Tag Archives: pregnancy

Maternal sepsis – challenges in diagnosis and management: A mini-summary of the literature

DOI: 10.2478/amma-2024-0001

Sepsis is still one of the leading causes of maternal mortality and morbidity, being the third most common cause of maternal death, after hemorrhage and hypertensive disorders. Maternal sepsis may appear due to obstetric causes such as: chorioamnionitis, endometritis, abortion-related uterine infections, and wound infections. For non-obstetric causes of maternal sepsis, the most common are urinary tract infections and respiratory tract infections. This mini summary presents the challenges in early diagnosis and prompt management, caused by pregnancy physiological changes. Physiological alterations during pregnancy, like an increase in white cell count, heart rate, and respiratory rate, associated with a decrease in blood pressure are also known signs of infection, making the diagnosis of sepsis during pregnancy more difficult. The three pillars of sepsis treatment are early antibiotics, vital organ support and fluid therapy, the last one being controversial. A more restrictive approach for fluid resuscitation could be more suitable for pregnant women, considering the risk of fluid overload and pulmonary edema. Criteria for early recognition and appropriate management customized for maternal sepsis are mandatory.

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Relationship Between High Levels of Salivary Cotinine Test and Demographic Characteristics of Pregnant Smokers from Mures County

DOI: 10.1515/amma-2017-0008

Objectives: To evaluate the relationship between the frequency of self-declared status regarding smoking in a group of pregnant women from Mures county, Romania and the high levels of Salivary Cotinine (SC) like biomarkers.
Material and methods: It was conducted a retrospective study among 230 pregnant women presented for prenatal care at 50 General Practitioners cabinets in Mures county, Romania, in 2015. Data were collected with a validated questionnaire which included age, level of education, socioeconomic status and ethnicity, also the self-reported smoking status. The Salivary Cotinine level was evaluated using NicAlert Saliva test kits.
Results: Using salivary test we identified a high prevalence of involuntary exposure to cigarette smoke among both non-smokers and those who quit smoking before pregnancy. Also we registered pregnant women that although declared smoking cessation before pregnancy their salivary Cotinine levels were high, almost like to an active smoker, probably because of second-hand exposure or because they didn’t say the truth about their habit.
Conclusions: We underline the importance of implementing more efficient community interventions among this vulnerable group in order to reduce the frequency of smoking and sustain quitting.

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Risk Assessment of Caries in Pregnancy

Objective: The purpose of this study was to evaluate the effects of salivary testing in dental caries assessment and to determine a possible relationship between oral hygiene, diet, salivary cariogenic flora, saliva secretion rate, buffer capacity of saliva, salivary pH and caries incidence during pregnancy. Another objective is to introduce a prevention program in teaching institutions.
Material and methods: The longitudinal and descriptive study was conducted from January 2010 to September 2011. Thirty-five pregnant women, aged between 20–35 years, were examined during the three trimesters of pregnancy in order to evaluate the caries risk factors. The study investigated the Streptococcus Mutans and Lactobacilli count in saliva; the salivary pH and the buffer capacity of saliva by using a salivary testing kit (CRT Bacteria and Buffer). These tests were non-invasive and well-accepted by all women.
Results: The results showed an increase in the number of Streptococcus Mutans and Lactobacilli in the second part of pregnancy (>105 CFU/ml saliva). An exception is the 20–24 years age group, where we observed a decrease in the third trimester. Also, their frequency increases with parity and women’s age. In terms of pH, we observed a decrease in the first trimester (6.35), but in the third trimester the pH was less acid (6.85).
Conclusions: Microbiological evaluations suggest that pregnant women present a high caries risk, but the implementation of preventive measures such as a rigorous hygiene and balanced diet prevent the appearance of new carious lesions.

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Possibilities and Difficulties of Treatment in the Case of a Pregnant Patient with Primary Mediastinal Large B-cell Lymphoma

DOI: 10.2478/amma-2013-0011

Background: There are several histologic variants and clinical subtypes of diffuse large B cell lymphoma, which includes the primary mediastinal large B cell lymphoma (PMBL). In the last 10 years the incidence of diffuse large lymphomas grew significantly.
Case report: We present the case and evolution of an aggressive life-threatening mediastinal B cell lymphoma with respiratory insufficiency, diagnosed in the 27th week of pregnancy. After 4 courses of R-CHOP the clinical status has somewhat improved, but the dyspnea, the facial and neck oedema and the trouble of speech persisted. After the patient was admitted to our hospital, she received DHAP regimen followed by mobilization with G-CSF. Before transplantation we administered another 3 courses of DHAP chemotherapy with spectacular results. We performed autologous hematopoietic stem cell transplantation preceded by BEAM chemotherapy. At present, 5 years post-transplant the patient is well, with no metabolically active disease on the PET-CT performed 3 months ago.
Conclusion: We can conclude that even in very complicated DLBCL cases, with a very good, efficient medical-team work we can salvage lives, in our case both of the mother and the child’s. Even in partially chemo-refractory cases like in the presented one, salvage chemotherapy followed by autologous transplantation can lead to a successful treatment.

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