Post-splenectomy splenic artery aneurysm rupture in an atypical presentation of pre-eclampsia.

Splenic artery aneurysm rupture in pregnancy is an uncommon catastrophic event. We report a patient who presented at 15 3/7 weeks with atypical pre-eclampsia. After termination was recommended, the patient chose to continue the pregnancy. Reversal of clinical and laboratory abnormalities occurred and the patient was discharged. The patient presented again at 24 weeks with severe pre-eclampsia and residual splenic artery aneurysm rupture, at the site of a splenectomy that had been performed 24 years previously.

Are women who are Jehovah's Witnesses at risk of maternal death?

OBJECTIVE: The purpose of this study was to determine the rates of obstetric hemorrhage and maternal mortality in women who are Jehovah's Witnesses and to evaluate a protocol that uses erythropoietin to optimize the red blood cell mass before delivery. STUDY DESIGN: Obstetric outcomes were described for all of the women who were Jehovah's Witnesses and who delivered at Mount Sinai Medical Center during an 11-year period. The risk of maternal death was compared with our general obstetric population during this interval. RESULTS: A total of 332 women who were Jehovah's Witnesses had 391 deliveries. An obstetric hemorrhage was experienced in 6% of this population. There were 2 maternal deaths among the women who were Jehovah's Witnesses, for a rate of 512 maternal deaths per 100,000 live births versus 12 maternal deaths per 100,000 live births (risk ratio, 44; 95% CI, 9-211). Erythropoietin was associated with a nonsignificant increase in hematocrit level. CONCLUSION: Women who are Jehovah's Witnesses are at a 44-fold increased risk of maternal death, which is due to obstetric hemorrhage. Patients should be counseled about this risk of death, and obstetric hemorrhage should be aggressively treated, including a rapid decision to proceed to hysterectomy when indicated.

Prenatal diagnosis and management of abnormalities in the urologic system.

We have reviewed the prenatal diagnosis and management of abnormalities in the urologic system. Urologic anomalies may be caused by embryologic aberrations, genetic disease, or a nonrandom association with other structural abnormalities. There is a wide range of prognoses, depending on the cause and the impact of the anomaly on the production of amniotic fluid. Management focuses on obtaining an accurate prenatal diagnosis, providing appropriate counseling, and ensuring the proper surveillance or treatment before and after birth.

Altered apoptosis levels in hearts of human fetuses with Down syndrome.

OBJECTIVE: We sought to test the hypothesis that apoptosis is a method of remodeling in second-trimester fetal heart development. We also hypothesized that hearts from fetuses with Down syndrome would have different levels of apoptosis than would control hearts, associated with their abnormal heart development. STUDY DESIGN: We obtained hearts from fetuses between 14 and 23 weeks' gestation with Down syndrome without anomalies (n = 10) and with the atrioventricular canal defect (n = 5). These hearts were compared with control hearts without anomalies (n = 5). Hearts were subjected to in situ end-labeling of deoxyribonucleic acid to test for evidence of apoptosis. The apoptotic indices were compared by anatomic location. RESULTS: Apoptotic nuclei were observed in each anatomic location in every category. The apoptotic indices were significantly lower in the atrial myocardial tissues of fetuses with Down syndrome than in control preparations (P < .05). The apoptotic index did not differ significantly in the atrial septum, ventricular myocardium, or ventricular septum. CONCLUSIONS: Apoptosis occurs in human fetal hearts during the second trimester. The different levels observed in our study suggest a different remodeling process in hearts of fetuses with Down syndrome than in hearts of control fetuses. Further study is needed to determine whether the different level of apoptosis associated with Down syndrome is due to the abnormal karyotype or to the presence of an anomaly.

Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome: a review of diagnosis and management.

Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a form of severe preeclampsia that threatens the gravida and her fetus. In this report, the diagnostic criteria and maternal and fetal risks of HELLP are defined. Prompt recognition and treatment in tertiary centers is emphasized, because the prognosis can be adversely affected by delayed or less than optimal diagnosis and treatment. Management guidelines are offered for treating this disorder. The potential roles of corticosteroids, plasmapheresis, and expectant management are critically evaluated. Subsequent pregnancy outcome, contraception, and preventative strategies are considered.

PIP: Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a form of severe preeclampsia which threatens the health and life of both pregnant women and their fetuses. Primary and consulting obstetricians therefore need to know how to recognize and treat the condition. The diagnostic criteria and maternal and fetal risks of HELLP are defined, with stress upon the prompt recognition and treatment of the condition in tertiary centers, because prognosis can be adversely affected by delayed or suboptimal diagnosis and treatment. Management guidelines are offered for treating the disorder, and the potential roles of corticosteroids, plasmapheresis, and expectant management are critically evaluated. Moreover, subsequent pregnancy outcome, contraception, and preventative strategies are considered.