DOCSLIB.ORG

The Neurology of Pregnancy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Neurology of Pregnancy J Neurol Neurosurg Psychiatry 1998;64:711–725 717 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.64.6.717 on 1 June 1998. Downloaded from NEUROLOGY AND MEDICINE The neurology of pregnancy Guy V Sawle, Margaret M Ramsay The neurology of pregnancy can be split into headache, visual disturbances (typically pho- two. On the one hand, there are women who topsia), epigastric pain, or vomiting. This pro- develop neurological symptoms during preg- dromal state is typical, but the convulsions of nancy. Some have simple neurological disor- eclampsia may arise apparently unheralded ders such as carpal tunnel syndrome, which are and at what seems to be normal blood pressure. more common during pregnancy. Others have Eclampsia is most common during the third disorders that are either peculiar to or very trimester of pregnancy or during labour, but much commoner during pregnancy, such as can also occur after delivery, typically within eclampsia, pelvic neural compression, or even the first 48 hours. tumours arising from the placenta. The most common, serious, and important of these con- ditions is eclampsia. Other women have PRODROMAL FEATURES AND DIAGNOSIS Certain clinical features, indicating pre- neurological problems such as epilepsy or eclampsia of significant severity, are typical in myasthenia first and then become pregnant. patients who subsequently develop generalised For these patients, pregnancy may aVect the convulsions. It is di cult to know whether and course of the disease, and there may be impor- Y over what time scale this progression may occur tant issues with respect to investigation, in an individual patient. Such patients typically treatment, and prognosis. have high and rapidly rising or extremely labile blood pressure, proteinuria (sometimes in the Eclampsia nephrotic range), visual disturbances (especially Eclampsia is one of the commonest causes of photopsia or cortical blindness), headache, maternal death. In the United Kingdom, recent malaise, new onset of peripheral oedema (espe- figures show that 15.5% of direct maternal cially periorbital or facial), oliguria, restlessness, deaths were due to the hypertensive disorders shivering, and clonus. Laboratory evidence of of pregnancy, and more than half of these multisystem disease (such as hyperuricaemia, women had eclampsia.1 As many as 50 000 thrombocytopaenia, raised liver enzymes, or maternal deaths annually world wide are haemolysis) is also common. thought to be as a consequence of eclampsia.2 Other patients fail to show these warning http://jnnp.bmj.com/ The incidence of eclampsia during a recent signs and clinicians may not recognise impend- nationwide survey in the United Kingdom was ing eclampsia or may even fail to make the about one in 2000 maternities, with a case diagnosis when convulsions ensue. Examples fatality ratio of almost one in 50.3 We do not include patients who present during the second know how many women presenting with the trimester of pregnancy or in association with fulminating features described below will go on molar degeneration of the placenta. In other to have convulsions, or whether drug treatment cases the prodromal features are distracting, Division of Clinical can reduce the chance of progression. In one such as predominantly epigastric pain and on October 1, 2021 by guest. Protected copyright. Neurology GVSawle observational study, only one in 75 women vomiting, rather than headache and visual dis- with severe pre-eclampsia developed eclamptic turbance. The diagnosis may also be missed 4 Department of convulsions. when patients present in labour or the early Obstetrics and puerperium, when the blood pressure has Gynaecology, Queens DEFINITIONS always been normal (but beware rapidly rising Medical Centre, Pregnancy induced hypertension (also known blood pressure or onset of proteinuria peripar- Nottingham NG7 2UH, UK as pre-eclampsia and pregnancy toxaemia) tum). In other cases the blood pressure may M M Ramsay develops after 20 weeks of gestation in not be particularly raised or else there may be previously normotensive women and resolves no information about the patient’s “normal” Correspondence to: by three months postpartum; the pressure is prepregnancy blood pressure. Sometimes the Dr GV Sawle, Division of Clinical Neurology, Queens considered raised if greater than 140/90 mm patient or her medical attendants