scholarly journals Previable Preeclampsia Diagnosed by Renal Biopsy in Setting of Novel Diagnosis of C4 Glomerulopathy

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Jessica Parrott ◽  
Timothy A. Fields ◽  
Marc Parrish
Keyword(s):  
Renal Biopsy ◽  
Gestational Age ◽  
Pregnancy Termination ◽  
Antihypertensive Agents ◽  
Rare Entity ◽  
Complement Pathway ◽  
Dense Deposits ◽  
Integral Role ◽  
Early Onset Preeclampsia ◽  
New Onset

Background. Preeclampsia diagnosed before 20 weeks’ gestational age is a rare entity, particularly without any predisposing factors. We report a case of preeclampsia occurring prior to 20 weeks’ gestational age in the setting of a novel diagnosis of C4 glomerulopathy.Case. A G3P0020 at 18 weeks presented with new onset hypertension and proteinuria, requiring multiple antihypertensive agents to maintain control. Renal biopsy demonstrated thrombotic microangiopathic lesions and glomerular endotheliosis. C4-dominant staining and numerous subendothelial and mesangial electron dense deposits were found within the glomerulus. With no other definable etiologies, preeclampsia was diagnosed. She developed posterior reversible encephalopathic syndrome and pregnancy termination was recommended.Conclusion. The lectin complement pathway may play a role in the pathophysiology of severe, early onset preeclampsia. Renal biopsy may play an integral role in diagnosis.

Early-Onset Preeclampsia with Pulmonary Edema and Massive Ascites: A Rare Presentation of Severe Preeclampsia or Concomitant Diagnoses?

2020 ◽  
Vol 2020 ◽  
Author(s):  
Elizabeth St. Laurent ◽  
Rebecca Fryer-Gordon ◽  
Tom McNeilis, ◽  
Leonard B. Goldstein
Keyword(s):  
Pulmonary Edema ◽  
Early Onset ◽  
Hellp Syndrome ◽  
Disease Process ◽  
Massive Ascites ◽  
Elevated Liver Enzymes ◽  
Biophysical Profile ◽  
Patient Reported ◽  
Early Onset Preeclampsia ◽  
New Onset

Preeclampsia, eclampsia, and HELLP syndrome, are a continuum of a dangerous disease process that can occur in pregnancy. Preeclampsia is defined by new onset hypertension and proteinuria. In more severe cases, preeclampsia can be associated with pulmonary edema, oliguria, persistent headaches, and impaired liver function. These symptoms reveal maternal end organ damage which may result in danger to the fetus such as oligohydramnios, decreased fetal growth, and placental abruption. The defining difference between preeclampsia and eclampsia is the presence of new onset seizure activity. HELLP syndrome occurs when the mother experiences hemolysis, elevated liver enzymes, and low platelets. This syndrome is seen in about 0.6% of pregnancies. Each of these conditions (preeclampsia, eclampsia, and HELLP) increase both the fetal and maternal morbidity and mortality rates with the most definitive cure being delivery of child and placenta.A 28 year-old Caucasian, G1P0 female at 26w4d presented to OB triage on the recommendation of her physician due to elevated uric acid levels and a recorded blood pressure of 180/110. The patient reported rapid onset of weight gain, facial edema, diminished fetal movements, and frequent headaches. Although the patient denied labor symptoms, she complained of back pain and was admitted to the hospital at 26w4d for observation due to elevated blood pressures. The patient was diagnosed with preeclampsia with severe features. As her presentation progressed, the patient developed massive ascites and pulmonary edema along with decreasing platelet counts and increasing liver enzyme values. Due to decreasing biophysical profile (BPP) scores of the fetus and decompensating lab values of the mother, an emergency cesarean was performed for the safety of mother and baby.This case presentation demonstrates the progression of hypertensive disorders of pregnancy with a rare and severe presentation of early-onset preeclampsia with severe features, pulmonary edema, and massive ascites that ultimately led to class III HELLP syndrome and extreme prematurity of the infant.

scholarly journals The Dynamics of Cullin-1 Expression in Preeclamptic Placenta and its Association with Pregnancy Termination Time

2020 ◽  
Vol 8 (B) ◽  
pp. 210-215
Author(s):  
Makbruri Makbruri ◽  
Isabella Kurnia Liem ◽  
Ahmad Aulia Jusuf ◽  
Tantri Hellyanti
Keyword(s):  
Gestational Age ◽  
Pregnancy Termination ◽  
Age Groups ◽  
Trophoblast Invasion ◽  
Age Group ◽  
Placental Development ◽  
Very Preterm ◽  
Significant Difference ◽  
Cellular Factors ◽  
Termination Time

