1/19. Fetal methotrexate and misoprostol exposure: the past revisited.BACKGROUND: Fetal aminopterin/methotrexate syndrome was described nearly 50 years ago when these agents were first used as abortifacients. physicians essentially stopped using these agents when the associated anomalies were recognized. Over the last several years the use of methotrexate with or without misoprostol for management of ectopic pregnancy and medical terminations of pregnancy has increased. methods: A 23-year-old female sought a termination at eight weeks gestation. She was given methotrexate followed by misoprostol. RESULTS: The medical termination was unsuccessful. The patient elected to continue the pregnancy secondary to financial considerations. She presented at 39 weeks without intervening prenatal care. She was diagnosed with severe preeclampsia. At delivery the infant was hypotonic and growth restricted with multiple anomalies. CONCLUSIONS: physicians are increasingly using methotrexate with or without misoprostol for treatment of ectopic pregnancies and medical terminations. Clinicians need to be aware of the characteristic teratologic effects of these two agents.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/19. Novel treatment of a patient with secondary infertility due to retained fetal bone.OBJECTIVE: To describe a simple and previously unreported treatment for retained fetal bone fragments as a cause of secondary infertility. SETTING: Fertility center at a Canadian teaching hospital. DESIGN: Case report. PATIENT(S): A 36-year-old woman with a 15-year history of secondary infertility. INTERVENTION(S): A second dilation and curettage (D C) performed under abdominal ultrasound guidance was performed where the curette could be directed for the removal of echogenic endometrial foci. MAIN OUTCOME MEASURE(S): Resolution of long-term infertility. RESULT(S): Spontaneous pregnancy 4 months after ultrasound-guided D C and subsequent term delivery. CONCLUSION(S): If an echogenic area is discovered in the endometrium, it is now standard to look at the uterine cavity by hysteroscopy. However, if the hysteroscopy is normal, we suggest that a D C with intraoperative abdominal ultrasound assistance be done to ensure that all the abnormal tissue is removed.- - - - - - - - - - ranking = 0.33333333333333keywords = pregnancy (Clic here for more details about this article) |
3/19. Uterine intramural bone after mid-trimester termination of pregnancy may not affect fertility: a case report.We present a case of a 27-year-old asymptomatic woman, gravida 2 para 0 abortus 2, diagnosed with uterine intramural fetal bone 30 days after a mid-trimester termination of pregnancy (TOP) by dilatation and evacuation (D&E). On ultrasound part of a fetal spine was seen within the right lateral isthmocervical area, adjacent to the descending branch of the uterine artery. Within 4 months after TOP the patient conceived again. This case illustrates the risk of myometrial penetration during mid-trimester TOP by D&E. Removal of intramural bony fragments may not be needed in an asymptomatic patient, as their presence does not seem to compromise fertility.- - - - - - - - - - ranking = 1.6666666666667keywords = pregnancy (Clic here for more details about this article) |
4/19. Severe fetal cytomegalovirus infection associated with cerebellar hemorrhage.cytomegalovirus (CMV) is the most common cause of congenital infection worldwide. We report on a fatal fetal manifestation of primary maternal CMV infection including cerebellar hemorrhage and hydrops. The diagnosis was established by maternal serological tests, culture and polymerase chain reaction testing of amniotic fluid and fetal blood. The pregnancy was terminated. Postmortem examination confirmed the diagnosis.- - - - - - - - - - ranking = 0.33333333333333keywords = pregnancy (Clic here for more details about this article) |
5/19. Anomalies associated with failed methotrexate and misoprostol termination.BACKGROUND: methotrexate and misoprostol are frequently used in combination for medical termination of pregnancy. Despite their frequent use, published information about low-dose exposures to these known teratogens is sparse and neonatal follow-up data are limited. We present neonatal outcomes in three infants from two different women who had failed medical terminations with methotrexate and misoprostol. CASES: A young gravida 1, para 0, presented with intrauterine pregnancy complicated by first-trimester exposure to oral methotrexate and vaginal misoprostol. ultrasonography determined that the fetus had intrauterine growth restriction and ventriculomegaly. The infant had growth and developmental delays. A young gravida 4, para 3-0-0-3, also presented after first trimester exposure to methotrexate and misoprostol, and was found to have a twin gestation. The infants were noted to have multiple congenital anomalies, growth restriction, and developmental delay. CONCLUSION: Even single doses of methotrexate and misoprostol used in medical termination of pregnancy can be associated with multiple congenital anomalies.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
