Obstetric Medicine最新文献

{"title":"Lactation anaphylaxis complicated by reversible cardiac dysfunction in a multiparous woman with previous breastfeeding experience.","authors":"Shahad Al-Tikriti, Mahendar Kumar, Maggie O'Brien, Roger McMorrow, David Crosby","doi":"10.1177/1753495X251317754","DOIUrl":"10.1177/1753495X251317754","url":null,"abstract":"<p><p>A multiparous woman in her late 20s developed postpartum angioedema, rash, profound hypotension, and decreased consciousness, progressing to acute myocardial dysfunction with left ventricular impairment. Despite thorough investigations, no clear cause was found. Anaphylaxis to medication was initially suspected as the patient had received paracetamol, ibuprofen and intrapartum antibiotics, however the symptoms resolved with cabergoline-induced lactation suppression leading to the diagnosis of lactation anaphylaxis being made. This case suggests lactation anaphylaxis can trigger transient cardiac issues, highlighting the need for awareness and further research. Lactation anaphylaxis is rarely documented, and cardiac involvement has not been previously described. Effective management of lactation anaphylaxis, particularly with cardiac complications, is crucial. This case emphasizes the importance of considering lactation anaphylaxis in postpartum allergic presentations and highlights the necessity for more research on its mechanisms and treatment.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":" ","pages":"1753495X251317754"},"PeriodicalIF":0.8,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urticarial reaction to low molecular weight heparin injections.","authors":"Amanda Hill, Charlotte Williams, Katherine Finucane, Naomi Carson, Francesca Neuberger, Fangyi Xie","doi":"10.1177/1753495X251317303","DOIUrl":"10.1177/1753495X251317303","url":null,"abstract":"<p><p>Low molecular weight heparin (LMWH) is a common agent given in pregnancy; however, cutaneous drug reactions with its use in pregnancy are rarely reported. The case describes a 30-year-old woman with stable Crohn's disease on ustekinumab presenting with a rash at prophylactic LMWH injection sites 30 weeks into her third pregnancy. Skin biopsy reported appearance consistent with an urticarial drug hypersensitivity reaction. A combination of steroid treatment, topical emollient and cessation of LMWH resulted in resolution of symptoms over 2 weeks. Postnatal venous thromboembolism prophylaxis with fondaparinux was uncomplicated. Overall, this case highlights the importance of reporting drug reactions in pregnancy. It additionally exposes a gap in research surrounding immunomodulators and heparins in the development of cutaneous reactions in pregnancy.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":" ","pages":"1753495X251317303"},"PeriodicalIF":0.8,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk of recurrence of acute fatty liver of pregnancy - a review of the current literature.","authors":"Adam Morton, Liza Phillips, Janelle Nisbet, Jin-Wen He","doi":"10.1177/1753495X251317259","DOIUrl":"10.1177/1753495X251317259","url":null,"abstract":"<p><p>Acute fatty liver of pregnancy is associated with significant maternal and fetal morbidity and mortality. Defects in fatty acid metabolism appear to play a role in pathogenesis, and several pathogenic variants leading to enzyme deficiencies have been associated with the development of acute fatty liver of pregnancy. The risk of recurrence in subsequent pregnancies is unknown. A review of 10 small case series of women with acute fatty liver of pregnancy disclosed only one case of recurrence in 35 subsequent pregnancies. This contrasted with a survey where 5 of 24 women reported recurrent acute fatty liver in subsequent pregnancies. Retrospective and prospective studies examining subsequent pregnancy outcomes following a diagnosis of acute fatty liver of pregnancy would be useful to better define risk and aid in preconception counselling of women who have had a diagnosis of acute fatty liver of pregnancy and wish to consider further pregnancies.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":" ","pages":"1753495X251317259"},"PeriodicalIF":0.8,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemophagocytic lymphohistiocytosis in early pregnancy: A rare and fatal diagnostic challenge.","authors":"Jose Rojas-Suarez, María Ramos, Isabel Lazarte, Sofia Cifuentes, Jorge Leon, Wendy Castañeda, Karen Morales, Yasaira Pajaro, Carmelo Dueñas-Castell","doi":"10.1177/1753495X251314168","DOIUrl":"10.1177/1753495X251314168","url":null,"abstract":"<p><strong>Objective: </strong>This report details the complexities of diagnosing and treating rapid-onset multisystemic hemophagocytic lymphohistiocytosis (HLH) during pregnancy, as evidenced by a fatal case in early pregnancy with severe hematological and obstetric complications.