AJP ReportsPub Date : 2024-01-23eCollection Date: 2024-01-01DOI: 10.1055/s-0043-1777999
Anne R Waldrop, Andrea Henkel, Kelley B Lee, Maurice L Druzin, Natali Aziz, Yasser El-Sayed, Deirdre J Lyell
{"title":"Intrahepatic Cholestasis of Pregnancy and Transaminitis in Women with COVID-19: A Case Series.","authors":"Anne R Waldrop, Andrea Henkel, Kelley B Lee, Maurice L Druzin, Natali Aziz, Yasser El-Sayed, Deirdre J Lyell","doi":"10.1055/s-0043-1777999","DOIUrl":"10.1055/s-0043-1777999","url":null,"abstract":"<p><p><b>Objective</b> The four initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected pregnant women presenting at term gestation to our institution presented with transaminitis. Three of the four were diagnosed with intrahepatic cholestasis of pregnancy (IHCP). Growing evidence exists of an associated transaminitis in nonpregnant SARS-CoV-2 patients. However, there are limited data of hepatic involvement of SARS-CoV-2 in pregnancy, and no previous studies have assessed the association with IHCP in patients with coronavirus disease 2019 (COVID-19). <b>Study Design</b> This was a retrospective, single-center case series of four consecutive pregnant women with a positive result for SARS-CoV-2 presenting with transaminitis in third trimester. <b>Results</b> The clinical courses of four pregnant women with COVID-19 and transaminitis, three of four of whom were diagnosed with IHCP, are described. Testing for SARS-CoV-2 was done through a reverse transcription polymerase chain reaction test of a nasopharyngeal swab. <b>Conclusion</b> As we await larger studies ascertaining the incidence of IHCP in SARS-CoV-2, this prevalence highlights the importance of diagnosing IHCP among women with COVID-19 as a potential etiology of transaminitis, as IHCP risks may be ameliorated with earlier delivery. Moreover, delineating a hepatobiliary association in pregnancy may provide further information about the mechanism of liver impairment in SARS-CoV-2 in all patients.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e16-e18"},"PeriodicalIF":0.8,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139548262","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}
AJP ReportsPub Date : 2024-01-23eCollection Date: 2024-01-01DOI: 10.1055/s-0043-1778112
Ann B Nguyen Pham, Madushka Y De Zoysa, Brian B Ghoshhajra, Nandita S Scott, Afshan B Hameed
{"title":"Bicoastal Spontaneous Coronary Artery Dissection: A Therapeutic Dilemma.","authors":"Ann B Nguyen Pham, Madushka Y De Zoysa, Brian B Ghoshhajra, Nandita S Scott, Afshan B Hameed","doi":"10.1055/s-0043-1778112","DOIUrl":"10.1055/s-0043-1778112","url":null,"abstract":"<p><p>Due to the potential for severe maternal morbidity and even mortality, pregnancy-associated spontaneous coronary artery dissection (P-SCAD) often presents as a clinical conundrum. While current recommendations encourage coronary interventions when medically indicated even during pregnancy, the hesitation still understandably exists. Meanwhile, given the rarity of the condition, the guidelines for management are still based on expert consensus. We present a case of P-SCAD in a 38-year-old woman with initial presentation at 28 weeks' gestation and recurrence at 9 days postpartum. A unique complication of this case is its transcontinental nature: the initial event occurred while the patient was on vacation across the country from her home. Questions arose not only with regard to her immediate management and care but also when she would be able to travel and how her complex care would be continued cross-country. This case raised important questions regarding the antepartum management of acute coronary syndrome (ACS). It also highlights the importance of multidisciplinary care, especially with a cardio-obstetrics team, in the management of P-SCAD and emphasizes the role for universal screening for cardiac diseases in pregnancy.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e34-e39"},"PeriodicalIF":0.8,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139544775","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}
AJP ReportsPub Date : 2024-01-23eCollection Date: 2024-01-01DOI: 10.1055/s-0043-1777998
Alyssa Savelli Binsted, Zeinab Kassem, David Le, Margarita de Veciana
