Cases reported "Pregnancy Complications"

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1/21. Report on intrauterine drug exposure during second trimester of pregnancy in a heroin-associated death.

    A 17-year-old girl was found dead in a public toilet with fresh needle puncture marks. She was 18-20 weeks pregnant with a male fetus. Drug screening of her blood and urine indicated recent heroin use. Chronic drug use was confirmed by hair analysis. amniotic fluid as well as fetal and maternal tissues and body fluids were analyzed by GC/MS and HPLC. All the fetal specimens were investigated, and the following levels of drugs were found: 6-monoacetyl-morphine (blood: 152 ng/g; amniotic fluid: 128 ng/g; brain: 140 ng/g; lung: 110 ng/g; liver: 2 ng/g; kidney: 40 ng/g), morphine (blood: 1360 ng/g; amniotic fluid: 604 ng/g; brain: 710 ng/g; lung: 1030 ng/g; liver: 2060 ng/g; kidney: 1100 ng/g), codeine (blood: 70 ng/g; brain: 60 ng/g; lung: 60 ng/g; liver: 90 ng/g; kidney: 70 ng/g), and morphine-3-glucuronide (amniotic fluid: 209 ng/g; brain: 170 ng/g; lung: 325 ng/g; kidney: 231 ng/g). morphine-6-glucuronide was present in the maternal circulation but could not be detected in the fetal circulation.
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2/21. Use of acupuncture for managing chronic pelvic pain in pregnancy. A case report.

    BACKGROUND: Chronic pelvic pain is a health problem that affects many reproductive-age women. During reproduction the dilemma is even more challenging. The growing uterus often exacerbates pain, and treatment is limited by the effect on the fetus. A multispecialty approach and alternative medicine are often effective. Recently, the FDA announced the use of acupuncture and acupressure as officially recognized modalities for treatment of chronic pain in oncology patients. CASE: Chronic pelvic pain in a 23 year-old primigravida at 27 weeks' gestation was incapacitating on narcotics. After organic causes were ruled out, acupuncture was employed successfully. Outpatient management for the duration of the pregnancy included acupuncture and narcotics for breakthrough pain while maintaining activities of daily living. Spontaneous vaginal delivery without complications at 38 5/7 weeks produced a 3,305-g female infant. The pain resolved immediately following delivery. CONCLUSION: This case demonstrates the benefit of combined allopathic with alternative forms of medicine. With the use of acupuncture, narcotic use was limited in this gravida while adding to her quality of life by allowing her to maintain normal activity.
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3/21. Spontaneous intracranial hypotension during pregnancy.

    BACKGROUND: Spontaneous intracranial hypotension is characterized by postural headache associated with low cerebrospinal fluid pressure. CASE: A 37-year-old Japanese woman, gravida 3, para 2, had sudden onset of severe postural headache at 8 weeks' gestation, accompanied by nausea and vomiting. Results of medical and neurologic examinations were normal, and there was no measurable cerebrospinal fluid pressure on lumbar puncture. brain magnetic resonance imaging showed diffuse subdural fluid collection and a narrowing of the ambient cistern, confirming the diagnosis of spontaneous intracranial hypotension. After a month of bed rest and intravenous fluid infusion, all symptoms subsided gradually and did not recur. CONCLUSION: Obstetricians should be aware that spontaneous intracranial hypotension can occur in pregnancy.
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4/21. low back pain in pregnancy.

    The aim of this case report is to discuss the subject of acupuncture in pregnancy and which acupuncture points, or areas, are safe to needle. low back pain in a 21-year-old Caucasian primigravida at 24 weeks gestation was incapacitating and acupuncture was offered. Prior to pregnancy investigations had excluded a serious organic cause and acupuncture was employed successfully to control pain and improve function. Acupuncture can be offered to sufferers of low back pain in pregnancy after risk / benefit analysis is undertaken and informed patient consent is obtained.
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5/21. Acupuncture for low back pain in pregnancy.

