Subject(s)
Analgesics, Opioid/adverse effects , Maternal Exposure/adverse effects , Opiate Overdose/etiology , Opioid-Related Disorders/etiology , Puerperal Disorders/chemically induced , Adolescent , Adult , Analgesics, Opioid/administration & dosage , Child , Emergency Service, Hospital/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Humans , Logistic Models , Middle Aged , Odds Ratio , Postpartum Period , Prenatal Care/statistics & numerical data , Risk Factors , Young AdultSubject(s)
Hematoma/chemically induced , Labor, Induced/adverse effects , Postpartum Hemorrhage/chemically induced , Puerperal Disorders/chemically induced , Uterine Rupture/chemically induced , Adult , Female , Humans , Oxytocics/adverse effects , Oxytocin/adverse effects , Pregnancy , Prostaglandins/adverse effectsSubject(s)
Antidepressive Agents/adverse effects , Antipsychotic Agents/pharmacology , Bipolar Disorder/diagnosis , Depressive Disorder, Major/diagnosis , Puerperal Disorders/diagnosis , Adult , Antidepressive Agents/administration & dosage , Antipsychotic Agents/administration & dosage , Bipolar Disorder/chemically induced , Bipolar Disorder/drug therapy , Depression, Postpartum/diagnosis , Depression, Postpartum/drug therapy , Depressive Disorder, Major/drug therapy , Female , Humans , Puerperal Disorders/chemically induced , Puerperal Disorders/drug therapy , Young AdultABSTRACT
BACKGROUND: Although the incidence of maternal mortality during Caesarean delivery remains very low, the rate of severe maternal morbidity is increasing. Improvements in obstetric anaesthetic practice have resulted in a dramatic reduction in the risk of maternal death from general anaesthesia. Less clear is whether the risk of severe maternal morbidity differs according to mode of anaesthesia for women undergoing Caesarean delivery. We analysed the association between the mode of anaesthesia and severe maternal morbidity during Caesarean delivery using a nationally representative inpatient database. METHODS: We identified 89 225 women undergoing scheduled Caesarean delivery from the Diagnosis Procedure Combination database in Japan, 2010-2013. We defined severe maternal morbidity as the presence of any life-threatening complications and identified women with severe maternal morbidity from the database. Propensity score-matched analysis was carried out to compare the odds of severe maternal morbidity between women who underwent general vs neuraxial anaesthesia. RESULTS: Of 89 225 women, 10 058 received general anaesthesia and 79 167 received neuraxial anaesthesia. In the propensity score-matched analysis with 10 046 pairs, a higher incidence of severe maternal morbidity was observed among patients receiving general (2.00%) rather than neuraxial anaesthesia (0.76%). The odds ratio of severe maternal morbidity was 2.68 (95% CI, 1.97-3.64) among women receiving general compared with neuraxial anaesthesia. CONCLUSIONS: For scheduled Caesarean delivery, general anaesthesia compared with neuraxial anaesthesia is associated with greater odds for severe maternal morbidity. However, we should be cautious with interpretation of these findings because they may be explained by confounding indications.
Subject(s)
Anesthesia, Epidural/adverse effects , Anesthesia, General/adverse effects , Anesthesia, Obstetrical/adverse effects , Cesarean Section , Puerperal Disorders/chemically induced , Adult , Databases, Factual , Female , Humans , Japan , Pregnancy , Young AdultABSTRACT
OBJECTIVE: To compare effectiveness and tolerability of carbetocin versus syntometrine in prevention of postpartum hemorrhage (PPH) after cesarean section (CS). METHODS: A double-blind randomized study conducted on 300 pregnant subjected randomly either to single 100 µg IV dose of carbetocin (150 women) or combination of 5 IU oxytocin and 0.2 mg ergometrine (150 women) after fetal extraction and before placental removal. Primary outcome parameter was the occurrence of PPH. Other parameters were hemoglobin and hematocrit changes, the need of additional oxytocic, hemodynamic changes and occurrence of side effects. RESULTS: There was no significant difference between the two study groups regarding hemoglobin and hematocrit at start of CS and after 2 days of surgery and mean blood loss during the operation (p > 0.05). There was a highly significant difference between the two study groups regarding incidence of primary PPH (2.7% versus10%) and the need of additional oxytocic (3.3% versus17.3%). Women in oxytocin group showed a statistically significant lower systolic and diastolic blood pressure at 1, 5 and 30 min than women in carbetocin group. Women in carbetocin group experienced more metallic taste, flushing, headache, dizziness, dyspnea and itching, while women in oxytocin methergine group experienced more palpitations. CONCLUSIONS: Carbetocin is a reasonable effective alternative to syntometrine in prevention of PPH after cesarean delivery.
