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Elevated Middle Cerebral Artery Peak Systolic Velocity in Non-Anemic Fetuses: Providing a Better Understanding of Enigmatic Middle Cerebral Artery Peak Systolic Velocity. 非贫血胎儿大脑中动脉峰值收缩速度升高--更好地理解神秘的大脑中动脉峰值收缩速度。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-18 DOI: 10.1159/000540342
Saja Anabusi, Tim Van Mieghem, Greg Ryan, Shiri Shinar

Introduction: Our aim was to investigate the incidence, comorbidities, and outcomes of fetuses with an elevated middle cerebral artery peak systolic velocity (MCA-PSV) >1.5 multiples of median (MoM), despite normal hemoglobin (Hgb) levels on fetal blood sampling (FBS).

Methods: A single-center observational retrospective cohort study of all fetuses undergoing FBS and MCA-PSV >1.5 MoM. Only those fetuses with no or mild anemia were included. Indications for Doppler assessment, associated anomalies, and neonatal outcomes were collected.

Results: Overall, 383 fetuses had an MCA-PSV >1.5 MoM and underwent FBS. Twenty-three (6%) fetuses met our inclusion criteria and had no or only mild anemia. Associations with elevated MCA-PSV were elucidated in 12 of the 23 cases (52.2%) and included mild anemia (n = 2), intracranial hemorrhage (n = 3), genetic disease (n = 1), idiopathic nonimmune hydrops (NIH, n = 1), hypoxic-ischemic encephalopathy (n = 1), maternal and or fetal acidosis (n = 3), and fetal growth restriction (n = 1). Favorable perinatal outcomes were observed in truly unexplained 11 cases with no additional anomalies (47.8%).

Conclusion: Elevated MCA-PSV >1.5 MoM with normal Hgb levels is seen in 6% of pregnancies undergoing FBS and is often associated with other significant maternal or fetal problems. Those with unexplained and isolated MCA-PSV elevation have normal outcomes.

引言 我们的目的是研究在胎儿血液采样(FBS)中血红蛋白(Hgb)水平正常,但大脑中动脉收缩峰值速度(MCA-PSV >1.5倍中位数(MoM))升高的胎儿的发病率、并发症和结局。方法 对所有接受 FBS 和 MCA-PSV 为 1.5 倍中位数的胎儿进行单中心观察性回顾性队列研究。仅纳入无贫血或轻度贫血的胎儿。研究收集了多普勒评估的指征、相关畸形和新生儿结局。结果 总体而言,383 个胎儿的 MCA-PSV 为 1.5 MoM,并接受了 FBS。23名(6%)胎儿符合我们的纳入标准,没有贫血或仅有轻度贫血。23例中有12例(52.2%)与MCA-PSV升高有关,包括轻度贫血(2例)、颅内出血(3例)、遗传病(1例)、特发性非免疫性水肿(NIH,1例)、缺氧缺血性脑病(HIE,1例)、母体或胎儿酸中毒(3例)和胎儿生长受限(1例)。在真正原因不明的 11 例病例中,未发现其他异常,围产期结局良好(47.8%)。结论 在接受 FBS 检查的孕妇中,有 6% 出现 MCA-PSV >1.5 MoM 升高但血红蛋白水平正常的情况,而且往往与其他重大的母体或胎儿问题相关。那些原因不明的、孤立的 MCA-PSV 升高孕妇的预后正常。
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引用次数: 0
Fetal Strain and Strain Rate Measured with Speckle Tracking Echocardiography in Maternal Diabetes: Systematic Review. 用斑点追踪超声心动图测量母体糖尿病患者的胎儿应变和应变率:系统综述。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-17 DOI: 10.1159/000538413
Chantelle de Vet, Hossy Zamani, Daisy van der Woude, Sally-Ann Clur, Guid Oei, Judith van Laar, Noortje van Oostrum

Introduction: The aim of this systematic review and meta-analysis was to evaluate fetal cardiac function in fetuses of mothers with diabetes compared to those of mothers without diabetes using 2D-STE.

Methods: Embase, MEDLINE, and CENTRAL were searched for observational studies on 2D-STE fetal left and right ventricular global longitudinal strain and strain rate that included singleton, non-anomalous pregnancies complicated by pregestational or gestational diabetes mellitus compared to uncomplicated pregnancies. The strain values were pooled per 4 weeks of gestation for meta-analysis using random-effects models.

Results: Fifteen studies met the criteria, including 990 fetuses of diabetic mothers and 1,645 control fetuses. The study design was cross-sectional in fourteen studies and longitudinal in one study. Gestational age, type of diabetes, ultrasound device, and 2D-STE software varied between the studies. Glycemic control and type of treatment were often lacking. In fetuses of diabetic mothers versus healthy mothers, left ventricular strain was significantly decreased (7 studies), increased (1 study), or not significantly different (7 studies). Right ventricular strain was decreased (7 studies), increased (1 study), or not different (2 studies). Left ventricular strain rate was decreased (3 studies), increased (1 study), or not different (2 studies). Right ventricular strain rate was increased (1 study) or not different (2 studies).

Conclusion: Fetuses of mothers with diabetes show evidence of systolic dysfunction, which is more visible in the right ventricle. Contradictory results are probably due to suboptimal study designs and variation in gestational age, diabetes severity, image acquisition, and software. Large prospective longitudinal studies are needed to assess fetal myocardial function with 2D-STE in pregestational diabetes mellitus type 1 and 2 and gestational diabetes mellitus pregnancies. The influence of glycemic control, BMI, and treatment should be evaluated.

