ABSTRACT
A 32-year-old multigravida woman had 3 pregnancies complicated by hypertensive disease, requiring iatrogenic preterm delivery. Middle aortic syndrome was diagnosed when uncontrolled hypertension persisted postpartum, and was treated with aortic stent-graft placement. A pregnancy subsequent to the endovascular repair was uneventful, culminating in repeated cesarean section at term.
Subject(s)
Aortic Diseases/surgery , Blood Vessel Prosthesis , Hypertension/surgery , Pregnancy Complications, Cardiovascular/surgery , Stents , Adult , Aortic Diseases/complications , Female , Humans , Hypertension/etiology , Pregnancy , SyndromeABSTRACT
OBJECTIVE: To evaluate limitations of the fetal anatomic survey in obese women. METHODS: Retrospective cohort study of obese gravidas with singleton gestations who had at least one, sonographic fetal evaluation at ≥ 14 weeks between January 2009 and March 2011. The impact of pre-pregnancy body mass index (BMI), placental location, prior cesarean scar and sonographer experience on ability to achieve an adequate ultrasound was evaluated using multilevel modeling. Ability to visualize specific fetal parts by BMI class and gestational age was also evaluated. RESULTS: There were 245 obese women (42% with class III obesity). Senior faculty (>20 years experience) were more likely to achieve adequate visualization (adjusted odds ratio [aOR] 3.27; 95% confidence interval [CI] 1.15-9.25) compared with junior faculty. Among women with BMI > 40.0, odds of inadequate views of the face and spine were 10.0 (95% CI 1.31-76.0) and 5.17 (95% CI 0.65-40.8), when compared with women with a BMI = 30-34.9. Odds for inadequate views of sex (OR 3.83; 95% CI 0.86-17.1) and extremities (OR 4.37; 95% CI 0.99-19.4) were similarly increased with a BMI ≥ 40. The optimal gestational age for a complete anatomic survey was 22-24 weeks (93% completion rate), with an OR of 41.3 (95% CI 7.89-215.8), compared with a survey at 14-16 weeks. CONCLUSIONS: Attending sonographer experience is associated with improved visualization of fetal anatomy among obese gravidas. Face, spine, sex and extremity views are particularly difficult in the highest BMI category.
Subject(s)
Fetus/anatomy & histology , Obesity , Pregnancy Complications , Ultrasonography, Prenatal , Adult , Body Mass Index , Cohort Studies , Female , Gestational Age , Humans , Logistic Models , Observer Variation , Odds Ratio , Pregnancy , Retrospective StudiesABSTRACT
BACKGROUND: Murine typhus is a flea-borne disease caused by Rickettsia typhi. Although uncommon in most of the United States, it is endemic in Southern California. Most cases are unrecognized given its nonspecific viral symptoms and rare complications. CASE: A pregnant patient presented with complaints of fever and chills. Physical examination was benign. Laboratory abnormalities included elevated transaminases, proteinuria, and thrombocytopenia. The patient gave a history of exposure to cats and opossums in an area endemic for murine typhus. After empiric treatment with azithromycin, her clinical symptoms and laboratory abnormalities promptly improved. Serologies confirmed acute infection with R. typhi. CONCLUSION: Although the signs and symptoms of murine typhus can mimic other pregnancy-related complications, a high index of suspicion in endemic areas can lead to the correct diagnosis and prompt treatment.