Pregnancy Biopsy Research Articles

Native kidney biopsy in pregnancy and postpartum: A single centre experience from India

Native kidney biopsy in pregnancy and postpartum: A single centre experience from India

Diagnostic yield and safety of percutaneous native kidney biopsy in pregnancy: 20-years of single-center experience.

Percutaneous kidney biopsy is a fundamental procedure in nephrology. Although pregnancy is not a contraindication, a careful risk-benefit assessment is mandatory in pregnancy. We aimed to evaluate safety and diagnostic accuracy of percutaneous kidney biopsy in pregnancy in a single-center retrospective study. Percutaneous kidney biopsy was performed in 19 pregnantpatients. Demographics, estimated glomerular filtration rates, serum albumin levels, and proteinuria levels at the time of biopsy were evaluated. Biopsy-related complications, diagnoses, and treatments during the follow-up were analyzed. In addition, delivery success, preeclampsia, early delivery, low birth weight rates, and long-term outcomes of the patients were retrieved and analyzed. Mean patient age was 27 (range 16-41) years. Median gestational week at kidney biopsy was 20th. All but one biopsies were diagnostic. Median gestational week of delivery was 35 (range 23-39)gestational weeks. Preterm delivery (< 37 gestational weeks) and low birth weight (< 2500mg) occurred in 73.7% and 52.6% of cases, respectively. Median weight at birth was 2500mg. The incidence of preeclampsia was 57.9%.Overall 89.5% of the children survived. Median post-biopsy follow-up was 64months. Maternal mortality was not observed during the follow-up period. End stage kidney disease developed in one patient. The results of percutaneous kidney biopsy led to therapeutic decisions in 73.7% of cases. Although percutaneous kidney biopsy is not frequently performed during pregnancy, it is relativelysafe and usuallydiagnostic, and may guide further follow-up.

Does mode of delivery impact the course of cervical dysplasia in pregnancy? A review of 219 cases

ObjectiveThe prevalence of cervical intraepithelial neoplasia (CIN) in pregnancy is about 1%.The aim of this study was to analyze the regression, persistence and progression rates of cervical dysplasia in pregnancy and the impact of delivery mode. Study designIn this retrospective study, data from pregnant patients with abnormal cytology findings, who presented to a colposcopic outpatient clinic of a university hospital within the last 10 years, were analyzed. Information on cytology, histology and Human Papillomavirus (HPV) status during pregnancy and postpartum and mode of delivery was collected. Results219 women, who were assessed with cytology and /or biopsy antepartum and postpartum between January 2010 and July 2020, were included in the study. Antepartum patients presented with low grade squamous intraepithelial lesions (LSIL) in 37% and high grade squamous intraepithelial lesions (HSIL) in 53%. During pregnancy biopsy was performed in 78 patients (36%). Postpartum evaluation revealed an overall regression rate of 39%. Persistence rates were especially high in the HSIL group with 70 %. HSIL regressed in 28 %. Progression to invasive disease was rare and seen in two patients postpartum only. 141 women delivered vaginally (VD) and 51 received a cesarean section (CS). Regression rates were similar: 36 % and 47 %. There was no significant difference in progression or persistence rates. ConclusionOur study demonstrates that mode of delivery does not influence the course of SIL. SIL show high rates of regression and persistence, progression to invasive disease is rare.

Kidney Imaging and Biopsy in Pregnancy.

Physiologic glomerular, tubular, and structural changes related to pregnancy may complicate the detection of underlying kidney disease in pregnant patients. Imaging studies may provide important clinical information to assist in the diagnosis and treatment of kidney disease during pregnancy. Furthermore, in select patients who develop new or worsening kidney disease in pregnancy, kidney biopsy may be essential to ensure the accuracy of diagnosis and guide treatment choices. This review article will discuss the risks and benefits of various modalities used to image the kidneys and urinary tract during pregnancy to aid in the judicious selection of appropriate imaging studies that are likely to maximize clinical benefit while minimizing fetal risk. It will also highlight the potential benefits and harms associated with antepartum kidney biopsy and will offer strategies for identifying patients who are most likely to benefit from kidney biopsy during pregnancy.

High-resolution epigenomic liquid biopsy for noninvasive phenotyping in pregnancy.

We explored the potential of genome-wide epigenomic liquid biopsy for the comprehensive analysis of cell-free DNA (cfDNA) methylation signatures in maternal plasma in early gestation. We used solution phase hybridization for targeted region capture of bisulfite-converted DNA obtained from plasma of pregnant women in early gestation and nonpregnant female controls. Targeted sequencing of ~80.5 Mb of the plasma methylome generated an average read depth across all 17 plasma samples of ~42x. We used these data to explore the pregnancy-specific characteristics of cfDNA methylation in plasma and found that pregnancy resulted in clearly detectable global alterations in DNA methylation patterns that were influenced by genomic location. We analyzed similar, previously published, data from first-trimester maternal leukocyte populations and gestational age-matched chorionic villus (CV) and confirmed that tissue-specific DNA methylation signatures in these samples had a significant influence on global and gene-specific methylation in the plasma of pregnant women. We describe an approach for targeted epigenomic liquid biopsy in pregnancy and discuss our findings in the context of noninvasive prenatal testing with respect to phenotypic pregnancy monitoring and the early detection of complex gestational phenotypes such as preeclampsia and preterm birth.

