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Obstetric Medicine

G L Malin, Svf Wallace, M Hall, A Ferraro
We present the case of a 28-year-old woman who was para 1, with end-stage renal failure secondary to reflux nephritis. She conceived after two years on peritoneal dialysis. She successfully continued this throughout pregnancy, although her antenatal course was complicated by an episode of peritonitis. Induction at 34 weeks resulted in a vaginal birth of a live boy. Her postnatal course was uncomplicated. We reviewed the literature regarding peritoneal dialysis in pregnancy. A recent systematic review identified 14 cases...
June 2018: Obstetric Medicine
Hiroaki Soyama, Morikazu Miyamoto, Takahiro Natsuyama, Masashi Takano, Hidenori Sasa, Kenichi Furuya
Refeeding syndrome very rarely develops during pregnancy. A 35-year-old primiparous woman pregnant with twins complained of severe fatigue at 19 weeks' gestation. She was admitted to our hospital in a malnourished condition because of repeated self-induced vomiting due to anorexia nervosa. Just after hospitalization, she voluntarily increased her caloric intake significantly above the recommended prescribed diet, without medical permission. Nine days later, she developed refeeding syndrome. Electrolyte replacement and calorie restriction were started and her condition gradually improved...
June 2018: Obstetric Medicine
Daniel Martingano, Xin Guan, Francis X Martingano
Main purposes of the study: To report an example of how concurrent von Willebrand disease type IIB disease and severe preeclampsia can be safely managed to and to review the current literature to evaluate management approaches that have proven safe and effective. The basic procedures used: Report of case with a review of literature. Conclusions: Through regular von Willebrand factor and platelet replacement during the prenatal period, immediately pre-delivery, and as needed intraoperatively and postoperatively, women with von Willebrand disease type IIB can safely undergo both normal spontaneous vaginal deliveries and caesarean deliveries, even with concurrent disorders like preeclampsia...
June 2018: Obstetric Medicine
Lisa Story, Catherine Nelson-Piercy
A recent multicentre placebo-controlled trial by Rolnick et al. has indicated that taking 150 mg aspirin daily in women at high risk of pre-eclampsia reduced the incidence of the disease from 4.3% to 1.5% in comparison with placebo. Although the findings of this study are important, a high proportion of women withdrew their consent and not all safety outcomes have been reported. This journal watch article discusses the paper in more detail.
June 2018: Obstetric Medicine
Sergio Carmona, Nada Alayed, Ali Al-Ibrahim, Rohan D'Souza
Background: This study aimed to explore the potential of using instant messaging to enhance patient-care and physician-education in obstetric medicine and maternal-fetal medicine. Methods: This retrospective study examined real-time correspondence between a closed group of maternal-fetal medicine physicians and fellows-in-training. Correspondence was grouped into four domains. Time to obtain a response and their utility was analysed. Results: Over the two-year period, 41 international members contributed 534 clinically relevant messages (291 stems and 243 responses)...
June 2018: Obstetric Medicine
Helen L Robinson, Helen L Barrett, Katie Foxcroft, Leonie K Callaway, Marloes Dekker Nitert
Background: Ketonuria may be associated with adverse fetal outcomes. This study aimed to determine the prevalence of ketonuria at three time points in pregnancy and to assess whether ketonuria correlates with a clinical indication for performing a urine test. Methods: Women had fasting urinary ketone levels measured at 16 and 28 weeks gestation and random ketone levels measured close to 36 weeks gestation. All ketone levels in the third trimester were recorded along with the clinical indication for the test...
June 2018: Obstetric Medicine
James E Haddow, Geralyn Lambert-Messerlian, Elizabeth Eklund, Louis M Neveux, Glenn E Palomaki
Background: High maternal weight is known to associate with both low free thyroxine and gestational diabetes mellitus. We explore a deiodinase-related mechanism that may help explain these associations. Methods: Among 108 women receiving routine oral glucose tolerance testing for gestational diabetes mellitus, we collected biophysical data and measured free thyroxine and total triiodothyronine, using residual plasma samples. Results: Fasting triiodothyronine/free thyroxine ratio and triiodothyronine were higher among women with gestational diabetes mellitus ( p  = 0...
June 2018: Obstetric Medicine
Adam Morton
Hypomagnesaemia is common in pregnancy, particularly in developing countries and low-income communities. Despite the frequent therapeutic use of magnesium in pregnancy, and the evidence regarding the association of hypomagnesaemia with adverse pregnancy outcomes in animal studies, it remains unclear whether hypomagnesaemia is associated with complications in human pregnancy. Three case reports of pregnancies complicated by moderate-severe hypomagnesaemia are presented and magnesium physiology in pregnancy is discussed...
June 2018: Obstetric Medicine
Kerry-Ann Louw
Substance use contributes significantly to the global burden of disease. Growing numbers of women use nicotine, alcohol, and illicit substances. Women are the most vulnerable to problematic substance use in their reproductive years. The first 1000 days of life, starting at conception, have been established as a critical window of time for long-term health and development. Substance use in pregnancy is associated with negative pregnancy and child health outcomes. The impact of antenatal substance use on these outcomes needs to be considered within a challenging and complex context...
June 2018: Obstetric Medicine
Stephanie C Cox
No abstract text is available yet for this article.
June 2018: Obstetric Medicine
Manpreet Mona Gill, Winnie Sia, Michael Hoskinson, Erin Niven, Rshmi Khurana
Positron emission tomography scanning is not commonly performed in pregnancy but can be done if required. Fetal doses of radiation can be minimized, and our case exemplifies the safe application of positron emission tomography/computed tomography in pregnancy. A 38-year-old woman in her first ongoing pregnancy presented at 28 weeks' gestation with symptomatic hypercalcemia. Given a history of parathyroid carcinoma, recurrence was suspected. Ultrasound and magnetic resonance imaging failed to locate the lesion...
