Effects on feto-placental markers with plasma exchange in pregnancy

To evaluate changes in feto-placental markers with plasma exchange in pregnancy, two patients at varying stages of pregnancy referred to a tertiary care hospital and requiring plasma exchange for intercurrent problems were evaluated. Alpha-fetoprotein, human chorionic gonadotropin, and free estriol were sequentially measured in the patients' plasma and in the fluid removed, thus permitting calculations of permeability rates and clearances. Despite markedly different molecular weights, all three feto-placental markers had similar permeabilities and clearances. While in both patients maternal levels of alpha-fetoprotein and human chorionic gonadotropin decreased rapidly with plasma separation and rebounded rapidly to baseline, free estriol responded differently and did not appear to decrease with therapy. Maternal levels of feto-placental markers only transiently changed with plasma exchange during pregnancy and rapidly returned to baseline with no apparent consequences to the pregnancy. © 1994 Wiley-Liss, Inc.     

Hepatic disorders mildly to moderately affected by pregnancy: medical and obstetric management

Hepatic, biliary, and pancreatic disorders are often complex and clinically challenging during pregnancy. Hepatic disorders can affect the pregnancy and vice versa. The differential diagnosis of hepatic diseases is particularly broad during pregnancy because it includes disorders related to, and unrelated to, pregnancy. This article discusses the physiologic effects of pregnancy on liver function; the differential diagnosis of hepatic findings during pregnancy; modifications of abdominal imaging and hepatobiliary endoscopic procedures during pregnancy; and the medical and obstetric management of hepatic, biliary, and pancreatic diseases that are mildly to moderately affected by pregnancy.     

16例输卯管间质部妊娠的超声误诊分析

目的探讨输卵管间质部妊娠超声误诊的原因。方法回顾性分析2007年我院就诊被超声误诊为其他疾病而经手术和病理确诊为输卵管间质部妊娠的病人16例。结果16例超声误诊的病例中误诊为浆膜下肌瘤6例,双子宫一侧子宫妊娠的4例,滋养细胞疾病4例,残角子宫2例：结论输卵管间质部妊娠因部位特殊,容易被误诊为其他疾病而延误病情,分析结果提示结合临床病史与超声图像特征分析可减少误诊率,提高超声诊断输卵管间质部妊娠的准确性：     

Gut microbiota in gastrointestinal diseases during pregnancy

Gut microbiota (GM) is a micro-ecosystem composed of all microorganisms in the human intestine. The interaction between GM and the host plays an important role in maintaining normal physiological functions in the host. Dysbiosis of the GM may cause various diseases. GM has been demonstrated to be associated with human health and disease, and changes during individual development and disease. Pregnancy is a complicated physiological process. Hormones, the immune system, metabolism, and GM undergo drastic changes during pregnancy. Gastrointestinal diseases during pregnancy, such as hepatitis, intrahepatic cholestasis of pregnancy, and pre-eclampsia, can affect both maternal and fetal health. The dysregulation of GM during pregnancy may lead to a variety of diseases, including gastrointestinal diseases. Herein, we review recent research articles on GM in pregnancy-related gastrointestinal diseases, discuss the interaction of the GM with the host under normal physiological conditions, gastrointestinal diseases, and pregnancy-specific disorders. As more attention is paid to reproductive health, the pathogenic mechanism of GM in gastrointestinal diseases during pregnancy will be further studied to provide a theoretical basis for the use of probiotics to treat these diseases.     

Diseases of the upper digestive system in pregnant women

The authors' and literature results concerning the peculiarities of a clinical course, diagnosis and therapy of the upper digestive tract in women during pregnancy were summed up. Exacerbation or first symptoms of diseases like cardiospasm, reflux esophagitis can often occur during pregnancy. Peptic ulcer in most pregnant women has a favorable course, exacerbations are rare. A conclusion has been made that measures aimed at the prevention of exacerbations and complications of these diseases, are recommended to women with chronic diseases of the digestive tract during pregnancy.     

Complications of second and third trimester pregnancies

The second and third trimester of pregnancy is a period of extensive physical growth and maturation of the fetus. Unfortunately, it is also a period that is marked by complications that can be life threatening for both the mother and fetus. The top three complications that affect pregnancy are hemorrhage, infection, and the hypertensive diseases of pregnancy. This article focuses on preterm labor, premature rupture of membranes, chorioamnionitis, bleeding in later pregnancy, and the hypertensive diseases of pregnancy.     

