Patients Of Childbearing Age Research Articles

Two successful pregnancies in a chronic myeloid leukemia patient treated with imatinib

The number of CML patients in child-bearing age and treated with imatinib is increasing. These women may want to be pregnant or are actually pregnant while on imatinib. Physicians do not know when to stop the treatment and what the risks are for the foetus and the mother. We report a case of a CML patient treated with imatinib who has two children, now 3 years and 10 months of age, in good health. The mother was in complete molecular remission, relapsed during pregnancy and reverted to remission in both cases after delivery.

Mortality in Sickle Cell Patients on Hydroxyurea Therapy

Mortality in Sickle Cell Patients on Hydroxyurea Therapy

Effects of 6-mercaptopurine treatment on sperm production and reproductive performance: A study in male mice

ObjectiveAzathioprine and 6-mercaptopurine interact in purine metabolism and DNA synthesis, thus their potential mutagenic effects have been of concern in the management of inflammatory bowel disease (IBD), especially in patients of childbearing age. Although several clinical studies have indicated their safety in both reproduction and pregnancy, in a recent large epidemiological study concerns were raised about their adverse effects in pregnant patients with IBD, and experimental or basic data on this subject are limited. The aim of this study was to investigate sperm production, sperm quality, and reproductive outcome following prolonged 6-MP administration to male mice.Material and methodsHighly inbred Balb/c adult male mice were used. 6-MP at doses of 2, 5, and 8 mg/kg (n=9 for each group) was given daily for 51 days and the treatment group was compared with controls. After 45 days of treatment, the mice were mated with females. Following 13 days of pregnancy, the products of conception were evaluated and live fetuses were examined for gross malformations. Sperm production and morphology were examined after 51 days of 6-MP administration.ResultsTreatment with 6-MP at all doses did not affect sperm morphology and sperm production in the testicular tubules, as compared with controls (70% normal sperm). However, pregnancy rates were inversely related to escalating doses of 6-MP: 55%, 41%, 28%, and 16% for control, 2, 5, and 8 mg/kg groups, respectively. Resorption rates (abortions) were 21% in the control group as compared with 45–50% in all the treatment groups, but the incidence of major congenital malformations was not increased.ConclusionsLong-term 6-MP treatment in male mice did not impair sperm production and sperm morphology. However, a significantly high rate of embryonic resorption indicated occult sperm damage. Thus, normal sperm analysis does not necessarily imply that sperm damage at genetic level did not occur. It is difficult to extrapolate from these results to the clinical use of 6-MP/azathioprine in IBD patients; however, further basic genetic testing for DNA damage and clinical follow-up are warranted.

Contraception for women with diabetes mellitus

Women with diabetes have a higher risk of foetal abnormalities than those without. Glycaemic control early in pregnancy has a major effect on this risk. Anecdotal evidence suggests that women wishing to conceive will actively seek advice from health care professionals and strive to achieve the recommended pre-conception targets. Appropriate contraception is crucial to prevent unplanned pregnancies. We wished to know if we were providing appropriate contraception advice to our patients. A database search of 505 women of childbearing age who attend the hospital clinic revealed only 15 entries of current contraception. Patient questionnaires were distributed to 65 female patients of childbearing age (16–49 years) attending the diabetes clinic. The results identified that 16% had received no advice regarding contraception, 49% were advised by their GP, 9% from a family planning clinic, 7% from the doctor at the diabetes clinic, 9% from their practice nurse, 4% from their gynaecologist and 6% from the hospital doctor and GP. In all, 24% were using condoms only. This group of women is at a higher risk of unwanted pregnancy. In this article we suggest that contraception advice should be part of the annual review and we discuss the risks and benefits of different methods of contraception. Copyright © 2005 John Wiley & Sons, Ltd.

Embolization of uterine fibroids.

