Pregnancy in the context of Multiple Sclerosis

Multiple Sclerosis is a chronic autoimmune neurodegenerative disorder which affects brain, spinal cord and optic nerve. During last years the perception over the disease changed dramatically, now being considered a handleable disease. The particularity of this subject is that Multiple Sclerosis is a disease which affects mostly young women, many of them not having any children at the moment of diagnosis. This article highlights the fact that women diagnosed with Multiple Sclerosis are allowed to get pregnant, and, moreover, they are encouraged to live a normal life. In most cases, disease activity freezes during pregnancy, only a small percentage of women will continue to have clinically and radiologically active disease. For those women, IFN-β and Glatiramer Acetate are the first-choice therapies that should be given. In cases when the disease is not responding to common medication, refractory to treatment forms may be successfully treated with Natalizuab, during the first and the second trimester. Breastfeeding is also encouraged, as it has a protective effect on disease progression. The main purpose of this article is to make a literature review in which to summarize the updates regarding pregnancy and postpartum management, relapses management and, also, the impact of pregnancy on Multiple Sclerosis course. The analysis was limited to articles written in English and published between August 2019 - October 2022 on PubMed, NCBI and Medical Journals

Managing intrauterine growth restriction

The fetal growth normally depends on sufficient delivery of oxygen and nutrients mainly via the placenta. Inadequate fetal nutrition may result in poor development and adaptation that permanently alter the fetus' metabolism and physiology. Intrauterine Growth Restriction is defined as a deviation on the fetal growth pattern. An estimated fetal weight (EFW) that is below the 10th percentile for gestational age is commonly used to describe fetal growth restriction. Usually obtained sonographically, there is evidence that ultrasound imaging of the uterine artery, middle cerebral artery, and fetal umbilical artery during the late third-trimester (approximately 35-37 weeks) significantly improves the detection and diagnosis of IUGR. In obstetrics, an increased risk of perinatal mortality and morbidity is associated with the diagnosis of IUGR

Oligohydramnios: A review of etiology and management options

Oligohydramnios is both a consequence of fetal malformations and of uteroplacental insufficiency. Its existence is associated with a high rate of both antepartum and intrapartum complications. It is vital that its occurrence is detected as early as possible so that we can manage it correctly. The main causes of its occurrence are identified and described in this review. The management of oligohydramnios is most often expectant, the timing of delivery also being determined by Doppler examination and changes in parameters measuring fetal growth and development

Breef overview of gestational diabetes mellitus

As obesity increases worldwide, so do the incidence of gestational diabetes mellitus (GDM) and the related perinatal complications. Pancreatic β-cell secretion is altered by hormonal changes during pregnancy. It appears, however, that patients who develop gestational diabetes have pre-existing insulin resistance. However, there are other risk factors to be considered, such as obesity, age, ethnicity, and polycystic ovary syndrome. Screening for gestational diabetes is very important to avoid maternal and fetal complications. For most pregnant women, glycemic control is achieved through dietary and lifestyle changes, although a small percentage requires pharmacological treatment

WAYS TO COMPLETE PREGNANCY IN DIABETIC PREGNANT WOMEN

Introduction. Gestational diabetes is the type of diabetes characterized by the presence of glucose intolerance, that first appears or is first diagnosed during pregnancy. The diagnosis of this condition is established between the 24 th and the 28 th week of pregnancy by the presence of a single abnormal blood glucose level during the oral glucose tolerance test (OGTT). Given the complex pathology of this disease, making the right decision at the right time is the key to success for both the mother and the fetus, thus choosing the moment and way of birth in diabetic pregnancies is a challenge for the obstetrician. Material and method. Multiple studies conducted worldwide have not yet been able to determine the optimal time and manner of birth to avoid the complications that occur in pregnant women with gestational diabetes. In recent years, researchers have been looking for a perinatal care in order to find the best way to finish the pregnancy and limit the effects of gestational diabetes to both the mother and the newborn. Conclusions. The time and the way of birth for diabetic pregnancy depends on several factors, including gestational age, fetal status, pregnancy, parity, metabolic status and other pregnancy-related pathologies, technical possibilities of the hospital and professional experience of the medical team. Choosing the moment and the way of birth is a decision that must be taken individually in each case as the results of research have not yet found an optimal standard to solve this problem

