Obstetrical Emergencies

Pregnancy should be considered in all adolescent females presenting to the emergency department. Roughly half of all teenagers report that they are sexually active. Pregnancy in teenagers has many unique risk factors and potential complications. Due to concerns about confidentiality, transportation, cost, embarrassment, and perception of judgment, teens are less likely to seek care for possible pregnancy. When they do seek care, they are more likely to present to the emergency department than to a primary care provider. They often present at a much more advanced gestational age compared to their adult counterparts. This chapter reviews several important complications in the diagnosis and management of pregnancy, associated complications, and details important management principles in the care of the pregnant teenager.

“I'll wait”: Crip-Queer Temporality and Reproductive Futurism in Musical Adaptations of Dürrenmatt's Der Besuch der alten Dame (The Visit of the Old Lady)

On 29 January 1956, a new play by up-and-coming Swiss dramatist Friedrich Dürrenmatt had its world premiere at the Zurich Schauspielhaus. From the stage of the venerable playhouse, the young playwright's “tragic comedy,” Der Besuch der alten Dame (lit.: The Visit of the Old Lady—a title I shall employ to distinguish it from a well-known but much-changed English adaptation), presented the story of billionairess Claire Zachanassian's return to her impoverished hometown after forty years. During those intervening decades, she used a string of strategic marriages to amass considerable financial assets, but lost a hand and a leg in various transportation accidents. The people of Güllen, a rundown town whose claim to fame is that Goethe once spent the night there, start off the play finalizing their plans for a strategic grand reception at the train station: they have high hopes of convincing their prodigal daughter to save them from poverty and return them to their former glory. That daughter, however, has justice—not salvation—on her mind for the cruel town that exiled her as an unwed, pregnant teenager. After secretly using her fortune to buy and close each of the town's factories, Claire has returned. At a banquet held in her honor, she offers the bankrupt town “one billion” in exchange for the communal murder of Alfred Ill, beloved citizen and father and heir apparent to the mayorship. He also happens to be the high-school sweetheart who perjured himself to betray Claire and the child they conceived all those years ago.

A Rare Case of Herpes Simplex Virus-2 Hepatitis with Negative Serology

Herpes simplex virus-2 (HSV2) hepatitis represents a rare but serious complication of HSV2 infection that can progress to acute liver failure (ALF). We describe a case of a pregnant teenager who presented with four days of fever, headache, malaise, nausea, and vomiting. She was initially misdiagnosed with sepsis of unclear source and treated with broad-spectrum antibiotics. Empiric acyclovir was started one week into her hospitalization despite negative serologies while awaiting HSV2 PCR leading to complete resolution of symptoms. Given its high mortality and nonspecific presentation, clinicians should consider HSV hepatitis in all patients with acute hepatitis especially in high-risk population.

Investigation of the prevalence and causes and of legal abortion of teenage married mothers in Iran

BackgroundThe therapeutic abortion law, in accordance with the fatwa issued by our Muslim jurisprudent approved by the parliament in 2005, has made major developments in dealing with cases of therapeutic abortions.ObjectiveThis study aimed at identifying the prevalence and causes of therapeutic abortion requests to the Legal Medicine Organization of Fars province, Shiraz, by pregnant teenager mothers.MethodsThis study was a retrospective, cross-sectional, descriptive survey. In this study, all documents related to therapeutic abortion requests from the Legal Medicine Organization of Fars province (southern Iran) from 2006 to 2013 were investigated. The total sample size included 1664, out of which 142 were teenagers. Sampling was carried out using Convenience method. Data were analyzed using SPSS statistical software, version 16, descriptive statistics and χ2.ResultsIn this study, 142 mothers were under 20 years of age (8.5%). The prevalence of fetal abortion license requests was 110 (78.6%) and for maternal causes was 30 (21.4%). There was no significant statistical correlation between fetal causes in different years (p = 0.083).The most common causes of fetal abortion request were for thalassemia treatment in 78 cases (79.9%) followed by fetal malformations (20.9%); also, the most common maternal cause was thalassemia in 14 cases (51.9%) and depression in three cases (1.11%), respectively.ConclusionOur results showed that after approval of therapeutic abortion law, requests for therapeutic abortion due to fetal causes are extensively increasing. There is still a need for coordination of judicial, medical and legal authorities for prompt notification.

Management of metastatic thyroid cancer in pregnancy: risk and uncertainty

Metastatic thyroid cancer is an uncommon condition to be present at the time of pregnancy, but presents a challenging paradigm of care. Clinicians must balance the competing interests of long-term maternal health, best achieved by iatrogenic hyperthyroidism, regular radioiodine therapy and avoidance of dietary iodine, against the priority to care for the developing foetus, with inevitable compromise. Additionally, epidemiological and cellular data support the role of oestrogen as a growth factor for benign and malignant thyrocytes, although communicating the magnitude of this risk to patients and caregivers, as well as the uncertain impact of any pregnancy on long-term prognosis, remains challenging. Evidence to support treatment decisions in this uncommon situation is presented in the context of a case of a pregnant teenager with known metastatic papillary thyroid cancer and recent radioiodine therapy. Learning points: Pregnancy is associated with the growth of thyroid nodules due to stimulation from oestrogen receptors on thyrocytes and HCG cross-stimulation of the TSH receptor. Thyroid cancer diagnosed during pregnancy has not been shown to be associated with increased rates of persistent or recurrent disease in most studies. There is little evidence to guide the management of metastatic thyroid cancer in pregnancy, where both maternal and foetal wellbeing must be carefully balanced.