Objective: This study aimed to determine the effect of fetal movements on the MCA pulsatility index (PI) and quantify the fall of MCA PI after initiation of fetal movements and/or breathing, and the time taken to reco...Objective: This study aimed to determine the effect of fetal movements on the MCA pulsatility index (PI) and quantify the fall of MCA PI after initiation of fetal movements and/or breathing, and the time taken to recover from a fall below the 5th percentile. Methods: 16 women with appropriate for gestational age (AGA) fetuses and 16 women with small for gestational age (SGA) fetuses were recruited. MCA PI during “no movement” state was compared with MCA PI values during fetal body movements and breathing movements. Results: MCA PI measurements with body or breathing movements were significantly (p 0.005) lower as compared to that observed without movements. MCA PI started rising immediately after cessation of body movements and/or breathing movements. Conclusions: MCA PI with fetal body or breathing movements is significantly lower as compared to that observed in the quiet state. If MCA PI measurement is below 5th centile, it should be measured again up to 90 seconds after cessation of fetal body and/or breathing movements in order to minimize false positive diagnosis of cerebral sparing effect in SGA as well as AGA fetuses.展开更多
We aimed to establish gestation age specific reference intervals for Doppler indices of fetal cardiac function from 12 to 40 weeks of pregnancy. In a cross-sectional observational study of singleton pregnancies, exami...We aimed to establish gestation age specific reference intervals for Doppler indices of fetal cardiac function from 12 to 40 weeks of pregnancy. In a cross-sectional observational study of singleton pregnancies, examinations were performed in 221 women evenly distributed across each week of pregnancy. Blood flow through the four cardiac valves was examined with Doppler. For the atrioventricular valves, velocity and duration of early (E) and atrial (A) waves and the interval (a) between E/A complexes was recorded. For the outflow valves, the duration (b), peak and average velocity of flow in systole was measured. Myocardial performance index (MPI) was calculated as (a - b)/b. Outlet valve diameters were measured and cardiac outputs were calculated. Gestation age specific ranges were constructed for all these parameters. We demonstrated that the cardiac output, peak systolic and time-averaged velocity increase with advancing gestation. However the MPI and E/A ratios show little change across gestation. Fetal cardiac physiology can be studied and Doppler indices reliably measured as early as the late first trimester of pregnancy. Establishing gestation age specific ranges for various cardiac indices throughout pregnancy will help the study of development of fetal cardiac function.展开更多
Postmenopausal bleeding is a very common and alarming symptom accounting for 5 percent of all gynecological outpatients’ clinic attendances. This cross-section study was conducted in the Department of Obstetrics and ...Postmenopausal bleeding is a very common and alarming symptom accounting for 5 percent of all gynecological outpatients’ clinic attendances. This cross-section study was conducted in the Department of Obstetrics and Gynecology </span><span style="font-family:Verdana;">at University Hospitals and included 176 patients with perimenopausal bleeding </span><span style="font-family:Verdana;">who attended a patient clinic during the period from January 2017 to May 2019. All patients were subjected to transvaginal ultrasound, saline sonohysterography and out-patient endometrial sampling using pipelle;all the results were compared to histopathology obtained by hysteroscopic guided biopsy and/or hysterectomy. </span><b><span style="font-family:Verdana;">Result: </span></b><span style="font-family:Verdana;">In comparing the validity of TVS and SHG we found highly significant decrease in malignancy assessment in </span><span><span style="font-family:Verdana;">the TVS method compared to hysteroscopic-guided biopsy. According to the validity of pipelle in detection of malignant lesion, it was found to detect 80 cases out of 88 cases of malignancy with sensitivity 90.9%, specificity 100% and 95.45% accuracy with respect to histopathology by hysteroscopy guided biopsy and/or hysterectomy. Combination tests were done between SHG and pipelle and we found that the validity of combination tests in detecting malignancy improves the sensitivity and specificity in detection of malignancy sensitivity = 100% and specificity = 100% and this was found to be as an effective method in detection of malignancy. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> When SHG combined to outpatient endometrial sampling “pipelle”, the results were the same as hysteroscopy.展开更多
Preeclampsia(PE)is a pregnancy-specific syndrome,complicating 2%-8% of pregnancies.PE is a major cause of maternal mortality throughout the world with 60000 maternal deaths attributed to hypertensive disorders of preg...Preeclampsia(PE)is a pregnancy-specific syndrome,complicating 2%-8% of pregnancies.PE is a major cause of maternal mortality throughout the world with 60000 maternal deaths attributed to hypertensive disorders of pregnancy.PE also results in fetal morbidity due to prematurity and fetal growth restriction.The precise aetiology of PE remains an enigma with multiple theories including a combination of environmental,immunological and genetic factors.The conventional and leading hypotheses for the initial insult in PE is inadequate trophoblast invasion which is thought to result in incomplete remodelling of uterine spiral arteries leading to placental ischaemia,hypoxia and thus oxidative stress.The significant heterogeneity observed in pre-eclampsia cannot be solely explained by the placental model alone.Herein we critically evaluate the clinical(risk factors,placental blood flow and biomarkers)and pathological(genetic,molecular,histological)correlates for PE.Furthermore,we discuss the role played by the(dysfunctional)maternal cardiovascular system in the aetiology of PE.We review the evidence that demonstrates a role for both the placenta and the cardiovascular system in early-and late-onset PE and highlight some of the key differences between these two distinct disease entities.展开更多
