Trends in outcomes of pregnancy in patients with congenital heart disease.

PURPOSE OF REVIEW: This review aims to analyze the trends in the management of pregnant patients with congenital heart disease (CHD). RECENT FINDINGS: The literature that this article reviews specifically highlights the importance of multidisciplinary and specialized care, the unique and variable physiologic differences within the umbrella of CHD in pregnancy, and recommendations for obstetric and anesthetic care in the prenatal and peripartum period. SUMMARY: The findings that this article summarizes have profound implications for clinical practice and management of the patient with CHD, including the optimization of preoperative screening, facilitation of ideal prenatal care to include qualified specialists and resources, and recommendations for optimal anesthetic management during labor and delivery.

Professionalism: COVID-19 made me do it!

PURPOSE OF REVIEW: COVID-19 pandemic has created profound ethical challenges, not only for clinical decision-making but also for defining physician professional conduct. RECENT FINDINGS: Multiple ethical questions arose as the COVID-19 pandemic ravaged globally, including physician obligations in a pandemic, allotment of personal protective equipment, care of unvaccinated patients, discern between evidence-based and unreliable information, addressing end-of-life wishes, implications of involving medical students in a public health crisis, and finally physician burnout aggravated by a pandemic. SUMMARY: There is a need to redefine existing medical professionalism standards so that future healthcare professionals are well prepared to deal with similar public health crisis.

Paraganglioma Presenting as Hypoxia and Syncope in Pregnancy: A Case Report.

Paragangliomas (PGLs) are rare tumors with an incidence of 0.007% in pregnant women. Patients with PGLs commonly present with hypertension and tachycardia. This case report describes the evaluation and management of a multiparous woman at 32 weeks of gestation with syncope, hypoxia, and tachycardia as unusual presenting symptoms of PGL. Her symptoms were attributable to paradoxical effects of circulating catecholamines on downregulated alpha-adrenergic receptors resulting in decreased systemic vascular resistance.

Peripartum Management in Myelodysplastic Syndrome Guided by Serial Thromboelastography: A Case Report.

Myelodysplastic syndrome with severe thrombocytopenia is a rare disease in women of child-bearing age. The challenging aspect in management of such a patient is maintaining optimal coagulation with minimum platelet transfusion during the peripartum period. Multiple transfusions can result in allo-sensitization which can affect lifesaving bone marrow transplantation in future. Thromboelastography is a useful tool to assess and guide appropriate transfusion requirements.

Adaptation of labor and delivery to COVID-19.

As the novel coronavirus disease (COVID-19) escalates globally, and no end in sight, we describe an approach for adapting swiftly to the increasing number of COVID-19 parturients admitted into labor and delivery unit. The adaptability includes physical layout, triaging, quick testing, isolating confirmed parturients, access to designated intensive care units, facilitating emergent cesarean deliveries, and educating health care personnel. It is vital that other healthy parturi-ents and healthcare providers must be protected from COVID-19. It is encouraged that institutions exchange and dis-seminate information to succeed in the global fight against this dreaded pandemic.