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The Role of Chorionicity in Placenta-Related Disorders. 绒毛膜性在胎盘相关疾病中的作用。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-23 DOI: 10.1159/000541457
Yana Brudner, Arwa Issa, Hila Sharabi, Livna Shafat, Boaz Weisz, Alon Shrim

Introduction: Twin pregnancy is associated with higher rates of maternal morbidities including gestational diabetes and hypertension. Dichorionic twins are believed to have greater placental mass. Our objective was to study the incidence of two placenta-related disorders: gestational diabetes and hypertension, in dichorionic versus monochorionic twin pregnancies.

Methods: Patients' data of all consecutive twin pregnancies over a period of 12 years were collected from medical records. Data on chorionicity were retrieved from 1st trimester ultrasound reports. Maternal complications including gestational hypertension and diabetes were collected, and incidence was compared between dichorionic and monochorionic twin pregnancies. Records lacking chorionicity data and cases with pregestational diabetes were excluded.

Results: A total of 960 twin pregnancies, 121 monochorionic and 839 dichorionic, were included. Average maternal age did not differ significantly between the groups. The median gestational age at delivery was 36.0 weeks in monochorionic and 36.7 in dichorionic twins. Primiparity (40.4% vs. 23.1%, p < 0.001) and the rate of infertility treatments (51.5% vs. 7.4%, p < 0.001) were both more common in the dichorionic group. The incidence of gestational hypertension disorders was 14% in monochorionic versus 11% in dichorionic twins (p = 0.36). Gestational diabetes was more common in dichorionic compared to monochorionic twins (9.4% and 2.5%, respectively); however, logistic multivariate analysis showed that gestational diabetes was highly correlated with maternal age (p < 0.001) and infertility treatments (p < 0.001) but not with chorionicity (p = 0.136).

Conclusion: Our results may imply that greater placental mass does not increase the risk for gestational hypertension and diabetes. This might support the role of additional multiple maternal factors associated with these complications.

导言:双胎妊娠与较高的产妇发病率有关,包括妊娠糖尿病和高血压。二绒毛膜双胎被认为胎盘质量更大。我们的目的是研究二绒毛膜双胎妊娠与单绒毛膜双胎妊娠两种胎盘相关疾病:妊娠糖尿病和高血压的发病率:方法:从医疗记录中收集 12 年间所有连续双胎妊娠患者的数据。绒毛膜性的数据来自怀孕头三个月的超声波报告。收集了包括妊娠高血压和糖尿病在内的产妇并发症,并对二绒毛膜双胎和单绒毛膜双胎的发生率进行了比较。缺乏绒毛膜性数据的记录和妊娠前糖尿病病例被排除在外:结果:共纳入了 960 例双胎妊娠,其中 121 例为单绒毛膜双胎,839 例为二绒毛膜双胎。两组孕妇的平均年龄无明显差异。单绒毛膜双胎和二绒毛膜双胎的中位胎龄分别为 36.0 周和 36.7 周。二绒毛膜双胎组的初产率(40.4% 对 23.1%,p<0.001)和不孕症治疗率(51.5% 对 7.4%,p<0.001)均较高。单绒毛膜双胎的妊娠高血压发病率为14%,而二绒毛膜双胎为11%(P=0.36)。妊娠糖尿病在二绒毛膜双胎中比单绒毛膜双胎更常见(分别为9.4%和2.5%),但逻辑回归分析显示,妊娠糖尿病与产妇年龄(p<0.001)和不孕治疗(p<0.001)高度相关,但与绒毛膜性无关(p=0.136):我们的结果可能意味着,胎盘质量越大并不会增加妊娠高血压和糖尿病的风险。结论:我们的结果可能意味着,胎盘质量越大并不会增加妊娠高血压和糖尿病的风险,这可能支持了与这些并发症相关的其他多种母体因素的作用。
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引用次数: 0
Increased Intrauterine Transfusion Blood Volume Needed to Correct Fetal Anemia due to Placental Chorioangioma. 为纠正胎盘绒毛膜血管瘤导致的胎儿贫血,需要增加宫内输血量。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-20 DOI: 10.1159/000541560
Catherine Hamzeh, Jessica Green, Grace Hamadeh, Lisa M Korst, Ramen H Chmait

Introduction: To compare the blood volume transfused for fetal anemia in cases of placental chorioangioma versus red blood cell (RBC) alloimmunization in patients matched for gestational age (GA) and hydrops.

Methods: Study patients had intrauterine transfusions and were obtained from 3 sources: group (1) placental chorioangioma patients treated at our center (2016-2023); group (2) placental chorioangioma patients reported in the medical literature; and group (3) RBC alloimmunization patients treated for fetal anemia at our center (2016-2023) matched (2:1) to patients in groups 1 and 2 by GA at procedure and presence of hydrops. The expected volume (cc) of transfusion was calculated for all patients based on a formula commonly used for fetal anemia in cases of RBC alloimmunization that includes the GA at procedure, pre-transfusion hemoglobin, donor hemoglobin, and target hemoglobin. The ratio of the volume actually transfused to the expected volume was calculated for each group and for groups 1 and 2 combined; comparisons were made using nonparametric testing.

