Cigarette smoking is associated with lower maternal sFlt-1 concentrations during pregnancy and preeclampsia. On the basis of these data, cigarette smoke exposure may decrease the risk of preeclampsia in part by moderating the anti-angiogenic phenotype observed in the syndrome.
There are multiple etiologies for fetal dilated bowel loops on ultrasonography (US), and we present a unique case of male siblings with a forkhead box P3 (FOXP3) mutation. Both children presented with fetal bowel anomalies on prenatal US. Family histories of cystic fibrosis and immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome were reported. Amniocentesis in both pregnancies identified a normal male karyotype and the familial mutation associated with IPEX syndrome. IPEX syndrome is one of a group of conditions known as congenital diarrhea disorders. Other congenital diarrhea disorder cases have presented with similar prenatal US findings. As a result of these associations, we suggest considering IPEX syndrome as a potential cause of fetal bowel anomalies, particularly with a known family history. However, continued research into the phenotypic and genotypic correlations for IPEX syndrome is likely needed to better understand this possible prenatal presentation.
performance is associated with morbidity and mortality in HLHS, in-utero assessment of systemic RV function may be helpful in postnatal care. Quantitative echocardiographic assessment of the fetal systemic RV may be improved with the use of 2DST.
INTRODUCTION:
The goal of this study is to analyze outcomes of periviable deliveries at a tertiary care center in Southwest Virginia from January 2010 to 2016 of those infants delivered from 22 to 25 weeks.
METHODS:
This is a retrospective case series of 76 infants delivered between 22 0/7 and 24 6/7 weeks from 2010-2015. Infant and maternal charts were reviewed for data from admission until NICU discharge or in hospital death. Outcomes included death prior to discharge and major morbidities associated with prematurity.
RESULTS:
Seventy-six patients were identified, with none less than 23 0/7 weeks. Three patients were excluded due to life-limiting genetic or anatomic abnormalities diagnosed antenatally. Mean gestational age at delivery was 24 0/7 weeks (22 6/7-24 6/7 weeks) with mean birth weight 610 g (342-907 g). Demographic information was obtained including maternal age/race, receipt of betamethasone and magnesium sulfate, and causes for delivery. Placental pathology reports were also reviewed. Overall survival was 63% (57% at 23 weeks, 70% at 24 weeks), with a mean length of stay of 159 days (77-167 days). Seventy-four percent of survivors were diagnosed with major morbidity including: stage 3-4 retinopathy of prematurity (15%); late onset sepsis (28%); necrotizing enterocolitis (20%); grade 3-4 intraventricular hemorrhage (15%); periventricular leukomalacia (9%); and spontaneous bowel perforation (22%). 70% of survivors were discharged with home oxygen requirements.
CONCLUSION:
Our survival rate is above national benchmark data for this gestational age. However, the majority of survivors experienced significant morbidity, which should be considered when making decisions regarding resuscitation at the threshold of viability.
INTRODUCTION:
Preeclampsia results in part from abnormal myometrial invasion by placental spiral arteries. It is unknown if and how fetal vessels remodel to compensate for these changes. We sought to characterize preeclampsia-associated vascular remodeling by comparing vessels within villi of placentas collected from preeclamptic and normotensive patients.
METHODS:
Carilion Clinic IRB approval was obtained prior to patient enrollment. Singleton pregnancies complicated by preeclampsia and normotensive controls were identified on Labor and Delivery. Placental biopsies were collected following delivery. Smooth muscle (alpha-SMA) and Type III collagen (COLIII) were identified by immunostaining of cryostat sections. Confocal microscopy was used to measure areas of alpha-SMA and COLIII positivity surrounding vessels. Ratios of alpha-SMA or COLIII positivity to vessel area were calculated. These ratios, which represent relative smooth muscle and collagen content, were compared between vessels from preeclamptic and normotensive placentas.
RESULTS:
Measurements from 342 vessels from 10 placentas (from five preeclamptic patients and five controls) were included in this analysis. Compared to vessels within placentas of normotensive patients, placental vessels of preeclamptic patients demonstrated a significantly reduced area of alpha-SMA positivity (2.48 vs 3.97; P=.008). A trend was seen towards decreased collagen surrounding vessels in preeclamptic placentas, though this was not statistically significant (4.33 vs 5.66; P=.054).
CONCLUSION:
Preeclampsia is associated with a decrease in vascular smooth muscle within placental villi and may be associated with decreased collagen content. This may represent a mechanism to increase transplacental flow of oxygen in the setting of impaired spiral artery remodeling, but further studies are needed to clarify this relationship.
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