Pregnancy

1月 16, 2015

A Successful Pregnancy Outcome after Surgical Decompression of Type I Arnold-Chiari Malformation

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=53234#.VLh0vcnQrzE

ABSTRACT

Type I Arnold-Chiari malformation (ACM) usually presents in adulthood and consists of a downward displacement of the cerebellar tonsils through the foramen magnum. A 25-year-old woman presented with a 5-month history of headache associated with blurred vision, tinnitus and sickness. Imaging recognised the need for surgical intervention, but whilst awaiting for surgery she fell pregnant. Considering the risks of neurological deterioration, the woman underwent surgical decompression of type I ACM at 15 weeks gestation. She subsequently presented with progressively worsening headaches during late pregnancy from 35 weeks. The obstetric plan was initially induction of labour at term but since the onset of worsening symptoms, this date was brought forward to 39 + 1 weeks gestation. She proceeded to have a normal delivery with no neonatal complications and an uneventful puerperium followed. Since the delivery, the patient reported fewer symptoms, showed no signs of neurological deficit and a repeat magnetic resonance imaging of the head showed good relief of neural compression. This case illustrates how judicious selection of the appropriate mode of delivery of women following surgically corrected ACM and a multidisciplinary approach is critical in the successful management of the antepartum period and labour.

Cite this paper

Ip, P. , Pankaja, S. and O’Mahony, F. (2015) A Successful Pregnancy Outcome after Surgical Decompression of Type I Arnold-Chiari Malformation. Open Journal of Obstetrics and Gynecology, 5, 44-48. doi: 10.4236/ojog.2015.51007.

References

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http://dx.doi.org/10.1016/S0029-7844(03)00682-3                                                          eww150116lx
12月 25, 2014

Pregnancy-Related Low Back Pain Relief after Maximum Static Flexibility Program

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=52555#.VJtsgcCAM4

ABSTRACT

Background: Pregnancy-related low back pain (LBP) impacts pregnancy. Flexibilizing facilitates movements providing posture correction and pain relief. Objective: To analyze effects of a maximum static flexibility program on pregnancy’s LBP. Methods: Clinical prospective randomized controlled trial. Setting: Brazilian Governmental Health Program’s prenatal care. Participants: 40 volunteer of pregnant women, gestational age between 20 and 31 weeks, with/without LBP randomly assigned to experimental group (EG) or control group (CG): EG n = 20 (E1 with LBP and E2 without LBP) and CG n = 20 (C1 with LBP and C2 without LBP). Interventions: EG intervention was sessions of static flexion. CG received conventional medical treatment. Pain intensity was measured by visual analog scale (VAS) of pain. Chi-square, Wilcoxon and the Kruskal-Wallis statistical tests were adopted. Results: Concerning percent variation (Δ%) E1 presented 56.4% reduction of LBP while E2, C1, C2 increased LBP by 2.9%, 0.1%, 0.5% respectively. Wilcoxon test outcome comparing pre- and post-test of experimental and control groups on pain intensity levels presented significant E1 p < 0.05. Kruskal-Wallis test comparing post-test C1 with E1 with E2 and C2 presented p < 0.05 (C1 post vs. E1 post: p = 0.006; C1 post vs. E2 post: p < 0.0001; C1 post vs. C2 post: p = 0.002), showing significant effect of the experimental treatment. Conclusion: Gains on LBP for EG show that the static flexibilizing exercises reduce and prevent pregnancy-related LBP.

Cite this paper

Figueira, H. , Vale, R. , Rodrigues, W. , Figueira, A. , Figueira, J. and Dantas, E. (2014) Pregnancy-Related Low Back Pain Relief after Maximum Static Flexibility Program. Health, 6, 2966-2972. doi: 10.4236/health.2014.621335.

References

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http://dx.doi.org/10.1089/jwh.2008.1295                                                                              eww141225lx
12月 9, 2014

Use of Oral Agents and/or Insulin in the Treatment of Diabetes during Pregnancy: An Examination of Outcomes in Pregestational versus Gestational Diabetics

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=52160#.VIZQWWfHRK0

ABSTRACT

The management of diabetes in pregnancy varies depending on whether the condition was first diagnosed during pregnancy (gestational diabetes) or was diagnosed before pregnancy (pregestational diabetes). Little has been published comparing the relative efficacy of various oral agents for the treatment of gestational diabetes and the reported experience with the insulin pump in pregnancy for pregestational diabetes remains meager. We conducted a retrospective chart review of women managed in a specialized diabetic clinic to compare the results of treatment of gestational diabetes with oral agents, glyburide and acarbose, to those treated with split-mixed insulin and treatment of pregestational diabetes with either the insulin pump or conventional splitmixed insulin. Gestational diabetics treated with split-mixed insulin were hospitalized significantly more often (p < 0.001) than those treated with oral agents only. The incidence of several important pregnancy complications (growth restriction, preterm labor, preeclampsia, oligohydramnios) did not differ between groups. Pregestational diabetics managed with an insulin pump had comparable glycemic control, as measured by hemoglobin A1c, to those managed with split-mixed insulin. Infant birth weights and Apgar scores were similar in each group. There were no perinatal deaths in either group. Acarbose and glyburide showed comparable efficacy in treating gestational diabetics. In addition, our experience adds to the small number of pregnant women with pregestational diabetes who were managed with an insulin pump that have been reported in the literature.