Subject(s)
Cesarean Section/adverse effects , Ergonovine/therapeutic use , Oxytocin/analogs & derivatives , Postpartum Hemorrhage/etiology , Postpartum Hemorrhage/prevention & control , Adult , Double-Blind Method , Ergonovine/adverse effects , Female , Humans , Infant, Newborn , Oxytocics/adverse effects , Oxytocin/adverse effects , Oxytocin/therapeutic use , Postoperative Hemorrhage/etiology , Postoperative Hemorrhage/prevention & control , Pregnancy , Puerperal Disorders/chemically induced , Young AdultABSTRACT
BACKGROUND: Postpartum reversible cerebral vasoconstriction syndrome is one of the rare reversible cerebral vasoconstriction syndromes. The clinical presentation is usually characterized by recurrent headache, focal neurological deficit, and reversible cerebral vasoconstriction seen on cerebral angiography. CASE PRESENTATION: We report a case of a 35-year-old Yemeni woman who presented with headache and focal neurological deficits that occurred 10 days after delivery, with segmental narrowing of cerebral arteries on angiography. She had significant clinical and radiological improvement on follow-up. CONCLUSIONS: The presentation of our patient's reversible cerebral vasoconstriction syndrome is unusual as she has two possible precipitating factors. In addition to being in the postpartum state, she also has a long history of chewing khat, a vasoactive substance commonly used by immigrants from Yemen. We hope that this case report will increase awareness among physicians about the use of this plant by immigrants from the horn of Africa and Yemen.
Subject(s)
Catha/adverse effects , Puerperal Disorders/chemically induced , Puerperal Disorders/physiopathology , Vasoconstriction/physiology , Vasospasm, Intracranial/chemically induced , Vasospasm, Intracranial/physiopathology , Adult , Brain/blood supply , Brain/diagnostic imaging , Brain/physiopathology , Cerebral Angiography , Female , Humans , Magnetic Resonance Angiography , Puerperal Disorders/diagnostic imaging , Syndrome , Vasospasm, Intracranial/diagnostic imaging , YemenABSTRACT
BACKGROUND: There are multiple clinical manifestations of hypercalcemia and several causes of hypercalcemia. Hypercalcemia caused by milk-alkali syndrome is increasing in frequency. CASE REPORT: A 26-year-old woman presented after having undergone caesarian section. She complained of severe myalgias, arthralgias, an inability to ambulate, nausea, vomiting, abdominal pain, and marked depression. Each of these symptoms has a broad differential diagnosis, but when considered together the theme "stones, bones, moans, and groans," seen in patients with hypercalcemia, is evident. This patient was found to have hypercalcemia caused by milk-alkali syndrome related to the ingestion of calcium carbonate. Her symptoms and hypercalcemia resolved with treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware of the many different symptoms of hypercalcemia. This case emphasizes the need for a careful medication history for any patient presenting with hypercalcemia, including over the counter medications. Physicians should have a high level of suspicion for milk-alkali syndrome in patients with hypercalcemia because milk-alkali syndrome is no longer a rare etiology but rather one of the most common causes of hypercalcemia.
Subject(s)
Antacids/adverse effects , Calcium Carbonate/adverse effects , Hypercalcemia/chemically induced , Hypercalcemia/diagnosis , Puerperal Disorders/chemically induced , Puerperal Disorders/diagnosis , Adult , Bone Density Conservation Agents/therapeutic use , Calcitonin/therapeutic use , Depression/etiology , Female , Humans , Hypercalcemia/complications , Muscle Cramp/etiology , Muscle Weakness/etiology , Nausea/etiology , Postpartum Period , Vomiting/etiologyABSTRACT
Nicolau syndrome, also known as embolia cutis medicamentosa, is a well known but very rare complication occuring after intramuscular drug injections and presenting with local intense pain. Immediately after injection the skin blanches and within minutes to hours an erythematous macule develops, which evolves into a livedoid violaceous patch with dendrites. This condition is initially hemorrhagic, then it ulcerates, and eventually heals with an atrophic scar. Many different drugs have been reported to cause Nicolau syndrome . To date there have been no reports of Nicolau syndrome caused by intramuscular oxytocin injection. We would like to report two cases that occured after intramuscular injection of oxytocin.
