To present a case of cesarean scar pregnancy combined with intrauterine pregnancy after IVF-embryo transfer. Successful embryo reduction was performed and preserved the normal intrauterine gestation.
...Case report.
Tertiary referral case center.
A woman with cesarean scar pregnancy combined with intrauterine pregnancy after IVF-embryo transfer.
Early diagnosis of heterotopic cesarean scar pregnancy and selective embryo reduction was performed by ultrasound-guided potassium chloride (KCl) directed injection.
Successful pregnancy outcome.
A 38-year-old woman achieve pregnancy by IVF-embryo transfer. Heterotopic cesarean scar pregnancy was diagnosed at 7 weeks gestational age. A transvaginal ultrasound-guided KCl injection was given to terminate the cesarean scar embryo and a healthy infant was delivered 6 months later.
Heterotopic cesarean scar pregnancy after IVF is extremely rare. Transvaginal intracardiac injection of KCl is a safe and reliable method to terminate the cesarean scar pregnancy. Satisfactory pregnancy outcome should be achieved.
The efficacy and safety of maternal tenofovir disoproxil fumarate (TDF) in reducing mother‐to‐infant hepatitis B virus (HBV) transmissions is not clearly understood. We conducted a prospective, ...multicenter trial and enrolled 118 hepatitis B surface antigen (HBsAg)– and hepatitis B e antigen–positive pregnant women with HBV DNA ≥7.5 log10 IU/mL. The mothers received no medication (control group, n = 56, HBV DNA 8.22 ± 0.39 log10 IU/mL) or TDF 300 mg daily (TDF group, n = 62, HBV DNA 8.18 ± 0.47 log10 IU/mL) from 30‐32 weeks of gestation until 1 month postpartum. Primary outcome was infant HBsAg at 6 months old. At delivery, the TDF group had lower maternal HBV DNA levels (4.29 ± 0.93 versus 8.10 ± 0.56 log10 IU/mL, P < 0.0001). Of the 121/123 newborns, the TDF group had lower rates of HBV DNA positivity at birth (6.15% versus 31.48%, P = 0.0003) and HBsAg positivity at 6 months old (1.54% versus 10.71%, P = 0.0481). Multivariate analysis revealed that the TDF group had lower risk (odds ratio = 0.10, P = 0.0434) and amniocentesis was associated with higher risk (odds ratio 6.82, P = 0.0220) of infant HBsAg positivity. The TDF group had less incidence of maternal alanine aminotransferase (ALT) levels above two times the upper limit of normal for ≥3 months (3.23% versus 14.29%, P = 0.0455), a lesser extent of postpartum elevations of ALT (P = 0.007), and a lower rate of ALT over five times the upper limit of normal (1.64% versus 14.29%, P = 0.0135) at 2 months postpartum. Maternal creatinine and creatinine kinase levels, rates of congenital anomaly, premature birth, and growth parameters in infants were comparable in both groups. At 12 months, one TDF‐group child newly developed HBsAg positivity, presumably due to postnatal infection and inefficient humoral responses to vaccines. Conclusions: Treatment with TDF for highly viremic mothers decreased infant HBV DNA at birth and infant HBsAg positivity at 6 months and ameliorated maternal ALT elevations. (Hepatology 2015;62:375–386
Summary
Background
Maternal anti‐viral treatment prevents mother‐to‐infant transmission of hepatitis B virus (HBV), but the role of neonatal viremia on subsequent HBV infection is not clear.
Aims
To ...investigate the effect of maternal anti‐viral treatment on neonatal serum HBV DNA and hepatitis B surface antigen (HBsAg) in infants born to highly viremic mothers and the roles of neonatal markers in predicting chronic HBV infection in children.
Methods
Serum HBV DNA and HBsAg were tested in children. Of the 201 pregnant mothers, 110 received tenofovir during the third trimester. Chronic infection in children was defined by HBsAg seropositivity at 6 or 12 months lasting more than 6 months.
Results
The maternal HBV viral loads from baseline to delivery were 8.25 ± 0.48 to 4.29 ± 0.98 log10 IU/mL; and 8.29 ± 0.49 to 8.12 ± 0.68 log10 IU/mL in the tenofovir and control group respectively. Of the 208 children, those in the tenofovir group had a lower rate of neonatal HBV DNA seropositivity at birth (5.22% vs 30.11%, P < 0.0001) and HBsAg seropositivity at 6 months (1.74% vs 11.83%, P = 0.003) and 12 months (1.74% vs 10.75%, P = 0.007). In a first multivariate analysis, maternal HBV DNA level at delivery (odds ratio = 1.70, P = 0.0172) and neonatal HBsAg positivity (odds ratio = 19.37, P < 0.0001) were significantly associated with children's chronic HBV infection. In a second model, neonatal HBV DNA positivity was a strong independent influence variable (odds ratio = 61.89, P = 0.0002).
Conclusions
Maternal tenofovir therapy decreased maternal viral load and neonatal viremia. Positive neonatal HBV DNA was highly correlated with chronic HBV infection in children. Clinical Trial Identifier: NCT01312012.
A 32-year-old parturient requested epidural analgesia for labor. A lumbar epidural block was performed at the L1-2 interspace. Thirty minutes after the loading dose of the local anesthetic mixture, ...she suffered numbness in both arms and high sensory block up to the C6 dermatome without significant motor blockade. The retained epidural catheter was later confirmed radiologically to be in the subdural space. Accidental subdural catheterization is a rare complication of epidural block. Due to the smaller potential space, a subdural injection usually produces a high level block disproportional to the volume injected. Thus, patients receiving epidural block should be closely monitored following injection of local anesthetics regardless of the concentration or volume administered.
Alpha-thalassemia is a common hereditary disease in Taiwan. Affected patients always carry a heavy burden of morbidity and early death. Prenatal diagnosis has reduced the disease burden on families ...and the health care system. This study evaluated a new non-radioactive Southern blotting hybridization method for prenatal diagnosis of this disease.
Seventy two chorionic villi samples (CVS) and 30 amniocyte samples from 102 pregnancies of couples who were both heterozygous for alpha-thalassemia-1 of the Southeast Asian (SEA) type deletion were studied. A non-radioactive Southern blotting hybridization method using a dig-alkaline phosphate detection system was developed for use in this study.
Non-radioactive Southern blotting hybridization data showed that 19 (26%) CVS and five (17%) amniotic fluid samples had 10 Kb and 4Kb fragments, indicating homozygosity of the alpha-thalassemia-1 SEA type deletion. DNA samples were extracted from most of the aborted tissue of the 24 fetuses with a diagnosis of homozygous for the alpha-thalassemia-1 SEA type deletion. Homozygosity for alpha-thalassemia-1 SEA type deletion was reconfirmed by Southern blotting hybridization in all of these samples.
The non-radioactive Southern hybridization protocol used in this study allows efficient and accurate early prenatal diagnosis of alpha-thalassemia-1 SEA type deletion. It can be routinely used for testing couples who both carry the alpha-thalassemia-1 SEA type deletion.
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