890 research outputs found
An update of diagnostic efficacy of ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders
Systematic screening and diagnosis of placenta accreta spectrum disorder (PAS) either by ultrasound or magnetic resonance imaging (MRI) would allow referral of high-risk women to specialized multidisciplinary teams. We aimed to report recent findings regarding the diagnostic accuracy of ultrasound and magnetic resonance imaging in the diagnosis of PAS
Ultrasound and MRI appearance of abnormally adherent placenta in a woman with Asherman's syndrome
: Although 10% of pregnancies following treatment of Asherman's syndrome are estimated to have abnormal placental adhesion, there is a paucity of reports describing imaging features in such cases. We describe ultrasound and MRI features in one of such cases, showing a peculiar pattern of shallow but diffuse abnormally adherent placenta
Twin reversed arterial perfusion sequence: current treatment options
Twin reversed arterial perfusion (TRAP) sequence is a specific and severe complication of monochorionic multiple pregnancy, characterized by vascular anastomosis and partial or complete lack of cardiac development in one twin. Despite its rarity, interest in the international literature is rising, and we aimed to review its pathogenesis, prenatal diagnostic features and treatment options. Due to the parasitic hemodynamic dependence of the acardiac twin on the pump twin, the management of these pregnancies aims to maximize the pump twinâs chances of survival. If treatment is needed, the best timing of intervention is still debated, although the latest studies encourage intervention in the first trimester of pregnancy. As for the technique of choice to interrupt the vascular supply to the acardiac twin, ultrasound-guided laser coagulation and radiofrequency ablation of the intrafetal vessels are usually the preferred approaches
Increased angiogenic factor secretion by decidual natural killer cells from pregnancies with high uterine artery resistance alters trophoblast function.
STUDY QUESTION
Are the concentrations of factors secreted by decidual natural killer (dNK) cells from pregnancies at high risk of poor spiral artery remodelling different to those secreted from pregnancies at low risk?
SUMMARY ANSWER
Expression levels of PLGF, sIL-2R, endostatin and angiogenin were significantly increased by dNK cells from high-risk pregnancies, and angiogenin and endostatin were found to alter trophoblast function.
WHAT IS KNOWN ALREADY
During early pregnancy, maternal uterine spiral arteries are remodelled from small diameter, low-flow, high-resistance vessels into larger diameter, higher flow vessels, with low-resistance. This change is essential for the developing fetus to obtain sufficient oxygen and nutrients. dNK cells have been implicated in this process.
STUDY DESIGN, SIZE, DURATION
dNK cells were isolated from first trimester terminations of pregnancies (obtained with local ethical approval) screened for normal- or high-resistance index, indicative of cases least (21%) likely to have developed pre-eclampsia had the pregnancy not been terminated (n = 18 each group). Secreted factors and the effects of these on the trophoblast cell line, SGHPL-4, were assessed in vitro.
PARTICIPANTS/MATERIALS, SETTING, METHODS
A multiplex assay was used to assess dNK cell-secreted factors. SGHPL-4 cell functions were assessed using time-lapse microscopy, 3D invasion assays, endothelial-like tube formation ability and western blot analysis.
MAIN RESULTS AND THE ROLE OF CHANCE
The expression levels of PLGF (P < 0.01), sIL-2R (P < 0.01), endostatin (P < 0.05) and angiogenin (P < 0.05) were significantly increased by dNK cells from high-risk pregnancies. Endostatin significantly decreased SGHPL-4 invasion (P < 0.05), SGHPL-4 tube formation (P < 0.05) and SGHPL-4 Aktser473 phosphorylation (P < 0.05). Angiogenin significantly decreased SGHPL-4 invasion (P < 0.05), but increased SGHPL-4 tube formation (P < 0.01) and decreased SGHPL-4 Aktser473 phosphorylation (P < 0.05).
LIMITATIONS, REASONS FOR CAUTION
The culture of dNK cells and protein concentrations in vitro may not fully represent the in vivo situation. Although SGHPL-4 cells are extravillous trophoblast derived, further studies would be needed to confirm the roles of angiogenin and endostatin in vivo.
WIDER IMPLICATIONS OF THE FINDINGS
The altered expression of secreted factors of dNK cells may contribute to pregnancy disorders associated with poor spiral artery remodelling.
STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by the Wellcome Trust (project reference 091550). R.F. was a recipient of a PhD studentship from the Division of Biomedical Sciences, St. George's, University of London. The authors have no conflict of interests
Cervical cerclage in twin pregnancies
Purpose To evaluate the outcomes of cervical cerclage
(CC) in twin pregnancies.
Methods Retrospective analysis of twin pregnancies
undergoing CC between January 2001 and December 2009
at our Institution. CC was offered in case of a cervical
length measurement B20 mm (ultrasound-indicated CC) or
in case of cervical dilatation with membranes at or beyond
the external cervical os (physical examination-indicated
CC). Cervicovaginal and rectal swabs were obtained preoperatively.
Perioperative antibiotics and tocolysis were
administered.
