[Deforming endonasal mass during pregnancy]. / Deformierende endonasale Raumforderung während der Schwangerschaft.

This article presents the case of a 33-year-old woman who consulted the authors' ENT clinic in the 39th week of pregnancy with recurrent epistaxis. A livid endonasal mass was found on the left side, subtotally displacing the nose and leading to deformation of the external nose. External biopsy provided no indications of malignancy. Postpartum CT of the paranasal sinuses revealed a mass destroying the cartilaginous nasal septum. Endoscopic resection of the finding was performed with preservation of the clinically sound nasal septal cartilage. Histopathological examination revealed a capillary hemangioma, which was classified as granuloma gravidarum due to its occurrence during pregnancy.

Maternal Hematologic Neoplasms during Pregnancy: Histologic Findings in the Placenta.

Placental metastasis of maternal neoplasms is well documented in solid tumors, unlike hematologic neoplasms. We reviewed placental findings from deliveries complicated by maternal hematologic neoplasms exploring the prevalence and patterns of placental transmission and insufficiency. In the 8-yr study period, 11 cases were analyzed. Acute myeloid leukemia was the most common diagnosis (4/11, 36%). Seven cases (63%) showed no evidence of placental spread of neoplasm, while four cases (36%) showed placental spread, restricted to the maternal compartment. Maternal vascular malperfusion was documented in 8/11 (72%) cases. Neonatal follow up was available in 10 cases, all children were alive and well.

How I treat lymphoma in pregnancy.

Lymphomas afflict all age groups of people, with certain types demonstrating a female predilection in adolescents and young adults. A proportion of lymphomas that are diagnosed in this population demographic occur in the setting of pregnancy. Most of these behave aggressively at presentation and require immediate or urgent therapy. Treatment must consider both maternal and fetal health, and management approaches are therefore influenced by gestational age at diagnosis and treatment and timing of delivery. Although there is a paucity of literature on how to treat these patients, limited retrospective reports demonstrate generally good outcomes and highlight the necessity of an experienced multidisciplinary team approach to management.

Prevalence and foetomaternal effects of iron deficiency anaemia among pregnant women in Lagos, Nigeria.

Anaemia in pregnancy is a major health problem and an important cause of adverse foetomaternal outcomes in developing countries. Iron deficiency is the cause of the overwhelming majority of the cases of anaemia in pregnancy. Iron deficiency anaemia (IDA) has been linked with adverse foetal and maternal outcomes. This study investigated the prevalence of IDA and evaluated its effects on foetomaternal outcomes among parturients in Lagos, Nigeria. This was a cross-sectional study that enrolled 220 women aged 15-49 years with singleton gestation at term, between May 1, 2016, and March 31, 2017. Participants were selected by systematic sampling and baseline data were collected through interviews. Venous blood samples were obtained to measure haemoglobin and serum ferritin concentrations, and the associations between IDA (defined as anaemia and iron deficiency) and pregnancy outcomes were examined. A P-value <0.05 was considered as statistically significant. The prevalence of IDA was 12.3%. Routine antenatal iron supplementation (adjusted odds ratio 0.18, 95% confidence interval 0.07-0.46; P = 0.001) and interpregnancy interval of at least 2 years (adjusted odds ratio 0.20, 95% confidence interval 0.05-0.97; P = 0.021) have significant association with IDA. Iron deficiency anaemia was not significantly associated with adverse perinatal outcomes but there were significant associations with increased risk of blood transfusion (P = 0.001) and maternal infectious morbidities such as puerperal pyrexia (P = 0.041) and wound infection (P = 0.020). IDA is still a fairly common condition among parturients in Lagos and it's mostly associated with maternal peripartum morbidities. Adequate pregnancy spacing through the use of effective contraception and routine antenatal iron supplementations in pregnancy is a recommended preventive measure against IDA and its adverse sequelae. Future studies should adopt the use of transferrin saturation (TSAT) in compliment with serum ferritin assay as a more sensitive marker of iron deficiency.

Acute myeloid leukemia during pregnancy: a systematic review and meta-analysis.