Results: By group, the patients studied included: (1) 7 treated chorioangioma patients, (2) 8 chorioangioma patients described in the literature, and (3) 30 matched RBC alloimmunization patients. The median (range) GA at procedure for groups 1, 2, and 3 was 29.6 (22.7-32.7), 27.0 (24.0-30.0), 28.4 (22.7-34.3) weeks. The median pre-procedure hemoglobin for each group was 8.5 (5.8-12.5), 6.7 (5.6-12.0), and 5.3 (2.2-10.7) g/dL, and the median post-procedure hemoglobin for each group was 12.9 (11.5-14.0), 12.7 (9.6-14.7), and 13.6 (8.0-15.7) g/dL. The median (range) ratio of the actual to the expected volume transfused for each group was 2.50 (1.79-8.33), 1.64 (1.11-3.85), and 1.10 (0.69-1.86) (p < 0.001). When groups 1 and 2 were combined, the median ratio was 1.89 (1.11-8.33), which remained statistically significant when compared to group 3 (p < 0.001).

Conclusion: Intrauterine transfusion for fetal anemia in cases of large placental chorioangiomas appeared to require nearly twice the blood volume that was normally anticipated for cases of RBC alloimmunization, although the actual amount transfused varied widely.

简介:目的目的:比较胎盘绒毛膜血管瘤与红细胞(RBC)同种免疫患者因胎龄(GA)和肾积水匹配而导致胎儿贫血的输血量:研究患者均有宫内输血,并从 3 个来源获得红细胞:第一组:在本中心接受治疗的胎盘绒毛膜血管瘤患者(2016-2023年);第二组:医学文献中报道的胎盘绒毛膜血管瘤患者;第三组:在本中心因胎儿贫血接受治疗的RBC同种免疫患者(2016-2023年),与第一组和第二组患者的匹配比例(2:1)为手术时的胎龄(GA)和是否存在肾积水。所有患者的预期输血量(cc)都是根据红细胞异体免疫病例中胎儿贫血的常用公式计算得出的,该公式包括手术时的GA、输血前血红蛋白、供体血红蛋白和目标血红蛋白。计算各组以及第一组和第二组的实际输血量与预期输血量之比;使用非参数检验进行比较:按组别划分,研究的患者包括(1)7名接受过治疗的绒毛膜血管瘤患者,(2)8名文献中描述的绒毛膜血管瘤患者,(3)30名匹配的RBC异体免疫患者。第 1 组、第 2 组和第 3 组患者手术时的年龄中位数(范围)分别为 29.6(22.7-32.7)周、27.0(24.0-30.0)周和 28.4(22.7-34.3)周。各组术前血红蛋白中位数分别为 8.5 (5.8-12.5)、6.7 (5.6-12.0) 和 5.3 (2.2-10.7) g/dl,各组术后血红蛋白中位数分别为 12.9 (11.5-14.0)、12.7 (9.6-14.7) 和 13.6 (8.0-15.7) g/dl。各组实际输血量与预期输血量之比的中位数(范围)分别为 2.50(1.79-8.33)、1.64(1.11-3.85)和 1.10(0.69-1.86)(P<.001)。将第 1 组和第 2 组合并后,中位比值为 1.89(1.11-8.33),与第 3 组相比仍具有统计学意义(P< .001):结论:胎盘巨大绒毛膜血管瘤病例中,宫内输血治疗胎儿贫血所需的血量似乎是通常预计的红细胞异体免疫病例血量的近两倍,尽管实际输血量差异很大。
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引用次数: 0
Prenatal Diagnosis of Anomalous Origin of the Left Pulmonary Artery in Fetus with a Right-Sided Aortic Arch - Case Report and Review of the Literature. 右侧主动脉弓胎儿左肺动脉起源异常的产前诊断 - 病例报告和文献综述。
IF 2.2 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-17 DOI: 10.1159/000541432
Laura Szlang,Rabih Chaoui,Bernd Opgen-Rhein,Mi-Young Cho,Wolfgang Henrich
Introduction Anomalous origin of the left pulmonary artery (AOLPA) is an exceptionally rare congenital malformation, requiring particular care to be detected during fetal echocardiography. Case presentation A 30-year-old woman, gravida 1, para 0, was referred for a mid-trimester anomaly scan. The three-vessel tracheal view in fetal echocardiographic examination led to the prenatal detection of an anomalous origin of the left pulmonary artery in the presence of a right-sided aortic arch. Additionally, a bilateral arterial duct and the ductal origin of the left pulmonary artery (LPA) were detected postnatally. Prenatal diagnosis enabled the scheduling of the delivery in a tertiary perinatal center, immediate postnatal treatment with prostaglandin E1 to avoid obstruction of the isolated LPA as well as surgical repair of the anomaly. Conclusion The rareness of the disease led to only sporadically published cases of prenatal diagnosis of AOLPA. However, early detection makes prenatal diagnosis crucial regarding the infants' outcome. This case report underlines the importance of a meticulous examination of the bifurcation of the pulmonary trunk during fetal echocardiography.
导言:左肺动脉起源异常(AOLPA)是一种非常罕见的先天性畸形,在胎儿超声心动图检查时需要特别小心。病例介绍 一位 30 岁的妇女,孕酮 1,para 0,被转诊进行孕中期异常扫描。胎儿超声心动图检查中的三血管气管切面导致产前发现左肺动脉起源异常,同时存在右侧主动脉弓。此外,产后还发现了双侧动脉导管和左肺动脉(LPA)的导管起源。通过产前诊断,患者被安排在一家三级围产中心分娩,产后立即使用前列腺素E1治疗,以避免孤立的左肺动脉阻塞,并通过手术修复了畸形。结论 由于这种疾病的罕见性,产前诊断 AOLPA 的病例仅有零星发表。然而,早期发现使得产前诊断对婴儿的预后至关重要。本病例报告强调了在胎儿超声心动图检查中仔细检查肺动脉干分叉的重要性。
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引用次数: 0
Transamniotic Fetal Immunotherapy (TRAFIT) with Secretory IgA: A Potential Novel Ancillary Strategy for the Prevention of Necrotizing Enterocolitis. 使用分泌型 IgA 的经羊膜胎儿免疫疗法 (TRAFIT):预防坏死性小肠结肠炎的潜在新型辅助策略。
IF 2.2 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-12 DOI: 10.1159/000541434
Ashlyn E Whitlock,Kamila Moskowitzova,Ina Kycia,Jeffrey Nelson,David Zurakowski,Dario O Fauza
