DOCSLIB.ORG

Prediction of Amnionicity Using the Number of Yolk Sacs in Monochorionic Multifetal Pregnancy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Prediction of Amnionicity Using the Number of Yolk Sacs in Monochorionic Multifetal Pregnancy CROSSMARK_logo_3_Test 1 / 1 ORIGINAL ARTICLE Obstetrics & Gynecology https://crossmarhttps://doi.org/10.3346/jkms.2017.32.12.2016k-cdn.crossref.org/widget/v2.0/logos/CROSSMARK_Color_square.svg 2017-03-16 • J Korean Med Sci 2017; 32: 2016-2020 Prediction of Amnionicity Using the Number of Yolk Sacs in Monochorionic Multifetal Pregnancy Sue Yeon Park,1 Jin Hoon Chung,2 The purpose of this article was to evaluate the accuracy of predicting amnionicity using the You Jung Han,2 Si Won Lee,2 number of yolk sacs by diagnostic ultrasound examination in monochorionic (MC) and Moon Young Kim2 multifetal pregnancies between 7 + 0 and 9 + 6 gestational weeks. A total of 97 patients with MC multifetal pregnancies underwent early ultrasound examination from 2004 to 1Department of Obstetrics and Gynecology, Lin Women’s Hospital, Seoul, Korea; 2Department of 2014 at Cheil General Hospital and Women’s Healthcare Center. All patients for whom the Obstetrics and Gynecology, Cheil General Hospital number of yolk sacs was reported were included in this study. We compared the number of and Women’s Healthcare Center, Dankook University yolk sacs with amnionicity confirmed by an intertwine membrane. Overall, there was a College of Medicine, Seoul, Korea 9.3% (9 cases) discrepancy in number of yolk sacs and amnionicity (4.3% for Received: 22 January 2017 monochorionic diamniotic, 36.4% for monochorionic monoamniotic, and 33% for Accepted: 9 September 2017 monochorionic triamniotic). Among the 9 cases with discrepancies, 4 cases with 2 yolk sacs were confirmed as monoamniotic pregnancies and 4 MC twin pregnancies showing a Address for Correspondence: single yolk sac were diagnosed as diamniotic twin pregnancies. One case with 2 yolk sacs Jin Hoon Chung, MD, PhD Department of Obstetrics and Gynecology, Cheil General was identified as a triamniotic triplet pregnancy. In 9.3% of MC gestations, the number of Hospital and Women’s Healthcare Center, Dankook University yolk sacs was not correlated with the number of amnions in our study. To determine College of Medicine, 17 Seoae-ro 1-gil, Jung-gu, Seoul 04619, Korea amnionicity in MC multifetal pregnancies, we recommend careful evaluation not of the E-mail: [email protected] number of yolk sacs but the presence or absence of intertwine dividing membrane after 8 gestational weeks. Keywords: Amnionicity; Multifetal Pregnancy; Twins; Ultrasound; Monochorionic Twin; Yolk Sac INTRODUCTION the dividing amniotic membrane (5). The amniotic membrane develops concurrently with the yolk sac, but it is difficult to vi- The incidence of multifetal pregnancy has increased with the sualize early in the first trimester because the membrane is close- use of assisted reproductive technologies. Multifetal pregnan- ly applied to the developing embryo without amniotic fluid be- cies increase the rate of preterm births, which compromise neo- tween the embryo and the amnion. The amnion only becomes natal survival and increase the risk of lifelong disability. The in- visible once there is enough fluid separating the embryo from fant mortality rate for multiple births is five times the rate as that the membrane. Therefore, the number of yolk sacs may be used for a singleton (1). These risks are magnified further with triplet to diagnose amnionicity initially (6). or quadruplet births. Recently, the accuracy of the relationship between the num- The determination of chorionicity antenatally in twin preg- ber of yolk sacs and amnionicity has been called into question nancy is important for predicting pregnancy complications (2). (7-9). In