BACKGROUND: Preeclampsia is a systemic syndrome occurring in 3–5% of pregnancies, caused by disorders of cellular factors resulting in the disruption of trophoblast differentiation and invasion which is important for the placental development and maintaining pregnancy. Cullin-1 is a protein that plays a role in the process of maintaining pregnancy, development, and trophoblast invasion in the placenta. Until now, there have been no studies linking the expression of cullin-1 in preeclamptic patients with the timing of pregnancy termination. AIM: This study analyzed cullin-1 expression in preeclamptic patients and their relationship to the timing of pregnancy termination was carried out. METHODS: Placental samples were taken from preeclampsia patients consisting of three gestational age groups, then immunohistochemical staining was performed to see the dynamics of expression and distribution in each age group of pregnancy and to find out their relationship with the timing of pregnancy termination. RESULTS: Cullin-1 was expressed in syncytiotrophoblasts and cytotrophoblasts. The lowest cullin-1 level was obtained in the very preterm age group, and the highest was found in the moderate preterm gestational age group. There was a significant difference between cullin-1 optical density (OD) expression and termination time of pregnancy, and there was a significant difference (OD) in cullin-1 preeclamptic patients with very preterm gestational age with moderate preterm gestational age. CONCLUSION: Cullin-1 was expressed both in syncytiotrophoblasts and cytotrophoblasts and was associated with the timing of pregnancy termination.

scholarly journals Association of gestational age with the option of pregnancy termination for fetal abnormalities incompatible with neonatal survival

2016 ◽  
Vol 14 (3) ◽  
pp. 311-316
Author(s):  
Flavia Westphal ◽  
Suzete Maria Fustinoni ◽  
Vânia Lopes Pinto ◽  
Patrícia de Souza Melo ◽  
Anelise Riedel Abrahão
Keyword(s):  
Gestational Age ◽  
Medical Records ◽  
Family Income ◽  
Proper Time ◽  
Pregnancy Termination ◽  
University Hospital ◽  
Alcoholic Beverages ◽  
Lower Percentage ◽  
Adult Women ◽  
Fetal Medicine

ABSTRACT Objective: To identify the profile of women seen in a Fetal Medicine unit, diagnosed with fetal abnormality incompatible with neonatal survival in their current pregnancy, and to check the association of gestational age upon diagnosis with the option of pregnancy termination. Methods: This is a retrospective cohort study carried out in the Fetal Medicine Outpatients Clinic of a university hospital, in the city of São Paulo (SP), Brazil, using medical records of pregnant women with fetus presenting abnormalities incompatible with neonatal survival. The sample comprised 94 medical records. The Statistical Package for the Social Sciences (SPSS), version 19, was used for the data statistical analysis. Results: The population of the study included young adult women, who had complete or incomplete high school education, employed, with family income of one to three minimum wages, single, nonsmokers, who did not drink alcoholic beverages or used illicit drugs. Women with more advanced gestational age upon fetal diagnosis (p=0.0066) and/or upon admission to the specialized unit (p=0.0018) presented a lower percentage of termination of pregnancy. Conclusion: Due to characteristics different from those classically considered as of high gestational risk, these women might not be easily identified during the classification of gestational risk, what may contribute to a late diagnosis of fetal diseases. Early diagnosis enables access to specialized multiprofessional care in the proper time for couple's counseling on the possibility of requesting legal authorization for pregnancy termination.

scholarly journals Maternofetal outcomes in early versus late onset pre-eclampsia: a comparative study

2019 ◽  
Vol 8 (2) ◽  
pp. 548
Author(s):  
Poornima Shankar ◽  
Kavitha Karthikeyan ◽  
Amrita Priscilla Nalini ◽  
Sindhura M. ◽  
Gowtham Kim
Keyword(s):  
Risk Factors ◽  
Gestational Age ◽  
Early Onset ◽  
Age Of Onset ◽  
Late Onset ◽  
Fetal Outcomes ◽  
Chi Square ◽  
Onset Type ◽  
Significant Difference ◽  
Early Onset Preeclampsia

Background: Preeclampsia is being increasingly recognized as two different entities: early-onset preeclampsia occurring at less than 34 weeks of gestation, and late-onset disease occurring at 34 or more weeks of gestation. Early-onset and late-onset pre-eclampsia are found to have different implications for the mother and neonate. The aim of this study is to compare the risk factors, maternal and fetal outcomes in early (<34 weeks) versus late (≥34weeks) onset preeclampsia.Methods: 208 patients diagnosed with pre-eclampsia in Chettinad Academy of Research and Education over a period of three years (From January 2014 to December 2016) were retrospectively studied. Patients were classified as early onset and late onset pre-eclampsia based on the gestational age of onset. Data on risk factors, maternal and fetal outcomes were collected and analyzed using Chi Square and Fisher’s test and compared.Results: The overall preeclampsia rate was 6.3%. Early onset and late onset were 34.6% and 65.3% respectively and the rate increased with increasing gestational age.35.3% of patients with late onset preeclampsia and 55.6% patients of early onset type required more than one drug which is a statistically significant difference. Proteinuria more than 3gm/l/day was significantly more in late onset preeclampsia than in early onset preeclampsia. 55.5% of patients with early onset pre-eclampsia required MgSO4 when compared to 17.4%. There was no statistically significant difference in the rate of caesarean section (61.1% vs 73.5%). Altered coagulation profile was significantly more in early onset preeclampsia (11.1%). The incidence of oligohydramnios, SGA and low APGAR at 5 minutes of birth were significantly high in early onset pre-eclampsia when compared to late onset type.Conclusions: Patients with early onset pre-eclampsia are found to have significantly higher rates of specific maternal and fetal morbidity when compared to the late onset type.

