Idiopathic granulomatous angiitis of the central nervous system (IGANS) is a rare vasculitis primarily affecting the spinal cord and brain not related to any underlying systemic disease. Clinical manifestations range from simple headache to cerebral vascular accidents secondary to vascular occlusion. The management of a pregnancy complicated by multiple risk ...

Bartter's syndrome is a rare autosomal recessive disorder characterized by hypokalemia, hyperaldosteronism, sodium wasting, normal blood pressure, hypochloremic alkalosis, and hyperplasia of the juxtaglomerular apparatus. We present a 21-year-old African-American nulliparous patient who was referred to our clinic at 9 weeks' gestation with a history of Bartter's syndrome. Her antenatal ...

We report our experience with a combined treatment of extracorporeal shock wave lithotripsy and percutaneous suprapubic lithotripsy for a dumbbell-shaped stone of prostatic fossa associated with multiple bladder calculi, in the same operative session. Because of the successful result, we believe the association of the two treatments for this complex ...

Urolithiasis during pregnancy, though rare, can be challenging both diagnostically and therapeutically. It is helpful if the physician is quick to suspect the presence of stones in the presence of appropriate signs and symptoms, particularly flank pain and tenderness, hematuria, or unresolved bacteriuria. Ultrasonography is the diagnostic imaging method of ...

OBJECTIVE: To provide an up-to-date review of primary hyperparathyroidism (HPT) as a complication of pregnancy. METHODS: We discuss the initial manifestations of primary HPT in pregnant patients, the diagnosis, the differential diagnosis of hypercalcemia, and the recommended treatment strategies. RESULTS: In the nonpregnant state, 50 to 80% of patients with ...

Fetal and neonatal alloimmune thrombocytopenia (AIT) is a serious disease that can affect subsequent siblings to an even greater degree than a first affected child. The devastating outcome of antenatal intracranial hemorrhage (ICH) is not uncommon. Great strides have been made in the antenatal diagnosis and treatment of this disease. ...

Early pregnancy loss is a profound adverse life event for many women, and increased psychiatric morbidity has been shown to occur after spontaneous abortion. Dilatation and curettage (D&C) has been the cornerstone in the treatment of first trimester spontaneous abortion over the last few decades. During recent years the possibility ...

As pulmonary disorders become more prevalent overall, obstetricians will see an increasing number of these conditions in their pregnant patients. Management of respiratory disorders during pregnancy is not markedly different from management in the nonpregnant state, but the physician must be aware of the respiratory changes in pregnancy and how ...

Currently available technology requires a new look to reduce intervention as well as to improve the detection of the truly at-risk fetus. Iatrogenic causes of so-called fetal distress, in particular the administration of uterotonics without due attention to avoiding hyperstimulation, predominate as a reason for intervention. There needs to be ...

The workup is a challenge, as genetic, anatomic, endocrine, or immunologic factors may be involved. Although 60% of patients will have a successful pregnancy even without intervention, correctable causes should be sought.

The management of pregnancy, labor, and delivery in women with spinal cord injury (SCI) has received increased attention by investigators and clinicians in recent years. Physicians who care for women with SCI need to become familiar with the general principles of care during pregnancy. This article presents a summary of ...

BACKGROUND: The transient but substantial alterations in the biliary system during pregnancy increase the risk of cholecystitis, choledocholithiasis, and pancreatitis. Traditionally, these disorders are managed conservatively or with operative cholecystectomy. Recent advances in fiber-optic technology allow endoscopy to be used as a safe, effective, and definitive treatment alternative for pancreaticobiliary ...

The article discusses the incidence and management of hypoglycemia and diabetic ketoacidosis (DKA) in pregnancy. Additional topics addressed are the incidence of hypoglycemia, pathophysiology, diagnosis and management of hypoglycemia in pregnancy, fetal monitoring with short- and long-term fetal sequelae, and prevention of hypoglycemic recurrences. Subsequently, attention is focused on the ...

We have reviewed 16 patients treated by leg lengthening for various forms of Turner dwarfism with regard to the long period of healing and the complications. We consider that Turner dwarfism is a suitable indication for leg lengthening because of the moderate length deficit and the morphological appearance of the ...

Maternal thrombocytopenia is a common find during pregnancy. The rapid determination of its cause can often be difficult, with the diagnosis only being made in retrospect once the course of the platelet count is known. The majority of patients with thrombocytopenia in pregnancy will have incidental thrombocytopenia of pregnancy which ...

Teaching in critical obstetric problems should have special interest during residency and thereafter. Obstetric emergencies are relatively rare but may occur at any time. The obstetrician at that moment enters a special area requiring a multidisciplinary approach. From experiences in recent years and study of the literature the following recommendations ...

During pregnancy, women may experience one or more of a wide variety of discomforts. Every pregnancy is different; discomforts felt during one pregnancy may not appear in another. Most discomforts experienced during pregnancy are thought to be the result of abundant hormonal changes. As pregnancy progresses, other discomforts are attributed ...

