A case report of Sheehan's syndrome with acute onset, hyponatremia and severe anemia.

Sheehan's syndrome is a well-known cause of panhypopituitarism secondary to pituitary apoplexy, that generally occurs after an intra- or postpartum bleeding episode characterized by severe hypertension or hemorrhagic shock. The diagnosis can be difficult and is often formulated after some years from the syndrome occurrence. We report the case of a woman with an early diagnosis of early-onset Sheehan's syndrome associated with severe hyponatremia following dystocic childbirth complicated by postpartum hemorrhage.

Second-trimester maternal serum alpha-fetoprotein elevation and its association with adverse maternal/fetal outcome: ten years experience.

BACKGROUND: Alpha-fetoprotein (AFP) is the major serum protein in the embryonic stage and in the early fetal stage. The aim of this study was to determine any possible association between an "unexplained" elevation of maternal serum alpha-fetoprotein (MSAFP) levels in the second trimester of pregnancy and adverse maternal/fetal outcome. METHODS: A retrospective cohort study, was carried out in the University of Parma, by reviewing all triple tests that had been found positive for neural tube defect screening, showing an "unexplained" MSAFP elevation (> or =2.5 multiples of the median [MoM]), which could not be ascribed to any apparent reason. These results were compared with those of negative controls (MSAFP <2.5 MoM) in order to evaluate the course and outcome of pregnancy. Statistical analysis was performed by chi-square test, Fisher's exact test, Student's t-test, and odds ratio calculation. RESULTS: We reviewed 16,747 tests: 143 tests with high MSAFP levels were found, including 105 data already available. Out of them 21 tests were excluded from the study because of the presence of fetal malformations, chromosomal diseases, or late miscarriage. Among the 84 remaining pregnancies, 43 were significantly associated with increased rates of pregnancy pathology compared with the control group of 199 patients, with 25 complicated pregnancies. In addition, high MSAFP levels were correlated with a less favorable neonatal outcome in terms of low birth weight, Apgar score, and transfer to a neonatal intensive care unit. CONCLUSIONS: Unexplained elevation of MSAFP levels in the second trimester of pregnancy is associated with an adverse maternal/fetal outcome, possibly suggesting the need for a more strict management of pregnancies.

Single-dose methotrexate for ectopic pregnancy treatment: preliminary data.

BACKGROUND AND AIM OF THE WORK: Our purpose was to evaluate the efficacy of a single-dose of MTX for ectopic pregnancy treatment in a sample of patients carefully selected according to strict inclusion criteria. METHODS: 11 patients that matched the inclusion criteria were enrolled. RESULTS: Beta-hCG at diagnosis averaged 1349 mIU/ml out of the 11 treated patients, 10 (90%) received a single dose of MTX and had a time of EP resolution averaging 27.3 days. The remaining patient received an additional dose of MTX, equal to the start dose, with a time resolution of 35 days. CONCLUSIONS: This study provides evidence of the efficacy of MTX in EP treatment, both as therapy and as a form of clinical management: the successful medical management of EP, defined as beta-hCG levels becoming negative after administration of one or more MTX doses, was obtained in all treated cases.

Meconium-stained amniotic fluid and fetal oxygen saturation measured by pulse oximetry during labour.

BACKGROUND AND AIM OF THE WORK: The high false-positive rate of electronic fetal heart rate monitoring is the major obstacle to the correct prediction and diagnosis of intrapartum fetal distress. Fetal pulse oximetry is a safe and accurate indicator of fetal oxygenation. The aim of this study was to evaluate the clinical use of this technique for the diagnosis of fetal hypoxia and for prevention of fetal metabolic acidosis and asphyxia during labour, in the presence of meconium-stained amniotic fluid with or without abnormal fetal heart rate patterns, using a threshold value of 30% oxygen saturation. METHODS: Fetal blood oxygen saturation levels (SpO2) of 58 term fetuses with non-reassuring fetal status were measured during labour by fetal pulse oximetry. In 35 cases the amniotic fluid was stained with meconium at onset of labour. Mean SpO2 levels at the different stages of labour were matched against fetal heart rate patterns, the amniotic fluid status, and neonatal outcome. The 35 cases with meconium-stained amniotic fluid were compared with a control group of 28 pregnant women at term who had meconium-stained amniotic fluid during labour but were not monitored by pulse oximetry. RESULTS: When the fetal heart rate tracings were abnormal, mean SpO2values were significantly lower in the first 30 minutes of application and in the last 30 minutes of labour or before Cesarean section. Meconium-stained amniotic fluid was associated with lower SpO2values only when fetal heart monitoring showed a "non-reassuring" pattern. No cases were observed with severe neonatal acidosis, with Apgar score <7 at 5 minutes, or with other adverse neonatal events. In patients with meconium-stained amniotic fluid, neonatal outcomes were better in the group monitored by pulse oximetry versus the control group, although the differences were not statistically significant. CONCLUSIONS: Continued monitoring of fetal oxygen saturation combined with fetal heart rate monitoring may improve accuracy in the evaluation of fetal well-being. As a result, labour could be more safely managed in pregnancies with non-reassuring fetal status as measured by conventional methods, especially in the presence of meconium-stained amniotic fluid.

Intrapancreatic rupture of a splenic artery aneurysm during pregnancy - a rare case report with fetal and maternal survival.

Rupture of a splenic artery aneurysm (SAA) during pregnancy is a rare and severe condition. A 35-year-old woman at 34 weeks' gestation came to our observation for acute abdominal pain. After being diagnosed with intra-pancreatic SAA rupture, she was delivered of a live fetus by cesarean section. This is a rare case with both fetal and maternal survival.

Association between fetal Doppler velocimetry abnormalities and confined placental trisomy 22: A case report.

The occurrence of trisomy 22 confined to the placenta is rare. We report on a patient who presented with fetal abnormal Doppler velocimetry (elevated umbilical artery pulsatility index), but serial ultrasound examinations revealed a spontaneous recovery throughout pregnancy. A healthy baby was normally delivered at 40 weeks.