A 25-year-old lady presented with a severe normocytic anemia (Hb 5.3 g/dl) and a sideroblastic marrow at the end of her first pregnancy. Six months into the puerperium, after the transfusion of a total of 8 units of red cells, there was apparent spontaneous improvement and then she was lost to follow-up. After a second pregnancy without clinical problems, she presented during a third pregnancy, at the age of 30 years, with similar hematological findings. Twenty-two months later she was well with a normal blood count. One possible reason for relapse in pregnancy is the increased demand for pyridoxine that occurs, but only one other case of sideroblastic anemia relapsing during pregnancies has been reported.
A 34-year-old multigravid woman with symptomatic primary biliary cirrhosis (PBC) of the liver had a successful pregnancy. A healthy baby was born prematurely at 36 weeks of gestation. Six months prior to the conception of this pregnancy, stage III PBC had been diagnosed. Portal hypertension and liver cirrhosis had not developed. It is uncommon for pregnancy to occur in the presence of PBC. In the case presented, the outcome of pregnancy was good and the liver function had not been significantly affected by the pregnancy.
Three cases of acute psychosis during pregnancy had been treated with electroconvulsive therapy (ECT) during their stay in hospital, due to their slow response to anti-psychotic medication. All three responded well to the treatment and two subsequently delivered normal healthy infants and they did not suffer maternal complications. The authors feel that ECT is as safe, if not safer than the use of high dosage of anti-psychotic medication and a review of the world literature appears to confirm this view. In addition, the psychotic process usually settles faster with the use of ECT than with the use of anti-psychotic drugs.
Benign cystic or solid lumps frequently occur in the breasts of young women, and consequently can also be seen during pregnancy and lactation. Simple cysts do not increase the risk of malignancy. The current management is routine follow-up. Complex cysts are thick walled or contain a mass, and should be followed by a US-guided biopsy and then treated similar to any non-gravid, non-lactating patient.Galactoceles can be detected during the last trimester of pregnancy and during or after stopping lactation. Aspiration can be done to confirm the content. Co-existence of galactocele and malignancy is extremely rare, and the key is to follow up until it resolves.Fibroadenoma is the most frequent lesion found during pregnancy and lactation. Management is usually conservative after triple assessment. Surgery is usually not recommended in pregnant and lactating women unless rapid increase in size occurs or there is discordance in the triple assessment.Lactating adenomas are sometimes interpreted as a variant of fibroadenoma . They can naturally disappear at the end of pregnancy or lactation. Management is usually conservative, and an excisional biopsy is only mandated if it is rapidly enlarging or if there is discordance in the triple assessment.Gestational gigantomastia is a rare condition consisting of diffuse severe hypertrophy of both breasts during pregnancy . Mastectomy and reconstruction may rarely be required in such cases.
The outbreak of the coronavirus disease 2019 (COVID-19) pandemic, caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a global public health crisis, causing substantial concern especially to the pregnant population. Pregnant women infected with SARS-CoV-2 are at greater risk of devastating pregnancy complications such as premature delivery and stillbirth. Irrespective of the emerging reported cases of neonatal COVID-19, reassuringly, confirmatory evidence of vertical transmission is still lacking. The protective role of the placenta in limiting in utero spread of virus to the developing fetus is intriguing. The short- and long-term impact of maternal COVID-19 infection in the newborn remains an unresolved question. In this review, we explore the recent evidence of SARS-CoV-2 vertical transmission, cell-entry pathways, placental responses towards SARS-CoV-2 infection, and its potential effects on the offspring. We further discuss how the placenta serves as a defensive front against SARS-CoV-2 by exerting various cellular and molecular defense pathways. A better understanding of the placental barrier, immune defense, and modulation strategies involved in restricting transplacental transmission may provide valuable insights for future development of antiviral and immunomodulatory therapies to improve pregnancy outcomes.
Anxiety and depression are prevalent during pregnancy. Estimates of the prevalence of anxiety and depression during pregnancy vary according to the criteria used, variable methodologies and population characteristics.
Bleeding into the rectus sheath is an uncommon but a well-recognised condition that mimics several other diagnoses of acute abdomen. A wide range of etiology has been proposed in association with this condition. It is often self-limiting, but can lead to unnecessary laparotomy if the diagnosis is not recognised.
Presentation of breast cancer during pregnancy is a rare situation and one that requires a multidisciplinary approach involving an obstetrician, surgeon and oncologist. Management should be along the same principles as in non-pregnant patients and delay is not justifiable. Mastectomy and axillary clearance is the best option, followed by chemotherapy, which is safe after the first trimester. Radiation if required should be delayed until after delivery of the baby. We present here our experience with 6 patients who presented with breast cancer during pregnancy. Five patients refused any treatment until after delivery, while one underwent only a mastectomy and axillary clearance. The outcome was poor; all of them died between 14 months and 52 months. The poor outcome probably reflects the late stage at presentation in four of the patients (State 3 and 4) rather than the delay in treatment, while delay in treatment in the two who presented with early cancer (Stage 1 and 2) led to a more advanced stage after delivery.
Peripartal cardiomyopathy is a rare form of heart disease in pregnancy with an unpredictable outcome. We describe one patient who presented in a decompensated state who was successfully managed with medical antifailure treatment. The etiology, management and future obstetric outcome are discussed.
A descriptive study was undertaken on 595 dairy cattle abortion submissions to the California Veterinary Diagnostic Laboratory System from July 1, 1987, to December 31, 1989, to determine the etiologic nature and distribution (seasonal and geographical) of dairy cattle abortion in California as reflected by laboratory submissions. Univariate analysis was performed to characterize abortion-related submissions by farm and laboratory variables, and logistic regression analysis was performed to determine factors that may influence success of abortion diagnosis in the laboratory. The proportions of dairies that submitted abortion-related specimens from northern, central, and southern milksheds during the 2.5-year period were 20.3%, 15.7%, and 13.1%, respectively, and 60% of submissions were from medium-sized (200-999 cows) dairies. Submissions consisted of fetus (58%), placenta (2%), fetus and placenta (12%), and fetus, placenta, and maternal blood (0.84%); fetal tissues and uterine fluid constituted the rest. An apparent pattern in abortion submissions was indicated by a peak in submissions during the winter and summer of 1988 and 1989. Infectious agents were associated with 37.1% of submissions; noninfectious causes, 5.5%, and undetermined etiology, 57.3%. Bacterial abortion accounted for 18% of etiologic diagnoses; protozoal, 14.6%; viral, 3.2%; and fungal, 1.3%. Submissions comprising fetus, placenta, maternal blood, or their combinations were associated with a higher likelihood of definitive diagnosis for abortion than tissues, as were fresher specimens and submissions associated with the second trimester of fetal gestation.
A pregnant woman with antiphospholipid syndrome presented with repeated venous thromboembolism (VTE) in the first and second trimesters of pregnancy despite receiving combination therapy with low-molecular-weight heparin and aspirin. The addition of hydroxychloroquine prevented further VTE recurrence, thus demonstrating its potential antithrombotic effects.