HYPOTHYROIDISM IN PREGNANCY -SIGNIFICANCE OF ADEQUATE TREATMENT: A STUDY OF 100 CASES IN NORTH BIHAR

2021 ◽  
pp. 40-41
Author(s):  
Vasudha Rani ◽  
Punam Kumari
Keyword(s):  
Post Partum ◽  
Adverse Outcomes ◽  
Endocrine Disorders ◽  
Potential Threat ◽  
Adequate Treatment ◽  
Antibody Positivity ◽  
Prompt Diagnosis ◽  
In Pregnancy

Pregnancy is a nature's gift of humanity for procreation and continuation of its race. This gift is however fraught with several complications and has potential threat to the mother and the foetus. When pregnancy is compounded by endocrine disorders such as hypothyroidism, the potential for maternal and foetal adverse outcomes can be immense. While a lot of attention has been focused on the adverse foetal outcomes consequent to hypothyroidism, attention is also being gradually directed towards the adverse maternal outcomes of this disorder. Role of antibody positivity in inuencing outcomes in a euthyroid woman, also needs further clarication. Prompt diagnosis and treatment of hypothyroidism in pregnancy is very essential. Subclinical hypothyroidism also needs to be detected and treated to prevent adverse outcomes, especially maternal. Since women with hypothyroidism during pregnancy, especially of the autoimmune variety might have a are up of the disorder post-partum, or might continue to require thyroxine replacement post-partum, adequate follow-up is mandatory. While targeted case nding is generally practised, recent evidence seems to indicate that universal screening might be a better option. In conclusion, routine screening, early conrmation of diagnosis and prompt treatment allied with regular post-partum follow up, is required to ensure favourable maternal and foetal outcomes.

Cancer in pregnancy: To treat or not?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e12533-e12533
Author(s):  
Elaine Walsh ◽  
Grainne O'Kane ◽  
Karen Anne Cadoo ◽  
Donna M. Graham ◽  
Grzegorz Korpanty ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Post Partum ◽  
In Utero ◽  
Adverse Outcomes ◽  
Cytotoxic Agents ◽  
Normal Delivery ◽  
Cancer In Pregnancy ◽  
Disease Free ◽  
In Pregnancy

e12533 Background: Cancer in pregnancy accounts for ~1 in 1,000 pregnancies. Studies show that cytotoxic agents are safe from the second trimester. Long-term follow up has not shown increased malformations or malignancies in children exposed to chemotherapy in utero. There is no evidence of worse outcomes among women diagnosed in pregnancy. Methods: We retrospectively identified women diagnosed with cancer in pregnancy over a 25-year period. Medical records were reviewed for demographics, diagnosis, gestation, timing of treatment and outcomes. We assessed if all cancers need to be treated in pregnancy or if treatment could be safely deferred to allow normal delivery. Results: Twenty-five women were diagnosed with cancer in pregnancy and referred to medical oncology. Of 25 women, 16 (64%) received chemotherapy during pregnancy. These included 13 cases of breast cancer, one Ewing’s sarcoma, one ovarian cancer, and one small cell of cervix. All 16 women received doxorubicin and cyclophosphamide. There were 15 live births and no abnormalities seen in children who received chemotherapy in utero. At a median follow-up of 6 years 11 mothers (69%) are disease free and 4 (25%) have recurrent disease. Of nine mothers who did not receive chemotherapy in pregnancy, seven received chemotherapy immediately post-partum. Six (86%) were diagnosed in early pregnancy (median gestation 13 weeks). There were three cases of Hodgkin lymphoma, two breast cancers, and one ovarian cancer. At a median follow-up of 12 years, all mothers remain disease free. There were no abnormalities seen in these children. Conclusions: We did not identify any adverse outcomes in mothers or infants exposed to chemotherapy during pregnancy. We identified a cohort of patients that do not need immediate treatment during pregnancy. In selected cases, it is safe and appropriate to delay chemotherapy until delivery of the baby. There were no adverse outcomes to mothers due to delayed treatment and no adverse outcomes to babies not exposed to chemotherapy in utero. A multi-disciplinary team is essential to individualize treatment planning. [Table: see text]

Abstract 15193: Pulmonary Hypertension in Pregnancy: WHO Group 1 Outcomes Improved, Time to Focus on WHO Group 2