{"title":"Small Cell Cervical Carcinoma in Pregnancy: Therapeutic Options for an Aggressive Cancer Diagnosis.","authors":"Alyssa Savelli Binsted, Zeinab Kassem, David Le, Margarita de Veciana","doi":"10.1055/s-0043-1777998","DOIUrl":"10.1055/s-0043-1777998","url":null,"abstract":"<p><p>Neuroendocrine small cell cervical carcinoma is an aggressive cancer which accounts for approximately 1 to 3% of all cervical neoplasms. Therapy must be altered in pregnancy to optimize maternal-fetal outcomes. A 39-year-old woman presented for a routine prenatal visit and was noted to have a grossly abnormal cervix. Cervical biopsies confirmed small cell carcinoma. At 19 weeks' gestation, chemotherapy was initiated. The patient delivered at 34 weeks' gestation to initiate radiation therapy. Six months later, she was diagnosed with metastatic disease and died from cancer complications. In pregnancy, treatment modalities for small cell cervical carcinoma are based on the patient's gestational age at diagnosis. While aggressive early treatment is preferred, platinum-based chemotherapy can be initiated in the second trimester and radiation therapy delayed until delivery. Small cell cervical carcinoma complicating pregnancy requires aggressive treatment. Chemotherapy in the second trimester with planned delayed radiation therapy, may optimize fetal outcomes.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e22-e25"},"PeriodicalIF":0.8,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139544920","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}
AJP ReportsPub Date : 2024-01-23eCollection Date: 2024-01-01DOI: 10.1055/s-0043-1777997
Violetta Lozovyy, Fawzi Saoud, Luis D Pacheco
{"title":"Peripartum Abdominal Compartment Syndrome Following Extracorporeal Hemodynamic Support.","authors":"Violetta Lozovyy, Fawzi Saoud, Luis D Pacheco","doi":"10.1055/s-0043-1777997","DOIUrl":"10.1055/s-0043-1777997","url":null,"abstract":"<p><p>In massive pulmonary embolism (PE), anticoagulation and thrombolytics may increase the risk of retroperitoneal bleeding following vascular cannulation for extracorporeal hemodynamic support resulting in abdominal compartment syndrome (ACS). A 27-year-old women at 33 weeks of gestation presented with acute chest pain and shortness of breath. Massive PE was diagnosed. Intravenous unfractionated heparin was started together with catheter-directed tissue plasminogen activator (tPA) infusion and mechanical thrombectomy. During the procedure, cardiac arrest developed. Cardiopulmonary resuscitation, intravenous tPA, and urgent perimortem cesarean delivery were performed. After return of spontaneous circulation, profound right ventricular failure required venoarterial membrane oxygenation. Six hours afterward, ACS secondary to retroperitoneal bleeding developed, requiring surgical intervention. ACS may result from retroperitoneal bleeding following cannulation for extracorporeal hemodynamic support.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e19-e21"},"PeriodicalIF":0.8,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139544915","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}
AJP ReportsPub Date : 2024-01-23eCollection Date: 2024-01-01DOI: 10.1055/s-0043-1776149
Amna Iftikhar, Kathleen Barnes, Melissa Figueroa, Antonia P Francis
{"title":"Early Prenatal Diagnosis of Cornelia de Lange's Syndrome with Whole-Exome Sequencing: A Case Report.","authors":"Amna Iftikhar, Kathleen Barnes, Melissa Figueroa, Antonia P Francis","doi":"10.1055/s-0043-1776149","DOIUrl":"10.1055/s-0043-1776149","url":null,"abstract":"<p><p>Cornelia de Lange's syndrome (CDLS) is a multisystem genetic syndrome characterized by well-defined physical, intellectual, and behavioral characteristics. The diagnosis of CDLS is typically done clinically after birth; however, recent studies have demonstrated the ability to use prenatal ultrasound and whole-exome sequencing to diagnose CDLS prenatally. Here we present a prenatal case in which multiple fetal anomalies were identified on ultrasound at 20 weeks of gestation. Use of whole-exome sequencing allowed for successful diagnosis of CDLS in this fetus prenatally.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e31-e33"},"PeriodicalIF":0.8,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139544782","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}
AJP ReportsPub Date : 2024-01-23eCollection Date: 2024-01-01DOI: 10.1055/s-0043-1778113
William M Curtin, Emily A O'Brien, Rachel M Mauro, Elizabeth A Lucarelli-Baldwin, Serdar H Ural, Christina T DeAngelis
