Obstetric Medicine - Volume 12, Number 2

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Editorial
Available accessEditorialFirst published June, 2019pp. 55-56
Gender diversity in Obstetric Medicine
Ghada BourjeilyORCIDSangeeta Mehta
Review article
Available accessReview articleFirst published June, 2019pp. 57-65
The forgotten father in obstetric medicine
A KothariORCIDK ThayalanJ Dulhunty
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Abstract
The role of fathers prior to conception, during pregnancy, and in the post-partum period has generally not been a key consideration for Obstetric Physicians. However, this view may need challenging. This paper outlines the key importance of fathers in all phases of obstetric medical care. We review the contribution of paternal factors such as genetics, health, and lifestyle to fetal development, pregnancy complications, and maternal and neonatal wellbeing. The role of fathers in complex care decisions during pregnancy is also reviewed. Postpartum, fathers have a substantial role in shaping the future of the family unit through encouraging breastfeeding and creating a supportive environment for motherhood. This review proposes areas for future research and recommends an evidence-based change in practice in obstetric medicine that focuses on recognizing the role of fathers in the pregnancy journey.
Review article
Available accessReview articleFirst published June, 2019pp. 66-75
Maternal monitoring and safety considerations during antiarrhythmic treatment for fetal supraventricular tachycardia
Isabelle MalhaméORCIDChristy GandhiGofran Tarabulsi
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Abstract
Fetal tachycardia is a rare complication during pregnancy. After exclusion of maternal and fetal conditions that can result in a secondary fetal tachycardia, supraventricular tachycardia is the most common cause of a primary sustained fetal tachyarrhythmia. In cases of sustained fetal supraventricular tachycardia, maternal administration of digoxin, flecainide, sotalol, and more rarely amiodarone, is considered. As these medications have the potential to cause significant adverse effects, we sought to examine maternal safety during transplacental treatment of fetal supraventricular tachycardia. In this narrative review we summarize the literature addressing pharmacologic properties, monitoring, and adverse reactions associated with medications most commonly prescribed for transplacental therapy of fetal supraventricular tachycardia. We also describe maternal monitoring practices and adverse events currently reported in the literature. In light of our findings, we provide clinicians with a suggested maternal monitoring protocol aimed at optimizing safety.
Research article
Available accessResearch articleFirst published June, 2019pp. 76-78
The biochemical diagnosis of intrahepatic cholestasis of pregnancy
Adam MortonORCIDJosephine Laurie
Abstract
Background
Bile acid levels and liver function tests may be normal at presentation in women with intrahepatic cholestasis of pregnancy. The biochemical results of patients presenting with pruritus typical for intrahepatic cholestasis of pregnancy were reviewed.
Methods
A retrospective audit of women coded as having intrahepatic cholestasis of pregnancy over a three-year period.
Results
One hundred and ninety-three women (1.1% of the obstetric population) presented with pruritus typical of intrahepatic cholestasis of pregnancy. Forty (21%) of these women had normal biochemistry at presentation, half subsequently developing abnormal results. Women with a history of allergic reactions were more likely to develop intrahepatic cholestasis of pregnancy.
Conclusions
Normal biochemistry should not preclude a trial of ursodeoxycholic acid in women with distressing pruritus typical for intrahepatic cholestasis of pregnancy. Biochemical tests which are more sensitive and specific in the diagnosis of intrahepatic cholestasis of pregnancy would be valuable. Investigation of other populations with intrahepatic cholestasis of pregnancy regarding a possible association with atopy/allergy would be interesting.
Research article
Available accessResearch articleFirst published June, 2019pp. 79-84
Optimal first trimester HbA1c threshold to identify Singaporean women at risk of gestational diabetes mellitus and adverse pregnancy outcomes: A pilot study
Zi X PooORCIDAnn WrightDu Ruochen
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Abstract
This pilot study examined the use of early HbA1c in screening for gestational diabetes mellitus and adverse pregnancy outcomes in Singapore. One hundred and fifty-one pregnant women with a gestational age of under 14 weeks had an HbA1c test measured with their antenatal bloods prior to a second trimester oral glucose tolerance test. Patient characteristics and pregnancy outcome data were collected. Gestational diabetes mellitus prevalence was 11%. A receiver operating characteristic curve showed an HbA1c level of 5.2% (33 mmol/mol), had an 82% sensitivity, 72% specificity, 97% negative predictive value and 27% positive predictive value to predict gestational diabetes mellitus. Women with HbA1c of 5.2% (33 mmol/mol) or over 5.2% (33 mmol/mol) were older, had higher BMI and were less likely to be Chinese than those with HbA1c less than 5.2% (33 mmol/mol). There was no difference in pregnancy outcomes. Early HbA1c less than 5.2% (33 mmol/mol) may be useful to exclude low-risk Singaporean women from further testing, while those with HbA1c of 5.2% (33 mmol/mol) or greater would still need a oral glucose tolerance test between 24 and 28 weeks’ gestation.
