First trimester fasting glucose and glycated haemoglobin cut-offs associated with abnormal glucose homeostasis in the post-partum reclassification in women with hyperglycaemia in pregnancy

2021 ◽  
Author(s):  
Catarina Chaves ◽  
Filipe M. Cunha ◽  
Mariana Martinho ◽  
Susana Garrido ◽  
Margarida Silva-Vieira ◽  
...  
Keyword(s):  
Glucose Homeostasis ◽  
Fasting Glucose ◽  
Post Partum ◽  
First Trimester ◽  
Glycated Haemoglobin ◽  
In Pregnancy

Antithrombin Deficiency in Pregnancy.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1879-1879
Author(s):  
Retter J. Andrew ◽  
Hunt J. Beverley
Keyword(s):  
Caesarean Section ◽  
Post Partum ◽  
Case Series ◽  
Fold Increase ◽  
First Trimester ◽  
Antithrombin Deficiency ◽  
Sagittal Sinus ◽  
Asymptomatic Patients ◽  
Estimated Blood Loss ◽  
In Pregnancy

Abstract Background: During pregnancy untreated antithrombin deficiency is associated with up to a 50% risk of venous thromboembolism (VTE) and a relative risk of pregnancy loss of 2.1 with a 5-fold increase in stillbirths. Thus thromboprophylaxis is widely used, but little data is available to select type, dose & duration of anticoagulation. Method: We performed a retrospective, single centre observational study of our antithrombin deficient pregnancies since 1996. Results: There were 9 pregnancies in 8 women; median age at conception 33 (age-range 19–37). They separated into 3 groups (1) 4 asymptomatic patients diagnosed on family screening. They received unmonitored enoxaparin 40mg until 16 weeks then 40mg BD. (2) 2 with previous VTE, received intermediate dose enoxaparin (1mg/kg), increased to BD at 16 weeks. Monitoring was done to maintain an anti-Xa trough of <0.12 iu/ml and peak <0.8iu.ml. (3) 2 referred after presenting with VTE in pregnancy. They received enoxaparin 1mg/kg BD and the same monitoring These included a known antithrombin deficient woman, referred in her second pregnancy at 26weeks gestation with premature rupture of the membranes and an iliofemoral deep vein thrombosis which developed on enoxaparin 60mg OD. Enoxaparin was increased to 1mg/kg BD and an IVC filter inserted. Despite the filter however she had a pulmonary embolism. The filter was removed after Caesarean section at 31 weeks. Two had sagittal sinus thromboses in the first trimester associated with severe hyperemesis requiring IV fluids. One was our only thromboprophylaxis failure, receiving enoxaparin 40mg OD, she weighed 80Kg. The second presented at 11weeks gestation. She was intolerant of self injecting and so switched to warfarin at 15 weeks until 35 weeks as did one other mother. All mothers had close feto-maternal monitoring with uterine artery Doppler at 24 weeks if possible and then monthly growth scans thereafter. Delivery: Thromboprophylaxis was stopped at labour initiation or 12hrs prior to Caesarean section (3 women) and 50iu/kg of antithrombin concentrate was given. Anticoagulation was restarted 24hrs after delivery. Six weeks enoxaparin post-partum thromboprophylaxis was given or the women converted back to warfarin. Estimated blood loss at delivery was a median of 200ml (range 200–500ml), no transfusions were required. There were no post partum VTEs. Nine births occurred at a median gestation of 38weeks (range 31–41), median birth weight 3045g (range 1420–4120g). One child has West’s syndrome. Conclusion: This is the largest case series on the management of antithrombin deficiency in pregnancy. The combined use of enoxaparin in pregnancy and post partum combined with antithrombin concentrate during labour appears to improve pregnancy outcome and reduce the rate of VTE. Larger studies are required to confirm this finding.

scholarly journals EFEKTIVITAS PEMBERIAN PISANG AMBON DAN VITAMIN B UNTUK MENURUNKAN HIPEREMESIS GRAVIDARUM DI BPM ENDAH BEKTI

