scholarly journals Lifting the veil of secrecy: maternal and neonatal outcome of oocyte donation pregnancies in Germany

2021 ◽  
Author(s):  
J. Altmann ◽  
J. Kummer ◽  
F. Herse ◽  
L. Hellmeyer ◽  
D. Schlembach ◽  
...  
Keyword(s):  
High Risk ◽  
Treatment Options ◽  
Mode Of Delivery ◽  
Obstetric Care ◽  
Fetal Outcome ◽  
Oocyte Donation ◽  
University Hospital ◽  
Detailed Knowledge ◽  
Peripartum Hemorrhage ◽  
The Veil

Abstract Background In Germany, performing fertility procedures involving oocyte donation is illegal, as stated by the Embryo Protection Law. Nonetheless, in our clinical routine we attend to a steadily rising number of pregnant women, who have sought oocyte donation abroad. Due to the legal circumstances many women opt to keep the origin of their pregnancy a secret. However, studies have shown, that oocyte donation is an independent risk factor for the development of pregnancy complications, such as preeclampsia. Objective The aim of this study is to evaluate maternal and neonatal outcomes of oocyte donation pregnancies in three large obstetric care units in Berlin, Germany. Methods We retrospectively analyzed all available medical data on oocyte donation pregnancies at Charité University hospital, Vivantes Hospital Friedrichshain, and Neukoelln in the German capital. Results We included 115 oocyte donation (OD) pregnancies in the present study. Our data are based on 62 singleton, 44 twin, 7 triplet, and 2 quadruplet oocyte donation pregnancies. According to our data, oocyte donation pregnancies are associated with a high risk of adverse maternal and fetal outcome, i.e., hypertension in pregnancy, preterm delivery, Cesarean section as mode of delivery, and increased peripartum hemorrhage. Conclusion Although oocyte donation is prohibited by German law, many couples go abroad to seek reproductive measures using oocyte donation after former treatment options have failed. OD pregnancies are associated with a high risk of preeclampsia, C-section as mode of delivery, and peripartum hemorrhage. Detailed knowledge of the associated risks is of utmost importance to both the patient and the treating physician and midwife.

scholarly journals Epidural analgesia during labour: its influences on pain relief, progress of labour, mode of delivery, maternal and foetal

2020 ◽  
Vol 9 (2) ◽  
pp. 555
Author(s):  
M. Suneetha ◽  
A. Saritha
Keyword(s):  
Pain Relief ◽  
Epidural Analgesia ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Obstetric Care ◽  
Fetal Outcome ◽  
Control Group ◽  
Sitting Position ◽  
Tertiary Care Centre ◽  
Group 2

Background: Today, the availability of regional anaesthesia for labour is considered a reflection of standard obstetric care. This study is to be conducted in a tertiary care centre with all facilities available for proposed end of proving that epidural analgesia is a safe and effective method for both parturient and the foetus in abolishing pain during labour.Methods: A total of 60 parturients were studied. they were randomly divided into two groups Group 1 includes 30 parturients. In this group parturient received epidural analgesia. The loading dose consisted of 10 ml of Bupivacaine 0.1% and Fentanyl 0.0002% (20 mcg). The top up doses were 10 ml of 0.1% Bupivacaine and Fentanyl 0.0002%, administered whenever the parturient complained of pain. When parturients enters into second stage a further 12-15 ml was injected with parturient in sitting position or semi-sitting position. Group 2 - (control group) Includes 30 parturients. In this group parturient was monitored without any analgesia.Results: This prospective study was done to assess the effect of epidural analgesia on the progress of labour and its outcome, to evaluate its efficacy as an analgesic technique and to study the maternal and fetal outcome. The total number of 60 parturients were selected and randomly categorized into two groups. CASE-Those who received epidural analgesia, CONTROL-Those who did not receive any analgesia.Conclusions: Epidural analgesia provides a versatile method of administering effective and satisfactory pain relief to parturient women. The technique should not be considered as a single entity, because the type and the dose of epidural medication can be altered as needed.

