scholarly journals Alpha-Methyldopa-Induced Autoimmune Hemolytic Anemia in the Third Trimester of Pregnancy

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Charalampos Grigoriadis ◽  
Aliki Tympa ◽  
Angelos Liapis ◽  
Dimitrios Hassiakos ◽  
Panagiotis Bakas
Keyword(s):  
Respiratory Failure ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Diagnostic Procedure ◽  
Gestational Hypertension ◽  
Third Trimester ◽  
The Third ◽  
Hypertension In Pregnancy ◽  
Potential Risks ◽  
In Pregnancy

Alpha-methyldopa has been demonstrated to be safe for use during pregnancy and is now used to treat gestational hypertension. In pregnancy, alpha-methyldopa-induced autoimmune hemolytic anemia does not have typical features and the severity of symptoms ranges from mild fatigue to dyspnea, respiratory failure, and death if left untreated. A case of alpha-methyldopa-induced autoimmune hemolytic anemia in a 36-year-old gravida 2, para 1 woman at 37+6weeks of gestation is reported herein along with the differential diagnostic procedure and the potential risks to the mother and the fetus.

scholarly journals Hypertension in pregnancy

2006 ◽  
Vol 12 (1) ◽  
pp. 7-15 ◽  
Author(s):  
E. I. Baranova
Keyword(s):  
Antihypertensive Drugs ◽  
Gestational Hypertension ◽  
Developed Countries ◽  
Third Trimester ◽  
Pregnancy Hypertension ◽  
The Third ◽  
Hypertension In Pregnancy ◽  
In Pregnancy

In developed countries hypertension is observed in 6 - 15% of all pregnancies and occupies the second place in pregnancy morality rate after embolism. Hypertension can be dangerous not only for maternal but fetal deal h as well. Criteria for pregnancy hypertension are the same as general criteria ( ≥ 140 / ≥ 90 mm Hg). Hypertension in pregnancy is classified as following; preexisting hypertension, gestational hypertension, preeclampsia, mixed hypertension (preexisting and gestational). All antihypertensive drugs excluding methyldopa are contraindicated during the first and second trimesters, while several other drugs can be administrated during the third trimester.

The renin-aldosterone system in pre-eclampsia, essential and transient hypertension during pregnancy, and normotensive pregnant and non-pregnant control subjects

1982 ◽  
Vol 101 (2) ◽  
pp. 273-280 ◽  
Author(s):  
E. B. Pedersen ◽  
A. B. Rasmussen ◽  
P. Johannesen ◽  
H. J. Kornerup ◽  
S. Kristensen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Plasma Renin ◽  
Urinary Sodium Excretion ◽  
Third Trimester ◽  
Plasma Aldosterone Concentration ◽  
The Third ◽  
Control Subjects ◽  
Hypertension In Pregnancy ◽  
Normotensive Pregnancy ◽  
In Pregnancy

Abstract. Plasma renin concentration (PRC), plasma aldosterone concentration (PAC), and blood pressure were determined in the third trimester in pregnancy, 5 days and 6 months after delivery in pre-eclampsia, essential and transient hypertension in pregnancy and in normotensive pregnant and non-pregnant control subjects. PRC and PAC were elevated several fold above non-pregnant level in all groups during pregnancy. In pre-eclampsia PRC and PAC were 220 and 160%, respectively, above the levels 6 months after delivery, and thus lower than the corresponding values, 360 and 402%, in normotensive pregnancy. In essential and transient hypertension PRC and PAC increased to the same degree as during normotensive pregnancy. Urinary sodium excretion, serum sodium and creatinine clearance were reduced in pre-eclampsia, but not in essential and transient hypertension when compared to normotensive pregnant controls. All the parameters determined were the same as in non-pregnant controls 6 months after delivery in all groups. There were no correlations between blood pressure and PRC or PAC in any of the groups neither in pregnancy nor after delivery. It is concluded that the renin-aldosterone system is stimulated in lesser degree in pre-eclampsia than in both essential hypertension, transient hypertension and normotensive pregnancy, and there was no evidence for a causal relationship between the renin-aldosterone system and blood pressure neither in normotensive nor hypertensive pregnancy.

scholarly journals Pregnancy-Associated Autoimmune Hemolytic Anemia: Meta-Analysis of Clinical Characteristics, Maternal and Neonatal Outcomes

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1959-1959
Author(s):  
Irina Murakhovskaya ◽  
Jesus Anampa ◽  
Hieu Nguyen ◽  
Veronica Sadler ◽  
Henny H. Billett
Keyword(s):  
Hemolytic Anemia ◽  
Pregnancy Outcomes ◽  
Autoimmune Hemolytic Anemia ◽  
Rare Condition ◽  
Adverse Pregnancy Outcomes ◽  
Neonatal Outcomes ◽  
Third Trimester ◽  
Maternal And Neonatal Outcomes ◽  
Adverse Pregnancy ◽  
In Pregnancy