INTRODUCTIONSecretory immunoglobulin-A (SIgA), which is not produced perinatally, binds bacteria enhancing mucosal immunity. Higher levels of intestinal bacteria bound by SIgA are protective against necrotizing enterocolitis. Transamniotic fetal immunotherapy (TRAFIT) has previously been used to deliver SIgA to the fetal digestive tract, however with unclear functional impact. We sought to determine whether SIgA administered via TRAFIT could functionally bind intestinal bacteria postnatally.METHODSFetuses (n=38) from four dams underwent intra-amniotic injections of human SIgA on gestational-day 19 (E19; term=E22-E23). After spontaneous delivery, pups were survived for 1-2 days postnatally before intestinal contents were procured and submitted to flow cytometry. Specimens were stained for bacteria (Syto-GFP) and human-SIgA (PE) to prevent cross-reactivity with maternal rat SIgA.RESULTSOverall survival was 94.7% (36/38). SIgA-bacterial complexes were identified in all samples at all time points showing significantly higher positive PE events than unstained controls (p=0.03-0.05). The proportion of bacteria bound by IgA decreased daily, from 45.6% to 29.9% bound at 4 to 6 days post-TRAFIT, respectively (overall p=0.05).CONCLUSIONSTransamniotic fetal immunotherapy with secretory-IgA leads to functionally IgA-bound bacteria into the postnatal period and may be a novel strategy for enhancing early mucosal immunity, potentially protecting the neonate against necrotizing enterocolitis.
简介分泌性免疫球蛋白-A(SIgA)不会在围产期产生,它能与细菌结合,增强粘膜免疫能力。SIgA 结合的肠道细菌水平越高,对坏死性小肠结肠炎越有保护作用。经羊膜胎儿免疫疗法(TRAFIT)曾被用于向胎儿消化道输送 SIgA,但其功能影响尚不明确。我们试图确定通过 TRAFIT 给药的 SIgA 是否能在出生后与肠道细菌发生功能性结合。方法四个母体的胎儿(38 个)在妊娠第 19 天(E19;足月=E22-E23)接受了人类 SIgA 的羊膜腔内注射。自然分娩后,幼崽在产后存活 1-2 天,然后采集肠道内容物并进行流式细胞术检测。标本经细菌(Syto-GFP)和人SIgA(PE)染色,以防止与母体大鼠SIgA发生交叉反应。结果总存活率为94.7%(36/38)。在所有时间点的所有样本中都发现了 SIgA-细菌复合物,显示 PE 阳性事件明显高于未染色对照组(p=0.03-0.05)。结论用分泌型 IgA 进行经羊膜胎儿免疫治疗可使 IgA 结合细菌进入出生后阶段,这可能是增强早期粘膜免疫的一种新策略,有可能保护新生儿免受坏死性小肠结肠炎的侵害。
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引用次数: 0
Transamniotic Delivery of Surfactant Protein B mRNA in a Healthy Model. 在健康模型中经羊膜输送表面活性蛋白 B mRNA。
IF 2.2 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-12 DOI: 10.1159/000541429
Kamila Moskowitzova,Abbie E Naus,Tanya T Dang,David Zurakowski,Dario O Fauza
INTRODUCTIONWe sought to determine whether exogenous surfactant protein B (SPB) mRNA could be incorporated and translated by the fetal lung after simple transamniotic administration.METHODSFetuses (n=149) of twelve time-dated dams underwent intra-amniotic injections of either human SPB (hSPB) mRNA encapsulated into lipopolyplex (mRNA, n=99), or of lipopolyplex without mRNA (control; n=50) on gestational day 17 (E17, term=E21-22). Lungs were screened for hSPB by ELISA daily until term. Phosphatidylcholine (a surrogate for surfactant production) was measured in the amniotic fluid by fluorometric assay. Statistical analysis included nonparametric Wilcoxon rank sum test.RESULTSSignificantly improved survival in the mRNA group compared to controls was observed at E18 (100% vs. 85.7%) and E20 (100% vs. 83.3%) (both p<0.001). When controlled by mRNA-free injections, hSPB protein was detected in the mRNA group's lungs at E18, 19, and term (p=0.002 to <0.001). Amniotic fluid phosphatidylcholine levels were increased compared to control at term [285.9 (251.1, 363.9)μM vs. 263.1 (222.8, 309.1)μM], however this did not reach significance (p=0.33).CONCLUSIONSEncapsulated exogenous SPB mRNA can be incorporated and translated by fetal lung cells following intra-amniotic injection in a healthy rat model. Transamniotic mRNA delivery could become a novel strategy for perinatal surfactant protein replacement.
引言我们试图确定外源性表面活性蛋白B(SPB)mRNA是否能通过简单的羊膜腔注射被胎儿肺部吸收和翻译。方法12个不同时间段的母体的胎儿(n=149)在妊娠第17天(E17,足月=E21-22)接受羊膜腔内注射包裹在脂质多聚物中的人SPB(hSPB)mRNA(mRNA,n=99)或不含mRNA的脂质多聚物(对照;n=50)。每天用 ELISA 方法筛查肺部的 hSPB,直至足月。通过荧光测定法测量羊水中的磷脂酰胆碱(表面活性物质生成的替代物)。结果与对照组相比,mRNA 组在 E18(100% 对 85.7%)和 E20(100% 对 83.3%)时的存活率显著提高(均为 p<0.001)。如果用不含 mRNA 的注射进行对照,在 E18、19 和足月时,mRNA 组的肺中可检测到 hSPB 蛋白(p=0.002 至 <0.001)。与对照组相比,羊水磷脂酰胆碱水平在足月时有所增加[285.9 (251.1, 363.9)μM vs. 263.1 (222.8, 309.1)μM],但这并不显著(p=0.33)。经羊膜递送 mRNA 可成为围产期表面活性蛋白替代的一种新策略。
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引用次数: 0
Neonatal Outcomes of Multiple Congenital Thoracic Lesions. 多发性先天性胸廓病变的新生儿结局。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-07 DOI: 10.1159/000541319
Anthony di Natale, Sabrina Flohr, Leny Mathew, Cara Katterman, Colby Gallagher, Thomas A Reynolds, Juliana S Gebb, Howard B Panitch, Edward R Oliver, Natalie E Rintoul, William H Peranteau, Alan W Flake, N Scott Adzick, Holly L Hedrick

