Kammala AK. New approach methods on the bench side to accelerate clinical trials during pregnancy. Expert Opin Drug Metab Toxicol 2024:1-6. [PMID: 38739076 DOI: 10.1080/17425255.2024.2353944] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION Pregnant women are therapeutic orphans as they are excluded from clinical drug development and therapeutic trials. We identify limitations in conducting clinical trials and propose two 'New Approach Methods'(NAMs) to overcome them. AREAS COVERED NAMs have proven invaluable tools in basic and clinical research to understand human health and disease better, elucidate mechanisms, and study the efficacy and toxicity of therapeutics that have not been possible through animal-based methodologies. The lack of humanized experimental models of FMi and drugs that can safely and effectively cross FMi to reduce the risk of adverse pregnancy has hindered progress in the field of reproductive pharmacology. This report discusses two technological advancements in perinatal research and medicine to accelerate clinical trials during pregnancy. (1) We have developed a humanized microphysiologic system, an Organ-on-a-chip (OOC) platform, to study FMi and their utility in pharmacological studies, and (2) use of extracellular vesicles (EVs) as drug delivery vehicles that are immunologically inert and can cross the fetomaternal barriers. EXPERT OPINION We provide an overview of NAMs that can accelerate preclinical trials and develop drugs to cross the feto-maternal barriers to reduce the risk of adverse pregnancy outcomes like preterm birth.
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Affiliation(s)
- Ramkumar Menon
- Division of Basic Science and Translational Research, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Lauren Richardson
- Division of Basic Science and Translational Research, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Ananth Kumar Kammala
- Division of Basic Science and Translational Research, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
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Robinson JL, Gatford KL, Hurst CP, Clifton VL, Morrison JL, Stark MJ. Do improvements in clinical practice guidelines alter pregnancy outcomes in asthmatic women? A single-center retrospective cohort study. J Asthma 2023:1-11. [PMID: 37021838 DOI: 10.1080/02770903.2023.2200824] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
OBJECTIVE Asthma occurs in ∼17% of Australian pregnancies and is associated with adverse perinatal outcomes, which worsen with poor asthma control . Consequently, the South Australian 'Asthma in Pregnancy' perinatal guidelines were revised in 2012 to address management according to severity. This study investigated if these revised guidelines reduced the impact of maternal asthma on risks of adverse perinatal outcomes before (Epoch 1, 2006-2011) and after the revision (Epoch 2, 2013-2018). METHODS Routinely collected perinatal and neonatal datasets from the Women's and Children's Hospital (Adelaide, Australia) were linked. Maternal asthma (prevalence:7.5%) was defined as asthma medication use or symptoms described to midwives. In imputation (n = 59131) and complete case datasets (n = 49594), analyses were conducted by inverse proportional weighting and multivariate logistic regression, accounting for confounders. RESULTS Overall, maternal asthma was associated with increased risks of any antenatal corticosteroid treatment for threatened preterm birth (aOR 1.319, 95% CI 1.078-1.614), any Caesarean section (aOR 1.196, 95% CI 1.059-1.351), Caesarean section without labor (aOR 1.241, 95% CI 1.067-1.444), intrauterine growth restriction (IUGR, aOR 1.285, 95% CI 1.026-1.61), and small for gestational age (aOR 1.324, 95% CI 1.136-1.542). After guideline revision, asthma-associated risks of any Caesarean section (p < 0.001), any antenatal corticosteroids (p = 0.041), and small for gestational age (p = 0.050), but not IUGR and Caesarean section without labour, were reduced. CONCLUSIONS Clinical practice guidelines based on the latest evidence do not guarantee clinical efficacy. Since adverse perinatal outcomes did not all improve, this work highlights the need to evaluate the ongoing impact of guidelines on clinical outcomes.
