Umbilical cord hemangioma and pseudocyst with favorable fetal outcome.

Key Clinical Message: There is a high association between umbilical cord hemangiomas or cysts with fetal mortality. However, favorable outcome is possible with proper prenatal monitoring and care. Abstract: Umbilical cord hemangiomas are rare neoplasms of vascular origin, commonly found in the free section of the umbilical cord proximal to placental insertion. They are associated with an increased risk of fetal mortality. We present a rare co-occurrence of an umbilical cord hemangioma and a pseudocyst managed conservatively, with favorable fetal outcome despite the interval increase in size, decreased caliber of the umbilical arteries, and fetal chest compression.

Takotsubo cardiomyopathy in pregnancy: a case report and literature review.

BACKGROUND: Takotsubo cardiomyopathy is rare in pregnancy and is characterized by left ventricular dysfunction with apical ballooning. This transient cardiac dysfunction may affect women of childbearing age in the antepartum, intrapartum or postpartum period. Most patients respond well to medical management with resolution of cardiac dysfunction within weeks. CASE PRESENTATION: A 35-year-old female in her second pregnancy presented with severe preeclampsia at 31 weeks of gestation. She subsequently developed severe substernal chest pain and workup showed a stress induced cardiomyopathy prior to her delivery via caesarean section. She had full recovery of her cardiac function by 12 weeks postpartum after medical management. CONCLUSIONS: Stress induced cardiomyopathy, though rare, should be considered after acute myocardial infarction has been ruled out in gravid females presenting with acute chest pain. Management should involve a multidisciplinary team. Cardiac function recovery is common within 4 weeks although some patients may require long term heart failure management.

Accuracy of angiogenic biomarkers at ⩽20weeks' gestation in predicting the risk of pre-eclampsia: A WHO multicentre study.

OBJECTIVE: To assess the accuracy of angiogenic biomarkers to predict pre-eclampsia. DESIGN: Prospective multicentre study. From 2006 to 2009, 5121 pregnant women with risk factors for pre-eclampsia (nulliparity, diabetes, previous pre-eclampsia, chronic hypertension) from Argentina, Colombia, Peru, India, Italy, Kenya, Switzerland and Thailand had their serum tested for sFlt-1, PlGF and sEng levels and their urine for PlGF levels at ⩽20, 23-27 and 32-35weeks' gestation (index tests, results blinded from carers). Women were monitored for signs of pre-eclampsia, diagnosed by systolic blood pressure ⩾140mmHg and/or diastolic blood pressure ⩾90mmHg, and proteinuria (protein/creatinine ratio ⩾0.3, protein ⩾1g/l, or one dipstick measurement ⩾2+) appearing after 20weeks' gestation. Early pre-eclampsia was defined when these signs appeared ⩽34weeks' gestation. MAIN OUTCOME MEASURE: Pre-eclampsia. RESULTS: Pre-eclampsia was diagnosed in 198 of 5121 women tested (3.9%) of whom 47 (0.9%) developed it early. The median maternal serum concentrations of index tests were significantly altered in women who subsequently developed pre-eclampsia than in those who did not. However, the area under receiver operating characteristics curve at ⩽20weeks' gestation were closer to 0.5 than to 1.0 for all biomarkers both for predicting any pre-eclampsia or at ⩽34weeks' gestation. The corresponding sensitivity, specificity and likelihood ratios were poor. Multivariable models combining sEng with clinical features slightly improved the prediction capability. CONCLUSIONS: Angiogenic biomarkers in first half of pregnancy do not perform well enough in predicting the later development of pre-eclampsia.

Health-related quality of life changes among users of depot medroxyprogesterone acetate for contraception.

BACKGROUND: Depot medroxyprogesterone acetate (DMPA) may have other noncontraceptive effects that could impact on the quality of life. The objective of this study was to assess the health-related quality of life changes associated with the use of DMPA for contraception. STUDY DESIGN: A prospective, observational study using the Short Form-36 quality of life questionnaire. RESULTS: After 6 months of use, the participants had an improved physical summary score, mean change [5.64 (95% confidence interval [CI], 1.87-9.4), p=.054]. There was no significant change in sexual function [5.33 (95% CI, -2.15 to 12.81), p=.0858] and mental summary score [-0.51 (95% CI, -1.90 to 2.92), p=.432]. The main side effect of DMPA was menstrual irregularity (32.5%); 17.2% of the participants found amenorrhea desirable. CONCLUSION: Besides its contraceptive efficacy, DMPA is associated with an improvement in perceived physical health with no apparent adverse effect on mental health and sexual function.

Severe propylthiouracil-induced hepatotoxicity in pregnancy managed successfully by liver transplantation: A case report.

INTRODUCTION: Propylthiouracil-induced severe hepatotoxicity is a relatively rare occurrence, with very few cases reported in the literature. The management of this complication in pregnancy can be a challenge because of the effects of the various treatment options on the fetus. CASE PRESENTATION: We report a rare case of fulminant hepatic failure in a 36-year-old gravida 2 black woman of African descent that occurred at 17 weeks gestation following propylthiouracil treatment for Graves' disease. Her liver failure was managed by liver transplantation and thyroidectomy. Her pregnancy was continued to term, though with not so favorable early childhood sequelae. CONCLUSION: This case illustrates a very rare complication of treatment with a presumed safe drug during pregnancy followed by adverse neonatal outcomes due to the extensive treatment.

Correlation between laparoscopic and histopathologic diagnosis of endometriosis.

OBJECTIVE: To review the histopathologic diagnosis of biopsies taken following visualization of endometriosis at laparoscopy and to correlate visual with microscopic diagnoses. METHODS: A retrospective review was undertaken of medical charts with a diagnosis of endometriosis at Aga Khan University Hospital, Nairobi, Kenya, between January 2001 and October 2010. Eligibility included visual diagnosis of endometriosis at laparoscopy, with a clear record of site, size, morphology, and number of lesions. The histopathologic diagnosis of the biopsies sampled was sought. Correlation was undertaken using κ statistics for diagnostic variability. RESULTS: Of the 204 relevant records, 152 (74.5%) met the eligibility criteria; from these cases, 239 specimens were submitted for histology. The most common symptom was chronic pelvic pain (108 [71.1%]). Most biopsies were obtained from the ovary and posterior cul-de-sac. Histopathologic diagnosis was confirmed in (152 [63.8%]) specimens and correlated with Asian race, multiparity, and chronic pelvic pain. Neither the site of the lesion nor the stage of disease influenced the histopathologic diagnosis. CONCLUSION: Laparoscopic visualization of endometriosis does not always correlate with histopathologic diagnosis; several other lesions may mimic endometriosis on histopathologic examination.