Abnormalities Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(11):640-644
Approximately 1 in every 76,000 pregnancies develops within a unicornuate uterus with a rudimentary horn.Müllerian uterus anomalies are often asymptomatic, thus, the diagnosis is a challenge, and it is usually made during the gestation or due to its complications, such as uterine rupture, pregnancy-induced hypertension, antepartum, postpartum bleeding and intrauterine growth restriction (IUGR). In order to avoid unnecessary cesarean sections and the risks they involve, the physicians should consider the several approaches and for how long it is feasible to perform labor induction in suspected cases of pregnancy in a unicornuate uterus with a rudimentary horn, despite the rarity of the anomaly. This report describes a case of a unicornuate uterus in which a pregnancy developed in the non-communicating rudimentary horn and the consequences of the delayed diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(11):640-644
Approximately 1 in every 76,000 pregnancies develops within a unicornuate uterus with a rudimentary horn.Müllerian uterus anomalies are often asymptomatic, thus, the diagnosis is a challenge, and it is usually made during the gestation or due to its complications, such as uterine rupture, pregnancy-induced hypertension, antepartum, postpartum bleeding and intrauterine growth restriction (IUGR). In order to avoid unnecessary cesarean sections and the risks they involve, the physicians should consider the several approaches and for how long it is feasible to perform labor induction in suspected cases of pregnancy in a unicornuate uterus with a rudimentary horn, despite the rarity of the anomaly. This report describes a case of a unicornuate uterus in which a pregnancy developed in the non-communicating rudimentary horn and the consequences of the delayed diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(3):133-138
DOI 10.1590/S0100-72032012000300008
The atypical and more severe form of Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) or MRKH type II is also known as MURCS association, an acronym meaning aplasia/hypoplasia of Müllerian ducts (MU), congenital renal dysplasia (R) and cervico-thoracic dysplasia (CS). It affects female patients with normal karyotype and ovarian function, evolving to primary amenorrhea. It has an incidence of 1:50,000, but it is underestimated due to late diagnosis and undefined etiology. We describe the cases of a child and an adolescent in order to predict the diagnosis even in childhood, before the onset of amenorrhea. Patients had in common renal malformation, agenesis or hypoplasia of Müllerian derivatives and vertebral anomalies, establishing the diagnosis of MURCS. The relevance of this paper is to show the importance of further investigation when some of pathologic signs are present, researching correlated abnormalities in order to establish an early diagnosis and consequently to provide guidance to the patients and their families about the best way to conduct the case, including genetic counseling.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(3):133-138
DOI 10.1590/S0100-72032012000300008
The atypical and more severe form of Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) or MRKH type II is also known as MURCS association, an acronym meaning aplasia/hypoplasia of Müllerian ducts (MU), congenital renal dysplasia (R) and cervico-thoracic dysplasia (CS). It affects female patients with normal karyotype and ovarian function, evolving to primary amenorrhea. It has an incidence of 1:50,000, but it is underestimated due to late diagnosis and undefined etiology. We describe the cases of a child and an adolescent in order to predict the diagnosis even in childhood, before the onset of amenorrhea. Patients had in common renal malformation, agenesis or hypoplasia of Müllerian derivatives and vertebral anomalies, establishing the diagnosis of MURCS. The relevance of this paper is to show the importance of further investigation when some of pathologic signs are present, researching correlated abnormalities in order to establish an early diagnosis and consequently to provide guidance to the patients and their families about the best way to conduct the case, including genetic counseling.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(7):358-365
DOI 10.1590/S0100-72032007000700006
