No abstract

There have been few reports on the effects of everolimus on the fetus, but none of six infants with documented everolimus exposure in utero had congenital malformations. A 32-year-old nulliparous woman on everolimus (5.0 mg/day) for renal angiomyolipoma (AML) due to tuberous sclerosis complex (TSC) was found to be pregnant at gestational week (GW) 7-5/7, at which time everolimus was withheld. To control AML in this patient, transarterial embolization was performed in the right and left kidneys at GW 21 and 24, respectively, and everolimus was reinitiated at GW 25. The patient gave birth at GW 37 to a normally formed infant weighing 3057 g, but who had cardiac tumors thought to be rhabdomyomas due to inherited TSC. Thus, although data are still limited, everolimus may be promising with respect to teratogenicity. Everolimus concentration in the maternal and umbilical cord blood at birth was 1.1 ng/mL and 1.0 ng/mL, respectively.

A 35-year-old Japanese nulliparous woman exhibited rapid weight gain (6 kg/7 days), reduced antithrombin activity and platelet count at 37 weeks of gestation without hypertension or proteinuria, and underwent cesarean section. Postnatally, pulmonary edema developed for 7 days, with transient hypertension and proteinuria, and bodyweight loss (14.6 kg) by 14 days postpartum. Platelet count and antithrombin activity normalized promptly postpartum. Despite a life-threatening clinical condition due to enhanced vascular permeability, neither hypertension nor proteinuria appeared antenatally. Determining antithrombin activity and platelet count may be useful for distinguishing between women with pathological edema and physiological edema.

This is the first report of large presacral Tarlov cysts (cerebrospinal fluid‐filled perineural cysts) diagnosed during pregnancy in which a cesarean delivery mode was selected to avoid the risk associated with vaginal delivery.

Cleft lip and palate is one of the most common congenital anomaly in head and neck. However, previous studies reported a broad range in prenatal detection rates for low-risk women from 9% to 100%. A 29-year-old multigravida woman was referred to our hospital at 21+6weeks' gestation with cleft lip and palate. Until then, the patient's antenatal examination was unremarkable. The ultrasound at our hospital showed a defect extending from left nostril to the oral rim and this defect caused distortion of the upper lip and nose, which was seen well with a 3D rendered image. The cleft palate was also visualised by axial planes. Any other anomalies were not noted. The prenatal diagnosis was cleft lip and palate. At 38+6weeks' gestation, a live baby boy weighing 3300g was delivered. He has cleft lip and palate. Echocardiography showed normal cardiac function and structure. Chromosomal analysis revealed 46 XY karyotype without any abnormalities. Immediate after birth, the baby did not have respiratory distress, however, suffered from feeding difficulty. Nasoalveolar molding device was applied to the baby and plastic surgery was planned at 3 months old. It is important to detect cleft lip and palate because it can be an indicator of other syndromic congenital anomalies or chromosomal abnormalities. A multidisciplinary approach is essential for proper management.