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Affiliation(s)
- J L Robinson
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Early Origins of Adult Health Research Group, Health, and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - K L Gatford
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - C P Hurst
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - V L Clifton
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - J L Morrison
- Early Origins of Adult Health Research Group, Health, and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - M J Stark
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Women's & Children's Hospital, Adelaide, Australia
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Oelmeier K, Schmitz R, Möllers M, Braun J, Deharde D, Sourouni M, Köster HA, Apsite G, Eveslage M, Fischhuber K, Storck M, Emming F, Wohlmann J, Juhra C. Satisfaction with and Feasibility of Prenatal Counseling via Telemedicine: A Prospective Cohort Study. Telemed J E Health 2021; 28:1193-1198. [PMID: 34861131 DOI: 10.1089/tmj.2021.0309] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Telemedicine has become increasingly important over the past decade. With the pressure of the COVID-19 pandemic, demands for remote health care solutions have seen an unprecedented rise. However, many questions regarding the feasibility and benefits of telemedicine remain. The aim of our study was to evaluate both the technical feasibility and patient satisfaction with video consultations in a tertiary center for obstetric care. Materials and Methods: This prospective single-center trial was part of the larger open Video Service project on telemedicine at the Department of Gynecology and Obstetrics at the University of Münster. Patients requiring prenatal or prepregnancy counseling were included. A questionnaire was designed for the evaluation of patient satisfaction and filled in by both patient and health care provider at the end of the video consultation. Results: Of 80 eligible cases, 75 video consultations were carried out and data from the questionnaire were collected. Overall patient satisfaction was high (95%, 71/75) although technical problems occurred in 37% (29/75) of the appointments. Health care providers' satisfaction was equally high and in 88% (66/75) of cases, remote consultations avoided an in-house visit without effect on health care quality. Conclusions: Remote consultations are feasible and yield high satisfaction rates even in a medical field as sensitive as perinatal medicine. Further research is necessary to determine the cost-effectiveness and effects on perinatal outcome. Health care systems should be offered clear guidance on medicolegal issues and funding of remote consultations to integrate telemedicine into routine health care.
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Affiliation(s)
- Kathrin Oelmeier
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Ralf Schmitz
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Mareike Möllers
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Janina Braun
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Daniela Deharde
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Marina Sourouni
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Helen Ann Köster
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Gunita Apsite
- Centre for Clinical Trials Münster, University of Münster, Münster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Karen Fischhuber
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Franziska Emming
- Office for eHealth, University Hospital Münster, Münster, Germany
| | - Jan Wohlmann
- Office for eHealth, University Hospital Münster, Münster, Germany
| | - Christian Juhra
- Office for eHealth, University Hospital Münster, Münster, Germany
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Pini N, Lucchini M, Esposito G, Tagliaferri S, Campanile M, Magenes G, Signorini MG. A Machine Learning Approach to Monitor the Emergence of Late Intrauterine Growth Restriction. Front Artif Intell 2021; 4:622616. [PMID: 33889841 PMCID: PMC8057109 DOI: 10.3389/frai.2021.622616] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/18/2021] [Indexed: 01/18/2023] Open
Abstract
Late intrauterine growth restriction (IUGR) is a fetal pathological condition characterized by chronic hypoxia secondary to placental insufficiency, resulting in an abnormal rate of fetal growth. This pathology has been associated with increased fetal and neonatal morbidity and mortality. In standard clinical practice, late IUGR diagnosis can only be suspected in the third trimester and ultimately confirmed at birth. This study presents a radial basis function support vector machine (RBF-SVM) classification based on quantitative features extracted from fetal heart rate (FHR) signals acquired using routine cardiotocography (CTG) in a population of 160 healthy and 102 late IUGR fetuses. First, the individual performance of each time, frequency, and nonlinear feature was tested. To improve the unsatisfactory results of univariate analysis we firstly adopted a Recursive Feature Elimination approach to select the best subset of FHR-based parameters contributing to the discrimination of healthy vs. late IUGR fetuses. A fine tuning of the RBF-SVM model parameters resulted in a satisfactory classification performance in the training set (accuracy 0.93, sensitivity 0.93, specificity 0.84). Comparable results were obtained when applying the model on a totally independent testing set. This investigation supports the use of a multivariate approach for the in utero identification of late IUGR condition based on quantitative FHR features encompassing different domains. The proposed model allows describing the relationships among features beyond the traditional linear approaches, thus improving the classification performance. This framework has the potential to be proposed as a screening tool for the identification of late IUGR fetuses.
