Interstitial pregnancy: a potential for misdiagnosis of ectopic pregnancy with emergency department ultrasonography

Interstitial pregnancy is a rare and dangerous form of ectopic pregnancy that can be mistaken for a normal intrauterine pregnancy on ultrasonography, leading to catastrophic results. Increasingly, emergency physicians are using ultrasonography to diagnose intrauterine pregnancy. Emergency physicians should be aware of the potential for mistaking an interstitial pregnancy for an intrauterine pregnancy. We present a case report of an interstitial pregnancy misdiagnosed as an intrauterine pregnancy and discuss ultrasonographic and physical examination findings to help differentiate interstitial pregnancy from an intrauterine pregnancy.     

Pregnancy in patients with primary sclerosing cholangitis

Abstract: A deterioration of liver function may occur during pregnancy in patients with chronic liver disorder. Primary sclerosing cholangitis (PSC) is a chronic progressive liver disorder with a highly variable and fluctuating course. This study aims at investigating the outcome of pregnancy in patients with PSC and, conversly, the effect of pregnancy on the disease. Thirteen pregnancies in 10 patients with PSC (4 with liver cirrhosis, 6 with mild liver disease) were observed. Seven patients had PSC before pregnancy, 2 developed the disease during pregnancy, and one patient developed PSC 2 months after a normal pregnancy with a normal delivery. Clinical symptoms and biochemical analyses were routinely evaluated during the pregnancy. No gastrointestinal haemorrhage was observed during the pregnancy. Two patients had pruritus and 2 abdominal pain before pregnancy, and these symptoms continued during pregnancy. Abdominal pain was noted in 3 patients lacking this symptom before pregnancy. Four patients without pruritus prior to pregnancy developed this symptom during the pregnancy. In two patients, pruritus was so intense as to bring on premature delivery. Liver tests did not indicate any deterioration during pregnancy. No fetal loss occured. The outcome for all babies was normal. In patients with PSC pregnancy does not seem to have a negative effect on the disease process, neither mothers nor babies showed any ill effects. PSC has not worsened during the pregnancy in our patients.     

Ovarian control of prolactin secretion during late pregnancy in the rat.

The involvement of the ovaries during late pregnancy in the rat upon serum prolactin was investigated. Ovariectomy on day 17 or day 21 of pregnancy prevented the dramatic rise of prolactin found in sham-ovariectomized animals between days 21 and 23 of pregnancy. While animals ovariectomized on day 17 of pregnancy failed to carry viable fetuses beyond day 19 of pregnancy, rats ovariectomized on day 21 of pregnancy had viable pups in utero on day 23 of pregnancy. These data suggest that the rise in serum prolactin during late pregnancy is stimulated by ovarian factors.     

Perception of Pregnancy and Social Support as Predictors of Alcohol Consumption during Pregnancy

Although an association between alcohol consumption during pregnancy and adverse fetal outcomes has been well documented, variables related to alcohol consumption during pregnancy have remained neglected. Since pregnancy has been considered a time of crisis and stress for pregnant women, this study sought to determine the association of perceptions of pregnancy and social support to alcohol consumption during pregnancy. The 311 Southern metropolitan prenatal patients sampled were interviewed twice during pregnancy. Perception of pregnancy was not found to be correlated with either social support or alcohol consumption during pregnancy. Social support was significantly associated with decreased alcohol consumption during pregnancy. Using standard multiple regressions, two components of social support, general support and pregnancy support, were found to be working in opposite directions prior to pregnancy, with general support showing a positive association with alcohol consumption. Only pregnancy support continued to account for a significant amount of the variance in alcohol consumption during the first 4 months of pregnancy. Pregnancy support, additionally, showed a significant negative association with high maximum drinking (consuming five or more drinks on occasion) prior to pregnancy. These findings suggest that social support may be an important predictor of alcohol consumption both prior to and during pregnancy and merits further investigation.     

Liver disease in pregnancy

Liver dysfunction during pregnancy can be caused by conditions that are specific to pregnancy or by liver diseases that are not related to pregnancy itself. This review attempts to summarize the epidemiology, pathophysiology, and management of the different pregnancy-related liver diseases, and to review different liver diseases not related to pregnancy and how they may affect or be effected by pregnancy. Some of the liver diseases specific to pregnancy can cause significant morbidity and mortality both to the mother and to the fetus, while most of the liver diseases not specific to pregnancy do not have a deleterious effect on the pregnancy itself.     

