Managing Risk—To Mother and Fetuses—In a Twin Gestation
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Pre-Term Pre-Labour Rupture of Membranes and the Role of Amniocentesis
Fetal and Maternal Medicine Review 2010; 21:2 75–88 C Cambridge University Press 2010 doi:10.1017/S096553951000001X First published online 15 March 2010 PRE-TERM PRE-LABOUR RUPTURE OF MEMBRANES AND THE ROLE OF AMNIOCENTESIS 1,2 ANNA P KENYON, 1,2 KHALIL N ABI-NADER AND 2 PRANAV P PANDYA 1Elizabeth Garrett Anderson Institute for Women’s Health, University College London, 86-96 Chenies Mews, London WCIE 6NX. 2Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, London NWI 2BU. INTRODUCTION Pre-labour premature rupture of membranes (PPROM) is defined as rupture of membranes more than 1 hour prior to the onset of labour at <37 weeks gestation. PPROM occurs in approximately 3% of pregnancies and is responsible for a third of all preterm births.1 Once membranes are ruptured prolonging the pregnancy has no maternal physical advantage but fetal morbidity and mortality are improved daily at early gestations: 19% of those infants born <25 weeks develop cerebral palsy (CP) and 28% have severe motor disability.2 Those infants born extremely pre term (<28 weeks) cost the public sector £75835 (95% CI £27906–145508) per live birth3 not to mention the emotional cost to the family. To prolong gestation is therefore the suggested goal: however how and why might we delay birth in those at risk? PPROM is one scenario associated with preterm birth and here we discuss the causative mechanisms, sequelae, latency, strategies to prolong gestation (antibiotics) and consider the role of amniocentesis. We will also discuss novel therapies. PATHOPHYSIOLOGY OF MEMBRANE RUPTURE The membranes, which act to protect and isolate the fetus, are composed of two layers. -
The Human Chimera: Legal Problems Arising from Individuals with Multiple Types of Dna
Seton Hall University eRepository @ Seton Hall Law School Student Scholarship Seton Hall Law 5-2-2014 The umH an Chimera: Legal Problems Arising From Individuals with Multiple Types of DNA Robert Russell Granzen Follow this and additional works at: https://scholarship.shu.edu/student_scholarship Recommended Citation Granzen, Robert Russell, "The umH an Chimera: Legal Problems Arising From Individuals with Multiple Types of DNA" (2014). Law School Student Scholarship. 485. https://scholarship.shu.edu/student_scholarship/485 THE HUMAN CHIMERA: LEGAL PROBLEMS ARISING FROM INDIVIDUALS WITH MULTIPLE TYPES OF DNA Robert Granzen INTRODUCTION Science continually changes, and with it our understanding of the human body. While some scientific developments are limited in scope, others have widespread effects. Scientists have just recently begun understanding the range of effects chimerism in humans can have. Chimerism, originally associated with hermaphrodites having both male and female sexual organs, is much more common than originally thought. As chimerism becomes more common, so do individuals with separate and distinct deoxyribonucleic acid (DNA) strands in their bodies. Most individuals are unaware of their chimeric genetic code and most will likely never know. Because of the inherent difficulty of testing for chimerism, many problems are presented to legal system. Part I of this article will begin with the history of human chimeras. The section will then describe the ways in which chimeras are formed. The section will discuss the most common form of chimerism in humans--fetal cell microchimerism (FMC). FMC occurs when cells are transferred from baby to mother or mother to baby via the umbilical cord.1 Studies have shown that mothers may keep cells from their children for years after giving birth.2 Moreover, cells can be exchanged between twins while inside the uterus.3 Secondly, the section will describe the process of embryo fusion, which can cause tetragametic chimerism. -
Association of Induced Abortion with Hypertensive Disorders Of
