scholarly journals Impacto da Corionicidade nas Complicações Perinatais da Gestação Gemelar

2017 ◽  
Vol 30 (1) ◽  
pp. 12 ◽  
Author(s):  
Marta Machado ◽  
Elsa Lima Teixeira ◽  
Lígia Maria Ferreira ◽  
Filipa Rodrigues ◽  
Raquel Henriques ◽  
...  
Keyword(s):  
Intrauterine Growth Restriction ◽  
Perinatal Outcomes ◽  
Hyaline Membrane Disease ◽  
Clinical Approach ◽  
Monochorionic Twins ◽  
Intrauterine Growth ◽  
Multiple Gestations ◽  
Tertiary Center ◽  
Significant Difference ◽  
The Impact

Introduction: The incidence of multiple gestations is increasing worldwide and many studies have shown higher perinatal morbidity and mortality rates in monochorionic twins compared to dichorionic. The aim of this study was to assess the twin population born at a tertiary center and to evaluate the impact of chorionicity on perinatal outcomes of twin pregnancies.Material and Methods: Retrospective study of all twins born in a tertiary center from January 2004 to December 2013.Results: In this period, 1051 twins were born, related to 540 gestations (26.7% monochorionic; 73.3% dichorionic). There was no statistical significant difference between the groups concerning obstetric complications. The monochorionic group had a higher incidence of intrauterine growth restriction (20.5 vs 11.3%, p < 0.001), lower mean maternal age (29.9 vs 31.9 years, p < 0.001), lower mean gestational age (33.4 vs 34.3 weeks, p < 0.05) and lower mean birth weight (1943 vs 2147 g, p < 0.001). Monochorionic twins had a higher incidence of hyaline membrane disease (7 vs 4%, p < 0.05), sepsis (10.3 vs 5.8%, p < 0.05) and anemia (9.5 vs 5.4%, p < 0.05). There were no statistical significant differences concerning necrotizing enterocolitis, intraperiventricular hemorrhage or retinopathy of prematurity. Perinatal mortality was higher in the monochorionic group (5.2 vs 2.9%, p < 0.05).Discussion: Monochorionic twins represent considerable challenges to both obstetricians and neonatologists and should be monitored and delivered at tertiary centers.Conclusion: Currently gemelarity has a major impact on total births. It would be interesting to develop protocols to standardize clinical approach to twins.

Cord Occlusion in Monochorionic Twins with Early Selective Intrauterine Growth Restriction and Abnormal Umbilical Artery Doppler: A Consecutive Series of 90 Cases

2015 ◽  
Vol 39 (3) ◽  
pp. 186-191 ◽  
Author(s):  
Mauro Parra-Cordero ◽  
Mar Bennasar ◽  
José María Martínez ◽  
Elisenda Eixarch ◽  
Ximena Torres ◽  
...  
Keyword(s):  
Intrauterine Growth Restriction ◽  
Umbilical Artery ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Ductus Venosus ◽  
Consecutive Series ◽  
Type Ii ◽  
Monochorionic Twins ◽  
Intrauterine Growth ◽  
Umbilical Artery Doppler

Objective: To describe perinatal outcomes achieved with cord occlusion (CO) in monochorionic twins with severe selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery Doppler in the IUGR twin (types II and III). Methods: We studied a consecutive series of 90 cases of sIUGR with abnormal Doppler treated with CO of the IUGR fetus. Abnormal Doppler was defined as continuous (type II, n = 41) or intermittent (type III, n = 49) absent/reversed end-diastolic flow. All cases presented at least one of the following severity criteria: gestational age (GA) <22 weeks, inter-twin estimated weight discordance >35%, reversed end-diastolic umbilical artery flow or ductus venosus pulsatility index >95th centile. We prospectively recorded pregnancy course and perinatal outcome. Results: Median GA at surgery was 20.6 weeks and mean duration 22.4 min. Miscarriage (<24 weeks) occurred in 3.3% (3/90) and preterm delivery <32 weeks in 7.1% (6/84) of continuing pregnancies. GA at delivery was 36.4 weeks and neonatal survival of the larger twin was achieved in 93.3%. Conclusion: In a consecutive series studied by an experienced team, CO in monochorionic twins with severe sIUGR type II or III was associated with delivery >32 weeks in 92.9% and neonatal survival of the normal twin in 93.3% of pregnancies.

