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BIRTH CONTROL (22 journals)

Showing 1 - 19 of 19 Journals sorted by number of followers
Journal of Maternal-Fetal & Neonatal Medicine     Hybrid Journal   (Followers: 40)
Birth     Hybrid Journal   (Followers: 37)
Contraception     Hybrid Journal   (Followers: 19)
Africa Journal of Nursing and Midwifery     Full-text available via subscription   (Followers: 16)
Journal of Family Planning and Reproductive Health Care     Hybrid Journal   (Followers: 14)
Adoption Quarterly     Hybrid Journal   (Followers: 10)
Journal of the American Board of Family Medicine     Open Access   (Followers: 10)
Obstetric Medicine     Hybrid Journal   (Followers: 7)
Perspectives On Sexual and Reproductive Health     Hybrid Journal   (Followers: 7)
Studies In Family Planning     Hybrid Journal   (Followers: 6)
Human Fertility     Hybrid Journal   (Followers: 6)
European Journal of Contraception & Reproductive Health Care     Hybrid Journal   (Followers: 5)
Fetal and Pediatric Pathology     Hybrid Journal   (Followers: 5)
BMJ Sexual & Reproductive Health     Hybrid Journal   (Followers: 3)
Biodemography and Social Biology     Hybrid Journal   (Followers: 1)
Revista Chilena de Obstetricia y Ginecologia     Open Access   (Followers: 1)
Contraception : X     Open Access  
Raigal     Open Access  
Teratology     Hybrid Journal  
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Journal Cover
Obstetric Medicine
Journal Prestige (SJR): 0.342
Citation Impact (citeScore): 1
Number of Followers: 7  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1753-495X - ISSN (Online) 1753-4968
Published by Sage Publications Homepage  [1176 journals]
  • Obituary: Dr Claire McLintock

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      Authors: Ian Kando
      Abstract: Obstetric Medicine, Ahead of Print.

      Citation: Obstetric Medicine
      PubDate: 2023-01-24T06:40:56Z
      DOI: 10.1177/1753495X231151525
       
  • A systematic review of posterior reversible encephalopathy syndrome in
           pregnant women with severe preeclampsia and eclampsia

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      Authors: Dalal A Tawati, Wee-Shian Chan
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundThe association of posterior reversible encephalopathy syndrome (PRES) and severe preeclampsia/eclampsia has been established but the frequency is uncertain.ObjectivesTo determine the frequency of PRES in severe preeclampsia or eclampsia.MethodsWe searched published articles in PubMed, Cochrane library, Embase, and CINAHL from 1990 to 2020. We included articles that reported on six or more cases of PRES with eclampsia or severe preeclampsia who underwent neuroimaging during pregnancy or up to 6 weeks postpartum.ResultsWe identified 29 studies presenting data on 1519 women with eclampsia or severe preeclampsia. Among 342 women with eclampsia who had neuroimaging, 176 (51.4%) were diagnosed with PRES. Of 121 women with severe preeclampsia, 24 (19.8%) had PRES. The pooled maternal death rate was 5.3% (21/395).ConclusionPRES is commonly reported on neuroimaging of women with eclampsia/ severe preeclampsia. The role of neuroimaging in eclampsia and especially in women with severe preeclampsia requires re-evaluation as further management is often dictated by this finding.
      Citation: Obstetric Medicine
      PubDate: 2023-01-18T07:36:27Z
      DOI: 10.1177/1753495X221150302
       
  • Pregnancy, childbirth and neonatal outcomes of women with rare inherited
           coagulation disorders

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      Authors: Lucy Jane McCann, Erin Scullion, Lauren Doy, Etienne Ciantar
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundWe aimed to describe the characteristics and the pregnancy outcomes of women with rare inherited coagulation factor disorders managed at a tertiary obstetric-haematology unit in the United Kingdom.MethodsA retrospective service evaluation was conducted using routinely collected medical records. Descriptive analyses were applied to investigate pregnancy, childbirth and neonatal management and outcomes.ResultsOverall, 20 patients with rare inherited coagulation disorders were included who birthed 30 live infants from 29 pregnancies. Regarding maternal bleeding outcomes, 3% experienced antepartum haemorrhage, 38% of pregnancies experienced primary post-partum haemorrhage, and none experienced secondary post-partum haemorrhage. Five (17%) neonates had cranial ultrasound scans for imaging to investigate for a neonatal haemorrhage, which were all normal.ConclusionsAlthough women with rare inherited coagulation disorders may be more susceptible to complications in pregnancy, within this cohort there was no evidence that the condition led to increased morbidity or mortality when best practices were observed.
      Citation: Obstetric Medicine
      PubDate: 2023-01-18T06:12:50Z
      DOI: 10.1177/1753495X221148813
       
  • Maternal and fetal outcomes in pregnant patients with non-cirrhotic portal
           hypertension: A systematic review and meta-analysis

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      Authors: Suprabhat Giri, Shradhanjali Sahoo, Sridhar Sundaram, Akash Shukla
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundConcerned studies with respect to the outcome of pregnant patients with non-cirrhotic portal hypertension are limited. Thus, a systematic review and meta-analysis of the available literature was conducted.MethodsA literature search was conducted from 1999 to December 2021 for studies evaluating pregnancy outcomes in patients with non-cirrhotic portal hypertension.ResultsTwelve studies were included in the meta-analysis. The pooled rate of variceal bleeding, ascites and severe anemia requiring blood transfusion were 9.6%, 2.3%, and 14.9%, respectively. The pooled rate of spontaneous miscarriage, gestational hypertension, delivery by cesarean section, and postpartum hemorrhage were 11.9%, 4.5%, 36.7%, and 4.7%, respectively. The pooled stillbirth rate was 2.5% and among the live births, the pooled rates of preterm birth, low birth weight, intensive care unit admission, and neonatal mortality were 21.6%, 18.7%, 15.5%, and 1.8%, respectively.ConclusionPregnancy in patients with non-cirrhotic portal hypertension is associated with increased maternal & fetal morbidity but mortality remains low.
      Citation: Obstetric Medicine
      PubDate: 2023-01-17T01:37:57Z
      DOI: 10.1177/1753495X221143864
       
  • Outcomes of pregnant women hospitalized with unrepaired congenital heart
           disease: Insights from a multidisciplinary center in Vietnam

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      Authors: Thanh-Huong Truong, Ngoc-Thanh Kim, Dinh-Phuc Nguyen, Mai-Ngoc Thi Nguyen, Doan-Loi Do, Thanh-Tung Le, Hong-An Le
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundIn developing countries, fewer women have access to multidisciplinary congenital heart disease and reproductive programs staffed by experts. We report pregnancy outcomes of a multidisciplinary healthcare strategy utilizing an in-hospital teamwork approach in Vietnam.MethodsThis retrospective cohort study included pregnant women with unrepaired congenital heart disease managed at a referral cardiovascular center.ResultsUndiagnosed congenital heart disease before pregnancy, a lack of pre-pregnancy cardiology counseling, and modified World Health Organization class III/IV were common. Under the multispecialty healthcare strategy, although the rate of maternal death was 8.2% in the modified World Health Organization class IV group, no deaths occurred in any other group. Fetal/neonatal complications occurred in 54% of pregnancies, and 49.4% of neonates survived. Poor pregnancy outcomes were associated with admission during the first/seconde trimester for fetus/neonates, third trimester for mother, modified World Health Organization class III/IV, cyanosis, and heart failure.ConclusionThe outcomes of pregnant women with unrepaired congenital heart disease were poor but seemed to improve with a multidisciplinary in-hospital healthcare teamwork strategy.
      Citation: Obstetric Medicine
      PubDate: 2023-01-11T07:52:15Z
      DOI: 10.1177/1753495X221148819
       
  • Pustular psoriasis of pregnancy: A rare cause of placental insufficiency

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      Authors: Daniel McStay, Sandy McBride, Sharleen Hill, Jonathan Sutton, Amber Saleem, Vinita Singh
      Abstract: Obstetric Medicine, Ahead of Print.
      Generalised pustular psoriasis of pregnancy (GPPP) is a rare dermatosis that presents in the third trimester. It merits careful clinical assessment given the difficulty in diagnosis, impact on maternal health and association with placental insufficiency. We present a case of generalised pustulosis in a pregnant woman at 30 weeks gestation and describe the clinico-pathological challenges in obtaining a diagnosis of GPPP. Furthermore, we provide evidence from cardiotocography and ultrasound of evolving fetal compromise and describe how intensive management can facilitate a positive maternal–fetal outcome.
      Citation: Obstetric Medicine
      PubDate: 2023-01-11T07:07:15Z
      DOI: 10.1177/1753495X221149134
       