Subject(s)
Injections, Intramuscular/adverse effects , Nicolau Syndrome/etiology , Oxytocin/adverse effects , Puerperal Disorders/chemically induced , Adult , Debridement , Female , Humans , Nicolau Syndrome/surgery , Oxytocin/administration & dosage , Postpartum Hemorrhage/prevention & control , Pregnancy , Skin Ulcer/chemically induced , Skin Ulcer/surgeryABSTRACT
Universal screening for maternal group B Streptococcus (GBS) in the prenatal period has led to administration of intrapartum antibiotic prophylaxis (IAP). Although IAP decreased the rate of early neonatal GBS disease, exposure of childbearing women to penicillin and other beta-lactam antibiotics has increased. Beta-lactam-induced anaphylaxis in the breastfeeding woman during the postpartum period illustrates risk factors for beta-lactam allergy and anaphylaxis. Treatment and nursing implications for this adverse reaction are suggested.
Subject(s)
Anti-Bacterial Agents/adverse effects , Antibiotic Prophylaxis/adverse effects , Pregnancy Complications, Infectious/drug therapy , Puerperal Disorders/chemically induced , Adult , Anti-Bacterial Agents/administration & dosage , Antibiotic Prophylaxis/methods , Female , Humans , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy , Puerperal Disorders/therapy , Streptococcal Infections/prevention & controlABSTRACT
Se presenta el caso de una paciente que ingresa por un primer episodio maníaco con sintomatología psicótica y mixta. El tratamiento inicial instaurado permitió un control parcial de los síntomas agudos y ocasionó una intensa elevación de los niveles séricos de prolactina. Ante esta situación, se planteó una solución terapéutica basada en la evidencia
The case of a patient admitted for a first manic episode with psychotic and mixed symptoms is presented. Partial control of acute symptoms was achieved through early treatment, which also caused a significant rise in prolactin serum levels. In this situation, an evidence-based therapeutic solution was suggested
Subject(s)
Humans , Female , Adult , Bipolar Disorder/drug therapy , Antipsychotic Agents/adverse effects , Hyperprolactinemia/chemically induced , Postpartum Period , Psychotic Disorders/complications , Puerperal Disorders/chemically induced , Risperidone/therapeutic useABSTRACT
Postpartum osteoporosis (PPO) is a rare disease associated with pregnancy and lactation period. Here, we report severe PPO and multiple vertebral compression fractures in two patients treated with enoxaparin--low-molecular-weight heparin (LMWH)--throughout their pregnancy. A 34-year-old woman who has delivered her second baby 3 months ago presented with severe low-back pain. She was treated with enoxaparin 40 mg/day for 8 months during her pregnancy. Dual-energy X-ray absorptiometry (DEXA) showed low T- and Z-scores in lumbar (L) vertebras. In magnetic resonance imaging (MRI), severe height losses in thoracic (T) 12, L1, and L2 vertebras were detected. She was diagnosed to have severe PPO and multiple vertebral compression fractures and was prescribed risedronate 35 mg/week, calcium, and vitamin D. The other patient was a 36-year-old woman diagnosed with PPO and vertebral fractures at the third week postpartum. She was also treated with enoxaparin 60 mg/day during her pregnancy. Severe osteoporosis in L vertebras and height losses indicative for compression fractures in T5-8, T11-12, and L2-5 vertebras were detected by DEXA and MRI, respectively. She was treated with calcitonin 200 U/day, calcium, and vitamin D. These findings suggest that vertebral compression fractures and PPO may be one of the causes of severe back pain in postpartum patients. Treatment with LMWH during pregnancy might be considered as a new risk factor for this rare condition.