addition, we have experienced several cases of MC mul- It is well known that monochorionic (MC) twin pregnancies are tifetal gestations with discrepancies between the number of yolk associated with higher mortality and morbidity than dichorion- sacs and amnionicity. To the best of our knowledge, previous ic twin pregnancies due to hemodynamic imbalance (3). Mono- reports have been case reports or very small studies. Therefore, amniotic (MA) twin pregnancies account for only 1% of all mono- we evaluated the accuracy of the number of yolk sacs for pre- zygotic twins and are associated with high fetal death rates from dicting amnionicity in MC multifetal pregnancies during early cord entanglement, congenital anomalies, and preterm birth first trimester ultrasound examination. (4). Therefore, accurate determination of amnionicity is an im- portant first step for establishing a clinical management plan MATERIALS AND METHODS and counseling women with MC multifetal pregnancies and their family members about pregnancy outcomes. This was a retrospective analysis of prospectively collected data Determination of amnionicity in MC multifetal pregnancies from patients with MC multifetal gestations from October 2004 is typically done around 8 weeks of gestation by visualization of to December 2014 at Cheil General Hospital and Women’s Health- © 2017 The Korean Academy of Medical Sciences. pISSN 1011-8934 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. eISSN 1598-6357 Park SY, et al. • Prediction of Amnionicity in Monochorionic Multifetal Pregnancy care Center. During the study period, a total of 97 viable MC mul- Review Board of Cheil General Hospital (Seoul) (IRB No. CGH- tifetal pregnancies were identified via ultrasound between 7 + 0 IRB-2015-54). The need to obtain informed consent was waived. and 9 + 6 weeks of gestation. Ultrasonography was performed using transvaginal and transabdominal transducers with one of RESULTS the following ultrasound models (Voluson E8, Voluson 730; GE Healthcare, Milwaukee, WI, USA) by five obstetricians, each with During the study period, a total of 97 cases of MC multifetal preg- more than five years of experience performing first trimester nancy were identified, including 83 cases of diamniotic (DA) scans. In our center, all pregnant women with multifetal preg- twins, 11 cases of MA twins, and 3 cases of TA triplets. The mean nancies were advised to receive fetal ultrasonography between maternal age of the study group was 32.2 ± 3.9 years old and 71 7 + 0 and 9 + 6 gestational weeks for determination of chorion- (66.0%) of the women were nulliparous. The median GA at the icity and amnionicity. When determination of chorionicity or first ultrasound scan was 8.0 ± 1.3 weeks of gestation. The most amnionicity was uncertain, the patient underwent sonography common method of conception was natural (69%), and other again by another senior staff. Follow-up fetal sonography was maternal characteristics are shown in Table 1. performed, usually two weeks later at 9–11 weeks of gestation Nine cases (9.3%) showed discrepancies between the num- by two examiners. In each scan, the number of gestational sacs, ber of yolk sacs determined on initial ultrasound examination number of yolk sacs within each gestational sac, presence or and the amnionicity confirmed by the presence and number of absence of a dividing membrane, number of fetuses, crown-rump dividing membranes in serial follow-up sonography and/or length (CRL), fetal heart rate, and presence or absence of asso- gross postpartum evaluation of the membrane (Table 2). In the ciated fetal anomaly were documented. Chorionicity and amnionicity were documented by serial ul- Table 2. Discrepancy rates between confirmed amnionicity and the number of yolk trasound assessment of the dividing membrane