Malignant Phylloides Tumor in Pregnancy

2010 ◽  
Vol 76 (3) ◽  
pp. 302-305 ◽  
Author(s):  
Kristen M. Blaker ◽  
Sunati Sahoo ◽  
Maria R. Schweichler ◽  
Anees B. Chagpar
Keyword(s):  
Histopathological Examination ◽  
First Trimester ◽  
Breast Conserving Surgery ◽  
Third Trimester ◽  
High Power Field ◽  
Cystosarcoma Phylloides ◽  
First Case ◽  
First Trimester Of Pregnancy ◽  
High Mitotic Count ◽  
In Pregnancy

Malignant phylloides tumors are exceedingly rare with few cases being reported in pregnancy. We describe the first case ever reported of a malignant phylloides tumor presenting in the first trimester of pregnancy and provide insight into the complexities of management as well as a review of the known literature. An extensive PubMed literature search for “cystosarcoma,” “phylloides,” and “pregnancy” was performed. References of each citation were reviewed. Only six previous cases of phylloides tumor in pregnancy were found, none of which were in the first trimester. Medical records of a patient presenting to our institution at 9 weeks gestation with a malignant phylloides tumor were reviewed. We further provide a review of the current literature of the management of phylloides tumor in pregnancy. A 27-year-old white G2P0SA1 woman with no family history of breast cancer presented with a right breast mass at her first prenatal examination at 9 weeks of pregnancy. Ultrasound confirmed a solid mass measuring 24 mm. Core needle biopsy demonstrated a malignant phylloides tumor. She previously had a fibroadenoma removed from the same breast 7 years previously. The current tumor was excised to clear margins. Histopathological examination revealed a 4-cm fibroepithelial tumor with marked stromal cellularity and a high mitotic count (five to seven mitoses/high-power field), confirming the diagnosis of malignant phylloides tumor. The patient continued her pregnancy without complications. Six other cases of phylloides tumor presenting in pregnancy have been reported in the literature, one of which had bilateral disease. Of these, the average patient age was 32 years (range, 28 to 35 years). The majority of these patients presented in their third trimester (mean, 29 weeks; range, 20 to 36 weeks) and often had large tumors (mean, 15 cm; range, 5 to 21 cm). Four of the seven tumors (57%) required a mastectomy. Previous cases have shown phylloides tumors to present in the third trimester as large masses that require mastectomy. With early detection, malignant phylloides tumors can present in the first trimester of pregnancy at smaller sizes; in these patients, breast-conserving surgery is possible.

scholarly journals Flu and Tdap Maternal Immunization Hesitancy in Times of COVID-19: An Italian Survey on Multiethnic Sample

Vaccines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1107
Author(s):  
Anna Franca Cavaliere ◽  
Simona Zaami ◽  
Marta Pallottini ◽  
Federica Perelli ◽  
Annalisa Vidiri ◽  
...  
Keyword(s):  
Prenatal Care ◽  
Pregnant Women ◽  
Vaccination Campaign ◽  
First Trimester ◽  
Communicable Diseases ◽  
Vaccine Hesitancy ◽  
Third Trimester ◽  
Maternal Immunization ◽  
First Trimester Of Pregnancy ◽  
In Pregnancy

