Maternal-fetal medicine (Wolters Kluwer Health, Inc.)最新文献

{"title":"Risk Factors and Pregnancy Outcome in Women with a History of Cesarean Section Complicated by Placenta Accreta","authors":"Yi Liang, Lizi Zhang, Shilei Bi, Jingsi Chen, Shanshan Zeng, Lijun Huang, Yulian Li, Minshan Huang, Hu Tan, Jinping Jia, S. Wen, Zhijian Wang, Yinli Cao, Shao-shuai Wang, Xiaoyan Xu, Ling Feng, Xianlan Zhao, Yangyu Zhao, Qiying Zhu, H. Qi, Lanzhen Zhang, Hong‐tian Li, L. Du, Dunjin Chen","doi":"10.1097/FM9.0000000000000142","DOIUrl":"https://doi.org/10.1097/FM9.0000000000000142","url":null,"abstract":"Abstract Objective: To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta (PA). Methods: This case-control study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. According to the intraoperative findings after delivery, the study population was divided into PA and non-PA groups. We compared the pregnancy outcomes between the two groups, used multivariate logistic regression to analyze the risk factors for placental accreta. Results: For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage (236/10,205, 2.31% vs. 283/869, 32.57%), severe postpartum hemorrhage (89/10,205, 0.87% vs. 186/869, 21.75%), diffuse intravascular coagulation (3/10,205, 0.03% vs. 4/869, 0.46%), puerperal infection (33/10,205, 0.32% vs. 12/869, 1.38%), intraoperative bladder injury (1/10,205, 0.01% vs. 16/869, 1.84%), hysterectomy (130/10,205, 1.27% vs. 59/869, 6.79%), and blood transfusion (328/10,205,3.21% vs. 231/869,26.58%) was significantly increased in the PA group (P < 0.05). At the same time, the neonatal birth weight (3250.00 (2950.00–3520.00) g vs. 2920.00 (2530.00–3250.00) g), the probability of neonatal comorbidities (245/10,205, 2.40% vs. 61/869, 7.02%), and the rate of neonatal intensive care unit admission (817/10,205, 8.01% vs. 210/869, 24.17%) also increased significantly (P < 0.05). Weight (odds ratio (OR) = 1.03, 95% confidence interval (CI): 1.01–1.05)), parity (OR = 1.18, 95%CI: 1.03–1.34), number of miscarriages (OR = 1.31, 95%CI: 1.17–1.47), number of previous cesarean sections (OR = 2.57, 95%CI: 2.02–3.26), history of premature rupture of membrane (OR = 1.61, 95%CI: 1.32–1.96), previous cesarean-section transverse incisions (OR = 1.38, 95%CI: 1.12–1.69), history of placenta previa (OR = 2.44,95%CI: 1.50–3.96), and the combination of prenatal hemorrhage (OR = 9.95,95%CI: 8.42–11.75) and placenta previa (OR = 91.74, 95%CI: 74.11–113.56) were all independent risk factors for PA. Conclusion: There was an increased risk of adverse outcomes in pregnancies complicated by PA in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with PA in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placentab accreta in pregnancies of women with a history of cesarean section.","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42826579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single vs. Recurrent Episodes of Preeclampsia-population–based Epidemiological and Clinical Characteristics","authors":"S. Mastrolia, Boris Taran, Eric Kachko, O. Mor, Ruth Beer-Wiesel, Tamar Eshkoli, D. Dukler, Shayna Miodownik, O. Erez","doi":"10.1097/FM9.0000000000000082","DOIUrl":"https://doi.org/10.1097/FM9.0000000000000082","url":null,"abstract":"Abstract Objective: The aims of this study were to determine the differences between women with single vs. recurrent episodes of preeclampsia in term of: (1) the outcome of the first pregnancy affected by preeclampsia; and (2) the perinatal outcomes of subsequent pregnancies. Methods: This population based retrospective cohort study included all multiparous patients with a singleton gestation who delivered at Soroka University Medical Center (Beer Sheva, Israel) from January 1988 until December 2012, meeting the inclusion criteria, those who had fetuses with chromosomal or anatomical abnormalities were exclude. Our cohort included 213,558 deliveries that met the inclusion criteria, of them 208,017 had normotensive pregnancies and 5541 had preeclampsia. The latter group was further divided into those who had a single episode of preeclampsia followed by normotensive gestations (n = 3879), and women who had recurrent preeclampsia (n = 1662). We used parametric and non-parametric statistics as appropriate. Results: (1) Women with recurrent preeclampsia had an increased rate of early ((130/1662) 7.8% vs. (171/3879) 4.4%, P < 0.001) and late ((268/1662) 16.1% vs. (438/3879) 11.3%, P < 0.001) preterm deliveries than a single episode of preeclampsia; (2) of interest, the rate of chronic hypertension is