Obstetric Medicine最新文献

{"title":"Postpartum complications following neuraxial anaesthesia for obstetric physicians.","authors":"Heather Lawrence, Adam Morton","doi":"10.1177/1753495X221146329","DOIUrl":"10.1177/1753495X221146329","url":null,"abstract":"<p><p>Neuraxial analgesia and anaesthesia are widely accepted and well-tolerated modes of delivery analgesia, being employed in up to 76% of vaginal deliveries and 94% of caesarean deliveries in the United States.¹ A cause of considerable concern for postpartum women, their family and caring health professionals is the occurrence of unexplained postpartum complications, not only for management in the index pregnancy, but the uncertain risk of recurrence in future pregnancies. Complications of neuraxial blocks may impact significantly on the ability of mothers to care for and bond with their newborn. The reported incidence of temporary neurological deficit following obstetric neuraxial blocks is 1 in 3900 procedures, and the risk of permanent neurological harm estimated to be between 1 in 80,000 and 1 in 320,425 procedures.² Obstetric physicians may be asked to review women with postpartum complications following neuraxial blocks. This article reviews complications that may be seen following neuraxial blocks for delivery.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":"16 3","pages":"142-150"},"PeriodicalIF":0.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10504890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10307093","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":"Crigler-Najjar type II in pregnancy: A case report.","authors":"Katherine Creeper, Dorothy Graham","doi":"10.1177/1753495X221099443","DOIUrl":"10.1177/1753495X221099443","url":null,"abstract":"<p><p>Crigler-Najjar is a rare, autosomal recessive disorder that results in mutations causing a complete absence (type I) or deficiency (type II) of the hepatic uridine diphospho-glucuronosyl transferase (UDPGT) enzyme. Both forms, however, result in unconjugated hyperbilirubinaemia which can lead to kernicterus and potentially death. Phenobarbitone can be used as an enzyme inducer in Type II to facilitate a reduction in total serum bilirubin. We report two consecutive pregnancies in a 29-year-old woman with Crigler-Najjar Type II syndrome. Phenobarbitone therapy was commenced in the first pregnancy at 16 weeks' gestation and was associated with favorable biochemical and clinical outcomes. There were no reports of long-term neonatal neurological sequelae. Tertiary center, multidisciplinary care is recommended for optimal pregnancy outcomes.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":"16 3","pages":"184-186"},"PeriodicalIF":0.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10504887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309619","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":"Impact of the COVID-19 pandemic on perinatal mental health screening, illness and pregnancy outcomes: A cohort study.","authors":"Andre C Q Lo,&nbsp;Michelle Kemp,&nbsp;Nikolett Kabacs","doi":"10.1177/1753495X221139565","DOIUrl":"https://doi.org/10.1177/1753495X221139565","url":null,"abstract":"<p><strong>Background: </strong>The aim was to explore the impact of the COVID-19 pandemic on perinatal mental health screening, illness and related pregnancy complications/outcomes.</p><p><strong>Methods: </strong>A single-centre retrospective cohort study in mothers giving birth before versus during the pandemic. Primary outcomes were the comparative prevalence/incidence of peripartum psychiatric diagnoses. Secondary outcomes were the pandemic's effect on psychiatric screening accuracy, and on other pregnancy outcomes linked to mental health.</p><p><strong>Results: </strong>The pandemic did not significantly increase the crude incidence of diagnosed peripartum anxiety (risk ratio (RR) = 1.39, 95% CI = 0.66-2.95), depression (RR = 1.63, 95% CI = 0.72-3.70) or other pregnancy outcomes. In multivariate models, the pandemic decreased Apgar scores and was involved in interaction effects for postpartum mental illness and birthweight. Psychiatric screening at the booking appointment exhibited lower sensitivity in predicting antenatal mental illness (pre-pandemic = 85.71%, pandemic = 25.00%; <i>p</i> = 0.035).</p><p><strong>Conclusions: </strong>The lowered screening sensitivity likely meant mental illness was poorly anticipated/under-detected during the pandemic, leading to no crude increase in perinatal psychiatric diagnoses.