Aortic dissection in pregnancy: A life-threatening disease and a diagnosis of worth considering

Acute thoracic aortic dissection is an uncommon, although not rare, life-threatening condition. With protean signs and symptoms that often suggest more common cardiac or pulmonary conditions, it can be difficult to diagnose. Ultrasound has proven useful in making the correct diagnosis. This case demonstrates that training gained using standard ultrasound machines can be easily and successfully adapted to newer handheld ultrasound devices. The examination technique using the handheld device is illustrated with photos and a video.

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Treatment and therapeutic strategies for pituitary apoplexy in pregnancy: a case series

Journal of Medical Case Reports ◽

10.1186/s13256-021-02892-5 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Yuya Kato ◽

Yoshikazu Ogawa ◽

Teiji Tominaga

Keyword(s):

Pituitary Apoplexy ◽

Clinical Symptoms ◽

Case Series ◽

Optimal Timing ◽

Presenting Symptoms ◽

Pathological Evaluation ◽

Mother And Child ◽

Life Threatening ◽

In Pregnancy

Abstract Background Pregnancy is a known risk factor for pituitary apoplexy, which is life threatening for both mother and child. However, very few clinical interventions have been proposed for managing pituitary apoplexy in pregnancy. Case presentation We describe the management of three cases of pituitary apoplexy during pregnancy and review available literature. Presenting symptoms in our case series were headache and/or visual disturbances, and the etiology in all cases was hemorrhage. Conservative therapy was followed until 34 weeks of gestation, after which babies were delivered by cesarean section with prophylactic bolus hydrocortisone supplementation. Tumor removal was only electively performed after delivery using the transsphenoidal approach. All three patients and their babies had a good clinical course, and postoperative pathological evaluation revealed that all tumors were functional and that they secreted prolactin. Conclusions Although the mechanism of pituitary apoplexy occurrence remains unknown, the most important treatment strategy for pituitary apoplexy in pregnancy remains adequate hydrocortisone supplementation and frequent hormonal investigation. Radiological follow-up should be performed only if clinical symptoms deteriorate, and optimal timing for surgical resection should be discussed by a multidisciplinary team that includes obstetricians and neonatologists.

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Thyroid storm in the second stage of labour: a case report

BMJ Case Reports ◽

10.1136/bcr-2021-243159 ◽

2021 ◽

Vol 14 (7) ◽

pp. e243159

Author(s):

Yudianto Budi Saroyo ◽

Achmad Kemal Harzif ◽

Beryliana Maya Anisa ◽

Fistyanisa Elya Charilda

Keyword(s):

Treatment Guidelines ◽

Thyroid Storm ◽

Lung Oedema ◽

Second Stage ◽

Second Stage Of Labour ◽

Failure Treatment ◽

Life Threatening ◽

Thyroid Hormone Levels ◽

Peripartum Period ◽

In Pregnancy

A thyroid storm (or thyroid crisis) is an emergency in endocrinology. It is a form of complication of hyperthyroidism that can be life-threatening. Inadequate control of hyperthyroidism in pregnancy could develop into thyroid storm, especially in the peripartum period. We present a woman came in the second stage of labour, with thyroid storm, superimposed pre-eclampsia, acute lung oedema and impending respiratory failure. Treatment for thyroid storm, pre-eclampsia protocol and corticosteroid was delivered. The baby was born uneventfully, while the mother was discharged after 5 days of hospitalisation. Delivery is an important precipitant in the development of thyroid storm in uncontrolled hyperthyroidism in pregnancy. Although very rare, it can cause severe consequences. Diagnosis and treatment guidelines for thyroid storm were available and should be done aggressively and immediately. Uncontrolled hyperthyroidism should be prevented by adequate control in thyroid hormone levels, especially before the peripartum period.

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Odontogenic deep neck space infection as life-threatening condition in pregnancy

Australian Dental Journal ◽

10.1111/adj.12189 ◽

2014 ◽

Vol 59 (3) ◽

pp. 375-378 ◽

Cited By ~ 8

Author(s):

D Dalla Torre ◽

D Burtscher ◽

D Höfer ◽

FR Kloss

Keyword(s):

Space Infection ◽

Threatening Condition ◽

Life Threatening ◽

Deep Neck Space Infection ◽

In Pregnancy

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Profound Hypokalaemia Resulting in Maternal Cardiac Arrest: A Catastrophic Complication of Hyperemesis Gravidarum?