do not know Medical Centre, Nottingham Hg, or if the diastolic blood pressure rises that she is pregnant; other times the convul- NG7 2UH, UK. 15–25 mm Hg above prepregnancy values.5 sions begin late in the puerperium (>48 hours Telephone 0044 115 970 9792; fax 0044 115 970 When such a patient has a convulsion, they after delivery). Rarely, in an obtunded patient, 9738. should be considered to have eclampsia unless the seizures may not have been witnessed. proved otherwise. Such patients are likely also Important diVerential diagnoses in a preg- Received 22 May 1997 and to have significant proteinuria (>0.5 g/24 nant woman having her first seizure are intrac- in final revised form 2 March 1998 hours, or at least + with urine dipstick testing), erebral (particularly subarachnoid) haemor- Accepted 3 March 1998 facial or generalised oedema, and symptoms of rhage and cerebral venous thrombosis. Other 718 Sawle, Ramsay J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.64.6.717 on 1 June 1998. Downloaded from possibilities are tumours, intracerebral infec- which show increased T2 signals on MRI.14–17 tion, metabolic disturbances, and autoimmune Abnormalities are more common in patients disorders (particularly systemic lupus with eclampsia.16 There is a predilection for erythematosus).6 abnormalities in the occipital and parietal lobes, in the watershed area between middle PATHOPHYSIOLOGY and posterior cerebral artery territories.15 16 It is always diYcult to know how best to treat or The distribution of lesions shows good correla- prevent a disease when its underlying patho- tion in most cases with the patient’s clinical physiology is incompletely understood. Our features, such as occipital pole lesions in understanding of the cerebral changes occur- women with cortical blindness.14 15 Enhance- ring in pre-eclampsia and eclampsia has ment of T1 signals after injection of gadolin- changed with the improvement of neuroradio- ium has been documented in regions with logical techniques. The traditional view was increased T2 signals.17 The lesions are inter- that eclampsia was due to intracerebral haem- preted as indicating areas of abnormal water orrhage, because that is what was typically content—that is, focal cerebral oedema. There 6 found postmortem. Yet proposed pathophysi- is much debate about whether such oedema is ological mechanisms must provide explana- intracellular, indicating areas of focal ischae- tions for several clinical findings: firstly, that mia, or whether it is extracellular, secondary to eclamptic convulsions can arise suddenly in a capillary leakage and breakdown of cerebral patient with little or no prodrome; secondly, autoregulation.14–17 that eclampsia does not always occur with It is, however, important to determine which extremely high blood pressure or prolonged is the more important mechanism, as this will increase in blood pressure; and thirdly, that determine pharmacological strategies to amel- there may be transient focal neurological iorate or prevent eclampsia. The proponents of defects (such as cortical blindness or hemipare- the breakdown of cerebral autoregulation sis) yet most women who survive eclampsia do theory argue that eclampsia is simply hyperten- so neurologically intact. sive encephalopathy and that the keystone of It has variously been proposed that eclamp- treatment should be good control of blood tic convulsions result from intracerebral haem- pressure.18 This leaves a dilemma in a patient orrhage, hypertensive encephalopathy, cerebral 67 with “normal” or only marginally raised blood oedema, or cerebral vasospasm. DiVerent mechanisms may be operating in diVerent pressure as to what should be the target blood patients, with the compounding eVects of pressure. If focal ischaemic areas develop as a cerebral hypoxia, intravenous fluid and drug consequence of cerebral vasospasm, then administration, and varying degrees of hyper- specific vasodilator agents are likely to be more tension. The women who die are likely to be at beneficial and lowering blood pressure in some the worst end of the range. Those who die of circumstances could further aggravate ischae- eclampsia have significantly higher blood pres- mic processes. sure, but no worse renal function or more pro- An increasing body of evidence points to the teinuria than those who survive.8 presence of cerebral vasospasm in eclampsia and Typical postmortem cerebral findings are also in severe pre-eclampsia. Cases have been