Cases reported "Pre-Eclampsia"

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1/39. liver rupture postpartum associated with preeclampsia and hellp syndrome.

    liver rupture is a rare perinatal complication with high maternal mortality. In a multiparous woman with preeclampsia and hemolysis, Elevated liver enzymes, and Low platelet count (HELLP) syndrome, liver rupture was suspected 10 h after a cesarean section. laparotomy revealed liver rupture which was treated by perihepatic packing. Eventually, the mother was discharged with her baby 88 days after admission. Clinical symptoms, maternal hemodynamics by Swan-Ganz monitoring, and laboratory findings were not predictive until the emergency situation and the consecutive complications required multidisciplinary management.
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ranking = 1
keywords = mortality
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2/39. pre-eclampsia and the hellp syndrome still cause maternal mortality in The netherlands and other developed countries; can we reduce it?

    maternal mortality in developed countries does not seem to have decreased during the past decade, despite good prenatal care. Hypertensive disorders of pregnancy are the main cause of maternal mortality in most countries. In more than half of these cases, the hellp syndrome is involved. In this article attention is drawn again to the life-threatening complications that might occur in cases of pre- eclampsia and the hellp syndrome. Two case histories with fatal outcomes are described to provide extra emphasis. The literature indicates that some cases of maternal mortality might be avoidable. From a review of the literature, suggestions and recommendations are made about how to achieve a decrease in maternal mortality from pre-eclampsia/the hellp syndrome. The most important are the making of an early, correct diagnosis, anticipating the possibilities of serious complications, and, if necessary, early referral to a regional centre with special expertise.
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ranking = 8
keywords = mortality
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3/39. brain MRI in peripartum seizures: usefulness of combined T2 and diffusion weighted MR imaging.

    Peripartum seizure is a serious disease with significant morbidity and mortality for women and their unborn children. The underlying etiologies are varied, with eclampsia and venous stroke being the most common causes. T2 weighted MR images of the brain show hyperintense lesions in either condition. diffusion weighted MR images (DWI) of the brain is abnormal in strokes. We report three cases of eclampsia with abnormal T2 weighted images, but normal DWI. diffusion weighted MR images in association with T2 weighted MR images can be extremely helpful in evaluation of women with new onset peripartum seizures.
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ranking = 1
keywords = mortality
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4/39. association of hypercytokinemia in the development of severe preeclampsia in a case of hemophagocytic syndrome.

    Hemophagocytic syndrome (HPS) is a syndrome presenting with signs of persistent remittent fever, hepatosplenomegaly, pancytopenia, hepatic dysfunction, and disseminated intravascular coagulation (DIC) due to hypercytokinemia caused by activated T lymphocytes and macrophages. The mortality in adults is high and a small number of complicated cases during pregnancy have been reported. We report one HPS case that developed a remittent fever, leukocytopenia, and thrombocytopenia in the 2st week of pregnancy, and abnormal blood coagulation, hepatic dysfunction, and hypercytokinemia were found. Antibiotics and immunoglobulin were given but failed to improve clinical and laboratory findings. At the 24th week, the patient was diagnosed with DIC, and antithrombin (AT) concentrate was given. With the increase in plasma levels of AT, improvements were seen in both clinical signs and laboratory findings. bone marrow biopsies were carried out, and a diagnosis of HPS was made. Preeclampsia developed in the 27th week and it became severe. cesarean section was performed in the 29th week because of severe preeclampsia, intrauterine growth retardation (IUGR), and fetal distress. The courses of mother and newborn were uneventful. We discuss the mechanism of AT in the treatment of this syndrome and the association between this syndrome and severe preeclampsia. In conclusion, AT concentrate was very effective in suppressing cytokine production, and the possibility that severe preeclampsia developed because of hypercytokinemia, which may be one of the pathogeneses of severe preeclampsia and IUGR, was suggested.
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ranking = 1
keywords = mortality
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5/39. perinatal mortality and maternal mortality at the Provincial Hospital, Quang Ngai, South vietnam, 1967-1970.

    The perinatal mortality, maternal mortality, infant mortality rates, and the complications of delivery at the Provincial Hospital of Quang Ngai, South vietnam are described. The perinatal mortality is the only valid statistic available as the infant usually leaves the hospital within three days of delivery. knowledge pertaining to the 4th to 28th day after birth is scanty and there is insufficient knowledge about the first year of life. infant mortality is estimated at 277 per 1,000 live births. The perinatal mortality 64.6 per 1,000 live births, and maternal mortality, 106 per 10,000 live births are extremely high in contrast to Western countries. The high perinatal mortality is attributable to deaths during birth, the neonatal and immediate postnatal period. The high maternal mortality is primarily due to caesarean section, anemia, uterine rupture, toxemia, post-partum hemorrhage and puerperal infection.
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ranking = 3156.1108023085
keywords = perinatal mortality, mortality
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6/39. Expectant management of severe preterm preeclampsia: is intrauterine growth restriction an indication for immediate delivery?