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
William H Marshall ◽  
Stephen Gee ◽  
Woobeen Lim ◽  
Elisa A Bradley ◽  
Lauren Lastinger ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Post Partum ◽  
Systolic Pressure ◽  
Adverse Outcomes ◽  
Cardiac Events ◽  
Ventricular Systolic Pressure ◽  
Group 5 ◽  
Group 2 ◽  
In Pregnancy ◽  
Group 1

Introduction: Pregnancy is contraindicated in women with pulmonary hypertension (PH), yet many still decide to pursue pregnancy. Hypothesis: We hypothesized improved maternal mortality with PH at our center’s cardio-obstetrics program and sought to identify factors to estimate the risk of major adverse cardiac events (MACE). Methods: Pregnant women with right ventricular systolic pressure (RVSP) ≥35 mmHg or tricuspid regurgitant velocity > 2.8 m/s on transthoracic echocardiogram (TTE) were identified. Women with intermediate to high probability PH by ESC criteria (TTE or catheterization, n = 70) were classified using the 6 th World Society of PH definitions. Results: In 70 women with PH (30 ± 6 years-old, RVSP 52 ± 16 mmHg) there were 12 (17%) with WHO Group 1 PH, 45 (64%) with Group 2 PH, 4 (6%) with Group 3 PH and 9 (13%) with Group 5 PH (Figure A). Baseline characteristics were similar except: Group 1 PH had 83% on prostacyclin (PC) therapy, higher RVSP (78 ± 20 mmHg vs. Groups 2 (46 ± 9), 3 (44 ± 2 mmHg) and 5 PH (48 ± 10mmHg), p<0.01), and compared to Group 2 PH, more Group 1 PH women were diagnosed pre-pregnancy (9 (75%) vs. 12 (27%), p = 0.01) and had cardio-obstetrics care (10 (83%) vs. 16 (36%), p < 0.01) (Figure B - E). There were no peripartum deaths, however 3 (4.3%) women with Group 2 PH had late mortality (7 ± 4 months post-partum). MACE occurred in 24 (34%) women and was more likely in those with: NYHA FC ≥ 2 (95% CI 4.7-57, p < 0.01), pre-eclampsia (95% CI 1.2-13, p = 0.03), RVSP >50 mmHg (95% CI 1.3-10, p = 0.02) and LVEF <50% (95% CI 1.1-8.8, p = 0.04) (Figure F). Preterm birth occurred in 32 (49%) pregnancies, with no neonatal mortality. Conclusion: To conclude, in a large single center cohort we report 100% 1-year survival in Groups 1, 3, and 5 PH, with most Group 1 PH patients on PC therapy and under cardio-obstetrics care. We identify Group 2 PH as an under-recognized group for adverse outcomes in pregnancy, with NYHA FC, pre-eclampsia, RVSP >50 mmHg and LVEF <50% associated with increased MACE.

Endocrine disorders in pregnancy

2018 ◽  
pp. 283-296
Author(s):  
Helen E. Turner ◽  
Richard Eastell ◽  
Ashley Grossman
Keyword(s):  
Thyroid Hormone ◽  
Hyperemesis Gravidarum ◽  
Post Partum ◽  
Management Strategies ◽  
Normal Pregnancy ◽  
Endocrine Disorders ◽  
Pituitary Diseases ◽  
Pregnant State ◽  
Pituitary Adrenal Axis ◽  
In Pregnancy

This chapter discusses thyroid, adrenal, and pituitary diseases that occur during pregnancy. A series of changes in thyroid hormone economy take place in normal pregnancy. As a result of these changes, thyroid hormone levels in pregnancy differ from those in the non-pregnant state. This chapter includes a description of normal thyroid physiology and thyroid pathophysiology, including hyperemesis gravidarum, post-partum thyroiditis, hypothyroidism, and hyperthyroidism. Changes in the hypothalamo-pituitary–adrenal axis during normal and abnormal pregnancies are also described, with syndromes such as Cushing’s syndrome and Addison’s disease listed. Finally, pituitary adenomas in pregnancy, and their respective features and management strategies, are listed, including acromegaly, hypopituitarism, TSH-secreting adenomas, and prolactinoma.

scholarly journals Can EPS Development be Avoided with Early Interventions? The Potential Role of Tamoxifen—A Single-Center Study

