scholarly journals Perinatal outcomes of monochorionic diamniotic triplet pregnancies: a case series

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tingting Xu ◽  
Xiaodong Wang ◽  
Haiyan Yu ◽  
Xinghui Liu
Keyword(s):  
Perinatal Care ◽  
Case Series ◽  
Perinatal Outcomes ◽  
First Trimester ◽  
Second Trimester ◽  
Triplet Pregnancy ◽  
Maternal Complications ◽  
Case Presentation ◽  
Life Threatening ◽  
Poor Outcomes

Abstract Background Triplet pregnancies are associated with higher fetal morbidity and mortality rates as well as life-threatening maternal complications. Monochorionic diamniotic (MCDA) triplet pregnancies are very rare compared to other types of triplet pregnancies. Case presentation We report three cases of MCDA triplet pregnancies between January 2012 and December 2017. Two of these MCDA triplet pregnancies received regular and intensive prenatal care, were diagnosed by ultrasonography during the first trimester or early second trimester, and had good perinatal outcomes. The case with irregular perinatal care had poor outcomes, and the MCDA triplet pregnancy was diagnosed intrapartum. Conclusions The possibility of continuing an MCDA triplet pregnancy should be recognized. Early diagnosis, regular antenatal care, close prenatal monitoring, and sufficient communication are recommended to obtain better perinatal outcomes in MCDA triplet pregnancies.

scholarly journals NUDT15 polymorphism explains serious toxicity to azathioprine in Indian patients with chronic immune thrombocytopenia and autoimmune hemolytic anemia: a case series

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Anup J. Devasia ◽  
Raveen Stephen Stallon Illangeswaran ◽  
Infencia Xavier Raj ◽  
Biju George ◽  
Poonkuzhali Balasubramanian
Keyword(s):  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Immune Thrombocytopenia ◽  
Case Series ◽  
Severe Toxicity ◽  
Toxic Side Effect ◽  
Case Presentation ◽  
Oral Ulcers ◽  
Asian Patients ◽  
Life Threatening

AbstractObjectivesAzathioprine (AZA) is a commonly used immunosuppressant in patients with autoimmune diseases. The toxic side effect to AZA (myelosuppression, hair loss, and oral ulcers) are highly unpredictable which can be life threatening if not identified earlier and dose adjustments made or the drug is withdrawn.Case presentationHere we report a case series of five patients with severe toxicity while on treatment with AZA for autoimmune hemolytic anemia (n=1) and Immune thrombocytopenia (n=4). The common thiopurine methyltransferase (TPMT) variants (TPMT*2, *3A, *3B) were not present in these patients. However, all these patients had the NUDT15 415C>T variant that has been reported to explain serious toxicity to thioguanine in Asian patients.ConclusionsOur report suggests pre-emptive genotype-based dosing of AZA could reduce adverse toxicity and hence better outcome.

Midgut volvulus secondary to congenital malrotation in pregnancy

2020 ◽  
Vol 13 (5) ◽  
pp. e234664 ◽  
Author(s):  
Eelyn Chong ◽  
David S Liu ◽  
Vishnupriya Rajagopal ◽  
Neil Strugnell
Keyword(s):  
Perinatal Outcomes ◽  
First Trimester ◽  
Small Bowel Resection ◽  
Emergency Laparotomy ◽  
Midgut Volvulus ◽  
Threatening Condition ◽  
Life Threatening ◽  
Uncommon Condition ◽  
Adverse Perinatal Outcomes ◽  
In Pregnancy

Midgut volvulus complicating congenital malrotation is a rare but life-threatening condition that can occur in pregnancy. We present a case of intestinal infarction resulting from midgut volvulus in a healthy 32-week pregnant woman who underwent emergency laparotomy and small bowel resection in the setting of fetal death in utero. This case highlights several challenging issues in diagnosing and managing this uncommon condition which leads to increased adverse perinatal outcomes. Prompt investigation and definitive surgical treatment are required when pregnant women present with bilious vomiting and new-onset abdominal or back pain especially beyond the first trimester.

scholarly journals Trichorionic Triamniotic Triplets After Single Embryo Transfer: A Case Series and Literature Review

