1/27. methotrexate treatment for retained placental tissue. Three cases of placental polyps not responding to conventional medical and surgical treatment are presented. In all three cases, hCG in serum was negative but despite this a single injection of methotrexate successfully treated the condition. It is suggested that methotrexate acts not only on dividing trophoblastic cells but also has other effects. ( info) |
2/27. Vesicouterine fistula after manual removal of placenta in a woman with previous cesarean section. Vesicouterine fistula is one of the less common acquired urogenital fistula and a rare event in obstetrics. We report a case which occurred after a vaginal delivery followed by manual removal of placenta in a woman who had a previous cesarean section. The fistula was successfully repaired 5 weeks after delivery. ( info) |
3/27. hysterotomy for retained placenta in a term angular pregnancy. A case report. BACKGROUND: Angular placentation may be a cause of retained placenta and may require hysterotomy. CASE: A 33-year-old woman with a prior cesarean section underwent an uncomplicated vaginal delivery, had a retained placenta with postpartum hemorrhage and required hysterotomy because the placenta was inaccessible due to its angular location. CONCLUSION: Antepartum ultrasound diagnosis may be possible in some cases of angular placentation. ( info) |
4/27. Subarachnoid haemorrhage following spinal anaesthesia in an obstetric patient. We describe an obstetric patient who presented for removal of a retained placenta. After insertion of the spinal anaesthetic, she developed a severe headache, and a subarachnoid haemorrhage was diagnosed. We discuss the differential diagnosis of the headache, the occurrence of intracranial haemorrhages after dural puncture and the future management of this patient. ( info) |
5/27. Disruption of lactogenesis by retained placental fragments. This case report describes a situation in which lack of milk production led the mother to seek help from a lactation consultant in private practice. Despite extensive breast stimulation with the baby at breast and mechanical breast expression, no milk was produced. Retained placenta was suspected by the lactation consultant. The mother was later diagnosed with placenta increta. Only when this condition was diagnosed and resolved did milk onset occur. It is important to evaluate for retained placental fragments when lactation appears to be delayed. ( info) |
6/27. Red degeneration of a leiomyoma masquerading as retained products of conception. BACKGROUND: The incidence of leiomyomas in pregnancy is approximately 1%. Their presence has been linked to spontaneous abortion, premature labor, soft tissue dystocia, uterine inertia, fetopelvic disproportion, malposition of the fetus, retention of the placenta, and postpartum hemorrhage. CASE: This case report documents a seldom-described event of a submucous leiomyoma masquerading as retained products of conception. The patient presented 4 weeks postpartum with complaints of urinary retention and heavy bleeding with cramping. Examination revealed a large mass resembling placental tissue filling the vaginal vault. The necrotic mass was removed with blunt and sharp dissection. The final pathology report revealed a degenerating leiomyoma. CONCLUSION: Complicating factors associated with this fibroid included a history of spontaneous abortion and preterm labor, as well as fetal malpresentation and carneous degeneration of the leiomyoma. Gestational myomas, although rare, can have an unusual appearance that may be misinterpreted. ( info) |
| Extramedullary hematopoiesis (EMH) in the endometrium is an extremely rare occurrence. Four of the eight previously reported cases were related to an underlying hematological disorder, although the remainder had no such relationship. We describe a case of endometrial EMH associated with retained products of conception after termination of pregnancy. Routinely and immunohistochemically stained slides revealed several collections of normoblasts and granulocytic precursors in the endometrium with synchronous chronic endometritis. Retained chorionic villi were also identified. The patient had no known history of a hematological disorder or systemic disease and no such abnormality was detected after detailed hematological work-up. Local effects of growth factors on circulating stem cells may play a pathogenetic role in this process, although an association with recent pregnancy in this case suggests that implantation of fetal hematopoietic elements from the fetus or yolk sac may be more likely. ( info) |
8/27. Use of sublingual isosorbide dinitrate tablet for manual extraction of a retained placenta. We present the first report of the use of an isosorbide dinitrate tablet for the purpose of uterine relaxation for manual extraction of a retained placenta. The tablet administered sublingually proved to be a rapid and effective uterine muscle relaxant for manual removal of the placenta without overt adverse effects. ( info) |
9/27. tongue piercing and obstetric anesthesia: is there cause for concern? The practice of oral tissue piercing, until recently, has been limited mainly to various native tribes in africa. However, in recent years, body piercing (including oral tissue piercing), has become increasingly popular in the united states and europe. We present a case of an obstetric patient who presented for emergency postpartum surgery with fixated tongue jewelry in situ, which resulted in trauma to the tongue and difficult airway management. The difficult airway management consisted of tongue bleeding at the time of laryngoscopy and tongue edema at extubation. We consider these two events to be near misses of "cannot intubate" and "cannot ventilate" situations, respectively. Because the popularity of body piercing is increasing in our society, it is reasonable to expect that the incidence of oral jewelry interference with airway management will also increase. Based on this experience, we advise laboring patients with oral jewelry to remove the hardware before receiving anesthesia for safety reasons. ( info) |
10/27. Embolization for advanced abdominal pregnancy with a retained placenta. A case report. BACKGROUND: Abdominal pregnancy is not encountered commonly, and management of the placenta is controversial. CASE: A 33-year-old woman presented with an abdominal pregnancy at 33 weeks' gestation with fetal death. The placental vasculature was embolized preoperatively. Following operative delivery. of the fetus, the placenta was left in situ in efforts to preserve fertility given its implantation on the reproductive organs. The patient suffered prolonged postoperative ileus but otherwise did well. Placental function ceased after two months. CONCLUSION: Placental vasculature embolization is a management option for a retained placenta associated with abdominal pregnancy. ( info) |