This case report concerns a 25-year-old patient with6-7 bloody stools/d, abdominal pain, tachycardia,and weight loss occurring during the third trimester of pregnancy. Severe ulcerative colitis complicated by toxic me...This case report concerns a 25-year-old patient with6-7 bloody stools/d, abdominal pain, tachycardia,and weight loss occurring during the third trimester of pregnancy. Severe ulcerative colitis complicated by toxic megacolon and gravidic sepsis was diagnosed by clinical evaluation, colonoscopy, and rectal biopsy that were performed safely without risk for the mother or baby. The patient underwent a cesarean section at28+6 wk gestation. The baby was transferred to the neonatal intensive care unit of our hospital and survived without complications. Fulminant colitis was managed conservatively by combined colonoscopic decompression and medical treatment. Although current European guidelines describe toxic megacolon as an indication for emergency surgery for both pregnant and non-pregnant women, thanks to careful monitoring, endoscopic decompression, and intensive medical therapy with nutritional support, we prevented the woman from having to undergo emergency pancolectomy. Our report seems to suggest that conservative management may be a helpful tool in preventing pancolectomy if the patient's condition improves quickly. Otherwise, surgery is mandatory.展开更多
<strong>Objective: </strong><span style="font-family:Verdana;">To assess whether the use of prenatal betamethasone in pregnancies with elective Caesarean section (C-section) at 38 weeks ha&...<strong>Objective: </strong><span style="font-family:Verdana;">To assess whether the use of prenatal betamethasone in pregnancies with elective Caesarean section (C-section) at 38 weeks ha</span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;"> a similar risk of adverse neonatal respiratory outcomes than elective C-section at 39 weeks. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Retrospective cohort study of pregnant patients with singleton pregnancies and elective C-section at term in a one-year period. Cases were C-section at 38 weeks of gestation with a complete course of betamethasone started 48-hours before. As a control group, pregnancies with a C-section at 39 weeks without betamethasone were included. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> During the study period, 186 patients were included. Of these, 91 were delivered at 38 weeks and 95 at 39 weeks. There were no significant differences in maternal age and parity. Moreover, there were no significant differences in respiratory complications (respiratory distress syndrome [RDS] = 0% vs 1.1%;p</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:Verdana;">1.0, transitory tachypnea [TT] = 0% vs 0%) and admission to Neonatal Intensive Care Unit (NICU) (8.8% vs 6.3%;p</span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">0.7) between deliveries at 38 weeks and 39 weeks, respectively. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Prophylactic use of betamethasone in early term pregnancies who undergo an elective C-section at 38 weeks is associated with similar adverse neonatal respiratory outcomes than patients with C-section at 39 weeks without corticosteroids.</span></span>展开更多
OBJECTIVE: Assessing the role of fetal ductus venosus and nasal bones evalua ti on in first-trimester screening for Down syndrome. METHODS: This was a prospect ive cohort study in a tertiary referral fetal medicine un...OBJECTIVE: Assessing the role of fetal ductus venosus and nasal bones evalua ti on in first-trimester screening for Down syndrome. METHODS: This was a prospect ive cohort study in a tertiary referral fetal medicine unit involving 628 consec utive fetuses undergoing chorionic villus sampling. The indication for chorionic villus sampling was an increased risk (more than 1:300) for trisomy 21 based on maternal age and nuchal translucency screening in 313 cases (54.7%), increased maternal age in 195 (34.1%), and other in 64 (11.2%). Immediately before chor ionic villus sampling, an ultrasound examination was performed. The pattern of b lood flow in the ductus venosus and the presence or absence of the nasal bones w as noted. RESULTS: A satisfactory examination of both ductus venosus and nasal b ones was possible in 572 fetuses. Of these, 497 (86.9%) had a normal karyotype, and 47 (8.2%) were affected with Down syndrome. The likelihood ratio for triso my 21 was 7.05 (95%confidence interval 4.27-11.64) in the case of abnormal duc tus venosus flow and 6.42 (95%confidence interval 3.86-10.67) in the case of a bsent nasal bones. CONCLUSION: In addition to increased fetal nuchal translucenc y, Down syndrome is significantly associated with first-trimester abnormal flow velocity patterns in the ductus venosus and hypoplasia of the nasal bones.展开更多
