levoleucovorin and Fetal-Death

Colon cancers arise only rarely in the course of a pregnancy. Yet colon obstruction, perforation and metastatic spread seem to occur more frequently in this setting than with the average colon cancer. Perhaps this is due to the immunotolerance which accompanies pregnancy. No case of epidermoid (squamous cell) cancer of the colon has been previously described in a pregnant woman. This conjunction has a catastrophic prognosis: the diagnosis of colon tumor is delayed since symptoms are masked by the pregnancy, and epidermoid colon cancer is a particularly aggressive lesion. A major sub-diaphragmatic surgical procedure can be performed with reasonable safety to mother and fetus. Radiotherapy is contraindicated. Neo-adjuvant chemotherapy can be administered although the risks to the fetus are not well known. During the first trimester, a therapeutic abortion can be proposed to optimise the treatment of the mother. During the second and third trimesters, treatment of the mother exposes the fetus to the risk of malformations or premature delivery; delay in maternal treatment in hopes of prolonging the pregnancy in order to obtain a viable neonate diminish the chances of maternal survival.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Squamous Cell; Cesarean Section; Chemotherapy, Adjuvant; Colonic Neoplasms; Combined Modality Therapy; Disease Progression; Diseases in Twins; Down Syndrome; Fatal Outcome; Female; Fetal Death; Fluorouracil; Humans; Intestinal Perforation; Leucovorin; Liver Neoplasms; Male; Organoplatinum Compounds; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy, Multiple

The effect of periconceptional multivitamin/trace element supplementation on pregnancy outcomes was evaluated in a randomised controlled trial. The final data-base included 5,502 females with confirmed pregnancy. A multivitamin including 0.8 mg folic acid or a trace element were supplemented for at least 28 days before conception and continuing for at least until the second missed menstrual period. Number of pregnancies, terminations of pregnancies, four types of fetal deaths, livebirths including low birth weight, preterm birth and sex ratio were analysed. Periconceptional multivitamin supplementation increased fertility (higher rates of cumulative conceptions and multiple births), had no significant effect on the rate of different groups of fetal deaths, low birth weight and preterm birth in singletons. This primary preventive method can reduce the occurrence and recurrence of neural-tube defects and had no other significant effect on pregnancy outcomes except multiple births.

Topics: Adult; Female; Fetal Death; Humans; Hungary; Infant, Low Birth Weight; Infant, Newborn; Leucovorin; Male; Neural Tube Defects; Obstetric Labor, Premature; Pregnancy; Pregnancy Outcome; Premedication; Risk Factors; Sex Ratio; Trace Elements; Vitamins

Cervical pregnancy is an uncommon ectopic pregnancy that accounts for approximately <1% of extrauterine gestations. This condition is associated with an extremely high risk of massive hemorrhage and previously often required hysterectomy. Current early ultrasonographic diagnosis and medical management in conjunction with other conservative measures, which include uterine artery embolization and intracervical balloon tamponade, have enabled conservation of the uterus. A young nulliparous patient ultrasonographically diagnosed with a cervical pregnancy and early fetal demise at 11 and 4/7 weeks gestation was managed with high-dose methotrexate and folinic acid rescue treatment. On the second day after treatment was initiated she spontaneously passed an intact gestational sac accompanied by minimal hemorrhage. Treatment was continued, with decreasing serum beta subunit of human chorionic gonadotropin levels and subsiding hemorrhage. Subsequent surgical measures were not required. This case suggests that complete abortion of a cervical pregnancy not necessitating surgical measures can occur.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Female; Fetal Death; Gestational Age; Humans; Leucovorin; Methotrexate; Pregnancy; Pregnancy Trimester, First; Pregnancy, Ectopic; Time Factors; Treatment Outcome; Ultrasonography, Prenatal; Uterine Hemorrhage

In this paper, we describe the outcome of 33 triplet pregnancies referred to us between 1985 and 1990. They were managed as follows: management at home as soon as the diagnosis was made, then hospitalization at 28 weeks' gestation. Progesterone and beta-mimetics were administered daily, a cesarean section was always performed. One late abortion occurred at 21 weeks. The rate of prematurity was 90.6%, mean gestational age at delivery was 34.1 +/- 3 weeks, and 62.5% of deliveries occurred between 34 and 37 weeks. Ninety-four fetuses were delivered alive. Mean birth weight was 1880 +/- 410 g. Fetal growth retardation rate was 61.8%, including 28 infants under the third centile and 31 under the 10th centile. Perinatal death rate was 4.16% including 2 in utero deaths and 2 neonate deaths. All infants are healthy except for one child with severe mental retardation. These results show that triplet pregnancies can be safely managed, and that selective first-trimester reduction in triplet pregnancies does not appear to be necessary.

Topics: Adult; Albuterol; Birth Weight; Cesarean Section; Female; Fetal Death; Humans; Iron; Leucovorin; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy, Multiple; Prenatal Care; Progesterone; Triplets

The anticonvulsant drug valproic acid (VPA) is suspected to be a developmental toxicant in humans, inducing primarily neural tube defects. The mechanism for this effect is unknown, but it has been suggested that the drug may act via a deficiency of the vitamin folic acid. We examined this possibility by concurrent treatment of rat embryos in a whole embryo culture system with VPA and folinic acid (FA), a folic acid derivative. Groups of CD rat embryos were treated with various concentrations of VPA, various concentrations of FA, or a combination of a teratogenic dose of VPA plus various levels of FA. At the end of the 44 hour culture period, each embryo was evaluated for viability (presence of a heartbeat), yolk sac circulation, presence of any malformations, morphological score, crown-rump and head lengths, as well as DNA and protein contents. The anticonvulsant did not decrease viability but did decrease yolk sac circulation and all growth and developmental endpoints in a dose-responsive manner. There was also a dose-related increase in the incidence of open neural tubes. The addition of FA alone had no significant effect on growth and development. When various concentrations of FA were added simultaneously with a teratogenic dose of VPA, there was no decrease in the incidence of open neural tubes. Growth and developmental endpoints were altered in a somewhat random fashion but were never increased to the control level. The lack of attenuation by FA was not due to instability of the compound in the culture system, nor was there a difference in the amount of FA present in the exocoelomic fluid of VPA-treated and control embryos.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Dose-Response Relationship, Drug; Embryo, Mammalian; Female; Fetal Death; In Vitro Techniques; Leucovorin; Neural Tube Defects; Pregnancy; Rats; Valproic Acid

Topics: Abnormalities, Drug-Induced; Animals; Cleft Palate; Female; Fetal Death; Fetus; Leucovorin; Mice; Organ Size; Phenytoin; Pregnancy; Sex Factors; Time Factors