scholarly journals Non-immune fetal hydrops in late pregnancу: antenatal ultrasound monitoring and pregnancy outcomes in a series of 14 cases

2021 ◽  
Vol 29 (3) ◽  
pp. 101-115
Author(s):  
I.М. Safonova ◽  
O.Р. Sharmazanova ◽  
M.O. Bortniy ◽  
V.V. Shapovalova
Keyword(s):  
Clinical Features ◽  
Pregnancy Outcomes ◽  
Parvovirus B19 ◽  
Venous Pressure ◽  
Hydrops Fetalis ◽  
Complete Regression ◽  
Fetal Hydrops ◽  
Circulating Blood Volume ◽  
Antenatal Ultrasound ◽  
Ultrasound Monitoring

Background. Fetal hydrops is the accumulation of extracellular fluid in two or more fetal cavities, often in combination with subcutaneous edema. An isolated accumulation of fluid only in the abdominal, pleural, or pericardial cavities is described as ascites, pleural effusion (hydrothorax), pericardial effusion (hydropericardium). Features of the pathogenesis of non-immune hydrops fetalis (NIHF) are the follow: high hydrophilicity of fetal tissues, obstruction of the lymphatic vessels, impaired lymph return, congestive heart failure, obstruction of venous return, changes in fetal venous pressure. All these factors lead to the release of fluid from cells and tissues into the «third» spaces – the abdominal, thoracic, pericardial cavities, as well as the subcutaneous space. The oncotic pressure of fetal plasma proteins is not of great importance in the formation of the fetal circulating blood volume. Currently, all the links in the pathogenesis of hydrops fetalis syndrome with various etiological factors are not fully known. The prevalence of NIHF is unknown because it is difficult to collect relevant data; many cases of the disease are not diagnosed until intrauterine fetal death or may spontaneously resolve during the prenatal period. Currently, up to 90% of all cases of fetal dropsy are attributed to NIHF. Purpose – acquaintance of the medical community with the diagnosis and treatment of non-immune hydrops as well as the analysis of clinical features, ultrasound monitoring and perinatal outcomes of 14 cases of non-immune fetal hydrops onset in a second half of pregnancy. Materials and methods. The material for the study were publications and results of clinical trials found in the databases Scopus, Web of Science Core Collection and PubMed for the period 2009–2020 and the analytic report of the own series of 14 cases of non-immune hydrops fetalis (NIHF) of various origins. During the period of 2005–2020 under the supervision in the Ultrasound Department of Kharkiv regional hospital with regional perinatal center there were 14 pregnant women with NIHF diagnosed in a second half of pregnancy. Clinical features are described, ultrasound images and Doppler monitoring are given, perinatal / postnatal results are studied. Results and discussion. The analysis of clinical features, ultrasound monitoring and pregnancy outcomes of 14 cases of non-immune fetal hydrops developed in the second half of pregnancy in presented series was carried out. 6/14 fetuses had structural anatomical defects (lung sequestration, СDH, myasthenia gravis, megacystis and hydronephrosis, epidermolysis bullosa, meconium peritonitis, intestinal atresia). Mortality rate (including perinatal and infant losses) was as high as 9/14 cases (64.2%): 3 of antenatal, 4 of neonatal, 2 of infant death). Surgical treatment was performed on 2 newborns. 5 newborns had apparently a favorable clinical postnatal outcome. In 2 cases, spontaneous resolution with complete regression of hydrops was observed (parvovirus-B19 and idiopathic NIHF). Complete recovery of fetus (spontaneous regression of hydrops without any deterioration and pathological consequences) was observed in 1 case. Conclusions. Antenatal ultrasound monitoring of fetus with NIHF is based on the assessment of PSV CMA, ductus venous, umbilical vein, atrioventricular flow. According to the results of the study, it was revealed that the cardiovascular profile of the fetus with NIHF is disturbed earlier, and the placental profile and arterial Doppler-later. Normal umbilical artery Doppler do not exclude the possibility of an adverse outcome, including intrauterine fetal demise. Extended Doppler monitoring is essential at NIHF. All neonates with NIHF in an antenatal anamnesis require postnatal follow-up.