2018 ◽  
Vol 7 (1) ◽  
pp. 17-21
Author(s):  
Elvika Fit Ari Shanti ◽  
Liberty Barokah ◽  
Budi Rahayu
Keyword(s):  
Pregnant Women ◽  
Vitamin B6 ◽  
Hyperemesis Gravidarum ◽  
Post Partum ◽  
Endocrine System ◽  
First Trimester ◽  
The Other ◽  
Vitamin B ◽  
Difference Test ◽  
In Pregnancy

Background: Endocrine system changes during pregnancy are important to keep the pregnancy, fetal growth and post partum recovery. Around 50-90% of pregnant women experience vomit and nausea. To solve those problems, ‘pisang ambon’ (Musa paradisiacal) consumption is one of choices because of its flavonoid and vitamin B6 which can overcome vomit and nausea in pregnancy. Objective: The aim of this research was to identify the effectiveness between pisang ambon (Musa paradisiacal) consumption and vitamin B6 to reduce hyperemesis gravidarum in BPM Endah Bekti. Methods: A quasy experimental design with two-group posttest only was assigned to 20 pregnant women on their first trimester. First ten sample was given vitamin B6 and the other ten sample were given vitamin B6 plus pisang ambon. Data were then analyzed using two independent mean difference test. Results: The result shows that in vitamin B6 consumption for hyperemesis gravidarum in 10% pregnant women were in the effective category. While in the pisang ambon consumption shows 100% of pregnant women are in the effective category. Conclusion: There is difference in effectiveness between vitamin B6 and pisang ambon consumption to overcome hyperemesis gravidarum (p=0,003<α).   Keywords: Hiperemesis gravidarum, vitamin B6, Pisang ambon

scholarly journals AB0424 PREDICTORS OF SLE FLARE-UP AND PREMATURE DELIVERY IN PREGNANCY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1511.1-1512
Author(s):  
C. H. Liao ◽  
L. C. Wang ◽  
S. C. Hsieh ◽  
B. L. Chiang
Keyword(s):  
Serum Albumin ◽  
Serum Albumin Level ◽  
Post Partum ◽  
First Trimester ◽  
Albumin Level ◽  
Complement C3 ◽  
Premature Delivery ◽  
Disease Flare ◽  
In Pregnancy ◽  
Low Serum

Background:Systemic lupus erythematosus (SLE) is a life-threatening autoimmune disease that affects many women of child-bearing age, with potentially severe consequences on pregnancy outcome. SLE flare-ups may occur during pregnancy and the post-partum period. Previous studies documenting the incidence and risk factors of flare-up of SLE during pregnancy and puerperium had partially discordant results.Objectives:We aimed to delineate the pregnancy complications of women with SLE, as well as neonatal outcomes of their offspring, and hoped to clarify the incidence and risk factors of SLE flare-ups during pregnancy and puerperium.Methods:We retrospectively reviewed the medical records of SLE patients with previous records of pregnancies in our institution. Flare events during pregnancy and puerperium were documented. The pregnancy outcomes recorded include live births, intra-uterine fetal death (IUFD), premature delivery (< 36 weeks of gestational age), NICU admission, and small for gestational age (SGA, <10thpercentile). Univariate logistic regression was performed to determine the factors associated with disease relapse and pregnancy outcomes.Results:From January, 2000 to December, 2019, a total of 94 SLE patients with 139 pregnancies were identified. The overall live birth rate was 92.4% (134/145). Forty-six (34.3%) of the neonates were delivered prematurely. Forty-six (34.3%) of them were SGA. The admission rate to the neonatal intensive care unit was 25% (30/120). Nine (6.4%) were diagnosed to have SLE during pregnancy. The flare rate during pregnancy was 20% while post-partum 9.4%. The majority of the relapses during pregnancy occurred in the second trimester (46.2%), followed by the first trimester (30.8%), and the third trimester (23.1%). Low complement C3 (C3 < 80mg/dl), thrombocytopenia (PLT < 100*103/uL) at conception, and low serum albumin level at the first trimester were associated with antepartum flare. Presence of disease flare and pre-eclampsia in pregnancy, and low serum albumin level at conception were significantly associated with premature delivery.Conclusion:Low complement C3 and thrombocytopenia at conception, and low serum albumin level at the first trimester were associated with disease flare-up during pregnancy. Patients with relative low serum albumin level at conception, or presence of eclampsia or disease flare-up during pregnancy had a higher risk of premature delivery.References:[1]Shaharir SS, Mohamed Said MS, Mohd R, et al. Predictors of SLE relapse in pregnancy and post-partum among multi-ethnic patients in Malaysia.PloS one2019;14(9):e0222343.[2]Bundhun PK, Soogund MZ, Huang F. Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: A meta-analysis of studies published between years 2001-2016.Journal of autoimmunity2017;79:17-27.Disclosure of Interests: :None declared