2018 ◽  
Vol 7 (3) ◽  
pp. 408-411
Author(s):  
Isao Takehara ◽  
Toshifumi Takahashi ◽  
Kuniaki Ota ◽  
Nobuhiko Ohta ◽  
Hideki Mizunuma ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Fetal Heart ◽  
Hormone Replacement ◽  
Case Series ◽  
Single Embryo Transfer ◽  
Heart Beat ◽  
Assisted Hatching ◽  
Triplet Pregnancy ◽  
Case Presentation ◽  
First Case

Objectives: Monozygotic triplet pregnancy very rarely occurs in assisted reproductive technology (ART) treatment. The present study reported two cases of trichorionic triplet pregnancies after single embryo transfer (SET) and reviewed the literature in this regard. Case Presentation: In the first case, a 29-year-old female underwent the long protocol using gonadotropin-releasing hormone analogue and one full blastocyst was transferred in a fresh cycle. At 6 gestational weeks, three gestational sacs were clearly observed, while only one fetus with fetal heart beat was found after one week. In the second case, a 39-year-old female underwent intracytoplasmic sperm injection treatment and seven embryos were frozen accordingly. After assisted hatching, one completely expanded blastocyst was transferred during a hormone replacement cycle. Three gestational sacs with three yolk sacs were observed at 6 gestational weeks. Finally, two fetuses with fetal heart beat were found after one week. Conclusions: Overall, although the developmental mechanisms of monozygotic triplets are unknown, clinicians should be aware of the possibility of multiple pregnancies under SET.

scholarly journals The elusive diagnosis and emergent management of a late-presenting ruptured interstitial pregnancy: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lauren M. Ahlschlager ◽  
David Mysona ◽  
A. Jenna Beckham
Keyword(s):  
Uterine Cavity ◽  
Exploratory Laparotomy ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Case Presentation ◽  
Interstitial Pregnancy ◽  
Fertility Sparing ◽  
Missed Diagnosis ◽  
Poor Outcomes ◽  
First Trimester Ultrasound

Abstract Background Interstitial pregnancies are rare and often difficult to diagnose given their proximal position to the uterine cavity, however most are identified by 12 weeks gestation. Delayed or missed diagnosis contributes to heightened incidence of poor outcomes including hemorrhage and death. Case presentation A 35-year-old woman at 15 weeks gestation with confirmed intrauterine pregnancy on first trimester ultrasound and prior negative MRI presented in hemorrhagic shock and was found to have a ruptured interstitial pregnancy. Exploratory laparotomy revealed the fetus to be in the abdomen as well as a large cornual defect and abnormal placentation that resulted in supracervical hysterectomy. Conclusions Interstitial pregnancy should be considered in a patient presenting with symptoms consistent with ectopic rupture, especially in the setting of equivocal or suboptimal prior imaging. Earlier diagnosis may allow for fertility-sparing intervention and decreased risk of morbidity and mortality.

scholarly journals A study of feto-maternal outcome in bleeding per vaginum in first trimester of pregnancy

2020 ◽  
Vol 9 (3) ◽  
pp. 1191
Author(s):  
Jaydeep J. Bhatu ◽  
Darshil S. Prajapati
Keyword(s):  
Vaginal Bleeding ◽  
Local Population ◽  
Previous History ◽  
Perinatal Outcomes ◽  
First Trimester ◽  
Maternal Complications ◽  
History Of ◽  
Threatened Abortion ◽  
Degree Of Association ◽  
In Pregnancy

Background: Bleeding per vaginum in the first trimester is a common obstetric entity. Four major causes of pathological bleeding in 1st trimester are miscarriage, ectopic pregnancy, implantation bleeding of pregnancy and cervical pathology. The purpose of this study was to investigate and understand the effect of first trimester vaginal bleeding on maternal and perinatal outcomes in the local population to which our hospital serves. Objective of this study was to estimate the degree of association between first-trimester bleeding and miscarriage, pregnancy outcomes in women with threatened abortion, various maternal complications and outcome of labor in pregnancy complicated by first-trimester bleeding and adverse fetal outcomes affected with first trimester bleeding.Methods: This prospective observational study was carried out on 110 women attending hospital with history of first trimester vaginal bleeding at a tertiary health center - sola civil hospital Ahmedabad for a period of twelve months.Results: Majority (69%) of first trimester bleeding occurs in age group of 21-30 years and majority of patients were primigravida constituting 53% out of 110 patients, 48 patients presented with abortions, out of which 26 had threatened abortion and 22 had other abortions. Primi para with previous history of bleeding per vaginum had more chances to go in full term in present pregnancy.Conclusions: Patients presenting with heavy bleeding per vaginum ended up in pregnancy loss and thus a poor outcome. In the presence of sub-chorionic hematoma, the prognosis of pregnancy is greatly affected as the risk of pre-term, IUGR and especially miscarriages increase significantly.

