#Hydronephrosis

[learnorneverrealize1888000888]

Hydronephrosis refers to a disease or condition where excessive amounts of water, in the form of urine, causes the kidneys to dilate.

[yourdrbhavesh]

Tongue-Tie: What It Is and How It's Treated | Dr. Bhavesh Doshi | Pediatric Surgeon in Mumbai

In this informative video, Dr. Bhavesh Doshi, a renowned Pediatric Surgeon in Mumbai, sheds light on tongue tie, a common condition that affects children.

He explains how tongue tie can lead to delayed speech or slurring of speech due to the inability to protrude the tongue beyond a particular part of the mouth, and how this condition can be corrected through a simple surgical procedure using a Bipolar Cautery device.

Dr. Doshi emphasizes that the surgery should be performed at around 8 to 10 months of age when the child is learning to speak, and that older children may require speech therapy for complete correction of their speech.

With over a decade of experience in the field, Dr. Doshi's expertise in pediatric surgery and his passion for educating people about common childhood conditions make this video a must-watch for parents and caregivers.

For any queries or questions, book an appointment with Dr. Bhavesh Doshi:

📞 Call: +91 9820565205

📧 Email: info@drbhaveshdoshi.com

🌐 Visit: https://dhanvantarihospitals.com/dr-b...

📍 Borivali West | Dahisar East | Kandivali West

Watch videos on similar topics by Dr. Bhavesh Doshi:

➡️ Hydronephrosis and neuroblastoma treatment in babies:    �� Hydronephrosis an...  

➡️ Intussusception in Children:    • Intussusception i...  

➡️ Choledochal Cyst:    • Choledochal Cyst ...  

➡️ Appendicitis in Children:    • Appendicitis in C...  

[little-pissbaby]

this is gonna get TMI and it will get sad and whiny so please don't feel obligated to keep reading.

it takes so many steps to be alive. all of the things you do subconsciously suddenly become arduous tasks when you have to do them manually. things like eating, drinking, sleeping, breathing, using the bathroom, it's exhausting having to think about and consciously or manually do even just one of those things.

I was officially diagnosed with dysautonomia a few months ago, although I have been struggling with my symptoms for over a decade and I've been in treatment for several years. I was also diagnosed with a neurogenic bladder that same month. this means I have to catheterize myself 3-4 times a day every day for the rest of my life, or until I can get a suprapubic catheter placed.

Y'ALL. self-cathing is beyond exhausting. it's a little bit of a genuine workout, especially when you're morbidly obese like me. I hate that I've gotten really good at it and that it doesn't take me long at all now. I didn't want to get good at it, I didn't want to have to have this skillset. I already have to know how to draw up and give an IM injection, how to flush an IV, how to reduce dislocated joints in myself and others... I am TIRED.

I'm sure a colostomy is also in my near future. I have the same problems in my colon that I have in my bladder, only it's also complicated by endometriosis in the walls of my colon and rectum. they haven't been completely infiltrated yet, but if this IUD doesn't do its job, then I'm definitely gonna start losing organs and my mind.

at this point I'm out of words to explain why I'm so cosmically fatigued but if I tag every diagnosis/condition I have maybe y'all can sorta get an idea.

sorry for ranting. I have to go cath myself now.

at least I do it under the supervision of the best medical advisor ever <3 all she asks for in return are kisses, cuddles, and crunchies <3<3

[hydronephrosis-child-treatment]

Hydronephrosis In Child Treatment Delhi-Trusted Pediatric Care

Minimally Invasive Hydronephrosis Care for Children in Delhi

Secure your child's health with advanced hydronephrosis in child treatment Delhi. Dr. Jain offers affordable and effective care tailored for young patients.

Introduction 🚼🌟🩺

Hydronephrosis in pediatric patients arises from renal swelling due to impaired urine drainage, often caused by obstructions. Hydronephrosis in child treatment Delhi offers cutting-edge solutions spearheaded by renowned specialists like Dr. Prashant Jain. This article delves into the etiology, clinical presentation, diagnostic modalities, and therapeutic strategies for hydronephrosis, emphasizing Delhi’s advanced care landscape.