31例妊娠合并普通外科急腹症的临床分析及护理

目的:探讨妊娠合并外科急腹症的临床特点和护理要点。方法:回顾性分析我院收治的31例妊娠合并外科急腹症的临床资料。结果:21例合并急性阑尾炎,6例合并肠梗阻,4例合并胰腺炎。14例实施手术治疗,其中3例妊娠晚期孕妇剖宫取胎后行剖腹探查术,另11例手术后继续妊娠,其他病例接受保守治疗,所有孕妇均痊愈出院。结论:妊娠合并急腹症,由于妊娠所致孕妇生理解剖改变的特殊性,容易出现漏诊、误诊,提示:严密的护理观察和记录,及时的汇报,迅速的处理可以有效提高妊娠合并急腹症的诊断和治愈率。     

Targeting the Dysfunctional Placenta to Improve Pregnancy Outcomes Based on Lessons Learned in Cancer

In recent decades, our understanding of the disrupted mechanisms that contribute to major obstetrical diseases, including preeclampsia, fetal growth restriction, preterm birth, and gestational diabetes, has increased exponentially. Common to many of these obstetric diseases is placental maldevelopment and dysfunction; the placenta is a significant component of the maternal–fetal interface involved in coordinating, facilitating, and regulating maternal and fetal nutrient, oxygen and waste exchange, and hormone and cytokine production. Despite the advances in our understanding of placental development and function, there are currently no treatments for placental maldevelopment and dysfunction. However, given the transient nature and accessibility from the maternal circulation, the placenta offers a unique opportunity to develop targeted therapeutics for routine obstetric practices. Furthermore, given the similar developmental paradigms between the placenta and cancer, there is an opportunity to appropriate current knowledge from advances in targeted therapeutics in cancer treatments. In this review, we highlight the similarities between early placental development and cancer and introduce a number of targeted therapies currently being explored in cancer and pregnancy. We also propose a number of new effectors currently being targeted in cancer research that have the potential to be targeted in the development of treatments for pregnancy complications. Finally, we describe a method for targeting the placenta using nonviral polymers that are capable of delivering plasmids, small interfering RNA, and other effector nucleic acids, which could ultimately improve fetal and maternal outcomes from complicated pregnancies.     

Hepatic and gastrointestinal disorders in pregnancy.

The presentation, nonradiologic diagnostic evaluation, and course (including complications and outcome) of gastrointestinal disorders in pregnancy are not substantially different than for the nonpregnant patient. The possible exception is the higher mortality for pancreatitis when it occurs during pregnancy. With the exception of nausea/vomiting and hyperemesis gravidarum, there does not appear to be a gastrointestinal tract disorder that is peculiar to the pregnant state. Hepatic disorders are somewhat different in that the excretory defect-pruritus gravidarum-cholestatic jaundice spectrum and perhaps part of what presents as acute hepatic failure are intimately associated with pregnancy and have an onset and course that are tied to the gestational period. Otherwise, hepatic diseases that occur during pregnancy share the characteristic of gastrointestinal diseases, that their manifestations are not clearly different from the nonpregnant state. As is true for the diagnostic approach to all medical diseases that occur during pregnancy, radiographic procedures are prohibited. Furthermore, therapy must be reconsidered with concern for its effect on the fetus. This leads to elimination of many or all measures used for purely symptomatic or nonspecific benefit. If no harm or potential harm will accrue for the fetus, therapy for hepatic and gastrointestinal disorders preceeds in pregnancy very much as it does in the nongravid individual.     

Severe cardiac disease in pregnancy, part II: impact of congenital and acquired cardiac diseases during pregnancy

PURPOSE OF REVIEW: Part II of this review gives an overview of the different maternal cardiac problems during pregnancy and their management, and developments over recent years. RECENT FINDINGS: Many studies published over the last 5 years provided new insights on different cardiac diseases in pregnancy. Publications discussed in this part of the review on cardiac disease in pregnancy, for example, provide epidemiological data on heart disease during pregnancy in general, and cardiomyopathy and ischemic heart disease in particular. In addition, we discussed the implications of a history of peripartum cardiomyopathy for a subsequent pregnancy, interventional strategies during pregnancy in women with ischemic heart disease, and the role of echocardiography in the evaluation of cardiac disease in pregnancy. SUMMARY: The prevalence of the different causes of heart disease has shifted towards congenital heart disease by the end of the millennium. In developing countries, relatively rare diseases like rheumatic fever are still common, so these diseases are increasingly 'exported' to developed countries. The group of women with congenital heart disease represents most women with heart disease during pregnancy, followed by rheumatic heart disease. With the exception of patients with Eisenmenger's syndrome, pulmonary vascular obstructive disease, and Marfan's syndrome with aortopathy, maternal death during pregnancy is rare in women with heart disease. Although the risk for mortality is low in pregnant women with preexistent cardiac disease, these women are at increased risk for serious morbidity such as heart failure, arrhythmias, and stroke.     