and/or confirm- sacs on ultrasonography ed by postpartum pathologic examination of the placenta. Cho- Confirmed No. of Yolk sacs Discrepancy rionicity was determined by assessing the number of gestation- amnionicity cases No. Cases rate al sacs and a dividing membrane within the gestational sac was MCMA 11 (11.3) 1 7 4/11 (36.3) considered adequate evidence of diamnionicity. When two di- 2 4 viding membranes were identified within a single gestational MCDA 83 (85.6) 1 4 4/83 (4.8) 2 79 sac, we determined the case to be a MC triamniotic (TA) triplet MCTA 3 (3.1) 1 0 1/3 (33.3) pregnancy. We reviewed the all images in each case for the pur- 2 1 pose of the study. 3 2 Gestational age (GA) was calculated from the first day of the Total 97 - - 9/97 (9.3) last menstrual period and was confirmed by CRL measurement Data are shown as number (%). in the first trimester of pregnancy. When estimated GA by men- MCMA = monochorionic monoamniotic, MCDA = monochorionic diamniotic, MCTA = monochorionic triamniotic. strual date varied from ultrasound date by more than 5 days, we used the ultrasound performed between 7 + 0 and 9 + 6 weeks of pregnancy to estimate GA. In cases of in vitro fertilization (IVF), the ovum pick-up day was defined as intrauterine pregnancy (IUP) 2 + 0 gestational weeks. Ethics statement Ethical approval of this study was provided by the Institutional Table 1. Clinical characteristics of the study population Characteristic Value Maternal age, yr 32.2 ± 3.9 Nulliparity 71 (66.0) GA at initial US scan, wk 8.0 ± 1.3 Method of conception Natural 67 (69.1) IVF 26 (26.8) Ovulation-induction 4 (4.1) Fig. 1. Transvaginal ultrasound at 9 weeks of gestation demonstrates two yolk sacs Data are shown as mean ± standard deviation or number (%). in a MCMA pregnancy. GA = gestational age, US = ultrasonography, IVF = in vitro fertilization. MCMA = monochorionic monoamniotic. https://doi.org/10.3346/jkms.2017.32.12.2016
Load more

Recommended publications
  • 3 Embryology and Development
    BIOL 6505 − INTRODUCTION TO FETAL MEDICINE 3. EMBRYOLOGY AND DEVELOPMENT Arlet G. Kurkchubasche, M.D. INTRODUCTION Embryology – the field of study that pertains to the developing organism/human Basic embryology –usually taught in the chronologic sequence of events. These events are the basis for understanding the congenital anomalies that we encounter in the fetus, and help explain the relationships to other organ system concerns. Below is a synopsis of some of the critical steps in embryogenesis from the anatomic rather than molecular basis. These concepts will be more intuitive and evident in conjunction with diagrams and animated sequences. This text is a synopsis of material provided in Langman’s Medical Embryology, 9th ed. First week – ovulation to fertilization to implantation Fertilization restores 1) the diploid number of chromosomes, 2) determines the chromosomal sex and 3) initiates cleavage. Cleavage of the fertilized ovum results in mitotic divisions generating blastomeres that form a 16-cell morula. The dense morula develops a central cavity and now forms the blastocyst, which restructures into 2 components. The inner cell mass forms the embryoblast and outer cell mass the trophoblast. Consequences for fetal management: Variances in cleavage, i.e. splitting of the zygote at various stages/locations - leads to monozygotic twinning with various relationships of the fetal membranes. Cleavage at later weeks will lead to conjoined twinning. Second week: the week of twos – marked by bilaminar germ disc formation. Commences with blastocyst partially embedded in endometrial stroma Trophoblast forms – 1) cytotrophoblast – mitotic cells that coalesce to form 2) syncytiotrophoblast – erodes into maternal tissues, forms lacunae which are critical to development of the uteroplacental circulation.