Background: Tdap and flu immunization in pregnancy has been proven to be both effective and safe. Despite this, the vaccination rate in pregnant women is low in Italy. The COVID-19 pandemic has focused the attention of public opinion on communicable diseases, underlining the importance of primary prevention measures such as vaccination. We conducted a survey to investigate the behavior of pregnant women during the COVID-19 pandemic regarding maternal immunization to identify the reasons for vaccine hesitancy in order to overcome them. The new challenge is COVID-19 vaccination in pregnancy, and preliminary data show hesitancy towards it. Our analysis may be useful to improve immunization in the pregnant population, including through the COVID-19 vaccine. Methods: A targeted survey was performed in Italy including 520 women who experienced in the first trimester of pregnancy, prior to the novel coronavirus spread, the 2019–2020 influenza vaccination campaign and the Tdap vaccine recommendation in the third trimester during the COVID pandemic. They represent a unique model to investigate if the new coronavirus outbreak might have changed attitudes towards vaccination in pregnancy in the same patients. Data were collected from a self-completed paper questionnaire. Descriptive statistics were calculated and percentages were compared using the chi-2 test or Fisher’s exact test. Results: We obtained data from 195 of the 520 women who gave birth during the inclusion period; 325 cases declined to participate in the survey. A total of 8.7% (17 cases) performed flu vaccination in the first trimester of pregnancy (pre-COVID era), 50.8% (99 cases) accepted Tdap immunization during their third trimester of gestation (COVID-19 pandemic) and 6.7% (13 cases) received both vaccines during pregnancy. For both the flu and Tdap shots, pregnant patients were more likely to accept the vaccines if they were recommended by a healthcare provider, whereas the main reason not to be vaccinated was the lack of such a recommendation. Conclusions: Our survey shows that the COVID-19 experience, which has raised awareness as to the role of vaccines in preventable diseases, may positively change attitudes toward immunization in pregnancy. Vaccination must be recommended to all pregnant women and organized during routine prenatal care as an important element for the prevention of communicable diseases. Vaccination hesitancy can be minimized through consistent recommendation to all pregnant women offered by obstetric staff during routine prenatal care. This approach is likely to be effective in terms of building trust in flu and Tdpa immunization among pregnant women, as well as to avoid unjustified hesitancy towards the more recent COVID-19 vaccines.

Correlations Between the Values of Maternal Glycemia from the Last Trimester of Pregnancy and Fetal Birth Weight

2013 ◽  
Vol 20 (3) ◽  
pp. 259-265
Author(s):  
Monica Vereş ◽  
Aurel Babeş ◽  
Szidonia Lacziko
Keyword(s):  
First Trimester ◽  
Mean Value ◽  
Fetal Macrosomia ◽  
Entire Group ◽  
Third Trimester ◽  
The Third ◽  
Group I ◽  
Fetal Birth Weight ◽  
First Trimester Of Pregnancy ◽  
The Mean

Abstract Background and aims: Gestational diabetes represents a form of diabetes diagnosed during pregnancy that is not clearly overt diabetes. In the last trimester of gestation the growth of fetoplacental unit takes place, thus maternal hyperglycemia will determine an increased transplacental passage, hyperinsulinemia and fetal macrosomia. The aim of our study was that o analyzing the effect of maternal glycemia from the last trimester of pregnancy over fetal weight. Material and method: We run an observational study on a group of 46 pregnant women taken into evidence from the first trimester of pregnancy, separated in two groups according to blood glucose determined in the third trimester (before birth): group I normoglycemic and group II with hyperglycemia (>92mg/dl). Results: The mean value of third trimester glycemia for the entire group was of 87.13±22.03. The mean value of the glycemia determined in the third trimester of pregnancy was higher in the second group (109.17 mg/dl) in comparison to the first group (74.,21 mg/dl). The ROC curve for third trimester glycemia as fetal macrosomia appreciation test has an AUC of 0.517. Conclusions: Glycemia determined in the last trimester of pregnancy cannot be used alone as the predictive factor for fetal macrosomia.

