Thrombotic Microangiopathy in a Pregnant Woman With Kidney Transplantation: A Case Report.

BACKGROUND: The differential diagnosis of thrombotic microangiopathy (TMA) in pregnancy includes common conditions, such as preeclampsia. In women with kidney transplantation, additional causes of TMA must be considered. CASE: A 22-year-old primigravid woman with a transplanted kidney presented with fetal growth restriction, hypertension, acute kidney injury, and hemolysis at 28 weeks gestation. While her clinical presentation was initially consistent with preeclampsia, hemolysis persisted beyond 1 week postpartum. Diagnoses of TMA associated with tacrolimus and antibody-mediated rejection were considered. An elevated tacrolimus level likely contributed to her TMA and a decrease in dosage improved her clinical picture and laboratory markers. CONCLUSION: We report the case of a pregnant kidney transplant recipient with TMA. A multidisciplinary approach is required to optimize the maternal health outcomes in this complex population.

Spontaneous Rectus Sheath Hematoma in Pregnancy: A Case Report.

CONTEXTE: L'hématome du grand droit (HGD) est une cause rare mais importante de douleur abdominale pendant la grossesse. CAS: Une femme de 32 ans a consulté à 316 semaines de grossesse en raison de douleurs abdominales du côté droit. L'échographie a révélé une structure hétérogène compatible avec un HGD. Une prise en charge s'est composée d'un traitement symptomatique au moyen d'analgésiques et d'un suivi obstétrical et échographique. L'échographie a révélé la résorption de l'HGD après 6 semaines. À 38 semaines de grossesse, la patiente a subi un déclenchement artificiel du travail pour cause de pré-éclampsie et a donné naissance à une fille en bonne santé. CONCLUSION: Notre étude de cas présente un HGD spontané survenu à 32 semaines de grossesse, lequel a été pris en charge par traitement symptomatique. La grossesse s'est soldée par un accouchement à terme.

Successful Rescue Cerclage in a Monochorionic Diamniotic Twin Pregnancy at 20 Weeks: Case Report and Overview of Literature.

BACKGROUND: In twin pregnancies, elective cerclage placement based on obstetrical history or ultrasound findings has been shown to be ineffective and even harmful. There are currently no guidelines for the use of rescue cervical cerclage in twin pregnancies. CASE: The current report presents the case of a 33-year-old patient with monochorionic diamniotic twins (MCDA) found to have dilated cervix at 3.5cm with exposed membranes upon physical examination at 19 weeks and 3 days. An emergency McDonald cerclage was placed at 20 weeks and the patient carried the current pregnancy until 35weeks 6 days. CONCLUSION: Rescue cerclage represents an important option to consider in order to preserve twin pregnancies regardless of chorionicity.

Spontaneous Retroperitoneal Hematomas Following Uncomplicated Vaginal Deliveries: A Case Report and Literature Review.

INTRODUCTION: Retroperitoneal hematomas are rare in obstetrics. CASE PRESENTATION: A 36-year-old female presented two days following uncomplicated non-traumatic spontaneous vaginal delivery with an acute onset of severe left lower quadrant abdominal pain. The patient was hypotensive, tachycardic, and febrile. The hemoglobin dropped post delivery to 75 g/L. A non-contrast CT scan revealed a retroperitoneal hematoma. MANAGEMENT AND OUTCOME: Conservative management approaches resulted in spontaneous remission of the retroperitoneal hematoma.

Is young maternal age really a risk factor for adverse pregnancy outcome in a canadian tertiary referral hospital?

OBJECTIVE: To assess the risk of adverse pregnancy outcome among teenage mothers within a large tertiary referral center in Canada. METHODS: All nulliparous singleton births in the McGill University Health Centre during 2001-2007 were retrieved using the "MOND" database. Patients were divided according to maternal age: <20 years (teenage), and between 20 and 39 years. Obstetric and neonatal complications were compared. RESULTS: 9744 nulliparous women were included; 250 (2.6%) were teenage and 9494 (97.4%) were 20-39 years old. Teenage mothers tended to deliver earlier (38.0 vs 39.2 weeks gestation, P < 0.001) and had higher rates of extreme prematurity (OR 4.5, 95% CI 2.5-8.1). Babies of teenage mothers had lower birth weights (3014 g vs 3326 g, P < 0.001), higher rates of NICU admission (OR 2.1, 95% CI 1.5-3.0), congenital anomalies (OR 1.8, 95% CI 1.2-2.6) and combined perinatal and neonatal mortality (OR 3.8, 95% CI 1.9-7.5). Logistic regression analysis showed an association between young maternal age and the risk to have at least one adverse outcome (P < 0.001). CONCLUSIONS: Even within a large tertiary referral hospital, teenage mothers carry a greater risk of adverse pregnancy outcome, mainly due to preterm births.

The effect of recent immigration to Canada on gestational weight gain.

OBJECTIVE: To determine whether recent immigration to Canada constitutes a risk factor for excessive gestational weight gain (GWG) in our patient population. METHODS: We performed a retrospective chart review of all deliveries performed by five obstetricians at the McGill University Health Centre in Montreal between 1998 and 2007. We extrapolated the total GWG from the weights documented at the first and last prenatal visits based on studies that demonstrated that 20% of the GWG occurs in the first trimester, 40% in the second trimester, and 40% in the third trimester. Women were classified into six ethnic groups (Caucasian, Black, Latin American, East Asian, West Asian/Arab, and South Asian) and into four immigration status groups (immigrated to Canada5 to 10 years, or >10 years before their first prenatal visit, and non-immigrants). A mixed model multiple linear regression was used to explore the effect of ethnicity and immigration status on GWG after adjustment for age, parity, BMI, diabetes, hypertension, and smoking. RESULTS: We analyzed the data from 960 pregnancies. Weight gain above the Health Canada recommendations was found in 64.6% of pregnancies. On average, non-immigrants gained more gestational weight than women who immigrated to Canada over 10 years ago (17.17±5.35 vs. 15.36±5.45, P=0.01). Women of Latin American origin gained more weight than South Asian women (17.27±5.29 vs. 14.08±5.30, P=0.03). CONCLUSION: Recent immigration to Canada was not found to be associated with excessive GWG. Larger prospective trials would be required to assess the full impact of recent immigration on pregnancy outcomes.

Bacterial sacroiliitis and gluteal abscess after dilation and curettage for incomplete abortion.

BACKGROUND: Pyogenic infection with Streptococcus agalactiae is a potentially life-threatening disease associated with significant morbidity and mortality. This type of infection has seldom been reported as a complication of dilation and curettage after an incomplete abortion. CASE: A young woman presented to the emergency department with rapidly progressive left-sided lower back pain, general malaise, and chills evolving over the previous 48-hours after dilation and curettage for incomplete abortion. Streptococcus agalactiae was isolated in the blood. The patient developed pelvic osteomyelitis despite aggressive medical therapy and required prolonged treatment before significant clinical improvement was noted. CONCLUSION: Although very rare, serious pyogenic complications of dilation and curettage after incomplete abortion do occur and may present a diagnostic challenge.