Urinary protein selectivity in nephrotic syndrome and pregnancy: resurrection of a biomarker when renal biopsy is contraindicated.

Significant proteinuria in pregnancy can indicate the presence of serious conditions requiring investigation and treatment. The nephrotic syndrome in pregnancy presents a multitude of difficulties and is a relative contraindication of renal biopsy, particularly in the third trimester. We present a case of nephrotic syndrome of unknown cause presenting at 33 weeks of pregnancy.

Gastroschisis and the risk of short bowel syndrome: outcomes and counselling.

Background: Gastroschisis can be associated with short bowel syndrome (SBS). We present 4 cases with significant bowel shortening with very different ante- and postnatal presentations.

Cases: Three of the cases demonstrated 'vanishing' gastroschisis with progressively worsening antenatal intra-abdominal bowel dilatation with no defect present at birth.

A randomised controlled trial comparing standard or intensive management of reduced fetal movements after 36 weeks gestation--a feasibility study.

Background: Women presenting with reduced fetal movements (RFM) in the third trimester are at increased risk of stillbirth or fetal growth restriction. These outcomes after RFM are related to smaller fetal size on ultrasound scan, oligohydramnios and lower human placental lactogen (hPL) in maternal serum. We performed this study to address whether a randomised controlled trial (RCT) of the management of RFM was feasible with regard to: i) maternal recruitment and retention ii) patient acceptability, iii) adherence to protocol.

Outpatient management of Gitelman's syndrome in pregnancy.

Gitelman's syndrome is a congenital renal tubular defect which affects the apical membrane of the distal convoluted tubule of the renal system. The syndrome is characterised by hypokalaemia, hypomagnesaemia, metabolic alkalosis and hypocalcuria. There are only a few cases describing the impact of Gitelman's syndrome on pregnancy and the foetus.

Outcomes of congenital diaphragmatic hernia: a 12-year experience.

Objective: To determine outcomes for babies with congenital diaphragmatic hernia (CDH) diagnosed prenatally and postnatally presenting to a tertiary unit.

Method: Fetal medicine database and neonatal surgical unit admission books were reviewed to identify cases of CDH over a 12-year period (Jan 1998- Dec 2009).

Results: A total of 132 cases of CDH were diagnosed prenatally and 39 cases diagnosed postnatally.

Antenatal diagnosis of bowel dilatation in gastroschisis is predictive of poor postnatal outcome.

Purpose: Although gastroschisis infants usually have a good outcome, there remains a cohort of babies who fare poorly. We inquired whether the presence of bowel dilatation in utero is predictive of postnatal course in infants with gastroschisis.

Methods: We compared the clinical course of infants who had bowel dilatation with those who did not.

Breast milk: friend or foe?

Anaphylaxis can occur secondary to breastfeeding. The authors present a case of a 30-year-old woman who complained of chest tightness, shortness of breath and a rash on the third day postpartum. She was treated for anaphylaxis and her symptoms resolved.

Post partum haemorrhage secondary to uterine atony, complicated by platelet storage pool disease and partial placenta diffusa: a case report.

Introduction: Uterine atony is the most common cause of primary post partum haemorrhage. We report a case where this was complicated by two rare conditions, platelet storage pool disease and placenta diffusa. Platelet storage pool disease is a platelet aggregation disorder associated with mild to moderate bleeding diathesis.

The effect of maternal characteristics on endothelial-dependent relaxation of myometrial arteries.

Objective: Endothelial dysfunction is central to the pathogenesis of pre-eclampsia (PE). This study aimed to determine if maternal characteristics, such as age, parity, BMI, smoking status and obstetric history, which affect the risk of developing pre-eclampsia, influenced endothelial function in myometrial arteries taken during an uncomplicated pregnancy.

Study Design: As part of ongoing studies investigating endothelial function in normal and compromised pregnancies, myometrial vessels were isolated from biopsies taken at elective Caesarean section.

Altered endothelial function in isolated human myometrial vessels induced by plasma from women with pre-eclampsia is not reproducible in isolated mouse vessels.

In order to facilitate characterization of the circulating factor(s) in pre-eclampsia, the present study aimed to determine whether plasma from women with pre-eclampsia, which induces attenuated endothelial-dependent relaxation in human myometrial arteries, is also capable of inducing altered endothelial function in mouse vessels. Human vessels were isolated from myometrial biopsies taken from women with uncomplicated pregnancies (n = 6). Mesenteric and uterine arteries were isolated from male, female, non-pregnant and pregnant C57B mice (n = 24).