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Added value in low-risk pregnancies of longitudinal changes in uterine Doppler and circulating angiogenic factors during the third trimester in predicting term preeclampsia. 在低危妊娠中,子宫多普勒和循环血管生成因子在妊娠三个月内的纵向变化在预测期前子痫方面的附加值。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-04 DOI: 10.1159/000541731
Lucie Roubalova, Vladimira Kroutilova, Maria Fernanda Lopez-G Tinajero, Judit Martinez-Egea, Claudia Pumarola, Francesc Figueras, Marek Lubusky

Introduction: To assess the relationship between longitudinal changes in the uterine Doppler velocimetry and the maternal profile of angiogenic factors in the third trimester of pregnancy and to assess their ability to predict term preeclampsia.

Methods: A cohort of low-risk pregnant women was constructed at second trimester routine scan and scheduled for a uterine Doppler evaluation and measurement of the circulating levels of angiogenic factors at ~30 and ~36 weeks. The performance of both parameters at both time-points and their change over time from the first to the second measurement in predicting term preeclampsia was evaluated by logistic regression and receiver operating characteristic curve (ROC) analyses.

Results: A total of 1172 women were analyzed, of which 28 (2.4%) women developed term preeclampsia. At ~30 weeks, a model including the ratio sFlt-1/PlGF (fms-like tyrosine kinase-1/placental growth factor) and the uterine Doppler explained 16.2% of the uncertainty of developing term preeclampsia, while at ~36 weeks the same variables explained 25.2% [p<0.001]. A model including the longitudinal changes of both predictors had an R2 of 26.8%, which was not significantly different from that of the ~36 weeks evaluation [p=0.45]. The area under the curve (AUC) of the ~36 weeks sFlt-1/PlGF ratio was significantly higher than at ~30 weeks (0.86 [0.77-0.94] vs. 0.81 [0.73-0.9]; p=0.043). The AUC of the 30-to-36 week change of the sFlt-1/PlGF ratio (0.85 [0.77-0.94]) did not significantly differ from that of at ~36 weeks (p=0.82). At ~36 weeks, for a 10% of false positives, the sFlt-1/PlGF ratio had a detection rate of 71.4%, with positive and negative likelihood ratios of 7.3 and 0.32, respectively.

Conclusion: A cross-sectional measurement of the sFlt-1/PlGF ratio outperforms uterine Doppler in predicting term preeclampsia. The combination of both markers does not improve such prediction, nor the evaluation of the longitudinal changes between ~30 and ~36 weeks.

引言目的:评估妊娠三个月时子宫多普勒速度测量的纵向变化与母体血管生成因子概况之间的关系,并评估其预测子痫前期的能力:方法:在妊娠后三个月常规扫描时建立低危孕妇队列,并计划在妊娠约 30 周和 36 周时进行子宫多普勒评估和血管生成因子循环水平测量。通过逻辑回归和接收器操作特征曲线(ROC)分析,评估了这两个时间点的两个参数及其从第一次测量到第二次测量的时间变化在预测子痫前期方面的性能:共对 1172 名妇女进行了分析,其中 28 名妇女(2.4%)出现了足月子痫前期。在妊娠约 30 周时,包括 sFlt-1/PlGF(类酪氨酸激酶-1/胎盘生长因子)比率和子宫多普勒在内的模型可解释 16.2% 的足月子痫前期不确定性,而在妊娠约 36 周时,同样的变量可解释 25.2% 的不确定性[p结论:在预测足月子痫前期方面,sFlt-1/PlGF 比率的横断面测量结果优于子宫多普勒。将这两种标记物结合使用并不能提高预测效果,也不能评估在 ~30 周和 ~36 周之间的纵向变化。
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引用次数: 0
Sequence of events leading to medical abortion for fetal indications after 34 weeks' gestation: 23 years of experience in a single medical center. 妊娠 34 周后因胎儿指征导致药物流产的事件顺序:一家医疗中心 23 年的经验。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-01 DOI: 10.1159/000540674
Marina Pekar Zlotin, Yael Nehama Berman, Yaacov Melcer, Howard Cuckle, Ron Maymon

Introduction: Technical advances are rapidly improving the ability to detect anatomical malformations and genetic abnormalities during pregnancy. We aimed to identify the sequence of events leading to medical abortion ≥ 34 weeks' gestation, to determine whether the procedure could have been carried out earlier.

