AJP Reports最新文献

Fetal adnexal cysts present unique challenges during pregnancy, requiring careful management strategies to mitigate risks throughout gestation and delivery. We present the case of a 35-year-old G4P2 patient, referred to our center for a large adnexal cyst confirmed by ultrasound (US) and fetal MRI, with a calculated volume of 210 mL. Given the cyst's size and the family's strong preference for vaginal delivery (VD), US-guided aspiration was performed at 35 ^6/7 weeks, followed by an uncomplicated spontaneous VD at 37 ^2/7 weeks. Two weeks postpartum, the ovarian cyst re-accumulated, requiring laparoscopic-assisted cystectomy in a torsed but viable left ovary. This case demonstrates the importance of individualized prenatal care, where clinical decisions balance parental preferences with medical risks. Maximizing the opportunity for vaginal birth was a top priority for the family, and the successful reduction of the cyst's size through percutaneous aspiration minimized the risk of abdominal dystocia and allowed for a safe VD. We review relevant literature, emphasizing the need for further research to refine fetal intervention criteria and improve outcomes for such cases.

Introduction: A didelphys uterus is a rare Müllerian duct anomaly (MDA) caused by the incomplete fusion of the Müllerian ducts, leading to the formation of two distinct uterine cavities. The occurrence of simultaneous twin pregnancies, with each fetus developing in a separate horn of a didelphys uterus, is estimated at approximately 1 in 1,000,000 cases. This case report describes a rare instance of a spontaneous dichorionic diamniotic twin pregnancy, with one fetus in each horn of a didelphys uterus.

Case description: This is the case of a 35-year-old woman with unilateral renal agenesis who presented with a spontaneous dichorionic diamniotic twin pregnancy, with one fetus in each uterine cavity. This patient's pregnancy complications included intrahepatic cholestasis of pregnancy and rising creatinine levels, leading to a planned cesarean delivery at 36 weeks. The delivery was complicated by intrapartum hemorrhage and the postpartum course was further complicated by sepsis and endometritis.

Conclusion: This case highlights the complexity of managing a dichorionic diamniotic twin pregnancy in a didelphys uterus with concomitant congenital unilateral renal agenesis. It contributes to the understanding of optimal management strategies for MDA presentations and highlights the necessity for ongoing research into complications and long-term outcomes associated with such anomalies.

Background: There are few reported cases of Dandy-Walker Malformation associated with Noonan syndrome (NS).

Case presentation: We herein present a case of a late preterm infant with Dandy-Walker malformation (DWM) that underwent a workup for feeding difficulty and was found to have NS. This is one of the few reported cases of DWM with NS having a PTPN11 gene mutation.

Conclusion: Overlapping clinical features may disguise diagnosis in infants with multiple pathologies.

Objectives: Outside of the association of SS-A antibody with congenital heart block, little is known about adverse maternal and neonatal outcomes, in patients with Sjogren's disease (SjD). Our study involved collaboration with maternal-fetal medicine (MFM).

Methods: A retrospective cohort study of pregnant patients: SjD patients were matched 1:3 with non-SjD controls. SjD patients were included by meeting the 2016 ACR/EULAR Criteria or by a rheumatologist diagnosis. Exclusion criteria were concurrent autoimmune disease or related antibodies. A composite of grouped outcomes was utilized and verified by MFM specialists. The primary outcome was adverse pregnancy outcome (APO) between the two groups. Statistical analysis was performed using a two-sample t -test and Fisher's exact test.

Results: 48 patients were included: 12 SjD patients and 36 controls. APO was significantly increased in SjD with one preterm birth, one fetal growth restriction, and one limb anomaly; non-SjD had one cardiac anomaly. There were no cases of CHB. SjD patients were more likely to be delivered by cesarean delivery.

Conclusion: There was an increased risk of APO in SjD patients compared with controls. No significant difference in neonatal outcomes was found. We speculate that placental pathology may play a role in pathophysiology and future studies should be performed.

Key points: There was an increased risk of APO in SjD patients compared with controls.No significant difference in neonatal outcomes was found.We speculate that placental pathology may play a role in pathophysiology, prompting future studies.

Objective: To evaluate the association of PIGF and sFlt-1 with low birth weight and/or small-for-gestational age neonates in pregnancy with or without preeclampsia.

Methods: Singleton pregnancies with sFlt-1/PlGF tested were included and set into four groups for case-control analysis. Distribution of sFlt-1/PlGF, sFlt-1, PlGF, and PGF% were evaluated, Kruskal-Wallis test and Mann-Whitney U test were adopted for significance analysis.

Results: Maternal sFlt-1/PlGF, PlGF, PlGF%, and sFlt-1 were statistically associated with low birth weight and/or small-for-gestational age in pregnancy complicated or uncomplicated with preeclampsia. A significant difference was shown on sFlt-1/PIGF ( p  = 0.0082), PIGF% ( p  = 0.0326), PIGF ( p  = 0.0128), and sFlt-1 ( p  = 0.0469) in pregnancy with small-for-gestational age and/or low birth weight neonates. A significantly higher median of sFlt-1/PlGF (448 vs. 61.6, p  < 0.0001) and sFlt-1 (15499 vs. 3226, p  < 0.0001), a significantly lower median of PlGF (33.92 vs. 115.2, p  < 0.0001) and PlGF% (-76.63 vs. -20.31, p  < 0.0001) were demonstrated, respectively, when preeclampsia with small-for-gestational age and/or low birth weight neonates was compared with preeclampsia with normal birth weight neonates. No significant difference was demonstrated between low birth weight and small-for-gestational age on sFlt-1/PlGF, PlGF, PlGF%, and sFlt-1.

