Maternal Left Ventricular Function in Uncomplicated Twin Pregnancies: A Speckle-Tracking Imaging Longitudinal Study

Objective: The knowledge of maternal cardiovascular hemodynamic adaptation in twin pregnancies is incomplete. We aimed to longitudinally investigate maternal left ventricular (LV) function in uncomplicated twin pregnancies. Methods: 30 healthy and uncomplicated twin pregnant women and 30 controls with normal singleton pregnancies were prospectively enrolled to undergo transthoracic echocardiography at 10–15 week’s gestation (w) (T1), 19–26 w (T2) and 30–38 w (T3). LV dimensions and volumes, as well as LV ejection fraction (LVEF), mass (LVM) and diastolic parameters (at transmitral pulsed wave Doppler and mitral annular plane tissue Doppler), were calculated. Speckle-tracking imaging was also applied to evaluate LV global longitudinal (GLS), radial and circumferential 2D strains. Results: During twin pregnancy, maternal LV dimensions, volumes and LVM had an increasing trend from T1 to T3, similar to singletons, while LVEF remained stable. There was LV remodeling/hypertrophy in 50% of women at T2 and T3 in both groups. Diastolic function had a worsening trend from T1 to T3 with no differences between twins and singletons, except for higher LV filling pressure (i.e., E/E′) at T2 in twins. Two-dimensional strains did not vary during gestation in either group, except for a linear trend to increase (i.e., worsen) GLS in singletons. Radial and circumferential 2D strains were impaired in about half of the women at each trimester, while GLS was altered in one-fourth/one-third of them in both groups. Conclusion: Maternal LV geometry, dimensions and function are significantly impaired during twin pregnancies, in particular in the second half of gestation, with no significant differences compared to singletons

Sleep-disordered breathing and pregnancy outcomes: The impact of maternal oxygen saturation

ObjectiveTo investigate pathological associations between sleep-disordered breathing (SDB) and pregnancy outcomes. MethodsFrom May 2016 to September 2019, obese women during their uncomplicated singleton pregnancies underwent screening sleep questionnaires, oxygen saturation monitoring, and, in proper cases, complete overnight polysomnography. Their medical records were also recorded. ResultsIn all, 112 pregnant women were included in the study cohort; 44 showed an oxygen desaturation index & GE;10, and their newborns had a significantly higher rate of congenital abnormalities and respiratory distress syndrome compared with the women with normal pulse oximetry. Stepwise multivariate regression analysis showed that basal oxygen saturation was independently associated with the occurrence of fetal growth restriction. ConclusionAmong obese pregnant women, the rate of congenital abnormalities is higher in the ones with altered pulse oximetry. Maternal basal oxygen saturation in the first trimester of pregnancy predicts fetal growth restriction independently of maternal age, ethnicity, body mass index, gravidity, and hypertensive disorders of pregnancy

Frequency of positive antiphospholipid antibodies in pregnant women with SARS-CoV-2 infection and impact on pregnancy outcome: A single-center prospective study on 151 pregnancies

Background: At the beginning of the SARS-CoV-2 pandemic, there was a lack of information about the infection’s impact on pregnancy and capability to induce de novo autoantibodies. It soon became clear that thrombosis was a manifestation of COVID-19, therefore the possible contribution of de novo antiphospholipid antibodies (aPL) raised research interest. We aimed at screening SARS-CoV-2 positive pregnant patients for aPL. Methods: The study included consecutive pregnant women who were hospitalized in our Obstetric Department between March 2020 and July 2021 for either a symptomatic SARS-CoV-2 infection or for other reasons (obstetric complications, labour, delivery) and found positive at the admission nasopharyngeal swab. All these women underwent the search for aPL by means of Lupus Anticoagulant (LA), IgG/IgM anti-cardiolipin (aCL), IgG/IgM anti-beta2glycoprotein I (aB2GPI). Data about comorbidities, obstetric and neonatal complications were collected. Results: 151 women were included. Sixteen (11%) were positive for aPL, mostly at low titre. Pneumonia was diagnosed in 20 women (5 with positive aPL) and 5 required ICU admission (2 with positive aPL). Obstetric complications occurred in 10/16 (63%) aPL positive and in 36/135 (27%) negative patients. The occurrence of HELLP syndrome and preeclampsia was significantly associated with positive aPL (p=0,004). One case of maternal thrombosis occurred in an aPL negative woman. aPL positivity was checked after at least 12 weeks in 7/16 women (44%): 3 had become negative; 2 were still positive (1 IgG aB2GPI + IgG aCL; 1 IgM aB2GPI); 1 remained positive for IgG aCL but became negative for aB2GPI; 1 became negative for LA but displayed a new positivity for IgG aCL at high titre. Conclusions: The frequency of positive aPL in pregnant women with SARS- CoV-2 infection was low in our cohort and similar to the one described in the general obstetric population. aPL mostly presented as single positive, low titre, transient antibodies. The rate of obstetric complications was higher in aPL positive women as compared to negative ones, particularly hypertensive disorders. Causality cannot be excluded; however, other risk factors, including a full-blown picture of COVID-19, may have elicited the pathogenic potential of aPL and contributed themselves to the development of complications

Insulinoma Identified in Puerperium: Association with Pregnancy and Literature Review