scholarly journals Maternal and Placental Risk Factors associated with Intrauterine Growth Restriction and the Perinatal Outcomes

2015 ◽  
Vol 7 (3) ◽  
pp. 176-181 ◽  
Author(s):  
Valsa CA Thekkedathu
Keyword(s):  
Risk Factors ◽  
Statistical Analysis ◽  
Intrauterine Growth Restriction ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Chronic Hypertension ◽  
Maternal Risk ◽  
Intrauterine Growth ◽  
Factors Associated ◽  
The Impact

ABSTRACT Objectives Identifying the factors responsible for the intrauterine growth restriction (IUGR) is very important, so that early interventions could be suggested to improve the perinatal outcome. The major objectives of this study are to analyze the impact of risk factors, specifically the maternal and placental risk factors, on IUGR and the perinatal outcomes. Materials and methods A prospective study was done on 60 women with IUGR pregnancies from January 2013 to January 2014, at Pushpagiri Medical College Hospital, Thiruvalla. Inclusion criteria were: singleton pregnancies, above the gestational age of 28 weeks, clinically diagnosed IUGR and confirmed subsequently on ultrasound. The statistical analysis was performed utilizing Statistical Package of the Social Sciences (SPSS) software and the significance level of p-value < 0.05 was accepted as statistically significant. Results Statistical analysis shows that maternal risk factors like chronic hypertension, pre-eclampsia, low socioeconomic status of mother, overt diabetes, anemia, gestational diabetes mellitus, low prepregnancy body mass index and hypothyroidism were significantly associated with IUGR. In this study, placental factors like chorangiomatosis, increased syncytial knotting, villous infarction, increased perivillous fibrinoid deposition, accelerated villous maturation, retroplacental hemorrhage and acute chorioamnionitis were significantly associated with IUGR. Conclusion Alertness toward antenatal risk factors for poor pregnancy outcome is important for the optimal management of IUGR pregnancies. Despite antenatal recognition of IUGR and associated risk factors, not all perinatal deaths can be prevented. How to cite this article Thekkedathu VCA. Maternal and Placental Risk Factors associated with Intrauterine Growth Restriction and the Perinatal Outcomes. J South Asian Feder Obst Gynae 2015;7(3):176-181.

scholarly journals Diagnostic Value of Fetal Thymus Size in Intrauterine Growth Restriction

2021 ◽  
pp. 43-50
Author(s):  
Mohamed Mosaad Elshishiny ◽  
Mohamed Mohsen Elnamoury ◽  
Ayman Abd Elaziz Aldorf ◽  
Essmat Hamdy AboZeid
Keyword(s):  
Intrauterine Growth Restriction ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Control Group ◽  
Fetal Thymus ◽  
Intrauterine Growth ◽  
Doppler Study ◽  
Significant Difference ◽  
Adverse Perinatal Outcomes ◽  
Thymus Size

Background: Changes in thymus size and histopathology have been observed both in animal models of intrauterine growth restriction (IUGR). The aim of the present study was to evaluate the size of the fetal thymus by sonography in pregnancies with IUGR and to search for a possible relationship between a fetal thymus size and adverse perinatal outcomes. Methods: This prospective observational study was carried out on 100 participants who were divided into two groups. Group A: Study group which include 50 patients with IUGR. Group B: Control group which Include 50 normal patients with appropriate gestational age. All patients were subjected to: History taking: (Personal, Obstetric History, Maternal Medical History) and trans-abdominal ultrasound. Results: IUGR group show statistically significant decrease in the estimate of fetal weight (EFW) compared to the control group (P<0.05). Doppler study of umbilical artery shows significant increase of (pulsatility index (PI), resistance index (RI) and systolic/diastolic (S/D) in IUGR group when compared to control group. Doppler study of middle cerebral artery (MCA) shows significant increase in (RI, SD) in IUGR group when compared to control group while PI doesn’t show significant difference between two groups.  Thymus size decrease in IUGR group when compared to the control group. IUGR group had low survival and lower APGR Score when compared to the control group. Correlation between thymus size with the studied doppler parameters and pregnancy outcome in the current study. Umbilical Doppler RI, PI and SD showed statistically significance in this study (P<0.05) and this means that the blood flow in the umbilical arterial (UA) is important for the fetus. As regard the MCA RI and SD Doppler, they show statistically significance in this study (P<0.05) while the MCA PI Doppler did not show any statistically significance in this study (P>0.05). Conclusions: IUGR is associated with small thymus and small fetal thymus may be an early indicator of adverse perinatal outcomes in pregnancies complicated by IUGR.