fibrinoid necrosis of vessels, thrombosed pre- reported where cerebral angiography and mag- 19 20 http://jnnp.bmj.com/ capillaries, perivascular ring haemorrhages, netic resonance angiography, performed subarachnoid, intraventricular, and intracer- after eclamptic seizures, have shown diVuse ebral haemorrhages (including patches of vasospasm. Similar images have also been noted 21 22 petechial haemorrhage in the cerebral cortex), in women with severe pre-eclampsia. Follow hypoxic-ischaemic damage, and perivascular up images documented resolution of vasospasm microinfarcts.67910 Studies with CT have in association with clinical recovery. Is cerebral shown that eclamptic patients with evidence
Load more

Recommended publications
  • Placenta Increta at 14 Weeks with Subsequent Hysterectomy: a Case Report Abigail E Collett1*, Jean Payer1 and Xuezhi Jiang1,2
    ISSN: 2378-3656 Collett et al. Clin Med Rev Case Rep 2018, 5:225 DOI: 10.23937/2378-3656/1410225 Volume 5 | Issue 7 Clinical Medical Reviews Open Access and Case Reports CASE REPORT Placenta Increta at 14 Weeks with Subsequent Hysterectomy: A Case Report Abigail E Collett1*, Jean Payer1 and Xuezhi Jiang1,2 1Departments of OB/GYN, The Reading Hospital of Tower Health System, Reading, USA Check for updates 2Departments of OB/GYN, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, USA *Corresponding author: Abigail E Collett, DO., Department of OB/GYN-R1, The Reading Hospital of Tower Health, P.O. Box: 16052, Reading, Philadelphia, PA 19612-6052, USA, Tel: 484-628-8827, Fax: 484-628-9292, E-mail: Abigail.collett@ towerhealth.org Abstract transvaginal ultrasound which showed heterogeneous myo- metrium and a heterogeneous mass-like solid and cystic Background: Abnormal placental implantation (API) is an appearing area in the lower uterine segment. A total ab- uncommon obstetrical phenomenon that is associated with dominal hysterectomy, bilateral salpingectomy and cystos- significant maternal morbidity. Typically, the diagnosis of copy were performed. Intra-operative evaluation revealed a API is made at the time of delivery in the third trimester. firm protruding tissue mass in the left anterior lower uterine However there are reports of API presenting in the second segment that was found to be placenta increta or more on trimester, and rarely in the first trimester. Cesarean Scar final pathology. The patient recovered appropriately during Pregnancy (CSP) can be considered a subset of API. Early her hospital stay and was discharged in stable condition.
    [Show full text]
  • Gestational Trophoblastic Disease Early Detection, Diagnosis, and Staging Detection and Diagnosis
    cancer.org | 1.800.227.2345 Gestational Trophoblastic Disease Early Detection, Diagnosis, and Staging Detection and Diagnosis Catching cancer early often allows for more treatment options. Some early cancers may have signs and symptoms that can be noticed, but that is not always the case. ● Can Gestational Trophoblastic Disease Be Found Early? ● Signs and Symptoms of Gestational Trophoblastic Disease ● How Is Gestational Trophoblastic Disease Diagnosed? Staging After a cancer diagnosis, staging provides important information about the extent of cancer in the body and anticipated response to treatment. ● How Is Gestational Trophoblastic Disease Staged? Questions to Ask About Gestational Trophoblastic Disease Here are some questions you can ask your cancer care team to help you better understand your diagnosis and treatment options. ● What Should You Ask Your Doctor About Gestational Trophoblastic Disease? 1 ____________________________________________________________________________________American Cancer Society cancer.org | 1.800.227.2345 Can Gestational Trophoblastic Disease Be Found Early? Most cases of gestational trophoblastic disease (GTD) are found early during routine prenatal care. Usually, a woman has certain signs and symptoms, like vaginal bleeding, that suggest something may be wrong. (See Signs and Symptoms of Gestational Trophoblastic Disease.) These problems will prompt the doctor to look for the cause of the trouble. Often, moles or tumors cause swelling in the uterus that seems like a normal pregnancy. But a doctor can usually tell that this isn't a normal pregnancy during a routine ultrasound exam. A blood test for HCG (human chorionic gonadotropin can also show something abnormal. This substance is normally elevated in the blood of pregnant women, but it may be very high if there is GTD.
