1/8. Intravenous nitro-glycerine versus general anaesthesia for placental extraction--a sequential comparison.BACKGROUND: Postpartum haemorrhage due to retained placenta is one of the commonest life-threatening conditions during the third stage of labour. Uterine relaxation is usually required to facilitate placental removal. 'Full-stomach' obstetric patients (which includes those who delivered within 48 h), parturients with a history of antepartum or recurrent postpartum hemorrhage, grand multiparity, twin pregnancy, and those with cardiac abnormalities may benefit from an alternative to volatile-based general anaesthesia for uterine relaxation to avoid complications associated with the technique (e.g. aspiration pneumonitis and cardiovascular compromise). CASE REPORT: A 34-year-old gravida 4, para 3 parturient with rheumatic valvular heart disease presented with retained placenta and postpartum haemorrhage on two consecutive deliveries and had the placenta removed manually by the same surgeon under two different anaesthetic techniques. On the first occasion, general anaesthesia was administered whereas only i.v. fentanyl and nitro-glycerine were used on the second occasion. The postoperative course was uneventful on both occasions. CONCLUSIONS: The use of nitro-glycerine was found to be efficacious for manual removal of placenta with minimal haemodynamic perturbations, avoiding the use (and associated risks) of general anaesthesia for uterine relaxation. The ability of nitro-glycerine to reduce spontaneous uterine activity, induce uterine relaxation, coupled with its short duration of action and high efficacy, may render it a safe alternative to general anaesthesia for facilitating intrauterine manoeuvres. Nitro-glycerine may be useful especially in patients with associated co-morbid chronic cardiac conditions, e.g. rheumatic heart disease, which is characterised by impaired haemodynamics and cardiac reserves.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |
2/8. Clinical manifestations and management of labor and delivery in women with factor ix deficiency.Haemophilia is uncommon in females and little is known about the clinical manifestations and postpartum management of women with this disorder. Clinical characteristics of postpartum bleeding were evaluated in women with factor ix deficiency (FIX:C < 0.20 U mL(-1)), including two with haemophilia B and three carriers of haemophilia B, undergoing labour and delivery. Data were collected prospectively during routine outpatient comprehensive haemophilia care at the haemophilia Center of Western pennsylvania and during inpatient management. Four of five women experienced postpartum bleeding, during six of 16 deliveries: the median haemoglobin was 10.7 g% and two required blood transfusion. Postpartum bleeding was significantly more common among those receiving fewer than 4 days of FIX replacement: six of 13 (46.1%) receiving fewer three or fewer days bled vs. none of three (0%) receiving six or more days treatment [P < 01 (Wilcoxon)]. Postpartum bleeding was not related to the route of delivery (P = 0.525), vaginal vs. Caesarean, nor the FIX level (P = 0.371; FIX > 0.05 U mL(-1) vs. < or =0.05 U mL(-1)). Compared with females with von Willebrand disease or FXI deficiency, females with FIX deficiency were more likely to experience postpartum bleeding (P = 0.008) and anaemia (P = 0.045); and they were less likely to experience menorrhagia (P = 0.065), but the latter did not reach significance. Postpartum bleeding is common in women with haemophilia B or carriers of haemophilia B, and treatment with factor replacement for at least 4 days of postpartum may prevent bleeding following delivery in such women.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |
3/8. Severe factor x deficiency in pregnancy: case report and review of the literature.Isolate factor x deficiency is an extremely rare clotting factor disorder inherited in autosomal recessive fashion and pregnancy in a homozygous patient is frequently complicated by recurrent miscarriage, uterine bleeding and premature labour. Eleven pregnancies in seven patients affected by FX deficiency have been reported in the literature. Two additional pregnancies have been reported in a FX variant (FX Friuli). We present a new case of successful at term pregnancy in a homozygous patient.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |
