Objective. To evaluate maternal and fetal outcomes in pregnant patients with fibrodysplasia ossificans progressiva (FOP; OMIM#135100), an ultrarare genetic disorder characterized by progressive heterotopic ossification of soft tissues and cumulative disability. Methods. This is a retrospective case series of three patients with FOP who were admitted to Grady Memorial Hospital in Atlanta, Georgia, from to February 2011 to July 2021. Results. Three women delivered preterm infants at our institution. These cases posed unique anesthetic and obstetric technical challenges, particularly when securing the airway and performing cesarean delivery. Importantly, each patient received perioperative glucocorticoids for prevention of further heterotopic ossification. Conclusion. FOP is a unique clinical diagnosis encountered by obstetricians and requires multidisciplinary management for optimal outcomes.
Dendritic cells (DCs) play dual roles in innate and adaptive immunity based on their functional maturity, and both innate and adaptive immune responses have been implicated in myocardial tissue remodeling associated with cardiomyopathies. Peripartum cardiomyopathy (PPCM) is a rare disorder which affects women within one month antepartum to five months postpartum. A high occurrence of PPCM in central Haiti (1 in 300 live births) provided the unique opportunity to study the relationship of immune activation and DC maturation to the etiology of this disorder. Plasma samples from two groups (n = 12) of age- and parity-matched Haitian women with or without evidence of PPCM were tested for levels of biomarkers of cardiac tissue remodeling and immune activation. Significantly elevated levels of GM-CSF, endothelin-1, proBNP and CRP and decreased levels of TGF-β were measured in PPCM subjects relative to controls. Yet despite these findings, in vitro maturation of normal human cord blood derived progenitor dendritic cells (CBDCs) was significantly reduced (p < 0.001) in the presence of plasma from PPCM patients relative to plasma from post-partum control subjects as determined by expression of CD80, CD86, CD83, CCR7, MHC class II and the ability of these matured CBDCs to induce allo-responses in PBMCs. These results represent the first findings linking inhibition of DC maturation to the dysregulation of normal physiologic cardiac tissue remodeling during pregnancy and the pathogenesis of PPCM.
As we face emerging and re-emerging health threats, we will need to understand how these novel diseases will affect pregnant women. In some cases, such as SARS, the hemorrhagic fevers, and smallpox, it appears that pregnant women may have more severe clinical courses compared with nonpregnant adults. In some cases, it appears that the rapid diagnosis of the disease may be delayed due to pregnancy. For example, in one of the reported anthrax cases, there was probably a delay in diagnosis of anthrax peritonitis because the pregnancy complicated the presenting clinical picture [41]. In terms of prophylaxis and treatment of emerging diseases, in many cases, such as anthrax, tularemia, and plague, first-line therapies and postexposure prophylaxis is similar in pregnant and nonpregnant adults. Although vaccinations such as those for smallpox and anthrax are not generally recommended for pregnant women, in some cases they may be used for postexposure prophylaxis. For example, for pregnant women exposed to monkeypox or smallpox, use of the vaccinia vaccine is recommended. In some cases, such as with ribavirin, which is generally contraindicated in pregnancy due to its teratogenic and embyrocidal effects, decisions about use in pregnancy need to be carefully weighed. In the case of SARS, where treatment is generally supportive and the effectiveness of ribavirin has not been convincingly demonstrated, use of ribavirin may not be indicated. By contrast, ribavirin has been shown to be effective treatment for some of the viral hemorrhagic fevers, such as Lassa fever, and despite the risks, treatment of pregnant women may be warranted given the severity of illness. In terms of perinatal transmission, there are cases of intrauterine transmission of West Nile virus, monkeypox, and smallpox virus reported in the literature. There are a growing number of new or newly recognized pathogens in the United States that threaten our health. As new disease threats emerge, it will be critical to evaluate and understand how these diseases affect pregnant women, so that reasonable response plans for diagnosis and treatment of pregnant women can be rapidly developed.
Objective: The purpose of this study was to summarize 3 recent high-profile infectious disease threats that have affected the United States: severe acute respiratory syndrome, West Nile virus, and anthrax.
Study design: A systematic review was conducted with the use of Medline searches, searches of the Centers for Disease Control and Prevention website, and review by experts at the Centers for Disease Control and Prevention.
Results: The 3 emerging infectious diseases pose very different threats: Severe acute respiratory syndrome is a newly identified pathogen that caused an international pandemic; the West Nile virus investigation involved an old pathogen that was identified in a new location; and the anthrax attacks involved the intentional introduction of a pathogen.
Conclusion: All 3 outbreaks highlight the importance of obstetrician-gynecologists keeping current with new information as it emerges. In this global environment, it is likely that novel disease threats will continue to emerge in the United States.
Background: Pica is a relatively common phenomenon in pregnancy and typically includes consumption of nontoxic substances such as earth/clay, raw starches, and ice. Occasionally, substances may be toxic or have unintended consequences. Case: A nulliparous woman presented to our facility complaining of numerous, vague symptoms that are common in pregnancy. She had multiple work-ups and an admission to our antepartum unit without clear etiology of her symptoms. Ultimately, she was diagnosed with talcum powder toxicosis secondary to talc ingestion as a coping mechanism for her anxiety, which was heightened in pregnancy. Conclusion: This case highlights the importance of screening for mental health disorders, which may be exacerbated during the peripartum period. Patients' coping mechanisms for mental health disorders may have unintended consequences.