scholarly journals Role of Ultrasound in Diagnosis of Fetus Acardius Acephalus in Multiple Pregnancies

2018 ◽  
Vol 4 (02) ◽  
pp. 085-087
Author(s):  
Ruby Yadav ◽  
Nishi Choudhary
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Gestational Age ◽  
Preterm Labor ◽  
Perinatal Outcomes ◽  
Therapeutic Interventions ◽  
Multiple Pregnancies ◽  
Triplet Pregnancy ◽  
Gestational Age At Delivery

AbstractThis case report describes an acardiac fetus of the acephalus phenotype in a triplet pregnancy. The diagnosis was confirmed at 13 weeks. In the absence of signs of heart failure in the co-fetus, the pregnancy was managed conservatively. The pregnancy was complicated by preterm labor and the fetuses were delivered at 23 + 4 weeks. Also, the perinatal outcomes of triplet pregnancies complicated by an acardiac fetus, where the median gestational age at delivery is 23 to 24 weeks, are summarized, and the possible therapeutic interventions have been discussed.

scholarly journals Selective termination of the fetus in multiple pregnancies using ultrasound-guided radiofrequency ablation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nan Li ◽  
Jimei Sun ◽  
Jiayan Wang ◽  
Wei Jian ◽  
Jing Lu ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Gestational Age ◽  
Loss Rate ◽  
Fetal Loss ◽  
Perinatal Outcomes ◽  
Multiple Pregnancies ◽  
Ultrasound Guided ◽  
Arterial Perfusion ◽  
Before And After ◽  
Gestational Age At Delivery

Abstract Background To evaluate the perinatal outcomes in women with selective termination using ultrasound-guided radiofrequency ablation (RFA). Methods Complicated monochorionic (MC) twin pregnancies and multiple pregnancies with an indication for selective termination by ultrasound-guided coagulation of the umbilical cord with RFA under local anesthesia between July 2013 and Jan 2020 were reviewed. We analyzed the indications, gestational age at the time of the procedure, cycles of RFA, duration of the procedure, and perinatal outcome. Results Three hundred and thirteen patients were treated during this period. Seven of whom were lost of follow-up. The remaining 306 cases, including 266 pairs of monochorionic diamniotic (MCDA) twins (86.93%), two pairs of monoamniotic twins (0.65%), 30 dichorionic triamniotic (DCTA) triplets (1%), and three monochorionic triamniotic (MCTA) triplets (0.98%), were analyzed. Indications included twin-to-twin transfusion syndrome (TTTS) (n = 91), selective fetal growth restriction (sFGR) (n = 83), severe discordant structural malformation (n = 78), multifetal pregnancy reduction (MFPR) (n = 78), twin reverse arterial perfusion sequence (TRAPS) (n = 19), and twin anemia-polycythemia sequence (TAPS) (n = 3). Upon comparison of RFA performed before and after 20 weeks, the co-twin loss rate (20.9% vs. 21.5%), the incidence of preterm premature rupture of membranes (PPROM) within 24 h (1.5% vs. 1.2%), and the median gestational age at delivery [35.93 (28–38) weeks vs. 36 (28.54–38.14) weeks] were similar (p > 0.05). Conclusions RFA is a reasonable option when indicated in multiple pregnancies and complicated monochorionic pregnancies. In our experience, the overall survival rate was 78.76% with RFA in selective feticide, and early treatment increases the likelihood of survival for the remaining fetus because the fetal loss rate is similar before and after 20 weeks.

Reduced Growth in Non-Small for Gestational Age Fetuses from 35 Weeks of Gestation to Birth and Perinatal Outcomes

2021 ◽  
pp. 1-10
Author(s):  
Peña Dieste Pérez ◽  
Luis M. Esteban ◽  
Ricardo Savirón-Cornudella ◽  
Faustino R. Pérez-López ◽  
Sergio Castán-Mateo ◽  
...  
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Perinatal Outcomes ◽  
Entire Study ◽  
Birth Weight Percentile ◽  
Gestational Age At Delivery ◽  
Study Population ◽  
The Difference ◽  
Relationship Of ◽  
The Relationship