Since the first description of uterine artery embolization for the treatment of symptomatic fibroids of the uterus in 1994, this minimally invasive procedure has been increasingly performed in many Western countries. The method is characterized by a high technical success rate of about 85%, a highly significant relief of symptoms, and a very low rate of complications that make this method an appealing alternative to classic treatment options of surgical or laparoscopic myomectomy or hysterectomy. These characteristics have made the procedure well accepted by affected women. Nevertheless, indications and potential contraindications have to be evaluated carefully, especially in patients of childbearing age whenever a considerable number of deliveries is reported after uterine fibroid embolization. This article discusses the clinical background, indications and contraindications, angiographic techniques, potential complications and side effects, and the mid-term results known at present.

Congenital heart disease and acquired valvular lesions in pregnancy

Hintergrund: Die jahrliche Zahl schwangerer Herzfehlerpatientinnen betragt in Deutschland etwa 6 000 (jede 130. Schwangerschaft). Die voraussehbaren hamodynamischen Veranderungen in der Schwangerschaft erlauben in der Mehrzahl der Falle eine recht zuverlassige Vorhersage des Schwangerschaftsverlaufs fur Mutter und Kind. Folgende funf Aspekte sind von betrachtlicher klinischer Bedeutung. Unkorrigierte angeborene Herzfehler: Patientinnen mit nicht korrigierbaren komplexen Herzfehlern, einer nach Palliationsoperation persistierenden myokardialen Insuffizienz oder betrachtlichen pulmonalvaskularen Widerstandserhohungen sollte von einer Schwangerschaft abgeraten werden. Pratrikuspidale Kurzschlussverbindungen werden in der Schwangerschaft in aller Regel gut toleriert. In den seltenen Fallen einer deutlichen symptomatischen Verschlechterung ist der katheterinterventive Shuntverschluss heute Therapie der Wahl. Bei Patientinnen mit Ventrikelseptumdefekt oder persistierendem Ductus Botalli liegt in aller Regel ein flussbegrenzender Defekt vor, der sich im Verlauf einer Schwangerschaft meist nicht negativ auswirkt. Bei unbehandelten Aortenisthmusstenosen sind in 2,3% der Falle schwere Hypertonien, myokardiale Dekompensationen, Aortendissektionen und zerebrale Blutungen berichtet worden, deren Pravention spezifische Beratung und Therapie erfordert. Korrigierte angeborene Herzfehler: Die Gefahrdung von Mutter und Kind ist nach Korrekturoperationen einer Fallot'schen Tetralogie vom Korrekturergebnis abhangig. Das Risiko erscheint gut abschatzbar. Bei komplexen zyanotischen Vitien besteht ein deutlich erhohtes maternales Risiko bezuglich myokardialen Pumpversagens, thromboembolischer Komplikationen, komplexer Arrhythmien und Endokarditiden. Die Inzidenz fetaler Aborte, Fruhgeburten, Unreife bei der Geburt sowie kongenitaler Fehlbildungen betragt > 50%. Erworbene Herzklappenfehler: Aufgrund der Schwangerschaftsphysiologie verschlechtert sich die hamodynamische Situation bei Mitralstenosen regelhaft. Patientinnen mit Klappenoffnungsflachen < 1,5 cm2 tolerieren diese Schwangerschaftsbedingungen haufig nicht. Sind die begrenzten Moglichkeiten einer medikamentosen Therapie erschopft, ist die perkutane Ballonvalvulotomie heute Therapie der Wahl. Die in Kompetenzzentren erzielten Behandlungsergebnisse sind auserordentlich gunstig. Die schwangerschaftstypische periphere Vasodilatation und Frequenzerhohung fuhren dazu, dass die hamodynamischen Auswirkungen einer Mitral- und Aorteninsuffizienz wahrend der Schwangerschaft in aller Regel nicht aggraviert werden. Aortenklappenstenosen sind bei Schwangeren auserordentlich selten. Der transaortale Blutfluss und Gradient nehmen im Verlauf der Schwangerschaft aufgrund der relativ verlangerten Systolendauer ab. Die linksventrikulare Wandspannung nimmt dagegen zu, so dass trotz Abnahme des Gradienten eine myokardiale Dekompensation resultieren kann. Hypertrophe Kardiomyopathie: Der Verlauf gestaltet sich meist gunstig. Eine praexistente Herzinsuffizienz wird bei etwa 20% der Patientinnen in der Schwangerschaft aggraviert. Besonders schlecht toleriert werden Vorhofflimmerepisoden und supraventrikulare Tachykardien. Beide konnen Mutter und Fetus gefahrden. Orale Antikoagulation: Die moglichen Antikoagulationsstrategien sind mit einem unterschiedlich hohen maternalen und fetalen Risiko verbunden. Bei gegebener Indikation ist die ununterbrochene orale Antikoagulation mit Phenprocoumon mit dem geringsten Risiko fur die Mutter, die Beendigung jeglicher Antikoagulation mit dem geringsten Risiko fur das ungeborene Kind verbunden. Einzelentscheidungen sind schwierig und sollten in die Hand eines erfahrenen Kompetenzzentrums gegeben werden.

