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Pulmonary Alveolar Proteinosis (PAP) is a rare, usually autoimmune, disease, where surfactant accumulates within alveoli due to decreased clearance, causing dyspnea and hypoxemia. The disease is even more rare in pregnancy; nevertheless, it has been reported in pregnant women and can even appear for the first time during pregnancy as an asthma-like illness. Therefore, awareness is important. Similarly to many autoimmune diseases, it can worsen during pregnancy and postpartum, causing maternal and fetal/neonatal complications. This paper offers a narrative literature review of PAP and pregnancy, while illustrating a case of a pregnant patient with known PAP who developed preeclampsia in the third trimester but had an overall fortunate maternal and neonatal outcome. [ABSTRACT FROM AUTHOR]

Management strategies for pregnancies with abnormal adherence/invasion of the placenta (placenta accreta spectrum, PAS) vary between centers. Expectant management (EM), defined as leaving the placenta in situ after the delivery of the baby, until its complete decomposition and elimination, has become a potential option for PAS disorders in selected cases, in which the risk of Caesarean hysterectomy is very high. However, expectant management has its own risks and complications. The aim of this study was to describe the rates of subsequent hysterectomy (HT) in patients that underwent EM for the treatment of PAS disorders. We reviewed the literature on the subject and found 12 studies reporting cases of HT after initial intended EM. The studies included 1918 pregnant women diagnosed with PAS, of whom 518 (27.1%) underwent EM. Out of these, 121 (33.2%) required subsequent HT in the 12 months following delivery. The rates of HT after initial EM were very different between the studies, ranging from 0 to 85.7%, reflecting the different characteristics of the patients and different institutional management protocols. Prospective multicenter studies, in which the inclusion criteria and management strategies would be uniform, are needed to better understand the role EM might play in the treatment of PAS disorders. [ABSTRACT FROM AUTHOR]

Surgery during pregnancy post additional concerns an represent a major stress factor for both anesthesiologist and gynecologists. Approximately 0.5-2% of all pregnant women undergo a least one nonobstetric surgery during their pregnancy, and the number is growing in recent years. Until present days, no anesthetic drug has been shown to be clearly dangerous to human fetus. Thus, a pregnant woman should never be delayed from surgery regardless of teratogenic effects at any gestational age. The choice of anesthetic technique, drugs and surgical procedure should be guided by mother safety and continuation of adequate uteroplacental perfusion. Regarding Cesarean Section, it is now the most common surgery performed in the United States, with over 1 million women delivered by cesarean every year. Due to medical and legal implication, anesthesia must be safe in order to improve maternal and fetal outcome. Ultimately, success of each case is granted by multidisciplinary team approach and adherence to the latest clinical practice guidelines. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) is one of the most frequent complications of pregnancy. Despite international efforts, there is no consensus regarding the optimal method of screening and diagnosis of GDM. Some organizations propose screening only for women with high risk of GDM, while others suggest testing all pregnant women. Furthermore, there are more types of screening and diagnostic tests (one vs. two-step approach) with different glycemic thresholds. The aim of this review is to present and compare the screening and diagnosis guidelines of the most influential organizations. Additionally, this study evaluates the differences between selective and universal screening. The necessity for a consensus and for a single acceptable guideline has been repeatedly highlighted by experts in order to allow uniform clinical practice and to improve perinatal and maternal outcomes. [ABSTRACT FROM AUTHOR]

Hydroxychloroquine (HCQ) is an antimalarial drug containing a 4-aminoquinoline radical, with immunomodulatory, antioxidant, anti-inflammatory and vascular protective effects, which is widely used in the treatment of various rheumatological conditions and is also compatible with pregnancy. It is well known that hydroxychloroquine crosses the placental barrier and hence it can protect against adverse perinatal outcomes, such as congenital heart block in fetuses of anti-SSA/ Ro positive mothers. When it is administered at daily doses inferior or equal to 400 mg, HCQ is not associated with augmented risk of perinatal morbidity and it has also been found to prevent disease flares among pregnant women with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA), improving maternal outcomes and being protective toward fetal health as well. However, the concerns about its safety in pregnancy are still present because studies on the risks of perinatal defects associated with HCQ administration arise sparse and have controversial results. The purpose of the current article is to make a review of the medical literature concerning the safety of HCQ in pregnancy. For this purpose, scientific research in online medical publications such as Elsevier, PubMed, and The Lancet, was conducted. [ABSTRACT FROM AUTHOR]