<b><i>Objective:</i></b> This study aimed to assess reduced fetal growth between 35 weeks of gestation and birth in non-small for gestational age fetuses associated with adverse perinatal outcomes (APOs). <b><i>Material and Method:</i></b> It is a retrospective cohort study of 9,164 non-small for gestational age fetuses estimated by ultrasound at 35 weeks. The difference between the birth weight percentile and the estimated percentile weight (EPW) at 35 weeks of gestation was calculated, and we studied the relationship of this difference with the appearance of APO. APOs were defined as cesarean or instrumental delivery rates for nonreassuring fetal status, 5-min Apgar score &#x3c;7, arterial cord blood pH &#x3c;7.10, and stillbirth. Fetuses that exhibited a percentile decrease between both moments were classified into 6 categories according to the amount of percentile decrease (0.01–10.0, 10.01–20.0, 20.01–30.0, 30.01–40.0, 40.01–50.0, and &#x3e;50.0 percentiles). It was evaluated whether the appearance of APO was related to the amount of this percentile decrease. Relative risk (RR) was calculated in these subgroups to predict APOs in general and for each APO in particular. Receiver operating characteristic and area under curves (AUC) for the difference in the percentile was calculated, used as a continuous parameter in the entire study population. <b><i>Results:</i></b> The median gestational age at delivery in uncomplicated pregnancies was 40.0 (39.1–40.7) and in pregnancies with APOs 40.3 (49.4–41.0), <i>p</i> &#x3c; 0.001. The prevalence of APOs was greater in the group of fetuses with a decrease in percentile (7.6%) compared to those with increased percentile (4.8%) (<i>p</i> &#x3c; 0.001). The RR was 1.63 (95% CI: 1.365–1.944, <i>p</i> &#x3c; 0.001). Although the differences were significant in all decreased percentile groups, RRs were significantly higher when decreased growth values were &#x3e;40 points (RR: 2.036, 95% CI: 1.581–2.623, <i>p</i> &#x3c; 0.001). The estimated value of the AUC for percentile decrease was 0.58 (0.56–0.61, <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> Fetuses with a decrease in the EPW between the ultrasound at 35 weeks of gestation and birth have a higher risk of APOs, being double in fetuses with a decrease of &#x3e;40 percentile points.

Abstract 865: Gata-4 Is An Angiogenic Survival Factor Of The Infarcted Heart

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Olli Tenhunen ◽  
Hanna Leskinen ◽  
Raisa Serpi ◽  
Jaana Rysä ◽  
Harri Pennanen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stem Cells ◽  
Gene Transfer ◽  
Dna Binding ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Therapeutic Interventions ◽  
Cardiac Stem Cells

Recent data suggest that the cardiac-restricted transcription factor GATA-4 is an anti-apoptotic factor required for adaptive responses as well as a key regulator of hypertrophy and hypertrophy-associated genes in the heart. As a leading cause of chronic heart failure, reversal of post-infarction left ventricular remodeling represents an important target for therapeutic interventions. Here we studied the role of GATA-4 as a mediator of post-infarction remodeling. Rats were subjected to experimental myocardial infarction (MI) by ligating the left anterior descending coronary artery (LAD). Ligation of the LAD decreased the DNA binding activity of GATA-4 by 69 % at day 1 after MI (P<0.001, n=7– 8) as assessed by gel mobility shift assays. At 2 weeks the GATA-4 DNA binding was significantly upregulated (2.4-fold, P<0.05, n=7), and returned to baseline at 4 weeks. To determine the functional role of GATA-4, rats underwent LAD ligation followed by peri-infarct intramyocardial delivery of adenoviral vector expressing GATA-4. Hearts treated with the GATA-4 gene transfer exhibited significantly increased ejection fraction (58±5% vs. 38±3% in LacZ-treated control animals with MI, P<0.001, n=8 –9) and fractional shortening (28±3% vs. 16±1%, P<0.001, n=8 –9) 2 weeks after MI. Accordingly, the infarct size was significantly reduced (26±4% vs. 45±4%, P<0.01, n=8 –9). To determine the cardioprotective mechanisms of GATA-4, the number of cardiac stem cells, apoptotic cardiomyocytes and capillaries were assessed. The number of capillaries (59±4/field vs. 48±3/field, P<0.051, n=7– 8) and c-kit positive stem cells (13±5 cells vs. 4±2 cells, P<0.05, n=7– 8) were increased in GATA-4 treated hearts, and a tendency to decreased apoptosis was observed in TUNEL-stained histological sections. These results indicate that the reversal of reduced GATA-4 activity prevents adverse post-infarction remodeling through increased angiogenesis, recruitment of cardiac stem cells and anti-apoptosis. GATA-4-based gene transfer may represent a novel, efficient therapeutic approach for heart failure.

