Physiological Changes Of Pregnancy Research Articles

COVID-19 suspicion and diagnosis in pregnancy: A big conundrum!

This article aims to discuss all the challenges faced in the diagnosis of coronavirus disease 2019 (COVID-19) in pregnancy, isolation of suspected and positive patients, their management, and the strategies to prevent the transmission of infection among the healthy population and medical fraternity. The diagnosis of COVID in pregnancy is influenced by many factors, including normal physiological changes in pregnancy, comorbid conditions associated with pregnancy, and the presence of asymptomatic infection in patients. Suspicion of COVID-19 in pregnant females is of utmost importance at a primary health center for risk mitigation of exposure to medical personnel. A retrospective study was carried out in the labour room in a tertiary care center in India. Two groups were made, suspected COVID and confirmed COVID in pregnant patients. The case records were analysed. Out of a total of 5164 admissions, 95 patients were admitted as suspected (1.8%), but only two patients were COVID-positive amongst them. 84% of COVID-positive patients were asymptomatic. Fever was the most common symptom in both groups (P-value: 0.15). Preeclampsia and anaemia were the most common comorbidities in both groups, not statistically significant. There were 32% of intensive acre unit (ICU) admissions in suspected COVID patients, and 77% of them were having respiratory distress. COVID-19 presents as an asymptomatic infection in most pregnant patients. Physiological changes to the cardiorespiratory and immune systems along with associated comorbidities in pregnancy, increase a woman's susceptibility and delay diagnosis. Consideration of patients as suspected COVID at triage stations on the basis of only contact or travel history poses a great burden on the health care system. Although triage is an essential tool to identify symptomatic COVID patients, universal testing strategies should continue simultaneously. Streamlining medical care professionals into self-sufficient teams ensures adequate clinical coverage amongst the suspected COVID, confirmed COVID, and routine labour room admissions.

Characteristics of COVID-19 positive pregnant patients admitted in a private tertiary hospital and their maternal and neonatal outcomes

Introduction: The severe acute respiratory syndrome coronavirus 2 pandemic has had profound effects globally. Historical experience with previous Coronaviruses has shown increased maternal and perinatal morbidity and mortality, theoretically secondary to the physiologic changes of pregnancy. As of August 2021, the Philippines is the 23rd top country worldwide in terms of total number of cases, yet there remains to be a sparse pool of information both internationally and locally.Objectives: This study aims to present the prevalence, clinical characteristics, as well as the neonatal, obstetric, and maternal outcomes of all pregnant women admitted in the institution who had active or previous COVID-19 infection.Methodology: Retrospective review of data using the hospital's health information system was utilized. Within the study period, all admitted obstetric patients who had at least one positive result in a RT-PCR naso-oropharyngeal swab for SARS-CoV-2 were included in this study and categorized into: (1) symptomatic, (2) recovered, and (3) asymptomatic.Results: A total of 48 patients were included in the study, where prevalence of COVID-19 in pregnancy was 3.65%. Results showed that most patients were in the third trimester, and contrary to the non-pregnant population, majority (60.41%) did not have comorbidities. Most remained asymptomatic (33.33%) or had mild symptoms (18.75%), and underwent abdominal delivery (50%) for obstetric indications. COVID-19 status was not associated with adverse obstetric outcomes in this study population, but had significant association with preterm birth (p=0.019) and NICU admission (P=<0.001). Conclusion: Overall, most cases were asymptomatic and had good prognosis even with the adaptations a pregnant woman undergoes. In addition, neonatal outcomes were generally good regardless of the association with preterm birth and NICU admission. Lastly, there was no appreciated evidence for vertical transmission.

Dermatologic and Cosmetic Procedures in Pregnancy.

