DOCSLIB.ORG

Velamentous Cord Insertion - an Important Obstetrical Risk Factor

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Velamentous Cord Insertion - an Important Obstetrical Risk Factor Gineco.eu [12] 129-134 [2016] DOI: 10.18643/gieu.2016.129 @ 2016 Romanian Society of Ultrasonography in Obstetrics and Gynecology gineco eu Velamentous cord insertion - an important obstetrical risk factor Abstract Monica Mihaela Cîrstoiu1,2, A velamentous insertion of the umbilical cord is characterized by the atypical aspect of the placental end of the cord, 2 consisting in divergent umbilical vessels surrounded by fetal membranes and with no Wharton’s jelly present, resulting a Natalia Turcan , cord that is inserted rather into membranes than the placental disk. By the divergence of the umbilical vessels as they travers E lv ira Brătilă1,3, the amnion and the chorion before reaching the placenta this condition associates important obstetrical complications Octavian and the diagnosis by ultrasonography as early is possible is important for the guidance of the subsequent management. Munteanu1,2, In this retrospective study we aimed to evaluate the incidence of velamentous cord insertion in University Emergency 2 Hospital of Bucharest for a period of five years and analyze the pregnancies outcome and the obstetrical impact of this Oana Bodean , condition. Using the statistics department of University Emergency Hospital Bucharest we determined an incidence of Diana Voicu2, 0.23% of pregnancies complicated by velamentous cord insertion. The examined parameters included intrauterine fetal Roxana Elena death, small for gestational age, preterm delivery (<37 weeks), single artery umbilical cord and low Apgar score at 1 Bohîlțea1,2, minute. We chose to exemplify with a case of early diagnosis of this condition, respectively at 15 weeks of gestation. The attempt to visualize cord insertion in the mid-trimester as a routine part of obstetric sonography is recommended. The Simona identification of velamentous cord insertion dictates the mode and timing of delivery and can improve fetal outcome Vladareanu1 Keywords: cord insertion, mid-trimester, sonography 1. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2. University Emergency Hospital Bucharest, Romania 3. ”St. Pantelimon” Clinical placenta proliferates toward the uterine fundus, and Emergency Hospital, Introduction Bucharest, Romania Normally and physiologically the umbilical cord is the other half involutes(3). Association of velamentous Correspondence: inserted into the central portion of the placenta, abnor- marginal umbilical cord insertion with vasa praevia or Dr. Roxana Bohîlțea mally variants of placental cord insertion are the edge praevia/low-lying, bilobed or succenturiate placental e-mail: r.bohiltea@ of the placental disk or velamentous cord insertion. lobe is encountered in 90-95% of cases(4,5). Other pre- yahoo.com A velamentous insertion of the umbilical cord is cha- sumed risk factors are pregnancies obtained through racterized by the atypical aspect of the placental end assisted human reproduction techniques, regarded as of the cord, consisting in divergent umbilical vessels amplifying the risk of developing velamentous cord surrounded by fetal membranes and with no Wharton’s insertion by 10 times, multiparous pregnancies and jelly present, resulting a cord that is inserted rather single artery umbilical cord(6). into membranes than the placental disk (Figure 1). By By the divergence of the umbilical vessels as they the absence of the Wharton’s jelly protection, umbilical travers the amnion and the chorion before reaching the cord vessels are susceptible to compression and rup- placenta this condition associates important obstetrical ture, risk which is amplified if they are located in the complications and the diagnosis by ultrasonography as membranes that covers the internal cervical ostium. early is possible is important for the guidance of the This particular appearance of the placental insertion subsequent management. By ultrasonography this form of the umbilical cord has been associated with several of the placental insertion of the umbilical cord can by obstetrical complications such as fetal growth restric- diagnosed with a sensitivity of 67% and a specificity of tion, prematurity, placental abruption, vasa praevia, 100% in the second trimester(7a), in the third trimester congenital anomalies and low Apgar score or even this condition is also reflected through variable dece- intrauterine fetal death(1). lerations and abnormal fetal heart rate variability in With an occurrence of about 1 percent of singleton non-stress test. gestation and about 15 percent of monochorionic twin The most reliable method is the real-time color gestation(2), the pathogenesis of this condition is still Doppler transvaginal ultrasound examination, thus unknown. One of the hypothesis, based on the fact being able to emphasize the umbilical vessel pathway, that velamentous cord insertion (VCI) occurs more which crosses the internal os or passes at less than 2 