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Paper III
Published in Justin C Konje, Complete Revision Guide for MRCOG Part 3, 2020
A 30-year-old primigravida was seen in the clinic in the delivery suite with loin pain and frequency of micturition. A urinalysis showed nitrites ++, leucocytes ++ and protein ++. She was sent home on analgesics and an MSU sent. This has now been reported as Pseudomonas species sensitive to tetracycline, gentamycin and amoxicillin.
Obstetric and Gynaecological Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Two terms are easy to confuse in obstetric practice: Gravida is the number of times a woman has been pregnant, with twins counting as one. A first pregnancy is a ‘primigravida’.Parity is defined as the number of times a woman has given birth to a fetus with a gestational age of 24 weeks or more.
The Pathophysiology of Intrauterine Growth Retardation
Published in Asim Kurjak, John M. Beazley, Fetal Growth Retardation: Diagnosis and Treatment, 2020
Mother and conceptus meet in the intervillous space. There maternal blood is in direct contact with the placenta. The effect of this blood supply on fetal nutrition and growth depends not only on the feto-placental factors which have been discussed but on the volume of maternal blood perfusing the villi and on the content of that blood. These are related to how well the mother adapts to the pregnancy, to her general health, and to her environment. Multigravid women tend to adapt to pregnancy better than those in their first pregnancy but intercurrent illness, smoking, and age may modify adaptation at all parities as may immunological interaction between mother and fetus. If a multigravid woman has changed partners this may be the first pregnancy by the child’s father so in some way she may respond like a primigravida.128 There are also a few mothers who recurrently produce light-for-dates babies,129,130 but others produce one in an otherwise normal sequence of birthweights. It is the balance of adaptation in all of the maternal systems which determines her contribution to fetal growth.
Downbeat Nystagmus as a Presenting Manifestation of Neurolisteriosis in a Pregnant Woman
Published in Neuro-Ophthalmology, 2023
Ritwik Ghosh, Moisés León-Ruiz, Sona Singh Sardar, Padavi Lalsing D, Julián Benito-León
A 23-year-old previously healthy primigravida (period of gestation 25 weeks) from rural West Bengal, India presented with fever, headache, and unsteadiness of gait. The fever had been there for the previous 5–6 days, was high grade, continuous, with chills and rigours, with an average recorded temperature of 40.3 ºC. It was associated with a few initial episodes of vomiting and a non-localising holocranial headache. She also complained of severe dizziness and difficulty getting up from the bed and tended to sway from side to side and fall. She also had slurred speech and was finding it difficult to speak fluently. Her personal, menstrual, and addiction history were unremarkable. General examination was normal except for fever and tachycardia. Neurological examination revealed preserved cognitive abilities, normal motor and sensory systems, and no autonomic dysfunction. Cerebellar examination showed slow and dysmetric saccades, florid downbeat nystagmus (online supplement Video), horizontal nystagmus, and ataxia (truncal and gait ataxia more than appendicular ataxia). She also had ataxic speech. The clinical diagnosis was of an infective rhombencephalitis.
Umbilical Cord Teratoma – A Short Case Report
Published in Fetal and Pediatric Pathology, 2023
Manuela Enciu, Gabriela Izabela Baltatescu, Oana Cojocaru, Ionut Burlacu, Viorel Constantin Cristurean, Liliana Mocanu, Sinziana-Andra Ghitoi, Alexandra Dinu, Antonela-Anca Nicolau
This 34-year-old primigravida, with no significant abnormal past medical history, presented at 37–38 weeks of pregnancy in labor in the emergency unit. The patient delivered vaginally a 3290-g female child with an Apgar Index of 9. The new-born baby was normally developed. The placenta was intact, discoid, measured 17 × 18 × 2cm and weighed 478 g with normal fetal and maternal surfaces. The umbilical cord, at 10 cm from the abdominal insertion, had an 8 cm nodule (Fig. 1). On sectioning, it was cystic, filled with a gelatinous material and contained hair, sebum and bone; the wall thickness was variable, from 0,5 to 3 cm. Microscopically, it displayed skin and skin adnexa, fat, bone, hyaline cartilage, smooth muscle fibers and mature nervous tissue (Fig. 2), with no immature elements. The placental examination showed mature, term villi and small areas of infarction.
Oxidative nucleic acid damage as a biomarker for preeclampsia
Published in Journal of Obstetrics and Gynaecology, 2022
Chandrakala Nagarajappa, Sheela Shikaripur Rangappa, Sharath Balakrishna
The following criteria of American College of Obstetricians and Gynecologists was used to diagnose preeclampsia in pregnant women (Roberts et al. 2013): (i) new-onset hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥ 90 mm Hg measured 4 hours apart twice while the patient is on bed rest, (ii) ≥20 weeks of gestation, (iii) new-onset proteinuria (≥300 mg protein in 24-hour urine sample or +1 on dipstick), (iv) in the absence of proteinuria, other symptoms like Haemolysis Elevated Liver Low Platelet counts (HELLP) syndrome, edoema, thrombocytopenia, impaired liver function, new-onset cerebral or visual disturbances and renal insufficiency, nausea, severe headache, and convulsions. The inclusion criteria of the study were as follows: (i) pregnant women diagnosed with preeclampsia, (ii) superimposed eclampsia, (iii) singleton and multiple gestations, and (iv) primigravida and multigravida condition. The exclusion criteria of the study were as follows: (i) pregnant women with chronic hypertension and (ii) co-morbidities such as diabetes mellitus, epilepsy, respiratory diseases, and heart diseases. Pregnant women were classified as ‘normotensive’ if no complications were present until delivery.