RESUMEN
Neobladder is continent urinary reservoir made from a detubularized segment of bowel, with implantation of ureters and urethra. The most common indication for this operation is bladder replacement after cystectomy following bladder cancer in elderly or cervical cancer Stage IV patients. Nowadays indications are expanded to many benign diseases (interstitial cystitis (IC), neurogenic bladder, chronic pelvic pain) in reproductive age. Pregnancy in women with neobladder is a rare condition, hence published experience is limited. Most of the published cases were delivered by cesarean, due to the concern for possible complications. The authors report a case of a 36-year-old woman who underwent a vesico ileocystoplasty for IC, became pregnant six years after the operation, and delivered a healthy baby vaginally. Her obstetric and urologic outcomes were assessed, during, and after pregnancy. Careful antenatal monitoring by both an obstetrician and a urologist, awareness of potential complications, and their prompt treatment, can result in a successful pregnancy and vaginal delivery where neither fetus or mother nor neobladder are endangered.
Asunto(s)
Cistitis Intersticial/cirugía , Íleon/cirugía , Complicaciones del Embarazo/cirugía , Vejiga Urinaria/cirugía , Adulto , Parto Obstétrico , Femenino , Humanos , Masculino , Embarazo , Procedimientos de Cirugía PlásticaRESUMEN
Factors of effect on the fetal glucose level can be of maternal, placental or fetal origin. The level of fetal insulin during gestation is regulated by the potentials of the endogenous fetal production on one hand and on the other by the factors (primarily glucaemia) that stimulate or inhibit its production. The aim of this paper was to analyze in which way and to what extent the congenital infection with the Cytomegalovirus disturbs the metabolism of the fetal glucose and insulin. Umbilical venous cord blood was obtained by cordocentesis at 22 to 29 weeks gestation from 52 women referred to our clinic for fetal karyotyping and scatological analysis of fetal CMV infection. To determine the effect of Cytomegalovirus (CMV) infection on insulin and glucose fetal homeostatis, we performed cordocentesis in 18 patients (group A) with proved congenital CMV fetal infection. Control group (B) consisted of 34 patients in whom blood samples were taken for fetal karyotyping. Maternal and fetal glucose levels were 3.95 mmol/l and 3.15 mmol/l in group A and 4.00 and 3.62 mmol/l in group B, respectively. Maternal average insulin level in group A was 14.45 mU/ml and in fetuses 10.64 mU/ml, while in group B maternal and fetal insulin levels were 12.85 mU/ml and 15.35 mU/ml, respectively. Maternal/fetal (M/F) insulin ratio was in group A 1.35, and in group B 0.84. Statistical analysis showed significantly lower glucose and insulin levels and also higher maternal/fetal insulin ratio in fetuses affected by CMV infection (t = 1.4, p < 0.001). Consequences of congenital CMV infection were fetal hypoglucaemia and hypoinsulinemia.
Asunto(s)
Infecciones por Citomegalovirus/metabolismo , Enfermedades Fetales/metabolismo , Feto/metabolismo , Glucosa/metabolismo , Homeostasis , Insulina/metabolismo , Femenino , Humanos , EmbarazoRESUMEN
Aim of the study was to evaluate correlation between valine and glycine, representatives of essential and nonessential amino acids, in fetuses appropriate and small for gestational age with congenital cytomegalovirus infection. Umbilical venous cord blood was obtained by cordocentesis at 22 to 29 weeks' gestation from 18 women (11 in appropriate for gestational age--A, and seven in small for gestational age--B) fetuses with CMV infection. Plasma amino acids were measured with an Beckman M 121 amino acid analyzer. Maternal valine level was 136.0 mmol/l; fetal valine in AGA and SGA fetuses: 219 and 189 mmol/l respectively. Fetomaternal valine ratio was significantly lower in SGA group (1.39 mmol/l-SGA, 1.61 mmol/l AGA, t = -6.9, p < 0.001). Glycine level in maternal blood was 139.0 mmol/l; fetal in SGA and AGA fetuses 137 mmol/l and 176 mmol/l, respectively. Fetomaternal glycine ratio was also significantly lower in SGA group than in AGA, 1.01 and 1.27 respectively (t = -2.96, p < 0.001). Valine/Glycine maternal and fetal ratio did not show any difference between groups. In congenitally CMV infected fetuses with intrauterine growth retardation there is a decreased valine and glycine level, compared to the congenitally CMV infected fetuses with normal intrauterine growth. There is a lower fetal concentration of these amino acids compared to the maternal level in SGA fetuses. A decreased glycine level compared to the valine level has also been found in congenitally CMV infected fetuses with intrauterine growth retardation.