Understanding Hydronephrosis 🏥🔍💡

Hydronephrosis varies in severity, necessitating a tailored approach to treatment.

Etiology of Hydronephrosis

Congenital Anomalies: Inherent structural irregularities disrupting urine flow.

Pelvi-Ureteric Junction Obstruction: Functional or anatomical blockages at the ureter-kidney interface.

Vesicoureteral Reflux (VUR): Retrograde urine flow due to incompetent vesicoureteral valves.

Nephrolithiasis or Masses: Rare obstructive factors like stones or tumors.

Clinical Manifestations

Persistent flank or abdominal pain.

Recurrent urinary tract infections (UTIs).

Fever associated with infections.

Dysuria or frequent urination.

Hematuria (blood in urine).

Diagnostic Approaches 🔬📝🩻

Precise diagnosis is pivotal in Hydronephrosis in child treatment Delhi, leveraging sophisticated tools:

Ultrasound: Primary imaging modality for detecting renal dilation.

Voiding Cystourethrogram (VCUG): Identifies reflux abnormalities.

Renal Nuclear Scintigraphy: Quantifies renal function and drainage efficiency.

Cross-sectional Imaging: MRI or CT for comprehensive anatomical evaluation in complex cases.

Treatment Paradigms 💊⚕️🛠️

Conservative Management

Observation: Regular monitoring for mild, asymptomatic cases.

Pharmacotherapy: Antibiotic prophylaxis to prevent secondary infections.

Lifestyle Interventions: Encouraging hydration and urinary hygiene.

Surgical Interventions

a. Pyeloplasty: Reconstruction of the pelvi-ureteric junction to restore normal drainage, favoring minimally invasive methods.

b. Ureteral Reimplantation: Corrects vesicoureteral reflux by repositioning the ureters.

c. Endoscopic Techniques: Minimally invasive options to alleviate obstructions or address reflux.

d. Stenting: Temporary measures to facilitate urinary drainage during recovery.

Advantages of Advanced Pediatric Care in Delhi 🌆👨‍⚕️👩‍⚕️

1. Expertise in Pediatric Urology

Delhi is home to highly skilled surgeons like Dr. Prashant Jain, specializing in pediatric urological conditions.

2. State-of-the-Art Infrastructure

Hospitals feature advanced diagnostic and surgical equipment tailored for pediatric care.

3. Minimally Invasive Options

Procedures emphasize reduced recovery times and minimal scarring.

4. Comprehensive Care Framework

Patients benefit from integrated pre- and post-operative care plans.

5. Affordability

Delhi combines cost-efficiency with high-quality care, attracting patients globally.

Preoperative and Postoperative Considerations 🏥🤝🩹

Pre-Treatment Preparations

Comprehensive evaluation involving imaging and lab tests.

Counseling to demystify procedures and allay parental concerns.

Preparing the child emotionally and logistically for hospitalization.

Postoperative Care

Pain Management: Tailored analgesic regimens.

Follow-Up Assessments: Regular imaging and clinical evaluations to ensure successful outcomes.

Behavioral Adjustments: Emphasizing hydration and hygiene to prevent recurrence.

Parental Support: Resources for emotional and psychological assistance.

Why Opt for Dr. Prashant Jain? 🩺🌟🤱

Dr. Prashant Jain is a distinguished authority in Hydronephrosis in child treatment Delhi, combining technical excellence with empathetic patient care. His proficiency in minimally invasive approaches ensures optimal results with minimal discomfort for young patients.

Conclusion ✨✅👶

Hydronephrosis, though complex, is highly manageable with timely intervention. Families seeking world-class pediatric care can trust hydronephrosis in child treatment Delhi for precise diagnostics and advanced treatments. With experts like Dr. Prashant Jain and superior medical infrastructure, Delhi stands as a beacon of hope for pediatric patients. Take the first step toward recovery—schedule a consultation today.

