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Obstetrical & Gynecological Survey Nov 2019The incidence and severity of Bell's palsy are increased in pregnancy, with most cases arising in the third trimester or postpartum period. It has been indicated that... (Review)
Review
IMPORTANCE
The incidence and severity of Bell's palsy are increased in pregnancy, with most cases arising in the third trimester or postpartum period. It has been indicated that pregnancy-related Bell's palsy has worse long-term outcomes, such as complete facial paralysis, compared with nonpregnant women and males.
OBJECTIVE
This article outlines the existing literature diagnosis, treatment, and prognosis of Bell's palsy, specifically looking at the implications during pregnancy. The aim is to provide a reference for physicians treating Bell's palsy in pregnant patients.
EVIDENCE ACQUISITION
Existing literature on neuropathies during pregnancy, clinical presentation, and treatment of Bell's palsy was reviewed through a MEDLINE and PubMed search. Referenced articles were reviewed and used as primary source materials as appropriate.
RESULTS
Multiple clinical tests of motor function are used to establish the diagnosis of Bell's palsy including Wartenberg's lid vibration test, an abnormal eyelash occlusion test, and asymmetry with voluntary and spontaneous smiling. Optimal treatment for Bell's palsy remains controversial. While early treatment with corticosteroids for 10 days is highly recommended, the simultaneous use of antiviral therapy is frequently performed but has less supporting evidence. Pregnancy itself and delay in treatment initiation are associated with persistent nerve palsy, whereas treatment started within 3 days of symptom onset is usually associated with full recovery. Recurrence of Bell's palsy in pregnancy is rare.
CONCLUSIONS AND RELEVANCE
To date, there is limited literature in the diagnosis and treatment of Bell's palsy during pregnancy. The prognosis of Bell's palsy in pregnancy is worse than in nonpregnant individuals. Early treatment with steroids is recommended, but not without risk.
Topics: Bell Palsy; Diagnostic Techniques, Neurological; Disease Management; Female; Humans; Pregnancy; Pregnancy Complications; Prognosis
PubMed: 31755544
DOI: 10.1097/OGX.0000000000000732 -
American Family Physician Jun 2022A preoperative evaluation is advised for all children and adolescents having elective surgery with anesthesia. The evaluation assesses medical and psychosocial factors... (Review)
Review
A preoperative evaluation is advised for all children and adolescents having elective surgery with anesthesia. The evaluation assesses medical and psychosocial factors that may affect surgery timing and identifies underlying conditions that may require evaluation or management before surgery. The evaluation also classifies the patient's American Society of Anesthesiologists' risk category. The history component of the evaluation should include a review of the patient's medical, behavioral, and social history; previous complications with surgery or anesthesia; a medication review; and a tobacco use history. The physical examination should involve the identification of airway anomalies that could interfere with intubation and the evaluation of cardiac, respiratory, neurologic, and fluid status. Routine laboratory testing is not recommended for healthy children and adolescents having low-risk procedures. Patients with underlying conditions may benefit from targeted laboratory and imaging studies to assess clinical stability. The HEMSTOP questionnaire can identify patients who have coagulation disorders. A pregnancy test should be considered for all adolescents who are postmenarchal on the day of surgery. Many children have anxiety about surgery, which can be reduced by educational pamphlets, videos, coaching provided to parents the week before surgery, and a parental presence during the induction of anesthesia.
Topics: Adolescent; Anxiety; Child; Elective Surgical Procedures; Female; Humans; Physical Examination; Pregnancy; Preoperative Care; Risk Factors
PubMed: 35704826
DOI: No ID Found -
Cureus Sep 2022While assessing maternal health is relatively easy, assessing fetal well-being has always been tricky. This has led to tremendous technological development in fetal... (Review)
Review
While assessing maternal health is relatively easy, assessing fetal well-being has always been tricky. This has led to tremendous technological development in fetal well-being assessment, thus bridging the gap between biotechnology and antenatal medicine. It is broadly divided into early pregnancy, late pregnancy, and during labour assessment. While the early assessment involves genetic check-ups and malformations, the late pregnancy check-ups aim at delivering a healthy fetus at term by normal vaginal delivery. The early tests can be invasive or non-invasive. Non-invasive include cell-free fetal DNA assessment and fetal cell-based assessment. Invasive tests include amniocentesis and chorionic villous sampling. These are followed by chromosomal microarray and next-generation sequencing. Under this procedure, exome sequencing is done, which is either clinical or whole. Sequencing of the whole genome can also be done. A recent advancement is pre-implantation genetic testing. These are mainly useful in identifying monogenic disorders for which the locus causing disease is identified beyond any doubt. In late pregnancy, the most commonly used test is biophysical. It works on the principle that an increase in the fetal heart rate occurs in conjugation with fetal movements. The next widely employed technology is Doppler, which is used to know fetal heart rates, valve timing intervals, and umbilical artery waveforms. Cardiotocography is also widely used both during pregnancy and during labour. It measures the fetal heart rate while correlating it with uterine contractions. Wireless fetal and maternal heart monitoring and telemonitoring are recent upcoming fields.