Data regarding clinical characteristics, therapy, maternal and fetal outcomes of pregnancy-associated acute myeloid leukemia (PA-AML) are limited. This study (including 138 cases published between 1955 and 2013) provides comprehensive assessment of these clinical parameters and may serve as a platform for developing management recommendations. Most patients (58%) received anthracycline-cytarabine-based regimens (ACBRs), which were associated with significantly increased complete remission (CR: 91%). Yet, the maternal overall survival (OS: ∼30%) was relatively low, probably reflecting reduced application of risk-adapted consolidation and allogeneic stem cell transplantation (allo-SCT). Fetal exposure to ACBRs resulted in a live birth rate of 87%, with complications (16%) diagnosed only in chemotherapy-subjected neonates. This study demonstrates safety and efficacy of ACBRs during pregnancy. Therapy and delivery schedule should allow early referral of high-risk patients to allo-SCT. Generation of a pool of high-quality data on PA-AML could contribute to providing evidence-based therapy and lead to improved maternal and fetal survival.

High Adherence to Iron/Folic Acid Supplementation during Pregnancy Time among Antenatal and Postnatal Care Attendant Mothers in Governmental Health Centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical Negative Binomial Poisson Regression.

BACKGROUND: Iron deficiency during pregnancy is a risk factor for anemia, preterm delivery, and low birth weight. Iron/Folic Acid supplementation with optimal adherence can effectively prevent anemia in pregnancy. However, studies that address this area of adherence are very limited. Therefore, the current study was conducted to assess the adherence and to identify factors associated with a number of Iron/Folic Acid uptake during pregnancy time among mothers attending antenatal and postnatal care follow up in Akaki kality sub city. METHODS: Institutional based cross-sectional study was conducted on a sample of 557 pregnant women attending antenatal and postnatal care service. Systematic random sampling was used to select study subjects. The mothers were interviewed and the collected data was cleaned and entered into Epi Info 3.5.1 and analyzed by R version 3.2.0. Hierarchical Negative Binomial Poisson Regression Model was fitted to identify the factors associated with a number of Iron/Folic Acid uptake. Adjusted Incidence rate ratio (IRR) with 95% confidence interval (CI) was computed to assess the strength and significance of the association. RESULT: More than 90% of the mothers were supplemented with at least one Iron/Folic Acid supplement from pill per week during their pregnancy time. Sixty percent of the mothers adhered (took four or more tablets per week) (95%CI, 56%-64.1%). Higher IRR of Iron/Folic Acid supplementation was observed among women: who received health education; which were privately employed; who achieved secondary education; and who believed that Iron/Folic Acid supplements increase blood, whereas mothers who reported a side effect, who were from families with relatively better monthly income, and who took the supplement when sick were more likely to adhere. CONCLUSION: Adherence to Iron/Folic Acid supplement during their pregnancy time among mothers attending antenatal and postnatal care was found to be high. Activities that would address the above mentioned factors were highly recommended to ensure the sustainability of mothers' adherence to the supplement.

Management of aplastic anaemia in pregnancy in a resource poor centre.

Aplastic anaemia occurring in pregnancy is a rare event with life threatening challenges for both mother and child. We present a successful fetomaternal outcome despite the challenges in the management of this rare condition in a tertiary but resource poor centre. This is case of a 37 year old Nigerian woman G6P0+5managed with repeated blood transfusions from 28 weeks of gestation for bone marrow biopsy confirmed aplastic anaemia following presentation with weakness and gingival bleeds. She had a cesarean section at 37 weeks for pre-eclampsia and oligohydraminous with good feto-maternal outcome. She was managed entirely with fresh whole blood and received 21 units. Aplastic Anaemia in Pregnancy is a rare event with poor feto maternal prognosis. Successful management is possible with good multi-disciplinary approach and availability of supportive comprehensive obstetric care.

Modifications in B-Lymphocyte Number and Phenotype in the Course of Pregnancy in a Woman with Persistent Polyclonal B-Cell Lymphocytosis: A Flow Cytometric Study.