[ziramanik]

Hydronephrosis is a kidney problem in which the kidneys swell due to the accumulation of urine. This problem arises when urine is unable to reach the bladder due to a blockage. Timely diagnosis and treatment of this condition is necessary, as it can affect the functioning of the kidney. The causes and symptoms of hydronephrosis can be many, depending on the severity of the condition.

The problem of hydronephrosis should not be ignored. Identifying and treating its symptoms at the right time can prevent kidney damage. So if you are experiencing the above symptoms, consult a specialist immediately and get proper treatment. Timely treatment maintains kidney health and future complications can be avoided.

[medicalcareinfo]

Is your child suffering from pediatric hydronephrosis? Know the causes, symptoms and hydronephrosis treatment options.

[prashantjainsblog]

What Is Antenatal Hydronephrosis?

Antenatal hydronephrosis is the condition that occurs in the fetus during pregnancy. The condition is characterized by enlargement of the kidney due to the accumulation of fluid. Antenatal hydronephrosis indicates various renal disorders in the fetus. found more in males as compared to females. The condition is It is found in 0.5 percent of females and 1 percent in males. Fortunately, in almost all the case, other organs are not affected due to antenatal hydronephrosis.

How Is Antenatal Hydronephrosis Diagnosed?

Antenatal hydronephrosis is diagnosed through various methods. Some diagnostic techniques involve advanced equipment and may not be available at al the centers for diagnosing this condition. Most cases of antenatal hydronephrosis are found during a routine ultrasound at around 20 weeks gestation period.

Following are the methods to diagnose antenatal hydronephrosis:

Laboratory testing: Evaluating the urine sample of the fetus may help in identifying kidney dysfunction or renal dysplasia. Through the ultrasound-guided technique, the urine sample of the fetus is obtained. In the case of a healthy fetus, the urine so formed is hypotonic. However, in a diseased condition, the urine obtained is isotonic. Increased level of calcium, sodium, Microglobulin, and chloride indicates possible renal dysplasia.

Ultrasonography: Ultrasonography was the first diagnostic method that helped in identifying hydronephrosis in the fetus. It also helps in identifying the possible cause of accumulation of fluid in the kidney.

Magnetic Resonance Imaging: Magnetic resonance imaging during pregnancy provides more detailed condition and provide important insight into the severity of the disease. Once the severity is identified, optimum medical interventions can be designed.

Other additional procedures: The procedures that can help in diagnosis include amniocentesis, chromosomal analysis, maternal serum biochemistry, and chorionic villus sampling.

What Are The Various Grades Of Antenatal Hydronephrosis?

The grades of antenatal hydronephrosis are determined by the Antero-posterior diameter (APD) of the renal pelvis. The diameter is evaluated through ultrasonography. The grades or classification of antenatal hydronephrosisis done as mild, moderate and severe.

Following are the various grades for antenatal hydronephrosis:

Almost 57–88% of the antenatal hydronephrosis is mild while 10 to 30 % of the cases are of moderate grade. 2–13% of the cases of antenatal hydronephrosis are severe.

Antenatal hydronephrosis is caused due to the following conditions:

Ureteral obstruction or blockage: This obstruction may be either

Ureteropelvic junction obstruction (UPJ) or ureterovesical junction obstruction (UVJ) or megaureter. The UPJ obstruction is indicated when there is a dilation of the pelvic-calyceal system without any ureteral dilation.

Renal anomalies: Generally, only a single ureter drains the urine from a kidney. However, in almost 1 % of the humans, there are two ureters originated from a kidney. This duplication does not cause any complications in the majority of patients. In approximately 1 in 1500 infants, there is an obstruction in the upper tube.

Urethral obstruction: Urethral obstruction in the fetus may also lead to antenatal hydronephrosis.

Vesicoureteral reflux: When there is the backflow of urine from the ureter and bladder towards the kidney, the urine does not flow properly and gets accumulated.