Background:Patients may develop a need to undergo procedures while being pregnant and this requires a certain risk-benefit profiling to be done by the clinician. Skin changes during pregnancy such as melasma, striae, varicose veins, hirsutism, and increased skin growths may raise concerns for the lady. Although pregnancy-induced physiologic changes may prompt a surgeon to delay nonessential procedures until after delivery, certain skin conditions may require urgent intervention. Others that may be nonurgent, elective, or cosmetic may need careful analysis.Materials and Methods:Data were extracted from available literature through a PubMed search for the following keywords: “dermatological procedures in pregnancy,” “dermatosurgical procedures during pregnancy,” “aesthetic procedures in pregnancy,” “safety in pregnancy,” “teratogenicity of drugs,” “local anesthesia during pregnancy,” “physiological changes in pregnancy,” “cosmetic procedures during pregnancy,” and “lasers in pregnancy.”Results:Only procedures which are safe and necessary should be carried out in a pregnant woman. Electrocautery, radiofrequency, cryotherapy, and lasers for warts, particularly genital, surgical interventions for skin malignancies, and other small growths should be performed. Safe but cautious outlook is required for intralesional steroid injections, aesthetic procedures such as chemical peeling, botulinum toxin, microdermabrasion, and biopsies for questionable lesions. Absolutely contraindicated procedures include fillers, sclerotherapy, and liposuction.

COVID-19 with Pregnancy: Obstetricians should be Alert for Postpartum Exacerbation

Abstract Introduction: Physiological changes in pregnancy make them more susceptible to infection. SARS-CoV-2 infection ranges in severity from common cold to acute respiratory distress syndrome. With the incredible increase in numbers of coronavirus disease-2019 (COVID-19), multiple studies were done with the significant increase of COVID-19 infected pregnant women. These studies support that pregnant women are not only susceptible to infection but more liable for severity and complications that may end unfortunately by death. Methods: In this review, we discuss the mode and steps of delivery in that situation. There is an argument about fetal transmission, possible methods of transmission, and recorded fetal complications. Breastfeeding is not a source of infection. The separation between the infected mother and her baby is under debate regarding many considerations taken.

Maternal Mortality Due to an Undiagnosed Large Thymoma in Puerperium: A Case Report

Introduction: Delayed or avoided medical care due to coronavirus disease 2019 (COVID-19) related concerns may increase morbidity and mortality associated with both acute and chronic health conditions. Thymoma is uncommon in pregnancy, although it could be accompanied with unfavorable outcomes. We report a puerperal woman presented with dyspnea and cardiac arrest with a recent diagnosis of thymoma that led to maternal mortality. Case Presentation: A 38-year-old woman with occasional dyspnea during pregnancy without medical referral was admitted to the hospital with severe dyspnea and orthopnea three days after cesarean section. Spiral computed tomography (CT) angiography showed a 64 × 84-centimeter mass with soft tissue density in the left perivascular that was originated from the anterior mediastinum; in biopsy, thymoma was suggested. She died shortly after due to severe dyspnea and cardiac arrest. Conclusions: Prenatal care during COVID-19 pandemic should not be postponed. Indeed, any symptom similar to the physiologic changes in pregnancy needs to be evaluated for optimal clinical management.

Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association.

Hypertensive disorders of pregnancy (HDP) remain one of the major causes of pregnancy-related maternal and fetal morbidity and mortality worldwide. Affected women are also at increased risk for cardiovascular disease later in life, independently of traditional cardiovascular disease risks. Despite the immediate and long-term cardiovascular disease risks, recommendations for diagnosis and treatment of HDP in the United States have changed little, if at all, over past decades, unlike hypertension guidelines for the general population. The reasons for this approach include the question of benefit from normalization of blood pressure treatment for pregnant women, coupled with theoretical concerns for fetal well-being from a reduction in utero-placental perfusion and in utero exposure to antihypertensive medication. This report is based on a review of current literature and includes normal physiological changes in pregnancy that may affect clinical presentation of HDP; HDP epidemiology and the immediate and long-term sequelae of HDP; the pathophysiology of preeclampsia, an HDP commonly associated with proteinuria and increasingly recognized as a heterogeneous disease with different clinical phenotypes and likely distinct pathological mechanisms; a critical overview of current national and international HDP guidelines; emerging evidence that reducing blood pressure treatment goals in pregnancy may reduce maternal severe hypertension without increasing the risk of pregnancy loss, high-level neonatal care, or overall maternal complications; and the increasingly recognized morbidity associated with postpartum hypertension/preeclampsia. Finally, we discuss the future of research in the field and the pressing need to study socioeconomic and biological factors that may contribute to racial and ethnic maternal health care disparities.

