Maternal passage of immunoglobulin G (IgG) is an important passive mechanism for protecting the infant while the neonatal immune system is still immature and ineffective. IgG is the only antibody ...class capable of crossing the histological layers of the placenta by attaching to the neonatal Fc receptor expressed at the level of syncytiotrophoblasts, and it offers protection against neonatal infectious pathogens. In pregnant women with autoimmune or alloimmune disorders, or in those requiring certain types of biological therapy, transplacental passage of abnormal antibodies may cause fetal or neonatal harm. In this review, we will discuss the physiological mechanisms and benefits of transplacental transfer of maternal antibodies as well as pathological maternal situations where this system is hijacked, potentially leading to adverse neonatal outcomes.
In this editorial we comment on the article by Gu
. We focus and debate the necessity of fertility sparing surgery in young women's with gynecologic cancers, specifically on those patients with the ...desire to conceive. This type of individualized treatment options is often very difficult, due to the risk of disease evolution and multiple disparities in fertility preservation services among women in different countries and societies. For this reason national policy interventions are mandatory in order to ensure equitable access this procedures, in women with cancer.
Background and objectives: Rosai–Dorfman disease (RDD) is a type of histiocytosis that usually appears in young adults or children as bilateral cervical lymphadenopathy, but extranodal involvement in ...not uncommon. Although the pathogenesis is not entirely elucidated, recent studies showed a possible neoplastic process. Materials and methods: Our manuscript presents a rare case of Rosai–Dorfman disease of the breast, the management of this rare case, and a literature review. There are few cases reported of RDD of the breast (around 90 globally reported cases); the data is poor, and the management not yet standardized for these cases. The case reported here shows the importance of correct breast investigation, breast imaging, and ultrasound-guided biopsy that provided an accurate diagnosis and guided further management. Results: Although RDD of the breast was rarely presented as bilateral disease in other case reports, our case showed bilateral breast disease with the suspicion of breast cancer on imaging. Pathology and immunohistochemistry were of critical importance and showed a specific pattern for histiocytosis. A multidisciplinary approach was taken into consideration for these cases in order to establish the approach. Some patients underwent surgery, but watchful waiting and close follow-up were the preferred approach. Conclusions: RDD of the breast is a rare form of histiocytosis, with fewer than 100 globally published cases. Although the management of this disease is not established yet by guidelines, a follow-up approach should be enough for these patients, and surgery might be overtreatment. Mortality from RDD is very low due to comorbidities. A multidisciplinary team decision is important, and abstinence might significantly benefit these patients.
Wharton’s jelly is a specialized connective tissue surrounding and protecting umbilical cord vessels. In its absence, the vessels are exposed to the risk of compression or rupture. Because the ...condition is very rare and there are no available antepartum investigation methods for diagnosis, these cases are usually discovered after delivery, frequently after in utero fetal demise. We report the fortunate case of a 29-year-old nulliparous woman, with an uncomplicated pregnancy, admitted at 39 weeks in labor where a persistently abnormal cardiotocographic trace led to delivery by cesarean section of a healthy 3500 g newborn. After delivery, a Wharton’s jelly anomaly was identified at the abdominal umbilical insertion (umbilical cord vessels, approximately 1 cm in length, were completely uncovered by Wharton’s jelly), which required surgical thread elective ligation. In the presence of a persistently abnormal CTG trace, in a pregnancy with no clinical settings suggestive of either chronic or acute fetal hypoxemia, the absence of Wharton’s jelly should be taken into consideration in the differential diagnosis.
Anti-Ro antibodies are detected frequently in the general population, but more so in patients with autoimmune conditions as Sjögren’s syndrome and systemic lupus erythematous (SLE). During pregnancy, ...anti-Ro antibodies can cross the placenta by hijacking physiological mechanisms and can have deleterious effects on the fetus. Administration of hydroxychloroquine (HCQ) to pregnant women with documented anti-Ro antibodies has been shown to prevent congenital heart block (CHB). Serial fetal ultrasound scans and echocardiograms are controversial in pregnant women with anti-Ro antibodies. When complete CHB is diagnosed, this is irreversible and can lead to fetal heart failure, hydrops, and death. After delivery, babies with complete CHB require pacemaker. In the presence of maternal anti-Ro antibodies, there is a high risk of recurrence of CHB for future pregnancies, if there is a previously affected child. Adequate counselling and prophylactic treatment with HCQ should be encouraged.
