Pregnancy Management After Bariatric Surgery.

Obesity is a source of major morbidity and mortality and is a growing concern worldwide. Maternal obesity is associated with increased maternal and fetal risks during pregnancy. Bariatric surgery has emerged as one of the most sustainable treatments for severe obesity and its comorbidities.

Management Considerations for Ongoing Pregnancies Complicated by Trisomy 13 and 18.

Pregnancies complicated by trisomy 13 (T13) or trisomy 18 (T18) present unique challenges for obstetric management. From the initial diagnosis, the task of counseling these women and families is difficult because fetal and neonatal outcomes vary depending on the phenotype and degree of intervention chosen by the family. A literature review was performed using PubMed to gather information regarding obstetric management and outcomes of pregnancies complicated by T13 and T18.

Carbon Monoxide Exposure During Pregnancy.

Importance: Carbon monoxide (CO) is the leading cause of poisoning in the United States and is associated with high maternal and fetal mortality rates. Given the nonspecific signs and symptoms of toxicity, cases may go unsuspected or attributed to other etiologies. As CO adversely affects both mother and fetus, it is important for practitioners to recognize and treat poisoning in a timely manner.

Cardiac performance is impaired in morbidly obese pregnant females.

Aim: To evaluate the effect of pregnancy on ventricular function in morbidly obese as compared to lean controls.

Material And Methods: We serially studied 33 obese and non-obese pregnant females with echocardiography during each trimester of pregnancy and after delivery. Two well-validated, relatively load-independent indices of contractility (systolic shortening index and systolic velocity index) were assessed, along with more traditional echocardiographic parameters.

Primary atony of the lower uterine segment as a distinct cause of early postpartum haemorrhage: a case series and management recommendations.

Primary atony of the lower uterine segment appears to be a distinct cause of postpartum haemorrhage. We report a case series of women with postpartum haemorrhage where ultrasound and clinical findings revealed a well contracted fundus and upper uterine segment and a ballooned out lower uterine segment, a condition we have called primary atony of the lower uterine segment. We hope that this case series will lead to increased recognition of this condition, stimulate others to report their experience and lead to additional studies to better characterise this entity, and develop more effective therapies.

Group B streptococcal antibiotic resistance patterns in pregnant women.

Group B Streptococcal (GBS) antibiotic susceptibility studies were performed in 95 pregnant women in Bridgeport, Connecticut. Testing for penicillin, ampicillin, cefazolin, and clindamycin sensitivity was performed. Resistance to clindamycin was seen in 5% of isolates.

Prenatal diagnosis of portal vein thrombosis by ultrasound.

Neonatal portal vein thrombosis (PVT) is a rare condition seen in the setting of thrombophilia or after umbilical vein catheterization. We report a case of fetal PVT with abnormal antenatal ultrasound findings at 27 weeks of gestation. This presented initially as dilation of the intrahepatic umbilical vein.

Hemorrhagic complication of anticoagulation during pregnancy in a woman with lupus anticoagulant.

Background: Lupus anticoagulant is an acquired antiphospholipid antibody that can increase greatly the risk of thromboembolism during pregnancy. Because a baseline elevated activated partial thromboplastin time (PTT) is associated frequently with this antibody, monitoring anticoagulant effect with activated PTT can be unreliable.

Case: A pregnant woman with lupus anticoagulant being treated with adjusted dose heparin experienced concurrent severe thrombotic and hemorrhagic complications.

Ursodeoxycholic acid for the treatment of intrahepatic cholestasis of pregnancy.

Objective: To report our experience in managing intrahepatic cholestasis of pregnancy with ursodeoxycholic acid.

Methods: All cases of intrahepatic cholestasis of pregnancy that were diagnosed at Bridgeport Hospital from January 1997 to August 1999 were identified. Information was abstracted on demographics, medical and obstetric history, symptoms, laboratory data, therapy and pregnancy outcome.

Dilutional hyponatremia in preeclampsia with and without nephrotic syndrome.

This report includes cases of hyponatremia in preeclampsia. Two patients were identified with preeclampsia complicated by hyponatremia, one with and the other without nephrotic syndrome. Together with 3 cases of hyponatremia recently reported, these additional cases from the same geographic area suggest that hyponatremia is not a rare complication of preeclampsia.

Successful pregnancy after suspected anaphylactoid syndrome of pregnancy (amniotic fluid embolus). A case report.

Background: Limited information is available on the recurrence risk of anaphylactoid syndrome of pregnancy.

Case: A successful pregnancy followed suspected anaphylactoid syndrome of pregnancy.

