Pregnancy In Association Research Articles

Lamotrigine and twin pregnancy, incidental event or possible correlation?

Lamotrigine is frequently used to manage epilepsy during pregnancy. However, some major and minor birth defects are reported with lamotrigine monotherapy. This study is a case series report on 20 epileptic women who were receiving lamotrigine in their pregnancy. Apart from the normal pregnancies and births, in our study three patients gave birth to healthy twins, two vanished twin syndromes occurred and one patient had abortion. Twin pregnancy in association with lamotrigine therapy has not been clearly described before. Our observational study raises the idea that lamotrigine may induce twin pregnancy but larger studies need to investigate the presence or absence of such association more decently.

The metabolic syndrome and the risks of unfavourable outcome of pregnancy

The metabolic syndrome is defined by abdominal obesity, elevation of blood pressure, fasting glucose and triglycerides and low levels of high-density lipoprotein cholesterol. The metabolic syndrome may play an important role in the pathogenesis of unsuccessful pregnancy, by including a pro-inflammatory and prothrombotic state. Some authors have suggested that in case of metabolic syndrome the LMW heparin therapy given from the time of conception has a favourable effect. The aim of our study was to elucidate the association of the metabolic syndrome with the risk of unsuccessful pregnancy. During the study period 2005-2008 (4 years) we followed 5869 pregnancies. Retrospectively, 172 (2.9%) patients met the criteria of metabolic syndrome at the time of the first trimester. The rate of premature birth was 15.1% [26/172 in the metabolic syndrome group vs. 11.7%; OR: 1.52 (95% CI: 0.996-2.33) p=0.051], in control group. Within the affected group 32 pregnancies were complicated with intrauterine grow retardation (18.6%); versus 3.6%, in the unaffected group; OR: 6.38 (95% CI: 4.24-9.61 p<0.001). In 47 cases we observed preeclampsia during pregnancy [27.3%; vs. 4.7%; OR: 7.93 (95% CI: 5.54-11.33) p<0.001] in the control group. Among the patients affected by the metabolic syndrome 67 patients (38.2%) had more then one pregnancy complications during pregnancy, and only 47 cases (27.3%) were lacking adverse events during pregnancy and delivery [OR: 3.11 (2.27-4.26) p<0.001]. Our study demonstrated higher rate of complicated pregnancies in association with metabolic syndrome compared to the control group. In addition, we started a prospective study in 2007, using LMWH therapy to prevent thromboplastic and atherosclerotic effects of the metabolic syndrome. The study is planned to be reported in 2010 to assess the effect of LMWH therapy on the outcome of pregnancies.

OBSTETRIC CHOLESTASIS

Obstetric cholestasis (OC) also known a intrahepatic cholestatsis of pregnancy (ICP) is defined as pruritus of onset in pregnancy in association with abnormal liver function in the absence of any other identifiable liver pathology which resolves on delivery. It may be associated with adverse obstetric outcome and significant maternal morbidity. In the UK the prevalence is thought to be 0.6–0.7%, with up to 39–41% of women with OC being of Indian or Pakistani origin. Higher prevalence is also observed in Scandinavia (2%) and Chile (4%), (especially women of Araucanian Indian descent 24%). The condition occurs more commonly amongst twin pregnancies (20–22%) and is more common in the winter months in both Scandinavian and Chilean populations. The condition may occur more frequently in those &gt;35 years of age (25% of cases).

Loss of Hypothalamic Response to Leptin During Pregnancy Associated with Development of Melanocortin Resistance