Method: Retrospective study of medical abortions in singleton pregnancies carried out in our department over a 23-year period from1998 to 2021.

Results: 36/4055 (0.88%) abortions were carried out ≥ 34 weeks' gestation. The indications were anatomical in 20 (55%), chromosomal or genetic in 14 (39%) and CMV infection In two. Evaluation of the sequence of events suggests that an earlier diagnosis would have been unfeasible before the third trimester in 18 cases (50%) because the disorder was developmental and ultrasound findings would not have presented earlier. By contrast, certain other cases might have been diagnosed earlier if the patient had not delayed routine screening or if screening had been administered on schedule.

Conclusion: In this series, full adherence to local screening tests and protocols, and timely decision-making could have substantially reduced the late abortion rate by as much as half.

导言:技术的进步迅速提高了检测孕期解剖畸形和遗传异常的能力。我们的目的是确定导致妊娠≥34 周药物流产的事件顺序,以确定是否可以更早进行手术:方法:对1998年至2021年23年间在我科进行的单胎妊娠药物流产进行回顾性研究:结果:36/4055(0.88%)例妊娠≥34周的人工流产。20例(55%)流产的适应症为解剖学原因,14例(39%)为染色体或遗传学原因,2例为巨细胞病毒感染。对事件发生顺序的评估表明,18 例(50%)患者在妊娠三个月前不可能得到早期诊断,因为他们的疾病是发育性的,超声检查结果不会更早出现。相比之下,如果患者没有推迟常规筛查或按计划进行筛查,其他一些病例可能会更早得到诊断:在这一系列病例中,如果能完全遵守当地的筛查测试和方案,并及时做出决定,则可将晚期流产率大幅降低一半之多。
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引用次数: 0
Postnatal outcomes of fetal variants of unknown significance in prenatal CMA: A single-center study. 产前 CMA 中意义不明的胎儿变异的产后结局:一项单中心研究。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-20 DOI: 10.1159/000542147
Lizhong Yin, Jing Wang, Bin Zhang, Wenli Wang, Bin Yu

Introduction: Chromosome microarray analysis(CMA) can identify clinically significant microdeletions and microduplications, providing valuable insights into the genetic basis of various disorders. Our study was to evaluate clinical management and prognosis of fetuses with prenatal variants of unknown significance (VOUS) and determine diagnostic approaches for subsequent pregnancies.

Methods: This study included 2,953 fetuses undergoing chromosome microarray analysis (CMA) at the Prenatal Diagnostic Center of Changzhou Maternal and Child Health Care Hospital from January 2018 to December 2022, identifying 162 cases with VOUS. Parent-of-origin testing determined the origin of copy number variations (CNVs). Prenatal genetic counseling was provided, and outcomes were followed for 3-36 months post-birth.

Results: All 162 VOUS cases received prenatal genetic counseling. Among these, 123 continued the pregnancy; 22 chose termination, and 17 were lost to follow-up. Of the continuations, 116 delivered at term, and 7 preterm. Post-birth follow-up showed 5/123 live-born fetuses developed relevant clinical phenotypes. Parent-of-origin testing in 21 cases identified 18 hereditary and 3 de novo variants. Additionally, five subsequent pregnancies were monitored, with two undergoing amniocentesis and three receiving low-risk non-invasive prenatal testing (NIPT), all with positive outcomes.

Conclusion: VOUS, occurring in approximately 5% of cases, require comprehensive prenatal genetic counseling and show generally favorable outcomes. Despite low association with adverse clinical phenotypes, the importance of postnatal follow-up and regular report updates is emphasized to detect potential clinical associations early.