scholarly journals Admission Cardiotocography in High Risk Pregnancies

2018 ◽  
Vol 12 (1) ◽  
pp. 50-54
Author(s):  
Jwala Thapa ◽  
Rajib Sah
Keyword(s):  
High Risk ◽  
Apgar Score ◽  
Mode Of Delivery ◽  
Neonatal Resuscitation ◽  
Fetal Outcome ◽  
Invasive Technique ◽  
P Value ◽  
Vaginal Deliveries ◽  
Admission Test ◽  
The Relationship

Aims: The objective of the study was to evaluate the relationship between admission cardiotocography and fetal outcome among high risk obstetrics patients.Methods: The study was a hospital based observational study of 130 patients, conducted at Paropakar maternity and Women’s Hospital, Kathmandu from January 2014 to June 2014. A 20-minute cardiotocography reading was done in admission room and reading was categorized in 3 groups- reactive, equivocal and ominous. The results were compared to see the relationship between normal and abnormal admission test in terms of color of liquor, mode of delivery, Apgar score at 5 minutes, neonatal resuscitation needed and NICU admission.Results: Result of admission test (AT) was reactive in 95(73.1%), equivocal in 19(14.6%) and ominous in 16(12.3%) which has significant relationship with mode of delivery (p-value=0.003), color of liquor (p-value=0.000), Apgar score at 5 minutes (p-value=0.000) and perinatal outcome (p-value=0.00). Incidences of vaginal deliveries were more common when the test was reactive whereas operative deliveries were more common when the AT was ominous/equivocal.Conclusions: Admission test is simple, cost effective and non-invasive technique for detecting fetal hypoxia and predicting fetal outcome that can serve as a screening tool in triaging fetuses of high-risk patients in developing countries with a heavy workload and limited resources.

scholarly journals Materno-Fetal Cardiovascular Complications in Turner Syndrome after Oocyte Donation: Insufficient Prepregnancy Screening and Pregnancy Follow-Up Are Associated with Poor Outcome

Endocrinology ◽  
2011 ◽  
Vol 152 (1) ◽  
pp. 334-335
Author(s):  
Nicolas Chevalier ◽  
Hélène Letur ◽  
Dominique Lelannou ◽  
Jeanine Ohl ◽  
Dominique Cornet ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
High Risk ◽  
Magnetic Resonance ◽  
Turner Syndrome ◽  
Growth Retardation ◽  
Cardiovascular Complications ◽  
Fetal Outcome ◽  
Oocyte Donation ◽  
Resonance Imaging

Context: Recombinant human GH treatment and oocyte donation (OD) have improved the quality of life in women with Turner syndrome (TS). However, life expectancy is reduced, mainly due to cardiovascular complications. Pregnancy may itself increase that risk and be associated with hazardous materno-fetal outcome. Objective: The objective of this study was to evaluate the materno-fetal outcome of ongoing pregnancies beyond 20 wk of gestation obtained by OD in TS. Design: This was a multicenter retrospective study including all assisted reproductive technology centers affiliated with the French Study Group for Oocyte Donation. Results: Among 93 patients, only 37.6% were prescreened with echocardiography or thoracic magnetic resonance imaging. Maternal outcome was dominated by 37.8% of pregnancy-associated hypertensive disorders including preeclampsia in 54.8% and severe eclampsia in four patients. Prematurity occurred in 38.3% and was correlated with PAHD (P = 0.01). The frequency of in utero growth retardation was 27.5%. One fetal demise was linked to eclampsia. Two patients died from aortic rupture after cesarean section in a context of aortic root dilatation. Only 40% of pregnancies were associated with an absolutely normal materno-fetal outcome. Conclusions: OD pregnancies in TS who have not been managed following recent specific recommendations were at high risk for maternal death by aortic dissection and for preeclampsia and its complications (fetal distress and in utero growth retardation). These recommendations include previous echocardiography, thoracic magnetic resonance imaging, and overnight blood pressure monitoring associated with a tight follow-up during pregnancy. Until future assessment of these recent recommendations, pregnancies obtained in TS after OD must be still considered as very high-risk pregnancies.

scholarly journals THE CORRELATION BETWEEN FOETAL MOVEMENTS COUNT AND FOETAL OUTCOME