OBJECTIVE: To investigate the relationship between the timing of disappearance of high-resistance uterine artery waveforms between the first and second trimester of pregnancy and birth weight. METHODS: Uterine artery ...OBJECTIVE: To investigate the relationship between the timing of disappearance of high-resistance uterine artery waveforms between the first and second trimester of pregnancy and birth weight. METHODS: Uterine artery Doppler recordings were obtained in a cohort of singleton pregnancies at 11-14 weeks of gestation and subsequently at 18-23 weeks. At each examination, the presence or absence of an early diastolic notch was recorded for each side. An abnormal pattern of blood flow was defined as the presence of bilateral notches. Cases complicated by preeclampsia or preterm delivery were excluded. RESULTS: Four hundred eleven pregnancies showed absent or unilateral uterine artery notches at the 11-14-week scan (group 1). All these cases maintained a low-resistance uterine blood flow pattern at the second-trimester scan. Of the 251 pregnancies with bilateral notches at the 11-14-week scan, 222 subsequently displayed a low-resistance blood flow at 18-23 weeks (group 2) whereas only 29 maintained bilateral notches (group 3). The mean birth weight was higher in group 1 (3,452 g) than in groups 2 (3,310 g) and 3 (3,224 g). This difference was confirmed after adjusting for confounding variables. Small-for-gestational-age fetuses were more common in groups 2 (14.9%) and 3 (14%) compared with group 1 (6.8%, P < .001). During the study period, severe preterm preeclampsia was observed in 6 cases only. CONCLUSION: The longitudinal variation in uterine artery blood flow pattern has a statistically significant correlation with birth weight, likely reflecting the timing and degree of trophoblastic invasion of the maternal vessels.展开更多
Objective: The purpose of this study was to assess the role of fetal nasal bones evaluation in first- trimester screening for trisomy 21 in selected and unselected pregnancies. Study design: Visualization of the nasal...Objective: The purpose of this study was to assess the role of fetal nasal bones evaluation in first- trimester screening for trisomy 21 in selected and unselected pregnancies. Study design: Visualization of the nasal bones was attempted in women attending for routine nuchal translucency screening (unselected population, n = 7116, 12 cases of trisomy 21), aswell as in high risk pregnancies referred to our tertiary care center (selected population, n = 510, 23 cases of trisomy 21). Results: The sensitivity, specificity, positive and negative predictive value of absent nasal bones for trisomy 21 were 16.7% , 97.3% , 1.1% , 99.8% and 47.6% , 95.3% , 33.3% , 97.4% in the unselected and selected population, respectively. At logistic regression analysis including nuchal translucency and nasal bones findings, the latter resulted to be an independent predictor of trisomy 21 in the selected but not in the unselected population. Conclusion: First- trimester nasal bones assessment for trisomy 21 screening has a very different performance in selected and unselected pregnancies.展开更多
Objective: To assess the effect of parity on endovascular trophoblastic invasion in early pregnancy. Design: Observational study. Setting: Teaching hospital. Patient(s): Healthy women at 10-14 weeks of gestation. Inte...Objective: To assess the effect of parity on endovascular trophoblastic invasion in early pregnancy. Design: Observational study. Setting: Teaching hospital. Patient(s): Healthy women at 10-14 weeks of gestation. Intervention(s): Surgical termination of pregnancy for nonmedical reasons. Main Outcome Measure(s): Products of conception were blindly examined histologically with regard to the extent of decidual endovascular trophoblast invasion. Result(s): Samples were obtained from 20 nulliparous and 10 parous women. The presence of normal intradecidual endovascular trophoblast invasion was identified with a similar frequency in both groups (P=.28). However, the proportion of decidual vessels with endovascular trophoblast invasion was significantly higher in parous women (60% ) compared with nulliparous women (32% , P < .001). Conclusion(s): Endovascular trophoblast invasion in early pregnancy is more extensive in parous women who already had an uncomplicated pregnancy than in nulliparous women.展开更多
Introduction The discovery of cell-free fetal DNA(cff-DNA),also known as noninvasive prenatal testing(NIPT),by Lo et al.in 1997,1 has significantly changed the screening for common chromosomal abnormalities.Its widesp...Introduction The discovery of cell-free fetal DNA(cff-DNA),also known as noninvasive prenatal testing(NIPT),by Lo et al.in 1997,1 has significantly changed the screening for common chromosomal abnormalities.Its widespread acceptance globally underscores its impact.NIPT analyzes fetal DNA originating from the apoptosis of the outer cytotrophoblast,the fetal hematopoietic system,and lysis of other fetal cells.The DNA fraction increases from 10%to 15%between 10 and 20 gestational weeks.Rapid cff-DNA clearance occurs in maternal circulation,spanning from 4 minutes to 2 weeks postpartum.展开更多
Fetal cardiac rhabdomyoma is associated with tuberous sclerosis complex(TSC)which is an autosomal dominant hereditary neurocutaneous disease with an incidence of approximately 1 in 5000 to 10000 live birth.It is cause...Fetal cardiac rhabdomyoma is associated with tuberous sclerosis complex(TSC)which is an autosomal dominant hereditary neurocutaneous disease with an incidence of approximately 1 in 5000 to 10000 live birth.It is caused by mutations in the TSC1 or TSC2 gene,de novo mutations accounting for approximately 80%of TSC cases,which can involve multiple organs and systems such as the heart,brain,kidney,lung,skin,and so on.Cardiac rhabdomyoma is the most common fetal heart tumor,accounting for about 60%of cases.It is closely related to TSC and may be the only manifestation of TSC which occurs during pregnancy.This study retrospectively analyzed the clinical data of a neonate with TSC diagnosed with fetal cardiac rhabdomyomas and confirmed by amniocentesis prenatal diagnosis as gene testing TSC1 gene positively.The parents had no such mutation.However,due to the influence of the sudden coronavirus disease 2019(COVID-19)epidemic,the TSC genetic test report was not obtained until 38 weeks of pregnancy.Multiple hypo-pigmented spots(diameter>5 mm)were found immediately after birth.The characteristic cardiac feature of TSC is a rhabdomyoma and the diagnosis of TSC is based upon genetic testing and multiple ultrasound examinations or magnetic resonance imaging.Most patients with TSC have epilepsy,and one-half or more have cognitive deficits and learning disabilities.So rigorous follow-up will continue for the case we reported.展开更多