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Affiliation(s)
- Nicolò Pini
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Milan, Italy.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Giuseppina Esposito
- Department of Obstetrical Gynaecological and Urological Science, Federico II University, Napoli, Italy
| | - Salvatore Tagliaferri
- Department of Obstetrical Gynaecological and Urological Science, Federico II University, Napoli, Italy
| | - Marta Campanile
- Department of Obstetrical Gynaecological and Urological Science, Federico II University, Napoli, Italy
| | - Giovanni Magenes
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Maria G Signorini
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Milan, Italy
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Yasuaki K, Mizue T, Akimichi S, Yoshio S. Current Status of the Obstetric Compensation System for Cases of Cerebral Palsy at a General Hospital in Tochigi, Japan. Glob Pediatr Health 2020; 7:2333794X20973845. [PMID: 33241087 PMCID: PMC7672716 DOI: 10.1177/2333794x20973845] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 11/29/2022] Open
Abstract
Objective. The Japan Obstetric Compensation System for Cerebral Palsy (JOCSC) was launched in January 2009 as the first nationwide nofault compensation system. The aim of the study was to clarify the present status of functioning of the JOCSC in pediatric and obstetric departments at a general hospital. Method. Children eligible for compensation are as follows: (1) Gestational week at 32 weeks or later and birth weight of 1400 g or more, or 28 weeks or later with apparent asphyxia at birth. (2) Severe cerebral palsy related to hypoxia at delivery, not caused by congenital reasons or factors during the neonatal period. Results. Applications for the JOCSC were submitted for 11 cases (5 cases born at our hospital and 6 cases born at other childbirth facilities). Eight cases (4 cases born at our hospital and 4 cases born at other childbirth facilities) were authorized for the JOCSC. Remaining 3 cases were judged as not being eligible because of 2 cases with congenital reasons for the condition and 1 case with the judgement as mild cerebral palsy. Conclusion. Ten years have elapsed since the establishment of the JOCSC. Improved awareness of the medical staff and caregivers of children with cerebral palsy about the JOCSC should be promoted.
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Affiliation(s)
| | - Tsukui Mizue
- Japanese Red Cross Ashikaga Hospital, Ashikaga City, Tochigi, Japan
| | - Shibata Akimichi
- Japanese Red Cross Ashikaga Hospital, Ashikaga City, Tochigi, Japan
| | - Suda Yoshio
- Japanese Red Cross Ashikaga Hospital, Ashikaga City, Tochigi, Japan
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Abstract
Systemic sclerosis is a rare multisystem connective tissue disease. It predominantly affects women and poses a significant risk to mother and baby during pregnancy if not managed appropriately. The commonest manifestations are skin fibrosis and Raynaud's phenomenon. Subgroups of women have an increased risk of organ involvement, especially interstitial lung disease, pulmonary arterial hypertension and renal crises. Pregnancy increases the risk to the mother, especially those with established organ involvement, but also the development of new organ dysfunction; and risks to the fetus. Optimising these women prior to conception, along with careful management and surveillance during pregnancy, is vital for optimising pregnancy outcome. Women with scleroderma need to be managed in a specialised centre with coordinated care from the multi-disciplinary teams including physicians, obstetricians, anaesthetists, neonatologists and midwives. This review aims to describe the risks associated with systemic sclerosis and pregnancy, with management advice for physicians looking after pregnant women with this chronic condition.
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Affiliation(s)
- Kristina En Clark
- Centre of Rheumatology and Connective Tissue Diseases, UCL Royal Free Medical School, London, UK
| | - Oseme Etomi
- Department of Obstetric Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Voon H Ong
- Centre of Rheumatology and Connective Tissue Diseases, UCL Royal Free Medical School, London, UK
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Abstract
Background Depression is the most common mental disorder during pregnancy, with prevalence rates between 4% and 20%. The objective of this review was to synthesize the literature on the association between antenatal depression and offspring birth outcomes, as well as developmental, behavioral, and psychiatric outcomes. Methods A search of PubMed, Cochrane, and Medline databases was conducted for articles published until December 2017. Articles focusing on the effects of antenatal depression on the offspring were selected to be reviewed. Reference lists of all studies were examined for any missed articles. A total of 32 articles were included in this review. Results Antenatal depression is associated with preterm birth, excessive infant crying, and offspring mental health problems. Untreated antenatal depression is strongly associated with adverse effects on the infant nervous system. Conclusion Antenatal depression increases the likelihood of poor offspring health outcomes. Research should investigate whether medication use confounds this relationship.
