scholarly journals Post-Transplant Pregnancy and Contraception

2021 ◽  
pp. CJN.14100820
Author(s):  
Christina L. Klein ◽  
Michelle A. Josephson
Keyword(s):  
Decision Making ◽  
Sexual Function ◽  
In Utero ◽  
Immunosuppressive Drugs ◽  
Critical Importance ◽  
Post Transplant ◽  
Early Return ◽  
Reproductive Counseling ◽  
Immunosuppressant Medications ◽  
In Pregnancy

Placed in a historic context, this overview focuses on post-transpant pregnancy, fatherhood, and contraception in women and men. The critical importance of early reproductive counseling because of improved sexual function and the early return of ovulation and menses post-transplant is emphasized. We explain the decision making regarding contraception choices. The available data on the safety of immunosuppressive drugs in pregnancy, and for men desiring fatherhood, are detailed. The risk of maternal ingestion of mycophenolate products on the in utero fetus is considered and contrasted with the lack of concern for their use by men fathering children. Pregnancy risks to the allograft, baby, and mother are discussed. An infant’s exposure to specific immunosuppressant medications through breastfeeding is reviewed. The ethics and realities of post-transplant parenthood are explored.

CAN BAYESIAN METHODS MAKE DATA AND ANALYSES MORE RELEVANT TO DECISION MAKERS?

2001 ◽  
Vol 17 (1) ◽  
pp. 114-122 ◽  
Author(s):  
Steven H. Sheingold
Keyword(s):  
Decision Making ◽  
Bayesian Methods ◽  
Paradigm Shift ◽  
Relevant Information ◽  
Decision Makers ◽  
Evidence Based ◽  
Critical Importance ◽  
Bayesian Approaches ◽  
Bayesian Analyses ◽  
And Performance

Decision making in health care has become increasingly reliant on information technology, evidence-based processes, and performance measurement. It is therefore a time at which it is of critical importance to make data and analyses more relevant to decision makers. Those who support Bayesian approaches contend that their analyses provide more relevant information for decision making than do classical or “frequentist” methods, and that a paradigm shift to the former is long overdue. While formal Bayesian analyses may eventually play an important role in decision making, there are several obstacles to overcome if these methods are to gain acceptance in an environment dominated by frequentist approaches. Supporters of Bayesian statistics must find more accommodating approaches to making their case, especially in finding ways to make these methods more transparent and accessible. Moreover, they must better understand the decision-making environment they hope to influence. This paper discusses these issues and provides some suggestions for overcoming some of these barriers to greater acceptance.

Approach to dyspnoea in pregnancy in the COVID-19 era

2020 ◽  
Vol 19 (4) ◽  
pp. 230-234
Author(s):  
Anita Banerjee ◽  
◽  
Lindsay A Arrandale ◽  
Srividhya Sankaran ◽  
Guy W Glover ◽  
...  
Keyword(s):  
Decision Making ◽  
Pregnant Women ◽  
Correct Diagnosis ◽  
Case Series ◽  
Differential Diagnoses ◽  
Shared Decision ◽  
First Case ◽  
Compromise Design ◽  
A Current ◽  
In Pregnancy

Importance: Dyspnoea and hypoxia in pregnant women during the COVID-19 pandemic may be due to causes other than SARS Co-V-2 infection which should not be ignored. Shared decision-making regarding early delivery is paramount. Objective: To highlight and discuss the differential diagnoses of dyspnoea and hypoxia in pregnant women and to discuss the risks versus benefit of delivery for maternal compromise. Design, setting and participants: Case series of two pregnant women who presented with dyspnoea and hypoxia during the COVID-19 pandemic. Results: Two pregnant women presented with dyspnoea and hypoxia. The first case had COVID-19 infection in the 3rd trimester. The second case had an exacerbation of asthma without concurrent COVID-19. Only the first case required intubation and delivery. Both recovered and were discharged home. Conclusion and relevance: Our two cases highlight the importance of making the correct diagnosis and timely decision-making to consider if delivery for maternal compromise is warranted. Whilst COVID-19 is a current healthcare concern other differential diagnoses must still be considered when pregnant women present with dyspnoea and hypoxia.

