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ABSTRACT: Severe sepsis in pregnancy is associated with multiorgan failure and a high risk of death for the mother and fetus.
We present the case of a pregnant patient at 26 weeks of gestation with severe sepsis secondary to pneumonia. She was admitted to the intensive care unit and started on combination antibiotics and bilevel positive airway pressure. Her condition continued to deteriorate, and she was treated with recombinant activated protein C (drotrecogin alfa). She improved and delivered at 28 weeks of gestation after preterm labor; neither the patient nor the neonate had evidence of drug-related complications.
This report describes a case of severe sepsis at 26 weeks of gestation secondary to pneumonia, with successful maternal and fetal outcome after use of drotrecogin alfa (activated).
Obstetrics and Gynecology 08/2011; 118(2 Pt 2):492-4. · 4.73 Impact Factor
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Heather L Mertz,
Lisa Mele,
Catherine Y Spong,
Donald J Dudley,
Ronald J Wapner,
Jay D Iams,
Yoram Sorokin,
Alan Peaceman,
Kenneth J Leveno,
Steve N Caritis,
Menachem Miodovnik,
Brian M Mercer,
John M Thorp,
Mary J O'Sullivan,
Susan M Ramin,
Marshall Carpenter,
Dwight J Rouse,
Baha Sibai
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ABSTRACT: To compare endothelial nitric oxide synthase expression and capillary density (CDS) in placentas exposed to single or multiple courses of betamethasone.
Placental specimens exposed to single vs repeat courses of betamethasone were analyzed through immunohistochemistry and digital image quantification for endothelial nitric oxide synthase and CD34. Quantified endothelial nitric oxide synthase staining, calculated capillary density, ratio of endothelial nitric oxide synthase to capillary density, and clinical characteristics were compared. Linear regression was performed with these as dependent variables.
Mean and maximum capillary density were increased (P = .013 and .005) and the ratio of endothelial nitric oxide synthase to capillary density decreased (P = .016) in specimens exposed to 4 courses of betamethasone compared with 1 to 3 courses. Exposure to 4 courses of betamethasone was associated with increased capillary density, but not with endothelial nitric oxide synthase expression.
Exposure to 4 courses of betamethasone is associated with increased placental capillary density. The placental effects of multiple courses of betamethasone are unrelated to endothelial nitric oxide synthase expression.
American journal of obstetrics and gynecology 04/2011; 204(6):545.e11-6. · 3.28 Impact Factor
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ABSTRACT: Migraine headaches have a female predominance with a peak in prevalence in the third and fourth decades of life. Women of reproductive age are liable to develop their first migraine while pregnant or exhibit changes in the character, frequency or severity of their headaches during pregnancy and the puerperium. The purpose of this Review is to examine the pathophysiology underlying the development of migraine headaches and the association of this pathophysiology with pregnancy-related complications. We also discuss the diagnosis and management of migraine headaches that precede pregnancy or develop de novo during pregnancy, placing an emphasis on the distinction between primary migraine headache and headache secondary to pre-eclampsia--a relatively frequent complication of pregnancy and the puerperium. We present the case of a woman with a history of migraine headaches before pregnancy, whose symptoms progressed during pregnancy in part because of increasing exposure to narcotic medications. We also review the options for migraine evaluation and treatment, and provide an overview of the risks associated with the different treatment options.
Nature Reviews Neurology 09/2009; 5(8):449-56. · 12.46 Impact Factor
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ABSTRACT: Thromboprophylaxis during pregnancy can be challenging when heparin is contraindicated. Limited data exist regarding alternative anticoagulants in the setting of pregnancy.
We present a patient with antiphospholipid syndrome who developed heparin-induced thrombosis in the third trimester of pregnancy. She was treated with therapeutic doses of intravenous lepirudin until delivery. Induction of labor, regional anesthesia, and forceps-assisted vaginal delivery were performed with no fetal, neonatal, or maternal complications. Postpartum, the patient was transitioned to warfarin therapy, and at 6 weeks postdelivery neither the patient nor her infant had developed any new problems.
