Brain tumors in pregnancy are uncommon occurrences. A 48-year-old female at 36 2/7 weeks of gestation presented with right-sided weakness and parasthesias, a facial droop, and an unsteady gait. Brain imaging studies revealed a left-sided parietal lesion impinging upon the lateral ventricle. She underwent a cesarean delivery and then a craniotomy with resection of a glioblastoma multiforme two days later. Despite treatment with radiation and chemotherapy, she died nine months later. Glioblastoma multiforme is a rare diagnosis during pregnancy which may present as a neurologic emergency.
The use of automated external defibrillators (AEDs) instead of manual defibrillators after in-hospital cardiac arrest on general wards was associated with lower survival rates among patients with an initial rhythm that was nonshockable. Patients with an initial rhythm that was shockable showed no association between outcome and AED use. Level of evidence: 2B (individual cohort study)
INTRODUCTION: The objective of the study is to determine if opioid maintenance therapy decreases the risk of neonatal abstinence syndrome in pregnant women with opioid use disorder. METHODS: A retrospective cohort study of pregnant women with opioid use disorder was performed at a tertiary care hospital from January 2016 to June 2016. Women were identified using the hospital's delivery logs. Women were categorized by whether they were on opioid maintenance therapy or actively using opioids. Maternal demographics, medical history, social history, delivery characteristics and neonatal outcomes were collected. A composite adverse neonatal outcome score was created and defined as the presence of any of the following: preterm delivery, birthweight <2500 grams, Apgar score < 7 at 5 minutes, NICU admission, and neonatal abstinence syndrome. Parametric and nonparametric statistics were used to compare groups. A p value of < 0.05 was considered statistically significant. RESULTS: Of 1,927 women who delivered, 50 women qualified for the study. There were no statistically significant differences in demographic characteristics between groups. Women on opioid maintenance therapy delivered at a statistically significant higher gestational age, had a higher neonatal birth weight and lower NICU admission rate compared to active opioid users. There were no statistically significant differences in neonatal outcomes, including neonatal abstinence syndrome, between groups. CONCLUSION: Opioid maintenance therapy use in pregnant women with opioid use disorder does not decrease incidence of NAS, but use may decrease the risk of preterm birth, low birth weight, and NICU admission.
Objective: The aim of this research was to determine the obstetric outcomes in patients who had singleton live birth after hysteroscopic septoplasty of complete uterine septum (CUS) that reached the internal or the external cervical os.
To evaluate the differences in vaginal matrix metalloproteinases (MMP) and tissue inhibitors of metalloproteinases (TIMPs) in pregnant patients with a history of prior preterm birth compared with controls.
Cervical pregnancy classically presents with life-threatening vaginal bleeding without prior diagnosis. This report describes a case of cervical pregnancy that was discovered by ultrasound and managed without the need for transfusion. Case report: A 37 yo G2 P2002 was seen in consultation at 10 wk, 5 days gestation for suspected cervical pregnancy. This was confirmed by ultrasound and the patient was immediately hospitalized. Methotrexate was given to begin the suppression of the invading trophoblasts. Angiography was performed to identify the specific pelvic vessels supplying the placental implantation site in the cervix (cervical-vaginal branch of the left pudendal artery, cervical branch of the left uterine artery, medial branch of the right obturator artery, and the cervical-vaginal branch of the right pudendal artery) and these were embolized. Two days later, ultrasound confirmed the ongoing fetal heart beat. Fetal cardioplegia was then performed using ultrasound guidance. the patient was observed in hospital for 5 additional days; no major bleeding was seen and the pregnancy within the cervix shrank substantially on ultrasound. A dilation and suction evacuation was done under ultrasound guidance 20 days after the embolization. The patient did not require transfusion and has done well since. Pathology confirmed degenerating chorionic tissue. This case illustrates the vital role for ultrasound in the diagnosis and treatment of cervical pregnancy.
