scholarly journals Severe Neonatal Anemia Due to Spontaneous Massive Fetomaternal Hemorrhage at Term: An Illustrative Case with Suspected Antenatal Diagnosis and Brief Review of Current Knowledge

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1285
Author(s):  
Nicolae Gică ◽  
Radu Botezatu ◽  
Mihaela Demetrian ◽  
Ana Maria Vayna ◽  
Brîndușa Ana Cimpoca-Raptis ◽  
...  
Keyword(s):  
Antenatal Diagnosis ◽  
Current Knowledge ◽  
Peak Systolic Velocity ◽  
Clinical Findings ◽  
Illustrative Case ◽  
Maternal Circulation ◽  
Fetal Demise ◽  
Fetomaternal Hemorrhage ◽  
Fetal Movements ◽  
High Index Of Suspicion

Fetomaternal hemorrhage is defined as transfer of fetal blood into placental circulation and therefore into maternal circulation during pregnancy, and represents an important contributor to intrauterine fetal demise and neonatal death. The condition is rarely diagnosed prenatally because clinical findings are often nonspecific, and it is unpredictable. In this paper we present an illustrative case of massive spontaneous fetomaternal hemorrhage where the diagnosis was highly suspected antenatally based on maternal reported reduced fetal movements, abnormal suggestive cardiotocographic trace, and increased peak systolic velocity in the fetal middle cerebral artery. We discuss obstetrical and neonatal management and review the current knowledge in the literature. Maintaining a high index of suspicion for this condition allows the obstetrician to plan for adequate diagnostic tests, arrange intrauterine treatment or delivery, and prepare the neonatal team.

scholarly journals Massive fetomaternal hemorrhage as a cause of severe fetal anemia

2016 ◽  
Vol 73 (11) ◽  
pp. 1068-1071
Author(s):  
Aleksandar Dobrosavljevic ◽  
Jelena Martic ◽  
Snezana Rakic ◽  
Vladimir Pazin ◽  
Svetlana Jankovic-Raznatovic ◽  
...  
Keyword(s):  
Fetal Hemoglobin ◽  
Test Case ◽  
Fetal Anemia ◽  
Fetal Blood ◽  
Maternal Circulation ◽  
Uterine Contractions ◽  
Fetomaternal Hemorrhage ◽  
Fetal Movements ◽  
Life Threatening ◽  
Red Cell Transfusion

Introduction. Fetomaternal hemorrhage (FMH) is a transfu-sion of fetal blood into the maternal circulation. A volume of transfused fetal blood required to cause severe, life-threatening fetal anemia, is not clearly defined. Some authors suggest vol-umes of 80 mL and 150 mL as a threshold which defines mas-sive FMH. Therefore, a rate of massive FMH is 1 : 1,000 and 1 : 5,000 births, respectively. Fetal and neonatal anemia is one of the most serious complications of the FMH. Clinical manifesta-tions of FMH are nonspecific, and mostly it presented as re-duced fetal movements and changes in cardiotocography (CTG). The standard for diagnosing FMH is Kleihaurer-Betke test. Case report. A 34-year-old gravida (G) 1, para (P) 1 was hospitalized due to uterine contractions at 39 weeks of gesta-tion. CTG monitoring revealed sinusoidal fetal heart rate and clinical examination showed complete cervical dilatation. Im-mediately after admission, the women delivered vaginally. Ap-gar scores were 1 and 2 at the first and fifth minute, respec-tively. Immediately baby was intubated and mechanical ventila-tion started. Initial analysis revealed pronounced acidosis and severe anemia. The patient received intravenous fluid therapy with sodium-bicarbonate as well as red cell transfusion. With all measures, the condition of the baby improved with normaliza-tion of hemoglobin level and blood pH. Kleihaurer-Betke test revealed the presence of fetal red cells in maternal circulation, equivalent to 531 mL blood loss. The level of maternal fetal hemoglobin (HbF) and elevated alpha fetoprotein also con-firmed the diagnosis of massive FMH. Conclusion. For the successful diagnosis and management of FMH direct commu-nication between the obstetrician and the pediatrician is neces-sary as presented in this report.