2014 ◽  
Vol 34 (6) ◽  
pp. 582-593 ◽  
Author(s):  
Erika De Sousa–Amorim ◽  
Gloria Del Peso ◽  
M. Auxiliadora Bajo ◽  
Laura Alvarez ◽  
Marta Ossorio ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cumulative Number ◽  
Randomized Controlled Studies ◽  
Single Center Study ◽  
Ultrafiltration Failure ◽  
Life Threatening ◽  
Severe Peritonitis ◽  
Prompt Diagnosis

BackgroundEncapsulating peritoneal sclerosis (EPS) is a severe complication of peritoneal dialysis (PD). Identification of patients at high risk for EPS (“EPS-prone”) and delivery of appropriate interventions might prevent its development. Our aim was to evaluate the clinical characteristics and outcomes of all EPS and EPS-prone patients diagnosed at our PD unit.MethodsFor a 30-year period representing our entire PD experience, we retrospectively identified all patients with EPS (diagnosed according to International Society for Peritoneal Dialysis criteria) and all patients defined as EPS-prone because they met at least 2 established criteria (severe peritonitis, PD vintage greater than 3 years, severe hemoperitoneum, overexposure to glucose, and acquired ultrafiltration failure).ResultsOf 679 PD patients, we identified 20 with EPS, for an overall prevalence of 2.9%. Mean age at diagnosis was 50.2 ± 16.4 years, with a median PD time of 77.96 months (range: 44.36 – 102.7 months) and a median follow-up of 30.91 months (range: 4.6 – 68.75 months). Of patients with EPS, 10 (50%) received tamoxifen, 10 (50%) received parenteral nutrition, and 2 (10%) underwent adhesiolysis, with 25% mortality related to EPS. Another 14 patients were identified as EPS-prone. Median follow-up was 54.05 months (range: 11.9 – 87.04 months). All received tamoxifen, and 5 (36%) received corticosteroids; none progressed to full EPS. We observed no differences in baseline data between the groups, but the group with EPS had been on PD longer (84 ± 53 months vs 39 ± 20 months, p = 0.002) and had a higher cumulative number of days of peritoneal inflammation from peritonitis (17.2 ± 11.1 days vs 9.8 ± 7.9 days, p = 0.015). Overall mortality was similar in the groups. The incidence of EPS declined during our three decades of experience (5.6%, 3.9%, and 0.3%).ConclusionsBeing a serious, life-threatening complication of PD, EPS requires high suspicion to allow for prompt diagnosis and treatment. Early detection of EPS-prone states and delivery of appropriate intervention might prevent EPS development. Tamoxifen seems to be a key strategy in prevention, but caution should be used in interpreting our results. Additional randomized controlled studies are needed.

scholarly journals The study of maternal and fetal outcome in pregnant women with thyroid disorders

2017 ◽  
Vol 6 (8) ◽  
pp. 3507 ◽  
Author(s):  
Sreelatha S. ◽  
Seema Nadagoudar ◽  
Asha Devi L.
Keyword(s):  
Pregnant Women ◽  
Thyroid Dysfunction ◽  
Post Partum ◽  
Perinatal Outcomes ◽  
Fetal Outcome ◽  
Endocrine Disorders ◽  
Thyroid Disorders ◽  
Thyroid Disorder ◽  
Neonatal Hypothyroidism ◽  
In Pregnancy

Background: Thyroid disorders are among the common endocrine disorders in pregnant women after diabetes mellitus. Several changes are observed in maternal thyroid function during pregnancy and failure to adapt to these physiological changes results in thyroid dysfunction. It is well established that not only overt, but subclinical thyroid dysfunction also has adverse effect on mother and the fetus, like miscarriages, preterm delivery, preeclampsia, eclampsia, polihydromnios, placental abruption, post-partum haemorrhage, low birth weight, neonatal hypothyroidism. Decreased availability of thyroid hormones may also impair neurological and intellectual development of foetus. With this background, we are conducting a study to know the effect of thyroid disorders on pregnancy and its maternal and the fetal outcome.Methods: The present study was conducted in ESI Hospital Rajaji Nagar, Bangalore. It is a prospective study which involved 100 patients diagnosed to have thyroid disorder during their antenatal checkup in the first trimister. It also includes known cases of thyroid disorder. TSH level was estimated. If it is deranged, then FT3 and FT4 levels estimated. Patients were managed accordingly and followed till delivery. Their obstetric and perinatal outcomes were noted.Results: In our study out of 100 cases, 96 cases are subclinical hypohyroid and 4 cases are subclinical hyperthyroid. Subclinical hypothyroidism in pregnancy are associated with abortions (2.1%), Anaemia (4.20%), PIH (14.7%), GDM (4.2%), Preterm labour (3.1%), oligohydromnios (16.67%), Lscs (22.9%), PPH (6.3%), LBW (21.9%), Hyperbilirubinemia (9.4%), NICU admission (14.6%), Which are co-relatine with other studies and hyperthyroid cases in our study were not sufficient for outcome analysis.Conclusions: Thyroid disorders in pregnancy have adverse effects on maternal and fetal outcome emphasizing the importance of routine antenatal thyroid screening.