  • Case report and discussion of pregnancy in a woman with Labrune syndrome
           and neurofibromatosis type 1

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      Authors: Alison Wilson, Anke Hensiek, Megan Jones
      Abstract: Obstetric Medicine, Ahead of Print.
      Labrune syndrome is a rare neurological autosomal recessive condition characterised by leukoencephalopathy, cerebral calcification and parenchymal cysts. Pregnancy has not been previously reported in an individual with this condition. This case report details the pregnancy of a primiparous woman with Labrune syndrome and neurofibromatosis type 1 who experienced a seizure in the second trimester of pregnancy, but went on to deliver her baby at term with good outcome for mother and baby. The case highlights the importance of pre-pregnancy advice in women with genetic conditions, and a multidisciplinary approach to the care of women with rare and complicated medical conditions during pregnancy.
      Citation: Obstetric Medicine
      PubDate: 2023-01-09T06:54:58Z
      DOI: 10.1177/1753495X221149161
       
  • Hemorrhage of cerebral cavernous malformation in third trimester of
           pregnancy: A case report

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      Authors: Lucia Merlino, Federica Del Prete, Luca Titi, Maria Grazia Piccioni
      Abstract: Obstetric Medicine, Ahead of Print.
      Cerebral cavernous malformation is a rare but important cause of cerebral hemorrhage in pregnancy and puerperium. In pregnancy, cavernomas can more easily bleed as a result of increased female hormones and growth factors such as Vascular Endothelial Growth Factor. We present the case of a pregnant woman who had been diagnosed with a cerebral cavernoma about ten years previously, after repeated headache episodes; at the 28th weeks of pregnancy the woman was hospitalized for epileptic seizures and active bleeding from the anterior cerebral artery. We describe the management of the case, the decision for a preterm delivery and for a resolutive neurosurgical procedure.
      Citation: Obstetric Medicine
      PubDate: 2023-01-03T07:56:26Z
      DOI: 10.1177/1753495X221134970
       
  • We meet again: Personal reflections from 2022 ISOM/NASOM meeting

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      Authors: Kenneth K Chen, Sandra A Lowe
      Pages: 215 - 215
      Abstract: Obstetric Medicine, Volume 15, Issue 4, Page 215-215, December 2022.

      Citation: Obstetric Medicine
      PubDate: 2022-12-07T01:53:19Z
      DOI: 10.1177/1753495X221144401
      Issue No: Vol. 15, No. 4 (2022)
       
  • Postpartum complications following neuraxial anaesthesia for obstetric
           physicians

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      Authors: Heather Lawrence, Adam Morton
      Abstract: Obstetric Medicine, Ahead of Print.
      Neuraxial analgesia and anaesthesia are widely accepted and well-tolerated modes of delivery analgesia, being employed in up to 76% of vaginal deliveries and 94% of caesarean deliveries in the United States. A cause of considerable concern for postpartum women, their family and caring health professionals is the occurrence of unexplained postpartum complications, not only for management in the index pregnancy, but the uncertain risk of recurrence in future pregnancies. Complications of neuraxial blocks may impact significantly on the ability of mothers to care for and bond with their newborn. The reported incidence of temporary neurological deficit following obstetric neuraxial blocks is 1 in 3900 procedures, and the risk of permanent neurological harm estimated to be between 1 in 80,000 and 1 in 320,425 procedures. Obstetric physicians may be asked to review women with postpartum complications following neuraxial blocks. This article reviews complications that may be seen following neuraxial blocks for delivery.
      Citation: Obstetric Medicine
      PubDate: 2022-12-26T07:37:15Z
      DOI: 10.1177/1753495X221146329
       
  • Pregnancy in women with cystic fibrosis and diabetes: An audit of outcomes
           at two tertiary obstetric hospitals in Australia in the pre-cystic
           fibrosis transmembrane conductance regulator modulator era

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      Authors: Sarah J Davidson, Megan France, Leonie K Callaway, Karin Lust, Daniel Chambers, Peter Hopkins, Scott C Bell, Lucy Burr, Rebecca Keating, Helen L Barrett
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundPregnancy in women with cystic fibrosis (CF) is becoming more common. Long-term metabolic issues such as diabetes are also becoming more common and have potentially important impacts on pregnancy outcomes. This study aimed to assess the impact of diabetes on pregnancy outcomes for women with CF.MethodsWe undertook a retrospective chart audit of pregnancies to women with CF at the two tertiary obstetric hospitals in Southeast Queensland associated with CF and transplant management clinics between 2006 and 2016.ResultsA total of 38 pregnancies among 26 women were identified. Four women (five pregnancies) had cystic fibrosis-related diabetes (CFRD) diagnosed prior to pregnancy, and 12 women (15 pregnancies) developed gestational diabetes (GDM) complicating pregnancy. CFRD and GDM were associated with higher rates of delivery complications, prematurity, and the need for neonatal intensive care unit admission.ConclusionDiabetes is common during pregnancy in women with CF and impacts pregnancy outcomes.
      Citation: Obstetric Medicine
      PubDate: 2022-12-26T06:35:13Z
      DOI: 10.1177/1753495X221146342
       
  • Gordon's syndrome in pregnancy

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      Authors: Adam Morton
      Abstract: Obstetric Medicine, Ahead of Print.
      Gordon's syndrome, also known as pseudohypoaldosteronism type II and familial hyperkalaemic hypertension, is a rare inherited condition characterised by familial hyperkalaemia, normal anion gap hyperchloraemic metabolic acidosis, low renin with normal glomerular filtration rate and hypertension. The outcome of 11 pregnancies in 3 women with Gordon's syndrome is presented and combined with 13 pregnancies in 7 women previously described. Pregnancy in women with Gordon's syndrome appears to be associated with a significant risk of adverse pregnancy outcomes, particularly where there is maternal hypertension preconception. No pregnancy registry exists for Gordon's syndrome. The available data is limited to case reports and small case series and may be affected by bias. A pregnancy registry would be valuable to assist in preconception counselling and management during pregnancy. The goal of this study was to summarise the available cases describing pregnancy outcomes with maternal Gordon's syndrome.
      Citation: Obstetric Medicine
      PubDate: 2022-12-22T06:36:04Z
      DOI: 10.1177/1753495X221146331
       
  • Management of fetal hyperthyroidism caused by persistent autoimmune
           antibodies in a case of previously treated maternal Graves’ disease

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      Authors: Susmita Reddy Karri, Priya Susan Roy, Nirjhar Nandi, Vasant Shenoy, David Watson
      Abstract: Obstetric Medicine, Ahead of Print.
      Maternal Graves’ autoantibodies are well known to cause fetal and neonatal thyroid disturbances. Despite radioiodine therapy, Graves’ autoantibodies are known to persist, which can cross the placenta and cause hyperthyroidism in the fetus. We present the case of a 26-year-old woman in her first pregnancy, clinically and biochemically euthyroid with history of treated Graves’ disease, where the fetus showed signs of hyperthyroidism on antenatal scans. This was confirmed by amniotic fluid testing as fetal blood sampling was not feasible and successfully treated with maternal carbimazole whilst continuing thyroxine for the mother (block-replacement). We discuss the challenges in the diagnosis of fetal hyperthyroidism and treatment whilst maternal thyroid status is maintained on thyroxine.
      Citation: Obstetric Medicine
      PubDate: 2022-12-20T07:26:07Z
      DOI: 10.1177/1753495X221146340
       
  • Calcium-alkali syndrome as a rare cause of severe hypercalcemia requiring
           dialysis in early twin gestation

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      Authors: P Beamish, C Mansour, I Druce, P O’Meara
      Abstract: Obstetric Medicine, Ahead of Print.
      Hypercalcemia is rare in women of child-bearing age, and most cases are due to primary hyperparathyroidism. A 28-year-old woman, 14 weeks pregnant with dichorionic diamniotic twins, presented to hospital with vomiting, muscle cramps, and weakness. She had been taking calcium carbonate for gastric reflux and nausea from 5 weeks of gestation. Investigations revealed severe hypercalcemia, metabolic alkalosis, and renal injury. She was transferred to intensive care, receiving fluid resuscitation and subcutaneous calcitonin followed by dialysis. Investigations revealed suppressed PTH and PTH-related peptide, negative malignancy screening and low vitamin D level. Calcium and renal function quickly normalized and with cessation of calcium carbonate remained normal throughout the rest of pregnancy. Reports of calcium-alkali syndrome causing severe hypercalcemia are scarce, with most cases occurring later in gestation. This case represents a dramatic presentation requiring renal replacement therapy early in twin gestation.
      Citation: Obstetric Medicine
      PubDate: 2022-12-19T05:13:43Z
      DOI: 10.1177/1753495X221145574
       
