Hindawi Publishing Corporation Case Reports in Obstetrics and Gynecology Volume 2012, Article ID 629583, 2 pages doi:10.1155/2012/629583 Case Report Management of Pseudohypoparathyroidism Type 1a during Pregnancy and Labor: A Case Report Anju Singh,1 Neelam Agarwal,1 Seema Chopra,1 Pooja Sikka,1 Vanita Suri,1 Bhupesh Kumar,2 and Pinaki Dutta3 1 Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India 2 Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India 3 Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India Correspondence should be addressed to Anju Singh, singha1712@gmail.com Received 16 March 2012; Accepted 6 May 2012 Academic Editors: D. Hochner-Celnikier and P. McGovern Copyright © 2012 Anju Singh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pseudohypoparathyroidism is rare during pregnancy and poses multiple challenges related to its diagnosis and management during pregnancy. We hereby report a case of a young woman who was diagnosed to have type 1a pseudohypoparathyroidism. She was managed by multidisciplinary team and had good maternal and perinatal outcome. Management-related issues are discussed here in detail. 1. Introduction Pregnancy is commonly associated with altered calcium metabolism. Pseudohypoparathyroidism (PsHP) is rare during pregnancy [1]. It poses multiple diagnostic and management-related challenges during pregnancy besides a more diﬃcult aspect of genetic counseling. To the best of our knowledge there is scant literature available for type 1a PsHP associated with pregnancy. In fact there is no publication regarding such case in the last 10 years. Here we report a case of type 1a PsHP presented to us during pregnancy with hypocalcemia and history of seizures. We discuss the man- agement issues in such a case during pregnancy and labour. 2. Case Report A 25-year-old pregnant lady was referred to our antenatal clinic at 24 weeks of gestation for investigations. She had a history of focal seizure, carpopedal spasm, and lip smacking movement since 6 years of age, for which she did not seek any medical advice. This was her second pregnancy which she had conceived spontaneously. Previously she had spontaneous abortion in ﬁrst trimester. So far she had been supervised at a primary health centre and was apparently uncomplicated. There was no seizure activity during this pregnancy. She achieved menarche at 14 years of age, and her menstrual cycles were regular with scanty ﬂow. At the age of 16 years, she had recurrent seizures for which she was prescribed oral phenytoin with some relief in symptoms. She stopped medication after 3 years without medical consultation. Her general physical examination revealed height of 145 cm (<3rd centile), round facies, and short right 4th metacarpal. Further detailed examination showed signs of latent tetany in the form of positive Chvostek’s sign and Trousseau’s sign. Abdominal examination revealed uterus of approximately 24 weeks of gestation. Blood investiga- tion showed low serum calcium (7.8 mg/dL) with high serum phosphate (5.8 mg/dL). The blood parathormone (PTH) level was raised (196 pg/mL) together with high alkaline phosphatase (200 U/L) and high 25(OH) vitamin D (29.77) level. The blood thyroxin level was below normal range and was associated with high thyroid stimulating hormone level. EEG revealed generalized epileptiform dis- charge. Computerized tomographic examination of brain showed multiple calciﬁcations in bilateral globus pallidus, caudate nucleus, thalamus, frontal region, parietal lobes, and cerebellar hemispheres. Ultrasonographic parameters for