Nonobstetric Surgery during Pregnancy: An Overview for Anesthesia Providers

A pregnant patient’s surgery can be challenging for the anesthesia provider—the needs of the parturient and fetus must be addressed while balancing the physiologic and pharmacologic changes that occur during pregnancy. Improved outcomes have led to an increase in the frequency of surgeries in parturients, with approximately 50,000 procedures performed annually in the US. Due to a lack of randomized controlled studies, determining the optimal anesthetic technique for nonobstetric surgery during pregnancy is predicated on understanding the physiologic changes of pregnancy. The anesthesia provider must become familiar with specific changes and challenges in each parturient to formulate a safe anesthetic plan. Here, we review physiologic and pharmacologic conditions observed in common surgical cases that may occur during pregnancy. Our goal is to inform safe clinical practices determined by the latest scientific methods for nonobstetric surgery during pregnancy. This review contains 5 figures, 3 tables and 45 references. Key Words: anesthesia, nonobstetric surgery, obstetric anesthesia, pregnancy, surgery, physiology, pharmacology, gynecology

Nonobstetric Surgery during Pregnancy: An Overview for Anesthesia Providers

A pregnant patient’s surgery can be challenging for the anesthesia provider—the needs of the parturient and fetus must be addressed while balancing the physiologic and pharmacologic changes that occur during pregnancy. Improved outcomes have led to an increase in the frequency of surgeries in parturients, with approximately 50,000 procedures performed annually in the US. Due to a lack of randomized controlled studies, determining the optimal anesthetic technique for nonobstetric surgery during pregnancy is predicated on understanding the physiologic changes of pregnancy. The anesthesia provider must become familiar with specific changes and challenges in each parturient to formulate a safe anesthetic plan. Here, we review physiologic and pharmacologic conditions observed in common surgical cases that may occur during pregnancy. Our goal is to inform safe clinical practices determined by the latest scientific methods for nonobstetric surgery during pregnancy. This review contains 5 figures, 3 tables and 45 references. Key Words: anesthesia, nonobstetric surgery, obstetric anesthesia, pregnancy, surgery, physiology, pharmacology, gynecology

A case of new-onset SLE during pregnancy an initial manifestation with all diagnostic criteria: The challenges of diagnosis and managing a complex disease in a low resource setting

Systemic lupus erythematosus (SLE) is a complex chronic multiorgan autoimmune disease. When newly diagnosed during pregnancy or puerperium, it is known as new-onset SLE during pregnancy. Delayed or missed diagnosis of newonset SLE during pregnancy may occur due to similar clinical manifestation of SLE with normal physiological changes of pregnancy and lupus nephritis with preeclampsia. New-onset SLE during pregnancy has major organ involvement with poor maternal and foetal outcomes. Management options are limited due to teratogenic side effects of drugs in pregnancy. This is further compounded in a low resource setting with lack of health seeking behaviours and inadequate access to timely care. Multidisciplinary management with close medical, obstetric, neonatal monitoring, patient education and improved access to care is essential for better outcomes. Our aim is to report a 19 year old primigravida with new onset SLE in pregnancy and multiorgan involvement fulfilling all criteria for diagnosis of SLE at the first presentation.

Hyperthyroidisme pada Kehamilan

Hyperthyroidism is defined by abnormally high levels of thyroid hormones caused by increased synthesis and secretion of thyroid hormones from the thyroid gland. Physiological changes in pregnancy affect the function of the thyroid gland. The sharp increase in human chorionic gonadotropin (hCG) from early pregnancy stimulates the thyroid gland to increase thyroid hormone production. hCG is a glycoprotein synthesized and released from the placenta, and stimulates the TSH receptor due to its structural similarity to TSH. Normal pregnancy produces a number of important physiological and hormonal changes that alter thyroid function. These changes mean that laboratory tests of thyroid function should be interpreted with caution during pregnancy. Thyroid function tests change during pregnancy due to the influence of two main hormones: human chorionic gonadotropin (hCG), the hormone measured in pregnancy tests and estrogen, the main female hormone. The treatment of choice in pregnancy is antithyroid drugs (ATD). These drugs are effective in controlling maternal hyperthyroidism, but they all cross the placenta, thus requiring careful management and control during the second half of pregnancy taking into account the risk of fetal hyperthyroidism or hypothyroidism. An important aspect in early pregnancy is that the main side effect of taking ATD at 6-10 weeks of gestation is birth defects which can develop after exposure to the types of ATD available and may be severe. This review focuses on the management of overt hyperthyroidism in pregnancy, including the etiology and incidence of the disease, how the diagnosis is made, the consequences of untreated or inadequately treated disease, and finally how to treat overt hyperthyroidism in pregnancy. This review discusses the etiology, pathophysiology, and initial evaluation of hyperthyroidism in pregnancy, followed by a discussion of its treatment, management, and complications.