简介:这项系统性综述和荟萃分析的目的是利用 2D-STE 评估糖尿病母亲与非糖尿病母亲胎儿的胎儿心脏功能:方法: 通过Embase、MEDLINE和CENTRAL检索了有关二维STE胎儿左心室和右心室整体纵向应变和应变率的观察性研究,这些研究包括单胎、因妊娠前或妊娠期糖尿病而并发的非异常妊娠与非并发妊娠的比较。使用随机效应模型对每4周妊娠的应变值进行汇总,以进行荟萃分析:15项研究符合标准,包括990名糖尿病母亲的胎儿和1645名对照组胎儿。14 项研究的研究设计为横断面研究,1 项研究为纵断面研究。不同研究的妊娠年龄、糖尿病类型、超声设备和 2D-STE 软件各不相同。血糖控制和治疗类型往往缺失。与健康母亲相比,糖尿病母亲的胎儿左心室应变显著降低(7 项研究)、增加(1 项研究)或无显著差异(7 项研究)。右心室应变减少(7 项研究)、增加(1 项研究)或无差异(2 项研究)。左心室应变率降低(3 项研究)、升高(1 项研究)或无差异(2 项研究)。右心室应变率增加(1 项研究)或无差异(2 项研究):结论:母亲患有糖尿病的胎儿会出现收缩功能障碍,这在右心室更为明显。结论:患有糖尿病的母亲所怀的胎儿有收缩功能障碍的迹象,右心室更为明显。出现矛盾的结果可能是由于研究设计不够理想,以及妊娠年龄、糖尿病严重程度、图像采集和软件的不同造成的。需要进行大型前瞻性纵向研究,用二维STE评估妊娠前1型和2型糖尿病妊娠及妊娠期糖尿病妊娠的胎儿心肌功能。应评估血糖控制、体重指数和治疗的影响。
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引用次数: 0
Effect of Maternal Ursodeoxycholic Acid Treatment on Fetal Atrioventricular Conduction in Patients with Intrahepatic Cholestasis of Pregnancy. 母体熊去氧胆酸治疗对妊娠肝内胆汁淤积症患者胎儿房室传导的影响
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-07-16 DOI: 10.1159/000540261
Ömer Gökhan Eyisoy, Oya Demirci, Ümit Taşdemir, Mucize Özdemir, Aydın Öcal, Özge Kahramanoğlu

Introduction: The aim of this study was, first, to investigate the difference in fetal atrioventricular conduction in patients with and without intrahepatic cholestasis of pregnancy (ICP) by measuring the fetal PR interval; second, to evaluate the altering effect of ursodeoxycholic acid (UDCA) treatment on the fetal PR interval in ICP patients.

Methods: The study consisted of 42 ICP patients and 48 healthy pregnant women. Fetal echocardiography was performed to measure the mechanical PR interval. The fetal PR interval and the clinical characteristics were compared between the two groups. The effect of UDCA treatment on the fetal PR interval in ICP patients was evaluated.

Results: In ICP patients, significantly longer fetal PR intervals were observed than in the control group (123.21 ± 8.54 vs. 115.13 ± 5.95 ms, p < 0.001). In the ICP group, there was a positive correlation between the fetal PR interval and maternal fasting total bile acid (TBA) levels (r = 0.514, p = 0.001). After 1 week of treatment with UDCA in patients with ICP, the PR interval was shorter than before, although the reduction was not statistically significant (120.98 ± 6.70 vs. 123.21 ± 8.54 ms, p = 0.095). In patients with severe ICP (TBA >40 mmol/L, n = 10), a significant reduction in the fetal PR interval was observed after treatment with UDCA (127.5 ms [IQR, 118.0-134.75] before vs. 122 ms [IQR, 109.5-126.5] after, p = 0.037).

Conclusion: Fetal PR interval increased in ICP patients in correlation with maternal serum TBA concentration. Treatment with UDCA may have limited positive effects on the fetal AV conduction system. The beneficial effects of UDCA on the fetal PR interval may be more pronounced in patients with higher bile acid levels.

简介本研究的目的首先是通过测量胎儿PR间期,研究妊娠肝内胆汁淤积症(ICP)患者和非ICP患者胎儿房室传导的差异;其次是评估熊去氧胆酸(UDCA)治疗对ICP患者胎儿PR间期的改变作用:研究对象包括 42 名 ICP 患者和 48 名健康孕妇。胎儿超声心动图测量机械性 PR 间期。比较两组孕妇的胎儿 PR 间期和临床特征。评估了 UDCA 治疗对 ICP 患者胎儿 PR 间期的影响:ICP患者的胎儿PR间期明显长于对照组(123.21±8.54 vs. 115.13±5.95 ms,p<0.001)。在 ICP 组中,胎儿 PR 间期与母体空腹总胆汁酸水平(TBA)呈正相关(r=0.514,p=0.001)。ICP患者使用UDCA治疗一周后,PR间期比治疗前缩短,但缩短幅度无统计学意义(120.98±6.70 vs. 123.21±8.54ms,p=0.095)。在重度 ICP(TBA>40 mmol/L,n=10)患者中,观察到 UDCA 治疗后胎儿 PR 间期显著缩短(治疗前 127,5ms [IQR, 118,0-134,75] vs. 治疗后 122ms [IQR, 109,5-126,5], p=0,037):结论:ICP 患者的胎儿 PR 间期延长与母体血清 TBA 浓度相关。使用 UDCA 治疗可能对胎儿房室传导系统产生有限的积极影响。UDCA 对胎儿 PR 间期的有利影响在胆汁酸水平较高的患者中可能更为明显。
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引用次数: 0
Middle Cerebral Artery Doppler before and after Fetal Spina Bifida Repair: An Indirect Sign of Hindbrain Compression and Decompression? 胎儿脊柱裂修复前后的大脑中动脉多普勒:后脑受压和减压的间接标志?
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-06-14 DOI: 10.1159/000539773
Ladina Vonzun, Ladina Ruegg, Julia Zepf, Nele Strübing, Patrice Grehten, Martin Meuli, Luca Mazzone, Ueli Moehrlen, Nicole Ochsenbein-Koelble

