Surgical Treatment of “Large Uterine Masses” in Pregnancy: A Single-Center Experience

Uterine myomas or uterine fibroids are the most common benign uterine masses affecting women. The management of large myoma during pregnancy is challenging, and surgical treatment is a possible option. We report nine cases of pregnant women affected by uterine masses larger than 10 cm, who underwent surgical treatment during the second trimester of pregnancy. In all cases, the masses were preconceptionally unknown and diagnosed during the first trimester. In eight cases, no maternal and fetal complications arose during or after surgical treatment and delivery occurred at full term of pregnancy. In one case, spontaneous abortion was recorded. In all cases, histologic diagnosis demonstrated the benign nature. Women affected by large uterine masses diagnosed for the first time in pregnancy could be taken into consideration for surgical treatment in a referral center during the second trimester.

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Primary Hyperparathyroidism in Pregnancy: A Two-Case Report and Literature Review

Case Reports in Obstetrics and Gynecology ◽

10.1155/2015/171828 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

A. D. Herrera-Martínez ◽

R. Bahamondes-Opazo ◽

R. Palomares-Ortega ◽

C. Muñoz-Jiménez ◽

M. A. Gálvez-Moreno ◽

...

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Early Diagnosis ◽

Literature Review ◽

Primary Hyperparathyroidism ◽

Serum Levels ◽

Second Trimester ◽

Uncommon Disease ◽

Fetal Complications ◽

In Pregnancy

Primary hyperparathyroidism (PHPT) in pregnant women is an uncommon disease. It could be easily misdiagnosed because of physiologic changes during pregnancy; in some cases, patients could remain asymptomatic maintaining elevated calcium serum levels, and this situation represents a threat to the health of both mother and fetus. We present two cases of PHPT during pregnancy and their evolution after surgical treatment in the second trimester; there were no observed complications during pregnancy or delivery in our patients. Early diagnosis and medical/surgical treatment in PHPT are necessary for avoiding maternal and fetal complications which could not be predicted based on duration or severity of hypercalcemia. An appropriate management of PHPT during pregnancy is necessary for preserving the health of both the woman and the fetus.

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Primary Hyperparathyroidism in Pregnancy: Successful Parathyroidectomy during First Trimester

Case Reports in Endocrinology ◽

10.1155/2018/5493917 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Niranjan Tachamo ◽

Bidhya Timilsina ◽

Rashmi Dhital ◽

Theresa Lynn ◽

Vasudev Magaji ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Conservative Management ◽

First Trimester ◽

Second Trimester ◽

Therapeutic Challenge ◽

Fetal Complications ◽

In Pregnancy

Primary hyperparathyroidism in pregnancy can result in significant maternal and fetal complications. When indicated, prompt parathyroidectomy in the early second trimester is considered the treatment of choice. Pregnant patients with primary hyperparathyroidism who have an indication for parathyroidectomy during the first trimester represent a therapeutic challenge. We present the case of a 32-year-old primigravida who presented with symptomatic hypercalcemia from her primary hyperparathyroidism. She remained symptomatic despite aggressive conservative management and underwent parathyroidectomy in her first trimester with excellent outcomes.

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Hemorrhoidectomy in the Third Trimester of Pregnancy: A Case Report of A Primipara With Twin Gestation

Journal of Biomedical Engineering and Medical Imaging ◽

10.14738/jbemi.72.8246 ◽

2020 ◽

Vol 7 (2) ◽

pp. 14-18

Author(s):

Edwin Onyedikachi Chukwudi ◽

Itekena Eugene Wakama ◽

Ugochukwu Onyinye ◽

Emi Membere-Otagi . ◽

Akano Charity . ◽

...