Irritable bowel syndrome and inflammatory bowel disease in pregnancy

Irritable bowel syndrome and inflammatory bowel disease are gastrointestinal disorders affecting young adults. The peak incidence of irritable bowel syndrome and inflammatory bowel disease is in the late adolescence and early adult years, the time during which many women are planning and beginning their families. Since the potential for life-altering changes and pregnancy complications exist with these diseases, affected pregnant women present a challenge for the gastroenterologist, pregnancy provider, and nurses caring for them. This article outlines what is known about these diseases and their effect on fertility and pregnancy as well as their clinical management during pregnancy.     

Clinical review: Special populations - critical illness and pregnancy

Critical illness is an uncommon but potentially devastating complication of pregnancy. The majority of pregnancy-related critical care admissions occur postpartum. Antenatally, the pregnant patient is more likely to be admitted with diseases non-specific to pregnancy, such as pneumonia. Pregnancy-specific diseases resulting in ICU admission include obstetric hemorrhage, pre-eclampsia/eclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, amniotic fluid embolus syndrome, acute fatty liver of pregnancy, and peripartum cardiomyopathy. Alternatively, critical illness may result from pregnancy-induced worsening of pre-existing diseases (for example, valvular heart disease, myasthenia gravis, and kidney disease). Pregnancy can also predispose women to diseases seen in the non-pregnant population, such as acute respiratory distress syndrome (for example, pneumonia and aspiration), sepsis (for example, chorioamnionitis and pyelonephritis) or pulmonary embolism. The pregnant patient may also develop conditions co-incidental to pregnancy such as trauma or appendicitis. Hemorrhage, particularly postpartum, and hypertensive disorders of pregnancy remain the most frequent indications for ICU admission. This review focuses on pregnancy-specific causes of critical illness. Management of the critically ill mother poses special challenges. The physiologic changes in pregnancy and the presence of a second, dependent, patient may necessitate adjustments to therapeutic and supportive strategies. The fetus is generally robust despite maternal illness, and therapeutically what is good for the mother is generally good for the fetus. For pregnancy-induced critical illnesses, delivery of the fetus helps resolve the disease process. Prognosis following pregnancy-related critical illness is generally better than for age-matched non-pregnant critically ill patients.     

Use of therapeutic plasma exchange for pediatric neurological diseases

Therapeutic plasma exchange is used to treat neurological diseases in the pediatric population. Since its first use in pediatric patients with hepatic coma in the form of manual whole blood exchange, therapeutic plasma exchange has been increasingly used to treat these disorders of the nervous system. This expansion is a result of improved techniques and apheresis instruments suitable for small children, as well as the recognition of its applicability to many diseases in the pediatric population. This review provides a historical overview of the use of therapeutic apheresis in children and highlights the most common applications for therapeutic plasma exchange to treat neurological disorders in children.     

Rebound and overshoot after plasma exchange in humans

On the basis of animal experiments, some authors recommend a routine combination of therapeutic plasma exchange in patients with immunologically mediated disorders, such as autoimmune and immune complex diseases, with administration of cytotoxic drugs to prevent overshoot in plasma levels of pathogenic components after plasma exchange. We examined one healthy volunteer, seven patients with nonimmunologic diseases, and seven patients with immunologically mediated disorders (six with non-organ specific and one with organ-specific autoantibodies) to test whether plasma exchange is succeeded by an overshoot in levels of immunoglobulins, isohemagglutinins, autoantibodies, and antibodies after booster immunization with diphtheria and tetanus toxoid combined with poliomyelitis vaccine. Our data indicate that overshoot is not a generally occurring phenomenon in humans. We also confirmed the capability of corticosteroids, administered immediately after a period of plasma exchange, to reduce autoantibody levels. We found no arguments to support the suggestions in the literature that plasma exchange be combined with cytotoxic drugs in treatment of immunologically mediated diseases to prevent stimulation of potentially pathogenic components such as autoantibodies.     

