AJP Reports最新文献

{"title":"Type 1 Narcolepsy in Pregnancy: A Case Report and Review of Literature.","authors":"Asnat Yuabov, Alexandra Kilinsky, Dina El Kady","doi":"10.1055/a-2297-4583","DOIUrl":"https://doi.org/10.1055/a-2297-4583","url":null,"abstract":"<p><p><b>Background</b>  Type 1 narcolepsy (with cataplexy) is a rare disorder affecting the central nervous system and is characterized by the inability to control sleep-wake cycles. There is a paucity of data regarding management during pregnancy. <b>Case</b>  This is a 23-year-old primigravida with narcolepsy and cataplexy, treated with methylphenidate in the third trimester, resulting in an improvement of episodes of cataplexy. A review of the literature reveals information regarding options for medical management and the mode of delivery for these women. <b>Conclusion</b>  Type 1 narcolepsy can be treated with medications after consideration of risks and benefits. For patients who are symptomatic at the time of birth, cesarean section may be the preferred mode of delivery in women with type 1 narcolepsy.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 2","pages":"e120-e123"},"PeriodicalIF":0.9,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11052643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855594","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 Pregnant Adolescent with COVID-19 and Multisystem Inflammatory Syndrome in Children.","authors":"Megan E Trostle, Tracy B Grossman, Christina A Penfield, Colin K L Phoon, Vanessa N Raabe, Mark F Sloane, Ashley S Roman","doi":"10.1055/s-0044-1779032","DOIUrl":"10.1055/s-0044-1779032","url":null,"abstract":"<p><p>Multisystem inflammatory syndrome in children (MIS-C), a new condition related to coronavirus disease 2019 (COVID-19) in the pediatric population, was recognized by physicians in the United Kingdom in April 2020. Given those up to the age of 21 years can be affected, pregnant adolescents and young adults are susceptible. However, there is scant information on how MIS-C may affect pregnancy and whether the presentation differs in the pregnant population. We report a case of a pregnant adolescent with COVID-19 and MIS-C with a favorable outcome. This case highlights the considerations in managing a critically ill pregnant patient with a novel illness and the importance of a multidisciplinary team in coordinating care.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e66-e68"},"PeriodicalIF":0.9,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899153","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":"Spontaneous Heterotopic Cesarean Scar Triplet Gestation Following Uterine Ablation.","authors":"Zane Frazer Aldrich, Rena Ow, Khyaati Modii, Timothy O'Leary","doi":"10.1055/s-0044-1779654","DOIUrl":"10.1055/s-0044-1779654","url":null,"abstract":"<p><p>Heterotopic triplet pregnancy, cesarean scar ectopic pregnancy, and pregnancy following uterine ablation are all rare events that confer significant morbidity including spontaneous abortion, intrauterine fetal demise, preterm labor, abnormal placentation, and uterine rupture. A woman in her 30s, G6P4014, with a history of uterine ablation presented with delayed menses and vaginal spotting with imaging showing two intrauterine pregnancies (one with cardiac activity) and one live pregnancy at the cesarean scar. The patient was extensively counseled on risk to her and to the pregnancies; treatment options were discussed including expectant management and termination of pregnancy. The patient underwent an uncomplicated dilation and curettage with bilateral salpingectomy and was discharged home the day of the procedure in stable condition. This case highlights the potential compound effect of comorbid conditions that can pose difficulty in counseling and management. <b>Key Points</b> Patients undergoing endometrial ablation should be carefully selected and counseled extensively on highly effective contraception.Suspected cesarean scar pregnancies should be carefully evaluated early in gestation. Management should include thorough counseling and may be indivisualized.Many conditions pose a significant threat to maternal health and warrant a discussion of termination, which should be widely availaible and safe for all who need and/or desire it.