</p><p><strong>Case presentation: </strong>A 20-year-old pregnant woman in her second pregnancy presented at 8 weeks of gestation with abdominal pain, fever, and rectal bleeding. Laboratory tests revealed leukopenia, thrombocytopenia, and anemia, leading to immediate transfusion and intensive care unit admission. Despite intensive interventions, including vasopressors and antibiotics, the patient developed progressive organ failure, with disseminated intravascular coagulation, and suffered a fatal stroke.</p><p><strong>Conclusions: </strong>This critical case with severe complications demonstrates the diagnostic and treatment challenges of rapid-onset HLH in early pregnancy. Early and accurate differential diagnosis in obstetric emergencies is vital for conditions such as HLH. This case highlights the importance of multifaceted care in managing pregnant patients with complex, atypical presentations.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":" ","pages":"1753495X251314168"},"PeriodicalIF":0.8,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The semantics of how we talk about maternity care.","authors":"Sandra A Lowe","doi":"10.1177/1753495X241311631","DOIUrl":"https://doi.org/10.1177/1753495X241311631","url":null,"abstract":"","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":" ","pages":"1753495X241311631"},"PeriodicalIF":0.8,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiography parameters and cardiac geometry in pregnancy by race and ethnicity.","authors":"Gianna Wilkie, Angela Essa, Sharina D Person, Lara Kovell","doi":"10.1177/1753495X241312774","DOIUrl":"10.1177/1753495X241312774","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to assess transthoracic echocardiography (TTE) parameters in pregnancy by race and ethnicity.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of pregnant individuals without cardiovascular disease who underwent a perinatal TTE between October 2017 and May 2022. Demographics and echocardiographic parameters were compared by race/ethnicity. Multivariate regression analysis was performed for TTE parameters after adjusting for age and hypertension.</p><p><strong>Results: </strong>During the study period, 369 individuals had TTEs with a mean age of 31.8 ± 6.0 years old. Subjects were 55.3% White, 24.7% Hispanic, 14.1% Black, and 6.0% Asian. TTE parameters of left ventricular (LV) ejection fraction and LV mass index differed by race/ethnicity, though no difference was seen in cardiac geometry.</p><p><strong>Conclusion: </strong>The differences in TTE parameters may not be clinically significant as most values fall within normal clinical ranges. Further prospective studies are needed to better evaluate cardiac outcomes by differences in echocardiographic parameters in pregnancy.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":" ","pages":"1753495X241312774"},"PeriodicalIF":0.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new diagnosis of primary biliary cholangitis in pregnancy treated with a combination of ursodeoxycholic acid and bezafibrate.","authors":"Laura Harrington, Caroline Ovadia, Michael Heneghan, Catherine Williamson","doi":"10.1177/1753495X241293324","DOIUrl":"10.1177/1753495X241293324","url":null,"abstract":"<p><p>This primigravid pregnant woman had a new diagnosis of primary biliary cholangitis (PBC) that was treated with a combination of ursodeoxycholic acid (UDCA) and bezafibrate. Pregnancy may unmask underlying chronic hepatic disorders in susceptible women and, in some cases, the associated abnormalities of liver function or increased serum bile acids (hypercholanaemia) can result in significant fetal and maternal risk. Maternal pruritus, with associated sleep deprivation, may cause considerable distress. To our knowledge, this is the first reported case of a new diagnosis of PBC in pregnancy treated with a combination of both UDCA and a fibrate. The case demonstrates the importance of accurate and efficient diagnosis alongside effective multidisciplinary team working to initiate appropriate, timely treatment to minimise the risk to fetus and mother. Early assessment, risk stratification and cautious surveillance is paramount in managing evolving or coexisting pathology plus individualised delivery planning, aiming to optimise fetal and maternal outcomes.