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":"16 3","pages":"178-183"},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9708533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10311481","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":"Gordon's syndrome in pregnancy.","authors":"Adam Morton","doi":"10.1177/1753495X221146331","DOIUrl":"10.1177/1753495X221146331","url":null,"abstract":"<p><p>Gordon's syndrome, also known as pseudohypoaldosteronism type II and familial hyperkalaemic hypertension, is a rare inherited condition characterised by familial hyperkalaemia, normal anion gap hyperchloraemic metabolic acidosis, low renin with normal glomerular filtration rate and hypertension. The outcome of 11 pregnancies in 3 women with Gordon's syndrome is presented and combined with 13 pregnancies in 7 women previously described. Pregnancy in women with Gordon's syndrome appears to be associated with a significant risk of adverse pregnancy outcomes, particularly where there is maternal hypertension preconception. No pregnancy registry exists for Gordon's syndrome. The available data is limited to case reports and small case series and may be affected by bias. A pregnancy registry would be valuable to assist in preconception counselling and management during pregnancy. The goal of this study was to summarise the available cases describing pregnancy outcomes with maternal Gordon's syndrome.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":"16 3","pages":"151-155"},"PeriodicalIF":0.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10504880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309622","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":"Effects of oral glibenclamide versus subcutaneous insulin on perinatal outcome of patients with gestational diabetes mellitus: A randomized clinical trial.","authors":"Azam Faraji, Lida Tahamtani, Najmeh Maharlouei, Nasrin Asadi","doi":"10.1177/1753495X221100167","DOIUrl":"10.1177/1753495X221100167","url":null,"abstract":"<p><strong>Background: </strong>The first-line treatment for gestational diabetes mellitus remains insulin, but oral hypoglycemic agents are easier and cheaper to use. The aim of the current study was to compare the efficacy and safety of oral glibenclamide and subcutaneous insulin on the serum glucose control and perinatal outcome of patients with gestational diabetes mellitus.</p><p><strong>Materials and methods: </strong>This randomized clinical trial was conducted during a 2-year period from 2017 to 2019 in two tertiary healthcare centers in Shiraz, Iran. We included 84 singleton pregnancies between 24 and 34 weeks of gestation diagnosed with gestational diabetes mellitus. Patients were randomly assigned to oral glibenclamide (<i>n</i> = 44) or subcutaneous insulin (<i>n</i> = 40) according to a standard protocol and followed until delivery. The primary endpoint was to compare the glycemic level of patients, and the secondary outcomes included pregnancy adverse events and neonatal complications such as preeclampsia, preterm and premature rupture of membranes, preterm labor, placental abruption, maternal hypoglycemia, birth weight, neonatal hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, and neonatal intensive care unit admission.</p><p><strong>Results: </strong>The two study groups had comparable baseline characteristics. After treatment, the two study groups were comparable regarding fasting blood glucose (<i>p</i> = 0.398) and 2 h postprandial glucose (<i>p</i> = 0.085). There was no significant difference between the two groups regarding the rate of preeclampsia (<i>p</i> = 0.250), preterm rupture of membranes (<i>p</i> = 0.998), preterm labor (<i>p</i> = 0.495), hypoglycemia (<i>p</i> = 0.476), and abruption (<i>p</i> = 0.815). There was no significant difference between the two study groups in birth weight (<i>p</i> = 0.863) and the Apgar score at 1 (<i>p</i> = 0.190) and 5 min (<i>p</i> = 0.055). The rates of neonatal adverse events including hypoglycemia (<i>p</i> = 0.999), hyperbilirubinemia (<i>p</i> = 0.160), neonatal intensive care unit admission (<i>p</i> = 0.852), and respiratory distress syndrome (<i>p</i> = 0.665) were comparable between the two groups.</p><p><strong>Conclusion: </strong>The results of the current study demonstrate that oral glibenclamide is as effective and safe as subcutaneous insulin in glycemic control and maternal and neonatal outcomes in women with gestational diabetes mellitus. Thus, it could be used as first-line treatment of gestational diabetes mellitus.