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e91-e95"},"PeriodicalIF":0.9,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899155","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":"Likely Vertical Transmission of Neonatal SARS CoV-2 Infection.","authors":"Andre A Robinson, Samantha Feder, Sushma Krishna, Lois Brustman","doi":"10.1055/s-0044-1779030","DOIUrl":"10.1055/s-0044-1779030","url":null,"abstract":"<p><p>Maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can affect placental function, but the possibility of intrauterine transmission has been debated. Several authors have published inclusion criteria for vertical transmission, but few reports exist that are able to meet the suggested requirements. Despite the fact that the majority of fetuses born to infected mothers do well, others become critically ill. We present a case of likely intrauterine transmission of a neonate born to a mother who was recently symptomatic with a positive SARS CoV-2 polymerase chain reaction (PCR). The parturient complained of decreased fetal movement and presented at 31 ^2/7 weeks' gestation with a biophysical profile score of 2/10 and required an emergency cesarean delivery. The neonate went on to develop severe leukopenia with signs of sepsis with a positive SARS CoV-2 PCR on day 4 of life and an otherwise pan-negative workup. Meeting criteria for transplacental transmission requires timely collection of several diagnostic studies that are not standard of care. Further research is needed to support the notion that intrauterine/transplacental infection is possible. Collection swabs should be obtained soon after delivery to help diagnose neonatal infection because early diagnosis is crucial to help identify opportunities for intervention.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e62-e65"},"PeriodicalIF":0.9,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899154","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":"Urinary Tract Infection and Progression to Pyelonephritis: Group B <i>Streptococcus</i> versus <i>E. coli</i>.","authors":"Sarika Sachdeva, Heather A Rosett, Madison K Krischak, Kristin E Weaver, R Phillips Heine, Anna E Denoble, Sarah K Dotters-Katz","doi":"10.1055/s-0044-1779031","DOIUrl":"10.1055/s-0044-1779031","url":null,"abstract":"<p><p><b>Objective</b>  Group B <i>Streptococcus</i> (GBS) colonization of the lower urinary tract in pregnancy is associated with severe infections such as chorioamnionitis, endometritis, and pyelonephritis. The objective of this study was to compare rates of progression to pyelonephritis between GBS and <i>Escherichia coli</i> lower urinary tract infections (LUTIs), as well as compare infectious and obstetric morbidity secondary to these pathogens. <b>Study Design</b>  Retrospective cohort of pregnant women with LUTIs (asymptomatic bacteria or acute cystitis [AC]) from a single health system between July 2013 and May 2019. Demographic, infectious, antepartum, and intrapartum data were abstracted from medical records of women with GBS or <i>E. coli</i> LUTI. The primary outcome was progression to pyelonephritis. Secondary outcomes included pyelonephritis-related anemia, sepsis, pyelonephritis length of stay (LOS), median gestational age (GA) at delivery, preterm delivery, and low birth weight (LBW). Logistic regression was used to calculate the adjusted odds of the primary outcome. <b>Results</b>  Of 729 pregnant women with urinary colonization, 433 were culture positive for one of the aforementioned bacteria, with 189 (43.6%) having GBS and 244 (56.4%) having <i>E. coli.</i> Women with <i>E. coli</i> were more likely to be younger, use tobacco, have a history of AC, and have a history of preterm birth. Rates of progression to pyelonephritis were markedly higher with <i>E. coli</i> (15.6%) than with GBS (1.1%; <i>p</i>  < 0.001). Median LOS for pyelonephritis and pyelonephritis-related morbidities did not differ. Median GA at delivery, preterm delivery, and LBW rates also did not differ. In adjusted analysis, controlling for history of AC, insurance status, tobacco use, prior preterm birth, primary infection type, and maternal age, women with GBS LUTI had markedly decreased odds of developing pyelonephritis in pregnancy compared with those with <i>E. coli</i> (adjusted odds ratio: 0.04, 95% confidence interval: 0.01-0.28). <b>Conclusion</b>   <i>Escherichia coli</i> infections progress to pyelonephritis in pregnancy at markedly higher rates than GBS, although obstetric outcomes are similar.