PubMed: 36249607
DOI: 10.7759/cureus.29039 -
Reproduction & Fertility Jan 2021The corpus luteum is the source of progesterone in the luteal phase of the cycle and the initial two-thirds of the first trimester of pregnancy. Normal luteal function...
UNLABELLED
The corpus luteum is the source of progesterone in the luteal phase of the cycle and the initial two-thirds of the first trimester of pregnancy. Normal luteal function is required for fertility and the maintenance of pregnancy. Progesterone administration is increasingly used during fertility treatments and in early pregnancy to mitigate potentially inadequate corpus luteum function. This commentary considers the concept of the inadequate corpus luteum and the role and effects of exogenous progesterone. Progesterone supplementation does have important beneficial effects but we should be wary of therapeutic administration beyond or outside the evidence base.
LAY SUMMARY
After an egg is released a structure is formed on the ovary called a corpus luteum (CL). This produces a huge amount of a hormone called progesterone. Progesterone makes the womb ready for pregnancy but if a pregnancy does not happen the CL disappears after 12-14 days and this causes a period. If a pregnancy occurs, then the pregnancy hormone (hCG) keeps the CL alive and its progesterone supports the pregnancy for the next 6-8 weeks until the placenta takes over and the corpus luteum disappears. That means that if the CL is not working correctly there could be problems getting pregnant or staying pregnant. If a CL is not producing enough progesterone it usually means there is a problem with the growing or releasing of the egg and treatment should focus on these areas. In IVF cycles, where normal hormones are switched off, the CL does not produce quite enough progesterone before the pregnancy test and extra progesterone is needed at this time. In recurrent or threatened miscarriage, however, there is not any evidence that the CL is not working well or progesterone is low. However, there is benefit in taking extra progesterone if there is bleeding in early pregnancy in women with previous miscarriages. This might be because of the effects of high-dose progesterone on the womb or immune system. As changes to the hormone environment in pregnancy may have some life-long consequences for the offspring we have to be careful only to give extra progesterone when we are sure it is needed.
Topics: Abortion, Spontaneous; Corpus Luteum; Female; Humans; Luteal Phase; Ovary; Pregnancy; Progesterone
PubMed: 35128435
DOI: 10.1530/RAF-20-0044 -
JAMA Aug 2019
Topics: Autoimmunity; Female; Humans; Infant, Newborn; Pregnancy; Premature Birth; Thyroid Diseases; Thyroid Function Tests
PubMed: 31429879
DOI: 10.1001/jama.2019.10159 -
American Family Physician Dec 2022Galactorrhea is the production of breast milk that is not the result of physiologic lactation. Milky nipple discharge within one year of pregnancy and the cessation of...
Galactorrhea is the production of breast milk that is not the result of physiologic lactation. Milky nipple discharge within one year of pregnancy and the cessation of breastfeeding is usually physiologic. Galactorrhea is more often the result of hyperprolactinemia caused by medication use or pituitary microadenomas, and less often hypothyroidism, chronic renal failure, cirrhosis, pituitary macroadenomas, hypothalamic lesions, or unidentifiable causes. A pregnancy test should be obtained for premenopausal women who present with galactorrhea. In addition to prolactin and thyroid-stimulating hormone levels, renal function should also be assessed. Medications contributing to hyperprolactinemia should be discontinued if possible. Treatment of galactorrhea is not needed if prolactin and thyroid-stimulating hormone levels are normal and the discharge is not troublesome to the patient. Magnetic resonance imaging of the pituitary gland should be performed if the cause of hyperprolactinemia is unclear after a medication review and laboratory evaluation. Cabergoline is the preferred medication for treatment of hyperprolactinemia. Transsphenoidal surgery may be necessary if prolactin levels do not improve and symptoms persist despite high doses of cabergoline and in patients who cannot tolerate dopamine agonist therapy.
Topics: Pregnancy; Humans; Female; Hyperprolactinemia; Prolactin; Cabergoline; Galactorrhea; Pituitary Neoplasms; Thyrotropin
PubMed: 36521467
DOI: No ID Found -
The British Journal of Sociology Jun 2020Is the test result positive or negative? Tests that occur in labs and doctors' offices pose specific questions to try to obtain specific information. But what happens in...
