Gout in Pregnancy: A Case Report and Review of the Literature

While gout is a common inflammatory joint disease, its occurrence in women in their reproductive years is very rare. This is thought to be the result of the uricosuric effect of estrogen. The higher estrogen levels during pregnancy are believed to protect the mother against an acute gout flare. We report a case of a patient with gout who experienced a flare in the third trimester of her pregnancy and a review of the English literature on gout in pregnancy. In addition to this case, we identified 19 pregnancies in 8 women with a diagnosis of gout. Of those, 6 experienced an antepartum flare and 7 a postpartum flare. Our patient developed a gout flare in the third trimester of the pregnancy, which was otherwise complicated by gestational diabetes. Her flare was well controlled with pharmacotherapy (hydrocodone and allopurinol). We hypothesize that her pregnancy induced insulin resistance, which decreased the renal excretion of urate provoked this flare. Little is known about the treatment of acute gout and long-term management during pregnancy. The initiation of preventive treatment with allopurinol should be based on individualized risks and benefits, but we suggest that gestational diabetes justifies its use in the second half of pregnancy. (C) 2015 S. Karger AG, Base

Gout in Pregnancy:A Case Report and Review of the Literature

While gout is a common inflammatory joint disease, its occurrence in women in their reproductive years is very rare. This is thought to be the result of the uricosuric effect of estrogen. The higher estrogen levels during pregnancy are believed to protect the mother against an acute gout flare. We report a case of a patient with gout who experienced a flare in the third trimester of her pregnancy and a review of the English literature on gout in pregnancy. In addition to this case, we identified 19 pregnancies in 8 women with a diagnosis of gout. Of those, 6 experienced an antepartum flare and 7 a postpartum flare. Our patient developed a gout flare in the third trimester of the pregnancy, which was otherwise complicated by gestational diabetes. Her flare was well controlled with pharmacotherapy (hydrocodone and allopurinol). We hypothesize that her pregnancy induced insulin resistance, which decreased the renal excretion of urate provoked this flare. Little is known about the treatment of acute gout and long-term management during pregnancy. The initiation of preventive treatment with allopurinol should be based on individualized risks and benefits, but we suggest that gestational diabetes justifies its use in the second half of pregnancy. (C) 2015 S. Karger AG, Base

Teen Pregnancy: Are Pregnancies following an Elective Termination Associated with Increased Risk for Adverse Perinatal Outcomes?

Study Objective: The authors sought to determine whether pregnancies in adolescents following an abortion of pregnancy is associated with an elevated risk for adverse perinatal outcomes. Methods: In a cohort study of all adolescent (younger than 18 years) deliveries over a 4-year period at 1 institution, we compared nulliparous women with a history of a prior abortion (cases) to those without a spontaneous loss or abortion of pregnancy (referent) for adverse perinatal outcomes, including preterm birth and fetal growth restriction. Results: Of the 654 included nulliparous adolescent deliveries, 102 (16%) had an abortion before the index pregnancy. Compared with the referent group, adolescents with a history of a abortion were older (17.8 +/- 0.8 vs 16.7 +/- 1.2 years, P = .0001), enrolled earlier for prenatal care (14.4 +/- 5.6 vs 17.2 +/- 7.6 weeks, P = .0004), along with a higher incidence of African American race (95% vs 88%, P = .05). The groups did not differ with respect to other maternal demographics. Perinatal outcomes, including spontaneous preterm birth, abnormal placentation, birth weight, and gestational age at delivery, did not differ between the 2 groups. Conclusion: Compared with adolescent women who had just delivered and did not have a prior abortion, women who had just delivered and had a previous abortion were more likely to be older at the age of their first pregnancy and more likely to initiate early prenatal care. Thus, having a prior abortion may improve the health of a pregnancy though adverse outcomes do not differ between the 2 groups

Maternal heart rate patterns in the first and second stages of labor

Objective. To analyze typical maternal heart rate (MHR) patterns in the first and second stages of labor. Design. Observational study. Setting. Tertiary care community hospital. Population. Normal term parturients with epidural anesthesia. Methods. Confirmed MHR and uterine activity were simultaneously recorded. The average MHR was analyzed 10 seconds before, as well as at the peak of, each contraction and/or pushing effort. Each woman contributed one datapoint at each time point to the analysis. Main outcome measure. Change in MHR during contractions. Results. First stage: 7.6 +/- 2.1 contractions per woman (n=18) were analyzed. Average MHR decreased during contractions: from 83 +/- 13 to 74 +/- 10bpm; p100bpm in three women (17%) in the first stage, and in four women (27%) in the second stage. Peak MHR >140bpm occurred during pushing in 20%. Conclusion. Decreases in MHR during contractions in the first stage of labor can mimic fetal heart rate (FHR) accelerations as well as early type decelerations. Thus, first stage tracings with a low baseline and early type decelerations may be maternal in origin and FHR should be independently confirmed in such tracings. Because second stage MHR accelerations generally show greater amplitude than FHR accelerations, tracings with repetitive accelerations during contractions (especially when ? >20bpm) should be considered MHR until proven otherwise