Massive Perivillous Fibrin Deposition and Chronic Histiocytic Intervillositis a Complication of SARS-CoV-2 Infection

2021 ◽  
pp. 109352662110207
Author(s):  
T Marton ◽  
B Hargitai ◽  
K Hunter ◽  
M Pugh ◽  
P Murray
Keyword(s):  
Placental Insufficiency ◽  
Intrauterine Death ◽  
Fibrin Deposition ◽  
Fetal Demise ◽  
Trophoblastic Cells ◽  
Stage Disease ◽  
Villous Trophoblast ◽  
Fetal Movements ◽  
Active Viral Replication ◽  
End Stage

An emerging complication of COVID-19 (SARS-CoV-2) infection is reported. A 23-year-old patient presented with high temperature and reduced fetal movements at 25 + 5/40 weeks of gestation. RT-PCR proved maternal COVID-19 infection. Ultrasound examination confirmed intrauterine death. Placenta histology showed necrosis of the villous trophoblast, associated with Chronic Histiocytic Intervillositis (CHI) and Massive Perivillous Fibrin Deposition (MPFD) with up to 90% - of the intervillous spaces being involved. Immunohistochemistry showed CD68 positive histiocytes in the intervillous spaces and the villous trophoblast was positive for the COVID-19 spike protein. RNA scope signal was indicative of the presence of the viral genome and active viral replication in the villous trophoblastic cells, respectively. MPFD is a gradually developing end-stage disease with various etiology, including autoimmune and alloimmune maternal response to antigens expressed at the feto-maternal interface and frequently accompanies chronic alloimmune villitis or histiocytic intervillositis. Covid-19 infection is associated with similar pattern of histological changes of the placenta leading to placental insufficiency and fetal death. This case report supports maternal- fetal vertical transmission of SARS-CoV-2 virus leading to placental insufficiency and fetal demise. MPFD and CHI appear to be the typical placental histology for SARS-CoV-2 virus infection associated fetal demise.

Personalized knowledge push system based on design intent and user interest

2015 ◽  
Vol 230 (11) ◽  
pp. 1757-1772 ◽  
Author(s):  
Zhan-Song Wang ◽  
Ling Tian ◽  
Yuan-Hao Wu ◽  
Bei-Bei Liu
Keyword(s):  
Knowledge Acquisition ◽  
Conceptual Design ◽  
Current Knowledge ◽  
Target Function ◽  
Design Knowledge ◽  
Prototype System ◽  
Sorting Algorithm ◽  
Illustrative Case ◽  
User Interest ◽  
Design Intent

Existing knowledge provides important reference for designers in mechanical design activities. However, current knowledge acquisition methods based on information retrieval have the problem of inefficiency and low precision, which mainly meet the requirement for knowledge coverage. To improve the efficiency of knowledge acquisition and ensure the availability of design knowledge, this paper proposes a knowledge push service method based on design intent and user interest. First, the design intent model, which is mainly the formal expression of the target function of conceptual design, is built. Second, the user interest model that consists of domain themes and operation logs is built, and an automatic updating method of user interest is proposed. Third, a matching method of design knowledge based on design intent, and a sorting algorithm of knowledge candidates based on user interest are proposed to realize personalized knowledge active push service. Finally, a prototype system called Personalized Knowledge Push System for Mechanical Conceptual Design (MCD-PKPS) is implemented. An illustrative case demonstrates that the proposed method can successfully improve the efficiency and availability of knowledge acquisition.

scholarly journals Pompe Disease: Cyanosed Hypotonic Infant with Normal Respiratory Rate