Hypothalamic leptin resistance during pregnancy is an important adaptation that facilitates the state of positive energy balance required for fat deposition in preparation for lactation. Within the arcuate nucleus, pro-opiomelanocortin (POMC) neurones and neuropeptide Y (NPY)/agouti-related gene protein (AgRP) neurones are first-order leptin responsive neurones involved in the regulation of energy balance. The present study aimed to investigate whether the regulation of these neuropeptides is disrupted during pregnancy in association with the development of leptin resistance. As measured by quantitative in situ hybridisation, POMC and AgRP mRNA levels were not significantly different during pregnancy, whereas NPY mRNA levels increased such that, by day 21 of pregnancy, levels were significantly higher than in nonpregnant, animals. These data suggest that these neurones were not responding normally to the elevated leptin found during pregnancy. To further characterise the melanocortin system during pregnancy, double-label immunohistochemistry was used to quantify leptin-induced phosphorylation of signal transducer and activator of transcription 3 (pSTAT3) in POMC neurones, using α-melanocyte-stimulating hormone (MSH) as a marker. The percentage of α-MSH neurones containing leptin-induced pSTAT3 did not significantly differ from nonpregnant animals, indicating that there was no change in the number of POMC neurones that respond to leptin during pregnancy. Treatment with α-MSH significantly reduced food intake in nonpregnant rats, but not in pregnant rats, indicating resistance to the satiety actions of α-MSH during pregnancy. The data suggest that multiple mechanisms contribute to leptin resistance during pregnancy. As well as a loss of responses in first-order leptin-responsive neurones in the arcuate nucleus, there is also a downstream disruption in the melanocortin system.

Placental site trophoblastic tumor with antecedent molar pregnancy in association with human immunodeficiency virus infection

The occurrence of placental site trophoblastic tumor (PSTT) is rare. PSTT following molar pregnancy is uncommon. The report describes the presentation of PSTT following molar pregnancy in the background of human immunodeficiency virus infection.

Pathogenic role of antiphospholipid antibodies.

The antiphospholipid antibody syndrome (APS) is characterized by recurrent arterial and venous thrombosis and/or pregnancy in association with antiphospholipid (aPL) antibodies. The pathogenic mechanisms in APS that lead to in vivo injury are incompletely understood. Recent evidence suggests that APL antibodies alter regulation of haemostasis and induce activation of complement. We will discuss the current knowledge on how aPL antibodies trigger increased inflammation and enhanced thrombotic tendency, and thereby lead to tissue damage.

The Antiphospholipid Syndrome

The primary antiphospholipid syndrome is an autoimmune thrombotic disease. It is characterized by recurrent arterial or venous thrombosis, recurrent fetal loss or in-utero death and thrombocytopenia. The risk of cerebral vascular disease (CVD), pulmonary embolism (PE) or deep venous thrombosis (DVT). It have been described the detection of antibodies directed against diverse phospholipids, both anionic and neutral, such as cardiolipin phosphatidylserine, phosphatidylethanolamine and phosphatidic acid, also some seric co-factors like b2-Glycoprotein I, prothrombin, antithrombin III and annexin V. Several hypotheses have been proposed to explain the molecular and cellular mechanisms by which antiphospholipid antibodies (APLA) promote thrombosis. Treatment decisions are allotted into four main areas: prophylaxis, prevention of further thromboses of large vessels, treatment of acute thrombotic microangiophaty, and management of pregnancy in association with APS

Placental site trophoblastic tumor with antecedent molar pregnancy in association with human immunodeficiency virus infection

The occurrence of placental site trophoblastic tumor (PSTT) is rare. PSTT following molar pregnancy is uncommon. The report describes the presentation of PSTT following molar pregnancy in the background of human immunodeficiency virus infection.

A review of upper extremity deep vein thrombosis in pregnancy: unmasking the 'ART' behind the clot.

Upper extremity deep vein thrombosis (UEDVT) is uncommon and is associated with well-defined risk factors in the general population. Increasingly, UEDVTs are being reported during pregnancy, particularly those achieved with the use of assisted reproductive techniques (ART), and in conjunction with ovarian hyperstimulation syndrome (OHSS). We performed this review was to estimate the incidence of UEDVT associated with ART, to examine the risk factors and presentation of UEDVT in pregnancy, and to determine if differences exist between this cohort and the general population. There were 35 published case reports of UEDVT in pregnant women. The incidence of this condition is estimated to be 0.08-0.11% of treatment cycles in women undergoing ART. The development of UEDVT is not always be preceded by OHSS. In addition, commonly associated risk factors for UEDVT were not often reported for UEDVT that developed during pregnancy. Instead the association of UEDVT and ART was common. UEDVT in pregnancy also appears to involve the internal jugular vein more often than the subclavian vein. The reported risk of thrombus extension in this cohort, despite anticoagulation therapy, is also disconcerting. Because UEDVT may not be a rare entity during pregnancy in association with the use of ART, clinicians should be better informed of its presentation and clinical course in these women. Once UEDVT develops, appropriate therapeutic anticoagulation should be instituted and patient carefully monitored. The long-term implications and recurrence rate of this condition in pregnancy warrants further prospective studies.