Introduction: Congenital pulmonary airway malformations (CPAM), intra- and extralobar bronchopulmonary sequestrations (iBPS/eBPS), CPAM-BPS hybrid lesions (HL), congenital lobar emphysema (CLE), bronchial atresia (BA), and foregut duplication cysts (FDC), collectively referred to as congenital thoracic lesions (CTL), are mostly solitary. Patients with multiple CTL are rare, and reports on such cases are scarce. To address this dearth, we analyzed a large multifocal CTL patient cohort.

Methods: Retrospective chart review of patients born between September 1, 2013, and March 31, 2023, who underwent surgery for a CTL at our tertiary center. Patients with radiological and surgical diagnosis of multifocal CTL, defined as ≥2 CTL present in more than one lobe were included to record pre-, peri-, and postnatal patient characteristics.

Results: Among 701 CTL patients, 74 (10.5%) had multiple CTL. CTL multifocality was prenatally recognized correctly in 8 (12.9%) patients. Most multiple CTL were right-sided, unilateral multilobar lesions (n = 33, 44%). Bilateral CTL were found in 9 (12.1%) patients. CPAM-CPAM lesions were the most prevalent CTL types (n = 36, 49%). Genetic syndromes were confirmed in 3 (4%) and additional congenital anomalies in 9 (12.9%) patients, 5 of those had multiple congenital anomalies. Of 49 (65%) patients with multilobar CTL, 25 (51%) underwent bilobectomy and 24 (49%) lung-sparing surgery. Length of stay was similar. Mortality was 5.4%.

Conclusion: We report on the largest patient cohort with multiple CTL to date. Multiple CTL occurred in 1/10 patients with CTL, and only 12.9% were recognized prenatally. Lung-sparing surgery can be considered. Multiple additional congenital anomalies and genetic syndromes may be more common and genetic testing should be considered. Overall, outcomes in this patient population are favorable.