  • Spontaneous haemothorax caused by a ruptured pulmonary arterio-venous
           malformation: A manifestation of hereditary haemorrhagic telangiectasia in
           pregnancy

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      Authors: Maike Filbrich, Denis Brisbois, Yves Lebrun, Pierre-Arnaud Godin, Sara Verscheure
      Abstract: Obstetric Medicine, Ahead of Print.
      We report our experience of managing a massive haemothorax caused by a ruptured, previously unknown, pulmonary arteriovenous malformation (pAVM) at 34 + 5 weeks of gestation, which proved to be a manifestation of hereditary haemorrhagic telangiectasia (HHT), also known as Osler–Weber–Rendu syndrome. The patient underwent an emergency caesarean section under general anaesthesia after placement of a chest tube and gave birth to a healthy infant. A postoperative thoracic computed tomography angiography highlighted the presence of the large pAVM. Transcatheter embolization was performed right after the delivery. Subsequent patient's anamnesis, family history and genetic analysis finally revealed the presence of the syndrome. The aim of our report is to create awareness of this serious condition with potential life-threatening complications, especially in pregnancy. Simple criteria have been published and allow to easily consider HHT and the presence of potential AVM during anamnesis, ideally even before pregnancy.
      Citation: Obstetric Medicine
      PubDate: 2022-12-16T07:05:07Z
      DOI: 10.1177/1753495X221145809
       
  • Diagnosis, management and outcomes of primary hypokalemic periodic
           paralysis during pregnancy

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      Authors: Nivedita Jha, Divya Mecheril Balachandran, Molly Mary Thabah, Ajay Kumar Jha
      Abstract: Obstetric Medicine, Ahead of Print.
      Primary hypokalaemic periodic paralysis during pregnancy has been rarely reported. Four pregnant women with the acute onset of flaccid paralysis presented between January 2018 and December 2021. Focussed history and physical examination helped an appropriate radiological and laboratory investigation plan to be made. All women recovered within 4–7 days of potassium supplementation. Supplemental potassium continued until delivery. A pain management plan with continuous epidural infusion helped in avoiding stress-induced hypokalaemia. None of the women developed an episode of muscle weakness during the intervening period. In conclusion, a focussed history and targeted laboratory investigation are needed to diagnose primary hypokalaemic periodic paralysis. Early administration of oral or intravenous potassium is crucial in improving fetomaternal outcomes.
      Citation: Obstetric Medicine
      PubDate: 2022-12-16T07:04:48Z
      DOI: 10.1177/1753495X221144670
       
  • Impact of the COVID-19 pandemic on perinatal mental health screening,
           illness and pregnancy outcomes: A cohort study

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      Authors: Andre C. Q. Lo, Michelle Kemp, Nikolett Kabacs
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundThe aim was to explore the impact of the COVID-19 pandemic on perinatal mental health screening, illness and related pregnancy complications/outcomes.MethodsA single-centre retrospective cohort study in mothers giving birth before versus during the pandemic. Primary outcomes were the comparative prevalence/incidence of peripartum psychiatric diagnoses. Secondary outcomes were the pandemic's effect on psychiatric screening accuracy, and on other pregnancy outcomes linked to mental health.ResultsThe pandemic did not significantly increase the crude incidence of diagnosed peripartum anxiety (risk ratio (RR) = 1.39, 95% CI = 0.66–2.95), depression (RR = 1.63, 95% CI = 0.72–3.70) or other pregnancy outcomes. In multivariate models, the pandemic decreased Apgar scores and was involved in interaction effects for postpartum mental illness and birthweight. Psychiatric screening at the booking appointment exhibited lower sensitivity in predicting antenatal mental illness (pre-pandemic = 85.71%, pandemic = 25.00%; p = 0.035).ConclusionsThe lowered screening sensitivity likely meant mental illness was poorly anticipated/under-detected during the pandemic, leading to no crude increase in perinatal psychiatric diagnoses.
      Citation: Obstetric Medicine
      PubDate: 2022-11-28T08:26:10Z
      DOI: 10.1177/1753495X221139565
       
  • Catastrophic Antiphospholipid syndrome after pregnancy complicated by
           hemolysis, elevated liver enzymes and low platelets syndrome

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      Authors: Aashna Saini, Gianna Wilkie, Tina Dumont
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundAntiphospholipid syndrome (APLS) is rarely complicated by catastrophic antiphospholipid syndrome (CAPS). Peripartum CAPS is rarer still and can masquerade as other obstetric disorders. A high degree of suspicion is critical for early diagnosis and specific management given the significant morbidity and mortality associated with this disorder.CaseWe report a case of a 27-year-old at 22 weeks gestation with a history of APLS found to have severe hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, resulting in termination of pregnancy. Further workup revealed the diagnosis of CAPS followed by prompt treatment with triple therapy leading to clinical improvement.ConclusionCAPS should be considered within the differential in an obstetric patient with a history of APLS who has evidence of multiorgan involvement with macro- or microvascular thrombosis. Although this may mimic alternative disorders, prompt diagnosis is imperative for appropriate therapy and reduction in maternal morbidity and mortality.
      Citation: Obstetric Medicine
      PubDate: 2022-11-15T07:36:08Z
      DOI: 10.1177/1753495X221137941
       
  • Akathisia and oculogyric crisis in hyperemesis gravidarum

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      Authors: Adam Morton, Conor Mackle, Julian Pavey
      Abstract: Obstetric Medicine, Ahead of Print.
      Hyperemesis gravidarum complicates 0.5–2% of pregnancies. HG is associated with insomnia, significantly increased risks of anxiety and depression, and may be associated with feelings of guilt, social isolation and thoughts of suicidal ideation or termination of pregnancy. Anti-emetic therapy may be complicated by akathisia and dystonic reactions, which may affect the ongoing management of nausea and vomiting. A case of akathisia and oculogyric crisis following the addition of parenteral prochlorperazine to ondansetron and metoclopramide is presented. The treatment options for extrapyramidal side effects with anti-emetics in pregnancy and for ongoing treatment of nausea and vomiting are discussed.
      Citation: Obstetric Medicine
      PubDate: 2022-11-14T07:27:36Z
      DOI: 10.1177/1753495X221137942
       
  • EXPRESSION OF CONCERN: Streptococcus oralis meningitis in pregnancy

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      Authors: Ankur Paul
      Abstract: Obstetric Medicine, Ahead of Print.

      Citation: Obstetric Medicine
      PubDate: 2022-11-14T07:27:16Z
      DOI: 10.1177/1753495X221137023
       
  • Elevated cord levels of ustekinumab following its use in the treatment of
           Crohn's disease in pregnancy

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      Authors: Niamh E Keating, Caroline J Walker, Damian A Lally, Celine M O’Brien, Siobhan M Corcoran, Barbara M Ryan, Gavin C Harewood, Fionnuala M McAuliffe
      Abstract: Obstetric Medicine, Ahead of Print.
      Ustekinumab (USK) was used in the treatment of two pregnant patients with Crohn's disease. It was given in the third trimester and restarted postnatally for both women. One woman remained on USK and in remission throughout pregnancy. The second woman, took a treatment break, flared, and then had remission induced with reintroduction of USK. Both women delivered healthy term infants. The interval from last dose to birth was 11 and 8 weeks respectively. Interestingly, USK levels in cord blood was observed in higher concentrations than in the maternal serum taken in third trimester. While no adverse effect in infants has been observed, clinicians should remain aware of fetal transfer when using USK in pregnancy. An evaluation of risk and benefit may favour continuing USK in pregnancy in patients with refractory disease.
      Citation: Obstetric Medicine
      PubDate: 2022-11-08T01:53:56Z
      DOI: 10.1177/1753495X221135201
       
  • Maternal health and pregnancy outcomes in autosomal dominant
           tubulointerstitial kidney disease

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      Authors: Anthony J Bleyer, Kendrah O Kidd, Adrienne H Williams, Emily Johnson, Victoria Robins, Lauren Martin, Abbigail Taylor, Alice Kim, Isai Bowline, Dervla M Connaughton, Carl D Langefeld, Martina Zivna, Stanislav Kmoch
      Abstract: Obstetric Medicine, Ahead of Print.
      IntroductionAutosomal dominant tubulointerstitial kidney disease (ADTKD) is an increasingly recognized cause of chronic kidney disease. ADTKD pregnancy outcomes have not previously been described.MethodsA cross-sectional survey was sent to women from ADTKD families.ResultsInformation was obtained from 85 afffected women (164 term pregnancies) and 23 controls (50 pregnancies). Only 16.5% of genetically affected women knew they had ADTKD during pregnancy. Eighteen percent of ADTKD mothers had hypertension during pregnancy versus 12% in controls (p  =  0.54) and>40% in comparative studies of chronic kidney disease in pregnancy. Eleven percent of births of ADTKD mothers were
      Citation: Obstetric Medicine
      PubDate: 2022-10-20T06:59:21Z
      DOI: 10.1177/1753495X221133150
       