Bartter syndrome is a group of autosomal recessive renal tubular disorders;it has two types of presentation:antenatal and classic.The antenatal type presents as severe unexplained polyhydramnios in the second trimeste...Bartter syndrome is a group of autosomal recessive renal tubular disorders;it has two types of presentation:antenatal and classic.The antenatal type presents as severe unexplained polyhydramnios in the second trimester.This is due to fetal urinary losses of sodium,chloride,and potassium,leading to fetal polyuria.The classic type presents in the late neonatal or infancy stage,with dehydration,dyselectrolytemia,failure to thrive,and nephrocalcinosis.Antenatal scans are normal in such cases.Type I and II Bartter syndrome presents in the antenatal period,whereas type IV has a classic presentation.We describe an unusual case of type IVa Bartter syndrome presenting in the antenatal period,with severe polyhydramnios.The initial diagnosis was made based on amniotic fluid chloride levels and later confirmed by performing a genetic test.Genetic testing is important for confirming diagnosis and prognostication regarding the condition.展开更多
Background The true risk of choronic villus sampling(CVS)is poorly defined.The objective of this study was to review the clinical outcome of transabdominal CVS performed in a university teaching unit,with an emphasis ...Background The true risk of choronic villus sampling(CVS)is poorly defined.The objective of this study was to review the clinical outcome of transabdominal CVS performed in a university teaching unit,with an emphasis on the complication rate.Methods A comprehensive audit database was maintained for 1351 pregnant women,including 17 sets ot twin pregnancies,who had a CVS.Details and outcome of all CVSs made in the unit between May 1996 and May 2004 were reviewed.All CVSs were performed by one of 5 operators using the identical techniques.Results All procedures were performed transabdominally.A total of 1355 CVSs were performed because there were 4 dichorionic twin pregnancies which required 2 punctures.The mean gestation at CVS was(11.8+0.7)weeks,and 97.3%of the procedures were performed between 11 and 13 completed weeks.The majority(96.2%)required only 1 puncture to achieve correct needle placement.The procedure failed to obtain an adequate sample in 4 subjects(0.30%).A total of 1351 chromosomal studies were requested and there was 1 case(0.07%)of culture failure.The results of chromosomal studies were available within 14 days in 36.7%of the cases and within 21 days in 94.0%.Overall,77 chromosomal abnormalities(5.7%)and 5 cases of thalassemia major were detected.Pregnancy outcome was unknown in only 13 singleton subjects(0.96%).In the remaining 1355 fetuses,there were 76 pregnancy terminations(5.56%),10 fetal losses with obvious obstetric causes(0.73%),and 21 potentially procedure-related fetal losses(1.54%).In the last group,the majority had one or more co-existing obstetric complications.The background fetal loss rate for pregnancies at similar gestational age in the unit was about 0.8%.Therefore,the procedure-related fetal loss rate was estimated to be at the maximum of 0.74%.Conclusions In experienced hands,first trimester transabdominal CVS is an accurate and safe invasive prenatal diagnostic procedure.It should be one of the treatment options available to pregnant women who require prenatal genetic diagnosis.展开更多
Objectives Explore(1)associations between maternal body mass index(BMI),demographic and clinical characteristics,(2)longitudinal trends in BMI,(3)geographical distributions in prevalence of maternal overweight and obe...Objectives Explore(1)associations between maternal body mass index(BMI),demographic and clinical characteristics,(2)longitudinal trends in BMI,(3)geographical distributions in prevalence of maternal overweight and obesity.Design Retrospective population-based study.Setting Linked,anonymised,routinely collected healthcare data and official statistics from Northern Ireland.Participants All pregnancies in Northern Ireland(2011-2017)with BMI measured at≤16 weeks gestation.Methods Analysis of variance andχ^(2)tests were used to explore associations.Multiple linear regression was used to explore longitudinal trends and spatial visualisation illustrated geographical distribution.Main outcomes are prevalence of overweight(BMI≥25 kg/m^(2))and obesity(BMI≥30 kg/m^(2)).Results 152961 singleton and 2362 multiple pregnancies were included.A high prevalence of maternal overweight and obesity in Northern Ireland is apparent(singleton:52.4%;multiple:48.3%)and is increasing.Obesity was positively associated with older age,larger numbers of previous pregnancies and unplanned pregnancy(p<0.001).BMI category was also positively associated with unemployment(35%in obese class III vs 22%in normal BMI category)(p<0.001).Higher BMI categories were associated with increased rate of comorbidities,including hypertension(normal BMI:1.8%vs obese III:12.4%),diabetes mellitus(normal BMI:0.04%vs obese III:1.29%)and mental ill-health(normal BMI:5.0%vs obese III:11.8%)(p<0.001).Prevalence of maternal obesity varied with deprivation(most deprived:22.8%vs least deprived:15.7%)(p<0.001).Low BMI was associated with age<20 years,nulliparity,unemployment and mental ill-health(p<0.001).Conclusions The prevalence of maternal BMI>25 kg/m^(2)is increasing over time in Northern Ireland.Women are entering pregnancy with additional comorbidities likely to impact their life course beyond pregnancy.This highlights the need for prioritisation of preconception and inter-pregnancy support for management of weight and chronic conditions.展开更多