导言:先天性肺气道畸形 (CPAM)、小叶内和小叶外支气管肺固着 (iBPS/eBPS)、CPAM-BPS 混合病变 (HL)、先天性肺叶气肿 (CLE)、支气管闭锁 (BA) 和前肠重复囊肿 (FDC),统称为先天性胸部病变 (CTL),大多为单发。多发性 CTL 患者很少见,有关此类病例的报道也很少。为了解决这一问题,我们对一个大型多灶性 CTL 患者群进行了分析:方法:对2013年1月1日至2023年3月31日期间出生、在我们的三级医疗中心接受过CTL手术的患者进行回顾性病历审查。纳入放射学和手术诊断为多灶 CTL(定义为一个以上肺叶出现≥2 个 CTL)的患者,记录患者产前、围产期和产后的特征:在701名CTL患者中,74人(10.5%)患有多灶性CTL。8例(12.9%)患者在产前正确识别了CTL多灶性。大多数多发性 CTL 为右侧、单侧多叶病变(33 例,44%)。9例(12.1%)患者发现双侧CTL。CPAM-CPAM 病变是最常见的 CTL 类型(36 例,49%)。3例(4%)患者被确诊为遗传综合征,9例(12.9%)患者存在额外的先天性异常,其中5例存在多种先天性异常。在49例(65%)多肺叶CTL患者中,25例(51%)接受了双肺切除术,24例(49%)接受了保肺手术。住院时间相似。死亡率为5.4%:我们报告了迄今为止最大的多发性 CTL 患者群。结论:我们报告了迄今为止最大的多发性 CTL 患者群。1/10 的 CTL 患者患有多发性 CTL,仅有 12.9% 的患者在产前被发现。可以考虑进行保肺手术。多种额外的先天性异常和遗传综合征可能更为常见,因此应考虑进行基因检测。总体而言,这类患者的预后良好。
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引用次数: 0
IFMSS at Forty: You Heard It Here First. 四十岁的 IFMSS:你在这里先听到的。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-30 DOI: 10.1159/000541136
Karen Mei Xian Lim, Francois I Luks

Background: The International Fetal Medicine and Surgery Society (IFMSS) was founded a little over 40 years ago, to offer a collegial, interdisciplinary forum for fetal specialists worldwide. Its inclusive culture has allowed innovations, successes, and failures to be reported freely. The present report examines progress in the field of fetal medicine, as reflected by the diversity and frequency of IFMSS presentations. We also test the hypothesis that throughout the decades, IFMSS has remained at the forefront of new developments in fetal diagnosis and therapy.

Summary: The scientific programs of annual conferences were reviewed for title and subject and assigned one or more keywords, and a single category (resulting in absolute, rather than relative incidences of topics). Select procedures covered at IFMSS meetings were plotted over time against comparable queries in PubMed. 5,467 presentations were reviewed and categorized. Keywords were plotted as a heatmap, showing a gradual shift from mostly observational to increasingly invasive studies. The relative interest of particular topics varied widely over the years, from bladder obstruction and renal pathology in early meetings, to complicated twin gestations, to fetal surgery for diaphragmatic hernia and myelomeningocele. Reports on the treatment of twin-to-twin transfusion syndrome, fetal surgery for myelomeningocele and stem cell therapy preceded similar publications in the world literature by several years.

Key messages: In its 40-year history, IFMSS has continued to offer an interdisciplinary forum for fetal medicine specialists, even as the topics of interests have evolved with the pace of technology, long-term follow-up, and new scientific discoveries.

简介:国际胎儿医学与外科学会(International Fetal Medicine and Surgery Society,IFMSS)成立于1984年,旨在为全世界的胎儿专家提供一个跨学科的学术论坛,让创新、成功和失败的案例得以自由报道。在此,我们将从 IFMSS 发言的多样性和频率来考察胎儿医学的进展。我们还检验了 IFMSS 始终站在该领域新发展前沿的假设:我们对年度会议的科学计划进行了标题和主题审查,并指定了一个或多个关键词和一个类别。将 IFMSS 会议涉及的部分程序与 PubMed 中的可比查询进行对比:结果:共审查并分类了 5,467 篇演讲。关键词被绘制成一张热图,从大部分观察性研究到越来越多的侵入性研究。关注的主题差异很大,从早期会议的肾脏病理学,到双胞胎输血综合征(TTTS)、膈疝和脊髓膜膨出的胎儿手术。关于TTTS、骨髓膜缺失修复和干细胞疗法的报告比世界文献中类似文章的发表时间要早数年:在其 40 年的历史中,IFMSS 为胎儿专家提供了一个跨学科的论坛,即使感兴趣的话题随着技术、长期随访和新科学发现的步伐而不断发展。
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引用次数: 0
Impact of a Stage-Based Classification on the Incidence of Fetal Growth Restriction, Preterm Birth Rates, and Birthweight in a Rural Community of Central India. 基于阶段的分类对印度中部一个农村社区胎儿生长受限发生率、早产率和出生体重的影响。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-29 DOI: 10.1159/000540199
Lalit Kishore Sharma, Rijo Mathew Choorakuttil, Praveen Kumar Nirmalan

Introduction: The objective of this study was to determine the impact of the stage-based classification of fetal growth restriction (FGR) on the magnitude of FGR, preterm births (PTBs), and birthweight (BW) in a rural population of Madhya Pradesh in Central India.

