Pregnancy in a homozygous familial hypercholesterolemic patient treated with long-term plasma exchange

Article Abstract:

Plasma exchange, in which patients are 'transfused' with their own blood cells in donor plasma, is one treatment for familial hypercholesterolemia, which normally results in excessively high levels of cholesterol in the blood. It is rare for women with familial hypercholesteremia to become pregnant and give birth. Plasma exchange was used to help one such patient to a normal delivery. The woman had been diagnosed with high cholesterol at age five, and with coronary artery disease at age 17. At 22 she began plasma exchange at three- to four-week intervals. At 25 she became pregnant, and refused plasma exchange for 15 weeks. After that time, plasma exchange was performed every four weeks until 27 weeks of gestation, at which point the interval was reduced to every 10 to 14 days. Ultrasonographic measurements demonstrated improved placenta blood flow after exchange, presumably resulting from a reduction in blood viscosity. Despite the hypercholesterolemic effect which pregnancy has on most women, and despite the pre-existing coronary disease in this patient, at 39 weeks the young woman gave uneventful birth to a 2,700 gram boy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Cardiovascular diseases, Pregnancy, Blood cholesterol, Hypercholesterolemia, Cardiovascular diseases in pregnancy, Plasmapheresis

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Transvaginal color Doppler imaging in the assessment of uteroplacental blood flow in the normal first-trimester pregnancy

Article Abstract:

During early pregnancy, as the embryo implants into the uterus, the total resistance of blood vessels in uterine tissues decreases. This is thought to be responsible for the improved flow of blood to the uterus during the diastolic (relaxation) phase of blood flow during each heartbeat. Previous studies using Doppler imaging, which allows visualization of blood flow, were confined to larger uterine arteries. Improvements in Doppler imaging allow study of changes in small arteries and veins. Color Doppler imaging was used to study the small vessels surrounding the embryo during the first trimester to better understand the changes which occur in the uterine circulation. Fifty healthy pregnant women were studied, 10 each during the fifth through ninth gestational weeks. Blood flow around the embryo was first detected in all women at week seven. As early as five weeks, there was significant blood flow during the diastolic phase. Previous studies had indicated that blood flow in uterine arteries did not occur until the second trimester. Color Doppler imaging may be useful in the future for detecting diseases of the placenta. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Measurement, Maternal-fetal exchange, Physiological aspects, Doppler ultrasonography, Uterine circulation, Placental function tests

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Sonographic findings in the prenatal diagnosis of bladder exstrophy

Article Abstract:

Ultrasonography, the use of high frequency sound to visualize internal structures, is a commonly used prenatal diagnostic tool. High-resolution real-time ultrasonography can detect abnormalities in fetal structure due to a number of congenital diseases. Although congenital malformations of the kidneys have been studied extensively, malformations of the bladder are rarely detected. A 32-year-old woman had an ultrasonographic evaluation at 30 weeks of pregnancy that revealed a protruding mass on the abdomen. Although the scrotum of the male fetus could be visualized, the penis was obscured. The kidneys appeared normal with no other malformations present. Bladder exstrophy, the external growth of the bladder outside of the abdomen, and epispadias, the abnormal placement of the urine canal under the penis, were diagnosed. Surgical reconstruction was performed on the bladder one day after birth. The repair of epispadias was delayed until a later time. Prompt surgical intervention immediately after birth was aided by ultrasonographic evaluation of a serious abnormality. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fetus, Surgery, Prenatal ultrasonography, Ultrasonics in obstetrics, Bladder exstrophy, Congenital bladder anomalies

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