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e80-e84"},"PeriodicalIF":0.9,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899156","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 Case of an Obstructed Delivery by a Large, Lower Uterine Segment Fibroid Interlocked with a Fetal Mentum.","authors":"Sarah E Miller, Hayley E Miller, Anne R Waldrop, Scarlett D Karakash, Kate A Shaw","doi":"10.1055/a-2202-4234","DOIUrl":"10.1055/a-2202-4234","url":null,"abstract":"<p><p>Uterine leiomyomata are associated with many pregnancy complications and will likely become increasingly common as the average age of childbearing increases. We describe a case of an obstructed delivery by a large fibroid. A 37-year-old G2P1001 with a 10-cm anterior, lower uterine segment fibroid presented for labor induction. Labor was complicated by arrest of descent due to suspected obstruction of the fetal body by the fibroid after descent of the fetal head, and delivery during cesarean section was complicated by apparent interlocking of the fetal mentum with the fibroid. Large, anterior lower uterine segment fibroids have the potential to obstruct delivery of the fetal head or of the fetal body, and these patients should be counseled regarding the potential for complications via both vaginal and cesarean deliveries.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e85-e87"},"PeriodicalIF":0.9,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899205","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":"Maternal and Neonatal Morbidities by Race in College-Educated Women.","authors":"Adina R Kern-Goldberger, Nigel Madden, Caitlin Baptiste, Alexander Friedman, Cynthia Gyamfi-Bannerman","doi":"10.1055/s-0043-1778000","DOIUrl":"10.1055/s-0043-1778000","url":null,"abstract":"<p><p><b>Objective</b>  Non-Hispanic black and Hispanic women experience significantly higher adverse maternal and neonatal outcomes compared with non-Hispanic white women. The purpose of this study is to explore whether disparities in obstetric outcomes exist by race among women who are college-educated. <b>Study Design</b>  This is a retrospective cohort study from a multicenter observational cohort of women undergoing cesarean delivery. Women were defined as \"college-educated\" if they reported completion of a 4-year college degree. Race/ethnicity was categorized as non-Hispanic white, non-Hispanic black, Hispanic, Asian, Native American, or unknown. The primary outcome was a composite of maternal morbidity, and a composite of neonatal morbidity was evaluated as a secondary outcome. A multivariable logistic regression model was then utilized to assess associations of race with the primary and secondary outcomes. <b>Results</b>  A total of 2,540 women were included in the study. After adjusting for potential confounding variables, maternal morbidity was found to be significantly higher for college-educated non-Hispanic black women compared with non-Hispanic white women (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.12-2.80). The incidence of neonatal morbidity was significantly higher for non-Hispanic black (OR 1.91, 95% CI 1.31-2.79) and Hispanic (OR 3.34, 95% CI 2.23-5.01) women. <b>Conclusion</b>  In this cohort, the odds of cesarean-related maternal and neonatal morbidities were significantly higher for college-educated non-Hispanic black women, compared with their non-Hispanic white counterparts. This demonstrates that even among women with higher level education, racial and ethnic disparities persist in obstetric outcomes.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e57-e61"},"PeriodicalIF":0.8,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10824592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139574768","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 Association between Sleep and Depression during Late Pregnancy and the Early Postpartum Period.","authors":"Angela G Jones, Bachar S Hadaie, Rachel Bennett, Nimisha Kumar, Chandan K Saha, David M Haas","doi":"10.1055/s-0043-1778003","DOIUrl":"10.1055/s-0043-1778003","url":null,"abstract":"<p><p><b>Objective</b>  To assess and correlate sleep quality and depressed mood symptoms in the late pregnancy and early postpartum periods. <b>Study Design</b>  In a prospective pilot observational study, participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Edinburgh Postnatal Depression Scale (EPDS) questionnaires at delivery, 1, and 2 months postpartum. Pearson's correlation coefficients and PROC MIXED function estimated overall correlation for repeated measures. <b>Results</b>  Twenty-six women were enrolled with a mean gestational age at delivery of 38.4 (± 2.4) weeks. Sleep quality and mood data were available at the three time points for 24, 16, and 11 participants, respectively. Poor sleep scores were noted by 75.0, 87.5, and 72.7% of women at the three time points. An elevated EPDS score of 10 or higher was claimed by 20.8, 12.5, and 18.2% of women, respectively. Higher PSQI scores were positively associated with higher EPDS scores overall ( <i>r</i>  = 0.71, <i>p</i>  < 0.001) and at each of the individual time points ( <i>r</i>  = 0.79, <i>p</i>  < 0.0001; <i>r</i>  = 0.52, <i>p</i>  = 0.04; and <i>r</i>  = 0.70, <i>p</i>  = 0.016, respectively). None of the women reporting good sleep quality had elevated EPDS scores. <b>Conclusion</b>  Poor sleep is commonly reported around delivery, and at 1 and 2 months postpartum, and there is an association between poor sleep and depression symptoms.