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Affiliation(s)
- Alexandra Smith
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
| | - Jasna Twynstra
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Jamie A Seabrook
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada.,Department of Paediatrics, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Human Environments Analysis Laboratory, Western University, London, Ontario, Canada
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8
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Ochiai D, Masuda H, Abe Y, Otani T, Fukutake M, Matsumoto T, Miyakoshi K, Tanaka M. Human Amniotic Fluid Stem Cells: Therapeutic Potential for Perinatal Patients with Intractable Neurological Disease. Keio J Med 2018; 67:57-66. [PMID: 29515049 DOI: 10.2302/kjm.2017-0019-IR] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mesenchymal stem cells (MSCs) have generated great interest in the fields of regenerative medicine and immunotherapy because of their unique biological properties. Among MSCs, amniotic fluid stem cells (AFS) have a number of characteristics that make them attractive candidates for tissue engineering and cell replacement strategies, particularly for perinatal medicine. If various neonatal conditions, including birth asphyxia, preterm birth, and congenital abnormalities, which result in long-lasting severe impairments, could be predicted during pregnancy, it would allow collection of small samples of amniotic fluid cells by amniocentesis. In vitro culture of these autologous AFS during pregnancy would make them available for use soon after birth. Hypoxic-ischemic encephalopathy (HIE) and myelomeningocele (MMC) are neonatal conditions that cause permanent neurological disability, for which the treatment options are extremely limited. Experiments using animal models of HIE and MMC and human clinical trials have demonstrated that MSCs, including AFS, have beneficial effects on the central nervous system through paracrine influences, indicating that autologous AFS treatment may be applicable for intractable neurological diseases, including HIE and MMC, during the perinatal period. In this review, we focus on recent research related to the therapeutic potential of AFS for perinatal neurological diseases such as HIE and MMC.
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Bergin H, Wood G, Walker SP, Hui L. Perinatal management of hepatitis B virus: Clinical implementation of updated Australasian management guidelines. Obstet Med 2017; 11:23-27. [PMID: 29636810 DOI: 10.1177/1753495x17731990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the implementation of the 2013 Royal Australian and New Zealand College of Obstetricians and Gynaecologists 'Management of Hepatitis B in Pregnancy' guideline. Methods Retrospective cohort study of the clinical management and obstetric outcomes among hepatitis B virus-positive women in a single tertiary maternity hospital. Women with viral load >200,000 IU/ml were referred to a specialised clinic for consideration of tenofovir disoproxil fumarate therapy to reduce mother to child transmission. Results A total of 11,496 women gave birth during the study period, of which 101 (0.9%) women were hepatitis B virus positive. Viral load was measured in 99 (98%) of 101 hepatitis B virus-positive women; 30 (30%) had a viral load >200,000 IU/ml. Twenty-six women accepted tenofovir disoproxil fumarate; of these, 23 had a successful virological response (viral load <200,000 IU/ml before delivery). Conclusions Adherence to updated management guidelines and patient acceptance of tenofovir disoproxil fumarate in our Australian population were high when provided in the context of a dedicated perinatal service.
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Affiliation(s)
- Hannah Bergin
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,2Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Gillian Wood
- 2Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,2Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,2Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
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Abstract
Traditional practices during pregnancy may lead to adverse outcomes in migrant women. Very little is known regarding the efficacy or safety of many cultural practices during pregnancy, and research is required to address this deficiency in knowledge. Greater awareness of traditional practices by health professionals may result in improved pregnancy outcomes in migrant women.
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Affiliation(s)
- Adam Morton
- Mater Hospital, University of QLD and Mater Health, South Brisbane, QLD, Australia
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Abstract
In 2015, 17 sustainable development goals were established for 2030. These global goals aim to ensure healthy lives and promote wellbeing for all. In support of the sustainable development goals, the World Health Organization proposed a new global strategy for women's, children's, and adolescents' health in 2016 with three overarching objectives: to survive, to thrive, and to transform. We are now globally seeking not only to end preventable deaths but also to ensure health and wellbeing, and expand enabling environments. This strategy builds on several prior initiatives in maternal and newborn health, such as the Every Woman, Every Child initiative, and the strategy to end preventable maternal mortality and implementation of an action plan to end preventable newborn death. This confluence of initiatives, strategies, and novel financing mechanisms under the umbrella of the sustainable development goals and the global strategy pave the way for a global agenda in which securing women's health is critical.