Establishment of a heart valve homograft bank using existing facilities

THE PROGRESS of cryobiology together with broadening surgical indications have increased the demand for heart valve homografts. Cryopreserved aortic valves have been implanted either in the sub-coronary position or as a complete aortic root replacement. Reconstruction of the right ventricular outflow tract for various forms of congenital heart defects has been performed with aortic or pulmonary homografts. Pulmonary valve homografts have been used for right ventricular outflow reconstruction during the “Ross” procedure. Mitral valve homografts are used for the replacement of the mitral valve in female patients of child-bearing age and in other patients who bears contraindications for anticoagulation. The disadvantages of homografts include limited availability and durability. Although some authors claim the durability of cryopreserved homograft to be superior to that of fresh homografts, other studies did not affirm this, and the different results are probably related to some extent to variability in the sterilization and the preservation protocols. On the other hand, it is widely agreed that cryopreservation increases the shelf life of homografts from a few weeks of the fresh antibiotic-preserved material to at least 5 years among cryopreserved grafts. Thus the problem of availability may be partly solved by using cryopreservation rather than “fresh” grafts, and by establishing more homograft laboratories (“banks”) in remote areas. Establishing an independent homograft bank is costly. We sought to establish an independent bank at no additional cost as a model that can be implemented in any medical center containing some form of tissue bank (eg, a bone marrow bank).

Postoperative changes in thyrotropin-binding inhibitory immunoglobulin level in patients with Graves' disease: is subtotal thyroidectomy a suitable therapeutic option for patients of childbearing age with Graves' disease?

Thyroid-stimulating hormone (TSH)-binding inhibitory immunoglobulin (TBII) is thought to be one of the essential causes of Graves' disease, and most cases of neonatal hyperthyroidism can be explained by transplacental passage of TBII. Because surgery is often indicated for patients of childbearing age, it is important to elucidate how surgery reduces TBII levels. Between 1988 and 1991 a total of 946 female patients with Graves' disease underwent subtotal thyroidectomy. Follow-up examination was undertaken at 1, 2, 3, and 4 to 5 years after surgery. At 4 to 5 years after surgery, 76.8% of patients without recurrent overt hyperthyroidism had TBII < 20%. In patients with recurrent hyperthyroidism, TBII increased gradually during follow-up, and they had higher TBII levels than nonrecurrence patients. There were a few euthyroid and hypothyroid patients who had TBII > 60%, and the number of such patients decreased annually. In most of the patients, immunologic remission was obtained by subtotal thyroidectomy except for their having recurrent hyperthyroidism. To acquire immunologic remission, hormonal remission, at least, would be necessary. Because no definite factor other than the size of the thyroid remnant related to postoperative thyroid function was elucidated, near-total thyroidectomy rather than subtotal thyroidectomy is expected to be induced not only hormonal remission but also immunologic remission. It should be noted that a few patients achieved hormonal remission but not immunologic remission.

Intra- and suprasellar colloid cysts.