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.

scholarly journals Spontaneous rupture of an unscarred uterus in early pregnancy: a rare but life-threatening emergency

2019 ◽  
Vol 12 (5) ◽  
pp. e228493 ◽  
Author(s):  
Bedayah Amro ◽  
Ghassan Lotfi
Keyword(s):  
Early Pregnancy ◽  
Uterine Rupture ◽  
Laparoscopic Approach ◽  
First Trimester ◽  
Rare Occurrence ◽  
Spontaneous Uterine Rupture ◽  
First Case ◽  
Life Threatening ◽  
First Trimester Of Pregnancy ◽  
Underlying Risk

Spontaneous uterine rupture during early pregnancy is an extremely rare occurrence and may vary in presentation and course of events, hence the clinical diagnosis is often challenging. We present our experience with two such cases of spontaneous uterine rupture in the first trimester of pregnancy without any identifiable underlying risk factors. The first case was at 12 weeks of gestation and the second case was at 6 weeks gestational age (GA). Both cases were diagnosed and managed by the laparoscopic approach. We are reporting the earliest documented GA in which spontaneous uterine rupture occurred. So far, the earliest GA reported in the literature according to our knowledge was at 7+3 weeks. Access to a laparoscopic facility is crucial in the early definitive diagnosis and prompt management of these cases, since this may significantly reduce the risk of severe morbidity and mortality.

scholarly journals Predictive value of the aspartate aminotransferase to platelet ratio index and aspartate aminotransferase to alanine aminotransferase ratio in early diagnosis of intrahepatic cholestasis in pregnancy

2021 ◽  
Vol 8 (11) ◽  
pp. 650-654
Author(s):  
İbrahim Kale
Keyword(s):  
Platelet Count ◽  
Intrahepatic Cholestasis ◽  
Predictive Value ◽  
Aspartate Aminotransferase ◽  
Alanine Aminotransferase ◽  
First Trimester ◽  
Control Group ◽  
Third Trimester ◽  
Apri Score ◽  
In Pregnancy

Objective: We aimed to investigate the predictive value of the first-trimester aspartate aminotransferase/platelet count ratio index (APRI) and aspartate aminotransferase/alanine aminotransferase ratio for intrahepatic cholestasis in pregnancy (ICP). Material and Methods: The clinical data of patients who admitted to the Obstetrics Department of Umraniye Training and Research Hospital, between 2015-2020 were analyzed retrospectively. The study group consisted of 44 patients with ICP and the control group consisted of randomly selected 92 healthy pregnant women. Results: The two groups were similar in terms of age, BMI, first and third-trimester platelet count and third-trimester hemoglobin level. Patients with ICP had a significantly higher first-trimester APRI and a lower first trimester AST/ALT ratio than the healthy controls (p <0.001, p = 0.001, respectively). According to the ROC analysis, the optimal cut-off value of the APRI to predict ICP was 0.191, with the sensitivity of 0.66 and specificity of 0.66 (AUC: 0,727), and the optimal cut-off value for AST/ALT ratio was 1.07, with the sensitivity of 0.64, and specificity of 0.62 (AUC: 0,681). Conclusion: The first-trimester APRI score and AST/ALT ratio is an easy, inexpensive, and non-invasive tool that may be useful in predicting ICP early.

scholarly journals Trends in maternal use of snus and smoking tobacco in pregnancy. A register study in Southern Norway

2019 ◽  
Author(s):  
Ellen Rygh ◽  
Frode Gallefoss ◽  
Liv Grøtvedt
Keyword(s):  
Tobacco Use ◽  
First Trimester ◽  
Third Trimester ◽  
Smoking During Pregnancy ◽  
Adverse Health Outcomes ◽  
Time Period ◽  
Moist Snuff ◽  
Southern Norway ◽  
High Level ◽  
In Pregnancy

