Obstetric Outcomes in Women With Turner Karyotype

Hagman, Anders; Källén, Karin; Barrenäs, M-L; Landin‐Wilhelmsen, Kerstin; Hanson, C.; Bryman, Inger; Wennerholm, U-B

doi:10.1097/ogx.0b013e31824e24fc

Cited by 14 publications

(27 citation statements)

References 14 publications

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“…Obstetric outcomes in 11 women with TS from Finland and in 11 women with TS from Sweden included in this study have been reported previously (Foudila et al, 1999;Hagman et al, 2011). All women with TS from Denmark are also included in the study by Malchau et al (2013).…”

Section: Methodsmentioning

confidence: 99%

Obstetric and neonatal outcome after oocyte donation in 106 women with Turner syndrome: a Nordic cohort study

et al. 2013

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summary answer: Pregnancies among women with TS carry a substantial risk, particularly for hypertensive disorders. Potentially lifethreatening complications occurred in 3.3% of pregnancies. The neonatal outcomes were generally reassuring, with similar rates of preterm birth and low birthweight (LBW) as after conventional IVF and better than previously reported in deliveries after OD in women with TS.what is known already: OD pregnancies in women with TS are known to be high-risk pregnancies. study design, size, duration: This retrospective cohort study included 106 women with TS who delivered after OD (n ¼ 122 deliveries, n ¼ 131 newborns) in three Nordic countries (Finland, Denmark, Sweden) between 1992 and participants, setting and methods: Women with TS who delivered after OD in three Nordic countries were identified (n ¼ 110). Four women declined to participate or were lost to follow-up, thus 106 women were included in the study. The medical data from fertility clinics, antenatal clinics and the hospitals where the women had been treated and/or delivered were scrutinized.main results and the role of chance: In this cohort, the karyotype was 45,X in 44% of the women with TS. Ten women (9.4%) had a known cardiac defect before pregnancy. Single embryo transfer was performed in 70.3% of the cases and the multiple birth rate was 7.4%. In total, 35.0% of the pregnancies were associated with a hypertensive disorder including pre-eclampsia in 20.5%. Potentially lifethreatening complications occurred in four pregnancies (3.3%), including one woman with aortic dissection, one with mild regurgitation of the tricuspid and mitral valve, one with a mechanical heart valve who developed HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) and one who underwent a post-partum hysterectomy due to severe haemorrhaging. Neonatal outcomes were reassuring, with a preterm birth rate of 8.0% and LBW rate of 8.8% in singletons. Major birth defects were found in 3.8% of the children. The perinatal mortality was 2.3% (3/131), including a set of extremely preterm twins.limitations, reasons for caution: Although this study was performed over a period of almost 20 years in three different countries, with a low drop-out rate and little missing data, much larger series are needed to assess rare events. This study also lacks an appropriate control group. Reproduction, Vol.28, No.6 pp. 1598-1609, 2013 Advanced Access publication on March 27, 2013 doi:10.1093/humrep/det082 Downloaded from https://academic.oup.com/humrep/article-abstract/28/6/1598/605487 by guest on 07 June 2019 wider implications of the findings: This study suggests that cardiovascular evaluation before and during pregnancy may contribute to favourable obstetric outcomes in many cases. Maternal outcomes were in agreement with the literature while neonatal outcomes were generally better than previously reported. The outcomes were consistent across the three countries, supporting generalizability to similar populations.

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Section: Methodsmentioning

confidence: 99%

Obstetric and neonatal outcome after oocyte donation in 106 women with Turner syndrome: a Nordic cohort study

et al. 2013

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“…This case, along with several recently published papers 4,15 demonstrates that favourable maternal and fetal outcomes are achievable in pregnant women with Turner's syndrome despite the significant risks posed by their associated medical conditions. Detailed pre-pregnancy counselling and cardiovascular assessment are vital, in addition to individualised, intensive multidisciplinary antenatal monitoring and delivery planning.…”

Section: Resultsmentioning

confidence: 99%

“…12,13 Mode of delivery is debatable, but the chances of operative intervention are high due to concerns regarding short stature, small pelvis, prematurity and growth restriction. 3,4,11,14 However, one recent case report describes a woman with no associated medical conditions, who did not develop any obstetric complications and had an instrumental delivery of an appropriately grown baby at term. 15 …”

Section: Discussionmentioning

confidence: 99%

“…3,4,11,14 However, one recent case report describes a woman with no associated medical conditions, who did not develop any obstetric complications and had an instrumental delivery of an appropriately grown baby at term.…”

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confidence: 99%

“…Hypertensive disorders are common with at least double the risk of pre-eclampsia. 4,5 Women may have pre-existing hypertension and diabetes, are likely to be primigravid and in combination with IVF have multiple risk factors for pre-eclampsia. Low-dose aspirin should be offered to reduce this risk.…”

