AJP Reports最新文献

Background: Lymphangiomas are benign vascular malformations of the lymphatic system, commonly affecting the head and neck. Neonatal cases pose significant clinical and surgical challenges.

Case presentation: We report a premature female neonate (35 weeks of gestation) with a large cervicothoracic cystic lymphangioma (8 × 7 cm), causing respiratory distress and vascular compression. Imaging revealed an extensive lymphatic malformation (160 × 67 × 87 mm), affecting the sternocleidomastoid muscle, salivary glands, and adjacent vasculature. Surgical resection achieved 90% tumor removal while preserving neurovascular structures. Postoperative complications included transient neuromotor deficit of the right upper limb and Candida lusitaniae sepsis. Despite intensive care, tumor progression led to respiratory failure, and the patient succumbed 12 days' postsurgery.

Discussion: Extensive cervicothoracic lymphangiomas in neonates require complex management. Imaging aids in surgical planning, delineating tumor extent, and complications. While surgical resection is the standard treatment, it carries risks in neonates with large lesions. Sclerotherapy has shown efficacy in macrocystic lymphangiomas but remains debated for extensive neonatal cases. A multidisciplinary approach is crucial to optimize outcomes.

Conclusion: Neonatal cervicothoracic lymphangiomas pose significant challenges. Surgery remains primary, but sclerotherapy may be considered in selected cases. Multidisciplinary management is essential to improve prognosis and reduce morbidity.

Introduction: We describe two patients presenting with preterm loss of fluid and inconclusive evaluations requiring further assessment. Patient 1 was a 41-year-old G3P1011 at 21 ^6/7 weeks; Patient 2 was a 22-year-old G2P1001 at 31 ^5/7 weeks. In both, preterm prelabor rupture of membranes (PPROM) workups yielded mixed results, prompting intra-amniotic dye testing. Due to a national indigo carmine shortage, sodium fluorescein was used. We present photographs of tampons examined under UV light, confirming PPROM in both cases.

Methods: Under ultrasound guidance, 5 cc of sodium fluorescein was injected into the amniotic cavity. Patients wore a tampon for 15 minutes while ambulating. Both provided consent for publication.

Results: On direct visualization, tampons appeared normal. Under UV light (Wood's lamp), the fluorescein emitted a bright neon green fluorescence. Both specimens demonstrated photoluminescence, confirming PPROM.

Conclusion: Although the use of 2 to 5 cc of fluorescein for intra-amniotic dye testing is described in the literature, visual documentation of positive results is limited. These images may guide clinicians in confirming PPROM when indigo carmine is unavailable, supporting fluorescein as a viable diagnostic alternative.

Key points: Fluorescein dye can be used to confirm PPROM when tampons are examined under UV light.We share unique images of positive fluorescein dye tests to confirm PPROM diagnosis.Images may aid diagnosis when indigo carmine is unavailable and fluorescein is used.

Introduction: Fetal and neonatal alloimmune thrombocytopenia (FNAIT) occurs in the setting of maternal anti-human platelet antigen (anti-HPA) antibodies against paternally derived fetal platelet antigens. Recent studies have also demonstrated an association between chronic placental inflammation and FNAIT, specifically low-grade chronic histiocytic intervillositis (CHI). We present a neonate with profound thrombocytopenia after delivery with co-occurring CHI, whose platelet counts recovered rapidly with platelet transfusions, born to a primigravida mother with late-onset preeclampsia.

Case report: A male neonate was born at 40 weeks to a mother who had no known history of pregnancies, miscarriages, or transfusions. The mother developed severe preeclampsia during the induction of labor. Shortly after delivery, a physical exam of the infant showed inappropriate bruising on the heels of both feet, scattered petechiae on the hard palate, a hematoma on the left thigh after a vitamin K shot, and a bruise on the upper left abdomen. His platelet count was found to be 7,000. Platelet count rose to 94K by day 3 of life following transfusions. Placental pathology confirmed CHI. Maternal testing revealed anti-HPA-1 antibodies supporting FNAIT.