COVID-19 em gestantes: Uma revisão do perfil clínico e epidemiológico

Introdução: As manifestações clínicas da COVID-19 são variadas na população geral. Em gestantes, o conhecimento sobre perfil de apresentação clínica ainda é restrito. O presente estudo objetivou sistematizar a literatura atual no que se refere ao perfil clínico e epidemiológico de gestantes com COVID-19. Método: A pesquisa foi desenvolvida de acordo com as recomendações fornecidas no protocolo PRISMA. Os estudos foram selecionados a partir das bases de dados PubMed / Medline e Scopus entre 01 de janeiro e 24 de abril de 2020, utilizando duas estratégias de busca: os descritores COVID-19, SARS-CoV-2, 2019-nCoV, n-CoV e coronavirus associados a “perfil clínico” e “epidemiologia”; posteriormente, foram incluídos os termos “ginecologia e obstetrícia”, “reprodução” e “gravidez” aos descritores anteriores. Resultados: Febre foi o principal sintoma relatado com frequência que variou entre 17,39 e 85,71%. Diabetes mellitus foi a principal complicação da gravidez cuja prevalência variou entre 7,76 e 14,29%. Houve 69,19% de cesáreas. Óbitos fetais e asfixia neonatal severa não foram observados. No entanto, nascimentos pré-termos/prematuros foram comumente reportados.&#x0D; Conclusão: O quadro clínico das pacientes gestantes não se diferenciou significativamente das pacientes não grávidas. Destacou-se o parto prematuro como possível consequência da infecção. A testagem universal para gestantes admitidas ao parto permite a adoção de cuidados precoces para evitar contaminação.

Physiological changes in pregnancy and their influence on the endocrine investigation.

Physiological changes in pregnancy may result in significant alterations in endocrine hormone profiles, serum and urine electrolytesand endocrine gland morphology on imaging. Pregnancy-specific pathophysiological processes may also affect the results for endocrine tests. Investigation of endocrine disorders in pregnancy requires knowledge of these changes and awareness of the safety of dynamic hormone testing and imaging for the mother and foetus. This review seeks to outline the important physiological changes in pregnancy affecting reference intervals of basal and dynamic endocrine tests in pregnancy and the scenarios in which these changes are clinically significant, the pregnancy-specific disorders that may affect the investigation of endocrine disorders, and the safety of dynamic testing and imaging. Awareness of the effect of physiological changes, and the potential impact of pregnancy-specific disorders of endocrine tests, and the safety of imaging is crucial to the management of endocrine disorders in pregnancy.

Cardiovascular Disease in Pregnancy.

Cardiovascular disease remains a major contributor to rising maternal morbidity and mortality. Both the pregnant woman and fetus are exposed to many potential complications as a result of the physiologic changes of pregnancy. These changes can exacerbate existing cardiac disease, as well as lead to the development of de novo issues during gestation, delivery, and the postnatal period. For women with preexisting cardiac disease, including congenital malformations, valvular disease, coronary artery disease, and aortopathies, it is crucial that they receive multidisciplinary evaluation, counseling, and optimization before conception, as well as close monitoring and medication management during pregnancy. Close monitoring is also essential for patients who develop cardiovascular complications such as preeclampsia, cardiomyopathy, congestive heart failure, coronary events, and arrhythmias during pregnancy. In addition, concerning disparities in maternal morbidity and mortality exist across many dimensions, in part because of the lack of uniformity of care in different treatment settings. Establishment of multidisciplinary cardio-obstetric teams including representatives from cardiology, anesthesia, obstetrics, maternal-fetal medicine, and specialized nursing has proven instrumental to delivering evidence-based and equitable care to high-risk patients. Multidisciplinary teams should work to guide these patients through the preconception, antepartum, delivery, and postpartum phases to ensure appropriate care for weeks to years after pregnancy.