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Second Trimester ◽

Third Trimester ◽

Cervical Cerclage ◽

The Third ◽

Multiple Gestations ◽

Male Twin ◽

In Pregnancy

Hemorrhoids in pregnancy rarely require surgical treatment. Hemorrhoidectomy when done in pregnancy may result in complications for the mother or fetus. With multiple gestations (twin gestation in this case), the risk of these complications could be higher, more so, when done in the third rather than second trimester. We report the management of a 29yr old woman with twin gestation and in situ cervical cerclage who developed strangulated hemorrhoids at 30 weeks gestation. She had successful hemorrhoidectomy, continued her pregnancy until vaginal delivery of a healthy set of male twin neonates at 37 weeks gestation without recurrence.

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A Comparative Study on Serum Levels of Iron, Magnesium, Calcium and Phosphorus during First & Second Trimesters of Pregnancy at a Tertiary Referral Hospital in South India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/481 ◽

2021 ◽

Vol 8 (29) ◽

pp. 2609-2614

Author(s):

Pradeep Kumar M ◽

Mayadevi Brahmanandan ◽

Dini S.B

Keyword(s):

Body Mass Index ◽

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Serum Levels ◽

First Trimester ◽

Second Trimester ◽

Mean Values ◽

Calcium And Phosphorus ◽

In Pregnancy

BACKGROUND Multiple micronutrient deficiencies commonly coexist in pregnancy and may play a role in the pathogenesis of many high-risk events in pregnancy. Mineral estimation during the first and second trimester may help in the identification of high-risk pregnancies predisposed to pre-eclampsia, preterm birth or low birth weight. Body mass index (BMI) is an independent risk factor influencing the serum levels of micronutrients like iron, calcium, phosphorous and magnesium. The purpose of this study was to compare the serum levels of iron, magnesium, calcium and phosphorus during first & second trimesters of pregnancy and their correlation with body mass index and adverse pregnancy outcomes. METHODS This was a longitudinal descriptive study, done over a period of twelve months, from April 2017 to March 2018. 94 low risk pregnant women were selected in the first trimester, and they were followed up for the entire duration of pregnancy. 2 ml of blood is collected at first and second trimester and analysed for the serum levels of iron (µg/dl), magnesium (mg/dl), calcium (mg/dl) and inorganic phosphorus (mg/dl). Mean values of these elements were noted and BMI was measured. Patients were followed up to observe the pregnancy outcome, especially development of hypertension, preterm birth and low birth weight. The data were subjected to suitable statistical analyses. P value less than 0.05 is considered as statistically significant. RESULTS Mean values of Ca, Mg, inorganic P and Fe were 9.3 mg/dl ± 0.52, 1.79 mg/dl ± 0.28, 3.59 mg/dl ± 0.54 and 83.7 µg/dl ± 25.36 respectively in first trimester and 8.9 mg/dl ± 0.47, 1.62 mg/dl ± 0.16, 3.17 mg/dl ± 0.44 and 76.17 µg/dl ± 21. 69 respectively in the second trimester. Hypocalcaemia was noted in 12.7 % and 38.3 % in the first and second trimester respectively. Hypomagnesaemia was seen in 51.1 % and 80.9 % in the first and second trimester respectively. Hypophosphatemia was seen in 3.2 % and 14.8 % in the first and second trimester respectively. These findings were statistically significant. There was no significant change in the iron levels in the present study. 19.1 % were underweight. 56.4 % had normal BMI. 19.2 % were overweight. 5.3 % were obese. CONCLUSIONS There is no correlation between serum values of trace elements and the BMI of study subjects. Even though significant hypocalcaemia, hypophosphatemia and hypomagnesaemia was noted in second trimester compared to first, there was no predisposition to the development of adverse outcomes like pre-eclampsia, preterm birth or low birth weight. This may be the effect of dietary and pharmacological supplementation during pregnancy. KEYWORDS Micronutrients, Pregnancy Complications, Calcium, Phosphorus, Magnesium, Iron

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Regulation of Microparticles and Adhesion Molecules in Pregnancy. Diagnostic and Pathophysiologic Implications.

Blood ◽

10.1182/blood.v110.11.1639.1639 ◽

2007 ◽

Vol 110 (11) ◽

pp. 1639-1639

Author(s):

Debra Hoppensteadt ◽

Josephine Cunanan ◽

Anita Sylvester Anderson ◽

Thomas Bergholt ◽

Jorgen Berthelsen ◽

...