Conclusion: sFlt-1/PlGF seems to be a promising biomarker in predicting low birth weight and/or small-for-gestational age neonates in pregnancy with or without preeclampsia.

Peptic ulcers and complications, such as perforation, are rare during pregnancy and the puerperium. Accordingly, many clinicians may place these diagnoses low on their differential diagnosis. We present two case reports of primigravida, advanced maternal-age females with a history of irritable bowel syndrome and nonsteroidal anti-inflammatory drug use found to have perforated duodenal ulcers after cesarean section. Postpartum surgical abdomens may not present with classic guarding and rigidity. A low threshold for imaging and identification of risk factors is critical to timely diagnosis and management.

This study presents a novel case of neonatal transient eosinophilic gastroenterocolitis, a proposed new entity causing upper and lower digestive symptoms and extensive gastrointestinal eosinophilic infiltration in newborns without a proven active food allergy. The condition's proposed pathophysiology and relationship to similar conditions, alongside clinical and therapeutic approaches, are also discussed.

Background  Wildfires produce air pollutants that have been associated with complications during pregnancy. This study examined the association between wildfire exposure before and during pregnancy and the odds of congenital heart defect (CHD) in the offspring. Methods  This retrospective cohort study used the California Linked Birth File and the Forestry and Fire Protection data between 2007 and 2010. Patients living within 15 miles of wildfire during pregnancy were considered exposed. Multivariate logistic regression models were used to estimate the association between wildfire exposure by these various exposure metrics and atrial septal defect (ASD) or ventricular septal defect (VSD) types of CHD compared to pregnancies without wildfire exposure. Results  Compared to births without wildfire exposure, those with first-, second-, and third-trimester exposure were associated with a higher risk of ASD with a first-trimester adjusted odds ratio (aOR) of 1.11 (95% confidence interval (CI): 1.04-1.18), second-trimester aOR of 1.12 (95% CI: 1.07-1.18), and third-trimester aOR of 1.08 (95% CI: 1.02-1.14). Wildfire exposure during the critical window of fetal heart development (weeks 3-8) was associated with aOR of 1.12 (95% CI: 1.02-1.23). Conclusion  Wildfire exposure during pregnancy appears to increase the risk of developing ASD. Key points Wildfire exposure during critical periods in pregnancy are associated with congenital cardiac malformation.Pre-pregnancy exposure to wildfire is not associated with increased risk of congenital cardiac malformation.Pregnant individuals should avoid wildfire exposure.

Objective  Congenital heart disease (CHD) is an important contributor to pediatric morbidity and mortality. Unfortunately, disparities in the diagnosis and treatment of CHD exist across racial and ethnic groups. The objective of this study was to share the experiences of Hispanic and Black families with CHD to better understand their needs. Study Design  This was a descriptive qualitative study involving two 2-part focus groups, one conducted in English and one in Spanish, consisting of parents of infants with CHD. Focus groups were audio recorded, transcribed, and analyzed via a conventional content analysis approach. Results  Six family members participated, representing a range of cardiac diagnoses. Two participants cited their identity as non-Hispanic Black and four as Hispanic. Three organizing themes emerged related to (1) communication, (2) psychosocial needs and processing, and (3) practical challenges associated with having a child with CHD. Together, these organizing themes supported a singular global theme: structural and socioemotional gaps in care exist for families of infants with CHD that need to be met in order to optimize care for patients and families. Conclusion  Societal and systems-level factors, including structural inequities, contribute to the care gaps experienced by racial and ethnic minority families of children with CHD. Key Points Poor communication around CHD diagnosis impairs provider-patient trust.Language barriers hinder accurate communication about CHD diagnosis and treatment.Parents of children with CHD have unmet mental health needs.Perinatal providers should champion health equity for CHD patients and their families.

Background  Gestational alloimmune liver disease (GALD) is characterized by maternal IgG-directed fetal hepatocyte damage and can lead to severe liver failure and fetal or infant death. Moreover, GALD is associated with a near 90% risk of recurrence in subsequent pregnancies. Case  We present a case of a newborn patient delivered to a 32-year-old G2P1000 mother who received prolonged antenatal intravenous immunoglobulin (IVIG) treatment during the current pregnancy due to the neonatal death of the first child from GALD-related liver failure. Postnatal testing, including a liver magnetic resonance imaging (MRI) and buccal biopsy of this newborn, showed normal morphology of the liver without any abnormal iron deposition. Additional laboratory testing showed a lack of any liver injury. Conclusion  This case supports the use of antenatal IVIG immunotherapy to prevent the recurrence of GALD in subsequent pregnancies. Key Points GALD can lead to severe fetal liver injury.GALD is highly recurrent in subsequent pregnancies.Prophylactic IVIG may prevent GALD recurrence.