Search

Objective: To review pregnancy outcomes and the safety of jet ventilation use in the gravid patient undergoing surgical airway intervention. Methods: A multi-institutional retrospective review of medical records was performed to identify women who underwent low-frequency jet ventilation during pregnancy for surgical treatment of airway stenosis. Postoperative complications were noted, and patients were interviewed regarding pregnancy outcomes. Results: Six women were included in this series. No immediate complications relating to anesthesia or surgical intervention were noted in five of the six women. One patient with a well-known history of uncontrolled seizures experienced seizure activity postoperatively. One patient returned to the operating room at a later date for debridement of tracheal crusts. Five mothers delivered via cesarean section and one via spontaneous vaginal delivery. The mean gestation age was 37.3 weeks. One of the six infants delivered prematurely and three were delivered at low birth weight. Three of the six infants required elevated care immediately post-delivery but, at present, all are in good health. Conclusion: Low-frequency jet ventilation and surgical management of airway stenosis should be recognized as a safe treatment option in the gravid patient. Surgical intervention should not be delayed in patients with severe symptoms, particularly given the potential risk associated with prolonged corticosteroid use. Level of evidence: 4

As the field of neurogenetics is expanding rapidly and variant classification criteria evolve, genetic variants in databases are re‐evaluated overtime allowing updated classifications of pathogenicity predication. When caring for patients with genetic disorders, it is important to obtain the original genetic report and also consider an updated reanalysis., As the field of neurogenetics is expanding rapidly and variant classification criteria evolve, the clinical utility of reanalysis to obtain updated classification of pathogenicity predication is described in a pregnant patient with a diagnosis of familial hemiplegic migraine.

Liver disease in the pregnant patient often causes concern. This chapter covers both acute liver pathologies that occur in pregnancy, and pregnancy in mothers with chronic liver disease, focusing on practical diagnostic and management strategies.

In spite of the fact that brain death during pregnancy is not a common occurrence, it is an important ethical problem for all cultures and religions can have a significant influence on the donation decision after brain death. Therefore, this study aimed to present the case of a pregnant patient developing brain death which occurred in our intensive care unit and to compare the medical, ethical and legal problems relating to pregnant cases developing brain death with 24 cases in the literature. A 21-year-old 19-week pregnant case with gestational diabetes was monitored in the anesthesia intensive care unit and developed brain death due to intracranial mass and intraventricular hemorrhage. Though brain death is a situation well understood by organ transplant professionals, brain death developing in pregnant patients still involves many medical, ethical and legal problems.

Congenital obstruction of the left ventricular outflow tract comprises a heterogeneous group of disorders, with obstruction potentially occurring below, above, or at the level of the aortic valve. Subvalvular stenosis is the second most common type of left ventricular outflow tract obstruction, of which discrete membranous type is the most common. Although surgical resection of the subaortic membrane is the treatment of choice in discrete membranous subaortic stenosis, in selected patients with isolated membranous subaortic stenosis, without significant aortic insufficiency, percutaneous balloon tearing of the membrane results in reduction in the degree of left ventricular outflow tract obstruction and symptomatic relief. We report a case of 22 year old pregnant patient admitted with NYHA class III breathlessness, found to have discrete membranous subaortic stenosis. Balloon aortic valvuloplasty was performed in the patient with good result. Patient underwent normal vaginal delivery at 38 weeks. Both mother and newborn were asymptomatic. Patient is asymptomatic on subsequent follow-ups.

La lumbalgia es una de las patologías más frecuentes durante el embarazo. Lo anterior se explica por la gran gama de cambios físicos, fisiológicos y hormonales que experimenta la mujer al albergar el producto de la concepción. Debido al impacto en la calidad de vida y economía, en los últimos años ha existido un aumento significativo en la investigación sobre esta patología, lo cual permite un diagnóstico más precoz y además ofrecer a la mujer embarazada un mejor abordaje. Se ha demostrado que las medidas preventivas en la mujer embarazada tiene una gran influencia, pues la corrección de la postura, soporte corporal y demás hábitos promueven un estilo de vida más ergonómico a la gestante. Sin embargo, tras la aparición de lumbalgia, existen múltiples medidas terapéuticas conservadoras y farmacológicas que son capaces de ofrecer un alivio para la paciente embarazada y por ende un impacto positivo en su calidad de vida.

