RESUMO
Hereditary angioedema is a relatively uncommon disease that may affect women during their reproductive years. A case report of a pregnancy complicated by hereditary angioedema, followed by a review of the literature, is presented. Although the disease usually follows a benign course, maternal mortality has been noted. Features unique to pregnancy are discussed. Knowledge of the pathophysiology and possible complications is essential for the proper management of the pregnancy.
Assuntos
Angioedema/genética , Complicações na Gravidez , Adulto , Androgênios/uso terapêutico , Angioedema/tratamento farmacológico , Angioedema/fisiopatologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/fisiopatologia , Recidiva , Estanozolol/uso terapêuticoRESUMO
Duplex Doppler ultrasound was used to measure umbilical venous blood flow in 209 normal pregnant women between 20-40 weeks' gestation. The relationship between umbilical venous blood flow and gestational age increased with gestational age, and is described by the equation y = -187.02 + 12.7x. The relationship between flow per kilogram fetal weight and gestational age (y = 198.629 - 2.24x) yielded values of 153 mL/minute/kg at 20 weeks, 131 mL/minute/kg at 30 weeks, and 108 mL/minute/kg at 40 weeks. Doppler ultrasound was also used to evaluate umbilical arterial waveforms (systolic/diastolic ratio) in 171 normal pregnant women between 20-40 weeks. The relationship between systolic/diastolic ratios and gestational age (y = 6.46 - 0.12x) decreased with advancing gestational age, yielding mean systolic/diastolic ratios (+/- 2 SD) of 4.1 (5.6, 2.6) at 20 weeks, 3.6 (5.1, 2.1) at 24 weeks, 3.1 (4.6, 1.6) at 28 weeks, 2.6 (4.1, 1.1) at 32 weeks, 2.1 (3.6, 0.6) at 36 weeks, and 1.7 (3.1, 0.1) at 40 weeks.
Assuntos
Gravidez/fisiologia , Reologia , Artérias Umbilicais/fisiologia , Veias Umbilicais/fisiologia , Velocidade do Fluxo Sanguíneo , Feminino , Idade Gestacional , Humanos , Contração Miocárdica , Valores de ReferênciaRESUMO
Amniocentesis was performed in 1038 patients with elevated maternal serum alpha-fetoprotein (MSAFP) concentrations. Patients were divided into two groups based upon the amniotic fluid AFP concentration. Group 1 (N = 964) had a normal amniotic fluid AFP concentration and group 2 (N = 74) had elevated amniotic fluid AFP. Fetal chromosomal results were reviewed from the study population, with the finding of eight major fetal chromosomal abnormalities. Of the eight fetal chromosomal abnormalities, five were associated with elevated amniotic fluid AFP and three were associated with normal amniotic fluid AFP. The sensitivity and specificity of elevated amniotic fluid AFP concentrations in screening for a fetal chromosomal abnormality were 62.5 and 93.3%, respectively. In women with elevated MSAFP but normal amniotic fluid AFP concentrations, the probability of a major fetal chromosomal abnormality is extremely small.
Assuntos
Aberrações Cromossômicas/diagnóstico , Doenças Fetais/diagnóstico , alfa-Fetoproteínas/análise , Amniocentese , Transtornos Cromossômicos , Feminino , Humanos , Cariotipagem , Masculino , Valor Preditivo dos Testes , Gravidez , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
A pregnancy complicated by cyanotic heart disease due to single ventricle was recently managed at the authors's institution. Review of the literature showed only five previous case reports. The management of this uncommon disorder is presented along with a review of the literature. The presence of pulmonary hypertension appears to be a major determinant in assessing maternal risk.
Assuntos
Ventrículos do Coração/anormalidades , Complicações Cardiovasculares na Gravidez/diagnóstico , Adulto , Cesárea , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Trabalho de Parto , Gravidez , Complicações Cardiovasculares na Gravidez/terapia , Estenose da Valva Pulmonar/complicações , Risco , Transposição dos Grandes Vasos/complicaçõesRESUMO
BACKGROUND: Despite the acceptance of protocols for the prevention of group B streptococcal (GBS) sepsis for the newborn, protocol violations, with subsequent failure to initiate intrapartum antibiotic therapy, occur at many institutions. The causes for GBS prophylaxis protocol violations are not well understood. CASES: We report two cases of indicated preterm birth in which appropriate antibiotic prophylaxis for GBS sepsis was not initiated. CONCLUSION: In the setting of indicated preterm birth, GBS prophylaxis may be overlooked. We suspect that the attention given to the medical or fetal complications of indicated preterm birth may contribute to the omission of GBS sepsis prophylaxis in these situations.