The Pregnant Surgical Patient

The most vulnerable time for a fetus is during embryogenesis in the first 8 to 10 weeks of pregnancy, when women may be unaware of their pregnancy. Once pregnancy is established, a standard approach to the pregnant patient is the optimal way to ensure medical and surgical decisions are made within the context of maintaining the safety of both mother and fetus. This review describes the approach to the pregnant patient for surgical conditions within the context of physiologic changes of the patient and fetus at each trimester, anesthesia and critical care in pregnancy, imaging and drugs safe for use in pregnancy, and nongynecologic surgery in the pregnant patient and specific surgical conditions. Tables outline the classification of abortion, the assessment of pregnancy viability, physiologic changes in pregnancy, laboratory changes in pregnancy, imaging modality and radiation dose, and antibiotics and safety in pregnancy. Figures include a diagram of types of hysterectomy, respiratory changes in pregnancy, and enlargement of the uterus. Algorithms outline the approach to abdominal pain in the pregnant patient and diagnosis and management of ectopic pregnancy. This review contains 5 figures, 6 tables, and 85 references.

Validation of the CARPREG II risk stratification model and the WHOm scale in pregnant women with heart disease

Abstract The physiological changes of pregnancy imply a state of haemodynamic stress, which increases the risk of maternal-fetal complications in women with cardiac pathology. Risk stratification models allow clinical decisions to be guided and optimal diagnostic, follow-up and management strategies to be established according to each estimated category in order to reduce adverse outcomes. Objective To validate the CARPREG II and WHOm risk prediction models in a population of pregnant women with heart disease. Materials and methods Validation and comparison study of a risk prediction model in a prospective cohort of pregnant women with heart disease assessed between 2016 and 2019 by a cardiobstetric team in an average income country. The CARPREG II score was established and patients were classified according to the WHOm risk scale. We assessed cardiovascular and perinatal outcomes and determined the calibration and level of discrimination of these tools. Results In a cohort of 328 pregnant women (27±7 years), 33% (n=110) had congenital heart disease, followed by arrhythmias in 30% (n=98), valvular pathologies in 14% (n=46) and cardiomyopathies in 9% (n=29). In 56% of the pregnancies, the route of delivery was caesarean section, 84% of these by obstetric indication. A cardiac event occurred in 15%, with left heart failure (5.3%) and arrhythmias (2.3%) being the most frequent. The frequency of maternal death of cardiac origin during the study was 1.6%. Neonatal outcomes occurred in 37% of gestations (preterm delivery (16%) and low weight for gestational age (8.4%)) and obstetric events in 12.5%: pregnancy-induced hypertension (9%) and postpartum haemorrhage (2.3%). NYHA functional class III-IV or cyanosis (OR 12 95% CI 3.1 - 46.4) and left ventricular dysfunction (LVEF &amp;lt;55%) (OR 3 95% CI 1 - 10.9) were the most statistically significant risk predictors. Discrimination of both models was adequate (AUC-ROC of 0.74 95% CI 0.64 - 0.84) for the CARPREG II risk index and 0.77 for the WHOm scale (95% CI 0.69 - 0.86) (Figure 2). Calibration is also good in the study population (Hosmer- Lemeshow goodness-of-fit 0.6 and 0.1, respectively). By including in the CARPREG II model the variables ejection fraction and pulmonary artery systolic pressure in their numerical and not dichotomised form, a discrete improvement in the predictive ability of the scale is evident (AUC-ROC 0.81 95% CI 0.71–0.91). Conclusions The CARPREG II and WHOm risk stratification models have good ability to discriminate the risk of adverse cardiac outcomes in pregnant women with heart disease and fit our population. To improve the predictive power of CARPREG II, the variables pulmonary hypertension and left ventricular dysfunction could be used numerically and not dichotomised as in the original model. Funding Acknowledgement Type of funding sources: Private hospital(s). Main funding source(s): San Vicente Foundation University Hospital, Cardio-obstetric Center