Systemic lupus erythematosus (SLE) is common in women of reproductive age and can have serious consequences on pregnancy outcomes. Recent updates in the clinical management of this condition have ...brought improvements for mothers affected and their babies. The aim of this general review is to offer the perspective of the maternal-fetal medicine specialist on the recent updates in clinical management of SLE in pregnancy and to bring into the attention of the rheumatology specialists the tools that obstetricians have nowadays in monitoring high-risk pregnancies.
Objective: To describe the incidence and the characteristics of pregnancies complicated by hypertensive disorders of pregnancy (HDP) in one of the largest maternity hospitals in Romania.
Methods: A ...retrospective cohort study including all deliveries at ≥24 weeks' gestation was performed.
Results: The incidence of preeclampsia was 1.2%, of gestational hypertension 2.2% and of chronic hypertension 0.4%. Pregnancies with HDP had higher rates of stillbirth, birthweight <10
th
percentile, birth <37 weeks' gestation and delivery by cesarean section.
Conclusions: Incidence of HDP in our population was relatively low, and was associated with early gestational age and adverse perinatal outcomes.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Management strategies for pregnancies with abnormal adherence/invasion of the placenta (placenta accreta spectrum, PAS) vary between centers. Expectant management (EM), defined as leaving the ...placenta in situ after the delivery of the baby, until its complete decomposition and elimination, has become a potential option for PAS disorders in selected cases, in which the risk of Caesarean hysterectomy is very high. However, expectant management has its own risks and complications. The aim of this study was to describe the rates of subsequent hysterectomy (HT) in patients that underwent EM for the treatment of PAS disorders. We reviewed the literature on the subject and found 12 studies reporting cases of HT after initial intended EM. The studies included 1918 pregnant women diagnosed with PAS, of whom 518 (27.1%) underwent EM. Out of these, 121 (33.2%) required subsequent HT in the 12 months following delivery. The rates of HT after initial EM were very different between the studies, ranging from 0 to 85.7%, reflecting the different characteristics of the patients and different institutional management protocols. Prospective multicenter studies, in which the inclusion criteria and management strategies would be uniform, are needed to better understand the role EM might play in the treatment of PAS disorders.
Borderline ovarian tumors represent a heterogeneous group of tumors with a specific noninvasive histology, a low malignant potential, and an uncertain outcome. They have a low incidence, occurring at ...younger age and diagnosed in early stages, and are associated with infertility, and they have a better prognosis when compared with epithelial ovarian cancer. We retrospectively evaluated all the patients with the diagnosis of borderline ovarian tumors who underwent surgical treatment between January 1, 2013, and December 31, 2016, in Filantropia Clinical Hospital. In the study, were included 50 patients with borderline ovarian tumors with an average age of 52. Thirty-four patients (68%) were postmenopausal and 16 (32%) were premenopausal. We found 44 unilateral tumors (88%) and 6 bilateral (12%), and the size varied between 3 and 40 cm. Regarding the histopathological examination, we found 34 patients with borderline ovarian tumors of serous type (68%), 12 of mucinous type (24%), and 4 (8%) other types. We had 2 cases of extraovarian extension, one to peritoneal surface and one to the appendix. Surgical treatment was radical in 38 cases and conservative in 12 cases. The management of borderline ovarian tumors should first consider the oncologic safety but will be well balanced with less radical treatment in selected cases. The various clinical and histological aspects of BOT should guide the surgeon and the oncologist to take the best decisions for the patient in order to be as radical as it is necessary.
Umbilical cord prolapse can be a life-threatening obstetrical event involving the fetus due to sudden oxygenated blood flow obstruction. These types of events most often happen in labor and are ...associated with obstetric maneuvers. Rarely, a clinical examination can diagnose the condition, but the situation is usually detected secondary to an abnormal cardiotocography trace. We present several clinical cases where a CTG trace was used to infer umbilical cord prolapse.
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