Pregnancy Intentions,Long‐Acting Contraceptive Use,and Rapid Subsequent Pregnancies Among Adolescent and Adult First‐Time Mothers

PROBLEM: Greater understanding is needed related to qualitatively assess pregnancy intentions and rapid subsequent pregnancies among adolescent and adult mothers. METHODS: Four‐site prospective study of 227 adolescent and adult mothers. Data were analyzed to understand the relationship between pregnancy intentions, adolescent status, and use of long‐acting contraceptives and rapid subsequent pregnancy. FINDINGS: The findings from this study provide evidence of the importance of goal‐oriented pregnancy intentions, long‐acting contraceptive use, and older age in delaying a second pregnancy. CONCLUSION: Findings reveal the need for clinician awareness of the qualitative pregnancy intentions of young women and potential desired use of long‐acting contraceptives.     

Three‐ and 4‐Dimensional Ultrasound in Obstetric Practice

OBJECTIVE: The purpose of this article was to review the published literature on 3-dimensional ultrasound (3DUS) and 4-dimensional ultrasound (4DUS) in obstetrics and determine whether 3DUS adds diagnostic information to what is currently provided by 2-dimensional ultrasound (2DUS) and, if so, in what areas. METHODS: A PubMed search was conducted for articles reporting on the use of 3DUS or 4DUS in obstetrics. Seven-hundred six articles were identified, and among those, 525 were actually related to the subject of this review. Articles describing technical developments, clinical studies, reviews, editorials, and studies on fetal behavior or maternal-fetal bonding were reviewed. RESULTS: Three-dimensional ultrasound provides additional diagnostic information for the diagnosis of facial anomalies, especially facial clefts. There is also evidence that 3DUS provides additional diagnostic information in neural tube defects and skeletal malformations. Large studies comparing 2DUS and 3DUS for the diagnosis of congenital anomalies have not provided conclusive results. Preliminary evidence suggests that sonographic tomography may decrease the examination time of the obstetric ultrasound examination, with minimal impact on the visualization rates of anatomic structures. CONCLUSIONS: Three-dimensional ultrasound provides additional diagnostic information for the diagnosis of facial anomalies, evaluation of neural tube defects, and skeletal malformations. Additional research is needed to determine the clinical role of 3DUS and 4DUS for the diagnosis of congenital heart disease and central nervous system anomalies. Future studies should determine whether the information contained in the volume data set, by itself, is sufficient to evaluate fetal biometric measurements and diagnose congenital anomalies.     

Learning Curve of Emergency Physicians Using Emergency Bedside Sonography for Symptomatic First‐Trimester Pregnancy

Objective. The purpose of this study was to prospectively assess the learning curve of emergency physician training in emergency bedside sonography (EBS) for first‐trimester pregnancy complications. Methods. This was a prospective study at an urban academic emergency department from August 1999 through July 2006. Patients with first‐trimester vaginal bleeding or pain underwent EBS followed by pelvic sonography (PS) by the Department of Radiology. Results of EBS were compared with those of PS using a predesigned standardized data sheet. Results. A total of 670 patients underwent EBS for first‐trimester pregnancy complications by 1 of 25 physicians who would go on to perform at least 25 examinations. The sensitivity and specificity of EBS for an intrauterine pregnancy increased from 80% (95% confidence interval [CI], 71%–87%) and 86% (95% CI, 76%–93%), respectively, for a physician's first 10 examinations to 100% (95% CI, 73%–100%) and 100% (95% CI, 63%–100%) for those performed after 40 examinations. Likewise, the sensitivity and specificity for an adnexal mass or ectopic pregnancy changed from 43% (95% CI, 28%–64%) and 94% (95% CI, 89%–97%) to 75% (95% CI, 22%–99%) and 89% (95% CI, 65%–98%), whereas the sensitivity and specificity for a molar pregnancy changed from 71% (95% CI, 30%–95%) and 98% (95% CI, 94%–99%) to 100% (95% CI, 20%–100%) and 100% (95% CI, 81%–100%). Although detection of an intrauterine or a molar pregnancy improved with training, even with experience including 40 examinations, the sensitivity of EBS for an adnexal mass or ectopic pregnancy was less than 90%. Conclusions. There is an appreciable learning curve among physicians learning to perform EBS for first‐trimester pregnancy complications that persists past 40 examinations.     