Retrospective Analysis of Hematological Parameters in Covid Positive Pregnancy

The newly identified SARS-CoV-2 virus and its ongoing implicated COVID-19 pandemic started off as pneumonia of unknown aetiology in Wuhan, China, in December 2019. Certain laboratory values that may be considered deranged in non pregnant states are normal physiological changes in pregnancy. An understanding of the normal haematological and immunologic parameters in pregnancy is necessary for the interpretation of COVID-19 severity. Considering the COVID-19 infection is still new, little is known about the clinical course of the disease in pregnancy. This is a retrospective observational study undertaken in the Department of Obstetrics and Gynaecology, Saveetha Medical College Hospital, Chennai, India, from April to November 2020. Out of the 50 women in the study, 19 women were anaemic with haemoglobin &lt;11, accounting for 38% of the study population. A neutrophil to lymphocyte ratio greater than 4.5 was observed in 44% of the population. Thrombocytopenia was present in 12% of the population. D-dimer greater than 1000 was found in 12% of the study population. All of our patients were asymptomatic, had good maternal and fetal outcomes even though derangement of inflammatory markers were noted. The immunological changes of pregnancy make pregnant women more susceptible to pathogens. Though our patients had instances suggestive of critical prognosis like an increased neutrophil-lymphocyte-ratio and affirmative acute phase reactants and inflammatory markers, they were asymptomatic (category BNH) and stable in room air. However, further analysis of laboratory parameters and their correlation to clinical scenarios in the second wave of COVID19 infection is warranted.

Norepinephrine as an Alternative in Hypotension Prophylaxis During Cesarean Sectionunder Spinal Anesthesia

Abstract Background Spinal anesthesia is the preferred method for elective cesarean sections (C.S.) due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases. Many approaches have been investigated to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both. Thus we compare the administration of intermittent I.V. boluses of norepinephrine and ephedrine to guard against the hypotensive effect of spinal anesthesia during cesarean delivery. Patients and Methods 120 female patients undergoing electiveC.S.were randomly divided into “group-E” for Ephedrine and “group-N” for Norepinephrine. Results Compared with ephedrine, norepinephrine maintained maternal blood pressure and uterine artery blood flow. Further, it was associated with lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia during cesarean delivery. Conclusion Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with no adverse effect on neonatal outcome.