Results There were 28 cases of ultrasound-indicated and
14 of physical examination-indicated CC. Positive swab
cultures were observed in 21 % of cases. The incidence of
preterm delivery\34 weeks was 32 % [95 % confidence
interval (CI) 16â52 %] and 50 % (95 % CI 23â77 %) in
the ultrasound-indicated and physical examination-indicated
CC group, respectively. The incidence of premature
rupture of membranes \34 weeks was 21 % (95 % CI
8â41 %) and 29 % (95 % CI 8â58 %) in the ultrasoundindicated
and physical examination-indicated CC group,
respectively. Perinatal survival was 96 % (95 % CI
88â100 %) in the ultrasound-indicated CC group, and
86 % (95 % CI 67â96 %) in the physical examinationindicated
CC group.Conclusions We showed a high-risk of preterm delivery
in both groups, but with a high overall perinatal survival.
Our data stress the importance of re-evaluating the efficacy
of CC in twin pregnancies by properly designed clinical
trials, particularly if it is physical examination indicated
Hepatocellular carcinoma in pregnancy: A systematic review
Introduction: Hepatocellular carcinoma (HCC) is the most frequent primary malignant liver tumor and typically develops in the context of chronic liver disease, such as liver cirrhosis or chronic hepatitis B virus infection. Ultrasound evaluation, CT scan, and MRI are used to detect HCC. α-fetoprotein (AFP) is a common marker used to detect HCC in the non-pregnant population, which notoriously increases in pregnant women in relation to gestational age. Treatment is driven by the extent of the disease and the severity of underlying liver disease. Pregnancy may represent an obstacle to diagnosis and appropriate treatment of HCC. The aim of this descriptive systematic review was to describe the clinical features and maternal and neonatal outcomes of HCC in pregnancy. Material and methods: We performed a systematic review of the literature about HCC diagnosed in pregnancy and the postpartum period, with signs or symptoms arising in pregnancy. We included case reports and case series describing the clinical features of women diagnosed with HCC, fibrolamellar variant of HCC, and mixed HCC and cholangiocarcinoma during pregnancy or the postpartum period (with onset of symptoms during pregnancy), from inception to March 2023. The study protocol was registered with the PROSPERO database (Registration number: ID CRD42021275584). Results: We identified 180 records. The articles included in this systematic review were 47 case reports and 5 case series, for a total of 63 pregnancies. The two most frequent predisposing conditions were hepatitis B virus infection (30/63; 47%) and liver cirrhosis (14/63; 22%). Ultrasound evaluation was the most used technique to detect HCC. AFP was higher than normal in 28/46 patients tested (61%). Surgical treatment was the most used therapy, both during pregnancy and after delivery. Twenty-six patients (26/63; 42%) died within 6âmonths of diagnosis. Survival >24âmonths was 9% (4/46) in symptomatic and 29% (5/17) in asymptomatic women. No patient with cirrhotic liver survived more than 12âmonths. Thirty-eight newborns were alive at 28âdays of age (38/63; 61%). Conclusions: Hepatocellular carcinoma in pregnancy is associated with a high risk of maternal and neonatal mortality. Diagnosis in asymptomatic high-risk women or following abnormal maternal serum AFP screening is associated with better maternal outcomes
Small-for-gestational-age fetus diagnosed in the second trimester: Possible etiologies and short-term neonatal outcomes
Introduction: The aim of our study was to investigate the causes of fetal growth <10th centile diagnosed <26âweeks' gestation in singleton pregnancies and compare pregnancy outcomes in relation to the identified etiology. Material and methods: Historical cohort study conducted in two Italian hospitals which included all small-for-gestational-age fetuses diagnosed between 18+0 and 26+0âweeks over a 10-year period. Fetuses were divided into three groups depending on the prenatally suspected etiology: chromosomal abnormalities (Group 1), malformations (Group 2) and isolated (Group 3). These groups were compared regarding pregnancy outcomes. Fetuses in Group 3 were divided into small-for-gestational-age and fetal growth restriction following the Delphi Consensus criteria and the outcomes were further compared. Fisher's Exact or Mann-Whitney test were used for comparison of groups. Results: In all, 435 fetuses were included. Of these, 20 cases (4.6%) were associated with chromosomal abnormalities (Group 1), 98 (22.5%) with fetal malformations (Group 2) and 317 (72.9%) were isolated (Group 3). A higher percentage of live births was reported for Group 3 (Pâ<â0.001). Termination of pregnancy was more common in Group 1 (Pâ<â0.001). No differences in gestational age at delivery, birthweight, intrauterine death or neonatal death were detected within groups. Growth-restricted fetuses had lower gestational age at delivery, birthweight and number of live births (Pâ<â0.001), higher rates of termination of pregnancy, intrauterine death (Pâ<â0.001) and neonatal death <10âdays (P = 0.002) compared to small-for-gestational-age. In 17 cases a chromosomal abnormality, genetic syndrome or adverse neurological outcome was diagnosed after birth: six from Group 2 (11.3% of live births in this group) and 11 from Group 3 (4.3%). Conclusions: We report that fetal growth <10th percentile diagnosed before 26âweeks is not isolated before birth in 27% of cases. Malformations and chromosomal abnormalities are common etiologies; therefore, detailed anomaly scans and invasive testing should be offered. In addition, there is a residual risk of neonatal death and postnatal diagnosis of a genetic syndrome or neurodevelopmental impairment despite normal prenatal tests. These results expand the small amount of information on the outcome of cases with very early diagnosis of impaired fetal growth currently available and highlight the importance of detailed counseling with couples
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