KEY WORDS: vitamin K; fetal intracranial hemorrhage; hyperemesis; hydrocephalus Hyperemesis gravidarum occasionally induces serious maternal complications such as Wernicke's encephalopathy due to vitamin B1 deficiency. Compared with those among infants born to women without hyperemesis, rates of low birth weight and preterm delivery are substantially higher among infants born to women with hyperemesis and low weight gain (Dodds et al., 2006). There is also a report demonstrating that infants born to women with hyperemesis gravidarum are more likely to demonstrate decreased gestational age and increased length of hospital stay (Paauw et al., 2005). Adverse infant outcomes associated with hyperemesis are a consequence of poor maternal weight gain (Dodds et al., 2006). As indicated above, there are several reports describing maternal and neonatal outcomes of pregnancies complicated by hyperemesis gravidarum. However, only limited data are available with regard to fetal complications and/or anomaly in hyperemesis gravidarum.In this report, we first describe a woman with hyperemesis gravidarum in whom fetal intracranial hemorrhage occurred, probably associated with vitamin K deficiency that resulted in nonobstructive hydrocephalus.A 33-year-old, gravida 2, para 0, pregnant (9 weeks of gestational age) woman was referred to our hospital seeking management of persistent hyperemesis gravidarum. Two years previously, she experienced a miscarriage at 15 weeks of gestational age at another hospital. During the previous pregnancy, she had also experienced hyperemesis gravidarum requiring hospitalization. On initial examination of the current pregnancy at our clinic, conjunctiva of the palpebrae and face were icteric. Her height and weight were 150 cm and 40 kg, respectively. Body weight had decreased 5 kg from the baseline. Transvaginal ultrasonographic tomography showed a viable embryo with a crown rump
Objective To compare cervical pessaries plus vaginal progesterone versus long‐term tocolysis for preventing preterm birth for women with a short cervix. Methods Retrospective evaluation of women with singleton pregnancy who received cervical pessaries plus vaginal progesterone (combined group) or ritodrine hydrochloride (tocolysis group) for short cervix (≤25 mm at 20–24 weeks, or ≤20 mm at 25–34 weeks) at a general hospital in Kagoshima, Japan, 2015–2019. The primary outcome was rate of preterm birth (<36 weeks); secondary outcomes were maternal hospital admittance and treatment complications. Results Data were evaluated from 95 women (combined group, n=43; tocolysis group, n=52). There was no significant difference in cervical length or gestational age at intervention between the groups. Overall, 3/43 (7.0%) women delivered before 36 weeks in the combined group versus 16/52 (30.8%) in the tocolysis group (relative risk, 0.56; 95% confidence interval, 0.41–0.76; P=0.004). Median maternal admittance was shorter in the combined group (6.6 vs 41.0 days, P<0.001). Although 36/43 (83.7%) women in the combined group reported increased vaginal discharge, no major complications occurred. Conclusion A combination of pessaries and vaginal progesterone reduced the rate of preterm birth (<36 weeks) for women with short cervix as compared with long‐term tocolysis.
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