1/13. Leflunomide: new antirheumatic drug. Effect on pregnancy outcomes.QUESTION: I am treating a 34-year-old woman with rheumatoid arthritis. She began taking the new drug leflunomide (Arava) 6 months ago and had good clinical response. She is now planning her first pregnancy. What should she do? ANSWER: Leflunomide is a new and effective disease-modifying antirheumatic drug. Animal studies have shown an increased rate of malformations and fetal death in various species, but there are no data on pregnancy outcomes in humans treated with leflunomide. Since the drug has a prolonged and unpredictable elimination half-life, it should be stopped during pregnancy. The manufacturer recommends that patients who wish to become pregnant be treated with cholestyramine, which enhances elimination.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/13. Impact of chemical warfare with agent orange on women's reproductive lives in vietnam: a pilot study.During the American war in vietnam, huge quantities of the highly toxic herbicide dioxin ('Agent Orange'), were sprayed over large areas of central and south vietnam. In addition to polluting the environment and causing cancers and other diseases in those directly exposed to it, dioxin has caused high rates of pregnancy loss, congenital birth defects and other health problems in their children. This paper reports the findings of a pilot study in the year 2000 among 30 Vietnamese women whose husbands and/or who themselves were exposed to Agent Orange. The aim was to develop research in order to explore the impact of chemical warfare on people's lives. Using the reproductive lifeline and semi-structured interviews, information was gathered on both partners' periods of exposure to Agent Orange, pregnancy outcomes, perceived health problems of children and experiences of living with handicapped children. The women had had a high number of miscarriages and premature births. About two-thirds of their children had congenital malformations or developed disabilities within the first years of life. Most of the families were poor, aggravated by impaired health in the men, the burden of caring for disabled children, and feelings of guilt and inferiority. The plight of 'Agent Orange families' is special and should be placed in its historical and political context.- - - - - - - - - - ranking = 2keywords = life (Clic here for more details about this article) |
3/13. esophageal atresia and tracheoesophageal fistula in two infants born to hyperthyroid women receiving methimazole (Tapazol) during pregnancy.We report on 2 newborn infants with esophageal atresia and tracheoesophageal fistula (EA TEF) born to hyperthyroid mothers receiving methimazole (Tapazol) before and during their entire pregnancies. Both mothers were euthyroid during gestation and developed hydramnios diagnosed during weeks 34 and 33 of gestation. Premature delivery (36.2 weeks of gestation) occurred in one case, and both newborn infants were small for date with palpable goiter; one of them had other associated malformations. hypothyroidism was diagnosed by laboratory tests in both cases. Corrective surgery was undertaken, but both newborn infants developed septicemia and renal insufficiency and died in the first week of life. The EA TEF and a normally placed enlarged thyroid gland were confirmed at necropsy. These cases represent a previously unreported example of the association of maternal ingestion of methimazole during pregnancy and EA TEF.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
4/13. Mobius sequence in children exposed in utero to misoprostol: neuropathological study of three cases.BACKGROUND: misoprostol exposure in the first trimester of pregnancy has been related to congenital malformations, particularly the Mobius sequence and terminal transverse limb defects. CASES: Neuropathological findings of three patients with Mobius sequence related to misoprostol are reported. No previous pathological studies have shown these abnormalities to be associated with misoprostol exposure in utero. The brain stem was cut serially, from the rostral mesencephalum to the caudal aspect of the medulla, and all fragments were stained with hematoxylin-eosin and cresyl violet. Old ischemic-anoxic foci of gliosis, with necrosis and calcification, dorsally situated, were present from the pons to the medulla, involving some cranial nerve nuclei (especially the IV, VII, and XII) that were partially or completely depopulated of neural cells. CONCLUSIONS: The findings suggest a circulatory mechanism to the Mobius sequence, with vascular disruption involving the territory of the subclavian artery, occurring in a critical period of embryonic life between six to eight weeks postconception. These cases add further evidence of the role of misoprostol as a teratogen.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
5/13. Acute promyelocytic leukemia during pregnancy: report of 3 cases.Acute promyelocytic leukemia (APL) is characterized by onset at a young age and a life-threatening hemorrhagic diathesis, which is attributed to a disseminated intravascular coagulation (DIC)-like coagulopathy. The discovery of all-trans-retinoic acid has changed the course of APL treatment by reducing the onset of DIC and inducing a complete and durable remission in more than 90% of patients. The occurrence of APL during pregnancy is not a frequent event, but the management of these patients raises many therapeutic and ethical dilemmas and requires a careful clinical case evaluation of fetal and maternal risk, coagulation status, the parents' wishes, and therapeutic options. Here we describe 3 patients with APL diagnosed during pregnancy. Clinical data and the therapeutic approaches are presented. In the discussion, we analyze clinical decisions and therapeutic options and compare our cases with those found in the literature.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