Is the test result positive or negative? Tests that occur in labs and doctors' offices pose specific questions to try to obtain specific information. But what happens in the social world when these tests never see the inside of a lab or doctor's office, and instead they are used in a house, in a Walmart bathroom, or in a dormitory bathroom stall? Putting the diagnosis aside, what does the presence of these tests do to social life? This paper examines one such test, the home pregnancy test, and specifically, its use in contemporary intimate life of people who do not want to be pregnant. Pregnancy tests test for pregnancy. But what else is the pregnancy test putting to the test? To investigate this, I spent 8 years studying American pregnancy tests using a qualitative mixed methods approach. This paper draws on some of my research materials, specifically, 85 life history interviews. Each participant was asked to recall, in full, all of their experiences with home pregnancy tests throughout their lives, resulting in well over 300 narratives of home pregnancy test usage which I qualitatively analyzed. I find that more than just a test for a pregnancy, the use of the home pregnancy test is a test of roles, relationships, and responsibilities in social life. These findings suggest implications for social life as more biomedical tests move out of the purview of the medical establishment.
Topics: Adolescent; Adult; Female; Humans; Interpersonal Relations; Male; Middle Aged; Pregnancy; Pregnancy Tests; Qualitative Research; Sexual Behavior; Sexual Partners; United States; Young Adult
PubMed: 32323866
DOI: 10.1111/1468-4446.12758 -
American Family Physician Aug 2023Acute pelvic pain is defined as noncyclic, intense pain localized to the lower abdomen and/or pelvis, with a duration of less than three months. Signs and symptoms are...
Acute pelvic pain is defined as noncyclic, intense pain localized to the lower abdomen and/or pelvis, with a duration of less than three months. Signs and symptoms are often nonspecific. The differential diagnosis is broad, based on the patient's age and pregnancy status and gynecologic vs. nongynecologic etiology. Nongynecologic etiologies include gastrointestinal, urinary, and musculoskeletal conditions. Urgent gynecologic conditions include ectopic pregnancy, ruptured ovarian cyst, adnexal torsion, and pelvic inflammatory disease. Approximately 40% of ectopic pregnancies are misdiagnosed at the presenting visit. Urgent nongynecologic conditions include appendicitis and pyelonephritis. Less urgent etiologies include sexually transmitted infections, pelvic floor myofascial pain, dysmenorrhea, and muscle strain. Approximately 15% of untreated chlamydia infections lead to pelvic inflammatory disease. History and physical examination findings guide laboratory testing. Questions should focus on the type, onset, location, and radiation of pain; timing and duration of symptoms; aggravating and relieving factors; and associated symptoms. Performing a urine pregnancy test or beta human chorionic gonadotropin test is an important first step for sexually active, premenopausal patients. Imaging options should be considered, with transvaginal ultrasonography first, followed by computed tomography. Magnetic resonance imaging can be useful if ultrasonography and computed tomography are nondiagnostic.
Topics: Female; Humans; Pregnancy; Pelvic Inflammatory Disease; Pelvic Pain; Acute Pain; Chorionic Gonadotropin, beta Subunit, Human; Dysmenorrhea; Pregnancy, Ectopic
PubMed: 37590858
DOI: No ID Found -
Current Opinion in Obstetrics &... Apr 2020Cell-free DNA-based noninvasive prenatal testing (cfDNA-based NIPT) using maternal blood is highly sensitive for detecting fetal trisomies. However, false-positive and... (Review)
Review
PURPOSE OF REVIEW
Cell-free DNA-based noninvasive prenatal testing (cfDNA-based NIPT) using maternal blood is highly sensitive for detecting fetal trisomies. However, false-positive and false-negative results can occur, which prevents NIPT from being a diagnostic test. Fetoplacental mosaicism is one of the main reasons for discordant test results. It is therefore important to understand this phenomenon to enable more comprehensive and appropriate genetic counselling. The present review aims to summarize the current knowledge of fetoplacental mosaicism ascertained during cfDNA-based NIPT and refers to the development of recent analytical pipelines for its detection during pregnancy.
RECENT FINDINGS
Publications are emerging demonstrating that genome-wide approaches to analyzing cfDNA can detect chromosomal aneuploidy other than the common trisomies. Despite the high accuracy of current cfDNA-based NIPT, a substantial number of false-positive and false-negative test results remain. Biological causes, such as fetal or (confined) placental mosaicism have been identified using advanced bioinformatics algorithms. Fetoplacental mosaicism can occur as part of normal pregnancy development, hence clinical practice standards recommend confirmation of positive NIPT results with a diagnostic karyotype or microarray study.
SUMMARY
cfDNA-based NIPT for fetal chromosomal aneuploidies is not diagnostic because of false-positive and false-negative test results. Recently, novel algorithms have been described that identify pregnancies with an increased risk of fetoplacental mosaicism. Reporting the presence of fetoplacental mosaicism during pregnancy can influence risk estimation and improve genetic counseling.
Topics: Aneuploidy; Chromosome Aberrations; Female; Genetic Counseling; Humans; Noninvasive Prenatal Testing; Predictive Value of Tests; Pregnancy
PubMed: 31977337
DOI: 10.1097/GCO.0000000000000610