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Affiliation(s)
| | - Özge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Abstract
A nulliparous woman presented at 21 weeks' gestation with a 72-h history of a rash on her left arm. Initially isolated to the forearm, it had quickly spread, becoming multiple itchy fluid-filled blisters. Blood tests showed mild neutrophilia and raised CRP. Skin swabs demonstrated the presence of herpes simplex virus type 1 (HSV1) DNA. There was no history of previous HSV1 exposure. There is scant literature on uncomplicated cutaneous HSV1 since the majority is oral/genital. The incidence of transmission varies and is dependent on site of infection and immunological status. Type-specific serological testing is recommended to identify a primary first episode infection due to the 30-60% vertical transmission rate. Infection is associated with morbidity and mortality for both mother and fetus including maternal encephalitis, acute retinal necrosis, pneumonia and hepatitis. Neonatal disease can be congenital (cutaneous lesions, microcephaly, hydranencephaly, intracranial calcifications, chorioretinitis, microphthalmia and optic nerve atrophy) or acquired (skin, eyes and mouth disease or central nervous system disease or disseminated disease). Prophylactic aciclovir reduces the number of women with active genital lesions at the time of delivery. If primary infection occurs outside of the first trimester and active genital lesions are present, then vaginal delivery should be avoided. If infection has occurred in the first trimester, vaginal birth can be attempted even in the presence of active lesions. There is no available guidance on prophylactic treatment of non-genital HSV1 in pregnancy.
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Affiliation(s)
- Rachel Lee
- Department of Obstetrics and Gynaecology, Royal Gwent Hospital, Newport, UK
| | - Manju Nair
- Department of Obstetrics and Gynaecology, Royal Gwent Hospital, Newport, UK
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Biscoe A, Kidson-Gerber G. Rare problems with RhD immunoglobulin for postnatal prophylaxis after large fetomaternal haemorrhage. Obstet Med 2016; 8:193-4. [PMID: 27512480 DOI: 10.1177/1753495x15597631] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/02/2015] [Indexed: 11/17/2022] Open
Abstract
We report a case of unusually large fetomaternal haemorrhage in a RhD- patient; of symptomatic non-sustained haemolysis of fetal red cells in the maternal circulation with infusion of intravenous high-dose RhD immunoglobulin; and of a failure to prevent RhD alloimmunisation. The haemolytic reaction is not previously reported in this patient group and we suggest would be limited to patients where the number of fetal red cells in the circulation is high. We advocate caution in treatment and spaced dosing of RhD immunoglobulin where the required dose is high, and refer readers to the WinRhoSDF™ RhD immunoglobulin product information for their updated dosing recommendations. There is a need for better understanding of pathophysiology and RhD immunoglobulin effects, to further reduce alloimmunisation rates, and we support the reporting of prophylaxis failures to haemovigilance programmes as is in place in the United Kingdom.
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Affiliation(s)
- Amber Biscoe
- Department of Haematology, Prince of Wales Hospital, Sydney, Australia; Department of Haematology, South Eastern Area Laboratory Services, Randwick, Australia
| | - Giselle Kidson-Gerber
- Department of Haematology, Prince of Wales Hospital, Sydney, Australia; Department of Haematology, South Eastern Area Laboratory Services, Randwick, Australia; Royal Hospital for Women, Sydney, Australia
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14
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Abstract
OBJECTIVE Some of the antenatally diagnosed fetal pathologies are unlikely to get compatible with life. Still some women choose to continue with pregnancy. Subsequently, perinatal palliative care (PPC) has become a constructive demarche in such situations. Our study, based on a multicentric survey, reports some cases of fetal pathologies considered as lethal according to perinatal professionals and reveals the decisional process in each case. METHODS We sent by emails a questionnaire to 434 maternal-fetal medicine specialists and fetal care pediatric specialists at 48 multidisciplinary centers for prenatal diagnosis. RESULTS The participation rate was 49.3%. In total, 61 obstetric-gynecologists and 68 neonatologists completed the survey. The results showed that 35.4% of the pregnant women asked for the continuation of pregnancy and 24.7% asked for the termination of pregnancy. More than half of professionals (52.9%) took the initiative of informing women about the options for birth support (including PPC), while 32.7% of obstetric gynecologists did not take this initiative versus 10.2% of neonatologists (p < 0.01). CONCLUSION This study demonstrates the absolute need to provide PPC training for professionals and to standardize its practices.