Subject(s)
Anticoagulants/adverse effects , Enoxaparin/adverse effects , Osteoporotic Fractures/chemically induced , Puerperal Disorders/chemically induced , Spinal Fractures/chemically induced , Absorptiometry, Photon/methods , Adult , Anticoagulants/therapeutic use , Bone Density/physiology , Enoxaparin/therapeutic use , Female , Fractures, Compression/chemically induced , Fractures, Compression/diagnosis , Humans , Lumbar Vertebrae/physiopathology , Magnetic Resonance Imaging , Osteoporotic Fractures/diagnosis , Pregnancy , Pregnancy Complications, Hematologic/prevention & control , Puerperal Disorders/diagnosis , Spinal Fractures/diagnosis , Thromboembolism/prevention & controlABSTRACT
Severe and mild iodine deficiency during pregnancy and lactation affects thyroid function of the mother and neonate as well as the infant's neuropsychological development. Studies performed in Spain confirm that most women are iodine deficient during pregnancy and lactation. Pregnant and breast feeding women and women planning to become pregnant should take iodine supplements.
Subject(s)
Dietary Supplements , Hypothyroidism/prevention & control , Iodine Compounds/therapeutic use , Iodine/deficiency , Lactation , Pregnancy Complications/prevention & control , Controlled Clinical Trials as Topic , Deficiency Diseases/blood , Deficiency Diseases/diet therapy , Deficiency Diseases/drug therapy , Deficiency Diseases/epidemiology , Deficiency Diseases/prevention & control , Dietary Supplements/adverse effects , Female , Fetal Blood/chemistry , Fetal Development/drug effects , Fetal Diseases/etiology , Fetal Diseases/prevention & control , Food Additives , Humans , Hypothyroidism/etiology , Infant, Newborn , Iodine/metabolism , Iodine/therapeutic use , Iodine Compounds/administration & dosage , Iodine Compounds/adverse effects , Iodine Compounds/pharmacology , Nutritional Requirements , Pregnancy , Pregnancy Complications/drug therapy , Pregnancy Complications/etiology , Puerperal Disorders/chemically induced , Seafood , Sodium Chloride, Dietary/therapeutic use , Spain/epidemiology , Thyroiditis/chemically induced , Thyrotropin/bloodSubject(s)
Anesthesia, Epidural/adverse effects , Anesthesia, Obstetrical/adverse effects , Dura Mater/injuries , Horner Syndrome/chemically induced , Postoperative Complications/chemically induced , Puerperal Disorders/chemically induced , Adult , Bupivacaine/administration & dosage , Bupivacaine/adverse effects , Bupivacaine/analogs & derivatives , Cesarean Section , Emergencies , Female , Fentanyl/administration & dosage , Fentanyl/adverse effects , Humans , Levobupivacaine , Lidocaine/administration & dosage , Lidocaine/adverse effects , Pregnancy , Subdural SpaceSubject(s)
Biological Products/adverse effects , Pregnancy Complications/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Abnormalities, Drug-Induced/epidemiology , Abnormalities, Drug-Induced/etiology , Abortion, Spontaneous/chemically induced , Abortion, Spontaneous/epidemiology , Adalimumab , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal/pharmacology , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized/adverse effects , Antibodies, Monoclonal, Humanized/pharmacology , Antibodies, Monoclonal, Humanized/therapeutic use , Biological Products/pharmacology , Biological Products/therapeutic use , Certolizumab Pegol , Clinical Trials as Topic , Cohort Studies , Drug Labeling , Etanercept , Female , Fetus/drug effects , Fetus/immunology , Humans , Immunoglobulin Fab Fragments/adverse effects , Immunoglobulin Fab Fragments/pharmacology , Immunoglobulin Fab Fragments/therapeutic use , Immunoglobulin G/adverse effects , Immunoglobulin G/pharmacology , Immunoglobulin G/therapeutic use , Infant, Newborn , Infliximab , Maternal-Fetal Exchange , Polyethylene Glycols/adverse effects , Polyethylene Glycols/pharmacology , Polyethylene Glycols/therapeutic use , Pregnancy , Pregnancy Complications/chemically induced , Pregnancy Outcome , Pregnancy Trimester, Third , Puerperal Disorders/chemically induced , Puerperal Disorders/epidemiology , Receptors, Tumor Necrosis Factor/therapeutic use , Registries , VaccinationSubject(s)
