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OB Medicine

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93 papers 25 to 100 followers
By Alyssa Shariff Internist with special interest in Obstetric Medicine
Thijs E van Mens, Luuk Jj Scheres, Paulien G de Jong, Mariska Mg Leeflang, Mathilde Nijkeuter, Saskia Middeldorp
BACKGROUND: Pulmonary embolism is a leading cause of pregnancy-related death. An accurate diagnosis in pregnant patients is crucial to prevent untreated pulmonary embolism as well as unnecessary anticoagulant treatment and future preventive measures. Applied imaging techniques might perform differently in these younger patients with less comorbidity and altered physiology, who largely have been excluded from diagnostic studies. OBJECTIVES: To determine the diagnostic accuracy of computed tomography pulmonary angiography (CTPA), lung scintigraphy and magnetic resonance angiography (MRA) for the diagnosis of pulmonary embolism during pregnancy...
January 26, 2017: Cochrane Database of Systematic Reviews
Bruno Hoen, Bruno Schaub, Anna L Funk, Vanessa Ardillon, Manon Boullard, André Cabié, Caroline Callier, Gabriel Carles, Sylvie Cassadou, Raymond Césaire, Maylis Douine, Cécile Herrmann-Storck, Philippe Kadhel, Cédric Laouénan, Yoann Madec, Alice Monthieux, Mathieu Nacher, Fatiha Najioullah, Dominique Rousset, Catherine Ryan, Kinda Schepers, Sofia Stegmann-Planchard, Benoît Tressières, Jean-Luc Voluménie, Samson Yassinguezo, Eustase Janky, Arnaud Fontanet
BACKGROUND: The risk of congenital neurologic defects related to Zika virus (ZIKV) infection has ranged from 6 to 42% in various reports. The aim of this study was to estimate this risk among pregnant women with symptomatic ZIKV infection in French territories in the Americas. METHODS: From March 2016 through November 2016, we enrolled in this prospective cohort study pregnant women with symptomatic ZIKV infection that was confirmed by polymerase-chain-reaction (PCR) assay...
March 15, 2018: New England Journal of Medicine
Mitzi L Murray, Melanie Pepin, Suzanne Peterson, Peter H Byers
PURPOSE: The purpose of this study was to characterize the nature and magnitude of pregnancy risks in women with vascular Ehlers-Danlos syndrome. METHODS: Pregnancy-related death rate was determined by a review of pedigrees of families with vascular Ehlers-Danlos syndrome. Maternal morbidity was characterized through semistructured interviews with women with vascular Ehlers-Danlos syndrome or their next of kin. RESULTS: Pregnancy-related deaths occurred in 30 of 565 deliveries (5...
December 2014: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Tiffany Patrick, Steve J Carlan, Jose Eugenio Najera, Julie Eastwood
Background Thrombotic thrombocytopenic purpura (TTP) can present with many laboratory features of preeclampsia, which can make an accurate diagnosis difficult in late pregnancy. Because the treatments of TTP and preeclampsia are different and the clinical sequelae of delayed therapy potentially lethal, a rapid and accurate diagnosis is important. Case Report We present a case of an acute episode of TTP secondary to acquired autoantibodies complicated by severe preeclampsia with headache and treated with corticosteroids, plasma exchange therapy, magnesium sulfate, and delivery...
November 2012: American Journal of Perinatology Reports
Gabriele Saccone, Vincenzo Berghella, Giuseppe Maria Maruotti, Tullio Ghi, Giuseppe Rizzo, Giuliana Simonazzi, Nicola Rizzo, Fabio Facchinetti, Andrea Dall'Asta, Silvia Visentin, Laura Sarno, Serena Xodo, Dalila Bernabini, Francesca Monari, Amanda Roman, Ahizechukwu Chigoziem Eke, Ariela Hoxha, Amelia Ruffatti, Ewoud Schuit, Pasquale Martinelli
BACKGROUND: Antiphospholipid syndrome is an autoimmune, hypercoagulable state that is caused by antiphospholipid antibodies. Anticardiolipin antibodies, anti-β2 glycoprotein-I, and lupus anticoagulant are the main autoantibodies found in antiphospholipid syndrome. Despite the amassed body of clinical knowledge, the risk of obstetric complications that are associated with specific antibody profile has not been well-established. OBJECTIVE: The purpose of this study was to assess the risk of obstetric complications in women with primary antiphospholipid syndrome that is associated with specific antibody profile...