Methods: The program covered 168 public sector centers for pregnant women and infants that provided services to nearly 220,000 people. The third-trimester assessments included fetal biometry, growth and environment assessments, and Doppler assessments. Fetal growth was staged using the Barcelona protocol as stages 1-4 FGR, small for gestational age, and no FGR. The data from the last ultrasound assessment before childbirth were considered. Regular training programs covering preconception care, antenatal and postnatal care were organized in the local language for the public sector community health workers of the program district. Childbirth outcomes were collected from the obstetric service of the local public sector hospital.

Results: The analysis included 1,229 pregnancies from 2019 to 2023. The overall magnitude of FGR using estimated fetal weight <10th centile was 19.61% and reduced to 13.34% with the stage-based classification. The magnitude of FGR using the stage-based classification reduced from 27.59% in 2019 to 8.95% in 2023. The PTB in the stage-based FGR subgroup declined from 35.0% in 2019 to 3.45% in 2023 and 96.55% of the stage 1 FGR babies in 2023 were delivered at term. The overall mean BW in the program area improved from 2,772.41 (357.11) g in 2019 to 2,819.68 (377.31) g in 2023. The perinatal mortality rate (8.95 per 1,000 pregnancies) in the program area for 2019-2023 was much lower than the 31.9 per 1,000 pregnancies reported for Madhya Pradesh.

Conclusion: The change to a stage-based classification of FGR integrated with low-dose aspirin and fetal Doppler studies reduced the incidence of FGR and PTB and perinatal mortality and increased BW in this rural community.

引言在印度中部中央邦的农村人口中,确定基于阶段的胎儿畸形分类对胎儿畸形、早产和出生体重的影响 方法:该计划覆盖了 168 个公共部门的孕妇和婴儿中心,为近 22 万人提供服务。第三孕期评估包括胎儿生物测量、生长和环境评估以及多普勒评估。根据巴塞罗那方案,胎儿发育被分为 1 至 4 期 FGR、小于胎龄(SGA)和无 FGR。分娩前最后一次超声波评估的数据也被考虑在内。用当地语言为项目地区的公共部门社区卫生工作者定期举办培训课程,内容包括孕前保健、产前和产后保健。分娩结果由当地公立医院的产科部门收集:分析包括 2019 年至 2023 年的 1 229 例妊娠。采用 EFW <10 百分位数的 FGR 总规模为 19.61%,而采用基于阶段的分类则降至 13.34%。使用基于阶段的分类方法,FGR 的幅度从 2019 年的 27.59% 降至 2023 年的 8.95%。基于分期的 FGR 亚组的 PTB 从 2019 年的 35.0% 降至 2023 年的 3.45%,2023 年 96.55% 的 FGR 1 期婴儿为足月分娩。计划地区的总体平均出生体重从 2019 年的 2772.41(357.11)克提高到 2023 年的 2819.68(377.31)克。计划地区 2019 年至 2023 年的 PMR(每千名孕妇 8.95 例)远低于中央邦报告的每千名孕妇 31.9 例:在这个农村社区,改用基于分期的 FGR 分类法并结合低剂量阿司匹林和胎儿多普勒研究,降低了 FGR 和 PTB 的发病率以及围产期死亡率,并提高了出生体重。
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引用次数: 0
Perinatal Outcomes of Pregnancies with Borderline Oligohydramnios at Term. 临产时边缘性少尿妊娠的围产期结局。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-22 DOI: 10.1159/000541008
Inshirah Sgayer, Mohamed Elafawi, Olga Braude, Sarah Abramov, Lior Lowenstein, Marwan Odeh

Introduction: Limited evidence exists on borderline oligohydramnios. Our objective was to determine perinatal outcomes in uncomplicated term pregnancies with borderline oligohydramnios.

Methods: This retrospective analysis compared adverse perinatal outcomes among pregnancies during 2018-2022, between those with borderline oligohydramnios defined as amniotic fluid index (AFI) of 5.1-8.0 cm, those with oligohydramnios (AFI ≤5 cm), and those with normal AFI (8.1-25 cm). The latter matched one-to-one to the borderline oligohydramnios group and served as the control group. The outcomes compared included birthweight, cesarean delivery due to fetal distress, the presence of meconium-stained amniotic fluid, Apgar scores, neonatal intensive care unit admission, and the occurrence of small-for-gestational-age (SGA) neonates.