Aplastic Anemia in Pregnancy - a Single Centre, North American Case Series

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3909-3909 ◽  
Author(s):  
Kelly E McGowan ◽  
Ann Kinga Malinowski ◽  
Andre C. Schuh ◽  
Nadine Shehata
Keyword(s):  
Bone Marrow ◽  
Aplastic Anemia ◽  
North American ◽  
Clinical Presentation ◽  
Post Partum ◽  
First Trimester ◽  
Mount Sinai Hospital ◽  
Newly Diagnosed ◽  
Single Centre ◽  
In Pregnancy

Abstract Introduction Little data exist on the clinical presentation, management and treatment of aplastic anemia (AA) in pregnancy.The aim of this study is to describe the clinical presentation, management and outcomes of patients with AA in pregnancy based on a single centre, North American experience. Methods Patients with AA during pregnancy managed at Mount Sinai Hospital, a tertiary care centre in Toronto, Canada, were retrospectively identified through the Special Pregnancy Program database from 1990 to 2014, inclusive. Charts and electronic medical records were reviewed to extract demographics, clinical features, bone marrow biopsy results, paroxysmal nocturnalhemoglobinuria(PNH) status, comorbidities, treatment and transfusion requirements, as well as obstetrical and post-partum outcomes.The Research Ethics Board at Mount Sinai Hospital approved the study. Results Between 1990 and 2014, 24 pregnancies were identified in 12 women with AA. Among these, 3 women (5 pregnancies) were excluded from subsequent analysis due to incomplete records. Among the 19 pregnancies in 9 women with AA, 6 women had at least one subsequent pregnancy during the study period. The initial diagnosis of AA occurred during pregnancy in 5 of the 19 pregnancies in 9 women (Table 1). Four of the 5 women were diagnosed with AA in the first trimester. The presenting signs and symptoms included fatigue (1), chest pain due to severeanemia(1),petechiae(1), hematemesis (1) and in 1 patient the diagnosis was made following a CBC performed for routine prenatal care. Among the 14 pregnancies with a prior diagnosis of AA, 4 were in complete remission (CR) and 6 were in partial remission (PR). In addition, there were 5 pregnancies in 3 women following allogeneic bone marrow transplant (alloBMT). Of these, 3 pregnancies occurred post-alloBMTin CR, 1 in PR and 1 was not in remission. PNH clones were present in 4 of the pregnancies (3 women). Among the 5 pregnancies with newly diagnosed AA, 3 were treated with cyclosporine during pregnancy and 1 was treated with prednisone alone, all without a response. Transfusion support was required in 10 of the 19 pregnancies, including all 5 pregnancies with newly diagnosed AA (Table 2). In the 5 pregnancies with newly diagnosed AA, the median haemoglobin was 67g/L, median WBC was 3.6/microLand median platelet count was 26x109/L at the time of diagnosis. In the 14 pregnancies with a prior diagnosis of AA, the median haemoglobin, WBC and platelet counts in the first trimester were higher (Table 2). Although there were no maternal deaths, significant complications occurred in 15 of the 19 (79%) pregnancies (Table 3). Four pregnancies (in two women) were not associated with significant complications and these patients were in PR or CR at the onset of pregnancy. Common complications during pregnancy and post-partum included transfusion-related event (13), drug adverse effect (8), bleeding (6), preterm birth (5), thrombosis (3) and infection (3) (Table 3). Most of the pregnancies experienced declining hematologic parameters over the course of pregnancy. However, relapses were not observed among the 10 pregnancies in CR or PR at onset of pregnancy. There were no spontaneous remissions of AA in the postpartum period. Among the 5 women with newly diagnosed AA in pregnancy, 3 underwentalloBMTand 2 had excellent outcomes with resolution ofcytopeniasand no complications. The third woman who underwentalloBMTsuffered significant complications following transplantation including disseminatedNocardia(brain and lung), renal dysfunction secondary to cyclosporine, acute GVHD of the gastrointestinal tract and liver, pericarditis, iron overload and transfusion dependency. Conclusions AA in pregnancy is rare, with 24 pregnancies in 12 women over 24 years in a single, tertiary hospital. AA in pregnancy was not associated with mortality but significant morbidity was seen. In our cohort, no spontaneous remissions of AA were observed post-partum. Further studies with larger sample sizes are required to clarify the natural history of AA in pregnancy and best approach to management to avoid complications during pregnancy and post-partum. Disclosures Schuh: Amgen: Membership on an entity's Board of Directors or advisory committees.

