Organ transplantation and pregnancy; a case report and review

Article Abstract:

Over the last two decades great advances have been made in the field of organ transplantation. Each year more and more organ transplants are performed and the rate of survival of the patients receiving the transplants is improving. As a result there is an increasing number of women of childbearing potential who have had organ transplants. It is estimated that 1 out of every 50 women of childbearing age who has had an organ transplant will become pregnant. Several cases of pregnancy following kidney transplantation have been described. These patients have experienced a high rate of therapeutic abortion (30 percent), premature birth (45 to 60 percent), preeclampsia (30 percent), intrauterine growth retardation (20 percent), and perinatal death (5 percent). The outcome of the pregnancy appeared to be improved if the woman waited for at least two years after the kidney transplant before becoming pregnant, and if the transplanted kidney was functioning properly. There have been single case reports of pregnancy following heart transplant, lung transplant, bone marrow transplant, liver transplant, and pancreas transplant. This article describes the case report of a 21-year-old woman who had a successful pregnancy three years after receiving a heart transplant. A normal, healthy infant was delivered, which was alive and at well at one year of age. It appears that complications are more likely to result from the immunosuppressive drugs that are required to prevent rejection of the transplanted organ, rather than a failure of the organ to function properly during pregnancy. Possible complications and risk factors associated with pregnancy after the receipt of other types of organ transplants are also discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation

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Postpartum coronary artery dissection followed by heart transplantation

Article Abstract:

Dissection, or rupture, of the coronary arteries, the major blood vessels supplying the heart, may occur during or after childbirth and can lead to sudden collapse and death or severe ischemia, an insufficient blood supply to the heart. Survival after coronary artery dissection is rare, and diagnosis of this abnormality is often made at autopsy. In most cases, the left coronary artery is involved. A case is described of a 33-year-old woman who had a coronary artery dissection four days after giving birth. She experienced severe pain above the stomach area, which spread towards the back and was associated with excessive sweating. Abnormalities in the electrical activity of the heart, dilation and swelling of the left ventricle, and decreased movement of the heart muscle were detected. Due to progressive heart failure, the patient required a heart transplantation three months after delivery. She has remained free of symptoms for 36 months after the transplantation, and is maintained on a drug regimen of cyclosporine, azathioprine, and prednisone to prevent rejection of the transplant. Examination of the diseased heart showed dissection of the left coronary artery leading to a myocardial infarction (heart attack). Changes in blood flow during labor, the straining during delivery, and degenerative changes in the blood vessels may contribute to rupture of the coronary arteries in pregnancy or after childbirth. This is the first reported case of coronary artery dissection occurring after childbirth which was successfully treated by heart transplantation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Coronary arteries, Dissection

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Obstetrician-gynecologists as primary care physicians: the Oregon experience--early perceptions regarding the effects of legislative action

Article Abstract:

A bill passed in Oregon in 1995 that allows women to choose an obstetrician-gynecologist as their primary care physician appears to have had little impact. This was the conclusion of a survey of 257 obstetrician-gynecologists and 26 directors of a managed care organization. Only 38% of the obstetrician-gynecologists identified themselves as a primary care physician. Only 35% of the managed care directors believed that obstetrician-gynecologists should be primary care physicians.

Laws, regulations and rules, Practice, Family medicine, Oregon, Gynecologists, Obstetricians

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