Persistent polyclonal B-cell lymphocytosis (PPBL) is a rare clinical condition, characterized by a persistent, generally moderate lymphocytosis, generally due to stimulation of central memory B-lymphocytes, and by a moderate increase of polyclonal IgM. In some patients, slight or moderate splenomegaly is observed. A variable percentage of circulating, bone marrow and splenic lymphocytes display an abnormal nucleus (generally bilobated) or are binucleated. The clinical course is benign in most cases and transformation into splenic B-cell lymphoma occurs in few cases. In the current paper we report the first case of pregnancy in PPBL. Our patient became pregnant 18 months after diagnosis. In the course of pregnancy, a marked down-regulation of lymphocytosis (from 6 × 10(9)/L to 2.1 × 10(9)/L) and a decrease in B-lymphocyte number was observed (from 3.6 × 10(9)/L to 1 × 10(9)/L), mainly due to a marked reduction in the percentage and absolute number of central memory B-cells. Such modifications were similar to those described in normal pregnant women. One year after the delivery of a healthy female baby, the number of total lymphocytes and B-lymphocytes showed an inverse behavior, with a new expansion of central memory B-cells. Our case shows that a normal pregnancy can occur in patients with PPBL and that pregnancy can induce marked modifications in B-lymphocyte kinetics and phenotype.

[Analysis of risk factors for adverse perinatal outcomes in women with pancytopenia].

OBJECTIVE: To explore the pregnancy outcomes of women with pancytopenia and the risk factors for the adverse perinatal outcomes. METHODS: A total of 106 pregnant women with pancytopenia were admitted to Peking University People's Hospital from Jan. 2005 to Sep. 2014. The clinical data and the pregnancy outcomes were reviewed retrospectively to investigate the risk factors for the adverse perinatal outcomes. RESULTS: (1 ) Eighty-four patients were found pancytopenia before pregnancy while 22 were found for the first time during pregnancy. Sixty-four patients were diagnosed as aplastic anemia; 30 as myelodysplastic syndrome; 2 as paroxysmal nocturnal hemoglobinuria; 4 as hypersplenism, and 1 as anti-phospholipid syndrome. Diagnoses of the remaining 5 patients were uncertain. (2) Sixty-nine patients received at least one time blood transfusion before delivery. (3) As for the complications, nine women developed gestational diabetes; twenty-two suffered severe preeclampsia (SPE); two were diagnosed as anemic heart disease and three experienced respiratory tract infection. The postpartum blood loss ranged from 50 ml to 3 800 ml, with the median of 400 ml. And six women had the blood loss more than 1 000 ml. The gestational age at delivery ranged from 24 weeks to 40 weeks, with the median of 37.0 weeks. (4) Thirty-one patients suffered adverse perinatal outcomes, including 3 cases of intrauterine death, 4 therapeutic labor induction before 28 gestational weeks, 6 premature delivery before 34 weeks. There were 2 neonates complicated with intracranial hemorrhage, 2 with neonatal respiratory distress syndrome, 3 with hypoxic-ischemic encephalopathy, 2 with severe asphyxia and death, and 14 with small for gestational age. Among the patients with adverse perinatal outcomes, 26 women received blood transfusion during pregnancy and 17 developed SPE. The maximum and the minimum value of their white cell count (WBC), hemoglobin concentration (Hb) and blood platelet count (BPC) were (4.9±1.4)×10(9)/L, (2.9±0.8)×10(9)/L, (88.6±14.9) g/L, (57.9±14.5) g/L, (47.7±27.4)×10(9)/L and (11.9±12.3)×10(9)/L, respectively. For those patients without adverse perinatal outcomes, 43 received blood transfusion during pregnancy and 5 developed SPE. The maximum and the minimum value of their WBC, Hb and BPC were (5.2±1.5)×10(9)/L, (3.2±0.9)×10(9)/L, (101.4±16.2) g/L, (71.9 ± 14.5) g/L, (52.3 ± 24.0) × 10(9)/L and (19.0±12.1) × 10(9)/L, respectively. The multivariate regression analyses indicated that SPE, Hb less than 70 g/L and BPC less than 20×10(9)/L were the independent risk factors for the poor perinatal outcomes in pregnant women with pancytopenia (P<0.05). CONCLUSIONS: The incidence of adverse perinatal complications increased dramatically in pregnant women with pancytopenia. Concurrent SPE, minimum Hb less than 70 g/L and minimum BPC less than 20 × 10(9)/L may be the independent risk factors for the adverse perinatal outcomes.

Hypoxia-inducible factor-1α (HIF-1α) expression in placentae of women with iron deficiency anemia and ß-thalassemia trait.

