Which Intrauterine Treatment for Autoimmune Congenital Heart Block?

Abstract: Autoimmune Congenital Heart Block (CHB) is considered an immune mediated manifestation, caused by the action of maternal autoantibodies anti-Ro/SSA and anti-La/SSB on fetal cardiac tissues. The incidence of CHB is 2% in anti-Ro/SSA positive women, 3% when both anti-Ro/SSA and anti-La-SSB are positive. In the subsequent pregnancies the risk of recurrence is 9 times higher. The antenatal diagnosis of CHB is possible by the measurement of the \u201cmechanical\u201d PR interval with fetal echocardiography. When CHB is diagnosed, an intrauterine therapy is possible to increase the atrioventricular conduction speed and improve the fetal outcome. Authors recommend maternal treatment with fluorinated steroids, as Dexamethasone or Betamethasone, which reduce the antibody-mediated inflammatory damage of nodal tissue. Other possibilities are the maternal administration of betasympathomimetics, in order to increase the fetal heart rate. In the last years three cases of complete CHB in infants of women affected by autoimmune disease were treated in our centre. They were treated in utero with the maternal administration of Betamethasone 4 mg/day soon after the diagnosis until delivery. After delivery, all children needed cardiac pacemaker. The long-term outcome is good in all cases

ROLE OF COMPLEMENT IN PREGNANCY WITH ANTIPHOSPHOLIPID SYNDROME: MECHANISMS OF PATHOGENESIS AND CLINICAL ASPECTS.

The antiphospholipid syndrome (APS) is a disease discovered just 25 years ago. Although clinical manifestations have been clearly described, pathogenetic mechanisms are still barely understood. A recent hypothesis involves inflammation in the setting of APS morbidity and experimental data support the activation of complement cascade as a pivotal event in its physiopathology. In this review we will analyze the recent literature, focusing on contemporary and emerging aspects of complement-mediated disease pathogenesis and we will point up the clinical significance of this novel finding

Neonatal outcome in hypertension disorders of pregnancy

BACKGROUND: Hypertensive disorders in pregnancy account for increased perinatal morbidity and mortality when compared to uneventful gestations. AIMS: To analyze perinatal outcome of pregnancies complicated by different kinds of hypertension to uncomplicated pregnancies in a series of Italian women and to compare our data with series from other countries. STUDY DESIGN: The sample was divided into four groups of hypertensive women: chronic hypertension (CH), gestational hypertension (GH), preeclampsia (PE), and chronic hypertension complicated by preeclampsia (CHPE). One thousand normal pregnancies served as controls. SUBJECTS: Neonatal features of the offspring of 965 Italian women with hypertension in pregnancy were evaluated. MEASURES: Gestational age, birthweight and the rate of small for gestational age were the outcomes. Perinatal asphyxia and mortality were also assessed. RESULTS: Gestational age, the mean of birth weight and birth percentile were significantly lower in all groups with hypertensive complications when compared with controls. The rate of very early preterm delivery (<32 weeks) was 7.8% in CH, 5.9% in GH, 21.2% in PE and 37.2% in CHPE while it was to 1.2% in the control group. The rate of SGA was globally 16.2% in CH, 22.8% in GH, 50.7% in PE, 37.2% in CHPE and 5% in controls. The rate of SGA in PE was much higher than reported in series from other countries. CONCLUSION: Comparing our data with those reported from other countries, it is evident that the rate of fetal growth restriction in PE we found in our center, is significantly higher even in the presence of a global lower incidence of PE

GESTATIONAL HYPERTENSION AND BIRTH WEIGHT IN TWIN PREGNANCIES

Introduction: It is well known that hypertensive disorders of pregnancy are most frequent in twin pregnancies than in singleton ones. As demonstrated by a previous work of our group, twin pregnancies complicated by preeclampsia are associated with a higher rate of \u201csmall for gestational age\u201d (SGA) neonates and inter-twin weight discordance than normotensive ones. Objectives: The present study investigates the effect of gestational hypertension (GH) on neonatal birth weight, inter-twin weight discordance and growth restriction rate among twin pregnancies. Methods: A 26 year retrospective study was undertaken by examining 196 twin pregnancies complicated by GH, from January 1, 1980 to December 31, 2006, and comparing them to 912 normotensive twin pregnancies. Results: No significant differences were observed between the two groups in relationship to birth weight, inter-twin weight discordance and growth restriction rate, with a trend towards a higher birth weight in GH group. In normotensive group, the discordance >25% was associated with a lower gestational age at the delivery (p<0.00001). Moreover, the rate of pregnancies with SGA second twin gradually rose while paralleling the degree of discordance. Conclusion Contrary to preeclampsia in twin pregnancies the outcome of those complicated by GH is similar to normotensive ones. The trend towards a higher birth weight in GH seems apparently paradoxical, but it may reflect the role of uncomplicated hypertension in twin pregnancies: the increased blood pressure could be a physiologic response for more blood nutrient supply to the fetuses

