Embarazos exitosos en hemodiálisis crónica: experiencia de un único centro / Pregnancy during dialysis: Experience in six patients

Background: The frequency of pregnancies during dialysis is increasing. This condition requires changes in the dialysis schedule and nutritional approach. Aim: To report the experience in six patients with terminal kidney disease who became pregnant. Material and Methods: Retrospective review of medical records of women with terminal kidney disease in dialysis who became pregnant in a period of 27 years. Results: We recorded six successful pregnancies among women in hemodialysis treatment aged 32 ± 4 years. The mean dialysis-time per week was 19.5 ± 2.7 hours and Kt/V was 1.55 ± 0.17. The mean systolic blood pressure was 130 ± 13.3 mmHg. The mean packed cell volume of the group increased from 22.7% during pre-gestational stage to 30.2% during third trimester of pregnancy. All patients received an intensive treatment for anemia. The most common symptom of pregnancy was hyperemesis. The mean gestational age (GA) at diagnosis was 13.4 ± 4.7 weeks. All patients had preterm deliveries at a GA of 33 ± 1.7 weeks, and 66% of offspring were appropriate for gestational age. Conclusions: A multidisciplinary approach allows high rate of successful pregnancies during hemodialysis.

Spontaneous perforation of choledochal cyst and hyperemesis gravidarum.

A 28-year-old primigravida at seven weeks gestation presented to the Accident & Emergency Department complaining of vomiting for five days. She was admitted and managed as a case of hyperemesis gravidarum. Two days later she developed abdominal distension. Ultrasound scan revealed ascites and common bile duct dilatation. The ascitic fluid was bile stained. At emergency laparotomy spontaneous perforation of the supraduodenal part of the common bile duct was seen. This was closed around a T-tube. She then underwent medical termination of pregnancy. The post-operative T-tube cholangiogram was suggestive of a type I choledochal cyst. Three months later this was excised and biliary enteric continuity restored by performing a hepaticojejunostomy. To the best of our knowledge, spontaneous rupture of a choledochal cyst in a patient of hyperemesis gravidarum has not been reported before. In this article, we discuss treatment options for choledochal cyst during pregnancy.

Helicobacter pylori seropositivity among patients with hyperemesis gravidarum

There are also reports from other parts of the world indicating the presence of significant association of H. pylori infection and hyperemesis gravidarum, a bothersome condition that affects pregnant women. To test the hypothesis that whether H. pylori infection is associated with hyperemesis gravidarum among Iranian H.P carriers. From November 1999 to February 2001, we enrolled 54 pregnant women with hyperemesis gravidarum and 53 asymptomatic pregnant women [control group] in a prospective study. Using a specific serum IgG against H. pylori, the seroprevalence of H. pylori infection was determined in both study and control groups. Serologically positive H. pylori infection was detected in 44 [82%] out of 54 patients with hyperemesis gravidarum and 29 [55%] out of 53 asymptomatic pregnant women. The prevalence was significantly [p<0.01] higher in those with hyperemesis gravidarum than those in the control group. The mean SD of the IgG titer in the study group [69.7 77.5] was significantly [p<0.01] more than that of the control group [34.5 47.8]. H. pylori infection may cause hyperemesis gravidarum

Alteraciones hepáticas durante el embarazo

During pregnancy, biochemical evaluation of the liver is affected in many significan ways. Alkaline phosphatase increases in the third trimester and rapidly returns to the normal limits after delivery. This increase is clearly secondary to the placental isoenzyme. AST and ALT are usually normal and GGTP doens't changes significantly. Hepatic flow remains unchanged and estrogen levels increase leading to several metabolic and cutaneous changes, such as hepatic palms and systemic vasodilatation. Liver diseases that occur during pregnancy can be classified as follows: a) Entities exclusive of pregnancy, b) Pregnancy associated diseases, and c) Previous liver diseases. The first group included: 1. Cholestasis of pregnancy, described mainly in Scandinavian and Chilean women and characterized by pruritus in the third trimester, biochemical evidence of cholestasis, increased frequency of cholelitiasis and fetal problems. The entity usually recurs in other pregnancies or during exposure to estrogens. Prognosis is good and the patient improves rapidly after delivery. Several reports have shown that s-Adenosyl-Methionine can be effective. 2) Hyperemesis gravidarum, characterized by protacted vomiting associated to significant malnutrition. Liver function tests are usually abnormal and the liver biopsy shows no specific changes. Prognosis is usually good and most of the patients improved spontaneously. 3) Acute fatty liver, is one of the causes of liver failure during the third trimester and is associated with a very high maternal mortality. Clinically the patient presents with encephalopathy, biochemical evidence of liver failure and microvesicular fat in the liver...

Hiperemese gravídica / Hyperemesis gravidarum

Abordam-se, através de extensa revisäo de literatura, os aspectos controvertidos relacionados à hiperemese gravídica (HG), principalmente quanto à incidência e etiopatogenia. Dentre inúmeras teorias aventadas para explicar a gênese da HG, sobressaem-se os fatores endócrinos e psicossomáticos. O diagnóstico da HG é feito baseado em dados clínicos e por exclusäo, uma vez que inúmeras patologias podem cursar com náuseas e vômitos na gravidez. Näo existem alteraçöes anátomo-patológicas específicas para esta afecçäo. A mortalidade por HG constitui na atualidade um evento de exceçäo. No que se refere à terapêutica, aspectos ligados à hidrataçäo, esquema dietético, sedaçäo, correçäo de distúrbios ácido-básicos e eletrolíticos, amparo psíquico e aborto terapêutico säo detalhadamente abordados