OBJECTIVE: To investigate hypoxia-inducible factor-1α (HIF-1α) expression in placentae of women with iron-deficiency anemia and ß-thalassemia trait and to correlate the results with hematological parameters as well as with parameters associated with the outcome of pregnancy. METHODS: About 126 women who delivered in the Larissa University Hospital were divided in three groups: iron-deficiency anemia (n = 39), ß-thalassemia trait carriers (n = 53) and control group (n = 34). HIF-1α expression was assessed with immunochemical assays and statistical analysis was performed with chi-squared test and ANOVA. RESULTS: HIF-1α immunostaining was intense in the two groups of anemia. A statistically significant association was found between HIF-1α immunoreactivity and hematocrit (p < 0.001), hemoglobin (p < 0.001), MCV (p < 0.001), transferrin (p < 0.001) and its receptors (p = 0.040), whereas no significant correlations were observed between HIF-1α, iron serum levels (p = 0.256) and ferritin (p = 0.232). We found no association between HIF-1α and birthweight (p = 0.256), placental weight (p = 0.870) and Apgar score at 1' (p = 0.210) and 5' (p = 0.400). CONCLUSIONS: HIF-1α expression is affected by anemia, although this factor has no important direct effect on the perinatal outcome.

[Ovarian vein thrombophlebitis during pregnancy--with a contribution of one clinical case].

Ovarian vein thrombosis (OVT) is a rare, but serious condition that affects mostly postpartum women but may also be associated with pelvic inflammatory disease, malignancies and pelvic surgical procedures. Concerning ovarian vein thrombosis in earlier stages of pregnancy there are only very few case reports. The authors consider this rare but potentially deadly disease and describe the clinical case study.

Association of severe thrombocytopenia and poor prognosis in pregnancies with aplastic anemia.

PURPOSE: We sought to estimate the risks of adverse obstetric outcomes and disease outcomes associated with severe thrombocytopenia in pregnant women with aplastic anemia (AA). METHODS: In a retrospective study, we compared demographics, clinical characteristics, laboratory results, and outcomes between severe thrombocytopenia (ST) and non-severe thrombocytopenia (non-ST) groups comprising pregnant women with AA. RESULTS: Of 61 AA patients, 43 (70%) were diagnosed as AA before pregnancy and 18 (30%) were AA during pregnancy. The ST group exhibited lower gestational age at nadir of platelet count (26.0 versus 37.0 weeks, p<0.001) and at delivery (37.3 versus 39.1 weeks, p = 0.008), and a higher rate of bleeding gums (33.8 versus 7.7%, p = 0.015) than the non-ST group. In addition, the ST group exhibited more transfusions during pregnancy (72.7 versus 15.4%, p<0.001) and postpartum period (45.0 versus 2.7%, p<0.001), and more bone marrow transplant after delivery (25.0 versus 0.0%, p<0.001) than the non-ST group. The ST group had a higher odds ratio of composite disease complications (OR, 9.63; 95% CI, 2.82-32.9; p<0.001) and composite obstetric complications (OR, 6.78; 95% CI, 2.11-21.8; p = 0.001) than the non-ST group. CONCLUSIONS: Severe thrombocytopenia is more associated with obstetric and disease complications than is non-severe thrombocytopenia in pregnant women with AA.

Proliferative glomerulonephritis with monoclonal IgG deposits in a patient with autoimmune hemolytic anemia.

A 25-year-old woman was admitted because of proteinuria. A renal biopsy showed mesangial/endocapillary proliferative glomerulonephritis with IgG2-κ deposits. Electron microscopy showed immune complex-type deposits. She also had Coombs-positive hemolytic anemia, anticardiolipin antibodies, and antinuclear antibodies. Middle-dose steroid therapy led to improvement of proteinuria and hemolytic anemia. Six years later, she developed crescentic glomerulonephritis with IgG2-κ deposits during pregnancy. Middle-dose steroid therapy improved renal dysfunction. This is an exceptional case of proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID), a recently described rare dysproteinemia-related glomerulonephritis, associated with autoimmune disease. This case also suggests that crescentic glomerulonephritis can be superimposed on PGNMID.

Clinical utility of flow cytometry in the study of erythropoiesis and nonclonal red cell disorders.

