Surgical Management of Massive Labial Edema in a Gravid Preeclamptic Diabetic

Background. Massive labial edema is a rare complication during pregnancy that can jeopardize vaginal delivery, as well as leading to maternal and fetal morbidity. It can be related to systemic pathologies, but has been commonly associated with preeclampsia and diabetes. This increased and sometimes longstanding pressure may result in a “labial compartment syndrome� leading to microvascular damage and tissue necrosis if not resolved in a timely fashion. Case. Massive labial edema was treated first conservatively and then surgically in a gravid diabetic patient with severe preeclampsia. Immediately after Cesarean section, the labial compartment syndrome was relieved surgically and resolved rapidly. Conclusion. When conservative attempts at management of labial edema fail, or rapid resolution is critical to maternal and fetal outcome, surgical alternatives should be considered

Postpartum Prolapsed Leiomyoma with Uterine Inversion Managed by Vaginal Hysterectomy

Background. Uterine inversion is a rare, but life threatening, obstetrical emergency which occurs when the uterine fundus collapses into the endometrial cavity. Various conservative and surgical therapies have been outlined in the literature for the management of uterine inversions. Case. We present a case of a chronic, recurrent uterine inversion, which was diagnosed following spontaneous vaginal delivery and recurred seven weeks later. The uterine inversion was likely due to a leiomyoma. This late-presenting, chronic, recurring uterine inversion was treated with a vaginal hysterectomy. Conclusion. Uterine inversions can occur in both acute and chronic phases. Persistent vaginal bleeding with the appearance of a prolapsing fibroid should prompt further investigation for uterine inversion and may require surgical therapy. A vaginal hysterectomy may be an appropriate management option in select populations and may be considered in women who do not desire to maintain reproductive function

Gestational Diabetes Is Characterized by Reduced Mitochondrial Protein Expression and Altered Calcium Signaling Proteins in Skeletal Muscle

The rising prevalence of gestational diabetes mellitus (GDM) affects up to 18% of pregnant women with immediate and long-term metabolic consequences for both mother and infant. Abnormal glucose uptake and lipid oxidation are hallmark features of GDM prompting us to use an exploratory proteomics approach to investigate the cellular mechanisms underlying differences in skeletal muscle metabolism between obese pregnant women with GDM (OGDM) and obese pregnant women with normal glucose tolerance (ONGT). Functional validation was performed in a second cohort of obese OGDM and ONGT pregnant women. Quantitative proteomic analysis in rectus abdominus skeletal muscle tissue collected at delivery revealed reduced protein content of mitochondrial complex I (C-I) subunits (NDUFS3, NDUFV2) and altered content of proteins involved in calcium homeostasis/signaling (calcineurin A, α1-syntrophin, annexin A4) in OGDM (n = 6) vs. ONGT (n = 6). Follow-up analyses showed reduced enzymatic activity of mitochondrial complexes C-I, C-III, and C-IV (−60–75%) in the OGDM (n = 8) compared with ONGT (n = 10) subjects, though no differences were observed for mitochondrial complex protein content. Upstream regulators of mitochondrial biogenesis and oxidative phosphorylation were not different between groups. However, AMPK phosphorylation was dramatically reduced by 75% in the OGDM women. These data suggest that GDM is associated with reduced skeletal muscle oxidative phosphorylation and disordered calcium homeostasis. These relationships deserve further attention as they may represent novel risk factors for development of GDM and may have implications on the effectiveness of physical activity interventions on both treatment strategies for GDM and for prevention of type 2 diabetes postpartum

Surgical Management of Massive Labial Edema in a Gravid Preeclamptic Diabetic

Background. Massive labial edema is a rare complication during pregnancy that can jeopardize vaginal delivery, as well as leading to maternal and fetal morbidity. It can be related to systemic pathologies, but has been commonly associated with preeclampsia and diabetes. This increased and sometimes longstanding pressure may result in a “labial compartment syndrome” leading to microvascular damage and tissue necrosis if not resolved in a timely fashion. Case. Massive labial edema was treated first conservatively and then surgically in a gravid diabetic patient with severe preeclampsia. Immediately after Cesarean section, the labial compartment syndrome was relieved surgically and resolved rapidly. Conclusion. When conservative attempts at management of labial edema fail, or rapid resolution is critical to maternal and fetal outcome, surgical alternatives should be considered

