Obstetric Medicine最新文献

Amniotic fluid embolism (AFE) is a rare but potentially catastrophic pregnancy complication. This is a 10-year retrospective study on women with AFE from 2014 to 2023. Cases that met Clark's criteria or in whom a clinical diagnosis was made after exclusion of other causes were included. Information on clinical characteristics, treatment, complications and outcomes were collected and analysed. Four cases of AFE were identified. Two met Clark's criteria and presented with cardiac arrest requiring extracorporeal membrane oxygenation, of which one had cognitive and functional impairment. Two women had atypical AFE, one with disseminated intravascular coagulation (DIC)-type AFE who did not survive, and another who had paradoxical intracranial emboli from a patent foramen ovale, who had full recovery. All had coagulopathy and postpartum haemorrhage. Early recognition and initiation of cardiovascular support is crucial in AFE. DIC and haemorrhage should be treated aggressively. Survival and good outcomes of AFE are possible.

Renal artery stenosis is rare in pregnancy. Patients generally present with hypertension and/or pre-eclampsia. Accompanying hypokalaemia is usually mild or absent. Our case demonstrates the unusual finding of severe and refractory hypokalaemia together with hypertension in a woman with renal artery stenosis in pregnancy. The differential diagnosis of hypokalaemia with hypertension in pregnancy is discussed.

Clinical infection with Janibacter species is an infrequently reported event. There are a small number of cases of patients with Janibacter bacteremia recognized to date. We report the first case of Janibacter bacteremia in a pregnant woman. The bacteremia was associated with pneumonia. Such cases can be difficult to manage due to the lack of antibiotic susceptibility data for these bacteria. We also report susceptibility data for the Janibacter hoylei that was isolated in our patient. This case demonstrates that J. hoylei can be a pathogen in otherwise immunocompetent pregnant women.

Pregnancy-onset inflammatory bowel disease (POIBD) is a rare diagnosis that has been associated with diagnostic delay and increased risk of hospitalization compared with inflammatory bowel disease diagnosed outside of pregnancy. There is a paucity of data on the clinical presentation and risk factors associated with maternal and fetal outcomes of POIBD. We present a 29-year-old patient who presented with acute severe ulcerative colitis at 24 weeks gestational age whose course was complicated by delayed diagnosis and therapy, colonic perforation, colectomy, prolonged hospitalization, and neonatal prematurity. The case illustrates the high index for suspicion required for making this diagnosis and the prevention of maternal and neonatal morbidity, together with a growing need to advocate for timely investigations and in-patient management in unwell pregnant patients.

The interplay of pregnancy, the immune system and its impact on autoimmune disease is an area of growing interest. Adult-onset Still's disease is a rare auto-inflammatory disorder characterised by fever, rash, arthralgia and leucocytosis. We describe a rare case of the disease presenting for the first time in the immediate postpartum period, highlighting pregnancy and birth as possible triggers for this condition.

Despite widespread anecdotal evidence of an increase in tonsil stone formation during pregnancy, including messages on internet pregnancy forums, there is little published research on this topic. Here we present three patients who experienced new or worsening of existing tonsil stones during various points of their pregnancy. Additionally, common presentations of tonsil stones as well as the medical and surgical management options are discussed. Physiological changes during pregnancy could be a contributing factor to an increase in tonsil stones during this period. Since patients may voice complaints of tonsil stones to their obstetricians prior to establishing care with an otolaryngologist, it is important that obstetricians are aware of this disease process and its management.

Gestational gigantomastia or gravid macromastia is a rare condition presenting as incapacitating breast enlargement during pregnancy. It is physically and psychologically debilitating for the patient. Fewer than 100 cases have been published to date. The etiology of the condition is unknown, but various theories have been proposed. Here we report a case of a 27 year old woman in her second pregnancy, with an abnormal increase in the size of breasts. Her breast size increased from 34B to 52D brassiere size. Routine antenatal, hormone, and initial autoimmune investigations were within normal limits. The patient was managed conservatively with breast support and had a spontaneous resolution in the postpartum period. During follow up she was diagnosed with systemic lupus erythematosus, making the association of the two conditions a possibility. Good knowledge about this rare condition is necessary for all doctors, especially obstetricians.

Background: Elexacaftor/tezacaftor/ivacaftor (ETI) was made available to eligible women in September 2020 by NHS Scotland.

Methods: Retrospective data collection for the 13 pregnancies in women taking ETI from the West of Scotland Adult Cystic Fibrosis Unit, September 2020-December 2023.

Results: Mean pre-pregnancy FEV1 was 2.26L, 70% predicted (range 1.25-3.19); (38-86% predicted). Mean FEV1 post-pregnancy was 2.29L, 71% predicted (range 1.49-3.40); (45-92% predicted). The mean age at conception (29 years) and mean percentage predicted FEV1 (70%) were higher than in other UK studies. Two pregnancies resulted in miscarriage, the remaining 11 pregnancies resulted in a live birth. Seven women had a pulmonary exacerbation of CF during pregnancy. Three of four women with FEV1 < 60% predicted had uncomplicated pregnancies with no pulmonary exacerbations.

Conclusion: We demonstrate that people with CF and varying spectrums of lung disease who take CFTR modulators can have uncomplicated pregnancies with positive lung function outcomes.