    [Show full text]
  • PRG2 and AQPEP Are Misexpressed in Fetal Membranes in Placenta Previa and Percreta Elisa T. Zhang1, Roberta L. Hannibal1,6, Keyl
    bioRxiv preprint doi: https://doi.org/10.1101/2020.08.14.248807; this version posted August 14, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-ND 4.0 International license. 1 PRG2 and AQPEP are misexpressed in fetal membranes in placenta previa and percreta 2 3 Elisa T. Zhang1, Roberta L. Hannibal1,6, Keyla M. Badillo Rivera1,7, Janet H.T. Song1,8, Kelly 4 McGowan1, Xiaowei Zhu1,2, Gudrun Meinhardt3, Martin Knöfler3, Jürgen Pollheimer3, Alexander 5 E. Urban1,2, Ann K. Folkins4, Deirdre J. Lyell5, Julie C. Baker1,5* 6 7 1DepartMent of Genetics, Stanford University School of Medicine, Stanford, California, United 8 States of AMerica. 9 2DepartMent of Psychiatry and Behavioral Sciences, Stanford University School of 10 Medicine, Stanford, California, United States of AMerica. 11 3DepartMent of Obstetrics and Gynaecology, Reproductive Biology Unit, Medical University of 12 Vienna, Vienna, Austria. 13 4DepartMent of Pathology, Stanford University School of Medicine, Stanford, California, United 14 States of AMerica. 15 5DepartMent of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, 16 California, United States of AMerica. 17 6Present address: Second GenoMe, Inc., Brisbane, California, United States of AMerica. 18 7Present address: Eversana Consulting, South San Francisco, California, United States of 19 AMerica. 20 8Present address: Division of Genetics and GenoMics, Boston Children’s Hospital, Harvard 21 Medical School, Boston, Massachusetts, United States of AMerica. 22 23 *Correspondence: [email protected] 24 300 Pasteur Dr.
    [Show full text]
  • Self-Organized Amniogenesis by Human Pluripotent Stem Cells in a Biomimetic Implantation-Like Niche
    LETTERS PUBLISHED ONLINE: 12 DECEMBER 2016 | DOI: 10.1038/NMAT4829 Self-organized amniogenesis by human pluripotent stem cells in a biomimetic implantation-like niche Yue Shao1†, Kenichiro Taniguchi2†, Katherine Gurdziel3, Ryan F. Townshend2, Xufeng Xue1, Koh Meng Aw Yong1, Jianming Sang1, Jason R. Spence2, Deborah L. Gumucio2* and Jianping Fu1,2,4* Amniogenesis—the development of amnion—is a critical factors seen in the in vivo amniogenic niche: a three-dimensional developmental milestone for early human embryogenesis (3D) extracellular matrix (ECM) that is provided by the basement and successful pregnancy1,2. However, human amniogenesis membrane surrounding the epiblast during implantation11; and a is poorly understood due to limited accessibility to peri- soft tissue bed provided by the uterine wall and trophoblast to implantation embryos and a lack of in vitro models. Here support the developing amnion (Fig. 1a,b). Since amniogenesis ini- we report an ecient biomaterial system to generate human tiates from the expanding pluripotent epiblast, we utilized mTeSR1 amnion-like tissue in vitro through self-organized development medium and basement membrane matrix (Geltrex) to render the of human pluripotent stem cells (hPSCs) in a bioengineered culture permissive for pluripotency maintenance. niche mimicking the in vivo implantation environment. We In this culture system, H9 human embryonic stem cells (hESCs) show that biophysical niche factors act as a switch to toggle were plated as single cells at 30,000 cells cm−2 onto a thick, hPSC self-renewal versus amniogenesis under self-renewal- soft gel bed of Geltrex (with thickness ≥100 µm, bulk Young's permissive biochemical conditions. We identify a unique modulus ∼900 Pa, coated on a glass coverslip), in mTeSR1 medium molecular signature of hPSC-derived amnion-like cells and supplemented with the ROCK inhibitor Y27632 (Fig.
