Obstetric Medicine最新文献

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.

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.

Although tumor necrosis factor inhibitors are recommended for preventing flare-ups in pregnant women with ulcerative colitis (UC), studies on golimumab use during pregnancy are scant. Herein, we present a 39-year-old woman with UC and spondyloarthritis. The patient preferred treatment with a long dosing interval that minimally affects the working life of the patient. Golimumab, considering its long dosing interval, was prescribed after discussion with the patient, physician and pharmacists. Clinical remission was achieved during pregnancy, and the patient delivered a healthy baby. The vaccines were administered according to the vaccine schedule: during the first year after birth, there were neither infections caused by live vaccines nor diseases that the administered vaccines are meant to prevent. Overall, this case suggests that golimumab treatment during pregnancy may be compatible; however, further evaluations, including drug-level analysis, are needed.

Background: There is limited information surrounding physical changes people with cerebral palsy (CP) experience during pregnancy.

Methodology: This is a subgroup analysis of an international online questionnaire, developed with input from individuals with CP. Data collection included demographics, baseline functional status, and functional status changes during pregnancy. Descriptive analysis was used.

Results: 158 participants from 15 countries participated of which 30 had a total of 49 pregnancies resulting in birth. Worsened strength, spasticity, bladder function and fatigue occurred in 56.5% (13/23), 47.8% (11/23), 56.5% (13/23) and 87.0% (20/23) of participants. 9/23 (40.9%) required new mobility devices. Worsening of fatigue, strength, spasticity and need for a new mobility device was reported by all groups regardless of functional status.

Conclusions: People with CP may experience significant functional changes during pregnancy, even those who mobilized independently prior to pregnancy. These findings may inform obstetricians, nurses, neurologists and physiatrists, and contribute to preconception counselling.

Background: Pulmonary embolism (PE) is a common cause of maternal death during pregnancy and the puerperium yet data on its prevalence in middle-income countries is lacking.

Methods: We examined the medical records and CTPA (computed tomography pulmonary angiography) images of 67 women in an obstetric high care unit during pregnancy and the puerperium. We aimed to determine the prevalence of PE in a high-risk obstetric population undergoing CTPA, assess associated clinical features in this cohort, and determine the prevalence of alternative CT findings.

Results: CTPA detected PE in 11 women (16.42%) and alternative CT findings in 46 (68.6%). Women with PE had a lower systolic blood pressure than those without PE (P = 0.001). Multiple gestation, preterm rupture of membranes, and gestational diabetes were linked to higher PE prevalence.

Conclusions: This study, set in an upper middle-income country, demonstrated a higher CTPA yield for PE and alternative diagnoses than in international literature, emphasising context-specific assessments.

Background: With the advances in medicine and imaging, renal biopsy is increasingly utilised for identifying pathologies during pregnancy.

Methods: This retrospective observational study aimed to assess indications and complications among 32 women who underwent native renal biopsies during pregnancy and postpartum from 2015 to 2022.

Results: The commonest indications for performing the biopsy were nephrotic syndrome and acute kidney injury during pregnancy or immediately postpartum. Most (62.5%) had biopsies performed in the antenatal period. Lupus nephritis was the most common finding on biopsy, and there were no procedure-related serious adverse effects. Most pregnancies were complicated by hypertensive disorders and preterm birth. All except six women with perinatal loss had healthy neonates.

Conclusions: Even as kidney biopsy remains the gold standard for diagnosing renal pathologies, it should be reserved for women where management in pregnancy would be altered by the result.

Ptyalism gravidarum, or sialorrhoea, is a highly distressing maternal condition characterised by excess salivation and difficulty swallowing saliva, requiring the affected woman to frequently expectorate. The literature is sparse and somewhat conflicting. There are marked geographical and cultural differences in prevalence. The aetiology is not known, and no trials have been performed with respect to treatment modalities. A review of the available literature is presented, and possible future directions for research are suggested.

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.