Research article
Available accessResearch articleFirst published June, 2019pp. 85-89
An analysis of demographic and pregnancy outcome data to explain non-attendance for postpartum glucose testing in women with gestational diabetes mellitus
Zora A CastlingTom Farrell
Abstract
Objectives
To identify significant differences in the demographic and pregnancy factors for women with gestational diabetes mellitus who attended or failed to attend for postpartum glucose testing.
Study design
A database of 1052 patients with gestational diabetes mellitus was reviewed. The sample was divided into those who attended for postpartum glucose testing and those who did not. Demographic and obstetric outcomes for the two groups were compared.
Results
Seventy-four per cent of patients who did not attend for postpartum glucose testing were in the two most deprived quintiles. Smokers, unemployed, younger women, those of higher parity and those who did not breast feed were less likely to attend.
Conclusions
Failure to attend for postpartum glucose testing is associated with demographic factors reflective of deprivation. The opportunity to afford lifestyle changes and diabetes screening in these groups of women has been missed. Targeted patient education and accessible postpartum testing may improve compliance.
Research article
Available accessResearch articleFirst published June, 2019pp. 90-96
Sepsis in Obstetrics Score (SOS) utility and validation for triaging patients with obstetric sepsis in the emergency department: Evidence from a low income health care setting
Rachna AgarwalRajesh Kumar YadavMedha Mohta
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Abstract
Background
Illness severity scores commonly used in critical care settings are not considered appropriate in obstetric practice as they do not account for pregnancy physiology. A new illness severity score called the ‘Sepsis in Obstetrics Score’ (SOS) was introduced by Albright et al. for triaging patients with sepsis in pregnancy in an emergency department setting.
Objectives
We aimed to determine whether this score could predict the need for critical care support using the presence of organ failure as the identification criteria. Severity and culture positivity in pregnancy-associated sepsis was also assessed.
Materials and methods
All pregnant, postabortal and postpartum women with suspected sepsis were enrolled (as per systemic inflammatory response syndrome criteria) were enrolled. Severe pregnancy-associated sepsis was defined as dysfunction of one or more organs due to sepsis. The severity of pregnancy-associated sepsis was graded according to the number of organ failures. A SOS cut off of 6 was taken for statistical analysis.
Results
Out of 100 women with pregnancy-associated sepsis, ‘severe sepsis’ was present in 58%. When the SOS test performance was compared with the severity of pregnancy-associated sepsis, it had sensitivity of 68.9% and specificity of 80.9%, positive predictive value of 83% and negative predictive value 65% to predict severe sepsis. The area under curve for the SOS detecting severe pregnancy-associated sepsis was 0.810. SOS predicted organ failure in pregnancy-associated sepsis and this was statistically significant for all organs involved. Culture positivity did not correlate with the SOS in our study.
Conclusions
Sepsis in Obstetrics Score correlated well with organ failure in pregnancy-associated sepsis. It had a high positive predictive value (83%) for severe sepsis.
Case report
Available accessCase reportFirst published June, 2019pp. 97-99
Reversible pulmonary hypertension and high-output heart failure triggered by pregnancy in a patient with congenital arteriovenous malformation: A case report
Héctor SaavedraCelina ToncelVanessa Delgado
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Abstract
Background
Arteriovenous malformations rarely cause congestive heart failure. Pregnancy may in theory trigger heart failure associated with congenital arteriovenous malformations leading to secondary pulmonary hypertension, but no cases have been reported proving that condition.
Methods and results
We report a 23-year-old pregnant woman at 36 + 5 weeks of gestation requiring urgent medical care because of shortness of breath. High-output heart failure was suspected, and a congenital arteriovenous malformation on the right scapular region was considered as the possible origin. The patient required urgent caesarean delivery because of ongoing cardiac failure, which improved soon after delivery. Postpartum angiography of the right subclavian artery revealed an arteriovenous malformation on the deltoid region with venous drainage through the subclavian vein and increased flow to the superior cava vein and right atrium.
Conclusion
A high index of suspicion of arteriovenous malformations should be maintained in pregnant women with cutaneous vascular malformation-like lesions, if symptoms of heart failure are present.
Case report
Available accessCase reportFirst published June, 2019pp. 100-102
Autoimmune progesterone dermatitis following vaginal progesterone exposure in pregnancy
Tomi T KanninenMichael L MorettiNisha A LakhiORCID
Abstract
In the non-pregnant state, exogenous as well as endogenous fluctuations of progesterone have been demonstrated to cause a rare delayed hypersensitivity reaction known as autoimmune progesterone dermatitis. We describe the case of a 20-year-old woman in her second pregnancy who presented to our delivery unit at 31 weeks and 3 days gestation for a cutaneous breakout with pruritic pustules, blisters, and crusts across her chest back and extremities 23 days after the initiation of vaginal progesterone. After suspension of the vaginal progesterone, the patient’s cutaneous lesions resolved. Differential diagnosis and management strategies are discussed. With the increased use of progesterone during pregnancy, complications arising from their use will rise. Clinicians should be aware of their potential adverse effects and consider autoimmune progesterone dermatitis in the differential diagnosis of patients presenting with pruritic lesion in pregnancy.

Volume 12, Issue 2, June 2019