Congenital diaphragmatic hernia is a congenital fetal disease,which mainly causes pulmonary hypoplasia and pulmonary hypertension.Effective early prenatal diagnosis can detect and predict the prognosis of congenital d...Congenital diaphragmatic hernia is a congenital fetal disease,which mainly causes pulmonary hypoplasia and pulmonary hypertension.Effective early prenatal diagnosis can detect and predict the prognosis of congenital diaphragmatic hernia in infants,thus provide a reference for prenatal counseling,early intervention,and potential choices for the child’s family.Ultrasound and magnetic resonance imaging are the most commonly used methods for non-invasive examination of the fetus.This paper discusses evaluation parameters based on these two imaging modalities.展开更多
To the Editor:The incidence of pulmonary atresia with intact ventricular septum (PA/IVS) is 1.9% in congential heart disease.The most serious manifestation is hypoplastic right heart syndrome (HRHS).HRHS and low birth...To the Editor:The incidence of pulmonary atresia with intact ventricular septum (PA/IVS) is 1.9% in congential heart disease.The most serious manifestation is hypoplastic right heart syndrome (HRHS).HRHS and low birth weight have been determined as the major risk factors of fetal death after birth.Fetal pulmonary valvuloplasty (FPV) could relieve obstruction of the right ventricular outflow tract,restore growth potential of right ventricle,and increase the chances of biventricular circulation.However,so far fewer than 70 HRHS cases have been reported at the International Fetal Cardiac Intervention Registry (http://www.ifcir.org/) and there is a lack of postnatal treatment experience.展开更多
文摘Objective: This study aimed to determine the effect of fetal movements on the MCA pulsatility index (PI) and quantify the fall of MCA PI after initiation of fetal movements and/or breathing, and the time taken to recover from a fall below the 5th percentile. Methods: 16 women with appropriate for gestational age (AGA) fetuses and 16 women with small for gestational age (SGA) fetuses were recruited. MCA PI during “no movement” state was compared with MCA PI values during fetal body movements and breathing movements. Results: MCA PI measurements with body or breathing movements were significantly (p 0.005) lower as compared to that observed without movements. MCA PI started rising immediately after cessation of body movements and/or breathing movements. Conclusions: MCA PI with fetal body or breathing movements is significantly lower as compared to that observed in the quiet state. If MCA PI measurement is below 5th centile, it should be measured again up to 90 seconds after cessation of fetal body and/or breathing movements in order to minimize false positive diagnosis of cerebral sparing effect in SGA as well as AGA fetuses.
文摘We aimed to establish gestation age specific reference intervals for Doppler indices of fetal cardiac function from 12 to 40 weeks of pregnancy. In a cross-sectional observational study of singleton pregnancies, examinations were performed in 221 women evenly distributed across each week of pregnancy. Blood flow through the four cardiac valves was examined with Doppler. For the atrioventricular valves, velocity and duration of early (E) and atrial (A) waves and the interval (a) between E/A complexes was recorded. For the outflow valves, the duration (b), peak and average velocity of flow in systole was measured. Myocardial performance index (MPI) was calculated as (a - b)/b. Outlet valve diameters were measured and cardiac outputs were calculated. Gestation age specific ranges were constructed for all these parameters. We demonstrated that the cardiac output, peak systolic and time-averaged velocity increase with advancing gestation. However the MPI and E/A ratios show little change across gestation. Fetal cardiac physiology can be studied and Doppler indices reliably measured as early as the late first trimester of pregnancy. Establishing gestation age specific ranges for various cardiac indices throughout pregnancy will help the study of development of fetal cardiac function.
文摘Postmenopausal bleeding is a very common and alarming symptom accounting for 5 percent of all gynecological outpatients’ clinic attendances. This cross-section study was conducted in the Department of Obstetrics and Gynecology </span><span style="font-family:Verdana;">at University Hospitals and included 176 patients with perimenopausal bleeding </span><span style="font-family:Verdana;">who attended a patient clinic during the period from January 2017 to May 2019. All patients were subjected to transvaginal ultrasound, saline sonohysterography and out-patient endometrial sampling using pipelle;all the results were compared to histopathology obtained by hysteroscopic guided biopsy and/or hysterectomy. </span><b><span style="font-family:Verdana;">Result: </span></b><span style="font-family:Verdana;">In comparing the validity of TVS and SHG we found highly significant decrease in malignancy assessment in </span><span><span style="font-family:Verdana;">the TVS method compared to hysteroscopic-guided biopsy. According to the validity of pipelle in detection of malignant lesion, it was found to detect 80 cases out of 88 cases of malignancy with sensitivity 90.9%, specificity 100% and 95.45% accuracy with respect to histopathology by hysteroscopy guided biopsy and/or hysterectomy. Combination tests were done between SHG and pipelle and we found that the validity of combination tests in detecting malignancy improves the sensitivity and specificity in detection of malignancy sensitivity = 100% and specificity = 100% and this was found to be as an effective method in detection of malignancy. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> When SHG combined to outpatient endometrial sampling “pipelle”, the results were the same as hysteroscopy.