Abstract Introduction: Autoimmune hemolytic anemia (AIHA) is a rare condition that can cause potentially serious complications in pregnant women and newborns. With the lack of prospective trials, physicians often have to make treatment decisions for this vulnerable population based on scarce literature with poor evidence. We sought to summarize existing literature and analyze maternal and neonatal outcomes in pregnancy-associated AIHA (p-AIHA). Methods: Cases of AIHA in pregnancy were collected using MEDLINE/PubMed and Google Scholar literature search using terms "autoimmune hemolytic anemia" and "pregnancy". Bibliography of each article was hand-searched for additional reports. Only publications in English were included. Cases of preexisting AIHA, autoimmune disease associated AIHA, non-immune hemolysis, and cases where direct antiglobulin testing (DAT) was not performed, were excluded. Laboratory, obstetric, neonatal and treatment data were collected. Data were analyzed using descriptive statistics. We used Wilcoxon rank sum test for continuous variables and Fisher's exact test for categorical variables. When missing data were encountered, we reported a valid number of analyzed patients in parentheses. Results: We identified 87 cases of p-AIHA from case reports, case series, abstracts and posters. Final analysis included 51 individual women. Median age at p-AIHA presentation was 28 years. Presentation was less common in the first pregnancy (34%); most cases presented in the second or third trimester (83.3%).Median nadir hemoglobin (Hb), lactate dehydrogenase, total bilirubin and peak reticulocyte count were 5.8 g/dL, 457 U/L, 2.2, and 13.6%, respectively. DAT negative hemolysis was reported in 41% of cases (Table 1). DAT positivity was not associated with pregnancy trimester, hemolysis severity, response to steroids, AIHA recurrence, adverse pregnancy outcomes, or hemolysis in newborn. There was a trend for longer duration of hemolysis postpartum in women with positive DAT compared to negative DAT (10 vs 2 weeks, p = 0.08). Median duration of hemolysis postpartum was 6 weeks (n=27, range 0-96 weeks). Two thirds of women were treated with steroids with hemoglobin response of 88.9% (n=27). There was no association between steroid use and duration of hemolysis postpartum. Blood transfusion was administered in 27 out of 33 women, with a median number of units transfused 5. Recurrent p-AIHA was seen in 40% (12/30) of women; there was no difference in nadir Hb levels for those with recurrent p-AIHA vs. not recurrent (6.8 vs 5.2 g/dL, p=0.11). Pregnancy resulted in term delivery in 61.9%, preterm delivery in 23.8%, and stillbirth in 9.5% (n=42). Adverse pregnancy outcomes, which included preterm labor and stillbirth, were reported in 50% of women who presented in the first or second trimester compared to 16% who presented in the third trimester (p=0.049, Table 2).Women with adverse pregnancy outcomes had significantly lower median nadir hemoglobin compared to women without adverse pregnancy outcomes (4.3 and 6.2 p = 0.0078) and were more likely to receive transfusion (73% and 56%, p= 0.071). Hemolysis at birth was reported in 59% (n=22) of newborns with available data with 13 neonates (38%) requiring transfusion support . Use of steroids had no effect on presence of hemolysis in the newborn. Conclusions: We present the largest cohort of p-AIHA described in the literature. Our study reports that p-AIHA is uncommon in primigravidas and typically presents later in pregnancy. Presentation in first or second trimester in pregnancy and lower Hb nadir were significantly associated with adverse pregnancy outcomes. Steroids and blood transfusions were needed in most patients, and hemolysis persisted on average for 6 weeks postpartum. There was a high frequency of Coombs negativity which was associated with shorter duration of postpartum hemolysis. Preterm labor and stillbirth were observed in 33.3% of pregnancies. The incidence of hemolysis in newborns from p-AIHA mothers is very high and is often clinically significant. Recurrence in subsequent pregnancy is common but has similar Hb nadir as non-recurrent cases. This study provides insights into the clinical course of pregnancy and neonatal outcomes in p-AIHA. Our findings may help guide management of this rare condition. A prospective study of patients with p-AIHA is needed to determine optimal therapy to reduce antepartum and neonatal complications. Figure 1 Figure 1. Disclosures Murakhovskaya: Alexion, Rigel, Bioverativ/Sanofi, Momenta, Annexion, Incyte: Research Funding; Bioverativ/Sanofi, Momenta, Apellis, Novartis: Consultancy; Cardiff Oncology, Trillium Therapeutics: Current holder of individual stocks in a privately-held company.

