Search Results (419)

Spontaneous hemoperitoneum in pregnancy is rare, and rupture of a superficial uterine fundal vein in an unscarred uterus is exceptionally uncommon. A 37-year-old woman at 27 + 0 weeks presented with left upper quadrant abdominal pain, and imaging revealed a localized hematoma adjacent to the left uterine fundus without active bleeding. During conservative management, she developed sudden severe pain with fetal heart rate decelerations at 27 + 6 weeks, prompting emergency cesarean delivery. Intraoperative findings showed approximately 2400 mL of hemoperitoneum caused by rupture of a superficial fundal vein, with the uterus otherwise intact, and bleeding was controlled with a fibrin sealant patch. Maternal recovery and neonatal outcome were favorable. This case underscores that rupture of superficial uterine veins should be considered in pregnant patients presenting with unexplained hemoperitoneum during pregnancy. Full article

Parvovirus B19 and cytomegalovirus are significant causes of congenital infections that can lead to adverse pregnancy outcomes. The present study aimed to investigate the infection of B19V and CMV in pregnant women with fetal anemia, effusions and intrauterine growth restriction and determine the utility of routine laboratory screening in pregnancy follow-up. Thirteen women with such pathological pregnancy complications attending an antenatal clinic from April 2024 to March 2025 were tested. Three types of clinical material were examined: maternal blood, amniotic fluid and umbilical cord serum. Participants underwent molecular and serological testing for both B19V and CMV. Demographic data, obstetric histories, and pregnancy outcomes were recorded and analyzed. Our results indicate that three participants showed evidence of either current infection with CMV and seven with B19V. Pregnant women with active infections required further follow-up and fetal surveillance. A stillbirth was reported in one woman with CMV infection. For seven samples that tested positive for B19V DNA, viral sequences were obtained and clustered with genotype 1a reference strains. The findings of this study highlight the significant contribution of B19V and CMV infections during pregnancy, particularly in cases complicated by fetal anemia, effusions, and intrauterine growth restriction. Full article

Acute liver injury during pregnancy is rare and predominantly associated with pregnancy-related conditions including acute fatty liver of pregnancy; Hemolysis, Elevated Liver Enzymes and Low Platelets syndrome; intrahepatic cholestasis of pregnancy; and preeclampsia. Drug-induced liver injury (DILI) is a less common and often overlooked cause of acute liver injury in pregnant patients. A literature search on acute liver injury during pregnancy and therapeutic plasma exchange was conducted, revealing the most common causative factors and syndromes. A 39-year-old woman was diagnosed with acute liver injury in the 23rd week of her third pregnancy and, upon extensive differential diagnoses, a suspicion of DILI occurred after the use of methyldopa. Methyldopa, the drug of choice for the treatment of hypertensive disorders of pregnancy, has a high safety profile for the developing fetus and is well tolerated by pregnant women, yet, in susceptible individuals, a hepatotoxic effect may occur. The drug was discontinued and symptomatic treatment with ursodeoxycholic acid and prednisone was implemented with marginal effect. Upon a multidisciplinary joint consultation, plasmapheresis procedures were introduced, granting a significant improvement in the patient’s liver function and enabling the continuation of the pregnancy. Plasmapheresis treatment was safely and effectively used for the first time in the therapeutic process in a pregnant patient with DILI. Interdisciplinary cooperation of specialists with gastroenterology, nephrology, and obstetrics expertise is crucial to achieving a timely diagnosis and begin effective treatment for pregnant patients with acute liver injury. Full article