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Affiliation(s)
- Barthélémy Tosello
- a Aix-Marseille University/EFS/CNRS, UMR 7268 ADÉS, Espace Éthique Méditerranéen, Hospital La Timone , Marseille , France and.,b Department of Neonatology , Assistance Publique-Hôpitaux De Marseille, Hospital Nord , Marseille , France
| | - Grace Haddad
- b Department of Neonatology , Assistance Publique-Hôpitaux De Marseille, Hospital Nord , Marseille , France
| | - Catherine Gire
- b Department of Neonatology , Assistance Publique-Hôpitaux De Marseille, Hospital Nord , Marseille , France
| | - Marie-Ange Einaudi
- a Aix-Marseille University/EFS/CNRS, UMR 7268 ADÉS, Espace Éthique Méditerranéen, Hospital La Timone , Marseille , France and
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15
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Mariona FG. Proceedings of the XIIth World Congress of Perinatal Medicine, Madrid, Spain, 3-6 November 2015. ACTA ACUST UNITED AC 2016; 12:171-3. [PMID: 26935143 DOI: 10.2217/whe.16.1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
XIIth World Congress of Perinatal Medicine, Madrid, Spain, 3-6 November 2015 The World Association of Perinatal Medicine convened its XIIth meeting in Madrid, Spain, 3-6 November 2015. More than 3000 health professionals from the world over and 200 speakers presented up-to-date clinical and basic material related to the care of pregnant women, fetus and neonate. Preceding the formal Congress several individual mini courses were offered. They were well attended and the audience had the opportunity to relate very closely to the speakers, an issue of great importance for young clinicians to share relevant clinical information. The identification and alternative treatments of threatened preterm birth and the care of the growth restricted newborn occupied significant amount of the speakers' efforts. Obesity, postpartum hemorrhage, maternal infections and morbidly adherent placenta were also addressed. 4 days of intensive learning and experience sharing were the result.
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Affiliation(s)
- Federico G Mariona
- Division of Maternal Fetal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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16
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Al-Dughaishi T, Al-Rubkhi IS, Al-Duhli M, Al-Harrasi Y, Gowri V. Alloimmunization due to red cell antibodies in Rhesus positive Omani Pregnant Women: Maternal and Perinatal outcome. Asian J Transfus Sci 2015; 9:150-4. [PMID: 26420934 PMCID: PMC4562135 DOI: 10.4103/0973-6247.162710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study is aimed to determine the prevalence of alloimmunization due to antibodies to red blood cell (RBC) antigens (other than rhesus [Rh] antigen) and report the maternal, perinatal, and neonatal outcomes. MATERIALS AND METHODS A retrospective review of medical records of all patients with minor RBCs antibodies alloimmunization who were followed and delivered at Sultan Qaboos University Hospital, Oman from June 2011 to June 2013. Maternal characteristics, antibody type, antibody titer in addition to perinatal and neonatal outcomes were reviewed. RESULTS There were 1160 patients with Rh positive status in the study. The most common ABO blood group was O, followed by A, B, and AB. We found 33 out of 1160 Rh positive women alloimmunized with minor RBCs antibodies that gave a prevalence of minor RBCs alloimmunization of 2.7%. The most frequent antibody was anti-E 38%, followed by anti-c 17% and anti-kell 17%. 6 of these 33 patients were identified to have significant antibody titer, and two cases showed evidence of fetal anemia. Only one case required an intrauterine blood transfusion. The most common neonatal complication was jaundice in 53%, followed by respiratory distress syndrome in 28%. Two cases complicated by neonatal anemia required a postnatal blood transfusion. CONCLUSION Alloimmunization with anti-E, anti-c, and anti-kell were the most common antibodies among the study group. Minor RBCs alloimmunization was an important cause of neonatal morbidity.