Received: common in placenta praevia than in normally located cm from it and the study of umbilical artery end-di- May 06, 2016 placentas, suggests that the centrally inserted cord ini- astolic velocity. Revised: June 17, 2016 tially is unable to follow the migration of the placenta, On ultrasound can be observed the ending of the Accepted: becoming progressively peripheral as one half of the cord on several centimeters from the placenta that August 25, 2016 Vol. 12 • No. 45 (3/2016) 129 Cîrstoiu et al. Velamentous cord insertion... Figure 1. Schematic representation of the velamentous insertion of umbilical cord most often occur at the margin of the placenta but Methods the presence at the apex of the gestational sac is also In this retrospective study, 18 500 pregnancies were possible. Typically, the umbilical vessels lie parallel to analyzed between January 1 2010 and July 1 2016, the uterine wall as they penetrate the placental pole. using the statistics Department of University Emergen- Although these are high percentages, and the possibility cy Hospital Bucharest, of which, 43 were complicated for intrapartum diagnosis of various pathological chan- by VCI. ges evolves daily, VCI is one of the most undiagnosed The examined parameters included intrauterine fetal conditions in obstetrics(7b, 8). death, small for gestational age, preterm delivery (<37 The American College of Radiology, the American weeks), single artery umbilical cord and low Apgar Institute of Ultrasound in Medicine, and the American score at 1 minute. College of Obstetricians and Gynecologists(9) do not recommend the evaluation of the placental insertion Results of the cord by routine but “the umbilical cord should be From 2010 to 2016, 18.500 women delivered at our imaged, and the number of vessels in the cord should Department. be evaluated when possible”(9). The study group includes 43 (prevalence 0.23%) Regarding the management of pregnancies with VCI, pregnancies that were diagnosed intrapartum or post- Lockwood at al. in a recent published article(10) recom- partum with VCI. Among the cases studied no cases of mends the following: intrauterine fetal death was registered. 1. Detailed fetal anatomic survey, including evalua- The smallest gestational age at birth was 30 weeks tion for coexistent vasa praevia, and 5 cases of birth at 40 weeks of gestation (Figure 2). 2. Serial assessment of fetal growth, every four to In over 50% of pregnancies complicated with VCI six weeks, birth occurred at 38-39 weeks of gestation, and in 3. Fetal heart rate tracings weekly, beginning at 36 14 cases (32.54%) preterm birth was registered. For weeks of gestation, to look for recurrent variable de- assessing the weight of newborns in accordance with celerations from kinking or compression, gestational age we used international conventional 4. Counseling patients to call their providers as soon values. as labor begins, The highest recorded weight of a new born delivered 5. Delivery by 40 weeks of gestation, at term of a pregnancy with velamentous insertion of In this paper we aimed to evaluate the incidence of the umbilical cord was 4050 g and the lowest weight VCI in University Emergency Hospital of Bucharest of a delivered at term newborn was 2450 g. In preterm for a period of five years and analyze the pregnancies cases, the lowest weight was 1100 g at 31 weeks of outcome and the obstetrical impact of this condition. gestation preterm newborn. 130 Vol. 12 • No. 45 (3/2016) Cîrstoiu et al. Velamentous cord insertion... gineco eu 25 51.16% 20 15 10 Number of cases 16.27% 16.27% 16.27% 5 0 <36 36-37 38-39 40-41 Weeks of Gestation Figure 2. Classification by gestational age <2500 gr >3500 gr 7% 13% 3000-3500 gr 2500-3000 gr 33% 47% Figure 3. Delivery weight at term Over 50% of the newborns delivered at 38 to 41 weeks born with a 3000 g weight and the mother associated of gestation weighed under 3000 g at birth (Figure 3). preeclampsia. Only 3 newborns at term received the All of preterm newborns had the delivery weight maximal score at delivery. The lowest score for this within the appropriate for gestational age limits (Fi- category was 8. gure 4). Only 5 cases of natural delivery were registered (Figu- In the course of studying the collected data, we no- re 5), the Apgar score for all this cases was 8 and above. ticed a slight predominance of single artery umbilical cord associated with VCI, respective 12 cases (27.9%) Discussion with VCI associated single artery umbilical cord, and We report a case of velamentous insertion of the the reason of this association is unknown. umbilical cord observed at 15 weeks gestation in a The lowest value of the Apgar score at 1 minute primiparous woman, with no significant antecedents, was “3” and obtained by a 36 weeks of gestation new- during a routine ultrasound scan (Figure 6). These Vol. 12 • No. 45 (3/2016) 131 Cîrstoiu et al. Velamentous cord insertion... 7% 7% 57% 29% 1000-1500 gr 1500-2000 gr 2000-2500 gr >2500 gr Figure 4. Delivery weight in preterm newborns Natural Birth 12% Caesarean section 88% Figure 5.