4/8. Coping with placenta praevia and accreta in a DGH setting and words of caution.The incidence of placenta praevia and accreta has been increasing with rising caesarean section rates. We highlight the increasing incidence of severe post-partum haemorrhage due to placenta accreta. Four cases occurred within 3 years (2002--2004) in a small District General Hospital (DGH) with a delivery rate of 1,800 per year. All of the cases had previous caesarean sections and three had an associated anterior low-lying placenta. These patients were diagnosed to have placenta accreta in the third stage of labour, as the placenta was completely adherent and was difficult to remove. However, two of them had a provisional diagnosis made of placenta accreta and prophylactic measures had been taken in the form of counselling and consent for possible hysterectomy. patients were counselled regarding this condition, and the possible need for hysterectomy was discussed. Two of them had to be managed by post-partum hysterectomy and the other two were treated conservatively. The purpose of writing these case reports is to warn others of the need for vigilance, particularly in keeping their primary caesarean section rates down and being prepared for long-term complications.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |
5/8. Retzius' space haematoma after spontaneous delivery: a case report.We report a case of a haematoma of the Retzius space after spontaneous uncomplicated delivery. In the postpartum period, the patient complained of urinary retention and pain in the hypogastric region radiating to her left hip and leg. The ultrasound examination showed the presence of 160 x 100 x 80 mm confluent solid and liquid areas with peripheral vascularization. At exploratory laparotomy a haemorrhagic infiltration was found in Retzius' space and the anterior wall of the bladder, which appeared thickened and swollen below the peritoneum. We tried to drain the haematoma, however, we failed to drain it completely because of the large blood infiltration in the bladder wall. Clinical and ultrasound follow-up examinations showed a progressive reduction of the haematoma which completely disappeared nine months later. The haemodynamic changes occurring during pregnancy and labour, associated with strong mechanical stress, seem to be among the major causative factors of haematoma formation. Moreover, the venous load in the pelvic vascular system is increased during pregnancy; a stress-induced increase in venous blood pressure might play a prominent role, especially in cases of venous ectasia, where the resistance of blood vessel walls is reduced. Intraoperative evidence seemed to suggest a haemorrhage secondary to the rupture of the venous vessels in the Santorini plexus. The rupture was probably caused by the thrust of the fetal head, associated with abnormality or fragility of the blood vessels, or by some pathologic changes occurring in the anatomical structures during pregnancy, which could not be accurately defined because of the severity and degree of the haematoma infiltration found intraoperatively.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |
6/8. Postpartum uterine wound dehiscence: a case report.INTRODUCTION: Late postpartum hemorrhage following a Caesarean section (CS) is uncommon. A partial or complete dehiscence of the lower segment CS incision is a rare but possible cause. CASE: A 33-year-old woman underwent a lower segment CS for chorioamnionitis and failure to progress in labour at 40 weeks and 5 days of gestation. On the 43rd postpartum day, she developed heavy vaginal bleeding. Emergency laparotomy revealed a complete dehiscence of the lower uterine segment incision. A subtotal hysterectomy was performed to control the bleeding, and the postoperative course was uneventful. CONCLUSION: Dehiscence of a lower uterine segment incision is a rare but potentially dangerous cause of late postpartum hemorrhage.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |
7/8. Cardiovascular collapse following an overdose of prostaglandin F2 alpha: a case report.A case report is presented of a parturient who suffered severe hypotension and pulmonary oedema following an overdose of intramyometrial prostaglandin F2 alpha. oxytocin induction of labour in this patient led to a rapid delivery, followed by a hypotonic uterus and postpartum haemorrhage. After resuscitation with blood and crystalloid fluids, the uterus was explored under general anaesthesia. The uterus was free of retained products but the lower uterine segment failed to contract despite bimanual uterine compression and intravenous oxytocin. Prostaglandin F2 alpha was injected into the lower uterine segment via a transvaginal approach. This was rapidly followed by cardiovascular collapse and later by pulmonary oedema. The differential diagnosis and subsequent management are discussed.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |
8/8. Post partum intra-abdominal hemorrhage due to placenta percreta.Placenta percreta is a serious complication of pregnancy. A 38-year-old nullipara presented at 25 weeks gestation with preterm labour. Spontaneous delivery was followed by retained placenta. During an attempt to remove the placenta manually placental tissue could not be distinguished. Initially, placenta increta was considered as the most likely diagnosis and conservative management was planned, but progressive shock emerged due to intra-abdominal hemorrhage and laparotomy was performed. Placenta percreta was diagnosed, followed by a supracervical hysterectomy. A review of risk factors, diagnostic tools and treatment possibilities is given.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |