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Sahu P, Balakrishnan D, Singh B. Acute Presentation of Asymptomatic Giant Endometrioma in Pregnancy: A Case Report. Cureus 2023; 15:e49580. [PMID: 38156175 PMCID: PMC10754297 DOI: 10.7759/cureus.49580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Endometriomas are associated with severe endometriosis and are uncommon in asymptomatic women. Reported cases of giant endometriomas are few especially in pregnancy. Decidualization of endometriomas can mimic malignancies in pregnancy. Fetal outcomes can be good after excision of large endometriomas in the 2nd trimester. We present a case of giant endometrioma diagnosed in an asymptomatic woman who developed symptoms after becoming pregnant. Clinical findings, investigations, and histopathology were consistent with ovarian endometrioma. Maternal and fetal outcomes were good after the excision of the mass.
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Affiliation(s)
- Pooja Sahu
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Deepthy Balakrishnan
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Bhavya Singh
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
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Wangwe P, Kibwana M, August F, Kikula AI. Decision to delivery interval, maternal and fetal outcomes in emergency caesarean sections in a tertiary teaching hospital, Dar es salaam, Tanzania. Afr Health Sci 2023; 23:17-26. [PMID: 38357110 PMCID: PMC10862602 DOI: 10.4314/ahs.v23i3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background Emergency caesarean section (CS) answers the question on how soon the procedure should be performed. Maternal and fetal outcomes deteriorate when decision to delivery interval (DDI) exceeds 75 min. This study aimed at determining the DDI, Maternal and fetal outcomes in CS categories at Muhimbili National Hospital (MNH). Methodology A descriptive cross-sectional study involving 427 emergency CS at MNH was conducted from September to November, 2017. Data was extracted and analysed using SPSS version 23.0 where frequency, means, chi-square test and DDI were calculated to determine its association with categories of CS. Results The mean DDI for category one, two and three CS were 126.73, 133.57 and 160.08 min respectively. Only two (0.5%) and 54 (12.6%) of category one and two emergency CS met the recommended DDI of 30 and 75 min respectively. Maternal and fetal adverse outcome were increasing with increase in DDI. There was no significant association between DDI and adverse maternal outcome (OR: 1.2; 95% CI 0.49-2.83) and fetal outcome (OR: 1.7; 95% CI 0.91-3.38). Conclusion The proportions of adverse maternal and fetal outcome were high when DDI was ≥ 75 min. Improving triage of the patients according to their urgency is crucial in reducing prolonged DDI.
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Affiliation(s)
- Peter Wangwe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Muhimbili National Hospital, Obstetrics and Gynecology
| | - Mfaume Kibwana
- Geita Regional Referral Hospital, Obstetrics and Genecology
| | - Furaha August
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Muhimbili National Hospital, Obstetrics and Gynecology
| | - Aman I Kikula
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Muhimbili National Hospital, Obstetrics and Gynecology
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Cevher Akdulum MF, Demirdağ E, Arık Sİ, Safarova S, Erdem M, Bozkurt N, Erdem A. Is the First-Trimester Systemic Immune-Inflammation Index Associated With Preeclampsia? Cureus 2023; 15:e44063. [PMID: 37746374 PMCID: PMC10517744 DOI: 10.7759/cureus.44063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE Preeclampsia (PE) is a serious and common pregnancy issue. There is a systemic inflammation in PE and it is accompanied by increased oxidative stress, but the clear etiology has not been revealed. We aimed to predict PE with the systemic immune-inflammation index (SII) value calculated in the first trimester. MATERIAL AND METHODS This is a retrospective study. One hundred fifty-seven pregnant women were included in the study. Twenty-seven pregnant women were excluded from the study. Age, gravida, parity, and hemogram values were recorded in the patients' first visit file records. The time and mode of delivery, birth weight, and APGAR scores were obtained from the file records of the patients. SII was created using the formula (neutrophil x platelet/lymphocyte). Result: The study group included 30 pregnant women who had been diagnosed with PE. The control group consisted of the remaining 100 pregnant women. There was a statistically significant difference between PE and control groups in terms of SII (p=0.03). The SII level cut-off value for predicting PE was determined to be 836.83. This value's area was found to be 0.635 (0.519-0.752). Furthermore, the selectivity is 0.60 and the sensitivity is 0.40 for these values. Conclusion: SII was found to be significantly higher in people with PE in the study. We showed that the SII value measured in the first trimester can be used to predict PE. It might make sense to combine this marker with the patient's history and other risk factors due to its low selectivity and sensitivity.