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e11-e15"},"PeriodicalIF":0.8,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139544926","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 Combined Influence of Maternal Medical Conditions on the Risk of Primary Cesarean Delivery.","authors":"Robert Fresch, Kendal Stephens, Emily DeFranco","doi":"10.1055/s-0043-1777996","DOIUrl":"10.1055/s-0043-1777996","url":null,"abstract":"<p><p><b>Background</b>  Common maternal medical comorbidities such as hypertensive disorders, diabetes, tobacco use, and extremes of maternal age, body mass index, and gestational weight gain are known individually to influence the rate of cesarean delivery. Numerous studies have estimated the risk of individual conditions on cesarean delivery. <b>Objective</b>  To examine the risk for primary cesarean delivery in women with multiple maternal medical comorbidities to determine the cumulative risk they pose on mode of delivery. <b>Study Design</b>  In this population-based retrospective cohort study, we analyzed data from Ohio live birth records from 2006 to 2015 to estimate the influence of individual and combinations of maternal comorbidities on rates of singleton primary cesarean delivery. The exposures were individual and combinations of maternal medical conditions (chronic hypertension [CHTN], gestational hypertension, pregestational diabetes, gestational diabetes, tobacco use, advanced maternal age, and maternal obesity) and outcomes were rates and adjusted relative risk (aRR) of primary cesarean delivery. <b>Results</b>  There were 1,463,506 live births in Ohio during the study period, of which 882,423 (60.3%) had one or more maternal medical condition, and of those 243,112 (27.6%) had primary cesarean delivery. The range of rates and aRR range of primary cesarean delivery were 13.9 to 29.3% (aRR 0.78-1.68) in singleton pregnancies with a single medical condition, and this increased to 21.9 to 48.6% (aRR 1.34-3.87) in pregnancies complicated by multiple medical comorbidities. The highest risk for primary cesarean occurred in advanced maternal age, obese women with pregestational diabetes, and CHTN. <b>Conclusion</b>  A greater number of maternal medical comorbidities during pregnancy is associated with increasing cumulative risk of primary cesarean delivery. These data may be useful in counseling patients on risk of cesarean during pregnancy.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e51-e56"},"PeriodicalIF":0.8,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139545012","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":"Atypical Presentation of Rocky Mountain Spotted Fever in Pregnancy.","authors":"Jenny Wu, Sarah K Dotters-Katz, Megan Varvoutis","doi":"10.1055/s-0043-1778118","DOIUrl":"10.1055/s-0043-1778118","url":null,"abstract":"<p><p>Rocky Mountain spotted fever (RMSF) is a common tick-borne disease and can have variable presentation with potentially fatal outcomes when untreated. We describe an atypical presentation of RMSF in the third trimester. A 37-year-old multiparous woman at 31 ^0/7 weeks' gestation presented normotensive with headaches and fever but no rash or significant tick exposure. She was initially treated for atypical hemolysis, elevated liver enzymes, and low platelet count syndrome but further decompensated, requiring intensive care unit transfer, intubation, and emergent delivery. Doxycycline administration was associated with marked improvement with no significant sequalae to mother or infant. Later convalescent serologies were positive for RMSF. RMSF is a clinically challenging diagnosis in pregnancy. Given significant morbidity and mortality associated with delayed treatment, high suspicion in endemic areas is needed, and prompt antibiotic use with doxycycline should be administered.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e40-e42"},"PeriodicalIF":0.8,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139544833","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}