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Nature Reviews. Neurology Aug 2009Migraine 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... (Review)
Review
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.
Topics: Diagnosis, Differential; Female; Humans; Migraine Disorders; Pre-Eclampsia; Pregnancy; Pregnancy Complications
PubMed: 19597515
DOI: 10.1038/nrneurol.2009.100 -
PloS One 2022We aimed to assess women's perceptions on the long-term risks for cardiovascular disease (CVD) after major pregnancy complications.
OBJECTIVES
We aimed to assess women's perceptions on the long-term risks for cardiovascular disease (CVD) after major pregnancy complications.
METHODS
Women who experienced major pregnancy complications and those who experienced uncomplicated pregnancies were invited to participate in a qualitative study. Focus group discussions (FGDs) and self-administered questionnaires were used to explore: The knowledge of long-term sequelae after experiencing a major pregnancy complication; Importance of education on heart health; The practicality of referral to a clinic after pregnancy complications; Willingness for regular postpartum clinic visits after pregnancy complications. A thematic qualitative analysis was undertaken.
RESULTS
26 women participated in four FGDs. The majority of women did not know of the association between major pregnancy complications and CVD. The main views expressed were: Women who experience pregnancy complications should receive education on improving heart health; An appointment for the first CVD risk screening visit needs to be made prior to discharge from the delivery suite; Women will benefit by having the option to select between a hospital and a general-practitioner based model of follow up.
CONCLUSIONS
These views are important in developing postpartum strategies to reduce CVD risk among women who experience pregnancy complications.
Topics: Cardiovascular Diseases; Female; Humans; Perception; Postpartum Period; Pregnancy; Pregnancy Complications; Qualitative Research
PubMed: 35862420
DOI: 10.1371/journal.pone.0271722 -
La Revue de Medecine Interne Jun 2011Pregnancy in women diagnosed with systemic sclerosis is an infrequent situation with a generally favourable outcome according to the most recent studies. Women with... (Review)
Review
Pregnancy in women diagnosed with systemic sclerosis is an infrequent situation with a generally favourable outcome according to the most recent studies. Women with systemic sclerosis who wish to become pregnant should obtain preconception counselling in order to withdraw teratogenic drugs and to carefully assess the disease activity. Severe organ impairment, early diffuse systemic sclerosis and pulmonary hypertension ought to discourage patients from pregnancy, as these situations are at high risk of complications for both mother and fetus during pregnancy and puerperium. During pregnancy, the most frequent maternal complication is worsening of gastroesophageal reflux, and the most severe complications are renal crisis and flaring arterial pulmonary hypertension. Angiotensin converting enzyme inhibitors are indicated at any stage of the pregnancy if renal crisis is suspected. Adverse obstetric outcomes are dominated by prematurity which may be the consequence of intra-uterine growth restriction or preeclampsia. Those complications might account for systemic sclerosis-associated vasculopathy, or for the presence of antiphospholipid antibodies. Patients with a previous history of placental insufficiency might benefit from treatment with aspirin, low dose anticoagulants or even nitric oxide donors. During the pregnancy, abnormal bilateral uterine artery Doppler is a predictor of vascular insufficiency and might guide initiation of further preventive treatments. Multicentric prospective cohort studies are warranted to identify more precisely the predictors of pregnancy-related complications and to define the best management of these patients.
Topics: Female; Humans; Placenta; Pregnancy; Pregnancy Complications; Scleroderma, Systemic
PubMed: 20633963
DOI: 10.1016/j.revmed.2010.02.004 -
Akusherstvo I Ginekologiia 2014During the past decades there is a tendency among women in developed countries for postponing their reproductive plans for later age. This results from the substantial... (Review)
Review
During the past decades there is a tendency among women in developed countries for postponing their reproductive plans for later age. This results from the substantial change of women's role in society and the development and availability of assisted reproduction technologies. The latter made possible women to become pregnant after the end of their reproductive years. In the present review, data from the literature, published in the recent 15 years and related to pregnancy course and outcome in women above the age of 35, are analyzed. Decreased fertility, higher incidence of early pregnancy complications including spontaneous abortions and ectopic pregnancy, and of congenital anomalies (chromosomal, structural, genetic syndromes) are discussed. Advanced maternal age is characterized with more frequent late pregnancy complication such as hypertension and diabetes. Problems of placentation, perinatal and maternal mortality are more frequent in these patients.. Data at present suggest higher risk for maternal and fetal pregnancy complications as maternal age advances. On the other hand, some positive aspects of postponing pregnancy have to be considered--financial, emotional, and the overall low absolute number of complications. With adequate antenatal care it is possible for women of advanced maternal age to have successful pregnancies with overall favorable outcome comparable to that in young women.