May 2017: American Journal of Obstetrics and Gynecology
Brian M Casey, Elizabeth A Thom, Alan M Peaceman, Michael W Varner, Yoram Sorokin, Deborah G Hirtz, Uma M Reddy, Ronald J Wapner, John M Thorp, George Saade, Alan T N Tita, Dwight J Rouse, Baha Sibai, Jay D Iams, Brian M Mercer, Jorge Tolosa, Steve N Caritis, J Peter VanDorsten
BACKGROUND: Subclinical thyroid disease during pregnancy may be associated with adverse outcomes, including a lower-than-normal IQ in offspring. It is unknown whether levothyroxine treatment of women who are identified as having subclinical hypothyroidism or hypothyroxinemia during pregnancy improves cognitive function in their children. METHODS: We screened women with a singleton pregnancy before 20 weeks of gestation for subclinical hypothyroidism, defined as a thyrotropin level of 4...
March 2, 2017: New England Journal of Medicine
Philip Webster, Liz Lightstone, Dianne B McKay, Michelle A Josephson
Chronic kidney disease (CKD) affects up to 6% of women of childbearing age in high income countries, and is estimated to affect 3% of pregnant women. Advanced renal dysfunction, proteinuria, hypertension, and poorly controlled underlying primary renal disease are all significant risks for adverse maternal, fetal, and renal outcomes. In order to achieve the best outcomes, it is therefore of paramount importance that these pregnancies are planned, where possible, to allow the opportunity to counsel women and their partners in advance and to optimize these risks...
May 2017: Kidney International
Kelsey McLaughlin, Dora Baczyk, Audrey Potts, Michelle Hladunewich, John D Parker, John C P Kingdom
Low molecular weight heparin (LMWH) has been investigated for the prevention of severe preeclampsia, although the mechanisms of action are unknown. The objective of this study was to investigate the cardiovascular effects of LMWH in pregnant women at high risk of preeclampsia. Pregnant women at high risk of preeclampsia (n=25) and low-risk pregnant controls (n=20) at 22 to 26 weeks' gestation underwent baseline cardiovascular assessments. High-risk women were then randomized to LMWH or saline placebo (30 mg IV bolus and 1 mg/kg subcutaneous dose)...
January 2017: Hypertension
Bonnie L Bermas
PURPOSE OF REVIEW: To review the recent literature on the safety of nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids and traditional disease-modifying antirheumatic drugs before and during pregnancy. RECENT FINDINGS: Recent data suggest that the risk of cleft palate formation after in-utero glucocorticoid exposure is lower than previously reported. Two studies of inadvertent leflunomide exposure during early pregnancy suggest that this medication may be less teratogenic than previously thought...
May 2014: Current Opinion in Rheumatology
Hilal Ince-Askan, Radboud J E M Dolhain
Fertility is impaired in female patients with rheumatoid arthritis (RA), which is related to disease activity and the use of certain medication. During pregnancy, disease activity usually improves, but less than previously thought. Especially in women with high disease activity, the pregnancy outcome is also impaired. All of this underscores the importance of strict control of disease activity in RA patients who wish to conceive. Management of RA disease activity during pregnancy might be a challenge as the treatment options are limited...
August 2015: Best Practice & Research. Clinical Rheumatology
Zoe A Stewart, Malgorzata E Wilinska, Sara Hartnell, Rosemary C Temple, Gerry Rayman, Katharine P Stanley, David Simmons, Graham R Law, Eleanor M Scott, Roman Hovorka, Helen R Murphy
BACKGROUND: In patients with type 1 diabetes who are not pregnant, closed-loop (automated) insulin delivery can provide better glycemic control than sensor-augmented pump therapy, but data are lacking on the efficacy, safety, and feasibility of closed-loop therapy during pregnancy. METHODS: We performed an open-label, randomized, crossover study comparing overnight closed-loop therapy with sensor-augmented pump therapy, followed by a continuation phase in which the closed-loop system was used day and night...
August 18, 2016: New England Journal of Medicine
Marc Blondon, Alessandro Casini, Kara K Hoppe, Françoise Boehlen, Marc Righini, Nicholas L Smith
BACKGROUND: Cesarean sections (CS) are believed to be associated with greater risks of postpartum VTE. Our objective was to systematically review the evidence on this association and on the absolute risk of VTE following CS. METHODS: We searched PubMed, Embase, and conference proceedings from 1980 to November 2015 for reports on the associations of delivery methods with postpartum VTE and on the incidence of VTE following CS. Studies on thrombophilia or recurrent VTE were excluded, and the search was restricted to prospective studies when assessing the incidence of VTE...
September 2016: Chest
Sherif W Ayad, Mahmoud M Hassanein, Elsayed A Mohamed, Ahmed M Gohar
BACKGROUND: Pregnancy is associated with several cardiocirculatory changes that can significantly impact underlying cardiac disease. These changes include an increase in cardiac output, sodium, and water retention leading to blood volume expansion, and reductions in systemic vascular resistance and systemic blood pressure. In addition, pregnancy results in a hypercoagulable state that increases the risk of thromboembolic complications. OBJECTIVES: The aim of this study is to assess the maternal and fetal outcomes of pregnant women with mechanical prosthetic heart valves (PHVs)...