简介染色体微阵列分析(CMA)可识别具有临床意义的微缺失和微重复,为了解各种疾病的遗传基础提供有价值的信息。我们的研究旨在评估产前意义不明变异(VOUS)胎儿的临床管理和预后,并确定后续妊娠的诊断方法:本研究纳入了2018年1月至2022年12月在常州市妇幼保健院产前诊断中心接受染色体微阵列分析(CMA)的2953例胎儿,共发现162例VOUS。亲本检测确定了拷贝数变异(CNV)的来源。提供产前遗传咨询,并对出生后3-36个月的结果进行随访:所有 162 例 VOUS 均接受了产前遗传咨询。结果:162 例 VOUS 均接受了产前遗传咨询,其中 123 例继续妊娠,22 例选择终止妊娠,17 例失去随访机会。在继续妊娠的孕妇中,116 人足月分娩,7 人早产。产后随访显示,5/123 的活产胎儿出现了相关的临床表型。对 21 个病例的原发父母进行了检测,发现了 18 个遗传变异和 3 个新生变异。此外,还对五例后续妊娠进行了监测,其中两例进行了羊膜腔穿刺术,三例接受了低风险无创产前检测(NIPT),结果均为阳性:结论:VOUS 的发生率约为 5%,需要进行全面的产前遗传咨询,其结果普遍良好。尽管VOUS与不良临床表型的相关性较低,但强调了产后随访和定期报告更新的重要性,以便及早发现潜在的临床关联。
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引用次数: 0
Fetal Hypoplastic Left Heart Syndrome with Intact Atrial Septum: From successful in-utero stenting to subtotal stent-occlusion - a case report. 胎儿左心发育不良综合征伴完整的心房隔膜:从胎儿期支架植入成功到次全支架闭塞--病例报告。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-16 DOI: 10.1159/000542069
Andreas Tulzer, Iris Scharnreitner, Eva Sames-Dolzer, Michaela Kreuzer, Rudolf Mair, Gerald Tulzer

Introduction: Fetuses with hypoplastic left heart syndrome (HLHS) and intact atrial septum (IAS) have an overall poor prognosis and a high risk of neonatal death due to severe secondary lung damage. Intrauterine stenting of the atrial septum was introduced in these patients to enable survival.

Case presentation: We present a case of a HLHS fetus with intact atrial septum and signs of incipient nutmeg lung , in whom at 30 weeks gestation an atrial stent was successfully placed but continuously developed subtotal stent- obstruction over the next weeks.

Conclusion: Continuous obstruction of placed atrial septum stents until delivery is possible and requires close monitoring of successfully treated fetuses.

简介患有左心室发育不全综合征(HLHS)和完整房间隔(IAS)的胎儿总体预后较差,而且由于严重的继发性肺损伤,新生儿死亡的风险很高。为了让这些患者存活下来,我们在宫内为他们植入了房间隔支架:我们介绍了一例 HLHS 胎儿,其房间隔完整,有初期肉豆蔻肺的体征,在妊娠 30 周时成功放置了心房支架,但在接下来的几周内持续出现支架下梗阻:结论:放置的房间隔支架在分娩前持续阻塞是可能的,需要对成功治疗的胎儿进行密切监测。
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引用次数: 0
Utility of 3-Dimensional Modeling in Prenatally Diagnosed Large Fetal Neck Mass. 三维建模在产前诊断胎儿颈部巨大肿块中的应用。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-10 DOI: 10.1159/000541950
Devashish S Joshi, Michael A Stellon, Michael D Puricelli, Michael J Beninati, Sylvana Garcia-Rodriguez, Casey Winchester, Teresa Chapman, Inna N Lobeck

Introduction: Prenatally diagnosed large fetal neck mass requires multidisciplinary consultation and evaluation of perinatal treatment options. The decision to perform ex utero intrapartum treatment (EXIT) is based on risk-benefit assessment for both the infant and mother. Though fetal ultrasound and MRI assist with operative planning, a three-dimensional anatomic model offers improved anatomic visualization and prenatal patient counseling.

Case presentation: Multiple surveillance ultrasound exams between gestational weeks 16 and 32 plus fetal MRI at 29/3 weeks were performed for fetal evaluation. A 3-dimensional model was printed (Form 3 and 3L, clear resin, Formlabs) incorporating fetal MRI (Ax SSFSE TE 100 DL and Cor SSFSE Brain DL) and using Mimics Medical and 3-matic Medical software (Materialise). A left fetal multicystic neck mass measuring 2.1 × 1.8 × 1.5 cm was diagnosed at 16/6 weeks gestation in a G8P2416. Fetal MRI performed at 29/3 weeks showed a large exophytic mixed solid-cystic cervicofacial mass, 10.3 × 9.4 × 10.6 cm arising from the left mandible, concerning for a teratoma. Prior to delivery, the model was used to educate and counsel the family regarding the complex clinical situation and the reasoning for delivery via EXIT followed by mass resection. Additionally, the model demonstrated tracheal narrowing and oropharyngeal compression, supporting airway intervention planning. The fetus was delivered at 32/3 weeks via EXIT to intubation using rigid bronchoscopy. Duration of time on placental support was 12 min. On day of life 5, the patient underwent resection of the cervical mass. Pathology revealed an immature teratoma, histologic grade 3 without yolk sac elements, and negative regional lymph nodes.