    [Show full text]
  • BMP-Treated Human Embryonic Stem Cells Transcriptionally Resemble Amnion Cells in the Monkey Embryo
    bioRxiv preprint doi: https://doi.org/10.1101/2021.01.21.427650; this version posted January 22, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC 4.0 International license. BMP-treated human embryonic stem cells transcriptionally resemble amnion cells in the monkey embryo Sapna Chhabra1,2,3, Aryeh Warmflash2,4* 1Systems Synthetic and Physical Biology graduate program, 2Department of Biosciences, 4Department of Bioengineering, Rice University, Houston, TX 77005 3Present address: Developmental Biology Unit, EMBL Heidelberg. *Correspondence to AW: [email protected] Abstract Human embryonic stem cells (hESCs) possess an immense potential to generate clinically relevant cell types and unveil mechanisms underlying early human development. However, using hESCs for discovery or translation requires accurately identifying differentiated cell types through comparison with their in vivo counterparts. Here, we set out to determine the identity of much debated BMP-treated hESCs by comparing their transcriptome to the recently published single cell transcriptomes of early human embryos in the study Xiang et al 2019. Our analyses reveal several discrepancies in the published human embryo dataset, including misclassification of putative amnion, intermediate and inner cell mass cells. These misclassifications primarily resulted from similarities in pseudogene expression, highlighting the need to carefully consider gene lists when making comparisons between cell types. In the absence of a relevant human dataset, we utilized the recently published single cell transcriptome of the early post implantation monkey embryo to discern the identity of BMP-treated hESCs.
    [Show full text]
  • The Science of Amnioexcite™ Three Layer Placental Membrane Allograft
    The Science of AmnioExcite™ Three Layer Placental Membrane Allograft REV. 10-2020 The Science of AmnioExcite™ Placental Membrane Allograft AmnioExcite™ is a full-thickness decellularized placental membrane. AmnioExcite™ is a lyophilized, full-thickness placental membrane allograft decellularized with LifeNet Health’s proprietary Matracell® process and patent pending technology and intended for homologous use as a barrier membrane.(1) Inclusion of the intact amniotic and chorionic membranes, as well as the trophoblast layer, makes it thicker than most available amniotic-only or amniotic-chorionic allografts, and provides a robust protective covering while also delivering superior handling. AmnioExcite™ retains the placental membrane’s naturally occurring growth factors, cytokines, protease inhibitors, and extracellular matrix components, such as proteoglycans, collagen and fibronectin(2) In vitro studies have shown that these endogenous factors are capable of inducing cellular proliferation and migration, mitigating inflammation, and inhibiting protein degradation(3-5) STRUCTURE OF THE THREE LAYER PLACENTAL MEMBRANE AMNIOTIC MEMBRANE CHORIONIC MEMBRANE TROPHOBLAST LAYER The placental membrane is comprised of the amnion and chorion (6). The amnion, also called amniotic membrane (AM) has five layers, including the epithelium, basement membrane, compact layer, fibroblast layer, and the spongy layer(6), which provide important extracellular membrane components, as well as a wide variety of growth factors, cytokines, and other proteins.(7) While these characteristics are important, the AM by itself lacks substantial structure for providing a protective covering and contains only a small portion of the biological factors found in the full-thickness placental membrane. AM-only grafts can also be difficult to apply and may migrate away from the intended site of application.(8) The chorion is comprised of four layers, including the cellular layer, reticular layer, the pseudobasement membrane and the trophoblast layer (TL) (6).
