Ectopic pregnancy

Anectopicpregnancyisonethatdevelopsoutsidetheuterus.Thevastmajority(98%)occurinthefallopiantube,buttheova ry,cervixandperitonealcavityareraresites.Theincidenceis1:150pregnancies,andthishasrisenfour-foldoverthelast20years.Thesignificanceofectopicpregnancyi…     

Guillain-Barré syndrome in pregnancy

Guillain-Barré syndrome (GBS) complicating pregnancy is a rare event. Reports before the mid-1980s suggested that GBS in pregnancy carries a high maternal morbidity and mortality. However, it is uncertain whether availability of active treatment such as plasmapheresis and intravenous immunoglobulin together with advancement in intensive care has improved maternal outcome. This review examines the maternal and fetal outcomes of GBS complicating pregnancy reported in the recent English literature.     

How to date pregnancy?

Accurate gestational assessment is essential for adequate growth assessment, appropriate aneuploidy screening and correct management of term. Based on expert opinion and beside ART pregnancies, it is recommended to use crown-rump length (CRL) to determine date of conception whenever there is an appropriate measurement taken at 11-14 weeks. This allows accurate dating at approximately 5 days in 95% of cases.     

Testing for HIV during pregnancy: 5 years after changing German pregnancy guidelines

Objective

A known HIV status is the most important step in preventing mother-to-child transmission of HIV and screening for HIV is recommended by German prenatal guidelines. In our study, we wanted to ascertain the prevalence of HIV-testing in a pregnant inner-city cohort.

Methods

Prenatal records of 279 women were prospectively studied, and the testing confirmed with the prenatal care providers.

Results

82.4 % of the patients had been tested for HIV during pregnancy. The test was refused by 4.0 % of the women. Contrary to current guidelines, in more than half of the cases documentation of the test or the result was found in the women’s prenatal care papers.

Conclusions

Even though a large majority of pregnant women are screened for HIV, the rates of testing need to be increased. Education of patients and providers as well as changing to the “opt-out” approach used in other countries may prevent unnecessary mother-to-child transmission of HIV.     

ART: iatrogenic multiple pregnancy?

Assisted reproductive technologies (ART) are now widely accepted as effective treatment for most causes of infertility. With improving success rates, attention has turned to the problem of multiple pregnancies, which are associated with a poor perinatal outcome, maternal complications and significant financial consequences. The challenge is to reduce multigestational pregnancies while maintaining good treatment outcomes. Methods to prevent multiple pregnancy include restrictive use of ART in couples with a good chance of spontaneous pregnancy, cautious use of gonadotrophins, and increased use of natural-cycle intra-uterine insemination and elective single embryo transfer in in-vitro fertilization and intracytoplasmic sperm injection. The aim of this article is to review the contribution of fertility treatment to multiple pregnancies and strategies for reducing multiples in ART.     

Behçet's disease and pregnancy

BACKGROUND: Beh?et's disease (BD) is a multisystem inflammatory chronic disorder, which is characterized by relapsing oral and genital ulceration and iridocyclitis. While being of unknown etiology, vasculitic changes of possible autoimmune origin are common to all involved organs, and thrombotic complications, which may adversely affect gestation, are frequently seen. Very little is known to date about the reciprocal influence of BD and pregnancy. We have undertaken to explore the mutual effect of BD and pregnancy with emphasis on maternal and fetal complications. METHODS: In this case-control study, we have evaluated pregnancies that occurred in women suffering from BD, who were treated in our institution during the last 25 years. All records were reviewed, and data were confirmed by a telephone interview and compared with a matched control group. To review the current knowledge, a Medline search together with a manual search of selected articles was performed. RESULTS: Thirty-one Beh?et's patients who had 135 pregnancies were studied. Remissions were significantly more frequent during both pregnancy and postpartum periods, while exacerbations were observed only in one-sixth of the patients (P < 0.001). Pregnancy complications (P < 0.001), cesarean section (P < 0.001), and miscarriage (P < 0.02) rates, however, were significantly higher in the study group. CONCLUSIONS: Our study suggests that pregnancy does not have a deleterious effect on the course of BD and may possibly ameliorate its course. However, it seems that BD may adversely affect pregnancy. The miscarriage rate was higher, and the pregnancy complications and cesarean section rates were significantly elevated.     