Cite this paper

Henslee, E. , Hatton, A. , Welt, S. , Holmes, J. , Penrose, L. , Prien, S. and Farooqi, N. (2014) Use of Oral Agents and/or Insulin in the Treatment of Diabetes during Pregnancy: An Examination of Outcomes in Pregestational versus Gestational Diabetics. Open Journal of Obstetrics and Gynecology, 4, 1052-1057. doi: 10.4236/ojog.2014.416144.

References

[1] Chu, S.Y., Bachman, D.J., Callaghan, W.M., Whitlock, E.P., Dietz, P.M., Berg, C.J., et al. (2008) Association between Obesity during Pregnancy and Increased Use of Health Care. The New England Journal of Medicine, 358, 1444-1453. http://dx.doi.org/10.1056/NEJMoa0706786
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http://dx.doi.org/10.1001/jama.290.14.1884
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[5] Carpenter, M.W. and Coustan, D.R. (1982) Criteria for Screening Tests for Gestational Diabetes. American Journal of Obstetrics and Gynecology, 144, 768.
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[9] Rowan, J.A., Hague, W.M., Gao, W., Battin, M.R. and Moore, M.P. (2008) Metformin versus Insulin for the Treatment of Gestational Diabetes. The New England Journal of Medicine, 358, 2003-2015. http://dx.doi.org/10.1056/NEJMoa0707193
[10] Jacobson, G.F., Ramos, G.A., Ching, J.Y., Kirby, R.S., Ferrara, A. and Field, D.R. (2005) Comparison of Glyburide and Insulin for the Management of Gestational Diabetes in a Large Managed Care Organization. American Journal of Obstetrics and Gynecology, 193, 118-124.
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[11] Tran, N.D., Hunter, S.K. and Yankowitz, J. (2004) Oral Hypoglycemic Agents in Pregnancy. Obstetrical & Gynecological Survey, 59, 456-463. http://dx.doi.org/10.1097/00006254-200406000-00024
[12] Wollitzer, A.D., Zisser, B.A.H. and Jovanovic, L. (2010) Insulin Pumps and Their Use in Pregnancy. Diabetes Technology & Therapeutics, 12, S33-S36. http://dx.doi.org/10.1089/dia.2009.0187
[13] Lapolla, A., Masin, M., Bruttomesso, D., Piva, I., Crepaldi, C., Tortul, C., et al. (2003) Analysis of Outcome of Pregnancy in Type 1 Diabetics Treated with Insulin Pump or Conventional Insulin Therapy. Acta Diabetologica, 40, 143-149. http://dx.doi.org/10.1007/s00592-003-0103-1
[14] Gimenez, M., Conget, I., Nicolau, J., Pericot, A. and Levy, I. (2007) Outcome of Pregnancy in Women with Type 1 Diabetes Intensively Treated with Continuous Subcutaneous Insulin Infusion or Conventional Therapy. A Case-Control Study. Acta Diabetologica, 44, 34-37.
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[15] Bergenstal, R.M., Tamborlane, W.V., Ahmann, A., Buse, J.B., Dailey, G., Davis, S.N., et al. (2010) Effectiveness of Sensor-Augmented Insulin-Pump Therapy in Type 1 Diabetes. The New England Journal of Medicine, 363, 311-320. http://dx.doi.org/10.1056/NEJMoa1002853                                                             eww141209lx
11月 21, 2014

Improved Pregnancy Outcomes in a Prospective Study of Pregnant Women Enrolling in an Antenatal Clinic in Western Kenya

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=51570#.VG6Ia2fHRK0

ABSTRACT

In areas of sub-Saharan Africa where malaria is endemic, pregnant women are at a greater risk of malaria than non-pregnant women leading to significant adverse consequences including anemia, intrauterine growth retardation, low birth weight (LBW), and pre-term delivery. The Kenya Ministry of Health adopted Intermittent Preventive Treatment (IPT) and use of insecticide-treated nets (ITN) as a National strategy for malaria prevention in pregnancy. In this report, we evaluated the prevalence of malaria, the anthropometric measures of birth outcomes and the reasons for loss to follow up among pregnant women participating in an ongoing cohort study in Western Kenya. A total of 175 HIV-negative pregnant women enrolled at antenatal clinic of Chulaimbo sub-District hospital were longitudinally evaluated in a monthly follow-up visits through antenatal visits (up to 4 per mother) and delivery. Thirty three percent and 15% of the pregnant women were malaria positive by real-time quantitative (Q)-PCR and microscopy respectively at enrolment, while 54% and 23% of the pregnant women had malaria by Q-PCR and microscopy respectively at any time during follow-up. Of the enrolled study participants, 65% delivered at Chulaimbo hospital. Overall, 39% (69) of the pregnant women were lost to follow-up. The major reasons for loss to follow up were relocation from the study area (26%) and delivery at alternative health facilities (25%). The mean birth weight of the newborn infants was 3202 g (range, 2000 g – 4000 g). Only 5.3% of the infants weighed less than 2500 g (low birth weight). The mean head circumference was 34 cm (range, 30 cm – 39 cm) with mean Apgar score (at 10 minutes) ± S.D. of 9.8 ± 0.97. In conclusion, we observed decreased adverse pregnancy outcomes among our study population. We recommend a larger study of all pregnant women attending the Chulaimbo hospital so as to assess whether effectiveness of malaria and anemia control programs lead to improved birth outcomes.