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Affiliation(s)
| | | | | | | | - Mehmet Erdem
- Obstetrics and Gynecology, Gazi University, Ankara, TUR
| | - Nuray Bozkurt
- Obstetrics and Gynecology, Gazi University, Ankara, TUR
| | - Ahmet Erdem
- Obstetrics and Gynecology, Gazi University, Ankara, TUR
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Liu P, Zhang X, Wang X, Liang Y, Wei N, Xiao Z, Li T, Zhe R, Zhao W, Fan S. Maternal sepsis in pregnancy and the puerperal periods: a cross-sectional study. Front Med (Lausanne) 2023; 10:1126807. [PMID: 37261123 PMCID: PMC10228646 DOI: 10.3389/fmed.2023.1126807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 04/17/2023] [Indexed: 06/02/2023] Open
Abstract
Maternal sepsis is a life-threatening condition and ranks among the top five causes of maternal death in pregnancy and the postpartum period. Herein, we conducted a retrospective study on sepsis cases to explain the related risk factors by comparing them with bloodstream infection (BSI) and control maternities. In total, 76 sepsis cases were enrolled, and 31 BSI and 57 maternal cases of the same age but with neither sepsis nor BSI were set as controls. Genital tract infection (GTI) and pneumonia were the two most common infection sources in both sepsis (22 cases, 29% and 29 cases, 38%) and BSI cases (18 cases, 58% and 8 cases, 26%). Urinary tract infection (UTI)/pyelonephritis (9 cases, 12%) and digestive infection cases (11 cases, 14%) only existed in the sepsis group. Significantly different infection sources were discovered between the sepsis-death and sepsis-cure groups. A higher proportion of pneumonia and a lower proportion of GTI cases were present in the sepsis-death group (17 cases, 45% pneumonia and 9 cases, 24% GTI) than in the sepsis-cure group (12 cases, 32% pneumonia and 13 cases, 34% GTI). In addition, although gram-negative bacteria were the dominant infectious microorganisms as previously reported, lower proportion of gram-negative bacteria infectious cases in sepsis (30 cases, 50%) and even lower in sepsis-death group (14 cases, 41%) was shown in this study than previous studies. As expected, significantly greater adverse maternal and fetal outcomes, such as higher maternal mortality (26.3% vs. 0% vs. 0%), higher fetal mortality (42.2% vs. 20.8% vs. 0%), earlier gestational age at delivery (26.4 ± 9.5 vs. 32.3 ± 8.1 vs. 37.7 ± 4.0) and lower newborn weight (1,590 ± 1287.8 vs. 2859.2 ± 966.0 vs. 3214.2 ± 506.4), were observed in the sepsis group. This study offered some potential pathogenesis and mortality risk factors for sepsis, which may inspire the treatment of sepsis in the future.