    [Show full text]
  • Partial Hydatidiform Molar Pregnancy
    DIAGNOSIS AT A GLANCE Marion-Vincent Mempin, MD, MSc; Poonam Desai, DO; Nadia Maria Shaukat, MD, RDMS, FACEP Partial Hydatidiform Molar Pregnancy Case partial molar pregnancy. A 26-year-old gravida 3, para 2-0-0-2, aborta 0 whose last An obstetric consultation was made and the patient menstrual period was 15 weeks 5 days, presented to the was taken to the operating room the following day for ED with complaints of mild vaginal spotting, which she a dilation and curettage (D&C) procedure. She was dis- first noted postcoitally the previous day. The patient de- charged home the next day without complications. The nied fatigue, lightheadedness, dyspnea, abdominal pain, products of conception were sent to pathology, and nausea, or vomiting. confirmed a triploid karyotype and p57 trophoblastic Physical examination revealed a well-appearing pa- immunopositivity, diagnostic of a partial hydatidiform tient with normal vital signs. The abdomen was soft and mole. nontender, and the fundus was palpable at the level of the umbilicus. A speculum examination was unremarkable, Discussion with normal external genitalia, a closed cervical os, no Hydatidiform moles are a subset of abnormal pregnan- adnexal masses or tenderness, and no blood in the vagi- cies termed gestational trophoblastic disease (GTD). nal vault. Laboratory studies were significant for a serum The two greatest risk factors for GTD are previous GTD beta human chorionic gonadotropin (beta-hCG) of 7,442 and extremis of maternal age.1 Patients often present mIU/mL (reference range for 15 weeks: 12,039-70,971 mIU/ mL). The patient was Rh posi- tive with a stable hematocrit.
    [Show full text]
  • Gestational Trophoblastic Disease
    4/12/17njm Gestational trophoblastic disease Background Gestational trophoblastic disease (GTD) is a spectrum of tumors with a wide range of biologic behavior and potential for metastases. GTD refers to both the benign and malignant entities of the spectrum and include hydatidiform mole, invasive mole, choriocarcinoma, and placental site trophoblastic tumor. The last three are termed gestational trophoblastic tumors (GTT); all may metastasize and are potentially fatal if untreated. The incidence of hydatidiform mole varies in different regions of the world, but has been falling. In North America the incidence is approximately 0.6 to 1.1 per 1000 pregnancies; the rate is approximately three times higher in Asia. Choriocarcinoma in North America occurs in one of every 20,000 to 40,000 pregnancies. The risk of repeat molar pregnancy in a conception following one molar pregnancy (complete, partial, or persistent GTN) is approximately 1 percent, which is increased compared with the 1:1000 risk of molar gestation in the general population. Therefore, ultrasound should be obtained in the late first trimester of subsequent pregnancies to confirm normal fetal development. Additionally, an hCG level should be obtained six weeks after completion of subsequent pregnancies to rule out occult choriocarcinoma. (see Management of Subsequent Pregnancies, below) Routine pathologic evaluation of the placenta, while recommended in the past, is not necessary. However, products of conception should be evaluated by a pathologist following any spontaneous or
    [Show full text]
  • Molar Pregnancy with Normal Viable Fetus Presenting with Severe Pre-Eclampsia: a Case Report Freddie Anak Atuk* and Juliana Binti Mohamad Basuni
    Atuk and Basuni Journal of Medical Case Reports (2018) 12:140 https://doi.org/10.1186/s13256-018-1689-9 CASE REPORT Open Access Molar pregnancy with normal viable fetus presenting with severe pre-eclampsia: a case report Freddie Anak Atuk* and Juliana Binti Mohamad Basuni Abstract Background: While gestational trophoblastic disease is not rare, hydatidiform mole with a coexistent live fetus is a very rare condition occurring in 0.005 to 0.01% of all pregnancies. As a result of the rarity of this condition, diagnosis, management, and monitoring will remain challenging especially in places with limited resources and expertise. The case we report is an interesting rare case which presented with well-described complications; only a few similar cases have been described to date. Case presentation: We report a case of a 21-year-old local Sarawakian woman with partial molar pregnancy who presented with severe pre-eclampsia in which the baby was morphologically normal, delivered prematurely, and there was a single large placenta showing molar changes. Conclusion: Even though the incidence of this condition is very rare, recognizing and diagnosing it is very important for patient care and it should be considered and looked for in patients presenting with pre-eclampsia. Keywords: Partial molar, Normal viable fetus, Pre-eclampsia Background Case presentation Molar pregnancy is significantly more common in A 21-year-old local Sarawakian primigravida woman was extremes of age [1]. Hydatidiform mole has been recog- diagnosed as having severe pre-eclampsia at 28 weeks and nized as a clinical entity since the time of Hippocrates and was admitted for blood pressure stabilization and moni- has always aroused interest because of its wide spectrum toring.