Topics: Adult; Congenital Abnormalities; Female; Fertility; Humans; Maternal Age; Obstetric Labor Complications; Pregnancy; Pregnancy Complications
PubMed: 24919338
DOI: No ID Found -
Clinical Obstetrics and Gynecology Mar 1997The prevalence of hyperthyroidism in pregnancy is about 0.2%. The most common cause is Graves' disease. Maternal, fetal, and neonatal morbidity and mortality may be... (Review)
Review
The prevalence of hyperthyroidism in pregnancy is about 0.2%. The most common cause is Graves' disease. Maternal, fetal, and neonatal morbidity and mortality may be reduced to a minimum with careful attention to the clinical symptoms and interpretation of thyroid tests. Ideally, hyperthyroid women should be rendered euthyroid before considering conception. The incidence of maternal and neonatal morbidity is significantly higher in those patients whose hyperthyroidism is not medically controlled. Even the incidence of thyroid storm is high in women who are under poor medical supervision in the presence of a medical or obstetric complication. Maternal morbidity includes a higher incidence of toxemia, premature delivery, placenta abruptio, congestive heart failure, and thyroid crisis. In some series, anemia and infections were also reported. Neonatal morbidity includes SGA neonates, intrauterine growth retardation, LBW infants, and prematurity. Fetal goiter and transient neonatal hypothyroidism is occasionally reported in infants of mothers who have been overtreated with ATD. Propylthiouracil and MMI are equally effective in controlling the disease. In most patients, symptoms improved and thyroid tests returned to normal in 3-8 weeks after initiation of therapy. Resistance to ATD is extremely rare, most cases are caused by patient poor compliance. Surgery for the treatment of hyperthyroidism is reserved for the unusual patient who is allergic to both ATD; to those who have large goiters; to those who require large doses of ATD; or to those patients who poorly comply. Fetal and neonatal hyperthyroidism can be predicted in the majority of cases by the previous maternal medical and obstetric history and by the proper interpretation of thyroid tests. Finally, hyperthyroidism may recur in the postpartum period.
Topics: Antithyroid Agents; Diagnosis, Differential; Female; Humans; Hyperthyroidism; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prevalence
PubMed: 9103949
DOI: 10.1097/00003081-199703000-00007 -
The Journal of Perinatal & Neonatal... Mar 2002Asthma, a chronic inflammatory disease of the airway system, is the most common respiratory complication that can impact pregnancy. Various physiologic changes in... (Review)
Review
Asthma, a chronic inflammatory disease of the airway system, is the most common respiratory complication that can impact pregnancy. Various physiologic changes in gestation may variably affect this pulmonary disease. The cornerstone of management involves implementing strategies and treatments that assist in maintaining normal maternal pulmonary function, thereby preventing fetal complications. Optimum therapy can provide a favorable outcome for both mother and fetus.
Topics: Anti-Asthmatic Agents; Asthma; Chronic Disease; Female; Humans; Patient Education as Topic; Pregnancy; Pregnancy Complications
PubMed: 11911619
DOI: 10.1097/00005237-200203000-00005 -
Human Reproduction (Oxford, England) Mar 2016Does the risk of adverse outcomes at the time of ectopic pregnancy vary by race/ethnicity among women receiving Medicaid, the public health insurance program for... (Observational Study)
Observational Study
STUDY QUESTION
Does the risk of adverse outcomes at the time of ectopic pregnancy vary by race/ethnicity among women receiving Medicaid, the public health insurance program for low-income people in the USA?
SUMMARY ANSWER
Among Medicaid beneficiaries with ectopic pregnancy, 11% experienced at least one complication, and women from all racial/ethnic minority groups were significantly more likely than whites to experience complications.
WHAT IS KNOWN ALREADY
In this population of Medicaid recipients, African American women are significantly more likely than whites to experience ectopic pregnancy, but the risk of adverse outcomes has not previously been assessed.