The Influence of Gestational Age at Diagnosis of Down Syndrome on Patientʼs Choice for Pregnancy Termination [20O]

2016 ◽  
Vol 127 ◽  
pp. 128S
Author(s):  
Steven Warsof ◽  
Sebastian Larion ◽  
Wendy DiNonno ◽  
David Peleg ◽  
Alfred Abuhamad
Keyword(s):  
Down Syndrome ◽  
Gestational Age ◽  
Pregnancy Termination ◽  
Age At Diagnosis

scholarly journals Ductus Venosus Agenesis and Fetal Malformations: Report of Four Cases

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Alexandra Matias ◽  
Diana Pacheco ◽  
Otilia Brandão ◽  
Nuno Montenegro
Keyword(s):  
Gestational Age ◽  
Umbilical Vein ◽  
Pregnancy Termination ◽  
Rare Condition ◽  
Normal Karyotype ◽  
First Trimester ◽  
The Other ◽  
Careful Examination ◽  
Ductus Venosus ◽  
Imaging Findings

Background: The agenesis of the ductus venosus (DVA) is a rare condition with a variable prognosis that relies partly on the presence of associated conditions. Therefore, the prenatal evaluation should include a careful examination of fetal circulation, particularly the umbilical and portal venous malformations.Methods In this study, we describe four cases of DVA diagnosed at our institution. For each case, we access the patient’s files in order to extract the following information: gestational age, umbilical vein connection, pre-natal imaging findings, gestational age at delivery or at pregnancy termination, fetal outcomes, post-natal imaging findings, post-mortem findings and karyotype.Results From the four cases included, two were diagnosed in the first trimester and the other two cases in the second trimester of gestation. Prenatal ultrasound studies revealed an intrahepatic shunt in one case and an extrahepatic shunt in three cases. In one case, the karyotype was not performed, whereas the other three had a normal karyotype. Cardiac anomalies were found in three of the four fetuses. All but one case presented with extracardiac abnormalities. None of the cases developed hydrops. Two cases are currently alive and well, one termination of pregnancy occurred at 25 weeks of gestation and one case died at 14 days during surgical correction of a complex cardiac malformation.Conclusions Clinicians should be aware of different and important findings during the fetal examination, which can be indicative of a DVA, and, when suspected, serial revaluations should be scheduled in order to identify any malformation.

scholarly journals Difficult Renal Pathological Classification in a Case of Pediatric Nephrotic Syndrome

2017 ◽  
Vol 7 (3) ◽  
pp. 161-166
Author(s):  
Hiroshi Yamaguchi ◽  
Atsutoshi Shiratori ◽  
Taku Nakagawa ◽  
Kyoko Kanda ◽  
Shigeo Hara ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Complete Remission ◽  
Renal Biopsy ◽  
Clinical Course ◽  
Minimal Change ◽  
Albumin Infusion ◽  
Dense Deposits ◽  
Old Japanese ◽  
Foot Process ◽  
The Impact

The underlying histopathology is very important in determining patient management, as the histopathology usually has direct repercussions on the treatment response and clinical course. However, the impact of the method used to assess renal biopsies, i.e., light microscopy (LM), immunofluorescence (IF), and electron microscopy (EM), on the occurrence of a difficult biopsy classification in the native kidneys of pediatric nephrotic patients is unknown. A 12-month-old Japanese boy was diagnosed with nephrotic syndrome (NS); he was administered prednisolone (60 mg/m2/day), and a continuous albumin infusion was started. A renal biopsy using LM revealed minimal change. However, an IF study showed granular staining for immunoglobulin G along the glomerular basement membrane. Therefore, he was diagnosed with membranous nephropathy (MN). As his proteinuria was so severe, we started immunosuppressant therapy and continued the albumin infusion for more than 2 months. However, he did not attain complete remission. A month later, EM examination of his renal biopsy showed extensive foot process fusion without electron-dense deposits. Although the result of the IF study suggested MN, the results of the LM and EM studies indicated minimal change. We finally diagnosed the patient with minimal change NS, in consideration of his clinical condition and course. Because of the failure of previous treatments, pulse steroid therapy was started. After five rounds of therapy the patient attained complete remission. A difficult renal biopsy finding classification, dependent on the diagnostic method used, might occur in the native kidneys of pediatric nephrotic patients. Therefore, a diagnosis should be made after considering all renal biopsy findings and the clinical course.

Sign in / Sign up

Export Citation Format

Share Document