Circulation
Department of Pediatrics and Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (S.A.M., D.J.P.); Texas Department of State Health Services, Austin, TX (M.K.E., M.A.C.); Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX (C.G.M.); Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX (D.E.F.); and the Department of Epidemiology & Biostatistics, University of South Florida, Tampa, FL (W.N.N.).
Published: January 2014
Background: Most studies have not demonstrated improved survival after prenatal diagnosis of critical congenital heart disease, including hypoplastic left heart syndrome (HLHS). However, the effect of delivery near a cardiac surgical center (CSC), the recommended action after prenatal diagnosis, on HLHS mortality has been poorly investigated.
Methods And Results: Using Texas Birth Defects Registry data, 1999 through 2007, which monitored >3.4 million births, we investigated the association between distance (calculated driving time) from birth center to CSC and neonatal mortality in 463 infants with HLHS. Infants with extracardiac birth defects or genetic disorders were excluded. The associations between prenatal diagnosis, CSC HLHS volume, and mortality were also examined. Neonatal mortality in infants born <10 minutes from a CSC was 21.0%, 10 to 90 minutes 25.2%, and >90 minutes 39.6% (P for trend <0.001). Prenatal diagnosis alone was not associated with improved survival (P=0.14). In multivariable analysis, birth >90 minutes from a CSC remained associated with increased mortality (odds ratio, 2.03; 95% confidence interval, 1.19-3.45), compared with <10 minutes. In subanalysis, birth >90 minutes from a CSC was associated with higher pretransport mortality (odds ratio, 6.69; 95% confidence interval, 2.52-17.74) and birth 10 to 90 minutes with higher presurgical mortality (odds ratio, 4.45; 95% confidence interval, 1.17-17.00). Higher surgical mortality was associated with lower CSC HLHS volume (odds ratio per 10 patients, 0.88; 95% confidence interval, 0.84-0.91).
Conclusions: Infants with HLHS born far from a CSC have increased neonatal mortality, and most of this mortality is presurgical. Efforts to improve prenatal diagnosis of HLHS and subsequent delivery near a large volume CSC may significantly improve neonatal HLHS survival.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.113.003711 | DOI Listing |
Rev Esc Enferm USP
January 2025
Universidade Federal do Maranhão, Departamento de Medicina I, São Luís, MA, Brazil.
Objective: To analyze the prevalence of prenatal tests of pregnant women and factors associated with variation in this prevalence in the years of the Brazilian National Health Survey 2013 and 2019.
Method: A cross-sectional study, carried out with women who underwent prenatal care, interviewed in the Brazilian National Health Survey 2013 (n = 1,851) and 2019 (n = 2,729).
Results: The most prevalent tests were urine and blood, and the least prevalent were syphilis and HIV.
Acta Obstet Gynecol Scand
January 2025
Department of Gynecology and Obstetrics, Federal University of Goiás (UFG), Goiânia, Brazil.
Introduction: Intrauterine devices (IUDs) are highly effective contraceptives. Despite their effectiveness, pregnancies can occur during IUD use, and the management of such cases, particularly when the pregnancy is desired, remains controversial.
Material And Methods: We conducted a systematic review and meta-analysis to evaluate outcomes in women who unintentionally conceived while using IUDs and chose to continue their pregnancies.
J Allergy Clin Immunol Glob
February 2025
Department of Molecular Medicine, Sapienza University, Rome, Italy.
Background: Many patients with X-linked agammaglobulinemia (XLA) nowadays have reached adulthood, as well as their sisters, possibly carriers of a deleterious Bruton tyrosine kinase variant. Studies on motherhood outcomes in families with XLA are lacking.
Objective: We sought to investigate adherence to carrier status screening, interest in preconception and prenatal genetic counseling, and reproductive decisions in relatives with XLA.
Front Pediatr
January 2025
Division of Neonatology, Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Background: Multisystem inflammatory syndrome in neonates (MIS-N) is a rare condition thought to be associated with prenatal exposure to maternal severe acute respiratory syndrome coronavirus 2 infection. This immune-mediated hyperinflammation has been described in neonates with multiorgan dysfunction, including cardiopulmonary, encephalopathy, coagulopathy, and vascular complications. However, renovascular complications in MIS-N are rare.
View Article and Find Full Text PDFInt Med Case Rep J
January 2025
Department of Obstetrics and Gynecology, Universitas Padjadjaran, Bandung, Indonesia.
Vasa previa is a condition where unprotected fetal vessels, neither by placenta nor umbilical cord, lie within the membranes over the internal cervical ostium and beneath the presenting part of the fetus. Due to this condition, the membranous vessels pose a higher risk of being compressed or ruptures and could lead to fetal demise, exsanguination, or even fetal death. In this case report, we reported a case of a 36-year-old woman, G3P2A0, at term gestation and oblique lie.
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