Asunto(s)
Aminoácidos/sangre , Infecciones por Citomegalovirus/sangre , Sangre Fetal/química , Enfermedades Fetales/sangre , Retardo del Crecimiento Fetal/sangre , Femenino , Edad Gestacional , Humanos , EmbarazoRESUMEN
The aim of this study was to present a new technique of administration of antenatal corticosteroid therapy in order to cause fetal lung maturation. A single dexamethasone dose of 4 mg was applied directly to the fetal gluteal musculature by ultrasound-guided intramuscular injection 48 h before delivery. This technique of fetal corticosteroid therapy was applied in six cases. Our patients had high risk pregnancies (preeclampsia diabetes mellitus, intracranial hemorrhage, epilepsy, hyperthyreosis). The pregnancies were terminated in the mother's vital interest. The lecithin/sphyngomyelin (US) ratio was < 1.5:1. There were no procedure-related complications. The fetuses were delivered by cesarean, 48 hours later except for the vaginal delivery in the patient in which fetal death occurred in utero. In five cases an uneventful outcome of fetuses indicated that direct fetal corticosteroid treatment improved postnatal lung function in preterm fetuses. A new technique of corticosteroid application successfully prevents respiratory distress in preterm infants decreasing the risk of maternal complications. To our knowledge, this is the first report of fetal intramuscular corticosteroid therapy in the human population.
Asunto(s)
Dexametasona/administración & dosificación , Glucocorticoides/administración & dosificación , Pulmón/embriología , Síndrome de Dificultad Respiratoria del Recién Nacido/prevención & control , Femenino , Muerte Fetal , Madurez de los Órganos Fetales/efectos de los fármacos , Humanos , Recién Nacido , Inyecciones Intramusculares , Pulmón/efectos de los fármacos , Embarazo , Complicaciones del Embarazo , Resultado del Tratamiento , Ultrasonografía PrenatalRESUMEN
The aim of the study was to evaluate the correlation between valine and glycine, representatives of essential and nonessential amino acids, in appropriate and small fetuses for gestational age with congenital cytomegalovirus (CMV) infection. Umbilical venous cord blood was obtained by cordocentesis at 22 to 29 weeks' gestation from 18 women (11 in appropriate for gestational age (AGA) -A, and 7 in small for gestational age (SGA) -B) fetuses with CMV infection. Plasma amino acids were measured with a Beckman M 121 amino acid analyzer. Maternal valine level was 136.0 mmol/l; fetal valine in AGA and SGA fetuses: 219 and 189 mmol/l, respectively. Fetomaternal valine ratio was significantly lower in the SGA group (1.39 mmol/l-SGA, 1.61 mmol/l AGA, t = 6.9 p < 0.001). The glycine level in maternal blood was 139.0 mmol/l; fetal in SGA and AGA fetuses 137 mmol/l, and 176 mmol/l, respectively. The fetomaternal glycine ratio was also significantly lower in the SGA group than in AGA. 1.01 and 1.27, respectively (t = -2.96, p < 0.001). Valine/glycine maternal and fetal ratio did not show any difference between groups. In the congenital CMV infected fetuses with intrauterine growth retardation there were decreased valine and glycine levels compared to the congenitally CMV infected fetuses with normal intrauterine growth. There was a lower fetal concentration of these amino acids compared to the maternal level in SGA fetuses. A decreased glycine level compared to the valine level has also been found in congenitally CMV infected fetuses with intrauterine growth retardation.