THE EFFECTS OF MATERNAL PERINATAL EXERCISE ON INFANT NEUROMOTOR OUTCOMES

BACKGROUND: Aerobic exercise during pregnancy has been well established as safe and effective for both mother and infant. Few studies have examined the effects of different exercise modes during pregnancy on infant outcomes. The purpose of this study is to examine the effects of exercise mode during pregnancy on 1-month infant neuromotor outcomes. METHODS: Pregnant women were recruited and randomized to either aerobic (AE), resistance (RE), combination (CE), or control (CON) groups. Participants completed 150 min each week of supervised activity. After delivery, 1-month infant neuromotor skills were assessed using the Alberta Infant Motor Scales (AIMs) and Peabody Developmental Motor Scales, 2nd Edition. ANOVAs were used to compare differences between exercise groups; data was stratified by pre-pregnancy BMI (healthy weight, HW vs. overweight-obese, OO) and infant sex (M, F). Regressions assessed predictors of 1-month neuromotor outcomes. RESULTS: Groups were similar in maternal, neonate, and 1-month descriptors. Trends for improved subscores included: AE and RE in Prone (p=.20); CE in Sitting (p=.11); RE in Standing (p=.20) relative to controls. In females (F) from Healthy Weight (HW) women, all exercise types had increased gestational age (p=.03), AE and CE had greater Stationary (p=.17) subscores; in males (M) of HW women, all exercise types had greater Sitting (p=.02) subscores. In F from OO women, AE had greater total AIMs score (p=.20), while AE and RE had greater Stationary (p=.02) Locomotion (p=.06) subscores, as well as GMQ (p=.05) scores; in M of OO women, all exercise with increased height (p=.03) and weight (p=.02), RE with greater Prone (p=.03) and Standing (p=.04) subscores, with greater total AIMS (p=.04) scores. Controlling for other factors, we found significant predictors of 1-month neuromotor scores. Reflex scores were predicted by maternal exercise attendance, pre-pregnancy activity, fitness level, ethnicity, infant sex and body fat. Stationary scores were predicted by exercise mode, pre-pregnancy activity, baby BMI. GMQ was predicted by maternal exercise mode, race, delivery type, pre-pregnancy activity, BMI, and 1-month body fat. CONCLUSION: Maternal exercise mode or attendance, and infant body fat influences 1-month neuromotor skills. There are differences in 1-month neuromotor outcomes based on infant sex as well as maternal pre-pregnancy BMI. Further research is needed to understand this

Self-Reported Intake and Circulating EPA and DHA Concentrations in US Pregnant Women

In the United States, pregnant women have low concentrations of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which are essential for fetal development. Although maternal blood provides accurate polyunsaturated fatty acid (PUFA) concentrations, venipuncture is expensive and not always accessible. PUFA-containing foods consumption, both omega-3 ad omega-6 is supposed to reflect in the status (plasma, RBC, adipose tissue) of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). De novo synthesis of DHA and EPA during pregnancy is supposed to be higher compared to pre and/or post-pregnancy periods. Thus, this study aimed to determine the association between maternal self-reported dietary intake of foods high in DHA and EPA, along with vegetable oils as a source of omega-6 fatty acids, with maternal blood DHA and EPA concentrations. Pregnant women (13–16 weeks gestation) were recruited and asked to complete a food-frequency questionnaire (FFQ) and blood draw at enrollment and 36 weeks. Circulating concentrations of DHA and EPA were quantified and change scores were calculated. Correlations were done to determine associations between FFQ results and EPA/DHA maternal blood concentrations. Regression analyses were run to examine significant predictors of the main outcomes. Overall, PUFA-food consumption and RBC’s DHA levels decreased from early to late pregnancy; self-reported PUFA-rich food consumption positively correlated with DHA and EPA levels. DHA concentration was predicted by self-reported PUFA-rich oils (sunflower/soy/corn/olive) consumption, but EPA concentration was predicted by maternal BMI. These findings suggest that EPA and DHA consumption decreased across pregnancy and the FFQ can be utilized as an effective method for estimating PUFA blood concentration during pregnancy

Mitochondrial respiratory chain complex proteins are not different between ONGT and OGDM women.

<p>Complex I (<i>A</i>), complex II (<i>B</i>), complex III (<i>C</i>), complex IV (<i>D</i>). Representative Western blots where calnexin is used as loading control (<i>E</i>).</p

AMPK phosphorylation is reduced in OGDM women, though regulators of mitochondrial biogenesis are not.

<p>Quantitative bar graphs of PPARα (<i>A</i>) and PGC-1α (<i>B</i>), total AMPK (<i>C</i>), and phospho-AMPK (<i>D</i>) protein content in pyramidalis muscle collected during scheduled cesarean section. Representative Western blots where calnexin is used as loading control (<i>E</i>). Data are mean ± SEM. *<i>P</i><0.05 <i>vs</i>. NGT.</p