PURPOSE: to evaluate fetal maternal complications after chorionic villus sampling (CVS) for prenatal diagnosis of genetic disorders in pregnant women of Salvador (BA), Brazil. METHODS: case-series study of 958 pregnancies with high risk for chromosomal abnormality submitted to CVS transabdominal between the ninth to the 24th week of gestation, using an ultrasound-guided 18G 3½ spinal needle, from 1990 to 2006. The variables for the analysis of immediate complications were uterine cramps, subchorionic hematoma, accidental amniotic cavity punction, pain in the punction area, amniotic fluid leakage, abdominal discomfort, fetal arrhythmias and vaginal bleeding, and of late complication, abdominal pain, vaginal bleeding, amniotic fluid leakage, infection and spontaneous miscarriage. Premature labor, obstetrical complications (abruption placenta and placenta previa) and newborn malformation were also studied. Qui-square, Student’s "t" or Mann-Whitney tests were used for the statistical analysis; the significance level was 5%. RESULTS: maternal mean age was 36.3±4.9 years old. Immediate complications ware found in 182 (19%) cases (uterine cramp in 14%, subchorionic hematoma in 1.8% and accidental amniotic cavity punction in 1.3%). Late complications were found in 32 (3.3%) cases (vaginal bleeding in 1.6%, abdominal pain in 1.4%, amniotic fluid leakage in 0.3% and spontaneous miscarriage in 1.6% cases). There was no case of abruption placentae, placenta previa or fetal malformation. CONCLUSIONS: CVS is a simple and safe procedure. CVS should be performed in high risk pregnant patients who need prenatal diagnosis of fetal chromosomal abnormalities.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(7):358-365
DOI 10.1590/S0100-72032007000700006
PURPOSE: to evaluate fetal maternal complications after chorionic villus sampling (CVS) for prenatal diagnosis of genetic disorders in pregnant women of Salvador (BA), Brazil. METHODS: case-series study of 958 pregnancies with high risk for chromosomal abnormality submitted to CVS transabdominal between the ninth to the 24th week of gestation, using an ultrasound-guided 18G 3½ spinal needle, from 1990 to 2006. The variables for the analysis of immediate complications were uterine cramps, subchorionic hematoma, accidental amniotic cavity punction, pain in the punction area, amniotic fluid leakage, abdominal discomfort, fetal arrhythmias and vaginal bleeding, and of late complication, abdominal pain, vaginal bleeding, amniotic fluid leakage, infection and spontaneous miscarriage. Premature labor, obstetrical complications (abruption placenta and placenta previa) and newborn malformation were also studied. Qui-square, Student’s "t" or Mann-Whitney tests were used for the statistical analysis; the significance level was 5%. RESULTS: maternal mean age was 36.3±4.9 years old. Immediate complications ware found in 182 (19%) cases (uterine cramp in 14%, subchorionic hematoma in 1.8% and accidental amniotic cavity punction in 1.3%). Late complications were found in 32 (3.3%) cases (vaginal bleeding in 1.6%, abdominal pain in 1.4%, amniotic fluid leakage in 0.3% and spontaneous miscarriage in 1.6% cases). There was no case of abruption placentae, placenta previa or fetal malformation. CONCLUSIONS: CVS is a simple and safe procedure. CVS should be performed in high risk pregnant patients who need prenatal diagnosis of fetal chromosomal abnormalities.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):557-564
DOI 10.1590/S0100-72032006000900009
Pregnant women may depend on the use of medications to minimize the problems caused by preexisting disease, and pregnancy itself can cause situations that compromise the maternal well-being and that require treatment. The obstetrician should be aware of the placental transfer of drugs and of fetal exposure to teratogenic or toxic agents that might compromise the development of the fetus or even its future life.Transport through the placenta involves the movement of molecules between three compartments: maternal blood, cytoplasm of the syncytiotrophoblast, and fetal blood. This movement can occur through the following mechanisms: simple diffusion, facilitated diffusion, active transport, class P, V, F and large ABC family pumps, and endocytosis. With the use of anticonvulsants the incidence of major malformations in exposed newborns is 4 to 6%, compared to 2 to 4% in the general population. Multidrug treatment is more damaging, especially when valproic acid and hydantoin are part of the combination. The recommendation for epileptic patients who have been clinically asymptomatic for two years is to discontinue the drugs they are taking. However, if seizures occur it is advisable to consult a neurologist to discuss anticonvulsant therapy with better benefits and less side effects.Local anesthetics and opioids are extensively used during the resolution of pregnancy. Lidocaine applied by the perineal route for episiotomy at a fixed dose of 400 mg presents a high concentration in maternal plasma and a high rate of placental transfer at the time of birth, with the need for caution regarding the use of repeated doses. Bupivacaine administered by the epidural route is a safe anesthetic which is present in the racemic form and has a placental transfer of about 30%. Fentanyl, an opioid anesthetic used by the epidural route in resolution of cesarean section at the fixed dose of 0.10 mg, presents high rates of placental transfer of the order of 90%, requiring caution with the use of repeated doses for analgesia during labor.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(9):557-564