Intravenous lepirudin use at therapeutic doses in late gestation as an alternative to heparin was accomplished with minimal maternal and fetal morbidity.
Obstetrics and Gynecology 09/2008; 112(2 Pt 2):432-3. · 4.73 Impact Factor
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ABSTRACT: Uterine rupture, whether in the setting of a prior uterine incision or in an unscarred uterus, is an obstetric emergency with potentially catastrophic consequences for both mother and child. Numerous studies have been published regarding various risk factors associated with uterine rupture. Despite the mounting data regarding both antepartum and intrapartum factors, it currently is impossible to predict in whom a uterine rupture will occur. This article reviews the data regarding these antepartum and intrapartum predictors for uterine rupture. The author hopes that the information presented in this article will help clinicians assess an individual's risk for uterine rupture.
Clinics in Perinatology 04/2008; 35(1):85-99, viii. · 2.46 Impact Factor
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ABSTRACT: This case-controlled study reviewed 26 cases of uterine rupture at an academic medical center. Controls were selected in a 2:1 design by reviewing the immediate successful vaginal birth after cesarean delivery (VBAC) before and after each case of uterine rupture. At less than 2 hours before delivery or acute uterine rupture, mild and severe variable decelerations, persistent abdominal pain, and hyperstimulation were more common in cases of uterine rupture as compared to controls and had statistically significant positive likelihood ratios (LR). Mild and severe variable fetal heart rate decelerations, especially in the presence of persistent abdominal pain, may predict uterine rupture in patients attempting VBAC.
American Journal of Perinatology 06/2007; 24(5):317-21. · 1.32 Impact Factor
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ABSTRACT: The importance of prostaglandins in the regulation of the renin-angiotensin system during development is not known. These experiments were conducted to examine the effects of prostaglandin synthesis inhibitors on basal and isoproterenol-induced plasma renin concentration and renin gene expression in the late-gestation fetal lamb. Eighteen lamb fetuses ranging in gestational age from 129 to 138 days underwent surgical insertion of femoral arterial and venous catheters under general endotracheal anesthesia. After a period of recovery, animals underwent an infusion of isoproterenol after administration of a saline bolus (control experiments); 24-48 h later a second study was performed after administration of NS-398, a cyclooxygenase (COX)-2 inhibitor, or saline for a second control study. Administration of COX-2 inhibitor significantly reduced baseline plasma renin levels and attenuated responses in fetal renin secretion to isoproterenol infusions. Renal cortical cells from animals receiving COX-2 inhibitor had significantly lower levels of renin mRNA compared with animals receiving only saline. Renal cortical cells in culture from animals receiving only saline exhibited increased levels of renin mRNA when treated with isoproterenol, forskolin, or IBMX. Only forskolin increased renin mRNA levels in renal cortical cells in culture from animals receiving COX-2 inhibitor. We conclude that prostaglandins play a stimulatory role in the regulation of the renin-angiotensin system and are necessary for beta-adrenergic stimulation of renin secretion and gene expression in the late-gestation fetal lamb.
AJP Regulatory Integrative and Comparative Physiology 05/2003; 284(4):R1012-8. · 3.34 Impact Factor
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ABSTRACT: Symptomatic cesarean scar defect is one of the commonly reported long-term complications of cesarean section.
We present two cases of symptomatic cesarean scar defect treated conservatively by robotic-assisted laparoscopy at our institution. Both patients presented with hematocele, pelvic discomfort and secondary infertility. Transvaginal ultrasound revealed hematocele measuring 3.7 x 1.9 x 3.8 cm and 3.0 x 2.0 x 1.6 cm in the lower uterine segments, respectively. After surgery normal menses resumed in both patients, and their childbearing potential was preserved. The patients conceived 3 and 11 months after surgery, respectively.
Recognition of cesarean scar defect is important in the explanation of certain menstrual disorders since surgical intervention can result in improvement of symptoms and prevent the related secondary obstetric and gynecologic complications. Robotic-assisted laparoscopic approach is a good minimally invasive alternative for the repair of cesarean scar defect.
The Journal of reproductive medicine 56(5-6):265-70. · 0.87 Impact Factor
