11/68. Treatment of postpartum thrombotic microangiopathy with plasma exchange using cryosupernatant as replacement.Hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are rare but acknowledged problems of pregnancy and the postpartum period. These diseases together with thrombotic angiopathy are associated with high maternal and fetal mortality and severe long-term morbidity. We describe four women with postpartum HUS/TTP treated with plasma exchange cryosupernatant fraction of plasma (CFP) as replacement fluid. anuria or oliguria at the beginning of treatment and thrombocytopenia [thromb- (29-68) x 109/L] were common features. Two of the patients developed a prolonged and more difficult clinical condition affecting the central nervous system and the liver and their platelet counts remained low despite the plasma exchange. The renal and hepatic function of all of the patients recovered fully. This small analysis lends weight to early plasma exchange with cryosupernatant as part of the treatment of postpartum HUS/TTP and suggests that persistent thrombocytopenia is a signal of more serious disease.- - - - - - - - - - ranking = 1keywords = hepatic (Clic here for more details about this article) |
12/68. Fulminant hepatic failure in a young mother.We report the case of a mother who developed fulminant hepatic failure with hypoglycaemia, coagulopathy, Grade III hepatic encephalopathy, two days after the delivery of her fourth child. She had complained of pruritus for the final two weeks of pregnancy. She received supportive medical management within a critical care unit, and the hepatic failure resolved completely within 48 hours. Liver biopsy confirmed the diagnosis of acute fatty liver of pregnancy. This case is unusual in that this patient deteriorated markedly following delivery, at a time when spontaneous recovery is normally expected.- - - - - - - - - - ranking = 7keywords = hepatic (Clic here for more details about this article) |
13/68. Spontaneous intracerebral hematoma from occult carotid-cavernous fistula during pregnancy and puerperium. Case report.In most cases, intracerebral hemorrhage during pregnancy or puerperium results from cerebral aneurysms or arteriovenous malformations. The authors present a case of a 30-year-old woman whose symptoms from a traumatic carotid-cavernous fistula had completely resolved 1 1/2 years after the event, but recurred 4 years later, causing two hemorrhages during pregnancy (33rd and 35th week of gestation) and one during the postpartum period (10 days after Caesarean section). Partial thrombosis of the cavernous sinus with obliteration of most of the drainage from the fistula accounted for the resolution of clinical symptoms, but also promoted back-flow to the preserved drainage of superficial cortical veins. The hemodynamic changes and the hormonal effects due to the patient's subsequent pregnancy further aggravated the venous engorgement and finally caused rupture. All three hematomas occurred in the vicinity of the extremely dilated veins, suggesting that back-flow with venous hypertension was the probable cause for the intracerebral hematomas. Spontaneous healing of the carotid-cavernous fistula should be confirmed with cerebral angiography.- - - - - - - - - - ranking = 6.4147107438017keywords = vein (Clic here for more details about this article) |
14/68. Thrombosis in a pregnant hemophilia a carrier after intrapartum recombinant factor viii.BACKGROUND: Symptomatic hemophilia a is a rare disorder in females. pregnancy and delivery in such women can be life threatening. Obstetric management is challenging and requires a multidisciplinary approach to ensure a good outcome. CASE: A woman with hemophilia a delivered by cesarean developed a deep vein thrombosis 10 days postpartum after recombinant factor viii administration. CONCLUSION: hemophilia a due to skewed X-inactivation is a rare cause of peripartum bleeding. Recombinant factor viii administration can prevent hemorrhage during and after cesarean delivery but may be associated with development of deep vein thrombosis.- - - - - - - - - - ranking = 6.4147107438017keywords = vein (Clic here for more details about this article) |
15/68. Budd-Chiari-like presentation of hepatic adenoma.Hepatic adenoma is a benign tumor characterized by its hypervascularity. Hepatic adenoma tends to occur more frequently in women and is related to the use of contraceptive hormones, androgenic/anabolic steroids, pregnancy, glycogen storage diseases and hemochromatosis. Hepatic venous obstruction, or budd-chiari syndrome, is a condition of hepatic vein occlusion that has many causes. A 35-year-old woman presented shortly after pregnancy with a huge cystic lesion in the liver. The lesion compressed the hepatic vein and created an early stage of budd-chiari syndrome. Tumor resection was carried out successfully. The final diagnosis of this case was multiple hepatic adenomas.- - - - - - - - - - ranking = 13.414710743802keywords = vein, hepatic (Clic here for more details about this article) |