2019 ◽  
Vol 3 (12) ◽  
Author(s):  
Mamta Gangwal
Keyword(s):  
High Risk ◽  
Apgar Score ◽  
Stress Test ◽  
Mode Of Delivery ◽  
Well Being ◽  
Fetal Outcome ◽  
Fetal Movement ◽  
Risk Pregnancy ◽  
Fetal Movements ◽  
Reduced Fetal Movement

Background: A reduced fetal movement is a common indication for assessment of fetal well being. A reduced fetal movement is considered as high risk pregnancy because the fetus is at high risk of hypoxia and sudden demise. Methods: Hospital based prospective study conducted at Department of Obstetrics and Gynecology, RVRS Medical College, Bhilwara. Total 130 pregnant women were included in this study. Results: 10.77% patients didn’t perceive fetal movements after admission. Out of 14 patients with absent DFMC, 6 babies (42.86%) died and 8 babies (57.14%) survived. The association betweenNon Stress Test and mode of delivery was found statistically significant. 83.33%) were admitted in NICU. Out of 24 patients presenting with non reactive NST, 20.83% (5) babies born with APGAR score more than 7 and 79.17% (19) babies had APGAR score 4-7. Conclusion: The association between NST & DFMC and fetal outcome was found statistically significant. Keywords: DFMC, NST, Fetal outcome, survived.

scholarly journals DOPPLER ULTRASOUND, AS VITAL AID TO PREDICT FETAL OUTCOME IN HIGHRISK PREGNANCIES

2020 ◽  
pp. 1-3
Author(s):  
Lalit D. Kapadia ◽  
Brinda patel ◽  
Amrita Patel
Keyword(s):  
High Risk ◽  
Flow Velocity ◽  
Doppler Ultrasound ◽  
Perinatal Asphyxia ◽  
Mode Of Delivery ◽  
Resistance Index ◽  
Fetal Distress ◽  
Fetal Outcome ◽  
Full Term ◽  
High Rate

Introduction:Pulsed Doppler ultrasound allows a clearer understanding of hemodynamic changes and has thus become one of the most effective clinical methods in highrisk pregnancies for fetomaternal surveillance.Fetuses with abnormal flow velocity waveform exhibit a high rate of perinatal asphyxia and death compared to those with normal flow properties.Doppler velocimetrydetermines not only the frequency of antenatal testing and the optimum delivery time, but also the mode of delivery. Objective: To evaluate fetal outcome in High Risk Pregnancies with Doppler changes. Material and methods: Fetal outcome of 100 high risk pregnancies with doppler changes showing abnormality were analysed over a period of 4 months from May 2020 to August 2020. Ultrasound was done followed by Doppler evaluation. Uterine, umbilical and middle cerebral artery flow velocity waveforms (FVW) were analyzed and the resistance index (RI), pulsatility index (PI) and the systolic/diastolic (S/D) ratios were measured. Fetal outcome was determined by APGAR score after 5minute. Results:Out of 100 cases, 43 patients underwent vaginal delivery, out of which 25 full term and 18 were preterm deliveries. 57 patients underwent caesarean section out of which 33 were full term and 24 were preterm. Out of 88 live births,22 babies had APGAR <6 at 5 minutes and 34 babies required NICU admission because of fetal distress, low birth weight, low APGAR, respiratory distress syndrome and IUGR. Conclusion: Doppler can be used as promising adjunct in management of high risk pregnancies. It helps in guiding early intervention and improving fetal outcome.

scholarly journals The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masayoshi Koike ◽  
Mie Yoshimura ◽  
Yasushi Mio ◽  
Shoichi Uezono
Keyword(s):  
Patient Safety ◽  
Retrospective Study ◽  
High Risk ◽  
Treatment Plan ◽  
Treatment Options ◽  
High Risk Patients ◽  
Appropriate Treatment ◽  
Risk Patients ◽  
Treatment Plans ◽  
Multidisciplinary Conference

Abstract Background Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. Methods In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. Results A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. Conclusions Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.