Introduction: Reduced middle cerebral artery resistance indices (MCA-RI) in fetuses with spina bifida (fSB) are commonly observed. Compression of neuronal pathways in the brainstem due to hindbrain herniation (HH) and disturbed cerebrospinal fluid circulation likely cause an imbalance of the autonomic nervous system. This may increase systemic vasoconstriction and compensatory increase cerebral vasodilation (like brain sparing). The aim of this study was to systematically analyze all fetal MCA-RI before and after fSB repair and to compare their correlation with the presence and postsurgical resolution of HH.

Methods: 173 patients were included. Standardized ultrasound examinations including MCA and umbilical artery (UA) Doppler as well as assessment of HH presence and regression were performed. Fetuses with MCA-RI <5th percentile (P) before fetal surgery were compared to the group with normal MCA-RI and correlated to the presence of HH before and its regression after fSB repair.

Results: 30% (49/161) fetuses showed RI's <5th P before fSB repair. All fetuses had normal UA-RI. 99.4% of fetuses (160/161) showed normal of MCA-RI before delivery. Normalization occurred within a mean of 1.3 ± 1.2 weeks. HH regression was observed in 97% in the group with normal MCA-RI and in 96% in the group with MCA-RI <5th P before surgery (p = 0.59). Time lapse to HH regression after fSB repair was 1.8 ± 1.7 and 1.9 ± 1.6 weeks, respectively.

Conclusion: In fetuses with MCA-RIs <5 P before fSB repair, a parallel timely course of MCA-RI normalization and HH regression was noted. To suggest common pathogenic factor(s), more studies are needed. However, normalization of the fetal cerebral circulation could be a further benefit of fSB repair.

导言:脊柱裂胎儿的大脑中动脉阻力指数(MCA-RI)降低是常见现象。后脑疝(HH)和脑脊液循环障碍导致脑干神经元通路受压,很可能造成自主神经系统失衡。这可能会增加全身血管收缩和代偿性增加脑血管扩张(如脑疏通)。本研究的目的是系统分析 fSB 修复前后的所有胎儿 MCA-RI,并比较其与 HH 存在和手术后缓解的相关性。方法:共纳入 173 例患者,进行了包括 MCA 和脐动脉(UA)多普勒在内的标准化超声检查,并评估了 HH 的存在和消退情况。将胎儿手术前MCA-RI<第5百分位数(P.)的胎儿与MCA-RI正常的胎儿组进行比较,并将两者与胎儿手术前是否存在HH及手术后HH是否消退进行比较:结果:30%(49/161)的胎儿在FSB修补术前显示出RI的第5百分位数。所有胎儿的 UA-RI 均正常。99.4%的胎儿(160/161)在分娩前显示 MCA-RI 正常。正常化平均发生在 1.3±1.2 周内。术前MCA-RI正常组中有97%的胎儿HH消退,MCA-RI<5thP.组中有96%的胎儿HH消退(P = 0.59)。FSB修复后HH消退的时间分别为1.8±1.7周和1.9±1.6周:结论:在fSB修复前MCA-RIs为5.P的胎儿中,MCA-RI正常化与HH消退的时间进程是平行的。要提出共同的致病因素,还需要更多的研究。然而,胎儿脑循环正常化可能是 fSB 修复的另一个益处。
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引用次数: 0
Comparison of Serial Amnioinfusion Strategies for Isolated Early-Onset Fetal Renal Anhydramnios. 针对孤立性早发性胎儿肾性无羊水症的连续无羊水灌注策略比较。
IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-06-10 DOI: 10.1159/000539732
Joyce M Cheng, Ahmet A Baschat, Meredith A Atkinson, Mara Rosner, Michelle L Kush, Denise Wolfson, Sarah Olson, Kristin Voegtline, Lindsey Goodman, Angie C Jelin, Jena L Miller

Introduction: The optimal protocol for serial amnioinfusions to maintain amniotic fluid in pregnancies with early-onset fetal renal anhydramnios before 22 weeks is not known. We compared the performance of two different approaches.

Methods: A secondary analysis was conducted of serial amnioinfusions performed by a single center during the external pilot and feasibility phases of the Renal Anhydramnios Fetal Therapy (RAFT) trial. During the external pilot, higher amnioinfusion volumes were given less frequently; in the feasibility study, smaller volume amnioinfusions were administered more frequently. Procedural details, complications, and obstetric outcomes were compared between the two groups using Pearson's χ2 or Fisher's exact tests for categorical variables and Student's t tests or Wilcoxon rank-sum tests for continuous variables. The adjusted association between procedural details and chorioamniotic separation was obtained through a multivariate repeated measure logistic regression model.

