Vertebral artery dissection in relation to pregnancy: a case series and literature review.

Cervical artery dissection is an uncommon condition for which pregnancy and postpartum states confer increased risk. Although the majority of patients with this condition fully recover, including resolution of the dissection on imaging, long-term sequelae include a variety of cardiovascular conditions that may be associated with high rates of morbidity and mortality. Here, we review 2 cases of vertebral artery dissection in relation to pregnancy. Our first case will review the management of a pregnant patient with a history of vertebral artery dissection; whereas our second case reviews a presentation of postpartum vertebral artery dissection. Providers should maintain a high suspicion of cervical artery dissection in pregnant and postpartum patients presenting with headache and neck pain.

Pelvic Girdle Pain in Pregnancy: A Review.

Importance: Pelvic girdle pain is often thought to be a recent phenomenon, but this condition was described as early as 400 BC by Hippocrates. Despite being identified for years, confusion continues about the definition and management of this ailment affecting many pregnancies. Objective: The purpose of the review is to assess the incidence, etiology, pathophysiology, risk factors, diagnosis, management, and pregnancy outcomes/recovery of current pregnancies, and outcomes of future pregnancies complicated by pelvic girdle pain. Evidence Acquisition: Electronic databases (PubMed and Embase) were searched from 1980 to 2021 with the only limitation being that the articles were in English. Studies were selected that examined associations between pelvic pain/pelvic girdle pain and pregnancy. Results: There were 343 articles identified. After reviewing the abstracts, 88 were used in this review. Pelvic girdle pain is a common condition of pregnancy, affecting a reported 20% of pregnant women. The pathophysiology is poorly understood and likely multifactorial, involving both hormonal and biomechanical changes that occur during pregnancy. Several risk factors have been identified. This diagnosis is most commonly made based on symptoms related to pelvic pain during pregnancy. Treatment should be multimodal, including pelvic girdle support, stabilizing exercises, analgesia, and potentially complementary therapies. The effects on future pregnancies are uncertain, although some limited information suggests an increased risk of recurrent PGP in subsequent pregnancies. Conclusions: Pelvic girdle pain in pregnancy is a common condition that is often overlooked as a normal part of pregnancy but has a significant impact on quality of life during, after, and in subsequent pregnancies. Multimodal therapies are available and are largely low cost and noninvasive. Relevance: Our aim is to increase the awareness of pelvic girdle pain in pregnancy as a common but often underdiagnosed and undertreated condition.

Severe thrombocytopenia after contrast infusion in pregnancy.

BACKGROUND: Intravenous contrast-induced thrombocytopenia is a rare but potentially life-threatening complication in pregnancy. CASE: A 22-year-old woman, gravida 2 para 1, at 33 2/7 weeks of gestation presented with chest pain, shortness of breath, and tachycardia. A computed tomography angiogram was pursued to evaluate for pulmonary embolus. During contrast infusion the woman experienced facial flushing, throat tightening, and worsening dyspnea. Her platelet count was noted to decrease precipitously to 4,000/microliter several hours after the imaging study. With medical management and observation, the woman's platelet count steadily recovered without further exacerbation of thrombocytopenia during gestation. CONCLUSION: Prompt recognition and therapy for intravenous contrast-induced thrombocytopenia during pregnancy are essential to optimize maternal-fetal outcome.

Postpartum cerebral venous thrombosis.

BACKGROUND: Cerebral venous thrombosis is a rare entity in pregnancy and the postpartum period, with an incidence of 1:10,000 to 1:25,000. CASE: A 19-year-old woman, gravida 1, para 1, presented to the emergency department on postpartum day 7, having experienced seizures. Severe preeclampsia had been diagnosed during the antepartum period. The patient initially was diagnosed with postpartum eclampsia and started on magnesium sulfate for seizure prophylaxis. Magnetic resonance imaging later showed cerebral venous thrombosis of the left transverse sinus and right frontal and left frontoparietal cortical veins. CONCLUSION: Cerebral venous thrombosis and eclampsia may manifest in a similar manner. Physicians can optimize the care of patients presenting with seizures by considering etiologies rarer than eclampsia and pursuing tests that may distinguish them.