higher in the first pregnancy of those with a single preeclampsia episode (P < 0.001), while women with recurrent preeclampsia developed it in the subsequent gestations (P < 0.001); (3) the rate of small for gestational age neonates in the index pregnancy was higher in those with recurrent rather than a single episode of preeclampsia (single episode 450/3879,11.6%, recurrent preeclampsia 244/1662, 14.7%, P = 0.002); (4) patients with recurrent disease had an increased rate of cesarean deliveries in the subsequent pregnancies (P < 0.001); and (5) patients who developed severe preeclampsia in the subsequent gestations had lower mean birthweight (P < 0.001), a higher rate of perinatal mortality (P < 0.001), and a lower Apgar score at 1 and 5 minutes (P < 0.001), than those who developed mild preeclampsia in subsequent pregnancies, those with a single episode of preeclampsia and the control group. Conclusion: Recurrent preeclampsia increases the rate of pregnancy complications in the following gestations. Early onset preeclampsia at the index pregnancy of women with recurrent preeclampsia, is associated with increased risk for severe preeclampsia, placental abruption and perinatal mortality in subsequent pregnancies.","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49088531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dysregulated Hepatic Expression of Glucose Transporter Type-1, Toll-Like Receptor 4, and Nuclear Factor Kappa B in Estrogen-Induced Cholestasis Pregnant Rats with Placental Ischemia-Reperfusion Stress","authors":"Fangni Zhou, Huafang Chen, Dan Shan, Yuxia Wu, Qian Chen, Yayi Hu","doi":"10.1097/FM9.0000000000000079","DOIUrl":"https://doi.org/10.1097/FM9.0000000000000079","url":null,"abstract":"Abstract Objective: This study aimed at investigating the expression of nuclear factor kappa B (NF-κB) and mammalian target of rapamycin (mTOR) related signal pathways in liver tissues of intrahepatic cholestasis of pregnancy animal models. Methods: Estrogen (EE)-induced cholestasis and a placental ischemia-reperfusion (IR) model were established in pregnant rats. All pregnant rats were divided into four groups by random number table: EE-IR group (n = 6), EE-sham group (n = 6), control-IR group (n = 6) and control-sham group (n = 6). Liver expression of mTOR, its upstream regulator DNA damage response-1 (REDD1), and downstream factor glucose transporter type-1 (GLUT1), accompanied by NF-κB (p65 is the most important component), its activator toll-like receptor 4 (TLR4), and inhibitor IκBα, were detected by western blot analysis and real-time polymerase chain reaction. The intergroup comparisons were performed with a one-way analysis of variance, the comparisons among groups were analyzed with the nonparametric Kruskal-Wallis test. Results: Giving pregnant rats EE alone reduced the hepatic expression of IκBα (0.72 ± 0.20 vs. 1.01 ± 0.07, P = 0.008). Meanwhile, giving pregnant rats placental IR alone increased liver levels of REDD1 (3.24 ± 0.98 vs. 1.06 ± 0.24, P = 0.025), GLUT1 (2.37 ± 0.82 vs. 1.09 ± 0.10, P = 0.039), TLR4 (2.12 ± 0.29 vs. 1.20 ± 0.28, P = 0.010), and p65 (2.09 ± 0.85 vs. 1.04 ± 0.06, P = 0.023), and decreased hepatic mTOR (0.50 ± 0.07 vs. 1.01 ± 0.03, P = 0.001) and IκBα (0.61 ± 0.08 vs. 1.01 ± 0.07, P = 0.014) expression. Subjecting EE-treated rats to placental IR did not further alter liver levels of GLUT1 (2.02 ± 0.45 vs. 1.79 ± 0.39, P = 0.240), TLR4 (2.10 ± 0.74 vs. 1.60 ± 0.36, P = 0.129), or p65 (2.41 ± 0.83 vs. 1.65 ± 0.46, P = 0.145), whereas it did decrease hepatic mTOR (0.42 ± 0.09 vs. 0.90 ± 0.14, P = 0.008) and IκBα (0.43 ± 0.09 vs. 0.72 ± 0.20, P = 0.004) expression and enhance REDD1 expression (4.46 ± 0.65 vs. 2.05 ± 0.47, P = 0.009). Placental IR stress did impact the hepatic expression of REDD1-mTOR-GLUT1 and TLR4/NF-κB/IκBα in pregnant rats. Conclusion: Placental IR-induced hepatic GLUT1, TLR4, and p65 alternation, which responded efficiently in control rats, were impaired in EE-induced ICP rats.","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41462180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Follow-up Study on the Outcomes of Recovered Pregnant Women with a History of COVID-19 in the First and Second Trimesters: A Case Series from China.","authors":"Yin Zhao,&nbsp;Bangxing Huang,&nbsp;Hui Ma,&nbsp;You Shang,&nbsp;Xiu Nie,&nbsp;Li Zou","doi":"10.1097/FM9.0000000000000080","DOIUrl":"https://doi.org/10.1097/FM9.0000000000000080","url":null,"abstract":"<p><strong>Objective: </strong>To determine the pregnancy and neonatal outcomes of women who recovered from coronavirus disease 2019 (COVID-19) that developed in early pregnancy.