Conclusion: This case highlights a potential relationship between maternal alloimmune response and preeclampsia. It also highlights the importance of considering FNAIT as a diagnosis in a neonate presenting with thrombocytopenia regardless of maternal preeclampsia, and the importance of submitting the placenta for a pathology exam.

[This corrects the article DOI: 10.1055/a-2697-2212.].

[This corrects the article DOI: 10.1055/a-2689-2550.].

Objective: Although thoraco-amniotic shunting (TAS) for severe pleural effusion is an effective fetal treatment, there are some cases in which it deteriorates, showing circulatory collapse. To evaluate the usefulness of umbilical venous blood flow volume (UVFV) for predicting deterioration, we analyzed the fetal low UVFV situation.

Methods: In 22 cases of fetal severe pleural effusion, we measured UVFV/fetal estimated birth weight (mL/minute/kg) prospectively before and after TAS by ultrasonography. We defined low UVFV/kg as < 50 mL/minute/kg (2.5 percentile) and compared subgroups based on their UVFV value and analyzed the outcome after birth.

Results: Total survival rate was 59% at 6 months. Seven cases in the low group before delivery (UVFV/kg 19.5) showed poor prognoses, such as fetal/neonatal death and longer neonatal intensive care unit management (100% vs. the normal UVFV group 40%, p  = 0.017). The low group also showed umbilical artery absent end-diastolic velocity (71%); edema resolved in 50%, suggesting hypo inflow from the placenta and fetal hypocardiac output status, revealing fetal cardiac collapse.

Conclusion: UVFV analyses would be a new marker of fetal management of severe pleural effusion, suggesting low UVFV after TAS seems to be hypovolemic cardiac collapse and shows poor prognosis, and we had better consider immediate delivery to prevent death even after TAS.

Objective: The purpose of this study was to investigate mental health and impacts upon daily life in patients with a history of pregnancy alloimmunization, and secondarily to examine the relationship between disease severity and quality of care on these outcomes.

Study design: This was a survey administered between November 2022 and February 2023 to U.S. adults with a history of red cell alloimmunization in pregnancy. Mental health outcomes, quality of care, and daily life impacts were reported.

Results: The survey was completed by 127 alloimmunized adults. Anxiety (90.6%), guilt (74.8%), self-doubt (68.0%), isolation (71.4%), depression (68.3%), and symptoms of posttraumatic stress disorder (PTSD) (61.3%) were frequently reported. Mental health support was offered in 24.4%. Respondents reporting a high quality of care in their alloimmunized pregnancies (rating of 8/10 or higher) were significantly less likely than those who perceived receiving lower-quality care to report feelings of guilt ( p  = 0.0006), self-doubt ( p  = 0.04), depression ( p  = 0.03), and symptoms of PTSD ( p  = 0.001).

Conclusion: Despite the pervasive patient burden, mental health support was infrequently offered, and patients reported low satisfaction with continuity of care and their providers' knowledge of alloimmunization. Clinicians interacting with alloimmunized patients must employ a comprehensive patient-centered approach to address the significant disease burden.

Key points: The impact of alloimmunization in pregnancy on patients' mental health and daily living has not been evaluated.Females with a history of alloimmunization in pregnancy reported widespread anxiety (115/127; 90.6%), guilt (95/127; 74.8%), self-doubt (85/127; 68.0%), isolation (90/127; 71.4%), depression (86/127; 68.3%), and symptoms of PTSD (76/127; 61.3%); mental health support was offered in 24.4% of the sample (31/127). Respondents reporting a high quality of care (rating of 8/10 or higher) were significantly less likely to report feelings of guilt ( p  = 0.0006), self-doubt ( p  = 0.04), depression ( p  = 0.03), and symptoms of PTSD ( p  = 0.001). This study highlights a need to utilize patient-centered comprehensive care models to support this rare high-risk population. Bolstered clinician knowledge and referral to peer support networks, mental health counselors, and social workers may prove highly beneficial to this patient population.