The prevalence of Human T-cell Lymphotropic Virus (HTLV) infections in Grenada has not been published since 2013. This study aimed to determine the combined seroprevalence and trends in HTLV-1 and HTLV-2 among pregnant women in Grenada from 2015 to 2024. Data were analyzed to determine the overall combined seroprevalence, observed trends, and public health implications over time. Data obtained from the Ministry of Health, Grenada, were analyzed to determine and compare the annual combined seroprevalence rate and the prevalence by age group and by health district during 2015–2024. Every pregnant woman included in the analysis was tested for HTLV-1 and -2 at the government’s public laboratories in Grenada. The overall rate of infection among persons tested was 1.45%. The highest prevalence of infection was among the 40+ (mature) age group. A significant association was found between HTLV infection and the mature age group (ϰ² = 7.981, p = 0.017, OR = 2.6, 95% CI: 1.1559–5.7122). Pregnant women aged 40 years and over are 2.6 times more at risk of infection compared to pregnant adolescents. Trends were also observed by health district, in which the prevalence rate was the highest in St. Patrick (2.18%) and the lowest in St. George (0.95%). Although there were no statistically significant associations observed between HTLV and the COVID-19 pandemic, there is a need for further research to understand the impact of emergencies on HTLV screening and prevalence. Further studies are also needed to identify factors and modes of HTLV transmission. Overall, these findings underscore the importance of targeted surveillance and tailored interventions to address HTLV transmission risks and protect population health in Grenada. Full article

Background/Objectives: A decrease in serum AMH is generally associated with low ovarian response in assisted reproductive procedures, whether or not in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) is performed. Methods: We report a case involving a 31-year-old woman who had never been pregnant and with irregular menstrual cycles. An ultrasound scan performed on the second day of the cycle showed several annular follicles, a high luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratio suggesting polycystic ovary syndrome (PCOS), and an undetectable serum level of AMH. Results: Despite these observations, she exhibited an unpredictable hyperresponse during controlled ovarian stimulation, followed by a failed pregnancy despite successful in vitro fertilization with ICSI and a good-quality thawed embryo transfer (4AA). Conclusions: This case highlights the challenges of relying solely on AMH as a predictive marker of ovarian response. Although AMH is widely used for assessing ovarian reserve and stimulation outcomes, its limitations become evident in atypical cases. The paradoxical hyperresponse observed here may result from alternative regulatory mechanisms influenced by elevated LH levels, enhanced gonadotropin receptor sensitivity, or local ovarian factors. This report underscores the need for a personalized, multidimensional approach combining hormonal profiles, ultrasound assessments, and clinical history to optimize stimulation protocols and mitigate risks such as ovarian hyperstimulation syndrome (OHSS). Such tailored protocols are essential for managing patients with complex profiles, particularly those with undetectable AMH levels. Further research is needed to explore the mechanisms behind these atypical ovarian responses, including the roles of genetic polymorphisms, inflammatory markers, and environmental factors. This case demonstrates the importance of cautious interpretation of AMH results and emphasizes the value of comprehensive evaluations in assisted reproductive technologies. Full article

Background: A 33-year-old pregnant woman experienced ear trauma from contact with a fish while swimming. Afterwards, the woman presented with vertigo and hearing loss. Methods: Clinical examination showed a foreign body (FB) in the middle and inner ear, which was removed surgically under general anesthesia. Postoperative care included antibiotics; the FB was sent to the lab for analysis. Results: Although vertigo resolved after surgical intervention, the woman continued to experience hearing loss and finally experienced deafness. Patient had an unusual mechanism of inner ear trauma. The FB was identified as part of a fish and determined to originate from a fish species of the genus Hemiramphus which is listed as harmless to humans in FishBase. Conclusions: As severe penetration of an FB into the middle and inner ear can lead to serious complications, removal of an FB from the ear requires special competence and should therefore only be performed by specifically skilled professional staff. Full article