The diagnosis of breast cancer during pregnancy remains uncommon and therefore leads to non-standardized management. We reviewed retrospectively 28 such women treated at this centre and compared them with age and stage matched controls. Differences in management and outcome were analysed for statistical significance. There was no significant difference in ...

We report a case of spontaneous hemorrhage secondary to renal angiomyolipoma treated with percutaneous transcatheter arterial embolization. Fourteen and 18 months after the procedure, the patient showed repeated spontaneous hemorrhage during pregnancy. However, a healthy female infant was delivered at the 39th week of the pregnancy. We discuss the management ...

Biliary tract disease is a relatively uncommon, heterogenous disease in pregnancy. Specifically, acute cholecystitis can be especially difficult to recognize in pregnancy. However, once diagnosed, the initial management plan should be conservative and include antibiotic therapy. Subsequent management depends on the gestational age at diagnosis. Surgical therapy, when indicated, should ...

The value of directed management based on contemporary fetal assessment techniques in the high-risk pregnancy is undisputed. Whether such benefits are evident in the low-risk pregnancy is now an issue of considerable clinical and economic importance. Recent literature suggests that extension of fetal surveillance to the low-risk pregnancy yields significant ...

Urological malignancies occur only rarely during pregnancy. However, when they do occur, the urologist must use judgement to deliver optimal care to the mother without unnecessary jeopardy to the fetus. Radiation exposure should be avoided if possible and therapy should be determined by the nature of the tumour and the ...

Dyspnea is a fairly common complaint during pregnancy. However, if one excludes allergic nasal congestion of pregnancy, upper airway obstruction is a distinctly uncommon cause of dyspnea in the pregnant patient. Three cases of laryngeal rhinoscleroma in pregnant women requiring tracheostomy for airway management are reported. All three delivered healthy ...

Unrecognized M. tuberculosis in pregnancy can have an adverse outcome for women and their babies. With world-wide trends of increasing incidence of M. tuberculosis and increasing migration to Australia of women of childbearing age from countries with a high incidence of this disease, it is imperative that clinicians recognize and ...

OBJECTIVE: Our purpose was to evaluate the pathologic features and outcome of pregnancy complicated by a persistent adnexal mass that was managed conservatively or with surgical intervention. STUDY DESIGN: A review was performed of patients who were seen with an adnexal mass in pregnancy from January 1988 to June 1994. ...

Disseminated intravascular coagulopathy is a process in which aberrant activation of the clotting mechanism results in defective coagulation. Although infrequently encountered during pregnancy, disseminated intravascular coagulopathy is associated with several clinical situations unique to obstetrics. Management consists of treating the underlying cause, restoring and maintaining the circulating blood volume, and ...

We report a case where dissection of the aorta occurred in pregnancy; only medical management was undertaken. Delivery was by Caesarean section during extradural anaesthesia and was accomplished safely several weeks after the dissection. The aetiology, association with pregnancy, diagnosis and management of acute dissection of the aorta are discussed.

A young woman presented with left sided chest pain. Chest radiography revealed a hyperexpanded left upper lobe and the rare diagnosis of congenital lobar emphysema was made. She was then found to be pregnant. Thoracotomy and left upper lobectomy were performed during the pregnancy without adverse effects to the mother ...

NST-EXPERT is a medical expert system designed to evaluate fetal condition (especially in 'high risk' pregnancies). The system reasons based on data from the Non-Stress Test (NST), a monitoring test widely used in obstetrics. From specific limited maternal-fetal context information together with the analysis of the NST results the system ...

A case of a pregnant woman with a subluxation of C-6 on C-7 with acute quadriplegia and sensory loss to the T-10 dermatome is described. Hemodynamic and fetal monitoring during the 3-week period of neurogenic shock resulted in good maternal and fetal outcomes. Pulmonary complications and anesthetic issues are important ...

Surgical procedures may be undertaken in the gravida with relatively little risk to the fetus or the continuation of pregnancy. The managing physician requires a thorough knowledge of the maternal physiologic adaptations to pregnancy to minimize maternal iatrogenic risks. The potential fetal effects of the planned procedure, diagnostic tests, therapeutic ...

OBJECTIVE: To determine the characteristics and long-term outcome of women succeeding or failing expectant management of ectopic pregnancy (EP). DESIGN: Prospective, defined protocol. SETTING: University-affiliated gynecology department. PATIENTS: We used a protocol that selected women with laparoscopic confirmed ectopic tubal pregnancy and declining plasma hCG values. Over a 5-year period, ...

Percutaneous fetal cystoscopy was performed in a male fetus with ultrasonographic evidence of lower urinary tract obstruction at 19 weeks of gestation. The diagnosis of posterior urethral valves was confirmed. Percutaneous endoscopic fulguration of the valves was successfully performed at 22 weeks of gestation, and urethral patency was established. This ...