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":"16 2","pages":"98-103"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10648353","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":"Pregnancy outcome with maternal <i>HNF1B</i> gene mutations and 17q12 deletions.","authors":"Adam Morton, Ling Li, Caroline Wilson","doi":"10.1177/1753495X221109734","DOIUrl":"10.1177/1753495X221109734","url":null,"abstract":"<p><p>There is an increasing body of literature regarding monogenic diabetes, particularly the more common forms of glucokinase and <i>HNF1-alpha</i> mutations (MODY2 and MODY3). There is relatively little published literature regarding rarer mutations. <i>HNF1-beta</i> mutations and 17q12 deletions may be associated with a broad range of organ dysfunction, renal disease and diabetes in particular resulting in high-risk pregnancies. This manuscript describes pregnancy outcomes in a woman with an <i>HNF1-beta</i> mutation and 2 women with an <i>HNF1B</i>/17q12 deletion and reviews the previously published literature. It highlights the significant rate of adverse maternal and fetal outcomes, and the maternal features suggestive of the diagnosis which should be considered in preconception counselling.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":"16 2","pages":"78-82"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9820545","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":"Stumbling on new knowledge: The loss of serendipity.","authors":"Sandra A Lowe","doi":"10.1177/1753495X231172619","DOIUrl":"10.1177/1753495X231172619","url":null,"abstract":"","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":"16 2","pages":"77"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10648357","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":"Management and complications of complete heart block in pregnancy.","authors":"A P Christensen,&nbsp;V Singh,&nbsp;A J England,&nbsp;R Khiani,&nbsp;A S Herrey","doi":"10.1177/1753495X211033489","DOIUrl":"https://doi.org/10.1177/1753495X211033489","url":null,"abstract":"<p><p>Although rare, increasing numbers of women with pacemakers are becoming pregnant. We describe the complications of a woman with arrhythmia and a pacemaker for complete heart block experienced before, during, between and after her pregnancies. We illustrate the benefits of multidisciplinary care, good communication and regular assessment in a stable, but complex woman.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":"16 2","pages":"120-122"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9817992","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":"Non-alcoholic fatty liver disease in pregnancy.","authors":"Charlotte S Benson, Jeremy F Cobbold, Charlotte J Frise","doi":"10.1177/1753495X211034709","DOIUrl":"10.1177/1753495X211034709","url":null,"abstract":"<p><p>Non-alcoholic fatty liver disease (NAFLD) is now the commonest liver pathology in the UK; however, relatively little is known about its course in pregnancy or the effect it has on maternal or fetal outcomes. Described here is a 24-year-old woman in her first pregnancy who presented with non-specific symptoms and raised alanine aminotransferase with ultrasonography of her liver showing changes of steatosis and suspicious for cirrhosis, leading to a diagnosis of NAFLD. The case illustrates the need for the clinician to have awareness of this increasingly prevalent condition and for multidisciplinary management.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":"16 2","pages":"116-119"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10174907","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":"Pregnancy and delivery in patients with Charcot-Marie-Tooth disease and related disorders.","authors":"Mariola Skorupinska,&nbsp;Gita Ramdharry,&nbsp;Bridgette Byrne,&nbsp;Matilde Laurá,&nbsp;Mary M Reilly","doi":"10.1177/1753495X221107328","DOIUrl":"https://doi.org/10.1177/1753495X221107328","url":null,"abstract":"<p><strong>Background: </strong>Charcot-Marie-Tooth disease is the most common inherited peripheral neuropathy and many patients with Charcot-Marie-Tooth are women of childbearing age. Guidelines for managing pregnancy in Charcot-Marie-Tooth are lacking.</p><p><strong>Aims: </strong>To assess the impact of pregnancy on Charcot-Marie-Tooth and how Charcot-Marie-Tooth affects pregnancy, delivery and postnatal care.</p><p><strong>Methods: </strong>A retrospective questionnaire exploring disease course during pregnancy, delivery, pregnancy complications, anaesthetic management and puerperium was administered to 92 patients with Charcot-Marie-Tooth and related disorders.</p><p><strong>Results: </strong>Worsening of Charcot-Marie-Tooth symptoms were reported in 37% of pregnant patients which resolved after delivery in half of the patients. No significant increase in pregnancy, delivery and anaesthetic complications were observed and the type of delivery did not significantly differ from the normal population.</p><p><strong>Conclusions: </strong>While these results are reassuring, ideally an international prospective study should be done to confirm these results and to develop practice guidelines on the management of pregnancy in Charcot-Marie-Tooth.</p>","PeriodicalId":51717,"journal":{"name":"Obstetric Medicine","volume":"16 2","pages":"83-87"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10353084","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}