Two cases of interstitial pregnancy (one singleton, one heterotopic twins) were confirmed 31 and 34 days after in-vitro fertilization. Serum human chorionic gonadotrophin concentrations were 35,000 and 86,000 mlU/ml, respectively. They were treated conservatively with transvaginal ultrasonically guided intra-ovular injection of either methotrexate in the singleton pregnancy, or potassium chloride into the ectopic sac of the heterotopic twins. No complications were observed. The intra-uterine pregnancy continued and the patient delivered a 3350 g healthy baby at 39 weeks.
BACKGROUND: Less invasive surfactant replacement therapy (SRT) methods have been linked to better respiratory outcomes. The primary aim of this study was to determine if Less Invasive Surfactant Administration (LISA) altered the rate of bronchopulmonary dysplasia (BPD) in preterm infants. Secondary objectives were to determine if LISA compared to Intubation Surfactant Extubation (InSurE) resulted in different respiratory outcomes and hospital course. METHODS: In this retrospective chart review, outcomes were compared in two preterm infant groups (25–32 weeks gestation). Infants in Group 1 received surfactant replacement therapy (SRT) via InSurE method, while infants in Group 2 received SRT via LISA method. RESULTS: Regardless of SRT method utilized, there were no significant differences in rates of BPD between the two groups in infants born at 25–32 weeks gestation (30.6% vs 33.3% ; P = 0.47). CONCLUSIONS: Despite using LISA method rather than InSurE for SRT, premature infants continue to be at high risk for BPD. LISA shows promise as a safe, noninvasive SRT alternative to invasive methods like InSurE.
The relationship between focal segmental glomerulosclerosis (FSGS) and pregnancy is complex and not completely elucidated. Pregnancy in patients with FSGS poses a high risk for complications, possibly due to hemodynamic factors, imbalance between angiogenic and antiangiogenic factors, and hormonal conditioning. Although poor clinical outcomes associated with collapsing FSGS are common outside of pregnancy, the prognosis during pregnancy is not well documented. We report 3 patients who developed collapsing FSGS during pregnancy, 2 of whom had presumed underlying FSGS. Two patients underwent biopsy during pregnancy, and 1, during the puerperium. None of the 3 patients improved spontaneously after delivery, and 1 experienced a rapid deterioration in kidney function and proteinuria after delivery. Aggressive immunosuppressive therapy led to a full response in 1 case (without chronic lesions) and to partial responses in the remaining 2 cases. These cases suggest that collapsing lesions should be considered in patients with FSGS who develop a rapid increase in serum creatinine level or proteinuria during pregnancy and that these lesions may at least partially respond to treatment.
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