Teatment by Emergency Cesarean Section Immediately Followed by Operative Repair of the Aortic Dissection under General Anesthesia in a Patient with Pregnancy-Induced Hypertension: A case report

Acute aortic dissection can occur in pregnancy in association with severe hypertension due to preeclampsia, coarctation of the aorta, or connective tissue diseases such as Marfan syndrome. The aims of anesthesia are to minimize fetal exposure to cardiopulmonary depressant drugs prior to delivery while ensuring a well-controlled hemodynamic environment for the mother. We encountered a case of a 31-year-old pregnant woman (gestational age 38 weeks) with preeclampsia, gestational DM, and acute aortic dissection (Stanford type A, DeBakey type II). The patient successfully underwent an emergency cesarean section and the subsequent repair of the aortic dissection under general anesthesia. We report this experience with a brief review of the relevant literature.

Mifepristone and Misoprostol Induced Abortion with A Large Myomatous Uterus

Summary Objective To report the management of an early pregnancy with a large myomatous uterus. Case Report A 34-year-old woman, with an unwanted pregnancy of 6 weeks' gestation and a large myomatous uterus, desired to terminate her pregnancy. She was first given three tablets of mifepristone 200 mg and three tablets of misoprostol 200 μg 48 hours later. However, this regimen did not produce an abortion, so five tablets of misoprostol 200 μg were placed into the posterior fornix of the vagina. The abortion was thus completed by the vaginal administration of 1,000 μg of misoprostol. Conclusion Supplementary use of high-dose vaginal misoprostol may be considered as an alternative to terminate an early pregnancy in association with a myomatous uterus when the conventional combination of mifepristone and misoprostol fails.

137 IRON TRANSFER ACROSS THE LLAMA PLACENTA (LAMA GUANICOE GLAMA)

The placenta of the llama has been described as epitheliochorial in type, but recent studies have not shown extensively the fetal nutrition aspects in this animal. In epitheliochorial placentation there is development of structures called areolae, as well as inter-microvillous attachment of the trophoblast, with irregular contact, to the uterine epithelium. This attachment is interrupted and the transfer of substances between the mother and the fetus takes place across the areolar cavity. These areolae appeared as small rounded or dome-shaped elevated areas of the chorioallantoic membrane over the narrow uterine gland openings. In order to detail their mechanisms of iron transfer in the llama placenta, we collected the samples of nine uteri between 28 to 36 weeks of pregnancy in association with fetal membranes. These samples were fixed in 4% paraformaldehyde in PBS, processed, and stained for light microscopy (HE, picrosirius, and Masson's trichrome), histochemistry (Perls, acid phosphatase, and PAS reactions) and immunohistochemistry with rabbit anti pig uteroferrin antibody to confirm the iron transfer, because the uteroferrin is an iron transporter and a progesterone-induced hematopoietic growth factor. The trophoblast formed a columnar-type single layer that was comprised of cells of various sizes and shapes with basal nuclei, including the giant binucleate cells. The trophoblast formed chorionic projections which presented ramifications in number from 4 to 5. A great quantity of blood vessels were found in the materno-fetal interface, between the cells of uterine epithelium and around of the chorionic projections. A PAS-positive reaction was observed with diffuse cytoplasmic PAS staining at the apical region of the trophoblast at the materno-fetal interface as well as in the endometrial glands. Collagen fibers were observed in the mesenchyme and inside the chorionic projections. In the areolae we confirmed the positive reaction of the acid phosphatase enzyme that detects phagocytic activity. In the basal region of the uterine gland epithelium, which is columnar type, and in the gland lumina, this reaction demonstrated a strong positive stain. The Perls histochemical reaction that reveals ferric iron was positive in the areola, as well as in the uterine glands. The uteroferrin immunohistochemistry showed a strong stained in the areolae and in the epithelium and lumina of the uterine glands. Our findings suggest that the areola region and the endometrial glands play an important role in histiotrophic nutrition in llamas, and in fetal red blood cell formation by iron transfer from mother to the fetus. This work was supported by FAPESP, CNPq, CAPES, PRONEX, Brazil.