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Affiliation(s)
- Tamima Al-Dughaishi
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Ikhlass S Al-Rubkhi
- 5th Year Medical Student, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Maymoona Al-Duhli
- 5th Year Medical Student, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Yusra Al-Harrasi
- 5th Year Medical Student, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Vaidyanathan Gowri
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman ; Department of Obstetrics and Gynecology, Sultan Qaboos University, Muscat, Oman
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Abstract
BACKGROUND Cystic fibrosis manifests as a multisystem disease, despite this female fertility is relatively preserved with levels approaching that of the non-cystic fibrosis population. We reviewed pregnancies in cystic fibrosis patients over a 10-year period from a UK adult cystic fibrosis centre by considering maternal and fetal outcomes. METHODS We conducted a retrospective case-note review of pregnancies during 2003-2013 using respiratory and obstetric records. RESULTS We observed moderate falls in lung function immediately after delivery, which persisted at 12 months postpartum. We found that a decline in lung function at delivery was a marker for further decline in function during the subsequent postpartum period. We found baseline lung function was predictive of gestational age at delivery. We observed a high incidence of haemoptysis. CONCLUSION Consistent with current guidance we found pregnancy is feasible and well tolerated in the majority of patients with cystic fibrosis. There was a high incidence of haemoptysis, which warrants further study.
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Affiliation(s)
- M Renton
- St John's College, University of Oxford, Oxford, UK
| | - L Priestley
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - L Bennett
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - L Mackillop
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - S J Chapman
- Oxford University Hospitals NHS Trust, Oxford, UK
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Abstract
BACKGROUND The first case report to describe amniotic fluid embolism that appeared in 1926 in Basil-Medico is translated from Portuguese to English. CASE A patient with a dead fetus for several weeks, presented in labor and died suddenly with fetal squames evident in the maternal pulmonary vasculature at autopsy. CONCLUSION As can be seen from the translation, this case report is remarkably similar in many of its features to some of the eight patients described 15 years later in the first English language discussion of the disease by Steiner and Luschbaugh in JAMA. An enigma presented by this first case remains today: fetal material in the maternal pulmonary vasculature appears specific for amniotic fluid embolism at autopsy but not in living patients.
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Affiliation(s)
- A Rafael
- Centro Hospitalar e Universitario de Coimbra, Portugal
| | - MD Benson
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Deerfield, IL, USA
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19
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Aydin M, Hakan N, Deveci U, Zenciroglu A, Okumus N. Comment on the paper entitled 'Erythropoietin ameliorates oxidative stress and tissue injury following renal ischemia/reperfusion in rat kidney and lung'. Med Princ Pract 2014; 23:485. [PMID: 24776692 PMCID: PMC5586910 DOI: 10.1159/000362338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/19/2014] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mustafa Aydin
- Division of Neonatology, Department of Pediatrics, Elazig Training and Research Hospital, Elazig, Turkey
- *Mustafa Aydin, MD, Division of Neonatology, Department of Pediatrics, Elazig Training and Research Hospital, Rýzaiye Mah. Ýnönü Cad. No. 74, TR-23000 Elazig (Turkey), E-Mail
| | - Nilay Hakan
- Division of Neonatology, Department of Pediatrics, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Ugur Deveci
- Division of Neonatology, Department of Pediatrics, Elazig Training and Research Hospital, Elazig, Turkey
| | - Aysegul Zenciroglu
- Division of Neonatology, Department of Pediatrics, Dr. Sami Ulus Maternity and Children's Hospital, Ankara, Turkey
| | - Nurullah Okumus
- Division of Neonatology, Department of Pediatrics, Dr. Sami Ulus Maternity and Children's Hospital, Ankara, Turkey
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Abstract
Amniotic fluid embolism was first recognized in 1926, in a Brazilian journal case report, on the basis of large amounts of fetal material in the maternal pulmonary vasculature at autopsy. The first English language description appeared in 1941 and consisted of eight parturients dying suddenly in which, once again, fetal material was seen in the pulmonary vasculature. A control group of 34 pregnant women dying of other recognized causes did not have fetal material in their lungs. The incidence of recognized, serious illness is on the order of two to eight per 100,000, with a mortality rate ranging from 13% to 35%. The diagnosis rests largely on one or more of four clinical signs: circulatory collapse, respiratory distress, coagulopathy, and seizures/ coma. The only confirmatory laboratory test remains autopsy findings although serum tests for fetal antigen, insulin-like growth factor binding protein-1, and complement are currently being investigated. One of the paradoxes of diagnosis is that fetal material in the pulmonary circulation at autopsy is specific for amniotic fluid embolism, while the same finding in the living is not. The mechanism of disease remains uncertain although the best available evidence suggests that complement activation might have a role. In contrast, mast cell degranulation probably is not a mechanism, so amniotic fluid embolism is not an anaphylaxis or anaphylactoid reaction as has been occasionally suggested. Perhaps the greatest unknown is not why 1 in 50,000 pregnant women develop what appears to be an immune response to their fetus, but rather why the other 49,999 do not?