Keyword(s):

Adhesion Molecules ◽

Inflammatory Responses ◽

Sandwich Elisa ◽

Coagulation Factors ◽

First Trimester ◽

Second Trimester ◽

Third Trimester ◽

Cellular Activation ◽

Rebound Increase ◽

In Pregnancy

Abstract OBJECTIVE In addition to increased levels of coagulation factors and platelet counts,, microparticles are also found in increased numbers in pregnancy and are generated due to cellular activation and consumption. Microparticles may also be capable of amplifying the procoagulant and inflammatory responses by up regulating the adhesion molecules such as P, E and L selectins. This study will provide newer data on the regulation of microparticles in different trimesters of pregnancy and their relevance to the generation of adhesion molecules and tissue factor (TF). STUDY DESIGN Blood samples from pregnant women at their first prenatal visit and during the second and third trimester (n=50) were collected and citrated plasma samples were profiled for TF (American Diagnostica, Stamford, CT), E, L and P-selection (R &D Systems, Minneapolis, MN) by using commercially available sandwich ELISA methods and microparticles utilizing a functional method from Hyphen Biomed (Neuville-Sur-Oise, France). The results were compiled for each trimester and compared to aged match non-pregnant controls (n=40). RESULTS During the first trimester all of the mediators were increased in comparison to the controls. The relative increase was mediator dependent. L-selectin remained elevated, at a steady level, throughout the pregnancy. E-selectin showed a decrease in the second trimester with a rebound increase in the third trimester. A gradual increase in the TF and microparticles was evident throughout the pregnancy. The P-selectin levels decreased during the second trimester and stayed at this level for the remainder of the pregnancy. CONCLUSION Throughout pregnancy the TF levels directly correlated with an increase in the MP levels indicating that TF cause cellular activation leading to the formation of MPs. However, the levels of the adhesion molecules, which were initially elevated, fluctuate throughout the 2nd and 3rd trimester. These results suggest that increased levels of TF and MPs are progressively generated during pregnancy and may be responsible for the observed thrombotic complications and prothrombotic state in pregnancy.

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A Longitudinal Study of Thyroid Markers Across Pregnancy and the Risk of Gestational Diabetes

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2017-02442 ◽

2018 ◽

Vol 103 (7) ◽

pp. 2447-2456 ◽

Cited By ~ 8

Author(s):

Shristi Rawal ◽

Michael Y Tsai ◽

Stefanie N Hinkle ◽

Yeyi Zhu ◽

Wei Bao ◽

...

Keyword(s):

Gestational Diabetes ◽

De Novo ◽

Conditional Logistic Regression ◽

Thyroid Autoimmunity ◽

First Trimester ◽

Biologically Active ◽

Second Trimester ◽

Free T4 ◽

Control Study ◽

In Pregnancy

Abstract Context T3 is the biologically active thyroid hormone involved in glucose metabolism. The free T3 (fT3)/free T4 (fT4) ratio, a marker indicating conversion of fT4 to fT3, is also implicated in glucose homeostasis. Objective To examine associations of fT3 and the fT3/fT4 ratio with gestational diabetes mellitus (GDM). Design In a case-control study, thyroid markers (fT3, fT4, TSH) were measured and the fT3/fT4 ratio was derived across four visits in pregnancy, including first (gestational weeks 10 to 14) and second (weeks 15 to 26) trimester. Conditional logistic regression adjusting for thyroid autoimmunity status and major GDM risk factors estimated trimester-specific associations of thyroid markers with subsequent GDM risk. Setting Twelve US clinical centers. Participants One hundred seven GDM cases and 214 non-GDM controls from a multiracial pregnancy cohort of 2802 women. Main Outcome Measures GDM diagnosis ascertained from medical records. Results Both fT3 and the fT3/fT4 ratio were positively associated with GDM: adjusted OR (95% CI) comparing the highest vs lowest fT3 quartile was 4.25 (1.67, 10.80) at the first trimester and 3.89 (1.50, 10.10) at the second trimester. Similarly, the corresponding risk estimates for the fT3/fT4 ratio were 8.63 (2.87, 26.00) and 13.60 (3.97, 46.30) at the first and second trimester, respectively. Neither TSH nor fT4 was significantly associated with GDM. Conclusions Higher fT3 levels, potentially resulting from de novo synthesis or increased fT4 to fT3 conversion, may be an indicator of GDM risk starting early in pregnancy.