    [Show full text]
  • OBGYN-Study-Guide-1.Pdf
    OBSTETRICS PREGNANCY Physiology of Pregnancy: • CO input increases 30-50% (max 20-24 weeks) (mostly due to increase in stroke volume) • SVR anD arterial bp Decreases (likely due to increase in progesterone) o decrease in systolic blood pressure of 5 to 10 mm Hg and in diastolic blood pressure of 10 to 15 mm Hg that nadirs at week 24. • Increase tiDal volume 30-40% and total lung capacity decrease by 5% due to diaphragm • IncreaseD reD blooD cell mass • GI: nausea – due to elevations in estrogen, progesterone, hCG (resolve by 14-16 weeks) • Stomach – prolonged gastric emptying times and decreased GE sphincter tone à reflux • Kidneys increase in size anD ureters dilate during pregnancy à increaseD pyelonephritis • GFR increases by 50% in early pregnancy anD is maintaineD, RAAS increases = increase alDosterone, but no increaseD soDium bc GFR is also increaseD • RBC volume increases by 20-30%, plasma volume increases by 50% à decreased crit (dilutional anemia) • Labor can cause WBC to rise over 20 million • Pregnancy = hypercoagulable state (increase in fibrinogen anD factors VII-X); clotting and bleeding times do not change • Pregnancy = hyperestrogenic state • hCG double 48 hours during early pregnancy and reach peak at 10-12 weeks, decline to reach stead stage after week 15 • placenta produces hCG which maintains corpus luteum in early pregnancy • corpus luteum produces progesterone which maintains enDometrium • increaseD prolactin during pregnancy • elevation in T3 and T4, slight Decrease in TSH early on, but overall euthyroiD state • linea nigra, perineum, anD face skin (melasma) changes • increase carpal tunnel (median nerve compression) • increased caloric need 300cal/day during pregnancy and 500 during breastfeeding • shoulD gain 20-30 lb • increaseD caloric requirements: protein, iron, folate, calcium, other vitamins anD minerals Testing: In a patient with irregular menstrual cycles or unknown date of last menstruation, the last Date of intercourse shoulD be useD as the marker for repeating a urine pregnancy test.
    [Show full text]
  • Table of Contents
    Problem-Based Clinical Cases Obstetrics and Gynecology Rotation Gyn Cases Updated December 2004 OB Cases Updated June 2005 By Dr. Manisha Patel Table of Contents Section I: General Gynecology Page 4. Breast Disorders..................................................................................................................................... 1 5. Contraception ......................................................................................................................................... 2 7. Dysmenorrhea........................................................................................................................................ 3 8. Dyspareunia ........................................................................................................................................... 5 9. Ectopic Pregnancy.................................................................................................................................. 8 10. Enlarged Uterus...................................................................................................................................... 9 19. Menorrhagia ......................................................................................................................................... 10 23. Pelvic Relaxation .................................................................................................................................. 12 25. Postmenopausal Bleeding...................................................................................................................
