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Obstetric Medicine

Jayalakshmi Durairaj, Esha R Shanbhag, P Veena, Mamtha Gowda, Anish Keepanasseril
Wilson's disease is an autosomal recessive genetic disorder affecting copper transport leading to hepatic and/or neuropsychiatric manifestations. Changes in pregnancy can mimic certain clinical features of chronic liver disease such as spider naevi, and constraints for the use of various investigation for diagnosis pose a challenge to physicians. A high index of suspicion, multi-disciplinary team approach, use of correct non-invasive testing including viral serology, autoantibodies and copper studies and ultrasonography help to diagnose most of the pre-existing, de novo or pregnancy-specific hepatological conditions...
September 2018: Obstetric Medicine
Farshad Tahmasebi, Alice Hurrell, Amie Ford, Manish Gupta, Damien Geindreau, Dominic Pimenta, Constantinos O'Mahony
Spontaneous coronary artery dissection is a rare but important cause of acute coronary syndrome. Its relevance for women during the puerperium mandates awareness and understanding amongst obstetric healthcare professionals. The aetiology of the increased risk in pregnancy has not been fully elucidated, but include medial eosinophilic angitis, pregnancy-induced degeneration of collagen in conjunction with the stresses of parturition, and rupture of the vasa vasorum. The risk of mortality necessitates prompt diagnosis, usually by angiography...
September 2018: Obstetric Medicine
Adam Morton
Acute fatty liver of pregnancy is a heterogeneous disorder which may occur in the absence of a detectable gene mutation for the enzyme long-chain L-3-hydroxyacyl-CoA dehydrogenase. Acute fatty liver of pregnancy has been reported to complicate several gastrointestinal disorders including viral hepatitis, chronic active hepatitis and intrahepatic cholestasis of pregnancy. A case of acute fatty liver of pregnancy in a woman with ulcerative colitis and familial hidradenitis suppurativa without a detectable gene mutation is presented...
September 2018: Obstetric Medicine
Sophie Grand'Maison, Stephen Lapinsky
No abstract text is available yet for this article.
September 2018: Obstetric Medicine
Julien Viau-Lapointe, Rohan D'Souza, Louise Rose, Stephen E Lapinsky
Background: Current data on critical illness during pregnancy are insufficient for evidence-based decision making. Core outcome sets are promoted to improve reporting of outcomes important to decision makers. We aim to develop a Core Outcome Set for research on critically ill obstetric patients (COSCO study). Methods: We will perform a systematic review of studies on critical illness in pregnancy and focus groups or interviews with women who were critically ill while being pregnant...
September 2018: Obstetric Medicine
Adam Morton, Josephine Laurie
The Swansea criteria are used to assess the likelihood of acute fatty liver of pregnancy. There are significant physiological changes in normal pregnancy in several of the pathology parameters used in the Swansea criteria. This may impact the sensitivity and specificity of the Swansea criteria. Five of the 11 case series reporting laboratory values in acute fatty liver of pregnancy used values divergent from the Swansea criteria. When using the Swansea criteria for diagnosis of acute fatty liver of pregnancy, using pregnancy-specific and/or laboratory-specific reference intervals is recommended...
September 2018: Obstetric Medicine
J Balani, S L Hyer, H Shehata, F Mohareb
Objective: To develop a model to predict gestational diabetes mellitus incorporating classical and a novel risk factor, visceral fat mass. Methods: Three hundred two obese non-diabetic pregnant women underwent body composition analysis at booking by bioimpedance analysis. Of this cohort, 72 (24%) developed gestational diabetes mellitus. Principal component analysis was initially performed to identify possible clustering of the gestational diabetes mellitus and non-GDM groups...
September 2018: Obstetric Medicine
P Soma-Pillay, R Pillay, T Y Wong, J D Makin, R C Pattinson
Background: The retinal microcirculation provides a unique view of microvessel structure by means of non-invasive, retinal image analysis. The aim of the study was to compare the retinal vessel caliber at delivery and one-year post-partum between women who have had pre-eclampsia during pregnancy to a normotensive control group. Methods: Digital photos of the eye were taken at delivery and one-year post-partum. Retinal vessels were analysed and summarised as the corrected central retinal arteriolar equivalent and corrected central retinal venular equivalent...
September 2018: Obstetric Medicine
Monica Tang, Kate Webber
Cancer survivors are increasing as improvements in cancer diagnosis and treatment translate to improved outcomes. As cancer survivors in their reproductive years contemplate pregnancy, it is important to understand the impact of cancer and its treatment on fertility and pregnancy outcomes. Cancer treatments such as chemotherapy and radiotherapy can affect patients' fertility, and strategies are available to help preserve the future fertility of survivors. The potential impact of previous cancer diagnoses and treatments on pregnancy and maternal and fetal outcomes needs to be assessed and discussed with survivors, with support from materno-fetal medicine specialists and high-risk antenatal services as needed...
September 2018: Obstetric Medicine
Akilandeswari Karthikeyan, Narayanaswamy Venkat-Raman
Ehlers-Danlos syndromes are a clinically and genetically heterogeneous group of rare inherited connective tissue disorders. Hypermobile Ehlers-Danlos syndrome is one of the common types and not infrequently encountered in pregnancy. While, in the majority of women with hypermobile Ehlers-Danlos syndrome, the pregnancy is uncomplicated, it is important to be aware of the condition in view of potential complications such as recurrent joint dislocations and history of surgical joint stabilization procedures, secondary autonomic pain and postural orthostatic tachycardia syndrome...
September 2018: Obstetric Medicine
Michael P Carson, Stephen E Lapinsky
No abstract text is available yet for this article.
September 2018: 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
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