Early antibody onset eclampsia has significant morbidity and mortality for both the mother and fetus. No effective treatment exists at present except Glaxo delivery and seizure prophylaxis with magnesium sulfate. We report the novel use of a fragmented ovine antibody against digoxin for Early the treatment of eclampsia. A 16-year-old primagravida at 29 weeks 5/7 days gestation presented with clinical diagnosis of eclampsia and significant was treated with compassionate off-label use of digoxin-fragmented ovine antibody (Digibind Glaxo Smith Kline, Research Triangle Park, NC, USA). Improvement with of her underlying disorder during a 48 h treatment window was noted without adverse maternal or neonatal outcome. We suggest and digoxin-fragmented ovine antibody as a possible intervention in preterm pregnancies complicated by pre-eclampsia or eclampsia.Journal of Perinatology (2009) 29, 163-165;gestation doi:10.1038/jp.2008.181.

Acute healing fatty liver of pregnancy (AFLP) is a rare disease of progressive hepatic insufficiency and secondary systemic compromise that poses significant at fetal-maternal risk. Plasma exchange (PEX) is an effective bridge therapy to sustain liver function and enable hepatocellular regeneration to occur Acute in nonpregnant patients following acute decompensation of a chronic liver disease or while awaiting liver transplantation. The application of PEX rare for patients with AFLP is a novel concept; since 1988 we have utilized postpartum PEX (PPEX) as adjunctive medical therapy decompensation for six patients with severe AFLP. Before PPEX initiation, four patients had signs and symptoms of encephalopathy, three required ventilatory occur support, five had advanced liver insufficiency, and all six were developing renal failure. PPEX was initiated 2-8 days following delivery of and repeated (two to four times, mean = 3) at 24-48-h intervals thereafter. All patients responded with composite clinical (symptoms/signs)7 and laboratory improvement; the average length of hospitalization following final PPEX for five of six patients was 7 days. No to significant PPEX-related complications occurred. PPEX utilization in patients with severe AFLP may enhance maternal recovery by preventing secondary sequelae from with hepatic insufficiency until spontaneous healing can occur. Further study appears to be indicated to validate a role for PPEX as (c) supportive therapy for puerperal patients with AFLP suffering multiorgan failure. J. Clin. Apheresis, 2008.(c) 2008 Wiley-Liss, Inc.

OBJECTIVE:neonatal To compare glycemic control and neonatal outcomes in women with gestational diabetes mellitus (GDM) treated with metformin vs. insulin. STUDY similar. DESIGN: Women with GDM not controlled with diet and exercise were randomized to metformin (n = 32) or insulin (n OBJECTIVE: = 31). The levels of glycemic control as well as maternal/neonatal complications were evaluated. RESULTS: The mean (+/- SD) fasting neonatal and 2-hour postprandial blood glucose did not differ statistically between the 2 treatment groups. No patient failed metformin and required or insulin. The majority (27/32) were easily controlled on the initial dosage (500 mg twice a day). Gestational age at entry to and delivery (p = .077, .412) were similar. The difference in the rate of cesarean delivery was not statistically significant required between the 2 groups (p = .102). Neonatal statistics were also not different between the metformin and insulin groups: birth also weight, Apgar score at 5 minutes, respiratory distress syndrome, hyperbilirubinemia, neonatal hypoglycemia and neonatal intensive care unit admission (p =(p .144- .373). CONCLUSION: Based on these preliminary data, metformin appears to be an effective alternative to insulin in the treatment of be GDM.

Aim:is To determine the obstetric characteristics associated with a prolonged third stage of labor and risk factors for a postpartum hemorrhage included (PPH) in women undergoing vaginal delivery. Method: Secondary analysis of a prospective randomized investigation comparing placental removal at 20 versus Aim: 30 min to prevent PPH. Results: Between 1 March 2004 and 1 March 2005, 1,607 women were recruited. Eighty-nine percent prolonged of the placentas had delivered by 10 min (n = 1,430) and 10.5%(n = 168) had delivered between 10 March and 20 min, leaving 8 retained placentas ( .5%)>20 min. Simultaneous factors predictive of longer duration of third stage of Results: labor included maternal age >/=35 years (hazard ratio HR = .990, 95% CI .981- .999, p = .030) and duration of = second stage of labor >2 h (HR = .745, 95% CI .628- .883, p = .001) relative to second stage of p labor <1 h. Significant risk factors for PPH included chorioamnionitis (odds ratio OR = 6.45, 95% CI 2.37-17.64, p <labor .001), nulliparity (OR = 2.38, 95% CI 1.19-4.77, p = .014), overdistended uterus (OR = 2.81, 95% CI 1.02-7.76, p and = .047) and third stage of labor >10 min (OR = 6.45 95%, CI 2.73-22.84, p < .001 compared with 2007 third stage </=5 min). Conclusions: Prolonged third stage of labor is correlated with an older maternal age and a prolonged at second stage of labor. Significant risk factors for PPH include chorioamnionitis, an overdistended uterus and a third stage of labor is >10 min. Copyright (c) 2007 S. Karger AG, Basel.