Conclusion: A review of the literature revealed five cases of successful subsequent pregnancies following anaphylactoid syndrome of pregnancy.

Indicated preterm birth: a possible contribution to group B streptococcal sepsis prophylaxis protocol failures. A case report.

Background: Despite the acceptance of protocols for the prevention of group B streptococcal (GBS) sepsis for the newborn, protocol violations, with subsequent failure to initiate intrapartum antibiotic therapy, occur at many institutions. The causes for GBS prophylaxis protocol violations are not well understood.

Cases: We report two cases of indicated preterm birth in which appropriate antibiotic prophylaxis for GBS sepsis was not initiated.

Prospective evaluation of bone density in pregnant women receiving the low molecular weight heparin enoxaparin sodium.

Objective: To evaluate changes in bone density in women receiving enoxaparin sodium during pregnancy.

Methods: Bone density in the proximal femur was serially measured in 16 women receiving enoxaparin sodium (40 mg daily) during pregnancy. Baseline measurements were taken within 2 weeks of starting therapy and then at 6-8 weeks postpartum and 6 months postpartum.

Evaluation and management of infertility in women: the internists' role.

Interventions for infertility have greatly increased in number and sophistication. Women with multiple medical problems and women near or beyond menopause are now able to conceive. The internist will be called on to assess the risk that infertility interventions pose and to counsel patients accordingly.

Changes in the pharmacokinetics of the low-molecular-weight heparin enoxaparin sodium during pregnancy.

Objective: We sought to evaluate the pharmacokinetics of subcutaneously administered enoxaparin sodium during and after pregnancy.

Study Design: Daily subcutaneous injections of enoxaparin sodium (40 mg) were administered to 13 pregnant women. On 3 separate occasions, once early in pregnancy (12-15 weeks), once late in pregnancy (30-33 weeks), and once in the nonpregnant state (6-8 weeks post partum), serial blood samples were collected, and plasma was analyzed for antifactor Xa activity.

Pregnancy outcome after successful external cephalic version.

Objective: Recent studies have suggested that the rate of cesarean delivery in patients who have undergone a successful external cephalic version is higher than expected. This study compares the incidence of cesarean delivery in patients who underwent successful external cephalic version and patients with primary cephalic presentations.

Study Design: We identified and reviewed the charts of 92 patients who underwent a successful external cephalic version.

The association of increased fetal nuchal translucency and spinal muscular atrophy type I.

We report a fetus with spinal muscular atrophy type I, who presented with an increased nuchal translucency at 13 weeks' gestation. A review of the literature reveals additional cases of spinal muscular atrophy type I associated with increased nuchal translucency and suggests increased nuchal translucency may be an early finding in this disorder.

Factors influencing preconception control of glycemia in diabetic women.

Background: Although periconceptional glycemic control directly impacts perinatal outcome for pregestational diabetic women, these women still frequently enter pregnancy with suboptimal control of glycemia.

Objectives: To determine how frequently diabetic women enter pregnancy with suboptimal glycemic control and to identify factors associated with not achieving optimal periconceptual control of glycemia.

Patients And Methods: Pregestational diabetic women (n = 55) who attended the Maternal Fetal Medicine Faculty Practice or the Resident Medical Complications Obstetric Clinic, Magee Women's Hospital, Pittsburgh, Pa, were administered a brief questionnaire pertaining to periconceptional education and control of glycemia.

Pregnancy after liver transplantation.

This article reviews the reported experience with pregnancy after liver transplantation and describes obstetric risks and medical issues that the maternal fetal medicine specialist has a reference for managing these pregnancies and for providing appropriate preconception counseling. Women who undergo liver transplantations have a higher risk of preeclampsia, worsening hypertension, preterm premature rupture of membranes, anemia, small for gestational age, preterm delivery, and cesarean section than the normal obstetric population. Women with preconceptional renal dysfunction appear to be at greatest risk for pregnancy complications.

Association of pregnancy complications and choice of immunosuppressant in liver transplant patients.

Background: The purpose of this study was to identify factors associated with antenatal complications for an ongoing series of pregnant women who have undergone orthotopic liver transplantation.

Methods: We reviewed Magee-Womens Hospital records from 14 pregnancies in 13 women in whom a liver had been transplanted before pregnancy. We collected and analyzed data regarding the primary liver disease, allograft status, liver function at conception and during pregnancy, immunosuppressive medications, associated medical conditions, time from transplant to conception, cytomegalovirus serostatus, and maternal and fetal outcome.