11/138. Major hemorrhage in a patient with multiple submucous leiomyomata during the treatment of long-acting gonadotropin-releasing hormone agonist.Gonadotropin releasing hormone agonist (GnRH-agonist) therapy has been useful as an adjunct before myomectomy or hysterectomy for uterine myoma but the concealed risk is often overlooked. We report an extremely rare clinical presentation of a patient with multiple submucosal myomata during the treatment of long-acting gonadotropin-releasing hormone agonist (GnRH-agonist) in a 23-year-old, virgin woman. This patient exhibited heavy menstruation and severe anemia for half of a year. Ultrasound demonstrated multiple submucous myomata and intramural myomata. She received a conservative medical treatment by GnRH-agonist. The patient showed marked suppression of serum estradiol concentrations throughout treatment (< 20 pg/ml since first dose injection). The volume of the uterus decreased 21% and the total volume of the uterine myomata decreased 27% at the end of the second dose injection. However, a sudden onset of major hemorrhage occurred at the 65th day without "add-back" hormonal replacement therapy after initial therapy of GnRH-agonist. Hypovolemic shock followed soon and immediately resuscitation was performed. After resuscitation, the patient was treated with hysteroscopic myomectomy, followed by 30 ml balloon Foley catheter placement for compressing the intrauterine rough surface and hormonal replacement therapy. When uterus returned to the normal size at the end of the first week, intrauterine device was positioned and maintained for three months. The patient married four months later and got pregnant soon. Now she has a pregnancy of 22 gestational weeks. The phenomenon suggests presence of concealed and potential risk of GnRH-agonist for managing a patient with multiple submucous myomata, even though GnRH-agonist is a well-documented transient treatment for uterine myomata not only by its effect on tumor shrinkage and decreasing blood loss during the myomectomy but also by providing a time for hematological recovery. This unexpected and unwanted clinical presentation should be alerted.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
12/138. Intrauterine pseudogestational sac in ectopic pregnancy.Ultrasonic diagnosis of ectopic pregnancy has been thought to depend on exclusion of intrauterine pregnancy on the basis of absence of an intrauterine gestational sac. Two cases illustrating intrauterine echoes suggesting a gestational sac associated with ectopic pregnancy and a plausible explanation for this phenomenon are presented. Because of this and the rare possibility of coexisting intrauterine and extrauterine pregnancies, the ultrasonographer must be wary of dismissing the possibility of an ectopic pregnancy because of an intrauterine gestational sac, whether real or apparent.- - - - - - - - - - ranking = 8keywords = pregnancy (Clic here for more details about this article) |
13/138. Chorioepithelioma presenting as a bleeding gingival mass.A case is reported in which a very malignant neoplasm appeared clinically to be a pregnancy tumor or a hemangioma. There was, of course, no question as to the cause of death in this particular case. It was of interest because of the rarity of the tumor, the metastasis to the oral cavity, and the fact that the final diagnosis was established from pathologic examination. The case demonstrates, with emphasis, the great importance of biopsy and routine pathologic examination of all tissue for accurate and correct diagnosis, regardless of its clinical appearance.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
14/138. Survey of amniocentesis for fetal sex determination in hemophilia carriers.A study was designed to determine whether there is an increased risk of complications when amniocentesis for fetal sex determination is performed on hemophilia carriers. questionnaires were sent to 112 medical centers providing this service in the united states, and to 19 outside the united states. Responses were received from 76% of the centers in the united states. Data on 11,819 taps were obtained. Only 75 taps (0.64%) were performed for the indication of hemophilia. The frequency of fetal deaths in the general sample (1.84%) was not significantly different from that in the subsample of hemophilia carriers (1.33%). The results of this survey correspond very closely to data from a National Registry on amniocentesis for various indicaions in such variables as the number of taps needed for diagnosis, color of the fluid obtained, and number of dry taps. Carrier women who had bleeding problems during the monitored pregnancy are described. The problems might have been related to the amniocentesis in three women. It is calculated that only 2-4% of hemophilia carrier women who might have amniocentesis are utilizing the service.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