During the past 11 years 69 patients underwent transsphenoidal surgery for symptomatic intra- and suprasellar non-neoplastic cysts in our department. Eighteen of them harbored intra- and suprasellar colloid cysts. The most frequent presenting symptoms were oligomenorrhea, galactorrhea, and headaches. One patient presented with polydipsia. One male patient complained about mild hypogonadism and oligospermia. Two male patients presented with symptoms of panhypopituitarism. Endocrine assessment revealed hyperprolactinaemia in 72% of the female patients. Hypogonadism was found in 72%. Panhypopituitarism was found in two cases. During transsphenoidal surgery, a circumscribed collection of colloid material was removed in each case. Additional tumorous tissue was encountered in three cases that harbored a concomitant pituitary adenoma. Biopsies confirmed the surrounding tissue to be normal pituitary tissue. Postoperatively, regular menstrual cycles were found in 82% of the female patients with oligomenorrhea and headaches improved in 80%. Serum prolactin levels were restored in 92%, galactorrhea ceased in 89%. Only in one case deterioration of pituitary function occurred (diabetes insipidus). Symptomatic SIADH occurred in another one. There were no other post-operative complications. We conclude, that transsphenoidal surgery is a safe therapy for treating symptomatic intra- and suprasellar colloid cysts. Surgery is mainly indicated for female patients in childbearing age to restore fertility and to prevent further deterioration of pituitary function. The differential diagnosis is often unclear preoperatively, but a non-enhancing mass on MRI between anterior and posterior lobe may suggest the presence of an intra- and suprasellar colloid cyst.

Registry of Pregnancy in Dialysis Patients

A total of 2,299 dialysis units listed by the Health Care Finance Administration were surveyed to determine the frequency and course of pregnancies in dialysis patients. The responses included 930 units caring for 6,230 females aged 14 to 44 years (1,699 receiving peritoneal dialysis and 4,531 receiving hemodialysis). Two percent of the female patients of childbearing age became pregnant over a 4-year period (2.4% of the hemodialysis patients and 1.1% of the peritoneal dialysis patients). The infant survival rate was 40.2% in the 184 pregnancies in women who conceived after starting dialysis and 73.6% in the 57 pregnancies in women who started dialysis after conception. In the subset of women in whom dialysis modality was known, infant survival was not significantly different between the hemodialysis and peritoneal dialysis patients (39.5% v 37%). There was a trend toward better infant survival in women who received dialysis > or = 20 hours per week and a weak correlation between number of hours of dialysis and gestational age (P = 0.05). Maternal complications included two maternal deaths and five intensive care unit admissions for hypertensive crisis. Seventy-nine percent of women had some degree of hypertension, and 32 had blood pressure higher than 170/110 mm Hg. Only 5.9% of women had a hematocrit greater than 30% throughout pregnancy. Twenty-six percent of women treated with erythropoietin (EPO) and 77% of women not receiving EPO required transfusions. Eleven infants had congenital anomalies and 11 had long-term medical problems. Eighty-four percent of infants born to women who conceived after starting dialysis were premature. The likelihood of a surviving infant resulting from pregnancy in dialysis patients is higher than previously observed. There is no preferred dialysis modality. There is a suggestion that increased dialysis time may improve outcome. Prematurity remains a major cause of morbidity and likely contributes to a high frequency of long-term medical problems in surviving infants.

Preconception Care

BACKGROUND: Preconception care (PC) aims to identify and reduce a number of modifiable factors that can adversely affect pregnancy outcome. AIM: To ascertain both knowledge of the attitudes towards PC among members of primary health care teams (PHCTs) and registered women of childbearing age in a representative sample of general practices in Harrow. METHOD: A questionnaire survey was conducted in a randomly selected group of nine general practices in the London borough of Harrow. Subjects included all relevant health professionals and female patients of childbearing age registered with the practices. RESULTS: A total of 62/88 (70.5%) health professionals and 811 women (1 in 20 of the entire target population) completed the questionnaires. Nurses' knowledge matched that of the doctors, except in the area of genetics. Over 85% of all health professionals believed that PC could be of benefit to both mother and baby. Women were generally well informed; Asian women, those born outside the UK, those who had never been pregnant, and those who had not undertaken education beyond the age of 18 years were significantly less well informed. Health professionals considered PC to be best delivered opportunistically by nurses, and this method appeared to be acceptable to most female patients of childbearing age, although it was significantly less acceptable among Asians. CONCLUSION: Among health professionals and women of childbearing age, there is generally a good level of knowledge of PC, although certain groups are less well informed than others and could benefit from a targeted education approach. Widespread agreement that PC is worthwhile was found among PHCT members, but this view is less strongly held by the female public, with the acceptability of providing PC opportunistically differing significantly between ethnic groups.

