Obstetric Medicine最新文献

Background: Anti-D is usually alloimmune and develops in exposed RhD-negative individuals with potential for haemolytic disease of the fetus and newborn (HDFN). However, autoimmune anti-D is rare with limited understanding of its haemolytic risk to the fetus and mother.

Case report: A 30-year-old woman previously typed as B RhD positive was found to have an autoimmune anti-D on antenatal screening in her third pregnancy. RHD genotyping confirmed RhD positivity without D variants. Anti-D titres remained elevated at 1:512 throughout pregnancy with normal Doppler monitoring and no maternal haemolysis. The neonate was born at 38 weeks and 3 days of gestation with no evidence of haemolysis.

Conclusion: Autoimmune anti-D in pregnancy is rare and requires a multidisciplinary approach to management. Strategies include RHD genotyping to exclude D variants, close monitoring for HDFN, and careful selection of Rh phenotype matched blood for transfusion if required to avoid alloimmunisation for future pregnancies.

Introduction: Casirivimab/imdevimab (CAS/IMD) comprises two monoclonal antibodies that neutralize SARS-CoV-2. Pregnant individuals were excluded from initial trials, limiting safety data.

Methods: The COVID-19 International Drug Pregnancy Registry enrolled 53 pregnant women treated with CAS/IMD, with 34 live births.

Results: No safety concerns were identified.

Discussion and conclusions: The findings of the COVID-PR study support the safety of CAS/IMD during pregnancy, adding to the growing body of evidence on COVID-19 treatments for this population. The available literature shows that CAS/IMD is effective in preventing the progression to severe COVID-19 in pregnant individuals. The drugs are well-tolerated, and there is no compelling evidence of adverse maternal or neonatal outcomes. The results from the COVID-PR study are consistent with those of the broader literature.

Background and objective: To review pregnancy outcomes in women exposed to semaglutide during early pregnancy.

Methods: A retrospective review of an obstetric database at a tertiary obstetric hospital in Brisbane, Australia.

Results: Thirteen women were exposed to semaglutide in first trimester. One infant had significant cardiac anomalies in the setting of very poor maternal glycaemic control in first trimester, as well as maternal obesity and hypertension.

Conclusion: This study adds to the growing literature suggesting there is no increased risk of major congenital anomalies following first trimester exposure to semaglutide, however, until larger studies are available to confirm these findings, reproductive-age women using semaglutide should practice effective contraceptive methods. Preconception counselling of all women with diabetes mellitus is critical to avoid adverse pregnancy outcomes.

A 32-year-old woman in her first pregnancy, presented with acute-onset hemidystonia and hemianesthesia which occurred while vomiting, on a background of hyperemesis gravidarum. Magnetic resonance imaging of the brain demonstrated right basal ganglia, thalamic, and capsular intracerebral hemorrhage, and time-of-flight magnetic resonance angiography demonstrated an occluded right middle cerebral artery with associated lenticulostriate collateral vessels, consistent with Moyamoya phenomenon. This case highlights the importance of managing hyperemesis gravidarum in patients with Moyamoya phenomenon to avoid Valsalva forces which are associated with intracerebral hemorrhage.

Thrombotic thrombocytopenic purpura (TTP) is a serious but rare cause of thrombocytopenia in pregnancy which poses a significant morbidity and mortality burden to the maternofetal dyad. Diagnosing TTP in pregnancy is challenging due to its non-specific clinical presentation, and the potential for similar or concomitant presentation with other thrombotic microangiopathies. We present an atypical case of TTP diagnosed in an asymptomatic 28-year-old female, at 35 weeks' gestation. TTP must be considered a differential for thrombocytopenia, especially in the context of autoimmune disease and even in the absence of typical signs or symptoms. Increasingly available diagnostic tools may help redefine our understanding of TTP presentations in pregnancy.

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.

Exemestane and goserelin combination therapy is a well-established adjuvant treatment for hormone receptor-positive breast cancer. Both medications are contraindicated during pregnancy as their safety in the pregnant population is not yet established. We report a rare case of a 40-year-old multigravida with T1N0M0 breast cancer, receiving exemestane and goserelin post bilateral mastectomy. Despite over four years of amenorrhoea on goserelin, she conceived unexpectedly, and inadvertently continued both medications until she discovered she was pregnant at 13 weeks' gestation. The pregnancy was uncomplicated. A healthy female infant was delivered via caesarean section at 40 weeks. The notable features of this case are inadvertent pregnancy despite induction of amenorrhoea, and no evidence of congenital fetal anomaly despite exposure to exemestane and goserelin until 13 weeks' gestation. Women of child-bearing age receiving adjuvant endocrine therapy for breast cancer should be counselled to use effective contraception to minimise risk of harmful effects in pregnancy.

Physiological pituitary hyperplasia is due to adenohypophyseal cell number increase and is characterised by diffuse isodense pituitary enlargement beyond age-appropriate sizes. It most commonly occurs in females undergoing reproductive changes (puberty, pregnancy, menopause). We report a case of pituitary hyperplasia (pituitary height 14 mm) in a 33-year-old female presenting as vision changes at 34 weeks 'gestation. Computer visual fields identified right sided superotemporal visual field loss with current retinal nerve fibre layer assessment suggestive of compressive optic neuropathy. Serial visual assessment was performed, and due to progression, a caesarean section was performed at 38 weeks' gestation. Cabergoline was not utilised, and one month following delivery, visual findings had resolved, and pituitary height had reduced to 11 mm. There is limited data regarding management for pituitary hyperplasia causing compressive neuropathy irrespective of pregnancy. This case highlights the temporary nature of hypertrophy during pregnancy and positive visual outcome with conservative interventions.

Background: We investigated the impact of the Maternal Medicine Network Hub, established at our centre in 2019, on post-partum haemorrhage (PPH) management in women with inherited bleeding disorders (IBDs).

Methods: Data from 63 patients with IBDs between 2020 and 2023 were compared to a general obstetric cohort. Specific data collected included haemoglobin levels, estimated blood loss, and PPH severity.

Results: Post-partum haemorrhage rates above 500 mL and 1000 mL were significantly higher in the IBD group (p = .02 and p = .002, respectively). However very severe PPH (>1500 mL) also known as massive obstetric haemorrhage (MOH) was not significantly different from the general obstetric population (p = .7) in our tertiary centre (The Royal London Hospital).

Conclusion: Multidisciplinary care at the Maternal Medicine Hub may mitigate the risk of extreme blood loss (MOH) in women with IBDs. This highlights the necessity of specialised care in improving outcomes for women with IBDs during childbirth.