Conclusion: Three-dimensional fetal modeling facilitates perinatal airway needs assessment, patient counseling, delivery, and postnatal management.

导言:产前确诊胎儿颈部巨大肿块需要多学科会诊,并评估围产期治疗方案。产前治疗(EXIT)的决定基于对婴儿和母亲的风险效益评估。虽然胎儿超声和核磁共振成像有助于手术规划,但三维解剖模型可提供更好的解剖可视化和产前患者咨询:病例介绍:在孕 16 至 32 周期间进行了多次超声监测检查,并在孕 29/3 周时进行了胎儿核磁共振成像,以评估胎儿情况。结合胎儿核磁共振成像(Ax SSFSE TE 100 DL 和 Cor SSFSE Brain DL)并使用 Mimics Medical 和 3-matic Medical 软件(Materialise)打印了一个三维模型(Form 3 和 3L,透明树脂,Formlabs)。一名 G8P2416 孕妇在妊娠 16/6 周时被诊断出左侧胎儿多囊性颈部肿块,大小为 2.1x1.8x1.5 厘米。29/3周时进行的胎儿核磁共振成像(MRI)显示,一个巨大的外生混合实性囊性颈面部肿块(10.3 x 9.4 x 10.6 cm)从左下颌骨处长出,疑似畸胎瘤。在分娩前,该模型用于教育和指导家属,让他们了解复杂的临床情况,以及通过 EXIT 分娩并切除肿块的理由。此外,模型还显示了气管狭窄和口咽受压的情况,为气道干预计划提供了支持。胎儿在 32/3 周时通过 EXIT 顺产,并使用硬质支气管镜进行了插管。胎盘支持时间为 12 分钟。在生命的第 5 天,患者接受了宫颈肿块切除术。病理结果显示为未成熟畸胎瘤,组织学 3 级,无卵黄囊成分,区域淋巴结阴性:三维胎儿建模有助于围产期气道需求评估、患者咨询、分娩和产后管理。
{"title":"Utility of 3-Dimensional Modeling in Prenatally Diagnosed Large Fetal Neck Mass.","authors":"Devashish S Joshi, Michael A Stellon, Michael D Puricelli, Michael J Beninati, Sylvana Garcia-Rodriguez, Casey Winchester, Teresa Chapman, Inna N Lobeck","doi":"10.1159/000541950","DOIUrl":"10.1159/000541950","url":null,"abstract":"<p><strong>Introduction: </strong>Prenatally diagnosed large fetal neck mass requires multidisciplinary consultation and evaluation of perinatal treatment options. The decision to perform ex utero intrapartum treatment (EXIT) is based on risk-benefit assessment for both the infant and mother. Though fetal ultrasound and MRI assist with operative planning, a three-dimensional anatomic model offers improved anatomic visualization and prenatal patient counseling.</p><p><strong>Case presentation: </strong>Multiple surveillance ultrasound exams between gestational weeks 16 and 32 plus fetal MRI at 29/3 weeks were performed for fetal evaluation. A 3-dimensional model was printed (Form 3 and 3L, clear resin, Formlabs) incorporating fetal MRI (Ax SSFSE TE 100 DL and Cor SSFSE Brain DL) and using Mimics Medical and 3-matic Medical software (Materialise). A left fetal multicystic neck mass measuring 2.1 × 1.8 × 1.5 cm was diagnosed at 16/6 weeks gestation in a G8P2416. Fetal MRI performed at 29/3 weeks showed a large exophytic mixed solid-cystic cervicofacial mass, 10.3 × 9.4 × 10.6 cm arising from the left mandible, concerning for a teratoma. Prior to delivery, the model was used to educate and counsel the family regarding the complex clinical situation and the reasoning for delivery via EXIT followed by mass resection. Additionally, the model demonstrated tracheal narrowing and oropharyngeal compression, supporting airway intervention planning. The fetus was delivered at 32/3 weeks via EXIT to intubation using rigid bronchoscopy. Duration of time on placental support was 12 min. On day of life 5, the patient underwent resection of the cervical mass. Pathology revealed an immature teratoma, histologic grade 3 without yolk sac elements, and negative regional lymph nodes.</p><p><strong>Conclusion: </strong>Three-dimensional fetal modeling facilitates perinatal airway needs assessment, patient counseling, delivery, and postnatal management.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Mortality of Politics: An American Paradox. 政治的死亡:美国的悖论
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-09 DOI: 10.1159/000541912
Mark I Evans, Gregory F Ryan, David W Britt, Christian R Macedonia

