ABSTRACT
At our institution, 2 of the initial 7 pregnant patients with confirmed coronavirus disease 2019 severe infection (28.6%; 95% CI, 8.2%-64.1%) developed cardiac dysfunction with moderately reduced left ventricular ejection fractions of 40%-45% and hypokinesis. Viral myocarditis and cardiomyopathy have also been reported in nonpregnant coronavirus disease 2019 patients. A case series of nonpregnant patients with coronavirus disease 2019 found that 33% of those in intensive care developed cardiomyopathy. More data are needed to ascertain the incidence of cardiomyopathy from coronavirus disease 2019 in pregnancy, in all pregnant women with coronavirus disease 2019, and those with severe disease (eg, pneumonia). We suggest an echocardiogram in pregnant women with coronavirus disease 2019 pneumonia, in particular those necessitating oxygen, or those who are critically ill, and we recommend the use of handheld, point-of-care devices where possible to minimize contamination of staff and traditional large echocardiogram machines.
Subject(s)
COVID-19/therapy , Cardiomyopathies/therapy , Cesarean Section , Heart Failure/therapy , Pregnancy Complications, Cardiovascular/therapy , Pregnancy Complications, Infectious/therapy , Respiration, Artificial , Adult , Anti-Arrhythmia Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Anticonvulsants/therapeutic use , Blood Gas Analysis , COVID-19/complications , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing , Cardiomyopathies/diagnosis , Cardiomyopathies/etiology , Cardiomyopathies/physiopathology , Diabetes, Gestational , Diuretics/therapeutic use , Echocardiography , Enzyme Inhibitors/therapeutic use , Female , Fever , Furosemide/therapeutic use , Heart Arrest/etiology , Heart Arrest/therapy , Heart Failure/diagnosis , Heart Failure/etiology , Heart Failure/physiopathology , Humans , Hydroxychloroquine/therapeutic use , Hypoxia/etiology , Hypoxia/therapy , Intubation, Intratracheal , Magnesium Sulfate/therapeutic use , Metoprolol/therapeutic use , Middle Aged , Obesity, Maternal/complications , Oxygen Inhalation Therapy , Point-of-Care Systems , Pre-Eclampsia/drug therapy , Pre-Eclampsia/physiopathology , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/physiopathology , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/physiopathology , Return of Spontaneous Circulation , SARS-CoV-2 , Severity of Illness Index , Stroke Volume , Tachycardia/drug therapy , Tachycardia/physiopathology , Tachycardia, Supraventricular/drug therapy , Tachycardia, Supraventricular/etiologyABSTRACT
Subcapsular liver hematoma (SLH) is a rare condition that is associated with preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. A high level of suspicion, early diagnosis, and coordinated, intensive multidisciplinary management are necessary to monitor for serious complications and prevent death. Options include conservative management, hepatic resection, hepatic artery ligation and liver transplantation. This paper describes a 34-year-old woman with HELLP syndrome who developed a large grade III SLH that was managed conservatively.
ABSTRACT
BACKGROUND: Late postpartum eclampsia is more frequently recognized than past reports indicate. This report describes the association of a reversible encephalopathy in a woman with late postpartum eclampsia. CASE: A woman with lupus nephritis presented 7 days postpartum with eclampsia. Postseizure findings included dramatic short-term memory loss. Although a computed tomography scan was negative, subsequent magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) demonstrated vascular changes associated with a reversible encephalopathy. Conservative treatment with analeptic and antihypertensive therapy allowed a rapid resolution of all symptomatology. CONCLUSION: In women with eclampsia and unusual neurologic findings, an MRI/MRA may be useful even in the presence of a negative computed tomography scan.
Subject(s)
Eclampsia/diagnosis , Memory Disorders/etiology , Posterior Leukoencephalopathy Syndrome/complications , Posterior Leukoencephalopathy Syndrome/diagnosis , Puerperal Disorders/diagnosis , Adult , Female , Humans , Lupus Nephritis/complications , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Memory Disorders/diagnosis , Memory, Short-Term , PregnancyABSTRACT
Background. We report a case of familial hyperlipidemia in pregnancy that resulted in hemorrhagic pancreatitis. Case. A patient at 27-week gestation was admitted for recurrent pancreatitis secondary to severe hyperlipidemia. With conservative care, the patient improved but on the fourth day of admission she experienced a sudden onset of hypotension and was diagnosed with hemorrhagic pancreatitis. Conclusion. Pancreatitis caused by hyperlipidemia is an uncommon event during pregnancy. A familiarity with the severe complications associated with this potentially life-threatening condition is important.
ABSTRACT
BACKGROUND: The risk of stillbirth in fetuses diagnosed with gastroschisis may range from 6% to 12%. Currently there is no agreement on the role of antepartum fetal surveillance, as fetal death within days of reassuring antepartum fetal testing has been reported. CASES: In 2 cases of fetal gastroschisis, fetal gastric distension was associated with decreased fetal movements and nonreactive nonstress tests. Despite reassuring biophysical profile and normal umbilical artery Doppler sonograms, 1 fetus underwent intrauterine death. CONCLUSION: Poor prognostic factors in fetal gastroschisis may include a new finding of persistent fetal gastric distension in association with decreased fetal movements or a nonreactive nonstress test.
Subject(s)
Gastroschisis/complications , Gastroschisis/diagnostic imaging , Prenatal Diagnosis , Adolescent , Adult , Female , Fetal Death , Fetal Distress , Fetal Movement , Humans , Pregnancy , Prognosis , Stomach/diagnostic imaging , Stomach/embryology , Stomach/pathology , Ultrasonography, PrenatalABSTRACT
At 38 weeks of gestation, a woman with a previously unremarkable pregnancy was noted to have fetal tachycardia without obvious cause. Fetal echocardiography resulted in a presumptive diagnosis of fetal atrial flutter with a 2:1 block. The newborn resumed the same rhythm. The neonate underwent transesophageal incremental overdrive pacing. A normal sinus rhythm was restored. The infant had no recurrence to age 6 months.