Cite this paper

Daud, I. , Opinya, F. , Midem, D. , Kigani, M. , Bukusi, E. , Ng’ang’a, Z. , Sumba, P. , Dent, A. and Rochford, R. (2014) Improved Pregnancy Outcomes in a Prospective Study of Pregnant Women Enrolling in an Antenatal Clinic in Western Kenya. Health, 6, 2651-2656. doi: 10.4236/health.2014.619304.

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[13] Parise, M.E., Ayisi, J.G., Nahlen, B.L., Schultz, L.J., Roberts, J.M., Misore, A., et al. (1998) Efficacy of Sulfadoxine-Pyrimethamine for Prevention of Placental Malaria in an Area of Kenya with a High Prevalence of Malaria and Human Immunodeficiency Virus Infection. American Journal of Tropical Medicine and Hygiene, 59, 813-822.
[14] Daud, I., Ogolla, S., Amolo, A., Namuyenga, E., Simbiri, K., Bukusi, E.A., et al. (2014) Plasmodium falciparum Infection Is Associated with Epstein-Barr Virus Reactivation in Pregnant Women Living in Malaria Holoendemic Area of Western Kenya. Maternal and Child Health Journal, 1-9.
[15] Hermsen, C.C., Telgt, D.S., Linders, E.H., van de Locht, L.A., Eling, W.M., Mensink, E.J.B.M. and Sauerwein, R.W. (2001) Detection of Plasmodium falciparum Malaria Parasites in Vivo by Real-Time Quantitative PCR. Molecular and Biochemical Parasitology, 118, 247-251.
http://dx.doi.org/10.1016/S0166-6851(01)00379-6
[16] Menendez, C., Ordi, J., Ismail, M.R., Ventura, P.J., Aponte, J.J., Kahigwa, E., et al. (2000) The Impact of Placental Malaria on Gestational Age and Birth Weight. Journal of Infectious Diseases, 181, 1740-1745.
http://dx.doi.org/10.1086/315449
[17] Yatich, N.J., Jolly, P.E., Funkhouser, E., Agbenyega, T., Rayner, J.C., Ehiri, J.E., et al. (2010) The Effect of Malaria and Intestinal Helminth Coinfection on Birth Outcomes in Kumasi, Ghana. American Journal of Tropical Medicine and Hygiene, 82, 28-34.
http://dx.doi.org/10.4269/ajtmh.2010.09-0165
[18] Gebremariam, A. (2005) Factors Predisposing to Low Birth Weight in Jimma Hospital South Western Ethiopia. East African Medical Journal, 82, 554-558.
[19] Tako, E.A., Zhou, A., Lohoue, J., Leke, R., Taylor, D.W. and Leke, R.F. (2005) Risk Factors for Placental Malaria and Its Effect on Pregnancy Outcome in Yaounde, Cameroon. American Journal of Tropical Medicine and Hygiene, 72, 236-242.
[20] Yazdani, M., Tadbiri, M. and Shakeri, S. (2004) Maternal Hemoglobin Level, Prematurity, and Low Birth Weight. International Journal of Gynecology and Obstetrics, 85, 163-164.
http://dx.doi.org/10.1016/j.ijgo.2003.07.004
[21] Bouyou-Akotet, M.K., Ionete-Collard, D.E., Mabika-Manfoumbi, M., Kendjo, E., Matsiegui, P.B., et al. (2003) Prevalence of Plasmodium falciparum Infection in Pregnant Women in Gabon. Malaria Journal, 2, 18.
http://dx.doi.org/10.1186/1475-2875-2-18
[22] Menendez, C., D’Alessandro, U. and ter Kuile, F.O. (2007) Reducing the Burden of Malaria in Pregnancy by Preventive Strategies. Lancet Infectious Diseases, 7, 126-135.
http://dx.doi.org/10.1016/S1473-3099(07)70024-5                                                                            eww141121lx
[23] Desai, M., ter Kuile, F.O., Nosten, F., McGready, R., Asamoa, K., Brabin, B. and Newman, R.D. (2007) Epidemiology and Burden of Malaria in Pregnancy. Lancet Infectious Diseases, 7, 93-104.
http://dx.doi.org/10.1016/S1473-3099(07)70021-X
[24] van Eijk, A.M., Bles, H.M., Odhiambo, F., Ayisi, J.G., Blokland, I.E., Rosen, D.H., et al. (2006) Use of Antenatal Services and Delivery Care among Women in Rural Western Kenya: A Community Based Survey. Reproductive Health, 3, 2.
http://dx.doi.org/10.1186/1742-4755-3-2
11月 20, 2014

Fatal Urosepsis: A 41 Year-Old Pregnant Woman—Case Report

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=51531#.VG1E-TRATyQ

ABSTRACT

Introduction: Urinary tract infections are one of the most frequent infectious complications during pregnancy[1]<span “=””>, while acute pyelonephritis is the main non-obstetric reason for hospitalisation [2] [3]and septic shock in pregnant women. Objectives and methods: The aim of our study is to analyse the diagnostics and treatment of a 41-year-old pregnant woman with the most severe form of urinary tract infection—urosepsis. Case report: A 41-year old woman in the 12th week of pregnancy hospitalised at Intensive Care Unit (ICU) after urological intervention (JJ stent). On the first day after the intervention, the patient was diagnosed as having urosepsis. Scores: SOFA 14 pts, APACHE II 26 pts, SAPS II SCORE 61 pts. Second day in ICU: spontaneous abortion. Microbiological investigation: Escherichia coli—extended-spectrum beta-lactamase (ESBL+). Conclusions: Apregnant patient with a complicated infection of the urinary system ought to be treated in a multi-profile hospital, offering a possibility to consult doctors of various specialisations (urologist, gynaecologist, anaesthesiologist, nephrologist) as well as full access to a radiology laboratory, which will ensure the choice of appropriate and safe treatment for both the mother and the developing foetus.