  • A clinical alert: Oral glucose tolerance test triggering diabetic
           ketoacidosis in pregnancy

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      Authors: Anjali Mundkur, Padavagodu Shivananda Roopa, Pratap Kumar Narayan, Akhila Vasudeva, Gazal Jain, Prashanth K Adiga
      Abstract: Obstetric Medicine, Ahead of Print.
      Gestational diabetes mellitus is a common medical disorder of pregnancy. Diabetic ketoacidosis is a complication that may affect both maternal and perinatal wellbeing adversely. It is rare, most often involving women with type 1 or type 2 diabetes, but occasionally can be seen in gestational diabetes mellitus. Here are two cases of ketoacidosis seemingly triggered by glucose ingestion for the oral glucose tolerance test in previously normoglycemic women, posing a diagnostic and therapeutic challenge. Prevention of such complications must be considered when treating high-risk pregnant women> 40 years of age, pregnant as a result of assisted reproductive techniques. Fasting blood glucose checked before ingestion of the glucose in a selected group of women may be one way of avoiding this complication. This suggestion may put women at risk of prolonged fasting and stretching services. Glucose tolerance test is a diagnostic test, and these cases demonstrate a rare complication.
      Citation: Obstetric Medicine
      PubDate: 2022-10-20T06:15:31Z
      DOI: 10.1177/1753495X221130659
       
  • Scrub typhus in pregnancy: A report of two cases

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      Authors: Advika Thamarai Selvan, Ishita Agarwal, Bijayini Behera, Sweta Singh
      Abstract: Obstetric Medicine, Ahead of Print.
      Scrub typhus shows a high prevalence in South-East Asia. In pregnant females, it can cause both maternal and fetal adverse outcomes. We report a case series of two women with scrub typhus and their varied outcomes.A 25-year-old primigravida treated for scrub typhus at 23 weeks' gestation presented at 34 weeks with stage three fetal growth restriction (FGR). Caesarean delivery was performed. The neonate had biliary atresia.A 24-year-old primigravida at 31 weeks' gestation was referred from a local hospital due to scrub typhus induced multi-organ dysfunction. She had FGR stage 1 with oligohydramnios. Emergency caesarean delivery was performed in view of acute fetal bradycardia.There is an emerging need for research to reassess what is already known about scrub typhus in pregnancy and to develop techniques for its treatment inorder to achieve a positive maternal and neonatal outcome in these cases.
      Citation: Obstetric Medicine
      PubDate: 2022-09-19T05:05:29Z
      DOI: 10.1177/1753495X221122593
       
  • Anomalous systemic arterial supply to the basal segment of the lung
           presenting with haemoptysis in the third trimester of pregnancy

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      Authors: Kate Hawke, Kaustuv Joshi, Hervey Lau, Arani Halder, Petrina Duncan, Penny Wolski
      Abstract: Obstetric Medicine, Ahead of Print.
      Anomalous systemic arterial supply to the basal segment of the lung (ABLL) is a rare cause of haemoptysis. ABLL may be complicated by massive haemoptysis, heart failure due to left-to-right shunt and infection. We describe a case of this condition presenting in the third trimester of pregnancy. Computed tomography chest angiogram confirmed the diagnosis. A multidisciplinary approach was necessary to determine treatment, which ultimately consisted of elective caesarean section at 36 weeks and 4 days’ gestation, followed by transarterial embolisation 9 days postpartum.
      Citation: Obstetric Medicine
      PubDate: 2022-09-15T07:17:51Z
      DOI: 10.1177/1753495X221125975
       
  • Concurrent valve replacement and caesarean section for rheumatic mitral
           valve disease with refractory heart failure in late pregnancy

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      Authors: Swaraj N Pande, Hemachandren Munuswamy, Durga P Rath, Sreevathsa KS Prasad, Jyoti Baghel, Ajith A Pillai, Satyen Parida, Nivedita Mondal, Anish Keepanasseril
      Abstract: Obstetric Medicine, Ahead of Print.
      ObjectiveTo assess clinical characteristics and outcomes of women who underwent concurrent valve replacement with caesarean section for severe rheumatic mitral valve disease with refractory heart failure.MethodsAll women admitted to a single centre from 2011 to 2020 with severe rheumatic mitral valve disease, having recurrent episodes of pulmonary edema on optimal medical therapy and contraindication to percutaneous balloon mitral valvotomy, who underwent concurrent valve replacement (for native valve disease) along with caesarean section, were included.ResultsAmong 1300 pregnancies with rheumatic heart disease, six underwent the concurrent procedure. All had replacement of mitral valve except one who had both aortic and mitral valve replacements, between 33 and 39 weeks of gestation. There were no maternal deaths, and there was one neonatal loss from late-onset sepsis.ConclusionPregnant women with severe rheumatic mitral valve disease with refractory heart failure, unsuitable for minimal access interventions, can be considered for a concurrent valve replacement with caesarean section.
      Citation: Obstetric Medicine
      PubDate: 2022-09-15T07:17:38Z
      DOI: 10.1177/1753495X221118433
       
  • Streptococcus oralis meningitis in pregnancy

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      Authors: Naina Mohan, Lucy O’Connor, Hannah Douglas, Anita Banerjee, Catherine Nelson-Piercy, John L Klein
      Abstract: Obstetric Medicine, Ahead of Print.
      While pregnancy is a time of relative immunosuppression, infective endocarditis and bacterial meningitis remain rare. We present a case of a pregnant woman with Streptococcus oralis endocarditis and meningitis. This is the first reported case of Streptococcus oralis meningitis in a patient without predisposing risk factors. This case highlights the importance of collecting blood cultures in febrile illness during pregnancy and illustrates that effective management plans can be formulated without performing invasive diagnostic tests such as transesophageal echocardiography.
      Citation: Obstetric Medicine
      PubDate: 2022-08-12T06:20:30Z
      DOI: 10.1177/1753495X221118168
       
  • A case of acute-onset paraplegia due to spinal tuberculosis in term
           pregnancy

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      Authors: Aishwarya Yadav, Anuradha Singh, Kiran Aggarwal
      Abstract: Obstetric Medicine, Ahead of Print.
      Acute paraplegia in pregnancy is uncommon but can result from pathology including Guillain-Barre syndrome, acute transverse myelitis, and spinal tuberculosis, also known as Pott's disease of the spine. India has a high incidence of tuberculosis (2.8 million cases annually) therefore spinal tuberculosis is a particularly important disease to consider during pregnancy. Management of spinal tuberculosis in pregnancy poses a challenge especially at term gestation as immobilization of the spine and maintaining supination is difficult, particularly at delivery.
      Citation: Obstetric Medicine
      PubDate: 2022-07-20T04:03:14Z
      DOI: 10.1177/1753495X221113758
       
  • Severe hyponatraemia peripartum associated with omeprazole therapy

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      Authors: Adam Morton
      Abstract: Obstetric Medicine, Ahead of Print.
      Hyponatraemia is the most commonly encountered electrolyte abnormality in pregnancy and may be associated with adverse maternal and neonatal outcomes. Rapid onset, severe hyponatraemia has been reported with proton-pump inhibitor therapy in non-pregnant individuals. Gastro-oesophageal reflux is very common during pregnancy, and proton-pump inhibitors are available without a prescription in many countries. A case of severe maternal hyponatraemia in the setting of recent omeprazole therapy is presented. Health professionals should be aware of this complication given the availability of proton-pump inhibitors without prescription and high rates of gestational gastro-oesophageal reflux.
      Citation: Obstetric Medicine
      PubDate: 2022-07-14T06:12:02Z
      DOI: 10.1177/1753495X221113489
       
  • Dialysis and a plant-based diet to achieve physiologic urea levels for
           fetal benefit: Normal pregnancy outcome despite chronic kidney disease and
           hypertension