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Affiliation(s)
- Ping Liu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Shenzhen Key Laboratory of Gynecological Diagnostic Technology Research, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiaowei Zhang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Shenzhen Key Laboratory of Gynecological Diagnostic Technology Research, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xinxin Wang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Shenzhen Key Laboratory of Gynecological Diagnostic Technology Research, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yiheng Liang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Nan Wei
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Zhansong Xiao
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Ting Li
- Department of Obstetrics and Gynecology, Suzhou Municipal Hospital, Suzhou, China
| | - Ruilian Zhe
- Department of Obstetrics, Shenzhen People’s Hospital, Shenzhen, China
| | - Weihua Zhao
- Department of Obstetrics, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Shangrong Fan
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Shenzhen Key Laboratory of Gynecological Diagnostic Technology Research, Peking University Shenzhen Hospital, Shenzhen, China
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Ghai A, Manghat S, Sarkar S, Venkatesh YS, Chaturvedula L. Outcome of emergency obstetric cases in relation to the referral pattern at a tertiary hospital in Puducherry: A cross-sectional descriptive study. Indian J Public Health 2023; 67:221-225. [PMID: 37459016 DOI: 10.4103/ijph.ijph_1124_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Background Referral is a crucial aspect of emergency obstetric care in India. Adequate and timely referrals help to improve the quality of health-care services and maternal and child well-being. Objectives Studies are needed to assess the outcome of obstetric mothers' emergency admissions in relation to referral patterns. Materials and Methods A hospital-based cross-sectional descriptive study was done among obstetric patients admitted to a tertiary care hospital's emergency department (emergency medical service [EMS]). A retrospective cohort was analyzed. The data were entered in Epicollect5 and imported to STATA software version 16 for analysis. Results A total of 685 mothers admitted to EMS were selected for the study, with a mean (standard deviation) age of 26.5 years (4.2). Among the study participants, 181 (26.4%) were referred from other institutions, 382 (55.8%) were nonreferral who received antenatal checkups in the tertiary hospital, and 122 (17.8%) were self-referral who had not received any antenatal checkup in the tertiary hospital. The adverse fetal outcome was 1.88 (1.21-2.95) times higher in the referred mothers compared to the self-referral. Conclusion We observed that a higher percentage of referrals were from the primary health centers. This kind of direct referral to tertiary care hospitals can be avoided by availing the emergency obstetric services at secondary hospitals to prevent adverse fetal outcomes and unnecessary referrals to the tertiary hospital.
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Affiliation(s)
- Abhilasha Ghai
- MPH Student, JIPMER International School of Public Health (JISPH), Puducherry, India
| | - Sreeja Manghat
- PhD Scholar, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sonali Sarkar
- Professor, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Yavana Suriya Venkatesh
- Assistant Professor, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Latha Chaturvedula
- Professor, Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Bali A, Naik R. The Impact of a Vegan Diet on Many Aspects of Health: The Overlooked Side of Veganism. Cureus 2023; 15:e35148. [PMID: 36950003 PMCID: PMC10027313 DOI: 10.7759/cureus.35148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/20/2023] Open
Abstract
Vegetarianism in any of its various forms, particularly veganism, has been increasing in popularity over the past few years, especially among the young population in the United States. While several studies have shown that a vegan diet (VD) decreases the risk of cardiometabolic diseases, such as cardiovascular disease, type 2 diabetes mellitus, obesity, and non-alcoholic fatty liver disease, veganism has been associated with adverse health outcomes, namely, nervous, skeletal, and immune system impairments, hematological disorders, as well as mental health problems due to the potential for micro and macronutrient deficits. The goal of this review article is to discuss the current literature on the impact and long-term consequences of veganism on vulnerable populations, including children, adolescents, pregnant and breastfeeding women, and fetal outcomes in strict vegan mothers. It also focuses on the many deficiencies of the vegan diet, especially vitamin B12, and the related increased risk of malignancies.