Results: Eleven participants underwent 159 amnioinfusions (external pilot: 3 patients, 21 amnioinfusions; feasibility: 8 patients, 138 amnioinfusions). External pilot participants had fewer amnioinfusions (7 vs. 19.5 in the feasibility group, p = 0.04), larger amnioinfusion volume (750 vs. 500 mL, p < 0.01), and longer interval between amnioinfusions (6 [4-7] vs. 4 [3-5] days, p < 0.01). In the external pilot, chorioamniotic separation was more common (28.6% vs. 5.8%, p < 0.01), preterm prelabor rupture of membranes (PPROM) occurred sooner after amnioinfusion initiation (28 ± 21.5 vs. 75.6 ± 24.1 days, p = 0.03), and duration of maintained amniotic fluid between first and last amnioinfusion was shorter (38 ± 17.3 vs. 71 ± 19 days, p = 0.03), compared to the feasibility group. While delivery gestational age was similar (35.1 ± 1.7 vs. 33.8 ± 1.5 weeks, p = 0.21), feasibility participants maintained amniotic fluid longer.

Conclusion: Small volume serial amnioinfusions performed more frequently maintain normal amniotic fluid volume longer because of delayed occurrence of PPROM.

导言 22 周前早发胎儿肾性羊水过少的孕妇进行连续羊水灌注以维持羊水的最佳方案尚不清楚。我们比较了两种不同方法的效果。方法 在肾性无水胎儿治疗(Renal Agenesis Fetal Therapy,RAFT)试验的外部试验和可行性阶段,我们对单个中心进行的连续羊水灌注进行了二次分析。在外部试验阶段,大容量羊膜腔注射的频率较低;在可行性研究阶段,小容量羊膜腔注射的频率较高。对两组的手术细节、并发症和产科结果进行了比较,对分类变量采用皮尔逊卡方检验或费雪精确检验,对连续变量采用学生 t 检验或 Wilcoxon Rank-Sum 检验。程序细节与绒毛膜羊膜分离之间的调整关联是通过多变量重复测量逻辑回归模型得出的。结果 11名参与者接受了159次羊膜腔注射(外部试点:3名患者,21次羊膜腔注射;可行性:8名患者,138次羊膜腔注射)。外部试点参与者的羊膜腔注射次数较少(可行性组为 7 次对 19.5 次,p = 0.04),羊膜腔注射量较大(750 毫升对 500 毫升,p < 0.01),羊膜腔注射间隔时间较长(6 [4-7] 天对 4 [3-5] 天,p < 0.01)。在外部试验中,绒毛膜羊膜分离更常见(28.6% vs. 5.8%,p < 0.01),早产胎膜早破(PPROM)在羊膜腔注射开始后更早(28 ± 21.5 对 75.6 ± 24.1 天,p = 0.03),与可行性组相比,首次和最后一次羊膜腔注射之间的羊水维持时间更短(38 ± 17.3 对 71 ± 19 天,p=0.03)。虽然分娩胎龄相似(35.1 ± 1.7 对 33.8 ± 1.5 周,p=0.21),但可行性组的羊水维持时间更长。结论 小容量连续羊水灌注更频繁地维持正常羊水量的时间更长,因为PPROM发生的时间会推迟。
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引用次数: 0
Needle Fetal Thoracoscopy: A Technique to Assist with Ultrasound-Guided Placement of Challenging Thoracoamniotic Shunts. 针式胎儿胸腔镜检查:一种在超声引导下辅助进行高难度胸羊膜分流术的技术。
IF 2.2 3区 医学 Q1 Medicine Pub Date : 2024-05-15 DOI: 10.1159/000539274
Steven T Papastefan, Daniel R Liesman, Katherine C Ott, Federico Scorletti, Xavier F Pombar, Aimen F Shaaban, Amir M Alhajjat

Introduction: Fetal thoracoamniotic shunts are common lifesaving interventions but frequently require replacement. Needle fetal thoracoscopy is a technique that uses standard thoracoamniotic shunt introducer sheaths to permit direct visualization and even instrument manipulation during shunt deployment to facilitate optimal positioning and primary shunt function in the most challenging cases.

Case presentation: In this study, 5 patients who underwent needle fetal thoracoscopy-assisted thoracoamniotic shunt placement were reviewed. Three patients with large, macrocystic congenital pulmonary airway malformations (CPAMs) with evidence of worsening mediastinal shift and/or hydrops and 2 patients with large chylothorax with fetal hydrops were treated. Four cases had previous shunts that failed due to poor sonographic visualization during initial placement, cyst septations, shunt obstruction, or dislodgment. Needle fetal thoracoscopy was used to disrupt cyst walls and septations, clear hematoma, and confirm the optimal initial position of the shunt. In this series, 1 severe CPAM patient with a short cervix developed preterm labor postoperatively resulting in neonatal demise. The remaining 4 patients experienced resolution of hydrops and progressed to successful delivery with excellent neonatal outcomes.

Conclusion: Needle fetal thoracoscopy is a procedure that may be selectively deployed in challenging thoracoamniotic shunt cases impacted by recurrent failure, poor sonographic windows, and challenging fetal positioning.