scholarly journals Von Willebrand disease in pregnancy: a case report

2021 ◽  
Vol 10 (12) ◽  
pp. 4602
Author(s):  
Rashmi A. G. ◽  
Riya Kumar ◽  
Dayamayi A. S. ◽  
Spandana Nallapilli
Keyword(s):  
Blood Loss ◽  
Post Partum ◽  
Adverse Outcomes ◽  
Von Willebrand Disease ◽  
Clotting Factor ◽  
Medical College ◽  
Life Threatening ◽  
Von Willebrand ◽  
Willebrand Factor

Von Willebrand disease (VWD) is a hereditary bleeding disorder that can be severe and potentially life-threatening, particularly in pregnant women during labor and subsequently during early puerperium. There is no optimal treatment or management for this disorder. Hence, all efforts aim at early diagnosis and the focus is mainly on minimising and controlling blood loss. We described the case of a woman in the post-partum period with severe VWD, admitted in the obstetrics and gynaecology ward at Rajarajeswari Medical College and Hospital, Bangalore. Prompt diagnosis, initiation of pre-partum and intra-partum Von Willebrand factor (VWF)/clotting factor replacement therapy, vigilant post-partum monitoring of blood loss and systematic follow up will help expedite recovery and prevent adverse outcomes.

scholarly journals Universal screening for hypothyroidism in pregnancy: is it necessary?

2019 ◽  
Vol 8 (7) ◽  
pp. 2683
Author(s):  
Meena Priyadharshini V. ◽  
Seetha Panicker
Keyword(s):  
Pregnant Women ◽  
Universal Screening ◽  
Reproductive Age ◽  
Antenatal Visit ◽  
Endocrine Disorders ◽  
Maternal Complications ◽  
Reproductive Age Group ◽  
Ethical Clearance ◽  
In Pregnancy

Background: Thyroid diseases are one of the commonest endocrine disorders affecting women of reproductive age group, and hence constitute one important disorders complicating pregnancy. The objective of this study was to determine the importance of universal screening for hypothyroidism in pregnancy at the first antenatal visit and to formulate whether this routine screening is mandatory in our country.Methods: This retrospective study was conducted in the year 2018 at PSG IMSR Hospital for all pregnant women who attended the first antenatal visit between Jan 2012 to Dec 2012 after obtaining ethical clearance. Pregnant women who were already taking treatment for hypothyroidism, diabetes mellitus, hypertension and those pregnant women who lost their follow up were excluded from the study.Results: The incidence of subclinical hypothyroidism among antenatal women were 7.06%. In our study the maternal complications like anemia 12 (8%), preeclampsia 26 (17.3%), gestational diabetes 25 (16.7%), fetal growth restriction 8 (5.3%), Oligohydramnios 13 (8.7%), pre mature rupture of membranes 25 (16.7%), placental abruption in 2 (1.33%), APLA syndrome 2 (1.33%), low birth weight 26 (17.3%) were observed.Conclusions: Universal screening for hypothyroidism is recommended for all antenatal women especially in iodine depleted country like India.

