Obstetric Medicine最新文献

Objectives: The objective of this study was to assess transthoracic echocardiography (TTE) parameters in pregnancy by race and ethnicity.

Methods: We performed a retrospective cohort study of pregnant individuals without cardiovascular disease who underwent a perinatal TTE between October 2017 and May 2022. Demographics and echocardiographic parameters were compared by race/ethnicity. Multivariate regression analysis was performed for TTE parameters after adjusting for age and hypertension.

Results: During the study period, 369 individuals had TTEs with a mean age of 31.8 ± 6.0 years old. Subjects were 55.3% White, 24.7% Hispanic, 14.1% Black, and 6.0% Asian. TTE parameters of left ventricular (LV) ejection fraction and LV mass index differed by race/ethnicity, though no difference was seen in cardiac geometry.

Conclusion: The differences in TTE parameters may not be clinically significant as most values fall within normal clinical ranges. Further prospective studies are needed to better evaluate cardiac outcomes by differences in echocardiographic parameters in pregnancy.

This primigravid pregnant woman had a new diagnosis of primary biliary cholangitis (PBC) that was treated with a combination of ursodeoxycholic acid (UDCA) and bezafibrate. Pregnancy may unmask underlying chronic hepatic disorders in susceptible women and, in some cases, the associated abnormalities of liver function or increased serum bile acids (hypercholanaemia) can result in significant fetal and maternal risk. Maternal pruritus, with associated sleep deprivation, may cause considerable distress. To our knowledge, this is the first reported case of a new diagnosis of PBC in pregnancy treated with a combination of both UDCA and a fibrate. The case demonstrates the importance of accurate and efficient diagnosis alongside effective multidisciplinary team working to initiate appropriate, timely treatment to minimise the risk to fetus and mother. Early assessment, risk stratification and cautious surveillance is paramount in managing evolving or coexisting pathology plus individualised delivery planning, aiming to optimise fetal and maternal outcomes.

Background: Cannabinoid hyperemesis syndrome (CHS) is a syndrome of cyclic nausea and vomiting in the setting of chronic cannabis use. To date, only 11 cases of CHS in pregnancy have been reported.

Case presentation: We describe two cases of uncontrolled vomiting in pregnancy due to CHS. Case 1 represents a 30-year-old Caucasian woman presenting in the 5th week of gestation with nausea, vomiting and abdominal pain intermittently of 1 week duration. Physical work-up was normal, and symptoms resolved with supportive treatment within 3 days, only to occur again at the 14th week of gestation, and again at the 30th week of gestation. Link between symptom relief and hot bathing led to suspicion for CHS, confirmed with positive cannabis urine toxicology screening. Nausea, vomiting and pain subsided with cannabis cessation, and baby was born healthy at 38 + 5 weeks gestation. Case 2 describes a 28-year-old Caucasian woman presenting in the 16th week of gestation with nausea, vomiting and abdominal pain. Physical examination was normal, and symptoms self-resolved. Two weeks later, in the 18th week of gestation, the patient re-presented to the emergency room with sudden re-occurrence of nausea, vomiting and abdominal pain. Once again, a link between symptom relief and hot bathing was noted on admission. The patient was educated on possible links of chronic cannabis use with CHS symptoms and subsequently relayed extensive (>14 years) cannabis use history. Symptoms resolved with cannabis cessation. Baby was born at 37 weeks gestation, with low birth weight of 2180 g requiring 5 days neonatal intensive care unit (NICU) treatment. Regular follow-up up to 5 months post-partum confirmed no CHS relapse with cannabis cessation.

Conclusion: CHS in pregnancy is likely under-reported, reflective possibly of limited physician and patient awareness of this condition, as well as patient concealment of cannabis use in pregnancy. In cases of severe, cyclic nausea and vomiting in pregnancy unresponsive to typical anti-emetic treatment, comprehensive social history including cannabis use should be sought, and associated hot bathing for symptomatic relief out-ruled.

Introduction: This systematic review is the first step in the process of standardizing outcome reporting through the development of a core outcome set for research on critically ill obstetric patients (COSCO).

Methods: A five-database search was performed to identify randomized and non-randomized studies published before November 2017, on patients admitted to intensive care or high-dependency units during or immediately after pregnancy. Reported outcomes were categorized into domains and definitions were documented.

Results: Of the 12,581 citations reviewed, 136 studies were included. The most reported outcome domains were maternal all-cause mortality (n = 128, 94.5%), resource use (n = 116, 85.6%), and clinical/physiological outcomes (n = 111, 82.8%). Outcomes related to functioning/life impact and adverse effects of treatment were only reported in four (2.9%) studies. There was inconsistency in outcome definitions.

Conclusions: This review identified considerable variation in outcome reporting and definitions and generated an outcome list to consider in COSCO development.

Pregnancy after laparoscopic adjusted gastric banding (LAGB) is thought to be safe and lowers the risk for maternal obstetric complications, without causing a difference in birth weight or a higher incidence of neonatal complications. Even though LAGB complications in pregnancy are rare, they are often severe and can cause significant maternal and neonatal morbidity. This report outlines the case of a pregnant 32-year-old female with gastric band slippage in the third trimester and provides a summary of the literature on LAGB complications in pregnancy and their management.

[This corrects the article DOI: 10.1177/1753495X221118168.][This corrects the article DOI: 10.1002/anr3.12133.].

Generalised pustular psoriasis of pregnancy (GPPP) is a rare dermatosis that presents in the third trimester. It merits careful clinical assessment given the difficulty in diagnosis, impact on maternal health and association with placental insufficiency. We present a case of generalised pustulosis in a pregnant woman at 30 weeks' gestation and describe the clinico-pathological challenges in obtaining a diagnosis of GPPP. Furthermore, we provide evidence from cardiotocography and ultrasound of evolving fetal compromise and describe how intensive management can facilitate a positive maternal-fetal outcome.

Labrune syndrome is a rare neurological autosomal recessive condition characterised by leukoencephalopathy, cerebral calcification and parenchymal cysts. Pregnancy has not been previously reported in an individual with this condition. This case report details the pregnancy of a primiparous woman with Labrune syndrome and neurofibromatosis type 1 who experienced a seizure in the second trimester of pregnancy, but went on to deliver her baby at term with good outcome for mother and baby. The case highlights the importance of pre-pregnancy advice in women with genetic conditions, and a multidisciplinary approach to the care of women with rare and complicated medical conditions during pregnancy.

Kasabach-Merritt syndrome (KMS) is a coagulopathy characterized by thrombocytopenia and hypofibrinogenemia associated with large vascular tumors. KMS can lead to disseminated intravascular coagulation which, if not treated promptly, can be life-threatening. There are few reported cases of this syndrome and its evolution in pregnant women.