1/110. Complications caused by extramembranous placement of intrauterine pressure catheters. A case report is described in which the inadvertent placement of a standard intrauterine pressure catheter in a laboring woman caused partial abruptio placentae and disseminated intravascular coagulation. Altering catheter placement technique and giving attention to aspects of placement can help avoid mishaps, and awareness of possible complications can lead to earlier diagnosis with increased appropriate intervention. ( info) |
2/110. Preterm labor and accidental hemorrhage after disopyramide therapy in pregnancy. A case report. BACKGROUND: Treatment of arrhythmias during pregnancy is complicated by concerns about the safety of antiarrhythmic therapy. This is the first case report of preterm labor and abruptio placentae following the administration of disopyramide during pregnancy. CASE: A 26-year-old woman, gravida 2, para 1, was diagnosed as having wolff-parkinson-white syndrome during the third trimester of pregnancy. Recurrent episodes of supra-ventricular tachycardia were refractory to medical therapy and required repeated direct current cardioversion. Administration of disopyramide led to the initiation of painful uterine contractions and accidental hemorrhage. CONCLUSION: Caution must be exercised during the use of disopyramide during pregnancy, and intensive monitoring should be instituted to avoid adverse maternal and fetal effects. ( info) |
| Two apparent acute problems that may occur in labor, nuchal cord and placental abruption, were associated with chorangiosis of the placenta. The importance of complete placental examination in perinatal mortality is re-emphasized. The association of apparent acute obstetrical conditions, e.g., nuchal cord and placental abruption with chorangiosis of the placenta, may be the cause of fetal-newborn deaths that were previously assumed to be issues of labor management. ( info) |
4/110. Twin pregnancy in a uterus didelphys, with unilateral placental abruption and onset of labour. A dizygotic twin pregnancy with a fetus in each side of a uterus didelphys is described. An antepartum haemorrhage at 26 weeks' gestation, with subsequent onset of contractions in the right-sided uterus, precipitated delivery by Caesarean section. ( info) |
5/110. A hypothesis to explain the occurence of inner myometrial laceration causing massive postpartum hemorrhage. BACKGROUND: Inner myometrial lacerations were found in three patients who developed uncontrollable postpartum massive bleeding despite the usual treatment for uterine atony. Because all the patients suffered from hemorrhage shock and their medical status deteriorated, their uteri were surgically removed to stop bleeding. After removal, one of them died. postpartum hemorrhage was caused by inner myometrial laceration. We hypothesized a cause of inner myometrial laceration, using the three resected uteri, an assumed model of the uterine body, and 34 women. methods: The subjects were 37 women, of whom three were patients with inner myometrial laceration, 23 were women without inner myometrial laceration who underwent cesarean section, and 11 were women in the first stage of labor. The three resected uteri were examined both macroscopically and microscopically. We measured the thickness of the wall of the uterine muscle at the widest point of the uterine corpus and the thickness of the myometrial wall at a transverse section of the uterine cervix, as well as the radius of the inner lumen at the widest point of the uterus in 23 women during cesarean section. We also measured the thickness of the myometrial wall at the widest point of the uterine corpus in 11 women at the end of the first stage of labor during ultrasonic examination. The data were then used to estimate the stress on the uterine muscle. RESULTS: The stress on the uterine cervix was stronger than that on the uterine corpus during labor. When the stress on the uterine muscle is stronger than a specific value, inner myometrial lacerations develop on the right and/or left side of the uterine cervix. These lacerations may involve large vessels. CONCLUSIONS: We have discovered another cause of postpartum hemorrhage which we have named inner myometrial laceration. These lacerations appeared to result from a strong stress on the uterine cervix caused by an abnormal rise in intrauterine pressure during labor. ( info) |
6/110. Bilateral renal cortical necrosis: a report of 2 cases. Two cases of renal cortical necrosis, one of which occurred after an obstetric complication (abruptio placentae) and the other after postpartum haemorrhage, are described. The diagnosis was made by percutaneous renal biopsy, intravenous pyelography and selective nephro-angiography. Immunofluorescence studies of the kidney showed no abnormality in one patient, but showed the presence of IgM in the glomerular basement membrane in the second patient. hypotension was not observed when anuria occurred. Both patients survived. The importance of prolonged haemodialysis is stressed, since one patient was oliguric for 57 days and required intermittent haemodialysis for 5 months, while the second patient was oliguric for 17 days, required haemodialysis for 5 months and now has established hypertension. ( info) |
7/110. Primary aldosteronism in pregnancy. Aldosteronism is a rare complication of pregnancy. We report a case of a 26-year-old woman who became pregnant soon after a diagnosis of primary aldosteronism due to left adrenal adenoma was made. Only oral potassium supplementation was required in addition to routine prenatal care until 36 weeks' gestation. Subsequently, antihypertensive medication was needed to control elevated blood pressure. A healthy male infant was delivered by cesarean section because of abruptio placentae. The postoperative course was uneventful. Left adrenalectomy was conducted eight months after delivery under laparoscopic visualization. In this case report, we discuss management of aldosteronism in pregnancy and review the literature. ( info) |
| A female driver, 24 weeks pregnant, was wearing a three-point seatbelt in the manner usual for nonpregnant women, when her automobile collided head-on with another vehicle. A cardiotocographic examination after the accident revealed the fetus to be alive. Five days after the accident, however, a cardiotocographic examination showed fetal death. At that time, a transverse ecchymotic band on the lower abdominal wall that had not been observed at the first examination was noticed. Eight days after the accident, the mother delivered a macerated female fetus. At autopsy, the baby showed no abnormality, but there was a hematoma on the placental surface toward the uterus. These results suggest that the fetus died of abruptio placentae associated with incorrect placement of the lap belt. ( info) |
9/110. Quantitative digital analysis of regional placental perfusion using power Doppler in placental abruption. PURPOSE: To apply digital imaging techniques to the quantification of placental vascularity using power Doppler. MATERIALS AND methods: Regional placental blood flow was measured in a case of large placental abruption, shortly after presentation and 1 week later. Images were stored digitally and analysed using purpose-designed software (CQ Analysis) to extract and measure vascular energy information. The integrated color energy (ice) was determined in the main body of placental tissue and in a cotyledon isolated by the retroplacental clot. RESULTS: Initial assessment at 25 weeks showed only a small difference in integrated energy between normal placenta and the isolated cotyledon (ice ratio 1.44, P < 0.04). One week later, perfusion in the isolated cotyledon had fallen both on qualitative and quantitative assessment (ice ratio 3.98, P < 0.0001). This area subsequently became devascularized. CONCLUSION: Placental perfusion may be quantified using digital power Doppler analysis. Further studies are indicated to evaluate its role in assessing regional and/or global placental perfusion as well as fetal organ perfusion. ( info) |
10/110. Hypovolaemic shock. Measured blood loss up to 1000 ml is well tolerated by healthy pregnant women. This is partly due to physiological increases in plasma volume and red cell mass during pregnancy. Nevertheless, hypovolaemic shock is a major cause of maternal mortality. Management requires teamwork, co-ordination, speed and adequate facilities to be life-saving. The first priority is rapid fluid replacement. Evidence from randomized trials has established that crystalloids are the fluids of choice over colloids and particularly albumen, which was associated with increased mortality. Rapid access to blood or blood products for transfusion is necessary, as well as laboratory back-up. Further management includes accurate assessment of the site of bleeding; control of the bleeding; diagnosis and management of the underlying condition; supportive therapy; and monitoring of the clinical, haematological and biochemical response to treatment. Bedside diagnostic ultrasound has several applications in the evaluation of obstetric hypovolaemic shock. ( info) |