引言胎儿胸羊膜分流术是常见的救生措施,但经常需要更换。针式胎儿胸腔镜是一种使用标准羊膜腔分流导管鞘的技术,可在分流管部署过程中直接观察甚至操作器械,从而在最具挑战性的病例中实现最佳定位和主要分流功能:本研究回顾了五例接受针式胎儿胸腔镜辅助羊膜腔分流术的患者。其中三例患者患有巨大囊性先天性肺气道畸形(CPAM),并伴有纵隔移位和/或水肿恶化的证据;两例患者患有巨大乳糜胸,并伴有胎儿水肿。四例患者之前曾进行过分流术,但因初次置入时声像图显示不清、囊肿隔膜、分流术阻塞或移位而失败。使用针式胎儿胸腔镜破坏囊壁和隔膜、清除血肿并确认分流管的最佳初始位置。在该系列手术中,一名宫颈短的重度 CPAM 患者术后出现早产,导致新生儿死亡。其余四名患者的水肿得到缓解,并顺利分娩,新生儿预后良好:结论:针刺胎儿胸腔镜手术可有选择性地应用于受反复失败、声像图窗口不佳和胎位困难影响的高难度胸羊膜腔分流术病例。
{"title":"Needle Fetal Thoracoscopy: A Technique to Assist with Ultrasound-Guided Placement of Challenging Thoracoamniotic Shunts.","authors":"Steven T Papastefan, Daniel R Liesman, Katherine C Ott, Federico Scorletti, Xavier F Pombar, Aimen F Shaaban, Amir M Alhajjat","doi":"10.1159/000539274","DOIUrl":"10.1159/000539274","url":null,"abstract":"<p><strong>Introduction: </strong>Fetal thoracoamniotic shunts are common lifesaving interventions but frequently require replacement. Needle fetal thoracoscopy is a technique that uses standard thoracoamniotic shunt introducer sheaths to permit direct visualization and even instrument manipulation during shunt deployment to facilitate optimal positioning and primary shunt function in the most challenging cases.</p><p><strong>Case presentation: </strong>In this study, 5 patients who underwent needle fetal thoracoscopy-assisted thoracoamniotic shunt placement were reviewed. Three patients with large, macrocystic congenital pulmonary airway malformations (CPAMs) with evidence of worsening mediastinal shift and/or hydrops and 2 patients with large chylothorax with fetal hydrops were treated. Four cases had previous shunts that failed due to poor sonographic visualization during initial placement, cyst septations, shunt obstruction, or dislodgment. Needle fetal thoracoscopy was used to disrupt cyst walls and septations, clear hematoma, and confirm the optimal initial position of the shunt. In this series, 1 severe CPAM patient with a short cervix developed preterm labor postoperatively resulting in neonatal demise. The remaining 4 patients experienced resolution of hydrops and progressed to successful delivery with excellent neonatal outcomes.</p><p><strong>Conclusion: </strong>Needle fetal thoracoscopy is a procedure that may be selectively deployed in challenging thoracoamniotic shunt cases impacted by recurrent failure, poor sonographic windows, and challenging fetal positioning.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916026","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
Continuous Fetal Cardiac Monitoring During Fetoscopic Myelomeningocele Repair and Relationship to Spectral Doppler Changes. 胎儿镜骨髓腔修补术中的连续胎儿心脏监测及其与频谱多普勒变化的关系
IF 2.2 3区 医学 Q1 Medicine Pub Date : 2024-04-20 DOI: 10.1159/000538122
Stephanie A Eyerly-Webb, Lisa Howley, Clifton O Brock, Joseph B Lillegard, James Fisher, Benjamin Reynolds, Emily F Barthel, Eric Dion, Saul Snowise
INTRODUCTIONNo evidence-based protocols exist for fetal cardiac monitoring during fetoscopic myelomeningocele (fMMC) repair and intraprocedural spectral Doppler data is limited. We determined the feasibility of continuous fetal echocardiography during fMMC repair and correlated Doppler changes with qualitative fetal cardiac function during each phase of fMMC repair.METHODSPatients undergoing fMMC repair had continuous fetal echocardiography interpreted in real-time by pediatric cardiology. Fetal data included fetal heart rate (FHR), qualitative cardiac function, mitral and tricuspid valve inflow waveforms, and umbilical artery (UA), umbilical vein (UV), ductus arteriosus (DA) and ductus venosus (DV) Dopplers.RESULTSUA abnormalities were noted in 14/25 patients, UV abnormalities were observed in two patients, and DV and DA abnormalities were each noted in 4 patients. Qualitative cardiac function was normal for all patients with the exception of one with isolated left ventricular dysfunction during myofascial flap creation, concurrent with an abnormal UA flow pattern. All abnormalities resolved by the first postoperative day.CONCLUSIONSContinuous fetal echocardiography was feasible during all fMMC repairs. Spectral Doppler changes in the UA were common during fMMC procedures but qualitative cardiac dysfunction was rare. Abnormalities in the UV, DV and DA Dopplers, FHR, and cardiac function were less common findings.