www.nature.com/scientificreports OPEN Association of induced abortion with hypertensive disorders of pregnancy risk among nulliparous women in China: a prospective cohort study Yinhua Su1,2, Xiaoping Xie3, Yanfang Zhou1, Hong Lin1, Yamei Li1, Na Feng1 & Jiayou Luo1* The relationship between induced abortion(IA) and hypertensive disorders of pregnancy(HDP) is inconclusive. Few studies have been conducted in China. In order to clarify the association between previous IA and risk of HDP, including gestational hypertension(GH) and pre-eclampsia(PE), we performed a community-based prospective cohort study enrolling 5191 eligible nulliparous women in selected 2 districts and 11 towns of Liuyang from 2013 to 2015. Multivariable logistic regression was conducted to examine whether IA was associated with HDP, GH and PE. Of the gravidea, 1378(26.5%) had a previous IA and 258(5.0%) diagnosed with HDP, including 141(2.7%) GH and 117(2.3%) PE. The diference in the incidence of GH and PE between gravidae having one versus those with two or more IAs was minimal. After adjustment for maternal age, body mass index at frst antenatal visit, education, virus infection and history of medical disorders, previous IA was signifcantly associated with HDP (OR = 0.67, 95%CI = 0.49 to 0.91) and PE (OR = 0.61, 95%CI = 0.38 to 0.97), but not with GH (OR = 0.73, 95%CI = 0.49 to 1.10). Additional adjustment for occupation, living area, anemia, gestational diabetes mellitus, psychological stress, conception climate and infant sex, multivariable analysis provided similar results. In conclusion, previous IA was associated with a lower risk of PE among nulliparous women. -
Association Between First-Trimester Intrauterine Hematoma and Twin Pregnancy Outcomes: a Retrospective Cohort Study
Association Between First-Trimester Intrauterine Hematoma and Twin Pregnancy Outcomes: A Retrospective Cohort Study Wanqing Ji Guangzhou Women and Children's Medical Center Jie Zheng Guangzhou Women and Children's Medical Center Weidong Li Guangzhou Women and Children's Medical Center Fang Guo Guangzhou Women and Children's Medical Center Bo Hou Third Aliated Hospital of Sun Yat-Sen University Ping He ( [email protected] ) Guangzhou Women and Children's Medical Center https://orcid.org/0000-0002-6551-8578 Research article Keywords: intrauterine hematoma, twin gestation, rst trimester, miscarriage, vanishing twin syndrome Posted Date: September 21st, 2020 DOI: https://doi.org/10.21203/rs.3.rs-75567/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Version of Record: A version of this preprint was published on January 11th, 2021. See the published version at https://doi.org/10.1186/s12884-020-03528-0. 1 Title page 2 Association between first-trimester intrauterine hematoma and twin pregnancy 3 outcomes: A retrospective cohort study 4 Wanqing Ji1,Ϯ , jie Zheng1,Ϯ, Weidong Li 2,Ϯ, Fang Guo1, , Ping He1,* Bo Hou3,* 5 1Department of Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical 6 University, Guangzhou, 510623,China. 7 2Department of Woman and Child Health Information Guangzhou Women and Children’s Medical 8 Center, Guangzhou Medical University, Guangzhou, 510623,China. 9 3Departments of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 10 Guangdong province, 510630, China.E-mail: [email protected] 11 *Correspondence address. Ping He, Guangzhou Women and Children’s Medical Center, Guangzhou 12 Medical University, Guangzhou, Guangdong province, 510623, China.Fax number: 86-20-8717 6790 13 E-mail: [email protected] 14 Bo Hou , Departments of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, 15 Guangzhou, Guangdong province, 510630, China. -
Prenatal Testing Options
PRENATAL TESTING OPTIONS There are many types of tests available during pregnancy. No test can detect every possible condition, however there are many tests that can provide more information. Patients may elect or decline any of these tests as they are all optional. NT Ultrasound Detailed Ultrasound SCREENING CA PNS 1st Blood Draw CA PNS 2nd Blood Draw Cell-Free DNA Screening pregnancy week 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 DIAGNOSTIC CVS Amniocentesis SCREENING TESTS Screening tests provide probabilities (odds) of having a baby with certain conditions, however screening tests cannot detect all cases of these conditions. Screening tests are performed through maternal blood and ultrasound, so there is no risk for miscarriage from these tests. Patients will receive either “screen negative” or “screen positive” results