Myotonic dystrophy and pregnancy: a review

The previous reports of 20 women with myotonic dystrophy and pregnancy are reviewed, and a new case report added. Myotonic dystrophy is often unrecognized in early life due to vague symptoms, and is often first diagnosed during pregnancy which is known to worsen the main features of muscular weakness and myotonia. Complications of pregnancy and delivery are frequent and serious and should be known to all those dealing with pregnant women. A history of fetal wastage or a child suffering from symptoms of congenital myotonic dystrophy may be a clue to the diagnosis and these patients should be closely followed until safe delivery. The neonatologist should be involved as feeding and respiratory problems in the neonate may indicate that the infant is affected.     

Crack abuse during pregnancy: maternal,fetal and neonatal complication

Objective: The aim of this study was to assess the effects of crack on pregnancy outcomes.

Methods: We studied 88 crack user pregnant women in this study. These women were matched to a drug-free group (n?=?90) chosen from the population of the same hospital. Maternal outcomes including preeclampsia, placenta abruption, gestational diabetes and preterm labor, and neonatal complication including low birth weight and low Apgar score in 5?min were compared in crack using and drug-free groups. Data were analyzed by SPSS software. Chi-square test and Student’s t-test and Relative Risks (RRs) were used in this study.

Results: The results of our study showed that crack abuse during pregnancy was associated with higher rate of preeclampsia p?=?0.003 (RR, 1.731; 95% CI, 1.777–2.545), placental abruption p?=?0.001 (RR, 2.439; 95% CI, 1.369–4.343), preterm labor p?<?0.000 (RR, 3.249; 95% CI, 2.053–5.141) and low birth weight p?<?0.000 (RR, 2.179; 95% CI, 1.462–3.247).

Conclusions: Crack abuse had significant influence on pregnancy outcomes. Crack appears to influence the prevalence of low birth weight, preterm labor, preeclampsia and placental abruption.     

Kyphoscoliosis complicating pregnancy: maternal and neonatal outcome

Introduction  

Laparoscopy, because of its availability and safety, provides a valuable tool in the evaluation of undiagnosed chronic pelvic pain. It is a simple and definitive means of establishing the presence or absence of pelvic pathology without resorting to major abdominal surgery.     

The cost of twin pregnancy: maternal and neonatal factors

OBJECTIVE: The purpose of this study was to evaluate factors affecting birth charges in twin pregnancies. STUDY DESIGN: Clinical and financial data were obtained on 1486 twin pregnancies delivered between 1995 to 2002 at medical centers in Maryland, Florida, Michigan, and South Carolina. Maternal and neonatal length of stay (LOS) and charges were modeled by gestational age and other risk factors using a general linear model. RESULTS: Maternal and infant birth admission LOS and charges increased significantly with a decline in gestational age. Maternal LOS and charges were also significantly increased by cesarean delivery and preeclampsia. Newborn LOS and charges increased significantly by monochorionicity and slowed growth between 20 to 28 weeks. For mother and infants, the shortest LOS and lowest birth charges were at 37 to 38 weeks. CONCLUSION: These findings reflect the substantial maternal and neonatal morbidity associated with twin pregnancies, and demonstrate that 37 to 38 weeks is their optimal gestation.     

Prenatal maternal paroxetine treatment and neonatal mortality in the rat: a preliminary study

Recent evidence has shown that prenatal maternal stress has negative consequences for the mental health of the adult organism. Our aim was to examine the efficacy of using the selective serotonin reuptake inhibitor, paroxetine, to alleviate the symptoms of prenatal maternal stress in Fisher 344 rats. Pregnant rats were subjected to daily restraint stress and concurrent paroxetine treatment (10 mg/kg p.o.) during the last week of gestation. Maternal paroxetine treatment led to a shortened gestational length, reduced birth weight and a 10-fold rise in neonatal mortality in both stressed and non-stressed litters. These results reiterate the need for further research on the effects of paroxetine treatment during gestation.     

Prenatal diagnosis in multiple pregnancy.

Fetal abnormality is more common in multiple than in singleton pregnancies. This, together with the requirement to consider the risks with at least two babies to sample correctly each fetus and to undertake accurately-targeted selective termination, amounts to a major challenge for obstetricians involved in prenatal diagnosis. Early determination of chorionicity should be routine, since this influences not only the genetic risks but also the invasive procedure chosen for karyotyping or genotyping. Assessment of nuchal translucency identifies individual fetuses at risk of trisomy. Contrary to expectation, invasive procedures in twins appear to have procedure-related miscarriage rates that are similar to those in singletons. Instead, contamination remains a concern at chorionic villus sampling. Elective late karyotyping of fetuses may have a role in some countries. Whereas management options for discordant fetal abnormality are relatively straightforward in dichorionic pregnancies, monochorionic pregnancies are at risk of co-twin sequelae after any single intrauterine death. Techniques have now been developed to occlude completely the cord vasculature by laser and/or ultrasound guided bipolar diathermy. Given the complexities associated with prenatal diagnosis, all invasive procedures in multiple pregnancies should be performed in tertiary referral centres.     

Infrequent neonatal opiate withdrawal following maternal methadone detoxification during pregnancy

The influence of maternal participation in a methadone detoxification program as compared to street drug use on intrauterine growth and neonatal morbidity was analysed in 75 newborns. -58 of 75 pregnant addicts joined the methadone program; in 17 women with successful prepartal detoxification, we found a longer course of pregnancy as well as normalized birth weight, head circumference and respiratory status of the neonates. The HIV-status showed no influence on prenatal growth. 63% of all infants developed a neonatal abstinence syndrome; this incidence was lower after maternal participation in the methadone detoxification program: 55 vs. 88%, p less than 0.05. Postnatal respiratory insufficiency occurred more frequently after methadone exposure than after heroin exposure before birth (p less than 0.05).     

Amiodarone treatment in pregnancy for dilatative cardiomyopathy with ventricular malignant extrasystole and normal maternal and neonatal outcome.

Amiodarone treatment in pregnancy might be difficult to handle because of the long half-life of the drug (14-28 days up to 2 months) and because it reduces maternal and neonatal thyroid activity. Although short-term use in pregnancy has been described in cases of fetal supraventricular tachycardia, there are few reports on the chronic use of the drug. In this paper we describe our experience with amiodarone treatment in two pregnant sisters with familial dilatative cardiomyopathy and ventricular malignant extrasystole. Prolonged administration of amiodarone (400-200 mg/die) since the beginning of pregnancy did not have any adverse effects; maternal and neonatal thyroid function was normal, as was the neurological and motor development of the neonates.     

Prenatal and postnatal maternal leucocyte ascorbic acid concentrations.

Leucocyte ascorbic acid was measured in 79 pregnant women in the 34th to 38th week of gestation and on the first, and third or fifth days post partum. No differences were found for time of year or age of the subjects. There was a significantly lower vitamin C status in social classes IV and V. The leucocyte ascorbic acid concentration fell significantly on the first day post partum and rose again to initial values by the fifth day. In late pregnancy 40 per cent of all subjects had leucocyte ascorbic acid concentrations less than the lower limit of normal (100 nmol/10(8) leucocytes). This rose to 75 per cent on the first day post partum.