妊娠期合并鼻咽癌放疗后顺产:1例报告并文献复习

妊娠期鼻咽癌患者发生率低,既往文献报道较少。目前我国针对妊娠期合并鼻咽癌患者的治疗方案有晚期妊娠引产再行放疗或中期妊娠患者人工流产后行放疗,但都难以两全。本文报道了1例妊娠中期合并鼻咽癌Ⅲ期患者的诊疗经过,并结合文献复习,探讨妊娠期合并鼻咽癌的诊治方法,为相关临床诊疗作参考。      

Liver disease in pregnancy

The entire spectrum of liver diseases may occur in pregnancy. It is useful to consider those disorders uniquely associated with pregnancy and those that are coincidental. The most common cause of jaundice during pregnancy is viral hepatitis. Intrahepatic cholestasis and fatty liver may be peculiar to pregnant women. Early recognition of these situations may be life-saving.     

Anti-Ce complicating two consecutive pregnancies with increasing severity of haemolytic disease of the newborn

The Ce antigen is expressed on red cells of individuals with Rh haplotypes, R1 or CDe and r' or Cde. However, anti-Ce is rare, and only two cases of severe haemolytic disease of the newborn (HDN) caused by this antibody have been described (Malde et al., 2000; Wagner et al., 2000). We describe a woman who was found to have anti-Ce in her second pregnancy, resulting in a neonate with HDN that required exchange transfusion. She subsequently had a twin pregnancy, where both the twins were affected by severe haemolytic disease (HD) of the fetus because of anti-Ce and required repeated fetal transfusions, followed by exchange transfusions after birth. This is the first reported case of HD caused by anti-Ce requiring fetal transfusions.     

Severe post-partum eclampsia: response to plasma exchange.

In their severest forms, pre-eclampsia and eclampsia may be life-threatening complications of pregnancy. We describe a patient with severe post-partum eclampsia characterized by seizures, deep coma, hypertension, renal insufficiency, coagulopathy, and microangiopathic hemolysis. The patient responded to treatment that included intensive plasma exchange, and she achieved full recovery. Our case supports the use of plasma exchange in patients with severe pre-eclampsia and eclampsia.     

Common dermatoses of pregnancy

Awareness of pregnancy-related skin changes can facilitate improved care of women during pregnancy by identifying those skin changes that require further evaluation. Women experience significant endocrine and metabolic changes during pregnancy that can cause both physiologic and pathologic alterations in the skin, nails, and hair. This review discusses the physiologic changes and pruritic dermatoses that are specifically associated with pregnancy. The effect of pregnancy on preexisting skin diseases and safe treatment options for usage during pregnancy will be provided.     

Plasma exchange in neurological diseases

The objective of therapeutic plasma exchange' is to remove plasma from toxic substances, either autoantibody, alloantibody, immune complex, monoclonal protein or toxin. Plasma exchange can also act through replenishment of a specific plasma factor. Pathophysiology was the first rationale for the use of plasma exchange. Its first indication was indeed the hyperviscosity syndrome,¹ on the single basis of pathogenesis. However, pathogenesis alone does not convince physicians to use such a costly and potentially unsafe treatment. Therefore, randomized clinical trials have been conducted for the last 15 years to ascertain the effectiveness and tolerance of plasma exchange, especially in neurological diseases.In myasthenia gravis, the recommended use of plasma exchange was mainly based on the theoretical argument of elimination of anti-acetylcholine receptor antibodies. However, even if clinical improvement was observed after plasma exchange, this was also observed in myasthenia gravis associated with no circulating antibodies.In contrast, numerous randomized clinical trials have been initiated in the Gullain-Barré syndrome, although the pathogenesis of the disease is unknown. Nevertheless, the large number of trials assessing plasma exchange in the last 15 years, especially in neurological diseases, explains the increased indications for plasma exchange in the national base of the French register of plasmapheresis.²The demonstrated clinical benefit of plasma exchange through randomization may be an initial step in the understanding of disease. Plasma exchange probably does not simply act through removal of toxic substances, but also, as high doses of intravenous immune globulins,³ through immunomodulation. This could at least explain the competition and the complementarity of these two treatments.The objective of this paper is to present the main indications for plasma exchange in neurological diseases, complementing the conclusions of the consensus conference that met in 1996.⁴ We focus on the assessments through randomized clinical trials, though uncontrolled studies in rare diseases are also reported.