Obstetric Medicine

To determine the levels of angiogenic biomarkers: vascular endothelial growth factor (VEGF), soluble vascular endothelial growth factor receptor 1 (sVEGFR1 or sFlt-1), platelet count, and the VEGF/platelet ratio in preeclampsia.

Forty-four cases of preeclampsia and 44 controls were recruited.

The serum VEGF, sVEGFR1, and VEGF/platelet ratio were significantly higher and platelet counts lower in preeclampsia in comparison to controls (VEGF: median = 178 vs. 97 pg/mL, p < 0.0001, sVEGFR1: 1634 vs. 627 pg/mL, p < 0.0001, VEGF/platelet ratio: 1.148 vs. 0.417, and platelet count: 178 × 10³/µL vs. 232 × 10³/µL, p = 0.0006). The VEGF and VEGF/platelet ratio showed better diagnostic accuracy for differentiating preeclampsia, with an area under the curve of 97.47% (95% CI: 0.95–1.00) and 89.46% (95% CI: 0.82–0.96), respectively. VEGFA: c.-2055A>C (rs699947) AA genotype exhibited higher serum VEGF levels associated with preeclampsia.

The higher levels of angiogenic biomarkers in preeclampsia, suggest a role in the pathogenesis and potential diagnosis.

Pregnancies in women on dialysis remain rare but are increasing in number.

Retrospective observational audit of seven cases from 1977 to 2022 of all women who conceived prior to dialysis or conceived whilst on dialysis.

Of a total of seven women, three were referred from regional centres in Australia, between the 6 and 20 weeks of gestation, generally without any opportunity for pre-conception counselling. Five were managed with intensive haemodialysis aiming for six sessions per week; one patient continued peritoneal dialysis until birth by caesarean section. Five women out of seven had live births, two of which were conceived whilst on dialysis. Four were delivered prematurely between 27 and 31 weeks of gestation, and one at term via spontaneous vaginal delivery.

Outcomes for women with pregnancies on dialysis benefit from intensive dialysis management however the practical implementation remains challenging. Our cases highlight the diversity of experience in our centre across two decades.

To determine the lipid profile and atherogenic indices in preeclamptic/eclamptic patients and compare with normal pregnant women.

Comparative cross-sectional study conducted in North Central Nigeria. The study population was preeclamptic/eclamptic patients and normal pregnant women. A total of 192 women, comprising 96 pregnant women with preeclampsia/eclampsia and an equal number of normotensive controls were recruited consecutively by purposive sampling. Lipid profiles were estimated and atherogenic indices were calculated.

Coronary heart disease risk ratio (CRR) and atherogenic index of plasma (AIP) showed significantly increased atherogenic potentials in subjects compared to controls. Mean ± SD CRR of subjects was 0.28 ± 0.17, Mean ± SD CRR of controls was 0.44 ± 0.24 (p = 0.001); Mean ± SD AIP of subjects was 0.32 ± 0.42 and mean ± SD AIP of controls was 0.16 ± 0.26 (p = 0.003).

Atherogenic indices show increased atherogenic potentials in preeclamptic/eclamptics.

Births in non-maternity hospitals pose significant challenges to ensure delivery of safe and effective care.

We conducted a retrospective chart review examining the maternal and neonatal demographics and care needs of women delivering in a non-obstetric general hospital over a 10-year period.

Cardiac conditions and placenta accreta spectrum disorder were the most common reasons for birth in this location. All 37 births occurred on a weekday, with 29 during core working hours (8 a.m.–4 p.m.). All cases required obstetric, midwifery, anaesthesiology, neonatology and inter-hospital transfer services. Level 3 support was required for 15 women following birth. Neuraxial anaesthesia was utilised in the majority of cases (24/37, 64.8%). One in six infants were breastfed on discharge, with a mean gestational age at birth of 34 weeks.

We demonstrate the significant input of the multi-disciplinary and highlight the importance of addressing both obstetric and neonatal considerations outside of their native care setting.

This study evaluates obstacles peripartum patients with additional medical needs face and services that would be helpful in obtaining this care.

A survey was administered to 226 patients at a clinic specializing in internal medicine care for peripartum patients. Data was analyzed through descriptive statistics and linear regression.

The three most reported barriers that interfered with attending medical appointments included the inability to leave work (41%), being too busy (33%), and lack of childcare (29%). Hispanic and Black patients reported more barriers to care as compared to White patients. The three most reported interventions that would be helpful in attending appointments were more virtual appointment options (38%), increased insurance coverage (31%), and provision of childcare (30%). Interventions were widely rated as helpful regardless of barriers faced and race reported.

Targeted interventions are needed to enhance access to peripartum care, especially for patients from marginalized racial and ethnic populations.

Primary hyperparathyroidism (PHPT) during pregnancy is rare, with the commonest cause being parathyroid adenoma. Parathyroid cysts represent 0.5% of parathyroid lesions. The diagnosis of PHPT requires elevated levels of calcium, along with elevated or non-suppressed parathormone levels. Conservative treatment prevails unless hypercalcemia persists.

A 33-week pregnant woman with preeclampsia and a cervical tumor was diagnosed with PHPT due to a functioning cystic adenoma. She underwent a caesarean section at 36 weeks, delivering a low-birthweight live newborn. Six months post-caesarean section the patient underwent right inferior parathyroidectomy and right hemithyroidectomy, with histopathological findings consistent with a giant cyst parathyroid adenoma. At review three months. after surgery, there are no signs of the persistence of the disease.

A giant functional parathyroid cyst causing PHPT and being identified in pregnancy is exceedingly rare. It is crucial to have a timely multidisciplinary diagnosis and management to avoid maternal and fetal complications.