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Hypertensive emergencies in pregnancy require prompt evaluation and treatment in an intensive care setting to prevent untoward effects to both the fetus and mother.

Congenital obstruction of the upper airway (CHAOS) is CASE REPORTA 27-year-old woman, gravida 2, para 1, was referred to our institution at 31 weeks of gestation. Previous ultrasound findings at 17, 20 and 23 weeks were interpreted as suggestive of bilateral congenital cystic adenomatoid malformation (CAM) of the lung, Type III. Both lungs were hyperechoic, with the mediastinum shifted to the midline, diaphragm flattened, and the heart appearing compressed (Figures 1 and 2). In addition, an elongated hypoechoic structure in the posterior mediastinum was identified and thought to represent the fluid-filled esophagus (Figure 3). Polyhydramnios and a single umbilical artery were also detected. The patient underwent genetic counseling and amniocentesis, which revealed a normal male karyotype. Ultrafast fetal magnetic resonance imaging performed at 24 weeks showed a grossly normal fetal chest (sequences after balanced fast field-echo localizers consisted primarily of T2-weighted single-shot imaging with additional fast field-echo images).The initial ultrasound scan at our facility at 31 weeks revealed normal echogenicity of the lungs, and the previously described elongated hypoechoic structure in the posterior mediastinum was no longer detectable. Amniotic fluid volume was normal by 32 weeks of gestation, when pectus excavatum and right ventricular enlargement were also noted. Fetal echocardiography confirmed right ventricular enlargement and suspected pulmonary hypertension. A repeat ultrasound scan at 35 weeks yielded no additional relevant information. Biometry indicated appropriate fetal growth, with an estimated fetal weight at the 39th percentile for dates.The mother had no significant personal or family history. The current pregnancy was complicated by dietcontrolled gestational diabetes and late-onset gestational hypertension. She was admitted for labor induction at 38 weeks of gestation after spontaneous rupture of membranes. Ten hours after admission, a nonreassuring fetal heart rate pattern necessitated a primary low-transverse Cesarean delivery under lumbar epidural anesthesia. A liveborn male infant weighing 2655 g

The purpose of this review was to examine the impact of varying degrees of renal insufficiency on pregnancy outcome in women with chronic renal disease. Our search of the literature did not reveal any randomized clinical trials or meta-analyses. The available information is derived from opinion, reviews, retrospective series, and limited observational series. It appears that chronic renal disease in pregnancy is uncommon, occurring in 0.03-0.12% of all pregnancies from two U.S. population-based and registry studies. Maternal complications associated with chronic renal disease include preeclampsia, worsening renal function, preterm delivery, anemia, chronic hypertension, and cesarean delivery. The live birth rate in women with chronic renal disease ranges between 64% and 98% depending on the severity of renal insufficiency and presence of hypertension. Significant proteinuria may be an indicator of underlying renal insufficiency. Management of pregnant women with underlying renal disease should ideally entail a multidisciplinary approach at a tertiary center and include a maternal-fetal medicine specialist and a nephrologist. Such women should receive counseling regarding the pregnancy outcomes in association with maternal chronic renal disease and the effect of pregnancy on renal function, especially within the ensuing 5 years postpartum. These women will require frequent visits and monitoring of renal function during pregnancy. Women whose renal disease is further complicated by hypertension should be counseled regarding the increased risk of adverse outcome and need for blood pressure control. Some antihypertensives, especially angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, should be avoided during pregnancy, if possible, because of the potential for both teratogenic (hypocalvaria) and fetal effects (renal failure, oliguria, and demise).

Aim: The aim of this study was to compare the performance of tests based on the detection of insulin-like growth factor binding protein 1 (IGFBP-1) and placental α -microglobulin-1 (PAMG-1) in diagnosing rupture of fetal membranes (ROM) across different patient populations. Methods: A meta-analysis was conducted on prospective observational or cohort studies investigating ROM tests based on the detection of IGFBP-1 and PAMG-1 meeting the following criteria: (1) performance metrics calculated by comparing results to an adequate reference method; (2) sensitivity thresholds of the investigated tests matching those of the currently available tests; (3) study population, as a minimum, included patients between 25 and 37 weeks of gestation. Sensitivities, specificities, and diagnostic odds ratios were calculated. Results: Across all patient populations, the analyzed performance measures of the PAMG-1 test were significantly superior compared with those of the IGFBP-1 test. Of particular clinical relevance, PAMG-1 outperformed IGFBP-1 in the equivocal group, which comprised patients with uncertain rupture of membranes (sensitivity, 96.0 % vs. 73.9 % ; specificity, 98.9 % vs. 77.8 % ; respectively). Conclusions: Compared with its performance in women with known membrane status, the accuracy of the IGFBP-1 test decreases significantly when used on patients whose membrane status is unknown. In this latter clinically relevant population, the PAMG-1 test has higher accuracy than the IGFBP-1 test.

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To compare the timing, duration, and severity of corticosteroid-associated hyperglycemia in pregnant women with and without diabetes mellitus (DM). An observational study was conducted of pregnant women with DM and controls who received corticosteroids. Median glucose levels were calculated over 4-hour intervals after the first dose of corticosteroid with a continuous glucose monitor. A glucose level increase of at least 15% above baseline was considered significant. Nine pregnant women participated in this study (six with DM and three without DM). Elevations of glucose levels occurred at hour 20, 44, and 68 in both groups and lasted for up to 4 hours. In those with DM, glucose levels increased 33 to 48%, whereas in those without DM, glucose levels rose 16 to 33%. Several, relatively short episodes of glucose elevation occur in response to corticosteroids, and are more pronounced in diabetic women.

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