Termination of Pregnancy as a Means to Reduce Maternal Mortality in Pregnant Women With Medical Comorbidities.

The United States is the world's only developed country with a rising maternal mortality rate, with an increase of 26% between 2000 and 2014. Of the approximately 700 pregnancy-related deaths per year in the United States, nearly 30% are attributable to preexisting disease. Maternal-fetal medicine physicians are in a unique position-they are tasked with counseling patients regarding the risks of pregnancy in the context of their medical comorbidities. Individual physicians' opinions regarding the level of risk of death at which a termination of pregnancy would be considered "medically indicated" are highly variable and are influenced by where physicians are from, where they trained, and their knowledge regarding the safety of termination of pregnancy. Additionally, 43 states have legislated restrictions to abortion access that contain exceptions to protect women's life or health, but what constitutes a risk to a woman's life or health is not well-defined and appropriates medical terminology for political purposes. The current statements from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine advocate for safe, legal, and unobstructed access to pregnancy termination services. These statements attempt to remove health care providers' own biases regarding the exact risk level at which they would consider an abortion to be medically indicated. Because the risk of death from a first- or second-trimester termination is less than that of a traditional delivery, any medical problem that increases that risk of death could be considered an indication for counseling patients regarding the option of termination of pregnancy as a means to reduce mortality or morbidity.

Uterine trauma with fetal loss associated with chronic perforation of the inferior vena cava by an infrarenal vena cava filter.

Gestational complications in pregnant women have been considered a theoretical sequelae of vena cava filters (VCFs) positioned in the infrarenal segment of the inferior vena cava. We describe a 32-year-old woman who became pregnant with the known existence of an asymptomatic but chronically perforated, permanent infrarenal VCF. At 24 weeks gestation, uterine trauma leading to massive intraperitoneal hemorrhage and fetal loss occurred. Our case documents that gestational risk, heretofore theoretical, is real and calls for heightened awareness of the need for appropriate VCF management in women of childbearing age and consideration for preconception evaluation of the filter-bearing inferior vena cava in women considering pregnancy in whom VCFs have been previously implanted.

Vagal nerve stimulator use during pregnancy for treatment of refractory seizure disorder.

BACKGROUND: In patients with medically refractory seizures, vagal nerve stimulation is becoming an increasingly common adjunctive therapy. Although its safety and efficacy have been proven in the general population, little is known about its use during pregnancy. CASE: A 19-year-old primigravid woman presented during the first trimester for routine prenatal care. She had a past medical history significant for generalized tonic-clonic seizure disorder since childhood. Multiple medical regimens had failed, and a vagal nerve stimulator was implanted approximately 2 months before conception. The patient continued to take phenytoin, with improved seizure control. She had a term spontaneous delivery complicated by mild preeclampsia. CONCLUSION: Adjunctive treatment of medically refractory seizures with a vagal nerve stimulator is a viable option during pregnancy.