引言 胎儿镜下脊髓空洞症(fMMC)修复术中的胎儿心脏监测尚无循证方案,且术中频谱多普勒数据有限。我们确定了胎儿髓母细胞瘤修补术中连续胎儿超声心动图的可行性,并将多普勒变化与胎儿髓母细胞瘤修补术各阶段的胎儿心功能定性相关联。胎儿数据包括胎心率(FHR)、定性心功能、二尖瓣和三尖瓣血流波形以及脐动脉(UA)、脐静脉(UV)、动脉导管(DA)和静脉导管(DV)多普勒。除一名患者在肌筋膜瓣形成过程中出现孤立性左心室功能障碍,同时出现 UA 血流模式异常外,所有患者的心功能均正常。所有异常均在术后第一天消除。胎儿超声心动图检查在所有胎儿超声心动图修补术中都是可行的。胎儿超声心动图检查过程中,UA 的频谱多普勒变化很常见,但定性心功能异常却很少见。UV、DV和DA多普勒、FHR和心功能异常是较少见的发现。
{"title":"Continuous Fetal Cardiac Monitoring During Fetoscopic Myelomeningocele Repair and Relationship to Spectral Doppler Changes.","authors":"Stephanie A Eyerly-Webb, Lisa Howley, Clifton O Brock, Joseph B Lillegard, James Fisher, Benjamin Reynolds, Emily F Barthel, Eric Dion, Saul Snowise","doi":"10.1159/000538122","DOIUrl":"https://doi.org/10.1159/000538122","url":null,"abstract":"INTRODUCTION\u0000No evidence-based protocols exist for fetal cardiac monitoring during fetoscopic myelomeningocele (fMMC) repair and intraprocedural spectral Doppler data is limited. We determined the feasibility of continuous fetal echocardiography during fMMC repair and correlated Doppler changes with qualitative fetal cardiac function during each phase of fMMC repair.\u0000\u0000\u0000METHODS\u0000Patients undergoing fMMC repair had continuous fetal echocardiography interpreted in real-time by pediatric cardiology. Fetal data included fetal heart rate (FHR), qualitative cardiac function, mitral and tricuspid valve inflow waveforms, and umbilical artery (UA), umbilical vein (UV), ductus arteriosus (DA) and ductus venosus (DV) Dopplers.\u0000\u0000\u0000RESULTS\u0000UA abnormalities were noted in 14/25 patients, UV abnormalities were observed in two patients, and DV and DA abnormalities were each noted in 4 patients. Qualitative cardiac function was normal for all patients with the exception of one with isolated left ventricular dysfunction during myofascial flap creation, concurrent with an abnormal UA flow pattern. All abnormalities resolved by the first postoperative day.\u0000\u0000\u0000CONCLUSIONS\u0000Continuous fetal echocardiography was feasible during all fMMC repairs. Spectral Doppler changes in the UA were common during fMMC procedures but qualitative cardiac dysfunction was rare. Abnormalities in the UV, DV and DA Dopplers, FHR, and cardiac function were less common findings.","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140681952","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
Prenatal management and perinatal outcome in a large series of hydrops fetalis. 大量胎儿水肿病例的产前管理和围产期结局。
IF 2.2 3区 医学 Q1 Medicine Pub Date : 2024-04-20 DOI: 10.1159/000538857
Lorena María Sebastián de Lucas, Polán Ordás Álvarez, Laura de Castro Marzo, Tamara Illescas Molina, Beatriz Herrero, J. L. Bartha, Eugenia Antolín
INTRODUCTIONNon-immune hydrops fetalis (NIHF) is the most frequent etiology of hydrops fetalis (HF), accounting for around 95% of cases. It associates high perinatal mortality and morbidity rates. The aim of the study was firstly, to investigate etiology, prenatal management, and perinatal outcome in a large single center series of HF; secondly, to identify prenatal prognostic factors with impact on perinatal outcome.MATERIAL AND METHODSObservational retrospective study of 80 HF diagnosed or referred to a single tertiary center between 2012 and 2021. Clinical characteristics, etiology, prenatal management, and perinatal outcome were recorded. Adverse perinatal outcome was defined as intrauterine fetal death (IUFD), early neonatal death (first 7 days of life) and late neonatal death (between 7 and 28 days).RESULTSSeventy-six of the 80 cases (95%) were NIHF, main etiology being genetic disorders (28/76; 36.8%). A total of 26 women (32.5%) opted for termination of pregnancy, all of them in the NIHF group. Intrauterine fetal death (IUFD) occurred in 24 of 54 patients (44.4%) who decided to continue the pregnancy. Intrauterine treatment was performed in 29 cases (53.7%). There were 30 newborns (55.6%). Adverse perinatal outcome rate was 53.7% (29/54), significantly higher in those diagnosed < 20 weeks of gestation (82.4% <20w vs. 40.5% ≥ 20w; p=0.004). Survival rate was higher when fetal therapy was performed compared to the expectantly managed group (58.6% vs. 32%; p=0.05). Intrauterine blood transfusion and thoraco-amniotic shunt were the procedures that achieved the highest survival rates (88.9% and 100% respectively, p=0.003).CONCLUSIONNIHF represented 95% of HF with genetic disorders as the main etiology. Most of them were diagnosed before 20 weeks of gestation, with worse prognosis than cases detected later in gestation. Rates of TOP, IUFD and early neonatal death were higher in NIHF. Intrauterine therapy when indicated, improved the perinatal outcome.
