Obstetric Medicine最新文献

Objective: To evaluate functional changes in patients with spinal cord injuries (SCIs) during and after pregnancy.

Method: This is part of an international observational questionnaire examining pregnancy outcomes of people with SCI. Parameters assessed included pain, fatigue and bladder function. Participants categorized functions as improved, no change, or worsened during pregnancy and based on longstanding differences following delivery. Descriptive analysis was used.

Results: This analysis included 263 pregnancies beyond 20 weeks' gestation. Overall level and types of injuries, fatigue (66.7%), bladder function (65.9%), and edema (42.3%) were the most commonly reported aspects of functional health that worsened during pregnancy.

Conclusions: Worsening fatigue and bladder function are the most common symptoms during pregnancy. Recovery is common in the post-partum period; however, nearly one-third of people experience longstanding changes. This study may provide guidance for pre-pregnancy consultation and inform expectations of pregnant people with SCI and their health care providers.

Falling insulin requirements during pregnancy in women with diabetes mellitus in pregnancy raise concerns regarding placental insufficiency and adverse pregnancy outcome. A case of a rapid fall in insulin requirements in a woman with type 2 diabetes mellitus, obesity, hypertension and chronic kidney disease at 23 weeks' gestation with high titres of insulin antibodies is presented. The possibility of exogenous insulin autoimmune syndrome as a cause for hypoglycaemia and reduction in insulin requirements is discussed.

Psoas abscess is a rare medical condition caused by the formation of a collection in and around the psoas muscle. It can be classified as primary or secondary. Primary causes include staphylococcus aureus infection or spreading from a distant area via haematological or lymphatic route, whereas secondary causes are often an extension of inflammatory process near the psoas muscle. This includes collection around the thoracic or lumbar vertebrae, or collection around the pelvic brim. These are the origin and insertion sites of the psoas muscle. Psoas abscess formation secondary to caesarean section is uncommon, with only a few known cases reported. We describe a case of psoas abscess secondary to caesarean section, diagnosis and management. This case illustrates the nonspecific presentation of psoas abscess and clinicians should possess a high degree of suspicion and consider psoas abscess as a diagnosis.

Background and purpose: Prior to dedicated curriculum development for General Internal Medicine (GIM) residency programs, GIM graduates reported feeling unprepared in managing medical disorders seen in pregnancy. This study aims to determine the comfort level of uOttawa IM residents with the management of obstetric patients and define obstetric medicine (OBM) curriculum gaps.

Methods: An online survey to determine critical OBM content, perceived comfort, and existing curriculum helpfulness was administered to IM residents, GIM fellows, as well as GIM staff.

Results: Twenty eight residents and 12 staff responded. Most residents were "somewhat" or "not at all" comfortable with OBM patients. Resident knowledge gaps were perceived by 75% of staff, largely due to limited exposure. Most residents requested more formal or informal teaching focused on acute management and differential diagnosis.

Conclusions: This needs assessment advances our understanding of OBM training gaps and will guide curriculum and resource development for uOttawa IM residents.

[This corrects the article DOI: 10.1177/1753495X251328111.].

Background: Natriuretic peptides, such as active brain-type natriuretic peptide (BNP) and inert N-terminal pro-B-type natriuretic peptide (NT-proBNP), are hormones secreted by the heart in response to increased intraventricular pressure and circulating blood volume. Physiological cardiovascular adaptations during pregnancy result in an increase in BNP secretion. In non-pregnant populations, these peptides are well-established markers for diagnosing heart failure and assessing cardiac risk; however, their clinical usefulness in pregnancy and cardiovascular risk assessment is limited. This paper aims to summarise the possible uses of BNP in pregnancy based on the available literature and research.

Materials and methods: We searched Medline, PUBMED, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for English-language studies published regarding BNP and pregnancy.

Result: BNP and NT-proBNP are valuable markers for diagnosing and predicting cardiac complications in pregnancy, including heart failure, pre-eclampsia, and peripartum cardiomyopathy, and for risk stratification in women with adverse pregnancy outcomes. Recommended upper limits are 50 pg/ml for BNP across all trimesters and 200 pg/ml (first and second trimester) and 150 pg/ml (third trimester) for NT-proBNP. A BNP >100 pg/ml demonstrates high diagnostic accuracy (sensitivity 98%, specificity 92%, PPV 92%, NPV 97%) for cardiac complications. In addition, BNP used in conjunction with sFlt-1/PlGF ratio tests, has improved the predictive capability of delivery in pre-eclampsia (p = 0.011).

Discussion: BNP and NT-proBNP are widely used in emergency settings to differentiate cardiac from non-cardiac causes of dyspnoea and heart failure, but their use in pregnancy-specific conditions remains. The fluctuation of BNP levels with pre-existing cardiac, renal disease and obesity needs further evaluation to identify a useful cut-off for the use of BNP in pregnancy.

Pregnancy after a lung transplant is relatively uncommon with a small number of cases in the literature. Here, a pre-pregnancy counselling appointment is described of a woman with a previous lung transplant due to cystic fibrosis planning pregnancy. The case highlights the clinical considerations before embarking on pregnancy. Pregnancy in a lung transplant recipient confers risk to the mother and fetus. It is critical to advise women on potential risks of pregnancy on lung transplant function, take the opportunity to undertake immunosuppressant tailoring (to avoid teratogenic complications) in conjunction with their specialist team with confirmation of stable allograft function before embarking on pregnancy. Risk stratification after careful consideration of the full history can help identify select individuals where pregnancy might be successful. Open discussion around the regular monitoring of lung function, screening for maternal-fetal complications and the risks are required.

Background: The severity of intrahepatic cholestasis of pregnancy (ICP) reflects peak maternal bile acid (BA) concentration. However, the course of the disease is unclear.

Methods: Longitudinal observational cohort study of individuals with ICP. Serial BA and alanine aminotransferase (ALT) trajectories were determined according to starting severity. Multiple logistic regression identified variables predictive of subsequent disease severity, validated using data from a randomised controlled trial.

Results: Although highly variable, BA concentrations increased across gestation (p > 0.001). Normal ALT concentration at diagnosis predicted concurrent non-severe disease (negative predictive value 94.2% (91.6-96.1%)). Gestational age and BA concentration at diagnosis somewhat predicted later moderate or severe disease (BA ≥ 40 µmol/L: ROCAUC 0.64 (0.58-0.69); BA ≥ 100 µmol/L: ROCAUC 0.68 (0.62-0.73)), similarly in the validation cohort (ROCAUC 0.70 (0.65-0.76) and 0.69 (0.63-0.76), respectively).

Conclusion: An earlier gestation and higher BA concentration at diagnosis increase the likelihood of more severe disease; however robust prediction is limited.