deamino-arginine-vasopressin and Puerperal-Disorders

To review the etiology, diagnosis, and management of diabetes insipidus during pregnancy.. A search of the literature was performed in PubMed using key word searching and citation snowballing to identify articles published in English between January 1, 1980, and December 31, 2008, on the subject of diabetes insipidus during pregnancy. Once the articles were identified, a thorough review of all results was conducted. Results and conclusions were compiled and summarized.. We reviewed 50 studies selected using the following key words: diabetes insipidus, pregnancy, arginine vasopressin, vasopressinase.. Gestational diabetes insipidus is underdiagnosed because polyuria is often considered normal during pregnancy. Clinicians caring for pregnant women should consider screening for gestational diabetes insipidus, because it could be associated with serious underlying pathology.

Topics: Antidiuretic Agents; Body Water; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes, Gestational; Diuretics; Female; Humans; Hydrochlorothiazide; Magnetic Resonance Imaging; Pituitary Gland, Posterior; Pregnancy; Puerperal Disorders; Ultrasonography, Prenatal; Vasopressins

Factor VIII auto-antibody inhibitors, though rare, may present significant and often life-threatening haemorrhage. These auto-antibodies, arising predominantly in older individuals, occur in association with autoimmune disorders, lymphoproliferative disorders, solid tumours, medications and the postpartum state. Almost half of the patients develop auto-antibodies spontaneously without an underlying medical condition. Factor VIII auto-antibody inhibitors are characterized as polyclonal IgG immunoglobulins directed against the FVIII procoagulant activity. Laboratory diagnosis is made by performing the aPTT clotting time in conjunction with a mixing study, and subsequently with specific factor assays. Auto-antibodies are quantified most commonly utilizing the Bethesda assay. Acquired inhibitors to other coagulation factors, including factors IX, XI, XIII, vWF protein, and the vitamin K-dependent proteins are extremely rare. The principles of therapy are similar to those which apply to the management of factor VIII auto-antibodies. Treatment of patients with acquired factor VIII auto-antibody inhibitors varies depending upon the underlying medical condition, the titre of the inhibitor, and the clinical presentation. Acutely bleeding patients with high-titre auto-antibodies generally respond well with infusions of porcine factor VIII concentrate, PCCs or rFVIIa. Extracorporeal plasmapheresis with exchange will acutely reduce circulating antibodies and can be used in conjunction with factor infusions and/or IgIV. Haemorrhage in a patient with a low titre auto-antibody will usually respond to high doses of human factor VIII concentrate. DDAVP may also increase factor VIII levels in patients with low-titre inhibitors. Long-term reduction of auto-antibodies can be achieved by immuno-suppressive regimens using steroids and/or cytotoxic agents, IgIV and interferon-alpha. The selection of the appropriate treatment depends upon the associated medical condition, likelihood of spontaneous remission, risk of toxicities of therapy and cost. Determining the efficacy and safety of new treatment modalities for factor VIII auto-antibodies and other coagulation factor inhibitors will require multicentre randomized clinical trials.

Topics: Adult; Aging; Animals; Antibodies, Anti-Idiotypic; Autoantibodies; Autoimmune Diseases; Blood Coagulation Disorders; Blood Coagulation Factors; Deamino Arginine Vasopressin; Factor VIIa; Factor VIII; Female; Hemophilia A; Hemorrhage; Humans; Immunization; Immunoglobulin G; Immunoglobulins, Intravenous; Immunosuppressive Agents; Incidence; Interferon-alpha; Isoantibodies; Male; Plasma Exchange; Plasmapheresis; Pregnancy; Prothrombin; Puerperal Disorders; Recombinant Proteins; Swine

There have only been thirty cases of total post-partum hypopituitarism published in the literature and these have nearly all been secondary to Sheehan's syndrome. The authors report a case of partial anterior hypopituitarism associated with diabetes insipidus which arose after an uneventful Caesarean operation and the origin of which seems to lie in auto-immune hypophysitis. The authors first describe the morphological and endocrine changes that the hypophysis undergoes during pregnancy and then point out that auto-immune hypophysitis seems to have been only recently recognised. This can be used to explain some cases of post-partum hypophyseal insufficiency occurring almost silently without any history of third haemorrhage. Research has been made systematically for anti-hypophyseal antibodies and for specific antibodies of the organ, but has not always been positive. So the diagnosis of auto-immune hypophysitis is often made only after eliminating other reasons for it. A brief review of the physiopathological mechanisms of diabetes insipidus makes it possible to suggest that vasopressinase coming from the placenta together with prostaglandins could play a role.