Introduction: The USA has the poorest health statistics of any high-income country. Political polarization has risen dramatically; newer safety net programs (the Affordable Care Act [ACA]) are unevenly provided because many Republican-leaning states refused expanded Federal coverage. Democratic programs have reduced physician leadership of medicine. Both have been deleterious. Here, we investigated associations among four key health measures two of which directly impact pregnancy outcomes and two that affect all patients by percentage of each state that voted for the Republican versus Democratic candidate in the 2020 presidential election.

Methods: For each state, we used public, non-partisan databases to assess the incidence of COVID, maternal, and infant mortality per 100,000 population and average life expectancy. Correlations among these four outcome variables and percentage Republican vote were calculated (r), contextualized by measuring associations with related variables including COVID vaccination rates, access to medical care, and incidences of heart disease, obesity, diabetes, gunshot deaths, and automotive fatalities.

Results: COVID mortality, maternal and infant mortality, and life expectancy were highly correlated with percentage Republican ("red") vote per state. If "red" states had vaccination rates equivalent to Democratic-leaning ("blue") states, 72,000 deaths could have been avoided. Overall, "red" states have lower health metrics, reduced access to care, and higher comorbidities.

Conclusion: The percent Republican vote was strongly associated, but not the whole answer, with worse health outcomes for multiple key measures of public health including mortality, access to care, and various comorbidities. Overall, the ACA has improved patient access to care but has also led to "maternity care deserts" disproportionately in rural areas in "red" states. Translating insurance coverage into improved care and outcomes requires further analysis and will require multi-pronged approaches including expanding coverage and incentivizing quality care.

导言:在所有高收入国家中,美国的健康统计数据最差。政治两极分化急剧加剧;较新的安全网计划(《平价医疗法案》[ACA])提供的医疗服务并不均衡,因为许多倾向于共和党的州拒绝扩大联邦保险的覆盖范围。民主党的计划削弱了医生对医疗的领导。两者都是有害的。在此,我们根据各州在 2020 年总统大选中投票支持共和党候选人和民主党候选人的比例,调查了四项关键健康指标之间的关联,其中两项直接影响妊娠结果,另外两项影响所有患者:对于每个州,我们使用非党派的公共数据库来评估每 10 万人中 COVID、孕产妇和婴儿死亡率的发生率以及平均预期寿命。我们计算了这四个结果变量与共和党选票百分比之间的相关性(r),并衡量了与相关变量(包括 COVID 疫苗接种率、获得医疗保健的机会以及心脏病、肥胖症、糖尿病、枪击死亡和汽车死亡事故的发生率)之间的关联:结果:COVID 死亡率、母婴死亡率和预期寿命与每个州的共和党("红色")选票百分比高度相关。如果 "红色 "州的疫苗接种率与民主党倾向州("蓝色")相当,则可避免 72,000 例死亡。总体而言,"红色 "州的健康指标较低,获得医疗服务的机会较少,合并症较多:结论:共和党选票的百分比与公共卫生的多个关键指标(包括死亡率、获得医疗服务的机会和各种合并症)的健康状况较差密切相关,但不是全部答案。总体而言,《医疗保险法》改善了患者获得医疗服务的机会,但也导致了 "红色 "州农村地区的 "孕产妇医疗荒漠"。将保险覆盖率转化为更好的护理和结果需要进一步分析,并需要多管齐下的方法,包括扩大覆盖率和激励优质护理。
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引用次数: 0
A clinical outcomes data archive for a comprehensive fetal diagnosis and treatment center. 一个综合性胎儿诊断和治疗中心的临床结果数据档案。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-08 DOI: 10.1159/000541877
Thomas A Reynolds, Matthew A Goldshore, Sabrina Flohr, Sierra Land, Leny Mathew, Juliana S Gebb, Edward R Oliver, Natalie E Rintoul, Anne M Ades, Elizabeth E Foglia, Catherine M Avitabile, Howard B Panitch, Gregory G Heuer, Lori J Howell, N Scott Adzick, Holly L Hedrick