Vertebral malformation in the mouse foetus caused by X-radiation of the mother during pregnancy

Development ◽  
1964 ◽  
Vol 12 (4) ◽  
pp. 841-850
Author(s):  
Ujihiro Murakami ◽  
Yoshiro Kameyama
Keyword(s):  
Early Pregnancy ◽  
Vertebral Column ◽  
Strain Differences ◽  
In Utero ◽  
Oxygen Deprivation ◽  
Experimental Animals ◽  
Vertebral Malformation ◽  
Pregnant Mice ◽  
Maternal Hypoxia ◽  
In Pregnancy

Maternal hypoxia in early pregnancy can result in malformations of the vertebrae of mouse foetuses, and there is a tendency for more posterior vertebrae to be affected the later in pregnancy the oxygen deprivation occurs (Murakami & Kameyama, 1963). Ingalls et al. (1957) and Degenhardt (1954, 1959) had earlier obtained similar results. We have also exposed pregnant mice to X-radiation and studied the consequent malformations. The effects on the extremities have already been described (Murakami, Kameyama & Nogami, 1963), and in the present paper we shall describe the effects on the vertebral column. Vertebral malformations in animals irradiated in utero have been described by Job, Leibold & Fitzmaurice (1935), Warkany and Schraffenberger (1947), Russell. (1950, 1954), and Russell & Russell (1954). In order to obtain results comparable with those of our experiments with hypoxia, no less than to detect inter-strain differences, we used mice of the ddN and CF1 strains originally supplied by the Central Laboratories for Experimental Animals, Tokyo (Zikkendobutsu Chuo Kenkyujo).

Neurodevelopment following exposure to antiseizure medications in utero: a review

2021 ◽  
Vol 19 ◽  
Author(s):  
Rebecca L Bromley ◽  
Matthew Bluett-Duncan
Keyword(s):  
Lower Risk ◽  
In Utero ◽  
Neurodevelopmental Outcomes ◽  
Unexposed Control ◽  
Long Period ◽  
Risks And Benefits ◽  
Limited Experience ◽  
Potential Impact ◽  
Child's Brain ◽  
In Pregnancy

: Exposure in the womb to antiseizure medications and their potential impact on the developing child's brain has long been researched. Despite this long period of interest, this review highlights above the well-known risks associated with valproate exposure; more data is required for conclusions regarding all other antiseizure medications. Limited experience with phenytoin and phenobarbital in monotherapy clearly defines the risk to later child postnatal functioning difficult. However, the evidence of an impact is stronger for phenobarbital than for phenytoin. The widely prescribed lamotrigine is limited in its investigation compared to unexposed control children. It has been demonstrated to carry a lower risk than valproate for specific outcomes; whether associated with a more moderate impact on broader aspects of neurodevelopmental functioning is still to be understood. Data for levetiracetam, topiramate, and oxcarbazepine are too limited to conclude most neurodevelopmental outcomes confidently. This slow accumulation of evidence impacts the safest use of medications in pregnancy and makes counseling women regarding the risks and benefits of specific antiseizure drugs difficult. Improved focus, funding, and research methodologies are urgently needed.

Coronal Craniostenosis: Fetal Head Constraint as One Possible Cause

PEDIATRICS ◽  
1980 ◽  
Vol 65 (5) ◽  
pp. 995-999 ◽  
Author(s):  
John M. Graham ◽  
Richard J. Badura ◽  
David W. Smith
Keyword(s):  
Retrospective Study ◽  
In Utero ◽  
Foot Deformities ◽  
Coronal Suture ◽  
Fetal Head ◽  
Normal Children ◽  
Possible Cause ◽  
In Pregnancy

A retrospective study of 11 instances of idiopathic coronal craniostenosis in otherwise normal children revealed that early lightening, prolonged moderate to severe pelvic discomfort late in pregnancy, and/or an abnormal fetal lie were unusual gestational features indicative of intrauterine constraint for eight of these patients. The impression of unusual constraint in utero was futher implied by finding associated positional foot deformities in four of these latter eight children. We hypothesize that prolonged constraint of the fetal head may limit anteroposterior growth stretch at the coronal suture and thereby predispose toward early sutural fusion.

Sign in / Sign up

Export Citation Format

Share Document