    [Show full text]
  • The Derivatives of Three-Layered Embryo (Germ Layers)
    HUMANHUMAN EMBRYOLOGYEMBRYOLOGY Department of Histology and Embryology Jilin University ChapterChapter 22 GeneralGeneral EmbryologyEmbryology FourthFourth week:week: TheThe derivativesderivatives ofof trilaminartrilaminar germgerm discdisc Dorsal side of the germ disc. At the beginning of the third week of development, the ectodermal germ layer has the shape of a disc that is broader in the cephalic than the caudal region. Cross section shows formation of trilaminar germ disc Primitive pit Drawing of a sagittal section through a 17-day embryo. The most cranial portion of the definitive notochord has formed. ectoderm Schematic view showing the definitive notochord. horizon =ectoderm hillside fields =neural plate mountain peaks =neural folds Cave sinks into mountain =neural tube valley =neural groove 7.1 Derivatives of the Ectodermal Germ Layer 1) Formation of neural tube Notochord induces the overlying ectoderm to thicken and form the neural plate. Cross section Animation of formation of neural plate When notochord is forming, primitive streak is shorten. At meanwhile, neural plate is induced to form cephalic to caudal end, following formation of notochord. By the end of 3rd week, neural folds and neural groove are formed. Neural folds fuse in the midline, beginning in cervical region and Cross section proceeding cranially and caudally. Neural tube is formed & invade into the embryo body. A. Dorsal view of a human embryo at approximately day 22. B. Dorsal view of a human embryo at approximately day 23. The nervous system is in connection with the amniotic cavity through the cranial and caudal neuropores. Cranial/anterior neuropore Neural fold heart Neural groove endoderm caudal/posterior neuropore A.
    [Show full text]
  • What Is the Role of the Placenta—Does It Protect Against Or Is It a Target for Insult?
    Teratology Primer, 3rd Edition www.teratology.org/primer What Is the Role of the Placenta—Does It Protect Against or Is It a Target for Insult? Richard K. Miller University of Rochester School of Medicine & Dentistry Rochester, New York The placenta is not just a barrier but has many functions that are vital to the health of the embryo/fetus. The placenta is the anchor, the conduit, and the controller of pregnancy—and it can also be a target for toxicant action. The placenta encompasses not only the chorioallantoic placenta but all of its extraembryonic membranes (chorion/amnion) and the yolk sac. (Figure 1). The placenta and its membranes secure the embryo and fetus to the decidua (uterine lining) and release a variety of steroid and protein hormones that characterize the physiology of the pregnant female. Figure 1. Placental Structure in the Mouse. Figures depict early development of the mouse conceptus at embryonic days (E3.5, E7.5, E12.5). In the fetus, the visceral yolk sac (vYS) inverts and remains active throughout the entire gestation providing for transfer of selective large molecules, e.g., immunoglobulins IgG and vitamin B12. Abbreviations: Al, allantois; Am, amnion; Ch, chorion; Dec, decidua; Emb, embryo; Epc, ectoplacental cone; ICM, inner cell mass; Lab, Labyrinth; pYS, parietal yolk sac; SpT, spongiotrophoblast; TCG, trophoblast giant cell; Umb Cord, umbilical cord; vYS, visceral yolk sac; C-TGC, maternal blood canal trophoblast giant cell; P-TGC, parietal trophoblast giant cell; S-TGC, sinusoidal trophoblast giant cell; SpA-TGC, Spiral artery-associated trophoblast giant cell; Cyan-trophectoderm and trophoblast lineage, Black- inner cell mass and embryonic ectoderm; Gray -endoderm, Red-maternal vasculature, Purple-mesoderm, Yellow- decidua, Pink-fetal blood vessels in labyrinth.
    [Show full text]
  • From Trophoblast to Human Placenta
    From Trophoblast to Human Placenta (from The Encyclopedia of Reproduction) Harvey J. Kliman, M.D., Ph.D. Yale University School of Medicine I. Introduction II. Formation of the placenta III. Structure and function of the placenta IV. Complications of pregnancy related to trophoblasts and the placenta Glossary amnion the inner layer of the external membranes in direct contact with the amnionic fluid. chorion the outer layer of the external membranes composed of trophoblasts and extracellular matrix in direct contact with the uterus. chorionic plate the connective tissue that separates the amnionic fluid from the maternal blood on the fetal surface of the placenta. chorionic villous the final ramification of the fetal circulation within the placenta. cytotrophoblast a mononuclear cell which is the precursor cell of all other trophoblasts. decidua the transformed endometrium of pregnancy intervillous space the space in between the chorionic villi where the maternal blood circulates within the placenta invasive trophoblast the population of trophoblasts that leave the placenta, infiltrates the endo– and myometrium and penetrates the maternal spiral arteries, transforming them into low capacitance blood channels. Sunday, October 29, 2006 Page 1 of 19 From Trophoblasts to Human Placenta Harvey Kliman junctional trophoblast the specialized trophoblast that keep the placenta and external membranes attached to the uterus. spiral arteries the maternal arteries that travel through the myo– and endometrium which deliver blood to the placenta. syncytiotrophoblast the multinucleated trophoblast that forms the outer layer of the chorionic villi responsible for nutrient exchange and hormone production. I. Introduction The precursor cells of the human placenta—the trophoblasts—first appear four days after fertilization as the outer layer of cells of the blastocyst.