    Medical doctors are particularly cautious about using acupuncture in pregnancy. This derives from the mostly historical and anecdotal claims that acupuncture can promote abortion, coupled with the fact that spontaneous early pregnancy loss is common, and litigation is increasing. This case report describes the circumstances that lead to the author using deep paraspinal and periosteal acupuncture throughout a patient's pregnancy to help control her low back pain.
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6/21. Epidural anaesthesia for caesarean section in an achondroplastic dwarf.

    This report describes the anaesthetic management of an 18-yr-old achondroplastic dwarf who presented for elective Caesarean section. Epidural anaesthesia was performed without technical difficulty using 8 ml carbonated lidocaine 2% with epinephrine 1:200,000. Although the skeletal abnormalities of achondroplasia have been cited as contraindications to the use of epidural anaesthesia, clinical experience does not support this contention. Previous reports have described technical difficulties in these patients, such as dural puncture and inability to advance the catheter into the epidural space, but no serious complications resulted and epidural anaesthesia was successful on subsequent attempts. The existing literature on the anaesthetic management of achondroplasia for Caesarean section is reviewed and considerations are presented concerning the choice of local anaesthetic, the epidural test dose, and dose titration.
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7/21. Epidural blood patch in a patient taking enoxaparin.

    A 36-year-old, 204-kg parturient with a past medical history of factor v Leiden requiring enoxaparin therapy developed a postdural puncture headache. With careful coordination of her enoxaparin dosing, an epidural blood patch was successfully performed. Performance of a blood patch in patients taking enoxaparin involves the withholding of the medication for a specific period.
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8/21. Inadvertent intrathecal injection of labetalol in a patient undergoing post-partum tubal ligation.

    After receiving a continuous spinal anesthetic for labor following an inadvertent dural puncture with a 17-gauge epidural needle, a morbidly obese parturient underwent post-partum tubal ligation 12 h after vaginal delivery. The patient received a total of 2 mL of 0.75% hyperbaric bupivacaine for the surgery. In response to moderate hypertension the patient received intravenous labetalol hydrochloride 20 mg. She subsequently was inadvertently administered approximately 15 mg of labetalol through the spinal catheter. The spinal catheter was removed immediately after the procedure. She suffered no apparent adverse neurologic effects.
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9/21. Choice of therapy and mode of delivery in idiopathic intracranial hypertension during pregnancy.

    Benign intracranial hypertension (BIH) or idiopathic intracranial hypertension (IIH) is a rare disorder of unknown etiology that is most often seen in obese women of reproductive age (19.3/100,000) and is reported only occasionally during pregnancy. Both pregnancy and exogenous estrogens are thought to promote IIH or worsen it. It can occur in any trimester during pregnancy, and the visual outcome is the same as for nonpregnant patients with IIH. There is no increase in fetal wastage; therapeutic abortion to limit its progression is not indicated, and subsequent pregnancies do not increase the risk of recurrence. Most therapies used during the nonpregnant state can also be used during pregnancy. The aim of treatment is to preserve vision and improve symptoms. Treatments include analgesics, diuretics, steroids, and serial lumbar punctures. When medical therapy fails, surgical procedures need to be considered. Although this condition has been reviewed often, the issue of mode of delivery, especially when papilledema has not resolved, is unclear. We report on 3 women with IIH during pregnancy and review the choice of therapy and mode of delivery.
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10/21. Severe fetal hydrops resulting from ABO incompatibility.

    Severe fetal hydrops was diagnosed at 34 weeks' gestation. Funipuncture revealed a normal 46,XX karyotype and a hematocrit of 20%. Cesarean delivery was performed. Neonatal blood testing showed blood type B positive, positive direct and indirect Coombs, and an anti-B antibody titer of 1:64. The maternal blood group was O positive with a titer of 1:65,536 immunoglobulin g (IgG) anti-B antibody (after inactivation of IgM anti-B antibody). This report documents a rare case of fetal hydrops resulting from ABO incompatibility with neonatal survival.
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