Preeclampsia is a multisystem disorder that develops during pregnancy and is associated with severe complications for both the pregnant woman and her infant. It remains a leading cause of maternal and perinatal mortality and morbidity. Although it affects only 2–8% of pregnancies, over 70,000 women and 500,000 children die from it each year. The exact etiology of preeclampsia is unclear; it is often referred to as a disease of theories and hypotheses. This paper reviews the most significant hypotheses and studies that aim to explain the etiology of preeclampsia. This may help identify new research paths and concepts that could bring us closer to understanding the exact etiology of preeclampsia. The complexity of pathogenetic relationships and mechanisms, heterogeneous clinical presentations, and the development of underlying changes early in pregnancy when patients are clinically asymptomatic and appear healthy are among the main reasons for difficulty identifying the exact causes of preeclampsia. Furthermore, preeclampsia is specific to human pregnancy; there is no ideal animal study model whose results could be fully extrapolated to humans. A more holistic approach that combines all the information, hypotheses, and pathogenetic relationships may offer hope for understanding why preeclampsia occurs and how to prevent and treat it effectively. A better understanding of the precise etiology of the condition holds promise for developing new options for the early diagnosis, effective prevention, and modern causal treatment of preeclampsia. This would reduce the risk of severe complications in affected patients and could have enormous implications for clinical practice. Full article

Background and Clinical Significance: Spontaneous intracranial hypotension (SIH) is a rare cause of headache characterised by cerebrospinal fluid (CSF) leakage, with an estimated incidence of 3.7 to 5 cases per 100,000 per year, peaking around the age of 40 years. Its diagnosis and management are particularly challenging in pregnancy due to overlapping symptoms and limited diagnostic options. Case Presentation: We report the case of a 42-year-old pregnant woman at 14 weeks of gestation presenting with a history of orthostatic headache and facial sinus tenderness, later diagnosed as spontaneous intracranial hypotension. Conclusions: Headache is a common clinical symptom that may be associated with a wide spectrum of underlying conditions, ranging from benign causes such as migraine or tension-type headache to potentially life-threatening pathologies, including subarachnoid haemorrhage. This case illustrates the diagnostic complexity of SIH in pregnancy and the importance of a multidisciplinary approach and vigilance for neurological symptoms during pregnancy. Full article

Targeted temperature management (TTM), particularly the avoidance of hyperpyrexia, is a cornerstone of intensive care, especially in conditions such as cerebral edema and increased intracranial pressure. Management becomes more complex in pregnancy, where maternal neuroprotection must be weighed against fetal safety. Both invasive and noninvasive methods for temperature control have been described, but evidence regarding their safety in pregnancy remains limited. We present the case of a 24-year-old pregnant woman admitted to the ICU with cerebral edema due to subdural empyema. The Arctic Sun surface cooling system was employed for fever control, with continuous maternal and fetal monitoring. The system effectively maintained normothermia without immediate adverse effects on either the mother or the fetus. However, on the third day of its use, the patient experienced a spontaneous preterm delivery of a stillborn fetus. Although a causal link between surface cooling and preterm labor cannot be established from this single case, the event underscores the need for caution and further investigation. This case highlights both the feasibility and the uncertainties of using advanced TTM devices in critically ill pregnant patients. It emphasizes the importance of multidisciplinary monitoring and the urgent need for evidence-based guidelines to balance maternal benefits with fetal safety. Full article

Background/Objectives: Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy. Diagnosing appendicitis in the third trimester remains especially challenging due to physiological changes that obscure clinical presentation and limit the utility of imaging modalities. These challenges can lead to diagnostic delays, increasing the risk of severe complications for both mother and fetus. Case presentation: We present a complex case of a 36-year-old pregnant woman at 29 + 4 weeks of gestation who developed acute appendicitis with an atypical clinical course. Her initial symptoms were nonspecific and misattributed to gastrointestinal discomfort related to pregnancy. Her condition progressively worsened, leading to an emergency laparoscopic appendectomy. Intraoperative findings confirmed a perforated, necrotic appendix. Postoperatively, she experienced multiple complications, including ileus, wound dehiscence, and complete eventration of the abdominal wall. These required two additional laparotomies and the application of vacuum-assisted closure (VAC) therapy for effective wound management. Despite the severity of maternal complications and the risk of preterm delivery, a multidisciplinary team provided coordinated care. The patient was delivered vaginally at 34 + 4 weeks using vacuum assistance. The neonate, who developed sepsis, was treated in the neonatal intensive care unit and discharged after 24 days. Both mother and child ultimately recovered. Conclusions: This case highlights the diagnostic complexity of appendicitis in late pregnancy and the potential for severe postoperative complications. Prompt surgical intervention, high clinical suspicion, and a multidisciplinary approach are crucial. Moreover, this report adds to the limited literature on the use of VAC therapy for abdominal eventration in pregnancy, demonstrating its feasibility and safety in selected cases. Full article

Background: Bisphenols (BPs) are present in medical instruments, plastic containers, and personal care products (PCPs). Bisphenol A has been replaced by its alternatives, bisphenol S, F, AF, and B. Due to the awareness of their toxicity, mixed exposure to these alternatives at the regional level has been given less attention; there is a need to study this area of research. This meta-analysis examined the exposure of urinary bisphenol A and its metabolites to blood Hypothalamic–Pituitary–Thyroid axis hormones (HPT axis hormones) in pregnant women and adult males and females. We searched Embase, PubMed, Web of Science, Cochrane Library, and CINAHL until 8 January 2025, yielding 4588 articles using the PECO framework. Quality assessment was done using AHRQ: Agency for Healthcare Research and Quality for cross-sectional and NOS: Newcastle Ottawa Scale for cohort studies, with combined exposure evaluated using random and fixed-effect models. The I² test assessed heterogeneity. We included eighteen studies for the final analysis. Fixed-effect model estimates revealed that BPA is negatively associated with thyroid-stimulating hormone (TSH) in female and male adults (β = −0.02; 95% CI = −0.04 to −0.01); (β = −0.08; 95% CI = −0.14 to −0.02). In Females, BPA was positively associated with free thyroxine, FT4 (β = 0.001, 95% CI, 0.001 to 0.001). In the male group, BPA was negatively associated with FT4 (β = −0.001, 95% CI, −0.001 to −0.001). As per pregnant women, there was no association found between exposure to bisphenols and total Thyroxine (TT4), FT4, and TSH in both trimesters (β = 0.010, 95% CI = −0.030 to 0.050); (β = 0.001, 95% CI = −0.010 to 0.010); (β = −0.001, 95% CI = −0.010 to 0.001), respectively, for early pregnancy. Bisphenols can significantly influence HPT axis hormones in adult males, females, and pregnant women. Gender-based studies were observed, concluding that adult females are more affected by bisphenol exposures than adult males. The subgroup analysis based on the regions did not reveal any associations. Full article

Background: Polypoid endometriosis is a rare variant of endometriosis that presents as a tumorous mass, making it difficult to differentiate it from a malignant tumor. It usually occurs in perimenopausal women or those undergoing hormone therapy, and its presence in a young pregnant woman is extremely uncommon. Case Presentation: This article describes a rare instance of polypoid ovarian endometriosis in a pregnant woman, a condition with few documented cases in the medical literature. An adnexal mass was discovered incidentally during a routine prenatal ultrasound, with imaging features that raised the suspicion of a neoplastic process and prompted surgery to exclude malignancy. However, histopathological examination of the excised lesion confirmed features compatible with polypoid endometriosis, without revealing evidence of cancer. This case highlights the diagnostic challenges of differentiating polypoid endometriosis from ovarian neoplasms, especially during gestation, where imaging findings can be ambiguous. In addition, the hormonal environment inherent in pregnancy may exacerbate the proliferative behavior of endometriotic lesions, thus complicating clinical evaluations. The presence of an adnexal mass in such a setting often requires careful evaluation to balance the risks of surgery with the potential consequences of delayed diagnosis. The data presented emphasize the importance of an accurate diagnosis. In conclusion, a well-coordinated approach ensures the protection of maternal and fetal health. Conclusions: By prioritizing accurate diagnosis and personalized treatment plans, physicians can minimize complications and improve outcomes for both mother and child. Full article