Cite this paper

Gosciniak, M. , Kawecki, D. , Miklaszewska, M. , Truszewski, Z. , Lazowski, T. , Wielgos, M. and Radziszewski, P. (2014) Fatal Urosepsis: A 41 Year-Old Pregnant Woman—Case Report. Open Journal of Urology, 4, 137-141. doi: 10.4236/oju.2014.411024.

References

[1] Morgan, J. and Roberts, S. (2013) Maternal Sepsis. Obstetrics and Gynecology Clinics of North America, 40, 69-87.
[2] Dawkins, J.C., Fletcher, H.M., Rattray, C.A., Reid, M. and Gordon-Strachan (2012) Acute Pyelonephritis in Pregnancy: A Retrospective Descriptive Hospital Based-Study. Obstetrics and Gynecology, 2012, 6 p.
[3] Gabbe, S.G., Niebyl, J.R. and Simpson, J.L. (2012) Renal Disease, Obstetrics: Normal and Problem Pregnancies. 6th Edition, Chapter 38, 875-886.
[4] Macejko, A.M. and Schaeffer, A.J. (2007) Asymptomatic Bacteriuria and Symptomatic Urinary Tract Infections during Pregnancy. Urologic Clinics of North America, 34, 35-42.
http://dx.doi.org/10.1016/j.ucl.2006.10.010
[5] Fulop, T., Batuman, V., Ed. (2013) Acute Pyelonephritis, Medscape.
[6] Schnarr, J. and Smaill, F. (2008) Asymptomatic Bacteriuria and Symptomatic Urinary Tract Infections in Pregnancy. European Journal of Clinical Investigation, 38(S2), 50-57.
http://dx.doi.org/10.1111/j.1365-2362.2008.02009.x
[7] Archabald, K.L., Friedman, A. and Raker, C.A. (2009) Impact of Trimester on Morbidity of Acute Pyelonephritis in Pregnancy. American Journal of Obstetrics & Gynecology, 201, e1-e4.
[8] Grabe, M., Bjerklund-Johansen, T.E., Botto, H., Çek, M., Naber, K.G., Pickard, R.S., Tenke, P., Wagenlehner, F. and Wullt, B. (2013) Urological Infektions. EAU, 12-25, 34-38.
[9] Johnson, E.K. and Kim, E.D. (2012) Urinary Tract Infection in Pregnancy. Medscape.
[10] Wagenlehner, F.M.E., Weidner, W. and Naber, K.G. (2007) Optimal Management of Urosepsis from the Urological Perspective. International Journal of Antimicrobial Agents, 30, 390-397.
http://dx.doi.org/10.1016/j.ijantimicag.2007.06.027
[11] Lucas, D.N., Robinson, P.N. and Nel, M.R. (2012) Sepsis in Obstetrics and the Role of the Anaesthetist. International Journal of Obstetrics Anaesthesia, 21, 56-67.
[12] Wagenlehner, F.M., Pilatz, A. and Weidner, W. (2011) Urosepsis—From the View of the Urologist. International Journal of Antimicrobial Agents, 38S, 51-57.
[13] ZapaIa, P., Dybowski, B. and Radziszewski, P. (2013) Posocznica moczowa, urosepsa, Przeglad Urologiczny.
[14] Dellinger, R.P., Carlet, J.M., Masur, H., Gerlach, H., Calandra, T., Cohen, J., Gea-Banacloche, J., Keh, D., Marshall, J.C., Parker, M.M., Ramsey, G., Zimmerman, J.L., Vincent, J.L. and Levy, M.M. (2004) Surviving Sepsis Campaign Management Guidelines Committee. Critical Care Medicine, 32, 858-873.
http://dx.doi.org/10.1097/01.CCM.0000117317.18092.E4
[15] Richard Bell: Education-Tutorials Urological Problems Complications in Pregnancy. Bristol Urological Institute.
[16] Charalambous, S., Fotas, A. and Rizk, D.E.E. (2009) Urolithiasis in Pregnancy. International Urogynecology Journal, 20, 1133-1136. http://dx.doi.org/10.1007/s00192-009-0920-z
[17] Semins, M.J. and Matlaga, B.R. (2009) Ureteroscopy during Pregnancy. Indian Journal of Urology, 25, 291-295.http://dx.doi.org/10.4103/0970-1591.56173
[18] Biyani, C.S. and Joyce, A.D. (2002) Urolithiasis in Pregnancy. II: Management. BJU International, 89, 819-823.http://dx.doi.org/10.1046/j.1464-410X.2002.02773.x
[19] Bres-Niewada, E., Judycki, J., Borkowski, A. and Czaplicki, M. (2006) Ureteroskopowe leczenie ciezarnych kobiet chorych na kamice moczowodowa. Urologia Polska.                                                                  eww141120lx
[20] Wayment, R.O., Schwartz, B.F., Ed. (2012) Pregnancy and Urolithiasis Clinical Presentation. Medscape.
11月 12, 2014