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Affiliation(s)
- Atul Bali
- Internal Medicine / Nephrology, Geisinger Health System, Wilkes-Barre, USA
- Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
- Medicine, Geisinger Medical Center, Danville, USA
| | - Roopa Naik
- Internal Medicine, Geisinger Health System, Wilkes-Barre, USA
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Isaac B, Hazari K, Harb DK, Mallick AK, Abdelkareem W, Ammar A, Gergawi T, Saeed Al Zahmi E, Khamis AH. Maternal and Fetal Outcome in Pregnant Women With Critical COVID-19 Treated With Tocilizumab in a Tertiary Care Hospital in Dubai. Cureus 2023; 15:e34395. [PMID: 36874696 PMCID: PMC9977079 DOI: 10.7759/cureus.34395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Pregnancy, complicated by coronavirus disease 2019 (COVID-19), results in higher hospitalization and mortality rate. Pathogenesis of COVID-19 is similar to any other systemic inflammatory condition but results in a cytokine storm of higher magnitude causing severe acute respiratory distress syndrome and multiorgan failure. Tocilizumab, a humanized monoclonal antibody, targets soluble and membrane-bound IL-6 receptors and is used in the treatment of juvenile idiopathic arthritis, rheumatoid arthritis, and cytokine release syndrome. However, studies exploring its role in pregnancy are minimal. Hence, this study was done to study the effect of tocilizumab on maternal and fetal outcomes in critical COVID-19 pregnant women. METHODOLOGY A retrospective study was conducted on 28 pregnant women with critical COVID-19 who received tocilizumab. Clinical status, chest x-ray, biochemical parameters, and fetal well-being were monitored and documented. The discharged patients were followed up through telemedicine. RESULT On treatment with tocilizumab, improvement was seen in the number of zones and patterns of chest x-ray, along with 80% reduction in the c-reactive protein (CRP) levels. Based on the WHO clinical progression scale, 20 patients improved by the end of first week, and by the end of first month, 26 patients became asymptomatic. Two patients died during the course of the disease. No fetal adverse effects were noted. CONCLUSION Based on the encouraging response and as tocilizumab did not impart any adverse effects on the pregnancy, tocilizumab may be administered as an adjuvant to critical COVID-19 pregnant women in their second and third trimesters.
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Affiliation(s)
- Bindu Isaac
- Obstetrics and Gynecology, Latifa Women and Children Hospital, Dubai Health Authority, Dubai, ARE
| | - Komal Hazari
- Internal Medicine, Latifa Women and Children Hospital, Dubai Health Authority, Dubai, ARE
| | - Deemah K Harb
- Internal Medicine, Latifa Women and Children Hospital, Dubai Health Authority, Dubai, ARE
| | - Ayaz K Mallick
- Clinical Biochemistry, College of Medicine, King Khalid University, Abha, SAU
| | - Widad Abdelkareem
- Internal Medicine, Latifa Women and Children Hospital, Dubai Health Authority, Dubai, ARE
| | - Abeir Ammar
- Obstetrics and Gynecology, Latifa Women and Children Hospital, Dubai Health Authority, Dubai, ARE
| | - Taghrid Gergawi
- Internal Medicine, Latifa Women and Children Hospital, Dubai Health Authority, Dubai, ARE
| | - Eiman Saeed Al Zahmi
- Obstetrics and Gynecology, Latifa Women and Children Hospital, Dubai Health Authority, Dubai, ARE
| | - Amar H Khamis
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE
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Mkhize P, Phoswa W, Khaliq O, Dorsamy V, Moodley J. Aspirin in the prevention of preeclampsia: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2021; 100:e27916. [PMID: 35049195 PMCID: PMC9191338 DOI: 10.1097/md.0000000000027916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Aspirin is widely used to prevent pregnancy related vascular disorders such as preeclampsia (PE), intrauterine growth restriction and maternal disorders. However, the indications for the use of aspirin during pregnancy is currently controversial because the dosage of aspirin used and the sample sizes in various studies differ considerably. Furthermore, women of African ancestry are more likely to have higher rates of PE and more severe cases than those of their Caucasian counterparts. Yet, there are very few studies in this population group. Therefore, the aim of this review will be to determine the effect of low-dose aspirin (LDA) for prevention of PE in women of African ancestry. METHODS AND ANALYSIS This is a protocol for a systematic review and meta-analysis of published studies on the effect of LDA for prevention of PE. Relevant