DOI 10.1590/S0100-72032006000900009
Pregnant women may depend on the use of medications to minimize the problems caused by preexisting disease, and pregnancy itself can cause situations that compromise the maternal well-being and that require treatment. The obstetrician should be aware of the placental transfer of drugs and of fetal exposure to teratogenic or toxic agents that might compromise the development of the fetus or even its future life.Transport through the placenta involves the movement of molecules between three compartments: maternal blood, cytoplasm of the syncytiotrophoblast, and fetal blood. This movement can occur through the following mechanisms: simple diffusion, facilitated diffusion, active transport, class P, V, F and large ABC family pumps, and endocytosis. With the use of anticonvulsants the incidence of major malformations in exposed newborns is 4 to 6%, compared to 2 to 4% in the general population. Multidrug treatment is more damaging, especially when valproic acid and hydantoin are part of the combination. The recommendation for epileptic patients who have been clinically asymptomatic for two years is to discontinue the drugs they are taking. However, if seizures occur it is advisable to consult a neurologist to discuss anticonvulsant therapy with better benefits and less side effects.Local anesthetics and opioids are extensively used during the resolution of pregnancy. Lidocaine applied by the perineal route for episiotomy at a fixed dose of 400 mg presents a high concentration in maternal plasma and a high rate of placental transfer at the time of birth, with the need for caution regarding the use of repeated doses. Bupivacaine administered by the epidural route is a safe anesthetic which is present in the racemic form and has a placental transfer of about 30%. Fentanyl, an opioid anesthetic used by the epidural route in resolution of cesarean section at the fixed dose of 0.10 mg, presents high rates of placental transfer of the order of 90%, requiring caution with the use of repeated doses for analgesia during labor.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(2):81-90
DOI 10.1590/S0100-72032006000200003
PURPOSE: to evaluate the incidence and types of major congenital malformations (MCM) in liveborn children conceived by intracytoplasmic sperm injection (ICSI). METHODS: a total of 680 liveborn children resulted from 511 couples submitted to ICSI from January, 1999 to December, 2002. Data collection of the children was performed through standardized questionnaire and clinical examination. Of the 511 couples, 366 had been contacted for a sampling of 371 gestations. Of the 680 liveborn, 520 had been evaluated, 250 of them (48.1%) through questionnaire and 270 (51.9%) through questionnaire and physical examination. Two hundred and fifty children were from singleton pregnancies and 270 from multiple pregnancies. Malformations were classified according to the 10th revision of the International Statistical Classification of Diseases and Related Health. Only MCM were analyzed in this study. The incidence of MCM was compared with that of the general population obtained by the Latin American Collaborative Study of Congenital Malformations. The statistical analysis was performed by the c² test (level of significance p<0.05). RESULTS: of the 520 children, 15 presented MCM, resulting in an incidence of 2.9%. There was no difference in relation to the control group (p>0.05), which showed 2.6% incidence of MCM. The most frequent malformations were of cardiac origin (four isolated and two associated), corresponding to 40% of the total. The other types of MCM were: renal (three), neural tube (two), skull (one), cleft lip (one), genital (one), Down syndrome (associated with cardiac malformations) (two), and musculoskeletal (one). Six MCM occurred in children from singleton pregnancies and nine in children from multiple pregnancies. CONCLUSION: the liveborn children conceived by ICSI presented incidence of major congenital malformations (2.9%) near to the expected for the general population (2.6%). However, to establish the risks of MCM with precision it is necessary to continue the evaluation of the children conceived by ICSI.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(2):81-90
DOI 10.1590/S0100-72032006000200003