from their screening tests. When results are screen negative, these are considered low-risk for that condition, however it is not impossible that the baby has that condition. When results are screen positive, these are considered high-risk for that condition, however most women with screen positive results are carrying a healthy baby! Follow up testing is available to confirm screening results. California Prenatal Screening Program (CA PNS) (also called Sequential Integrated Screening) Combines blood draw(s) and the NT ultrasound with maternal age risk to screen for Down syndrome, trisomy 18, open neural tube defects (example: spina bifida), and Smith-Lemli-Opitz syndrome In a pregnant woman’s blood there are natural -
CDC Having Healthy Babies One at a Time
HAVING HEALTHY BABIES ONE AT A TIME Why are we worried about twin pregnancies? We know that you are ready to start or add to your family. You may be concerned about your chances of having a baby using in vitro fertilization (IVF) or how much cycles of IVF cost. These concerns are common and may lead you to think about transferring more than one embryo during your IVF procedure. However, transferring more than one embryo increases your chances of having twins or more. Twin pregnancy is risky for baby and mother, whether or not IVF is used. Some of these risks include: Almost 3 out of 5 Twin babies are more likely to be stillborn, twin babies are born preterm, or at less than experience neonatal death, have birth defects of 37 weeks of pregnancy. Twin babies are nearly the brain, heart, face, limbs, muscles, or digestive 6 times as likely to be born preterm as system, and have autism than single babies. single babies. Almost 1 out of 10 About 1 out of 4 women carrying twins gets pregnancy-related twin babies are admitted to the neonatal high blood pressure. Women carrying twins intensive care unit (NICU). Twin babies are are twice as likely to get pregnancy-related high more than 5 times as likely to be admitted to the blood pressure as women carrying single babies. NICU as single babies. Almost 1 out of 20 About 7 out of 1,000 women carrying twins gets gestational diabetes. twin babies have cerebral palsy. Twin babies are Women carrying twins are 1.5 times as likely to get more than 4 times as likely to have cerebral palsy gestational diabetes as women carrying as single babies. -
Chorionic Villus Sample CVS Brochure
CVS C Chorionic Villus Sampling G A A T GENETICS LABORATORIES GENETICS LABORATORIES GENETICS LABORATORIES 3/2015 ou are being asked to consider prena- tal diagnosis in your current pregnancy. Y Chorionic villus sampling (CVS) is available as a method of prenatal testing for women who are less than 13 weeks pregnant. This test can be performed earlier than amniocentesis, which is usually performed between 15 and 20 weeks, thereby offering results earlier in the pregnancy. This brochure is to provide you with some basic information on CVS. A separate brochure is avail- able which describes amniocentesis. Who should consider CVS? CVS should be considered by women age 35 or older at the time of delivery, individuals who have had a child with a chromosome abnormality, individuals who have a chromosome translocation, and couples at risk for a prenatally diagnosable genetic disease (e.g., hemophilia or sickle cell disease). CVS is not appropriate for individuals with a family history of neural tube defects (spina bifida or anencephaly). When is CVS performed? CVS is traditionally performed between 10 - 13 weeks after a woman’s last menstrual period (during the first trimester). How is CVS performed? There are two methods for obtaining chorionic villi. For many women, either method can be safely per- formed. First, an ultrasound evaluation is performed to locate the developing placenta and to date the pregnancy. Often, the placental location determines which method of CVS is more appropriate. There are certain other obstetrical considerations which may make one method preferable, including uterine anatomy and vaginal infections. TRANSCERVICAL CVS: A thin catheter (hollow tube) is inserted into the vagina and through the cervix. -
Prenatal and Preimplantation Genetic Diagnosis for Mps and Related Diseases
