Prenatal vitamins: help or hype?

Professiona

Congenital diaphragmatic hernia

Professiona

Prenatal vitamins: A review of the literature on benefits and risks of various nutrient supplements

Pregnancy represents a time of rapid change in maternal physiology and nutritional requirements. Most pregnant women take a daily prenatal vitamin, but advising the patient can be difficult because so many different formulations are available. Vitamin and mineral supplements cannot replace a healthy diet, and there are not enough high-quality data to recommend multivitamin supplements for all American women. Folic acid is the 1 vitamin for which definitive evidence supports preventive supplementation in the periconceptional period. This article reviews the evidence in support of supplemental vitamin use during pregnancy. The discussion focuses primarily on data retrieved from the developed world, because the nutritional challenges of the developing world are distinct. (Formulary. 2013; 48:77-82.

Mechanisms of progesterone action in inhibiting prematurity

Progesterone is a steroid hormone that plays an integral role in each step of human pregnancy. In early pregnancy, progesterone produced by the corpus luteum is critical to the maintenance of early pregnancy until the placenta takes over this function at 7 to 9 weeks of gestation, hence its name (pro-gestational steroid hormone). The role of progesterone in later pregnancy, however, is less clear. It has been proposed that progesterone may be important in maintaining uterine quiescence in the latter half of pregnancy by limiting the production of stimulatory prostaglandins and inhabiting the expression of contraction-associated protein genes within the myometrium. Although systemic progesterone withdrawl may not correlate directly with the onset of labour in humans, there is increasing evidence to suggest that progesterone exerts its influence indirectly via a 'functional' withdrawl at the level of the uterus. The molecular mechanisms by which progesterone is able to maintain uterine quiescence and prevent preterm birth in some high-risk women are not clear. Six putative mechanisms have been proposed in the literature by both US and other investigators and are explored in this review

Consonant Repertoire of a Prelinguistically Deaf Child with Late-Mapping Cochlear Implants

Objective: The present case study aims to report on the consonant repertoire during the pre-linguistic and first linguistic stage of a Greek-Cypriot speaking child bilaterally implanted with multichannel Cochlear Implants (CIs). Background: Children with Hearing Loss (HL) produce canonical babble later, and consonantal inventories of HL children are smaller. However, the consonant repertoire of CI Greek-speaking children has not been examined thus far and research on types of consonantal errors during phonological acquisition is scant. Clinical Case: A pre-linguistically deaf child (CY, 7;0 years old) received the first CI at 7 months of age, but the external part of the device was fitted at 2;7 years. An investigation of the child’s speech at 7;0 years was conducted through auditory analysis. The child’s canonical utterances were transcribed in IPA and his consonants were classified into subcategories, depending on articulation place, articulation manner and resonance. Regarding place, alveolar consonants were the main category produced. As regards manner, closed consonants was the first category to appear, while in terms of voicing, voiceless consonants were recorded more often than voiced ones. The analysis also showed that consonants /t/, /s/ and /p/ were dominant in the child’s speech and revealed several phonological processes. Conclusion: The present case holds special interest as the child’s phonological system is still between the pre-linguistic/first linguistic stages due to the delayed CI mapping. The results agree in part with several studies in the literature, while specific phonological error patterns observed, remain to be verified in other CI Greek-speaking children

Uterine Dehiscence in Early Second Trimester

BACKGROUND: The diagnosis of uterine dehiscence in the early second trimester by ultrasonography is rare and its effect on pregnancy outcome is unclear. CASE: An asymptomatic woman presented for anatomy survey in the 19th week of pregnancy. Uterine dehiscence at the site of previous hysterotomy was diagnosed by ultrasound scan. She was admitted to the hospital for expectant management and eventually opted for termination of pregnancy in the 22nd week of pregnancy. Termination was performed by classical hysterotomy without any complications. CONCLUSION: Given the increasing cesarean delivery rate and improvements in ultrasound technology, obstetricians should expect to face the management dilemma of antenatally diagnosed uterine dehiscence. The risks of expectant management compared with termination remain theoretical, and timing of delivery and methods of termination are important questions to consider. (Obstet Gynecol 2011;118:497-500) DOI:10.1097/AOG.0b013e3182257b5

Primary psoas muscle abscess after an uncomplicated spontaneous vaginal delivery

The occurrence of a psoas abscess after a spontaneous vaginal delivery is a rare postpartum complication with a significant mortality risk. A 17-year-old primiparous patient presented 3 weeks after an uncomplicated spontaneous vaginal delivery with fever refractory to antibiotics. Imaging revealed the patient to have a 4x4-cm abscess of the right iliopsoas muscle. The patient underwent drainage of the abscess along with the administration of intravenous antibiotics. Prompt recognition of and subsequent effective treatment for a psoas abscess are crucial to avoid potential long-term morbidity and even mortality

Cesarean section in patient with metastatic Ewing sarcoma requiring VA‐ECMO support

A 26‐year‐old pregnant woman, with multiple metastatic Ewing sarcoma, presented with a sternal mass that began enlarging during pregnancy. Due to high‐risk pregnancy, the patient was discussed in a multidisciplinary meeting and intubation was considered too risky without cardiopulmonary support. Computed tomography showed extrinsic tumor compression of the right ventricle outflow tract. Veno‐arterial (VA) extracorporeal membrane oxygenation (ECMO) was initiated before general anesthesia, followed by Cesarean section (C‐section). VA ECMO was initiated with the patient in the awake position, ECMO support was discontinued when the patient had stable ventilation and hemodynamics. This case represents a unique indication of VA ECMO, during C‐section, with maternal and fetal survival

Uterine didelphys and vaginal birth after cesarean delivery

Müllerian anomalies are associated with adverse pregnancy outcomes. We discuss pregnancy in anomalous uteri, with a focus on uterine didelphys, in the setting of a prior cesarean delivery. A 30-year-old woman, gravida 2 para 1001, presented in latent labor at 40 1/7 weeks of gestation. Her first pregnancy was in the right horn of a didelphic uterus and resulted in a cesarean delivery in the setting of chorioamnionitis remote from delivery. The current pregnancy was in the left horn and resulted in a vacuum-assisted vaginal delivery after spontaneous labor. There is sparse literature on a trial of labor after cesarean delivery in a uterine didelphys