Clinical Features of 10 Fetuses With Prenatally Diagnosed Parvovirus B19 Infection and Fetal Hydrops

2014 ◽  
Vol 34 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Kyu-Sang Kyeong ◽  
Hye-Sung Won ◽  
Mi-Young Lee ◽  
Jae-Yoon Shim ◽  
Pil Ryang Lee ◽  
...  
Keyword(s):  
Clinical Features ◽  
Parvovirus B19 ◽  
Fetal Hydrops ◽  
Parvovirus B19 Infection

Identifying the etiologic role of Parvovirus B19 in non-immune hydrops fetalis by histopathology, immunohistochemistry and nucleic acid testing: a retrospective study

Open Medicine ◽  
2007 ◽  
Vol 2 (3) ◽  
pp. 271-279 ◽  
Author(s):  
Koray Ergunay ◽  
Gulcin Altinok ◽  
Bora Gurel ◽  
Ahmet Pinar ◽  
Arzu Sungur ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Real Time ◽  
San Francisco ◽  
Real Time Pcr ◽  
Nested Pcr ◽  
Parvovirus B19 ◽  
Etiologic Agent ◽  
Hydrops Fetalis ◽  
Nucleic Acid Detection

AbstractIntrauterine Parvovirus B19 infections may cause fetal anemia, non-immune hydrops fetalis or abortion. This study focuses on the pathogenic role of Parvovirus B19 in non-immune hydrops fetalis at Hacettepe University, a major reference hospital in Turkey. Twenty-two cases of non-immune hydrops fetalis were retrospectively selected out of a total of 431 hydrops fetalis specimens from the Department of Pathology archieves. Paraffine embedded tissue sections from placental and liver tissues from each case were evaluated by histopathology, immunohistochemistry, nested PCR and commercial quantitative Real-time PCR. Viral DNA was detected in placental tissues by Real-time PCR in 2 cases (2/22, 9.1%) where histopathology also revealed changes suggestive of Parvovirus B19 infection. No significant histopathologic changes were observed for the remaining sections. Nested PCR that targets the VP1 region of the viral genome and immunohistochemistry for viral capsid antigens were negative for all cases. As a result, Parvovirus B19 is identified as the etiologic agent for the development of non-immune hydrops fetalis for 9.1% of the cases in Hacettepe University, Turkey. Real-time PCR is observed to be an effective diagnostic tool for nucleic acid detection from paraffine embedded tissues. Part of this study was presented as a poster at XIIIth International Congress of Virology, San Francisco, USA (Abstract V-572).

Cardiac output, GFR, and renal excretion rates during maintained volume load in rats

1978 ◽  
Vol 235 (6) ◽  
pp. H670-H676 ◽  
Author(s):  
U. Ackermann
Keyword(s):  
Cardiac Output ◽  
Blood Volume ◽  
Renal Excretion ◽  
Venous Pressure ◽  
Circulating Blood Volume ◽  
Reservoir Volume ◽  
Volume Load ◽  
Blood Volume Expansion ◽  
Highly Correlated ◽  
Excretion Rates

The correlation among cardiac output (CO), glomerular filtration rate (GFR), fractional tubular sodium rejection (TFRNa), and renal excretion rates of water and salt was investigated during ischemic blood volume expansion in rats. Initially circulating blood volume was equilibrated isovolemically with a reservoir volume of 6% albumin solution equal to one-third the estimated blood volume. Later the equilibrated reservoir contents were infused intravenously. CO was measured by thermodilution, GFR by inulin clearance. Significant linear correlations existed between GFR and the rates of urine flow (r = 0.90), sodium excretion (r = 0.75) and potassium excretion (r = 0.76) that prevailed 5--10 min after a given GFR change. The increased GFR was highly correlated with CO (r = 0.94), probably correlated with mean central venous pressure (r = 0.45), but not correlated with mean abdominal aortic blood pressure. The correlation between CO and time-delayed (5--10 min) TRFNa was also highly significant (r = 0.98). The saluresis appears to have been caused initially by increased tubular load and subsequently by decreased absolute tubular reabsorption.

Atrial Flutter in Infancy: Diagnosis, Clinical Features, and Treatment

PEDIATRICS ◽  
1985 ◽  
Vol 75 (4) ◽  
pp. 725-729
Author(s):  
Ann Dunnigan ◽  
D. Woodrow Benson ◽  
David G. Benditt
Keyword(s):  
Central Venous Pressure ◽  
Atrial Flutter ◽  
Clinical Features ◽  
Normal Sinus Rhythm ◽  
Venous Pressure ◽  
Atrial Pacing ◽  
Central Venous ◽  
Normal Sinus ◽  
Successful Termination ◽  
Asymptomatic Infant

