Sonographic characteristics of linear nevus sebaceous sequence.

Linear nevus sebaceous is a hamartomatous lesion most commonly seen on the face and head of infants and diagnosed after birth. We describe a patient with sonographic findings of linear nevus sebaceous seen initially at 30 weeks' gestation. Other associated sonographic findings include macrocephaly and polyhydramnios. When associated with a midline soft tissue mass, these findings are highly suggestive of the presence of congenital linear nevus sebaceous sequence.

Incidence of postpartum depression in Olmsted County, Minnesota. A population-based, retrospective study.

OBJECTIVE: To provide population-based data on the recognition of postpartum depression by reviewing diagnostic and treatment practices of all physicians caring for pregnant and postpartum women in Olmsted County, Minnesota. STUDY DESIGN: We reviewed the medical charts of a random sample of 403 Olmsted County women who gave birth in 1993. Using outpatient and hospital medical records, we recorded all documented symptoms and diagnoses of depression, drug therapy for depression and variables that were previously associated with postpartum depression, during pregnancy and for one year postpartum. RESULTS: Fifteen (3.7%) of the women were identified as having postpartum depression during the year following delivery. Two (0.5%) other women had preexisting depression that did not remit before delivery. We found significant associations between postpartum depression and young maternal age, single marital status, hyperemesis gravidarum, tobacco or illegal drug use during pregnancy, history of substance abuse, high utilization of emergency department services and previous affective disorder. Using multivariate analysis with stepwise logistic regression, only single marital status, previous affective disorder and high utilization of emergency services remained associated with postpartum depression. CONCLUSION: The incidence of postpartum depression was significantly below incidences seen in prospective studies. Systematic screening for postpartum depression may be appropriate in this population.

Portal vein thrombosis associated with pregnancy. A case report.

This report illustrates a case of portal vein thrombosis that developed in the second trimester of pregnancy. The patient did not have any of the known associations or predisposing factors for portal vein thrombosis or any past medical history of thrombosis or bleeding disorders. Antepartum and postpartum laboratory studies showed no evidence of a coagulation disorder; therefore, it seems that the sole cause of this thrombotic event was the hypercoagulable state of pregnancy.

Selected neurologic complications of pregnancy.

Many neurologic disorders, such as eclampsia, pseudotumor cerebri, stroke, obstetric nerve palsies, subarachnoid hemorrhage, pituitary tumors, and choriocarcinoma, can develop in the pregnant patient. Maternal mortality from eclampsia, which ranges from 0 to 14%, can be due to intracerebral hemorrhage, pulmonary edema, disseminated intravascular coagulation, abruptio placentae, or failure of the liver or kidneys. Associated fetal mortality ranges from 10 to 28% and is directly related to decreased placental perfusion. Pseudotumor cerebri can be associated with serious visual complications; thus, the therapeutic goal is to prevent loss of vision. The risk of stroke in the pregnant patient is 13 times the risk in the nonpregnant patient of the same age. The major causes of stroke in pregnant patients are arterial occlusion and cerebral venous thrombosis. Lumbar disk prolapse is common in pregnant patients, and lumbosacral plexus injuries can occur during labor or delivery. In addition, peripheral nerve compression or entrapment syndromes are thought to be caused by the retention of fluid during pregnancy. The incidence of subarachnoid hemorrhage during pregnancy is 1 in every 10,000 patients, a rate 5 times higher than in nonpregnant women. Because of a proliferation of prolactin-secreting cells, the pituitary gland can enlarge dramatically during pregnancy, a change that can disclose a previously unknown tumor or cause a known pituitary tumor to become symptomatic. The incidence of choriocarcinoma is 1 in 50,000 full-term pregnancies but 1 in 30 molar pregnancies. This malignant tumor has a high rate of cerebral metastatic lesions. In addition to these disorders that develop during pregnancy, the pregnant state can affect numerous preexisting neurologic conditions, including epilepsy, headaches, multiple sclerosis, myasthenia gravis, spinal cord injury, and brain tumors. We discuss advice for patients with such conditions who wish to become pregnant, recommendations for medical and surgical management, and surgical considerations for neurologic complications during pregnancy.

CA-125 levels in endometriosis.

CA-125 is a cellular antigen detected in many patients with ovarian cancer, but it has also been detected in patients with endometriosis. Preoperative CA-125 levels were drawn from 113 patients before they underwent laparoscopy. Patients were categorized into diagnostic groups on the basis of pathologic findings. CA-125 levels in patients with evidence of intraabdominal adhesions were not statistically different from those in patients with normal pelvic anatomy. However, patients with advanced endometriosis had significantly elevated levels of CA-125 when compared with patients with normal pelvic anatomy (P less than 0.05). The clinical and immunologic implications of elevated CA-125 levels in patients with advanced endometriosis are discussed.

Effect of serum source on human fertilization and embryonic growth parameters in vitro.

A total of 100 mature oocytes from 13 consecutive patients were randomly assigned from each patient to one of two treatment groups (n = 53 for group 1, n = 47 for group 2). Group 1 oocytes were incubated throughout the culture periods in medium supplemented with 7.5% homologous patient serum. Group 2 oocytes were treated similarly, except the serum supplement was of fetal cord origin. End points for examination included fertilization frequency, normality of fertilization, stage of embryonic development at two time periods, and quality of embryonic development at two time periods. None of the end points examined revealed significant differences between patient serum and fetal cord serum.

Venous air embolism. Life-threatening complication of orogenital sex during pregnancy.

Vaginal insufflation in pregnant women leading to acute venous air embolism has been appreciated by obstetricians and pathologists for several decades. Initially described as a complication of powder insufflation for treatment of trichomonal vaginitis, insufflation-induced air embolism has been more recently associated with orogenital sex. The case herein illustrates a typical history that is almost pathognomonic. Clinical and laboratory abnormalities as well as treatment measures are briefly described. Familiarity with this syndrome is essential if prompt and appropriate therapy is to be rendered.