Treatment of Unexplained Infertility by Acupuncture in Natural and Control Ovarian Hyperstimulation Cycles: A Prospective Analysis

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=51313#.VGLChWfHRK0

ABSTRACT

Acupuncture is an important method of treatment in Chinese medicine. The objective of this study was to evaluate the efficacy of acupuncture as an adjuvant treatment for unexplained infertility. Here we conducted a prospective study, with data consisting of acupuncture group (38 cases) and control group (42 cases). Infertility evaluation workup consisted of semen analysis, ovulation assessment, hysterosalpingogram (HSG) and blood analysis. The patients in acupuncture group received 3 acupuncture sessions, and each at seven acupuncture points (EX-CA1, CV4, CV6, SP10, ST36, SP6, and KI3). The session started 12 days before menstruation and continued for 10 days. The patients in control group did not receive acupuncture. All patients tried 1 – 3 natural cycles 3 months after HSG test, if not pregnant, underwent 1 – 3 cycles of control ovarian hyperstimulation (COH) and timed intercourse. Pregnancy was evaluated by measurement of blood β human chorionic gonadotrophin (β-hCG) and subsequent trans-vaginal ultrasound. No significant difference of clinical pregnancy rate was found between the acupuncture group and the control group, however, numbers of COH cycles were significantly less and more pregnancies occurred in natural cycle in the acupuncture group. We concluded that acupuncture can be used as an adjuvant treatment for unexplained infertility. Although acupuncture did not increase the cumulative pregnancy rate, it decreased the number of COH cycles and more patients got pregnant in natural cycles after receiving acupuncture.

Cite this paper

Cai, L. , Hai, R. , Zhang, B. , Wen, Y. , Zeng, M. and Jiang, M. (2014) Treatment of Unexplained Infertility by Acupuncture in Natural and Control Ovarian Hyperstimulation Cycles: A Prospective Analysis. Advances in Reproductive Sciences, 2, 88-92. doi: 10.4236/arsci.2014.24011.

References

[1] The Practice Committee of the American Society for Reproductive Medicine (2006) Effectiveness and Treatment for Unexplained Infertility. Fertility and Sterility, 86, S111-S114.
http://www.ncbi.nlm.nih.gov/pubmed/17055802
http://dx.doi.org/10.1016/j.fertnstert.2006.07.1475
[2] The Practice Committee of the American Society for Reproductive Medicine (2006) Optimal Evaluation of the Infertile Female. Fertility and Sterility, 86, S264-S267.
http://www.ncbi.nlm.nih.gov/pubmed/17055838
http://dx.doi.org/10.1016/j.fertnstert.2006.08.041
[3] Villahermosa, D.I., Santos, L.G., Nogueira, M.B., Vilarino, F.L. and Barbosa, C.P. (2013) Influence of Acupuncture on the Outcomes of in Vitro Fertilisation When Embryo Implantation Has Failed: A Prospective Randomised Controlled Clinical Trial. Acupuncture in Medicine, 31, 157-161.
http://aim.bmj.com/content/31/2/157.long
http://dx.doi.org/10.1136/acupmed-2012-010269
[4] Smith, C.A. and Betts, D. (2014) The Practice of Acupuncture and Moxibustion to Promote Cephalic Version for Women with a Breech Presentation: Implications for Clinical Practice and Research. Complementary Therapies in Medicine, 22, 75-80.
http://www.ncbi.nlm.nih.gov/pubmed/24559820
http://dx.doi.org/10.1016/j.ctim.2013.12.005
[5] Smith, C.A., de Lacey, S., Chapman, M., Ratcliffe, J., Norman, R.J., Johnson, N., Sacks, G., Lyttleton, J. and Boothroyd, C. (2012) Acupuncture to Improve Live Birth Rates for Women Undergoing in Vitro Fertilization: A Protocol for a Randomized Controlled Trial. Trials, 13, 60.
http://www.ncbi.nlm.nih.gov/pubmed/22607192
http://dx.doi.org/10.1186/1745-6215-13-60
[6] Isoyama, D., Cordts, E.B., de Souza van Niewegen, A.M., de Almeida Pereira de Carvalho, W., Matsumura, S.T. and Barbosa, C.P. (2012) Effect of Acupuncture on Symptoms of Anxiety in Women Undergoing in Vitro Fertilisation: A Prospective Randomised Controlled Study. Acupuncture in Medicine, 30, 85-88. http://www.ncbi.nlm.nih.gov/pubmed/22499825
http://dx.doi.org/10.1136/acupmed-2011-010064
[7] Quaas, A. and Dokras, A. (2008) Diagnosis and Treatment of Unexplained Infertility. Reviews in Obstetrics & Gynecology, 1, 69-76. http://www.ncbi.nlm.nih.gov/pubmed/18769664
[8] Birkeflet, O., Laake, P. and Vøllestad, N. (2012) Traditional Chinese Medicine Patterns and Recommended Acupuncture points in Infertile and Fertile Women. Acupuncture in Medicine, 30, 12-16.
http://www.ncbi.nlm.nih.gov/pubmed/22378581
http://dx.doi.org/10.1136/acupmed-2011-010089
[9] Guzick, D.S., Sullivan, M.W., Adamson, G.D., Cedars, M.I., Falk, R.J., Peterson, E.P. and Steinkampf, M.P. (1998) Efficacy of Treatment for Unexplained Infertility. Fertility and Sterility, 70, 207-213.
http://www.ncbi.nlm.nih.gov/pubmed/9696208
http://dx.doi.org/10.1016/S0015-0282(98)00177-0
[10] Schankath, A.C., Fasching, N., Urech-Ruh, C., Hohl, M.K. and Kubik-Huch, R.A. (2012)
Hysterosalpingography in the Workup of Female Infertility: Indications, Technique and Diagnostic Findings. Insights into Imaging, 3, 475-483. http://www.ncbi.nlm.nih.gov/pubmed/22802083                                               eww141112lx
[11] Firmal, P., Yadav, R. and Agrawal, S. (2014) A Prospective Study to Evaluate the Role of Aparohysteroscopy in Unexplained Infertility. Journal of Obstetrics and Gynaecology. (Epub ahead of print) http://www.ncbi.nlm.nih.gov/pubmed/25325846
11月 10, 2014