Updates in Diagnosis and Management of Preeclampsia in Women with CKD.

It is estimated that women with CKD are ten times more likely to develop preeclampsia than women without CKD, with preeclampsia affecting up to 40% of pregnancies in women with CKD. However, the shared phenotype of hypertension, proteinuria, and impaired excretory kidney function complicates the diagnosis of superimposed preeclampsia in women with CKD who have hypertension and/or proteinuria that predates pregnancy. This article outlines the diagnoses of preeclampsia and superimposed preeclampsia. It discusses the pathogenesis of preeclampsia, including abnormal placentation and angiogenic dysfunction. The clinical use of angiogenic markers as diagnostic adjuncts for women with suspected preeclampsia is described, and the limited data on the use of these markers in women with CKD are presented. The role of kidney biopsy in pregnancy is examined. The management of preeclampsia is outlined, including important advances and controversies in aspirin prophylaxis, BP treatment targets, and the timing of delivery.

Conservative Treatment of Stage IA1 Adenocarcinoma of the Uterine Cervix during Pregnancy: Case Report and Review of the Literature

Microinvasive adenocarcinoma (MIAC) of the uterine cervix is rare in pregnancy. Published data on conservative treatment of MIAC both in pregnant and nonpregnant women are scarce. A conservatively treated case of MIAC in a 13-week-pregnant woman after a diagnosis of atypical glandular cells (AGC) on pap smear at the 6th week of pregnancy is presented. The problems of suspected adenocarcinoma in situ (AIS) on biopsy and MIAC on cone biopsy in pregnancy, as well as the risks and benefits of a conservative treatment are discussed. After colposcopic guide laser cervical conization and expression of informed consent the patient underwent followup and vaginal delivery at 40 weeks plus 3 days of gestation. In this case, no obstetric complication has been recorded after the cervical conization, and after a followup of 18 months the patient was alive and free of disease, with negative results as far as pap smear, colposcopy, HPV status, and cervical curettage are concerned. In a stage Ia1 disease of endocervical type, with clear margins and without lymph-vascular space invasion, cervical conization performed during the second trimester may be considered a definitive and safe treatment, at least up to delivery, after expression of informed consent by the woman.

Kidney biopsy in pregnancy: evidence for counselling? A systematic narrative review

Kidney diseases, which have a prevalence of 3% in women of childbearing age, are increasingly encountered in pregnancy. Glomerulonephritis may develop or flare up in pregnancy, and a differential diagnosis with pre-eclampsia may be impossible on clinical grounds. Use of kidney biopsy is controversial, but a systematic review has not been carried out to date. To review the literature on kidney biopsy in pregnancy, with a focus on indications, risks and timing. Medline, Embase, CHINAL and the Cochrane Library were searched in September 2012, with 'pregnancy' and 'kidney biopsy' used as MESH and free terms, for the period 1980-2012. Results were filtered for 'human' if this option was available. Biopsies during pregnancy and within 2months after delivery. Case reports (fewer than five cases) and kidney grafts were excluded. Paper selection was performed in duplicate. Data were extracted in duplicate. The high heterogeneity in study design necessitated that the review be narrative, except for data on adverse events, which were analysed with regard to the timing of kidney biopsy. Of 949 references, 39 were selected, providing data on 243 biopsies in pregnancy and 1236 after delivery (timing was unclear in 106 women). The main aims of the studies were to define morphology in pre-eclampsia (23 studies), to carry out a risk-benefit analysis of kidney biopsy (11 studies), and to investigate pregnancy-related acute kidney injury (five studies). Four cases of major bleeding complications occurred at 23-26weeks of gestation. Relevant complications were observed in 7% of women during pregnancy and 1% after delivery (P=0.001). Kidney biopsy performed for the diagnosis of glomerulonephritis or pre-eclampsia led to therapeutic changes in 66% of cases. The evidence on kidney biopsy in pregnancy is heterogeneous, but a significantly higher risk of complications (relative to postpartum biopsy) was found, with a possible peak at around 25 gestational weeks.

P22. Systematic review of sentinel lymph node biopsy in pregnancy associated breast cancer

P22. Systematic review of sentinel lymph node biopsy in pregnancy associated breast cancer

Renal biopsy and pregnancy

Objective: Our aim was to review our experience with renal biopsy in pregnancy. Study Design: We reviewed 18 renal biopsies performed during pregnancy or in the immediate postpartum period at the University of North Carolina. Indications, histopathologic findings, complications, and neonatal outcome were reviewed for each case. Results: Fifteen patients underwent biopsy during the antepartum period and 3 in the postpartum period. Only 5 patients had the classic histopathologic preeclamptic lesion glomeruloendotheliosis confirmed. There were 7 identifiable renal hematomas after biopsy; 2 patients required blood transfusion. There were 4 intrauterine fetal deaths in this series; it is presumed that none were a result of the biopsy. Conclusion: Renal biopsy in pregnancy is a morbid procedure and should be considered only if it offers the opportunity to make a diagnosis other than severe preeclampsia in a patient remote from term. (Am J Obstet Gynecol 2001;184:1093-6.)