Results: During the study period, 140 women had borderline oligohydramnios and 345 had oligohydramnios; the control group included 140 women. Borderline oligohydramnios was associated with increased rates of delivering SGA neonates (adjusted odds ratio [aOR] = 3.6, 95% confidence interval [CI] 1.1-11.6, p = 0.034) and cesarean delivery due to fetal distress (aOR = 3.0, 95% CI 1.1-8.3, p = 0.032). Rates of composite neonatal outcome (including at least one of the following: cesarean delivery due to fetal distress, meconium-stained amniotic fluid, 5-min Apgar score <7, umbilical artery pH <7.15, or neonatal intensive care unit admission) were higher in both the borderline oligohydramnios (20.7%) and oligohydramnios (18.6%) groups compared to the control group (9.3%) (p = 0.019).

Conclusions: Pregnancies with borderline oligohydramnios were associated with increased risks of delivering SGA neonates and requiring cesarean delivery due to fetal distress. These findings support considering closer antepartum surveillance for these pregnancies, especially for identifying abnormal fetal growth.

引言 有关边缘性少尿症的证据有限。我们的目的是确定患有边缘性少水羊膜症的无并发症足月妊娠的围产期结局。方法 这项回顾性分析比较了2018-2022年期间妊娠的围产期不良结局,包括边缘性少水羊膜症(定义为羊水指数(AFI)5.1-8.0厘米)、少水羊膜症(AFI≤5厘米)和AFI正常(8.1-25厘米)的妊娠。后者与边缘少尿组一一对应,作为对照组。比较的结果包括出生体重、胎儿窘迫导致的剖宫产、羊水中是否有胎粪染色、Apgar 评分、新生儿重症监护室入院情况以及小于胎龄(SGA)新生儿的发生率。结果 在研究期间,140 名妇女患有边缘性少水羊膜症,345 名妇女患有少水羊膜症;对照组包括 140 名妇女。边缘性少水妊娠与分娩 SGA 新生儿的比率增加有关(调整后的比值比 (aOR) = 3.6,95% 置信区间 (CI) 1.1-11.6,p=0.034),也与因胎儿窘迫而剖宫产的比率增加有关(aOR = 3.0,95% CI 1.1-8.3,p=0.032)。与对照组(9.3%)相比,边缘性少水羊膜症组(20.7%)和少水羊膜症组(18.6%)的新生儿综合结局(包括以下至少一项:因胎儿窘迫而剖宫产、羊水中含有胎粪,5 分钟 Apgar 评分 <7,脐动脉 pH <7.15,或入住新生儿重症监护室)发生率均较高(P=0.019)。结论 边缘性少水妊娠与分娩 SGA 新生儿和因胎儿窘迫而需要剖宫产的风险增加有关。这些研究结果支持对这些孕妇进行更严密的产前监测,尤其是在发现胎儿发育异常时。
{"title":"Perinatal Outcomes of Pregnancies with Borderline Oligohydramnios at Term.","authors":"Inshirah Sgayer, Mohamed Elafawi, Olga Braude, Sarah Abramov, Lior Lowenstein, Marwan Odeh","doi":"10.1159/000541008","DOIUrl":"10.1159/000541008","url":null,"abstract":"<p><strong>Introduction: </strong>Limited evidence exists on borderline oligohydramnios. Our objective was to determine perinatal outcomes in uncomplicated term pregnancies with borderline oligohydramnios.</p><p><strong>Methods: </strong>This retrospective analysis compared adverse perinatal outcomes among pregnancies during 2018-2022, between those with borderline oligohydramnios defined as amniotic fluid index (AFI) of 5.1-8.0 cm, those with oligohydramnios (AFI ≤5 cm), and those with normal AFI (8.1-25 cm). The latter matched one-to-one to the borderline oligohydramnios group and served as the control group. The outcomes compared included birthweight, cesarean delivery due to fetal distress, the presence of meconium-stained amniotic fluid, Apgar scores, neonatal intensive care unit admission, and the occurrence of small-for-gestational-age (SGA) neonates.</p><p><strong>Results: </strong>During the study period, 140 women had borderline oligohydramnios and 345 had oligohydramnios; the control group included 140 women. Borderline oligohydramnios was associated with increased rates of delivering SGA neonates (adjusted odds ratio [aOR] = 3.6, 95% confidence interval [CI] 1.1-11.6, p = 0.034) and cesarean delivery due to fetal distress (aOR = 3.0, 95% CI 1.1-8.3, p = 0.032). Rates of composite neonatal outcome (including at least one of the following: cesarean delivery due to fetal distress, meconium-stained amniotic fluid, 5-min Apgar score &lt;7, umbilical artery pH &lt;7.15, or neonatal intensive care unit admission) were higher in both the borderline oligohydramnios (20.7%) and oligohydramnios (18.6%) groups compared to the control group (9.3%) (p = 0.019).</p><p><strong>Conclusions: </strong>Pregnancies with borderline oligohydramnios were associated with increased risks of delivering SGA neonates and requiring cesarean delivery due to fetal distress. These findings support considering closer antepartum surveillance for these pregnancies, especially for identifying abnormal fetal growth.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035564","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
Reproducibility Analysis of Two Speckle Tracking Software for the Antenatal Semiautomated Assessment of the Fetal Cardiac Function. 用于产前胎儿心脏功能半自动评估的两种斑点追踪软件的重现性分析。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-19 DOI: 10.1159/000541007
Andrea Di Tonto, Laura Nogue, Beatrice Valentini, Mar Bennasar, Chiara Melito, Sara Sorrentino, Olga Gómez, Enrico Corno, Maria Teresa Baffa, Tullio Ghi, Fàtima Crispi, Andrea Dall'Asta