Load more

Recommended publications
  • Fetal Membrane Architecture, Aging and Inflammation in Pregnancy And
    Placenta 79 (2019) 40–45 Contents lists available at ScienceDirect Placenta journal homepage: www.elsevier.com/locate/placenta Fetal membrane architecture, aging and inflammation in pregnancy and parturition T ∗ ∗∗ Ramkumar Menona, , Lauren S. Richardsona, Martha Lappasb,c, a Division of Maternal-Fetal Medicine & Perinatal Research, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA b Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia c Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia ARTICLE INFO ABSTRACT Keywords: Preterm birth is the single major cause of infant mortality. Short and long term outcomes for infants are often Fetal membranes worse in cases of preterm premature rupture of the fetal membranes (pPROM). Thus, increased knowledge of the Structure structure characteristics of fetal membranes as well as the mechanisms of membrane rupture are essential if we Senescence are to develop effective treatment strategies to prevent pPROM. In this review, we focus on the role of in- Inflammation flammation and senescence in fetal membrane biology. 1. Introduction 2. Fetal membrane growth and microfractures Human fetal membranes (placental membranes or amniochorionic Amnion and chorion takes distinct growth trajectory upon embry- membranes) is the innermost tissue layer that forms the intrauterine ogenesis [9]. The development of amnion and chorion begins with cavity [1,2]. Fetal membranes are comprised of amnion (innermost embryogenesis although they do not participate in the formation of the layer of the intraamniotic cavity) and chorion (fetal tissue connected to embryo or fetus [10–12].
    [Show full text]
  • Infections at the Maternal–Fetal Interface: an Overview of Pathogenesis and Defence
    REVIEWS Infections at the maternal–fetal interface: an overview of pathogenesis and defence Christina J. Megli 1 ✉ and Carolyn B. Coyne 2 ✉ Abstract | Infections are a major threat to human reproductive health, and infections in pregnancy can cause prematurity or stillbirth, or can be vertically transmitted to the fetus leading to congenital infection and severe disease. The acronym ‘TORCH’ (Toxoplasma gondii, other, rubella virus, cytomegalovirus, herpes simplex virus) refers to pathogens directly associated with the development of congenital disease and includes diverse bacteria, viruses and parasites. The placenta restricts vertical transmission during pregnancy and has evolved robust mechanisms of microbial defence. However, microorganisms that cause congenital disease have likely evolved diverse mechanisms to bypass these defences. In this Review, we discuss how TORCH pathogens access the intra- amniotic space and overcome the placental defences that protect against microbial vertical transmission. Infections during pregnancy can be associated with pathogen mediated, placenta mediated and/or can be devastating consequences to the pregnant mother and through inflammation­ induced previable delivery. developing fetus. Vertical transmission, defined as There are also outcomes of congenital infections that infection of the fetus from the maternal host, is a major do not manifest until after delivery. These can include cause of morbidity and mortality in pregnancy. In some hearing loss, developmental delays and/or blindness as cases, bacterial, viral and parasitic infections induce detailed below. dire outcomes in the fetus. The sequelae of infections Inflammation initiated by an infection of the mater­ in pregnancy include teratogenic effects, which cause nal host is also a known cause of preterm labour and can congenital anomalies; growth restriction, stillbirth, mis­ result in previable delivery or sequelae of prematurity10 carriage and neonatal death; prematurity; and maternal with lifelong consequences to the neonate.