15/138. Alternative conservative management of placenta accreta. A case report.BACKGROUND: placenta accreta is a rare event in pregnancy and may cause life-threatening hemorrhage. This obstetric complication is a diagnostic and management challenge. When the condition is diagnosed, medical management is usually employed first for hemostasis. If the bleeding cannot be controlled, conservative surgical management is attempted, but hysterectomy is often required for definitive care. CASE: The diagnosis of placenta accreta was made intraoperatively at cesarean section undertaken for breech presentation. The placenta was densely adherent to the anterior lower uterus. Severe hemorrhage, which resulted from attempts to manually remove it, was treated with oxytocin, carboprost tromethamine and methylergonovine without success. The uterus was everted to provide access to the placental site, which was excised; the myometrial defect was sutured closed. Three Foley balloons were used to provide uterine tamponade. methotrexate was administered prophylactically. These measures effectively controlled the hemorrhage. CONCLUSION: Because placenta accreta might not be diagnosed antepartum or during labor, especially when no risk factors are present, adequate preparations cannot be made. If it is diagnosed at the time of cesarean section, a combined conservative approach may prove helpful in controlling bleeding and avoid hysterectomy and hypovolemia.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
16/138. A 22-week cervical pregnancy.We report on a cervical pregnancy at advanced gestational age. Misdiagnosis allowed pregnancy to proceed until the 22nd week of gestation and made its management more complicated. An abdominal hysterectomy with preservation of the adnexa was performed.- - - - - - - - - - ranking = 6keywords = pregnancy (Clic here for more details about this article) |
17/138. Surgical treatment for acute type A aortic dissection in pregnancy: a case of aortic root replacement just after cesarean section.A 25-year-old woman with marfan syndrome in the 37th week of pregnancy was referred for acute chest pain and dyspnea. An emergency cesarean section was performed because of fetal distress. Intraoperative echocardiography at the end of the cesarean section showed dilatation of the aortic root and dissection of the ascending aorta. The patient underwent replacement of the aortic root and the ascending aorta on the following day because of uterine bleeding. The postoperative course was uneventful for the mother and her baby.- - - - - - - - - - ranking = 5keywords = pregnancy (Clic here for more details about this article) |
18/138. vascular malformations in the uterus: ultrasonographic diagnosis and conservative management.OBJECTIVE: To investigate the presence and outcome of uterine vascular malformations in women with abnormal premenopausal bleeding. STUDY DESIGN: In this observational study 265 consecutive patients with abnormal premenopausal bleeding were examined by the same ultrasonographer with transvaginal gray-scale ultrasonography and color Doppler imaging. A final diagnosis of uterine vascular malformation was based on ultrasonographic findings, hysteroscopy or histological findings. patients suspected of uterine vascular malformations at ultrasonography were closely monitored. RESULTS: In nine patients (3.4%) we found ultrasonographic features of uterine vascular malformations. color Doppler imaging showed hypervascularity, marked turbulence, and low-impedance, high-velocity flow. In six patients the condition resolved spontaneously. Two patients with hydatiform mole needed chemotherapy and their condition normalized. One patient underwent a selective embolization of the uterine artery. Subsequently, five patients had uncomplicated pregnancies after resolution of the vascular malformation. CONCLUSION: Uterine vascular malformations are more common than previously thought. We conclude that conservative management is a valuable option in many of the acquired pregnancy-related cases that are diagnosed with color Doppler imaging.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
19/138. uterine artery pseudo-aneurysm: diagnosis and therapy during pregnancy.Arterial aneurysms and pseudo-aneurysms are a rare but recognized cause of obstetric hemorrhage. diagnosis during pregnancy, prior to rupture, is exceptional. We report the first case of diagnosis and treatment of an uterine artery pseudo-aneurysm during pregnancy.- - - - - - - - - - ranking = 6keywords = pregnancy (Clic here for more details about this article) |
20/138. arteriovenous malformations of the uterus associated with medical abortion.Seven cases of uterine arteriovenous malformations associated with pregnancy were initially suspected by the history of prolonged bleeding after a medical abortion and then confirmed by color Doppler scanning. All cases were managed expectantly and resolved spontaneously. When AVMs required diagnosis by pathology or angiography, only the most severe cases would have been reported. Now that they can be recognized on ultrasound, it is possible that mild cases such as these will be found to be much more common.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
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