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      Authors: Emma Seed, Elise Gilbertson
      Abstract: Obstetric Medicine, Ahead of Print.
      Chronic kidney disease significantly increases the risk of adverse maternal and perinatal outcomes. A growing body of evidence suggests that intensive dialysis, achieving physiologic pre-dialysis blood urea, is associated with decreased morbidity. We report a case of a successful pregnancy outcome in a 32-year-old nulliparous woman with stage 4 chronic kidney disease who dialysed from 11 to 31 weeks, gestation for fetal benefit and concurrently trialled a plant-based diet. We hypothesise that her dietary changes assisted with urea reduction, enabling her to become dialysis independent. Although we must recognise that such pregnancies remain high risk, as demonstrated both in this case and more recent literature, advances in complex obstetric care and dialysis protocols may now give women with chronic kidney disease a realistic hope of a successful pregnancy.
      Citation: Obstetric Medicine
      PubDate: 2022-07-08T06:08:04Z
      DOI: 10.1177/1753495X221110821
       
  • Survey of Australian clinicians’ antenatal care and management practices
           in pregnant women with a history of bariatric surgery

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      Authors: Elaina C Elder-Robinson, Susan de Jersey, Helen Porteous, Shannon L Huxtable, Michelle A Palmer
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundPregnancy following bariatric surgery requires tailored care. The current Australian care provision and its alignment with consensus guidelines is unclear.MethodsAntenatal care clinicians were invited to complete a web-based survey assessing multidisciplinary referral, gestational diabetes mellitus (GDM) and micronutrient management practices.ResultsRespondents (n = 100) cared for pregnant women with a history of bariatric surgery at least monthly (63%) with most (54%) not using a specific guideline to direct care. GDM screening methods included one-week of home blood glucose monitoring (43%) or the oral glucose tolerance test (42%). Pregnancy multivitamin supplementation changes (59%) with bariatric surgery type were common. Half (54%) screened for micronutrient deficiencies every trimester and conducted additional growth ultrasounds (50%).ConclusionThe care clinicians report providing may not align with current international consensus guidelines. Further studies with increased obstetric clinician response may aid increased understanding of current practices. The development of workplace management guidelines for pregnancy in women with a history of bariatric surgery may assist with providing consistent evidence-based care.
      Citation: Obstetric Medicine
      PubDate: 2022-07-07T06:56:38Z
      DOI: 10.1177/1753495X221106085
       
  • Acute leg pain and weakness in pregnancy: A new diagnosis of myotonic
           dystrophy

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      Authors: Vanessa C Heron, Ashmitha Thomas, Bonnia Liu, Amy A Crosthwaite, Hannah Skrzypek, Catriona A McLean, Kathy Paizis
      Abstract: Obstetric Medicine, Ahead of Print.
      We present a unique case of a 44-year-old woman who presented at 29 weeks’ gestation with proximal limb pain and elevated creatine kinase. This occurred in the background of premature cataracts, atrial fibrillation and abnormal liver function. Clinical, pathological and neurodiagnostic findings supported a diagnosis of myotonic dystrophy, confirmed by genetic testing which revealed dystrophia myotonica protein kinase gene expansion. Muscle biopsy found both recent necrotising and chronic myopathic processes. Following delivery, the mother's myalgia resolved and creatine kinase quickly declined. The fetus was diagnosed with congenital myotonic dystrophy. We review the impact of myotonic dystrophy on pregnancy and discuss potential explanations for this patient's clinical course. This case emphasises the importance of considering myotonic dystrophy as a differential diagnosis in the right clinical context and the need for pre-pregnancy assessment and genetic counselling in women with known myotonic dystrophy.
      Citation: Obstetric Medicine
      PubDate: 2022-07-01T06:44:57Z
      DOI: 10.1177/1753495X221109738
       
  • Pregnancy outcome with maternal HNF1B gene mutations and 17q12 deletions

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      Authors: Adam Morton, Ling Li, Caroline Wilson
      Abstract: Obstetric Medicine, Ahead of Print.
      There is an increasing body of literature regarding monogenic diabetes, particularly the more common forms of glucokinase and HNF1-alpha mutations (MODY2 and MODY3). There is relatively little published literature regarding rarer mutations. HNF1-beta mutations and 17q12 deletions may be associated with a broad range of organ dysfunction, renal disease and diabetes in particular resulting in high-risk pregnancies. This manuscript describes pregnancy outcomes in a woman with an HNF1-beta mutation and 2 women with an HNF1B/17q12 deletion and reviews the previously published literature. It highlights the significant rate of adverse maternal and fetal outcomes, and the maternal features suggestive of the diagnosis which should be considered in preconception counselling.
      Citation: Obstetric Medicine
      PubDate: 2022-06-27T07:06:58Z
      DOI: 10.1177/1753495X221109734
       
  • Cardiac tamponade during pregnancy due to primary lung cancer: A case
           report

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      Authors: Tomomichi Ito, Norikazu Watanabe, Mariko Watanabe, Urara Idei, Keiko Yamanouchi, Masamichi Sato, Masafumi Watanabe, Satoru Nagase
      Abstract: Obstetric Medicine, Ahead of Print.
      We report a rare case of cardiac tamponade caused by lung cancer in a pregnant woman. A 32-year-old multiparous pregnant woman was admitted to the hospital at 15 weeks of gestation with a persistent cough and dyspnea. Transthoracic echocardiography revealed a pericardial effusion with evidence of tamponade physiology. Computed tomography (CT) revealed a massive pericardial effusion and a left lung tumor. Pericardial tamponade was successfully treated using pericardiocentesis. She was diagnosed with lung adenocarcinoma stage IVB based on bronchoscopic lung biopsy, which showed adenocarcinoma and CT, which showed brain metastasis. Pregnancy was terminated at 18 weeks of gestation, followed by molecular-targeted therapy with alectinib hydrochloride and whole-brain irradiation. 24 months after treatment initiation the patient is alive without disease progression. Although pericardial tamponade caused by a malignant tumor during pregnancy is a rare and serious life-threatening condition, appropriate diagnosis and prompt treatment can improve maternal prognosis.
      Citation: Obstetric Medicine
      PubDate: 2022-06-27T07:06:39Z
      DOI: 10.1177/1753495X221110103
       
  • A curious case of ‘COVID toes’ in pregnancy

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      Authors: Harold Wilson-Morkeh, Iona Thorne
      Abstract: Obstetric Medicine, Ahead of Print.
      The novel coronavirus of 2019 (COVID-19) can affect multiple organ systems with a wide spectrum of illness severity. Its effect on the respiratory tract is well-documented and has resulted in considerable excess mortality worldwide. However, observed cutaneous manifestations of COVID-19 are rising, ranging from short-lived viral exanthems to vesicular eruptions and urticaria. An unusual subgroup of these manifestations – pseudo-chilblains, also referred to as pernio-like lesions or ‘COVID toes’ – describes the acral areas of erythema and oedema that can affect young individuals following COVID-19. We present a case associated with pustule and vesicle formation occurring in the context of pregnancy.
      Citation: Obstetric Medicine
      PubDate: 2022-06-20T04:13:41Z
      DOI: 10.1177/1753495X221109461
       
  • Pregnancy and delivery in patients with Charcot–Marie–Tooth disease
           and related disorders

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      Authors: Mariola Skorupinska, Gita Ramdharry, Bridgette Byrne, Matilde Laurá, Mary M Reilly
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundCharcot–Marie–Tooth disease is the most common inherited peripheral neuropathy and many patients with Charcot–Marie–Tooth are women of childbearing age. Guidelines for managing pregnancy in Charcot–Marie–Tooth are lacking.AimsTo assess the impact of pregnancy on Charcot–Marie–Tooth and how Charcot–Marie–Tooth affects pregnancy, delivery and postnatal care.MethodsA retrospective questionnaire exploring disease course during pregnancy, delivery, pregnancy complications, anaesthetic management and puerperium was administered to 92 patients with Charcot–Marie–Tooth and related disorders.ResultsWorsening of Charcot–Marie–Tooth symptoms were reported in 37% of pregnant patients which resolved after delivery in half of the patients. No significant increase in pregnancy, delivery and anaesthetic complications were observed and the type of delivery did not significantly differ from the normal population.ConclusionsWhile these results are reassuring, ideally an international prospective study should be done to confirm these results and to develop practice guidelines on the management of pregnancy in Charcot–Marie–Tooth.
      Citation: Obstetric Medicine
      PubDate: 2022-06-17T06:13:59Z
      DOI: 10.1177/1753495X221107328
       
  • Cutaneous hypersensitivity reaction to low molecular weight heparins in
           pregnancy, cross reactivity and prednisolone treatment: A case report