Abstract Background The use of tobacco products including Swedish snus (moist snuff) in pregnancy may cause adverse health outcomes. While smoking prevalence has decreased among fertile women in Norway, snus use has increased during the last years. We investigated whether these trends were reflected also during pregnancy in a population of women in Southern Norway. Methods Data on smoking tobacco and snus use at three time points before and during pregnancy for 20 844 women were retrieved from the electronic birth record for the years 2012-2017. The results for the three-year period 2015-2017 were compared with a previously studied period 2012-2014. Prevalence and quit rates of tobacco use within groups of age, parity and education were reported. Within the same groups adjusted quit rates were analyzed using logistic regression. Mean birthweight and Apgar score of offspring were calculated for tobacco-users and non-users. Results There was an increase of snus use before pregnancy from the period 2012-2014 to the period 2015-2017 from 5.1% (CI; 4.6 to 5.5) to 8.4% (CI; 7.8 to 8.9). Despite this, the use of snus during pregnancy did not increase from the first to the second period, but stabilized at 2.8% (CI; 2.5 to 3.2) in first trimester and 2.0% (CI; 1.7 to 2.2) in third trimester. Cigarette smoking decreased significantly both before and during pregnancy. Snus use and smoking during pregnancy were associated with a reduction in average birthweight, but no significant effects on Apgar scores. Odds ratios for quitting both snus and smoking tobacco during pregnancy were higher for women aged 25-34 years, for the primiparas and for those with a high level of education. Pregnant women were more likely to have quit tobacco use in the last time period compared to the first. Conclusions While smoking during pregnancy was decreasing, the use of snus remained constant, levelling off to around 3% in first trimester and 2% in third trimester. Approximately 25% of those that used snus, and 40% that smoked before pregnancy, continued use to the third trimester. This calls for a continuous watch on the use of snus and other nicotine products during pregnancy.

scholarly journals Trends in maternal use of snus and smoking tobacco in pregnancy. A register study in southern Norway

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ellen Rygh ◽  
Frode Gallefoss ◽  
Liv Grøtvedt
Keyword(s):  
Tobacco Use ◽  
First Trimester ◽  
Third Trimester ◽  
Smoking During Pregnancy ◽  
Adverse Health Outcomes ◽  
Time Period ◽  
Moist Snuff ◽  
Southern Norway ◽  
High Level ◽  
In Pregnancy

Abstract Background The use of tobacco products including Swedish snus (moist snuff) in pregnancy may cause adverse health outcomes. While smoking prevalence has decreased among fertile women in Norway, snus use has increased during the last years. We investigated whether these trends were reflected also during pregnancy in a population of women in Southern Norway. Methods Data on smoking tobacco and snus use at three time points before and during pregnancy for 20,844 women were retrieved from the electronic birth record for the years 2012–2017. The results for the three-year period 2015–2017 were compared with a previously studied period 2012–2014. Prevalence and quit rates of tobacco use within groups of age, parity and education were reported. Within the same groups adjusted quit rates were analyzed using logistic regression. Mean birthweight and Apgar score of offspring were calculated for tobacco-users and non-users. Results There was an increase of snus use before pregnancy from the period 2012–2014 to the period 2015–2017 from 5.1% (CI; 4.6 to 5.5) to 8.4% (CI; 7.8 to 8.9). Despite this, the use of snus during pregnancy did not increase from the first to the second period, but stabilized at 2.8% (CI; 2.5 to 3.2) in first trimester and 2.0% (CI; 1.7 to 2.2) in third trimester. Cigarette smoking decreased significantly both before and during pregnancy. Snus use and smoking during pregnancy were associated with a reduction in average birthweight, but no significant effects on Apgar scores. Odds ratios for quitting both snus and smoking tobacco during pregnancy were higher for women aged 25–34 years, for the primiparas and for those with a high level of education. Pregnant women were more likely to have quit tobacco use in the last time period compared to the first. Conclusions While smoking during pregnancy was decreasing, the use of snus remained constant, levelling off to around 3% in first trimester and 2% in third trimester. Approximately 25% of those that used snus, and 40% that smoked before pregnancy, continued use to the third trimester. This calls for a continuous watch on the use of snus and other nicotine products during pregnancy.

scholarly journals Effectiveness of Ginger in Treating Nausea and Vomiting of Pregnancy

2021 ◽  
Vol 3 (1) ◽  
pp. 120-124
Author(s):  
Ahmad Ramadhanu
Keyword(s):  
Lifestyle Modification ◽  
First Trimester ◽  
Nausea And Vomiting ◽  
Main Complaint ◽  
Significant Burden ◽  
First Trimester Of Pregnancy ◽  
Cns Side Effects ◽  
Possible Cause ◽  
In Pregnancy