scholarly journals Double Trouble: Heterotopic Pregnancy

2014 ◽  
Vol 6 (3) ◽  
pp. 167-170
Author(s):  
Shruthi Krishnamoorthy ◽  
G Usha Rani ◽  
O Syamala ◽  
Rukshana LNU ◽  
Naveen Alexander
Keyword(s):  
Ectopic Pregnancy ◽  
Assisted Reproductive Technology ◽  
South Asian ◽  
Surgical Intervention ◽  
Case Series ◽  
First Trimester ◽  
Reproductive Technology ◽  
Heterotopic Pregnancy ◽  
Life Threatening ◽  
Threatening Situation

ABSTRACT A heterotopic pregnancy is defined as the presence of a combined intrauterine and ectopic pregnancy. Its estimated incidence is as between 1/7000 and 1/30,000 pregnancies. It is also reported to be as high as 1% after the use of assisted reproductive technology. Heterotopic pregnancies are diagnostic and therapeutic challenges for obstetricians. If they continue without diagnosis, a life-threatening situation may occur even when timely surgical intervention with laparotomy is performed. Here, we report a case series of three patients having three different scenarios, who were diagnosed with heterotopic pregnancies in the first trimester and managed successfully. How to cite this article Krishnamoorthy S, Rani GU, Syamala O, Rukshana, Alexander N. Double Trouble: Heterotopic Pregnancy J South Asian Feder Obst Gynae 2014;6(3):167-170.

scholarly journals Orbital aspergillosis: a case report and review of the literature

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mael Lever ◽  
Benjamin Wilde ◽  
Roman Pförtner ◽  
Cornelius Deuschl ◽  
Oliver Witzke ◽  
...  
Keyword(s):  
Case Series ◽  
Diagnostic Techniques ◽  
Diagnostic Process ◽  
Interdisciplinary Management ◽  
Upper Eyelid ◽  
Orbital Mass ◽  
Case Presentation ◽  
Idiopathic Orbital Inflammation ◽  
Orbital Tissue ◽  
Life Threatening

Abstract Background Orbital aspergillosis is a rare sight- and life-threatening fungal infection affecting immunocompromised or otherwise healthy patients. It is often misdiagnosed due to its unspecific clinical and radiologic appearance. Therapeutic delay can have dramatic consequences. However, progress in microbiological diagnostic techniques and therapeutic experience from case series help improve the management of this disease. Case presentation A 78-year-old immunocompetent woman presented at an eye clinic for subacute swelling, reddening, and ptosis of her left upper eyelid. Based on radiologic and histologic considerations, she was treated for idiopathic orbital inflammation, but her condition worsened. After a second biopsy of the orbital mass, aspergillosis was diagnosed. Her condition improved promptly after initiation of an oral voriconazole treatment. Additionally, using a polymerase chain reaction (PCR) assay, A. fumigatus was identified on tissue of both biopsies and its azole susceptibility was examined simultaneously. Conclusions In the case described here, oral antifungal treatment was sufficient for the therapy of invasive orbital aspergillosis. Performing fungal PCR on orbital tissue can accelerate the diagnostic process and should be performed in ambiguous cases of slowly growing orbital mass. Finally, interdisciplinary management is the key to optimal treatment of orbital tumours and infections.

scholarly journals Maternal and perinatal outcomes in women with first trimester vaginal bleeding

2019 ◽  
Vol 8 (11) ◽  
pp. 4320
Author(s):  
K. Suganya ◽  
Latha Maheswari Subbarayan
Keyword(s):  
Pregnant Women ◽  
Vaginal Bleeding ◽  
Case Control Study ◽  
Preterm Labour ◽  
Perinatal Outcomes ◽  
First Trimester ◽  
Case Control ◽  
Second Trimester ◽  
Trimester Abortion ◽  
Control Study