Vascular anastomoses in intrauterine growth in monochorionic twins

2020 ◽  
Vol 48 (6) ◽  
pp. 539-543
Author(s):  
Michał Lipa ◽  
Przemysław Kosinski ◽  
Paweł Stanirowski ◽  
Mirosław Wielgos ◽  
Dorota Bomba-Opon
Keyword(s):  
Injection Technique ◽  
Digital Analysis ◽  
Monochorionic Twins ◽  
Intrauterine Growth ◽  
Blood Exchange ◽  
Sharing Patterns ◽  
A Prospective Study ◽  
The Impact ◽  
Umbilical Cords

AbstractObjectivesTo evaluate the impact of placental anastomoses on the intrauterine growth of monochorionic (MC) twins.MethodsA prospective study was conducted in a group of 53 MC twins. Intrapartally umbilical cords were clamped to identify placental sides corresponding to each twin. The postnatal dye injection technique was administered to evaluate vascular anastomoses, their number and type and visualize placental territory sharing patterns. Data from digital analysis were correlated with obstetrical follow-up.ResultsVascular anastomoses were revealed in 88.7% of cases. Arteriovenous (AV) anastomoses occurred in 75.4% and arterioarterial (AA) in 71.1% while venovenous (VV) in 26.4%. In the subgroup of MC twins without placental anastomoses, significantly higher birthweight difference and discordance were revealed when compared to MC twins without anastomoses (382.0 vs. 22 g; P = 0.03 and 49.14% vs. 16.02%; P = 0.03). On the other hand, in subgroups of MC twins with at least one AA anastomosis, twins’ birthweights were similar (p = ns) despite significantly higher placental territory sharing discordance (30.44% vs. 15.81%; P = 0.31).ConclusionsVascular anastomoses have a major impact on the intrauterine growth of MC twins. In certain cases, they may cause specific complications; however, in general, they regulate intertwin blood exchange and may compensate unequal placental territory.

scholarly journals 152 Impact of chorionic somatomammotropin RNA interference on uterine blood flow and placental glucose uptake in the absence of intrauterine growth restriction

2020 ◽  
Vol 98 (Supplement_4) ◽  
pp. 121-121
Author(s):  
Amelia R Tanner ◽  
Asghar Ali ◽  
Quinton A Winger ◽  
Paul J Rozance ◽  
Russell V Anthony
Keyword(s):  
Rna Interference ◽  
Glucose Uptake ◽  
Intrauterine Growth Restriction ◽  
Growth Restriction ◽  
Intrauterine Growth ◽  
Blood Flows ◽  
Umbilical Blood ◽  
Exact Function ◽  
Chorionic Somatomammotropin ◽  
The Impact

Abstract Chorionic somatomammotropin (CSH) is one of the most abundant hormones produced by the sheep placenta, yet the exact function of CSH has been elusive. Previously we reported the use of in vivo RNA interference (RNAi) to assess the impact of CSH deficiency on placental and fetal growth in sheep. Near-term (135 dGA), there are two distinct CSH RNAi phenotypes: 1) pregnancies with intrauterine growth restriction (IUGR), and 2) pregnancies with normal fetal and placental weights. This study describes physiological changes in the latter phenotype. To generate the CSH RNAi pregnancies, the trophectoderm of hatched blastocysts (9 dGA) were infected with lentiviral-constructs expressing either a scrambled control (NTS) or CSH-specific shRNA (CSH RNAi), prior to transfer into synchronized recipient ewes. At 120 dGA, 6 NTS and 6 CSH RNAi pregnancies were fitted with maternal and fetal catheters. Uterine and umbilical blood flows were measured utilizing the 3H2O transplacental diffusion technique at 132 dGA, and nutrient uptakes were calculated by the Fick principle. Resulting data were analyzed by Student’s t-test and significance was set at P ≤ 0.05. CSH RNAi tended (P ≤ 0.10) to reduce placentome weight with no effect on fetal weight. Absolute (ml/min) and relative (ml/min/kg fetus) uterine blood flows were reduced (P ≤ 0.05) in CSH RNAi pregnancies, but umbilical flows were not impacted. The uterine artery-to-vein glucose gradient (mmol/l) was significantly (P ≤ 0.05) increased, whereas the gradients for taurine and glycine were reduced (P ≤ 0.05). Uteroplacental glucose uptake (mmol/min/kg placenta) was increased 27% (P ≤ 0.05), whereas umbilical glucose uptake (mmol/min/kg fetus) was reduced 13%. This cohort demonstrates that even in the absence of IUGR, CSH deficiency has significant physiological ramifications, and the investigation of CSH RNAi pregnancies exhibiting both IUGR and non-IUGR phenotypes may help determine the direct effects of CSH and its potential impact on fetal programming. Supported by NIH R01 HD093701.