DEVELOPMENT OF A NEW FETAL GROWTH CURVE FOR THE ITALIAN POPULATION

DEVELOPMENT OF A NEW FETAL GROWTH CURVE FOR THE ITALIAN POPULATIO

Ultrasound features and clinical outcome of patients with malignant ovarian masses diagnosed during pregnancy: experience of a gynecological oncology ultrasound center

OBJECTIVE: The number of women diagnosed with ovarian masses during pregnancy has increased in recent years and the management of these women can be controversial. We aim to describe ultrasound characteristics and clinical outcomes of patients with malignant ovarian masses diagnosed during pregnancy. METHODS: Patients with a histological diagnosis of malignant ovarian mass detected during pregnancy who underwent pre-operative ultrasound by experienced ultrasound examiners between December 2000 and November 2017 were included in this retrospective observational study. Ultrasound characteristics of the masses were described using International Ovarian Tumor Analysis terminology. Patients with ovarian masses but without histopathological reports were excluded. Results are presented as absolute frequency (percentage) for nominal variables and as median (range) for continuous variables. Results A total of 22 patients were included in the analysis. The median age was 32.5 (range 23-42) years and median gestational age at diagnosis was 13.5 (range 4-30) weeks. Eight (36.4%) patients had a serous/endocervical-type borderline tumor, seven (31.8%) patients had a primary epithelial ovarian carcinoma, five (22.8%) patients had a metastatic tumor to the ovary, and two (9%) patients had a mucinous borderline tumor. At ultrasound, mucinous borderline tumors were multilocular (1/2, 50%) or multilocular-solid (1/2, 50%) lesions. Serous/endocervical-type borderline tumors were unilocular-solid (3/8, 37.5%) or multilocular-solid (5/8, 62.5%) masses and all had papillary projections. Most invasive epithelial ovarian cancers were multilocular-solid masses (5/7, 71.4%). All metastatic tumors appeared as solid masses. No patients with borderline tumors had a cesarean section due to disease, whereas most patients with epithelial ovarian carcinomas (4/7, 57.2%) and with ovarian metastases (3/5, 60%) had a cesarean section due to disease. No neonatal complication was reported for patients with borderline tumors or epithelial ovarian carcinomas, whereas two of three newborns of patients with metastatic tumor died of the disease. CONCLUSION: At ultrasound, morphological features of malignant ovarian masses detected during pregnancy are similar to those described in non-pregnant patients. The likelihood of undergoing cesarean section increases with malignant disease in the ovary

Impact of maternal obesity on the risk of preterm delivery : insights into pathogenic mechanisms

Purpose: Preterm delivery (PTD) represents the leading cause of neonatal death and disability. Among risk factors for PTD, maternal obesity (MO) is becoming an ever more relevant condition in developed countries, although the mechanisms relating this condition to higher risk of PTD is not clear. Aim of this narrative review is to summarize evidences from clinical and translational research showing how MO might negatively impact on pregnancy and neonatal outcomes, particularly, by increasing the risk of PTD. Methods: We performed comprehensive review of the literature in PubMed and Google Scholar databases for studies from 1998 to 2018 linking MO to PTD and inflammation. Results: Chronic inflammatory status associated to increased synthesis of adipokines and cytokines from fat tissue has been shown in obesity. Obese women have a higher risk of both spontaneous and medically induced PTD. In about 50% of cases of spontaneous PTD, an infection-induced chorion amnionitis can be detected while in the remaining 50% a sterile inflammatory response has been described. Activation of uterine innate immunity system in intra-amniotic cavity and in chorioamniotic membranes might represent the missing link between MO and the pathogenesis of PTD. Conclusion: Tissue inflammation might represent the pathogenic link between MO and increased occurrence of PTD. The achievement of pre-pregnancy normal maternal weight and body mass index is a fundamental aim of public health to reduce the incidence of PTD and get optimal reproductive outcomes