Obstetric Medicine最新文献

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.

Background: Isolated sixth nerve palsy is a rare neurologic manifestation of preeclampsia suggesting severity. The purpose of this article is to describe a case of recurrent sixth cranial nerve palsy in the setting of preeclampsia and to highlight its clinical significance, management considerations, and prognosis.

Case: A 28-year-old woman presented with recurrent left sixth nerve palsy in the setting of preeclampsia at 36 weeks' gestation. No alternative diagnosis was found in laboratory investigations and cerebral imaging. Symptoms resolved spontaneously within 5 days of delivery.

Conclusion: A case of recurrent isolated sixth cranial nerve palsy as a manifestation of preeclampsia is described. This rare finding must be recognized by those caring for pregnant individuals.

Background: HIV disproportionately affects women of childbearing age in South Africa. Despite progress in antiretroviral therapy access, challenges persist in HIV vertical transmission prevention (VTP).

Methods: We conducted a single-centre, retrospective observational audit of women delivering between May and August 2023 at the Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg, South Africa to assess adherence to national VTP guidelines.

Results: Of 563 women, 22% (125/563) were living with HIV at their first antenatal visit, increasing to 24.3% (137/563) by delivery. HIV retesting rates declined from 46% (181/394) at the second visit to 20% (30/151) by the eighth. HIV viral load testing was performed in 71.5% of women (98/137) at delivery, with 72.4% (71/98) achieving viral suppression. Birth PCR testing was not performed for 21.1% (29/137) of HIV-exposed infants.

Conclusion: Significant gaps in HIV retesting, viral load monitoring, and birth PCR testing highlight ongoing challenges in VTP guideline adherence.

A multiparous woman in her late 20s developed postpartum angioedema, rash, profound hypotension, and decreased consciousness, progressing to acute myocardial dysfunction with left ventricular impairment. Despite thorough investigations, no clear cause was found. Anaphylaxis to medication was initially suspected as the patient had received paracetamol, ibuprofen and intrapartum antibiotics, however the symptoms resolved with cabergoline-induced lactation suppression leading to the diagnosis of lactation anaphylaxis being made. This case suggests lactation anaphylaxis can trigger transient cardiac issues, highlighting the need for awareness and further research. Lactation anaphylaxis is rarely documented, and cardiac involvement has not been previously described. Effective management of lactation anaphylaxis, particularly with cardiac complications, is crucial. This case emphasizes the importance of considering lactation anaphylaxis in postpartum allergic presentations and highlights the necessity for more research on its mechanisms and treatment.

Low molecular weight heparin (LMWH) is a common agent given in pregnancy; however, cutaneous drug reactions with its use in pregnancy are rarely reported. The case describes a 30-year-old woman with stable Crohn's disease on ustekinumab presenting with a rash at prophylactic LMWH injection sites 30 weeks into her third pregnancy. Skin biopsy reported appearance consistent with an urticarial drug hypersensitivity reaction. A combination of steroid treatment, topical emollient and cessation of LMWH resulted in resolution of symptoms over 2 weeks. Postnatal venous thromboembolism prophylaxis with fondaparinux was uncomplicated. Overall, this case highlights the importance of reporting drug reactions in pregnancy. It additionally exposes a gap in research surrounding immunomodulators and heparins in the development of cutaneous reactions in pregnancy.

Introduction: Wünderlich syndrome is defined as spontaneous, non-traumatic retroperitoneal bleeding, often associated with the rupture of a renal angiomyolipoma. Though rare, this condition is life-threatening if not treated promptly. The syndrome is particularly uncommon during pregnancy, posing significant challenges in diagnosis and management due to overlapping symptoms with other obstetric emergencies.

Case presentation: We report the case of a 25-year-old woman at 37 weeks of gestation who presented to the emergency department with hypovolemic shock, left flank pain, and fetal bradycardia. A large retroperitoneal hematoma was discovered during an emergency caesarean section, later identified as secondary to a ruptured renal angiomyolipoma. Despite the critical presentation, a total nephrectomy was performed successfully, and both mother and child had favorable outcomes.

Conclusion: This case highlights the importance of considering Wünderlich syndrome in differential diagnoses of acute abdominal pain during pregnancy, especially in the presence of shock and renal masses. Prompt interdisciplinary management is crucial for positive maternal and fetal outcomes.

Acute fatty liver of pregnancy is associated with significant maternal and fetal morbidity and mortality. Defects in fatty acid metabolism appear to play a role in pathogenesis, and several pathogenic variants leading to enzyme deficiencies have been associated with the development of acute fatty liver of pregnancy. The risk of recurrence in subsequent pregnancies is unknown. A review of 10 small case series of women with acute fatty liver of pregnancy disclosed only one case of recurrence in 35 subsequent pregnancies. This contrasted with a survey where 5 of 24 women reported recurrent acute fatty liver in subsequent pregnancies. Retrospective and prospective studies examining subsequent pregnancy outcomes following a diagnosis of acute fatty liver of pregnancy would be useful to better define risk and aid in preconception counselling of women who have had a diagnosis of acute fatty liver of pregnancy and wish to consider further pregnancies.