VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

The Uterine Spiral Arteries In Human Pregnancy: Facts and Controversies

Rheological and Physiological Consequences of Conversion of the Maternal Spiral Arteries for Uteroplacental Blood Flow during Human Pregnancy

ContextPreeclampsia is believed to result from release of placental factors
that damage maternal vascular endothelium. However, because most studies have
been conducted during pregnancy, it has not been possible to separate maternal
from placental mechanisms underlying endothelial dysfunction in preeclampsia.ObjectiveTo determine whether endothelial function is impaired in nonpregnant
women with previous preeclampsia and whether endothelial dysfunction is mediated
by oxidative stress.Design and SettingCase-control study conducted at 3 hospital maternity units in London,
England, between July 1997 and June 2000.ParticipantsA total of 113 women with previous preeclampsia (n = 35 with recurrent
episodes; n = 78 with a single episode) and 48 women with previous uncomplicated
pregnancies, all of whom were at least 3 months (median, 3 years) postpartum.Main Outcome MeasuresBrachial artery flow-mediated (endothelium-dependent) and glyceryl trinitrate–induced
(endothelium-independent) dilatation were compared between previously preeclamptic
women and controls. To investigate oxidative stress, these measurements were
repeated after administration of ascorbic acid, 1 g intravenously, in 15 cases
and 15 controls.ResultsMean (SD) flow-mediated dilatation was lower in women with previous
preeclampsia compared with controls (recurrent group, 0.9% [4.1%]; single-episode
group, 2.7% [3.5%]; and control group, 4.7% [4.3%]; P<.001).
In contrast, glyceryl trinitrate–induced dilatation was similar in the
3 groups (recurrent, 19.5% [5.9%]; single-episode, 21.0% [8.0%]; and control,
21.0% [8.3%]; P = .65). Impaired flow-mediated dilatation
in previously preeclamptic women was not accounted for by recognized vascular
risk factors. Ascorbic acid administration increased flow-mediated dilatation
in previously preeclamptic women (baseline, 2.6% [3.3%]; after administration,
5.6% [3.0%]; P = .001) but not in controls (baseline,
6.2% [3.3%]; after administration, 6.7% [5.0%]; P
= .72).ConclusionsOur results indicate that endothelial function is impaired in women
with previous preeclampsia and is not explained by established maternal risk
factors but is reversed by antioxidant ascorbic acid administration.

https://jamanetwork.com/journals/jama/articlepdf/193675/JCI10003.pdf

Association of Maternal Endothelial Dysfunction With Preeclampsia

The main-stay of therapy for preeclampsia re-mainsclinicalrecognitionthroughpre-natalcareandterminationofthediseaseprocess with delivery. Maternal mor-tality has been reduced in the UnitedStates, but in countries where prena-tal care is not adequate, preeclampsia/eclampsia accounts for 40% to 80% ofmaternal deaths, an estimated 50000per year. Many of these deaths may bepreventablewithprenatalcareandevi-dence-based prophylactic seizuretherapy.Infants of women with preeclamp-sia have a 5-fold increase in mortalitycomparedwithinfantsofmotherswith-out the disorder. Much of the neona-tal mortality is attributable to iatro-genicprematurity.Approximately10%ofpreeclampsiaoccursbefore34weeks’gestational age, and indicated deliveryforpreeclampsiaisresponsiblefor15%of preterm US births.

Contemporary concepts of the pathogenesis and management of preeclampsia.

Neonatal death following termination of pregnancy

Vanishing gastroschisis is a rare in utero complication of gastroschisis. It is associated with a high mortality. We present a case report of an infant with vanishing gastroschisis that was managed with a combination of reconstructive bowel surgery and hepatosparing parenteral nutrition. The technique is described and a review of the literature is provided.

/pdf/successful-management-of-short-gut-due-to-vanishing-17bmt0iuzm.pdf

Successful management of short gut due to vanishing gastroschisis - case report and review of the literature.

the retroverted gravid uterus – a case report. Acta Obstetricia et Gynecologica Scandinavica 78:737. Matsushita H, Kurabayashi T, Higashino M et al. 2004. Incarceration of the retroverted uterus at term gestation. American Journal of Perinatology 21:387–389. Smalbraak I, Bleker OP, Schutte MF et al. 1991. Incarceration of the retroverted gravid uterus; a report of four cases. European Journal of Obstetrics Gynecology and Reproductive Biology 39:151–155. Spearing GJ. 1978. Uterine sacculation. Obstetrics and Gynecology 51:11S–18S.

Osteopenic fractures in pregnancy: Is low molecular weight heparin (LMWH) implicated?

The haemoglobinopathies are a complex group of red blood cell disorders. The ethnic diversity of the population in many parts of the UK means that these disorders are increasingly being seen in the antenatal setting. With the planned introduction of both antenatal and newborn screening programmes for haemoglobinopathies in England and Wales, a review of the subject is timely. This article explains the genetic background and clinical features of the major haemoglobinopathies, discusses antenatal screening and prenatal diagnosis, and highlights the implications of pregnancy for women with these disorders.

Haemoglobinopathies in pregnancy

Cardiac arrest in pregnancy is rare. Effective management involves the decision to perform a perimortem caesarean section if the gestation is greater than 20 weeks and return of spontaneous circulation does not occur after 4 minutes of effective cardiopulmonary resuscitation. Delivery should ideally be achieved within 5 minutes of cardiac arrest as this maximises maternal survival and reduces the risk of long‐term neurological impairment. In hospital, the procedure should be undertaken at the site of the cardiac arrest without moving to an operating theatre. Minimal equipment is required to undertake the procedure. Clinical areas where pregnant women are seen should have a designated ‘equipment box’. Debriefing all personnel is of utmost importance after the acute event.

/pdf/perimortem-caesarean-section-why-when-and-how-qbamomi5ga.pdf

Tracey A. Johnston

Papers

Neonatal death following termination of pregnancy

Successful management of short gut due to vanishing gastroschisis - case report and review of the literature.

Osteopenic fractures in pregnancy: Is low molecular weight heparin (LMWH) implicated?

Haemoglobinopathies in pregnancy

Perimortem caesarean section – why, when and how