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Study on the expression of interleukins in patients with twin-twin transfusion syndrome

Vietnam Journal of Biotechnology ◽

10.15625/1811-4989/18/3/15709 ◽

2020 ◽

Vol 18 (3) ◽

pp. 417-423

Author(s):

Nguyen Duy Anh ◽

Nguyen Thi Sim ◽

Phan Huyen Thuong ◽

Tran Thi Phuong Thao ◽

Hoang Van Tong ◽

...

Keyword(s):

Surgical Treatment ◽

Birth Defects ◽

Fetal Death ◽

Plasma Concentrations ◽

First Trimester ◽

Second Trimester ◽

Potential Marker ◽

Significant Difference ◽

Before And After ◽

Twin Pregnancies

Twin-twin transfusion syndrome (TTTS) is an unusual and serious condition that occurs in twin pregnancies when identical twins share a placenta but develop discordant amniotic fluid volumes. The TTTS has a high risk of fetal death and birth defects if left untreated. IL-1β, IL-6 and IL-8 have been shown to play an important role in preterm birth in twin pregnancies, which is one of the consequences of TTTS. This study quantified plasma levels of IL-1β, IL-6 and IL-8 in twin pregnant women with (n = 52) and without TTTS (n = 73) by ELISA and analyzed the association of interleukin expression levels with TTTS. The results showed that plasma concentrations of IL-1β and IL-8 were low and not significantly different between the first trimester and the second trimester of pregnancy, between the patients with and without TTTS or between patients with TTTS before and after treatment. IL-6 levels showed no significant difference between first trimester and second trimester of pregnancy or between patients with and without TTTS. Importantly, IL-6 levels were significantly elevated in TTTS patients after surgical treatment compared to those before surgical treatment. In conclusion, IL-6 may be considered as a potential marker for the prognosis of surgical treatment of TTTS.

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CML In Pregnancy: A Case Report Using Leukapheresis and Literature Review

Blood ◽

10.1182/blood.v122.21.5177.5177 ◽

2013 ◽

Vol 122 (21) ◽

pp. 5177-5177 ◽

Cited By ~ 1

Author(s):

Yellu Mehander ◽

Stephen Medlin

Keyword(s):