6/13. Renal tubular dysgenesis associated with in utero exposure to Nimuselide.Maternal ingestion of the selective cyclo-oxygenase-2 (COX-2) inhibitor Nimuselide has been reported to be associated with the development of oligohydramnios and neonatal renal failure in some cases. We report a case of neonatal renal failure associated with maternal ingestion of Nimuselide in the third trimester of pregnancy. The neonate presented with metabolic acidosis and non-oliguric renal failure on the second day of life. The renal histopathology showed evidence of renal tubular dysgenesis. The child continues to have elevated serum creatinine and hypertension at 10 months of age.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
7/13. Foetal life and a legal duty of care.Until 1932 in england the right to sue for injuries caused by the fault of another was not recognised in the absence of contract. The law of negligence has expanded and developed as new facts are presented to the courts of their decision. One of the basic elements of the tort of negligence is proof that the defendant owed a duty of care to the plaintiff. The law with respect to those who suffer injury who are in being has been clearly defined. However, the law has now developed to hold that a child is born with injuries caused by the negligence of another whilst the child was in utero has a right to bring an action for compensation for those injuries provided the child is born alive. A further development in this area of law has been the legal recognition of a claim by a child who suffers injuries in utero caused by a negligent act committed against the mother at a time when the child was not even conceived provided the child can prove a duty of care was owed and that the injuries complained of were caused by the alleged negligent act. Thus midwives and other health professional who care for and advise pregnant women need to keep in mind that a duty of care may be owed to an unborn child or a future unborn child as well as to the pregnant women.- - - - - - - - - - ranking = 4keywords = life (Clic here for more details about this article) |
8/13. Congenital glaucoma and retinal dysplasia.The differential diagnosis of leukocoria (pseudoglioma) in the neonate includes multiple conditions, including malformations with retinal dysplasia as a component. Typically bilateral, retinal dysplasia is characteristically seen in microphthalmic eyes. Certain chromosomal defects have been described. The case reported herein presented in the first month of life with an enlarged eye, elevated intraocular pressure, prominent iris vasculature, and leukocoria. family history was positive in one respect: this is the second child of a Viet Nam veteran exposed to Agent Orange. The first child, from a different mother, also had birth defects. Other than his left eye, the child is completely normal. ultrasonography showed posterior vitreous opacities of indeterminate configuration. CT scan suggested a posterior intraocular mass. Histologically, the principal features were an anomalous, largely unformed corneoscleral angle, intraocular hemorrhage, and retinal dysplasia. light microscopic studies were performed. The corneoscleral angle revealed an anteriorly inserted iris with an absence of trabecular meshwork and Schlemm's canal. This case is considered unique on the basis of the association of retinal dysplasia with congenital glaucoma and larger-than-normal eye. The significance of reported paternal exposure to Agent Orange in this instance is unknown.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
9/13. indomethacin and the fetal renal nonfunction syndrome.A pregnancy during which both beta-adrenergics and indomethacin were administered in order to stop preterm uterine contractions is reported. After 8 wk of therapy a Caesarean section was performed. The female neonate had all the characteristics of a Potter's facies, was anuric and died after 47 h of extra-uterine life. A possible relationship between this perinatal death and the prolonged intra-uterine exposure to indomethacin is discussed.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
10/13. Neonatal manifestations of maternal phencyclidine (PCP) abuse.Two cases concerning newborn infants whose mothers used phencyclidine (PCP) during pregnancy are described. The neonatal symptoms of maternal PCP abuse were jitteriness, hypertonicity, vomiting, and one case of diarrhea. In both infants, PCP was detected in the urine during the first few days of life. Both infants were successfully treated with phenobarbital but they continued to remain jittery and slightly hypertonic following discontinuation of the therapy. In one case the infant was noted to be microcephalic. In the neonate, the symptoms of maternal PCP abuse are similar to the symptoms of narcotic withdrawal. The diagnosis of PCP effects in the neonate can be confirmed by urinalysis for the drug. The teratogenicity of PCP remains a possibility. The metabolism and treatment of PCP effects in the newborn need further clarification.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
| | Next -> |