Preeclampsia is a multiorgan vascular disease complicating approximately 8.5 million pregnancies worldwide annually and is a leading cause of maternal and neonatal mortality. The impact is especially severe in Latin America, where maternal deaths attributable to preeclampsia are 2.5 times higher than in any other region. Bolivia is particularly affected due to economic and environmental challenges, including high altitude, which increases the risk of fetal growth restriction and hypertensive disorders of pregnancy. Early and accessible diagnostic tools are required to maximize patient care and improve reproductive outcomes in limited-resource settings. This report details a case from Bolivia of rapid-onset severe preeclampsia with liver rupture in the third trimester; the patient required multiple surgical interventions for recurrent liver bleeding and extended hospitalization in the intensive care unit (ICU). She delivered a preterm, growth-restricted infant with signs of acute hypoxia by emergency cesarean section. Notably, 2 weeks before ICU admission, abnormal uterine artery and maternal hemodynamic measurements were detected, without other signs of preeclampsia. The patient had previously been healthy and was considered low risk. Both mother and newborn survived. This case underscores the value of combining uterine artery Doppler with maternal hemodynamics to identify high-risk pregnancies early and prevent life-threatening complications.

Introduction: Neonatal diabetes mellitus (NDM) is a rare monogenic form of diabetes presenting within the first 6 months of life. It can be transient or permanent; early diagnosis is essential to improve outcomes.

Case presentation: A 45-day-old male infant presented with fever, dehydration, and marked hyperglycemia. Initially misdiagnosed as meningitis, further evaluation revealed diabetic ketoacidosis, confirmed by elevated blood glucose and +4 urine ketones. He was stabilized with IV fluids and insulin, then transitioned to subcutaneous insulin. Persistent hyperglycemia and patient's age raised suspicion for NDM, warranting genetic testing, which identified a heterozygous pathogenic ABCC8 missense variant. Oral sulfonylurea was initiated using a locally compounded suspension due to limited resources. Insulin was successfully tapered, and euglycemia was achieved on sulfonylurea monotherapy.

Discussion: Highlighted here is the importance of genetic testing in suspected NDM; it directly guides management. Shifting from insulin to oral agents improves glycemic control and long-term prognosis. Managing NDM in low-resource settings requires adaptive, multidisciplinary approaches. Ideally, patients should be followed into adolescence, focusing on neurodevelopment, as some variants may lead to neurological complications.

Conclusion: Recognizing NDM in infants with unexplained hyperglycemia is important for timely, targeted treatment. Individualized care is possible in constrained settings, offering improved overall outcome.

Background: Preconception care (PCC) involves interventions before conception to prevent adverse pregnancy outcomes, yet it remains underutilized in many regions. Its availability influenced by both women's awareness and HCPs' expertise. This study aimed to assess physician's knowledge, attitudes, and practices regarding PCC.

Objective: To assess physicians knowledge, attitudes, and practices related to PCC and associated factors.

Methods: A cross-sectional study was conducted from March 20 to May 30, 2023, on 251 physicians. Data were collected using a pretested, semi-structured questionnaire and analyzed using Stata version 14. Bivariate and multivariable logistic regression were used to identify factors associated with PCC knowledge, attitudes, and practices.

Results: From 251 physicians, 133 (52.99%) had strong PCC practices, 180 (71.71%) had good knowledge, and 143 (56.97%) demonstrated positive attitudes. Significant factors influencing knowledge included working department (adjusted odds ratio [AOR] = 3.02) and reading PCC guidelines (AOR = 1.82). Strong PCC practices were linked to working department (AOR = 2.74), reading about PCC (AOR = 2.86), and perceptions of who should provide PCC (AOR = 2.21).

Conclusion and recommendation: Physicians' expertise in PCC is enhanced by reading guidelines and working in obstetrics and gynecology. Regular review of PCC resources is recommended to improve knowledge and practices.