Obstetric Medicine最新文献

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.

A 35-year-old woman with a bicuspid aortic valve, moderate-severe aortic stenosis and severe aortic dilatation underwent aortic valve and ascending aorta replacement when 14 weeks pregnant. We discuss the risks of aortic dilatation associated with bicuspid aortic valves during pregnancy and options for management. Included is a summary of the management of mechanical valves during pregnancy and delivery. This case emphasises the importance of multi-disciplinary counselling and patient-centred, informed decision making.

Objective: We present clinical features and outcomes of second-trimester acute fatty liver of pregnancy (AFLP), a serious but rare condition.

Results: Fourteen pregnant women with AFLP or compatible biopsy were identified in the literature. Diagnosis occurred between 20 and 27 + 6 weeks of gestational age. In total, 50% were primigravid. Thirteen cases met the Swansea criteria while the other case had a compatible liver biopsy. In total, 10 out of 11 cases had microvesicular steatosis on their liver biopsy. Common maternal complications included acute renal failure, hypoglycaemia, liver failure, encephalopathy, intensive care unit admission and need for blood transfusions. Seven deliveries were on the day of diagnosis, five within four weeks, and two within three months. One maternal death, seven fetal deaths and three neonatal deaths occurred.

Conclusion: AFLP diagnosed in the second trimester is a rare condition. Neonatal mortality and maternal morbidity are high. Most cases had nonspecific symptoms and clinical findings, but a majority had compatible biopsies.

We report the case of a 21-year-old woman at 29 weeks and four days of gestation who presented with one-week history of severe epigastric pain, pleuritic chest pain, dyspnoea, and chills. A peripherally inserted central catheter line had been placed at 14 weeks of gestation for outpatient management of hyperemesis gravidarum. Initial investigations included a transthoracic echocardiogram which revealed a large tricuspid valve vegetation with mild tricuspid regurgitation and CT pulmonary angiogram which identified multiple septic pulmonary emboli. Blood cultures grew methicillin-susceptible Staphylococcus aureus. Despite appropriate antimicrobial therapy, they remained bacteraemic and underwent percutaneous mechanical debulking of tricuspid valve infective endocarditis using an AngioVac aspiration thrombectomy device. Their clinical course post-AngioVac was complicated by the development of multiple pulmonary emboli and suspected left-sided empyema. They delivered by caesarean section at 32 weeks and one day of gestation due to maternal health reasons.