scholarly journals Fetal death: an extreme manifestation of maternal anti-fetal rejection

2017 ◽  
Vol 45 (7) ◽  
Author(s):  
Kia Lannaman ◽  
Roberto Romero ◽  
Tinnakorn Chaiworapongsa ◽  
Yeon Mee Kim ◽  
Steven J. Korzeniewski ◽  
...  
Keyword(s):  
Cohort Study ◽  
Amniotic Fluid ◽  
Study Design ◽  
Fetal Death ◽  
Unknown Etiology ◽  
Amniotic Cavity ◽  
Inflammatory Lesions ◽  
Esi Ms ◽  
Chemokine Ligand ◽  
Placental Inflammation

AbstractObjective:The aim of this study was to determine the association between chronic placental inflammation and amniotic fluid (AF) markers of maternal anti-fetal rejection as well as the presence of microorganisms in the AF fluid of patients with fetal death.Study Design:This cohort study included 40 patients with fetal death whose placentas were examined for chronic inflammatory lesions and whose AF chemokine ligand (CXCL)10 and interleukin (IL)-6 concentrations were determined by immunoassays. AF was processed for bacteria, mycoplasmas and viruses using cultivation and molecular microbiologic techniques (i.e. PCR-ESI/MS).Results:(1) The most prevalent placental findings were maternal vascular underperfusion (63.2%, 24/38), followed by chronic inflammatory lesions (57.9%, 22/38); (2) chronic chorioamnionitis (18/38) was three times more frequent than villitis of unknown etiology (6/38); (3) an elevated AF CXCL10 concentration (above the 95Conclusion:In women with unexplained fetal death, there is an association between elevated AF CXCL10 and chronic placental inflammatory lesions. Therefore, we conclude that a subset of patients with fetal death may have endured a breakdown of maternal-fetal tolerance, which cannot be attributed to microorganisms in the amniotic cavity.

scholarly journals Disorders of placental villous maturation in fetal death

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Sunil Jaiman ◽  
Roberto Romero ◽  
Percy Pacora ◽  
Eunjung Jung ◽  
Gaurav Bhatti ◽  
...  
Keyword(s):  
Cohort Study ◽  
Fetal Death ◽  
Prevalence Ratio ◽  
Normal Pregnancy ◽  
Observational Cohort Study ◽  
Maturation Arrest ◽  
Inflammatory Lesions ◽  
Multiple Gestations ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Abstract Objective The aims of this study were to ascertain the frequency of disorders of villous maturation in fetal death and to also delineate other placental histopathologic lesions in fetal death. Methods This was a retrospective observational cohort study of fetal deaths occurring among women between January 2004 and January 2016 at Hutzel Women’s Hospital, Detroit, MI, USA. Cases comprised fetuses with death beyond 20 weeks’ gestation. Fetal deaths with congenital anomalies and multiple gestations were excluded. Controls included pregnant women without medical/obstetrical complications and delivered singleton, term (37–42 weeks) neonate with 5-min Apgar score ≥7 and birthweight between the 10th and 90th percentiles. Results Ninety-two percent (132/143) of placentas with fetal death showed placental histologic lesions. Fetal deaths were associated with (1) higher frequency of disorders of villous maturation [44.0% (64/143) vs. 1.0% (4/405), P < 0.0001, prevalence ratio, 44.6; delayed villous maturation, 22% (31/143); accelerated villous maturation, 20% (28/143); and maturation arrest, 4% (5/143)]; (2) higher frequency of maternal vascular malperfusion lesions [75.5% (108/143) vs. 35.7% (337/944), P < 0.0001, prevalence ratio, 2.1] and fetal vascular malperfusion lesions [88.1% (126/143) vs. 19.7% (186/944), P < 0.0001, prevalence ratio, 4.5]; (3) higher frequency of placental histologic patterns suggestive of hypoxia [59.0% (85/143) vs. 9.3% (82/942), P < 0.0001, prevalence ratio, 6.8]; and (4) higher frequency of chronic inflammatory lesions [53.1% (76/143) vs. 29.9% (282/944), P < 0.001, prevalence ratio 1.8]. Conclusion This study demonstrates that placentas of womem with fetal death were 44 times more likely to present disorders of villous maturation compared to placentas of those with normal pregnancy. This suggests that the burden of placental disorders of villous maturation lesions is substantial.

scholarly journals The Nicaraguan pediatric influenza cohort study: design, methods, use of technology, and compliance

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Aubree Gordon ◽  
Guillermina Kuan ◽  
William Aviles ◽  
Nery Sanchez ◽  
Sergio Ojeda ◽  
...  
Keyword(s):  
Cohort Study ◽  
Study Design ◽  
Design Methods ◽  
Use Of Technology ◽  
Cohort Study Design

Oligohydramnion in the First Half of Pregnancy in the Fetuses with Congenital Abnormalities: Ultrasound Diagnostics and Obstetric Outcomes

2021 ◽  
Vol 76 (4) ◽  
pp. 341-350
Author(s):  
Sergey M. Voevodin ◽  
Tatiana V. Shemanaeva ◽  
Alyona V. Serova
Keyword(s):  
Amniotic Fluid ◽  
Congenital Malformations ◽  
Fetal Death ◽  
Congenital Abnormalities ◽  
Neonatal Period ◽  
Perinatal Outcomes ◽  
Main Group ◽  
Obstetric Outcomes ◽  
Fetal Abnormalities ◽  
4D Ultrasound