导言非免疫性胎儿水肿(NIHF)是胎儿水肿(HF)最常见的病因,约占 95% 的病例。它的围产期死亡率和发病率都很高。该研究的目的首先是调查一个大型单中心系列 HF 的病因、产前管理和围产期结局;其次是确定对围产期结局有影响的产前预后因素。研究记录了临床特征、病因、产前管理和围产期结局。围产期不良结局定义为胎儿宫内死亡(IUFD)、新生儿早期死亡(出生后7天内)和新生儿晚期死亡(7至28天内)。结果80例中有76例(95%)为NIHF,主要病因为遗传性疾病(28/76;36.8%)。共有 26 名妇女(32.5%)选择终止妊娠,全部属于 NIHF 组。在决定继续妊娠的 54 名患者中,有 24 名(44.4%)发生了胎儿宫内死亡(IUFD)。有 29 例(53.7%)进行了宫内治疗。新生儿有 30 例(55.6%)。围产期不良结局率为 53.7%(29/54),在妊娠 20 周以下确诊的患者中,不良结局率明显更高(妊娠 20 周以下为 82.4%,妊娠 20 周以上为 40.5%;P=0.004)。与预期管理组相比,胎儿治疗组的存活率更高(58.6% 对 32%;P=0.05)。宫内输血和胸羊膜分流术的存活率最高(分别为 88.9% 和 100%,P=0.003)。大多数病例在妊娠 20 周前确诊,预后比妊娠晚期发现的病例差。在 NIHF 中,TOP、IUFD 和新生儿早期死亡的比例较高。宫内治疗可改善围产期预后。
{"title":"Prenatal management and perinatal outcome in a large series of hydrops fetalis.","authors":"Lorena María Sebastián de Lucas, Polán Ordás Álvarez, Laura de Castro Marzo, Tamara Illescas Molina, Beatriz Herrero, J. L. Bartha, Eugenia Antolín","doi":"10.1159/000538857","DOIUrl":"https://doi.org/10.1159/000538857","url":null,"abstract":"INTRODUCTION\u0000Non-immune hydrops fetalis (NIHF) is the most frequent etiology of hydrops fetalis (HF), accounting for around 95% of cases. It associates high perinatal mortality and morbidity rates. The aim of the study was firstly, to investigate etiology, prenatal management, and perinatal outcome in a large single center series of HF; secondly, to identify prenatal prognostic factors with impact on perinatal outcome.\u0000\u0000\u0000MATERIAL AND METHODS\u0000Observational retrospective study of 80 HF diagnosed or referred to a single tertiary center between 2012 and 2021. Clinical characteristics, etiology, prenatal management, and perinatal outcome were recorded. Adverse perinatal outcome was defined as intrauterine fetal death (IUFD), early neonatal death (first 7 days of life) and late neonatal death (between 7 and 28 days).\u0000\u0000\u0000RESULTS\u0000Seventy-six of the 80 cases (95%) were NIHF, main etiology being genetic disorders (28/76; 36.8%). A total of 26 women (32.5%) opted for termination of pregnancy, all of them in the NIHF group. Intrauterine fetal death (IUFD) occurred in 24 of 54 patients (44.4%) who decided to continue the pregnancy. Intrauterine treatment was performed in 29 cases (53.7%). There were 30 newborns (55.6%). Adverse perinatal outcome rate was 53.7% (29/54), significantly higher in those diagnosed < 20 weeks of gestation (82.4% <20w vs. 40.5% ≥ 20w; p=0.004). Survival rate was higher when fetal therapy was performed compared to the expectantly managed group (58.6% vs. 32%; p=0.05). Intrauterine blood transfusion and thoraco-amniotic shunt were the procedures that achieved the highest survival rates (88.9% and 100% respectively, p=0.003).\u0000\u0000\u0000CONCLUSION\u0000NIHF represented 95% of HF with genetic disorders as the main etiology. Most of them were diagnosed before 20 weeks of gestation, with worse prognosis than cases detected later in gestation. Rates of TOP, IUFD and early neonatal death were higher in NIHF. Intrauterine therapy when indicated, improved the perinatal outcome.","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140680472","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
Fetal phenotype of CHARGE syndrome with a molecular confirmation: a series of 13 cases. 经分子确证的 CHARGE 综合征胎儿表型:13 例系列病例。
IF 2.2 3区 医学 Q1 Medicine Pub Date : 2024-04-17 DOI: 10.1159/000538949
Qiuxia Yu, L. Zhen, Dong-Zhi Li
Introduction CHARGE syndrome is an autosomal dominant genetic disorder with known pattern of features. The aim of the study was to present the fetal features of CHARGE syndrome to gain awareness that the antenatal characteristics can be very nonspecific. Case Presentation This was a retrospective study of 13 cases with CHARGE syndrome diagnosed by prenatal or postnatal genetic testing and physical examination. Two (15.4%; 2/13) had normal ultrasound scans during pregnancy. One (7.7%; 1/13) with first-trimester cystic hygroma presented intrauterine fetal demise (IUFD) at 16 weeks gestation. The remaining 10 (76.9%; 10/13) cases had abnormal ultrasound features in utero; among these, 1 