Assuntos
Parto Obstétrico , Doenças do Recém-Nascido/prevenção & controle , Recém-Nascido Prematuro , Complicações Infecciosas na Gravidez/microbiologia , Medicina Preventiva/métodos , Infecções Estreptocócicas/prevenção & controle , Streptococcus agalactiae , Adulto , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Gravidez , Infecções Estreptocócicas/transmissãoRESUMO
A pregnancy was complicated by recurrent episodes of cholecystitis unresponsive to medical management. Total parenteral nutrition (TPN), rather than surgery, was elected to minimize fetal and maternal morbidity.
Assuntos
Colecistite/terapia , Nutrição Parenteral Total , Complicações na Gravidez/terapia , Adulto , Doença Crônica , Feminino , Humanos , GravidezRESUMO
Antenatal ultrasonography detected a fetal splenic cyst at 35 weeks' gestation. Serial ultrasonography and follow-up neonatal ultrasonography confirmed the presence of a solitary splenic cyst. The finding of asymptomatic but potentially serious fetal lesions allows optimum management of the newborn infant and adds to the benefits of antenatal sonography.
Assuntos
Cistos/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Gêmeos Dizigóticos , Ultrassonografia Pré-Natal , Adulto , Cistos/etiologia , Feminino , Humanos , Recém-Nascido , Gravidez , Esplenopatias/etiologiaRESUMO
Maternal isoimmunization can result in fetal anemia. Current management of isoimmunized pregnancies involves amniocentesis and spectrophotometry. Pulsed Doppler ultrasound can provide fetal blood flow determinations from the fetal umbilical vein. A pregnancy complicated by severe rhesus isoimmunization was studied with Doppler ultrasound. Increased fetal umbilical blood flow was associated with increased fetal hemolysis. Umbilical vein blood flow decreased after intrauterine transfusion. Doppler ultrasound assessment of fetal blood flow is a useful noninvasive adjunct in isoimmunized pregnancies.
Assuntos
Velocidade do Fluxo Sanguíneo , Isoimunização Rh/fisiopatologia , Ultrassonografia , Veias Umbilicais/fisiopatologia , Adulto , Anemia/diagnóstico , Feminino , Doenças Fetais/diagnóstico , Humanos , Recém-Nascido , Masculino , Gravidez , Isoimunização Rh/diagnósticoRESUMO
BACKGROUND: Limited information is available on the recurrence risk of anaphylactoid syndrome of pregnancy. CASE: A successful pregnancy followed suspected anaphylactoid syndrome of pregnancy. CONCLUSION: A review of the literature revealed five cases of successful subsequent pregnancies following anaphylactoid syndrome of pregnancy. No instances of recurrent anaphylactoid syndrome of pregnancy have been reported.
Assuntos
Anafilaxia/prevenção & controle , Parto Obstétrico , Embolia Amniótica/prevenção & controle , Adulto , Feminino , Humanos , GravidezRESUMO
Laser vaporization of the cervix has been reported to have an extremely low incidence of infectious morbidity compared to other treatment modalities. This case report describes the development of an ovarian abscess following laser surgery of the cervix in a patient with no known risk factors for disease.
Assuntos
Abscesso/etiologia , Colo do Útero/cirurgia , Terapia a Laser/efeitos adversos , Doenças Ovarianas/etiologia , Complicações Pós-Operatórias/etiologia , Adulto , Colo do Útero/fisiopatologia , Doença Crônica , Feminino , Humanos , Histerectomia , Doenças Ovarianas/fisiopatologia , Doença Inflamatória Pélvica/etiologia , Doença Inflamatória Pélvica/cirurgia , Cervicite Uterina/diagnóstico , Cervicite Uterina/fisiopatologia , Cervicite Uterina/cirurgia , Esfregaço VaginalAssuntos
Neoplasias dos Genitais Femininos/patologia , Neoplasias Primárias Múltiplas/patologia , Adenocarcinoma/patologia , Adulto , Carcinoma in Situ/patologia , Colo do Útero/patologia , Cistadenocarcinoma/patologia , Feminino , Humanos , Neoplasias Ovarianas/patologia , Ovário/patologia , Neoplasias do Colo do Útero/patologiaRESUMO
A case in which fetal ultrasonography detected increased fetal bladder size at 11 weeks' gestation is reported. A subsequent scan at 13 weeks' gestation showed increased fetal bladder size along with bilateral hydronephrosis, which confirmed the diagnosis of fetal bladder outlet obstruction.
Assuntos
Doenças Fetais/diagnóstico , Diagnóstico Pré-Natal , Ultrassonografia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Adulto , Feminino , Idade Gestacional , Humanos , GravidezRESUMO
Cyclic neutropenia is characterized by periodic episodes of neutropenia that are often associated with infectious complications. A patient with cyclic neutropenia experienced two pregnancies with an amelioration of her infectious complications and an increase in neutrophil count. Cyclic neutropenia may follow a benign course during pregnancy.