文摘Preeclampsia(PE)is a pregnancy-specific syndrome,complicating 2%-8% of pregnancies.PE is a major cause of maternal mortality throughout the world with 60000 maternal deaths attributed to hypertensive disorders of pregnancy.PE also results in fetal morbidity due to prematurity and fetal growth restriction.The precise aetiology of PE remains an enigma with multiple theories including a combination of environmental,immunological and genetic factors.The conventional and leading hypotheses for the initial insult in PE is inadequate trophoblast invasion which is thought to result in incomplete remodelling of uterine spiral arteries leading to placental ischaemia,hypoxia and thus oxidative stress.The significant heterogeneity observed in pre-eclampsia cannot be solely explained by the placental model alone.Herein we critically evaluate the clinical(risk factors,placental blood flow and biomarkers)and pathological(genetic,molecular,histological)correlates for PE.Furthermore,we discuss the role played by the(dysfunctional)maternal cardiovascular system in the aetiology of PE.We review the evidence that demonstrates a role for both the placenta and the cardiovascular system in early-and late-onset PE and highlight some of the key differences between these two distinct disease entities.
文摘This case report concerns a 25-year-old patient with6-7 bloody stools/d, abdominal pain, tachycardia,and weight loss occurring during the third trimester of pregnancy. Severe ulcerative colitis complicated by toxic megacolon and gravidic sepsis was diagnosed by clinical evaluation, colonoscopy, and rectal biopsy that were performed safely without risk for the mother or baby. The patient underwent a cesarean section at28+6 wk gestation. The baby was transferred to the neonatal intensive care unit of our hospital and survived without complications. Fulminant colitis was managed conservatively by combined colonoscopic decompression and medical treatment. Although current European guidelines describe toxic megacolon as an indication for emergency surgery for both pregnant and non-pregnant women, thanks to careful monitoring, endoscopic decompression, and intensive medical therapy with nutritional support, we prevented the woman from having to undergo emergency pancolectomy. Our report seems to suggest that conservative management may be a helpful tool in preventing pancolectomy if the patient's condition improves quickly. Otherwise, surgery is mandatory.
文摘<strong>Objective: </strong><span style="font-family:Verdana;">To assess whether the use of prenatal betamethasone in pregnancies with elective Caesarean section (C-section) at 38 weeks ha</span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;"> a similar risk of adverse neonatal respiratory outcomes than elective C-section at 39 weeks. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Retrospective cohort study of pregnant patients with singleton pregnancies and elective C-section at term in a one-year period. Cases were C-section at 38 weeks of gestation with a complete course of betamethasone started 48-hours before. As a control group, pregnancies with a C-section at 39 weeks without betamethasone were included. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> During the study period, 186 patients were included. Of these, 91 were delivered at 38 weeks and 95 at 39 weeks. There were no significant differences in maternal age and parity. Moreover, there were no significant differences in respiratory complications (respiratory distress syndrome [RDS] = 0% vs 1.1%;p</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:Verdana;">1.0, transitory tachypnea [TT] = 0% vs 0%) and admission to Neonatal Intensive Care Unit (NICU) (8.8% vs 6.3%;p</span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">0.7) between deliveries at 38 weeks and 39 weeks, respectively. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Prophylactic use of betamethasone in early term pregnancies who undergo an elective C-section at 38 weeks is associated with similar adverse neonatal respiratory outcomes than patients with C-section at 39 weeks without corticosteroids.</span></span>
文摘OBJECTIVE: Assessing the role of fetal ductus venosus and nasal bones evalua ti on in first-trimester screening for Down syndrome. METHODS: This was a prospect ive cohort study in a tertiary referral fetal medicine unit involving 628 consec utive fetuses undergoing chorionic villus sampling. The indication for chorionic villus sampling was an increased risk (more than 1:300) for trisomy 21 based on maternal age and nuchal translucency screening in 313 cases (54.7%), increased maternal age in 195 (34.1%), and other in 64 (11.2%). Immediately before chor ionic villus sampling, an ultrasound examination was performed. The pattern of b lood flow in the ductus venosus and the presence or absence of the nasal bones w as noted. RESULTS: A satisfactory examination of both ductus venosus and nasal b ones was possible in 572 fetuses. Of these, 497 (86.9%) had a normal karyotype, and 47 (8.2%) were affected with Down syndrome. The likelihood ratio for triso my 21 was 7.05 (95%confidence interval 4.27-11.64) in the case of abnormal duc tus venosus flow and 6.42 (95%confidence interval 3.86-10.67) in the case of a bsent nasal bones. CONCLUSION: In addition to increased fetal nuchal translucenc y, Down syndrome is significantly associated with first-trimester abnormal flow velocity patterns in the ductus venosus and hypoplasia of the nasal bones.
文摘OBJECTIVE: To investigate the relationship between the timing of disappearance of high-resistance uterine artery waveforms between the first and second trimester of pregnancy and birth weight. METHODS: Uterine artery Doppler recordings were obtained in a cohort of singleton pregnancies at 11-14 weeks of gestation and subsequently at 18-23 weeks. At each examination, the presence or absence of an early diastolic notch was recorded for each side. An abnormal pattern of blood flow was defined as the presence of bilateral notches. Cases complicated by preeclampsia or preterm delivery were excluded. RESULTS: Four hundred eleven pregnancies showed absent or unilateral uterine artery notches at the 11-14-week scan (group 1). All these cases maintained a low-resistance uterine blood flow pattern at the second-trimester scan. Of the 251 pregnancies with bilateral notches at the 11-14-week scan, 222 subsequently displayed a low-resistance blood flow at 18-23 weeks (group 2) whereas only 29 maintained bilateral notches (group 3). The mean birth weight was higher in group 1 (3,452 g) than in groups 2 (3,310 g) and 3 (3,224 g). This difference was confirmed after adjusting for confounding variables. Small-for-gestational-age fetuses were more common in groups 2 (14.9%) and 3 (14%) compared with group 1 (6.8%, P < .001). During the study period, severe preterm preeclampsia was observed in 6 cases only. CONCLUSION: The longitudinal variation in uterine artery blood flow pattern has a statistically significant correlation with birth weight, likely reflecting the timing and degree of trophoblastic invasion of the maternal vessels.