Inflammation in Complicated Pregnancy and Its Outcome

2016 ◽  
Vol 33 (14) ◽  
pp. 1337-1356 ◽  
Author(s):  
Ram Kalagiri ◽  
Timothy Carder ◽  
Saiara Choudhury ◽  
Niraj Vora ◽  
Amie Ballard ◽  
...  
Keyword(s):  
Preterm Labor ◽  
Maternal Obesity ◽  
Normal Pregnancy ◽  
Adverse Outcomes ◽  
Therapeutic Interventions ◽  
Inflammatory Factors ◽  
Diagnostic Tools ◽  
Inflammatory Reactions ◽  
Mortality And Morbidity

Background Normal pregnancy relies on a careful balance between immune tolerance and suppression. It is known that strict regulation of maternal immune function, in addition to components of inflammation, is paramount to successful pregnancy, and any imbalance between proinflammatory and anti-inflammatory cytokines and chemokines can lead to aberrant inflammation, often seen in complicated pregnancies. Inflammation in complicated pregnancies is directly associated with increased mortality and morbidity of the mother and offspring. Aberrant inflammatory reactions in complicated pregnancies often lead to adverse outcomes, such as spontaneous abortion, preterm labor, intrauterine growth restriction, and fetal demise. The role of inflammation in different stages of normal pregnancy is reviewed, compared, and contrasted with aberrant inflammation in complicated pregnancies. The complications addressed are preterm labor, pregnancy loss, infection, preeclampsia, maternal obesity, gestational diabetes mellitus, autoimmune diseases, and inflammatory bowel disease. Aim This article examines the role of various inflammatory factors contributing to aberrant inflammation in complicated pregnancies. By understanding the aberrant inflammatory process in complicated pregnancies, novel diagnostic tools and therapeutic interventions for modulating it appropriately can be identified.

Gestational age at delivery and perinatal outcomes of twin gestations

2012 ◽  
Vol 207 (5) ◽  
pp. 410.e1-410.e6 ◽  
Author(s):  
Amy E. Doss ◽  
Melissa S. Mancuso ◽  
Suzanne P. Cliver ◽  
Victoria C. Jauk ◽  
Sheri M. Jenkins
Keyword(s):  
Gestational Age ◽  
Perinatal Outcomes ◽  
Gestational Age At Delivery

scholarly journals Congenital Nasolacrimal Duct Cyst/Dacryocystocele: An Argument for a Genetic Basis

2012 ◽  
Vol 3 (1) ◽  
pp. ar.2012.3.0024 ◽  
Author(s):  
Henry P. Barham ◽  
Justin M. Wudel ◽  
Robert W. Enzenauer ◽  
Kenny H. Chan
Keyword(s):  
Case Report ◽  
Preterm Labor ◽  
Genetic Basis ◽  
Monozygotic Twins ◽  
Nasolacrimal Duct ◽  
Duct Cyst ◽  
Common Presentation ◽  
Inferior Meatus ◽  
Cystic Masses

Embryogenesis of a congenital nasolacrimal duct (NLD) cyst is attributed to the failure of the Hasner membrane of the NLD system to cannulate. Prenatal diagnosis of congenital NLD cysts supports the argument for a developmental error, with a postnatal prevalence of 6%. The role of a genetic basis for this malformation has never been ascribed. We present a set of monozygotic twins with bilateral congenital NLD cysts as an argument for a genetic basis of this entity. A case report and literature review were performed. We present two cases of bilateral congenital NLD cysts occurring in a set of monozygotic twins. Patients were delivered at 37 weeks via cesarean section. The pregnancy was complicated by preterm labor at 33 weeks requiring administration of terbutaline and betamethasone. At presentation, twin A had bilateral eye discharge, erythema, and swelling medial to the medial canthi as well as nasal obstruction. Computed tomography (CT) showed classic bilateral cystic masses in the inferior meatus. The diagnosis of bilateral infected congenital dacryocystoceles was made. Twin B initially presented with only bilateral eye discharge and CT showed a dilated NLD system. Twin B subsequently developed early signs of bilateral dacryocystoceles the following day. Both patients underwent lacrimal probing and endoscopic marsupialization of the dacryocystoceles. Biopsies were consistent with dacryocystocele. Dacryocystocele is a common presentation of unresolved neonatal NLD obstruction. This case report in a set of identical twins is an argument for a genetic basis for the formation of this lesion.

scholarly journals Perinatal Outcomes of Babies Born with Fresh or Frozen-Thawed Testicular Sperm in Patients with Azoospermia

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Mehmet AK ◽  
Nur Dokuzeylul Gungor
Keyword(s):  
Birth Weight ◽  
Live Birth ◽  
Gestational Age ◽  
Neonatal Death ◽  
Perinatal Outcomes ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Testicular Sperm ◽  
Significant Difference ◽  
Gestational Age At Delivery