{"title":"Fetal Metabolic Alkalosis Resulting from Maternal Vomiting.","authors":"William M Curtin, Emily A O'Brien, Rachel M Mauro, Elizabeth A Lucarelli-Baldwin, Serdar H Ural, Christina T DeAngelis","doi":"10.1055/s-0043-1778113","DOIUrl":"10.1055/s-0043-1778113","url":null,"abstract":"<p><p>We describe a pregnant patient with severe compulsive water ingestion and vomiting that lead to metabolic alkalosis and preterm delivery. A 21-year-old patient was hospitalized multiple times throughout pregnancy for symptoms initially thought to be related to hyperemesis gravidarum. Overtime, it became apparent that the patient induced vomiting by rapidly drinking large volumes of water. At 32 weeks' gestation, rapid ingestion of water caused 3 days of vomiting with findings of hyponatremia, hypokalemia, hypochloremia, metabolic alkalosis, and compensatory respiratory acidosis. Fetal monitoring showed minimal variability and recurrent decelerations; subsequent biophysical profile score of 2/10 prompted urgent cesarean section. A male newborn was delivered and cord blood gases reflected neonatal metabolic alkalosis and electrolyte imbalances identical to those of the mother. Compensatory hypoventilation in both mother and fetus were treated with assisted ventilation. With saline administration and repletion of electrolytes, metabolic alkalosis resolved for both patients within days. Metabolic alkalosis was transplacentally acquired by the fetus. This case demonstrates the development of metabolic alkalosis in a pregnant woman caused by vomiting severe enough to prompt preterm delivery for nonreassuring fetal status. It also demonstrates fetal dependence on both placenta and mother to maintain physiologic acid-base and electrolyte balance.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"14 1","pages":"e48-e50"},"PeriodicalIF":0.8,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139544914","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}
AJP ReportsPub Date : 2023-11-28eCollection Date: 2023-07-01DOI: 10.1055/s-0043-1777099
Dana Senderoff Berger, Anna Galyean, Kelvin Nguyen, Najeeb Alshak, Elizabeth Blumenthal
{"title":"A Case of Significant Transaminitis with Liver Biopsy in a Pregnant Patient with COVID-19.","authors":"Dana Senderoff Berger, Anna Galyean, Kelvin Nguyen, Najeeb Alshak, Elizabeth Blumenthal","doi":"10.1055/s-0043-1777099","DOIUrl":"10.1055/s-0043-1777099","url":null,"abstract":"<p><p>Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has led to a global health crisis. The virus can cause varying severity of liver injury, but the mechanism has not yet been elucidated, especially in pregnancy. We present a morbidly obese 30-year-old woman with COVID-19 at 28 weeks' gestation complicated by significant transaminitis with peak liver enzymes levels of 501/1,313 (aspartate aminotransferase/alanine aminotransferase). Liver biopsy showed reactive changes consistent with medication effect and mild steatosis. Significant transaminitis has been found in both pregnant and nonpregnant patients with COVID-19. Our case demonstrates the multifactorial nature of liver injury in COVID-19 patients including mild underlying liver steatosis combined with possible viral potentiation of medication effect.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"13 4","pages":"e78-e81"},"PeriodicalIF":0.9,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10684339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138457274","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}
AJP ReportsPub Date : 2023-11-07eCollection Date: 2023-07-01DOI: 10.1055/s-0043-1776150
Andrew S Haddad, Melissa H Fries, Helain Landy, Priyanka S Tripuraneni, Sara N Iqbal
{"title":"Evaluation of Early Screening for Diabetes Mellitus in Pregnancy with Hemoglobin A1c.","authors":"Andrew S Haddad, Melissa H Fries, Helain Landy, Priyanka S Tripuraneni, Sara N Iqbal","doi":"10.1055/s-0043-1776150","DOIUrl":"10.1055/s-0043-1776150","url":null,"abstract":"<p><p>Early diabetes screening is recommended for high-risk pregnant women risk via a 1-hour glucose challenge test (1-hour GCT). Hemoglobin A1c (HbA1c) can be obtained with initial obstetric laboratories. We sought to examine the relationship between HbA1c and 1-hour GCT for early diabetes screening in pregnancy. This is a retrospective cohort study of 204 high-risk pregnant women who underwent early HbA1c and 1-hour GCT. Simple logistic regression analysis was performed to predict abnormal 1-hour GCT and diagnosis of diabetes using HbA1c. A total of 158 (77.5%), 44 (21.5%), and 2 (1%) women had HbA1c of less