scholarly journals Use of monoclonal antibody therapy for nosocomial SARS-CoV-2 infection in patients at high risk for severe COVID-19: experience from a tertiary-care hospital in Germany

Infection ◽  
2021 ◽  
Author(s):  
Johanna Koehler ◽  
Barbara Ritzer ◽  
Simon Weidlich ◽  
Friedemann Gebhardt ◽  
Chlodwig Kirchhoff ◽  
...  
Keyword(s):  
High Risk ◽  
Tertiary Care Hospital ◽  
Severe Disease ◽  
Treatment Options ◽  
Tertiary Care ◽  
Antibody Therapy ◽  
Additional Treatment ◽  
Care Hospital ◽  
Cross Sectional ◽  
Asymptomatic Patients

AbstractAdditional treatment options for coronavirus disease (COVID-19) are urgently needed, particularly for populations at high risk of severe disease. This cross-sectional, retrospective study characterized the outcomes of 43 patients with nosocomial severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with and without treatment using monoclonal SARS-CoV-2 spike antibodies (bamlanivimab or casirivimab/imdevimab). Our results indicate that treatment with monoclonal antibodies results in a significant decrease in disease progression and mortality when used for asymptomatic patients with early SARS-CoV-2 infection.

scholarly journals Couples’ experiences with expanded carrier screening: evaluation of a university hospital screening offer

2021 ◽  
Author(s):  
Ivy van Dijke ◽  
Phillis Lakeman ◽  
Naoual Sabiri ◽  
Hanna Rusticus ◽  
Cecile P. E. Ottenheim ◽  
...  
Keyword(s):  
High Risk ◽  
Medical Center ◽  
Informed Choice ◽  
Carrier Screening ◽  
University Hospital ◽  
Structured Interviews ◽  
Expanded Carrier Screening ◽  
Post Test ◽  
Future Child ◽  
Clinically Significant

AbstractPreconception carrier screening offers couples the possibility to receive information about the risk of having a child with a recessive disorder. Since 2016, an expanded carrier screening (ECS) test for 50 severe autosomal recessive disorders has been available at Amsterdam Medical Center, a Dutch university hospital. This mixed-methods study evaluated the experiences of couples that participated in the carrier screening offer, including high-risk participants, as well as participants with a general population risk. All participants received genetic counselling, and pre- (n = 132) and post-test (n = 86) questionnaires and semi-structured interviews (n = 16) were administered. The most important reason to have ECS was to spare a future child a life with a severe disorder (47%). The majority of survey respondents made an informed decision (86%), as assessed by the Multidimensional Measure of Informed Choice. Among the 86 respondents, 27 individual carriers and no new carrier couples were identified. Turn-around time of the test results was considered too long and costs were perceived as too high. Overall, mean levels of anxiety were not clinically elevated. High-risk respondents (n = 89) and pregnant respondents (n = 13) experienced higher levels of anxiety before testing, which decreased after receiving the test result. Although not clinically significant, distress was on average higher for carriers compared to non-carriers (p < 0.0001). All respondents would opt for the test again, and 80.2% would recommend it to others. The results suggest that ECS should ideally be offered before pregnancy, to minimise anxiety. This study could inform current and future implementation initiatives of preconception ECS.

scholarly journals Retargeting of NK-92 Cells against High-Risk Rhabdomyosarcomas by Means of an ERBB2 (HER2/Neu)-Specific Chimeric Antigen Receptor

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1443
Author(s):  
Leonie D. H. Gossel ◽  
Catrin Heim ◽  
Lisa-Marie Pfeffermann ◽  
Laura M. Moser ◽  
Halvard B. Bönig ◽  
...  
Keyword(s):  
High Risk ◽  
Tumor Cells ◽  
Chimeric Antigen Receptor ◽  
Treatment Options ◽  
Antigen Receptor ◽  
Proof Of Concept ◽  
Cell Monolayers ◽  
Novel Treatment ◽  
Dismal Prognosis