Blood Cell ◽

Interferon Alpha ◽

White Blood Cell ◽

Bed Rest ◽

First Trimester ◽

Myelogenous Leukemia ◽

Cytotoxic Agents ◽

Second Trimester ◽

Wbc Count ◽

In Pregnancy

Abstract Chronic myelogenous leukemia (CML) complicating pregnancy is rare and managing this specific subgroup of patients is challenging due to very limited data on this patient group. Management options differ depending on control of the CML at the time of the pregnancy. Patients who become pregnant during CML treatment with a TKI have been managed with watchful waiting, as well as Interferon-alpha, hydroxyurea, leukapheresis, and continuing tyrosine kinase inhibitors (TKI’s). Patients with concurrent diagnosis of CML and pregnancy present a more difficult management dilemma. In the absence of prospective trials, treatment has been tailored to individual patient needs and goals as well as past individual physician experience. The literature for treatment of CML in pregnancy is reviewed and a relevant case discussed. A 37 y/o woman with past medical history five miscarriages and asymptomatic mitral valve prolapse, presented for a routine visit in her first trimester. She complained of fatigue. CBC showed white blood cell (WBC) count at 189,000 with bone marrow consistent with CML and FISH positive for BCR-ABL. Patient was offered elective abortion but declined. She was started on interferon, 90mcg per week, which was then increased to 135mcg/week after about 3 weeks. Her elevated WBC count persisted and her symptoms as well. Second opinion led to initiation of leukapheresis mid-second trimester with an empiric goal of less than 100,000. She underwent once weekly leukapheresis without significant complications and within four weeks, her white blood cell count dropped to between 50,000 and 75,000, with hemoglobin between 8.5 and 9.7 and platelets of 450,000 to 550,000 until week 32. Her fatigue improved. She had been found to have a small placental abruption at her ultrasound in the second trimester prior to leukapheresis. This led to spotting and bed rest at 32 weeks. She delivered at 35 weeks with a healthy fetus. She had a pulmonary embolus complicating her period of bed rest. Pregnancy diagnosed concurrently with CML is uncommon and difficult to treat due to limited available options and lack of enough data about the potential harm to the fetus. Termination of pregnancy is considered safe for the mother when caught in the first trimester but was not desired in this case. Treatment during the second trimester with agents such as TKI’s is reported to be associated with fetal malformations. Interferon alpha therapy is FDA approved as category C in pregnancy, but can work slowly. Leukapheresis is thought to involve minimal risk to the fetus and minimize risk of complications of hyperleukocytosis. The effect of Leukapheresis is transient; therefore chance of rebound is high in rapidly proliferating leukemia. Successful use of leukapheresis has been reported in a few case reports. No specific guidelines have been developed to manage this specific group of patients. Use of TKI and other cytotoxic agents may be safer in third trimester but since enough data is not available to date, use of these agents cannot be recommended as routine therapy. Use of cytotoxic agents such as hydroxyurea may also be reasonable but also are not FDA approved for use. Leukapheresis may be a safe procedure to use in select situations when preservation of the fetus is desired, particularly during hyperleukocytosis. This procedure has very few complications and no major complications have been reported in the literature. Our patient had a PE after 2 weeks of strict bedrest in the hospital. This was not thought to be directly related to the underlying CML. The newborn was healthy at birth and the mother was treated with a TKI two weeks after delivery. Disclosures: No relevant conflicts of interest to declare.

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Comparison of uterine fibroids’ growth pattern during pregnancy according to fetal sex: an observational study

Biology of Sex Differences ◽

10.1186/s13293-019-0266-2 ◽

2019 ◽

Vol 10 (1) ◽

Author(s):

Giovanni Delli Carpini ◽

Valeria Verdecchia ◽

Maria Papiccio ◽

Camilla Grelloni ◽

Andrea Ciavattini

Keyword(s):

Observational Study ◽

Uterine Fibroids ◽

Serum Levels ◽

First Trimester ◽

Obstetric Outcomes ◽

Second Trimester ◽

Third Trimester ◽

Fetal Sex ◽

Female Fetus ◽

The Mean

Abstract Background To investigate the effect of fetal sex on fibroids’ growth during pregnancy according to the hCG serum levels Methods Observational study conducted from January 2007 to December 2016 on women with ultrasound identification of uterine fibroids who had a pregnancy within 1 year from diagnosis. The fibroids diameter was determined during the pre-pregnancy ultrasound, early first trimester (5–7 weeks), late first trimester (11–13 weeks), second trimester (19–21 weeks), and third trimester (31–33 weeks). The diameter growth was calculated in each interval between two ultrasounds. The hCG serum levels were determined both in early and late first trimester. The correlation between hCG levels and fibroid diameter was evaluated. Obstetric outcomes collected were gestational weeks at birth and the rate of cesarean section. Neonatal outcomes were birthweight and Apgar score at 1 min. Results Eighty-seven of the included women had a male fetus, and 70 had a female fetus. A progressive increase of fibroid diameter was observed from pre-pregnancy to second trimester for both fetal sexes. In third trimester, the mean ± SD fibroid diameter of female fetuses showed a slowdown, while the mean ± SD fibroid diameter of male fetuses continued to grow. Women carrying a female fetus presented a higher fibroid diameter in early first trimester (33.5 ± 13.3 mm vs 27.4 ± 11.0 mm, p < 0.01), late first trimester (40.2 ± 13.9 mm vs 34.6 ± 11.7 mm, p < 0.01), and second trimester (40.5 ± 14.9 mm vs 34.7 ± 10.3 mm, p < 0.01). The hCG serum levels resulted higher in women with a female fetus: 61406 (50554-71760) mU/ml vs 46016 (37160-56744) mU/ml (p < 0.01). A positive correlation between hCG levels and fibroid diameter was found both for male and female fetuses (male r = 0.77, 95% CI 0.71–0.82, p < 0.01 and female r = 0.82, 95% CI 0.76–0.86, p < 0.01). Conclusion Women with female fetus seem to have a higher growth of fibroids up to second trimester of pregnancy. This process may be mediated by the higher serum hCG levels found in women expecting a female fetus.