文摘Objective: The purpose of this study was to assess the role of fetal nasal bones evaluation in first- trimester screening for trisomy 21 in selected and unselected pregnancies. Study design: Visualization of the nasal bones was attempted in women attending for routine nuchal translucency screening (unselected population, n = 7116, 12 cases of trisomy 21), aswell as in high risk pregnancies referred to our tertiary care center (selected population, n = 510, 23 cases of trisomy 21). Results: The sensitivity, specificity, positive and negative predictive value of absent nasal bones for trisomy 21 were 16.7% , 97.3% , 1.1% , 99.8% and 47.6% , 95.3% , 33.3% , 97.4% in the unselected and selected population, respectively. At logistic regression analysis including nuchal translucency and nasal bones findings, the latter resulted to be an independent predictor of trisomy 21 in the selected but not in the unselected population. Conclusion: First- trimester nasal bones assessment for trisomy 21 screening has a very different performance in selected and unselected pregnancies.
文摘Objective: To assess the effect of parity on endovascular trophoblastic invasion in early pregnancy. Design: Observational study. Setting: Teaching hospital. Patient(s): Healthy women at 10-14 weeks of gestation. Intervention(s): Surgical termination of pregnancy for nonmedical reasons. Main Outcome Measure(s): Products of conception were blindly examined histologically with regard to the extent of decidual endovascular trophoblast invasion. Result(s): Samples were obtained from 20 nulliparous and 10 parous women. The presence of normal intradecidual endovascular trophoblast invasion was identified with a similar frequency in both groups (P=.28). However, the proportion of decidual vessels with endovascular trophoblast invasion was significantly higher in parous women (60% ) compared with nulliparous women (32% , P < .001). Conclusion(s): Endovascular trophoblast invasion in early pregnancy is more extensive in parous women who already had an uncomplicated pregnancy than in nulliparous women.
文摘Introduction The discovery of cell-free fetal DNA(cff-DNA),also known as noninvasive prenatal testing(NIPT),by Lo et al.in 1997,1 has significantly changed the screening for common chromosomal abnormalities.Its widespread acceptance globally underscores its impact.NIPT analyzes fetal DNA originating from the apoptosis of the outer cytotrophoblast,the fetal hematopoietic system,and lysis of other fetal cells.The DNA fraction increases from 10%to 15%between 10 and 20 gestational weeks.Rapid cff-DNA clearance occurs in maternal circulation,spanning from 4 minutes to 2 weeks postpartum.
基金This work was supported by the National Key Research and Development Program of China(No.2018YFC1002900)the National Natural Science Foundation of China(No.81671527)
文摘Fetal cardiac rhabdomyoma is associated with tuberous sclerosis complex(TSC)which is an autosomal dominant hereditary neurocutaneous disease with an incidence of approximately 1 in 5000 to 10000 live birth.It is caused by mutations in the TSC1 or TSC2 gene,de novo mutations accounting for approximately 80%of TSC cases,which can involve multiple organs and systems such as the heart,brain,kidney,lung,skin,and so on.Cardiac rhabdomyoma is the most common fetal heart tumor,accounting for about 60%of cases.It is closely related to TSC and may be the only manifestation of TSC which occurs during pregnancy.This study retrospectively analyzed the clinical data of a neonate with TSC diagnosed with fetal cardiac rhabdomyomas and confirmed by amniocentesis prenatal diagnosis as gene testing TSC1 gene positively.The parents had no such mutation.However,due to the influence of the sudden coronavirus disease 2019(COVID-19)epidemic,the TSC genetic test report was not obtained until 38 weeks of pregnancy.Multiple hypo-pigmented spots(diameter>5 mm)were found immediately after birth.The characteristic cardiac feature of TSC is a rhabdomyoma and the diagnosis of TSC is based upon genetic testing and multiple ultrasound examinations or magnetic resonance imaging.Most patients with TSC have epilepsy,and one-half or more have cognitive deficits and learning disabilities.So rigorous follow-up will continue for the case we reported.
文摘Bartter syndrome is a group of autosomal recessive renal tubular disorders;it has two types of presentation:antenatal and classic.The antenatal type presents as severe unexplained polyhydramnios in the second trimester.This is due to fetal urinary losses of sodium,chloride,and potassium,leading to fetal polyuria.The classic type presents in the late neonatal or infancy stage,with dehydration,dyselectrolytemia,failure to thrive,and nephrocalcinosis.Antenatal scans are normal in such cases.Type I and II Bartter syndrome presents in the antenatal period,whereas type IV has a classic presentation.We describe an unusual case of type IVa Bartter syndrome presenting in the antenatal period,with severe polyhydramnios.The initial diagnosis was made based on amniotic fluid chloride levels and later confirmed by performing a genetic test.Genetic testing is important for confirming diagnosis and prognostication regarding the condition.