Assuntos
Neutropenia , Complicações Hematológicas na Gravidez , Adulto , Feminino , Humanos , Contagem de Leucócitos , Neutropenia/sangue , Neutrófilos , Periodicidade , Gravidez , Complicações Hematológicas na Gravidez/sangueRESUMO
Transvaginal ultrasonography was performed in 139 patients at risk for ectopic pregnancy. Among these patients, 22 ectopic pregnancies and 117 intrauterine pregnancies were eventually confirmed. Transvaginal ultrasonography definitively identified 18 of 22 (82%) ectopic pregnancies at initial evaluation by either direct visualization of an ectopically placed gestational sac (N = 14) or failure to visualize an intrauterine gestational sac combined with a level of the beta-subunit of human chorionic gonadotropin greater than 1300 mIU/ml (First International Reference Preparation) (N = 4). Transvaginal ultrasonography definitively diagnosed 103 of 117 (88%) intrauterine pregnancies at initial evaluation. Eighteen patients could not be definitively diagnosed by transvaginal ultrasonography at initial evaluation because nonvisualization of a gestational sac and a beta-subunit of human chorionic gonadotropin value less than 1300 mIU/ml. Evaluation of this group with serial measurements of beta-subunit of human chorionic gonadotropin, repeat ultrasonography, or both, revealed ectopic gestation (N = 4), early intrauterine pregnancy (N = 4), and complete abortion (N = 10).
Assuntos
Gravidez Ectópica/diagnóstico , Ultrassonografia/métodos , Gonadotropina Coriônica/sangue , Diagnóstico Diferencial , Feminino , Humanos , Cistos Ovarianos/diagnóstico , Gravidez , Gravidez Ectópica/sangueRESUMO
A pregnancy complicated by Vel isoimmunization is presented. Despite known immunoglobulin G component and significant titer rise, hemolytic disease of the newborn was not present. The maternal and neonatal significance of Vel sensitization is discussed.
Assuntos
Antígenos de Grupos Sanguíneos/imunologia , Complicações Hematológicas na Gravidez/imunologia , Adulto , Feminino , Humanos , Imunidade Materno-Adquirida , GravidezRESUMO
Latex agglutination testing for colonization of the vagina with group B streptococci was carried out in 1100 patients. Samples underwent latex testing after 8 to 12 hours of preincubation in selective growth medium. This technique allowed a sensitivity of 91.8% and specificity of 97.6%. This study demonstrates the usefulness of latex agglutination testing in the detection of vaginal colonization with group B streptococci.
Assuntos
Testes de Fixação do Látex , Streptococcus agalactiae/isolamento & purificação , Vagina/microbiologia , Feminino , Humanos , Gravidez , Sensibilidade e EspecificidadeRESUMO
Neonatal portal vein thrombosis (PVT) is a rare condition seen in the setting of thrombophilia or after umbilical vein catheterization. We report a case of fetal PVT with abnormal antenatal ultrasound findings at 27 weeks of gestation. This presented initially as dilation of the intrahepatic umbilical vein. To our knowledge, this is the first reported case evaluated prenatally. Color Doppler ultrasound was valuable in detecting constriction of the vessel with a high-velocity jet seen past the obstruction site. A discussion of this condition and differential diagnosis is presented.
Assuntos
Doenças Fetais/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia Pré-Natal/métodosRESUMO
We report a pregnancy complicated by anti-B isoimmunization that resulted in fetal ascites, anemia, hepatomegaly, and polyhydramnios. A previous pregnancy in the same patient was complicated by neonatal ABO incompatibility. A review of the obstetric literature suggests that ABO incompatibility may cause severe fetal anemia, especially in patients with type O blood or a previous history of ABO incompatibility of the newborn.
Assuntos
Sistema ABO de Grupos Sanguíneos/imunologia , Ascite/etiologia , Incompatibilidade de Grupos Sanguíneos/complicações , Doenças Fetais/etiologia , Adulto , Feminino , Humanos , Recém-Nascido , GravidezRESUMO
OBJECTIVE: Recent studies have suggested that the rate of cesarean delivery in patients who have undergone a successful external cephalic version is higher than expected. This study compares the incidence of cesarean delivery in patients who underwent successful external cephalic version and patients with primary cephalic presentations. STUDY DESIGN: We identified and reviewed the charts of 92 patients who underwent a successful external cephalic version. We identified a control population of 184 patients from the delivery room logs. We collected outcome data and information on additional risk factors that may affect cesarean delivery rates. RESULTS: There were no significant differences between study and control populations. There was no significant difference in the cesarean delivery rate between study patients (22.8%) and control patients (23.4%). CONCLUSIONS: We could not demonstrate a significant increase in the cesarean delivery rate for women who underwent successful external cephalic version in comparison with patients in labor with primary cephalic presentations.