Obstetric Medicine最新文献

Primary aldosteronism is one of the important causes of secondary hypertension. However, pregnancy with primary aldosteronism is rare. Eplerenone is an aldosterone antagonist which is used in the treatment of primary aldosteronism. This is a case of successful pregnancy outcome in a young woman who was known to have primary aldosteronism and was on oral eplerenone from preconception. There are only five case reports on eplerenone use during pregnancy in the literature.

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.

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.

Background: Research benefits from the incorporation of patient-important outcomes. We interviewed individuals after a critical illness during pregnancy to identify outcomes for the development of a core outcome set (COS).

Methods: Participants were identified through intensive care unit (ICU) admissions in Toronto, Canada, and Barranquilla, Colombia. Interviewers used a semi-structured guide, and discussions were recorded and transcribed. Transcripts underwent inductive thematic analysis to delineate themes and patient-important outcomes.

Results: Twelve individuals were interviewed. Twenty-six patient-important outcomes were elicited, which represented the core outcome areas of mortality (n = 1), physiological/clinical outcomes (n = 7), functioning and life impact (n = 13), resource use (n = 4) and adverse events (n = 1). These related to five identified themes of mental well-being, quality of care delivered, clinicians' communication, regaining functional independence and mother-newborn separation.

Conclusions: This qualitative study identified patient-important outcomes from persons with lived experience of critical illness in pregnancy which will inform the development of a COS.

Pregnancy-associated pulmonary embolism (PA-PE) is a life-threatening presentation however literature surrounding its optimal management is limited. This case describes a case of PA-PE treated with catheter-directed thrombolysis after clinical deterioration despite standard anticoagulation therapy. Careful multidisciplinary planning is required to successfully manage the deteriorating patient with PA-PE with catheter-directed thrombolysis being considered as potential first-line therapy in these patients.

Familial chylomicronaemia syndrome (FCS) is a rare genetic disorder characterised by significantly elevated triglyceride levels which increases the risk of acute pancreatitis. Due to the changes in lipid metabolism during pregnancy, triglyceride levels may rise further, particularly in the third trimester, and cause challenges in the management of these patients. Apart from strict dietary restriction of all fats, there is limited evidence on the efficacy of pharmacological treatment with omega-3 fatty acids and fibrates in maintaining triglyceride levels below the desired threshold of 10 mmol/L. Familial chylomicronaemia syndromes are particularly resistant to treatment and escalation of treatment to more invasive procedures such as plasma exchange may be required in pregnancy. We present two cases of FCS in pregnancy which posed different challenges and both required management with plasma exchange but led to the safe delivery near term without adverse consequences to the mother or fetus.

Background: Preeclampsia is an independent risk factor for vascular diseases. The Postpartum Preeclampsia Clinic (PPPC) intervenes in the first year postpartum to address these risks. This study aims to characterize physicians' understanding and management of the cardiovascular risk associated with preeclampsia and whether this differs in physicians who had a patient attend the PPPC.

Methods: Family physicians, obstetricians, internists, obstetric internists, and cardiologists in Edmonton were anonymously surveyed. Results were analyzed using SPSS.

Results: Sixty-four surveys were returned, with physicians correctly identifying preeclampsia as a vascular risk factor 73% of the time. Physicians who had a patient attend the PPPC were more likely to counsel patients on their increased cardiovascular risk, although increased knowledge did not reach statistical significance.

Conclusion: Vascular risk reduction clinics may benefit the long-term management of patients with a history of preeclampsia by improving counseling by physicians, which may reduce the disproportionate vascular morbidity these patients face.

Background: Female childhood cancer survivors with history of bone marrow transplant with or without total body irradiation have increased pregnancy risks. Preconception counselling and early referral to appropriate clinical pathways may improve pregnancy outcomes.

Methods: UK-wide survey of clinicians, promoted via social media and conferences, jointly funded by Action Medical Research/Borne.

Results: Forty responses received between 22 October 2020 and 21 October 2021: 43% reviewed this group monthly, 15% annually, 15% less than annually, and 27% never (for O & G only: 13%, 13%, 26%, and 48%, respectively).Pre-pregnancy, most discussed potential fertility/pregnancy implications.Early pregnancy discussions included late miscarriage (34%), preterm birth (44%), fetal growth restriction (31%), and health risks other than cancer (30%).During pregnancy: 80% refer to specialist clinics; 87% offer extra investigations; 33% prescribed aspirin; 20% offered cervical cerclage; and 13% prescribed progesterone.

Conclusions: Evidence of variation in care. As previous observations suggest pregnancy outcomes improve when managed in specialist clinics, clearer guidance is required.

Extracellular vesicles (EVs) are small, nonreplicating, lipid-encapsulated nanoparticles that carry protein and nucleic acid cargo derived from their tissue of origin. Due to their capacity to provide comparable insights to solid organ biopsy through a minimally invasive collection procedure, EVs provide an attractive biomarker source. This review will provide an insight, how EVs in circulation may provide a novel way to assess cholestasis and will address the possibility of getting a better understanding of the mechanisms of cholestasis of pregnancy through the use of serial hepatic-specific EVs as a window.

In this paper, we discuss the Bile Acid Comparison and Harmonisation project, a sub-study of the Trial of URsodeoxycholic acid vs RIFampicin in early-onset severe Intrahepatic Cholestasis of pregnancy, giving an overview of the current state of affairs for total bile acid measurements.