1/6. The course of pregnancy in a patient with nail-patella syndrome.INTRODUCTION: The nail-patella syndrome is a rare autosomal dominant condition with high penetrance. pregnancy in such a patient is rare and we believe this to be the first report of a live birth occurring in a patient with nail-patella syndrome. CLINICAL PICTURE: A 25-year-old patient presented in her first pregnancy with nephrotic syndrome associated with characteristic bone abnormalities and nail dysplasia and was later diagnosed to have nail-patella syndrome. In her second pregnancy, the course of her pregnancy was complicated by further deterioration of renal function with superimposed pre-eclampsia resulting in early delivery at 28 weeks. CONCLUSION: Such pregnancies should be regarded as high risk and managed jointly with the renal physician in a tertiary care centre to ensure an optimal outcome to the mother and baby.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Fetal meconium peritonitis in the infant of a woman with fulminant hepatitis b. A case report.BACKGROUND: Simultaneous fulminant maternal hepatitis b infection and fetal meconium peritonitis has never been reported before in the English-language literature. CASE REPORT: Fetal meconium peritonitis was detected at 32 weeks' gestation in a 21-year-old woman suffering from fulminant hepatitis. Fulminant hepatitis b was confirmed by clinical observation and serologic examination results. The course was also complicated with preterm labor. The fetus was diagnosed with meconium peritonitis prenatally. Because of failed tocolytic treatment, the fetus was delivered vaginally. Both the mother and fetus received intensive care, and the mother recovered. In contrast, the fetus's course worsened due to progressive abdominal distension. Although exploratory laparotomy was attempted, the operation was not successful. The infant died five days after birth. CONCLUSION: Recognition of the predisposing factors in fetal meconium peritonitis and immediate referral to a tertiary medical center, where specialists are available, could help physicians determine an accurate diagnosis and might improve prognosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. sepsis and multisystem organ failure in a woman attempting interval delivery in a triplet pregnancy: a case report.BACKGROUND: Interval delivery of the fetuses in multiple gestations has been shown to increase perinatal survival. CASE: A woman attempting interval delivery of triplets at 21 weeks developed chorioamnionitis, acute respiratory distress syndrome and tubular necrosis 7 days after delivery of the first fetus. CONCLUSION: When counseling women about the typically favorable outcomes of delayed interval deliveries, physicians should also warn of the potential risk of complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Maternal osteoporosis after prolonged magnesium sulfate tocolysis therapy: a case report.tocolysis therapy with magnesium sulfate is known to affect calcium homeostasis. Prolonged infusion of magnesium sulfate (MgSO(4)) has been used for the treatment of refractory preterm labor, and has been reported to change maternal calcium homeostasis and possible mineralization. In this case report, we present a woman in her mid thirties who had undergone intravenous MgSO(4) tocolysis therapy, and developed osteoporosis leading to significant morbidity after delivery. The laboratory investigation, including the bone scan, magnetic resonance image, indices of bone turnover, and the results of 2 years of follow-up of bone mineral density, are also reported. This case report supports the existence of a possible association between prolonged intravenous magnesium tocolysis and maternal osteoporosis. To prevent osteoporosis, it is important to avoid a prolonged period of MgSO(4) tocolysis. In cases of prolonged MgSO(4) treatment and bedrest, physicians should be aware of the risk of osteoporosis. The recommended management is also discussed in this report.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Preterm labor in the quadriplegic parturient.The occurrence of preterm labor is not uncommon in the pregnant quadriplegic. early diagnosis is hampered by the inability of most quadriplegics to sense uterine contractions in the usual way. A patient we recently treated for preterm labor learned to recognize contractions by the associated symptoms of autonomic hyper-reflexia: flushing, headache, and piloerection. Tocolytic therapy was successful and a favorable neonatal outcome occurred. Increased awareness by the physician and the pregnant quadriplegic patient is encouraged so that symptoms of autonomic hyper-reflexia may be recognized as potentially indicative of uterine contractions.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. pregnancy and delivery in tetraplegic women.Increase in survival of spinal cord injured (SCI) women, society's acceptance that their lives should be similar to those of non-disabled women and their better general health are increasing the number of SCI women who become pregnant and will be delivered of a child. Vaginal delivery is preferred. Any SCI woman whose level is at T6 or higher is at risk for acute autonomic hyperreflexia as a result of uterine contractions. If induction is with Pitocin/oxytocin, the risk is even greater. communication with the woman's obstetrician is essential. The patient should be provided with a packet of information to share with the obstetrician. This should be followed with a phone call from the SCI physician to the obstetrician. Effective management includes epidural anesthesia; vacuum extraction is helpful in the expulsion stage. episiotomy is usually not needed since the pelvic floor is relaxed. In addition, there is an increased incidence of dehiscence since SCI women should be mobilized early and need to transfer in and out of a wheelchair. blood pressure needs to be taken during the peak of contraction. This needs to be compared to prenatal blood pressures. If prenatal blood pressure is 80/60 or 90/60 but during contraction is 130/80 with a pounding headache, that indicates autonomic hyperreflexia which is an indication for epidural anesthesia. With improvement of acute care and more effective rehabilitation, pregnancy and delivery in spinal cord injured (SCI) women will occur more frequently. No one has any great experience with this situation and most articles report only a few cases. Even the report by Goller and Paeslack4 dealt with 175 cases from 42 centers in 24 countries. Most women were paraplegic and several who were injured early in their pregnancy had abnormal babies (possibly due to x-rays taken for spinal injury). Our spinal cord injury staff were pleased when we had two tetraplegic patients who were pregnant. It helped confirm our belief that life and its functions continue after paralysis. Staff members were involved in prenatal care, were present during delivery and were involved with postnatal care. Even more important is the fact that rehabilitation from the start was oriented with child care in mind. Occupational therapists used their skills and imagination to develop a program for newborn baby care by the tetraplegic mother.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |