Browse Complications of Pregnancy

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Case Records of the Massachusetts General Hospital
Case 35-2011 — A 33-Year-Old Woman with Postpartum Leukocytosis and Gram-Positive Bacteremia
Presentation of Case. Dr. Edwin C. Huang (Obstetrics and Gynecology): A 33-year-old woman was admitted to the intensive care unit (ICU) at this hospital 16.5 hours post partum because of leukocytosis and gram-positive rods in the blood. The patient had received routine prenatal care at this…
- November 17, 2011
- Soper D.E., Lee S.I., Kim J.Y., McDonald A.G.
- N Engl J Med 2011; 365:1916 - 1924
- CME
A 33-year-old woman was admitted to the ICU 16.5 hours post partum because of leukocytosis and gram-positive rods in the blood. Diagnostic test results were received, and management decisions were made.
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Clinical Practice
Depression during Pregnancy
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 24-year-old…
- October 27, 2011
- Stewart D.E.
- N Engl J Med 2011; 365:1605 - 1611
- CME
- Full Text Audio
Evaluation and treatment (with psychotherapy, antidepressant therapy, or both) of women with depression during pregnancy are described. Data on potential benefits and risks of antidepressant medications in pregnancy are reviewed; overall, the absolute risks are small.
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Clinical Problem-Solving
A Problem in Gestation
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 39-year-old woman (gravida 2,…
- September 1, 2011
- Chamarthi B., Greene M.F., Dluhy R.G.
- N Engl J Med 2011; 365:843 - 848
- CME
A 39-year-old woman presented to her obstetrician at 32 weeks' gestation with a 2-day history of low back pain. The pain was abrupt in onset and constant. She reported no fever, chills, dysuria, urinary frequency, vaginal discharge or bleeding, or other associated symptoms.
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Perspective
Global Health: Pediatric HIV — A Neglected Disease?
The results of the HIV Prevention Trials Network 052 (ClinicalTrials.gov number, NCT00074581) study were released this past May, 30 years after the first publication about U.S. cases of what would come to be called AIDS. The new study's stunning results — earlier treatment of human…
- August 18, 2011
- Lallemant M., Chang S., Cohen R., Pecoul B.
- N Engl J Med 2011; 365:581 - 583
- Free Full Text
New data show earlier treatment of HIV vastly reduces transmission risk, but “test and treat” and “treatment as prevention” are well recognized notions in pediatric HIV care. Yet children with HIV in low- or middle-income countries remain a largely neglected population.
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Clinical Practice
Chronic Hypertension in Pregnancy
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 35-year-old…
- August 4, 2011
- Seely E.W. and Ecker J.
- N Engl J Med 2011; 365:439 - 446
- CME
- Full Text Audio
This article reviews the potential risks associated with pregnancy among women with chronic hypertension and recommended treatment before and during pregnancy. Current recommendations regarding medications are reviewed.
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Perspective
The Long-Term Effects of In Utero Exposures — The DES Story
It has been 40 years since the Journal published a seminal article by Herbst et al. (1971;284:878-81) noting the association of in utero exposure to a synthetic nonsteroidal estrogen, diethylstilbestrol (DES), and the development of a rare clear-cell adenocarcinoma (CCA) of the vagina in young…
- June 2, 2011
- Goodman A., Schorge J., Greene M.F.
- N Engl J Med 2011; 364:2083 - 2084
In 1971, Herbst et al. reported an association between in utero exposure to diethylstilbestrol (DES) and development of clear-cell adenocarcinoma of the vagina — changing medical thinking about embryologic development of the genital tract and mechanisms of carcinogenesis.
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Perspective
Are We Making Progress in Maternal Mortality?
The number of women who die during pregnancy or childbirth has decreased by more than a third globally since 1990, according to new estimates from the United Nations — from nearly 550,000 deaths in that year to roughly 350,000 in 2008. Yet progress has been uneven: while some countries have seen…
- May 26, 2011
- Paxton A. and Wardlaw T.
- N Engl J Med 2011; 364:1990 - 1993
- Interactive/Multimedia
The number of women who die during pregnancy or childbirth has decreased by more than a third globally since 1990. Yet progress has been uneven: while some countries have seen significant improvements, others have seen marked increases in maternal mortality.