    [Show full text]
  • Placenta Praevia/Low-Lying Placenta
    LOCAL OPERATING PROCEDURE – CLINICAL Approved Quality & Patient Safety Committee 18/6/20 Review June 2022 PLACENTA PRAEVIA/LOW-LYING PLACENTA This LOP is developed to guide clinical practice at the Royal Hospital for Women. Individual patient circumstances may mean that practice diverges from this LOP. 1. AIM • Diagnosis and clinical management of woman with low-lying placenta (LLP) or placenta praevia (PP) 2. PATIENT • Pregnant woman with a LLP/PP after 20 weeks gestation 3. STAFF • Medical and midwifery staff 4. EQUIPMENT • Ultrasound • 16-gauge intravenous (IV) cannula • Blood tubes 5. CLINICAL PRACTICE Screening: • Recommend a morphology ultrasound at 18-20 weeks gestation to ascertain placental location • Include, on the ultrasound request form, any history of uterine surgery e.g. previous caesarean section (CS), myomectomy, to ensure that features of placenta accreta are examined • Identify woman with a: o LLP i.e. within 2cm of, but not covering the internal cervical os o PP i.e. covering the internal cervical os Antenatal care: • Reassure woman that 9 out of 10 LLP found at 18-20 week morphology ultrasound are no longer low-lying by term1 • Reassure woman with LLP that if she remains asymptomatic, there is no increased risk of adverse outcomes in the mid-trimester and she can continue normal activities e.g. travel, intercourse, exercise2 • Advise woman with LLP from 36 weeks that it is not a contraindication for trial of labour, chance of vaginal birth approximately9: o 43% if placenta is 0-10mm from cervical os o 85% if placenta
    [Show full text]
  • Cohort Study of High Maternal Body Mass Index and the Risk of Adverse Pregnancy and Delivery Outcomes in Scotland
    Open access Original research BMJ Open: first published as 10.1136/bmjopen-2018-026168 on 20 February 2020. Downloaded from Cohort study of high maternal body mass index and the risk of adverse pregnancy and delivery outcomes in Scotland Lawrence Doi ,1 Andrew James Williams ,2 Louise Marryat ,3,4 John Frank3,5 To cite: Doi L, Williams AJ, ABSTRACT Strengths and limitations of this study Marryat L, et al. Cohort Objective To examine the association between high study of high maternal maternal weight status and complications during pregnancy ► This study used a large, retrospectively accessed body mass index and the and delivery. risk of adverse pregnancy but cohort- structured, national database covering Setting Scotland. and delivery outcomes some of the major maternal and neonatal outcomes Participants Data from 132 899 first- time singleton in Scotland. BMJ Open in Scotland over eight recent years. deliveries in Scotland between 2008 and 2015 were used. 2020;10:e026168. doi:10.1136/ ► Analyses were adjusted for some of the key potential Women with overweight and obesity were compared with bmjopen-2018-026168 confounders to estimate impact of high maternal- women with normal weight. Associations between maternal ► Prepublication history and weight status on each outcome. body mass index and complications during pregnancy and 2 additional material for this ► All women with body mass index (BMI) of 30 kg/m delivery were evaluated. paper are available online. To or more were considered as having obesity; it is like- Outcome measures Gestational diabetes, gestational view these files, please visit ly that differentiating morbid obesity or obesity class hypertension, pre- eclampsia, placenta praevia, placental the journal online (http:// dx.
