Bilateral renal artery stenosis due to fibromuscular dysplasia presenting as superimposed pre-eclampsia

2021 ◽  
Vol 14 (5) ◽  
pp. e237759
Author(s):  
Aruna Munasinghe ◽  
Lilantha Wedisinghe ◽  
Thin Han ◽  
Rajit Narayan
Keyword(s):  
Fibromuscular Dysplasia ◽  
First Trimester ◽  
Interventional Treatment ◽  
Fetal Exposure ◽  
Bilateral Renal Artery Stenosis ◽  
Bilateral Renal Artery ◽  
Conclusive Diagnosis ◽  
Renal Vascular ◽  
Safe Dose ◽  
In Pregnancy

Renal vascular hypertension is a diagnosis that needs to be entertained in the setting of refractory, otherwise unexplained hypertension in pregnancy. Conclusive diagnosis of the condition is made by the use of angiography, which confers only a low, safe dose of radiation to the fetus, especially after the first trimester. Percutaneous angioplasty is effective in treating this condition and is best performed postnatally to avoid fetal exposure to ionising radiation. While it could be managed pharmacologically, more refractory cases in pregnancy may be offered interventional treatment.

Successful Stenting of Bilateral Renal Artery Stenosis Due to Fibromuscular Dysplasia Assessed by Use of Pressure Guidewire Technique

Angiology ◽  
1998 ◽  
Vol 49 (1) ◽  
pp. 69-74 ◽  
Author(s):  
Mitsuaki Isobe ◽  
Hiroaki Takenaka ◽  
Osamu Kinoshita ◽  
Morie Sekiguchi ◽  
Masayoshi Ohta ◽  
...  
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Fibromuscular Dysplasia ◽  
Artery Stenosis ◽  
Bilateral Renal Artery Stenosis ◽  
Bilateral Renal Artery

scholarly journals Congenital adrenal hyperplasia in pregnancy: approach depends on who is the ‘patient’

2012 ◽  
Vol 5 (4) ◽  
pp. 154-160 ◽  
Author(s):  
Erin Keely ◽  
Janine Malcolm
Keyword(s):  
Congenital Adrenal Hyperplasia ◽  
Autosomal Recessive ◽  
First Trimester ◽  
Female Child ◽  
Fetal Exposure ◽  
Adrenal Hyperplasia ◽  
Autosomal Recessive Disorders ◽  
Adrenal Steroid ◽  
Recessive Disorders ◽  
In Pregnancy

Congenital adrenal hyperplasia (CAH) is a group of autosomal-recessive disorders caused by a reduced or absent enzymatic activity at one of the stages of adrenal steroid biosynthesis. Prenatal exposure to androgens leads to external genital masculinization of the affected female child. In pregnancy, the provider may be optimizing care for the woman with CAH or targeting treatment to reduce virilization in the affected unborn child. For the affected adult woman the goals of therapy in pregnancy are to prevent adrenal insufficiency, reduce fetal exposure to androgens and glucocorticoids and to avoid damage to reconstructed genitalia. For prenatal therapy for prevention of virilization of possibly affected female children, dexamethasone is used. However, questions remain about the efficacy and safety of exposing 7/8 unaffected children in the first trimester. Prenatal treatment should only be undertaken after careful discussion with the parents of the risks and benefits in an experienced centre or as part of a research protocol.

Nanoparticulate Drug Delivery in Pregnancy: Placental Passage and Fetal Exposure

2011 ◽  
Vol 12 (5) ◽  
pp. 731-742 ◽  
Author(s):  
Vinith Menezes ◽  
Antoine Malek ◽  
Jeffrey A. Keelan
Keyword(s):  
Drug Delivery ◽  
Fetal Exposure ◽  
Placental Passage ◽  
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 Maternal and Fetal Outcomes in Women with Brain Arteriovenous Malformation Rupture during Pregnancy

2021 ◽  
pp. 1-7
Author(s):  
Kimberly L. Yan ◽  
Nerissa U. Ko ◽  
Steven W. Hetts ◽  
Shantel Weinsheimer ◽  
Adib A. Abla ◽  
...  
Keyword(s):  
San Francisco ◽  
Treatment Strategies ◽  
First Trimester ◽  
Interventional Treatment ◽  
Maternal Outcomes ◽  
Fetal Outcomes ◽  
Brain Avm ◽  
Risk Of Hemorrhage ◽  
The University

Background: Sporadic brain arteriovenous malformations (BAVM) are a major cause of hemorrhagic stroke in younger persons. Prior studies have reported contradictory results regarding the risk of hemorrhage during pregnancy, and there are no standard guidelines for the management of pregnant women who present with BAVM rupture. The purpose of this study is to describe maternal and fetal outcomes and treatment strategies in patients with BAVM hemorrhage during pregnancy. Methods: We performed a retrospective review of the University of California, San Francisco Brain AVM Project database for female patients who were pregnant at the time of BAVM hemorrhage between 2000 and 2017. Clinical and angiographic characteristics at presentation, BAVM treatment, and maternal outcomes using modified Rankin scale (mRS) score at presentation and 2-year follow-up were recorded. Fetal outcomes were abstracted from medical records and maternal reports. Results: Sixteen patients presented with BAVM hemorrhage during pregnancy, 81% (n = 13) of whom were in their second or third trimester. Three patients (19%) who were in their first trimester terminated or miscarried pregnancy prior to BAVM intervention. Of the remaining 13 patients, 77% (n = 10) received emergent BAVM treatment at time of hemorrhage prior to delivery, and 85% of patients achieved BAVM obliteration and good maternal outcomes (mRS 0–2) at 2-year follow-up. All patients had uncomplicated deliveries (69% cesarean and 23% vaginal) with no reports of postnatal cognitive or developmental delays in infants at 2-year follow-up. Conclusions: Our study shows good long-term maternal and fetal outcomes in ruptured BAVM patients presenting during pregnancy, the majority who received BAVM interventional treatment prior to delivery.

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.

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