Pregnancy and Birth

New guidelines from the American College of Obstetricians and Gynecologists contain recommendations to help prevent, manage and treat blood clots in pregnant women. Blood clots are a leading cause of maternal morbidity, with pregnancy associated with a four-fold increase in the risk of thromboembolism. As such, ACOG released “Thromboembolism in Pregnancy” in the September 2011 issue of Obstetrics & Gynecology to guide clinicians in the prevention, management and treatment of blood clots during pregnancy.

OBGYN.net Conference CoverageFrom American Association of Reproductive Medicine55th Annual Meeting of ASRM held conjointly with CFAS- Toronto, Ontario, Canada - September, 1999

Asherman’s Syndrome is an extremely common and occasionally complicated disease entity. It takes many forms and can follow a routine D&C, a hysteroscopy, a delivery or even a surgical procedure such as a myomectomy or polypectomy. This case study from Dr. Alan Copperman reviews diagnosis and treatment options.

Rates of asthma continue to rise in the general population, which translates to increased rates among women who are pregnant. When this happens, asthma not only affects the mother but the fetus as well. However, the specific effects are unclear. With that in mind, Dr Vanessa Murphy, postdoctoral research fellow school of medicine and public health at the University of Newcastle in Australia, and colleagues conducted a meta-analysis to determine if maternal asthma is associated with adverse perinatal outcomes.

Laparoscopic Myomectomy uses a small telescope placed through the belly button along with several small instruments to remove fibroids from the uterus. The technique of actually removing the fibroid from the uterus is similar to that of an abdominal myomectomy except we use small instruments placed through the abdominal wall. Once the fibroid is freed from the uterus it needs to be removed from the abdomen. In order to remove a large fibroid from a small incision we use an instrument called a morcellator, to cut it into pieces small enough to be removed through the small incisions.

In the United States, 20% of preschoolers are overweight and, of those, 50% are obese. Children who are obese are more likely to be obese in adulthood and thus are at greater risk for chronic diseases such as heart disease, stroke, and type 2 diabetes mellitus. A baby’s risk of becoming overweight or obese is reduced with each month of breastfeeding. The American Academy of Pediatrics recommends that healthy babies be given only breast milk for the first 6 months of life.

When an adverse outcome and missed diagnosis occur, problems in the organization of care and issues with communication between caregivers are frequently the true cause rather than an isolated error made by one practitioner. In recent years, seeking to capitalize on frustration with the health care delivery, plaintiff’s lawyers have sought to identify disagreements among providers in patient management and/or errors within the patient care management system. Allegations that nonphysician personnel should have recognized a problem with the care plan and accessed the “chain of command” in an effort to alter the clinical course are included in these types of claims.

What are echogenic intracardiac foci (EIF)? EIF are small, echogenic lesions seen (on sonography) inside the left or right ventricles of the fetal heart within the papillary muscles or chordae tendinae. These lesions are not attached to the wall of the ventricles.

Biophysical Profile and Color Doppler Ultrasound in the High Risk Pregnancy Presented by: Dr. Farzad Afzali Kasra Ultrasound Clinic   • BPP is applying to detect prenatal asphyxia • Doppler ultrasound is a modality for detecting fetal hypoxia and acidosis • Doppler can also predict later pre- eclampsia at the 24-26 gestational weeks.   • Hypoxia: Low oxygen tension • Asphyxia: Low oxygen and high CO2 • Ischemia: Drop in blood flow Comment So, Doppler ultrasound can predict fetal distress sooner than BPP   • Prediction of the effect of an asphyxial insult on the fetus requires a measure of:

The foetal blood in the chorionic villi is separated from the maternal blood, in the intervillous spaces, by the Placental Barrier which is composed of :1. Endothelium of the foetal blood vessels, 2. The villous stroma, 3. The cytotrophoblast, and 4. The syncytiotrophoblast.

HELLP Syndrome as a Separate Entity Dr. Mohammed Abdalla EGYPT, Domiat G. HospitalHELLP Syndrome May it be a separate entity? yes   HELLP, a syndrome characterized by hemolysis, elevated liver enzyme levels and a low platelet count, is an obstetric complication that is frequently misdiagnosed at initial presentation. Many investigators consider the syndrome to be a variant of preeclampsia, but it may be a separate entity.

DEFINITIONExcessive blood loss sufficient to affect the general condition of the mother.INCIDENCELow parity 0.3%Para 4 or > 2%Babiszki et al, 1999

Generalized skin thickening of more than 5mm and / or two or more of the following • Pericardial Effusion • Pleural Effusion • Ascites • Placental Enlargement