Background.Oligohydramnion in the first half of pregnancy, combined with congenital abnormalities in the fetus has objective difficulties in diagnosis. The morphology features and type of defects associated with oligohydramnion, which manifests in the first half of pregnancy, are not sufficiently studied at the present stage. Aims to evaluate the clinical significance of diagnosing oligohydramnion in the first half of pregnancy in women with congenital fetal malformations. Materials and methods.The analysis of the course of pregnancy and perinatal outcomes in 77 women with low water content in combination with congenital malformations of the fetus and 72 patients with a normal amount of amniotic fluid and no congenital malformations of the fetus was performed. The patients of the main group were divided into two subgroups depending on the severity of oligohydramnion: the 1st subgroup (n = 54) patients with severe oligohydramnion and the 2nd subgroup (n = 23) patients with moderate oligohydramnion. The amount of amniotic fluid was determined by 3D/4D ultrasound (1321 weeks of gestation) and the structure of fetal abnormalities associated with oligohydramnion was analyzed. We evaluated perinatal outcomes in women with congenital malformations of the fetus in combination with oligohydramnion and the effect of its severity on the outcome of pregnancy. Results.In the main group (n = 77), fetal abnormalities were detected in patients: urinary system 39 (50.6%), respiratory system 4 (5.2%), heart 1 (1.3%), chromosomal and genetic abnormalities 14 (18.2%), central nervous system 3 (3.9%), osseous system 3 (3.9%), multiple 13 (16.9%). In the main group (n = 77), pregnancy was terminated for medical indications in 47 (61%) cases, in 6 (7.8%) spontaneous miscarriage occurred, in 5 (6.5%) antenatal fetal death. 19 (24.7%) children were born alive, and surgical treatment in the neonatal period was required in 8 (10.4%) cases. In the 1st subgroup (n = 54) in 53 (98.1%) cases, there was a loss of the fetus, in 1 (1.9%) the newborn died on the 9th day. In the 2nd subgroup (n = 23), fetal death occurred in 5 (21.7%) cases, 18 (78.3%) children were born alive, and 8 (44.4%) newborns were operated on in the neonatal period. In the control group, all pregnancies ended with the birth of healthy children. A decrease in ultrasound imaging of internal organs in the fetus was observed when a pregnant woman was obese (BMI more than 35). Conclusions.Oligohydramnion in the first half of pregnancy in combination with fetal malformation should be considered an extremely unfavorable clinical sign for the prognosis of pregnancy and the health of the fetus and newborn. 3D/4D ultrasound scanning allows you to reliably determine oligohydramnion in the first half of pregnancy, and the degree of its severity to assume the nature of complications.

Fertility Treatments and the Risk of Preterm Birth Among Women with Subfertility: A Linked-Data Retrospective Cohort Study

2021 ◽  
Author(s):  
Jessica N Sanders ◽  
Sara E Simonsen ◽  
Christina A Porucznik ◽  
Ahmad O Hammoud ◽  
Ken Smith ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
In Vitro Fertilization ◽  
Retrospective Cohort ◽  
Fetal Death ◽  
Perinatal Outcomes ◽  
Birth Certificates ◽  
Vitro Fertilization ◽  
Fertility Treatments

Abstract Background: In vitro fertilization (IVF) births contribute to a considerable proportion of preterm birth (PTB) each year. However, there is no formal surveillance of adverse perinatal outcomes for less invasive fertility treatments. The study objective was to determine the effect of fertility treatment (in vitro fertilization, intrauterine insemination, usually with ovulation drugs (IUI), or ovulation drugs alone) on preterm birth, compared to no treatment in subfertile women.Methods: The Fertility Experiences Study (FES) is a retrospective cohort study conducted at the University of Utah between April 2010 and September 2012. Women with a history of primary subfertility self-reported treatment data via survey and interviews. Participant data were linked to birth certificates and fetal death records to asses for perinatal outcomes, particularly preterm birth.Results: A total 487 birth certificates and 3 fetal death records were linked as first births for study participants who completed questionnaires. Among linked births, 19% had a PTB. After adjustment for maternal age, paternal age, maternal education, annual income, religious affiliation, female or male fertility diagnosis, and duration of subfertility, the odds ratios and 95% confidence intervals (CI) for PTB were 2.17 (CI: 0.99, 4.75) for births conceived using ovulation drugs, 3.17 (CI: 1.4, 7.19) for neonates conceived using IUI and 4.24 (CI: 2.05, 8.77) for neonates conceived by IVF, compared to women with subfertility who used no treatment during the month of conception. A reported diagnosis of female factor infertility increased the adjusted odds of having a PTB 2.99 (CI: 1.5, 5.97). Duration of pregnancy attempt was not independently associated with PTB. In restricting analyses to singleton gestation, odds ratios remained elevated but were not significant for any type of treatment.Conclusion: IVF, IUI, and ovulation drugs were all associated with a higher incidence of preterm birth and low birth weight, predominantly related to multiple gestation births.

Review of Modern Management of the Rh Problem, by John T. Queenan, M.D. New York: Harper and Row (Hoeber Medical Division), 1967, 318 pp., $12.50

PEDIATRICS ◽  
1968 ◽  
Vol 42 (2) ◽  
pp. 379-379
Author(s):  
Thomas E. Cone
Keyword(s):  
New York ◽  
Amniotic Fluid ◽  
Fetal Death ◽  
Modern Management ◽  
Medical Division

Pity the busy practicing obstetrician who tries to keep up with the latest on the management of the "Rh problem" in his practice. Whereas once, there were only two Rh types, Rh positive and Rh negative, now there are more than two dozen, of which at least six can cause problems, though most rather rarely. And, there is a 20% danger of fetal death which may now be foretold by pigment changes in the amniotic fluid. So amniocentesis is an important prognostic measure.

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