scholarly journals Ibuprofen-related renal tubular acidosis in pregnancy

2011 ◽  
Vol 4 (3) ◽  
pp. 122-124 ◽  
Author(s):  
Andrew Mallett ◽  
Matthew Lynch ◽  
George T John ◽  
Helen Healy ◽  
Karin Lust
Keyword(s):  
Renal Dysfunction ◽  
Renal Tubular Acidosis ◽  
History Taking ◽  
Third Trimester ◽  
The Third ◽  
Healthy Neonate ◽  
Renal Tubular ◽  
In Pregnancy

Ibuprofen-related renal tubular acidosis (RTA) has not been previously described in pregnancy but its occurrence outside of pregnancy is being increasingly described. In this case, a 34-year-old woman presented in the third trimester of pregnancy with Type 1 or distal RTA related to ibuprofen and codeine abuse. It was complicated by acute on chronic renal dysfunction and hypokalemia. Delivery at 37 weeks gestation due to concerns of evolving preeclampsia resulted in the birth of a healthy neonate. RTA and hypokalemia were remediated and ibuprofen and codeine abuse ceased. Some renal dysfunction however continued. Thorough and repeated history taking as well as vigilance for this condition is suggested.

scholarly journals DESENHO DA GRAVIDEZ E SENSIBILIDADE SONORA: CONTRIBUTOS PARA O ESTUDO DA PSICOLOGIA DA GRAVIDEZ

2016 ◽  
Vol 1 (1) ◽  
pp. 25
Author(s):  
Mª Eduarda Salgado Carvalho ◽  
Joao Manuel Rosado de Miranda Justo
Keyword(s):  
Longitudinal Study ◽  
Graphical Representation ◽  
Third Trimester ◽  
Psychological Study ◽  
Portuguese Version ◽  
The Third ◽  
Projective Measures ◽  
Music Representations ◽  
Maternal Orientation ◽  
In Pregnancy

Resumo.Introdução: Esta comunicação pretende descrever um estudo longitudinal acerca da aplicação da Escala do Desenho da Gravidez e da Escala da Sensibilidade Sonora-Musical na Gravidez, ambas construídas e validadas para este estudo, numa amostra de 211 mulheres grávidas aguardando a realização das ecografias do II e do III trimestres de gestação. Objectivos: 1) avaliar a evolução das variáveis do desenho da gravidez e das variáveis sonoro-musicais na passagem do II para o III trimestre e 2) analisar a contribuição de cada uma de estas variáveis para o estudo da psicologia da gravidez. Método: 1) estudo longitudinal comparando as variáveis do desenho da gravidez e a sensibilidade sonoro-musical observadas nos dois momentos de avaliação; 2) estudo correlacional entre cada uma destas variáveis e as variáveis de vinculação materna pré-natal e de orientação materna pré-natal. Instrumentos: Escala do Desenho da Gravidez (Carvalho, 2011), Escala da Sensibilidade Sonora-Musical na Gravidez (Carvalho & Justo, 2013), Escala de Vinculação Materna Pré-natal (versão Portuguesa, Camarneiro & Justo, 2010) e Questionário do Paradigma Placentário (versão portuguesa, Carvalho, 2011). Resultados: Os resultados revelam a existência de diferenças significativas, entre o II e o III trimestres nas variáveis estudadas, apontando para: a) um aumento da sensibilidade sonoro-musical no terceiro trimestre, b) uma evolução da auto-representação da imagem materna no terceiro trimestre e c) um aumento da frequência de representação gráfica da posição de apresentação fetal cefálica da imagem do bebé na passagem para o terceiro trimestre. Observaram-se correlações significativas entre, por um lado, as variáveis da sensibilidade sonoro-musical e as variáveis do desenho da gravidez e, por outro lado, as variáveis de orientação materna pré-natal. Registaram-se correlações significativas entre sensibilidade sonoro-musical, por um lado, e vinculação materna pré-natal e a orientação maternal pré-natal, por outro. Conclusão: Será importante investigar a dialética entre a representação do bebé imaginado através de medidas projectivas maternas e a percepção do comportamento fetal recorrendo à observação ecográfica e a medidas biofísicas e hemodinâmicas.Palavras chave: Gravidez, Escala do Desenho da Gravidez, Escala das Representações Sonoro-Musicais na Gravidez, Escala de Vinculação Materna Pré-Natal, Questionário do Paradigma Placentário.Abstract.Background: This paper aims to describe a longitudinal study about the use of the Drawing Pregnancy Scale and of the Sound-Music Representations in Pregnancy Scale, both of it created and validated in a sample of 211 pregnant women while waiting for sonograms of the II and III trimesters of pregnancy. Aims: 1) to assess, the evolution of variables in drawings of pregnancy and also of sound-music variables, by the transition of the II to the III trimester of gestation and 2) to analyze the contribution of each one of these variables for the psychological study of pregnancy. Method: 1) longitudinal study comparing variables in drawings of pregnancy and sound-music variables at the two moments of assessment; 2) correlational study between each one of these variables and variables of maternal pre-natal attachment and also of maternal pre-natal orientation. Instruments: Drawing Pregnancy Scale (Carvalho, 2011), Sound-Music Representations in Pregnancy Scale (Carvalho & Justo, 2013), Maternal Pre-natal Attachment Scale (Portuguese version, Camarneiro & Justo, 2010) and Placental Paradigm Questionnaire (Portuguese version, Carvalho, 2011). Results: Results show the existence of significant diferences between the II and the III trimestres in some of the variables under analysis, suggesting: a) a increase of the sound-music sensibility by the third trimester, b) an evolution of the maternal image at the third trimester and c) an increase of the frequency of the graphical representation of the cephalic fetal presentation of the baby’s image at the third trimester. Significant correlations were observed between, on one side, the variables of soundmusic sensibility and the variables of the pregnancy drawings and, on another side, variables of prenatal maternal orientation. Significant correlations between sound-music sensibility, on one side, and prenatal maternal attachment and prenatal maternal orientation, on the other side, were found. Conclusion: It will be important to investigate about the representation of the imagined baby through maternal projective measures and the perception of fetal behaviour using sonograms as well as biophysical and hemodynamic measures.Keywords: Pregnancy, Drawing Pregnancy Scale, Sound-Music Representations in Pregnancy Scale, Maternal Pre-natal Attachment Scale, Placental Paradigm Questionnaire.