Case Reports in Obstetrics and Gynecology ◽

10.1155/2018/4687587 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Anna Walch ◽

Madeline Duke ◽

Travis Auty ◽

Audris Wong

Keyword(s):

Cardiac Arrest ◽

Hyperemesis Gravidarum ◽

Extracellular Fluid ◽

Nutritional Deficiencies ◽

Normal Limits ◽

Life Threatening ◽

Total Body ◽

Anuric Renal Failure ◽

Hospital Cardiac Arrest ◽

In Pregnancy

We present a case of a 39-year-old G8P6 Pacific Islander woman who at 15+5 weeks’ gestation had an out-of-hospital cardiac arrest secondary to profound hypokalaemia which was associated with severe hyperemesis gravidarum (HG). Her clinical course after arrest was complicated by a second 5-minute cardiac arrest in the Intensive Care Unit (ICU) (pre-arrest potassium 1.8), anuric renal failure requiring dialysis, ischaemic hepatitis, and encephalopathy and unfortunately fetal demise and a spontaneous miscarriage on day 2 of admission. Despite these complications, she was discharged home 4 weeks later with a full recovery. Following a plethora of inpatient and outpatient investigations, the cause of her cardiac arrest was determined to be profound hypokalaemia. The hypokalaemia was presumed second to a perfect storm of HG with subsequent nutritional deficiencies causing electrolyte wasting, extracellular fluid (ECF) volume reduction, and activation of the renin-angiotensin-aldosterone axis (RAAS). This combined with the physiological changes that promote potassium wasting in pregnancy including volume expansion, increased renal blood flow, increased glomerular filtration rate, and increase in cortisol contributed to the patient having a profoundly low total body potassium level. This diagnosis is further strengthened by the fact that her pre- and post-pregnancy potassium levels were within normal limits in the absence of supplementary potassium. This case highlights the potentially life-threatening electrolyte imbalances that can occur with HG and the importance of recognising the disease, comprehensive electrolyte monitoring, and aggressive management in pregnancy.

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Thyroid Disease I: Hyperthyroidism in Pregnancy

10.2310/obg.19041 ◽

2020 ◽

Author(s):

Robert B. Martin ◽

Brian Casey

Keyword(s):

Hyperemesis Gravidarum ◽

Beta Blockers ◽

Thyroid Stimulating Hormone ◽

Thyroid Storm ◽

Care Level ◽

Hypermetabolic State ◽

Life Threatening ◽

Overt Hyperthyroidism ◽

In Pregnancy ◽

Stimulating Hormone

Thyroid physiologic adaptations in pregnancy may be confused with pathologic changes. Human chorionic gonadotropin rises early in pregnancy, stimulating thyrotropin secretion and suppressing thyroid stimulating hormone. These chemical changes are often seen in hyperemesis gravidarum and gestational transient thyrotoxicosis. Therefore, mild thyrotoxicosis may be difficult to differentiate from early pregnancy thyroxine stimulation. However, overt hyperthyroidism usually includes classic symptoms seen outside of pregnancy in addition to suppressed TSH and T4 levels. Treatment includes thionamides propylthiouracil and methimazole. Thyroid ablation is contraindicated in pregnancy. Often, in affected women, the fetus is euthyroid, but neonates can develop hyper or hypothyroidism with or without a goiter. Lastly, thyroid storm, though rare, is life threatening. Often presenting as a hypermetabolic state with cardiomyopathy and pulmonary hypertension, it generally results from decompensation from preeclampsia, anemia, sepsis, or surgery. Treatment requires intensive care level management, with initiation of thionamides, iodine, and beta blockers. This review contains 2 figures, 4 tables and 38 references. Keywords: Thyroid-releasing hormong, thyroid-stimulating hormone, thyromegaly, thyroid-stimulating immunoglobulins, thryotoxicosis, thionamides, thyroid storm

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Posttraumatic Stress During Pregnancy and the Postpartum Period

10.1093/oxfordhb/9780199778072.013.18 ◽

2014 ◽

Cited By ~ 1

Author(s):

Susan Ayers ◽

Elizabeth Ford

Keyword(s):

Subjective Experience ◽

Negative Impact ◽

Post Traumatic Stress ◽

Individual Vulnerability ◽

Postpartum Ptsd ◽

Pregnancy And Postpartum ◽

Life Threatening ◽

Post Traumatic ◽

In Pregnancy

Research on post-traumatic stress disorder (PTSD) in pregnancy and postpartum is relatively new but clearly demonstrates the importance of recognizing and treating women with PTSD at this time. Women with PTSD in pregnancy are at greater risk of pregnancy complications and health behaviors that have a negative impact on the woman and fetus. Approximately –3% of women develop PTSD after giving birth, and rates increase for women who have preterm or stillborn infants or life-threatening complications during pregnancy or labor. Models of the etiology of postpartum PTSD focus on the interaction among individual vulnerability, risk, and protective factors during and after birth. Research shows evidence for the role of previous psychiatric problems, depression in pregnancy, severe complications during birth, support, and women’s subjective experience of birth in postpartum PTSD. Very little research has examined screening or intervention. The chapter highlights key research topics that need addressing.

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