Obstetric Medicine最新文献

Disseminated intravascular coagulation (DIC) is a potentially fatal condition commonly encountered in the context of obstetric complications. Various ocular manifestations have been reported as a consequence of DIC such as choroidal infarctions and vitreous and orbital hemorrhage. We report a case of a 24-year-old female, who developed DIC secondary to placental abruption at 33 weeks' gestation with a bilateral panophthalmitis-like picture, hyphema, and corneal blood staining.

New-onset refractory status epilepticus (NORSE) is a rare condition in which a previously healthy individual develops refractory seizures without an identifiable cause. In pregnancy, management is particularly challenging due to the need to control seizures while minimizing teratogenic risk for the fetus. We report a 22-year-old woman who developed NORSE at 19 weeks' gestation following recurrent tonic-clonic seizures. Treatment included multiple antiseizure medications: levetiracetam, oxcarbazepine, lacosamide, clobazam, and lamotrigine. Due to super-refractory status, she required intubation and sedation with propofol and midazolam and was extubated once seizure-free. Following a breakthrough seizure and suicide attempt, levetiracetam was replaced with brivaracetam. Fetal growth and biophysical profile remained appropriate on serial surveillance. She underwent term induction of labor, delivering a healthy neonate without signs of withdrawal. This is the first reported case of second-trimester NORSE with favorable perinatal outcomes, underscoring the need for a multidisciplinary approach to balance seizure control and fetal safety.

Stiff Person Syndrome (SPS) is a rare autoimmune neurological disorder linked to anti-GAD antibodies, marked by muscle rigidity, spasms, and heightened sensitivity to stimuli, predominantly affecting axial muscles. Managing SPS during pregnancy is complex and necessitates a multidisciplinary approach. This case report details the management of a 32-year-old pregnant woman with SPS and type 1 diabetes mellitus. Diagnosed 10 years prior to pregnancy, her SPS was managed with intravenous immunoglobulin, diazepam, and baclofen. During pregnancy, adjustments were made to minimise potential risks; diazepam was replaced with clonazepam near delivery to support breastfeeding, and IVIG dosing was modified based on symptoms. Her type 1 diabetes remained well controlled with an insulin pump. Delivery planning addressed risks of SPS spasms, shoulder dystocia, and caesarean recovery. This case highlights the importance of individualised care and collaboration among specialists in managing pregnancy with SPS.

Background: : Gitelman's syndrome (GS) and Bartter's syndrome (BS) are rare renal disorders causing electrolyte disturbances, with physiological changes of pregnancy potentially worsening symptoms and electrolyte derangement.

Methods: A literature search of electronic databases was conducted using terms describing (1) GS or BS and (2) pregnancy, and the quality of studies was graded using the NIH/NHLBI quality assessment tool. Data collected included measures of maternal and neonatal outcomes, pregnancy information, and details of treatment, diagnosis, and electrolyte monitoring.

Results: Fifty-eight pregnancies in 52 women were reported in GS, and 55 pregnancies in 27 women were reported in BS. Adverse events and symptoms, including intrauterine growth restriction, oligohydramnios, preterm birth, fatigue, weakness, and paraesthesia, were commonly reported. The mainstay of therapy remains oral and intravenous electrolyte replacement coupled with frequent monitoring.

Conclusions: The management of GS and BS in pregnancy presents a challenge and has the potential for significant maternal and neonatal morbidity.

Salmonella typhi in Australia is uncommon, with a reported incidence of less than 1 per 100,000. In pregnancy, untreated Salmonella can lead to complications including intrauterine fetal death and preterm labour. Described here is a woman who travelled home to India for a month in the second trimester of her pregnancy and contracted the illness there. She had a protracted incubation phase with the bacterium, initially having negative stool samples and then testing positive almost a month after her return. Despite a delay in antibiotic treatment, she went on to recover from her illness and have an uncomplicated vaginal delivery. S. typhi should be considered in the differential for a febrile patient with a recent travel history.

Antisynthetase syndrome (anti-SS) is an autoimmune condition characterised by autoantibodies against aminoacyl tRNA synthetases. Clinical features can include interstitial lung disease (ILD), myositis, Raynaud's phenomenon and arthritis. Described here is a 25-year-old pregnant woman with anti-SS with worsening ILD in the latter part of pregnancy, requiring emergency delivery at 36 weeks and 3 days of gestation.

Nausea, vomiting and anaemia are common complications of pregnancy. A case of hyperemesis and unexplained anaemia in a woman of South Asian ethnicity is presented. Further investigation revealed hypothalamic-pituitary-adrenal axis insufficiency and lead toxicity, most likely secondary to an Ayurvedic powder she had recently ceased. The importance of considering adulteration of complementary and alternative preparations as a cause of pregnancy complications is discussed.

The early recognition and appropriate management of diseases affecting the retina and choroid is important to optimise visual outcomes. However, treating these conditions in pregnant women may pose unique challenges and requires multidisciplinary collaboration between obstetricians and ophthalmologists. This review provides an overview of chorioretinal conditions that may arise or worsen during pregnancy or labour, their clinical presentation, current evidence on management in pregnant women, as well as their relevance to maternal-fetal health.

Background: Hereditary spherocytosis (HS) is a genetic haemolytic anaemia, mainly inherited in an autosomal dominant manner. Management varies by severity, and limited data exist on HS in pregnancy in India; this study assesses clinical and obstetric outcomes in affected women.

Methods: This retrospective study at JIPMER from 2014 to 2020 included 10 pregnant women with confirmed HS identified from labour room records. Data on demographics, medical and obstetric history, clinical presentation, pregnancy course, delivery details, complications, maternal and neonatal intensive care unit admissions, laboratory findings and postpartum outcomes were collected using a structured proforma.

Results: This case series of 10 pregnant women with HS highlights anaemia, jaundice, and weakness as common symptoms confirmed by laboratory findings. Most had term vaginal deliveries; one required caesarean section due to complications. Neonatal outcomes were favourable, with no neonatal HS cases. Anaemia was more pronounced in women without splenectomy, while splenectomised patients showed greater hematologic stability. Bone marrow findings indicated compensatory erythroid hyperplasia. Diagnosis relied on clinical and haematological criteria, as genetic testing was not performed.

Conclusion: HS in pregnancy is rare but manageable with appropriate antenatal care. This study confirms its classical presentation in the Indian population and supports early diagnosis, Eosin-5-maleimide testing and supportive management. Genetic testing and improved postnatal surveillance are recommended.

Septic arthritis of the pubic symphysis is a rare but potentially life-threatening condition, particularly in the peripartum period. This case report details a 32-year-old woman in her first pregnancy, who developed severe pelvic pain, fever, and immobility following induction of labor at 41 weeks and 2 days of gestation. Initially diagnosed with chorioamnionitis, the patient underwent a caesarean section, but persistent groin pain and elevated inflammatory markers led to the discovery of septic arthritis of the pubic symphysis, confirmed by computed tomography and magnetic resonance imaging. Blood cultures grew methicillin-sensitive Staphylococcus aureus. The patient was treated with a 6-week course of intravenous cefazolin, and her condition complicated by endocarditis. Despite the severity of her illness, she made a full recovery and went on to have a successful subsequent pregnancy. This case emphasizes the importance of considering septic arthritis in peripartum pelvic pain, as early detection and treatment can prevent severe complications and preserve functional recovery.