Catherine Nelson-Piercy

Diagnosis and management of migraine. Low dose aspirin may be used for prophylaxis.

EDITOR,—Peter J Goadsby and Jes Olesen do not mention the use of low dose aspirin to prevent migraine.1 Migraine is common in pregnancy, both in women with a history of migrainous headaches and as a phenomenon related to pregnancy in women without such a history. Sometimes the presentation may be dramatic, with hemiplegic migraine. Migraine accounts for almost a third of neurological problems encountered in our obstetric medicine clinic and is the diagnosis in about 4% of all women referred.2nnBecause drugs …

Withholding imaging in pregnancy may be hazardous

Failure or reluctance to image pregnant women contributes to maternal mortality.1 Rajaraman and colleagues state that x ray imaging of mothers during pregnancy increases the risk of childhood cancer and leukaemia.2 However, the risk is small and not statistically significant. Although controls were similar for many identified confounding factors, …

Cord liver function and bile acids in actively managed obstetric cholestasis (OC) are not abnormal

Obstetric cholestasis (OC) is associated with increased fetal morbidity and mortality. Active management (delivery by 38 weeks) may reduce this. Poor fetal outcome may be linked to high concentrations of bile acids in the maternal or fetal circulation. This study compared maternal and fetal liver function in a group of actively managed women with OC. Matched cord and maternal (day of delivery) serum was obtained from women with: (i) OC [nu2009=u200943, 16 ursodeoxycholic acid (UDCA)], (ii) pruritus gravidarum (PG, nu2009=u200928) and (iii) healthy controls (nu2009=u20099). Women with OC were delivered by 38 weeks; there were no stillbirths. Bile acids, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and glutathione S-transferase alpha 1-1 (GSTA1-1) were measured. Maternal liver function parameters were raised in OC and not reduced significantly by UDCA treatment (Pu2009=u20090.748, 95% CI= 0.934–1.099). In OC, cord serum liver function values were no different to controls and PG. Cord serum ALT, AST and GSTA1-1 in OC were lower than the maternal serum. Cord serum bile acid concentrations (µm) in the OC group were 16.97u2009±u20091.13 and in maternal blood 18.57u2009±u20093.20 compared to 12.89u2009±u20091.00 and 7.24u2009±u20091.2 in PG and 15.99u2009±u20091.95 and 6.76u2009±u20090.96 in controls, respectively.