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":" ","pages":"1753495X241293324"},"PeriodicalIF":0.8,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11670224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cannabinoid hyperemesis syndrome in pregnancy: a case series and review.","authors":"Sarah Hanley, Mendinaro Imcha, Mas Mahady Mohamad","doi":"10.1177/1753495X241307415","DOIUrl":"https://doi.org/10.1177/1753495X241307415","url":null,"abstract":"<p><strong>Background: </strong>Cannabinoid hyperemesis syndrome (CHS) is a syndrome of cyclic nausea and vomiting in the setting of chronic cannabis use. To date, only 11 cases of CHS in pregnancy have been reported.</p><p><strong>Case presentation: </strong>We describe two cases of uncontrolled vomiting in pregnancy due to CHS. Case 1 represents a 30-year-old Caucasian woman presenting in the 5th week of gestation with nausea, vomiting and abdominal pain intermittently of 1 week duration. Physical work-up was normal, and symptoms resolved with supportive treatment within 3 days, only to occur again at the 14th week of gestation, and again at the 30th week of gestation. Link between symptom relief and hot bathing led to suspicion for CHS, confirmed with positive cannabis urine toxicology screening. Nausea, vomiting and pain subsided with cannabis cessation, and baby was born healthy at 38 + 5 weeks gestation. Case 2 describes a 28-year-old Caucasian woman presenting in the 16th week of gestation with nausea, vomiting and abdominal pain. Physical examination was normal, and symptoms self-resolved. Two weeks later, in the 18th week of gestation, the patient re-presented to the emergency room with sudden re-occurrence of nausea, vomiting and abdominal pain. Once again, a link between symptom relief and hot bathing was noted on admission. The patient was educated on possible links of chronic cannabis use with CHS symptoms and subsequently relayed extensive (>14 years) cannabis use history. Symptoms resolved with cannabis cessation. Baby was born at 37 weeks gestation, with low birth weight of 2180 g requiring 5 days neonatal intensive care unit (NICU) treatment. Regular follow-up up to 5 months post-partum confirmed no CHS relapse with cannabis cessation.</p><p><strong>Conclusion: </strong>CHS in pregnancy is likely under-reported, reflective possibly of limited physician and patient awareness of this condition, as well as patient concealment of cannabis use in pregnancy. In cases of severe, cyclic nausea and vomiting in pregnancy unresponsive to typical anti-emetic treatment, comprehensive social history including cannabis use should be sought, and associated hot bathing for symptomatic relief out-ruled.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":" ","pages":"1753495X241307415"},"PeriodicalIF":0.8,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11694266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome reporting in studies on critically ill obstetric patients: A systematic review.","authors":"Julien Viau-Lapointe, Julia Kfouri, Mary Thompson, Rizwana Ashraf, Rohan D'Souza, Stephen Lapinsky","doi":"10.1177/1753495X241302848","DOIUrl":"10.1177/1753495X241302848","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review is the first step in the process of standardizing outcome reporting through the development of a core outcome set for research on critically ill obstetric patients (COSCO).</p><p><strong>Methods: </strong>A five-database search was performed to identify randomized and non-randomized studies published before November 2017, on patients admitted to intensive care or high-dependency units during or immediately after pregnancy. Reported outcomes were categorized into domains and definitions were documented.</p><p><strong>Results: </strong>Of the 12,581 citations reviewed, 136 studies were included. The most reported outcome domains were maternal all-cause mortality (<i>n</i> = 128, 94.5%), resource use (<i>n</i> = 116, 85.6%), and clinical/physiological outcomes (<i>n</i> = 111, 82.8%). Outcomes related to functioning/life impact and adverse effects of treatment were only reported in four (2.9%) studies. There was inconsistency in outcome definitions.</p><p><strong>Conclusions: </strong>This review identified considerable variation in outcome reporting and definitions and generated an outcome list to consider in COSCO development.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":" ","pages":"1753495X241302848"},"PeriodicalIF":0.8,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric medicine national organizations.","authors":"Stephen E Lapinsky, Kenneth K Chen, Charlotte J Frise","doi":"10.1177/1753495X241301873","DOIUrl":"https://doi.org/10.1177/1753495X241301873","url":null,"abstract":"","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":" ","pages":"1753495X241301873"},"PeriodicalIF":0.8,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}