Problems of Rational Therapy for Epilepsy during Pregnancy

Read  full  paper  at:

http://www.scirp.org/journal/PaperInformation.aspx?PaperID=47153#.VGAnHGfHRK0

Author(s)

Diana V. Dmitrenko, Natalia A. Shnayder, Ilia A. Kiselev, Andrej V. Shulmin, Natalia V. Zhirova, Evgeniya A. Shapovalova, Elena A. Kantimirova, Elena N. Bochanova, Olga F. Veselova, Yulia S. Panina, Anastasiya V. Muravieva

Affiliation(s)

Neurological Center of Epileptology, Neurogenetics and Brain Research, University Clinic of Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia.
Neurological Center of Epileptology, Neurogenetics and Brain Research, University Clinic of Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia.
Neurological Center of Epileptology, Neurogenetics and Brain Research, University Clinic of Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia.
Neurological Center of Epileptology, Neurogenetics and Brain Research, University Clinic of Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia.
Neurological Center of Epileptology, Neurogenetics and Brain Research, University Clinic of Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia.
Neurological Center of Epileptology, Neurogenetics and Brain Research, University Clinic of Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia.
Neurological Center of Epileptology, Neurogenetics and Brain Research, University Clinic of Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia.
Neurological Center of Epileptology, Neurogenetics and Brain Research, University Clinic of Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia.
Neurological Center of Epileptology, Neurogenetics and Brain Research, University Clinic of Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia.
Neurological Center of Epileptology, Neurogenetics and Brain Research, University Clinic of Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia.
Neurological Center of Epileptology, Neurogenetics and Brain Research, University Clinic of Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia.

ABSTRACT

Epilepsy is one of the most frequent neurological disorders. In these circumstances, more than 25% of the patients are women of reproductive age. The aim of our research was to analyze the effectiveness and safety of antiepileptic therapy in women with epilepsy during pregnancy and to analyze the pregnancies’ outcomes. We included in our research 121 pregnancies of 101 women aged at the moment of childbearing about 26.9 ± 4.57 years old. Idiopathic forms of epilepsy were predominant among all causes—47.1% (р < 0.01). Of all cases, 65.4% remained seizure-free from generalized tonic-clonic seizures (GTCS), including 69.6% of all idiopathic epilepsy cases and 68.6% among symptomatic ones. The antiepileptic drugs (AED) dosages were exceeding teratogenic level at the moment of conception in 54.7% of the cases. Worse control of epileptic seizures was associated with Benzobarbital (66.7%) and Lamotrigine (50.0%). Women with epilepsy did not receive specialized neurological therapy before conception in most cases, which leaded to the usage of AED teratogenic doses and less effectiveness of AED during pregnancy. It is necessary to plan the pregnancy and prescribe rational treatment for epilepsy starting at the stage of planning and during gestation in order to obtain a better seizures control and to decrease congenital disorders risk in fetus.

KEYWORDS

Epilepsy, Women, Pregnancy, Anticonvulsants, Rational Therapy, Outcomes

Cite this paper

Dmitrenko, D. , Shnayder, N. , Kiselev, I. , Shulmin, A. , Zhirova, N. , Shapovalova, E. , Kantimirova, E. , Bochanova, E. , Veselova, O. , Panina, Y. and Muravieva, A. (2014) Problems of Rational Therapy for Epilepsy during Pregnancy. Open Journal of Obstetrics and Gynecology, 4, 506-515. doi: 10.4236/ojog.2014.49072.