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      Authors: Susana Saraiva, Matilde Martins, Sara Sereno, Patrícia Ferreira, Augusta Pinto, Cátia Rasteiro
      Abstract: Obstetric Medicine, Ahead of Print.
      In pregnant women, low molecular weight heparin is recommended as the preferred agent for venous thromboembolism prophylaxis and treatment. Despite their widespread application, heparin-induced skin lesions are probably under-reported and under-estimated. We present a case report of a primigravida treated with low molecular weight heparin for deep vein thrombosis, who developed a delayed-type hypersensitivity reaction to enoxaparin, tinzaparin and dalteparin. As the patient was pregnant, treatment options were restricted. Tolerance was achieved with dalteparin with adjuvant administration of prednisolone. An attempt to decrease prednisolone dose triggered delayed-type hypersensitivity reaction recurrence that was solved by keeping the initial prednisolone prescription. To the best of our knowledge, there are no described cases using this approach. In cases of delayed-type hypersensitivity reaction to low molecular weight heparin during pregnancy our case suggests that switching low molecular weight heparin and adjuvant administration of prednisolone can be an option.
      Citation: Obstetric Medicine
      PubDate: 2022-05-27T08:03:27Z
      DOI: 10.1177/1753495X221102709
       
  • Possible additional criteria for the diagnosis of preeclampsia with severe
           features

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      Authors: Adam Morton
      Abstract: Obstetric Medicine, Ahead of Print.
      Preeclampsia is a disorder affecting multiple organ systems. Preeclampsia with severe features may prompt consideration of delivery. The diagnostic criteria for preeclampsia with severe features, while focusing upon maternal cardiopulmonary, neurological, hepatic, renal and haematological systems, vary considerably in International practice guidelines. In the absence of alternative causes. severe hyponatraemia, pleural effusions and ascites, and abrupt severe maternal maternal bradycardia are proposed as possible additional criteria for the diagnosis of preeclampsia.
      Citation: Obstetric Medicine
      PubDate: 2022-05-27T05:42:53Z
      DOI: 10.1177/1753495X221103981
       
  • Effects of oral glibenclamide versus subcutaneous insulin on perinatal
           outcome of patients with gestational diabetes mellitus: A randomized
           clinical trial

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      Authors: Azam Faraji, Lida Tahamtani, Najmeh Maharlouei, Nasrin Asadi
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundThe first-line treatment for gestational diabetes mellitus remains insulin, but oral hypoglycemic agents are easier and cheaper to use. The aim of the current study was to compare the efficacy and safety of oral glibenclamide and subcutaneous insulin on the serum glucose control and perinatal outcome of patients with gestational diabetes mellitus.Materials and methodsThis randomized clinical trial was conducted during a 2-year period from 2017 to 2019 in two tertiary healthcare centers in Shiraz, Iran. We included 84 singleton pregnancies between 24 and 34 weeks of gestation diagnosed with gestational diabetes mellitus. Patients were randomly assigned to oral glibenclamide (n = 44) or subcutaneous insulin (n = 40) according to a standard protocol and followed until delivery. The primary endpoint was to compare the glycemic level of patients, and the secondary outcomes included pregnancy adverse events and neonatal complications such as preeclampsia, preterm and premature rupture of membranes, preterm labor, placental abruption, maternal hypoglycemia, birth weight, neonatal hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, and neonatal intensive care unit admission.ResultsThe two study groups had comparable baseline characteristics. After treatment, the two study groups were comparable regarding fasting blood glucose (p = 0.398) and 2 h postprandial glucose (p = 0.085). There was no significant difference between the two groups regarding the rate of preeclampsia (p = 0.250), preterm rupture of membranes (p = 0.998), preterm labor (p = 0.495), hypoglycemia (p = 0.476), and abruption (p = 0.815). There was no significant difference between the two study groups in birth weight (p = 0.863) and the Apgar score at 1 (p = 0.190) and 5 min (p = 0.055). The rates of neonatal adverse events including hypoglycemia (p = 0.999), hyperbilirubinemia (p = 0.160), neonatal intensive care unit admission (p = 0.852), and respiratory distress syndrome (p = 0.665) were comparable between the two groups.ConclusionThe results of the current study demonstrate that oral glibenclamide is as effective and safe as subcutaneous insulin in glycemic control and maternal and neonatal outcomes in women with gestational diabetes mellitus. Thus, it could be used as first-line treatment of gestational diabetes mellitus.
      Citation: Obstetric Medicine
      PubDate: 2022-05-25T07:14:11Z
      DOI: 10.1177/1753495X221100167
       
  • Haematinic deficiency in pregnancy: another HELLP mimic

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      Authors: Lauren J Green, Christina YL Aye, Rayan Mohamed-Ahmed, Balvinder Sagoo, Lucy Mant, Charlotte J Frise
      Abstract: Obstetric Medicine, Ahead of Print.
      Haematinic deficiency is not uncommon in pregnancy. Folate deficiency is more common than B12 deficiency because of the increased uptake of folate in pregnancy, and the fact that B12 stores take much longer to deplete. Described here are five cases of anaemia in pregnancy secondary to severe haematinic deficiency with subsequent management and pregnancy outcomes. In the majority of cases, the women were proteinuric, but systemically well and normotensive. Thrombotic thrombocytopenic purpura and HELLP were both considered, but the identification of very abnormal folate levels of less than 3 μg/L in all and low B12 deficiency in the majority made haematinic deficiency the most likely diagnosis. They all received high dose folic acid, parenteral vitamin B12 and oral iron and made good haematological recoveries. Adequate antenatal correction of vitamin deficiency like this avoids bone marrow suppression and helps minimise poor obstetric outcomes associated with pre-existing anaemia including post-partum haemorrhage.
      Citation: Obstetric Medicine
      PubDate: 2022-05-19T04:39:58Z
      DOI: 10.1177/1753495X221101802
       
  • Crigler-Najjar type II in pregnancy: A case report

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      Authors: Katherine Creeper, Dorothy Graham
      Abstract: Obstetric Medicine, Ahead of Print.
      Crigler-Najjar is a rare, autosomal recessive disorder that results in mutations causing a complete absence (type I) or deficiency (type II) of the hepatic uridine diphospho-glucuronosyl transferase (UDPGT) enzyme. Both forms, however, result in unconjugated hyperbilirubinaemia which can lead to kernicterus and potentially death. Phenobarbitone can be used as an enzyme inducer in Type II to facilitate a reduction in total serum bilirubin. We report two consecutive pregnancies in a 29-year-old woman with Crigler-Najjar Type II syndrome. Phenobarbitone therapy was commenced in the first pregnancy at 16 weeks’ gestation and was associated with favorable biochemical and clinical outcomes. There were no reports of long-term neonatal neurological sequelae. Tertiary center, multidisciplinary care is recommended for optimal pregnancy outcomes.
      Citation: Obstetric Medicine
      PubDate: 2022-05-12T01:00:59Z
      DOI: 10.1177/1753495X221099443
       
  • Managing a new diagnosis of interstitial lung disease in pregnancy

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      Authors: Sophie Platts, Gavin Thomas, Rebecca Allen
      Abstract: Obstetric Medicine, Ahead of Print.
      Interstitial lung disease (ILD) presents rarely in pregnancy. Reports have associated disease activity with higher rates of preeclampsia, preterm births and fetal loss. This case report describes a patient presenting in her fifth pregnancy with worsening dyspnoea. She was treated with tacrolimus, prednisolone and post-partum methylprednisolone and ultimately had a successful outcome of childbirth.
      Citation: Obstetric Medicine
      PubDate: 2022-05-04T05:47:47Z
      DOI: 10.1177/1753495X221092603
       
  • Swyer-James-MacLeod syndrome in pregnancy: A case report

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      Authors: Omar Al-Bakri, Mary Malebranche, Nabha Shetty, Ashley Miller, Kyle McCoy, Christopher M Nash
      Abstract: Obstetric Medicine, Ahead of Print.
      Scant literature is available regarding pregnancy outcomes in women with Swyer-James-MacLeod syndrome, a rare obstructive lung disease. We present a case of a woman with this syndrome in pregnancy. Her baseline pulmonary function tests (PFT) demonstrated moderate airflow obstruction however she had excellent functional status and exercise tolerance. Her disease remained clinically stable in pregnancy. PFTs demonstrated slight worsening of her obstruction with forced expiratory volume in one second (FEV1). 59% and FEV1/FVC ratio 64%. She was diagnosed with gestational diabetes requiring metformin and insulin. Her labor and delivery was uncomplicated with vaginal delivery of a live male at term with no maternal respiratory complications. She did have a delayed postpartum hemorrhage requiring a D&C procedure. This case report demonstrates women with Swyer-James-MacLeod syndrome can have a successful pregnancy and need not avoid pregnancy if desired.
      Citation: Obstetric Medicine
      PubDate: 2022-04-25T05:54:51Z
      DOI: 10.1177/1753495X221092601
       