than 5.7, 5.7 to 6.4, and 6.5% or higher, respectively. Seven of 158 (4.4%) women with HbA1c less than 5.7% and 8 of 44 (18.2%) with HbA1c of 5.7 to 6.4% had a diagnosis of diabetes. A positive correlation between early HbA1c and 1-hour GCT was detected. Logistic regression showed HbA1c significantly predicted the risk of diabetes but was not a good predictor of abnormal 1-hour GCT. HbA1c of 5.5% or less had a 97% or higher negative predictive value for early diabetes in pregnancy. There is a positive correlation between HbA1c and 1-hour GCT for the early screening of diabetes in pregnancy. Women with early HbA1c ≤ 5.5% could forego further testing in early pregnancy.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"13 4","pages":"e71-e77"},"PeriodicalIF":0.9,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10630085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71520239","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}
AJP ReportsPub Date : 2023-11-06eCollection Date: 2023-07-01DOI: 10.1055/s-0043-1774728
Omoloro Adeleke, Hussein Elmufti, Jie Zhang, Bhuvaneshwari Jagadesan, Mimily Harsono
{"title":"Double Aneuploidy of Down Syndrome (Trisomy 21) and Jacobs Syndrome (Trisomy XYY) with Complete Tracheal Rings Deformity: Case Report and Literature Review.","authors":"Omoloro Adeleke, Hussein Elmufti, Jie Zhang, Bhuvaneshwari Jagadesan, Mimily Harsono","doi":"10.1055/s-0043-1774728","DOIUrl":"10.1055/s-0043-1774728","url":null,"abstract":"<p><p>Down syndrome (DS, trisomy 21) with an extra copy of chromosome 21 is one of the most common aneuploidies in humans. Jacobs syndrome or XYY syndrome (trisomy XYY) with an extra copy of sex chromosome Y is a rare sex chromosome trisomy in males. Double aneuploidy (DA) with an extra copy of chromosome 21 and sex chromosome Y is an extremely rare occurrence. Most trisomy 21 results from nondisjunction during maternal oocyte meiosis-I, whereas trisomy XYY is results from nondisjunction during paternal spermatocyte meiosis-I. We present a case of natural conception premature newborn of 30.4 weeks gestational age who had a DS facial phenotype with extensive syndactyly on both hands and feet. Other multisystem congenital anomalies were discovered, including mal-aligned perimembranous ventricular septal defect, bicuspid aortic valve, Dandy-Walker malformation's tetra-ventriculomegaly, and a rare complete tracheal rings deformity (CTRD) with trachea stenosis. Prenatal amniocentesis and postnatal chromosomal karyotyping analysis detected 48, XYY, + 21 nontranslocation trisomy 21, and free-lying Y chromosome without translocation. The existence of DA is rarely reported in literature reviews. In this review, we will discuss the characteristics of DS and Jacobs syndrome as well as the associated multiorgan malformation including the rare lethal CTRD.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"13 4","pages":"e53-e60"},"PeriodicalIF":0.9,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71477162","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}
AJP ReportsPub Date : 2023-11-06eCollection Date: 2023-07-01DOI: 10.1055/s-0043-1776148
Dana S Berger, Virginia Tancioco, Vineet K Shrivastava
{"title":"Congenital Sodium Diarrhea: Antenatal Diagnosis May Prevent Unnecessary Surgery in the Neonate.","authors":"Dana S Berger, Virginia Tancioco, Vineet K Shrivastava","doi":"10.1055/s-0043-1776148","DOIUrl":"10.1055/s-0043-1776148","url":null,"abstract":"<p><p>Congenital sodium diarrhea (CSD) is a rare, life-threatening condition characterized by intractable diarrhea, hyponatremia, and metabolic acidosis. It presents similarly to other congenital disorders and, therefore, is often misdiagnosed and mistreated. We present a case of CSD that presented with dilated loops of bowel and polyhydramnios at 18 weeks and was thought to be a congenital bowel obstruction. The patient was therefore managed surgically after birth with a diverting ileostomy, however was later found to have elevated stool sodium levels and metabolic derangements consistent with CSD. Our case demonstrates the need for high index of suspicion for congenital diarrheal disorders to prevent unnecessary surgery and a delay in appropriate medical management of this rare condition.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"13 4","pages":"e61-e64"},"PeriodicalIF":0.9,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71477161","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}