information will be accessed from the following databases; PubMed, Cochrane Central Register of Controlled Trials, Google Scholar, Google, EBSCO Host, and the Web of Science. The studies will be mapped in 2 stages: stage 1 will map studies descriptively by focus and method; stage 2 will involve additional inclusion criteria, quality assessment and data extraction undertaken by 2 reviewers in parallel. Evidence will be synthesized using relevant systematic research tools. Meta-analysis and subgroup analysis will be conducted using RevMan whilst Stata 13 will be used for meta-regressions. We will follow recommendations described in the preferred reporting items for systematic reviews and meta-analyses statement and the Cochrane Handbook for Intervention Reviews. DISCUSSION The use of LDA as a prophylactic treatment has been considered for the prevention of PE. However, studies evaluating the use of LDA in women of African ancestry are few. Therefore, with the increase in the prevalence of PE in the African population, it is critical to further investigate the use of LDA in pregnant women of African ancestry. ETHICS AND DISSEMINATION The review and meta-analysis will not require ethical approval and the findings will be published in peer-reviewed journals and presented at local and international conferences. The findings of this review will inform all stakeholders on current and future guidelines on the use of aspirin in pregnancy, especially in populations of African ancestry. SYSTEMATIC REVIEW REGISTRATION International prospective Register of Systematic Reviews (PROSERO) number: (CRD42020213213).
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Affiliation(s)
- P.Z. Mkhize
- Department of Obstetrics and Gynecology, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - W.N. Phoswa
- Department of Life and Consumer Sciences, University of South Africa (UNISA), Science Campus, Florida, Roodepoort, South Africa
| | - O.P. Khaliq
- Department of Obstetrics and Gynecology, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - V. Dorsamy
- School of Laboratory Medicine and Medical Sciences College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - J. Moodley
- Department of Obstetrics and Gynecology, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Dahshan D, Suliman M, Rahman EU, Curtis Z, Thompson E. Intravenous Drug Use-Associated Infective Endocarditis in Pregnant Patients at a Hospital in West Virginia. Cureus 2021; 13:e17218. [PMID: 34540445 PMCID: PMC8445856 DOI: 10.7759/cureus.17218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Due to high levels of intravenous drug use (IVDU) in West Virginia (WV), there are increasing numbers of hospitalizations for infective endocarditis (IE). More specifically, pregnant patients with IE are a uniquely challenging population, with complex management and a clinical course that further affects the health of the fetus, with high morbidity and mortality. Timely recognition and awareness of the most common bacterial causes will provide hospitals and clinicians with valuable information to manage future patients. Methods This retrospective study analyzed the clinical course of pregnant patients admitted with IE and IVDU history presenting at Cabell Huntington Hospital from 2013 to 2018. Inclusion criteria were women between 16 and 45 years of age confirmed to be pregnant by urine pregnancy test and ultrasonography with at least eight weeks gestation, with a first-time diagnosis of endocarditis and an identified history of IVDU. We excluded charts with pre-existing risk factors including a history of valvular disease, rheumatic heart disease, surgical valve repair or mechanical valve replacement, or a diagnosis of coagulopathies. The resulting charts were evaluated for isolated organisms, reported clinical course, and complications of the pregnancy. Results A total of 10 patients were identified, with methicillin-susceptible and methicillin-resistant Staphylococcus aureus, Serratia marcescens, Haemophilus parainfluenza, and Enterococcus faecalis species. Complications included loss of fetus (30%), septic embolization (40%), hemorrhagic stroke (10%), and transfer to outside facilities for cardiothoracic surgical intervention (40%). Discussion IE in pregnancy, while rare, has serious complications. In the context of the IVDU epidemic, it has an increasing impact on WV hospitals. A better understanding of the clinical course may allow for early diagnosis and guide the development of rational empiric therapies. More effective management of IE in pregnant patients can reduce complications and potentially improve maternal and fetal morbidity or mortality.