Polycystic Kidney: Due to the complete obstruction of the ureter, one of the kidneys is not normally developed. The other kidney functions normally and the baby usually born with a multicyclic kidney.

If there is a prolonged obstruction of urine and increased pressure, this may cause a progressive reduction in kidney function. Medical interventions may reduce the pressure and allow the kidney to function but may not be able to regain the lost function.

No intervention is required in antennal hydronephrosis due to various reasons such as lack of technology for accurate diagnosis, non-identification of the definite reason for the fluid accumulation, and no strong data corresponding to safety and efficacy of medical/surgical interventions. However, a follow-up is required during the post-natal period in infants with varying degrees of antenatal hydronephrosis.

[drprashantjain1]

Hydronephrosis Treatment In Delhi

Many people have never heard of the term hydronephrosis. That’s because it is only prevalent in around 1% of the general population according to a research paper published by Science Direct. Hydronephrosis can affect both children and adults. In fact, it can even affect babies in the womb; this can be found via prenatal ultrasound. The same study by Science Direct observed that 1 in 100 to 200 fetuses suffered from hydronephrosis. Because of this, finding out that you suffer from hydronephrosis and require surgery might seem daunting. But don’t worry about it. You can find hydronephrosis treatment in Delhi without breaking a sweat!

What exactly is it?

Hydronephrosis is a condition wherein one or both of the kidneys swell up. This happens either because of some blockage in drainage system of urineor urine refluxing back in the kidneys which can eventually damage the kidney of child.

Therefore, it is essential that you consult doctor once hydronephrosis has been diagnosed. Once the diagnosis is made child needs to be evaluated in detail. Not all hydronephrosis requires surgical intervention but needs to be monitored closely to avoid any renal damage.

Signs of Hydronephrosis

Here are some of the most commonly known signs and symptoms of hydronephrosis.

Antenatal diagnosis on ultrasound scan.

Urinary tract infection

Pain and lump in the back and the sides.

Urinary symptoms like frequent urination, crying during urination etc.

These signs are particularly useful to suspect hydronephrosis in children. Infants, in particular, can have failure to thrive. If you have suspicion that your child may be suffering from hydronephrosis or has all the signs mentioned above, it might be a good idea to consult a doctor.

Causes of Hydronephrosis

As mentioned above, hydronephrosis is a condition that prevents urine draining from the kidneys, which causes the kidneys to swell up. Hydronephrosis usually develops because of two main causes:

Obstruction in Urinary System

Blockage in the upper ureter (Pelvi-ureteric Junction) or lower ureter (Uretero-vesical junction) or Bladder oulet (Posterior urethral valve) can cause hydronephrosis on one side or both sides.

One of the commonest cause is blockage at ureteropelvic junction. This is essentially the very point (or junction) where the ureter and kidney meet.

Posterior Urethral valves are seen in boys and usually causes bilateral hydronephrosis. This is treated by endoscopic resection surgery. If not treated timely it can cause significant morbidity.

Vesicoureteral Reflux

Another cause of hydronephrosis is the vesicoureteral reflux where the urine flows backward from the bladder to the kidneys via the ureter. This condition is unique because usually the urine should only flow from the kidneys to the bladder- not the other way around.

Hydronephrosis treatment in Delhi

If you’re looking for hydronephrosis treatment in Delhi, then you’ll be happy to know that there’s plenty of options available. Your doctor who, after examination, ask for a few tests. This may include the following:

Blood test

Urine test

Ultrasound Imaging

Voiding Cystourethrogram

Renal Scan (DTPA or DMSA scan)

Combined, these tests examine your kidneys, bladder, Urethra and checks if they’re working fine. The kind of treatment you’ll receive for hydronephrosis depends strictly on how severe the condition is.

Some of the causes are self-limiting and may need just close observation with regular testings. Hydronephrosis causing recurrent urinary infections or deterioration of renal functions might require surgical intervention.