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Perspective
Unintended Consequences — The Cost of Preventing Preterm Births after FDA Approval of a Branded Version of 17OHP
At a time when so many people are working to deliver on the promise of the "affordable" aspect of the Patient Protection and Affordable Care Act, can there be any justification for driving up the cost of an available medication from about $300 to $30,000 — about a 100-fold increase — with…
- May 5, 2011
- Armstrong J.
- N Engl J Med 2011; 364:1689 - 1691
- Free Full Text
The recent approval by the Food and Drug Administration of Makena, a new version of progesterone 17 alpha-hydroxyprogesterone caproate, will drive up the drug's cost about 100-fold, with minimal added clinical benefit.
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Correspondence
Increased 36-Week Survival with High Oxygen Saturation Target in Extremely Preterm Infants
To the Editor: Following advice from the Data Monitoring Committees (DMCs), recruitment to the U.K. and Australian Benefits of Oxygen Saturation Targeting (BOOST II) trials has closed early after a joint safety analysis showed higher survival rates at 36 weeks' postmenstrual age in infants born at…
- April 28, 2011
- N Engl J Med 2011; 364:1680 - 1682
- Free Full Text
The authors report pooled preliminary results from two trials of oxygen saturation (SpO2) targeting in infants born at less than 28 weeks of gestation.
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Images in Clinical Medicine
Ovarian-Vein Thrombosis
Figure 1.
- April 21, 2011
- Wiggermann P. and Stroszczynski C.
- N Engl J Med 2011; 364:1544
- Free Full Text
Four days after uncomplicated delivery of a full-term infant, a 36-year-old woman presented to the ER with severe pain in the right flank. Her medical history included a remote deep-vein thrombosis of the leg and heterozygosity for the factor V Leiden mutation.
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Original Article
Neonatal Abstinence Syndrome after Methadone or Buprenorphine Exposure
Opioid dependence during pregnancy is compounded by multiple risk factors contributing to adverse maternal, neonatal, and long-term developmental consequences.– Improved treatment options should reduce the public health and medical costs associated with the treatment of neonates exposed to…
- December 9, 2010
- Jones H.E., Kaltenbach K., Heil S.H., et al.
- N Engl J Med 2010; 363:2320 - 2331
- Free Full Text
In this trial comparing methadone with buprenorphine in opioid-dependent pregnant women, neonates exposed to buprenorphine required less morphine to treat neonatal abstinence syndrome (NAS) and had a significantly shorter duration of hospitalization and of treatment for NAS.
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Original Article
Use of Proton-Pump Inhibitors in Early Pregnancy and the Risk of Birth Defects
Symptoms of gastroesophageal reflux are common in pregnant women as early as the first trimester of pregnancy. Proton-pump inhibitors (PPIs) are the most efficacious drugs for the treatment of gastroesophageal reflux and are therefore prescribed for pregnant women who have this condition.…
- November 25, 2010
- Pasternak B. and Hviid A.
- N Engl J Med 2010; 363:2114 - 2123
- Free Full Text
In this nationwide cohort study conducted in Denmark, there was no significant increase in the risk of birth defects associated with exposure to proton-pump inhibitors in the first trimester of pregnancy.
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Editorial
Proton-Pump Inhibitors and Birth Defects — Some Reassurance, but More Needed
Limited data on safety are usually available when new medications are first marketed, but for appropriate ethical reasons, safety studies of the use of medications during pregnancy are rarely conducted before marketing. Because we must await postmarketing studies to resolve questions of fetal…
- November 25, 2010
- Mitchell A.A.
- N Engl J Med 2010; 363:2161 - 2163
Limited data on safety are usually available when new medications are first marketed, but for appropriate ethical reasons, safety studies of the use of medications during pregnancy are rarely conducted before marketing. Because we must await postmarketing ...
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Clinical Practice
Recurrent Miscarriage
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 32-year-old…
- October 28, 2010
- Branch D.W., Gibson M., Silver R.M.
- N Engl J Med 2010; 363:1740 - 1747
- CME
- Full Text Audio
This article reviews current evaluation and management strategies for recurrent miscarriage and highlights both the lack of good evidence to support several interventions used in practice and the relatively high rate of subsequent live birth without intervention.
