Folic acid alone or multivitamin containing folic acid intake during pregnancy and the risk of gestational hypertension and preeclampsia through meta-analyses

OBJECTIVE: The objective of this study was to assess the effect of folic acid and multivitamin use during pregnancy on the risk of developing of hypertensive disorder of pregnancy. METHODS: Two reviewers independently determined all prospective cohort study, retrospective cohort study, large population based cohort study, retrospective secondary analysis, and double blinded, placebo-controlled, randomized clinical trial published using PubMed Medline database, KERIS (Korea Education and Research Information Service), Scopus, and the Cochrane Central Register of controlled trials comparing before conception throughout pregnancy intake oral multivitamin containing folic acid or folic acid alone. Meta-analyses were estimated with odds ratios and 95% confidence intervals (CIs) using random effect analysis according to heterogeneity of studies. RESULTS: Data from six effect sizes from six studies involving 201,661 patients were enrolled. These meta-analyses showed multivitamin containing folic acid or folic acid alone was not significantly effective in reducing gestational hypertension or preeclampsia incidence (odds ratio, 0.91; 95% CI, 0.81 to 1.03) than the placebo. And the difference of effective sizes of preeclampsia and gestational hypertension according to two dependent variables, multivitamin and folic acid were not significant, respectively (point estimate, 0.66; 95% CI, 0.46 to 0.96). CONCLUSION: These meta-analyses demonstrate multivitamin containing folic acid or folic acid alone was not significantly effective in reducing gestational hypertension or preeclampsia incidence.

Acute Kidney Injury Arising from Severe Hyperemesis Gravidarum: Case Report with a Review of Literatures

Severe hyperemesis gravidarum is a rare but potentially life-threatening it left untreated. Its serious complications are dehydration, ketosis, alkalosis from loss of hydrochloric acid, hypokalemia, and compromised pre-renal acute kidney injury. We experienced a very rare case of a 20-year-old woman who presented to the emergency department with severe hyperemesis gravidarum associated with a loss of kidney function at 25 weeks' gestation. Her initial serum creatinine and blood urea nitrogen were 5.0 and 45.9 mg/dL, respectively. The patient underwent hemodialysis for three days and achieved a subsequent recovery of renal function. In conclusion, our case indicates that clinicians should be aware of the possibility of acute kidney injury associated with severe hyperemesis gravidarum although rare.

Sudden Cardiac Arrest Postoperative Day due to Pulmonary Embolism

Cardiac arrest one day after cesarean section is extremely rare. Obstetrical clinicians have low experience to these serious situations necessitating immediate first aid and knowledge of its differential diagnosis. A 33-year-old woman underwent elective repeat cesarean section at 38 weeks of gestation under spinal anesthesia. The patient underwent uneventful course on that day. Loss of consciousness occurred one day after cesarean section during her first ambulation. Immediate cardiac compression was performed and eventually resulted in good recovery of her heartbeat. Her condition was suitable disseminated intravascular coagulation (DIC). She developed acute ischemic pancreatitis after cardiac arrest. We describe the consideration of amniotic fluid embolism with DIC as most appropriate in this case. To our knowledge, our case is one of the most dangerous conditions after the cesarean section. Here, we report our case with a review of literatures.

Prevotella bivia Infection Following Supracervical Hysterectomy: Case Report with a Review of Literatures

Prevotella bivia (P. vivia) has a high proliferative potential in the presence of estrogen. Therefore, its involvement in vaginal tract infections, such as endometritis and pelvic inflammatory disease, has been well described in the literature. We experienced a very rare case of a 40-year old woman with a 6-cm abscess on the cuff who presented with a large amount of vaginal discharge and nausea two months after laparoscopic supracervical hysterectomy. Our case indicates that clinicians should be aware of the possibility of P. vivia infections although rare.

The Formation of Abscesses in the Peritoneal Cavity and the Left Internal Obturator Muscle as the Complications of the Transobturator Tape Procedure

The synthetic, tension-free midurethral sling procedure using transobturator tape (TOT) was introduced in 2001. Since then, it has become a mainstream modality in patients with stress urinary incontinence. But, it has been reported to produce many complications such as mesh erosion, hematoma formation, and abscess. We experienced a case of abscess formation in the peritoneal cavity and left internal obturator muscle seven days after the TOT sling procedure, for which we performed a complete removal of mesh and a percutaneous drainage of the peritoneal abscess using 10.2-F drain-fix at the department of interventional radiology. To our knowledge, our case is one of the serious complications of the TOT procedure. Here, we report our case with a review of literatures.