Takotsubo cardiomyopathy in pregnancy.

Background: Takotsubo cardiomyopathy is a cardiac condition associated with the acute onset of chest pain, abnormalities in cardiac enzymes and electrocardiogram, and a distinct pattern of left ventricular dysfunction on echocardiography. This case evaluates an obstetric patient diagnosed with Takotsubo cardiomyopathy during her 23rd week of pregnancy.

Case: A woman (G3P2002) at 23 weeks in an intrauterine pregnancy was admitted with chest pain.

Comparative analysis of 5-mm trocars: dilating tip versus non-shielded bladed.

Study Objective: To examine whether there are statistically significant differences in multiple variables evaluated at different times in the course of surgery and postoperative period when using 5-mm dilating-tip trocars (DTTs) and 5-mm non-shielded-bladed trocars (NSBTs) at randomly selected right or left lateral entry sites on the same patient.

Design: Randomized, single-blinded, controlled trial (Canadian Task Force classification I).

Setting: Center for Women's Care and Reproductive Surgery (CWCRS), Atlanta, Georgia.

Role of C825T polymorphism of GNbeta3 gene in preeclampsia.

Objective: The main objective of the study was to understand the role of C825T polymorphism that generates a splice variant in the beta3 subunit of heterotrimeric G-protein in preeclampsia.

Results: We analyzed genomic DNA of 151 women with preeclampsia (72 Caucasians and 79 African-Americans) and 198 women with normal delivery (102 Caucasians and 96 African-Americans) for C825T polymorphism of GNbeta3 gene. The T-allele frequency in Caucasian women with preeclampsia was 0.

Gestational diabetes is associated with depressed adiponectin levels.

Objective: Adiponectin is a 29-kd adipocyte-secreted protein that has been linked to insulin resistance in obesity and diabetes. The aim of the present study was to evaluate adiponectin levels in the insulin-resistant state of diabetes in gestation.

Methods: Term, gravid subjects with diabetes (n = 31; age, 30.

Septic pelvic thrombophlebitis and preeclampsia are related disorders.

Objective: To elicit factors associated with the postpartum development of septic pelvic thrombophlebitis in a single large referral tertiary patient population.

Methods: A nine-year single institution retrospective case review of all patients with enigmatic fever and septic pelvic thrombophlebitis was analyzed.

Results: A total of 55 patients with septic pelvic thrombophlebitis were provided care during the study interval.

The importance of parity to major maternal morbidity in the eclamptic mother with HELLP syndrome.

Objective: To determine if the rate of major morbidity from severe preeclampsia with/without hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome differs by parity.

Methods: Retrospective investigation of 970 gravidas with severe preeclampsia with and without HELLP syndrome analyzed according to parity.

Results: Altogether 609 (63%) patients were nulliparous and 361 (37%) parous.

Evaluation of a rat model of preeclampsia for HELLP syndrome characteristics.

Objective: To determine whether a rat model of preeclampsia includes features consistent with HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome.

Methods: Preeclampsia was induced experimentally in timed-pregnant Sprague-Dawley rats using the reduced uterine perfusion pressure (RUPP) model. On day 14 of gestation, silver clips were placed around the aorta below the renal arteries and on the left and right uterine arcade at the ovarian artery.

Postpartum seizure prophylaxis: using maternal clinical parameters to guide therapy.

Objective: To use individual patient clinical parameters to signal cessation of postpartum magnesium sulfate seizure prophylaxis for the spectrum of pregnancy-related hypertensive disorders.

Methods: This was a prospective study using clinical symptoms (absence of headache, visual changes, epigastric pain) and signs (sustained blood pressure less than 150/100 without need for acute antihypertensive therapy, spontaneous diuresis more than 100 mL per hour for no less than 2 hours) to signal cessation of intravenous magnesium sulfate postpartum in gravidas diagnosed with preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelets syndrome. Laboratory assessments (including proteinuria) were not used as criteria for drug discontinuation.

Preeclampsia: pathophysiology and practice considerations for the consulting nephrologist.

Abnormal placental implantation presumed to be secondary to maternal genetic susceptibility or immune maladaptation is considered to be fundamental to the pathogenesis of preeclampsia. The reduced placental perfusion resulting in placental ischemia is hypothesized to cause the known endothelial dysfunction, which leads to the clinical manifestations of this disease. Oxidative stress is a postulated linking factor, an aberration that possibly has its genesis via cytokines released from the abnormally implanted and perfused placenta.