March 2018: Obstetric Medicine
Sabrina Piedimonte, Mohammad Almohammadi, Todd C Lee
Background: Tricuspid valve endocarditis caused by Group B streptococcus is a rare clinical entity with poor prognosis and has been previously reported following gynecologic procedures. Case summary: We report a case of an 18-year-old female diagnosed with Group B streptococcus tricuspid valve endocarditis with septic emboli following an elective therapeutic abortion. After six weeks of treatment with ceftriaxone, she returned with recurrent symptoms and was found to have embolized a sizable vegetation to the pulmonary artery with probable lung infarction...
March 2018: Obstetric Medicine
Patrick Harrington, Catherine Nelson-Piercy, Catherine Williamson, Nichola Cooper, Rachel Kesse-Adu, Susan Robinson
A 34-year-old woman presented at 29 weeks gestation of a twin pregnancy, with a platelet count of 1 × 109 /l. She was extensively investigated and was subsequently diagnosed with severe immune thrombocytopenia. She did not respond to initial treatment with corticosteroids and intravenous immunoglobulin. She also failed to respond to second-line therapies of Anti-D immunoglobulin, Azathioprine and the thrombopoietin agonist Romiplostim. Her case was further complicated by an episode of obstetric cholestasis possibly related to Azathioprine treatment...
March 2018: Obstetric Medicine
Amy Daly, Annette Robertson, Gabriele Bobek, Sally Middleton, Colin Sullivan, Annemarie Hennessy
Background: There is recent interest exploring the possible impact of sleep disordered breathing on the mechanisms of preeclampsia. A biomarker of preeclampsia, soluble fms-like tyrosine kinase-1, has come to prominence in recent years. The aim of this study was to investigate the relationship between continuous positive airway pressure treatment, sleep disordered breathing and soluble fms-like tyrosine kinase-1 concentrations during pregnancy. Methods: A 38-year-old G1P0 presented at 20 + 5 weeks...
March 2018: Obstetric Medicine
Renuka Shanmugalingam, Danny Hsu, Angela Makris
Pregnancy is a well-recognised trigger of atypical haemolytic syndrome (P-aHUS) and often occurs in the post-partum period. Similar to atypical haemolytic uremic syndrome, it carries a poor prognosis with high morbidity particularly in the form of renal failure. Early recognition and intervention is crucial in its management particularly with the recent availability of eculizumab, a humanized monoclonal antibody to complement component C5, which has demonstrated drastic improvement in prognosis. The issue, however, is arriving at a timely diagnosis given the considerable amount of overlap in the clinical and biochemical manifestation of P-aHUS, HELLP syndrome (haemolysis, elevated liver enzyme and low platelet count) and other hypertensive disorders of pregnancy...
March 2018: Obstetric Medicine
Hannah Bergin, Gillian Wood, Susan P Walker, Lisa Hui
Objective: To evaluate the implementation of the 2013 Royal Australian and New Zealand College of Obstetricians and Gynaecologists 'Management of Hepatitis B in Pregnancy' guideline. Methods: Retrospective cohort study of the clinical management and obstetric outcomes among hepatitis B virus-positive women in a single tertiary maternity hospital. Women with viral load >200,000 IU/ml were referred to a specialised clinic for consideration of tenofovir disoproxil fumarate therapy to reduce mother to child transmission...
March 2018: Obstetric Medicine
Mai He, Alison Migliori, Nisreen S Maari, Niharika D Mehta
Massive perivillous fibrinoid deposition is a rare placental pathology associated with significant adverse pregnancy outcome and can recur. We provide a detailed case review of a woman through 10 of her pregnancies, including 8 consecutive pregnancy losses and 2 live births. We also conducted a retrospective chart review of all massive perivillous fibrinoid deposition placenta specimens at our institution over an eight-year period. A total of 42 cases of massive perivillous fibrinoid deposition were identified from 2007 to 2015, yielding an incidence of 0...
March 2018: Obstetric Medicine
K S Gilmore, C McLintock
Objective: We reviewed outcomes of 52 pregnancies in 45 women with immune thrombocytopenic purpura who delivered at Auckland Hospital with an antenatal platelet count of <100 × 109 /L. Outcome measures: Primary outcomes were maternal platelet count at delivery and treatment response. Secondary outcomes included post-partum haemorrhage (PPH). Results: Most women had thrombocytopenia at delivery. Treatment with prednisone was given in 14 (27%) pregnancies with responses considered safe for delivery in 11 pregnancies (79%)...
March 2018: Obstetric Medicine
Emily Moroney, Elske Posma, Alicia Dennis, Yves d'Udekem, Rachael Cordina, Dominica Zentner
More women with congenital heart disease survive to childbearing ages, due to improvements in surgical practice and postoperative care. This review discusses pregnancy in women with a single ventricle, describing maternal obstetric and cardiovascular complications and the increased risks of prematurity and adverse neonatal outcomes. Recommendations are made based on current understanding, guidelines and published literature, with recognition that there is much knowledge yet to be gained.
March 2018: Obstetric Medicine
James A Ker, Priya Soma-Pillay
Pregnancy, viewed as a stress test of the haemodynamic system, may unmask underlying cardiac disease. Pregnancy may also induce de novo cardiac disease. N-terminal pro brain-type natriuretic peptide (NT-proBNP) is a useful biomarker in all clinical conditions in which the ventricle is stressed and especially stretched in the general population. In hypertensive diseases of pregnancy, increased levels of NT-proBNP in preeclampsia are associated with increased cardiac filling pressures and diastolic dysfunction...
March 2018: Obstetric Medicine
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