Aim: To compare the perinatal outcomes of pregnancies obtained with fresh or frozen-thawed sperm in patients who underwent surgical sperm extraction for the diagnosis of azoospermia. Materials and Methods: In this retrospective study, data were collected on couples who conceived following Intracytoplasmic Sperm Injection using surgically retrieved fresh or frozen-thawed sperm. Participants were divided into two equal groups as follows. Group 1 (n = 100) consisted of patients who underwent ICSI and subsequent embryo transfer using fresh testicular sperm and Group 2 (n = 100) consisted of patients who underwent ICSI by using frozen-thawed testicular sperm. Perinatal outcome was compared according to the use of fresh or frozen-thawed sperm. Primary outcome measures included clinical pregancy, miscarriage, live birth, congenital abnormality, birthweight, gestational age at delivery, stillbirth and neonatal death. Results: Live birth and clinical pregnancy rates were found to be significantly higher in patients who underwent ICSI/ET with frozen-thawed testicular sperm compared to fresh sperm group. The miscarriage rates were significantly lower in the frozen-thawed sperm group compared to the fresh testicular sperm group. Clinical pregnancy was detected in 18 cases, while no pregnancy was detected in 82 cases undergoing ICSI with fresh sperm. In the group where ICSI/ET was applied with frozen sperm, clinical pregnancy was detected in 51 cases, whereas pregnancy was not detected in 49 cases. In the frozen sperm group, in addition to C/S and multiple pregnancy rates, the number of babies with a birth weight below 2500 g was significantly higher than in the fresh sperm group. There was no significant difference between the groups in terms of minor and major congenital anomalies, birth weight, gestational age at delivery, stillbirth and neonatal death. Conclusion: Using fresh or frozen testicular sperm does not have a significant effect on perintal outcome in patients with azoospermia.

scholarly journals Effects and outcomes of septostomy in twin-to-twin transfusion syndrome after fetoscopic laser therapy

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Wen-Fang Li ◽  
An-Shine Chao ◽  
Shuenn-Dyh Chang ◽  
Po-Jen Cheng ◽  
Lan-Yan Yang ◽  
...  
Keyword(s):  
Laser Therapy ◽  
Gestational Age ◽  
Odds Ratio ◽  
Case Series ◽  
Perinatal Outcomes ◽  
Neonatal Brain ◽  
Brain Image ◽  
Fetal Survival ◽  
Gestational Age At Delivery ◽  
Adverse Perinatal Outcomes

Abstract Background To evaluate the incidence and outcomes of septostomy in twin-to-twin transfusion syndrome (TTTS) after fetoscopic laser therapy. Methods A retrospective analysis of TTTS postlaser septostomy between 2005 and 2018 was performed. Postlaser septostomy was diagnosed using both (1) a free-floating intertwin membrane flap visible on ultrasound examination and (2) the rapid equalization of amniotic fluid maximum vertical pocket in the donor and recipient amniotic sacs observed after laser therapy. Perinatal survival, neonatal brain image anomaly, gestational age at operation and birth, incidence of premature rupture of membranes (PROM) within 3 weeks after operation, pseudoamniotic band syndrome, and cord entanglement were evaluated. Results In the 159 TTTS cases included, 12 had postlaser septostomy. Relative to the group without septostomy, the septostomy group had a lower total fetal survival rate (54.2% vs 73.6%, p = 0.041), an earlier mean gestational age at delivery (27.8 vs 34.4 weeks, p = 0.009), a higher risk of PROMs within 3 weeks after operation (33.3% vs 5.4%, p = 0.004), a higher cord entanglement rate (16.7% vs 0%, p = 0.005), and a higher brain image anomaly rate (23.0% [3/13] vs 5.0% [11/218], p = 0.035). After considering the severe Quintero stages (stage III and IV), postlaser septostomy was the only variable [p = 0.003, odds ratio = 5.1] to predict neonatal brain image anomaly. Postlaser septostomy combined with severe Quintero stages could predict PROMs within 3 weeks after laser therapy [p = 0.001, odds ratio = 14.1 and p = 0.03, odds ratio = 5.4, respectively] and delivery before the gestational age of 28 weeks [p = 0.017, odds ratio = 4.5 and p = 0.034, odds ratio = 2.3, respectively]. The risk of pseudoamniotic band syndrome was not increased by postlaser septostomy in this case series. Conclusions Postlaser septostomy in TTTS was associated with poorer fetal survival and more adverse perinatal outcomes even after considering severe Quintero stages before laser therapy. Efforts should be made to prevent septostomy during laser therapy, and septostomy as the primary method to treat TTTS is not advisable.

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