Summary
Background
Women with inflammatory bowel diseases (IBD) often receive biologicals during pregnancy to maintain disease remission. Data on outcome of vedolizumab‐exposed pregnancies (VDZE) are sparse.
Aims
To assess pregnancy and child outcomes of VDZE pregnancies and to compare these results to anti‐TNF exposed (TNFE) or both immunomodulatory and biologic unexposed (CON IBD) pregnancies.
Methods
A retrospective multicentre case‐control observational study was performed.
Results
VDZE group included 79 pregnancies in 73 IBD women. The TNFE and CON IBD group included 186 pregnancies (162 live births) in 164 IBD women and 184 pregnancies (163 live births) in 155 IBD women, respectively. At conception, cases more often had active disease ([VDZE: 36% vs TNFE: 17%, P = .002] and [VDZE: 36% vs CON IBD: 24%, P = .063]). No significant difference in miscarriage rates were found between groups (VDZE and TNFE: 16% vs 13%, P = .567; VDZE and CON IBD: 16% vs 10%, P = .216). In live‐born infants, median gestational age and birthweight were similar between groups. Median Apgar score at birth was numerically equal. Prematurity was similar in the VDZE group compared to the control groups, even when correcting for disease activity during pregnancy. The frequency of congenital anomalies was comparable between groups as were the percentages of breastfed babies. During the first year of life, no malignancies were reported and infants' infection risk did not significantly differ between groups.
Conclusion
No new safety signal was detected in VDZE pregnancies although larger, prospective studies are required for confirmation.
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Encephalocele (E) is a defect of the neural tube that refers to congenital malformations featured by skull defect and dura with extracranial spread of intracranial structures. Occipital encephalocele (OE)are the most common form of this congenital disorder and are manifested as a swelling of different sizes over the occipital bone in the midline. They are more frequent in females than in males. Although the exact cause of E is unknown, it is probably multifactorial , including both genetic and environmental factors. The incidence is between 1 in 3000 to 1 in 10,000 live births; approximately 90% of them involve the midline. Magnetic resonance imaging is the method of choice in diagnosis of OE and surgery is the best option for the treatment of OE. Overall morbidity and mortality is still high in spite of advenced surgical management ,but have been significantly improved in recent years thanks to sophisticated high-resolution imaging , adequate and proper surgical treatment and decent post-operative care.
The hypoglossal artery is rarely described member of carotid-basilar family anastomoses. Together with a caudal end of the primitive internal artery, trigeminal, otic, and proatlantal intersegmental arteries, it represents the remnant of vascular channels' unsuccessful involution which function normally stops in human embryo with 12 to 14 mm crown-rump length. The persistence of hypoglossal artery alone is usually incidental and asymptomatic finding during the routine angiography, while during autopsies or surgical operations, its presence is frequently associated with other vascular or organic abnormalities and diseases. The aim of this review is to document the hypoglossal artery developmental morphology, as well as the normal anatomical and clinical aspects and better understanding of its persistence overall significance.
Two rare cases of the circle of Willis are presented. One of them represents a fetal circle of Willis (crown-rump length, or CRL, 17 cm), the other one is adult circle from a male cadaver 65 years of age. Arterial variations and abnormalities of the represented circles of Willis are described. Interpretation of the appearance of variations and abnormalities is based on the acceptable embryological, anatomical, and clinical reports. Summarizing these opinions, we have supplemented them with a hypothesis that arterial variations and abnormalities could preserve their relationships because of constant interaction between primitive arterial remnants and cerebral arteries in postnatal life, unless some pathological lesions appear.
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