Liver disease in pregnancy

Development of liver diseases during pregnancy is not uncommon. They are caused by either a disorder that is unique to pregnancy or an acute or chronic liver disease that already exists or coincidentally develops as a comorbidity of pregnancy. Liver diseases unique to pregnancy include hyperemesis gravidarum; hypertensive disorders of pregnancy, such as pre‐eclampsia/eclampsia; hemolysis, elevated liver enzymes, and low platelet count syndrome; intrahepatic cholestasis of pregnancy; and acute fatty liver of pregnancy. Chronic liver diseases that affect pregnancy, or are affected by pregnancy, mainly include autoimmune liver diseases and non‐alcoholic fatty liver disease. Prompt diagnosis and management of liver diseases in pregnancy, while very challenging, is extremely important, as they might cause adverse maternal and fetal outcomes. Therefore, a multidisciplinary, collaborative approach involving both hepatologists and obstetricians is required. In this review article, the up‐to‐date epidemiology, etiology, clinical features, and outcomes of liver diseases in pregnancy are discussed, to promote a deeper understanding among physicians, and subsequently improved outcomes.     

Temporary increase in the risk for recurrence during pregnancy in women with a history of venous thromboembolism

There is strong evidence that the incidence of venous thromboembolism (VTE) is increased during pregnancy. However, it is unknown whether and to which extent pregnancy influences the risk for recurrent VTE in women with previous thrombosis. To investigate whether pregnancy temporarily increases the risk for recurrent thrombosis, we retrospectively evaluated the recurrence rate in 109 women who had at least one pregnancy after an episode of VTE by comparing the time period during pregnancy with the nonpregnant period. Forty-three women had a first recurrence during a total observation time of 1014 years. Eight events (73 observation years) occurred during pregnancy, and 35 events (941 observation years) occurred outside pregnancy. Recurrence rates per 100 patient-years were 10.9% during and 3.7% outside pregnancy. Relative risk during pregnancy was 3.5 (95% confidence interval, 1.6-7.8; P =.002). Our data suggest that pregnancy leads to a temporary increase in the risk for recurrent thrombotic events.     

Organ-specific systemic lupus erythematosus activity during pregnancy is associated with adverse pregnancy outcomes

Systemic lupus erythematosus (SLE) is a disease of reproductive-age women, and thus questions regarding how disease influences pregnancy outcomes arise. We investigated whether five specific types of SLE activity during the 6 months before conception or during pregnancy (nephritis, cytopenias, skin disease, arthritis, serositis) were associated with adverse pregnancy outcomes. We performed a retrospective cohort study of pregnancy outcomes among women with SLE at the Brigham and Women’s Hospital Lupus Center. Adverse pregnancy outcomes included pre-eclampsia, pre-term delivery, elective termination due to SLE, spontaneous miscarriage at weeks 12–20, and stillbirth. SLE and obstetric history, laboratories, and medications were obtained from electronic medical records. Generalized linear mixed models adjusting for potential confounders were used to identify predictors of any adverse pregnancy outcome. Most pregnancies resulted in a live term delivery (76.5 %). After adjustment for Hispanic ethnicity, prior adverse pregnancy outcome and medication use 6 months before conception, nephritis during pregnancy (odds ratio (OR) 3.6, 95 % confidence interval (CI) 1.0–12.8), cytopenias during pregnancy (OR 3.9, 95 % CI 1.3–11.4), and serositis during pregnancy (OR 5.9, 95 % CI 1.0–34.0) were significantly associated with adverse pregnancy outcome. Specific types of SLE disease activity during pregnancy were related to adverse pregnancy outcome. Nephritis, cytopenias, and serositis carried a higher risk of adverse pregnancy outcome, suggesting that these abnormalities should be carefully monitored during pregnancy.     

系统性红斑狼疮患者妊娠与分娩过程处理的初步探讨

目的 探讨系统性红斑狼疮(SLE)患者的妊娠时机、妊娠期并发症处理、终止妊娠时机、分娩过程中及娩后治疗问题。方法 前瞻性地观察29例SLE患者妊娠结果，其中23例患者病情控制1年以上妊娠。2例妊娠前1年内有病情活动，4例妊娠期首发SLE。结果 10例发生妊娠高血压综合征，6例妊娠晚期伴发心力衰竭．3例妊娠晚期伴发广泛性肺间质炎。29例患者均于孕30～37周终止妊娠，出生婴儿29名．无新生儿狼疮．无母婴死亡。6例分娩后狼疮加重。结论 SLE患者病情控制1年以上妊娠母婴安全度显著提高．疾病活动、妊娠过程及产后适当应用激素控制并发症是成功的关键，有并发症者应适时终止妊娠以确保母婴安全。     

Pregnancy in patients with visceral lupus erythematosus, with special reference to kidney involvement