THE ROLE OF VITAMIN D IN FETAL DEVELOPMENT AND IN THE OCCURRENCE OF GESTATIONAL DIABETES

Introduction. Due to the alarming global growth of metabolic disorders and the complications of these disorders, in recent years researchers have tried to find new mechanisms for b the imbalances and during their attempts have found that vitamin D, a vitamin that was not enough studied before, plays an important role in preventing metabolic disorders in pregnancy. Numerous studies have highlighted the beneficial role of vitamin D, especially in the first trimester of pregnancy. Vitamin D is a secosteroid hormone with a role in foasfo-calcic metabolism and is essential in the development of musculo - skeletal system and in the absorption of calcium. In order to become a biological active substance, after being secreted at skin, vitamin D suffers a number of metabolic processes of activation at the renal level. The latest studies have shown that in addition to the kidneys, the granulated tissue and the placenta are organs in which this hormone is activated. In addition to the effects such as immunomodulation, inhibition of keratinocyte and fibroblast proliferation, increased contractility myocardial, increased insulin production, inhibition of angiogenesis and apoptosis induction, new research has shown that vitamin D has an important role in intrauterine fetal development and in the development of gestational diabetes. Conclusions. The current medical studies reveal that vitamin D is a hormone which has an active biological action beneficial to both bone metabolism and carbohydrate metabolism. The deficit of this vitamin may increase the risk of developing gestational diabetes and intrauterine growth restriction. Since research concerning this topic is still at the beginning, subsequent studies will have to elucidate the optimum value of vitamin D in maternal serum during pregnancy, especially in the first trimester, in order to lower the risk of developing metabolic damage and intrauterine fetal restriction

NEUROLOGICAL DISORDER IN PREGNANCY

Bell facial paralysis association with pregnancy pathology is quite rare in practice, but reported to the cases outside gestation it is 2 times more frequent, which was why we decided to present this case. In the presented case, we note that the neurological pathology was revealed in a patient, aged 34 years and located in 34 weeks gestation with pregnancy-induced hypertension which was presented accusing facial asymmetry insidiously installed. The treatment was agreed between the obstetrician and the neurologist. Birth was conducted in normal dynamic parameters, evolving naturally with a good fetal and maternal prognosis. Further development of the peripheral facial paralysis was slowly favorable, with a partial remission 3 weeks later. A year and a half after this episode that took place during the gestation, the neurological and clinical examination revealed the persistence of a discrete facial asymmetries

CONVULSIVE SYNDROME IN ECLAMPSIA AND EPILEPSY IN PARTURITION UNDER 30 YEARS OF AGE

The convulsive syndrome in eclampsia and epilepsy is often a major complication in obstetrics. If eclampsia is a pathology of gestation, epilepsy is a pre-existing pathology of pregnancy. Epilepsy can be aggravated by the presence of preeclampsia and eclampsia in both terms of fetal-placental units, frequency of convulsions. Obstetrical behaviour at birth by caesarean surgery or vaginal delivery with or without applying forceps should be chosen so as not to delay maternal and fetal prognosis. Epileptic patients have a higher risk of developing complications in pregnancy, by increasing maternal morbidity due to seizures, coma, birth bleeding or caesarean section, pelvi-genic hematoma, infections. The extraction of the fetuses was performed by caesarean surgery and forceps application. The immediate maternal and fetal, vital and functional prognosis was good. We recommended ablation in epileptic patients and administration of anticonvulsant treatment. The objective of the paper is represented by the study of the neuro-convulsive syndrome in eclampsia, epilepsy and in the association of the preeclampsia – epilepsy, the difference between the three entities and the therapeutic medical and obstetrical attitude for a good materno-fetal prognostic