Cervical Ectopic Pregnancy Complicated by Escherichia Coli Septicemia: A Case Report.

BACKGROUND: Cervical ectopic pregnancy is an uncommon form of ectopic pregnancy. The spectrum of treatment options includes systemic medical therapy, local injection with methotrexate and/or potassium chloride, surgery, or a combination of these modalities. CASE: A 29-year-old woman, gravida 3, aborta 2, was found to have a cervical ectopic pregnancy on ultrasound at 5+6 weeks' gestation. She presented to the hospital with vaginal bleeding. Treatment was initiated with multidose methotrexate and leucovorin rescue. She subsequently developed Gram-negative septicemia, with blood cultures growing Escherichia coli. This was managed successfully by surgical removal of the ectopic pregnancy and antimicrobial therapy. CONCLUSION: A cervical ectopic pregnancy can be complicated by E. coli septicemia.

Maternal and pregnancy related predictors of cardiometabolic traits in newborns.

BACKGROUND: The influence of multiple maternal and pregnancy characteristics on offspring cardiometabolic traits at birth is not well understood and was evaluated in this study. METHODS AND FINDINGS: The Family Atherosclerosis Monitoring In earLY life (FAMILY) Study prospectively evaluated 11 cardiometabolic traits in 901 babies born to 857 mothers. The influence of maternal age, health (pre-pregnancy weight, blood pressure, glycemic status, lipids), health behaviors (diet, activity, smoking) and pregnancy characteristics (gestational age at birth, gestational weight gain and placental-fetal ratio) were examined. Greater gestational age influenced multiple newborn cardiometabolic traits including cord blood lipids, glucose and insulin, body fat and blood pressure. In a subset of 442 singleton mother/infant pairs, principal component analysis grouped 11 newborn cardiometabolic traits into 5 components (anthropometry/insulin, 2 lipid components, blood pressure and glycemia), accounting for 74% of the variance of the 11 outcome variables. Determinants of these components, corrected for sex and gestational age, were examined. Baby anthropometry/insulin was independently predicted by higher maternal pre-pregnancy weight (standardized estimate 0.30) and gestational weight gain (0.30; both p<0.0001) and was inversely related to smoking during pregnancy (-0.144; p = 0.01) and maternal polyunsaturated to saturated fat intake (-0.135;p = 0.01). Component 2 (HDL-C/Apo Apolipoprotein1) was inversely associated with maternal age. Component 3 (blood pressure) was not clustered with any other newborn cardiometabolic trait and no associations with maternal pregnancy characteristics were identified. Component 4 (triglycerides) was positively associated with maternal hypertension and triglycerides, and inversely associated with maternal HDL and age. Component 5 (glycemia) was inversely associated with placental/fetal ratio (-0.141; p = 0.005). LDL-C was a bridging variable between the lipid factors and glycemia. CONCLUSIONS: Maternal health, health behaviours and placenta to fetal weight ratio are associated with newborn cardiometabolic traits over and above gestational age. Future investigations are needed to determine if these factors remain important determinants of cardiometabolic health throughout childhood.

The Family Atherosclerosis Monitoring In earLY life (FAMILY) study: rationale, design, and baseline data of a study examining the early determinants of atherosclerosis.

BACKGROUND: Complex interactions among genetic, epigenetic, and environmental exposures, further modified by a child's postnatal environment, underlie the relationship among maternal health, fetal growth, and the development of cardiovascular disease (CVD) risk factors in the child and disease in the adult. Few available studies consider the genetic and environmental influences of the family, beyond maternal health. The purpose of this study is to examine the fetal and early childhood family-based determinants for the development of adiposity, CVD risk factors, and atherosclerosis in childhood. METHOD: A cohort of 850 children and their families (mother, father, eldest sibling) are being recruited during pregnancy to a prospective longitudinal study to investigate the relative contribution of (a) prenatal and postnatal determinants and (b) individual and family (maternal/paternal) determinants for the development of adiposity and CVD risk factors at 3, 5, and 10 years of age and carotid intima media thickness at 10 years. IMPLICATIONS: The FAMILY study will advance understanding of the fetal and early childhood determinants for CVD development and will contribute to the design of primary prevention programs based on identification of the most important modifiable determinants for early childhood adiposity and CVD risk factor development.

Two cases of umbilical vein thrombosis, one with associated portal vein thrombosis.

BACKGROUND: Thrombosis of the umbilical vessels is extremely rare. It is unpredictable and is associated with high perinatal mortality. Few cases with neonatal survival have been reported. CASES: We identified two instances of umbilical vein thrombosis occurring two weeks apart in the same unit. Each case was identified at the time of delivery and each had a good outcome. In the first case, a 22-year-old primigravid woman had severe fetal bradycardia develop in the second stage of labour. Delivery was expedited with vacuum extraction, and a large thrombus in the umbilical vein was noted. In the second case, a 23-year-old multigravid woman underwent emergency Caesarean section because of a non-reassuring fetal heart tracing before the onset of labour. An umbilical cord thrombus was noted at delivery. The infant was later found to have a portal vein thrombus but subsequently did well. CONCLUSION: When a neonate is found to have a thrombosis in the umbilical cord, it is prudent to rule out portal vein thrombosis. End-organ damage in the infant should be considered, and a thrombophilia screen is warranted.

Ectopic pregnancy in a caesarean scar: a case report.

BACKGROUND: An ectopic pregnancy developing in a Caesarean section scar is extremely rare. This type of ectopic pregnancy carries with it a high risk of morbidity related to uterine rupture and extensive hemorrhage. Conservative treatment in the form of local or systemic injection of methotrexate or local injection of potassium chloride is preferable to surgical management, as the former is fertility sparing. CASE: A 36-year-old multigravid woman was found to have an ectopic pregnancy in a Caesarean scar at seven weeks' gestation with a significantly elevated beta-human chorionic gonadotrophin (Beta-hCG) level. Systemic methotrexate therapy was unsuccessful; subsequently, a local injection of methotrexate was used with resolution of the pregnancy. CONCLUSION: An ectopic pregnancy in a Caesarean scar can be managed effectively with local injection of methotrexate.

Vaginal birth after caesarean section: clinical and legal perspectives.

Vaginal birth after Caesarean section (VBAC) is currently the preferred method of delivery for pregnant women who have undergone 1 previous low transverse Caesarean section. This common practice warrants some reconsideration in light of recent clinical data on the risks associated with VBAC, and it is incumbent upon clinicians to ensure that women under their care are fully aware of these risks. Indeed, in some circumstances, an attempt at VBAC may be perceived by the courts to represent a negligent standard of care.

Ultrasonographic assessment of endometrial thickness: a review.

Measurement of endometrial thickness with ultrasonography is a modality commonly used today. Its clinical importance and applications extend throughout the phases of the reproductive lives of women. In premenopausal women, endometrial thickness is used to monitor infertility treatment, while in postmenopausal women with abnormal uterine bleeding it is useful as an initial investigation for endometrial hyperplasia or cancer. Moreover, endometrial thickness can vary with the menstrual cycle and with the use of hormone replacement therapy or selective estrogen receptor modulators. In this review, the use of ultrasound to measure both the premenopausal and postmenopausal endometrium is discussed.