Ursodeoxycholic acid for the treatment of intrahepatic cholestasis of pregnancy.

OBJECTIVE: To report our experience in managing intrahepatic cholestasis of pregnancy with ursodeoxycholic acid. METHODS: All cases of intrahepatic cholestasis of pregnancy that were diagnosed at Bridgeport Hospital from January 1997 to August 1999 were identified. Information was abstracted on demographics, medical and obstetric history, symptoms, laboratory data, therapy and pregnancy outcome. Statistical analysis was primarily descriptive; continuous variables were analyzed with t tests. RESULTS: A total of 20 cases of intrahepatic cholestasis of pregnancy were identified (0.32% of live births). All patients presented with pruritus. The mean gestational age at onset of symptoms was 31.1 weeks (range 13-38.4, median 32.4). Bile acids were measured in 18 cases and were elevated in all. The mean gestational age at delivery was 36.4 weeks (32.3-39.9). Eight patients were treated with ursodeoxycholic acid (600-1200 mg). All eight patients experienced subjective improvement in pruritus after initiation of treatment with ursodeoxycholic acid. Ursodeoxycholic acid was associated with a decrease in bile acids in most patients (p = 0.16) and with a significant decrease in serum transaminases (p = 0.03). CONCLUSIONS: Ursodeoxycholic acid is an effective therapy for relief of pruritus and improvement of the liver dysfunction that occurs with intrahepatic cholestasis of pregnancy.

Indicated preterm birth: a possible contribution to group B streptococcal sepsis prophylaxis protocol failures. A case report.

BACKGROUND: Despite the acceptance of protocols for the prevention of group B streptococcal (GBS) sepsis for the newborn, protocol violations, with subsequent failure to initiate intrapartum antibiotic therapy, occur at many institutions. The causes for GBS prophylaxis protocol violations are not well understood. CASES: We report two cases of indicated preterm birth in which appropriate antibiotic prophylaxis for GBS sepsis was not initiated. CONCLUSION: In the setting of indicated preterm birth, GBS prophylaxis may be overlooked. We suspect that the attention given to the medical or fetal complications of indicated preterm birth may contribute to the omission of GBS sepsis prophylaxis in these situations.

Successful pregnancy after suspected anaphylactoid syndrome of pregnancy (amniotic fluid embolus). A case report.

BACKGROUND: Limited information is available on the recurrence risk of anaphylactoid syndrome of pregnancy. CASE: A successful pregnancy followed suspected anaphylactoid syndrome of pregnancy. CONCLUSION: A review of the literature revealed five cases of successful subsequent pregnancies following anaphylactoid syndrome of pregnancy. No instances of recurrent anaphylactoid syndrome of pregnancy have been reported.

The association of increased fetal nuchal translucency and spinal muscular atrophy type I.

We report a fetus with spinal muscular atrophy type I, who presented with an increased nuchal translucency at 13 weeks' gestation. A review of the literature reveals additional cases of spinal muscular atrophy type I associated with increased nuchal translucency and suggests increased nuchal translucency may be an early finding in this disorder.

Fetal ascites associated with ABO incompatibility: case report and review of the literature.

We report a pregnancy complicated by anti-B isoimmunization that resulted in fetal ascites, anemia, hepatomegaly, and polyhydramnios. A previous pregnancy in the same patient was complicated by neonatal ABO incompatibility. A review of the obstetric literature suggests that ABO incompatibility may cause severe fetal anemia, especially in patients with type O blood or a previous history of ABO incompatibility of the newborn.

Pregnancy in patients with cyclic neutropenia.

Cyclic neutropenia is characterized by periodic episodes of neutropenia that are often associated with infectious complications. A patient with cyclic neutropenia experienced two pregnancies with an amelioration of her infectious complications and an increase in neutrophil count. Cyclic neutropenia may follow a benign course during pregnancy.

Effect of pregnancy on graft function and graft survival in renal cadaver transplant patients.

Variable experience is documented for pregnancy in renal transplant patients. Furthermore, little information is available that compares graft function and graft survival of cadaver transplant patients who undergo pregnancy with those of a similar group of patients who do not undergo pregnancy. From 1970 to 1979, 30 patients of childbearing age were identified who were first-time recipients of cadaver-donor kidneys. Long-term follow-up was from 32 to 136 months. Five patients have undergone seven pregnancies that resulted in six viable infants and one therapeutic termination. Pregnancy complications included severe preeclampsia, spontaneous premature rupture of membranes, and proteinuria. One infant was small for gestational age. There were no neonatal problems, and no congenital anomalies. Rejection episodes were more common in the postpartum than in the antepartum period (four of six versus one of six). Chronic rejection that led to graft loss occurred in two patients. Ten patients who did not undergo pregnancy were identified for comparison of graft function and graft survival. Late graft rejections occurred in four patients, two of whom eventually suffered graft loss. Survival rates of the grafts by actuarial analysis for the two groups were not significantly different.

Pregnancy in renal transplant recipients: report of two successful pregnancies in a patient with impaired renal function.

Pregnancy in renal transplant recipients is common and, in spite of several potential problems, overall maternal and fetal outcome has been good in patients with transplants that are functioning well. The presence of renal impairment or hypertension, or both, usually leads to complications, especially in the mother. A patient is described who had a baseline creatinine clearance of about 35 mL/min-1.73 m2 and two successful pregnancies. Renal function deteriorated in the 3rd trimester of the first pregnancy but was reversible; permanent loss of function occurred in the 3rd trimester of the second pregnancy. The potential fetal and maternal risks and details of management of pregnant transplant recipients are reviewed.

Assessment of intrauterine growth retardation by diagnostic ultrasound.

In the first 1,000 cases referred to the Department of Diagnostic Ultrasound for Obstetrics and Gynaecology, 200 patients with singleton pregnancies were examined by this modality for possible intrauterine growth retardation (IUGR). Inclusion in this study was based on one or more of the following criteria: past history of IUGR, present clinical impression of IUGR, present high risk of developing IUGR, and unsuspected IUGR evidenced by diagnostic ultrasound. In 34 per cent of cases, serial examinations indicated that the date of confinement had to be recalculated. Ultrasound was in agreement with delivery results in 82 per cent of cases. Sixteen per cent of cases in this study resulted in growth-retarded infants. Ultrasound correctly diagnosed 70 per cent of these.