had an increased nuchal translucency in the first trimester, 5 had second-trimester abnormal ultrasounds including micrognathia, cardiac defects and facial defects, and 4 third-trimester abnormal ultrasounds including micrognathia, isolated fetal growth restriction and polyhydramnios. Among the 11 cases with abnormal prenatal ultrasound scans, no fetus could reach the diagnostic criteria of CHARGE syndrome if only based on the results of ultrasound. However, the diagnosis was made in all cases when CHD7 defects were detected. Discussion/Conclusion The CHARGE syndrome presents non-specific abnormal ultrasound markers in utero. Exome sequencing in the genetic work up will aid in prenatal diagnosis of this syndrome.
导言 CHARGE 综合征是一种常染色体显性遗传疾病,具有已知的特征模式。本研究的目的是介绍 CHARGE 综合征的胎儿特征,使人们认识到产前特征可能是非常非特异性的。病例介绍 这是一项回顾性研究,共收集了 13 例通过产前或产后基因检测和体格检查确诊的 CHARGE 综合征病例。2例(15.4%;2/13)在怀孕期间超声波扫描正常。1例(7.7%;1/13)在妊娠16周时出现胎儿宫内死亡(IUFD)。其余 10 例(76.9%;10/13)胎儿宫内超声异常,其中 1 例在妊娠头三个月颈部透亮度增加,5 例在妊娠第二个月超声异常,包括小颌畸形、心脏缺陷和面部缺陷,4 例在妊娠第三个月超声异常,包括小颌畸形、孤立性胎儿生长受限和多羊水。在 11 例产前超声扫描异常的病例中,如果仅凭超声检查结果,没有一个胎儿能达到 CHARGE 综合征的诊断标准。然而,当检测到 CHD7 缺陷时,所有病例均可确诊。讨论/结论 CHARGE 综合征在子宫内表现为非特异性异常超声标记。遗传学工作中的外显子组测序将有助于该综合征的产前诊断。
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引用次数: 0
Left ventricular strain, arch angulation, and velocity-time integral ratio improve performance of a clinical pathway for fetal diagnosis of neonatal coarctation of the aorta. 左心室应变、心弓角度和速度-时间积分比提高了新生儿主动脉共动脉胎儿诊断临床路径的性能。
IF 2.2 3区 医学 Q1 Medicine Pub Date : 2024-04-15 DOI: 10.1159/000538550
A. Phillips, R. Punn, Claudia Algaze, Y. Blumenfeld, Valerie Y. Chock, David M Kwiatokowski, Amy Quirin, Theresa A Tacy, Kelly Thorson, S. Maskatia
INTRODUCTIONNeonatal presentation of coarctation of the aorta (CoA) is a potentially life-threatening condition that is difficult to diagnose in fetal life. We therefore sought to validate and compare novel metrics that may add diagnostic value for fetal coarctation of the aorta, including the diastolic to systolic aortic isthmus VTI ratio (VTId:VTIs), ascending aorta to descending aorta angle (AAo-DAo), transverse aorta to descending aorta angle (TAo-DAo), and LV longitudinal strain (LVS). Then to evaluate whether these novel metrics improve specificity to identify fetuses at the highest risk for postnatal coarctation of the aorta (CoA) without compromising sensitivity.METHODSRetrospective cohort study of fetuses followed a prospective clinical pathway and previously classified as mild, moderate, or high-risk for CoA based on standard fetal echo metrics. Novel metrics were retrospectively measured in a blinded manner.RESULTSAmong fetuses with prenatal concern for coarctation of the aorta, VTId:VTIs, AAo-DAo angle, TAo-DAo angle, and LVS were significantly different between surgical and non-surgical cases (p <0.01 for all variables). In the subgroup of moderate- and high-risk fetuses, the standard high-risk criteria (flow reversal at the foramen ovale or aortic arch) did not discriminate effectively between surgical and non-surgical cases. VTId:VTIs, AAo-Dao angle, Tao-DAo angle, and LVS all demonstrated greater discrimination than standard high-risk criteria, with specificity of 100% and PPV (positive predictive value) of 78-100%.CONCLUSIONSThe incorporation of novel metrics added diagnostic value to our clinical pathway for fetal CoA with higher specificity than the previous high-risk criteria. The incorporation of these metrics into the evaluation of fetuses at moderate- or high-risk for surgical CoA may improve prenatal counseling, allow for more consistent surgical planning, and ultimately optimize hospital resource allocation.
简介:新生儿主动脉共动脉症(CoA)是一种可能危及生命的疾病,在胎儿期很难诊断。因此,我们试图验证和比较可增加胎儿主动脉共缩的诊断价值的新指标,包括舒张期与收缩期主动脉峡部 VTI 比值(VTId:VTIs)、升主动脉与降主动脉夹角(AAo-DAo)、横主动脉与降主动脉夹角(TAo-DAo)和左心室纵向应变(LVS)。方法:对遵循前瞻性临床路径的胎儿进行回顾性队列研究,这些胎儿之前根据标准胎儿回声指标被划分为轻度、中度或高风险CoA胎儿。结果在产前怀疑有主动脉粥样硬化的胎儿中,手术和非手术病例的 VTId:VTIs、AAo-DAo 角、TAo-DAo 角和 LVS 有显著差异(所有变量的 p 均小于 0.01)。在中、高危胎儿亚组中,标准的高危标准(卵圆孔或主动脉弓处血流逆转)并不能有效区分手术和非手术病例。VTId:VTIs、AAo-Dao 角、Tao-Dao 角和 LVS 均比标准高危标准具有更高的区分度,特异性为 100%,PPV(阳性预测值)为 78-100%。将这些指标纳入中、高危胎儿的手术CoA评估中,可改善产前咨询,使手术计划更加一致,并最终优化医院的资源分配。
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引用次数: 0
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Fetal Diagnosis and Therapy
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