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Successful pregnancy outcome in a woman with Turner’s syndrome

et al. 2014

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Women with Turner's syndrome have a high incidence of cardiovascular complications, endocrine and hypertensive disorders. Those with the 45X chromosome complement require oocyte donation and in vitro fertilisation to conceive. Pregnancies in such women are challenging to manage due to the high risk of pregnancy-related hypertensive disorders, impaired glucose tolerance, fetal growth restriction and preterm birth. Women also need to be aware of the significant risk of aortic dilatation, dissection or rupture in pregnancy, which may be fatal. Despite these risks, favourable obstetric outcomes are achievable with careful pre-pregnancy counselling and cardiovascular assessment, intensive multidisciplinary antenatal monitoring and individualised delivery planning. We report the case of a 33-year-old woman with Turner's syndrome, pre-existing hypertension, insulin-dependent diabetes and primary hypoparathyroidism who had a successful pregnancy with good maternal and fetal outcomes despite the complexity of her medical conditions. Keywords High-risk pregnancy, diabetes, hypertension, infertility, Turner's syndrome Case reportA 33-year-old woman diagnosed with Turner's syndrome in childhood became pregnant after five cycles of in vitro fertilisation (IVF) with donor oocytes. She suffered from recurrent ear infections as a child, necessitating an adenoidectomy and myringotomy aged four. Karyotyping performed at the age of 10 due to short stature (126 cm) revealed monosomy 45X. She received growth hormone until the age of 16 to induce adult height. Oestradiol was commenced at age 13 to stimulate puberty, then switched to combined sequential hormone replacement therapy to protect the endometrium and induce progesterone withdrawal bleeds. Cardiac imaging revealed a small subaortic membrane with no significant gradient across the left ventricular outflow tract (peak of 12 mmHg only), good left ventricular function and no coarctation or dilatation of the aorta. She attended for annual echocardiogram and cardiology review and remained asymptomatic. She was admitted to hospital with persistent vomiting aged 22, found to be in diabetic ketoacidosis and diagnosed with type 1 diabetes. At the age of 27, she developed hypertension which was treated with lisinopril. She attended for pre-pregnancy counselling aged 28. Her height was 153 cm, weight 62 kg and BMI 26. Her antihypertensive medication was changed to methyldopa, as angiotensin-converting enzyme inhibitors are contraindicated in pregnancy. She commenced folic acid 5 mg daily. With the support of the diabetes team over the next four years, she reduced her HbA1c from 8.4% to obtain optimal glycaemic control with a continuous subcutaneous insulin pump. She also underwent laser treatment for diabetic retinopathy.Her fifth IVF cycle was successful and supported by oestradiol, progesterone, prednisolone, aspirin and low-molecular-weight heparin (LMWH). She received intralipid infusions on days 4-9 of her IVF treatment protocol in a research context, as investigations for ...

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Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

Yuan

2013

Clinical Cardiology

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Aortic dissection (AoD) during pregnancy is a rare but lethal condition and highlights the need for extensive elucidation. The aim of this study is to reveal the risk factors for AoD during pregnancy and to compare the 2 main risk factors, Marfan syndrome and pregnancy itself in the previously healthy woman. The pregnant patients developed AoD at 31.7 ± 7.6 weeks of gestation. It occurred much earlier in the Marfan patients than in the previously healthy women (30.7 ± 8.6 weeks of gestation vs 34.4 ± 4.4 weeks of gestation, P = 0.0263). In the Marfan patients, AoD developed in 3 (3.2%), 15 (15.8%), and 43 (46.3%) patients in the 3 trimesters, respectively, compared with 31 of the previously healthy women, and only in the third trimester. The neonates of the Marfan patients had better Apgar scores at 1 and 5 minutes, lower intubation rates, and fewer stays in the neonatal intensive care unit than those of the previously healthy women. Marfan syndrome and pregnancy itself in the previously healthy woman were the 2 main risk factors responsible for the occurrence of AoD during pregnancy. Marfan patients may develop AoD at an early age and an early stage of pregnancy, probably due to the preexisting weakened aortic wall. Better outcomes for the surviving neonates of Marfan patients compared with neonates of the previously healthy women might be the result of the poor condition of Marfan patients causing a higher death rate for those fetuses.

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Obstetric Outcomes in Women With Turner Karyotype

Cited by 14 publications

References 14 publications

Obstetric and neonatal outcome after oocyte donation in 106 women with Turner syndrome: a Nordic cohort study

Obstetric and neonatal outcome after oocyte donation in 106 women with Turner syndrome: a Nordic cohort study

Successful pregnancy outcome in a woman with Turner’s syndrome

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

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