Pregnancy and delivery in Ehlers-Danlos syndrome. Role of copper and zinc

Connective tissue and related disorders and preterm birth: clues to genes contributing to prematurity

To identify candidate genes contributing to preterm birth, we examined the existing literature on the association between known disorders of connective tissue synthesis and metabolism and related diseases and prematurity. Our hypothesis was that abnormal matrix metabolism contributes to prematurity by increasing risk of preterm premature rupture of membranes (PPROM) and cervical incompetence. Based on this review, we identified gene mutations inherited by the fetus that could predispose to preterm birth as a result of PPROM. The responsible genes include COL5A1, COL5A2, COL3A1, COL1A1, COL1A2, TNXB, PLOD1, ADAMTS2, CRTAP, LEPRE1 and ZMPSTE24. Marfan syndrome, caused by FBN1 mutations, and polymorphisms in the COL1A1 and TGFB1 genes have been associated with cervical incompetence. We speculate that an analysis of sequence variation at the loci noted above will reveal polymorphisms that may contribute to susceptibility to PPROM and cervical incompetence in the general population.

Ehlers-Danlos syndrome: insights on obstetric aspects

Ehlers-Danlos syndrome (EDS) is a heterogeneous group of connective tissue disorders characterized by joint hypermobility, skin hyperelasticity, tissue fragility, easy bruising, and poor healing of wounds. The clinical manifestations vary depending on the type of disease. The syndrome may be associated with a number of pregnancy and peripartum complications. Because of the multiorgan involvement and varied presentation of this disease, no uniform or routine obstetric and anesthetic recommendations can be made for the perinatal care of these patients. We present a review of the literature on EDS with emphasis on the obstetric, anesthetic, and perinatal consequences. We also report our experience with this syndrome: an uneventful term vaginal delivery in a 32-year-old woman diagnosed with hypermobility type of EDS.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader should be able to recall the potentially severe nature of Ehlers-Danlos Syndrome (EDS) in both pregnant and nonpregnant patients, summarize the wide range of signs and symptoms and its genetic inheritance, and explain the difficulty in recommending obstetric and anesthesia procedures to avoid complications.

Cesarean section and Ehlers-Danlos syndrome: choice of anesthesia

Ehlers-Danlos syndrome is a rare genetically transmitted connective tissue disorder, non-specific to pregnancy. Because of multi-organ involvement and varied presentations of this disease, no uniform anesthetic recommendations can be made. We report a case of a parturient with Ehlers-Danlos syndrome who presented in active labor with spontaneous rupture of membranes and footling breech presentation. She received single dose spinal anesthesia for an uneventful emergency cesarean section.

Ehlers-Danlos syndrome in the parturient: an uncommon disorder--common dilemma in the delivery room

DESCRIPTION

Ehlers-Danlos syndrome (EDS) is a rare genetically transmitted connective tissue disorder, non-specific to pregnancy.

CONCLUSION

Because of multi-organ involvement and the varied presentations of this disease, no uniform obstetric and anesthetic recommendations regarding the peripartum care of these parturients can be made.

Dermatoses of pregnancy

The dermatoses of pregnancy can be classified into the following 3 groups: physiologic skin changes in pregnancy, dermatoses and cutaneous tumors affected by pregnancy, and specific dermatoses of pregnancy. Correct diagnosis and classification are essential for the treatment of these disorders, when necessary. Laboratory investigations are required when the diagnosis remains in question despite a careful history and thorough physical examination. A discussion with the pregnant woman about the nature of her skin condition, and the possible fetal risks associated with it, is imperative.

Anaesthesia for caesarean section in a patient with Ehlers-Danlos syndrome and mitral valve prolapse

We report the successful use of single-shot spinal anaesthesia for elective caesarean section in a multigravid woman with Ehlers-Danlos syndrome, complicated by mitral valve prolapse. This is a rare inherited collagen disorder that has been reported to have a high pregnancy-related morbidity and mortality, particularly from uterine rupture and uncontrolled bleeding from friable vessels, coagulopathy and major vessel rupture. The literature concerning obstetric anaesthetic management for different types of Ehlers-Danlos syndrome and the management of mitral valve prolapse in pregnancy are reviewed.

Skin diseases aggravated by pregnancy

During pregnancy, immunologic, endocrine, metabolic, and vascular changes occur that make the pregnant woman susceptible to aggravation of certain skin diseases. These diseases can be organized into five broad categories: infections, diseases of altered immunity, metabolic diseases, connective tissue disorders, and miscellaneous conditions. A discussion of how each of these diseases is altered by pregnancy and how treatment may differ during gestation is presented.

Application of particle-induced X-ray emission to research in biology and medicine

The analytical technique of particle-induced X-ray emission (PIXE) is described, and recent applications to problems in biomedical research are surveyed.