    [Show full text]
  • Incidence of Eclampsia with HELLP Syndrome and Associated Mortality in Latin America
    International Journal of Gynecology and Obstetrics 129 (2015) 219–222 Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo CLINICAL ARTICLE Incidence of eclampsia with HELLP syndrome and associated mortality in Latin America Paulino Vigil-De Gracia a,⁎, José Rojas-Suarez b, Edwin Ramos c, Osvaldo Reyes d, Jorge Collantes e, Arelys Quintero f,ErasmoHuertasg, Andrés Calle h, Eduardo Turcios i,VicenteY.Chonj a Critical Care Unit, Department of Obstetrics and Gynecology, Complejo Hospitalario de la Caja de Seguro Social, Panama City, Panama b Critical Care Unit, Clínica de Maternidad Rafael Calvo, Cartagena, Colombia c Department of Gynecology and Obstetrics, Hospital Universitario Dr Luis Razetti, Barcelona, Venezuela d Unit of Research, Department of Gynecology and Obstetrics, Hospital Santo Tomás, Panama City, Panama e Department of Gynecology and Obstetrics, Hospital Regional de Cojamarca, Cajamarca, Peru f Department of Gynecology and Obstetrics, Hospital José Domingo de Obaldía, David, Panama g Unit of Perinatology, Department of Gynecology and Obstetrics, Instituto Nacional Materno Perinatal, Lima, Peru h Department of Gynecology and Obstetrics, Hospital Carlos Andrade Marín, Quito, Ecuador i Unit of Research, Department of Gynecology and Obstetrics, Hospital Primero de Mayo de Seguridad Social, San Salvador, El Salvador j Department of Gynecology and Obstetrics, Hospital Teodoro Maldonado Carbo, Guayaquil, Ecuador article info abstract Article history: Objective: To describe the maternal outcome among women with eclampsia with and without HELLP syndrome Received 7 July 2014 (hemolysis, elevated liver enzymes, and low platelet count). Methods: A cross-sectional study of women with Received in revised form 14 November 2014 eclampsia was undertaken in 14 maternity units in Latin America between January 1 and December 31, 2012.
    [Show full text]
  • Vitamin D, Pre-Eclampsia, and Preterm Birth Among Pregnancies at High Risk for Pre-Eclampsia: an Analysis of Data from a Low-Dos
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author BJOG. Author Manuscript Author manuscript; Manuscript Author available in PMC 2021 January 29. Published in final edited form as: BJOG. 2017 November ; 124(12): 1874–1882. doi:10.1111/1471-0528.14372. Vitamin D, pre-eclampsia, and preterm birth among pregnancies at high risk for pre-eclampsia: an analysis of data from a low- dose aspirin trial AD Gernanda, HN Simhanb, KM Bacac, S Caritisd, LM Bodnare aDepartment of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA bDivision of Maternal-Fetal Medicine, Magee-Women’s Hospital and Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA cDepartment of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA dDepartment of Obstetrics, Gynecology and Reproductive Sciences and Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA eDepartments of Epidemiology and Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Graduate School of Public Health and School of Medicine, Pittsburgh, PA, USA Abstract Objective—To examine the relation between maternal vitamin D status and risk of pre-eclampsia and preterm birth in women at high risk for pre-eclampsia. Design—Analysis of prospectively collected data and blood samples from a trial of prenatal low- dose aspirin. Setting—Thirteen sites across the USA. Population—Women at high risk for pre-eclampsia. Methods—We measured 25-hydroxyvitamin D [25(OH)D] concentrations in stored maternal serum samples drawn at 12–26 weeks’ gestation (n = 822). We used mixed effects models to Correspondence: LM Bodnar, University of Pittsburgh Graduate School of Public Health, A742 Crabtree Hall, 130 DeSoto St, Pittsburgh, PA 15261, USA.
    [Show full text]
  • Policy of Interventionist Versus Expectant Management of Severe
    WHO recommendations Policy of interventionist versus expectant management of severe pre-eclampsia before term WHO recommendations Policy of interventionist versus expectant management of severe pre-eclampsia before term WHO recommendations: policy of interventionist versus expectant management of severe pre-eclampsia before term ISBN 978-92-4-155044-4 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. WHO recommendations: policy of interventionist versus expectant management of severe pre-eclampsia before term. Geneva: World Health Organization; 2018.
