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Shortened Cervix in the Subsequent Pregnancy after Embolization for Postpartum Cervical Hemorrhage  [PDF]
Zoltan Kozinszky,Sverre Sand,Nils-Einar Kl?w,Kirsten Hald
Case Reports in Obstetrics and Gynecology , 2014, DOI: 10.1155/2014/607835
Abstract: Introduction. Rupture of a branch of uterine artery during delivery often leads to a massive postpartum hemorrhage that can be successfully treated using uterine artery embolization. Case Report. A 33-year-old woman had a cesarean section at term followed by a secondary postpartum hemorrhage due to a ruptured cervicovaginal branch terminating in a large, partially thrombosed hematoma of the cervix. She was given selective uterine artery embolization, and she was discharged to home in stable condition on the third day after embolization. In the forthcoming pregnancy a shortened cervix was a risk of threatened premature delivery from 26 weeks of gestation onwards. Conclusion. Superselective unilateral embolization of a thrombosed hematoma in the cervix might prevent extensive iatrogenic trauma of the cervix, which allows preservation of reproductive function. 1. Introduction The rupture of a branch of uterine artery subsequent to a delivery is a rare cause of postpartum hemorrhage that can be often successfully treated by uterine artery embolization (UAE). To our knowledge, no obstetrical followup in the subsequent pregnancy after UAE has been published so far. 2. Materials and Methods A 33-year-old healthy, nonsmoking, normal-weight, primiparous, Caucasian woman had an uncomplicated pregnancy. During spontaneous labor at full term, the cervix was completely dilated after 6 hours, and a relative cephalopelvic disproportion was suspected based on the lack of descent of the fetal head without any clinical sign of chorioamnionitis. A cesarean section was performed via low isthmic incision. Her immediate postpartum course was unremarkable with no pathological bleeding. Fifteen days later she was readmitted with persistent uterine bleeding. The cervix was tender by palpation and enlarged with widened external orifice. Doppler ultrasound (US) examination showed an extraluminal collection of blood with turbulent echo within the cervix. Computed tomography (CT) angiography presented a partially thrombosed large hematoma within the wall of cervix (Figure 1). Digital subtraction angiography was carried out on an emergency basis using right-sided transfemoral intervention. Contralateral internal iliac artery angiography revealed contrast media extravasation from a ruptured left cervical arteriolar branch of the uterine artery (UA). CT showed a ruptured branch terminating in a large, partially thrombosed hematoma (6.2?cm × 5?cm × 6?cm) embedded in the left part of the cervix. The thrombus was encircled with the thin wall of the cervix, whereas inside the thrombus, a
Vitamin D Status during Pregnancy and the Risk of Subsequent Postpartum Depression: A Case-Control Study  [PDF]
Nina O. Nielsen, Marin Str?m, Heather A. Boyd, Elisabeth W. Andersen, Jan Wohlfahrt, Marika Lundqvist, Arieh Cohen, David M. Hougaard, Mads Melbye
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0080686
Abstract: Epidemiological studies have provided evidence of an association between vitamin D insufficiency and depression and other mood disorders, and a role for vitamin D in various brain functions has been suggested. We hypothesized that low vitamin D status during pregnancy might increase the risk of postpartum depression (PPD). The objective of the study was thus to determine whether low vitamin D status during pregnancy was associated with postpartum depression. In a case-control study nested in the Danish National Birth Cohort, we measured late pregnancy serum concentrations of 25[OH]D3 in 605 women with PPD and 875 controls. Odds ratios [OR) for PPD were calculated for six levels of 25[OH]D3. Overall, we found no association between vitamin D concentrations and risk of PPD (p = 0.08). Compared with women with vitamin D concentrations between 50 and 79 nmol/L, the adjusted odds ratios for PPD were 1.35 (95% CI: 0.64; 2.85), 0.83 (CI: 0.50; 1.39) and 1.13 (CI: 0.84; 1.51) among women with vitamin D concentrations < 15 nmol/L, 15–24 nmol/L and 25–49 nmol/L, respectively, and 1.53 (CI: 1.04; 2.26) and 1.89 (CI: 1.06; 3.37) among women with vitamin D concentrations of 80–99 nmol/L and ≥ 100 nmol/L, respectively. In an additional analysis among women with sufficient vitamin D (≥ 50 nmol/L), we observed a significant positive association between vitamin D concentrations and PPD. Our results did not support an association between low maternal vitamin D concentrations during pregnancy and risk of PPD. Instead, an increased risk of PPD was found among women with the highest vitamin D concentrations.