Clinical outcomes related to fasting plasma glucose variability, history of diabetes mellitus and antidiabetic regimens in patients with atrial fibrillation: a subgroup analysis from the SPORTIF trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Proietti ◽  
J Gumprecht ◽  
A Farcomeni ◽  
G.F Romiti ◽  
G.Y.H Lip
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Adverse Outcomes ◽  
Composite Outcome ◽  
Oral Antidiabetics ◽  
History Of

Abstract Introduction The role of diabetes mellitus in determining of major adverse outcomes in patients with atrial fibrillation (AF) is well-established. Little is known about fasting plasma glucose (FPG) visit-to-visit variability (VVV) and its impact on outcomes. Aim To analyse the role of FPG-VVV in determining major adverse outcomes in AF patients. Second, to evaluate the prognostic impact of history of diabetes mellitus and antidiabetic regimens. Methods Warfarin-treated patients from the SPORTIF trials were considered for analysis if they had FPG evaluation at baseline and at least 4 determinations throughout follow-up. Standard deviation (SD) of the mean of FPG throughout follow-up was the main measure of VVV, according to its quartiles (SD-Qs). A composite of cardiovascular events and the occurrence of all-cause death was the adverse outcome considered. Results Among the 3665 patients originally included, 3415 (93.2%) were included in this analysis. Throughout a mean (±SD) of 577.59 (±122.09) days of follow-up patients in the highest SD-Q (SD-Q4) had the highest rate of the composite outcome and all-cause death [Figure]. A Cox multi-regression analysis confirmed that SD-Q4 had a significant independent association with occurrence of composite outcome (hazard ratio [HR]: 1.61, 95% confidence interval [CI]: 1.10–2.35) [Figure, Upper Panel], with a non-significant trend for all-cause death, [Figure, Lower Panel]. If no significant impact of history of diabetes mellitus was found, there was a significant impact on the composite outcome of the various antidiabetic regimes: there was no difference found in patients treated with oral antidiabetics, compared to no antidiabetic treatment, but those patients treated with insulin (±oral antidiabetics) were independently associated with the occurrence of composite outcome (HR: 2.38, 95% CI: 1.05–5.38) (Table). Conclusion In AF patients treated with warfarin, patients with the highest FPG-VVV had an increased rate of outcomes and the largest FPG-VVV being significantly associated with the composite outcome of adverse clinical events. In diabetic patients, use of insulin is independently associated with an increased risk of the composite outcome, reflecting the more severe disease in determining adverse events amongst AF patients. Major Adverse Outcomes Funding Acknowledgement Type of funding source: None

The vegf-a gene polymorphism in prognosis of outcomes in patients with stemi

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Kutya ◽  
Y Hilova ◽  
J Rodionova ◽  
M Kopytsya ◽  
O Petyunina
Keyword(s):  
Gene Polymorphism ◽  
Cardiovascular Death ◽  
Adverse Outcomes ◽  
Public Institution ◽  
Control Group ◽  
Case Group ◽  
Funding Source ◽  
Polymerase Chain

Abstract   One of the promising parameter for the prognosis in patients with STEMI can be suggested the VEGF-A gene polymorphism. Purpose Estimate the role of the VEGF-A gene polymorphism in the prediction of outcomes in patients with STEMI. Methods The study involved 135 STEMI patients (80.7% male and 19.3% female) with an average age of 59.21±8.92 years. Control group of 30 healthy volunteers included. Patients were divided into two groups: the first one – “case” group, those who reached the end point, and the second group – “control”, those who did not reached. The combined endpoint included cardiovascular death, recurrent myocardial infarction, the occurrence / progression of heart failure that required hospitalization. The study of the VEGF-A gene polymorphism (rs 2010963) was carried out by polymerase chain reaction (PCR). Follow-up period was 6 month. VEGF-A level was measured by ELISA. Results The patients from the “case” group had significantly elevated VEGF-A levels compared to controls (217.40 [102.54–473.78] pg/ml; 311.45 [204.20–680.86] pg/ml; p=0.046). Multivariate linear regression analyses demonstrated that polymorphism G634C (rs2010963) of VEGF-A gene (G634C+C634C) – β=0.8079, CI [1.1907 to 5.6490] p=0.0465; and LVEF &lt;50.60% – β=0.0488 CI [0.9179 to 0.9882], p=0.0096 are significantly associated with negative outcomes (combined endpoints). Conclusions STEMI patients with G634C+C634C polymorphism G634C (rs2010963) of VEGF-A gene, and with LVEF &lt;50.60% have greater chances for adverse outcomes. Further investigations of the VEGF-A gene polymorphism are the perspective direction in the development of prevention and treatment of STEMI. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): GI “L.T. Malaya Therapy National Institute NAMSU”

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