However, we do not recommend that you go with this approach as it can even lead to your mild case developing into a severe case of hydronephrosis, which will need surgery. Hydronephrosis surgery cost depends solely on how critical the situation is.

However, you should not look at hydronephrosis surgery costs when looking to treat the disease. As we mentioned, it’s not life-threatening at the same time living with hydronephrosis can severely impact your quality of living. So don’t wait it out!

[heidistephanymd]

Hypospadias Specialist

Dr. Stephany is a hydronephrosis specialist and hypospadias specialist with expertise across the field of pediatric urology.

This pediatric urology program is unique. It is Orange County, CA’s sole dedicated center with fellowship-trained pediatric specialists. The team provides diagnosis, ongoing treatment, and surgical intervention for pediatric urology concerns.

Dr. Stephany and her colleagues recognize that the urology care and services needed by a child are different from the needs of an adult patient. The treatments that are provided are specialized and tailored for kids with the ultimate goal of preserving childhood, regardless of the diagnosis.

A wide variety of patients are treated at CHOC Children’s Urology Center, and Dr. Stephany and her team are committed to developing evidence-based management and treatment plans, so that each child’s care plan is customized and individual to that child’s needs.

The team works closely with each child’s parents/legal guardians, along with other specialists, in order to get a detailed perspective of a diagnosis. Our team understands that the child’s family is an important resource in providing complete and thorough care, and by providing comprehensive care under one roof with coordination between the family and multiple specialists helps to simplify the process.

[jcsmicasereports]

Acute Myeloid Leukemia In Pregnancy: Difficult Journey From Diagnosis To Delivery And Treatment by Vina Kumari in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

The incidence of Acute Myeloid Leukemia in pregnancy is about 1 in 75,000 to 1 in 100,000. Owing to the therapy attributable risks to mother and fetus, the management of AML in pregnancy is very challenging, both for the parents and the medical fraternity. Furthermore, the diagnosis of leukemia in pregnancy is very difficult owing to vague presenting symptoms like fatigue and weakness which are confused with physiological changes during pregnancy.

Case Report: Primigravida, 33 weeks 6 days gestation age, with history of weakness and fatigue for 15 days and fever, cough and cold for 3 days was referred to our hospital with blood reports of raised total leucocyte count. The lab reports showed thrombocytopenia, anemia and leukocytosis with increased circulating blasts in the peripheral smear. As she was in her third trimester, plan of induction of labor and delivery followed by chemotherapy was taken. She delivered a live healthy baby. Post-delivery, she was advised chemotherapy. She had an immediate remission after the chemotherapy. The disease relapsed after 10 months and she succumbed to the disease due to unavailability of facilities during the COVID pandemic.

Conclusion: AML during pregnancy is rare. There is no fixed protocol for management of AML during pregnancy .The aim of management should be to take care of the initial concerns regarding fetal well-being according to gestation age and commence chemotherapy as soon as possible. This would give the best survival chances to the mother.

Keywords: Acute myeloid leukemia, pregnancy, chemotherapy.

Introduction

The association of leukemia and pregnancy is very rare, rather under-diagnosed and sparsely reported. The prevalence based on diagnosed and reported cases is one in 75,000 to 100,000 pregnancies. Most of the leukemias diagnosed in pregnancy are myeloblastic.

Acute myeloid leukemia (AML) is characterized by excessive proliferation of blast cells of myeloid lineage. This results in hematopoietic insufficiency like anemia and thrombocytopenia. The symptoms are related to complications of the pancytopenia, such as infections or hemorrhagic diathesis. The mentioned initial symptoms of leukemia in pregnancy are easily attributed to physiological changes related to the pregnancy and hence are either missed or diagnosed late. We report a case of Acute Myeloid Leukemia in a pregnant patient, its management and outcome.