The Effect of Low-Dose Oxytocin Infusion on Cerebral Hemodynamics in Pregnant Women

We investigated the cerebrovascular effects of continuous infusion of low-dose oxytocin in normal pregnant women undergoing induction of labor. In our prospective observational study, middle cerebral artery velocity was measured with transcranial Doppler ultrasound in 25 healthy, normotensive, nonsmoking patients undergoing induction of labor. No vasoactive drugs were used before or during the study period. Measurements were made at baseline and 15, 30, 60, and 120 minutes after oxytocin initiation. Mean arterial pressure, cerebral perfusion pressure, resistance index, resistance area product, and cerebral flow index at different times were calculated and compared using one-way analysis of variance (ANOVA) for repeated measures or Friedman repeated-measures ANOVA as appropriate, with p <0.05 regarded as significant. No significant systemic or cerebrovascular changes were noted after oxytocin initiation, and there was no correlation between the dosage administered and any hemodynamic parameter. Induction-dose oxytocin does not significantly affect selected cerebral hemodynamic parameters in the first 2 hours after initiation

Changes in Maternal Posterior and Anterior Cerebral Artery Flow Velocity During Pregnancy and Postpartum-A Longitudinal Study

<p>BackgroundTo evaluate the normal range of blood flow velocity in the maternal anterior (ACA) and posterior cerebral arteries (PCA) along the normal pregnancy and postpartum period.</p><p>MethodsTranscranial Doppler ultrasound was used to measure the systolic, diastolic, and mean blood velocities in the ACA and PCA during normal gestation. The resistance and pulsatility indices were calculated. Data were analyzed using multilevel modeling, incorporating random effects models, to construct mean and percentile curves.</p><p>ResultsWe performed 355 measurements on 59 patients, which showed that systolic and mean velocity in the ACA decreased, whereas diastolic velocity increased in the PCA during normal pregnancy. Resistance and pulsatility indices in both vessels increased to a maximum in the second trimester, decreased during the third trimester, and increased during the postpartum period.</p><p>ConclusionsThis study provides normative data for ACA and PCA velocity and indices during pregnancy and postpartum, demonstrating changes in velocity that suggest a shift of cerebral blood flow from the anterior to the posterior cerebral circulation. (c) 2013 Wiley Periodicals, Inc. J Clin Ultrasound41:532-537, 2013.</p>

Neonatal side effects of maternal labetalol treatment in severe preeclampsia

Objective: Labetalol is often used in severe preeclampsia (PE). Hypotension, bradycardia and hypoglycemia are feared neonatal side effects, but may also occur in (preterm) infants regardless of labetalol exposure. We analyzed the possible association between intrauterine labetalol exposure and such side effects. Study design: From 1 January 2003 through 31 March 2008, all infants from mothers suffering severe PE admitted to one tertiary care center were included. Severe PE was defined according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Infants exposed to labetalol in utero (labetalol infants) were compared with infants, who were not exposed to labetalol (controls). Neonatal records were reviewed for hypotension (RR Results: Of 109 infants, 55 had been exposed to labetalol, whereas 54 were not (controls). Gestational age at delivery and birthweight were similar in both groups (31.8 vs. 32.8 weeks (p = 0.06) and 1510 vs. 1639 grams (p=0.25), respectively for the labetalol vs. control group). Hypotension occurred significantly more in conjunction with labetalol exposure (16, (29.1%) vs. 4 (7.4%); p = 0.003). irrespective of the route of administration. Patent ductus arteriosus (PDA) was present in 9(56%) of hypotensive labetalol infants compared to 1(24%) infant in the hypotensive control group (NS). In a multivariate regression model, labetalol exposure, the need for intubation and PDA appeared independently associated with hypotension (P Conclusion: Hypotension is more common after maternal labetalol exposure, regardless of the dosage and route of administration. The need for intubation and the presence of a PDA also play a role. Hypoglycemia is a very common finding in this population and is merely related to prematurity and independent of labetalol exposure as was the incidental occurrence of bradycardia. These findings on the neonatal side effects of maternal labetalol treatment in preeclampsia underline the importance of frequent blood glucose and blood pressure measurements in the first days of life, especially in intubated preterm infants with a PDA. (C) 2012 Elsevier Ireland Ltd. All rights reserved