Erythropoiesis involves proliferation and differentiation of small population of hematopoietic stem cells resident in the bone marrow into mature red blood cells. The determination of the cellular composition of the blood is a valuable tool in the diagnosis of diseases and monitoring of therapy. Flow cytometric analysis is increasingly being used to characterize the heterogeneous cell populations present in the blood and the hematopoietic cell differentiation and maturation pathways of the bone marrow. Here we discuss the role of flow cytometry in the study of erythropoiesis and nonclonal red blood cell disorders. First, we discuss flow cytometric analysis of reticulocytes. Next, we review salient quantitative methods that can be used for detection of fetal-maternal hemorrhage (FMH). We also discuss flow cytometric analysis of high hemoglobin F (HbF) in Sickle Cell Disease (SCD), hereditary spherocytosis (HS), red cell survival and red cell volume. We conclude by discussing cell cycle of erythroid cells.

Thrombophilic-type placental pathologies and skeletal growth delay following maternal administration of angiostatin4.5 in mice.

During placentation, the concentration of fibrinous deposits on the surfaces of maternal vasculature plays a role in villous development and has been strongly implicated in the pathophysiology of human fetal growth restriction (FGR). Fibrinous deposits are conspicuous sites of platelet aggregation where there is local activation of the hemostatic cascade. During activation of the hemostatic cascade, a number of pro- and antiangiogenic agents may be generated at the cell surface, and an imbalance in these factors may contribute to the placental pathology characteristic of FGR. We tested the hypothesis that angiostatin(4.5) (AS(4.5)), a cleavage fragment of plasminogen liberated at the cell surface, is capable of causing FGR in mice. Increased maternal levels of AS(4.5) in vivo result in reproducible placental pathology, including an altered vascular compartment (both in decidual and labyrinthine layers) and increased apoptosis throughout the placenta. In addition, there is significant skeletal growth delay and conspicuous edema in fetuses from mothers that received AS(4.5). Maternally generated AS(4.5), therefore, can access maternal placental vasculature and have a severe effect on placental architecture and inhibit fetal development in vivo. These findings strongly support the hypothesis that maternal AS(4.5) levels can influence placental development, possibly by directly influencing trophoblast turnover in the placenta, and contribute to fetal growth delay in mice.

[Clinical analysis of bicytopenia and pancytopenia during pregnancy].

OBJECTIVE: To investigate the diagnosis, management, pregnancy outcome and prognosis of bicytopenia or pancytopenia during pregnancy. METHODS: Retrospective chart review was conducted on 24 pregnancies who were found bicytopenia or pancytopenia during pregnancy for the first time. The diagnoses were reconfirmed. The management and pregnancy outcome were collected. And the prognoses were followed. RESULTS: According to the clinical data and laboratory findings, the latter including complete blood cell count, reticulocyte count, peripheral smear, serum folate and vitamin B12 level, autoimmune antibody screening, bone marrow smear and biopsy, thirteen patients were diagnosed as having chronic aplastic anemia (CAA), six as having myelodysplastic syndromes (MDS), two as having megaloblastic anemia (MA), one as having paroxysmal nocturnal hemoglobinuria (PNH), one as having Evan's syndrome and one as having acute leukemia. The management basically consisted of supportive transfusions. Six patients suffered pregnancy complications including four with severe preeclampsia (one with intracranial hemorrhage and one with intrauterine death concomitantly) and two with gestational diabetes. The delivery ages of the 21 patients were term or nearly term with all good neonatal outcomes. Postpartum follow-up showed the two patients with MA achieved complete remission, the one with PNH had mild anemia and that with Evan's syndrome had mild thrombocytopenia. The patient with acute leukemia died of recurrence six months postpartum. Of the thirteen patients with CAA, two achieved complete remission, six partial remission, four no remission and one was lost follow-up. Of the 6 patients with MDS, one achieved partial remission, four no remission, and one transformed into acute monocytic leukemia, then refused chemotherapy and was lost follow-up. CONCLUSIONS: CAA may be one of the most common causes of bicytopenia or pancytopenia during pregnancy, MDS may be the second. Diagnosis should be made as soon as possible through appropriate and reasonable laboratory examinations. Most patients could achieve good pregnancy outcomes through supportive management. The maternal prognosis may vary widely depending on the causes.