</p><p><strong>Methods: </strong>This case series analyzed five pregnant women (26-33 years) whom recovered from COVID-19 which were developed in early pregnancy (6-27 weeks) and admitted at the Wuhan Union Hospital from January 15, 2020 to April 30, 2020. The clinical manifestation, laboratory examinations, treatment, pregnancy outcomes, maternal and neonatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throat swab reverse transcription polymerase chain reaction test results, and SARS-CoV-2 antibody test results in neonates were reviewed. The placental pathology, placental angiotensin-converting enzyme 2 expression were studied by hematoxylin-eosin and immunohistochemistry staining, SARS-CoV-2 presence was examined by QT-PCR. We also followed up the infants at 3-6 months.</p><p><strong>Results: </strong>Three pregnant women were diagnosed with COVID-19 in early pregnancy (Cases 1-3), and two were serum immunoglobulin G positive asymptomatic cases (Cases 4 and 5). Cases 1-3 showed complete recovery after severe COVID-19. Case 3 was infected at 6 weeks of gestation during the first trimester and had induced medical abortion at 12 weeks of gestation. All neonates had no pneumonia, SARS-CoV-2 mRNA reverse transcription polymerase chain reaction and serum immunoglobulin M were negative, and immunoglobulin G were positive. All placental samples were negative for SARS-CoV-2 in the nucleic acid test. Placental pathology showed chronic ischemia changes. ACE-2 expressed in both placenta and decidua. The follow-up showed that the infants were healthy and asymptomatic at 3-6 months.</p><p><strong>Conclusion: </strong>No adverse outcomes was observed in our case series. However, systemic inflammatory responses to SARS-CoV-2 infection may cause placental injury. At the time of delivery after recovery from COVID-19, no SARS-CoV-2 positive results was found in the placenta in this case series.</p>","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6c/fa/mfm-3-24.PMC8428491.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39419202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Length at 28–32 Weeks of Gestation Predicts Preterm Birth","authors":"Menglei Zhang, Xiao-xiao Zhang, Huixia Yang, C. Shi","doi":"10.1097/FM9.0000000000000074","DOIUrl":"https://doi.org/10.1097/FM9.0000000000000074","url":null,"abstract":"Abstract Objective: To evaluate the ability of cervical length (CL) at 28–32 weeks of gestation to predict spontaneous preterm delivery and preterm premature rupture of membranes (PPROM). Methods: It was a retrospective cohort study that vaginal ultrasonography at approximately 28–32 weeks of gestation was performed in 14,953 women between 17–49 years old with singleton pregnancies who delivered after 28 weeks of gestation at the Peking University First Hospital from June 2008 to December 2012. The pregnancy outcomes were followed and the relationship between the CL and preterm delivery or PPROM was assessed. The relative risk was calculated to assess group differences in the likelihood of an event occurring. Results: The overall prevalence of preterm delivery was 5.7% (858/14,953); the incidence for therapeutic preterm delivery was 2.1% (318/14,953), for spontaneous preterm delivery was 0.9% (133/14,953), and for PPROM was 2.7% (407/14,953). Excluding the 318 women who had therapeutic preterm delivery, the relative risk of preterm delivery for women with a CL between 25 mm and <30 mm, between 15 mm and <25 mm, and <15 mm was 3.7, 9.3, and 30.2, respectively. The sensitivity, specificity, and positive and negative predictive values of CL ≤25 mm at 28–32 weeks of gestation as the cut-off value for predicting preterm delivery were 19.8%, 97.5%, 23.4%, and 96.9%, respectively. For preterm delivery before 35 weeks of gestation, the sensitivity, specificity, and positive and negative predictive values of a CL ≤ 25 mm at 28–32 weeks of gestation as the cut-off value were 30.0%, 97.2%, 11.8%, and 99.1%, respectively. In addition, women with PPROM (n = 407) had significantly shorter CL (31.9 ± 7.4) mm at 28–32 weeks of gestation compared that of women without PPROM (34.0 ± 8.3) mm. The incidence of PPROM in women with a CL≤25 mm at 28–32 weeks of gestation (19.4%, 79/407) was significantly lower than that for women with a CL >25 mm (80.6%, 328/407, P < 0.05). Conclusion: CL at 28–32 weeks of gestation can predict spontaneous preterm delivery, and is valuable for predicting