scholarly journals Maternal and perinatal outcomes of hyperthyroidsm in pregnancy at Dr. Cipto Mangunkusumo Hospital, Jakarta, period of January 2015 - December 2016

2021 ◽  
Vol 29 (1) ◽  
pp. 36
Author(s):  
Fita Maulina ◽  
M Adya F F Dilmy ◽  
Ali Sungkar
Keyword(s):  
Pregnant Women ◽  
Preterm Delivery ◽  
Intrauterine Growth Restriction ◽  
Fetal Death ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Intrauterine Fetal Death ◽  
Adequate Treatment ◽  
Intrauterine Growth ◽  
In Pregnancy

Objectives: To report maternal and perinatal outcomes of hyperthyroidsm in pregnancy.Case Report: There were 3622 cases of delivering pregnant women during the period of the study. From this number, the prevalence of pregnant women with hyperthyroid was 0.2 %. We reported 9 cases of hyperthyroid in pregnancy. The number of pregnancy complication and outcome on pregnant women with hyperthyroidism were preterm labor (44%) and preeclampsia (22%), both were found in group of mother who did taking antihyperthyroid therapy. In those who did not take antihyperthyroid therapy 11% had spontaneous abortion and 11% had preterm delivery. Fetal complications were intrauterine growth restriction (11%) and intrauterine fetal death (23%), both of these complication were on the group who did not take antihyperthyroid. On the contrary, 44% babies were born with normal birthweight in group who took antihyperthyroid.Conclusion: There were differences noted between the group that took adequate treatment and the group that did not take antihyperthyroid. The incidence of intrauterine growth restriction and intrauterine fetal death were high in group that did not took antihyperthyroid therapy but the incidence of preterm delivery as the maternal complication was high in group that did take the antihyperthyroid therapy.  

Relationship between abnormal fetal testing and adverse perinatal outcomes in intrauterine growth restriction

2007 ◽  
Vol 196 (5) ◽  
pp. e48-e51 ◽  
Author(s):  
Juan M. Gonzalez ◽  
David M. Stamilio ◽  
Serdar Ural ◽  
George A. Macones ◽  
Anthony O. Odibo
Keyword(s):  
Intrauterine Growth Restriction ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Intrauterine Growth ◽  
Adverse Perinatal Outcomes

Placental elasticity assessment by point shear wave elastography in pregnancies with intrauterine growth restriction

2019 ◽  
Vol 47 (8) ◽  
pp. 841-846 ◽  
Author(s):  
Murat Akbas ◽  
Faik M. Koyuncu ◽  
Burcu Artunç-Ulkumen
Keyword(s):  
Pregnant Women ◽  
Shear Wave ◽  
Intrauterine Growth Restriction ◽  
Perinatal Outcomes ◽  
Shear Wave Elastography ◽  
Growth Restriction ◽  
Intrauterine Growth ◽  
The Mean ◽  
Adverse Perinatal Outcomes ◽  
Doppler Indices

Abstract Background Placental elasticity varies in different diseases. Our objective was to evaluate placental elasticity using point shear wave elastography (pSWE) in pregnancies with intrauterine growth restriction (IUGR). Methods A total of 66 pregnant women with IUGR and 81 healthy pregnant women were enrolled. Placental elasticity was measured using the transabdominal pSWE method. Ten measurements were made, and the mean was accepted as the mean placental elasticity value in each case. The results for IUGR pregnancies and controls were compared. Results The mean pSWE values were significantly higher in pregnancies with IUGR, which means that women with IUGR have stiffer placentas (P < 0.001). Furthermore, the pSWE values were significantly and positively correlated with Doppler indices and adverse perinatal outcomes. Conclusion The pregnancies with IUGR had stiffer placentas than the healthy controls. The utilization of pSWE for placental elasticity may be useful in the diagnosis and management of IUGR as a supplement to the existing ultrasonography methods.

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