Introduction: Data on near and long-term outcomes are critical for the care of all maternal-fetal patients presenting to a fetal center. This is important since physiologic and neurodevelopmental attributes do not manifest until childhood when multi-level factors influence health outcomes. Electronic health records (EHR) documentation structures are not designed for acquisition of key attributes, and changes over time and between-clinician differences can affect resultant output. Therefore, EHR derived datasets have limited ability to accurately characterize the clinical presentation and care trajectory of patients with congenital anomalies. Moreover, the fetus lacks a digital identity and requires relinking attributes documented in the maternal chart to those in the pediatric EHR. This conundrum amplifies in the setting of multiple gestation, returning maternal patients, and pregnancies with fetal demise. Current data systems result in incomplete abstraction of variables that may confound, mediate, or moderate critical associations. Our objective was to develop and implement a prospective data capture platform to transform EHR data into an analytic-grade database for multi-purpose use.

Methods: A unified platform for longitudinal follow-up of maternal-child dyads named the Clinical Outcomes Data Archive (CODA) was constructed. CODA was designed using a data dictionary based on multidisciplinary input, a relational identity for each patient, fetus, and pregnancy, and a process by which EHR-sourced and chart-abstracted data are validated. Descriptive analyses were performed for data acquired between July 2022 - July 2023, and a comparison of studies before and after implementation of CODA is presented.

Conclusion: 5,394,106 data points were validated for 7,662 patients across 12 conditions. 2% of data points were found to be unreliable or undocumented. 91% of data points were sourced from the EHR. 85% of condition-specific variables required manual chart abstraction. The study conducted with CODA contributed to 18 studies. CODA successfully merges EHR-sourced and manually abstracted documentation for longitudinal study of the maternal-child dyad.

导言:有关近期和远期疗效的数据对所有到胎儿中心就诊的母胎患者的护理至关重要。这一点非常重要,因为生理和神经发育属性直到童年时期才会显现,而童年时期的多层次因素会影响健康结果。电子健康记录(EHR)的文档结构并不是为获取关键属性而设计的,随着时间的推移而发生的变化以及医生之间的差异都会影响结果的输出。因此,电子病历衍生数据集准确描述先天性畸形患者临床表现和护理轨迹的能力有限。此外,胎儿缺乏数字身份,需要将母体病历中记录的属性与儿科电子病历中的属性重新链接。这一难题在多胎妊娠、回流孕产妇和胎儿夭折的情况下会进一步扩大。目前的数据系统导致对变量的抽取不完整,而这些变量可能会混淆、调解或缓和关键关联。我们的目标是开发并实施一个前瞻性数据采集平台,将电子病历数据转化为分析级数据库,供多用途使用:方法:我们建立了一个统一的母婴二人组纵向随访平台,命名为临床结果数据档案(CODA)。CODA 的设计使用了基于多学科输入的数据字典,每个患者、胎儿和妊娠的关系标识,以及对电子病历来源和图表摘要数据进行验证的流程。对 2022 年 7 月至 2023 年 7 月期间获取的数据进行了描述性分析,并对实施 CODA 前后的研究进行了比较。发现 2% 的数据点不可靠或未记录。91%的数据点来自电子病历。85%的特定病症变量需要人工抽取病历。使用 CODA 进行的研究为 18 项研究做出了贡献。CODA 成功合并了电子病历来源和人工抽取的文档,用于母婴二元组的纵向研究。
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引用次数: 0
Callosal injuries in cytomegalovirus fetopathy: a neurosonographic study. 巨细胞病毒胎儿病的胼胝体损伤:神经超声研究。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-04 DOI: 10.1159/000541794
Karina Krajden Haratz, Gustavo Malinger, Hadas Miremberg, Joseph Hartoov, Igal Wolman, Ariel Jaffa, Michael Busilov, Roee Birnbaum