The clinical features and treatment of atrial flutter in eight infants (four male and four female) less than 2 months of age are presented. Atrial flutter was noted during the first week of life in six of the infants and between 6 and 8 weeks of life in the other two infants. Four of the eight infants had associated structural or functional cardiovascular disease, and in three infants a central venous pressure catheter was present in the atrium at the time atrial flutter was diagnosed. Classic flutter waves were apparent on 12-lead ECGs in only two infants. In six infants, flutter waves were not obvious on standard ECGs, but transesophageal electrogram recordings demonstrated the presence of atrial flutter with second degree atrioventricular block. The atrial cycle length during flutter ranged from 135 to 180 ms (mean 149 ms; mean atrial rate 403 beats per minute); there was a 2:1 ventricular response to atrial flutter. Successful termination of atrial flutter was accomplished using three modes of electrical cardioversion in seven of the eight infants: direct curent cardioversion in one, transvenous atrial pacing in one, and transesophageal atrial pacing in five. One asymptomatic infant converted to normal sinus rhythm 24 hours following digoxin administration. One infant had multiple atrial flutter recurrences and required chronic procainamide therapy. In seven of the eight infants, no recurrences have been noted in 6 months to 31/2 years of follow-up. These results demonstrate that atrial flutter may be difficult to diagnose in infants with tachycardia unless transesophageal electrogram recording is utilized for evaluation. In these eight infants, atrial flutter was frequently associated with underlying cardiac disease and/or the presence of central venous pressure catheters in the atrium. Acute treatment with electrical conversion was sufficient in most infants; only one infant required chronic drug therapy to prevent recurrences of atrial flutter.

Nonimmune Hydrops Fetalis

1987 ◽  
Vol 9 (6) ◽  
pp. 197-202
Author(s):  
Barbara C. McGillivray ◽  
Judith G. Hall
Keyword(s):  
Mortality Rate ◽  
Cardiac Rhythm ◽  
Hydrops Fetalis ◽  
Entire Body ◽  
Serous Fluid ◽  
Fetal Hydrops ◽  
Abnormal Accumulation ◽  
Metabolic Screening ◽  
Nonimmune Hydrops ◽  
Blood Grouping

Hydrops fetalis or fetal hydrops is defined as a generalized abnormal accumulation of serous fluid in the entire body including abnormal collection in tissues and body cavities. It is not a specific disease but the end result of many fetal conditions. Presentation may be prenatal with ultrasound diagnosis on at the time of delivery. There are many causes of fetal hydrops including cardiac, pulmonary, chromosomal, hematologic, and metabolic. The mortality rate is high, with the best survival in those infants who have cardiac rhythm abnormalities. Proper assessment of the infant with hydrops requires familiarity with the major causes and a stepwise protocol for investigation. Not only are the usual blood-grouping studies important, but also chromosomal analysis, metabolic screening, and carefully performed autopsy. The aim of the protocol that is suggested is to improve intrauterine detection and survival after birth and to ascertain the cause of the condition to aid in counseling and care in subsequent pregnancies.

Cardiorespiratory Status of Erythroblastotic Newborn Infants: III. Intravascular Pressures During the First Hours of Life

PEDIATRICS ◽  
1976 ◽  
Vol 58 (4) ◽  
pp. 484-493
Author(s):  
Roderic H. Phibbs ◽  
Paul Johnson ◽  
Joseph A. Kitterman ◽  
George A. Gregory ◽  
William H. Tooley ◽  
...  
Keyword(s):  
Central Venous Pressure ◽  
Blood Volume ◽  
High Pressures ◽  
Venous Pressure ◽  
Newborn Infants ◽  
Hydrops Fetalis ◽  
Central Venous ◽  
Myocardial Failure ◽  
Prematurely Born Infants

We measured aortic and central venous pressures beginning soon after birth in 40 prematurely born infants with moderate or severe erythroblastosis fetalis, including 13 with severe and 10 with mild hydrops fetalis. All but four were asphyxiated at birth and this affected intravascular pressures. Before resuscitation, aortic or central venous pressure or both were elevated in more than one third. All but two of the remaining infants had normal initial pressures. Following resuscitation which relieved acidosis, hypoxia, and anemia, but did not reduce blood volume, the high pressures usually fell to normal and occasionally to subnormal levels, normal pressures fell to subnormal in almost one half, and those with initial subnormal pressures remained hypotensive. In all, 40% were hypotensive after resuscitation; treatment with blood volume expanders consistently returned these pressures to normal. Only two of the 13 severely hydropic infants and none of the mildly hydropic had findings indicative of hypervolemia and myocardial failure which persisted after treatment of asphyxia.

