Intrahepatic cholestasis of pregnancy (ICP) generally presents in the third trimester with pruritus without a rash, characterised by elevated bile acids, with or without transaminitis and hyperbilirubinaemia. Risk factors include a family history of cholestasis, South Asian ethnicity, multifetal gestation, in vitro fertilisation (IVF) and history of hepatitis or biliary disorders.IVF involves the use of high dose gonadotropin stimulation and human chorionic gonadotropin trigger. High doses of progesterone supplementation are additionally given after embryo transfer. The increase in oestrogen and progesterone levels early on in the pregnancy is a possible explanation for the development of ICP in IVF pregnancies at earlier gestations.We present a rare case of iatrogenic ICP presenting in the first trimester in a pregnancy conceived by IVF. Unlike other cases reported, our patient did not have recurrence of ICP in the third trimester, and also had no history of ICP in her first pregnancy.
Spontaneous hemoperitoneum in pregnancy (SHiP), an unprovoked, non‐traumatic intraperitoneal bleed in pregnancy and up to 42 days postpartum, is a rare but potentially life‐threatening clinical condition. Here, we report a rare case of spontaneous rupture of uterine surface variceal vessels in the second trimester of pregnancy mimicking acute appendicitis that posed diagnostic difficulties and challenges in management.
A woman in her early twenties with dichorionic diamniotic twins underwent emergency caesarean section (CS) for failed induction of labor for discordant growth at 37 weeks. Her CS was complicated by atonic postpartum hemorrhage (PPH) requiring uterotonics, B-lynch suture, and Bakri balloon. She presented on the 5th postoperative day (POD) with fever and wound pain and collapsed due to desaturation. Investigations confirmed ascites on computed tomography (CT) of her abdomen and cardiomyopathy on echocardiogram. She was readmitted on the 22nd POD with watery vaginal discharge. CT abdomen revealed a dehisced CS scar and loculated ascites. Her discharge settled after three weeks with antibiotics and drainage of the ascites. A CT scan 3 months later showed reduction of the peritoneal collection. Caesarean scar dehiscence should be considered for patients presenting with ascites and vaginal discharge after a CS, particularly in the presence of risk factors such as infection or anemia.
Introduction: Perinatal transmission remains one of the important causes of the transmission of the human immunodeficiency virus (HIV). Over the years, with better knowledge and awareness of HIV, the perinatal transmission rate has been significantly reduced. We previously reported on the pregnancy outcomes of HIV-positive mothers from 1997 to 2007 in our institution. This paper aims to review standards of care of HIV-positive pregnant women since then. Methods: A retrospective study reviewed 84 HIV-positive women who delivered in a tertiary centre from January 2008 to December 2015. Patient demographics and antenatal, intrapartum, postnatal and immediate neonatal data were analysed.Results: There were a total of 97 deliveries with 98 neonates. 12 women delivered more than once and there was one set of twins. Mean maternal age at diagnosis of HIV was 27.8 years.Of the study population, 63.1% of women were non-Singaporeans. 56 women were known to have HIV on presentation and 90.7% were on antiretroviral therapy during pregnancy. 88.7% of the women received intrapartum intravenous zidovudine, and 93.1% of women with detectable and 58.7% with undetectable viral load underwent Caesarean sections. All neonates were HIV-negative.
Conclusion:Having high standards of care for HIV-positive women has successfully reduced our perinatal transmission rate to zero.
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