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RRM Academy Synopsis
Hyper-IgE syndrome pregnancy ended in a safe premature delivery
This report is about one pregnant woman with a rare illness, hyper-IgE syndrome. At 34 weeks, she got very sick with pneumonia and had emergency surgery to have her baby.
Key Findings
Before this pregnancy, she already had chronic lung disease, recurrent dermatitis, repeated airway infections, and reflux.
At 34 weeks and 4 days, she was admitted with worsening breathing, a bad cough, and low blood oxygen. A chest x-ray showed pneumonia.
Doctors gave steroids and magnesium to protect the baby, then delivered by emergency cesarean the next day as her condition worsened.
The baby was born prematurely in good condition and needed only routine newborn care.
After delivery, her breathing worsened again and a scan showed lung inflammation. Her surgical wound then got infected, but she recovered fully and went home.
Interpretation
A single case report is the least certain kind of medical evidence. It tells the story of one patient. The report cannot show how often this happens, what caused it, or how her care compares to other approaches. The findings cannot be applied to other pregnant women with this disorder. The value here is descriptive: a severe breathing crisis from this rare disorder can arise late in pregnancy. In this case, the mother recovered and was discharged without complications after close watching, an early cesarean, and treatment for the infection. The authors also note the newborn had a rash on day five but was not diagnosed with the mother's disorder.
RRM Context
The case is not about fertility. RRM's usual focus is finding and treating the root causes of infertility and cycle problems. It is still a reminder: pregnancy with a lasting lung or immune illness needs care from more than one doctor, working together through the whole pregnancy.
Our editorial summary of this paper, not the article's abstract.
Zabochnicki M et al., 2024·Annales Academiae Medicae Silesiensis·Free to read
Wprowadzenie Objawy lękowe i depresyjne są powszechnymi objawami w okresie ciąży. Wystąpienie pandemii wirusa COVID-19 jest wyjątkowym stresorem, który wpłynął na psychologiczny aspekt przebiegu porodu. Celem pracy jest ocena wpływu pandemii COVID-19 na przebieg ciąży i porodu w populacji polskiej. Materiał i metody Grupę badawczą stanowiło 2186 kobiet. Badanie ankietowe zostało przeprowadzone w okresie od listopada 2020 r. do grudnia 2020 r. za pośrednictwem Internetu. Kryterium włączenia do badania były ciąża i poród w okresie pandemii COVID-19. Do oceny stopnia poziomu strachu i obaw wykorzystano pytania stworzone przez autorów z zastosowaniem pięciostopniowej skali Likerta. Wyniki U kobiet hospitalizowanych w czasie ciąży występował większy poziom strachu i obaw związanych z ciążą (średnia 30,9 vs 29,6; p = 0,007). Podobną zależność stwierdzono w przypadku kobiet, u których wykonano cesarskie cięcie (30,6 vs 29,5; p = 0,006) lub które były hospitalizowane > 7 dni (31,8 vs 29,7; p = 0,012). Stwierdzono również istotną statystycznie, choć słabą korelację pomiędzy średnimi wynikami pytań dotyczących obaw a liczbą hospitalizacji w czasie ciąży (współczynnik korelacji Pearsona r = 0,1654; p < 0,000). Wnioski Badanie wykazało alarmująco wysoki poziom lęku u kobiet w ciąży podczas pandemii COVID-19, co może mieć długoterminowe konsekwencje dla ich dzieci.
Pietrus M et al., 2024·Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology·Free to read
The increasing awareness of women's health issues, specifically pelvic organ prolapse (POP) and urinary incontinence (UI), has spurred a surge in patients seeking specialised advice for these conditions, necessitating modern diagnostic approaches for such issues. This study explored the diagnostic utility of translabial ultrasound for POP, emphasising its correlation with clinical assessments based on International Continence Society (ICS) criteria.
Seventy-one patients with POP Quantification System (POP-Q) stage 0-IV with or without UI were prospectively enrolled at Jagiellonian University Medical College between 2014 and 2016. The study objectives included evaluating diagnostic accuracy and concordance across pelvic compartments, correlating the diagnoses with patient-reported symptoms, and identifying variables contributing to diagnostic discrepancies.