STUDY DESIGN, SIZE, AND DURATION
We conducted a cross-sectional observational study of all women (n = 19 135 106) ages 15-44 enrolled in Medicaid for any amount of time during 2004-2008 who lived in one of the following 14 US states: Arizona; California; Colorado; Florida; Illinois; Indiana; Iowa; Louisiana; Massachusetts; Michigan; Minnesota; Mississippi; New York; and Texas.
PARTICIPANTS/MATERIALS, SETTINGS, METHODS
We analyzed Medicaid claims records for inpatient and outpatient encounters and identified ectopic pregnancies with a principal diagnosis code for ectopic pregnancy from 2004-2008. We calculated the ectopic pregnancy complication rate as the number of ectopic pregnancies with at least one complication (blood transfusion, hysterectomy, any sterilization, or length-of-stay (LOS) > 2 days) divided by the total number of ectopic pregnancies. We used Poisson regression to assess the risk of ectopic pregnancy complication by race/ethnicity. Secondary outcomes were each individual complication, and ectopic pregnancy-related death. We calculated the ectopic pregnancy mortality ratio as the number of deaths divided by live births.
MAIN RESULTS AND THE ROLE OF CHANCE
Ectopic pregnancy-associated complications occurred in 11% of cases. Controlling for age and state, the risk of any complication was significantly higher among women who were black (incidence risk ratio [IRR] 1.47, 95% CI 1.43-1.53, P < 0.0001), Hispanic (IRR 1.16, 95% CI 1.12-1.21, P < 0.0001), Asian (IRR 1.34, 95% CI 1.24-1.45, P < 0.0001), American Indian/Alaskan Native (IRR 1.34 95% CI 1.16-1.55, P < 0.0001), and Native Hawaiian/Pacific Islander (IRR 1.61, 95% CI 1.39-1.87, P < 0.0001) compared with white women. The ectopic pregnancy mortality ratio was 0.48 per 100 000 live births, similar to that reported in previous US surveillance.
LIMITATIONS, REASONS FOR CAUTION
This is a secondary analysis of insurance claims.
WIDER IMPLICATIONS OF THE FINDINGS
Among women at higher baseline risk of pregnancy complications due to their economic status, women from racial/ethnic minority groups face an additional risk of ectopic pregnancy adverse outcomes compared with whites. Systematic changes to reduce racial disparities are an essential part of improving maternal health in the USA.
STUDY FUNDING/COMPETING INTERESTS
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (1 K08 HD060663 to D.B.S.). The authors report no conflict of interest.
TRIAL REGISTRATION NUMBER
Not applicable.
Topics: Adolescent; Adult; Cross-Sectional Studies; Ethnicity; Female; Humans; Length of Stay; Medicaid; Morbidity; Poisson Distribution; Poverty; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy, Ectopic; Socioeconomic Factors; United States
PubMed: 26724794
DOI: 10.1093/humrep/dev332 -
Obstetrical & Gynecological Survey Sep 2021Spontaneous renal rupture is a rare pregnancy complication, which requires a high index of suspicion for a timely diagnosis to prevent a poor maternal or fetal outcome. (Review)
Review
IMPORTANCE
Spontaneous renal rupture is a rare pregnancy complication, which requires a high index of suspicion for a timely diagnosis to prevent a poor maternal or fetal outcome.
OBJECTIVE
This review highlights risk factors, pathophysiology, symptoms, diagnosis, management, and complications of spontaneous renal rupture in pregnancy.
EVIDENCE ACQUISITION
A literature search was carried out by research librarians using the PubMed and Web of Science search engines at 2 universities. Fifty cases of spontaneous renal rupture in pregnancy were identified and are the basis of this review.
RESULTS
The first case of spontaneous renal rupture in pregnancy was reported in 1947. Rupture occurs more commonly on the right side and during the third trimester. Pain was a reported symptom in every case reviewed. Treatment usually consists of stent or nephrostomy tube placement. Conservative management has been reported.
CONCLUSIONS
When diagnosed early and managed appropriately, maternal and fetal outcomes are favorable. Preterm delivery is the most common complication.
RELEVANCE
Our aim is to increase the awareness of spontaneous renal rupture in pregnancy and its associated complications in order to improve an accurate diagnosis and maternal and fetal outcomes.