scholarly journals EFEKTIVITAS PEMBERIAN PISANG AMBON DAN VITAMIN B UNTUK MENURUNKAN HIPEREMESIS GRAVIDARUM DI BPM ENDAH BEKTI

2019 ◽  
Vol 7 (1) ◽  
pp. 17-21
Author(s):  
Elvika Fit Ari Shanti ◽  
Liberty Barokah ◽  
Budi Rahayu
Keyword(s):  
Pregnant Women ◽  
Vitamin B6 ◽  
Hyperemesis Gravidarum ◽  
Post Partum ◽  
Endocrine System ◽  
First Trimester ◽  
The Other ◽  
Vitamin B ◽  
Difference Test ◽  
In Pregnancy

Background: Endocrine system changes during pregnancy are important to keep the pregnancy, fetal growth and post partum recovery. Around 50-90% of pregnant women experience vomit and nausea. To solve those problems, ‘pisang ambon’ (Musa paradisiacal) consumption is one of choices because of its flavonoid and vitamin B6 which can overcome vomit and nausea in pregnancy. Objective: The aim of this research was to identify the effectiveness between pisang ambon (Musa paradisiacal) consumption and vitamin B6 to reduce hyperemesis gravidarum in BPM Endah Bekti. Methods: A quasy experimental design with two-group posttest only was assigned to 20 pregnant women on their first trimester. First ten sample was given vitamin B6 and the other ten sample were given vitamin B6 plus pisang ambon. Data were then analyzed using two independent mean difference test. Results: The result shows that in vitamin B6 consumption for hyperemesis gravidarum in 10% pregnant women were in the effective category. While in the pisang ambon consumption shows 100% of pregnant women are in the effective category. Conclusion: There is difference in effectiveness between vitamin B6 and pisang ambon consumption to overcome hyperemesis gravidarum (p=0,003<α). Keywords: Hiperemesis gravidarum, vitamin B6, Pisang ambon

Hormonal changes causing rhinitis in pregnancy among Malaysian women

2013 ◽  
Vol 127 (9) ◽  
pp. 876-881 ◽  
Author(s):  
B Indirani ◽  
R Raman ◽  
S Z Omar
Keyword(s):  
Growth Factor ◽  
Post Partum ◽  
First Trimester ◽  
Insulin Like Growth Factor ◽  
Hormonal Changes ◽  
Third Trimester ◽  
The Third ◽  
Pregnancy Rhinitis ◽  
In Pregnancy ◽  
Malaysian Women

