11/119. pregnancy in a patient with chronic intestinal pseudo-obstruction on long-term parenteral nutrition.parenteral nutrition support is provided in most instances for short intervals during pregnancy in conditions where oral/enteral intake is severely compromised. Few reports describe the use of parenteral nutrition from conception to delivery. We report the case of a 30-year-old woman suffering from a severe form of chronic intestinal pseudo-obstruction on long-term parenteral nutrition because of malabsorption and malnutrition. pregnancy and delivery developed uneventfully. The fetus grew normally throughout pregnancy. Our patient needed only slight modifications in her parenteral nutrition regimen during lactation. There were no metabolic complications during pregnancy. We conclude that female patients even with severe forms of gastrointestinal diseases, such as chronic intestinal pseudo-obstruction requiring long-term home parenteral nutrition, can conceive and carry successfully a pregnancy to term.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
12/119. Persistence of macroprolactinemia due to antiprolactin autoantibody before, during, and after pregnancy in a woman with systemic lupus erythematosus.A woman with systemic lupus erythematosus (SLE) with marked increases in circulating 150-kDa PRL was studied from before conception, throughout pregnancy, and after pregnancy. The clinical features of the patient included idiopathic hyperprolactinemia without clinical symptoms such as amenorrhea and galactorrhea before pregnancy. No clinical lupus activity was present during follow-up. serum PRL increase during pregnancy in this patient was considerably higher at weeks 27 and 33 than in normal pregnant women. In contrast, serum-free PRL levels were considerably lower at weeks 20, 27, and 33 than in normal pregnant women. A 150-kDa PRL (big big PRL) species persisted as the predominant circulating form of PRL throughout each measurement in this woman with SLE. In contrast, the predominant form of PRL in serum from healthy pregnant women was little PRL (or monomeric PRL). The nature of big big PRL was due to the presence of anti-PRL autoantibodies forming an IgG-23 kDa PRL complex, in accordance with the studies by affinity chromatography for IgG and Western blot analysis. The IgG-PRL complex was fully bioactive in vitro (Nb2 rat lymphoma cell assay). Injection of the serum into the rats demonstrated that the IgG-PRL complex was cleared more slowly than serum containing predominantly monomeric PRL. The data suggest that the IgG-PRL complex has biological activity; the absence of symptoms in this woman may be attributed to the fact that due to its large molecular weight, big big PRL does not easily cross the capillary walls. Delayed clearance may account for increased serum PRL levels in this SLE patient with anti-PRL autoantibodies.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
13/119. Successful pregnancy in a woman with bloom syndrome.bloom syndrome is a rare autosomal recessive disorder notable for increased chromosome fragility and an increased rate of somatic mutation. The clinical manifestations include small stature, a characteristic dermatologic lesion, and an excess incidence of malignancy. Fertility is generally reduced. A 19-year-old white woman with bloom syndrome was successfully treated for preterm labor at 32 weeks' gestation, and ultimately delivered a healthy male infant at 35 weeks' gestation. Reports of pregnancy in women with bloom syndrome are few. Despite reduced fertility, conception can occur, and women with bloom syndrome should receive appropriate reproductive counseling to prevent unintended pregnancies and increased surveillance for preterm birth.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
14/119. The marfan syndrome and pregnancy: a retrospective study in a Dutch population.OBJECTIVE: To assess the course and outcome of pregnancies in women with the marfan syndrome with the aim of developing guidelines for counseling. STUDY DESIGN: A retrospective study based on data collected from members of the Dutch association of Marfan patients. Pregnancies and neonatal outcomes of affected mothers were compared with those of non-affected mothers who delivered a Marfan infant. RESULTS: In a group of 44 affected women 78 pregnancies beyond 24 weeks of gestation were evaluated, compared with 51 in non-affected women. Obstetric course and neonatal outcome of pregnancy were similar in both groups. Aortic dissection was observed in five affected women, three of which were known to have an aorta diameter of 40 mm or more; two neurovascular events were recorded; all mothers survived. CONCLUSIONS: A preconceptional aortic diameter of 40 mm or more, progression of dilatation and decreased cardiac function are risk factors in pregnancy for women with the marfan syndrome. A multidisciplinary approach is recommended for the care of these patients and their infants.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
15/119. osteogenesis imperfecta in pregnancy: two case reports and review of literature.osteogenesis imperfecta (OI) is an inherited disease where basic pathology is of defective maturation of collagen. It is more common in women, and the incidence in pregnancy is 1 in 25,000 to 30,000. A multidisciplinary approach is necessary. Ideally, genetic counseling is sought before conception. Once pregnant, prenatal diagnosis can be established by chorion villous sampling. Serial scans would identify the affected fetus with fractures. A cesarean delivery is advocated if the fetus is affected or if the mother has pelvic fractures. An experienced anesthetist should be involved. Because these women are more likely to have a postpartum hemorrhage due to uterine atony, Syntocinon infusion and close observation in the third stage is indicated.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