Hepatotoxicity of alpha‐methyldopa in pregnancy

Alpha‐methyldopa is one of the most widely prescribed antihypertensive agents used during pregnancy. Despite its known potential hepatotoxicity, there have been only a few reports describing hepatotoxicity with the use of this drug during pregnancy. We report here a new case of acute hepatitis in a pregnant woman related to the use of alpha‐methyldopa, and briefly review the literature on alpha‐methyldopa‐induced hepatotoxicity in pregnancy.     

Prevalence and predictors for post‐thrombotic syndrome 3 to 16 years after pregnancy‐related venous thrombosis: a population‐based,cross‐sectional,case‐control study

Background:  The long‐term outcome of pregnancy‐related venous thrombosis (VT) is not known. Objectives:  To assess predictors and long‐term frequency of post‐thrombotic syndrome (PTS) after pregnancy‐related VT. Patients/Methods:  In 2006, 313 women with pregnancy‐related VT during 1990–2003 and 353 controls answered a comprehensive questionnaire that included self‐reported Villalta score as a measure of PTS. Cases were identified from 18 Norwegian hospitals using the Norwegian Patient Registry and the Medical Birth Registry of Norway. The latter was used to select as possible controls women who gave birth at the same time as a case. Thirty‐nine patients and four controls were excluded because of VT outside the lower limbs/lungs or missing Villalta scores. Two hundred and four patients had DVT in the lower limb and 70 had pulmonary embolism (PE). The control group comprised 349 women naive for VT at the time of the index pregnancy. Results:  Forty‐two per cent of cases with DVT in the lower limb, compared with 24% of cases with PE and 10% of controls, reported a Villalta score of ≥ 5. Severe PTS (Villalta score of ≥ 15) was reported among 7%, 4% and 1%. Proximal postnatal, but not antenatal, thrombosis was a strong predictor of PTS with an adjusted odds ratio of 6.3 (95% confidence interval, 2.0–19.8; P = 0.002). Daily smoking before the index pregnancy and age above 33 years at event were independent predictors for post‐thrombotic syndrome. Conclusions:  PTS is a common long‐term complication after pregnancy‐related DVT. Proximal postnatal thrombosis, smoking and higher age were independent predictors of the development of PTS.     

Ulcerative colitis and granulocyte‐monocyte‐apheresis: Safety and efficacy of maintenance therapy during pregnancy

Inflammatory bowel disease characteristically affects young adults in their reproductive ages. Thus the medication used for the treatment of active disease should not compromise fertility and, also, should not have teratogenic effect on baby. A lot of data are available about effects of steroids, antibiotics, and mesalazine but no data are available about safety and efficacy of granulocyte‐monocyte‐apheresis (GMA) during pregnancy. In this case report, the 37 year‐old pregnant woman with chronically active and steroid dependent ulcerative colitis (UC), at risk of abortion, refused more aggressive pharmacological therapeutic options and gave the informed consent to GMA. To minimize symptoms and the risk of severe clinical relapse, a maintenance GMA treatment was performed throughout pregnancy. The course of pregnancy was uneventful with no side effects; the mother and the baby were all healthy and well at the delivery. J. Clin. Apheresis 30:55–57, 2015. © 2014 Wiley Periodicals, Inc.     

Review article: Late post‐hysterectomy ectopic pregnancy

Ectopic pregnancy after hysterectomy is a rare but potentially life‐threatening condition requiring prompt diagnosis to prevent the increased mortality associated with rupture. Twenty‐seven cases of late post‐hysterectomy ectopic pregnancy reported in the English literature since 1918 were reviewed and analysed for presenting symptoms, missed diagnosis rate at initial presentation, location of ectopic and rupture rate at diagnosis. The presenting symptoms were found to be non‐specific. The diagnosis in this population is twice more likely to be missed than in women with intact uteri. The rupture rate is 63%, compared with 37% in women with intact uteri. The majority of late post‐hysterectomy ectopic pregnancies (62%) were located in the fallopian tubes. Because of the potential risk of mortality, emergency physicians should always consider the possibility of ectopic pregnancy in childbearing women whose surgical history includes hysterectomy without oophorectomy. Evaluation of abdominal pain in this population should include a pregnancy test to ensure prompt diagnosis when the possibility of pregnancy exists clinically.     

A case of retroperitoneal para‐aortic ectopic pregnancy detected by sonography

Retroperitoneal ectopic pregnancy is extremely rare. We present a case of a retroperitoneal ectopic pregnancy with a gestational sac located to the left of the abdominal aorta and of the left renal vessels at 9 weeks of gestation. Careful transabdominal sonographic examination is suggested when an ectopic pregnancy is suspected and the examination of the pelvis is negative.