Michael Bolz

Unilateral ovarian agenesis: report of three cases and review of the literature

Introduction.Unilateral ovarian agenesis is a rare event and only a few case have been reported.Case report.We present three additional cases, where patients presented with diffuse lower abdominal pain. During laparoscopy, an unilateral ovarian agenesis was observed in the three cases.Discussion.There are two possible explanations of a unilateral ovarian absence, involving an asymptomatic adnexal torsion or congenital absence. Unknown environmental factors or genetic predisposition could contribute to this kind of anomaly.

A woman with acute myelopathy in pregnancy: case outcome

Four weeks ago ( BMJ 2009;339:b3862) we described the case of 23 year old Andrea G, who presented with progressive transverse spinal cord syndrome in early pregnancy. Her symptoms recurred during a subsequent pregnancy ( BMJ 2009;339:b4025). We considered many possible causes, including autoimmune inflammatory disorders such as multiple sclerosis or systemic lupus erythematosus and acute rubella infection, but these were excluded by the combination of clinical presentation and the results of laboratory tests or magnetic resonance imaging (MRI). Since the most striking feature was the vertical extension of the spinal cord lesion on MRI, we considered recurrent relapses of longitudinally extensive transverse myelitis to be the most likely diagnosis. This condition is characterised by transverse myelitis with spinal cord lesions extending over three or more vertebral segments.1 Tests showed anti-aquaporin 4 (AQP4) antibodies in our patient’s serum, …

Hantavirus infections by Puumala or Dobrava-Belgrade virus in pregnant women

BACKGROUND Hantavirus infection in humans usually occurs via inhalation of infectious aerosolized excreta of rodents. Horizontal human-to-human transmission was reported only for the highly virulent Andes virus. The likelihood of vertical transmission and the clinical outcome of hantavirus infections in pregnancy is still unpredictable. OBJECTIVES Very few data were published about the impact of hantaviruses in pregnancy. Here we present four cases of pregnant women infected by European hantaviruses. The risk of vertical virus transmission was investigated. STUDY DESIGN Four pregnant women with clinical signs of acute hantavirus disease were investigated for hantavirus IgM and IgG after onset of clinical symptoms. Furthermore, the newborns were tested for presence of viral RNA and antibodies in cord blood and, if any parameter was found positive, 8-12 months after delivery. RESULTS Four women suffered from a hantavirus infection, two of them due to infection by Puumala virus and two by Dobrava-Belgrade virus. Three women delivered healthy babies by vaginal route and one woman by Caesarean section (week 28). In no case hantavirus RNA was detected in cord blood after delivery or in the 8-12 month old babies. Hantavirus IgG was detectable in the cord blood of 3 babies (but not in the preterm child); these antibodies disappeared after 8-12 months indicating a passive transfer of immunoglobulins. No child had any clinical sign of hantavirus infection. CONCLUSIONS In this study, the absence of vertical hantavirus transmission was demonstrated for pregnant women with onset of hantavirus disease between gestation weeks 14 and 28.

PP117. Measurement of sFlt-1 and PlGF for prediction of pregnancy associated diseases

INTRODUCTION Severe preeclampsia is associated with characteristic changes of sFlt-1 and PlGF levels in the maternal serum. OBJECTIVES The aim of our study is the determination of the predictive value of sFlt-1 and PlGF for preeclampsia and other pregnancy associated diseases in women with a pathological uterine Doppler measurement during the second trimester of pregnancy. METHODS An updated analysis of an ongoing prospective trial will be presented. Criterion of inclusion was a bilateral pathological uterine Doppler measurement with an increase of the resistance index (RI) >95th percentile and/or a bilateral postsystolic notch during 19 and 24 weeks. Ratio of sFlt-1 and PlGF was repeatedly measured during pregnancy using a full-automated system (Elecsys®, Roche). RESULTS Presently, we recruited 36 patients. Full data are available from 17 patients. Out of these in 23.5% (n=4) a delivery before 37 weeks was indicated. 41% of all newborns (7/17) showed a birth weight <5th percentile. 23.5% of all patients developed a hypertensive pregnancy disorder but without fulfilling the criterions of preeclampsia. Only two patients had a sFlt-1/PlGF ratio >95th percentile. In both cases we found severe fetal growth retardation. One of them developed a pregnancy related hypertension based on an antiphospholipid syndrome. CONCLUSION The additional measurement of the sFlt-1/PlGF ratio in a high risk group of pregnancies may improve the prediction of severe pregnancy related diseases during the second trimester. But keeping the low incidence of severe preeclampsia in mind, the measurements seem to be only usefulness in a high risk population. Although we reported presently only of a small part of our study population the sFlt-1/PlGF ratio did not revealed a good specificity for prediction of preeclampsia. Pathological values were also found in cases with fetal growth retardation without signs of preeclampsia.

The Treatment of Illnesses Arising in Pregnancy

BACKGROUND The treatment of pregnant women who have illnesses unrelated to pregnancy can cause uncertainty among physicians. METHODS We searched the PubMed database and specialty guidelines from Germany and abroad (the guidelines of the German Society for Gynecology and Obstetrics, the American Congress of Obstetri cians and Gynecologists, and the Royal College of Obstetricians and Gynaecologists) over the period 2007-2016 for information on standards for the diagnosis and treatment of five illnesses that can arise in pregnancy: bronchial asthma, migraine, hypothyroidism, hyperthyroidism, and varicose veins. RESULTS Any diagnostic tests that are carried out in pregnant women should be simple and goal-directed. The choice of drugs that can be used is limited. For many drugs, no embryotoxic or teratogenic effect is suspected, but the level of evidence is low. CONCLUSION When illnesses unrelated to pregnancy arise in pregnant women, attention must be paid to potential diver gences from the typical disease course and to pos sible drug side effects on the fetus in order to prevent serious complications for both mother and child.