Case Presentation

18-year-old primigravida presented at 33 weeks 6 days gestation. She was referred with history of weakness since 15 days and fever, cough, cold since 3 days associated with raised leucocyte count. She belonged to low socioeconomic status, was unbooked and had two antenatal visits during her pregnancy. She visited the facility when she had symptoms of gross weakness.

Her first trimester was uneventful. She was registered at a local hospital but was not compliant. Dating scan, trisomy screening and anomaly scan was not done.

On examination, her pulse rate was 88, blood pressure 100/60, respiratory rate 20 per minute, and temperature 99 degree Fahrenheit. She was pale but there was no jaundice, icterus or edema. She had angular stomatitis, and glossitis indicating malnutrition. Lymph nodes were not palpable.

On per abdomen examination, Uterus was relaxed, 33-34 weeks size and fetal heart 143/min. Ultrasound showed a single live fetus in cephalic presentation with effective fetal weight of 2.4 kg and liquor 12.7cm. Placenta was in upper posterior position. The fetus had overdistended urinary bladder with hydronephrosis of fetal kidneys suggestive of bladder outlet obstruction. Moderate hepatosplenomegaly was present. She was moderately anemic with hemoglobin of 8.3 gm/dl. The leucocyte count was very high 2,66,000/cu mm with neutrophils 4, lymphocytes 1, eosinophils 1 and basophils 1. The blood picture showed marked leucocytosis with blasts cells predominating 86% and 2 myelocytes and 1 metamyelocyte. The blast cells typically showed large nuclei, opened up chromatin, prominent nucleoli and cytoplasmic blebs. This picture raised the suspicion of Acute Myeloid Leukemia in pregnancy. Her platelet count was 96000/cu mm. LDH was raised 995 U/L signifying cell lysis. Liver enzymes were also borderline raised. Dengue serology was found negative. Her blood group was O negative. Serum Creatinine - 1.05 mg/dl and Serum uric acid - 10.9 mg/dl were also raised. The blood picture thus indicated towards normochromic normocytic anemia, thrombocytopenia and leukocytosis. On further examination of the peripheral blood smear, a leukoerythroblastic formula was noted with the presence of predominant blast population (86%).

Peripheral smear showed mostly Monoblasts (red arrow), promonocytes (green arrow) and few myeloblasts (blue arrow) under the oil immersion object 100 X, Leishman stain.

Monoblasts are large cells with abundant cytoplasm, moderately to intensely basophilic, scattered fine azurophilic granules, round nuclei with lacy chromatin and one or more large nucleoli.

Promonocytes have moderate cytoplasm, less basophilic, granulated with occasional large azurophilic granules. Vacuoles are more irregular. Nuclei are delicately folded.

Myeloblasts have large nuclei, fine chromatin, 3-4 prominent nucleoli and few Auer rods in the cytoplasm.

In view of suspected Acute Myeloid Leukemia, she was advised Bone marrow aspiration, biopsy and immunophenotyping, flow cytometry and translocation (15:17) study by oncologist.

The obstetrical examination was normal. All cardiotocographies were reactive. She was started on IV antibiotics, Inj Ceftriaxone 1 gm IV BD and steroids, Inj Betamethasone was given for fetal lung maturity. In view of malignancy with pregnancy, the case was discussed in tumor board on 10/9/19 and a decision for delivery followed by chemotherapy was taken.

She was induced with one dose of intracervical dinoprostone gel following which she went into labour and delivered live baby 2.8 kg weight with good apgar. The baby was shifted to nursery in view of premature delivery and mother was planned to transfer to medical oncology department for Induction chemotherapy.