The overall risk of methicillin-resistant Staphylococcus aureus (MRSA) in obstetric populations is unknown. MRSA infection incidence has increased in pregnant women and neonates even if prevention techniques of MRSA have improved. MRSA infections affect both mothers and their infants. MRSA is the most common pathogen responsible for postpartum mastitis. There are also other postpartum infections with MRSA such as cellulitis, pelvic thrombophlebitis, pneumonia, septicemia, cesarean wound infections, episiotomy infections and urinary tract infections. The objectives of this review were to identify the most frequent risk factors for postpartum MRSA infection and to determine the frequency of antibiotic-resistant Staphylococcus aureus infections after delivery. A literature review was conducted using PubMed and we used the following key words “MRSA infection in postpartum”, “risk factors for postpartum MRSA infection”. We are included in our review 27 articles from the last 20 years which presented rare cases of MRSA infection in postpartum and those which identified the risk factors of this infection after delivery. Infections with MRSA appear to be more frequent among pregnant women colonized with MRSA. Early identification of MRSA, early diagnosis and appropriate treatment of infection is mandatory for a good prognosis. By now, vigilance and effective MRSA prevention strategies are considered essential to limit the spread and infection. [ABSTRACT FROM AUTHOR]

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Diabetes mellitus is a metabolic disease with life-threatening morbidity and with epidemic spread. This metabolic disorder affects an increasing number of pregnant women. General practitioners and obstetricians need to know how some occult maternal metabolic disorders could be revealed by pregnancy and how pregnancy could influence the fetal health and the long-term progression of maternal disease. Pregnancy is considered a stress test for life and diabetes mellitus is a good example to illustrate this correlation. [ABSTRACT FROM AUTHOR]

Maternal passage of immunoglobulin G (IgG) is an important passive mechanism for protecting the infant while the neonatal immune system is still immature and ineffective. IgG is the only antibody class capable of crossing the histological layers of the placenta by attaching to the neonatal Fc receptor expressed at the level of syncytiotrophoblasts, and it offers protection against neonatal infectious pathogens. In pregnant women with autoimmune or alloimmune disorders, or in those requiring certain types of biological therapy, transplacental passage of abnormal antibodies may cause fetal or neonatal harm. In this review, we will discuss the physiological mechanisms and benefits of transplacental transfer of maternal antibodies as well as pathological maternal situations where this system is hijacked, potentially leading to adverse neonatal outcomes. [ABSTRACT FROM AUTHOR]

Peptic ulcer disease during pregnancy has to be separated from its management and treatment in the general populations. It was demonstrated to have a low incidence rate, with symptoms, frequency and complications decreasing due to maternal hormones. We aimed to outline the actual management and treatment of peptic ulcer disease (PUD) during pregnancy. We performed a literature review by searching relevant information on the subject in PubMed database using the keywords: peptic ulcer disease, pregnancy, H2 receptor antagonists, proton-pump inhibitors, fetal, congenital abnormalities. Current literature studies show a decreased rate of both incidence and symptoms in pregnant women compared to the general population. Step by step therapy combines both lifestyle modifications and medical drugs for the benefit of both mother and fetus. It is difficult to differentiate from the beginning between PUD and gastroesophageal reflux (GERD) or hyperemesis gravidarum, due to similar symptoms. An accurate anamnesis and a good understanding of serological and paraclinical investigations can define the right diagnosis. Management of this pathology in a pregnancy state can be difficult, but a compliant attitude of the mother together with an organized medical approach can facilitate treatment. [ABSTRACT FROM AUTHOR]