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Affiliation(s)
- Michael D Benson
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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21
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Hall D, New D, Kelly T. Postpartum dilated cardiomyopathy in a patient with systemic lupus erythematosus, nephritis and lupus anticoagulant: a diagnostic dilemma. Obstet Med 2011; 4:117-9. [PMID: 27579105 DOI: 10.1258/om.2011.100063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2011] [Indexed: 11/18/2022] Open
Abstract
A 32-year-old Caucasian woman presented with shortness of breath four weeks postpartum. She was known to suffer from systemic lupus erythematosus with cutaneous, joint and minor renal involvement. During pregnancy, the patient had developed nephrotic syndrome for which she was managed with prophylactic anticoagulation and corticosteroid therapy. A leg deep vein thrombosis had arisen following caesarean section following antepartum haemorrhage. Examination revealed a heart murmur, and pulmonary signs. Computed tomography pulmonary angiogram showed cardiomegaly and bilateral pleural effusions but no pulmonary embolus. Echocardiogram demonstrated dilated cardiomyopathy. An initial diagnosis of peripartum cardiomyopathy was considered, with lupus myocarditis and coronary in situ thrombosis among the differential diagnoses.
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Affiliation(s)
- Daniel Hall
- University of Manchester Medical School , Manchester , UK
| | - David New
- Salford Royal Foundation Trust , Greater Manchester , UK
| | - Teresa Kelly
- Salford Royal Foundation Trust , Greater Manchester , UK
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Giles W, Maher C. Myophosphorylase deficiency (McArdle disease) in a patient with normal pregnancy and normal pregnancy outcome. Obstet Med 2011; 4:120-1. [PMID: 27579106 DOI: 10.1258/om.2011.100015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2011] [Indexed: 11/18/2022] Open
Abstract
McArdle disease is a rare, mostly autosomal recessive disorder of deficient myophosphorylation of glycogen in skeletal muscles. Recent knowledge regarding this condition means that women of childbearing age with McArdle disease can expect to labour normally without ill effect. We report a case of a 30-year-old woman in her first pregnancy who had an episode of exercise-induced myoglobinuria with a significant rise in serum creatine kinase (CK) levels in early pregnancy who then laboured normally but did require a caesarean section for a malposition of the fetal head.
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Affiliation(s)
- Warwick Giles
- Maternal Fetal Medicine Unit, Division of Women's Children's and Family Health, Royal North Shore Hospital, Northern Clinical School, University of Sydney , St Leonards, NSW 2065 , Australia
| | - Catherine Maher
- Maternal Fetal Medicine Unit, Division of Women's Children's and Family Health, Royal North Shore Hospital, Northern Clinical School, University of Sydney , St Leonards, NSW 2065 , Australia
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Abstract
The limb-girdle muscular dystrophies (LGMDs) are a group of genetically determined disorders of skeletal muscle, predominantly affecting the pelvic and shoulder-girdle musculature. The clinical course is variable but steadily progressive. Type 2A LGMD is the most frequent form, accounting for approximately 30% of identified cases. There are few reports of patients with Type 2A LGMD undergoing pregnancy and delivery. This case outlines a successful vaginal delivery in a woman with this condition.
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Affiliation(s)
- Carin Black
- The Royal Women's Hospital , Parkville, Victoria , Australia
| | - Joanne Said
- The Royal Women's Hospital , Parkville, Victoria , Australia
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