Systemic lupus (LS) is an autoimmune disease mainly affecting young women of childbearing age, The occurrence of pregnancy with lupus has become a usual situation, active lupus in the 6 months preceding or at the beginning of pregnancy has more risk of having an attack, the lupus known preceding the pregnancy must make this last programmed.Maternal mortality is multiplied by 20 in lupus patients, this seems to be essentially linked to the activity of LS, the occurrence of pre-eclampsia, the presence of anti-phospholipid antibodies and the side effects of therapies, in particular infectious.Fetal and perinatal risks are linked to prematurity, the presence of maternal anti-phospholipid or anti- SSA antibodies and the side effects of treatment.The most common situation is the knowledge of lupus before pregnancy. Our case treats an unrecognized lupus triggered by pregnancy, monitoring and management must be multidisciplinary, including regular clinical, biological and ultrasound evaluation.The treatment of relapses varies according to the severity and the type of organ affected and remains similar to the treatment outside pregnancy subject to the compatibility of the treatments with this one: hydroxy chloroquine, corticosteroid bolus if necessary then orally with the lowest possible dose, which markedly improved the prognosis.
Hereditary angioedema is a recently identified inherited entity. Schematically, the C1 inhibitor (C1Inh) sees its function decrease with estrogens, an event associated with a semiology made up of edema attacks. Classically, this clinical form is aggravated by synthetic estrogens, and improved by natural estrogens. We report the case of a woman who successfully led a pregnancy, despite the various crises observed throughout the pregnancy with functional repercussions.
Carbon monoxide poisoning during pregnancy is a rare and potentially serious condition. Fetal complications are uncommon, related to anoxic lesions. The severity of these complications does not depend on the level of maternal COHb.We report the case of 25-year-old woman 2 months pregnant and half accidentally exposed to domestic gas who was received in a state of unconsciousness with medium abundant bleeding in gynecology and obstetrics emergencies of the maternity souissi CHU in Rabat where we have seen an abortion in progress with expulsion of the product of conception.
The systematization of ultrasound in the 1st trimester with a search for the nuchal translucency has made it possible to detect numerous pathologies, in particular cystic hygroma, the prevalence of which can reach 2%, and which is defined as having a retro and laterocervical poly cystic mass, These cystic formations are composed of multiple compartments of varying size and containing a liquid; and they are microscopically defined as new cavities formed in the connective tissue and lacking a classic cystic wall, that is to say, they are pseudo-cysts without an internal coating, hence the interest in differentiating them from cervical cystic lymphangioma which has a lymphatic endothelial type coating of variable volume, related to sequestration of lymphatic fluid in the nuchal connective tissue. And which is generally unilateral left anterolateral, and can also involve the shoulder.And also differentiating them from the occipital meningocele by the demonstration of a defect of the bone closure at the level of the cervical spine.Cystic hygroma is often associated with karyotype abnormalities of up to 80% made of monosomy X or trisomy 21 or others, as well as other morphological abnormalities; cardiac, diaphragmatic, skeletal or a set of syndrome. A good knowledge of the factors of poor prognosis makes it possible to inform prenatal counseling and set up correct management.
It is estimated that more than 2% of pregnant women have hypothyroidism and that the incidence of treated hypothyroidism prior to pregnancy is around 0.3% of pregnancies. In the majority of cases, hypothyroidism is mild and is due to an autoimmune mechanism, as evidenced by the presence of anti-TPO or antithyroglobulin antibodies. Pregnancy may be indicative of a fruste form, related to asymptomatic autoimmune thyroiditis, which is unable to increase its hormone production to meet the specific needs of pregnancy. It can also be the consequence of moderate or severe iodine deficiency. Moreover, thyroid balance during pregnancy is essential for good fetal brain development. In fact, several studies have shown that children born to mothers who are not or insufficiently substituted for hypothyroidism have lower intelligence quotients than the general population. In addition, other maternal consequences (gravid hypertension, pre-eclampsia, etc.) and fetal consequences (IUGR, intellectual deficit) of hypothyroidism during pregnancy have been described. Although current recommendations suggest targeted screening of patients at risk of hypothyroidism, it is desirable that, in the near future, this screening becomes systematic as soon as the diagnosis of pregnancy is confirmed. L-thyroxine treatment should then be rapidly initiated (or adapted in the case of known hypothyroidism prior to pregnancy) with the aim of achieving a TSH of less than 2.5 mIU/l. In all cases, iodine supplementation should be offered from the preconceptional period through to breastfeeding.