OBJECTIVE: To evaluate management recommendations from the current literature for patients whose fetuses are certain to have lethal anomalies or absent (or virtually absent) cognitive function. These recommendations include termination of pregnancy or, for cases in the third trimester, nonaggressive intrapartum management, avoiding cesarean delivery for fetal indications. METHODS: We ...

Vaginal candidiasis, trichomoniasis, and bacterial vaginosis can be difficult to manage because of predisposing factors and frequent recurrence. Thus, in addition to drug therapy, management should include attempts to minimize factors that contribute to recurrence. Both topical and oral agents are available for vaginal candidiasis and bacterial vaginosis, and both ...

The therapist's pregnancy and subsequent maternity leave affects treatment by stimulating many transference and countertransference reactions. Many clients will feel abandoned and rejected, and experience sibling rivalry and oedipal strivings. The therapist's pregnancy can be an opportunity for clients to work through issues of separation and loss, and to make ...

Trauma is a major cause of maternal death in pregnancy. The pregnant woman who has been involved in an episode leading to her arrival in an accident and emergency department presents with specific problems that often require specialist attention. The correct initial management of such patients should not be beyond ...

Early pregnancy can be best divided into embryonic and fetal periods (dividing line 70 days after last menstrual period), which more naturally reflect developmental changes, morphologic appearance, loss rates, and concerns about teratogens. Newer endovaginal probes and a better understanding of anatomic landmarks and expected growth rates can improve clinical ...

Headache is very common among women of childbearing age and can be influenced by hormonal fluctuations. When pregnant women develop headache, the cause is usually tension-type headache or migraine, but headache may be a symptom of a more serious neurologic or medical condition. This article discusses the differential diagnosis and ...

The author reviewed a 3 year experience in the treatment of bilateral cornual obstruction using an Olympus 4.7 mm flexible, operating hysteroscope (Olympus HYF-P) with a modified Katayama transcervical tubal catheter (Cook, Inc.) and concomitant laparoscopy. Of 120 patients undergoing treatment of bilateral cornual obstruction, the following results were obtained: ...

In the assessment and management of the pregnant trauma patient, all efforts should be directed toward stabilizing the mother first, according to Advanced Trauma Life Support protocols, with airway, breathing, and circulation being priorities. Subsequent to this, attention can be turned to evaluation of the fetus. Standard laboratory values must ...

Pregnancy in uremic patient is extremely rare. Successful outcome with live birth is achieved after the use of hemodialysis during the course of pregnancy but still remains distinctly uncommon. Good experiences in detection, prevention and management of maternal and fetal complications are limited. Under the care of multidisciplinary team including ...

Considerable pathophysiologic changes accompany cirrhosis. Elevation of portal venous pressure predisposes to esophageal varices and hematemesis. The physiologic changes associated with pregnancy may exacerbate these conditions. Medical management of cirrhosis-associated problems may fail, necessitating surgical intervention. The anesthetic management of a pregnant cirrhotic patient for a Warren shunt is complicated ...

Recent diagnostic advances have resulted in earlier and more consistent diagnosis of ectopic pregnancy. This may be responsible, in part, for the increasing incidence of the condition. Also, early diagnosis of ectopic pregnancies has prompted conservative surgical treatment, the use of medical therapy and even expectant management in selected cases. ...

Trends in the management of the postdate pregnancy are reviewed. An updated approach to management of the postdate pregnancy is presented. A range of research from descriptive studies to prospective, randomized clinical trials for the pregnancy exceeding term is referenced for the clinician who seeks the rationale behind current protocol ...

The appearance of a pregnant trauma patient is rare even in the busiest of trauma centers. Management of these cases can present difficult challenges. A successful outcome for both mother and child is dependent on an immediate team approach and response involving physician, nursing, and ancillary staff. The disciplines of ...

The management of ITP in pregnancy remains controversial, particularly with reference to labour management. Thirteen pregnancies in 9 women with ITP are analysed with respect to maternal and neonatal outcome. One pregnancy culminated in spontaneous abortion. Ten infants were born by vaginal delivery and two by Caesarean section. There were ...

Once a diagnosis of early pregnancy failure has been made, it is normal gynaecological practice to proceed to evacuation of any retained products of conception. In many cases, however, there may be little residual tissue within the uterus, and the patient may be exposed to an unnecessary operative procedure. The ...

Guillain-Barré syndrome (GBS) in pregnancy is a rare neurological disorder which confronts the obstetrician with a difficult decision regarding the management of pregnancy and delivery. Two case reports illustrate the problems of obstetrical and neurological patient management. We thereby discuss indications for intervention based on the reciprocal influences of GBS ...

Inductive analysis of the portrayal of menstruating women in contemporary menstrual product advertisements revealed a profound shift in the meaning of feminine hygiene over the last few decades. The phrase sanitary protection has been replaced by a more euphemistic phrase, feminine hygiene, to refer to menstrual management products. What first ...