scholarly journals 562. Tocilizumab Use in the Second Trimester Pregnant Patients with Severe Covid-19 Pneumonia and their Maternal and Fetal Outcomes: Two Case Reports

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S383-S383
Author(s):  
Fatima iqbal ◽  
Shiema A Ahmed ◽  
Kamran Mushtaq ◽  
Faraj S Howady ◽  
Fatima Rustom ◽  
...  
Keyword(s):  
Full Recovery ◽  
Maternal Outcomes ◽  
Shortness Of Breath ◽  
Second Trimester ◽  
Fetal Outcomes ◽  
Fetal Demise ◽  
Breath Figure ◽  
Intrauterine Fetal Demise ◽  
High Dependency ◽  
History Of

Abstract Background Tocilizumab is an interleukin-6 monoclonal antibody with widespread use in rheumatologic conditions. Observational studies have shown a promising role of Tocilizumab in severe COVID-19 patients with cytokine storm syndrome. Data about tocilizumab use in pregnant patients is limited. We report two outcomes of two pregnant patients with COVID-19 in the second trimester who received tocilizumab Methods A 24-year-old 20 weeks pregnant lady with a history of asthma and gestational diabetes mellitus presented with three days history of fever, cough and shortness of breath (Figure 1). She was clinically stable but later developed ARDS and developed increased oxygen demand up to 10 liters/min. She received Tocilizumab on. Patient was observed in a high dependency unit but did not require mechanical ventilation. Patient was discharged home with full recovery and later delivered a healthy baby. Timeline of medicines used during hospital (Figure 2). Case 2: 39-year-old 23 weeks pregnant lady presented with seven days history of fever cough and shortness of breath (Figure 1). On presentation, she had progressive worsening hypoxic respiratory failure and was intubated. Patient had her nasopharyngeal swab for CODI-19 RT PCR was positive. The patient had severe ARDS requiring ECMO (extracorporeal membrane oxygenation) for respiratory support. Tocilizumab 400 mg was given on the presentation, along with other medications (Figure 3). Patient had regular monitoring of fetus; however, she had intrauterine fetal demise on day 14. Patient It is unclear if IUFD was due to using of tocilizumab or severity of COVID19 itself. The patient stayed in ICU for 20 days and was discharged after full recovery. Figure 1. Case 1 treatment timeline. Abberviations: Azithro: Azithromycin, HCQ: Hydroxychloroquine, CQ: Chloroquine, LPV/r: lopinavir/Ritonavir, Osel: Oseltamivir, MP: Methylprednisolone, Ampi-sulb: Ampicillin-sulbactam, TCZ: tocilizumab Figure 2. Case 2 treatment timeline Results Learning points: Tocilizumab use in pregnant patients with severe COVID-19 pneumonia during the second trimester improved maternal outcomes in our cases. Tocilizumab use may be associated with worse fetal outcomes, including intrauterine fetal demise (IUFD). Figure 3. Table of clinical characteristics, pregnant outcomes. Abbreviations: LRTI: lower respiratory tract infection, HCQ: Hydroxychloroquine, CQ: chloroquine, Osel: Oseltamivir, Cef: Ceftrixone, Ampi-Sulb: ampicillin-sulbactam, Azithro: Azithromycin, TCZ: tocilizumab, MP: methylpredinisolone, H/O: History of, LSCS: C-section, NA: not available. Pip-tazo: Piperacillin-tazobactam, Mero: Meropenem, Sulfa-trim: Sulfamethoxazole-Trimethoprim, IUFD: Intrauterine fetal death. Conclusion The pharmacological management of pregnant patients with severe COVID-19 pneumonia poses significant challenges. The use of Tocilizumab may improve maternal outcomes but may also increase the risk of worse fetal outcomes. Caution should be exercised in using this agent, and risks and benefits should be discussed with the patients. Disclosures All Authors: No reported disclosures

Risk of hemorrhage during surgical evacuation for second-trimester intrauterine fetal demise