Repeat investigations three days after delivery, haemoglobin decreased to 7 g/dl, TLC increased to 3,81,000 cells per cu mm with neutrophils 2, lymphocytes 5 and myelocytes 5. The abnormal blast cells had increased to 88% and platelets decreased to 21000 per cu mm (TABLE 1). Serum creatinine also increased to 1.43 mg/dl and e-GFR decreased to 54 ml/min/1.73 m2, indicating compromised renal function. The peripheral picture showed mostly agranuloblasts with moderate to scanty grey blue vacuolated cytoplasmic nuclei showing convolutions and 1-3 nucleoli occasional myelocytes, metamyelocytes seen, findings in favour of Acute myeloid leukemia (M4/M5). On myeloperoxidase staining, only 40 % took up the stain indicating AML-M4 lineage. She was transfused with one packed cell and one single donor platelet, following which her condition improved. She was transferred to medical oncology ward where she received chemotherapy and had immediate remission of the disease.

Discussion

The Incidence of Acute Myeloid Leukemia is 1 in 75,000 to 100,000 pregnancies with maximum 40% presenting in third trimester and 23% and 37% in first and second trimester respectively. In a population based study by Nolan et al [1], out of total acute leukaemia cases, two thirds are myeloblastic and one third lymphoblastic leukemia.

The rarity of disease during pregnancy, might also be due to very low reporting in view of confusing diagnosis. The symptoms of AML can easily be confused with symptoms of anaemia like malaise, easy fatigueability, low grade fever. Thrombocytopenia and anaemia are relatively common findings in pregnancy. Although, Neutropenia is rare and merits further investigation or close monitoring. But in the developing country like India, it is majorly missed. Thus, whenever there is presence of circulating blasts in a blood film, it suggests a diagnosis of haematological malignancy and is an indication for bone marrow biopsy. The other differential diagnosis that should be kept in mind are Thrombotic microangiopathy, HELLP syndrome and Cytopenias of deficiency or immune origin [2].

The tests to be done before bone marrow aspiration are Full blood count, blood film examination, Vitamin B12, folate and ferritin measurement, Coagulation screen, Renal and liver function tests. All these were done for our patient and further bone marrow aspiration was suggested with studies directed at Immunophenotypic, cytogenetic and molecular analysis for accurate subtyping and understanding of prognostic features.

Once diagnosed, a Multidisciplinary approach comprising of hematologists, obstetricians, anesthetists and neonatologists is the key to appropriate management. Consideration should be given to health of both mother and baby. The woman should be fully informed about the diagnosis, treatment of the disease and possible complications during pregnancy , clearly implying that any treatment delays might result in compromised maternal outcome without improving the outcome for the fetus [3].

The risks of Leukemia, disease per se, to pregnancy is miscarriage, foetal growth restriction, perinatal mortality, premature labour and Intrauterine fetal death [4].

Due to the high risk of the disease, there are different recommendations for management of AML in pregnancy in the three trimesters owing to the urgent need of chemotherapeutic agents and the adverse effects of the drugs involved .

If it is diagnosed in the first trimester, the patient should be counselled for elective abortion, medical/surgical and starting of chemotherapy. Between 13- 24 weeks, the Induction chemotherapy should be started while pregnancy is continued [5]. Preterm termination of pregnancy is indicated after fetal viability. Similar conclusions were derived by Nicola et al and Farhadfar in a single centre study of 5 and 23 case of AML diagnosed during pregnancy respectively [6,7].

Between 24 - 32 weeks, chemotherapy exposure to the fetus must be balanced against risks of prematurity following elective delivery at that stage of gestation (Grade 1C). At gestation age more than 32 weeks, the fetus should be delivered prior to Induction chemotherapy.

Chemotherapy with anthracycline based regimens are favored. According to a meta-analysis done by Natanel A Horowitz et al, anthracycline based regimens were associated with maximum remission but overall maternal survival was very low (30%)[8]. Even in our case, although the mother immediately had remission with chemotherapy. There was a recurrence after disease free 10 months and she succumbed to the disease during the COVID pandemic. Quinolones, tetracyclines and sulphonamides are better avoided in pregnancy(Grade 1B).

