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Obstetrics: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Likely parvovirus B19. Detailed history and maternal FBC, blood group and antibodies, Kleihauer, infection screen, autoantibodies, oral GTT.Detailed fetal ultrasound and fetal echocardiography.Fetal blood testing – cordocentesis.
SBA Answers
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
E 25%–35%The incidence of primary B19 infection during pregnancy has been estimated at 1%–5%, and the subsequent transplacental transmission is 24%–33%. The risk of developing hydrops following this infection is reportedly varied (0%–24%), but according to recent studies, the rate is probably quite low (1%–1.6%). However, in pregnant women with a confirmed primary infection, the overall risk of an abnormal outcome is approximately 5%–10%. Non-immune hydrops fetalis is rare (1 in 3000), and in 20%–50% of cases, the aetiology is unknown. Meta-analysis has shown that B19 accounts for 15%–20% of cases of nonimmune hydrops fetalis, with a mean interval between the onset of maternal infection and fetal symptoms of 6 weeks. The chance of an adverse fetal outcome after infection seems to be greatest between 11 and 23 weeks of gestation, which correlates with the hepatic period of haematopoietic activity. Cordocentesis allows precise assessment of fetal anaemia, which might then be corrected by intravenous transfusion of erythrocytes. Accordingly, in series of hydropic fetuses, the case fatality rate may be almost 50%, but transfusions have proven beneficial, lowering the mortality rate to 18%. (Heegaard ED and Brown KE. Clinical Microbiology Reviews. 2002; 15(3): 485–505 and Ismail KMK and Kilby MD. Human parvovirus B19 and pregnancy. The Obstetrician & Gynaecologist 2003; 5: 4–9)
Infections
Published in Anne Lee, Sally Inch, David Finnigan, Therapeutics in Pregnancy and Lactation, 2019
Prenatal diagnosis of fetal infection is difficult. Detection of specific IgM in fetal blood, obtained by cordocentesis, is probably diagnostic, although there is a high false negative rate. IgM is not detectable in the first half of pregnancy, probably because of immaturity of the fetal immune system.13,14 Ultrasound abnormalities are usually a late finding and are not specific enough to make the diagnosis of congenital CMV infection. Currently the best way of making a diagnosis is by isolating the virus from amniotic fluid.8 A positive diagnosis, however, does not predict the severity of congenital CMV infection and many infected infants will be asymptomatic.14
Excision of subcutaneous endometriosis lesions in obese patients by marking them with methylene blue with ultrasound guidance: a novel technique
Published in Journal of Obstetrics and Gynaecology, 2023
Çağlar Çetin, Mehmet Serdar Kütük, Fatma Başak Tanoğlu, Seda Ateş, Pınar Özcan, Rabia Zehra Bakar
After cleaning the suprapubic regions of the patients and covering them with sterile drapes just before starting the operation, the lesion was reached with a 20 gauge cordocentesis needle under ultrasound guidance (Figure 1). The procedure was terminated by injecting approximately 2 ccs of methylene blue into the central part of the lesion, and the patients were taken into operation. In the operations, approximately 3 cm incision was made to exclude the skin-subcutaneous fat tissue, endometriotic foci stained with methylene blue were reached in the adjacency of the rectus abdominis, and the lesion was excised containing 1 cm of intact tissue around it (Figure 1). Since the foci were observed to invade the fascia during excision, the fascia adjacent to the associated rectus abdominis was also excised, and the resulting fascia defect was primarily repaired. Afterward, the operations were terminated after suturing subcutaneous tissue and skin. No intraoperative complications developed. No recurrence or complication was observed in the one-year follow-up of the patients. Pathology results of both patients were reported as endometriosis externa.
Correlation of liver and kidney indicators with foetal vital organ function
Published in Journal of Obstetrics and Gynaecology, 2022
Jun Zhou, Yuying Chen, Li Ma, Cuixiang Zhou, Ruilian Zhe
Cord blood samples were taken at the time of prenatal intervention diagnosis with the consent of the parturient women and their families prior to the sampling. The operation strictly followed aseptic procedures, and cordocentesis was performed under ultrasound guidance. Before operation, the pregnant woman was examined by ultrasonography, the foetal umbilical vessels were punctured transabdominally under the guidance of puncture exploration, 3 ml of cord blood was collected, centrifuged and processed, and the supernatant was taken. The liver and renal function indicators, including alanine transaminase (ALT), aspartate transaminase (AST), total protein (TP), albumin, total bilirubin, total bile acids (TBA), glycosidase, gamma-glutamyl transferase, alkaline phosphatase (ALP), LDH, adenosine dehydrogenase, direct bilirubin, fibrinogen-binding protein, urea nitrogen, creatinine, and indirect bilirubin levels were measured using a Hitachi 7170 automatic biochemical analyser (Wang 2020).
Abnormal chromosomes identification using chromosomal microarray
Published in Journal of Obstetrics and Gynaecology, 2022
Yunfang Shi, Xiaozhou Li, Duan Ju, Yan Li, Xiuling Zhang, Ying Zhang
A 32-year-old primigravida showed low risk in the second trimester maternal serum screening for trisomy 21 and 18. Ultrasound examination did not show any pathological findings before 28 weeks gestation. She had a previous spontaneous abortion. At the regular 32-week visit, the ultrasound scan showed the intrauterine growth restriction (IUGR). Cordocentesis was performed at a gestational age of 35 weeks. The foetal karyotype was 46,XX,del(18) and its breakouts were not known. SNP-array revealed a 5.1 Mb duplication in 7p22.3p22.1 and a 29.8 Mb deletion in 18q21.2q23, as well as a suspicious unbalanced translocation between chromosome 7 and 18 (Figure 2). The duplication region contained 31 OMIM genes and the deletion region contained 74 OMIM genes that were associated with Chromosome 18q deletion syndrome. A balanced translocation was screened in maternal karyotype 46,XX,t(7;18)(p22;q21.1), while the paternal karyotype revealed no obvious abnormalities. The pregnant woman and her family also terminated the pregnancy after genetic counselling.