Topics: Adult; Autoimmune Diseases; Cesarean Section; Cystinyl Aminopeptidase; Deamino Arginine Vasopressin; Diabetes Insipidus; Diagnosis, Differential; Female; Humans; Hypopituitarism; Magnetic Resonance Imaging; Pituitary Gland, Anterior; Pregnancy; Prostaglandins; Puerperal Disorders

Diabetes insipidus during pregnancy is an uncommon medical problem, and its cause is not entirely clear. We present a woman with twin pregnancy associated with HELLP syndrome, who developed diabetes insipidus during postpartum period. A hypertonic saline infusion study with measurement of plasma arginine vasopressin concentrations confirmed the diagnosis. She had mild response to 1-desamino-8-d-arginine-vasopressin (dDAVP) during the immediate postpartum period. On the 3rd postpartum day two doses of 100 microliters of dDAVP were administered, and her urinary volume gradually decreased. We could stop dDAVP on the 30th postpartum day. This exacerbation may result from increased vasopressinase activity caused by the excessive production in the placenta due to twin pregnancy, together with the insufficient degradation in the liver due to HELLP syndrome.

Topics: Adult; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Gestational Age; HELLP Syndrome; Humans; Pregnancy; Puerperal Disorders; Twins

A report is made on the manifestation of diabetes insipidus (neuropituitary syndrome), observed six days after a Caesarean section (29-years old I. Gravida). The progress of pregnancy and delivery as well as the successful treatment with Desmopressin (Minirin) post partum are described. The aetiology is still obscure.

Topics: Adult; Cesarean Section; Chorioamnionitis; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Male; Pregnancy; Puerperal Disorders; Water-Electrolyte Balance

Sheehan's syndrome and diabetes insipidus were diagnosed in a 31-year-old woman seven months after postpartum bleeding with a short duration of hypotension. The diagnosis of diabetes insipidus was established by the inability to concentrate urine during water deprivation and the marked increase in urinary osmolality after administration of 1-Desamino-8-D-arginine-vasopressin (DDAVP). Obstetricians should be aware of diabetes insipidus as a postpartum complication.

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypopituitarism; Postpartum Hemorrhage; Pregnancy; Puerperal Disorders; Water Deprivation

Six patients having different subtypes of von Willebrand's disease were followed up during eight complete pregnancies. Two additional pregnancies terminated in spontaneous abortions. Five pregnancies ended in cesarean section either because of obstetric problems (three) or electively (two) to avoid infant bleeding. Three deliveries were complicated by vaginal bleeding attributed to von Willebrand's disease, while bleeding during two deliveries had clear obstetric causes. Only two deliveries were associated with no bleeding complications. Five newborn babies were found to have von Willebrand's disease. One of them was born with a head hematoma. Management, which included cryoprecipitate and desmopressin (Stimate), is discussed. It is important to manage each case individually since obstetric parameters and severity of bleeding disorder must be known before treatment is planned.

Topics: Adolescent; Adult; Antigens; Blood Coagulation Tests; Deamino Arginine Vasopressin; Delivery, Obstetric; Factor VIII; Female; Fetal Blood; Fibrinogen; Genetic Counseling; Humans; Infant, Newborn; Perinatology; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Uterine Hemorrhage; von Willebrand Diseases; von Willebrand Factor

Topics: Arginine Vasopressin; Blood Coagulation Disorders; Deamino Arginine Vasopressin; Factor VIII; Female; Humans; Pregnancy; Puerperal Disorders