This review has the purpose to evaluate and report clinical characteristics, treatment, and obstetric outcomes of adnexal torsion in pregnant women in order to raise awareness of the need for prompt diagnosis and surgical intervention. Adnexal torsion (AT) in pregnancy is a rare event but is a surgical emergency that needs prompt intervention. Misdiagnosis or delay in treatment can lead to loss of ovarian function with an effect on future fertility and loss of the pregnancy. The use of assisted reproductive technology is associated with an increased risk of AT. Diagnosis of AT is very challenging due to its nonspecific signs and symptoms such as abdominal pain, nausea, vomiting, and abdominal tenderness. Furthermore, pregnant women with AT present with specific characteristics, and these common signs and symptoms may be caused by other obstetric and non-obstetric conditions. Ultrasound examination may not be as valuable as in non-pregnant women. MRI can assist in making the diagnosis in pregnant women. Clinical suspicion of AT should not delay treatment if the imaging evaluation is not clarifying. In standard practice, the surgical treatment of AT is performed by laparoscopy which is safe for pregnant patients regardless of the trimester. The treatment is based on a conservative approach by preserving the adnexa although initially, the ovary may seem necrotic. During the intervention the adnexa is de-twisted, and cystectomy or cyst aspiration is performed, if any adnexal mass is present, to reduce the recurrence risk. Surgery during pregnancy for suspected AT does not lead to adverse obstetrical outcomes. Given the difficulties of the diagnosis of AT in pregnancy, it is of great importance that clinicians are familiar with this complication in pregnancy and are aware of the need for prompt intervention. [ABSTRACT FROM AUTHOR]

Acute cholecystitis is the most common non-obstetric abdominal emergency in pregnant patients. It is a consequence of increased formation of cholelithiasis, and occurs due to inflammation of the gallbladder, usually caused by the blockage of the cystic duct. There is also described the appearance of cholecystitis without the presence of gallstones, and this is named as acalculous cholecystitis. Elevated levels of estrogen and progesterone are thought to be a cause of women’s increased predisposition to this condition. In pregnancy, literature describe the appearance of gallstones in 1% to almost 3% pregnancies, and it is known that pregnancy by itself affects the contractility of gallbladder. For sludge and gallstones, even if there is a large range of symptoms, almost up to 50% of patients are asymptomatic. Acute cholecystitis is suspected in a patient with continuous pain in the right upper quadrant, alongside anorexia, vomiting, and fever. Laboratory findings in acute cholecystitis show leukocytosis, an elevated level of bilirubin, up to 4 mg/dl and elevated liver tests. The most useful imaging tool in diagnosing gallstones and further acute cholecystitis is an abdominal ultrasound. Any pregnant women with upper right quadrant pain should be hospitalized to exclude other differential diagnoses and for pain management, usually done with acetaminophen. Supportive care treatment includes administration of intravenous fluids and when necessary antibiotic therapy. Recent studies have showed that interventional surgery by itself brings some associated risks during pregnancy, but with an experienced team of surgeon, anesthesia specialist, and obstetrician, outcomes are better, no matter the trimester of pregnancy. [ABSTRACT FROM AUTHOR]

Urolithiasis during pregnancy is a rare condition despite the prolithogenic state determined by the physiological changes in the urinary system. The incidence is similar among pregnant women and the general female population, pregnancy not being a risk factor for the appearance of kidney stones. Urolithiasis is a challenge for the obstetrician because diagnosis and treatment require a particular approach in order not to harm the fetus. Ultrasonography is the first choice for diagnosing kidney stones even though it has a reduced sensibility. The first line of treatment in renal colic is expectant management. If this is ineffective, then urological interventions are being taken into consideration. Left untreated, urolithiasis exposes the pregnancy and the baby to higher risks of complications. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD), with its two main forms, Crohn’s disease, and ulcerative colitis, are characterized by chronic inflammation of the gastrointestinal tract. It is frequently diagnosed during childbearing years and its overlapping with pregnancy adds more complexity to the management of the disease. This review article aims to summarize what is acknowledged so far regarding IBD in pregnancy, providing up-to-date information. A systematic literature electronic search for journal articles and guidelines regarding IBD during pregnancy was undertaken. The most favorable pregnancy outcomes for pregnant women with IBD occur when the disease is in remission both at the time of conception and during the pregnancy. Most of IBD medication is considered safe during pregnancy and continuing therapy in pregnancy is fundamental for achieving optimal outcomes. Proper management of active IBD in pregnancy requires multidisciplinary care to lower adverse outcomes. There is insufficient knowledge among patients regarding how their pregnancy outcomes could be optimized. [ABSTRACT FROM AUTHOR]