Introduction - This study aimed to describe the rate and pattern of callosal injury in CMV fetopathy. Methods - This retrospective study included fetuses with confirmed CMV-PCR. Dedicated US including neurosonography was performed. Callosal Length below the 5th centile or morphological abnormalities were considered abnormal. Any additional abnormal findings were reported. Results - Seventy-two patients were included. In 76% infection occurred in the 1stT or periconceptional. In 34.7% a callosal anomaly was observed and it was never isolated. CNS abnormalities included: periventricular hyperechogenicity (PVHE) 55.5%, calcifications 52%, ventriculomegaly 33%, periventricular pseudocysts 31.4%, occipital cysts 22.2%, echogenic precaudate germinal matrix 30.5%, LSV 26.4%, sulcation abnormalities 22.2%, cerebellar findings 18% and HC below -2SD 18%. The most common association with CC insult was PVHE (56%) and calcifications (52%). Conclusion - Although not referred to as a classic brain structure affected by CMV infection, the CC was injured in one-third of our patients, including cases of late infection. The mechanism of disease and the prenatal patterns of callosal involvement in these cases appear to be different from the postnatal patterns and are not reversible. The presence of a callosal injury would imply a worse prognosis and a significant increment in the risk of neurodevelopmental impairment.

引言 - 本研究旨在描述 CMV 胎儿病中胼胝体损伤的发生率和模式。方法 - 这项回顾性研究包括确诊为 CMV-PCR 的胎儿。进行了包括神经超声在内的专用超声检查。胼胝体长度低于第 5 百分位数或形态异常被视为异常。任何其他异常结果均需报告。结果 - 共纳入 72 例患者。76%的患者感染发生在第1胎或围产期。34.7%的患者出现胼胝体异常,但从未被分离出来。中枢神经系统异常包括:脑室周围高回声(PVHE)55.5%、钙化52%、脑室肿大33%、脑室周围假性囊肿31.4%、枕囊肿22.2%、回声前包膜生发基质30.5%、LSV26.4%、沟纹异常22.2%、小脑发现18%和HC低于-2SD18%。与CC损伤最常见的关联是PVHE(56%)和钙化(52%)。结论 - 尽管CC并不是受CMV感染影响的典型脑结构,但三分之一的患者(包括晚期感染病例)的CC受到了损伤。这些病例的发病机制和胼胝体受累的产前模式似乎与产后模式不同,且不可逆转。胼胝体损伤的存在意味着预后较差,神经发育障碍的风险显著增加。
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引用次数: 0
Erratum. 勘误。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-03 DOI: 10.1159/000541608
{"title":"Erratum.","authors":"","doi":"10.1159/000541608","DOIUrl":"https://doi.org/10.1159/000541608","url":null,"abstract":"","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Double Outlet Left Ventricle with Intact Ventricular Septum: A Rare Prenatally Diagnosed Case Report. 双出口左心室伴完整的室间隔:一个罕见的产前诊断病例报告。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-26 DOI: 10.1159/000541164
Jyoti Gur, Michael P Collins, Frank Smith, Lauren Tague

Introduction: Double outlet left ventricle (DOLV) is a rare congenital heart anomaly, and cases of DOLV with an intact ventricular septum are uncommon. To date, only four such cases have been reported in the medical literature.

Case presentation: This report presents a case of prenatally diagnosed DOLV. A fetal echocardiogram at 21 weeks of gestation demonstrated both great arteries, aorta and pulmonary artery, arising from the left ventricle with severely dysplastic tricuspid valve and severe hypoplasia of the right ventricle. Subsequent echocardiograms demonstrated no ventricular septal defect. The patient required balloon atrial septostomy in the first week of life, underwent pulmonary artery banding at 5 weeks of life, and is currently status post-bidirectional Glenn, and is awaiting final Fontan palliation.

Conclusion: Prenatal diagnosis aided in predicting and guiding postnatal management.

导言双出口左心室(DOLV)是一种罕见的先天性心脏畸形,心室间隔完整的双出口左心室病例并不多见。迄今为止,医学文献中仅报道过四例此类病例:本报告介绍了一例产前确诊的 DOLV 病例。妊娠 21 周时的胎儿超声心动图显示,主动脉和肺动脉均来自左心室,三尖瓣严重发育不良,右心室严重发育不良。随后的超声心动图显示没有室间隔缺损。患者在出生后第一周需要进行球囊心房隔成形术,在出生后5周接受了肺动脉束缚术,目前处于双向格伦术后状态,正在等待最终的丰坦姑息治疗:结论:产前诊断有助于预测和指导产后管理。
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Fetal Diagnosis and Therapy
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