Amniotic fluid embolism.

Amniotic fluid embolism is one of the most catastrophic complications of pregnancy. First described in 1941, the condition is exceedingly rare and the exact pathophysiology is still unknown. The etiology was thought to be embolic in nature, but more recent evidence suggests an immunologic basis. Common presenting symptoms include dyspnea, nonreassuring fetal status, hypotension, seizures, and disseminated intravascular coagulation. Early recognition of amniotic fluid embolism is critical to a successful outcome. However, despite intensive resuscitation, outcomes are frequently poor for both infant and mother. Recently, aggressive and successful management of amniotic fluid embolism with recombinant factor VIIa and a ventricular assist device, inhaled nitric oxide, cardiopulmonary bypass and intraaortic balloon pump with extracorporeal membrane oxygenation have been reported and should be considered in select cases.

A comparison of speculum and nonspeculum collection of cervicovaginal specimens for fetal fibronectin testing.

OBJECTIVE: Current recommendations include the use of a vaginal speculum for fetal fibronectin specimen collection. This article evaluates the equivalency of nonspeculum methods for collecting fetal fibronectin specimens. STUDY DESIGN: Two separate prospective studies of patients more than 22 weeks' gestation were performed at 2 institutions with similar hypotheses and methods. Two sequential specimens were collected on each patient: 1 with speculum and 1 with the nonspeculum method. The order of collection was reversed or randomized in both studies. Two alternative nonspeculum collection methods are described. RESULTS: The 2 study sample sizes were 169 and 31. Comparison of the fetal fibronectin test results between the speculum and nonspeculum methods demonstrated greater than 95% agreement with an intraclass Kappa coefficient greater than 0.85 in both studies. The order of collection did not result in significantly different fetal fibronectin averages. CONCLUSION: These studies demonstrate that there is excellent agreement between fetal fibronectin results obtained by speculum and nonspeculum collection methods.

Severe Graves' ophthalmopathy in pregnancy.

BACKGROUND: Thyroid ophthalmopathy is a rare extrathyroidal complication most commonly associated with Graves' disease. The disease course ranges from mild to severe, with severe cases resulting in major visual impairment and facial disfigurement. CASE: A 22-year-old primigravida developed severe thyroid ophthalmopathy during pregnancy, requiring high-dose steroids and surgical orbital wall decompression to restore visual acuity. CONCLUSION: Severe thyroid ophthalmopathy can occur in the euthyroid pregnant patient. Corticosteroid therapy and surgical intervention may be required during pregnancy in this clinical scenario.