Reoperations in cardiac surgery are very difficult and risky operations due to possible complications. A 35-week pregnant, 27-year-old woman patient presented to the cardiology department with palpitations. Control transthoracic echocardiography revealed a mass in the right atrium with dimensions of 24 × 25 mm. The patient had dextrocardia and situs inversus totalis, and had undergone a robotic atrial septal defect repair operation 1 year ago. Operation was planned for the patient with the joint decision of cardiology, obstetrics, pediatrics, anesthesia, and cardiovascular surgery departments. Redo robotic heart surgery was performed in beating heart after the operation of the cesarean, and the mass in the right atrium was successfully removed. In conclusion, as it is seen in our case, robotic cardiac surgery can be safely and successfully performed, and can minimize morbidity and mortality even in very complex clinical conditions such as pregnancy, dextrocardia, and reoperation.

The article describes a difficult clinical case, when cystic fibrosis was detected in an adult pregnant patient, who had been followed since her childhood due to frequent bronchitis and consequently had a long-term treatment due to unconfirmed pulmonary tuberculosis.

Travel associated infectious disease, such as malaria, should be considered in returningtravelers from an endemic area presenting with fever. Malaria in pregnancy has a high maternaland fetal morbidity and mortality burden. Early diagnosis is essential to improve maternal andfetal outcomes by providing maternal supportive measures and anti-malarial medication.We present a patient with severe acute febrile illness with mental status changes at 32 weeksgestation. She became acutely symptomatic including high grade fever while visiting WestTexas from Nigeria. Despite initial diagnostic uncertainty, a multidisciplinary team successfullydiagnosed and treated her severe malaria. She delivered at term with no long lasting maternal orfetal sequelae from her malarial infection. In an age of globalization, travel associated infectiousdiseases should be considered in the differential of acute febrile illness in pregnant women.

An incidence of 30–40 deaths per triennium in pregnant patients is reported because of brain pathology. Over the last two decades, the obstetric cause of mortality in the pregnant patient has declined, but the trend is rising for non-obstetric cause of mortality. Pregnancy is associated with a host of anatomical and physiological alterations that complicate the conduct of anesthesia. The brain is one of the vital organs of the body, and physiological changes during pregnancy alter the anesthesia management if associated with brain pathology. Malignant brain tumors and trauma remain a leading cause of indirect maternal mortality. Review of literature revealed paucity of evidence-based neuroanesthesia management for such patients. Navigating these uncharted waters remains a challenging exercise. With the lack of guidelines, the management is based largely on few case reports or case series.

Aim Despite research suggesting increased anxiety and depressive symptoms after a perinatal loss and during future pregnancies, little knowledge exists to guide clinicians treating pregnant women after perinatal loss. This case study explores processes that facilitated therapeutic change for a pregnant patient with major depressive disorder (MDD) and posttraumatic stress disorder after perinatal losses. Method The study integrated quantitative and narrative analyses in a single case derived from the pilot phase of a randomized controlled trial on supportive-expressive therapy for MDD. Results The quantitative and narrative analyses suggest that an improvement in maladaptive interpersonal patterns toward the therapist, in the form of attachment avoidance, made it possible to form a strong alliance, which in turn led to a successful outcome. Conclusions The findings highlight the importance of improving maladaptive interpersonal patterns as a prerequisite to enable patients after pregnancy losses to develop and maintain a corrective therapeutic experience.

