Cases reported "Pregnancy Complications"

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1/184. Devic's neuromyelitis optica during pregnancy in a patient with systemic lupus erythematosus.

    Neuropsychiatric forms of systemic lupus erythematosus (SLE) vary, most commonly consisting of seizures, psychiatric disturbances, or focal central nervous deficits. This is a new case of neuromyelitis optica or Devic's syndrome during the course of SLE. Few reports of this association exist in the literature. Our objective is to report this unique case of Devic's neuromyelitis optica during pregnancy in a patient with systemic lupus erythematosus. A 28-year-old woman had been diagnosed as having SLE with cutaneous and articular involvement in 1987 when she was 17 years old. She was treated with a synthetic antimalarial agent associated with corticosteroids. In 1994, during the fourth month of pregnancy, she had signs of transverse myelitis with a sensory level at T6 associated with an optic neuropathy suggesting a Devic's syndrome. The patient was managed by plasmapheresis sessions and intravenous corticosteroids. Transverse myelitis recurred postpartum and three years later at the same thoracic level. Management by bolus administration of a steroid and cyclophosphamide resulted in remission again. There have only been around a dozen reports in the literature of patients who had both Devic's neuromyelitis optica and SLE. magnetic resonance imaging is contributive to diagnosis and therapeutic follow-up, showing spinal cord lesions with increased intensity on T2-weighted sequences. Although the clinical course of the present patient has been favourable so far, the prognosis of this neurologic disease is generally considered to be poor with elevated mortality.
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2/184. Ruptured tuboovarian abscess in late pregnancy. A case report.

    BACKGROUND: Tuboovarian abscess is an unusual obstetric complication that causes maternal and fetal morbidity and mortality. CASE: A woman, G1, P0, with a 32-week pregnancy presented with abdominal pain. physical examination on admission revealed fever and unremarkable abdominal signs. Eleven hours after admission, signs of peritonitis became prominent, necessitating emergency laparotomy. Surgical findings included an 8-cm, right, ruptured tuboovarian abscess with massive purulent contamination of the abdominal cavity. Cesarean hysterectomy with bilateral salpingo-oophorectomy was performed. Neither the newborn nor the mother had postoperative complications. CONCLUSION: Since there are discrepancies in the incidences of tuboovarian abscess in pregnant and nonpregnant groups, the pathogenesis of tuboovarian abscess may be different in the two populations. In pregnancy, diagnosis and management are also more difficult than in the nonpregnant state. Clinical data may not reveal the diagnosis until surgery is mandatory. Because most pregnant women with tuboovarian abscesses are young, conservative surgery should be attempted if the pathology is limited to only one side of the adnexa and further reproduction is desired.
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3/184. Combined maternal and congenital myotonic dystrophy managed by a multidisciplinary team.

    myotonic dystrophy is a rare autosomal dominant degenerative neuromuscular and neuroendocrine disease. pregnancy can aggravate the maternal disease. Obstetrical complications include stillbirth, premature labor, polyhydramnion, abnormal presentation, prolonged labor, increased operative delivery, postpartum hemorrhages and anesthetic accidents. If the fetus is affected severe neonatal morbidity and mortality with arthrogryposis and mental retardation is common. We present a case where the family chose continuation of pregnancy with a known diagnosis of maternal and severe fetal myotonic dystrophy. A multidisciplinary team was used in the management of pregnancy and counseling the patient.
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4/184. 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 = 1082.2070595227
keywords = perinatal mortality, mortality
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5/184. esophageal achalasia in pregnancy.

    Achalasia is rare motor disorder of esophageal smooth muscle. It has been linked to malnutrition during pregnancy leading to maternal and fetal mortality. We report a case of achalasia with intrauterine fetal death who succeeded in following pregnancy with good fetal and maternal outcome after operative treatment. A 34-year-old pregnant woman had intrauterine fetal death at 27 gestational weeks due to severe and persistent maternal malnutrition during pregnancy. Achalasia was diagnosed postpartum and myotomy-fundoplasty was performed. She succeeded in normal delivery with a healthy baby 21 months after the operation. This case suggests the effect of severe achalasia of early onset on poor fetal outcome, and the efficacy of surgical myotomy for the improvement of following pregnant outcome.
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6/184. Successful pregnancy and birth after IVF in a woman with cystic fibrosis.