    [Show full text]
  • Umbilical Cord Prolapse Guideline
    Umbilical Cord Prolapse Guideline Document Control Title Umbilical Cord Prolapse Guideline Author Author’s job title Specialty Trainee in Obstetrics and Gynaecology Directorate Department Women’s and Children’s Obstetrics and Gynaecology Date Version Status Comment / Changes / Approval Issued 1.0 Mar Final Approved by the Maternity Services Guideline Group in 2011 April 2011. 1.1 Aug Revision Minor amendments by Corporate Governance to 2012 document control report, headers and footers, new table of contents, formatting for document map navigation. 2.0 Feb Final Approved by the Maternity Services Guideline Group in 2016 February 2016. 2.1 Apr Revision Harmonised with Royal Devon & Exeter guideline 2019 3.0 May Final Approved by Maternity Specialist Governance Forum 2019 meeting on 01.05.2019 Main Contact ST1 O&G Tel: Direct Dial– 01271 311806 North Devon District Hospital Raleigh Park Barnstaple Devon EX31 4JB Lead Director Medical Director Superseded Documents Nil Issue Date Review Date Review Cycle May 2019 May 2022 Three years Consulted with the following stakeholders: (list all) Senior obstetricians Senior midwives Senior management team Filename Umbilical Cord Prolapse Guideline v3. 01May 19.doc Policy categories for Trust’s internal Tags for Trust’s internal website (Bob) website (Bob) Cord, accidents, prolapse Maternity Services Maternity Page 1 of 11 Umbilical Cord Prolapse Guideline CONTENTS Document Control .................................................................................................... 1 1. Introduction
    [Show full text]
  • Low-Lying Placenta
    LOW- LYING PLACENTA LOW-LYING PLACENTA WHAT IS PLACENTA PRAEVIA? The placenta develops along with the baby in the uterus (womb) during pregnancy. It connects the baby with the mother’s blood system and provides the baby with its source of oxygen and nourishment. The placenta is delivered after the baby and is also called the afterbirth. In some women the placenta attaches low in the uterus and may be near, or cover a part, or lie over the cervix (entrance to the womb). If it is shown in early ultrasound scans, it is called a low-lying placenta. In most cases, the placenta moves upwards as the uterus enlarges. For some women the placenta continues to lie in the lower part of the uterus in the last months of pregnancy. This condition is known as placenta praevia. If the placenta covers the cervix, this is known as major placenta praevia. Normal Placenta Placenta Praevia Major Placenta Praevia WHAT ARE THE RISKS TO MY BABY AND ME? When the placenta is in the lower part of the womb, there is a risk that you may bleed in the second half of pregnancy. Bleeding from placenta praevia can be heavy, and so put the life of the mother and baby at risk. However, deaths from placenta praevia are rare. You are more likely to need a caesarean section because the placenta is in the way of your baby being born. HOW IS PLACENTA PRAEVIA DIAGNOSED? A low-lying placenta may be suspected during the routine 20-week ultrasound scan. Most women who have a low-lying placenta at the routine 20-week scan will not go on to have a low-lying placenta later in the pregnancy – only 1 in 10 go on to have a placenta praevia.
    [Show full text]
  • Ophthalmic Associations in Pregnancy
    CLINICAL Ophthalmic associations in pregnancy Queena Qin, Celia Chen, Sudha Cugati PREGNANCY RESULTS in various physiological variation in pregnancy.2 It normally changes in the female body, including in fades slowly after pregnancy and does the eyes. A typical pregnancy results in not need active intervention. Background A range of ocular pathology exists cardiovascular, pulmonary, metabolic, • Cornea – corneal thickness, curvature during pregnancy. Some pre-existing eye hormonal and immunological changes. and sensitivity may be altered during conditions, such as diabetic retinopathy, Hormonal changes occur, with a rise of pregnancy. Corneal thickness and can be exacerbated during pregnancy. oestrogen and progesterone levels to curvature can increase in pregnancy, Other conditions manifest for the first suppress the menstrual cycle.1 especially in the second and third time during pregnancy as a result of The eye, an end organ, undergoes trimesters, and return to normal in complications such as pre-eclampsia changes during pregnancy. Some of the postpartum period.3 Patients who and eclampsia. Early recognition and understanding of the management of these changes exacerbate pre-existing wear contact lenses may experience ophthalmic conditions is crucial. eye conditions, while other conditions intolerance to the use of contact lenses. manifest for the first time during Pregnant women should be advised Objective pregnancy. Early recognition and to delay obtaining a new prescription The aim of this article is to discuss the understanding of management of for glasses or undergoing a contact physiological and pathological changes in the eyes of pregnant women. ophthalmic conditions during pregnancy lens fitting until after delivery. Laser Pathological changes are sub-divided is crucial for the primary care physician.