The dismal prognosis of pediatric and young adult patients with high-risk rhabdomyosarcoma (RMS) underscores the need for novel treatment options for this patient group. In previous studies, the tumor-associated surface antigen ERBB2 (HER2/neu) was identified as targetable in high-risk RMS. As a proof of concept, in this study, a novel treatment approach against RMS tumors using a genetically modified natural killer (NK)-92 cell line (NK-92/5.28.z) as an off-the-shelf ERBB2-chimeric antigen receptor (CAR)-engineered cell product was preclinically explored. In cytotoxicity assays, NK-92/5.28.z cells specifically recognized and efficiently eliminated RMS cell suspensions, tumor cell monolayers, and 3D tumor spheroids via the ERBB2-CAR even at effector-to-target ratios as low as 1:1. In contrast to unmodified parental NK-92 cells, which failed to lyse RMS cells, NK-92/5.28.z cells proliferated and became further activated through contact with ERBB2-positive tumor cells. Furthermore, high amounts of effector molecules, such as proinflammatory and antitumoral cytokines, were found in cocultures of NK-92/5.28.z cells with tumor cells. Taken together, our data suggest the enormous potential of this approach for improving the immunotherapy of treatment-resistant tumors, revealing the dual role of NK-92/5.28.z cells as CAR-targeted killers and modulators of endogenous adaptive immunity even in the inhibitory tumor microenvironment of high-risk RMS.

scholarly journals 789. Evaluation of Bezlotoxumab for Prevention of Recurrent Clostridioides difficile Infection in Patients at High Risk for Recurrence

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S438-S439
Author(s):  
Tanner M Johnson ◽  
Amanda Howard ◽  
Kerry Schwarz ◽  
Lorna Allen ◽  
Misha Huang ◽  
...  
Keyword(s):  
High Risk ◽  
Fecal Microbiota Transplantation ◽  
Therapeutic Option ◽  
Treatment Options ◽  
High Risk Patient ◽  
Recurrent Infection ◽  
Control Group ◽  
Clostridioides Difficile ◽  
All Cause Mortality ◽  
Clostridioides Difficile Infection

Abstract Background Recurrent Clostridioides difficile infection (rCDI) within 180 days of the index episode is associated with a 33% increase in mortality and, to-date, few treatment options exist to prevent recurrent infection. Bezlotoxumab (BEZ) is a novel therapeutic option for the prevention of rCDI, yet limited data exist regarding its effectiveness in patients at high-risk for recurrence outside of controlled trials. This study aimed to compare BEZ to a historical standard of care (SoC) cohort for the prevention of rCDI in patients at high risk for recurrence. Methods A multi-center retrospective cohort study of patients within an academic health-system with one or more risk factors for rCDI. Patients received SoC with oral vancomycin (VAN) or fidaxomicin (FDX) from January 2015 to December 2017 or BEZ, in addition to oral SoC, from September 2017 to September 2019. The primary outcome was rCDI within 90 days of completion of oral VAN or FDX. Secondary outcomes included all-cause readmission, all-cause mortality, and safety events at 90 days. Results One-hundred twenty patients received BEZ in addition to SoC (n=47) or SoC alone (n=73). Mean (SD) age was 55 (16) years, mean (SD) number of lifetime CDI was 3 (2) episodes, and 30.8% of patients had severe CDI. Six (12.8%) patients in the BEZ cohort and thirty-one (42.5%) in the SoC cohort experienced rCDI at 90 days [OR (95% CI) = 0.20 (0.07-0.53), p=&lt; 0.01]. Incidence of all-cause mortality (2.1% vs 5.5%, p=0.67) and all-cause readmission (42.6% vs 56.2%, p=0.20) within 90 days were not statistically different between groups. Patient body weight, timing of BEZ administration, CDI severity, nor prior receipt of fecal microbiota transplantation significantly affected BEZ effectiveness. BEZ was well tolerated with one infusion-related reaction. There were no heart failure exacerbations among BEZ recipients and two exacerbations identified from control group. Conclusion In patients with at least one risk factor for rCDI, BEZ in addition to SoC was associated with lower rates of recurrent infection than SoC alone and may be a reasonable adjunct therapy in high risk patient populations. Disclosures matthew miller, PharmD, Allergan (Speaker’s Bureau)Tetraphase (Speaker’s Bureau)

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