References

[1] Battino, D., Tomson, T., Bonizzoni, E., Craig, J., Lindhout, D., Sabers, A., et al. (2013) Seizure Control and Treatment Changes in Pregnancy: Observations from the EURAP Epilepsy Pregnancy Registry. Epilepsia, 54, 1621-1627. http://dx.doi.org/10.1111/epi.12302
[2] Cantwell, R., Clutton-Brock, T., Cooper, G., Dawson, A., Drife, J., Garrod, D., et al. (2011) Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG, 118, 1-203.
http://dx.doi.org/10.1111/j.1471-0528.2010.02847.x
[3] Adab, N., Kini, U., Vinten, J., Ayres, J., Baker, G., Clayton-Smith, J., et al. (2004) The Longer Term Outcome of Children Born to Mothers with Epilepsy. Journal of Neurology, Neurosurgery & Psychiatry, 75, 1575-1583. http://dx.doi.org/10.1136/jnnp.2003.029132
[4] Cummings, C., Stewart, M., Stevenson, M., Morrow, J. and Nelson, J. (2011) Neurodevelopment of Children Exposed in Utero to Lamotrigine, Sodium Valproate and Carbamazepine. Archives of Disease in Childhood, 96, 643-647. http://dx.doi.org/10.1136/adc.2009.176990
[5] Tomson, T., Battino, D., Bonizzoni, E., Craig, J., Lindhout, D., Sabers, A., et al. (2011) Dose-Dependent Risk of Malformations with Antiepileptic Drugs: An Analysis of Data from the EURAP Epilepsy and Pregnancy Registry. The Lancet Neurology, 10, 609-617.
http://dx.doi.org/10.1016/S1474-4422(11)70107-7
[6] Shnayder, N.A., Dmitrenko, D.V., Sadykova, A.V., Sharavii, L.K., Shulmin, A.V., Shapovalova, E.A., et al. (2011) Epidemiological Studies on Epilepsy in Siberia. Medical and Health Science Journal, 6, 35-42. http://dx.doi.org/10.15208/mhsj.2010.105
[7] Harden, C.L., Meador, K.J., Pennell, P.B., Hauser, W.A., Gronseth, G.S., French, J.A., et al. (2009) Management Issues for Women with Epilepsy-Focus on Pregnancy (an Evidence Based Review): II. Teratogenesis and Perinatal Outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia, 50, 1237-1246. http://dx.doi.org/10.1111/j.1528-1167.2009.02129.x
[8] Shnayder, N.A., Pilyugina, M.S., Dmitrenko, D.V., Bochanova, E.N., Shapovalova, E.A., Erikalova, S.A., et al. (2011) Pharmacogenetics of Valproic Acid as Unmodified Risk Factor of Adverse Drug Reactions. Medical and Health Science Journal, 7, 20-28. http://dx.doi.org/10.15208/mhsj.2011.129
[9] Fairgrieve, S.D., Jackson, M., Jonas, P., Walshaw, D., White, K., Montgomery, T.L., et al. (2000) Population Based, Prospective Study of the Care of Women with Epilepsy in Pregnancy. The British Medical Journal, 321, 675-674. http://dx.doi.org/10.1136/bmj.321.7262.674
[10] Adamyan, L.V., Kunkina, Yu.B., Zhidkova, I.A. and Kaznacheeva, T.V. (2009) Molecular Mechanisms of Epilepsy’s and Antiepileptic Therapy’s Influence on Woman’s Reproductive System (Review). Reproductive problems Journal, 2, 13-17. [Russian]
[11] Grebenyuk, O.V., Svetlik, M.V. and Alifirova, V.M. (2013) Clinico-Electroencephalographic Predictors of Generalized Seizures Increasing in Gestational and Postnatal Periods. Bulletin of the Russian Academy of Medical Sciences Siberian Branch, 12, 24-30. [Russian]
[12] Herndandez-Diaz, S., Smith, C.R., Shen, A., Mittendorf, R., Hauser, W.A., Yerby, M., et al. (2012) Comparative Safety of Antiepileptic Drugs during Pregnancy. Neurology, 78, 1692-1699.
http://dx.doi.org/10.1212/WNL.0b013e3182574f39
[13] Kiseleva, L.G., Kalinina, L. and Chumakova, G.N. (2011) The Influence of Mother’s Antiepileptic Therapy on Condition of Fetus and Newborn. Vrach-Aspirant, 45, 363-372. [Russian]                                               eww141110lx
11月 10, 2014

Improving Infant and Maternal Health through CenteringPregnancy: A Comparison of Maternal Health Indicators and Infant Outcomes between Women Receiving Group versus Traditional Prenatal Care

Read  full  paper  at:

http://www.scirp.org/journal/PaperInformation.aspx?PaperID=47152#.VGAnGWfHRK0

Author(s)

Ruth Zielinski, Leslie Stork, Megan Deibel, Catherine L. Kothari, Kimberly Searing

Affiliation(s)

School of Nursing, University of Michigan, Ann Arbor, USA.
Bronson School of Nursing, Western Michigan University, Kalamazoo, USA.
School of Nursing, University of Michigan, Ann Arbor, USA.
School of Medicine, Western Michigan University, Kalamazoo, USA.
Bronson School of Nursing, Western Michigan University, Kalamazoo, USA.

ABSTRACT

Background: Despite efforts to increase participation in prenatal care, outcomes for women and infants in the United States remain below global and national health targets. CenteringPregnancy, a model of group prenatal care, incorporates practices consistent with national and international guidelines while allowing for greater freedom in providing content tailored to the specific needs of women receiving care. Objective: To determine whether the CenteringPregnancy model improves maternal and neonatal health indicators such as prenatal care attendance, smoking cessation, weight gain during pregnancy, gestational age at delivery, mode of delivery, and initiation and continuation of breastfeeding. Methods: A retrospective study was conducted including all pregnant women participating in CenteringPregnancy at two prenatal clinic sites in southwest Michigan from January 2010 to April 2012 (n = 173). A comparison group of women receiving traditional care from certified nurse-midwives was created using propensity scores to match for age, race, and insurance status (n = 170). A chart review was performed to analyze maternal and neonatal health indicators including attendance at prenatal visits, gestational age at delivery, baseline maternal weight and weight gain during pregnancy, smoking cessation, infant birth weight, mode of delivery (vaginal birth vs. cesarean section), and rates of breastfeeding. Results: There were no significant differences in pre-pregnancy weight, amount of weight gained during pregnancy, prenatal care attendance, gestational age at delivery, mode of delivery or infant birth weight. The CenteringPregnancy group had significantly higher rates of smoking cessation during pregnancy, as well as higher rates of breastfeeding initiation and continuation. Conclusions: This study provides support for the benefits of CenteringPregnancy in improving rates of smoking cessation during pregnancy which is important to both maternal and infant health. Additionally, in this population CenteringPregnancy resulted in improved rates of breastfeeding initiation and continuation, providing benefits to both infants and mothers.

