Obstetric Medicine最新文献

Background: Hairy cell leukaemia (HCL) represents less 1% of all lymphoid neoplasms with cases rarely reported in pregnancy. Management of HCL requires multidisciplinary care to optimise maternal and neonatal outcomes.

Methods: A literature search of Ovid MEDLINE and EMBASE for 'hairy cell leukaemia' and 'Pregnancy' was undertaken.

Results: Thirteen cases were reviewed including three within our own institutions. Interferon-alpha was the most prominent treatment at varying doses in n = 3 (23%) patients. Other management included antenatal cladribine and rituximab, post-partum cladribine with and without rituximab, laparoscopic splenectomy and termination of pregnancy. 46.1% (n = 6) of patients birthed vaginally. Due to thrombocytopenia, there was a greater proportion of caesarean delivery under general anaesthetic and half of the cases documented bleeding complications.

Conclusion: Diagnosis and management of HCL in pregnancy is difficult. Women can be managed safely and outcome aims should be the same as non-pregnant patients.

Cerebral venous sinus thrombosis (CVST) is a neurological emergency caused by occlusion of the dural venous sinus and/or the cerebral veins. It is more common in women during pregnancy and puerperium. Described here is a woman with an expanding CVST diagnosed at 36 weeks of gestation who had a successful vaginal delivery at 38 weeks of gestation with meticulous anticoagulation and labour management, multidisciplinary team input and close monitoring.

Acute aortic dissection related to pregnancy is rare, however represented the third most common cause of pregnancy-related cardiovascular death in the 2017 UK-MBBRACE report. The majority of women with pregnancy-related aortic dissection have an underlying inherited syndromic aortopathy, though this is often not recognised until an event. Data regarding the immediate and long-term effects of pregnancy on aortic outcome are not uniform due to publication and ascertainment biases, small sample sizes, inclusion of women whose dissection was the first presentation of the underlying disease, and incompleteness of collected data. Management recommendations are based on relatively low levels of evidence, and there is some variation between society guideline recommendations. This article seeks to review the available evidence regarding pregnancy-related aortic dissection in women inherited syndromic aortopathies, highlighting the importance of pre-conception counselling, genetic testing and a multi-disciplinary team approach to management.

Splenic artery aneurysm (SAA) rupture in pregnancy is an unpredictable and rare emergency associated with maternal and fetal mortality. Ruptured SAA is characteristically diagnosed at laparotomy and managed with splenectomy, with embolisation favoured for uncomplicated cases. We report a case of a ruptured SAA in a morbidly obese pregnant woman with medical comorbidities, who presented as a diagnostic dilemma, but was subsequently managed successfully with interventional radiology at the time of caesarean section.

Haemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory sepsis-like syndrome that accounts for 1% of maternal deaths in the United Kingdom (UK). In 2019, a UK-wide HLH network was developed to provide specialist advice for patients with HLH. Until September 2024, eight individuals had been referred to this service with HLH onset during pregnancy or within 6 months postpartum, and this article summarises their management. Shared themes were of postpartum predominance, with onset typically within a month of delivery, preceding infection, and underlying immune dysfunction. Common therapies included corticosteroids and the interleukin-1 receptor antagonist, anakinra. Most individuals required level 3 care, three were considered for extracorporeal membrane oxygenation, and one died. HLH should be included in the differential of maternal sepsis, given all cases presented with fever and organ dysfunction, particularly if there is ongoing deterioration despite antimicrobial therapy and/or without an identified source.

Radiation-induced brain necrosis (RIBN) is a rare but serious delayed complication of intracerebral radiotherapy. We present the case of a 34-year-old woman with a history of gestational trophoblastic neoplasia (GTN) with brain metastases, who presented with symptoms related to RIBN at 20 weeks' gestation in a subsequent pregnancy. These included right homonymous inferior quadrantanopia and headaches. We describe the imaging and diagnostic tests used to assess for GTN recurrence and the specific management of RIBN in pregnancy within a multidisciplinary care setting.

Background: Pregnancy causes physiological changes, including ureteral compression by the enlarged uterus, leading to hydronephrosis in 90% of cases, though only 3% are symptomatic. This study evaluates outcomes in pregnant women with hydronephrosis managed with or without ureteral stenting to define criteria for intervention.

Methods: A retrospective analysis of 92 symptomatic pregnant women with hydronephrosis diagnosed at MP Hospital (2019-2024) was conducted. Patients were categorized into conservative treatment (Group I) and stenting (Group II). Renal dilation, parenchymal thickness, and infection status were assessed.

Results: Patients in Group II also had hydronephrosis at earlier gestational weeks (p < .001), and also had more male fetuses (p = .033), lower parenchymal thickness (p < .001), and higher infection rates (p < .001).

Conclusion: Indicators for stenting in pregnancy-related hydronephrosis include parenchymal thickness ≤20 mm, renal dilation >30 mm, early symptoms, and infections.

Objective: This systematic review and meta-analysis sought to assess the impact of pregnancy on bioprosthetic valve (BPV) structural valve deterioration. Methods: We searched Ovid MEDLINE, Scopus, Clinicaltrials.gov, and Cochrane Library from inception through October 17, 2022. We included all studies that compared patients with BPV with and without a pregnancy history. The initial search yielded 1748 unique citations that were screened in Covidence by two independent reviewers. Our outcome of interest was structural valve deterioration. Results: We performed random-effects meta-analyses from nine eligible studies. Meta-analysis of 321 individuals with a pregnancy history and 987 control individuals without pregnancy showed there was an increased odds in development of structural valve deterioration among those with a pregnancy history (OR 2.34, 95% CI 1.40-3.89) with an I ² of 59.8%. Conclusions: A pregnancy history was associated with an increased risk of structural valve deterioration; however, further research is needed due to the heterogeneity of results.

Dilated cardiomyopathy in pregnancy, whether diagnosed pre-conception, or occurring de novo during pregnancy, may be associated with significant maternal morbidity and mortality. Hypomagnesaemia is associated with ventricular arrhythmias and may be a risk factor for heart failure, coronary artery disease and atrial fibrillation in the general population. Pregnancy is associated with a progressive physiological fall in serum magnesium concentration. Intracellular magnesium deficiency may exist despite normal serum magnesium concentration. Three cases of dilated cardiomyopathy developing in the peripartum period with hypomagnesaemia are presented. The literature regarding associations between magnesium deficiency and dilated cardiomyopathy is reviewed. Potential future research examining magnesium deficiency as a potential contributor to dilated cardiomyopathy in pregnancy is proposed, and possible implications for management are discussed.