In one case report by Abdullah et al, a trial of 5- azacytidine has shown promising results [9]. The antifungal of choice in pregnancy is Amphotericin B or lipid derivatives (Grade 2C). If blood transfusion is needed, the blood should be screened for Cytomegalovirus (Grade 1B). Supportive therapy like a course of Corticosteroids given if delivery is between 24 and 35 weeks gestation (Grade 1A) [10]. Magnesium sulphate should be considered 24 h prior to delivery before 30 weeks gestation (Grade 1A).

Delivery should be planned for a time when the woman is at least 3 weeks post-chemotherapy to minimize risk of neonatal myelosuppresion (Grade 1C). Planned delivery is preferred, like Induction of labour (Grade 2C). Caesarean section is indicated only for obstetric indications. Epidural analgesia is better avoided.

The Dose of chemotherapy is calculated on their actual body weight with dose adjustments for weight gain during pregnancy owing to various pregnancy changes.

The Chemotherapy agents have a MW of 250-400 KDa and hence can cross the placenta resulting in detrimental teratogenic effects on developing fetus.Sunny J. Patel et al have done a comprehensive analysis on outcomes in hospitalized pregnant patients with acute myeloid leukemia and come to conclusion that a multidesciplinary, holistic approach leads to quick remission of the disease [11]

After delivery, histopathologic examination of placenta to rule out placental transfer to fetus is advisable. Cytologic examination should be performed in both maternal and umbilical cord blood and neonates should be clinically examined for palpable skin lesions, organomegaly or other masses. If the baby is found to be healthy, a follow up after every six months for two years is recommended. In each visit, physical examination, chest x-ray and liver function tests should be done.

Conclusion

Acute myeloid leukemia in pregnancy is a Rare diagnosis and even rarely reported. With the trend for delaying pregnancy into the later reproductive years, we expect to see more cases of cancer complicating pregnancy. Presently, there are no clear management guidelines to address timing and dosing of anthracycline/cytarabine based regimens especially in pregnancy. The potential drug toxicity to mother and fetus and transplant considerations in intermediate and highrisk patients during pregnancy has not been addressed.

What we also need today is a National registry for leukemia patients, treated in pregnancy. This will help us to answer many unanswered queries and improve maternal and fetal overall survival rates. Although we have few comprehensive studies, but further studies and references are needed. Finally, a Multidisciplinary team is needed to provide comprehensive care to patients.

[campcrow2]

I’ve spent the last….17 years really dealing with chronic illness. And as stupid as it sounds I got my third chance and wish I hadn’t. I got my first transplant at 17. So from 14-17 I was in highschool having a hard time making friends because I missed school so often. Doctors appointments, aeronesp injections every week, additional surgery and dialysis. Preparing for organ transplant with the “you’ll be better after this”. I wasn’t invited to parties or have a lot of friends so I was basically invisible in highschool. Then you go to college and they feed you the bullshit line of “things will get better” but again I dont drink because kidney issues and then I got sick with pneumonia 4 times leading to additional issues. So again I put my head down and did the work I had to to graduate and didn’t make a ton of friends. I got out of university and started a decent job until I got fired for taking a day off to go to the doctor because I had pneumonia again. Leading to 2020 when I got laid off for asking for accommodations to work from home during covid (everyone else was laid off a week later) and I started a new job in Dec/2020. I was laid off Feb/2022 and then rushed into the hospital where my transplanted kidney failed…..I had done what they asked and it still failed. So I started dialysis and did everything they wanted. Got peritonitis 3 times, incredibly sick from low blood pressure where all I did was dialysis, sleep, and repeat. Now last November I got another kidney and I should be thankful because it’s another chance. But after that I had an allergic reaction to the meds causing me to be hospitalized with inflammation for a week, hydronephrosis where the transplanted kidney was swollen, then Covid, and now incredibly depression because I feel alone. 16 years later from my initial work up and I’ve lost all of my friends, and this “third chance” doesn’t even feel worth it anymore. They should have just let me end it in 2022 because this isn’t existing. All I do anymore is bloodwork, sleep, and panic about hospital bills.

This isn’t a post for really anyone I just wanted to write something because I’m over all of this.

What’s the point of all of this?