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Heart and Lung Disorders Complicating Pregnancy and the Puerperium: Pitfalls in Practice &Lessons Learned

Open Journal of Obstetrics and Gynecology 2021年第4期11卷 338-354页

作者： James Nello Martin Jr. James Martin Tucker Department of Obstetrics & Gynecology University of Mississippi Medical Center Jackson Mississippi USA Winfred L. Wiser Hospital for Women & Infants University of Mississippi Medical Center Jackson Mississippi USA

Objective: To review a case series of 12 women with unexpected heart and lung disorders that occurred during pregnancy and the puerperium, describing for teaching purposes the pitfalls in practice and the lessons learned from this experience. Materials & Methods: We reviewed case files of women with medical and/or hypertensive complications of pregnancy that were evaluated for medicolegal defense purposes by the first author between 1986-2015. Twelve women in these case files experienced unexpected cardiovascular and/or cardiopulmonary complications late in pregnancy or early in the puerperium. For each case, the pertinent medical record information was extracted. Important concepts as lessons learned are summarized and referenced for teaching purposes. Results: Five women had undetected preexisting heart disease which acutely deteriorated during the third trimester, four women developed postpartum heart failure related to pregnancy and delivery, and three women suffered an intrapartum cardiac arrest;none survived. Their case presentations illustrate the importance of obstetric health care professionals being alert to the signs/symptoms of developing cardiopulmonary disease late in pregnancy and following delivery so that timely evaluation and intervention can be accomplished to potentially avoid morbidity and mortality. Diagnostic categories include peripartum heart failure, high-risk chronic hypertension, s

关键词： Cardiopulmonary Cardiovascular maternal morbidity & mortality Pregnancy & Postpartum Complications

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Pregnant-Postpartum Women with Severe Epigastric Pain and HELLP Syndrome: A Highly Dangerous Combination

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Open Journal of Obstetrics and Gynecology 2021年第8期11卷 1081-1091页

作者： James Nello Martin Jr. James Martin Tucker Department of Obstetrics and Gynecology The Winfred L. Wiser Hospital for Women & Infants at the University of Mississippi Medical Center Jackson Mississippi USA

OBJECTIVE: HELLP syndrome is a severe preeclampsia spectrum disorder diagnosed when laboratory evidence of hemolysis, liver dysfunction and thrombocytopenia are present. The presence of epigastric pain with laboratory criteria for HELLP syndrome may indicate higher maternal-fetal risk. Thus we explored maternal outcomes in 42 pregnant/postpartum women that had HELLP syndrome by laboratory criteria in addition to sudden severe epigastric pain. METHODS: A database was constructed from the medical files of all patients with medical/hypertensive disorders evaluated by the first author from 1986-2015 for medicolegal purposes. All patient files of women who presented to their physicians with a diagnosis of presumptive HELLP syndrome were examined. RESULTS: Fifty-eight pregnant/postpartum women fulfilled study inclusion criteria;they presented to physicians for evaluation usually in non-tertiary care hospital settings. Clinical presentation and care including lab data and details of pregnancy outcome were evaluated. A correct diagnosis of HELLP syndrome was verified for 42 women (72.4%);others were determined to have AFLP-Acute Fatty Liver of Pregnancy (n

关键词： HELLP SYNDROME with or without Epigastric Pain maternal morbidity & mortality LDH to AST Ratio

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