Contraception ◽  
2016 ◽  
Vol 94 (5) ◽  
pp. 496-498 ◽  
Author(s):  
Amber N. Fontenot Ferriss ◽  
Laurin Weisenthal ◽  
Jeanelle Sheeder ◽  
Stephanie B. Teal ◽  
Kristina Tocce
Keyword(s):  
Second Trimester ◽  
Fetal Demise ◽  
Intrauterine Fetal Demise ◽  
Surgical Evacuation ◽  
Risk Of Hemorrhage

Fetal Vascular Malperfusion Due To Long and Hypercoiled Umbilical Cords Resulting in Recurrent Second Trimester Pregnancy Loss: A Case Series and Literature Review

2020 ◽  
pp. 109352662096206
Author(s):  
Jonathan C Slack ◽  
Theonia K Boyd
Keyword(s):  
Umbilical Cord ◽  
Rare Event ◽  
Case Series ◽  
Second Trimester ◽  
Fetal Demise ◽  
Flow Restriction ◽  
Intrauterine Fetal Demise ◽  
Increased Risk ◽  
Second Trimester Pregnancy ◽  
Umbilical Cords

Background Intrauterine fetal demise due to fetal vascular malperfusion in mid-gestation is a rare occurrence. Abnormally long and hypercoiled umbilical cords are associated with an increased risk of umbilical cord blood flow restriction, which in turn can result in adverse perinatal and maternal outcomes. The factors that regulate umbilical cord development, specifically umbilical cord length and coiling, are poorly understood. Methods Maternal history, along with fetal and placental findings (post-mortem, pathological, and molecular), were reviewed for a series of 3 consecutive pregnancies that ended in second trimester intrauterine fetal demise. Results All 3 umbilical cords were exceptionally long and hypercoiled, and all placentas showed evidence of high-grade fetal vascular malperfusion. At fetopsy, all 3 fetuses were developmentally normal for gestational age and lacked congenital anomalies. Maternal medical history and antenatal testing (including an extensive work-up for maternal hypercoagulability syndromes) were normal and/or noncontributory. Conclusion Although excessively long and hypercoiled cords are generally thought of as sporadic, nongenetic events, rare examples of recurrent intrauterine fetal demise secondary to such exist have been reported. This intrafamilial clustering of a rare event is suggestive that at least a subset of hypercoiled, long umbilical cords may have an underlying genetic etiology.

scholarly journals Intraplacental Leiomyoma in a Case of Second-Trimester Intrauterine Fetal Demise

2020 ◽  
Vol 13 ◽  
pp. 2632010X2092832
Author(s):  
Selene C Koo ◽  
Fang Bu
Keyword(s):  
Smooth Muscle ◽  
Umbilical Cord ◽  
Incidental Findings ◽  
Adverse Outcome ◽  
Implantation Site ◽  
Rare Tumor ◽  
Second Trimester ◽  
Histological Findings ◽  
Fetal Demise ◽  
Intrauterine Fetal Demise

Intraplacental leiomyomas are extremely rare and are generally incidental findings in term placentas. We present the first reported case of a placental leiomyoma associated with preterm intrauterine fetal demise, with histological findings providing the cause of adverse outcome. This was an intrauterine fetal demise detected at 26 weeks gestation with a placental finding of a 2.8-cm leiomyoma. Histological findings in the placenta and fetus were consistent with intrauterine fetal demise of weeks. The umbilical cord was markedly hypercoiled, with 6 twists per 10 cm. Features of maternal vascular malperfusion were evident in the placenta, including villous hypermaturity, an infarct adjacent to the leiomyoma, and retention of smooth muscle in spiral arterioles within the decidua overlying the leiomyoma. Implantation-site trophoblasts invaded into the leiomyoma and the overlying decidua. We hypothesize that incorporation of the leiomyoma into the placenta contributed to fetal demise due to disordered placental implantation, implying that these tumors may not be as benign and incidental as previously described. The finding of implantation-site changes in the leiomyoma may also suggest a potential cause for this rare tumor.

scholarly journals History of Adverse Pregnancy on Subsequent Maternal-Fetal Outcomes in Patients with Immunoglobulin A Nephropathy: A Retrospective Cohort Study from a Chinese Single Center

