11/25. Endoscopic sclerotherapy during pregnancy.pregnancy in patients with portal hypertension is an uncommon occurrence. Hence, there are no clear guidelines for management of variceal bleed during pregnancy. Moreover, the outcome of variceal sclerotherapy, particularly its effect on conception, as well as its safety and efficacy when used during pregnancy, is not known. We have treated four patients of portal hypertension during pregnancy with sclerotherapy. Two of them presented to us before conception, were put on sclerotherapy for variceal bleed, and conceived while on sclerotherapy schedule. Two other patients were started on sclerotherapy during pregnancy when they presented with variceal bleed. sclerotherapy with absolute alcohol was effective in control of variceal bleed as well as obliteration of varices in pregnant patients. There was no untoward effect on mother or fetus. The mean number of sessions and volume of alcohol required for variceal obliteration were 6.5 and 42.0 ml, respectively. Variceal sclerotherapy does not interfere with conception and successful pregnancy, and is safe as well as effective during pregnancy.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
12/25. in vitro fertilization patient presenting in hemorrhagic shock caused by unsuspected heterotopic pregnancy.A 30-year-old woman who had undergone in vitro fertilization and embryo transfer (IVF-ET) presented to the emergency department in hemorrhagic shock 4 weeks after a spontaneous abortion. She was found to have a ruptured uterus caused by an unsuspected second pregnancy located in the cornual region of the uterus. Women undergoing IVF-ET are at a higher risk for multiple pregnancies, ectopic pregnancies, and heterotopic pregnancies.- - - - - - - - - - ranking = 10.678283801877keywords = fertilization (Clic here for more details about this article) |
13/25. Rapid development of nephrotic syndrome, hypertension, and hemolytic anemia early in pregnancy in patients with IDDM.In recent years, the prognosis for a successful pregnancy has greatly improved for women with insulin-dependent diabetes mellitus (IDDM) who are under good glycemic control and free of complications such as vascular disease and nephropathy. We report the rapid development of severe nephrotic syndrome, malignant hypertension, and microangiopathic hemolytic anemia during the first trimester of pregnancy in a 29-yr-old woman with IDDM of 18 yr duration. Our patient had no pregestational history of retinopathy or hypertension and only minimal proteinuria. Significant improvement in blood glucose levels had been achieved over the 6 mo before conception. kidney biopsy performed before the termination of pregnancy at 10 wk gestation revealed diabetic nephropathy. No other etiology for her renal disease could be found. An arteriole was noted to have entrapped red blood cell fragments and platelet thrombi, revealing the probable source of her hemolytic process. By 8 wk postpartum, her nephrotic syndrome and hemolysis had completely resolved. At 3 mo postgestation, the patient's hypertension was still present but less severe. Her serum creatinine has continued to decrease toward normal. This is the first report of a woman with IDDM in White's classification C who developed a toxemia-like syndrome during the first trimester of pregnancy, attributable to the underlying diabetic state.- - - - - - - - - - ranking = 0.33333333333333keywords = conception (Clic here for more details about this article) |
14/25. Effect of pregnancy on the natural course of preexistent glomerular disease.The clinical course of pregnancies in 3 patients with well defined glomerular diseases is described. Two women who had moderate renal insufficiency (serum creatinine greater than or equal to 1.6 mg/dl) at conception had also a dramatic progress to end-stage renal disease during pregnancy which in one case resulted in fetal loss. Glomerular diseases were focal glomerular sclerosis and poststreptococcal glomerulonephritis respectively. One patient with membranoproliferative glomerulonephritis was not affected. It is concluded that pregnancy can change the natural course of preexistent glomerular disease in patients with impaired renal function.- - - - - - - - - - ranking = 0.33333333333333keywords = conception (Clic here for more details about this article) |
15/25. Prognostic aspects of aplastic anemia in pregnancy. Experience on six cases and review of the literature.Our resent experience on six cases of aplastic anemia complicated with pregnancy is described. In addition, 43 similar cases were collected from the literature and reviewed to analyze some prognostic aspects of this relatively rare but potentially serious complication. Clinical and hematological data were treated to extract some clinically meaningful factors in relation to the success and failure of pregnancy. Among initial hematological parameters, no significant difference was found between successful and unsuccessful cases with an exception of hemoglobin concentration. The patients diagnosed as aplastic anemia prior to conception demonstrated an better outcome of pregnancy as well as survival rate of mother when compared with those diagnosed during pregnancy. Mortality has apparently improved after the late 1950's. Success rate of pregnancy before 1958 was 21%, while it was 67% and 71% in the era of 1959-1969 and after 1970, respectively. However, hemorrhage and infection remained to be two major causes of maternal death in both eras. Based on these observations, the currently recommendable attitude to this complication is discussed.- - - - - - - - - - ranking = 0.33333333333333keywords = conception (Clic here for more details about this article) |