AbstractObjectives:To investigate the aetiology of rhinitis occurring in pregnancy, by (1) describing the relationship between pregnancy rhinitis and serum oestrogen, progesterone, placental growth hormone and insulin-like growth factor, and (2) assessing the prevalence of pregnancy rhinitis among Malaysian women.Methods:Prospective study involving 30 pregnant women followed at an ante-natal clinic for 14 months. Hormone levels were analysed during pregnancy and the post-partum period.Results:Levels of all four hormones were elevated in the third trimester, compared with first trimester and post-partum values. Rhinitis patients had higher levels of oestrogen and insulin-like growth factor 1 in the third trimester than non-rhinitis patients, although these differences were not statistically significant. The prevalence of rhinitis was 53.3 per cent, with most cases occurring in the third trimester. Patients with pregnancy rhinitis had a higher prevalence of female babies, compared with non-rhinitis patients (p = 0.003).Conclusions:Pregnancy rhinitis was significantly more common in women giving birth to female babies. Women with pregnancy rhinitis had a non-significant elevation in oestrogen and insulin-like growth factor 1 levels, compared with those without rhinitis.

Low back pain in pregnancy and post-partum period. Principles for medical rehabilitation

2018 ◽  
Vol 1 (19) ◽  
pp. 22
Author(s):  
Iulia Filipescu ◽  
Mihai Berteanu ◽  
George Alexandru Filipescu ◽  
Radu Vlădăreanu
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Post Partum ◽  
Medical Rehabilitation ◽  
Low Back ◽  
Post Partum Period ◽  
In Pregnancy

EXPRESS: Method dependent variation in TSH and FT4 reference intervals in pregnancy: a systematic review

2021 ◽  
pp. 000456322110269
Author(s):  
O E Okosieme ◽  
Medha Agrawal ◽  
Danyal Usman ◽  
Carol Evans
Keyword(s):  
Systematic Review ◽  
Reference Interval ◽  
First Trimester ◽  
Reference Intervals ◽  
Assay Method ◽  
Specific Reference ◽  
Upper Limits ◽  
Wide Range ◽  
Assay Methods ◽  
In Pregnancy

Background: Gestational TSH and FT4 reference intervals may differ according to assay method but the extent of variation is unclear and has not been systematically evaluated. We conducted a systematic review of published studies on TSH and FT4 reference intervals in pregnancy. Our aim was to quantify method-related differences in gestation reference intervals, across four commonly used assay methods, Abbott, Beckman, Roche, and Siemens. Methods: We searched the literature for relevant studies, published between January 2000 and December 2020, in healthy pregnant women without thyroid antibodies or disease. For each study, we extracted trimester-specific reference intervals (2.5–97.5 percentiles) for TSH and FT4 as well as the manufacturer provided reference interval for the corresponding non-pregnant population. Results: TSH reference intervals showed a wide range of study-to-study differences with upper limits ranging from 2.33 to 8.30 mU/L. FT4 lower limits ranged from 4.40–13.93 pmol/L, with consistently lower reference intervals observed with the Beckman method. Differences between non-pregnant and first trimester reference intervals were highly variable, and for most studies the TSH upper limit in the first trimester could not be predicted or extrapolated from non-pregnant values. Conclusions: Our study confirms significant intra and inter-method disparities in gestational thyroid hormone reference intervals. The relationship between pregnant and non-pregnant values is inconsistent and does not support the existing practice in some laboratories of extrapolating gestation references from non-pregnant values. Laboratories should invest in deriving method-specific gestation reference intervals for their population.

scholarly journals The Role of TNF-α and Anti-TNF-α Agents during Preconception, Pregnancy, and Breastfeeding