Nausea and vomiting in pregnancy (NVP) is one of the common main complaint in pregnancy. NVP can be a significant burden to the patient, make a decrease in quality of life, pregnancy threatening or even worse can lead to nutritional loss and death. NVP diagnosed when in first trimester of pregnancy and the other possible cause of NVP is excluded. Management of NVP is included maintaining hydration, nutrition, and lifestyle modification. Also avoiding the smells, food, or activity that can cause nause are necessary. There are some methods to treat NVP including pharmalogical or non-pharmalogical. The non-pharmalogical approach is change nutritional habits, lifestyle and medications. Several pharmalogical agents that can be used to relief the symptoms of NVP are pyridoxine, anti- histamines, metoclopramide, pyridoxine/doxylamine, promethazine and metoclopramide. Some patients also want to try more “natural” medications for NVP like ginger. The pharmacological activity is thought to stand in the pungent principles (gingerols and shogaols) and volatile oils (sesquiterpenes and monoterpenes). The true mechanism of action of ginger is probable to be a gastric effect, to increase tone and peristaltic due to anticholinergic and antiserotonin act. Ginger acts straight to the digestive tract and avoids the CNS side effects common to centrally acting antiemetics. Ginger is available in capsule or syrup form or in candy, cookies, beer, tinctures, teas, sodas, and jam. Nowadays, true dosing is available only if one uses standardized extracts; however, women may choose to use another form of ginger.

scholarly journals Suicide due to fear of COVID-19, in pregnancy, lead to Neonatal malformations: A case report

2021 ◽  
Author(s):  
Javad Boskabadi ◽  
Saeed Kargar-Soleiman abad ◽  
shahrokh mehrpishe ◽  
Elham Pishavar ◽  
Roya Farhadi
Keyword(s):  
Mental Health ◽  
Case Report ◽  
Antipsychotic Drugs ◽  
First Trimester ◽  
Limited Data ◽  
First Trimester Of Pregnancy ◽  
In Pregnancy

There is limited data about various effect of COVID-19 in pregnancy. The Covid-19 pandemic can increase anxiety or schizophrenia exacerbation. Neonatal malformations from antipsychotic drugs exposures during first trimester of pregnancy have been reported. However, their effect near delivery have been less studied. Keywords: Covid-19, pregnancy, mental health, neonatal malformations

scholarly journals Myasthenia Gravis in Pregnancy Treated With Daily Massive Vitamin D Dose

2020 ◽  
Vol 3 (2) ◽  
pp. 171-177
Author(s):  
Silva LFF ◽  
Martins MC ◽  
Caplum MC ◽  
Luz MS ◽  
Amaral VM ◽  
...  
Keyword(s):  
Vitamin D ◽  
T Cells ◽  
Myasthenia Gravis ◽  
Striated Muscle ◽  
First Trimester ◽  
Effector T Cells ◽  
Myasthenic Crisis ◽  
First Trimester Of Pregnancy ◽  
Muscle Groups ◽  
In Pregnancy

Myasthenia gravis (MG) is an autoimmune disease affecting the motor endplate of striated muscle. It is caused by antibodies that act in the cholinergic receptors at the post-synaptic portion of the neuromuscular junction, which results in asthenia and fatigue in some muscle groups. In pregnancy, it’s unpredictable, because pregnant women can present MG exacerbation, remission, stability, or even a myasthenic crisis during pregnancy. Complications are more frequent in the first trimester of pregnancy and the first 30 days of puerperium. Vitamin D and its metabolites are potent immunomodulators since their immuno-regulatory effect directly inhibits effector T cells and induces regulatory T cells (Treg) to decrease the production of inflammatory cytokines. The authors present a case report of a patient with MG who was treated throughout pregnancy with massive doses of vitamin D, obtaining good results.

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