Large pseudocyst of the umbilical cord associated with patent urachus

Cystic masses of the umbilical cord have been detected in the second and third trimesters of pregnancy in association with fetal abdominal wall defects and chromosomal anomalies. We present a case of an umbilical cord pseudocyst diagnosed using routine ultrasound at the 20 weeks of gestation. Serial sonography followed the progression of the cystic masses. A 2960-g male infant was delivered at term, in whom a patent urachus was detected. The infant underwent repair with closure of the patent urachus and plastic reconstruction of the abdominal wall, and the postoperative course was uneventful. This case demonstrated an uneventful outcome despite the persistent multiple cord cysts.

OBSTETRIC CHOLESTASIS

Obstetric cholestasis (OC) is defined as pruritus of onset in pregnancy in association with abnormal liver function in the absence of any other identifiable liver pathology which resolves on delivery. It may be associated with adverse obstetric outcome and significant maternal morbidity. The significance of the disease has only recently been appreciated, and our understanding of its pathophysiology is in its infancy. This article will describe our current knowledge of the disease and critically review the interventions proposed to improve obstetric outcome and maternal morbidity.

Lost intrauterine devices during pregnancy: maternal and fetal outcome after ultrasound-guided extraction. An analysis of 82 cases.

It is generally agreed that intrauterine devices (IUDs) with visible strings in pregnancy should be removed because of the increased risk of miscarriage, septic complications and premature delivery. The precise management of pregnancies in association with so-called 'lost IUDs', and especially the technique of their removal, has remained controversial. We present our experience of the management of intrauterine pregnancies with a lost IUD. Ultrasound-guided extraction of a lost IUD was performed in 82 intrauterine pregnancies. The subsequent outcome of the pregnancies is described. There were no intra- or post-procedure maternal complications. Although the miscarriage rate in the first 3 weeks after the procedure was higher than that in normal pregnancy, the complication rate approached that of normal pregnancy as the pregnancies progressed. The total miscarriage rate of 22% was comparable to that following extraction of IUDs with visible filaments. The rate of live births was 77.0%. Delivery before 37 weeks occurred in 13.5% of cases. Ultrasound-guided extraction is a minimally invasive and inexpensive procedure that is associated with few postoperative complications. It has a high success rate and is associated with a moderate miscarriage rate and no maternal complications.

The nineteenth pregnancy in a patient with cor pulmonale and severe pulmonary hypertension: A management challenge

The nineteenth pregnancy in a patient with cor pulmonale and severe pulmonary hypertension: A management challenge

Reversible acute renal failure in association with bilateral ureteral obstruction and hydronephrosis in pregnancy

This is a case report of a 16-year-old girl with renal failure in pregnancy in association with bilateral ureteral obstruction and hydronephrosis. The presenting symptom was a common nonspecific type of abdominal pain. The diagnosis was made on incidental laboratory work to rule out preeclampsia. Renal function reverted back to normal after induced vaginal delivery. (Am J Obstet Gynecol 2001;184:239-40.)

Successful laparoscopic treatment of a ruptured primary abdominal pregnancy

Successful laparoscopic treatment of a ruptured primary abdominal pregnancy

Pregnancy-associated breast cancer in BRCA1 and BRCA2 germline mutation carriers

Alterations of the hormonal environment may affect the risk of developing breast cancer in carriers of BRCA1 and BRCA2 germline mutations. Oral contraceptive use therefore increases risk, whereas smoking, through a possible antioestrogenic effect, decreases risk.1 In studies on mice, BRCA1 mRNA concentrations rise in pregnancy in association with epithelial proliferation and stay raised during pregnancy.2 Furthermore, the BRCA1 region and its promotor region contain hormone-receptor binding sites and combined treatment with 17β-oestradiol and progesterone has been shown to increase BRCA1 mRNA concentrations, although some studies suggest that this effect is indirect.

Low-Density Lipoprotein Particle Size Decreases During Normal Pregnancy in Association With Triglyceride Increases

Low-Density Lipoprotein Particle Size Decreases During Normal Pregnancy in Association With Triglyceride Increases