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Affiliation(s)
- Deena Dahshan
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Mohamed Suliman
- Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Ebad U Rahman
- Internal Medicine, St. Mary's Medical Center, Huntington, USA
| | - Zachary Curtis
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Ellen Thompson
- Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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Peddi NC, Avanthika C, Vuppalapati S, Balasubramanian R, Kaur J, N CD. A Review of Cordocentesis: Percutaneous Umbilical Cord Blood Sampling. Cureus 2021; 13:e16423. [PMID: 34422463 PMCID: PMC8369974 DOI: 10.7759/cureus.16423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 12/03/2022] Open
Abstract
We discuss the current indications, technical variation and procedure-related complications of percutaneous umbilical cord blood sampling (PUBS). The term PUBS is commonly used in the United States. Cordocentesis and funipuncture are equivalent terms. A needle guided by ultrasound is introduced into a blood vessel (usually the vein) of the umbilical cord to collect fetal specimen in PUBS. We conducted a literature search in PubMed indexed journals and analyzed all related articles on PUBS and cordocentesis. We chose this subject because it is a relatively new but convenient method that has both diagnostic and therapeutic value in fetal medicine. At present the only procedure that provides direct access to fetal circulation is PUBS. The most common clinical indication for PUBS is suspected fetal anemia. Other major indications for PUBS are the diagnosis of congenital infections, cytogenetic analysis, metabolic disorders, fetal growth restriction and hematologic disorders. Therapeutic applications of cordocentesis or puncture of the umbilical cord are in utero transfusions for rhesus alloimmunization and medication administration. PUBS also provides a direct assessment of fetal thyroid function diagnosing fetal thyroid disorders and helps administer therapy in utero. Literature demonstrates a low incidence of complications associated with percutaneous umbilical blood sampling. For PUBS, the true complication rate related to the method of sampling remains unclear. A few cases reported complications conducted PUBS for therapeutic purposes which naturally has a higher accident rate compared to diagnostic purposes. Although life-threatening complications are rare, there are potential risks that include bleeding from the puncture site, fetal bradycardia, vertical transmission of maternal infection. Therefore, PUBS should be performed at perinatal care centers by experienced physicians and the best time is between 17 to 40 weeks of gestation. There are three methods used to approach the umbilical cord that includes direct, indirect and free puncture. Anteriorly placed placenta allows an easier approach to the umbilical cord. The danger of abruption of placenta must be kept in mind while using this technique. The number of punctures should be limited to a maximum of 3 to reduce complications. According to a case series report, the mean time required for the procedure was 4 minutes with a fall in duration seen with increased experience. In conclusion, percutaneous blood sampling allows direct access to fetal circulation thus opening up new areas of prenatal diagnosis and therapy. PUBS is now a well-codified procedure. It is clear from our literature review that risks directly related to the technique are small. The indication of the procedure must be carefully chosen as the risk of complications of umbilical cord puncture is directly related to the severity of the condition. Complications such as bleeding and hematoma formation are related to duration and number of punctures which are operator-dependent. Thus, only highly trained personnel should conduct the procedure. The list of indications is extensive and growing. Nevertheless, this technique shows potential to open up new realms in the area of fetal medicine.