Dopamine Agonists/adverse effects , Ergolines/adverse effects , Psychotic Disorders/etiology , Puerperal Disorders/chemically induced , Adult , Antipsychotic Agents/therapeutic use , Cabergoline , Cesarean Section , Female , Hallucinations/chemically induced , Humans , Lactation/drug effects , Postoperative Complications/chemically induced , Postoperative Complications/psychology , Pregnancy , Pregnancy Complications/drug therapy , Pregnancy Complications/psychology , Pregnancy, Twin , Psychomotor Agitation/etiology , Psychotic Disorders/drug therapy , Puerperal Disorders/drug therapy , Risperidone/therapeutic use , Sleep Initiation and Maintenance Disorders/chemically inducedABSTRACT
OBJECTIVE: A single course of antenatal corticosteroids (ACS) is associated with a reduction in respiratory distress syndrome and neonatal death. Multiple Courses of Antenatal Corticosteroids Study (MACS), a study involving 1858 women, was a multicentre randomized placebo-controlled trial of multiple courses of ACS, given every 14 days until 33+6 weeks or birth, whichever came first. The primary outcome of the study, a composite of neonatal mortality and morbidity, was similar for the multiple ACS and placebo groups (12.9% vs. 12.5%), but infants exposed to multiple courses of ACS weighed less, were shorter, and had smaller head circumferences. Thus for women who remain at increased risk of preterm birth, multiple courses of ACS (every 14 days) are not recommended. Chronic use of corticosteroids is associated with numerous side effects including weight gain and depression. The aim of this postpartum assessment was to ascertain if multiple courses of ACS were associated with maternal side effects. METHODS: Three months postpartum, women who participated in MACS were asked to complete a structured questionnaire that asked about maternal side effects of corticosteroid use during MACS and included the Edinburgh Postnatal Depression Scale. Women were also asked to evaluate their study participation. RESULTS: Of the 1858 women randomized, 1712 (92.1%) completed the postpartum questionnaire. There were no significant differences in the risk of maternal side effects between the two groups. Large numbers of women met the criteria for postpartum depression (14.1% in the ACS vs. 16.0% in the placebo group). Most women (94.1%) responded that they would participate in the trial again. CONCLUSION: In pregnancy, corticosteroids are given to women for fetal lung maturation and for the treatment of various maternal diseases. In this international multicentre randomized controlled trial, multiple courses of ACS (every 14 days) were not associated with maternal side effects, and the majority of women responded that they would participate in such a study again.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , Adult , Affect/drug effects , Birth Weight/drug effects , Depression, Postpartum/epidemiology , Female , Fetal Organ Maturity , Gestational Age , Humans , Infant, Newborn , Lung/embryology , Patient Satisfaction , Placebos , Pregnancy , Premature Birth , Puerperal Disorders/chemically induced , Respiratory Distress Syndrome, Newborn/prevention & controlABSTRACT
We report the case of a woman who first received MgSO(4) for eclampsia prophylaxis and then was treated with MgSO(4) for eclampsia. She developed hyperkalemia without severe renal failure or another explanation. We recommend close monitoring, including serial measurements of electrolytes, when MgSO(4) is administered for eclampsia prophylaxis or treatment.
Subject(s)
Anticonvulsants/adverse effects , Hyperkalemia/chemically induced , Magnesium Sulfate/adverse effects , Puerperal Disorders/chemically induced , Renal Insufficiency/chemically induced , Adult , Eclampsia/drug therapy , Eclampsia/pathology , Female , Humans , Postpartum Period , Pregnancy , Pregnancy Trimester, ThirdSubject(s)
Akathisia, Drug-Induced/etiology , Pimozide/pharmacokinetics , Pimozide/therapeutic use , Pregnancy Complications/drug therapy , Puerperal Disorders/chemically induced , Tourette Syndrome/drug therapy , Adult , Akathisia, Drug-Induced/metabolism , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Humans , Infant, Newborn , Pimozide/adverse effects , Pregnancy , Pregnancy Complications/metabolism , Puerperal Disorders/metabolism , Risk Factors , Tourette Syndrome/metabolismABSTRACT
Kounis syndrome is the coincidental occurrence of acute coronary syndromes with allergic or hypersensitivity reactions. Clinicians should be aware that various mediators of allergy can cause coronary spasm and even plaque rupture and thrombus formation, thereby causing a serious impact on the course, prognosis and management of the allergic reaction. We report a case of a 20 year old female who developed acute coronary syndrome after anaphylactic reaction to ibuprofen.