    [Show full text]
  • Ectopic Molar Tubal Pregnancy: an Important Histological Presentation
    CASE REPORT Ectopic Molar Tubal Pregnancy: An Important Histological Presentation Alexander Sabre∗,1, Ashley Molina∗, Manonmani Arul∗ and Malvina Elmadjian∗ ∗Lincoln Hospital and Mental Health Center 249 E 149th St. Bronx, N.Y. USA 10451. ABSTRACT BACKGROUND: Ectopic localization of molar pregnancy is rare from review of literature. To date, only 132 cases have been reported. The identification of molar pregnancies in this setting is critical given their malignant potential and post-surgical management. We present a case of tubal hydatiform molar pregnancy with features suggestive of partial mole, detailing the patient’s initial presentation, explorative surgical evaluation, and finally the revelation of diagnosis based upon pathological determination. It is essential for providers to not only be informed of an unusual pathology but of the importance and value of histological examination of tubal specimens post-surgery with the pertinence to diagnose cases of molar pregnancy for prompt and appropriate post-operative surveillance. KEYWORDS Ectopic pregmancy; Molar Pregnancy; Gynecology; Gynecological Malignancy; Laparoscopy need for further management. Other than genotypic analysis for definitive diagnosis, the molar pregnancy may be elucidated upon histological findings. These criteria include circumferential Introduction trophoblastic proliferation, hydropic scalloped villi, decidual- The incidence of ectopic pregnancy is approximately 20 in 1,000 ized tissue, myxomatous and karyorrhexis effects of stroma, and pregnancies [2]. Hydatidiform molar pregnancies are more rare, avascular cisternae [1]. Once diagnosed, close surveillance with occurring approximately 1 in 500 for partial moles and 1 in serial beta-human chorionic gonadotropic hormone (b-hCG) is 1,000 for complete molar pregnancies [2]. Molar pregnancy required to assess for malignant potential.
    [Show full text]
  • Management of Partial Hydatidiform Mole and Subsequent Intrauterine
    Clinical Experience PHARMACY PRACTICE Management of Partial Hydatidiform Mole and Subsequent Intrauterine Adhesions: A Case Report and Literature Review Dor Partosh, BPharm; Genevieve Hale, PharmD, BCPS, BCCP Nova Southeastern University College of Pharmacy Abstract Background: Gestational trophoblastic disease (GTD) originates from placental tissue and is among rare human tumors that can be cured even in the presence of widespread metastases. The most common form of GTD is hydatidiform mole (HM), commonly referred to as molar pregnancy. Molar pregnancies have the potential to locally invade the uterus and metastasize and result as a result of gestational trophoblastic neoplasia. Intrauterine adhesions (IUAs) is a condition where scar tissue develops within the uterine cavity, often following a procedure. Hysteroscopy has been established as the criterion standard for the diagnosis of IUAs, although the optimal adjuvant treatment after surgical intervention remains unclear. Case: A 35-year-old-female underwent suction curettage a week after the detection of a molar pregnancy. Two months later, she suffered from amenorrhea and hormonal therapy was initiated. Saline-infusion sonogram was tried and failed due to cervical stenosis. IUAs leading to scar tissue developed along with uterine polyps. Hysteroscopy successfully lysed IUAs and uterine polyps. The patient conceived two months after stopping hormonal therapy and proceeded to a pregnancy which resulted in a healthy live birth. Conclusion: Although the etiology of the patient’s molar pregnancy is still unknown, this report demonstrates the need to utilize hysteroscopy as a primary and early mode of treatment if IUAs are found in patients along with providing adjuvant treatment while utilizing clinical judgement in order to prevent IUAs recurrence.