Topics: Female; Humans; Infant, Newborn; Kidney; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third; Premature Birth; Rupture, Spontaneous
PubMed: 34586421
DOI: 10.1097/OGX.0000000000000926 -
American Journal of Surgery Oct 1992Intestinal obstruction is a rare but serious complication of pregnancy with significant maternal and fetal mortality. The reported incidence of intestinal obstruction... (Review)
Review
Intestinal obstruction is a rare but serious complication of pregnancy with significant maternal and fetal mortality. The reported incidence of intestinal obstruction complicating pregnancy varies widely, from 1 in 66,431 to 1 in 1,500 deliveries. A retrospective review of 66 cases of intestinal obstruction complicating pregnancy and the puerperium, including 2 cases from our institution, revealed that the most common causes of mechanical obstruction were adhesions (58%), volvulus (24%), and intussusception (5%). Seventy-seven percent of the patients with obstruction due to adhesions had undergone previous abdominal or pelvic surgery. Presenting symptoms and signs were similar to those of the nonpregnant patient; abdominal pain was present in 98% of patients, vomiting in 82%, and tenderness to palpation in 71%. In 82% of patients, obstruction was evident on radiographic evaluation. Prompt management of obstruction is essential; the median length of time from admission to laparotomy in the 66 patients was 48 hours. Bowel strangulation requiring resection was present in 23% of patients. Thirty-eight percent of patients completed term pregnancies after operative resolution of obstruction; total maternal mortality was 6%, and total fetal mortality 26%. Thus, both mother and fetus are at risk when intestinal obstruction complicates pregnancy. Clinical suspicion of the presence of obstruction and aggressive intervention are required to decrease the morbidity and mortality of this rare complication of pregnancy.
Topics: Female; Humans; Intestinal Obstruction; Pregnancy; Pregnancy Complications; Puerperal Disorders
PubMed: 1415949
DOI: 10.1016/s0002-9610(05)80910-9 -
BMC Pregnancy and Childbirth Jan 2021Chorangiosis is a vascular change involving the terminal chorionic villi in the placenta. It results from longstanding, low-grade hypoxia in the placental tissue, and is...
BACKGROUND
Chorangiosis is a vascular change involving the terminal chorionic villi in the placenta. It results from longstanding, low-grade hypoxia in the placental tissue, and is associated with such conditions as intrauterine growth restriction (IUGR), diabetes, and gestational hypertension in pregnancy. Chorangiosis rarely occurs in normal pregnancies. However, its prevalence is 5-7% of all placentas from infants admitted to newborn intensive care units. The present study was aimed at determining the association of chorangiosis with pregnancy complications and perinatal outcomes.
METHODS
In this case-control study, 308 chorangiosis cases were compared with 308 controls (with other diagnoses in pathology) in terms of maternal, placental, prenatal, and neonatal characteristics derived from the medical records of participants retrospectively. R and SPSS version 22 software tools were used, and the statistical significance level was considered 0.05 for all the tests.
RESULTS
Preeclampsia, diabetes mellitus, maternal hemoglobin, maternal hematocrit, C/S, oligohydramnios, fetal anomaly, dead neonates, NICU admissions were significantly higher in the chorangiosis group OR = 1.6, 3.98, 1.68, 1.92, 2.1, 4.47, 4.22, 2.9, 2.46, respectively (p-value< 0.05 for all). Amniotic fluid index, birth weight, cord PH amount, 1st, and 5th Apgar score was lower in the chorangiosis group OR = 0.31, 1, 0.097, 0.83, 0.85, respectively (p-value< 0.05 for all). Moreover, fundal placenta, retro placental hemorrhage, perivillous fibrin deposition, calcification, and acute chorioamnionitis were higher in the chorangiosis group OR = 2.1, 11.8, 19.96, 4.05, and 6.38 respectively, (p-value< 0.05). There was a high agreement between the two pathologists, and the power of the study was estimated at 99%.
CONCLUSION
Although chorangiosis is an uncommon condition, it is associated with a higher incidence of perinatal and neonatal morbidity and mortality. Therefore, it should be considered an important clinical sign of adverse pregnancy outcomes and should be reported in the pathology evaluation.
Topics: Adult; Apgar Score; Case-Control Studies; Chorioamnionitis; Chorionic Villi; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Placenta; Placenta Diseases; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Young Adult
PubMed: 33516193
DOI: 10.1186/s12884-021-03576-0