Of 44 female patients with lupus erythematosus visceralis after and with manifestation of the disease, respectively, in eight women ten pregnancies developed, out of them three viable births between the 33rd and 40th week of pregnancy, one stillbirth in the 37th week of pregnancy, one miscarriage in the IIIrd month of pregnancy and five interruptions of pregnancy. It is reported on the course of the disease and pregnancy of five women, taking into particular consideration the lupus nephritis. With the help of the literature and on the basis of own experiences course of the lupus erythematosus visceralis and lupus nephritis during pregnancy, the influence of the lupus erythematosus visceralis on pregnancy and development of the child, peculiarities of the treatment of lupus erythematosus visceralis during pregnancy as well as questions of prevention and interruption of pregnancy are discussed. Finally is tried to draw universal conclusions.     

Pregnancy and autoimmune connective tissue diseases

Autoimmune connective tissue diseases predominantly affect women and often occur during the reproductive years. Thus, specialized issues in pregnancy planning and management are commonly encountered in this patient population. This chapter provides a current overview of pregnancy as a risk factor for onset of autoimmune disease, considerations related to the course of pregnancy in several autoimmune connective tissue diseases, and disease management and medication issues before pregnancy, during pregnancy, and in the postpartum period. A major theme that has emerged across these inflammatory diseases is that active maternal disease during pregnancy is associated with adverse pregnancy outcomes, and that maternal and fetal health can be optimized when conception is planned during times of inactive disease and through maintaining treatment regimens compatible with pregnancy.     

Liver disease in pregnancy

Changes in the liver biochemical profile are normal in pregnancy. However, up to 3% to 5% of all pregnancies are complicated by liver dysfunction. It is important that liver disease during pregnancy is recognized because early diagnosis may improve maternal and fetal outcomes, with resultant decreased morbidity and mortality. Liver diseases that occur in pregnancy can be divided into 3 different groups: liver diseases that are unique to pregnancy, liver diseases that are not unique to pregnancy but can be revealed or exacerbated by pregnancy, and liver diseases that are unrelated to but occur coincidentally during pregnancy.     

Ruptured heterotopic pregnancy presenting with relative bradycardia in a woman not receiving reproductive assistance

We report a case of heterotopic pregnancy in a woman who had not undergone in vitro fertilization or any other reproductive assistance. The patient failed to mount a tachycardic response to hemorrhagic shock. Bradycardia is a well-established phenomenon in the setting of hemoperitoneum and particularly with ruptured ectopic pregnancy. This is a case of heterotopic pregnancy with relative bradycardia in a woman without predisposing factors for heterotopic pregnancy. We make suggestions on avoiding common pitfalls in the emergency department diagnosis of heterotopic pregnancy. We also address the similar clinical presentations of heterotopic pregnancy and intrauterine pregnancy with ruptured corpus luteum cyst.     

Liver disease in pregnancy

Liver diseases in pregnancy may be categorized into liver disorders that occur only in the setting of pregnancy and liver diseases that occur coincidentally with pregnancy. Hyperemesis gravidarum, preeclampsia/eclampsia, syndrome of hemolysis, elevated liver tests and low platelets （HELLP）, acute fatty liver of pregnancy, and intrahepatic cholestasis of pregnancy are pregnancy-specific disorders that may cause elevations in liver tests and hepatic dysfunction. Chronic liver diseases, including cholestatic liver disease, autoimmune hepatitis, Wilson disease, and viral hepatitis may also be seen in pregnancy. Management of liver disease in pregnancy requires collaboration between obstetricians and gastroenterologists/hepatologists. Treatment of pregnancy-specific liver disorders usually involves delivery of the fetus and supportive care, whereas management of chronic liver disease in pregnancy is directed toward optimizing control of the liver disorder. Cirrhosis in the setting of pregnancy is less commonly observed but offers unique challenges for patients and practitioners. This article reviews the epidemiology, pathophysiology, diagnosis, and management of liver diseases seen in pregnancy.     

Role of pelvic ultrasonography in evaluation of symptomatic first-trimester pregnancy

Early identification of an abnormal pregnancy is important. The diagnosis of ectopic pregnancy before tubal rupture can prevent life-threatening hemorrhage. This article provides a review of the normal development in early pregnancy and correlates this with ultrasound findings, followed by a structured approach to the ultrasound examination. The specific findings in early pregnancy are reviewed, and the predictive value of these findings in identifying either a normal or abnormal intrauterine pregnancy or an ectopic pregnancy are discussed.     