KEYWORDS

CenteringPregnancy, Prenatal Care, Breastfeeding, Group Care, Smoking Cessation, Pregnancy

Cite this paper

Zielinski, R. , Stork, L. , Deibel, M. , Kothari, C. and Searing, K. (2014) Improving Infant and Maternal Health through CenteringPregnancy: A Comparison of Maternal Health Indicators and Infant Outcomes between Women Receiving Group versus Traditional Prenatal Care. Open Journal of Obstetrics and Gynecology, 4, 497-505. doi: 10.4236/ojog.2014.49071.

References

[1] The World Bank Group (2014) Mortality Rate, Infant (per 1,000 Live Births).
http://data.worldbank.org/indicator/SP.DYN.IMRT.IN
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11月 6, 2014

Efficacy of Magnesium and Alpha Lipoic Acid Supplementation in Reducing Premature Uterine Contractions

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=47309#.VFrZiGfHRK0

ABSTRACT

Objective: Premature uterine contractions represent one of the major symptoms related to preterm labor. So far, primary prevention of preterm labor is based on the early identification of symptoms and on pharmacological treatments which are prone of several secondary effects. In this double-blinded, randomized, placebo-controlled trial, the efficacy of a supplementation of magnesium and alpha-lipoic acid has been evaluated. Methods: Three hundred pregnant women at 14 – 34 weeks of gestation were enrolled and randomly divided to receive a daily single tablet containing a supplement of magnesium and alpha-lipoic acid (DAV®LoLiPharmasrl, Rome-Italy) or placebo until delivery. The incidence of episodes of preterm uterine contraction, associated or not with pain, as well as maternal need of hospitalization was evaluated. Results: Magnesium and lipoic acid supplementation was effective to significantly reduce the incidence of preterm uterine contractions compared to placebo. In particular, 52% of women who received the supplementation reported no symptoms of preterm uterine contractions throughout pregnancy, and persistent episodes of uterine contractions were significantly reduced compared to placebo (20% vs 60%, respectively). Furthermore, only 20% of subjects who received the supplementation required hospitalization, while it has been necessary for 40% of women who received placebo. Conclusions: Our findings suggest that supplementation with magnesium and lipoic acid is effective in reducing the incidence of premature uterine contraction and related episodes of hospitalization, compared to placebo. Nevertheless, further studies based on larger cohorts of patients are necessary to confirm the efficacy of these preliminary results.

Cite this paper

Parente, E. , Colannino, G. and Ferrara, P. (2014) Efficacy of Magnesium and Alpha Lipoic Acid Supplementation in Reducing Premature Uterine Contractions. Open Journal of Obstetrics and Gynecology, 4, 578-583. doi: 10.4236/ojog.2014.49082.

References

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11月 5, 2014

Pregnancy with Gastric Stromal Tumor

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=51179#.VFlyWWfHRK0

ABSTRACT

Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. GIST are rare during pregnancy. We report here the case of a patient who was admitted in our university hospital for GIST discovered during the second trimester of pregnancy. She was 42 years old, in the fifth months of pregnancy. She was admitted for biliary colic pain with vomiting. On abdominal examination, we objectified a distended abdomen with uterine height of 18 cm and epigastric mass of 10 cm. Abdominal ultrasound and magnetic resonance imaging (MRI) showed a hepatic, tissue and cystic mass, developing at the expense of the left liver. Endoscopy objectified an aspect of extrinsic compression at the front of the stomach. A cesarean was scheduled at the 35th month of pregnancy for fetal extraction and rescue. Exploration of the peritoneal cavity during surgery has objectified a hepatic highly vascularised mass reaching up to the umbilicus. This mass was unresectable. A postoperative CT scan revealed a large bilobed epigastric mass adhering to the stomach and the left liver. Histological and immunohistochemical study of hepatic process showed a gastrointestinal stromal tumor of high risk of malignancy. Conclusion: few cases have been reported in the literature on GIST during pregnancy showing the rarity of the condition that requires multidisciplinary care.

Cite this paper

Charif, I. , Khalil, N. , Ousadden, A. , Benjelloun, E. , Slimani, O. , Alaoui, F. , Hijri, F. , Mesbahi, O. , Ibrahimi, A. and Mellouki, I. (2014) Pregnancy with Gastric Stromal Tumor. Case Reports in Clinical Medicine, 3, 571-576. doi: 10.4236/crcm.2014.311124.

References

[1] Cuerva-Gonzalez, M.J., Lacoponi, S., de la Calle-Fernandez, M. and Pozo-Krielinger, J. (2010) Gastrointestinal Stromal Tumor in Pregnancy and Control. Case Report. Ginecologia y Obstetricia de Mexico, 78, 697-702.
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