6/19. Term delivery of the second twin after miscarriage of the first: a case report.BACKGROUND: Term delivery of the second twin after miscarriage of the first twin is rare. There is always a risk of preterm delivery as well as infection leading to chorioamnionitis. CASE: The second twin was delivered at term after miscarriage of the first twin at 17 weeks'gestation. The pregnancy was carefully monitored for prevention and early detection of chorioamnionitis. Delivery was delayed to 30 weeks after the miscarriage of the first twin, with a good outcome. CONCLUSION: Delayed delivery of the second twin with conservative management clearly is of benefit.- - - - - - - - - - ranking = 0.33333333333333keywords = pregnancy (Clic here for more details about this article) |
7/19. Pseudogestational sacs: Doppler US differentiation from normal or abnormal intrauterine pregnancies.Doppler ultrasound (US) evaluation of 40 empty intrauterine sac-like structures was performed to evaluate the ability of this technique to permit distinction between intrauterine pregnancy and pseudogestational sac associated with ectopic pregnancy. Proof of the location of the pregnancy was available in all cases. There were 31 intrauterine pregnancies, of which 23 were missed or incomplete abortions and eight were early normal pregnancies. With an insonating frequency of 3 MHz, the average frequency shift detected from these intrauterine pregnancies was 1.7/1.0 kHz (peak systolic/end diastolic ratio). Nine pseudogestational sacs were evaluated, of which seven demonstrated no flow and two demonstrated minimal flow that averaged 0.4/0.1 kHz. Defining intrauterine peritrophoblastic flow as a peak systolic frequency shift of 0.8 kHz or greater (equivalent to 21 cm/sec with an angle of 0 degree) correctly classifies 26 of the 31 intrauterine pregnancies and all of the nine pseudosacs. The sensitivity of the Doppler technique for the detection of intrauterine pregnancies was 84%, and the specificity was 100%.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
8/19. sheep-acquired severe chlamydia psittaci infection in pregnancy.There have been five confirmed cases of severe chlamydia psittaci infection during pregnancy, three having been treated in Edinburgh, scotland. The most recent case is presented and previous experience is reviewed. The illness usually causes thrombocytopenia with disseminated intravascular coagulation, renal failure and hepatic dysfunction during the late second and early third trimester. The outcome for the fetus is usually fatal and the infection only resolves after delivery or abortion. The main hope is for education to prevent infection occurring in susceptible populations.- - - - - - - - - - ranking = 1.6666666666667keywords = pregnancy (Clic here for more details about this article) |
9/19. Gestational trophoblastic neoplasia: diagnosis with Doppler US.The sonographic appearance of gestational trophoblastic neoplasia is nonspecific and also seen in complete or partial hydatidiform mole, hydropic degeneration, degenerating fibroids, or ovarian dysgerminomas. Correlation with the serum human chorionic gonadotropin (hCG) level may be helpful since levels exceeding 100,000 IU/L are strongly suggestive of gestational trophoblastic neoplasia. However, low hCG levels may also be found in the presence of this disease. The authors studied six patients who were suspected of having gestational trophoblastic neoplasia. Three of the six proved to have incomplete abortions or molar degeneration. Doppler ultrasound (US) was used to record the signal in the uterine arteries of these patients. The signals were compared with those of three nongravid volunteers and three patients in the first trimester of pregnancy. Analysis of the signals in the uterine artery showed higher systolic and diastolic Doppler shifts in gestational trophoblastic neoplasia when compared with postabortal, gravid, and nongravid signals. These preliminary results indicate that Doppler US has the potential to be clinically useful in the diagnosis of gestational trophoblastic neoplasia.- - - - - - - - - - ranking = 0.33333333333333keywords = pregnancy (Clic here for more details about this article) |
10/19. Intrauterine bone contraceptive device: an accident of nature.ultrasonography and hysterosalpingography led to discovery of four bony plates retained in the uterine fundus after an abortion 33 months earlier and which had apparently led to secondary infertility in a 26-year-old woman. Removal of the bony plates was soon followed by a successful pregnancy.- - - - - - - - - - ranking = 0.33333333333333keywords = pregnancy (Clic here for more details about this article) |
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