Hydroxychloroquine in lupus pregnancy

OBJECTIVE: Hydroxychloroquine (HCQ) is often needed to manage disease activity in systemic lupus erythematosus (SLE) during pregnancy. The purpose of this study was to examine lupus activity and pregnancy outcomes in women with SLE treated or not treated with HCQ during pregnancy. METHODS: This was a prospective study of pregnancies in women with SLE who were evaluated between 1987 and 2002. The pregnancies were divided into 3 groups: no HCQ exposure during pregnancy (163 pregnancies), continuous use of HCQ during pregnancy (56 pregnancies), or cessation of HCQ treatment either in the 3 months prior to or during the first trimester of pregnancy (38 pregnancies). The pregnancy outcomes, fetal outcomes, and lupus activity during pregnancy were compared among these groups. RESULTS: The rates of miscarriage, stillbirth, pregnancy loss, and congenital abnormality were not statistically different among the 3 groups. The degree of lupus activity during pregnancy, however, was significantly higher in women who stopped taking HCQ. These women had a higher degree of lupus activity, as measured by the physician's estimate of lupus activity and the SLE Disease Activity Index, as well as an increased rate of flare, during pregnancy. More serious lupus complications, such as proteinuria and thrombocytopenia, were not significantly higher in women who stopped taking HCQ. Women who continued taking HCQ were maintained on a lower average dose of prednisone during pregnancy. CONCLUSION: We recommend the continuation of HCQ treatment during pregnancy. Our findings are consistent with prior reports of the absence of fetal toxicity. Similar to studies of nonpregnant women, the cessation of HCQ treatment during pregnancy increases the degree of lupus activity.     

Predictors of post-partum damage accrual in systemic lupus erythematosus: data from LUMINA, a multiethnic US cohort (XXXVIII)

OBJECTIVE: To determine the impact of pregnancy on systemic lupus erythematosus (SLE) outcome. METHODS: SLE patients, age >or=16 yrs, disease duration 相似文献   

A retrospective analysis of outcome of pregnancy in patients with acute porphyria

A survey was posted to 27 women with acute porphyria about complications and outcome of pregnancy. Fifteen women returned the completed questionnaire and the pregnancies were characterised depending on the timing of diagnosis of porphyria. Four women were diagnosed with porphyria before the first pregnancy, five during a pregnancy and six after pregnancy. Five women were diagnosed with porphyria from family studies and the remaining ten were diagnosed when they presented with acute symptoms. There were a total of 33 pregnancies and 23 live births. Four women reported symptoms associated with porphyria during pregnancy. Two women received treatment with haem arginate during pregnancy with one of them having haem arginate therapy weekly with no adverse effect either to her or the baby. One woman had acute pain and skin symptoms during pregnancy but was not diagnosed until after delivery, and another reported acute symptoms during pregnancy. There were no differences, compared to the general population, between birth weight and miscarriage rate, and there were few obstetric complications with only one patient having pre-eclampsia at 37 weeks gestation. These results show that pregnancy is typically uncomplicated in acute porphyria, and that problems are more likely if the porphyria has not been diagnosed previously. We found that administration of haem arginate during pregnancy is safe and its continuous use during pregnancy has no detrimental effect on the outcome of pregnancy.     

Pregnancy and severe aplastic anaemia: causal relation or coincidence?

The relationship between aplastic anaemia (AA) and pregnancy remains uncertain. To assess whether an association between pregnancy and severe aplastic anaemia (SAA) exists, we compared the frequency of pregnancy in 35 young women with newly diagnosed SAA with the expected frequency in the general population. The observed pregnancy rate in the SAA group was 3–6%. This percentage approximates the expected pregnancy rate of 4.4% in the general population and is not compatible with a strong association between pregnancy and SAA.     

Metabolic profile of pre-pregnancy,pregnancy and early lactation in multiple lambing Sakiz ewes. 2. Changes in plasma progesterone,estradiol-17beta and cholesterol levels

Twenty synchronized Sakiz ewes (aged 3-4 years) were used in this study. Blood samples were taken once in pre-pregnancy and at the 100th day of pregnancy. At the 120th day of pregnancy and the 10th day postpartum, blood samples were collected every 2 h for 24 h from 10 ewes. Plasma progesterone and estradiol-17beta levels were estimated by radioimmunoassay. Plasma cholesterol levels were determined by colorimetric method. Plasma progesterone levels increased during pregnancy and especially late pregnancy and decreased to basal values during lactation. Plasma estradiol-17beta and cholesterol levels were not significantly different between pre-pregnancy, pregnancy and early lactation periods. The insignificant rise in plasma cholesterol during pregnancy showed that pregnancy toxemia may not occur in multiple lambing ewes when fed a balanced diet sufficient in energy and protein levels. The increased plasma progesterone level above normal observed during pregnancy and especially late pregnancy may be interpreted as a feature of multiple lambing breeds.