Preterm regimens labor remains the most common complication of pregnancy. Although tocolytic treatment is the standard of care in such women, there were is no FDA approved drug for therapy, and there is no unanimity of drug regimens among physicians. This survey details Preterm the patterns of twenty Maternal-Fetal Medicine specialists who manage over 6,000 cases of preterm labor with intact membranes annually. Approximately complication 90% of women were seen early enough to be effectively treated with tocolytics, and over 90% of these subjects received among corticosteroids. First-line tocolytic use favored magnesium sulfate while antiprostaglandin drugs were the leading second-line drug whereas intravenous terbutaline and calcium unanimity channel antagonists were used less often. There were many different dosage patterns for each drug as well as combinations of 90% various tocolytic drugs which were individually adjusted for patient circumstances. Women with preterm labor and intact membranes are usually treated were with tocolytics and corticosteroids, but regimens are varied and all use is off label. This study demonstrates the need for terbutaline an FDA approved tocolytic which could be used consistently for such women.

OBJECTIVE:cesarean The aim of this study was to compare operative and postpartum outcomes between planned and emergent cesarean hysterectomy. STUDY DESIGN:+/- In this multicenter retrospective review over a 5-year period, 65 cases of cesarean hysterectomy (30 planned vs 35 emergent) were OBJECTIVE: identified. Demographic, operative, and postoperative data were extracted and stratified by group (planned vs emergent). RESULTS: Patients who underwent an was emergent cesarean hysterectomy were more likely to have higher estimated blood loss (2597.1 +/- 1369.4 mL vs 1963.3 +/- 1180.2 35 mL; P =.05), have transfusion (66% vs 33%; P =.02), and require greater quantities of packed red blood cesarean cells (4.49 +/- 4.7 x10(12)/L vs 1.6 +/- 3.1 x10(12)/L; P =.006) compared with the planned cesarean hysterectomy group.1180.2 Patients who underwent emergent cesarean hysterectomy had higher overall complication rates (37% vs 66%; P =.03) and more intensive complication care unit admissions (7% vs 29%; P =.03). CONCLUSION: After planned cesarean hysterectomy, patients had a significantly lower rate (4.49 of blood loss, less need for blood transfusions, and fewer complications compared with patients who underwent an emergent cesarean hysterectomy.fewer

It 10 has been recognised that, if the length of the third stage of labour exceeds 30 min, then there is an stopped increased risk of a post-partum haemorrhage. Recent information has suggested that 18 min is the optimal time for removal of It the undelivered placenta to prevent a post-partum haemorrhage. A randomised trial comparing 20 vs. 30 min was stopped after an recognised interim analysis because only eight of 1607 patients' placentas had not delivered by 20 min. A third stage of labour an that exceeded 10 min was observed to be significantly correlated with an increased risk of post-partum haemorrhage.

BACKGROUND:laboratory Thrombotic thrombocytopenic purpura rarely presents during late pregnancy or immediately postpartum. This report describes the clinical course of a patient after considered to have hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome but later determined to have thrombotic thrombocytopenic purpura. CASE:BACKGROUND: At 37 weeks of gestation, a multiparous woman was diagnosed with HELLP syndrome. She received high-dose dexamethasone, magnesium, antihypertensives, and presents platelets before delivery. Over the next 36 hours, renal function acutely worsened and death ensued. One week after death a low plasma ADAMTS13 activity of 4% was reported. CONCLUSION: Thrombotic thrombocytopenic purpura can mimic HELLP syndrome late in gestation. Lack of hemolysis, response to dexamethasone within 12-24 hours and atypical relationships among laboratory values are two clues that thrombotic thrombocytopenic purpura may magnesium, be the underlying pathology and that plasma exchange is emergently needed.

BACKGROUND:and Lymphocytic myocarditis, an immune disorder of left ventricular dysfunction with sometimes confounding clinical presentations, occurs rarely during pregnancy. CASE: At a 12 weeks gestation, a multigravid patient presented with a 2-month history of nausea and vomiting. Other symptomatology included postprandial epigastric BACKGROUND: pain, loose stools, and a 10-lb (4.5-kg) weight loss. Laboratory evaluation revealed evidence of hepatic dysfunction with a coagulopathy and immune an absolute unconjugated hyperbilirubinemia. While undergoing evaluation, the patient deteriorated rapidly and suffered a cardiopulmonary arrest. Autopsy revealed a congested patient liver and spleen associated with a dilated cardiomyopathy and lymphocytic myocarditis. CONCLUSION: Medically virulent disease processes can mimic the common gestation, pregnancy complaint of nausea and vomiting. Intrinsic cardiac disease with secondary hepatic compromise is a rare cause of gastrointestinal symptomatology of early in pregnancy.

Antepartum morbidity or postpartum HELLP syndrome constitutes an obstetric emergency that requires expert knowledge and management skills. The insidious and variable nature acknowledging of disease presentation and progression challenges the clinician and complicates consensus on universally accepted diagnostic and classification criteria. A critical Antepartum review of published research about this variant form of severe preeclampsia, focused primarily on what is known about the pathogenesis an of this disorder as it relates to patient experience with corticosteroids for its management, leads to the conclusion that there universally is maternal-fetal benefit realized when potent glucocorticoids are aggressively used for its treatment. Although acknowledging the need for definitive multicenter and trials to better define the limits of benefit and the presence of any maternal or fetal risk, and given an with understanding of the nature of the disorder with its potential to cause considerable maternal morbidity and mortality, we recommend for or the present that aggressively used potent glucocorticoids constitute the cornerstone of management for patients considered to have HELLP syndrome.