16/68. Isolated idiopathic ovarian vein thrombosis: a rare case.This article describes the case of a 36-year-old woman who presented with a 2-day history of abdominal pain and nausea. Laboratory investigations revealed no abnormalities. Ovarian vein thrombosis was detected on ultrasound examination, and computed tomography of the pelvis and abdomen confirmed this finding. The patient was placed on anticoagulant therapy with unfractionated heparin and warfarin. Within 40 days her thrombosis improved. Laboratory testing for coagulation disorder revealed nothing abnormal. Ovarian vein thrombosis must be recognized and treated early to reduce the risk of serious complications. This case of idiopathic ovarian vein thrombosis underlines the importance of including this condition in the list of differential diagnoses for abdominal pain.- - - - - - - - - - ranking = 22.451487603306keywords = vein (Clic here for more details about this article) |
17/68. Case report: cerebral vein thrombosis after subarachnoid analgesia for labour.PURPOSE: We report a case of sagittal sinus thrombosis occurring after spinal analgesia for labour to highlight the difficulty of such diagnosis in the presence of postpartum atypical headache following regional anesthesia/analgesia. CLINICAL FEATURES: A previously healthy 21-yr-old, primiparous, preeclamptic parturient was admitted to the hospital at 37 weeks gestation for uterine contractions. Before pregnancy she was taking no medication other than oral contraceptives and was a non-smoker. Spinal analgesia was established on the first attempt at 8 cm of cervical dilation, in the setting of rapid progression of labour. Following an uneventful delivery, on the third day postpartum, the patient experienced gradual onset of an atypical headache with unclear postural character, followed by focal neurological signs five days later. Emergency neuroimaging revealed direct evidence of thrombosis in the posterior sagittal venous sinus. Anticoagulation was initiated with iv heparin (500 UI x kg(-1) x day(-1)). The patient's headache decreased progressively and full motor recovery was noted by day 14 postpartum. After 24 days, the patient was discharged without any neurological disability. Common inherited thrombophilic dispositions were absent, with the exception of a decrease in protein s level. CONCLUSION: Central venous thrombosis, while rare, is a recognized cause of puerperium stroke. The present case highlights the importance of considering the diagnosis in the presence of postpartum atypical headache following spinal anesthesia/analgesia. Early intervention with systemic heparinization is critical when the diagnosis is confirmed.- - - - - - - - - - ranking = 12.829421487603keywords = vein (Clic here for more details about this article) |
18/68. pulmonary embolism secondary to puerperal ovarian vein thrombophlebitis.Four cases of pulmonary embolism (PE) secondary to puerperal ovarian vein thrombophlebitis (POVT) were treated surgically during the first semester 1990. Clinical features are described in detail. The diagnosis was made by echotomography in three cases, but the crucial examination was contrast phlebocavography in all the subjects. Ovarian vein ligation, caval thrombectomy and inferior vena cava interruption by DeWeese clip positioning was the operation performed in any cases. Postoperative courses were always uneventful and three to six months follow-up was available. The extensive practice of echotomography during the first week of puerperium could demonstrate that POVT is more frequent than previously thought.- - - - - - - - - - ranking = 19.244132231405keywords = vein (Clic here for more details about this article) |
19/68. Antibody to cardiolipin causing hepatic infarction in a post partum patient with systemic lupus erythematosus.This is a case of a thirty one year old post partum patient, with SLE and antibodies to cardiolipin causing hepatic vascular thrombosis leading to infarction. No previous literature account is recorded.- - - - - - - - - - ranking = 5keywords = hepatic (Clic here for more details about this article) |
20/68. Fulminant hepatic failure during perinatal period in a pregnant woman with Wilson's disease.Wilson's disease associated with hepatic failure is not common and the underlying mechanism triggering the event is not known at present. We treated a 28-year-old Japanese woman with Wilson's disease who developed hepatic failure associated with hemolytic crisis just after delivery. She was diagnosed as having Wilson's disease at 12 years of age, at which time she started taking D-penicillamine. She had previously delivered two children without difficulty. When she found out she was pregnant this time, she stopped taking D-penicillamine in contrast to taking it faithfully during her first two pregnancies. On the day of delivery of her full-term baby, jaundice developed accompanied with severe hemolytic crisis. Plasma exchanges and blood transfusion were performed and D-penicillamine administration was started again. She gradually recovered and apparently was following a good clinical course. However, on day 30 the second hemolytic crisis occurred and subsequent liver failure led her to death on day 50. At autopsy her liver was cirrhotic and showed massive necrosis. Prophylactic oral administration of D-penicillamine and careful observation are therefore recommended to prevent hemolytic crisis during the perinatal period.- - - - - - - - - - ranking = 6keywords = hepatic (Clic here for more details about this article) |
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