PREGNANCY MANAGEMENT AND OUTCOME IN A WOMAN WITH CONGENITAL UNILATERAL LUNG AGENESIS: A CASE REPORT

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Congenital unilateral lung agenesis is a rare condition characterized by the complete absence of a lung and the bronchovascular tree. It is often associated with cardiac and bronchopulmonary malformations, resulting in significant morbidity and mortality. Pregnancy, due to the physiologic changes during gestation and childbirth, poses additional risks to these patients. We report a case of a woman with congenital right lung agenesis (CRLA) whose successful pregnancy could offer guidance to clinicians in the interdisciplinary management of a high-risk condition (1). CASE PRESENTATION: A 26-year-old G1P0 was referred to our Maternal Fetal Medicine (MFM) clinic for her CRLA with resultant dextrocardia and left lung hyperinflation. She was asymptomatic and was able to tolerate daily activities without concerns. Pre-conceptional imaging studies showed results consistent with her medical history.There were no obstetric concerns with normal prenatal labs and normal fetal anatomy ultrasound. She was recommended to undergo cardiopulmonary evaluation and follow up with the relevant specialists.The patient remained clinically stable throughout the gestation. Delivery and postpartum planning was done in the early third trimester at a multidisciplinary conference with the MFM, Anesthesia, Cardiology, Pulmonology, Obstetrics, and Critical Care teams.The patient was electively induced at 39 weeks resulting in an uncomplicated vaginal delivery. Careful monitoring of the patient's hemodynamic status was performed during the intra- and postpartum periods due to the concern of volume overload from intravenous fluid infusions during and autotransfusion following delivery. Her postpartum course was uncomplicated. DISCUSSION: Several cardiopulmonary physiological changes occur in pregnancy to accommodate the growing fetus. An increase in cardiac output with a decrease in pulmonary and systemic vascular resistance leads to an increase in pre-load and increased pulmonary capillary permeability. The risk of pulmonary edema is highest in the second stage of labor due to the autotransfusion into the systemic circulation and the relief of pressure on the inferior vena cava (2). During pregnancy, there is a 40% increased oxygen requirement by the growing fetus, placenta, and maternal organs with a decreased reserve secondary to the increased consumption and decreased functional residual capacity. These changes are often the source of significant morbidity and mortality in women with compromised systems (3). For these reasons, a multidisciplinary care approach was of utmost importance for this patient. CONCLUSIONS: We advocate for the utility of a multidisciplinary approach with frequent follow-up and testing with each specialty to ensure the best care for a successful pregnancy outcome in this patient with CRLA. REFERENCE #1: Wert S. E. (2016). Normal and Abnormal Structural Development of the Lung. In Polin R. A., Abman S. H., Rowitch D. H., Benitz W. E., & Fox W. W., Fetal and Neonatal Physiology (pp. 627-641). Elsevier. https://doi.org/10.1016/B978-0-323-35214-7.00061-5 REFERENCE #2: Silversides C. K. & Colman J. M. (2007). Physiological changes in pregnancy. Oakley, C. & Warnes C. A. (2007). Heart Disease in Pregnancy (pp. 6-16). Blackwell Publishing Limited. REFERENCE #3: Gabbe, S. G., Niebyl, J. R., Simpson, J. L., Landon, M. B., Galan, H. L., Jauniaux, E. R., ... & Grobman, W. A. (2016). Obstetrics: normal and problem pregnancies e-book. Elsevier Health Sciences. DISCLOSURES: No relevant relationships by Kajal Angras, source=Web Response No relevant relationships by Kelly Ca, source=Web Response No relevant relationships by Cherise Hatch, source=Web Response No relevant relationships by VANI MOVVA, source=Web Response

Ruptured Spinal Arteriovenous Malformation (AVM) Results in Paraplegia During Pregnancy

A 21-year-old pregnant woman at 34-weeks’ gestation presented to the emergency room with sudden lower extremity weakness and discovered a devastating diagnosis. A magnetic resonance imaging report described a neoplasm versus spinal arteriovenous malformation (AVM). Diagnostic angiogram indicated an AVM involving thoracic spinal levels 8–12, a rare condition that results in rapidly progressive paraplegia. Undiagnosed congenital vascular malformation developmental defects of the arterial and venous vasculature may become symptomatic due to physiological changes in pregnancy.

A RETROSPECTIVE STUDY ON PREVALANCE OF ANEMIA IN PREGNANCY IN A TERITIARY CARE HOSPITAL

Objective: To study about prevalence in anemia among the antenatal women, its clinical features, and access the severity and its treatment response. Methods: A hospital-based retrospective study on the prevalence of anemia among the antenatal women in tertiary care hospital for 6 months duration in gynecology and obstetrics department. In evaluating pregnant women with anemia, it is essential to do a complete history and physical examination, as well as complete blood count with indices and a blood smear examination. Based on these findings, other test such as ferritin and serum or red cell folate may be ordered. Because of normal physiologic changes in pregnancy that effect the hematocrit, indices, and some other parameters, diagnosing true anemia, as well as the etiology of anemia, is challenging. Results and Discussion: In this retrospective study, the prevalence of Anemia in pregnancy in a tertiary care hospital was evaluated and determined in fifty patients. The most common age group was between 21 and 25 years i.e., (21 patients) 42%. Among 50 patients, majority of them, i.e., 35 patients (70%) were treated with Injection. Iron Sucrose (200 mg). In this study, increase in prevalence were seen majorly in the third trimester, i.e., 25 patients (50%) of which 22 patients (88%) were with moderate anemia with 7.9 gm/dl average hemoglobin (Hb) percentage and 3 patients (12%) were with mild anemia with 9.3 gm/dl average Hb percentage. Conclusion: The plan of management for anemia complicating pregnancy depends on the type of anemia. Oral iron therapy is the route of choice in women with mild to moderate anemia and for severe anemia in pregnant women &lt;30 weeks of gestation. The rise of Hb with parenteral iron therapy is almost the same (avg: 1gm/dl/week) as that of oral iron therapy.