Pregnancy-associated pathology

This edition of our journal brings forward a series of pregnancy-associated medical conditions and their particular diagnosis and management. To begin, we report an interesting case of a minor woman diagnosed with stage II Hodgkin nodular sclerosis lymphoma at 30 weeks of pregnancy. The particularity of such a case derives from the fact that specific oncologic treatment (chemotherapy) is challenging in pregnancy, due to its well-known teratogenicity, carcinogenesis, intrauterine growth restriction and fetal low birth weight. Thus, the therapy should be delayed until the second trimester if possible.

Moreover, one of the major emergencies in pregnancy and a serious cause of maternal mortality is the pulmonary embolism, a complication which requires great care in both setting a clear diagnosis and initiating as soon as possible anticoagulant therapy. 

Similarly, one of the major life-threatening conditions for mother and infants, with a worldwide mortality rate of 10-15%, is preeclampsia. The physiopathology of this condition is highly complex and involves an altered expression of placental anti-angiogenic factors. We present the results of a prospective study which was carried out to validate the sFlt-1/PIGF ratio as a predictive marker to rule out preeclampsia. Moreover, a review presents the association between maternal chronic periodontal disease and preeclampsia, based on the chronic systemic inflammation.

Another potential risky obstetrical entity is the postterm pregnancy, and the physiopathological mechanisms for the associated fetal risk is not yet fully understood. Taking this into account, the question arises: should labour be induced or an expectant management is the appropriate option?

Regarding the topic of infertility, adenomyosis is a common pathology among women who have difficulties in conceiving and some authors even recommend screening for adenomyosis before starting assisted human reproduction procedures. Hysteroscopy can prove to be a useful tool for this category of infertile patients.

The midwives and nurses section offers an introspection in the cervical cancer screening programmes and their effects on the population, also addresing the management from the nursing point of view.