scholarly journals Dopamine in the Pathophysiology of Preeclampsia and Gestational Hypertension: Monoamine Oxidase (MAO) and Catechol-O-methyl Transferase (COMT) as Possible Mechanisms

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Wendy N. Phoswa
Keyword(s):  
Monoamine Oxidase ◽  
Gestational Hypertension ◽  
Morbidity And Mortality ◽  
Therapeutic Interventions ◽  
Hypertensive Disorders Of Pregnancy ◽  
Methyl Transferase ◽  
Hypertension In Pregnancy ◽  
Health Burden ◽  
Hypertensive Disorders ◽  
In Pregnancy

Purpose of the Review. Hypertension in pregnancy is the global health burden. Amongst the hypertensive disorders of pregnancy, preeclampsia and gestational hypertension are the world’s leading disorders that lead to both maternal and fetal morbidity and mortality. Recent Findings. Dopamine inactive metabolites, namely, monoamine oxidase (MAO) and catechol-O-methyl transferase (COMT), have been reported to be associated with hypertensive disorders of pregnancy such preeclampsia and gestational hypertension. Summary. This review discusses the involvement of MAO and COMT in the pathophysiology of both conditions in order to have a better understanding on the pathogenesis of both conditions, suggesting promising therapeutic interventions and subsequently reducing maternal and fetal morbidity and mortality.

scholarly journals Hypertension in pregnancy: Pathophysiology and treatment

2019 ◽  
Vol 7 ◽  
pp. 205031211984370 ◽  
Author(s):  
Stephanie Braunthal ◽  
Andrei Brateanu
Keyword(s):  
Gestational Hypertension ◽  
Severe Hypertension ◽  
Organ Damage ◽  
Morbidity And Mortality ◽  
Perinatal Morbidity ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertension In Pregnancy ◽  
Hypertensive Disorders ◽  
In Pregnancy ◽  
The Ideal

Hypertensive disorders of pregnancy, an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and eclampsia, complicate up to 10% of pregnancies and represent a significant cause of maternal and perinatal morbidity and mortality. Despite the differences in guidelines, there appears to be consensus that severe hypertension and non-severe hypertension with evidence of end-organ damage need to be controlled; yet the ideal target ranges below 160/110 mmHg remain a source of debate. This review outlines the definition, pathophysiology, goals of therapy, and treatment agents used in hypertensive disorders of pregnancy.

scholarly journals Juvenile granulosa cell tumour in the third trimester of pregnancy

2020 ◽  
Vol 9 (2) ◽  
pp. 861
Author(s):  
Jonathan Gaughran ◽  
Argha Datta ◽  
Judith Hamilton ◽  
Tom Holland ◽  
Ahmad Sayasneh
Keyword(s):  
Case Report ◽  
Granulosa Cell ◽  
Cell Tumour ◽  
Granulosa Cell Tumour ◽  
Third Trimester ◽  
Rare Finding ◽  
Histopathological Findings ◽  
The Third ◽  
In Pregnancy

This case report describes the rare finding of a granulosa cell tumour in the third trimester of pregnancy. The presentation, investigation, management, histopathological findings and subsequent follow up are detailed. The difficulties associated with such diagnoses in pregnancy are explored.

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