Cases reported "Abruptio Placentae"

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1/8. 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.
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ranking = 1
keywords = haemorrhage
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2/8. 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.
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ranking = 1
keywords = haemorrhage
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3/8. 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.
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ranking = 17.033944022197
keywords = blood loss
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4/8. The use of Doppler umbilical artery waveforms in placental abruption; a report of two cases.

    In a prospective study, the predictive value of Doppler umbilical arterial velocimetry waveforms in detecting the fetus at risk was examined in ten patients with abruptio placenta. One patient suffered intra-uterine fetal death within 8 h of obtaining a normal reactive cardiotocograph and normal umibilical artery waveforms. In another patient with severe placental abruption, following 2500 ml of blood loss, the umbilical artery waveforms were normal. In this study, umbilical artery waveforms failed to predict fetal outcome in cases of placental abruption.
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ranking = 17.033944022197
keywords = blood loss
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5/8. The value of cardiotocography in abruptio placentae. Case report.

    The main indication for Caesarean section in cases of placental abruption is fetal distress. We report a patient in whom clinical examination, including auscultation of the fetal heart, suggested a mild haemorrhage, which would normally have been managed conservatively, but continuous fetal heart rate monitoring showed severe asphyxia, necessitating emergency Caesarean section at which a large concealed haemorrhage was found.
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ranking = 2
keywords = haemorrhage
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6/8. Value of cardiotocography in women with antepartum haemorrhage--is it too late for caesarean section when the cardiotocograph shows ominous features?

    Caesarean section is thought to be indicated by an ominous antepartum cardiotocograph (CTG). However, the fear remains that infants delivered for this indication in the presence of antepartum haemorrhage, especially when premature, are destined to have severe hypoxic neurological damage. We therefore reviewed our experience of cardiotocography in women with antepartum haemorrhage (APH) from 1989 to 1992. There were 472 women with APH who had a CTG performed. Of them, 68 had abruptio placentae and 317 had an APH of undetermined cause. For the group with abruptio placentae, the perinatal mortality rate (PMR) was 230.7 per 1,000 when the CTG was abnormal, but only 18.2 per 1,000 if the CTG was normal (odds ratio 16.2, 95% confidence interval [CI] 1.53-171.9, p = 0.02). For APH of undetermined cause, the corresponding rates were 90.9 per 1,000 and 9.8 per 1,000 (odds ratio 10.1, 95% CI 0.96-105.8, p = 0.13). There were no perinatal losses in women with APH due to placenta praevia (87 cases). There were 6 cases of critical fetal reserve identified on a CTG in women with abruptio or APH of undetermined cause. All were delivered by Caesarean section, with 4 surviving infants, 3 with normal neurological outcome and 1 lost to follow-up. There were 3 cases of APH resulting in an infant with cerebral palsy, all of whom had had a normal antepartum CTG. Our data suggest that cardiotocography allows pregnancy to be safely prolonged in pregnancies complicated by abruptio placentae or APH of undetermined cause, and that Caesarean section is an appropriate form of delivery when the CTG becomes abnormal in these cases.
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ranking = 6
keywords = haemorrhage
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7/8. Case report: torsion of a gravid horn of a didelphic uterus.

    Acute abdominal pain during pregnancy presents a dilemma as signs and symptoms are often modified. Abdominal massage by traditional birth attendants (TBAs') during early labour is a common practice in the rural population, as it is perceived to give a soothening effect to the labouring mother. Many instances of abruptio placentae were reported in the past by this procedure, and in this case, the clinical picture presented as an abruptio placenta. Malpresentation and failure to progress were the indications for caesarean section despite the fetal demise. Severe post partum haemorrhage and failure to contract despite massive oxytocics resulted in the hysterectomy of the gravid horn, leaving the other horn intact.
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ranking = 1
keywords = haemorrhage
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8/8. retinopathy of prematurity in infants of birth weight > 2000 g after haemorrhagic shock at birth.

    BACKGROUND: The risk of retinopathy of prematurity (ROP) is associated with low birth weight and low gestational age. For ROP screening examination is recommended in infants weighing < or = 1500 g or of less than 32 weeks' gestational age. methods: From 1991 ROP screening was performed in 452 premature infants with either a birth weight < or = 1500 g (n = 303) or a birth weight > 1500 g (n = 149) and who required additional oxygen supplementation or underwent surgery with general anaesthesia before estimated term. RESULTS: Unexpectedly, three infants with birth weights between 2080 and 2325 g and a gestational age of 32 or 33 weeks developed stage 2 or 3 ROP. One of these underwent cryocoagulation. In three infants, preterm birth was induced by sudden placental abruption with severe prenatal blood loss followed by haemorrhagic shock. The umbilical cord packed cell volume was reduced to 0.14-0.19 (normal 0.43-0.63). All three infants underwent surgery with general anaesthesia within the first weeks of life. Of the remaining 449 infants none with a birth weight > 1650 g developed any stage of ROP. CONCLUSION: Severe prenatal blood loss requiring blood transfusions and surgery with general anaesthesia may induce higher stages of ROP even in infants with birth weights exceeding the usual screening criteria.
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ranking = 34.067888044395
keywords = blood loss
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