Cases reported "Pregnancy Complications"

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1/11. Gangrenous sigmoid volvulus in a pregnant woman.

    A rare case of gangrenous sigmoid volvulus in a pregnant woman causing intestinal obstruction is reported. The patient had intrauterine foetal death. Laparatomy for resection of sigmoid colon and hysterotomy for removal of dead foetus was carried out. Terminal iliac colostomy with closure of rectal stump was done in the first surgery. The patient underwent colorectal anastomosis 2 months after the first operation and recovered uneventfully.
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2/11. Recurrent sacculation of the pregnant uterus. A case report.

    BACKGROUND: Recurrent uterine sacculation is very rare and associated only with pregnancy. It commonly complicates delivery with a retained placenta. CASE: A 24-year-old woman, gravida 4, para 0, with three previous elective abortions, presented in preterm labor at 32 6/7 weeks' gestation. Her second and third abortions were complicated by incomplete evacuation of uterine contents, and uterine sacculation was diagnosed. Preterm delivery and a retained placenta complicated the present pregnancy. At laparotomy, recurrence of uterine sacculation was noted in the left fundal region of a bicornuate uterus. A hysterotomy was performed to remove the placenta from the sacculation. CONCLUSION: In a patient with multiple uterine procedures and retained placenta, uterine sacculation can develop.
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3/11. Torsion of the pregnant uterus.

    A 31-year-old woman, with a history of previous cesarean section and right oophorectomy, was admitted for a repeat cesarean section. After the commencement of surgery uterine torsion was diagnosed because of the anterior position of the remaining left ovary and tube, the absence of normal uterovesical peritoneum, and extremely engorged vessels in the lower uterine surface. Posterior classical hysterotomy was performed and a healthy female baby was delivered. Following delivery of the baby and suturing the incision site of the uterus, the contracted uterus was detorted and put back in the pelvic cavity. Extreme uterine torsion of 180 degrees at term is a rare obstetric event. This paper presents a case of uterine torsion at full term pregnancy in which the delivery and repositioning of the uterus was successful.
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4/11. The marfan syndrome and pregnancy.

    The patient described had the marfan syndrome complicated by a 22-week pregnancy. Because pregnancy potentiates the cardiovascular complications of aortic aneurysm or dissection and there is a 50% risk of having a child afflicted with the disorder, this pregnancy was electively terminated by hysterotomy along with a bilateral tubal ligation. The risks of pregnancy to a woman with the marfan syndrome are reviewed. The rationale for the method of pregnancy termination chosen is discussed.
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5/11. Cesarean delivery by posterior hysterotomy due to torsion of the pregnant uterus.

    BACKGROUND: We describe a case of cesarean delivery by posterior hysterotomy in a woman with uterine torsion secondary to a blocked retroverted uterus. CASE: At 28 weeks of gestation this patient's fetus was found to have club feet, initially suspected to be secondary to sacculation of the posterior uterine segment. At cesarean delivery, intraoperative inspection revealed the uterus to be twisted 180 degrees without evidence of posterior sacculation. The uterine incision was performed on the posterior aspect of the lower uterine segment. CONCLUSION: Fixed uterine retroversion with torsion is associated with fetal abnormalities and may require a posterior uterine incision.
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ranking = 5
keywords = hysterotomy
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6/11. idiopathic pulmonary fibrosis (IPF) necessitating therapeutic midtrimester abortion: a case report.

    A 35-year old multiparous lady was admitted at 19 weeks of pregnancy with rapid onset of dyspnoea which progressed to grade III in 2 months. She was diagnosed as a case of idiopathic pulmonary fibrosis (IPF). She had a vital capacity of 1.25 l, 46.5% of predicted and PaO2 of 60 mmHg at rest, dropping to 35 mmHg on mild exercise testing. She did not respond to prednisolone 40 mg daily given orally for one month. In view of lack of improvement, therapeutic abortion was carried out at 24 weeks by abdominal hysterotomy combined with tubal ligation. Subsequent to termination of pregnancy, her clinical status and pulmonary function improved markedly and she had only grade I dyspnoea 30 months later without corticosteroids. Effect of pregnancy on interstitial lung disorders especially IPF is not yet clear because of extreme rarity of their association. Therapeutic abortion should be seriously considered in patients who cannot increase their oxygen consumption 3 times normal without uncorrectable hypoxaemia.
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keywords = hysterotomy
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7/11. Gunshot wounds to the gravid uterus. A case report.

    A pregnant woman sustained an abdominal gunshot wound during the second trimester; the bullet injured multiple loops of bowel and passed through the uterus, placenta and fetus. Although the stillborn fetus was delivered by cesarean section, a review of the literature indicated that operative delivery is not indicated when the fetus has died already. Labor and delivery are well tolerated, and an unnecessary hysterotomy is thus avoided. If labor does not ensue spontaneously, it can be induced. Approximately 40% of fetuses will survive the initial injury. In past reviews the risk of prematurity often outweighed the benefits of delivery of those infants. Advances in neonatology now make survival routine after 28 weeks' gestation, and viable fetuses should be delivered promptly by cesarean section to decrease the risk of delayed death from fetal or placental injury.
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ranking = 1
keywords = hysterotomy
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8/11. Fetal hydrops and death from sacrococcygeal teratoma: rationale for fetal surgery.