2016: Clinical Medicine Insights. Cardiology
T Marchetti, P de Moerloose, J C Gris
BACKGROUND: pre-eclampsia (PEecl) can be defined as non-severe (NS-PEecl) or severe (S-PEecl). Our study aimed to determine the incidence of antiphospholipid antibodies (aPLs) in women with a past history of NS-PEecl or S-PEecl. PATIENTS AND METHODS: This case-control study includes 195 control women, 199 NS-PEecl patients and 143 S-PEecl patients whose plasma samples were collected 6 months after their first delivery. Each plasma was tested for lupus anticoagulant (LA), anticardiolipin (aCL) and antiβ2GP1 antibodies, as well as antibodies against phosphatidylserine/prothrombin complex (aPS/PT) and domain I of the β2GP1...
April 2016: Journal of Thrombosis and Haemostasis: JTH
Diana Aguiar de Sousa, Patrícia Canhão, José M Ferro
BACKGROUND AND PURPOSE: Pregnancy and puerperium are associated with an increased risk of venous thrombotic events (VTEs), including cerebral venous thrombosis (CVT). We aimed to systematically review, in pregnant woman with previous CVT, (1) the risk of recurrence of CVT or other VTE; (2) the result of pregnancy; and (3) the association of antithrombotic prophylaxis with these outcomes. METHODS: We searched MEDLINE, Cochrane Database of Systematic Reviews, clinicaltrials...
March 2016: Stroke; a Journal of Cerebral Circulation
Victoria L Meah, John R Cockcroft, Karianne Backx, Rob Shave, Eric J Stöhr
OBJECTIVE: Cardiac output, a fundamental parameter of cardiovascular function, has consistently been shown to increase across healthy pregnancy; however, the time course and magnitude of adaptation remains equivocal within published literature. The aim of the present meta-analyses was to comprehensively describe the pattern of change in cardiac output during healthy pregnancy. METHOD: A series of meta-analyses of previously published cardiac output data during healthy, singleton pregnancies was completed...
April 2016: Heart: Official Journal of the British Cardiac Society
Geoffrey C Nguyen, Cynthia H Seow, Cynthia Maxwell, Vivian Huang, Yvette Leung, Jennifer Jones, Grigorios I Leontiadis, Frances Tse, Uma Mahadevan, C Janneke van der Woude
BACKGROUND & AIMS: The management of inflammatory bowel disease (IBD) poses a particular challenge during pregnancy because the health of both the mother and the fetus must be considered. METHODS: A systematic literature search identified studies on the management of IBD during pregnancy. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. RESULTS: Consensus was reached on 29 of the 30 recommendations considered...
March 2016: Gastroenterology
Eliot R Spindel, Cindy T McEvoy
Use of e-cigarettes, especially among the young, is increasing at near-exponential rates. This is coupled with a perception that e-cigarettes are safe and with unlimited advertising geared toward vulnerable populations, the groups most likely to smoke or vape during pregnancy. There is now wide appreciation of the dangers of maternal smoking during pregnancy and the lifelong consequences this has on offspring lung function, including the increased risk of childhood wheezing and subsequent asthma. Recent evidence strongly supports that much of the effect of smoking during pregnancy on offspring lung function is mediated by nicotine, making it highly likely that e-cigarette use during pregnancy will have the same harmful effects on offspring lung function and health as do conventional cigarettes...
March 1, 2016: American Journal of Respiratory and Critical Care Medicine
Frauke Bergmann, Werner Rath
BACKGROUND: Thrombocytopenia is, after anemia, the second most common abnormality of the complete blood count in pregnancy, with a reported frequency of 6.6% to 11.2%. It has many causes. Thrombocytopenia should be diagnostically evaluated as early as possible in pregnancy, so that the obstetrical management can be accordingly planned to minimize harm to the mother and child. As the various underlying diseases share clinical features and laboratory findings, the differential diagnosis is often a difficult interdisciplinary challenge...
November 20, 2015: Deutsches Ärzteblatt International
Aina Ruiz, Queralt Ferrer, Olga Sánchez, Irene Ribera, Silvia Arévalo, Onofre Alomar, Manel Mendoza, Lluís Cabero, Elena Carrerras, Elisa Llurba
INTRODUCTION: Recent studies pointed to an intrinsically angiogenic imbalance in CHD in the maternal and foetal circulation suggestive of impaired placentation. OBJECTIVES: To assess whether pregnant women with a CHD foetus are at greater risk of placenta-related complications. METHODS: Perinatal results of women with a CDH foetus were compared with those of a non-selected population followed up at our centre. Multiple pregnancies and chromosomal abnormalities were excluded from the analysis...
October 2016: Journal of Maternal-fetal & Neonatal Medicine
2016-01-13 03:15:50
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