Proteinuria during pregnancy is often associated with preeclampsia (PE) but may also indicate aggravated or newonset renal disease. As recently reviewed by Bartal et al., 1 2% of pregnancies exhibit isolated gestational proteinuria, and progress to PE or severe PE at a rate of up to 30%. As isolated proteinuria is part of the multisystem disease of PE, it shares many risk factors with PE. 2 In particular, patients with late-onset isolated proteinuria, at 33-36 or 37 weeks and later, were found to be at an elevated risk for PE, equal to 2.44 (95% CI: 0.80-4.08)-or 8.62 (95% CI: 7.54-9.70)-fold, respectively. In the clinic, however, proteinuria in the absence of gestational hypertension often does not flag a pregnancy as high risk or commit it to robust monitoring protocols.Ascites is sometimes observed in PE patients. Previously, it was reported that 1.9 of 1000 PE cases exhibit ascites. This rate increases to 21.6 of 1000 patients if the PE has severe features. 3 Ascites associates with poor outcomes for both mother and neonate, but the evidence is limited. 4,5 In addition to severe PE, ascites arises from independent underlying conditions such as portal hypertension, inflammatory diseases, malignancies, and diseases associated with low hypoalbuminemia. Here, we report a patient with massive ascites becoming prominent postpartum associated with late-onset preeclampsia.
| CASE REPORTOur patient was a 26-year-old primigravid woman managed by an obstetrics practitioner at a private clinic over the course of a naturally conceived pregnancy. She had no history of hypertension or kidney disease, but proteinuria (3+ by urine dipstick test) was observed after 35 weeks'
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Background: Although the shock index (SI) (heart rate/systolic blood pressure) and heart rate (HR) are a helpful indicator in the management of postpartum blood loss, there are few reports of SI in pregnant women complicated with hypertensive disorders in pregnancy (HDP). The purpose of this study was to examine whether SI and HR would be a clinically helpful indicator, and to detect the cutoff value for judging abnormal obstetric bleeding. Methods: This was a retrospective case-control study in 107 patients with HDP in a singleton tertiary perinatal medical facility. The values of postpartum highest SI (peak SI) and highest HR (peak HR), and the amount of bleeding until peak SI and peak HR were retrospectively examined and analyzed. We used the receiver operating characteristic analysis to assess the diagnostic value of peak SI and peak HR for judging abnormal obstetric bleeding. Results: Peak SI and peak HR were significantly related to the amount of bleeding up to peak SI and up to peak HR. The cutoff values of peak SI with blood loss volumes above 500 ml, 1000 ml, and 1500 ml were 0.77, 0.76, and 0.99, respectively. The cutoff values of peak HR with blood loss volumes above 500 ml, 1000 ml, and 1500 ml were 97, 98, and 103, respectively. Conclusion: In cases of pregnant women complicated with HDP, both SI and HR were probably useful indicators in the management of postpartum blood loss. Further prospective trials are warranted to confirm these results.
Preeclampsia causes various presentations by increased endothelial
permeability and microvascular damages. Maternal ascites related severe
preeclampsia is generally explained by increased capillary permeability
due to endothelial cell dysfunction and reduced intravascular oncotic
pressure. Here we report a patient with postpartum massive ascites
associated with preeclampsia.
There are few reports on pregnancy and childbirth of HTLV-1-associated
myelopathy/tropical spastic paraparesis (HAM/TSP) patients. We present a
woman who diagnosed with HAM/TSP and used a wheelchair in daily life.
She had no neurological impairments and no obstetrical complications
during her three courses of pregnancy and childbirth.
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