    [Show full text]
  • Increased Apoptosis in Chorionic Trophoblasts of Human Fetal Membranes with Labor at Term*
    International Journal of Clinical Medicine, 2012, 3, 136-142 http://dx.doi.org/10.4236/ijcm.2012.32027 Published Online March 2012 (http://www.SciRP.org/journal/ijcm) Increased Apoptosis in Chorionic Trophoblasts of Human * Fetal Membranes with Labor at Term Hassan M. Harirah1#, Mostafa A. Borahay1, Wahidu Zaman1, Mahmoud S. Ahmed1, Ibrahim G. Hager2, Gary D. V. Hankins1 1The Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, USA; 2The Department of Ob- stetrics & Gynecology, Zagazig University, Zagazig, Egypt. Email: #[email protected] Received December 7th, 2011; revised January 17th, 2012; accepted February 8th, 2012 ABSTRACT Objective: To determine the association of apoptosis in the layers of human fetal membranes distal to rupture site with labor at term. Study Design: Fetal membranes were collected from elective cesarean sections (n = 8) and spontaneous vaginal deliveries (n = 8) at term. The extent of apoptosis within fetal membrane layers was determined using terminal deoxynucleotidyl transferase deoxy-UTP-nick end labeling (TUNEL) assay and western blots for pro-apoptotic active caspase-3 and anti-apoptotic Bcl-2. Results: Apoptotic index in chorionic trophoblasts of membranes distal to rupture site obtained after vaginal delivery was 3-fold higher than those obtained from elective cesarean (11.57% ± 4.98% and 4.05% ± 2.4% respectively; p = 0.012). The choriodecidua layers after vaginal deliveries had higher expression of the pro-apoptotic active caspase-3 and less expression of the anti-apoptotic Bcl-2 than those obtained from elective cesar- ean sections. Conclusions: Labor at term is associated with increased apoptosis in chorionic trophoblast cells of human fetal membranes distal to rupture site.
    [Show full text]
  • Pre-Eclampsia and High Blood Pressure During Pregnancy
    Pre-eclampsia and High Blood Pressure During Pregnancy What is high blood pressure? A blood pressure measurement is usually recorded as two numbers, Blood pressure is the force that pushes against your blood vessel such as 120 over 80 (120/80). High blood pressure is also called walls each time your heart squeezes and relaxes to pump the blood hypertension. Hypertension is diagnosed when either the top or the through your body. Blood pressure measurement is a very useful bottom number is higher than normal. way to monitor the health of your cardiovascular system (heart and blood vessels). Why is blood pressure important develops, it does not go away until after the baby is born. Women with pre-eclampsia may require an earlier delivery, during pregnancy? either by labour induction or caesarean section, in order to During pregnancy, very high blood pressure (severe hypertension) protect the health of themselves and their baby. In some cases, can cause complications for both you and your baby, including: pre-eclampsia can develop after childbirth and you should • Poor growth of your baby – due to low nutrition and oxygen alert your doctor or midwife of any concerns you may have supply from the placenta after your baby is born. • Prematurity – if early delivery (before 37 weeks) is required to protect the health of you or your baby • Placental abruption – the placenta may prematurely separate from the wall of the uterus (womb), leading to bleeding and the need for an emergency birth in some cases • Pre-eclampsia – a condition involving high blood pressure and abnormal function in one or more organs during pregnancy What are the different types of high blood pressure that affect pregnant women? 1.
    [Show full text]