PPROM.","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47215604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction of Maternal-Fetal Medicine Centers in the Netherlands","authors":"D. Oepkes, F. Slaghekke","doi":"10.1097/fm9.0000000000000060","DOIUrl":"https://doi.org/10.1097/fm9.0000000000000060","url":null,"abstract":"","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45550980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Value of Artery Umbilical Cord Blood Gas in Predicting Neonate Condition: A Prospective Cohort Study","authors":"Xing Xin, Wei-xin Lu, Chun-hua Ye, Hong Du, Shao-shuai Wang, Ling Feng","doi":"10.1097/FM9.0000000000000073","DOIUrl":"https://doi.org/10.1097/FM9.0000000000000073","url":null,"abstract":"Abstract Objective: To evaluate the predictive ability of neonate condition through the traditional parameters and artery umbilical cord blood gas (aUCBG). Methods: A prospective cohort study was conducted in obstetrics and gynecology department between October 2017 and August 2018 at Tongji Hospital in Wuhan, China, and 360 aUCBG samples were collected. The average age of pregnant women was (29.50 ± 4.42) years, range from 19 to 48 years old. The gestational age range from 28+4 weeks to 41+3 weeks at admission. Logistic regression and area under the curve (AUC) from Receiver operating characteristic curves were used to identify risk factors, such as, premature rupture of membranes (PROM), high blood pressure, premature delivery (PD), low 1-minute Apgar scores (Apgar 1), low 5-minute Apgar scores (Apgar 5), pH, base excess, bicarbonate, neonatal blood sugar (NBS), and so on, to predict neonatal condition and evaluate the predictive ability of traditional and aUCBG parameters. Results: In all cases, PROM, PD, Apgar 1, Apgar 5, pH, base excess, bicarbonate, total carbon dioxide, and neonatal blood sugar were risk factors and were associated with poor condition of neonate. Apgar 1 were an independent risk factor. Combined traditional and aUCBG parameters had higher AUC of 0.895 (95% confidence interval (CI): 0.830–0.960, P < 0.001). In cesarean section subgroup, high blood pressure, PD, and Apgar 1 were risk factors and were associated with poor condition of neonate. Apgar 1 and low pH were the independent risk factors. Combined traditional and aUCBG parameters had highest AUC of 0.940 (95% CI: 0.886–0.993, P < 0.001). In vaginal delivery subgroup, maternal age above 35 years, PROM, PD, Apgar 1, Apgar 5, and male newborn were risk factors and were associated with poor condition of neonate. Maternal age above 35 years was an independent risk factor. Combined traditional and aUCBG parameters had highest AUC of 0.897 (95% CI: 0.828–0.965, P < 0.001). For pregnant women without comorbidities and complications of pregnancy, aUCBG may not be necessary. Conclusion: In high-risk pregnancies, especially lower Apgar scores, PD, and maternal age above 35-year old, aUCBG is recommended. Traditional parameters combined with aUCBG might increase the predicting ability of neonate condition.","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48249956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human Coronavirus Infections and Pregnancy.","authors":"Shangrong Fan, Shaomei Yan, Xiaoping Liu, Ping Liu, Lei Huang, Suhua Wang","doi":"10.1097/FM9.0000000000000071","DOIUrl":"10.1097/FM9.0000000000000071","url":null,"abstract":"<p><p>Human coronavirus (HCoV) causes potentially fatal respiratory disease. Pregnancy is a physiological state that predisposes women to viral infection. In this review, we aim to present advances in the pathogenesis, clinical features, diagnosis, and treatment in HCoV in pregnancy. We retrieved information from the Pubmed database up to June 2020, using various search terms and relevant words, including coronaviruses, severe acute respiratory syndrome coronavirus, Middle East respiratory syndrome coronavirus, 2019 coronavirus disease, and pregnancy. Both basic and clinical studies were selected. We found no evidence that pregnant women are more susceptible to HCoV infection or that those with HCoV infection are more prone to developing severe pneumonia. There is also no confirmed evidence of vertical mother-to-child transmission of HcoV infection during maternal HCoV infection. Those diagnosed with infection should be promptly admitted to a negative-pressure isolation ward, preferably in a designated hospital with adequate facilities and multi-disciplinary expertise to manage critically ill obstetric patients. Antiviral treatment has been routinely used to treat pregnant women with HCoV infection. The timing and mode of delivery should be individualized, depending mainly on the clinical status of the patient, gestational age, and fetal condition. Early cord clamping and temporary separation of the newborn for at least 2 weeks is recommended. All medical staff caring for patients with HCoV infection should use personal protective equipment. This review highlights the advances in pathogenesis, maternal-fetal outcome, maternal-fetal transmission, diagnosis and treatment in HCoV including severe acute respiratory syndrome coronavirus, Middle East respiratory syndrome coronavirus, and coronavirus disease 2019 in pregnancy.