Introduction: The failure rate of both filtration surgery and of aqueous shunt implantation is higher for iridocorneal endothelial syndrome than in other scenarios, due to the continuous proliferation of abnormal endothelial cells over the trabecular meshwork and the filtration area and also due to the more pronounced cicatrizing response shown by these young patients. We present the first case ever described in the literature of a pregnant patient with iridocorneal endothelial syndrome and uncontrolled ocular hypertension who was implanted an Ex-PRESS mini-shunt. Clinical case: A 35-year-old female presented with diminution of vision in the left eye for 2 months. She was 20 weeks pregnant. Her visual acuity was 20/20 in right eye and 20/25 in left eye, and intraocular pressure was 11 mmHg in right eye and 34 mmHg in left eye. Slit lamp biomicroscopic examination revealed no alterations in right eye, whereas left eye showed corectopia and uveal ectropion, stroma of iris’ sectoral atrophy and moderate corneal epithelial edema. Gonioscopy showed some anterior iris synechiae in left eye. Fundus evaluation was normal. Based on clinical features and examination, the diagnosis of left eye iridocorneal endothelial syndrome with decompensated intraocular pressure was made. She was prescribed topical timolol (0.5%) and dorzolamide. As a result of uncontrolled intraocular pressure and the impossibility to prescribe other hypotensive treatment available due to her being pregnant, it was decided to perform surgery in left eye using an Ex-PRESS mini-shunt and Ologen®; 6 months post surgery, intraocular pressure was 9 mmHg with no need for hypotensive treatment. The cornea was transparent, and the patient maintained her left eye visual acuity. Conclusions: Ex-PRESS mini-shunt can be considered a surgical option for iridocorneal endothelial syndrome. Its composition allows the ostium to remain open and the device triggers a milder postoperative inflammatory response. In our particular case, taking into account that the subject was a young, phakic, pregnant woman, whose intraocular pressure had to be closely controlled and we had to ensure that her postoperative care included as few drugs and as few reoperations as possible, we thought that using this device was the most appropriate option.

Literature regarding cases of pregnant patients with hereditary spastic paraparesis (Strumpell-Lorrain disease) and those treated by intrathecal baclofen therapy is sparse. There are currently no specific guidelines to manage pregnancy and delivery in these patients. A 42-year-old woman presented to our clinic with hereditary spastic paraparesis and was treated with intrathecal baclofen for spasticity. She conceived twice and delivered successfully by caesarean section under subarachnoid anaesthesia. The two pregnancies had favourable outcomes with no increase in spasticity and no problems encountered with the intrathecal device. In this report, we discuss the evolution of both pregnancies and the anaesthetic management for deliveries in the presence of an intrathecal catheter. Keywords: Caesarean section; case report; hereditary spastic paraparesis; intrathecal baclofen; pregnancy.

Pericardial agenesis is a rare congenital anomaly found predominantly in men, and its complete form is extremely rare and difficult to diagnose. This report describes the case of a pregnant patient with complete pericardial agenesis in which mode of delivery and sterilization raised debate among specialists. Complete Pericardial Agenesis in a Pregnant Patient: A Clinical Dilemma

Cardiovascular disease (CVD) has become increasingly prevalent in women of childbearing age in the western world. This has led to CVD now being the leading cause of maternal morbidity and mortality. In the modern era optimal cardiology care is dependent on cardiovascular imaging and this is especially so in the appropriate management of the pregnant woman with CVD. CVD imaging allows for accurate risk assessment before pregnancy and guides appropriate management during pregnancy. In this article we outline the hemodynamic and structural changes that occur in the cardiovascular system in pregnancy. We examine the role of echocardiography, cardiac magnetic resonance imaging, computed tomography, and coronary angiography within the care of the pregnant patient and highlight the strengths and weaknesses of each.

Dengue virus infection is an arthropod-born infection with high global prevalence. A spectrum of clinical syndromes and complications were recognized following dengue fever that can range from undifferentiated fever to dengue shock syndrome. Neurological complications following dengue fever can extend to various sequelae, including transverse myelitis. We report a 20-year-old pregnant woman with a recent diagnosis of dengue hemorrhagic fever (DHF) at the period of amenorrhea (POA) of 28 weeks, presenting with left-sided severe buttock pain. Following extensive investigations, we found left-sided sacroiliitis to be the cause of the buttock pain. She completely recovered with appropriate management.

This study presents a comparison of novel pregnant model phantoms with a handmade phantom in terms of shape and radiation measurement points to determine which model is more suitable for measuring the foetal radiation dose during x-ray examinations. Novel pregnant model phantoms were constructed using an anthropomorphic phantom in combination with two differently-sized custom-made abdomen phantoms simulating pregnancy, which were constructed from a polyurethane resin. The size and shape of the polyurethane resin were designed based on abdominal sizes and shapes collected from the computed tomography examinations at 18 pregnant patients of one hospital. The handmade pregnant model phantom was constructed using an anthropomorphic phantom and a beach ball containing water. Compared with the handmade phantom, there were additional dose measurement points on the novel pregnant model phantoms. Our model phantoms improved upon the handmade phantom in terms of shape and radiation measurement points. We produced pregnant model phantoms that simulated the shapes and sizes of actual patients for the first time.