Background: First trimester bleeding is one of the common complications during pregnancy which affects almost 16-25% of all pregnancies. To evaluate and ascertain the adverse maternal and perinatal outcomes in pregnant women presenting with first trimester vaginal bleeding.Methods: Prospective case-control study. A case control study involving 60 pregnant women with vaginal bleeding in the first 13 weeks + 6 days of gestational age with 60 matched controls. The study period was from March 2015 to March 2016 and conducted at PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu.Results: The complications seen in the study group were: first trimester abortion (16.7%), second trimester abortion (6.7%), preterm labour (25%), abruption (6.7%), neonatal intensive care admission (25%), ectopic (6.7%), IUGR (10%), IUD (1.7%) and PROM (8.3%). When compared with the parity matched controls there was statistically significant increase in first and second trimester abortions, preterm labour, abruption, NICU admission and ectopic pregnancy whereas there was no significant difference between the two groups with regard to intrauterine growth restriction (IUGR) and intrauterine death (IUD).Conclusions: Women with first trimester vaginal bleeding had several adverse outcomes in both the mother and the fetus, and it is very important to explain about the possibility of these outcomes and ensure proper follow up with close antenatal surveillance.

No Legal Impediment: Access to Abortion in the United States

1986 ◽  
Vol 20 (2) ◽  
pp. 189-205 ◽  
Author(s):  
A. S. Cohan
Keyword(s):  
United States ◽  
Pregnant Woman ◽  
Medical Practitioner ◽  
First Trimester ◽  
The United States ◽  
The State ◽  
Second Trimester ◽  
Life Threatening ◽  
Do So

If a pregnant woman in the United States wishes to terminate her pregnancy, she may do so unimpeded by the state during the first trimester of the pregnancy, so long as the termination is performed by a registered medical practitioner. In the second trimester, she must have closer consultation with her physician than in the first three months, but the choice of an abortion still resides with her. State interest in that period may be concerned only with the safety of the procedure for the mother since abortion during the second trimester is more life-threatening to the mother than in the first. Only in the last trimester of her pregnancy does the state interest in that choice become paramount because the state finds itself in the position of being advocate for the foetus which, in thelater stages of pregnancy, may be viable outside of the mother's womb.

scholarly journals Pregnancy after liver transplant: maternal and perinatal outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Izabela Marzec ◽  
Aleksandra Słowakiewicz ◽  
Jolanta Gozdowska ◽  
Olga Tronina ◽  
Marek Pacholczyk ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Perinatal Outcomes ◽  
First Trimester ◽  
Reproductive Age ◽  
Maternal Complications ◽  
Optimal Method ◽  
Life Saving ◽  
Transplant Center ◽  
Gestational Week ◽  
The Mean

Abstract Background Liver transplantation is a life-saving and successful therapeutic procedure which is more and more frequent worldwide, also among women of reproductive age. Consequently, there is an increasing number of reports of pregnancy following liver transplantation, but doubts still exist regarding preconception counseling and the optimal method of managing pregnancy. The aim of this study was to report and evaluate pregnancy outcomes in women who had undergone liver transplantation. Methods We retrospectively analyzed female patients after orthotopic liver transplantation who reported pregnancy and were under medical care of a single transplant center. Results We identified 14 pregnancies in 10 women who had undergone liver transplantation (12 childbirths, one induced abortion due to fetal death in the first trimester, one pregnancy is still ongoing). Causes of transplantation include congenital or acquired disorders and the most common indication was autoimmune hepatitis (50%). The mean age at the point of transplantation was 28.5 (range 21–36), mean maternal age at pregnancy was 32 (range 26–43), and transplant-to-pregnancy interval was 4.07 years (range 1.5–7). The mean gestational week was 36.67 (range 31–40). Immunosuppression was maintained with combinations of prednisone (n = 11), tacrolimus (n = 13), and azathioprine (n = 8) prior to and during pregnancy. Two pregnancies were unintended, so women took mycophenolate mofetil in the first weeks of gestation. Another two women stopped taking azathioprine due to increasing anemia. Maternal complications included increase of aspartate transaminase and alanine transaminase (n = 2), anemia (n = 4) and hyperthyroidism (n = 2). Among the 12 childbirths, five (41.67%) were preterm. Only five women entered labor spontaneously, while seven (58,33%) had cesarean delivery. Conclusions Pregnancy after liver transplantation can achieve relatively favorable outcomes. Liver transplantation does not influence women’s fertility and, during pregnancy, we report low rates of minor graft complications. A multidisciplinary team should be involved in contraceptive, fertility and consequently pregnancy counseling of female transplant recipients.

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