2021 ◽  
Vol 22 (6) ◽  
pp. 2922
Author(s):  
Katarzyna Romanowska-Próchnicka ◽  
Anna Felis-Giemza ◽  
Marzena Olesińska ◽  
Piotr Wojdasiewicz ◽  
Agnieszka Paradowska-Gorycka ◽  
...  
Keyword(s):  
Inflammatory Cytokines ◽  
First Trimester ◽  
Endocrine Function ◽  
Necrosis Factor Alpha ◽  
Hormone Synthesis ◽  
Migratory Activity ◽  
Immune System Diseases ◽  
Tnf Α ◽  
The Impact ◽  
In Pregnancy

Tumor necrosis factor-alpha (TNF-α) is a multifunctional Th1 cytokine and one of the most important inflammatory cytokines. In pregnancy, TNF-α influences hormone synthesis, placental architecture, and embryonic development. It was also shown that increased levels of TNF-α are associated with pregnancy loss and preeclampsia. Increased TNF-α levels in complicated pregnancy draw attention to trophoblast biology, especially migratory activity, syncytialisation, and endocrine function. Additionally, elevated TNF-α levels may affect the maternal-fetal relationship by altering the secretory profile of placental immunomodulatory factors, which in turn affects maternal immune cells. There is growing evidence that metabolic/pro-inflammatory cytokines can program early placental functions and growth in the first trimester of pregnancy. Furthermore, early pregnancy placenta has a direct impact on fetal development and maternal immune system diseases that release inflammatory (e.g., TNF-α) and immunomodulatory factors, such as chronic inflammatory rheumatic, gastroenterological, or dermatological diseases, and may result in an abnormal release of cytokines and chemokines in syncytiotrophoblasts. Pregnancy poses a challenge in the treatment of chronic disease in patients who plan to have children. The activity of the disease, the impact of pregnancy on the course of the disease, and the safety of pharmacotherapy, including anti-rheumatic agents, in pregnancy should be considered.

scholarly journals Axial torsion of Meckel’s diverticulum causing acute peritonitis in the first trimester of pregnancy: a case report

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Hiromitsu Nagata ◽  
Hiroyasu Nishizawa ◽  
Susumu Mashima ◽  
Yasuyuki Shimahara
Keyword(s):  
Clinical Diagnosis ◽  
Meckel’S Diverticulum ◽  
Ileocecal Valve ◽  
First Trimester ◽  
Meckel's Diverticulum ◽  
Ileocecal Resection ◽  
Bowel Loop ◽  
Axial Torsion ◽  
First Trimester Of Pregnancy ◽  
In Pregnancy

Abstract Background Meckel’s diverticulum is considered the most prevalent congenital anomaly of the gastrointestinal tract. Approximately 4% of patients are symptomatic with complications such as bleeding, intestinal obstruction, and inflammation, while axial torsion of Meckel’s diverticulum is rare, particularly in pregnancy. Case presentation A 31-year-old woman in week 15 of pregnancy complained of epigastric pain, nausea and vomiting. Clinical diagnosis was severe hyperemesis gravidarum. Because the symptoms persisted during hospitalization, CT was performed and revealed dilated small bowel loops with multiple air-fluid levels. In the right mid-abdomen, there was a large part of air containing a cavity connected to the small intestine, which was considered a dilated bowel loop. Emergency laparotomy was performed and axial torsion of a large Meckel’s diverticulum measuring 11 cm was found at a few centimeters proximal to the ileocecal valve. Ileocecal resection including Meckel’s diverticulum was performed. The postoperative course was uneventful. At 40 weeks gestation, she had vaginal delivery of normal baby. Conclusion The physiological and anatomical changes in pregnancy can make a straightforward clinical diagnosis difficult. Prompt diagnosis and management were needed in order to avoid significant maternal and fetal risks. The use of imaging examinations, especially CT examination, with proper timing may be helpful to prevent delay in diagnosis and surgical intervention. Here, we report the case of a patient with axial torsion of Meckel’s diverticulum in pregnancy. To our knowledge, axial torsion of Meckel’s diverticulum in the first trimester of pregnancy has not been reported in the English medical literature.

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