2017 ◽  
Vol 13 (2) ◽  
pp. 172-174 ◽  
Author(s):  
S. Koirala ◽  
A. Poudel ◽  
R. Basnet ◽  
K. Subedi
Keyword(s):  
Respiratory Rate ◽  
Pompe Disease ◽  
Clinical Findings ◽  
Diagnostic Challenge ◽  
Floppy Infant ◽  
History Of ◽  
Infantile Pompe Disease ◽  
High Index Of Suspicion ◽  
To Receive ◽  
Remote Part

Infantile hypotonia or floppy infant is a diagnostic challenge when it presents with other presenting complaints such as fever, cough or diarrhea. Many times the hypotonia goes unnoticed when other symptom covers the hypotonia and child continues to receive the treatment for other symptoms. We report a rare case from Nepal of infantile Pompe disease who presented with the history of fever and cough in the recent earthquake disaster camp at remote part of Sindhupalchowk, Nepal. He was being treated as a case of pneumonia.Pompe disease can be diagnosed clinically by taking detailed history and correlating the clinical findings during the presentation with other symptoms. In our case the normal respiratory rate, reduced Spo2 and presence of crackles dominated the hypotonia and was mistreated as pneumonia. High index of suspicion is necessary in diagnosing Pompe disease.

scholarly journals Acute and Chronic Fetal Anemia as a Result of Fetomaternal Hemorrhage

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Paul Singh ◽  
Tara Swanson
Keyword(s):  
Fetal Heart ◽  
Fetal Anemia ◽  
Fetal Blood ◽  
Maternal Circulation ◽  
Unique Case ◽  
Diastolic Velocity ◽  
Fetomaternal Hemorrhage ◽  
Ultrasound Findings ◽  
Perinatal Management ◽  
Cerebral Vascular Resistance

Introduction.Fetomaternal hemorrhage represents a transfer of fetal blood to the maternal circulation. Although many etiologies have been described, most causes of fetomaternal hemorrhage remain unidentified. The differentiation between acute and chronic fetomaternal hemorrhage may be accomplished antenatally and may influence perinatal management.Case.A 36-year-old gravida 6 para 3 presented at 37 and 5/7 completed gestational weeks with ultrasound findings suggestive of chronic fetal anemia such as right ventricular enlargement, diminished cerebral vascular resistance, and elevated middle cerebral artery end-diastolic velocity. On the other hand, signs of acute fetal decompensation such as deterioration of the fetal heart tracing, diminished biophysical score, decreased cord pH, and increased cord base deficit were noted. Following delivery, the neonate’s initial hemoglobin was 4.0 g/dL and the maternal KB ratio was 0.015 indicative of a significant fetomaternal hemorrhage.Discussion.One should consider FMH as part of the differential diagnosis for fetal or immediate neonatal anemia. We describe a unique case of FMH that demonstrated both acute and chronic clinical features. It is our hope that this case will assist practitioners in differentiating acute FMH that may require emergent delivery from chronic FMH which may be able to be expectantly managed.

scholarly journals Umbilical true knot: a case study

2018 ◽  
Vol 7 (7) ◽  
pp. 2956
Author(s):  
Hima Bindu Kommuri ◽  
Valsa Diana G.
Keyword(s):  
Risk Factors ◽  
Umbilical Cord ◽  
Rare Condition ◽  
Fetal Outcome ◽  
Prenatal Ultrasonography ◽  
Male Fetus ◽  
Fetal Demise ◽  
Intrauterine Fetal Demise ◽  
Fetal Movements

Umbilical cord true knot is a rare condition which affects about 1% of all pregnancies. The incidence is not only very low, but it is often undiagnosed antenatally when present despite the availability of prenatal ultrasonography as in this case, where the diagnosis of true knot of umbilical cord was missed even when an ultrasonogram was done 1 week prior to the presentation of patient with decreased fetal movements to opd. Majority of times it does not have any relation with fetal outcome but in certain occasions it is associated with intrauterine fetal demise as in present case presented here. Risk factors include long umbilical cord, polyhydramnios, small fetus, male fetus, etc.

