Clinical medicine (London, England)
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Adrenal haemorrhage in pregnancy is rare but can lead to significant maternal and fetal morbidity if unrecognised. We present the case of a 25-year-old woman in her second pregnancy, who was admitted at 34 + 4 weeks of gestation with severe abdominal pain. ⋯ This report underscores the diagnostic challenges of adrenal pathology in pregnancy, where symptoms may overlap with more common conditions. Immediate management with hydrocortisone therapy, supported by a multidisciplinary team (MDT), was employed, with a successful outcome for both mother and child following delivery by caesarean section.
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Palpitations are common in pregnancy and warrant investigation. Palpitations may be caused by non-cardiac and cardiac causes. Patients with structural or functional abnormalities or inherited cardiovascular disease are more likely to develop arrhythmia, especially during pregnancy when the mother's body undergoes extensive physiological adaptations, which further contribute to an increased arrhythmia risk. ⋯ If the patient is stable, medical management is indicated, and early involvement of the pregnancy heart team can help facilitate appropriate treatment. In complex arrhythmia, consultation of an arrhythmia expert should be sought. Many anti-arrhythmics are safe in pregnancy, and it is important to reassure the pregnant patient of this.
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Pregnancy leads to significant changes in renal physiology, which result in increases in glomerular filtration rate (GFR) and enhanced protein excretion. These changes may continue in the postnatal period and might be observed for 5-6 months after birth. Once confirmed, proteinuria warrants investigation and close surveillance. ⋯ New onset of proteinuria before 20 weeks' gestation (with or without kidney impairment) suggests known or previously undetected kidney disease. As pregnancy evolves, hyperfiltration may lead to increasing proteinuria, posing a diagnostic challenge in the diagnosis and recognition of pre-eclampsia. This article was written as a guide for the evaluation and management of proteinuria in pregnancy, as well as appreciating diagnostic dilemmas.
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Pulmonary embolism (PE) is a significant cause of morbidity and mortality in pregnancy and the puerperium. In severe cases, it causes haemodynamic instability and can lead to cardiac arrest due to obstructive shock. Patients with acute PE can be risk stratified to guide their monitoring and treatment; this article focuses on intermediate- and high-risk PE. ⋯ Diagnostic imaging should not be delayed due to pregnancy. Low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) can be used during pregnancy and breastfeeding, and systemic thrombolysis can be used in obstetric patients, but there are significant bleeding risks and it should be reserved for high-risk PE with hypotension and shock. Although pregnancy and the puerperium are risk factors for PE, it is important to avoid early diagnostic closure, and to consider other causes for the patient's presentation.
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Asthma is the most common chronic disease to affect pregnant women and can have a significant effect on pregnancy outcomes, with increased rates of preterm birth, premature delivery and caesarean section observed if poorly controlled. Pregnancy can also influence asthma control. ⋯ The majority of asthma treatment can be continued as normal in pregnancy and there is emerging evidence of the safety of biologic medications also. This article aims to summarise the current evidence about asthma in pregnancy and guide the appropriate management of this population.