Polymorphic eruption of pregnancy developing postpartum: 2 case reports  [cached]
Ellen Cathrine Pritzier,Carsten Sauer Mikkelsen
Dermatology Reports , 2012, DOI: 10.4081/dr.2012.e7
Abstract: Polymorphic eruption of pregnancy (PEP), also known as pruritic urticarial papules and plaques of pregnancy, is a common benign dermatosis of pregnancy mainly affecting primigravidae and multiple pregnancies. We report here two cases of PEP with typical clinical and histological features presenting in the postpartum period.
Lipid profile in consecutive pregnancies
David Mankuta, Matan Elami-Suzin, Asher Elhayani, Shlomo Vinker
Lipids in Health and Disease , 2010, DOI: 10.1186/1476-511x-9-58
Abstract: Blood lipid levels of 1752 women aged 20-45 years who delivered between 1999 and 2005 were measured. The lipid profile included total cholesterol, LDL-C (Low density lipoprotein), HDL-C (High density lipoprotein-C), VLDL-C (Very low density lipoprotein) and triglycerides (TG). The measurements were classified into the following categories: non-pregnant state (12 months prior to conception), during the three trimesters of pregnancy and from 6 weeks to 12 months postpartum. This profile was tested in up to three subsequent pregnancies.Total cholesterol levels overall rose during pregnancy. In the first trimester there is an average decrease of 11.4 mg/dL in total cholesterol level (p < 0.0001) followed by an average increase of 50.5 mg/dL and 28 mg/dL in the second and third trimesters respectively (p < 0.0001). In the year after pregnancy, the levels return to pre- pregnancy levels. LDL and triglyceride levels show a similar pattern.In contrast, HDL-C levels do not change significantly in the first trimester. The second trimester is characterized by an average elevation of 14 mg/dL (p < 0.0001) and a decrease of 5 mg/dL in the third trimester (p = 0.03).The average HDL-C levels of every period tested were lower in the 2nd and 3rd subsequent pregnancies.There is a general increase in total cholesterol, LDL and VLDL during pregnancy. We demonstrate a cumulative effect of consecutive pregnancies on lowering HDL cholesterol levels. This effect may have negative implications on future cardiovascular health.Blood lipid concentrations, lipoproteins and apolipoproteins in the plasma increase significantly during pregnancy [1]. Fat storage occurs primarily during mid-pregnancy [2,3].There is some evidence that progesterone, which increases markedly in the second half of pregnancy, may act to reset the lipostat in the hypothalamus.Hypercholesterolemia is an important cause of early atherosclerosis [4]. Nevertheless, there is conflicting evidence for an association between pari
The effect of abortion on outcome of subsequent pregnancy
Abortion,Pregnancy,Spontaneous abortion,Cohort
Tehran University Medical Journal , 1999,
Abstract: In a historical cohort study we evaluated the effects of spontaneous abortion on subsequent pregnancy outcome. 1693 pregnant women were classifield in three groups: 1100: without any prior pregnancy, group 1; 550: with history of one spontaneous abortion (G2A1), group 2; 43: with two or more prior spontaneous abortions and no other prior pregnancies, group 3. We collected data through interview, patient's records and physical examination. We matched the patients according to their age subgroups, history of chronic disease, drug administration and radiation during current pregnancy and familial marriage. Then we compared adverse outcome of present pregnancy in group 1 and 2 with the women without prior pregnancy. We analysed the data with Chi-square and Fisher's exact methods. In this study we concluded that history of one spontaneous abortion had no effect on subsequent pregnancy except on prolonged ROM (P<0.000), but history of two or more abortions significantly affects occurrence of stillbirth (RR=29, P=0.003) and placenta previa (RR=8.5, P=0.03). These findings suggest that pregnant women with history of two or more spontaneous abortion need special prenatal care.