    Most sacrococcygeal teratomas diagnosed before birth can be managed by planned delivery and postnatal surgery. However, large tumors early in gestation may result in placentomegaly, hydrops, and fetal death and a preeclampsia-like syndrome in the mother. This chain of events may result from high output cardiac failure in the fetus caused by arteriovenous shunting through the tumor. We recently encountered this situation in a fetus at 21 weeks' gestation and performed fetal surgery in an attempt to reverse the process. Excision of the teratoma resulted in reversal of hydrops, diminution of descending aortic flow on Doppler echocardiography, and decrease in placental thickness. Despite these changes, uterine irritability after hysterotomy resulted in labor and delivery of a nonviable premature infant. This case demonstrates that when fetal sacrococcygeal teratoma becomes very large early in gestation, high output cardiac failure can endanger both fetus and mother. In the future, use of Doppler echocardiography may allow appropriate selection of high-risk fetuses. Intervention to prevent arteriovenous shunting through the tumor may offer these fetuses an improved chance for survival.
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ranking = 1
keywords = hysterotomy
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9/11. Eisenmenger's syndrome and pregnancy.

    Two additional cases of successfully managed Eisenmenger's syndrome (ES) during pregnancy are described. A review of the literature on this subject revealed 115 reported cases, of which only 44 (including our two cases) were felt to be adequately documented, representing 70 pregnancies. These formed the material for statistical evaluation. Fifty-two per cent of all patients died in connection with pregnancy. Thirty and three-tenths per cent of all pregnancies results in maternal death. maternal mortality in first, second, and third pregnancies was not significantly different. A high incidence of maternal death was assoicated with hypovolemia, thromboembolic phenomena and preeclampsia, but mortality was not higher in the toxemia than in the non-toxemia group. Cesarean sections and other operations are associated with extremely high maternal mortality during pregnancy. Thirty-four per cent of all vaginal deliveries, three out of four cesarean sections, and only 1 out of 14 pregnancy interruptions (the only one by hysterotomy) resulted in maternal death. Abortions are significantly safer than any kind of delivery (p less than 0.05). Ventricular septal defect (VSD) is the most frequent underlying shunt defect. maternal mortality in association with VSD is higher (60%) than in association with atrial septal defect (ASD) (44%) and patent ductus arteriosus (PDA) (41.7%). The majority of maternal deaths occurred during or within the first week after delivery. Only 25.6 per cent of all pregnancies reached term. At least 54.9 per cent of all deliveries occurred prematurely. Thirty and two-tenths per cent of all infants showed intrauterine growth retardation. This represented almost half of all new borns with available information. perinatal mortality reached 28.3 per cent and was significantly associated with prematurity (p less than 0.001). pregnancy is contraindicated in patients with ES. Abortion is the treatment of choice, once pregnancy has occurred. Where interruption of pregnancy is refused, utmost care must be taken to assure maternal and fetal survival. A protocol for the management of such pregnancies is discussed on the basis of available information.
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ranking = 1
keywords = hysterotomy
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10/11. Chorioamniotic membrane separation: a potentially lethal finding.

    Sonographic detection of chorioamniotic membrane separation (CMS) has been considered a benign incidental finding. We now report 6 cases of CMS identified by prenatal ultrasound; 1 in an otherwise normal pregnancy and 5 following fetal surgery. Following membrane separation, amniotic bands formed and compromised the umbilical cord in 4 cases leading to 2 fetal deaths. In the first case, CMS was detected by ultrasound at 22 weeks' gestation in an otherwise uncomplicated pregnancy. Because CMS was considered benign and umbilical cord blood flow was ample, the mother was followed by intermittent sonographic examinations. Fetal demise occurred 2 weeks later, clearly due to umbilical cord strangulation by an amniotic band. Surprised by this unexpected outcome, we reviewed our experience with CMS after hysterotomy for fetal surgery. Out of more than 40 fetal surgical cases, we have 5 cases in which CMS was recognized after hysterotomy. Three of these fetuses had umbilical cord compromise by a band of amniotic membrane leading to 1 fetal death. This experience demonstrates that membrane separation may be associated with amniotic band formation which can lead to cord strangulation and fetal compromise. Following fetal surgery, serial ultrasound evaluation and close fetal monitoring are indicated. In otherwise unremarkable pregnancies, clinician awareness of the possibility of amniotic band formation following CMS should be heightened. In either situation, knowledge of this potential life-threatening complication may identify cases in which cord compromise requires emergent delivery or fetoscopic release of the strangulating amniotic band.
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ranking = 2
keywords = hysterotomy
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