Maternal perception of decreased fetal movements (DFM) is associated with increased incidence of stillbirth and intrauterine growth restriction. We hypothesised that clinical assessment of women perceiving DFM may identify patients at highest risk of poor perinatal outcome. This was a retrospective study of 203 patients presenting to the obstetric triage service with DFM. Information on obstetric and past medical history, the current presentation with DFM and the outcome of pregnancy was collected. Using multivariate analysis, odds ratios (OR) and 95% confidence intervals (CI) were calculated for poor pregnancy outcome defined as stillbirth, small for gestational age or pre-term delivery. The rate of stillbirth was increased in women with DFM (OR 2.9). Some 26.6% of women perceiving DFM had a poor perinatal outcome. Women with relevant past obstetric history (OR 2.11), two or more presentations of DFM (OR 1.92), or who measured small-for-dates (OR 19.53) were at increased risk of poor pregnancy outcome. These preliminary data suggest that some features of clinical assessment can identify patients at increased risk of poor perinatal outcome after presentation with DFM. Such patients may be prioritised for detailed assessment of fetal growth and wellbeing.
Atrial myxoma is the most common primary cardiac tumour with a prevalence of 0.075% with a mean age for sporadic cases of 56 years. We report the case of a 30 year old primigravida who presented at 6+5 weeks pregnant with worsening dyspnoea and palpitations. Cardiac echo revealed a large left sided atrial myxoma causing outflow obstruction and mitral valve damage. The primary excision surgery required 84 minutes of cardiopulmonary bypass, and whilst successful, follow-up transthoracic echo revealed significant mitral valve regurgitation requiring valve replacement. This was performed with a bioprosthetic valve with 105 minutes of cardiopulmonary bypass. Post-operatively she remained in a pacing dependent rhythm and so had a permanent pacemaker sited. The first trimester was complicated with recurrent episodes of vaginal bleeding thought to be related to the heparin given at time of bypass. Routine anomaly ultrasound at 20 weeks gestation revealed a normal fetus but mild polyhydramnios and subsequent glucose tolerance testing found her to have gestational diabetes which was controlled with dietary measures. She was induced at 42 weeks gestation for post-maturity and had an emergency caesarean section for fetal distress. We report this case for its rarity – not only for the underlying disease process but for a successful pregnancy outcome following 2 prolonged periods of cardiopulmonary bypass in early pregnancy.
In each of the 12 cases presented, the fistula was the result of obstructed labor. Common features to each case were: (a) a large retropubic defect involving the anterior vaginal wall, bladder and urethra, (b) total or partial urethral rupture, and (c) marked vaginal wall scarring with vaginal stenosis. Primary repair was performed by the vaginal route, and two patients were cured by the first operation. Six patients required two or more vaginal procedures for successful closure. Following repeated failure of vaginal closure, two patients had a successful transvesical closure and two require ureterosigmoidostomy.
Background There is accumulating evidence that sterile inflammation is a driver of labour in myometrium and cervix; however the involvement of the decidua is poorly defined. Our previous studies report decidual leukocyte infiltration prior to and during labour. The current study aimed to characterise the inflammatory gene profile in the decidua during term labour. Methods Decidua was obtained from two groups (no labour and term labour); pooled RNA was applied to Human Genome U133 Plus 2.0 Affymetrix GeneChips. Bioinformatic and pathway analysis was performed using Ingenuity pathway analysis (IPA), with gene validation by real time PCR. Results Affymetrix analysis identified widespread changes in decidual gene expression following labour. The most highly altered biological functions included: haematological system function, cell-cell signalling, immune cell trafficking, cellular movement and inflammatory responses; however those involved in tissue morphology, metabolism and cell survival were also altered. PCR validation was selected based on fold change and functional significance: ICAM (p = 0.006), CXCR4 (p = 0.017), CD44 (p = 0.02), TLR 4 (p = 0.035), SOCS3 (p = 0.02), BCL2A (p = 0.018) and IDO1 (p = 0.029) were upregulated following labour. Transcription factors predicted, from the gene array, as potential upstream regulators were: NFkB, RELA, STAT1 (Signal transducer and activator of transcription 1) and MEOX2 (mesenchyme homeobox 2) Conclusions This study provides further evidence of non-infection related inflammatory pathways contributing to term labour, in particular identifying inflammatory changes in the decidua similar to those in myometrium and cervix. Ongoing studies focus on identifying potential targets to suppress decidual inflammation as a potential means of arresting labour.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.