1/21. Acute promyelocytic leukemia and pregnancy.In acute promyelocytic leukemia (APL), the use of all-trans-retinoic acid (ATRA) as a differentiating agent induces complete remission in a high percentage of patients. In pregnancy, however, this drug bears the risk of severe teratogenicity to the child. We report the case of a 23-yr-old woman at 21 weeks' gestation suffering from APL. She was treated with ATRA (45 mg/m2) for 40 d and two courses of standard chemotherapy. The mother achieved complete remission within 22 d of treatment. fetal development was normal, and a healthy premature girl was born in the 35th week of pregnancy. In a review of the literature we have identified 14 cases of APL in pregnancy treated with ATRA alone or in combination with chemotherapy. ATRA has been used as early as in the 3rd week of gestation and in no case have malformations or other teratogenic effects occurred. Side-effects, however, ranged from fetal cardiac arrhythmias to induction of labour. Although known to exhibit severe teratogenic effects during the first trimester of pregnancy, ATRA seems to be reasonably safe during the second and third trimesters in the treatment of APL. However, careful obstetric follow-up is mandatory regarding fetal cardiac complications.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |
2/21. Phaeochromocytoma diagnosed during labour.The diagnosis of phaeochromocytoma during pregnancy is rare. We present the management of vaginal delivery in a woman diagnosed with the condition during labour. A medline search and follow-up of references failed to find any similar report in the last 30 years.- - - - - - - - - - ranking = 5keywords = labour (Clic here for more details about this article) |
3/21. Intra-uterine death resulting from placental metastases in adenocarcinoma of unknown primary.A thirty-five year old woman presented with bilateral neck, chest wall and back masses. She was 16 weeks pregnant. lymph node excision revealed metastatic poorly differentiated adenocarcinoma of unknown primary. Abdominal ultrasound showed a mildly enlarged spleen and a 2-3 cm porta hepatis node. All other investigations were negative. The lymph node and cutaneous metastases progressed rapidly so it was decided to initiate systemic chemotherapy with a view to delivery at 28 weeks gestation by Caesarean section. Shortly after the second 3-weekly cycle of cisplatinum chemotherapy the patient suffered severe lower back and hip pain with MRI scan showing multiple bony metastases in the pelvic girdle. Ultrasound revealed the fetus to have been dead for at least 10 days. The products of conception were delivered following medical induction of labour. Two days later the patient suffered a cardiac arrest from which she could not be resuscitated. Placental histology revealed extensive metastases. With the exception of melanoma this has rarely been reported in solid adult malignancy. As a cause of fetal death, placental metastases are extremely rare.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |
4/21. Accessory breast in the perineum.A rare case of functional accessory breast in the perineum presenting in labour is reported. It showed a well-formed nipple and pregnancy induced changes. The organ was completely excised postpartum. Histopathology confirmed normal breast tissue.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |
5/21. Placental chorioangioma: a case report and review.Placental Chorioangioma occurs in 1% of pregnancies and are generally asymptomatic. However, they are known to cause a number of complications which are detrimental to the mother, fetus or the neonate. A typical case where acute polyhydramnios precipitated premature labour and delivery of the fetus as a result of a large placental chorioangioma is presented. A brief review of the other possible complications are also included.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |
6/21. Anesthetic management of a labouring parturient with urticaria pigmentosa.PURPOSE: To report the anesthetic management of labour pain and cesarean section in a patient with urticaria pigmentosa at risk for systemic mastocytosis. CLINICAL: A 37-yr-old patient with a history of urticaria pigmentosa and an allergic reaction to a local anesthetic agent was seen in consultation at 36 weeks gestation. She previously tested negative for an allergy test to lidocaine. Recommendations to avoid systemic mastocytosis included: avoidance of histamine-releasing drugs, using lidocaine for labour epidural, and regional anesthesia in case of a cesarean section. The patient presented at term in labour. Intravenous fentanyl was used for early labour, followed by a combined spinal-epidural. The spinal contained lidocaine and fentanyl, but because of pruritus, the epidural infusion contained lidocaine only. Most likely because of tachyphylaxis to lidocaine, an epidural bolus of lidocaine with epinephrine failed to provide adequate anesthesia for a cesarean section. The block was supplemented with nitrous oxide by mask, with fentanyl postdelivery. Postoperative pain control was managed with an epidural infusion of lidocaine and fentanyl for three days. The patient was discharged without complications four days postsurgery. CONCLUSION: Proper allergy testing prior to pregnancy is important to help the management of labour pain and anesthesia for cesarean section in a patient at risk for systemic mastocytosis.- - - - - - - - - - ranking = 9keywords = labour (Clic here for more details about this article) |
7/21. Desmoplastic small round cell tumour: obstetric and gynecological presentations.BACKGROUND: Desmoplastic small round cell tumour (DSRCT) is a rare sarcoma primarily affecting young men. We report two cases in young women mimicking gynaecological malignancy. CASES: A 23-year-old woman underwent caesarean section for obstructed labour. At surgery, multiple tumour deposits were found throughout abdomen and pelvis. histology and PCR confirmed DSRCT. Despite chemotherapy, the patient relapsed and died 27 months after diagnosis. A 29-year-old woman presented with abdominal distension and elevated Ca125. Imaging demonstrated widespread tumour within abdomen and pelvis. histology confirmed DSRCT. Although attaining a complete response to chemotherapy, she relapsed within 2 months and died 11 months after diagnosis. CONCLUSION: DSRCT should be considered in the differential diagnosis of young women presenting with abdominal distension and multiple masses on imaging.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |
8/21. Management of labour and delivery in patients with intracranial neoplasms.The presence of an intracranial neoplasm (ICN) during pregnancy has serious implications for the anaesthetic management of labour and delivery. The physiological changes of pregnancy and labour are potentially hazardous to women with ICN, but the provision of adequate pain relief during labour reduces the risk to the mother. Extradural anaesthesia is the only technique that provides pain-free labour reliably, but it carries added risks. Three patients are reported who were managed with extradural anaesthesia: two delivered per vaginam and one by Caesarean section. None suffered any complication related to the anaesthetic technique. At present, there are no published data on the influence of anaesthetic management on outcome of labour and delivery in patients with ICN. Anaesthetists should report such cases so that the relative risks of different management strategies may be assessed.- - - - - - - - - - ranking = 9keywords = labour (Clic here for more details about this article) |
9/21. Metastatic malignant melanoma in pregnancy.A 29 year old expectant mother was critically ill at 27 weeks gestation with disseminated metastatic malignant melanoma and was treated with dacarbazine. A dramatic remission was induced and at 38 weeks gestation she went into labour spontaneously and delivered a healthy infant. She relapsed and died eight weeks post partum. This is the first reported use of dacarbazine in pregnancy.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |
10/21. Secondary chordoma of the mandible.The first case of primary sacrococcygeal chordoma metastasising to the mandible and presenting with obstructed labour is described. The pathological features of this tumour, its clinical presentation and management are discussed.- - - - - - - - - - ranking = 1keywords = labour (Clic here for more details about this article) |
| | Next -> |