Translabial ultrasound identified POP in 74.5% of the patients, aligning closely with clinical evaluations. Concordance was the highest in assessments performed in the medial compartment (85.8%), while assessments performed in the anterior (29.6%) and posterior (29.6%) compartments showed higher rates of discrepancies. Correlation analyses showed varying associations, with the posterior compartment exhibiting the least pronounced correlation (R = 0.72, p < 0.0001). Self-perceive POP showed no discernible differences in relation to ultrasonographic and clinical assessments. Among the respondents, 55.9% reported experiencing the sensation of POP. Mean POP levels determined using the two approaches precisely matched in 46.5% of these cases. Discrepancies involved variables such as self-perceived POP, number of deliveries, child weight at birth, UI, and sexual activity.
Translabial ultrasound showed robust correlation with clinical assessments for evaluating POP, especially for defining defects and facilitating treatment-related decision-making. Our findings highlight the reliability of this method, particularly for assessments in the medial compartment. The evidence did not indicate the superiority of either method in detecting POP disorders for symptomatic versus asymptomatic patients. Significantly, a higher POP-Q measurement in clinical examination was correlated with greater sexual activity.
Wikarek A et al., 2022·Journal of clinical medicine·Free full text on PubMed Central
The COVID-19 pandemic undoubtedly had significant effects on women's health and the course of pregnancy. The aim of this single-center study was to explore the impact of the COVID-19 pandemic on adult pregnant and postpartum women's mental health, as well as to identify factors associated with depressive symptoms, anxiety and fear of delivery. The 465 women included in this questionnaire-based cohort study were divided into two groups: one (controls) of women who gave birth before (n = 190), and the second who were pregnant and delivered during the pandemic (n = 275). The COVID-19 pandemic affected the severity of self-reported anxiety regarding childbirth (mean scores 2.7 vs. 2.36, p = 0.01). The depression (19.84 ± 13.23) and anxiety (16.71 ± 12.53) scores were higher in pregnant women during the COVID 19 pandemic, compared to women who gave birth before the pandemic (8.21 ± 7.38 and 11.67 ± 9.23, respectively). These findings demonstrate the magnitude of the pandemic's impact on women's mental health, and actions to improve the mental health of pregnant women in Poland may be crucial for maternal and fetal well-being.
Nowosielski K et al., 2020·Menopause (New York, N.Y.)
The menopausal transition is a biological adaptation to the variety of life changes (body, comorbidities, relationship), but that biology is not an "end all" in the context of sexual function and overall sexual health. The aim of this study is to evaluate determinants altering the risk of female sexual dysfunction (FSD) and other sexual problems and to establish whether menopausal hormonal therapy (MHT) decreases that risk and modifies sexual behaviors.
A cross-sectional observational study was conducted in 210 women between the ages of 45 and 55. Two groups were identified: MHT users (n = 107) and controls-MHT non-users (n = 103). Diagnostic and Statistical Manual of Mental Disorders -five criteria were used to assess sexual dysfunction. Sexual problems were evaluated by the Changes in Sexual Function Questionnaire (CSFQ), body image by Body Exposure during Sexual Activity Questionnaire, and quality of relationship by the Well-Match Relationship Questionnaire. Logistic regression was used to determine the risk factors for FSD and sexual problems.
Women using MHT had higher body esteem during sexual activities, better sexual function (CSFQ) in all domains except desire/interest, better quality of relationship, and lower prevalence of FSD and sexual complaints (CSFQ) except arousal/excitement problems. However, self-rated effects of MHT on sexual behaviors showed that MHT did not play a major role. Women with secondary and higher education (OR = 0.09, CI: 0.02-0.4; P < 0.01 and OR = 0.2, CI: 0.05-1.0; P < 0.05, respectively) and with a higher number of lifetime sexual partners (OR = 0.6, CI: 0.4-0.9; P < 0.01) were less likely to have FSD. In contrast, individuals with more anxious behaviors during sexual activity (OR = 3.2, CI: 1.3-7.3; P < 0.01) and with more severe menopausal symptoms (OR = 1.1, CI: 1.0-1.2; P < 0.001) were more likely to have FSD. Using MHT was not associated with that risk nor with sexual function.
In women during menopausal transition, sexual behaviors were different in MHT users compared with non-users. However, in this cross-sectional observational study conducted in 210 women between the ages of 45 to 55 years, using MHT was not associated with modification of sexual function, decreasing the risk of sexual dysfunction, nor sexual problems.
Milosz K Matyja, Mateusz Klimek, Magdalena Lemm
M Matyja, M Klimek, M Lemm
PMID 35315026 35315026 DOI 10.5603/GP.a2021.0251 10.5603/GP.a2021.0251 Matyja et al. 2022, Matyja 2022