Differentiating peripartum cardiomyopathy (PPCM) from pregnancy-associated myocardial infarction (PAMI) is challenging due to shared risk factors. We report a case of a 35-year-old woman who suffered a seizure and cardiac arrest in the final month of her second pregnancy. Echocardiography showed a normal left ventricular ejection fraction (LVEF). Three days later, she developed heart failure symptoms and a marked reduction in LVEF. After one month of treatment, LVEF nearly normalized, but regional wall motion abnormalities subsequently appeared, prompting coronary angiography, which showed normal coronary arteries. Thus, PPCM was diagnosed. One year later, cardiac magnetic resonance imaging, performed due to her wish for another pregnancy, showed a scar consistent with a previous transmural myocardial infarction. We interpret this as a case of PAMI. Despite medical contraindications, she became pregnant one year after the infarction and delivered via C-section. Five years post-event, there are no signs of heart failure. This case lies in the gray zone of pregnancy-related cardiac complications and highlights the importance of multimodality imaging for thorough structural and functional assessment. Full article

Background/Objectives: Gestational diabetes mellitus (GDM) and maternal obesity are major global health gestation-related conditions associated with several adverse maternal and neonatal outcomes. GDM is a common gestational metabolic disorder, presented usually during the second or third trimester of pregnancy with maternal hyperglycemia due to insulin intolerance. Maternal obesity, defined as a BMI of a woman during gestation ≥ 30 kg/m², has been associated with maternal complications such as GDM, fetal macrosomia and others. Methods: The presented article is a narrative review. The aim of this study was to review scientific evidence and conduct a comprehensive analysis of GDM and maternal obesity (“diabesity”) and its immediate and late complications for both maternal and fetal/offspring wellbeing. Results: This review highlighted that gestational hyperglycemia results in oxidative and nitrogen stress development and that maternal obesity may have an impact similar to maternal diabetes, as it may cause fetal macrosomia and cardiometabolic complications later in life. Conclusions: Optimal diabetic control is responsible for the prevention of oxidative stress in diabetic pregnancies. Similarly, pregnant women should exercise regularly, receive folic acid supplementation and avoid excess weight gain during pregnancy. Breastfeeding during the first months of life has a positive impact on weight monitoring in infants born to mothers with diabesity and may be crucial in the prevention of obesity and metabolic syndrome later in life. Full article

Preterm birth is a major cause of perinatal mortality and morbidity in newborns, and its risk is increased by bacterial vaginosis (BV) during pregnancy. This multicenter prospective cohort study aimed to evaluate whether Flora select™ (FS), a newly developed real-time polymerase chain reaction test, is clinically useful for assessing the effectiveness of BV treatment during pregnancy. The vaginal microbiome characterized by relative dominance rates of Lactobacillus ≤ low (<50%), together with a positive test for Gardnerella, Prevotella, or Atopobium species, was defined as BV-FS A criterion. The vaginal microbiome characterized by Lactobacillus medium (50%≤, <80%), together with positive tests for Gardnerella plus either Prevotella species or Atopobium species, was defined as BV-FS B criterion. This study enrolled 25 pregnant women with classical BV (Nugent score ≥ 7) at initial examinations, and they met the BV-FS A (n = 23) and BV-FS B (n = 2) criteria. No woman with classical BV had a missed diagnosis of molecular BV. Treatments with metronidazole vaginal tablets resulted in the improvement of 88.0% (22/25) of classical BV, 65.2% (15/23) of BV-FS A, and 50.0% (1/2) of BV-FS B cases, whereas positive rates of Ureaplasma species in women with classical BV increased by 42.9%. Although most classical BV cases were cured following metronidazole treatments, a considerable proportion still harbored molecular BV detected by FS. Although the Nugent scoring system revealed that 80.0% (20/25) of women with classical BV (Nugent score ≥ 7) were sufficiently cured as BV-negative (Nugent scores 0–3), 5 (25%) of the 20 cured cases still met the BV-FS A/B criteria. FS particularly detected Ureaplasma species in 9 (45%) of the 20 cured cases. It could identify pregnant women who require additional treatments for residual molecular BV and Ureaplasma species. Therefore, the FS test may be clinically useful for assessing the vaginal microbiome and evaluating the effectiveness of BV treatments. Full article