Ovarialtumor geringer maligner Potenz (Borderline) im fertilen Alter

This study reports on the operative procedure in a 25-year-old female patient with a borderline ovarian tumour. The patient underwent initial laparoscopic salpingo-ophorectomy for a 6-cm cystic process in the left ovary. After the process was diagnosed as an ovarian tumour with a low malignant potential, a second laparoscopic procedure was performed, which involved resection of a wedge of tissue from the right ovary, a left pelvic lymphadenectomy, and an omentectomy. A metastasis of low malignant potential of the same histologic type as the primary tumour was found in one of the 16 of the removed lymph nodes. Due to these findings, we then performed a hysterectomy, right salpingo-ophorectomy, and pelvic lymphadenectomy in a third procedure. A focal tumour with a low malignant potential was also detected in the right ovary; otherwise the tissue specimen was free of tumour. Aspiration cytology was negative. The tumour markers were within the normal range. The diagnosis and management of borderline tumours in female patients of childbearing age are discussed on the basis of the presented case.

Childbearing age patients with essential thrombocythemia: Should they be placed on interferon?

American Journal of HematologyVolume 52, Issue 4 p. 331-332 Letters and CorrespondenceFree Access Childbearing age patients with essential thrombocythemia: Should they be placed on interferon? Jose L. Díez-Martín, Corresponding Author Jose L. Díez-Martín Servicio de Hematología, Clínica Puerta de Hierro, Universidad Autónoma, Madrid, SpainServicio de Hematología, Clínica Puerta de Hierro, Universidad Autónoma, Madrid, SpainSearch for more papers by this authorM. Helena Bañas, M. Helena Bañas Servicio de Hematología, Clínica Puerta de Hierro, Universidad Autónoma, Madrid, SpainSearch for more papers by this authorManuel N. Fernández, Manuel N. Fernández Servicio de Hematología, Clínica Puerta de Hierro, Universidad Autónoma, Madrid, SpainSearch for more papers by this author Jose L. Díez-Martín, Corresponding Author Jose L. Díez-Martín Servicio de Hematología, Clínica Puerta de Hierro, Universidad Autónoma, Madrid, SpainServicio de Hematología, Clínica Puerta de Hierro, Universidad Autónoma, Madrid, SpainSearch for more papers by this authorM. Helena Bañas, M. Helena Bañas Servicio de Hematología, Clínica Puerta de Hierro, Universidad Autónoma, Madrid, SpainSearch for more papers by this authorManuel N. Fernández, Manuel N. Fernández Servicio de Hematología, Clínica Puerta de Hierro, Universidad Autónoma, Madrid, SpainSearch for more papers by this author First published: August 1996 https://doi.org/10.1002/(SICI)1096-8652(199608)52:4<331::AID-AJH21>3.0.CO;2-FCitations: 10AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume52, Issue4August 1996Pages 331-332 ReferencesRelatedInformation

Ultrasound as an Aid in the Diagnosis of Acute Appendicitis

This 1-year prospective study used high-resolution ultrasound at 5 MHz to assess 79 patients admitted with a possible diagnosis of acute appendicitis. The sonographic criterion used to diagnose acute appendicitis was visualization of a noncompressible appendiceal shadow having a diameter of 5 mm or more. Ultrasound examination proved to be a valuable tool in the differential diagnosis of acute appendicitis in all patients who had equivocal symptoms and signs. Ultrasound was particularly useful when applied to female patients of childbearing age.

Preconception health care: a critical task for family physicians.