</p>","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bd/fb/mfm-3-53.PMC7834663.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39124633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Placenta Accreta Spectrum: Conservative Management and Its Impact on Future Fertility","authors":"Riwa A. Abbas, A. Nassar","doi":"10.1097/FM9.0000000000000077","DOIUrl":"https://doi.org/10.1097/FM9.0000000000000077","url":null,"abstract":"Abstract Placenta accreta spectrum is a complication of pregnancy, which poses a great risk on maternal health. Historically, hysterectomy was the modality of treatment of such condition, but an approach towards a more conservative management has been in the light recently. This includes several methods with varying rates of success and complications. Expectant management is effective in up to 78%–80% of the cases. The extirpative method is associated with a high risk of postpartum hemorrhage. The success of the one-step conservative procedure depends on the degree of placental invasion, and the triple-P procedure appears to be successful but requires and interdisciplinary approach. Adjuvant treatment options can be tailored according to individual cases, and these include methotrexate injection, uterine devascularization and hysteroscopic resection of retained placental tissues. Follow up after conservative management is crucial to detect complications early, and it can be done by ultrasound, Doppler examination, and trending β human chorionic gonadotropin levels. Conservative management of placenta accreta spectrum can preserve future fertility but should only be done in hospitals with enough experience as it carries a high risk of maternal complications. In the future, more research should be directed to achieve clear guidelines regarding this topic.","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41522796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal Phenotype and Prenatal Diagnosis of Kabuki Syndrome","authors":"Yan Pan, Hong Yao, Gongli Chen, Qiong Tan, Qing Chang, Yong-yi Ma, Zhiqing Liang","doi":"10.1097/FM9.0000000000000070","DOIUrl":"https://doi.org/10.1097/FM9.0000000000000070","url":null,"abstract":"Abstract Kabuki syndrome (MIM 147920) is an autosomal dominant rare disease featured with multiple malformations and mental retardation. The main clinical manifestations of Kabuki syndrome are characteristic facial features, skeletal abnormalities, dermatoglyphic abnormalities, postpartum growth retardation, mild to moderate mental retardation, as well as other structural and functional abnormalities that may involve multiple systems. The establishment of diagnosis needs to be combined with clinical phenotype and the discovery of pathogenic mutation. Compared with the abundant descriptions and records of genotype-phenotype of postpartum patients, few prenatal diagnosis cases of Kabuki syndrome had been reported, which partially result from lacking the knowledge of its phenotype in fetuses that might suggest the diagnosis. This report performed comprehensive prenatal examinations to identify a fetus's etiology with multiple structural anomalies characterized by ascites, thickening of local skin, and cardiac abnormalities. We ruled out intrauterine infection, thalassemia, and chromosome abnormality by corresponding tests. Finally, trio whole-exome sequencing revealed a de novo heterozygous variation c.15641g > A (p.r5214h) in exon 48 of the KMT2D gene was the fetus's genetic pathogeny causing Kabuki syndrome. This result suggests that Kabuki syndrome should be in the suspected etiology list for prenatal hydrops/ascites. Our study confirmed that prenatal whole-exome sequencing is an efficient tool for diagnosing fetal abnormalities, and a multidisciplinary team is necessary for providing pregnancy guidance to patients.","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48009872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}