Postpartum hypoglycemia in non-diabetic women is a rare condition. We report the case of a 34-year-old woman who experienced neuroglycopenia 2 days after delivery. Corresponding to severe hypoglycemia, we found inappropriately elevated insulin and C-peptide levels. Following magnetic resonance imaging a lesion of 10×8 mm was detected in the head of the pancreas. An ultrasound-guided fine needle aspiration of the mass confirmed the diagnostic suspicion of a pancreatic neuroendocrine tumor. Complete surgical enucleation of the insulinoma resulted in immediate and permanent resolution of the hypoglycemia. The postoperative course was uneventful. Histopathological and immunohistochemical analyses were consistent with insulinoma. The diagnostic approach to postpartum hypoglycemia represents a challenge for multidisciplinary teamwork

Fulminant ulcerative colitis in a healthy pregnant woman

This case report concerns a 25-year-old patient with 6-7 bloody stools/d, abdominal pain, tachycardia, and weight loss occurring during the third trimester of pregnancy. Severe ulcerative colitis complicated by toxic megacolon and gravidic sepsis was diagnosed by clinical evaluation, colonoscopy, and rectal biopsy that were performed safely without risk for the mother or baby. The patient underwent a cesarean section at 28+6 wk gestation. The baby was transferred to the neonatal intensive care unit of our hospital and survived without complications. Fulminant colitis was managed conservatively by combined colonoscopic decompression and medical treatment. Although current European guidelines describe toxic megacolon as an indication for emergency surgery for both pregnant and non-pregnant women, thanks to careful monitoring, endoscopic decompression, and intensive medical therapy with nutritional support, we prevented the woman from having to undergo emergency pancolectomy. Our report seems to suggest that conservative management may be a helpful tool in preventing pancolectomy if the patient's condition improves quickly. Otherwise, surgery is mandatory

Primary Hyperparathyroidism in Pregnancy: A Case Report

Primary hyperparathyroidism (PHP) is the third most common endocrine disorder. We report the case of a 28-year-old woman who experienced general weakness, hyperemesis gravidarum and hypercalcemia at 11 weeks of gestation. Corresponding to hypercalcemia, we found inappropriately elevated parathyroid hormone levels. Through neck computed tomography a solitary adenoma of the parathyroid gland, measuring 6 × 2.9 × 11 mm has been documented. An ultrasound-guided fine needle aspiration from the mass confirmed the suspicious of a benign tumor. Left superior parathyroidectomy resulted in immediate and permanent resolution of hypercalcemia. The postoperative course was uneventful. Histopathological and immunohistochemical analyses were consistent with parathyroid adenoma. The diagnostic approach to hypercalcemia in pregnancy represents a challenge for multidisciplinary teamwork

Insights into cardiac alterations after pre-eclampsia: an echocardiographic study

OBJECTIVES: Pre-eclampsia (PE) is associated with persistent abnormalities in cardiac findings, known to be important in cardiovascular (CV) risk stratification. Two-dimensional (2D) speckle tracking echocardiography (STE) allows an objective quantification of myocardial deformation overcoming many of the limitations of tissue Doppler imaging (TDI), and provides insights into aspects of left ventricular (LV) function that were exclusively analyzed by magnetic resonance imaging. Early-onset (EO) and late.onset (LO) PE could be more than one disease leading to a different CV involvement, being myocardial and vascular impairment more frequent after pregnancies complicated by the early form of the disease than the late one. Understanding LV performance status requires examining not only the properties of the left ventricle itself, but also investigating the modulating effects of the arterial system on LV function. This aspect is globally resumed in the concept of ventricular-arterial coupling (VAC). The aim of this study was to investigate CV performance status few years after EOPE or LOPE taking into account myocardial 2D strain, LV torsional mechanics and VAC. METHODS: 30 non-pregnant women with a previous singleton pregnancy complicated by EOPE, 30 who experienced LOPE and 30 controls underwent echocardiography from 6 months to 4 years after delivery. All the study cohort was free from any CV risk factor. VAC was defined as the ratio between aortic elastance (Ea) and left ventricular end-systolic elastance (Ees). RESULTS: The EOPE group showed a subclinical impairment in left ventricular systole and a slight alteration in right ventricular function. Although VAC was normal in the whole study cohort, Ea and Ees were altered significantly more in the EOPE group than both LOPE and controls. All parameters we studied were independently associated with GA at the diagnosis of PE. CONCLUSIONS: Women with a history of EOPE showed a persistent subclinical contractile impairment involving the whole heart, if compared with LOPE and healthy controls. In previously pre-eclamptics VAC value was maintained in normal range, although its single components showed subclinical alterations which were more significant in EOPE than LOPE and controls

Endothelial dysfunction and vascular stiffness in women with a previous pregnancy complicated by early or late pre-eclampsia

Pre-eclampsia leads to an increased cardiovascular risk later in life. The persistence of endothelial dysfunction after delivery may represent the link between pre-eclampsia and cardiovascular disease. We aimed at evaluating endothelial function and arterial stiffness after pregnancies complicated by early-onset or late-onset pre-eclampsia and their correlation with gestational age and mean uterine artery pulsatility index both considered at the diagnosis of pre-eclampsia and birth weight percentile

Cardiac dysfunction in patients with a previous pregnancy complicated by early or late preeclampsia without cardiovascular risk factors

7nonenoneOrabona, R.; Vizzardi, E.; Sciatti, E.; Bonadei, I.; Valcamonico, A.; Metra, M.; Frusca, T.Orabona, Rossana; Vizzardi, Enrico; Sciatti, Edoardo; Bonadei, Ivano; Valcamonico, A.; Metra, Marco; Frusca, T