Appendectomy is the standard of care in pregnant patients with acute appendicitis. The use of laparoscopy in pregnant patients with acute appendicitis is still debated, especially for patients in their third trimester. We present a case of a patient who safely underwent a laparoscopic appendectomy during early labor and subsequently delivered a healthy baby. In the correct situations and hands, laparoscopy can likely be safely used throughout pregnancy.

We present a case of a pregnant woman admitted for malnutrition secondary to a large gastrocolic fistula (GCF). She has a history of perforated duodenal ulcer that required surgical pyloroplasty 6 years ago. This fistula was diagnosed on the gastrointestinal barium series showing direct transit of barium from the stomach to the colon. An upper endoscopy showed a large gastrocolonic fistula with stool leaking to the stomach. Her nutrition was optimized, then she underwent surgical repair. GCF is suspected in the patient presenting with malnutrition with a history of intra-abdominal surgery.

Background This article reports a unique case of cesarean scar pregnancy, demonstrating importance of early management and diagnosis. Case presentation A 30-year-old pregnant woman with prior history of two cesarean sections found to have cesarean scar pregnancy at approximately 13 weeks’ gestation and underwent a gravid hysterectomy. Conclusions While rare, cesarean scar pregnancies should be considered on the differential diagnosis of any pregnant patient with history of cesarean section who presents in early pregnancy with vaginal bleeding and/or cramping. Given the increased rates of cesarean sections in the times of COVID-19, one may anticipate seeing more cases of cesarean scar pregnancies.

Generally, intentional exposure of pregnant women is avoided as far as possible in both medical and occupational situations. This paper aims to summarise available information on sources of radiation exposure of the embryo/foetus primarily in medical settings. Accidental and unintended exposure is also considered. Knowledge on the effects of radiation exposure on the developing embryo/foetus remains incomplete—drawn largely from animal studies and two human cohorts but a summary is provided in relation to the key health endpoints of concern, severe foetal malformations/death, future cancer risk, and future impact on cognitive function. Both the specific education and training and also the literature regarding medical management of pregnant females is in general sparse, and consequently the justification and optimisation approaches may need to be considered on a case by case basis. In collating and reviewing this information, several suggestions for future basic science research, education and training, and radiation protection practice are identified.

The number of women of childbearing age with cardiovascular disease (CVD) is growing because of increased survival of children with congenital heart disease. More women are also becoming pregnant at an older age, which is associated with increased rates of comorbidities including hypertension, diabetes, and acquired CVD. Over the past decade the field of cardio-obstetrics has significantly advanced with the development of multidisciplinary cardio-obstetric programs (COPs) to address the increasing burden of CVD in pregnancy. With the introduction of formal COPs, pregnancy outcomes in women with heart disease have improved. COPs provide preconception counselling, antenatal and postpartum cardiac surveillance, and labor and delivery planning. Prepregnancy counselling in a COP should be offered to women with suspected CVD who are of childbearing age. In women who present while pregnant, counselling should be performed in a COP as early as possible in pregnancy. The purpose of counselling is to reduce the risk of pregnancy to the mother and fetus whenever possible. This is done through accurate maternal and fetal risk stratification, optimizing cardiac lesions, reviewing safety of medications in pregnancy, and making a detailed plan for the pregnancy, labor, and delivery. This Clinical Practice Update highlights the COP approach to prepregnancy counselling, risk stratification, and management of commonly encountered cardiac conditions through pregnancy. We highlight “red flags” that should trigger a more timely assessment in a COP. We also describe the approach to some of the cardiac emergencies that the care provider might encounter in a pregnant woman.

The development of technology can be used to facilitate many matters. One of them is childbirth in the medical fields. Maternal mortality rate (MMR) is the number of maternal deaths during pregnancy to postpartum caused by pregnancy, childbirth or its management. There are several methods of labors that can be done. The determination of the labor is based on many factors and must be in accordance with the conditions of pregnant patient. Caesarean birth is the last alternative in labor, due to high risk factors. The objective of this research is to predicte and analyse caesarean section using C4.5 and Naive Bayes classifier models. For experimentation the dataset is collected from UCI Machine Learning Repository and the main attributes represented in this dataset are age, delivery number, delivery time, blood of pressure, and heart problem. The accuracy using C4.5 by 80 training cases is 45% And the accuracy using Naive Bayes is 50%.

The pregnant migraineur is often frustrated by the lack of safe therapies. Fortunately there are actually a number of good management options.