    OBJECTIVE: Expectant management of severe preterm preeclampsia is gaining widespread acceptance in clinical practice. The objective of our study was 2-fold-to determine the frequency of fetal deterioration with expectant management of severe preterm preeclampsia and to evaluate whether the presence of intrauterine growth restriction on admission is associated with a shorter admission-to-delivery interval or more deliveries resulting from nonreassuring fetal status in comparison with pregnancies with preeclampsia but without intrauterine growth restriction. STUDY DESIGN: This was an observational study of women with singleton pregnancies at <34 completed weeks' gestation who were admitted to the hospital with the diagnosis of severe preeclampsia and managed expectantly. Fetal status on admission, admission-to-delivery interval, indication for delivery, and neonatal outcome were examined. RESULTS: Forty-seven women were studied during a 3-year period (1996-1999). gestational age at admission was 29.8 /- 2.6 weeks. The mean admission-to-delivery interval for the entire group was 6.0 /- 5.1 days; in 42.5% delivery was for fetal indications. In comparison with the absence of intrauterine growth restriction, the presence of intrauterine growth restriction at admission resulted in a significantly shorter admission-to-delivery interval (3.1 /- 2.1 vs 6.6 /- 6.1 days; P <.05). Most fetuses with intrauterine growth restriction (85.7%) were delivered before 1 week. Although 57% of fetuses with intrauterine growth restriction were delivered for fetal indications, versus 39% of fetuses without intrauterine growth restriction, these rates were not found to be significantly different. Neonatal outcomes, as reflected by Apgar scores, number of admissions to and duration of stay in the neonatal intensive care unit, and neonatal mortality rates, were similar. CONCLUSION: Pregnancies complicated by severe preterm preeclampsia and the presence of intrauterine growth restriction at admission may not benefit from expectant management beyond the 48 hours needed for betamethasone to act. Furthermore, all patients may benefit from close fetal monitoring before delivery because of the high rate of intervention for deteriorating fetal status.
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ranking = 1
keywords = mortality
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7/39. 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 = 2
keywords = mortality
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8/39. Anesthetic implications of a partial molar pregnancy and associated complications.

    In the united states, molar pregnancy occurs between 1 in 1,200 and 1 in 2,500 pregnancies. The critical nature of complications associated with a molar pregnancy requires advanced perioperative anesthetic management. This case report details the perioperative events of a 34-year-old gravida 5, para 3, with a partial molar pregnancy who underwent general anesthesia for a dilatation and curettage procedure, following therapeutic termination of a coexisting fetus at 18 weeks' gestation. Her initial presentation, anesthetic and operative management, and postoperative course are described clearly. The medical and anesthetic interventions required for treatment of molar pregnancy are reviewed. Of molar pregnancies, 80% are uncomplicated and follow an unremarkable course. However, for the remaining 20%, complications can be severe and may lead to substantial morbidity and mortality in otherwise healthy women.
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ranking = 1
keywords = mortality
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9/39. Fatal maternal outcome of a parturient with Eisenmenger's syndrome and severe preeclampsia.

    Eisenmenger's syndrome in pregnancy is associated with a high maternal and fetal morbidity and mortality. When it occurs with severe preeclampsia, the morbidity and mortality are higher. We report the case of a 30 weeks' pregnant woman with Eisenmenger's syndrome and severe preeclampsia. cesarean section was performed due to severe preeclampsia and an unfavorable cervix under general anesthesia. The intraoperative period was uneventful and a healthy 1300 g male infant was delivered, but the patient died on the second postoperative day due to a pulmonary embolism. This case confirms the frequently fatal maternal outcome of Eisenmenger's syndrome in pregnancy. Early termination of pregnancy is the treatment of choice.
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ranking = 2
keywords = mortality
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10/39. An autopsied case of Eisenmenger syndrome complicated by recurrent thromboembolic phenomena in postpartal period.

    dyspnea, back pain, edema, and cyanosis developed suddenly in a 23-year-old woman during the last trimester of her first pregnancy. Although she had been noticed to have the enlarged heart and exertional shortness of breath to a slight degree, she had been apparently in good condition without any significant heart murmurs. Clinically, recurrent episodes of disseminated intravascular coagulation, including pulmonary thrombosis, were thought to be superimposed to Eisenmenger syndrome associated with toxemia of pregnancy. Anticoagulant and fibrinolytic treatments were tried, but their effectiveness was limited by hemorrhagic diathesis. She died of respiratory and circulatory failure after delivery of a moribund baby. autopsy revealed eisenmenger complex (a defect in the membranous portion of the interventricular septum and pulmonary vascular disease) and many fresh hemmorrhages in both lungs with a lot of new and organized thrombi. Fresh thrombi were also seen in the heart, the pancreas and the kidneys. The high peripartal mortality in Eisenmenger syndrome could be attributed to pulmonary thrombosis, which may be related to DIC, as well as to peripartal changes in circulatory function.
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ranking = 1
keywords = mortality
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