  • Impact of new diagnostic pathway for gestational diabetes in time of
           COVID-19

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      Authors: Betrice Walker, Jenna Edey, Leanne Hall, Kathleen Braniff, Clare Heal
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundIn April 2020, the diagnostic criteria for gestational diabetes mellitus (GDM) changed in Queensland, with the goal of reducing exposure of pregnant women to COVID-19.MethodsA retrospective clinical audit was conducted at a regional hospital to compare the incidence of GDM, and specific maternal and neonatal outcomes four months before and after the change in guidelines was implemented.ResultsLess than 50% of diagnostic tests were performed according to new guidelines. There was a non-significant increase in the incidence of GDM (13.3% to 15.3%), and pharmacological treatments. Instrumental deliveries (p = 0.01) and shoulder dystocia (p = 0.04) increased following the change in guidelines. There were no differences in the incidence of elective and emergency caesarean delivery, macrosomia and fetal weight. Maternal pre-pregnancy body mass index (BMI) was higher in the COVID-19 GDM cohort (p = 0.02).ConclusionsDespite the change in guidelines, there was a non-significant increase in the incidence of diagnosis of gestational diabetes.
      Citation: Obstetric Medicine
      PubDate: 2022-04-20T06:32:35Z
      DOI: 10.1177/1753495X221094899
       
  • Management of giant adrenal pseudocyst in pregnancy – A unique approach
           and review of literature

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      Authors: Tazeen Khan, Brinda Sabu, Vidyalekshmy Ranganayaki, P Rafeekha, Renu Thomas
      Abstract: Obstetric Medicine, Ahead of Print.
      Pseudocysts of the adrenal gland are rare and in the majority of cases are non- functioning. They become symptomatic only when they are complicated by hormonal excess, rupture, haemorrhage or infection. Described here is a 26-year-old woman who developed an acute abdomen at 28 weeks of gestation due to a left adrenal haemorrhagic pseudocyst A conservative approach was adopted, which was followed by elective term caesarean delivery with surgical intervention at the same time. The described case is unique in terms of strategizing timing and mode of management and thus minimizing the risk of prematurity and maternal morbidity associated with interval surgery.
      Citation: Obstetric Medicine
      PubDate: 2022-04-07T12:22:05Z
      DOI: 10.1177/1753495X221089210
       
  • Maternal and neonatal complications during delivery according to passive
           versus active second stage in woman with medical conditions (ComPActSS)

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      Authors: Élisabeth Gagnon, Anne-Marie Côté, Marie-Ève Roy-Lacroix, Édith Massé, Mandy Malick, Nadine Sauvé
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundThe incidence of serious complications during vaginal delivery with a passive second stage in women with medical conditions is unknown.MethodsOur retrospective cohort study with matched groups (pairing 1 passive with 2 active second stage) included women who had a medical delivery plan from the high risk obstetric team at our center. The primary outcome was a composite of major maternal and neonatal complications.ResultsThe primary outcome occurred in 50% (12/24) of women in the passive group versus 35.4% (17/48) (p = 0.24) in the active group. In the passive group, we observed a longer passive second stage of labor (28 vs. 8 min, p 
      Citation: Obstetric Medicine
      PubDate: 2022-03-31T06:05:48Z
      DOI: 10.1177/1753495X221089206
       
  • Maternal history of childhood maltreatment is associated with diurnal
           cortisol and DNA methylation of placental 11-beta-hydroxysteroid
           dehydrogenase type 2

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      Authors: Margaret Bublitz, Karl Kelsey, Rondi Butler, Ghada Bourjeily
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundAccumulating evidence indicates that maternal hypothalamic-pituitary-adrenal (HPA) axis activity over pregnancy differs according to maternal history of childhood maltreatment. DNA methylation of the placental 11-beta-hydroxysteroid dehydrogenase (BHSD) type 2 enzyme regulates fetal exposure to maternal cortisol, yet the association between maternal history of childhood maltreatment and methylation of placental 11BHSD type 2 has not been previously studied.MethodsWe examined if maternal cortisol production at 11 and 32 weeks’ gestation (n = 89) and placental methylation of the 11BHSD type 2 gene (n = 19) differed among pregnant women with and without histories of childhood maltreatment. Twenty-nine percent of participants reported a history of childhood maltreatment (physical/sexual abuse).ResultsWomen with histories of childhood maltreatment displayed lower cortisol in early gestation, hypo-methylation of placental 11BHSD type 2, and lower levels of cord blood cortisol.ConclusionPreliminary results suggest alterations in cortisol regulation over pregnancy according to maternal history of childhood maltreatment.
      Citation: Obstetric Medicine
      PubDate: 2022-03-18T08:19:05Z
      DOI: 10.1177/1753495X221087168
       
  • Diagnostic challenges in cerebral tuberculoma presenting with seizures in
           pregnancy

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      Authors: R Sujithra Devi, Sathiya Priya, Manoranjitha Kumari, G. Ramkumar, SreeRekha Jinkala, Dilip Kumar Maurya, Anish Keepanasseril
      Abstract: Obstetric Medicine, Ahead of Print.
      Tuberculoma is an uncommon presentation of tuberculosis and is found in regions with a high prevalence of tuberculosis. This is rarely diagnosed during pregnancy. The presentation can mimic other etiologies such as eclampsia or cerebral venous sinus thrombosis so the diagnosis can be challenging, particularly when presenting with seizures in pregnancy. Described here is a woman in her first pregnancy who presented with seizures mimicking eclampsia and was suspected to have a brain tumour on neuroimaging. She was diagnosed to have a intracerebral tuberculoma on histopathological examination following surgical decompression after delivery.
      Citation: Obstetric Medicine
      PubDate: 2022-02-15T05:47:07Z
      DOI: 10.1177/1753495X221078695
       
  • Pregnancy following personalised aortic root support in Marfan syndrome

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      Authors: Christina Coroyannakis, Maite Tome, Ingrid Watt-Coote, Matthew Cauldwell
      Abstract: Obstetric Medicine, Ahead of Print.
      Marfan syndrome (MFS) is linked with adverse pregnancy events, one of the most significant being aortic dissection. We present a case of a woman with MFS with prior aortic root dilatation who opted for a Personalised External Aortic Root Support (PEARS). To date, she is only the fifth woman to have had this valve-sparing procedure prior to pregnancy. We outline her care in a tertiary centre with multidisciplinary expertise, from preconception through to the postpartum period.
      Citation: Obstetric Medicine
      PubDate: 2022-02-11T01:33:36Z
      DOI: 10.1177/1753495X221078447
       
  • Optimal management of post-discharge postpartum hypertensive disorders of
           pregnancy: a quality improvement initiative

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      Authors: Alexia Tanguay Lecomte, Lauriane Vittoz, Nadine Sauvé, Marie-Ève Roy-Lacroix, Mandy Malick, Anne-Marie Côté
      Abstract: Obstetric Medicine, Ahead of Print.
      Introduction: Postpartum hypertensive disorders of pregnancy occur in 2-5% of pregnancies. It is a major cause of urgent postpartum consultation and is associated with life-threatening complications. Our objective was to evaluate if local management of postpartum hypertensive disorders of pregnancy was congruent with expert recommendations. Methods: We conducted a quality improvement initiative through a retrospective single-centre cross-sectional study. All women over 18-year-old consulting emergently for hypertensive disorders of pregnancy in the first six weeks postpartum, from 2015 to 2020, were eligible. Results: We included 224 women. Optimal management of postpartum hypertensive disorders of pregnancy was observed in 65.0%. While diagnosis and laboratory work-up were excellent, adequate blood pressure surveillance and recommendations upon discharge of an outpatient postpartum episode (69.7%) did not meet expectations. Conclusion: Efforts should be targeted to improve discharge recommendations on optimal blood pressure surveillance after delivery for women at risk for hypertensive disorders of pregnancy and for postpartum hypertensive disorders of pregnancy in women treated as outpatients.
      Citation: Obstetric Medicine
      PubDate: 2022-02-10T03:50:04Z
      DOI: 10.1177/1753495X221074613
       
  • A case series of severe symptomatic peripartum hyponatraemia

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      Authors: Louise Carlson-Hedges, Arani Pillai
      Abstract: Obstetric Medicine, Ahead of Print.
      This single centre case series describes the presentation and management of six cases of peripartum hyponatraemia in women who were otherwise deemed low-risk at delivery. It highlights presenting symptoms such as fatigue, confusion and seizures as well as the effects on the neonate. It also focuses on areas of interest such as fluid intake, hormonal effects of ADH and oxytocin and the association with birthing pools for future research.
      Citation: Obstetric Medicine
      PubDate: 2022-02-09T01:46:57Z
      DOI: 10.1177/1753495X221078440
       
