Castillothaysen3878

it will reduce the cost of bioreactor cooling and erythritol purification.

Tacrolimus has been used in pregnant women following transplantation and for management of lupus nephritis. We report a case of successful control of nephrotic syndrome due to membranous glomerulonephritis during pregnancy using tacrolimus.

A 26-year-old female presented with severe nephrotic syndrome in her first pregnancy. Post-partum renal biopsy confirmed idiopathic membranous glomerulonephritis. She had persistent proteinuria of 6 g/day with hypoalbuminaemia despite angiotensin receptor blockade. Treatment with tacrolimus monotherapy led to remission of proteinuria, three months prior to conceiving again. She maintained remission with tacrolimus therapy in pregnancy, resulting in a successful birth outcome.

Membranous glomerulonephritis can be successfully and safely managed with tacrolimus monotherapy during pregnancy. This provides an alternative immunosuppressant with a favourable side effect profile suitable for use in women planning a pregnancy when other immunosuppressive drugs should be avoided.

Membranous glomerulonephritis can be successfully and safely managed with tacrolimus monotherapy during pregnancy. This provides an alternative immunosuppressant with a favourable side effect profile suitable for use in women planning a pregnancy when other immunosuppressive drugs should be avoided.Rituximab targets the CD20 antigen expressed on B-lymphocytes and is used to treat recurrent minimal change disease, but experience of its use in pregnancy is limited. We describe a 28-year-old Caucasian female, with recurrent nephrotic syndrome secondary to minimal change disease. She had failed to respond to non-teratogenic alternative therapies. The patient was successfully maintained in remission with rituximab during two consecutive pregnancies. Rituximab (1 g) was administered at 14+6 weeks 14 weeks and 6 days during Pregnancy 1 and 500 mg administered at 23+4 weeks 23 weeks and 4 days of Pregnancy 2. Rituximab had no apparent effect on infant B-cell development in either pregnancy, as neonatal lymphocyte titres were within normal range. There were no maternal complications in either pregnancy. Neither infant encountered infection-related complications. Although rituximab administration during pregnancy appeared safe, evidence of placental transfer is reported with neonatal B-cell depletion, thus alternatives with known safety profiles in pregnancy should be considered before rituximab administration.Pregnancy in women with portal hypertension is high risk due to the danger of variceal haemorrhage, which complicates 15-34% of cases. Variceal bleeding in pregnancy to women with non-cirrhotic portal hypertension is associated with increased risk of abortion (29%) and perinatal death (33%). Pregnancy in women with cirrhosis while less common due to hypogonadism, is associated with additional potential complications of hepatic decompensation and encephalopathy (10%), hepatorenal syndrome, ascites and bacterial peritonitis. Pregnancy in women with cirrhotic portal hypertension is associated with maternal death in 1.6%, and fetal loss in 10-66%. We present a case of non-cirrhotic portal hypertension in pregnancy, discussing two other potential critical complications of portal hypertension in pregnancy, splenic artery aneurysm (SAA) and pulmonary hypertension.

Women with an uncorrected single ventricle heart are at increased risk of adverse maternal and perinatal outcomes.

We report our experience of managing pregnant women with uncorrected single ventricles, during the time period 2011 to 2017, in a low-resource setting and compare pregnancy outcome with healthy concurrent controls. Outcomes assessed include the mode of delivery, maternal complications, neonatal death and birth weight.

There were six pregnant women with uncorrected single ventricles who had a total of 14 pregnancies. There was one maternal death in a woman with atrioventricular-septal defect and Eisenmenger syndrome. Caesarean section rates and preterm delivery were similar, whereas perinatal loss and low-birth weight rates were higher among women with a single ventricle compared to healthy controls.

Unplanned pregnancies without prenatal counselling/care pose a challenge to physicians especially in low to middle income countries and with the high risk of morbidity/mortality, pregnancy should be discouraged.

Unplanned pregnancies without prenatal counselling/care pose a challenge to physicians especially in low to middle income countries and with the high risk of morbidity/mortality, pregnancy should be discouraged.

To investigate the outcomes of critically ill obstetric patients managed in a obstetric critical care unit in South Africa.

Patients with severe maternal morbidity managed in the labor ward of Tygerberg Hospital were studied over three months before the establishment of the obstetrician-led obstetric critical care unit. One year later, patients managed in the obstetric critical care unit were studied using the same methods. The primary outcome measures were maternal morbidity and mortality.

In the before-obstetric critical care unit prospective audit 63 patients met criteria for obstetric critical care. During the second period 60 patients were admitted to the obstetric critical care unit. Lotiglipron in vitro There were no significant differences between the groups in baseline characteristics, admission indications or Acute Physiology and Chronic Health Evaluation scores. Continuous positive airway pressure (

 < 0.01) was utilized more in the second group. Seven deaths occurred in the first, but none in the second group (

 = 0.01).

The establishment of an obstetrician-led obstetric critical care unit facilitated a decrease in maternal mortality.

Not applicable.

The establishment of an obstetrician-led obstetric critical care unit facilitated a decrease in maternal mortality.Trial registration Not applicable.Repair of transposition of the great arteries usually involves an atrial switch or arterial switch operation, which can complicate physiological adaptation to the demands of pregnancy and adversely affect the fetus. We retrospectively compared outcomes of 48 completed pregnancies in 23 women with surgically corrected transposition of the great arteries (38 atrial switch/10 arterial switch operation) under joint cardiac-obstetric care in our tertiary referral clinic between 1997 and 2017. Most women delivered vaginally (85%). The pre-term delivery rate was high (atrial switch 39%; arterial switch operation 40%). Small for gestational age occurred in 56% of babies, significantly more in the atrial switch group (66%) than arterial switch operation (20%), p = 0.013. Women with surgically corrected transposition of the great arteries wishing to become pregnant are at high risk of obstetric complications, primarily pre-term delivery and small for gestational age baby. They require more careful ultrasound surveillance beyond 36 weeks' gestation and/or may benefit from early induction of labour.