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Affiliation(s)
- Nikhil Chowdary Peddi
- Pediatrics, People's Education Society Institute of Medical Sciences and Research, Kuppam, IND
| | | | - Sravya Vuppalapati
- Pediatrics, People's Education Society Institute of Medical Sciences and Research, Kuppam, IND
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11
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Zhou Q, Peng P, Liu X, Liu J, Gao J, Chen W. Evaluation of maternal and fetal outcomes in pregnancy complicated with pulmonary arterial hypertension. Ann Palliat Med 2020; 10:1404-1410. [PMID: 33183028 DOI: 10.21037/apm-20-551] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/19/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is an uncommon type of pulmonary hypertension (PH) disease characterized by progressive remodeling of distal pulmonary arteries. It could inevitably lead to pulmonary vascular resistance and even right ventricular failure. Biologists have explored the basic pathobiology of PAH, but its functional mechanism and effect in pregnant people remain unknown. This study was designed to investigate the maternal and fetal outcomes of pregnancy-related PAH. METHODS Clinical data of 59 pregnant women with PAH who were admitted to Peking Union Medical College Hospital from Jan. 2000 to Dec. 2018 were retrospectively reviewed and analyzed. Multiple parameters, including age, gestational week, the New York Heart Association (NYHA) cardiac functional classification, ultrasonic cardiogram (UCG), blood test, pregnancy complications, pulmonary arterial systolic pressure, maternal and fetal outcomes, were comprehensively investigated and analyzed. RESULTS According to the pulmonary arterial systolic pressure, all 59 pregnant women were divided into mild PAH (30-49 mmHg, n=18), moderate PAH (50-79 mmHg, n=17) and severe PAH (>79 mmHg, n=24). Five patients died, and the mortality rate was 8.5%. Compared with the mild and moderate groups, the mean gestational week, age of the pregnancy, and NYHA cardiac functional classification grade in the severe PAH group were dramatically different (all P<0.05). The incidence of pregnancy-related complications in the severe PAH group was significantly higher than those in the mild and moderate PAH groups (both P<0.05). CONCLUSIONS The blood parameters, PAH, and NYHA cardiac functional classification grade were significantly changed before and after surgery. We found that the severity of PAH was a major factor of maternal and fetal outcomes. Strengthening the nursing care for pregnant women with PAH is of great clinical significance.
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Affiliation(s)
- Qian Zhou
- Department of Obstertrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China
| | - Ping Peng
- Department of Obstertrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China.
| | - Xinyan Liu
- Department of Obstertrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China
| | - Juntao Liu
- Department of Obstertrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China
| | - Jinsong Gao
- Department of Obstertrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China
| | - Weilin Chen
- Department of Obstertrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China
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Zipori Y, Grunwald O, Ginsberg Y, Beloosesky R, Weiner Z. The impact of extending the second stage of labor to prevent primary cesarean delivery on maternal and neonatal outcomes. Am J Obstet Gynecol 2019; 220:191.e1-191.e7. [PMID: 30616966 DOI: 10.1016/j.ajog.2018.10.028] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND A low rate of primary cesarean delivery is expected to reduce some of the major complications that are associated with a repeat cesarean delivery, such as uterine rupture, adhesive placental disorders, hysterectomy, and even maternal death. Since 2014, and in alignment with the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, we changed our approach to labor dystocia, defined as abnormal progression of labor, by allowing a longer duration of the second stage of labor. OBJECTIVE To examine the effect of prolonging the second stage of labor on the rate of cesarean delivery, and maternal and neonatal outcomes. MATERIALS AND METHODS In a historical control group, we compared maternal and neonatal outcomes over 2 periods. Period I (9300 patients): from May 2011 until April 2014, when a prolonged second stage in nulliparous women was considered after 3 hours with regional anesthesia or 2 hours if no such anesthesia was provided. Second-stage arrest was defined in multiparous women after 2 hours with regional anesthesia or 1 hour without it. Period II (10,531 patients): from May 2014 until April 2017, allowed nulliparous and multiparous women continuing the second stage of labor an additional 1 hour before diagnosing second-stage arrest. Singleton deliveries at or beyond 37 weeks' gestation were initially considered for eligibility. We excluded women with high-risk pregnancies and known fetal anomalies. For comparing means, we used the t test. If variables were not normally distributed, we used the Mann-Whitney test instead. For comparing proportions, we used the χ2 test with continuity correction. RESULTS The primary cesarean delivery was decreased in nulliparous women from 23.3% (819 of 3515) in period I to 15.7% (596 of 3796) in period II (relative risk [RR], 0.67; 95% CI, 0.61-0.74), a trend that was also significant in multiparous women (10.9%, 623 of 5785, in period I vs 8.1%, 544 of 6735, in period II; RR, 0.75; 95% CI, 0.67-0.84). The rate of operative vaginal deliveries in nulliparous women was higher in period II than in period I (19.2%, 732 of 3515, vs 17.7%, 622 of 3796, P < .0001). Rates of third- and fourth-degree laceration and of shoulder dystocia were also higher in period II. The rate of arterial cord pH < 7.0 and the rate of admission to the neonatal intensive care unit were higher in period II, but the early neurological outcome was not different when comparing the 2 periods. CONCLUSION The new policy of labor management successfully decreased primary cesarean deliveries, with a small rise in instrumental deliveries. However, it also increased the other immediate maternal and neonatal complications. A higher rate of lower umbilical artery cord pH was the most significant finding; however, the early neurological outcome did not change. It is possible that the ongoing adjustment to the new labor protocol will avoid, in the future, maternal and neonatal complications. The long-term maternal and neonatal consequences of our new approach will be evaluated in future studies.