    [Show full text]
  • Abundant Expression of Parathyroid Hormone-Related Protein in Human Amnion and Its Association with Labor (Pregnancy/Myometrium/Decidua/Placenta/Amniotic Fluid) J
    Proc. Nati. Acad. Sci. USA Vol. 89, pp. 8384-8388, September 1992 Physiology Abundant expression of parathyroid hormone-related protein in human amnion and its association with labor (pregnancy/myometrium/decidua/placenta/amniotic fluid) J. E. FERGUSON II*, JANET V. GORMAN*, DAVID E. BRUNS*, ELEANOR C. WEIRt, WILLIAM J. BURTISt, T. J. MARTINt, AND M. ELIZABETH BRUNS*§ *Departments of Obstetrics & Gynecology and Pathology, University of Virginia Medical School, Charlottesville, VA 22908; tDepartments of Medicine and Comparative Medicine, Yale University Medical School, New Haven, CT 06510; and tDepartment of Medicine, University of Melbourne, Melbourne 3065 Australia Communicated by Robert H. Wasserman, June 1, 1992 (receivedfor review December 12, 1991) ABSTRACT In animal models, parathyroid hormone- and reaches a peak 48 hr prior to parturition (4). A peak in related protein (PTHrP) increases placental calcium transport peptide content has also been demonstrated by biological and and inhibits contraction ofuterine smooth muscle. The present immunological assays. As PTHrP and PTH have been shown studies were undertaken to characterize the expression of to be vasodilators and to relax smooth muscles, including PTHrP in human uteroplacental tissues. PTHrP mRNA was uterine smooth muscle (7-9), PTHrP may play a role in (i) identified by Northern analysis as a single species (:1.8 vasodilation in the uteroplacental unit, (ii) expansion of the kilobases) in human amnion, chorion, placenta, decidua, and uterus to accommodate fetal growth, (iii) maintenance ofthe myometrium. The most abundant signal was seen in amnion, pregnant uterus in a quiescent, relaxed state prior to the onset where it was 10-400 times that in the other uteroplacental of labor, and/or (iv) relaxation of the uterine cervix to allow tissues.
    [Show full text]
  • Management of Spontaneous Rupture of the Amnion with an Intact Chorion Jenny A
    Jacob et al. Obstet Gynecol cases Rev 2015, 2:5 ISSN: 2377-9004 Obstetrics and Gynaecology Cases - Reviews Case Report: Open Access Management of Spontaneous Rupture of the Amnion with an Intact Chorion Jenny A. Jacob1, Norman A. Ginsberg2, Lee P. Shulman2* and Leeber Cohen2 1Albert-Ludwigs-University School of Medicine, Germany 2Northwestern Feinberg School of Medicine, USA *Corresponding author: Prof. Lee P. Shulman MD, 250 E. Superior Street, Prentice Women’s Hospital, Room 05- 2174, Chicago, IL, USA 60611, Tel: 1.312.730.8694, Email: [email protected] weeks‘gestation with an AFI of 1cm. The patient reported no history Abstract of vaginal amniotic fluid leakage. Speculum examination showed Idiopathic severe preterm oligohydamnios as a result of spontaneous no evidence of vaginal pooling. The fetal kidneys were visualized at rupture of the amnion with an intact chorion is a rare event with a the time of the ultrasound and were considered functioning since scarcity of reports found in the literature. We evaluated the impact the fetal bladder was visualized at the time of ultrasound. Chorionic of serial amnioinfusions on this unusual occurrence. This is a follow- villus sampling (CVS) was performed after the 18-week scan and up of a 37-year-old woman with idiopathic severe oligohydramnios diagnosed at 18 weeks of gestation. We performed five serial showed a normal 46,XX complement. amnioinfusions with the purpose of improving fetal lung maturity The patient was informed of the complications accompanied and to prevent Potter anomalad. At 31 weeks‘gestation the patient with oligohydramnios and was offered pregnancy termination.