文摘Background The true risk of choronic villus sampling(CVS)is poorly defined.The objective of this study was to review the clinical outcome of transabdominal CVS performed in a university teaching unit,with an emphasis on the complication rate.Methods A comprehensive audit database was maintained for 1351 pregnant women,including 17 sets ot twin pregnancies,who had a CVS.Details and outcome of all CVSs made in the unit between May 1996 and May 2004 were reviewed.All CVSs were performed by one of 5 operators using the identical techniques.Results All procedures were performed transabdominally.A total of 1355 CVSs were performed because there were 4 dichorionic twin pregnancies which required 2 punctures.The mean gestation at CVS was(11.8+0.7)weeks,and 97.3%of the procedures were performed between 11 and 13 completed weeks.The majority(96.2%)required only 1 puncture to achieve correct needle placement.The procedure failed to obtain an adequate sample in 4 subjects(0.30%).A total of 1351 chromosomal studies were requested and there was 1 case(0.07%)of culture failure.The results of chromosomal studies were available within 14 days in 36.7%of the cases and within 21 days in 94.0%.Overall,77 chromosomal abnormalities(5.7%)and 5 cases of thalassemia major were detected.Pregnancy outcome was unknown in only 13 singleton subjects(0.96%).In the remaining 1355 fetuses,there were 76 pregnancy terminations(5.56%),10 fetal losses with obvious obstetric causes(0.73%),and 21 potentially procedure-related fetal losses(1.54%).In the last group,the majority had one or more co-existing obstetric complications.The background fetal loss rate for pregnancies at similar gestational age in the unit was about 0.8%.Therefore,the procedure-related fetal loss rate was estimated to be at the maximum of 0.74%.Conclusions In experienced hands,first trimester transabdominal CVS is an accurate and safe invasive prenatal diagnostic procedure.It should be one of the treatment options available to pregnant women who require prenatal genetic diagnosis.
基金Scholarships Committee,School of Medicine,Dentistry and Biomedical Sciences,Queen’s University Belfast.
文摘Objectives Explore(1)associations between maternal body mass index(BMI),demographic and clinical characteristics,(2)longitudinal trends in BMI,(3)geographical distributions in prevalence of maternal overweight and obesity.Design Retrospective population-based study.Setting Linked,anonymised,routinely collected healthcare data and official statistics from Northern Ireland.Participants All pregnancies in Northern Ireland(2011-2017)with BMI measured at≤16 weeks gestation.Methods Analysis of variance andχ^(2)tests were used to explore associations.Multiple linear regression was used to explore longitudinal trends and spatial visualisation illustrated geographical distribution.Main outcomes are prevalence of overweight(BMI≥25 kg/m^(2))and obesity(BMI≥30 kg/m^(2)).Results 152961 singleton and 2362 multiple pregnancies were included.A high prevalence of maternal overweight and obesity in Northern Ireland is apparent(singleton:52.4%;multiple:48.3%)and is increasing.Obesity was positively associated with older age,larger numbers of previous pregnancies and unplanned pregnancy(p<0.001).BMI category was also positively associated with unemployment(35%in obese class III vs 22%in normal BMI category)(p<0.001).Higher BMI categories were associated with increased rate of comorbidities,including hypertension(normal BMI:1.8%vs obese III:12.4%),diabetes mellitus(normal BMI:0.04%vs obese III:1.29%)and mental ill-health(normal BMI:5.0%vs obese III:11.8%)(p<0.001).Prevalence of maternal obesity varied with deprivation(most deprived:22.8%vs least deprived:15.7%)(p<0.001).Low BMI was associated with age<20 years,nulliparity,unemployment and mental ill-health(p<0.001).Conclusions The prevalence of maternal BMI>25 kg/m^(2)is increasing over time in Northern Ireland.Women are entering pregnancy with additional comorbidities likely to impact their life course beyond pregnancy.This highlights the need for prioritisation of preconception and inter-pregnancy support for management of weight and chronic conditions.
基金This studywas supported by the National Key Research and Development Program of China(No.2018YFC1002900)the National Natural Science Foundation ofChina(No.81671527),China.
文摘Congenital diaphragmatic hernia is a congenital fetal disease,which mainly causes pulmonary hypoplasia and pulmonary hypertension.Effective early prenatal diagnosis can detect and predict the prognosis of congenital diaphragmatic hernia in infants,thus provide a reference for prenatal counseling,early intervention,and potential choices for the child’s family.Ultrasound and magnetic resonance imaging are the most commonly used methods for non-invasive examination of the fetus.This paper discusses evaluation parameters based on these two imaging modalities.
基金grants from the National Natural Science Foundation of China (No. 81770316)the Research Fund for the Taishan Scholars Project (2018).
文摘To the Editor:The incidence of pulmonary atresia with intact ventricular septum (PA/IVS) is 1.9% in congential heart disease.The most serious manifestation is hypoplastic right heart syndrome (HRHS).HRHS and low birth weight have been determined as the major risk factors of fetal death after birth.Fetal pulmonary valvuloplasty (FPV) could relieve obstruction of the right ventricular outflow tract,restore growth potential of right ventricle,and increase the chances of biventricular circulation.However,so far fewer than 70 HRHS cases have been reported at the International Fetal Cardiac Intervention Registry (http://www.ifcir.org/) and there is a lack of postnatal treatment experience.