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Case Records of the Massachusetts General Hospital
Case 32-2010 — A Pregnant Woman with Abdominal Pain and Fluid in the Peritoneal Cavity
Presentation of Case. Dr. Kevin M. Elias (Obstetrics and Gynecology): A 28-year-old primigravida was admitted to the labor and delivery suite of this hospital at 34 weeks 4 days of gestation because of abdominal pain and fluid in the peritoneal cavity. On the morning of admission, abdominal pain…
- October 21, 2010
- Bloom S.L., Uppot R., Roberts D.J.
- N Engl J Med 2010; 363:1657 - 1665
A woman at 34 weeks of gestation presented with sudden abdominal pain, most severe in the right lower quadrant. Imaging revealed peritoneal fluid. After delivery, pain decreased but recurred suddenly the next day, with hypotension. A procedure was performed.
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Clinical Practice
Nausea and Vomiting in Pregnancy
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 25-year-old…
- October 14, 2010
- Niebyl J.R.
- N Engl J Med 2010; 363:1544 - 1550
- CME
- Full Text Audio
This article reviews the management of nausea and vomiting in pregnancy, with attention to pharmacologic and alternative management strategies and nutritional support.
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Case Records of the Massachusetts General Hospital
Case 28-2010 — A 32-Year-Old Woman, 3 Weeks Post Partum, with Substernal Chest Pain
Presentation of Case. Dr. Rebecca R. Saff (Medicine): A 32-year-old woman, 3 weeks post partum, was seen in the emergency department of this hospital because of substernal chest pain. The patient had been well until the day of admission when, while she was shopping at 7:25 p.m. pain in the left jaw…
- September 16, 2010
- Sabatine M.S., Jaffer F.A., Staats P.N., Stone J.R.
- N Engl J Med 2010; 363:1164 - 1173
- Video
A 32-year-old woman, 3 weeks post partum, was seen in the emergency department because of intermittent substernal chest pain. The pain had developed suddenly during normal activity, resolved after 20 minutes, and then recurred. Diagnostic procedures were performed.
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Images in Clinical Medicine
Gestational Pituitary-Tumor Apoplexy
Figure 1.
- August 12, 2010
- Ginath S. and Golan A.
- N Engl J Med 2010; 363:e10
- Free Full Text
A 31-year-old woman with a history of prolactinoma was admitted at the 39th week of her first pregnancy for headache and nausea. She had been receiving bromocriptine until she became pregnant. The neurologic examination, which included a dilated fundus ...
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Interactive Medical Case
Hard to Conceive
A 31-year-old woman originally from Nepal presented to her primary care physician after failing to become pregnant despite having regular unprotected intercourse for the past 18 months. Her menarche had occurred at 13 years of age. Her menses lasted for 6 or 7 days, occurred regularly every 4 weeks,…
- August 12, 2010
- Ross J.J., Levison J.H., Barbieri R.L.
- N Engl J Med 2010; 363:e11
- Free Full Text
- CME
A 31-year-old woman originally from Nepal presented to her physician after unsuccessful attempts at pregnancy for the past 18 months. She had no history of sexually transmitted diseases, pelvic inflammatory diseases, use of an intrauterine device, exposure to diethylstilbestrol, abnormal Papanicolaou smears, or previous pregnancies. What diagnostic and management steps do you choose? Direct the investigation of the case, test your diagnostic and therapeutic skills, and compare your performance with that of others at NEJM.org.
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Case Records of the Massachusetts General Hospital
Case 21-2010 — A Request for Retrieval of Oocytes from a 36-Year-Old Woman with Anoxic Brain Injury
Presentation of Case. The family of a 36-year-old woman with anoxic brain injury requested oocyte retrieval for the purpose of posthumous conception. The patient had been well until 11 days earlier, when she collapsed approximately 7 hours into an international airplane flight. She had taken…
- July 15, 2010
- Greer D.M., Styer A.K., Toth T.L., Kindregan C.P., Romero J.M.
- N Engl J Med 2010; 363:276 - 283
A 36-year-old woman had severe anoxic brain damage due to a pulmonary embolus during a long airplane flight. She was admitted to the neurology intensive care unit but remained in a coma despite maximal medical therapy. On the ninth day, the family decided to institute comfort measures only. Later, they requested that maximal therapy be resumed, to permit consideration of oocyte retrieval for the purpose of posthumous conception of future offspring. A management decision was made.
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