Benefits and Risks of Directed Biopsy in Pregnancy

Department of Obstetrics and Gynecology 1, Hautepierre University Hospital, Strasbourg, France. J Lower Genital Tract Dis 1997;1:214-220.

Benefits and risks of directed biopsy in pregnancy.

Our aim was to assess the risks of directed biopsy in pregnant women and to compare its reliability to that of colposcopy. One hundred seventy six gravidas, whose final diagnosis could be ascertained either by the histological analysis of a surgical specimen or by a sufficiently informative postpartum follow-up, were examined by the same colposcopist. The reliability of colposcopy and directed biopsy were compared using the McNemar χ test for univariate analysis and the Mantel-Haenszel χ test for multivariate analysis. Directed biopsies were performed in 128 patients (72.7%), only 1 of whom experienced hemorrhage requiring vaginal packing. No other complications occurred, and premature labor was not more frequent after biopsy. The reliability of biopsy was significantly higher than that of colposcopy (82.6 vs 65.2%; p < .005). Among patients with accurate biopsy but discordant colposcopy, the final diagnosis was normal cervix, low-grade cervical intraepithelial neoplasia (CIN), high-grade CIN, and cancer in 48.4, 29.0, 22.6, and 0% of cases, respectively. When results were stratified by final diagnosis, biopsy was no more accurate than was colposcopy, regardless of cytological findings, colposcopic impression, gestational age, parity, or colposcopist's experience. One of the two occult invasive cancers correctly diagnosed by biopsy had an unsatisfactory colposcopy suggesting invasion. The difficulties of colposcopy during pregnancy and the minimal risks of directed biopsy justify a biopsy in gravidas when either cytology or colposcopy suggests at least a high-grade CIN, to ensure that no cancer has been overlooked.

Cone cerclage in pregnancy

We report a technique of cone cerclage and the results and outcome in 17 patients who required a diagnostic cone biopsy in pregnancy. The mean age of the patients was 30.6 years (range 21-41). The mean gestational age was 18.8 weeks (range 10-32) at the time of the procedure. There were no major complications and hemorrhage was not a significant problem. There were no second-trimester abortions. Two patients required beta-sympathomimetics to suppress uterine activity for longer than 24 hours after the procedure. Six patients had invasive carcinoma, nine had cervical intraepithelial neoplasia (CIN) III, and two had CIN II. In 14 cases, the endocervical and ectocervical margins were negative; two patients with CIN and one with multifocal microinvasion had positive margins. Cone cerclage is a safe and easy method for performing diagnostic cervical conization during pregnancy.

CONE CERCLAGE IN PREGNANCY

We report a technique of cone cerclage and the results and outcome in 17 patients who required a diagnostic cone biopsy in pregnancy. The mean age of the patients was 30.6 years (range 21-41). The mean gestational age was 18.8 weeks (range 10-32) at the time of the procedure. There were no major complications and hemorrhage was not a significant problem. There were no second-trimester abortions. Two patients required beta-sympathomimetics to suppress uterine activity for longer than 24 hours after the procedure. Six patients had invasive carcinoma, nine had cervical intraepithelial neoplasia (CIN) III, and two had CIN II. In 14 cases, the endocervical and ectocervical margins were negative; two patients with CIN and one with multifocal microinvasion had positive margins. Cone cerclage is a safe and easy method for performing diagnostic cervical conization during pregnancy.

Renal biopsy: indications and complications in pregnancy.

A series of 111 renal biopsies performed in 104 pregnant women during the past 20 years at The Royal Melbourne Hospital and Royal Women's Hospital, Melbourne were reviewed. The indications for biopsy and the histological findings are detailed. The complication rate was very low (4.5%). It is concluded that the procedure is safe and that renal biopsy during pregnancy yields a definitive histological diagnosis in almost all cases. The indications for renal biopsy in pregnancy are discussed.

Colposcopy in the management of abnormal cervical smears in pregnancy

Forty-seven pregnant patients with abnormal cervical cytologic findings (Class III or IV) were evaluated by means of colposcopically guided biopsies. In no instance were mandatory indications for conization present. No invasive cancers were found on biopsy nor on later histologic re-evaluation. Of 37 patients who had carcinoma in situ or severe dysplasia on colposcopic biopsy in pregnancy, 25 showed a persistent lesion of the same severity on later histologic examination, while 12 showed a lesion of lesser severity. The importance of close and expert cooperation between colposcopist, cytologist, and pathologist is stressed, as is good follow-up of patients evaluated in this manner.