  • Monitoring the safety of COVID-19 vaccination in pregnancy in the UK: A
           national study using the UK Obstetric Surveillance System (UKOSS), UK
           Teratology Information Service (UKTIS) and Vaccination in Pregnancy (VIP)
           safety monitoring systems

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      Authors: Jonathan L Richardson, Sally Stephens, Lucy C Chappell, Helen Campbell, Gayatri Amirthalingam, Shennae O’Boyle, Antoaneta Bukasa, Marian Knight, Kenneth K Hodson
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundCOVID-19 vaccines are protective against disease. Pregnant women benefit from vaccination as they are at higher risk of poor maternal and neonatal outcomes following infection.MethodsFollowing regulatory approval of two COVID-19 vaccines in the United Kingdom, a rapid national study of vaccination in pregnancy was instituted using three existing safety surveillance platforms: UKOSS, UKTIS and VIP. This preliminary report describes the data collected up to the 15th June 2021.ResultsThere were 971 reports of COVID-19 vaccination in the UKOSS/UKTIS (n = 493) and VIP (n = 478) monitoring systems describing 908 individual pregnancies. Pfizer-BioNTech mRNA vaccination was most common (n = 501, 55.2%), most women were vaccinated in their second or third trimester (n = 566, 62.3%), and were mainly vaccinated due to occupational infection risk (n = 577, 63.5%).ConclusionObstetric outcome data will be obtained by December 2021. However, women should not delay vaccination whilst awaiting further safety data to emerge.
      Citation: Obstetric Medicine
      PubDate: 2022-02-08T04:57:02Z
      DOI: 10.1177/1753495X221076713
       
  • Impetigo herpetiformis: A rare pregnancy-specific dermatosis

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      Authors: Mohsen M. A. Abdelhafez, Karim A. M. Ahmed, Mohd Nazri Bin Mohd Daud, Mohammad Saffree Jeffree, Fairrul Kadir, Dg Marshitah pg Baharuddin, Win Win Than, Firdaus Hayatti, Kai Xin Tay, Aya M. Eldiastey
      Abstract: Obstetric Medicine, Ahead of Print.
      Impetigo herpetiformis (IH) is a pregnancy-specific dermatosis that is currently considered a form of generalised pustular psoriasis and mainly occurs in late pregnancy during the third trimester. IH presents as erythematous patches and pustules and might have systemic involvement. The disease may be associated with severe maternal, fetal, and neonatal complications. IH treatment is very challenging, however, various therapeutic options are available and effective for disease treatment.
      Citation: Obstetric Medicine
      PubDate: 2022-01-28T01:19:56Z
      DOI: 10.1177/1753495X221074610
       
  • VTE prophylaxis in pregnant people with chronic physical disability: Data
           from a physicians survey and the need for guidance

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      Authors: Sajida Kazi, Anne McLeod, Anne Berndl
      Abstract: Obstetric Medicine, Ahead of Print.
      BackgroundInternational guidelines recommend risk assessment during the antepartum and postpartum period to inform VTE prophylaxis. We aimed to evaluate physicians’ approach to VTE prophylaxis of women with chronic physical disability (CPD) during pregnancy.MethodsA cross-sectional study consisting of a self-administered electronic questionnaire was sent to specialists across Canada.ResultsSeventy-three participants responded to the survey, and 55 (75.3%) completed the survey including 33 (60%) Maternal Fetal Medicine (MFM) specialists and 22 (40%) Internal Medicine (IM) specialists including physicians with interest in Obstetric Medicine. Our study shows considerable variation in VTE thromboprophylaxis during pregnancy with CPD. Most respondents favoured antepartum (67.3%) and postpartum (65.5%) VTE prophylaxis for pregnancies within a year of spinal cord injury.ConclusionsIn order to better manage this complex population CPD should be considered as a risk factor for development of VTE.
      Citation: Obstetric Medicine
      PubDate: 2022-01-27T02:22:43Z
      DOI: 10.1177/1753495X221074616
       
  • Successful pregnancy and delivery management in a patient with Bernard
           Soulier Syndrome

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      Authors: Ufuk Demirci, Esra Altan Erbilen, Elif Gülsüm Ümit, Cihan İnan, N. Cenk Sayın, Ahmet Muzaffer Demir
      Abstract: Obstetric Medicine, Ahead of Print.
      Bernard Soulier Syndrome (BSS) is an inherited bleeding disorder characterized by macrothrombocytopenia and absence of ristocetin-induced platelet aggregation. Clinical findings vary from person to person. Most of the patients are diagnosed with muco-cutaneous bleeding such as purpura, epistaxis and gingival bleeding in early childhood. Few pregnant women with BSS are described in the literature. Management of thrombocytopenia during pregnancy and delivery requires a multidisciplinary approach. The family should be warned about the potentially life-threatening bleeding during pregnancy and the delivery and the decision about mode of delivery should be individualised, involving discussion with patient and multidisciplinary team.
      Citation: Obstetric Medicine
      PubDate: 2022-01-13T01:13:36Z
      DOI: 10.1177/1753495X211067119
       
  • COVID-19 in pregnancy: A UK perspective

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      Authors: Sanaa Zayyan, Charlotte Frise
      First page: 216
      Abstract: Obstetric Medicine, Ahead of Print.
      COVID-19 infection in pregnancy can cause respiratory and obstetric complications, however emerging evidence on its impact in pregnancy is limited. This article aims to review data collected and analysed so far over the course of the coronavirus pandemic, that examine demographic associations, patterns of disease, severity and outcomes of COVID-19 in pregnancy in the UK.Hospital admission, for which black and minority ethnic background and raised body mass index are risk factors, is associated with maternal mortality and admission to intensive care and is more likely in the late second or third trimester. Vaccination is safe in pregnancy and is protective against severe COVID-19 and admission to intensive care,, Maternal SARS CoV-2 is associated with a greater risk of stillbirth, preterm birth, small for gestational age (SGA) and preeclampsia. Efforts to reduce the incidence of COVID-19 in pregnancy, including vaccination, are therefore likely to reduce preventable complications from this disease.
      Citation: Obstetric Medicine
      PubDate: 2022-03-23T07:40:11Z
      DOI: 10.1177/1753495X221083134
       
  • A review of COVID-19 therapeutics in pregnancy and lactation

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      Authors: Sarah CJ Jorgensen, Najla Tabbara, Lisa Burry
      First page: 225
      Abstract: Obstetric Medicine, Ahead of Print.
      Pregnant people have an elevated risk of severe COVID-19-related complications compared to their non-pregnant counterparts, underscoring the need for safe and effective therapies. In this review, we summarize published data on COVID-19 therapeutics in pregnancy and lactation to help inform clinical decision-making about their use in this population. Although no serious safety signals have been raised for many agents, data clearly have serious limitations and there are many important knowledge gaps about the safety and efficacy of key therapeutics used for COVID-19. Moving forward, diligent follow-up and documentation of outcomes in pregnant people treated with these agents will be essential to advance our understanding. Greater regulatory push and incentives are needed to ensure studies to obtain pregnancy data are expedited.
      Citation: Obstetric Medicine
      PubDate: 2022-01-12T12:07:10Z
      DOI: 10.1177/1753495X211056211
       
  • Considerations for women with COVID-19 admitted to hospital

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      Authors: Felicity Coad, Charlotte Frise
      First page: 233
      Abstract: Obstetric Medicine, Ahead of Print.
      The number of pregnant women being admitted with severe COVID-19 infection and dying has increased with each wave of the pandemic. These women often present unique challenges to the medical and obstetric teams given the changes in physiology that occur in pregnancy, affecting assessment and management, as well as the practical difficulties such as the ideal location of care. Whilst the basis of treatment remains the same, there are nuances to caring for pregnant women that need considerable thought and multidisciplinary collaboration. Obstetricians, neonatologists, midwives, intensivists, anaesthetists and physicians may all be involved at some point, depending on the gestation and severity of illness. Implementing a COVID-19 in pregnancy guideline or checklist for your hospital will help ensure pregnant women are managed in a safe and timely manner. Here described are some key recommendations to help in the management of pregnant women admitted with COVID-19.
      Citation: Obstetric Medicine
      PubDate: 2022-03-17T06:46:13Z
      DOI: 10.1177/1753495X221083504
       
 
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