PRENATAL AND PREIMPLANTATION GENETIC DIAGNOSIS FOR MPS AND RELATED DISEASES Donna Bernstein, MS Amy Fisher, MS Joyce Fox, MD Families who are concerned about passing on genetic conditions to their children have several options. Two of those options are using prenatal diagnosis and preimplantation genetic diagnosis. Prenatal diagnosis is a method of testing a pregnancy to learn if it is affected with a genetic condition. Preimplantation genetic diagnosis, also called PGD, is a newer technology used to test a fertilized embryo before a pregnancy is established, utilizing in vitro fertilization (IVF). Both methods provide additional reproductive options to parents who are concerned about having a child with a genetic condition. There are two types of prenatal diagnosis; one is called amniocentesis, and the other is called CVS (chorionic villus sampling). Amniocentesis is usually performed between the fifteenth and eighteenth weeks of pregnancy. Amniocentesis involves inserting a fine needle into the uterus through the mother's abdomen and extracting a few tablespoons of amniotic fluid. Skin cells from the fetus are found in the amniotic fluid. These cells contain DNA, which can be tested to see if the fetus carries the same alterations in the genes (called mutations) that cause a genetic condition in an affected family member. If the specific mutation in the affected individual is unknown, it is possible to test the enzyme activity in the cells of the fetus. Although these methods are effective at determining whether a pregnancy is affected or not, they do not generally give information regarding the severity or the course of the condition. -
Module 2: Hypertensive Disorders of Pregnancy and Gestational Diabetes FINAL Description Text
Module 2: Hypertensive Disorders of Pregnancy and Gestational Diabetes FINAL Description Text Welcome to the module Hypertensive Disorders of Pregnancy and Gestational Diabetes. In this module, we will be discussing hypertensive Slide 1 disorders of pregnancy, including pregnancy induced hypertension and preeclampsia. We will also discuss Gestational Diabetes as well as nutrition solutions related to these issues Slide 2 We will begin by discussing hypertensive disorders in pregnancy. There are at least 5 distinct categories of hypertension and related disorders that occur during pregnancy. These categories are: preeclampsia/eclampsia, chronic hypertension, preeclampsia Slide 3 superimposed upon chronic hypertension, gestational hypertension and transient hypertension. Each of these will be discussed individually throughout the module, with recommendations based on best practices provided. Blood pressure is the force of blood on the walls of the arteries. Systolic blood pressure is measured when the ventricles are contracting while diastolic pressure is measured when the ventricles are relaxed. Normal Slide 4 blood pressure is typically 120/80 mm Hg.The general definition of high blood pressure in adults is a systolic BP > 140 mg HG or a diastolic blood pressure > 90 mm Hg. These criteria should be used for women throughout pregnancy. Chronic hypertension often exists prior to pregnancy and continues throughout pregnancy. It may not be noticed until the second trimester of pregnancy if prenatal care is delayed or if women have suffered from prolonged nausea and vomiting or morning sickness. If hypertension is Slide 5 diagnosed in early pregnancy and persists past 6 weeks postpartum, it would be considered to be a chronic health condition. -
L&D – Amnioinfusion Guideline and Procedure for Amnioinfusion
L&D – Amnioinfusion Guideline and Procedure for Amnioinfusion. Purpose: Replacing the amniotic fluid with normal saline has been found to be a safe, simple, and very effective way to reduce the occurrence of repetitive variable decelerations. Procedure: Initiation of Amnioinfusion will be ordered and performed by a Certified Nurse Midwife (CNM) or physician (MD). 1. Prepare NS or LR 1000ml with IV tubing in the same fashion as for intravenous infusion. Flush the tubing to clear air. 2. An intrauterine pressure catheter (IUPC) will be placed by the MD/CNM. 3. Elevate the IV bag 3-4 feet above the IUPC tip for rapid infusion. Infuse 250-500ml of solution over a 20-30 minute time frame followed by a 60-180ml/hour maintenance infusion. The total volume infused should not exceed 1000ml unless one has access to ultrasound and can titrate to an amniotic fluid index (AFI) of 8-12 cm to prevent polyhydramnios and hypertonus. 