Natural course of subsequent pregnancy after peripartum cardiomyopathy
Albanesi Fo, Francisco Manes;Silva, Tatiana Tavares da;
Arquivos Brasileiros de Cardiologia , 1999, DOI: 10.1590/S0066-782X1999000700005
Abstract: objective: to assess the effect of subsequent pregnancy after peripartum cardiomyopathy (ppcm) on maternal and fetal outcome. methods: prospective study of 34 patients with the diagnosis of ppcm (mean age= 26years). at the time of first diagnosis 5 were in nyha functional class (fc) ii for heart failure, one in fc iii and 28 in fc iv. after clinical treatment, patients were advised to avoid new pregnancies and a follow-up was obtained. results: there were 12 (35.3%) subsequent pregnancies in patients (pt) aged 19 to 44 years (mean 32), divided into two groups: gi: 6 pts who had normalized their heart size and gii: 6 pts with persistent cardiomegaly. gi had initially mild clinical manifestations ( 3 were in fc ii, 1 in fc ii and 2 in fc iv) and complete recovery of cardiac function (fc i). a new pregnancy was well-tolerated in 5 (83.3%); 1 pt presented with preeclampsia, and progressed to fc ii. presently, 5 pt are in fc i and 1 in fc ii. gii pts had more severe heart failure at the onset of ppcm (1 pt in fc ii and 5 in fc iv); during follow-up, 4 pt were in fc i and 2 in fc ii. a new pregnancy was well tolerated in all of them, but the eldest, who had had 2 pregnancies and had a progressive worsening of clinical status, dying 8 years after the last pregnancy and 13 years after the diagnosis of ppcm. the remaining 5 pt are still alive, 3 in fc i and 2 in fc ii, with worsening of fc in 1. subsequent pregnancies occurred 3-7 years after clinical treatment of ppcm and no fetal distress was observed. conclusion: subsequent pregnancies are well-tolerated after ppcm, but not devoid of risk. no fetal distress was observed. a minimum interval of 3 years after the recovery of function seems to be safe for subsequent pregnancies.
Natural course of subsequent pregnancy after peripartum cardiomyopathy
Albanesi Fo Francisco Manes,Silva Tatiana Tavares da
Arquivos Brasileiros de Cardiologia , 1999,
Abstract: OBJECTIVE: To assess the effect of subsequent pregnancy after peripartum cardiomyopathy (PPCM) on maternal and fetal outcome. METHODS: Prospective study of 34 patients with the diagnosis of PPCM (mean age= 26years). At the time of first diagnosis 5 were in NYHA functional class (FC) II for heart failure, one in FC III and 28 in FC IV. After clinical treatment, patients were advised to avoid new pregnancies and a follow-up was obtained. RESULTS: There were 12 (35.3%) subsequent pregnancies in patients (pt) aged 19 to 44 years (mean 32), divided into two groups: GI: 6 pts who had normalized their heart size and GII: 6 pts with persistent cardiomegaly. GI had initially mild clinical manifestations ( 3 were in FC II, 1 in FC II and 2 in FC IV) and complete recovery of cardiac function (FC I). A new pregnancy was well-tolerated in 5 (83.3%); 1 pt presented with preeclampsia, and progressed to FC II. Presently, 5 pt are in FC I and 1 in FC II. GII pts had more severe heart failure at the onset of PPCM (1 pt in FC II and 5 in FC IV); during follow-up, 4 pt were in FC I and 2 in FC II. A new pregnancy was well tolerated in all of them, but the eldest, who had had 2 pregnancies and had a progressive worsening of clinical status, dying 8 years after the last pregnancy and 13 years after the diagnosis of PPCM. The remaining 5 pt are still alive, 3 in FC I and 2 in FC II, with worsening of FC in 1. Subsequent pregnancies occurred 3-7 years after clinical treatment of PPCM and no fetal distress was observed. CONCLUSION: Subsequent pregnancies are well-tolerated after PPCM, but not devoid of risk. No fetal distress was observed. A minimum interval of 3 years after the recovery of function seems to be safe for subsequent pregnancies.
Thyroid Peroxidase Antibody and Screening for Postpartum Thyroid Dysfunction  [PDF]
Mohamed A. Adlan,Lakdasa D. Premawardhana
Journal of Thyroid Research , 2011, DOI: 10.4061/2011/745135
Abstract: Postpartum thyroid dysfunction (PPTD) is a common disorder which causes considerable morbidity in affected women. The availability of effective treatment for hypothyroid PPTD, the occurrence of the disease in subsequent pregnancies and the need to identify subjects who develop long term hypothyroidism, has prompted discussion about screening for this disorder. There is currently no consensus about screening as investigations hitherto have been variable in their design, definitions and assay frequency and methodology. There is also a lack of consensus about a suitable screening tool although thyroid peroxidase antibody (TPOAb) is a leading contender. We present data about the use of TPOAb in early pregnancy and its value as a screening tool. Although its positive predictive value is moderate, its sensitivity and specificity when used in early pregnancy are comparable or better compared to other times during pregnancy and the postpartum period. Recent studies have also confirmed this strategy to be cost effective and to compare favourably with other screening strategies. We also explore the advantages of universal screening. 