Spontaneous hemoperitoneum in pregnancy (SHP) is an uncommon, but very critical complication when present in pregnancy, leading to important morbidity and mortality for both mother and fetus. The etiology includes a large spectrum of causes, not taking into consideration trauma or other pathologies not pregnancy related. One of the most frequent triggers is the rupture of the varicose veins around the uterus that can occur either spontaneously or during labor, that can be associated with the unfortunate event of delivery of a stillborn baby. Endometriosis has been suspected to be also implicated in the apparition of spontaneous hemoperitoneum in pregnant women due to the fragility of the tissues associated with endometriosis chronic inflammation (ruptured endometrioma, intraabdominal adhesions, decidualization at the site of endometriotic implants). Even the operative vaginal delivery can conduct to this complication, but the cases described in the literature were also associated with lesion of endometriosis at the bleeding site. Moreover, assisted reproductive procedures (IVF-ET) is incriminated as one of the possible etiologies. The improvements in the resuscitation, operative and anesthetic management of these cases have lowered the maternal mortality, but perinatal mortality still has a high value (31%). Symptoms as acute or subacute abdominal pain, that can be associated or not with hypovolemic shock and signs of fetal affliction, identified as heart decelerations, should raise a question mark regarding the possibility of a hemoperitoneum. Electronic research for subject related reviews and articles has been made, using PubMed, Medline, Cochrane Data Base and also the current international guidelines regarding the management of hemoperitoneum in pregnancy, recommended by Obstetrics and Gynecology Societies in United States and United Kingdom. Adequate case management as hematologic analysis, abdominal ultrasound, CT scan or MRI should reveal free intrabdominal fluid and estimate the blood loss, which can then be confirmed by paracentesis or by direct urgent laparotomy or laparoscopy. The aim of the current review is to raise awareness of this rare, but potentially fatal, complication in pregnancy and its most appropriate management, according to the current information presented in the medical literature. [ABSTRACT FROM AUTHOR]

Moyamoya disease (MMD) is a chronic vasculopathy characterized by progressive bilateral stenosis and occlusion of the terminal portion of the internal carotid artery (ICA) and the presence of an abnormal vascular network at the base of the brain, termed Moyamoya vessels (MMV). The main presentations of MMD are ischemia and hemorrhage, and diagnosis is done via angiography. Cerebral events were reported in 5.1% of pregnancies of MMD diagnosed mothers, in Japan. In the case of MMD diagnosis due to cerebrovascular events during gestation, 34.7% of patients presented with an ischemic event, while 69.5% suffered from hemorrhage. During gestation, hemorrhagic events were found to occur mostly antepartum, after 24 weeks of gestation, while cerebral infarction peaked 3-7 days after delivery. No treatment has been found to halt or reverse the progress of the disease. Interventions focus on reducing the risk of stroke and cognitive disfunction as a result of ischemia. In the case of pregnant women suffering hemorrhage due to MMD, conservative treatment, as well as ventricle puncture and drainage were to be efficient, and did not severely impact the child. When diagnosed before pregnancy occurs, MMD under treatment does not pose a significantly increased risk of complications, compared to pregnancies in unaffected women. No evidence suggests that MMD is a contraindication for pregnancy [ABSTRACT FROM AUTHOR]

Although there has been various pandemics throughout the history of humankind, modern age was thought to be ready to face such a challenge by implementing an advanced health care system. However, epidemic outbreaks are ubiquitous, and they have a substantial potential to evolve into pandemics, hence this being the actual context of SARS-CoV-2 pandemics from 2019. The difficulty of the addressed subject consists in the fact that the majority of pharmacological clinical studies omited pregnant patients. Acknowledging the physiological changes, pregnant women represent an unique group of patients as pregnancy could embody a particular substrate for this contemporary type of infection. [ABSTRACT FROM AUTHOR]