PURPOSE: to evaluate the incidence and types of major congenital malformations (MCM) in liveborn children conceived by intracytoplasmic sperm injection (ICSI). METHODS: a total of 680 liveborn children resulted from 511 couples submitted to ICSI from January, 1999 to December, 2002. Data collection of the children was performed through standardized questionnaire and clinical examination. Of the 511 couples, 366 had been contacted for a sampling of 371 gestations. Of the 680 liveborn, 520 had been evaluated, 250 of them (48.1%) through questionnaire and 270 (51.9%) through questionnaire and physical examination. Two hundred and fifty children were from singleton pregnancies and 270 from multiple pregnancies. Malformations were classified according to the 10th revision of the International Statistical Classification of Diseases and Related Health. Only MCM were analyzed in this study. The incidence of MCM was compared with that of the general population obtained by the Latin American Collaborative Study of Congenital Malformations. The statistical analysis was performed by the c² test (level of significance p<0.05). RESULTS: of the 520 children, 15 presented MCM, resulting in an incidence of 2.9%. There was no difference in relation to the control group (p>0.05), which showed 2.6% incidence of MCM. The most frequent malformations were of cardiac origin (four isolated and two associated), corresponding to 40% of the total. The other types of MCM were: renal (three), neural tube (two), skull (one), cleft lip (one), genital (one), Down syndrome (associated with cardiac malformations) (two), and musculoskeletal (one). Six MCM occurred in children from singleton pregnancies and nine in children from multiple pregnancies. CONCLUSION: the liveborn children conceived by ICSI presented incidence of major congenital malformations (2.9%) near to the expected for the general population (2.6%). However, to establish the risks of MCM with precision it is necessary to continue the evaluation of the children conceived by ICSI.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(5):268-274
DOI 10.1590/S0100-72032005000500007
PURPOSES: to analyze the frequency, associated risk factors for the occurrence of spina bifida and differences between the newborns carrying this malformation and the newborns' morbidities. METHODS: data were obtained through interview of 47 cases and 47 controls, born in the five maternities of the city of Pelotas, during the period from January 1, 1990 to December 31, 2003. This is a population-based case-control study, comprising all births occurred in hospitals. The control was the normal newborn that was born after each case with spina bifida. All data were obtained by using the model ECLAMC questionnaire. The planning of analysis of data included the use of the Student's t test, chi² and odds ratio. RESULTS: in this period there were approximately 77,000 births. Of these, 1,043 (1.35%) presented some type of congenital malformation. Among these, 47 of 162 anomalies of the neural tube (29%) were spina bifida cases. Significant differences have been found in the number of previous stillborn babies, as well as a higher rate of spina bifida cases in females. In this study, many factors such as the use of medical drugs; acute and chronic illnesses; number of gestations; age, education and occupation of the parents, among others, did not influence the occurrence of spina bifida. CONCLUSIONS: spina bifida must be considered as an important factor of risk for perinatal morbidity, and its occurrence is associated with a history of previous stillborn babies.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(5):268-274
DOI 10.1590/S0100-72032005000500007
PURPOSES: to analyze the frequency, associated risk factors for the occurrence of spina bifida and differences between the newborns carrying this malformation and the newborns' morbidities. METHODS: data were obtained through interview of 47 cases and 47 controls, born in the five maternities of the city of Pelotas, during the period from January 1, 1990 to December 31, 2003. This is a population-based case-control study, comprising all births occurred in hospitals. The control was the normal newborn that was born after each case with spina bifida. All data were obtained by using the model ECLAMC questionnaire. The planning of analysis of data included the use of the Student's t test, chi² and odds ratio. RESULTS: in this period there were approximately 77,000 births. Of these, 1,043 (1.35%) presented some type of congenital malformation. Among these, 47 of 162 anomalies of the neural tube (29%) were spina bifida cases. Significant differences have been found in the number of previous stillborn babies, as well as a higher rate of spina bifida cases in females. In this study, many factors such as the use of medical drugs; acute and chronic illnesses; number of gestations; age, education and occupation of the parents, among others, did not influence the occurrence of spina bifida. CONCLUSIONS: spina bifida must be considered as an important factor of risk for perinatal morbidity, and its occurrence is associated with a history of previous stillborn babies.