Dermatomyositis occurs extremely rarely during pregnancy. A number of studies in the published literature have documented how the outcome of pregnancy is poor for both mother and fetus. The present case study reports on a patient who was diagnosed with clinically amyopathic dermatomyositis complicated by interstitial lung disease during pregnancy, and was successfully treated with a combined immunosuppressant regimen. To the best of the authors’ knowledge, this is the first case study detailing how a pregnant woman with clinically amyopathic dermatomyositis with positive anti-melanoma differentiation-associated gene 5 antibody achieved complete remission after early intervention of combined immunosuppressive therapy without residual pulmonary interstitial changes.

Acute pulmonary embolism (APE) is one of the most important preventable mortality causes during pregnancy. In this case report, a 24-week pregnant patient who were diagnosed with APE and who underwent thrombolytic treatment was discussed in the light of a literature review. The 27-year-old female patient, who was pregnant, applied to the emergency service with sudden shortness of breath and chest pain. Since the hemodynamic condition of the patient was unstable, no imaging could be carried out in the radiology unit. As a result of the right ventricular load symptoms detected in bedside Transthoracic Echocardiography (ECO), massive APE was diagnosed, and thrombolytic treatment was initiated. APE should be considered in patients who are admitted to emergency services with sudden shortness of breath and chest pain complaints. Patients who are excessively unstable for imaging in the radiology unit should be evaluated quickly with bedside transthoracic ECO in terms of massive embolism., Akut pulmoner emboli (APE), gebelik döneminde en önemli önlenebilir ölüm nedenlerinden birisidir. Bu yazıda APE tanısı alan ve trombolitik tedavi uygulanan 24 haftalık gebe bir hastayı litaratür eşliğinde tartışılmıştır.Gebe olan 27 yaşındaki bayan hasta, ani başlayan nefes darlığı ve göğüs ağrısı şikayetleriyle acil servise müracaat etti. Kan tetkik sonuçları gebelikteki fizyolojik değişikliklerle karışması nedeniyle yol gösterici olmadı, yapılan bilateral alt ekstremite venöz doppler ultrasonografi (USG)’de tromboz izlenmedi. Hastanın hemodinamik durumu unstabil olduğundan radyoloji ünitesinde herhangi bir görüntüleme yapılamadı. Yatakbaşı transtorasik ekokardiyografi (EKO)’de sağ ventrikül yüklenme bulguları görülmesi sonucu massif APE tanısı konularak trombolitik tedavi uygulandı.APE, hemodinamik olarak unstabil olan hastalarda kardiyovasküler acil durumların en yaygın nedenlerinden birisi olup, çok mortal seyreder. Ani başlayan nefes darlığı ve göğüs ağrısı şikayetleriyle acil servise başvuran hastalarda, mutlaka APE düşünülmelidir. Radyoloji ünitesinde görüntüleme yapılamayacak kadar unstabil olan hastalar, hızlıca yatakbaşı transtorasik EKO ile massif emboli açısından değerlendirilmelidir.

Copyright © 2021, Fondazione Società Italiana di Neurologia, Spinal muscular atrophy (SMA) is an autosomal recessive motor neuron disorder caused by homozygous deletion or mutation in 5q11.2-q13.3, affecting the SMN1 gene. It is characterized by progressive lower motor neuron loss in the brainstem and spinal cord, resulting in muscle weakness and atrophy. SMA is classified into four distinct clinical phenotypes, from the most severe phenotype (type I) to milder clinical forms (type IV), based on onset age and the highest level of motor milestones. Therefore, many SMA female patients reach fertile age and consider pregnancy. To date, there have been few reports on pregnancy in women with SMA type II, and all of them were instrumental or caesareans deliveries.

BackgroundEisenmenger syndrome belongs to the 0.4–4.1% (incidence) rarely encountered congenital cardiac lesions in pregnancy. Management of a pregnant patient with Eisenmenger syndrome is a challenging task for the anesthesiologist.Case presentationHere, we report the successful outcome with the use of low-dose sequential combined spinal–epidural (CSE) anesthesia in a patient with Eisenmenger syndrome posted for cesarean section. Low-dose sequential CSE anesthesia was adequate for the performance of cesarean section with minimal hemodynamic changes and good fetal outcome.ConclusionLow-dose sequential CSE can be a safe alternative to achieve good anesthesia with hemodynamic stability in such case.