2021 ◽  
pp. 1-8
Author(s):  
Xingji Lian ◽  
Li Fan ◽  
Xin Ning ◽  
Cong Wang ◽  
Yi Lin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Immunoglobulin A ◽  
Maternal Outcomes ◽  
Single Center ◽  
Immunoglobulin A Nephropathy ◽  
Fetal Outcomes ◽  
Increased Risk ◽  
History Of ◽  
Adverse Pregnancy

<b><i>Background:</i></b> Gestation complications have a recurrence risk and could predispose to each other in the next pregnancy. We aimed to evaluate the relationship between a history of adverse pregnancy and maternal-fetal outcomes in subsequent pregnancy in patients with Immunoglobulin A nephropathy (IgAN). <b><i>Methods:</i></b> A retrospective cohort study from a Chinese single center was conducted. Pregnant women with biopsy-proven primary IgAN and aged ≥18 years were enrolled and divided into the 2 groups by a history of adverse pregnancy. The primary outcome was adverse pregnancy outcome, which included maternal-fetal outcomes. Logistical regression model was used to evaluate the association of a history of adverse pregnancy with subsequent adverse maternal and fetal outcomes. <b><i>Results:</i></b> Ninety-one women with 100 pregnancies were included, of which 54 (54%) pregnancies had a history of adverse pregnancy. IgAN patients with adverse pregnancy history had more composite maternal outcomes (70.4% vs. 45.7%, <i>p</i> = 0.012), while there was no difference in the composite adverse fetal outcomes between the 2 groups (55.6% vs. 45.7%). IgAN patients with a history of adverse pregnancy were associated with an increased risk of subsequent adverse maternal outcomes (adjusted odds ratio [OR], 2.64; 95% CI, 1.07–6.47). Similar results were shown in those with baseline serum albumin &#x3c;3.5 g/dL, 24 h proteinuria ≥1 g/day, and a history of hypertension. There was no association between a history of adverse pregnancy and subsequent adverse fetal outcomes in IgAN patients (adjusted OR, 1.56; 95% CI, 0.63–3.87). <b><i>Conclusion:</i></b> A history of adverse pregnancy was associated with an increased risk of subsequent adverse maternal outcomes, but not for adverse fetal outcomes in IgAN patients.

scholarly journals Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

2013 ◽  
Vol 137 (3) ◽  
pp. 326-337 ◽  
Author(s):  
Linda M. Ernst ◽  
Lori Gawron ◽  
Michael K. Fritsch
Keyword(s):  
Pregnancy Termination ◽  
Placental Tissue ◽  
The United States ◽  
Legal Issues ◽  
Surgical Pathology ◽  
Second Trimester ◽  
Pathologic Examination ◽  
Fetal Demise ◽  
Intrauterine Fetal Demise ◽  
Clinical Diagnoses

Context.—Dilation and evacuation (D&E) is an alternative method to induction of labor for pregnancy termination and intrauterine fetal demise, and it is the most common mode of second-trimester uterine evacuation in the United States. Many D&E specimens are examined in surgical pathology, and there is little information available in surgical pathology textbooks or the literature to assist pathologists in these examinations. Objective.—To provide an overview of the D&E procedure, discuss related legal issues, provide guidelines for routine pathologic examination of D&E specimens, and demonstrate the importance of careful pathologic examination of D&E specimens. Data Sources.—Case-derived material and literature review. Conclusions.—Pathologic examination of D&E specimens has been understudied. However, the available literature and our experience support the fact that careful pathologic examination of D&E specimens can identify significant fetal and placental changes that can confirm clinical diagnoses or provide definitive diagnosis, assist in explaining the cause of intrauterine fetal demise, and identify unexpected anomalies that may provide further clues to a diagnostic syndrome or mechanism of anomaly formation.

scholarly journals Maternal and Fetal outcomes of Cesarean Delivery and factors associated with its unfavorable management outcomes; In Ayder Specialized Comprehensive Hospital, Mekelle, Tigray, Ethiopia, 2017.

