Idiopathic granulomatous mastitis with erythema nodosum simulating breast abscess in pregnancy: A case report.

Granulomatous mastitis is a rare benign inflammatory condition of the breast and is known to be associated with pregnancy. A 25-year-old Hispanic G2P1 at 17 weeks gestation presented to the emergency department with findings consistent of a breast abscess. The abscess failed to resolve with incision and drainage followed by multiple courses of antibiotic therapy. A biopsy was then obtained and yielded a diagnosis of granulomatous lobulitis. The patient was treated with steroids and her symptoms resolved. Granulomatous lobulitis may present with characteristics of various clinical entities including neoplasm or, as in this case, abscess. Clinicians should consider a diagnosis of granulomatous mastitis in cases of recalcitrant breast abscess.

Delivery route following elective induction of labor at term: analysis of 807 patients.

BACKGROUND: The purpose of this study is to compare mode of delivery for both nulliparous and multiparous women at term that underwent elective induction of labor to those who arrived in spontaneous labor. METHODS: Medical records of 807 deliveries were reviewed. There were 566 labor patients and 241 elective induction patients. RESULTS: Women who underwent elective induction of labor were more likely to undergo cesarean delivery compared to those women who arrived in spontaneous labor (41.1% versus 9.9%, P = 0.001). This was true for both nulliparous women (49% versus 31%, P < 0.0001), and multiparous women (22.7% versus 1.6%, P < 0.0001). The rate of operative vaginal delivery was also increased in the elective induction of labor group (8.4% versus 3.6%, P < 0.0001). Operative vaginal delivery was statistically significant in multiparous women (21% versus 4.1%, P < 0.0001), but not in nulliparous women (10.1% versus 9.8%, P = NS). CONCLUSION: Elective induction of labor at term is associated with an increased risk of cesarean section in both nulliparous and multiparous women. There is also an increased risk of an operative vaginal delivery in multiparous women who underwent elective induction of labor.

A case of isolated elevated copper levels during pregnancy.

INTRODUCTION: Outside of Wilson's Disease, abnormal copper metabolism is a rare condition. In pregnancy, excess copper levels can be associated with intrauterine growth restriction, preeclampsia and neurological disease. CASE REPORT: A 32 year old Gravida 4 para 2012 with an obstetrical history complicated by elevated copper levels presented for routine prenatal care. Her children had elevated copper levels at birth, with her firstborn child being diagnosed with autism and suffering three myocardial infarctions and being treated for elevated copper levels. During her prior pregnancies, she declined treatment for her elevated copper levels. During this pregnancy, she had declined chelation therapy and instead choose zinc therapy. She delivered a healthy infant with normal copper levels. CONCLUSION: Alterations in copper metabolism are rare, the consequences in pregnancy can be devastating. While isolated elevations of copper in pregnancy is exceedingly rare, it is treated the same as Wilson's disease. The goal is to prevent fetal growth restricting and neurological sequelae in the newborn and preeclampsia in the mother. Counseling, along with treatment options and timely delivery can greatly improve neonatal and maternal outcome.

Clinical Presentation and Conservative Management of Tympanic Membrane Perforation during Intrapartum Valsalva Maneuver.

Background. Tympanic membrane perforation may occur when ear pressures are excessive, including valsalva maneuver associated with active labor and vaginal delivery. A pressure differential across the eardrum of about 5 psi can cause rupture; the increased intraabdominal pressure spikes repeatedly manifested by "pushing" during second-stage labor easily approach (and may exceed) this level. Material and Method. We describe a healthy 21-year old nulliparous patient admitted in active labor at 39-weeks' gestational age. Results. Blood appeared asymptomatically in the left ear canal at delivery during active, closed-glottis pushing. Otoscopic examination confirmed perforation of the left tympanic membrane. Complete resolution of the eardrum rupture was noted at postpartum check-up six weeks later. Conclusion. While the precise incidence of intrapartum tympanic membrane rupture is not known, it may be unrecognized without gross blood in the ear canal or subjective hearing loss following delivery. Only one prior published report on tympanic membrane perforation during delivery currently appears in the medical literature; this is the first English language description of the event. Since a vigorous and repetitive valsalva effort is common in normal vaginal delivery, clinicians should be aware of the potential for otic complications associated with the increased intraabdominal pressure characteristic of this technique.