Introduction Osteosarcoma is the most common primary malignant bone tumor; however, involvement of the temporal bone is exceptionally rare, particularly during pregnancy. The coexistence of malignancy and pregnancy presents unique diagnostic and therapeutic challenges requiring multidisciplinary management.
Objective Maternal red cell alloimmunization is a rare pregnancy condition that can cause hemolytic disease of the fetus and newborn (HDFN), which can be serious and fatal. As subsequent alloimmunized pregnancies carry HDFN risk, families' future pregnancy decisions may be affected. Findings from qualitative interviews in alloimmunized mothers are presented to understand experiences and perspectives during their previous pregnancy affected by severe HDFN, aiming to inform patient-centered interventions. Study Design This article presents qualitative findings of a broader mixed-methods study published elsewhere. Semi-structured 1:1 interviews were conducted via Microsoft Teams with adults (≥18 years) who experienced a pregnancy within the past 5 years affected by severe HDFN (i.e., intrauterine transfusion, fetal loss after 14 weeks' gestation, or neonatal death within 4 weeks of birth due to HDFN). A patient advocacy group ensured study design's relevance, recruited participants, and helped interpret results. Interviews were audio-recorded, transcribed, and analyzed to identify key themes. Results Of 28 participants, 27 completed interviews. Participants reported a median 2 (range, 1-5) affected HDFN pregnancies and a median 4 (1-11) intrauterine transfusions during their most recent pregnancy affected by severe HDFN. Seven themes were identified: (1) diagnosis communication and information seeking, (2) emotional journey at diagnosis, (3) navigating the treatment regimen, (4) physical/emotional challenges during pregnancy, (5) impacts on social life, (6) experience at delivery, and (7) postdelivery adjustment and reflections. Results indicated that participants felt inadequately informed about their diagnosis, experienced significant emotional distress, along with difficulties managing intense monitoring/treatments. Many described their delivery as traumatic and their postpartum as very stressful, which influenced their decision about additional pregnancies. Conclusion These findings highlight opportunities to strengthen communication and support for pregnant individuals experiencing severe HDFN. Developing comprehensive support models and improving care, guided by patient preferences, could address the needs of affected individuals and families.
Objective Surgical necrotizing enterocolitis (NEC, Bell stage 3B) complicating neonatal supraventricular tachycardia (SVT) is exceedingly rare. We describe a novel per-rectal propranolol strategy to maintain antiarrhythmic prophylaxis during mandatory nil per oral (NPO) status imposed by NEC. Study Design This study includes a single case report at a tertiary neonatal unit in Western India. Results A 35-week neonate with antenatal fetal tachyarrhythmia (>300 beats per minute [bpm]) developed postnatal SVT at 6 h of life (280-300 bpm), requiring adenosine cardioversion and oral propranolol. On day of life (DOL) 4, hematochezia, abdominal distension, and portal venous gas indicated Bell stage 3A NEC, mandating NPO status. With enteral routes contraindicated, propranolol was continued per rectum, to our knowledge the first reported neonatal antiarrhythmic use of this route. Deterioration to pneumoperitoneum by DOL 8 necessitated laparotomy with jejuno-jejunal and ileo-caecal resection and anastomosis. No SVT recurred during NPO. The infant was discharged on DOL 25 on oral propranolol. Conclusion This first Indian report of SVT-associated surgical NEC highlights two novelties: Bell stage 3B NEC requiring surgery and per-rectal propranolol as a novel antiarrhythmic bridge during NPO. Clinicians should maintain vigilance for NEC in neonates with SVT regardless of hemodynamic stability, and consider the rectal route for propranolol when NPO.
Background Uterine rupture is a rare but life-threatening obstetric emergency, usually associated with labor in patients with a prior cesarean delivery. Spontaneous rupture remote from a uterine scar, particularly at the cornua in the second trimester, is exceedingly uncommon. Case We report a 30-year-old gravida 2 para 1 at 25 3/7 weeks' gestation with a dichorionic-diamniotic twin pregnancy who presented with abrupt abdominal pain and hemoperitoneum of unclear etiology. Despite reassuring imaging, progressive maternal deterioration and non-reassuring fetal status prompted emergent laparotomy and cesarean delivery. A 3 cm × 3 cm full-thickness left cornual rupture was identified. Conclusion In pregnant patients with unexplained hemoperitoneum, clinical status must override reassuring imaging, and prompt surgical intervention is essential.
Background Pneumatoceles are air-filled cystic lesions within the lung parenchyma, often arising from severe pneumonia or mechanical ventilation-induced lung injury, which pose significant risk, particularly in neonates requiring high positive-pressure ventilation. Traditional management includes conservative monitoring, percutaneous drainage, and/or surgical intervention. High-frequency ventilation is frequently employed to minimize barotrauma. Case Summary We present a neonate born at 29 0/7 weeks of gestation, weighing 780 g. Post-delivery, the patient developed pneumonia, leading to multiple refractory bilateral pneumatoceles and transfer to our hospital. Initial management included high-frequency jet ventilation and inhaled nitric oxide, with limited improvement over 3 weeks, after which we initiated neurally adjusted ventilatory assist (NAVA), leading to significant clinical improvement. Radiographic imaging showed rapid improvement of the pneumatoceles on NAVA, with complete resolution observed at outpatient follow-up. Discussion This case demonstrates successful management of refractory bilateral pneumatoceles using NAVA. Its patient-driven approach provides synchronized, gentle ventilation, crucial for treating pulmonary air leak syndromes and facilitating natural weaning. NAVA's dynamic adjustments and ability to closely match ventilatory support to the patient's neural respiratory drive using less peak inspiratory pressure offers a promising strategy for managing complex pulmonary conditions, such as pneumatoceles, in neonates.