Introduction: Speckle tracking echocardiography is a non-Doppler modality allowing the semiautomated evaluation of the fetal cardiac function by tracking the speckles of the endocardial borders. Little evidence is available on the evaluation and comparison of different software for the functional assessment of the fetal heart by means of speckle tracking echocardiography. The aim of this study was to evaluate the reproducibility and agreement of two different proprietary speckle tracking software for the prenatal semiautomated assessment of the fetal cardiac function.

Methods: The prospective study including non-anomalous fetuses was referred for different indications at two tertiary academic units in Italy (University of Parma) and Spain (University of Barcelona). Two-dimensional clips of the four-chamber view of the fetal heart were acquired by two dedicated operators using high-end ultrasound machines with a frame rate higher than 60 Hz. The stored clips were pseudo-anonymized and shared between the collaborating units. Functional echocardiographic analyses were independently performed using the two proprietary software (TomTec GmbH and FetalHQ®) by the same operators. Inter-software reproducibility of the endocardial global longitudinal strain (EndoGLS) and fractional area change (FAC) of the left (LV) and the right ventricles (RV) and ejection fraction (EF) of the LV were evaluated by the intraclass correlation coefficient (ICC).

Results: Forty-eight fetuses were included at a median of 31+2 (21+6-40+3) gestational weeks. Moderate reproducibility was found for the functional parameters of the LV: EndoGLS (Pearson's correlation 0.456, p < 0.01; ICC 0.446, 95% CI: 0.189-0.647, p < 0.01); EF (Pearson's correlation 0.435, p < 0.01; ICC 0.419, 95% CI: 0.156-0.627, p < 0.01); FAC (Person's correlation 0.484, p < 0.01; ICC 0.475, 95% CI: 0.223-0.667, p < 0.01). On the contrary, RV functional parameters showed poor reproducibility between the two software: EndoGLS (Pearson's correlation 0.383, p = 0.01; ICC 0.377, 95% CI: 0.107-0.596, p < 0.01) and FAC (ICC 0.284, 95% CI: 0.003-0.524, p = 0.02).

Conclusion: Our results demonstrate a moderate reproducibility of the speckle tracking analysis of the LV using TomTec GmbH and FetalHQ®, with poor reproducibility for RV analysis.

简介:斑点追踪超声心动图(STE)是一种非多普勒模式,可通过追踪心内膜边界的斑点对胎儿心脏功能进行半自动评估。通过 STE 对胎儿心脏功能进行评估和比较不同软件的证据很少。本研究旨在评估两种不同的专有斑点追踪软件在产前半自动胎儿心脏功能评估中的可重复性和一致性。方法 前瞻性研究包括意大利帕尔马大学(University of Parma)和西班牙巴塞罗那大学(University of Barcelona)两所三级学术单位因不同适应症转诊的非畸形胎儿。胎儿心脏四腔切面的二维片段由两名操作员使用帧频高于 60 Hz 的高端超声设备采集。存储的片段经过伪匿名处理,并在合作单位之间共享。功能超声心动图分析由同一操作人员使用两款专有软件(TomTec GmbH 和 FetalHQ®)独立完成。心内膜整体纵向应变(EndoGLS)、左心室(LV)和右心室(RV)的分数面积变化(FAC)以及左心室射血分数(EF)的软件间重现性由类内相关系数(ICC)进行评估。结果 共纳入48个胎儿,中位孕周为31+2(21+6 - 40+3)。发现左心室功能参数具有适度的可重复性:EndoGLS(Pearson's correlation 0.456,p<0.01;ICC 0.446,95%CI (0.189-0.647),p<0.01);EF(Pearson's correlation 0.435,p<0.01;ICC 0.419,95%CI (0.156-0.627),p<0.01);FAC(Person's correlation 0.484,p<0.01;ICC 0.475,95%CI (0.223-0.667),p<0.01)。相反,RV 功能参数在两个软件之间的重现性很差:EndoGLS(Pearson's correlation 0.383,p=0.01;ICC 0.377,95%CI (0.107-0.596),p<0.01)和 FAC(ICC 0.284,95%CI (0.003-0.524),p=0.02)。结论 我们的结果表明,使用 TomTec GmbH 和 FetalHQ® 对左心室进行斑点追踪分析的可重复性适中,而对左心室分析的可重复性较差。
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引用次数: 0
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Fetal Diagnosis and Therapy
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