16/25. pregnancy in a woman with class H diabetes mellitus and previous coronary artery bypass graft: a case report and review of the literature.BACKGROUND: Maternal and fetal mortality have been reported to be high in pregnant women with diabetes mellitus and ischemic heart disease. review of the literature identified only two cases of pregnancy after coronary artery bypass surgery in diabetic patients. Because of limited case experience, there are no clear recommendations for counseling and managing such patients. CASE: We managed a pregnancy complicated by class H diabetes mellitus in which the patient had an earlier need for four-vessel coronary artery bypass surgery. The application of contemporary techniques for diabetic and cardiac management led to successful maternal and perinatal outcomes at 36 weeks' gestation. CONCLUSION: Preconception coronary artery bypass surgery, along with contemporary medical and obstetric management, may lead to improvement in the outcome of pregnancies complicated by class H diabetes.- - - - - - - - - - ranking = 0.33333333333333keywords = conception (Clic here for more details about this article) |
17/25. pregnancy in diabetes: reducing the risks.Meticulous glucose control that begins long before conception is fundamental to protecting the fetus and mother. Maternal hypertension, retinopathy, renal disease, and neuropathy may lead to complications, but optimal education, care, and fetal monitoring can reduce the risks.- - - - - - - - - - ranking = 0.33333333333333keywords = conception (Clic here for more details about this article) |
18/25. Massive deep vein thrombosis in a patient with antithrombin iii deficiency undergoing ovarian stimulation for in vitro fertilization.OBJECTIVE: To present the first report of a thromboembolic complication in early pregnancy after ovarian hyperstimulation for IVF in a patient with AT III deficiency who was treated successfully and subsequently delivered a healthy male infant at 32 weeks of gestation. DESIGN: Case report. SETTING: Hospital-based clinic for reproductive medicine. PATIENT: A 28-year-old woman who consulted our IVF clinic with a 3.5-year history of primary infertility. INTERVENTIONS: Intravenous heparin therapy. RESULTS: The patient responded adequately to heparin therapy and was discharged home on SC heparin. A primary cesarean section was performed at 32 weeks of gestation because of poor fetal growth and transverse lie. CONCLUSIONS: We stress the importance of obtaining a thorough personal and family history before initiation of ovarian hyperstimulation. Measuring activity of AT III, protein c, and protein s in patients with a suspicious history of thromboembolic episodes occurring at an early age may lead to the implementation of appropriate prophylactic measures, preventing potentially life-threatening complications.- - - - - - - - - - ranking = 8.5426270415013keywords = fertilization (Clic here for more details about this article) |
19/25. Congenital coagulopathies and pregnancy: report of four pregnancies in a factor X-deficient woman.pregnancy in women with congenital coagulation factor deficiencies has been associated with adverse fetal outcomes. Recurrent spontaneous abortions, placental abruptions, and premature births are reported, the exact reasons for which are not clear, and management of such patients continues to be a challenge. We reviewed the outcome of four pregnancies in a patient with factor x deficiency, and looked at the effect of factor replacement therapy on pregnancy. Her first two pregnancies resulted in the birth of extremely premature babies at 21 and 25 weeks of gestation, both of which died in the neonatal period. The patient was treated with fresh frozen plasma for acute bleeding episodes during these pregnancies. In addition during her second conception she was given factor IX complex [Konyne] prophylactically, but only in the latter half of her pregnancy. During her next two pregnancies she was treated early on during pregnancy, with prophylactic replacement of factor X. She delivered healthy babies at 34 and 32 weeks of gestation, and they are both doing well. We therefore suggest possible mechanisms by which aggressive prophylactic factor support in a female with severe congenital coagulopathy, may improve on fetal outcome.- - - - - - - - - - ranking = 0.33333333333333keywords = conception (Clic here for more details about this article) |
20/25. hypertension in pregnancy.High blood pressure, which complicates approximately 10% of all pregnancies, remains a major cause of morbidity and mortality for both mother and fetus. A relative paucity of investigative data, as well as the frequent difficulty in making an etiological diagnosis by clinical criteria alone, may be among the reasons why there are many conflicts about the management of hypertension during pregnancy. This clinical conference summarizes current concepts regarding the hypertensive disorders of gestation, focusing on the most dangerous cause, preeclampsia-eclampsia. It further highlights a recent report of the Working Group on High blood pressure in pregnancy convened by the National High blood pressure education Program at the National heart, lung, and Blood Institute (the consensus Report). Among the Working Group's most interesting recommendations in controversial areas were a return to the classification schema suggested by the American College of Obstetricians and Gynecologists in 1972, use of the fifth Korotkoff sound to determine diastolic blood pressure levels, and institution of treatment with antihypertensive drugs for sudden elevations of blood pressure near term to diastolic levels greater than or equal to 105 mm Hg or for levels of 100 mm Hg or higher in pregnant women with chronic hypertension. The consensus Report further recommended parenteral hydralazine and methyldopa as the drugs of choice for the acute hypertensive crisis and management of chronic hypertension, respectively, based on the long histories of safe use of these agents in gravidas. Parenteral magnesium sulfate remained the preferred therapeutic approach for avoiding or treating the convulsive complication, eclampsia, but the Working Group underscored the need for controlled trials of magnesium's efficacy. Finally, they noted that diuretics should be avoided in preeclampsia, but that these drugs can be continued during gestation if taken before conception, and may be prescribed to pregnant women with chronic hypertension who appear overly salt sensitive.- - - - - - - - - - ranking = 0.33333333333333keywords = conception (Clic here for more details about this article) |
| <- Previous || Next -> |