Pregnancy in Women with Cardiovascular Diseases.

Patients with cardiovascular disease represent a significant cohort at risk for complications during pregnancy. The normal physiologic changes of pregnancy could further compromise the hemodynamics of various cardiovascular conditions, resulting in clinical deterioration and even death. The fetus of a gravida with cardiovascular disease also has an increased risk of morbidity, including an increased risk of inherited cardiac genetic disorders, fetal growth restriction, and premature delivery. These complications also increase the risk for antenatal and perinatal mortality. Ideally, the management of a patient with cardiac disease who is considering pregnancy should start with pre-conception counseling that outlines the maternal and fetal complications associated with her particular cardiac disorder. The pregnancy is best managed by a dedicated team of specialists in maternal-fetal medicine, cardiology, cardiovascular surgery, anesthesiology, and neonatology, preferably in a tertiary care center.

Uterine incarceration in a primigravid retroverted bicornuate uterus.

Uterine incarceration is a rare complication that usually occurs after the first trimester of pregnancy. It leads to increased maternal and/or fetal morbidity and mortality. Risk factors include retroversion of uterus and other pelvic abnormalities. Clinical presentation includes severe abdominal and pelvic pain symptoms. Patients can present with concurrent urinary symptoms due to increasing distortion of adjacent structures from the enlarging uterus. A high clinical suspicion of uterine incarceration is confirmed with ultrasound. More advanced imaging such as MRI can be used as an adjunct to ultrasound imaging. Progression from expectant management to intervention is recommended as soon as possible to prevent complications such as uterine rupture and fetal demise. In subsequent pregnancies, close monitoring with serial ultrasounds is warranted to monitor for recurrence of incarceration which has been reported in a few rare cases.

Fetal lung interstitial tumor: a cause of late gestation fetal hydrops.

Most fetal lung masses present by mid gestation, grow during the canalicular phase of lung development (18-26 weeks of gestation), and plateau in growth or shrink after 26 weeks of gestation. We describe the unique case of a fetal lung mass presenting at 37 weeks of gestation with hydrops and fetal heart failure. The late growth of this lesion and resultant hydrops prompted resection as part of the ex utero intrapartum treatment. Histopathology revealed a rare, recently described fetal lung interstitial tumor. This case demonstrates that a subset of fetal lung masses may continue to grow later in gestation and emphasizes the need for late gestation imaging and close follow-up in this patient cohort.

Treatment of metastatic breast cancer with trastuzumab and vinorelbine during pregnancy.

The management of breast cancer during pregnancy is a crucial clinical issue. It is important to evaluate the impact of chemotherapy on a woman and her fetus. Studies from our institution have demonstrated the safety and efficacy of treating women with adjuvant 5-fluorouracil/doxorubicin/cyclophosphamide during the second or third trimester of pregnancy. However, the literature regarding the treatment of metastatic breast cancer in a pregnant patient is scarce. In this article, we describe the successful treatment of a woman at 27 weeks of pregnancy with recurrent HER2/neu-overexpressing breast cancer who was symptomatic from multiple liver metastases. Per our review of the literature and to our knowledge, she is the first patient to be treated with weekly vinorelbine plus trastuzumab. Our patient had near complete resolution of her disease and delivered a healthy male infant at 34 weeks of gestation.