Büschke-Lowenstein tumour in pregnancy

During pregnancy a localised human papillomavirus (HPV) lesion may, in rare cases, develop into a Büschke-Lowenstein tumour. The choice of treatment is crucial as standard systemic treatment is teratogenic. We performed laser CO2 microsurgery because it has a low incidence of complications.     

Who stops smoking during pregnancy?

BACKGROUND: The proportion of women who stop smoking during pregnancy has varied between 17 and 40% percent in Sweden with a tendency of lower prevalence in recent years. The aim of the present study was to examine the factors that might influence the ability to stop smoking during pregnancy. METHOD: One hundred and two women were interviewed shortly after their first visit to the antenatal clinic and a second time approximately one month after delivery. Two women who had late spontaneous abortions were excluded. The women were asked about background factors, smoking habits of their parents, smoking history and current smoking habits. The carbon monoxide in expiratory air was measured to verify reported smoking habits. RESULTS: Fifty-six of the 100 participating women had stopped smoking before the second interview. Having started smoking at an older age, having no previous children, smoking few cigarettes, a higher level of education, positive support from the partner and having lived with non-smoking parents were all associated with stopping smoking when tested as single factors. Reported smoking habits could be verified. Age, smoking habits of the partner, passive smoking at work, quality of sleep, general perceived health, length of sick-leave or amount of nausea were not correlated to stopping smoking. CONCLUSION: The presence of several factors found to influence stopping smoking during pregnancy, and the tendency for smoking habits to be passed over to the new generation, are reasons for comprehensive and individualized, anti-smoking support.     

Meckel’s diverticulum complicating pregnancy

INTRODUCTION: Symptomatic Meckel's diverticulum is a rare entity in pregnancy. The clinical presentation is variable and preoperative diagnosis is hampered by the various anatomical and physiological changes of pregnancy that can obscure serious underlying intra-abdominal pathology. CASE REPORT: We report a 14-year-old who presented at 32 weeks' gestation with worsening abdominal pain, distension, and leukocytosis. Abdominal computed tomography showed a pelvic fluid collection with extraluminal air suggestive of a perforated viscus and mechanical small bowel obstruction with features of a closed-loop obstruction. Explorative laparotomy revealed a perforated Meckel's diverticulum. Multiple adhesions between the appendix and the perforated diverticulum, and phlegmon sequelae led to the incarceration of an adjacent segment of ileum. DISCUSSION: Meckel's diverticulum in pregnancy can have serious consequences. There is a high rate of perforation due to delayed diagnosis and surgical intervention. Our report and review of the literature suggest that a high index of clinical suspicion can lead to earlier diagnosis and help to keep maternal and fetal morbidity and mortality to a minimum.     

Maternal obesity: can pregnancy weight gain modify risk of selected adverse pregnancy outcomes?

Reports by the Institute of Medicine (IOM) recommend that gestational weight gain goals should be modified according to prepregnancy body mass index (BMI), which could result in better maternal and infant outcomes. The authors assessed whether the risk of the pregnancy outcomes such as rate of cesarean section to primiparous and multiparous women, macrosomia, and breastfeeding at 10 weeks postpartum can be modified by following the IOM guidelines for gestational weight gain irrespective of prepregnancy BMI. Staff from the New Jersey Pregnancy Risk Assessment Monitoring System interviewed a sample of women who delivered live births in New Jersey during 2002 through 2005 (n = 7661). In New Jersey, 18% of mothers were obese, 13% were overweight, and 16% were underweight. In logistic regression analyses, after controlling for maternal characteristics, the effect of prepregnancy obesity and weight gain more than 34 lb independently and significantly increased the risk of all four adverse outcomes. For no outcomes was the 25- to 34-pound weight gain category significantly distinguishable from the 16- to 24-pound reference category. These results strongly support the idea that the IOM weight gain recommendation (education during preconception regarding the importance of optimal BMI at the start of pregnancy) will help to achieve better pregnancy outcomes in obese and overweight women.