scholarly journals How I treat thrombotic thrombocytopenic purpura in pregnancy

Blood ◽  
2020 ◽  
Vol 136 (19) ◽  
pp. 2125-2132
Author(s):  
Barbara Ferrari ◽  
Flora Peyvandi
Keyword(s):  
Differential Diagnosis ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Current Knowledge ◽  
Fetal Outcome ◽  
Subsequent Pregnancy ◽  
Thrombocytopenic Purpura ◽  
Severe Deficiency ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
In Pregnancy

Abstract Thrombotic thrombocytopenic purpura (TTP) is an acute, life-threatening thrombotic microangiopathy (TMA) caused by acquired or congenital severe deficiency of ADAMTS13. Pregnancy is a recognized risk factor for precipitating acute (first or recurrent) episodes of TTP. Differential diagnosis with other TMAs is particularly difficult when the first TTP event occurs during pregnancy; a high index of suspicion and prompt recognition of TTP are essential for achieving a good maternal and fetal outcome. An accurate distinction between congenital and acquired cases of pregnancy-related TTP is mandatory for safe subsequent pregnancy planning. In this article, we summarize the current knowledge on pregnancy-associated TTP and describe how we manage TTP during pregnancy in our clinical practice.

Normal Development and Malformations of the Cerebellar Cortex

2003 ◽  
Vol 16 (3) ◽  
pp. 383-391
Author(s):  
B. Bernardi ◽  
F. Roncaroli
Keyword(s):  
Cerebellar Cortex ◽  
Normal Development ◽  
Current Knowledge ◽  
Clinical Findings ◽  
Cellular Organization ◽  
Developmental Abnormalities ◽  
Cerebellar Malformations ◽  
The Central Nervous System

The cerebellum is one of the first structures of the central nervous system that begins differentiation and one of the last to reach maturity. Neurogenesis of granular neurons is largely postnatal and cellular organization continues several months after birth. This protracted maturation causes susceptibility to developmental abnormalities. Such abnormalities encompass structural malformations and even cerebellar tumors. Current knowledge on the development of the cerebellar cortex is increasing. Cerebellar cortex development includes proliferation, migration, neuronal differentiation, guided axonal growth, neuronal map formation and synaptogenesis. These steps follow different timing and modalities compared to neocortex. The high resolution Magnetic Resonance (MR) improved the in vivo depiction of the cerebellar cortex and its developmental malformations. Correlation between neuroimaging and clinical findings as well as neurogenetic allowed practical classification of cerebellar malformations. The proposed morphology-based classifications appear incomplete and need continuous revision. In this review, we have followed a neuroradiological schema in order to reconcile previous classifications. Sviluppo normale e malformazioni della corteccia cerebellare

scholarly journals The Unpredictability of Idiopathic Membranous Nephropathy: An Illustrative Case Report

2018 ◽  
Vol 8 (2) ◽  
pp. 103-106
Author(s):  
Murray L. Levin ◽  
Shubhada Ahya
Keyword(s):  
Nephrotic Syndrome ◽  
Case Report ◽  
Complete Remission ◽  
Female Patient ◽  
Membranous Nephropathy ◽  
Low Dose ◽  
Conservative Therapy ◽  
Current Knowledge ◽  
Illustrative Case ◽  
Cytomegalovirus Colitis

The case of a female patient with primary membranous nephropathy is presented. She was treated with corticosteroids and chlorambucil after conservative therapy had failed and went into remission for 5 years. Her nephrotic syndrome recurred but did not respond to the same regimen. She had another complete remission after treatment with corticosteroids and cyclosporine, but the nephrosis recurred after 7 years. Again, she failed to respond with retreatment of steroids plus cyclosporine. She was treated with alternate-day steroid plus mycophenolate and, once again, had a complete remission. She was maintained on low-dose mycophenolate for 7 more years. The mycophenolate had to be discontinued because of cytomegalovirus colitis. Treatment with ganciclovir abolished the colitis. She is still in remission 10 years later. The case is discussed with regard to current knowledge of the immune pathogenesis of membranous nephropathy as well as the unknowns of the immunogenesis of the disease.

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