Health care leaders in the United States have recently advised that preconception care be made available to all prospective parents because health in pregnancy depends on health status prior to pregnancy. Prenatal care usually begins after the early critical period of pregnancy has passed, and optimal early prenatal care can be achieved only through preconception care. Family physicians, who are ideally suited to provide this care, can readily integrate it into the routine health maintenance they currently provide for their patients of childbearing age. This review highlights components of the medical, family, and social histories, current health, and physical examination that are important to preconception health. There is good evidence that attention to patients' health needs before conception is related to improved perinatal outcomes.

New York City's In-Hospital Family Planning Program

The In-Hospital Family Planning Program was begun on an experimental basis in July 1969 with maternity patients in three hospitals. The program is expected to reach 4000 low-income women each month by the end of 1970 and will be extended from the obstetrics and gynecology departments at least to the out- patient departments of the municipal hospitals. Two more municipal eight voluntary and four state mental hospitals will be added to the program with counselors assigned to medical surgical psychiatric and other services can be offered to all of the 140000 general service patients of child-bearing age who are discharged each year from New York City municipal and voluntary hospitals. (excerpt)

Not in Our Own Image: Educating the Pediatrician for Practice

As many inflammatory rheumatic diseases affect patients in childbearing age, some concern has been expressed about the safety of biologic drugs during pregnancy. This study evaluated the effects of anti-tumor necrosis factor alpha (TNFα) agents on pregnancy/foetal outcomes.Thirty-eight pregnancies were followed prospectively from November 2008 to February 2015. Information about the patients’ exposure to anti-TNFα, disease activity, DMARD therapy, pregnancy/foetal outcomes were registered.Twenty-four/38 (71.1%) pregnancies were exposed to anti-TNFα at conception/I trimester, 11/38 (28.9%) prior to conception and 3 (11.1%) following paternal exposure. There were two congenital malformations: one infant (4.2%) was diagnosed with congenital diaphragmatic hernia and obstructive megaureter; the mother was exposed to adalimumab at conception/I trimester. While one foetus (9.1%) showed a trisomy 16, the mother 38 year-old had suspended etanercept 4 weeks before conception. There was no significant difference in pregnancy/foetal outcome between the two groups. Nor were there any significant differences in pregnancy/foetal outcomes in the various groups being treated with different anti-TNFα antagonists. No congenital malformations were found in connection to paternal exposure.Study results suggest that anti-TNFα drugs could be safe when administered during conception/I trimester and following paternal exposure.

EFFECTS OF CANCER CHEMOTHERAPEUTIC AGENTS ON THE HUMAN FETUS

Pregnancy is not a common complication in cancer. When it does occur, it often does not affect greatly the treatment of the malignancy, although it may change the prognosis. Occasionally, however, pregnant women with disseminated malignant disease are seen as candidates for palliative therapy with irradiation or chemotherapeutic agents. In such cases, the presence of the pregnancy may be a major factor in determining the therapy to be given. Although various types of cancer may occur in patients of childbearing age, the subject of cancer chemotherapy during pregnancy has been important principally in the leukemias and lymphomas, so far, since it is in these diseases that chemotherapeutic agents have been most widely used. As the use of chemotherapy is extending to other types of malignancy, however, this problem will become a more general one. A major factor in reaching decisions regarding therapy in pregnant women is the possibility of producing

Effects of cancer chemotherapeutic agents on the human fetus.

Pregnancy is not a common complication in cancer. When it does occur, it often does not affect greatly the treatment of the malignancy, although it may change the prognosis. Occasionally, however, pregnant women with disseminated malignant disease are seen as candidates for palliative therapy with irradiation or chemotherapeutic agents. In such cases, the presence of the pregnancy may be a major factor in determining the therapy to be given. Although various types of cancer may occur in patients of childbearing age, the subject of cancer chemotherapy during pregnancy has been important principally in the leukemias and lymphomas, so far, since it is in these diseases that chemotherapeutic agents have been most widely used. As the use of chemotherapy is extending to other types of malignancy, however, this problem will become a more general one. A major factor in reaching decisions regarding therapy in pregnant women is the possibility of producing