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Lauritsch‐Hernandez LS, Kraehenmann F, Balabanov S, Kimmich N. Eculizumab application during pregnancy in a patient with paroxysmal nocturnal hemoglobinuria: A case report with review of the literature. Clin Case Rep 2018; 6:1582-1587. [PMID: 30147909 PMCID: PMC6099006 DOI: 10.1002/ccr3.1634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/19/2018] [Accepted: 05/19/2018] [Indexed: 01/20/2023] Open
Abstract
Eculizumab is highly effective in inhibiting complement activation and has successfully shown to prevent complications and to improve quality of life in patients with paroxysmal nocturnal hemoglobinuria (PNH). Its application during pregnancy showed favorable fetal and maternal outcome in the presented case and has proven to be effective without raising safety concerns.
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Affiliation(s)
| | | | - Stefan Balabanov
- Department of HematologyUniversity Hospital of ZurichZurichSwitzerland
| | - Nina Kimmich
- Department of ObstetricsUniversity Hospital of ZurichZurichSwitzerland
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Uma R, Bhavadharini B, Ranjani H, Mahalakshmi MM, Anjana RM, Unnikrishnan R, Kayal A, Malanda B, Belton A, Mohan V. Pregnancy outcome of gestational diabetes mellitus using a structured model of care : WINGS project (WINGS-10). J Obstet Gynaecol Res 2016; 43:468-475. [PMID: 28026897 DOI: 10.1111/jog.13249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/05/2016] [Accepted: 11/04/2016] [Indexed: 12/16/2022]
Abstract
AIM To evaluate the impact of a structured model of care (MOC) prepared for resource-constrained settings, on the pregnancy outcomes of Asian Indian women with gestational diabetes mellitus (GDM). METHODS Pregnant women were screened under the Women in India with GDM Strategy (WINGS) MOC for GDM using the International Association of Diabetes and Pregnancy Study Groups criteria. Women with GDM went through a structured MOC that included medical nutrition therapy (MNT), regular physical activity (PA); and insulin when indicated. Fasting blood glucose and post-prandial blood sugar were monitored every 2 weeks. The pregnancy outcomes of women with GDM who underwent the MOC were compared with those without GDM. RESULTS Under the MOC, 212 women with GDM were followed through pregnancy, of whom 33 (15.6%) required insulin and 179 (84.4%) were managed with MNT and PA. The maternal and neonatal outcomes of women with GDM were similar to the non-GDM women: there were no significant differences in pregnancy complications such as cesarean section, macrosomia, pre-eclampsia, oligo/polyhydramnios, preterm delivery, neonatal death, fetal distress, hyperbilirubinemia and low birthweight. CONCLUSION Implementation of a structured MOC for women with GDM helped achieve pregnancy outcomes similar to those without GDM.
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Affiliation(s)
- Ram Uma
- Seethapathy Clinic and Hospital, Chennai, India
| | | | | | | | | | | | | | - Belma Malanda
- International Diabetes Federation, Brussels, Belgium
| | - Anne Belton
- International Diabetes Federation, Brussels, Belgium
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