2019 ◽  
Author(s):  
Meresa Berwo mengesha ◽  
Hadgay Hagos Adhanu ◽  
Desta Abraha weldegiwergis ◽  
Natnael Etsay Assefa ◽  
Woldu mammo werid ◽  
...  
Keyword(s):  
Neonatal Death ◽  
Caesarean Delivery ◽  
Wound Dehiscence ◽  
Maternal Outcomes ◽  
Early Neonatal Death ◽  
Fetal Outcomes ◽  
Obstructed Labor ◽  
Factors Associated ◽  
History Of ◽  
Caesarean Hysterectomy

Abstract Objectives: The aim of this study was to determine the unfavorable outcomes and to assess factors contribute for the unfavorable management outcomes after caesarean deliveries in Ayder Specialized Comprehensive Hospital, Mekelle, Tigray, Ethiopia, 2017. Results: The unfavorable maternal management outcomes were Adhesion 28(8.3%), excessive blood loss and blood transfusion 19(5.6%), caesarean hysterectomy 10(3%), relaparotomy 5(1.5%), wound infection and wound dehiscence 23(6.8%).Unfavorable fetal outcomes were were still birth 9(2.6%), early neonatal death 8(2.4%), low birth weight 58(17.2%). Women’s who did not booked for Antenatal Care and having history of previous Caesarean delivery were found to be associated with unfavorable maternal outcomes and indications of Caesarean delivery as obstructed labor was associated with unfavorable fetal outcomes. Key words: caesarean delivery, fetal outcomes, maternal outcomes.

Risk of hemorrhage during dilation and evacuation for second-trimester intrauterine fetal demise

Contraception ◽  
2014 ◽  
Vol 90 (3) ◽  
pp. 310-311
Author(s):  
L. Weisenthal ◽  
A. Fontenot ◽  
J. Sheeder ◽  
S. Teal ◽  
K. Tocce
Keyword(s):  
Second Trimester ◽  
Fetal Demise ◽  
Intrauterine Fetal Demise ◽  
Risk Of Hemorrhage

scholarly journals Acute Fatty Liver Disease of Pregnancy in the Second Trimester

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Faraz Afridi ◽  
Michael Feely ◽  
Raju Reddy
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Fulminant Liver Failure ◽  
Second Trimester ◽  
Third Trimester ◽  
Fetal Demise ◽  
The Third ◽  
History Of ◽  
Acute Fatty Liver

Acute fatty liver of pregnancy (AFLP) is a rare disorder that typically presents in the third trimester. We report a case of a 21-year-old woman with a history of intrauterine fetal demise at 19 weeks’ gestation who developed fulminant liver failure 1 week after the fetal demise. She was diagnosed with AFLP as per the Swansea criteria. An orthotopic liver transplant was attempted but was unsuccessful. AFLP usually presents between the 30th to 38th weeks of gestation. However, it can occur in the postpartum period after only 19 weeks of gestation as highlighted in our case.

scholarly journals Maternal and fetal outcomes of cesarean delivery and factors associated with its unfavorable management outcomes; in Ayder Specialized Comprehensive Hospital, Mekelle, Tigray, Ethiopia, 2017

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Meresa Berwo Mengesha ◽  
Hadgay Hagos Adhanu ◽  
Desta Abraha Weldegeorges ◽  
Natnael Etsay Assefa ◽  
Weldu Mammo Werid ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Wound Dehiscence ◽  
Maternal Outcomes ◽  
Early Neonatal Death ◽  
Fetal Outcomes ◽  
Obstructed Labor ◽  
Factors Associated ◽  
Cesarean Deliveries ◽  
History Of ◽  
Previous Cesarean

Abstract Objectives This study aimed to determine the unfavorable outcomes and to assess factors contribute to the unfavorable management outcomes after cesarean deliveries in Ayder Specialized Comprehensive Hospital, Mekelle, Tigray, Ethiopia, 2017. Results The unfavorable maternal management outcomes were Adhesion 28 (8.3%), excessive blood loss and blood transfusion 19 (5.6%), cesarean hysterectomy 10 (3%), relaparotomy 5 (1.5%), wound infection and wound dehiscence 23 (6.8%). Unfavorable fetal outcomes were were stillbirth 9 (2.6%), early neonatal death 8 (2.4%), low birth weight 58 (17.2%). women who did not book for Antenatal Care and having a history of previous cesarean delivery were found to be associated with unfavorable maternal outcomes and indications of cesarean delivery as obstructed labor was associated with unfavorable fetal outcomes.

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