1. Postpartum Thyroid Dysfunction Is Common Postpartum thyroid dysfunction (PPTD) is a common disorder which causes considerable morbidity in some women [1]. The availability of effective treatment particularly for the symptomatic hypothyroid phase, and the awareness that hypothyroidism is a long-term consequence in a significant minority of these subjects, has prompted discussion about screening for PPTD [2, 3]. However, there is currently no consensus because of unresolved issues about an effective and sensitive prediction tool. The current worldwide pooled prevalence for PPTD is estimated to be 8% (95% CI 7.8–8.2%), with regional variations—USA 5.7%, Asia 4.4%, Spain 9.3%, Sweden 7.3%, and The Netherlands 6.3% [4]. These differences may be due to (a) variable study design (timing and number of thyroid tests), (b) definition of PPTD, (c) prevalence of thyroid peroxidase antibody (TPOAb), (d) assay methods used (antimicrosomal versus TPOAb), and (e) population characteristics (including prevalence of type 1 diabetes mellitus (T1DM), PPTD in previous pregnancies, iodine intake and genetics) [5]. The early hyperthyroid phase of PPTD causes minimal symptoms and hardly ever requires specific treatment. However, the hypothyroid phase which occurs later often needs to be treated with thyroxine for up to 9 months [6]. A significant number of subjects who have hypothyroid PPTD remain so at the end of the first postpartum year and require
Possible Predictive Factors for Low Back and Pelvic Pain at Three Months Postpartum Assessed in a Prospective Study from Early Pregnancy until the Postpartum Period  [PDF]
Yuko Uemura, Toshiyuki Yasui, Kimiyo Horike, Hirokazu Uemura, Mari Haku, Reiko Sakae, Keiko Matsumura
Open Journal of Nursing (OJN) , 2018, DOI: 10.4236/ojn.2018.88041
Abstract: Background: Low back and pelvic pain (LBPP) is an important issue related to mental health as well as to difficulty for daily life activity during early pregnancy and in the postpartum period. We examined the intensity of LBPP, difficulty for daily life activity and mental health and their associations from early pregnancy until 3 months postpartum in a prospective study. We also examined predictive factors for LBPP at 3 months postpartum. Methods: We recruited 55 pregnant women who responded to questionnaires in the first, second and third trimesters and at one week, one month and 3 months postpartum. We designed a self-administered questionnaire including a visual analog scale (VAS), pregnancy mobility index (PMI) of LBPP and Edinburgh postnatal depression scale (EPDS). Results: There were significant differences in the proportions of women with LBPP in the first trimester (63.6%), second trimester (78.2%) and third trimester (83.6%) and at one week postpartum (80.0%), one month postpartum (69.1%) and 3 months postpartum (56.4%). VAS score at 3 months postpartum was significantly correlated with VAS scores at the first trimester (r = 0.410, p = 0.002), second trimester (r = 0.298, p = 0.027) and one month postpartum (r = 0.476, p < 0.001). VAS score at 3 months postpartum was significantly correlated with PMI scores at the first trimester and one month postpartum. The presence of LBPP at 3 months postpartum was significantly associated with the proportion of women with LBPP at the first trimester. In multiparous women, predictive factor of LBPP at 3 months postpartum was a past history of LBPP in the previous pregnancy. Conclusion: The proportion of women with LBPP and the intensity of LBPP were increased at late pregnancy and gradually decreased until 3 months postpartum. LBPP at 3 months postpartum was associated with LBPP at the first trimester and a past history of LBPP in a previous pregnancy was an important factor for prediction of LBPP at 3 months postpartum. Provision of information regarding LBPP and confirmation of LBPP before pregnancy in addition to assessment of LBPP at early pregnancy are necessary for reduction of LBPP at 3 months postpartum.
Low Back Pain in Pregnancy  [PDF]
Bar?? Nac?r,Aynur Karag?z,H. Rana Erdem
Romatizma , 2009,
Abstract: Pregnancy-related low back pain is a common problem during pregnancy. More than half of all pregnant women experience low back pain at some time during pregnancy. The pain can vary from a mild discomfort to being severe and disabling. In one-third of these women, pain is a severe problem compromising activities of daily living, work and sleep. The awareness of the possible impact of low back pain on the quality of life and the associated costs to society has increased medical attention over the last decade. Pain usually develops between the fifth and seventh month of pregnancy but may appear as early as the first trimester. Moreover, some women who experience back pain during pregnancy experience persistent back pain in the postpartum period or have an increased risk of back pain in subsequent pregnancies, and many women with chronic back pain link its onset to a pregnancy. Despite its high frequency, there are some ambiguities inherent in the terminology, diagnosis and classification. The etiology and pathogenesis are not yet clearly understood. The etiology of pain is probably related to a combination of mechanical, hormonal and vascular contributing factors. Low back pain in pregnancy is most commonly subdivided into lumbar pain and posterior pelvic pain. This subdivision is important in terms of both management and prognosis. Characteristic findings and treatment may differ between the two categories. Accurate assessment and effective treatment are important for managing the low back pain of pregnancy.The purpose of the present article was to provide a summary review of the performed studies on pregnancy-related low back pain.
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