Pregnancy and Birth

AMNIOTIC FLUID EMBOLISM •AFE us thought to occur when amniotic fluid, fetal cells, hair, or other debris enter the maternal circulation. • Ricardo Meyer (1926); reported the presence of fetal cellular debris in the maternal circulation • Steiner and Luschbaugh (1941) described the autopsy findings of eight cases of AFE. Until 1950, only 17 cases had been reported • AFE was not listed as a distinct heading in causes of maternal mortality until 1957 when it was labeled as obstetric shock • Since then more than 400 cases have been documented, probably as a result of an increased awareness.

The FDA has issued a drug safety communication about fluconazole: long-term use at high dosages (400 to 800 mg/d) may be associated with a rare and distinct set of birth defects in infants whose mothers were treated with the drug during the first trimester of pregnancy.1 This risk does not appear to be associated with a single, low dose (150 mg) of fluconazole to treat vaginal yeast infection (candidiasis).

Insufficient thyroid activity during pregnancy is harmful to maternal and fetal health as well as to the child’s future intellectual development, according to emerging data that led to new guidelines released by the American Thyroid Association (ATA). These guidelines highlight the role of thyroid function tests, hypothyroidism, thyrotoxicosis, iodine, thyroid antibodies and miscarriage or preterm delivery, thyroid nodules and cancer, postpartum thyroiditis, screening recommendations during pregnancy, and areas for future research.

Proper functioning of the placenta-the life support system for the fetus-is crucial for a healthy pregnancy and healthy fetus. When placenta disorders arise, so does the likelihood of neurologic abnormalities in the fetus. Specifically, two population-based studies have shown an association between placental infarction and cerebral palsy (CP).

With the rate of diabetes and prediabetes/glucose intolerance increasing, it is imperative for clinicians to help reduce the risk of their patients developing full-blown diabetes as well as to help patients manage the illness.

Data increasingly point to the benefits of breastfeeding, both for the infant and for the mother. Now, a new study points to the relationship between postpartum depression and negative early breastfeeding experiences, just as the Centers for Disease Control and Prevention sheds light on the lack of breastfeeding support for women in hospitals.

We received the following comment from Mitch Nudelman, MD, regarding the use of office-based uterine evacuation in early pregnancy failure. Seems there’s more to the issue than the lack of physician training highlighted in a recent study.