16/119. Anesthetic management of parturients with Eisenmenger's syndrome--report of two cases.pregnancy is badly tolerated in patients with Eisenmenger's syndrome; maternal mortality with coherent fetal morbidity is high. Even with the advancement of both obstetric and anesthetic managements, the maternal mortality still exceeds 25%. Once conception occurs in patients of Eisenmenger's syndrome with severe pulmonary hypertension, interruption of pregnancy is still the best manipulation to be recommended. We report two cases of parturients with Eisenmenger's syndrome, who underwent termination of pregnancy. In this report, the obstetric and anesthetic management of this kind of parturients with Eisenmenger's syndrome has been thoroughly discussed.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
17/119. Successful ovulation induction, conception, and normal delivery after chronic therapy with etanercept: a recombinant fusion anti-cytokine treatment for rheumatoid arthritis.Etanercept (Enbrel; Wyeth-Ayerst/Immunex Inc, Seattle, WA, USA) is a subcutaneously administered novel fusion protein consisting of the extracellular ligand-binding domain of the 75 kD receptor for tumor necrosis factor-alpha (anti-TNFalpha) and the Fc portion of human IgG1. The agent is synthesized by plasmid transfection of a Chinese hamster ovary cell line, utilizing recombinant dna technology. Etanercept was approved by the US FDA for treatment of multi-drug resistant rheumatoid arthritis in 1998, but no human data exist regarding the impact of anti-TNFalpha therapy on human reproductive function or its use before ovulation induction. As TNFalpha potentiates collagenolysis via matrix metalloproteinase gene expression (thereby facilitating ovulation), there exists a theoretical risk that TNFalpha-inhibition could exert an undesirable effect on ovulation and pregnancy. In this report, we describe the first case of ovulation induction, intrauterine insemination, normal pregnancy and singleton delivery of a healthy infant following chronic ( > 1 year) pre-ovulatory TNFalpha-inhibitor therapy for rheumatoid arthritis. Reproductive endocrinologists and obstetrician-gynecologists should be familiar with etanercept therapy in the context of severe rheumatic disease, and offer appropriate reassurance regarding its safe use for infertility patients planning ovulation induction.- - - - - - - - - - ranking = 4keywords = conception (Clic here for more details about this article) |
18/119. Management of inflammatory bowel disease during pregnancy and nursing.The peak age of onset for inflammatory bowel disease (IBD) coincides with the peak age for conception and pregnancy, and gastroenterologists will frequently be called on to treat pregnant IBD patients. The greatest threat to a normal conception and pregnancy is active disease, not active medicine. The majority of IBD medications are safe in pregnancy and nursing and should be used as needed. When in remission, ulcerative colitis and Crohn's disease usually do not affect fertility. Fertility may be impaired, however, by pelvic adhesions and scarring from old operations or disease. Pregnant IBD patients should be followed in a facility where diagnostic tests, such as sigmoidoscopy and ultrasound, and surgery can be performed if necessary.- - - - - - - - - - ranking = 2keywords = conception (Clic here for more details about this article) |
19/119. Inflammatory colorectal disease and pregnancy: report of a case.A retrospective study of women in the child-bearing age with inflammatory disease of the bowel seems to suggest that these women become pregnant as often as other women in the general population. In this small study it was 100 per cent. The incidence of subjective difficulty with conception is likewise small. patients with Crohn's disease appear to feel better in pregnancy with regard to their intestinal problems, while more than 60 per cent of the patients with ulcerative colitis appear to do poorly. The live-birth rates for both conditions in our series were approximately 80 per cent. An unusual complication in two of our patients with Crohn's disease was a postpartum, postepisiotomy rectovaginal fistula. This may indicate a possible danger of episiotomy in patients who have Crohn's disease.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
20/119. cystic fibrosis during pregnancy.QUESTION: I have a 23-year-old patient with cystic fibrosis (CF) who recently married and has come to see me regarding preconception counseling and prospects of pregnancy. According to my sources, patients with CF can have successful pregnancies. How should I advise my patient? ANSWER: cystic fibrosis in all degrees of severity is not a strict contraindication for pregnancy, especially if disease is mild; pregnancy by itself does not appear to adversely affect patients with CF. pregnancy could proceed normally in women with normal lung function, but could adversely affect mild and moderate lung disease due to CF and should be avoided when patients have pulmonary hypertension or cor pulmonale, and when reduced lung function is predicted. Ideally, all pregnancies should be planned with prior counseling and be monitored by dedicated CF teams.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
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