Disorders of the red cell membrane

2020 ◽  
pp. 5456-5463
Author(s):  
Patrick G. Gallagher
Keyword(s):  
Cell Membrane ◽  
Clinical Features ◽  
Parvovirus B19 ◽  
Clinical Manifestations ◽  
Peripheral Blood Smear ◽  
Membrane Lipid ◽  
Red Cell ◽  
Red Cell Membrane ◽  
Membrane Lipid Bilayer ◽  
Parvovirus B19 Infection

The integrity of the red cell membrane depends on molecular interactions between proteins and the phospholipid membrane: vertical interactions stabilize the membrane lipid bilayer; horizontal interactions provide resistance against shear stress. Hereditary spherocytosis—affects 1 in 25 000 individuals of northern European descent. There is typically a dominant family history, but the condition is genetically heterogeneous: combined spectrin and ankyrin deficiency is the most common defect observed, followed by band 3 deficiency, isolated spectrin deficiency, and protein 4.2 deficiency. These affect vertical membrane interactions with loss of surface area relative to red cell volume. Clinical features—the key clinical manifestations are anaemia and signs of persistent haemolysis, with jaundice and a marked propensity to gallstones. Complications and treatment—parvovirus B19 infection of erythropoietic precursors may cause acute aplastic crises. Megaloblastic anaemia due to folate deficiency occurs in response to increased requirements during growth and pregnancy, but is preventable with supplementation. Splenectomy can alleviate the anaemia in many patients and reduces the risk of gallstones. Hereditary elliptocytosis—occurs with a frequency of 1 in 2000 to 1 in 4000 worldwide, and is more frequent in parts of Africa. The inheritance is usually dominant, with defects in red cell proteins such as α‎- and β‎-spectrin causing disturbances in horizontal interactions in the erythrocyte membrane. Clinical features, diagnosis, and treatment—most patients are asymptomatic and are typically diagnosed incidentally during testing for unrelated conditions, but about 10% experience haemolysis, anaemia, splenomegaly, and intermittent jaundice. Diagnosis is based on the presence of elliptocytes on a peripheral blood smear. Treatment is rarely required. Other conditions include hereditary pyropoikilocytosis, South-East Asian (or Melanesian) ovalocytosis, stomatocytosis, and acanthocytosis.

ECHOGRAPHIC AND CLINICAL FEATURES OF CERVICAL CANCER

2020 ◽  
Vol 93 (1) ◽  
pp. 46-48
Author(s):  
Dilfuzaxon Mamarasulova ◽  
◽  
Dilnoza Isakova ◽  
Habibaxon Negmatshayeva ◽  
Albina Validova ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Disease Progression ◽  
Clinical Features ◽  
Malignant Tumors ◽  
Cancer Center ◽  
Optimal Methods ◽  
Ultrasound Monitoring ◽  
Methods Of Treatment

This article discusses the clinical and echodopplerographic features of cervical cancer, which allows to improve the differential, topical and clarifying diagnosis of malignant tumors of the uterus. The material for the study included 115 patients with cervical cancer who applied to the Andijan branch of the cancer center. The revealed clinical and echodopplerographic features of СС made it possible to predict the course, outcome of the disease and to choose the optimal methods of treatment. Ultrasound monitoring of patients with СС, allows to assess the effectiveness of treatment and timely detect metastases and disease progression.

scholarly journals Analysis of the clinical features of pericentric inversion of chromosome 9

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095782
Author(s):  
Xiaolei Xie ◽  
Fuguang Li ◽  
Weihe Tan ◽  
Jiang Tang
Keyword(s):  
Amniotic Fluid ◽  
Clinical Features ◽  
Pregnancy Outcomes ◽  
Pericentric Inversion ◽  
Adverse Pregnancy Outcome ◽  
Normal Population ◽  
Chorionic Villus ◽  
Clinical Impact ◽  
Chromosome 9 ◽  
Adverse Pregnancy

Objective The pericentric inversion of chromosome 9 (inv9) is one of the most common structural balanced chromosomal variations, and it is considered to be a normal population variant. The aim of this study was to re-evaluate the clinical impact of patients with inv9. Methods We studied the karyotypes from 4853 patients at a single center and retrospectively reviewed their clinical data. Results There were 67 inv9 patients among 2988 adults, and 62 of them showed different clinical features, including male and female infertility, oligoasthenozoospermia, and azoospermia. Thirty-one cases of inv9 were found in 1865 fetuses, including two cases in chorionic villus (6.90%) and 29 in amniotic fluid (1.67%), but there were no cases in umbilical cord blood. The rates of fetal phenotype abnormal and adverse pregnancy outcome with inv9 in the chorionic villus were 100.00% (2/2), while only 17.24% (5/29) in the amniotic fluid showed abnormalities, among which 60.00% (3/5) had adverse pregnancy outcomes. Conclusions Although there is no clear evidence that inv9 is pathogenic, the genetic counseling on inv9 in early pregnancy and adults needs to be given more attention.

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