4. If variable decelerations recur or other new non-reassuring FHR patterns develop, notify the MD/CNM. The procedure may be repeated as ordered. 5. Resting tone of the uterus will be increased during infusion but should not increase > 15mmHg from previous baseline. If this occurs, infusion should stop until there is a return to the previous baseline then it can be restarted. An elevated baseline prior to infusion is a contraindication. 6. Monitor for an outflow of infusion. If there is a sudden cessation of outflow fetal head engagement may have occurred increasing the risk of polyhydramnios. Complications are rare but can include iatrogenic polyhydramnios, uterine hypertonus, chorioamnionitis, uterine rupture, placental abruption, and maternal pulmonary embolus. -
Proteomic Biomarkers of Intra-Amniotic Inflammation
0031-3998/07/6103-0318 PEDIATRIC RESEARCH Vol. 61, No. 3, 2007 Copyright © 2007 International Pediatric Research Foundation, Inc. Printed in U.S.A. Proteomic Biomarkers of Intra-amniotic Inflammation: Relationship with Funisitis and Early-onset Sepsis in the Premature Neonate CATALIN S. BUHIMSCHI, IRINA A. BUHIMSCHI, SONYA ABDEL-RAZEQ, VICTOR A. ROSENBERG, STEPHEN F. THUNG, GUOMAO ZHAO, ERICA WANG, AND VINEET BHANDARI Department of Obstetrics, Gynecology and Reproductive Sciences [C.S.B., I.A.B., S.A.-R., V.A.R., S.F.T., G.Z., E.W.], and Department of Pediatrics [V.B.], Division of Perinatal Medicine, Yale University School of Medicine, New Haven, CT 06520 ABSTRACT: Our goal was to determine the relationship between 4 vein inflammatory cytokine levels, but not maternal serum val- amniotic fluid (AF) proteomic biomarkers (human neutrophil de- ues, correlate with the presence and severity of the placental fensins 2 and 1, calgranulins C and A) characteristic of intra-amniotic histologic inflammation and umbilical cord vasculitis (7). inflammation, and funisitis and early-onset sepsis in premature neo- Funisitis is characterized by perivascular infiltrates of in- nates. The mass restricted (MR) score was generated from AF flammatory cells and is considered one of the strongest hall- obtained from women in preterm labor (n ϭ 123). The MR score marks of microbial invasion of the amniotic cavity and fetal ranged from 0–4 (none to all biomarkers present). Funisitis was graded histologically and interpreted in relation to the MR scores. inflammatory syndrome (8,9). While there is some debate with Neonates (n ϭ 97) were evaluated for early-onset sepsis. -
Association Between Chorionicity and Preterm Birth in Twin Pregnancies: a Systematic Review Involving 29 864 Twin Pregnancies
DOI: 10.1111/1471-0528.16479 Systematic Review www.bjog.org Association between chorionicity and preterm birth in twin pregnancies: a systematic review involving 29 864 twin pregnancies S Marleen,a,b C Dias,b R Nandasena,b R MacGregor,c J Allotey,d J Aquilina,c A Khalil,e,f S Thangaratinamg a Barts Research Centre for Women’s Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK b Sri Jayewardenepura Postgraduate Teaching Hospital, Nugegoda, Sri Lanka c Royal London Hospital, Barts Health NHS Trust, London, UK d Institute of Applied Health Research, University of Birmingham, Birmingham, UK e St George’s University Hospitals NHS Foundation Trust, London, UK f Molecular and Clinical Sciences Research Institute, St George’s Medical School, University of London, London, UK g World Health Organization (WHO) Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK Correspondence: S Marleen, Barts Research Centre for Women’s Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Road, London E1 4NS, UK. Email: [email protected] Accepted 7 August 2020. Published Online 7 October 2020. Background The perinatal mortality and morbidity among twins I2 = 46%, OR 1.55, 95% CI 1.27–1.89 I2 = 68%, OR 1.47, 95% CI vary by chorionicity. Although it is considered that 1.27–1.69, I2 = 60%, OR 1.66, 95% CI 1.43–1.93, I2 = 65%, monochorionicity is associated with an increased risk of preterm respectively).