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The Quantose Insulin Resistance Test for Maternal Insulin Resistance: A Pilot Study

American Journal of Perinatology ◽

10.1055/s-0040-1716730 ◽

2020 ◽

Author(s):

Joe Eid ◽

Talar Kechichian ◽

Elisa Benavides ◽

Lisa Thibodeaux ◽

Ashley E. Salazar ◽

...

Keyword(s):

Insulin Resistance ◽

Glucose Tolerance ◽

Glucose Tolerance Test ◽

First Trimester ◽

Tolerance Test ◽

Model Assessment ◽

Second Trimester ◽

Obese Women ◽

Blood Draw ◽

In Pregnancy

Objective Insulin resistance (IR) increases during pregnancy which can lead to hyperinsulinemia, gestational diabetes mellitus (GDM), and neonatal hypoglycemia (NH), especially in obese women. Glucose tolerance testing (GTT) is used clinically to evaluate IR in pregnancy. Quantose IR score index is a novel blood screen of IR validated in nonpregnant individuals. The score is generated using an algorithm that combines insulin and three biomarkers of fatty acid pathways (α-hydroxybutyrate, oleic acid, linoleoyl-glycerophospocholine). Our objective was to determine the validity of Quantose IR test (Metabolan Inc. Morrisville, NC) in assessing IR in pregnant obese women, as compared with the homeostatic model assessment of insulin resistance (HOMA-IR), and its ability to predict GDM and NH. Study Design Women between 100/7 and 136/7 weeks of gestation with a pre-pregnancy or early pregnancy body mass index more than 30 kg/m2, and no pregestational diabetes, were included. Fasting blood samples were collected at 100/7 to 136/7 (T1) and 240/7 to 280/7 (T2) weeks. Quantose IR and HOMA-IR were calculated. All women underwent an early (T1; indicated for women with obesity) and a T2 glucose tolerance tests. GDM was diagnosed using the two-step approach, and NH was defined as a neonatal glucose less than 40 mg/dL in the first 24 hours of life. Linear regression and receiver operating characteristic curves were used for analysis. Results The trial enrolled 100 patients. Ten subjects (10%) were diagnosed with GDM in the second trimester and none in the first trimester. At T1, Quantose IR (R2 = 0.48), but not 1-hour glucose tolerance test (R2 = 0.07), correlated with HOMA-IR. Similar correlations were observed at T2. The 1-hour glucose tolerance test followed by HOMA-IR and Quantose IR (area under the curve [AUC]: 0.82, 0.68, and 0.62, respectively) were predictors of GDM. Quantose IR (AUC: 0.74) and 1-hour glucose tolerance test (AUC: 0.72) at T1 and T2 (AUC: 0.75; AUC: 0.93; respectively) were best predictors of NH. The best cut offs, sensitivities, and specificities for prediction of NH were determined. Conclusion Similar to nonpregnant individuals, Quantose IR appears to be a valid measure of IR in obese pregnant women. First trimester Quantose IR is a predictor of GDM diagnosed in the second trimester and NH. Given that it requires a single blood draw and no glucose challenge, it may be a useful test to evaluate and monitor IR in pregnancy. Our findings may be used as pilot data to explore the potential use of Quantose IR in pregnancy further. Key Points

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