ABSTRACT
OBJECTIVE: To describe the maternal and neonatal outcome of a twin pregnancy in a renal transplant recipient patient and reviewe the current literature on this theme. METHODS: A case of 27 years old woman with a twin pregnancy arisen spontaneously in a renal transplant recipient from living donor characterized by an episode of slight anemia, mild hypertension, and a subsequent optimal maternal/neonatal outcome. During admission, the patient was treated with iron therapy, nifedipine, and methyldopa due to anemia and hypertension episodes. Strict monitoring of patient's blood and urinary parameters, ultrasound fetues evaluation, and fetal lung maturity induction was performed. RESULTS: Both anemia and hypertension were controlled through pharmacological intervention. During the second admission, the serum creatinine was 185 µmol/L and urine examination showed a proteinuria of 0.3 g/L. Ultrasound evaluation showed fetal wellness for both twin. Patient underwent caesarean section and gave birth to two healthy babies. CONCLUSIONS: It is necessary to define more strict criteria for the management of women with twin pregnancy and a history of renal transplantation to ensure the better maternal and neonatal outcome.
Subject(s)
Anemia/pathology , Hypertension, Pregnancy-Induced/pathology , Kidney Transplantation/rehabilitation , Pregnancy, Twin , Transplant Recipients , Adult , Anemia/complications , Anemia/drug therapy , Female , Humans , Hypertension, Pregnancy-Induced/drug therapy , Iron/therapeutic use , Methyldopa/therapeutic use , Nifedipine/therapeutic use , Pregnancy , Pregnancy Complications, Hematologic/drug therapy , Pregnancy Complications, Hematologic/pathologyABSTRACT
BACKGROUND: The effect of epidural analgesia on labor and effective breastfeeding is still being debated. The aim of this study is to define its impact on the trend of labor, the newborns' well-being, and early breastfeeding. METHODS: We considered first-term physiologic pregnant women who delivered by the vaginal route. We divided them into two groups: group A received epidural analgesia during labor, whereas group B received no analgesia. We recorded maternal age, gestational age, modality of delivery, length of labor, and length of active labor. All newborns received skin-to-skin contact; early breastfeeding was encouraged. We recorded data on birth weight and length, Apgar score at minutes 1 and 5, type of crying, neonatal reactivity, and time between birth and exposure to the breast. Statistical significance was considered for p<0.05. RESULTS: Of 934 pregnant women who delivered by the vaginal route, 317 patients required labor analgesia, and 245 patients agreed to participate in our study. Only 128 patients met inclusion criteria. We randomized them in 64 women in group A and 64 women in group B. Data on maternal age, gestational age, type of delivery, neonatal birth weight and length, and Apgar score showed no significant differences. Total length of labor was 363.58±62.20 minutes in Group A versus 292.30±64.75 minutes in group B (p<0.001). The length of active labor showed no significant difference. Among neonatal parameters we found a statistically significant difference only for length of first breastfeeding, with a mean duration of <30 minutes in 62.2% in group A versus 29.3% in Group B (p<0.001). CONCLUSIONS: Epidural analgesia has little effect on trend of labor and duration of first breastfeed and none on neonatal outcome. A new protocol of epidural analgesia may solve these side effects.
Subject(s)
Analgesia, Epidural/methods , Breast Feeding , Cesarean Section/statistics & numerical data , Delivery, Obstetric/statistics & numerical data , Pregnancy Outcome , Adult , Analgesia, Epidural/adverse effects , Analgesia, Obstetrical/adverse effects , Analgesia, Obstetrical/methods , Birth Weight/drug effects , Breast Feeding/statistics & numerical data , Female , Humans , Infant, Newborn , Mothers , Oxytocin/administration & dosage , Pregnancy , Pregnancy Complications/chemically induced , Prospective Studies , Time FactorsABSTRACT
INTRODUCTION: Synchronous gynecological tumors are uncommon. Identifying the primary site of lymphatic spread may be difficult. METHODS: Two women with synchronous squamous cervical and adenosquamous endometrial cancers (patient A) and squamous cervical and serous borderline ovarian tumors (patient B) entered retrospectively this study. Both patients had pelvic nodal metastases of unknown origin. Uterine cervix, endometrium, and lymph nodes were tested for human papillomavirus DNA using high-sensitive polymerase chain reaction, followed by oligonucleotide microarray for genotyping. RESULTS: Human papillomavirus 16 DNA was extracted from portio vaginalis and pelvic nodes of both women. Viral homology between cervical and lymph nodal lesions helped to identify the primary metastasizing tumors in both patients. CONCLUSIONS: Human papillomavirus testing on pelvic lymphatic tissue represents a feasible tool to detect the primary site of lymphatic spread in synchronous gynecological malignancies, when uterine cervix is involved.