    As survival increases, patients with cystic fibrosis (CF) are often confronted with reproductive issues. Initial reports gave conflicting advice regarding the outcome of pregnancy in CF. However a recent large longitudinal study of pregnancies in CF women suggested that pregnancy has little impact on morbidity or mortality. Reduced fertility in CF women has been described, possibly due to thickened cervical mucus, and intrauterine insemination (IUI) has been used to overcome this. We report the first woman with CF, to our knowledge, to be successfully treated with IVF after repeated failed attempts at IUI.
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7/184. Intracerebral hemorrhage and moyamoya disease in pregnancy.

    PURPOSE: To present a case of moyamoya disease with intracranial hemorrhage complicating pregnancy. CLINICAL FEATURES: A 36-yr-old parturient at 34 wk gestation presented with left hemiparesis, headache, nausea and vomiting. Subsequent deterioration in level of consciousness and the development of a dilated right pupil necessitated immediate intubation. Urgent non-contrast CT scan revealed a large right intracerebral hematoma with transtentorial herniation. The patient underwent simultaneous emergency cesarean section and craniotomy. A postoperative angiogram revealed findings consistent with Moyamoya disease. The neonate survived but the patient developed severe cerebral edema and died eleven days postoperatively. CONCLUSION: adult patients with moyamoya disease often present with intracranial hemorrhage which poses unique anesthetic challenges. We report a case of intracerebral hemorrhage during pregnancy, which is known to be associated with high morbidity and mortality. The anesthetic techniques are reviewed and discussed.
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8/184. Small bowel obstruction in early pregnancy treated by jejunotomy and total parenteral nutrition.

    BACKGROUND: Small bowel obstruction in early pregnancy increases maternal and fetal morbidity and mortality and might be diagnosed mistakenly as hyperemesis gravidrum. Prompt diagnosis and therapy is essential. CASE: A 29-year-old primigravida was admitted at 13 weeks' gestation with small bowel obstruction. After jejunotomy, total parenteral nutrition was given until oral intake was resumed completely 1 month after surgery. She was discharged with no complications and the rest of her pregnancy and delivery were uneventful. CONCLUSION: Small bowel obstruction in early pregnancy should be diagnosed expeditiously and can be treated with jejunotomy and total parenteral nutrition.
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keywords = mortality
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9/184. Acute asthma. Emergency management in the community.

    BACKGROUND: The prevalence of asthma in australia is one of the highest in the world. statistics suggest that two million or more Australians across all age groups have the disease. It is one of the top five medical problems referred to hospital and one of the commonest presentations seen in emergency departments. asthma was the cause of death of 685 Australians in 1998. All general practitioners will have a cohort of asthmatics in their practice and consequently must be prepared to manage these people at any time, but especially at times of acute exacerbation. OBJECTIVE: To outline the features of acute asthma and its management in the community setting. DISCUSSION: general practitioners have a crucial role to play in the community and prehospital management of asthma. An awareness of the features and treatment of acute exacerbations will help them reduce an enormous burden on the health system and contribute to a reduction in morbidity and mortality in their patients.
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10/184. Fetal chylothorax response to maternal dietary treatment.

    BACKGROUND: Fetal chylothorax is associated with elevated perinatal mortality. Development of mediastinal shift with significant lung compression before 35 weeks' gestation needs treatment. CASE: A 24-year-old gravida 2, para 0 presented at 26 weeks' gestation with a fetal pleural effusion with a mediastinal shift and abnormal Doppler velocimetry indices in several vessels. Thoracentesis was successful but 3 days later, the fetal effusion had reaccumulated. Because of fetal position, a pleuro-amniotic shunt was difficult technically, so maternal medical treatment was initiated with a low-fat, high medium-chain triglyceride diet. After initial mild decrease, the estimated volume of the fetal chylothorax remained stable until 36 weeks' gestation, at which time we delivered by cesarean an infant with good Apgar scores. After aspiration of the remaining thoracic fluid and administration of a similar diet, the infant did well, with normal growth and development. CONCLUSION: Maternal dietary treatment might help delay the need for thoracentesis in cases of fetal chylothorax.
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ranking = 267.30176488068
keywords = perinatal mortality, mortality
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