    [Show full text]
  • Yolk Sac Diameter in Multiple Gestations
    Case Studies Yolk Sac Diameter in Multiple Gestations Chelsea Fox, MD; Karenne Fru, MD, PhD; and Bruce A. Lessey, MD, PhD From the Department of OB/GYN, Greenville Health System, Greenville, SC (C.F., B.A.L.), University of South Carolina School of Medicine Greenville, Greenville, SC (B.A.L.), and Department of Obstet- rics and Gynecology, New Hanover Regional Medical Center, Wilmington, NC (K.F.) Abstract Enlargement of the yolk sacs is an ominous sign even in multi-gestational pregnancies. he yolk sac functions as the primary route ity conceived after placement of 2 embryos on of exchange between the embryo and post-retrieval day 3. Quantitative hCG levels were Tmother prior to the establishment of the higher than expected and transvaginal ultrasound placental circulation. It is well established that an at 6 weeks’ gestation demonstrated a triplet preg- abnormally large yolk sac serves as a prognostic nancy with a singleton sac and a separate mono- indicator for early pregnancy failure in singleton chorionic-monoamniotic versus conjoined twin gestation. However, no studies have been per- pregnancy with symmetrically enlarged yolk sacs, formed to describe normal versus abnormal yolk each with cardiac activity present (Figs. 1A and B). sac diameters (YSD) in multiple gestations. In this The yolk sacs associated with the twin pregnancy case, we describe a patient with triplet pregnancy were 6.15 mm and 7.37 mm, respectively, while the consisting of monochorionic-monoamniotic singleton had a normal yolk sac. A repeat ultra- twins both with enlarged yolk sacs in addition to sound 10 days later confirmed absence of fetal car- singleton pregnancy in a separate sac with a nor- diac activity in the monochorionic-monoamni- mal yolk sac.
    [Show full text]
  • Intrauterine Vertical Transmission of SARS‐Cov‐2
    Intrauterine vertical transmission of SARS-CoV-2: what we know so far Chen Wang1, Yi-Hua Zhou2*, Hui-Xia Yang1*, Liona C. Poon3 1Department of Obstetrics and Gynaecology of Peking University First Hospital, Beijing, China; 2Department of Laboratory Medicine and Infectious Diseases, Nanjing Drum Tower Hospital, China; 3Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR * Joint corresponding authors Correspondence to: Article Hui-Xia Yang: Department of Obstetrics and Gynaecology, Peking University First Hospital, Beijing 100034, China (e-mail: [email protected]) Yi-Hua Zhou: Department of Laboratory Medicine and Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing 210008, China (e-mail: [email protected]) Short title: Vertical transmission of SARS-CoV-2 Keywords: COVID-19, SARS-CoV-2, vertical transmission, intrauterine infection, congenital infection Accepted This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/uog.22045 This article is protected by copyright. All rights reserved. The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been rapidly spreading worldwide and is now a global pandemic. One of the major concerns is whether SARS-CoV-2 can be vertically transmitted to fetuses, thus causing congenital infection. The most convincing evidence of intrauterine transmission of COVID-19 would be to confirm the replication of SARS-CoV-2 in fetal pulmonary tissues, which is technically almost infeasible.
    [Show full text]