Obstetric Medicine最新文献

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.

Background: It appears that some ABO blood groups may be a risk factor for venous thrombosis. The association between ABO group and risk of pre-eclampsia remains controversial. The purpose of this study was to evaluate the relationship between pre-eclampsia and ABO groups.

Methods: A retrospective case-control (1:2) study in a prospective monocentric registry including 20171 pregnancies was performed. Women with pre-eclampsia and severe pre-eclampsia were identified. Controls were matched according to age, parity, year of delivery and body mass index. Blood groups were considered.

Results: Two hundred fifty-three cases and 506 controls were included. No difference in distribution was found between cases and controls for non-O group (57.51% vs 62.56, p: 0.19), group A (39.92% vs 44.05, p: 0.29), group B (13.83% vs 15.42, p: 0.57) group AB (3.75 vs 3.08, p: 0.64). The analysis extended to severe pre-eclampsia showed no difference.

Conclusion: This study did not document any relationship between ABO groups and the risk of preeclampsia.

Congenital thrombocytopenia results from mutations in genes implicated in megakaryocyte differentiation and/or platelet formation and clearance. We report the case of a 25 year old primigravida who presented with severe macro-thrombocytopenia from the age of 12 years. She delivered an alive female baby at 35 weeks of gestation. She was diagnosed to have GNE gene mutation. GNE gene encodes the key enzyme in sialic acid biosynthesis, glucosamine (UDP-N-acetyl)-2-epimerase/N-acetylmannosamine kinase (GNE/MNK). The mutation is responsible for the reduction in sialic acid biosynthesis and consequently leads to severe congenital thrombocytopenia and/or myopathy. Although no sign of myopathy was observed in this patient; it is possible myopathy can be developed later, thus long-term follow-up with neurology is highly advisable. We recommend the genetic counselling and a segregation analysis of this variant in other affected individuals in the family.

Whilst uncommon in pregnancy, hypercalcaemia can lead to significant maternal and fetal morbidity. An important complication of hypercalcaemia is uncontrolled hypertension. This case outlines an example of refractory hypercalcaemia exacerbating an emerging hypertensive crisis. The proposed aetiology was parathyroid hormone-related protein (PTHrP)-mediated hypercalcaemia secondary to a necrotic uterine fibroid. We highlight how effective and prompt involvement of the Maternal Medicine Network and multidisciplinary team led to a successful pregnancy outcome.

Objective: This study aimed to investigate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in amniotic fluid, umbilical cord blood, both the maternal and fetal sides of placenta, as well as neonatal nasopharyngeal among infants born to mothers with COVID-19.

Methods: The inclusion criteria was pregnant women with confirmed COVID-19 who delivered by caesarean section at Persahabatan General Hospital, University of Indonesia, Jakarta, Indonesia, from May 2020 to August 2020. SARS-CoV-2 presence was assessed in vaginal mucus, anal, amniotic fluid, umbilical cord blood, both maternal and fetal sides of placenta, as well as neonatal nasopharynx.

Results: During the study period, 24 pregnant women met the criteria. A total of 132 swab samples were obtained from vaginal mucus, anal swab, amniotic fluid, umbilical cord blood, both maternal and fetal sides of placenta, as well as neonatal nasopharynx. Reverse transcription polymerase chain reaction test yielded negative results for SARS-CoV-2 in all samples except one sample from anal.

Conclusions: There was no evidence of SARS-CoV-2 in vaginal mucus, anal, amniotic fluid, umbilical cord blood, placenta, and neonatal nasopharyngeal samples. The exception of one positive anal sample, necessitating further investigation.