    [Show full text]
  • XI. COMPLICATIONS of PREGNANCY, Childbffith and the PUERPERIUM 630 Hydatidiform Mole Trophoblastic Disease NOS Vesicular Mole Ex
    XI. COMPLICATIONS OF PREGNANCY, CHILDBffiTH AND THE PUERPERIUM PREGNANCY WITH ABORTIVE OUTCOME (630-639) 630 Hydatidiform mole Trophoblastic disease NOS Vesicular mole Excludes: chorionepithelioma (181) 631 Other abnormal product of conception Blighted ovum Mole: NOS carneous fleshy Excludes: with mention of conditions in 630 (630) 632 Missed abortion Early fetal death with retention of dead fetus Retained products of conception, not following spontaneous or induced abortion or delivery Excludes: failed induced abortion (638) missed delivery (656.4) with abnormal product of conception (630, 631) 633 Ectopic pregnancy Includes: ruptured ectopic pregnancy 633.0 Abdominal pregnancy 633.1 Tubalpregnancy Fallopian pregnancy Rupture of (fallopian) tube due to pregnancy Tubal abortion 633.2 Ovarian pregnancy 633.8 Other ectopic pregnancy Pregnancy: Pregnancy: cervical intraligamentous combined mesometric cornual mural - 355- 356 TABULAR LIST 633.9 Unspecified The following fourth-digit subdivisions are for use with categories 634-638: .0 Complicated by genital tract and pelvic infection [any condition listed in 639.0] .1 Complicated by delayed or excessive haemorrhage [any condition listed in 639.1] .2 Complicated by damage to pelvic organs and tissues [any condi- tion listed in 639.2] .3 Complicated by renal failure [any condition listed in 639.3] .4 Complicated by metabolic disorder [any condition listed in 639.4] .5 Complicated by shock [any condition listed in 639.5] .6 Complicated by embolism [any condition listed in 639.6] .7 With other
    [Show full text]
  • Molar Pregnancy Is Known Medically As a Hydatid Week of Pregnancy Some Additional Symptoms May Form Mole
    M olar Pregnancy P atient Information Women’s Health Service A molar pregnancy is known medically as a hydatid week of pregnancy some additional symptoms may form mole. Another term to describe a molar appear: pregnancy is trophoblastic disease. In this brochure Severe nausea and vomiting we will explain what a molar pregnancy is and how Vaginal bleeding or spotting it is diagnosed and treated. Early high blood pressure (pre-eclampsia) There are two types of molar pregnancies: In addition to these symptoms, a blood test may show a higher than normal level of the Complete mole: This occurs when the centre of pregnancy hormone, βHCG. the mother’s egg becomes lost or inactivated during fertilisation. As a result the fertilised egg has Diagnosis and treatment no genetic material from the mother. All of the When a molar pregnancy is suspected, a procedure genetic material is from the father and this genetic call an evacuation of products of conception will be mix does not form a baby; instead an unusual recommended to you. This is sometimes known as cluster of tissue grows in the placenta. a dilation and curettage (D&C). This is a procedure usually performed under general anaesthetic to Partial mole: This occurs when two sperm cells gently remove and collect tissue from inside the fertilise the mother’s egg. This usually results in a uterus. The vagina is held open by a speculum and baby with an abnormal amount of genetic material, the cervix is widened (dilated). Suction is used to which is unable to develop normally.
    [Show full text]
  • Recurrent Pregnancy Loss
    Recurrent Pregnancy Loss November 2017 Version 2 0 ESHRE Early Pregnancy Guideline Development Group [1] Version 2 was published 1 April 2019 and includes a correction in the numbers mentioned in section 4.2 on page 39 (changes were marked in green). No further changes were made as compared to version 1 (published November 2017) DISCLAIMER The European Society of Human Reproduction and Embryology (hereinafter referred to as 'ESHRE') developed the current clinical practice guideline, to provide clinical recommendations to improve the quality of healthcare delivery within the European field of human reproduction and embryology. This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. The aim of clinical practice guidelines is to aid healthcare professionals in everyday clinical decisions about appropriate and effective care of their patients. However, adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not override the healthcare professional's clinical judgment in diagnosis and treatment of particular patients. Ultimately, healthcare professionals must make their own clinical decisions on a case-by-case basis, using their clinical judgment, knowledge, and expertise, and taking into account the condition, circumstances, and wishes of the individual patient, in consultation with that patient and/or the guardian or carer. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose.
    [Show full text]