ABSTRACT
We report the diagnosis and treatment of a rare case of epidural analgesia failure followed by postpartum subdural hematoma. The patient underwent vaginal delivery under epidural analgesia at 32 +6 gestational weeks due to threatened premature labor, during which an unexpected dural rupture occurred. She gave no history of headache and there was no obvious abnormality during the pregnancy. However, on postpartum day 4, the patient complained of headache that could not be relieved when supine, but without any other neurological symptoms. A prompt cranial CT examination showed a left frontotemporal subdural hematoma. After conservative management with intravenous drip of mannitol, re-examination of cranial CT showed that the left frontotemporal subdural hematoma was mostly absorbed and the patient was discharged on postpartum day 18. The patient was healthy during follow up. Intracranial subdural hematoma after dural puncture is a rare and serious complication that requires early recognition and treatment.
ABSTRACT
We report the induced labor of conjoined twins in the second trimester in a woman with a history of two previous cesarean sections, the last one of which was performed in 2017. This 25-year-old patient was found to have thoracolumbar conjoined fetuses with one heart and polyhydramnios through the routine ultrasound examination at 19 +5 gestational weeks and was admitted at 20 +1 gestational weeks. After a full assessment of the fetal and maternal condition through multidisciplinary consultation, it was determined to attempt a vaginal delivery as no absolute contraindication for induction of labor. The patient was given 300 mg mifepristone orally plus an amniotic cavity injection of 100 mg ethacridine lactate. Regular contractions occurred 28 hours after medication. The patient delivered a pair of dead female conjoined twins at 20 +6 gestational weeks following successful induction of labor, with an assisted vaginal breech delivery. There was no soft tissue damage in the birth canal, and the estimated blood loss was 150 ml. Pathological examination and autopsy showed thoracolumbar conjoined deformity twins with a common heart and liver. Adequate prenatal evaluation, a detailed understanding of the indications for induction of labor and vaginal delivery, closed monitoring during labor, and preparation for emergency cesarean section, are essential safety measures for induced labor of conjoined twins in women with a scarred uterus in the second trimester.
ABSTRACT
Objective To investigate the effects on pelvic pseudocyst,ovarian function and symptoms of peri-menopausal period in patients with benign uterine disease undergoing simultaneous hysterectomy and bilateral salpingectomy.Methods From Jan.2000 to Dec.2006,1193 patients with benign uterine disease underwent total or subtotal hysterectomy,they were followed up for 48 months,334 patients lost follow-up,the other 859 patients were divided into 2 groups,including 348 patients undergoing simultaneous hysterectomy and bilateral salpingectomy in study group and 511 patients undergoing only hysterectomy in control group.The occurrence of pelvic pseudocyst and symptoms of peri-menopausal period and the changes of serum sexual hormone were observed.Results ( 1 ) The rate of pelvic pseudocyst was 1.7％ (6/348) in study group,which was significantly lower than 4.3％ (22/511) in control group (P =0.036).(2) There was an increasing trend of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and a decreasing trend of estradiol ( E2 ) at range of 6 - 48 months after surgery.At 3 months after surgery,LH in study group was significantly higher than that in control group [ (13.9 ±2.2) U/L vs.(12.6 ± 2.5 ) U/L,P =0.032 ]; FSH in study group at 6 months and 12 months after surgery were ( 17.6 ± 2.2) U/L and (26.7 ± 5.0) U/L,which were significantly higher than ( 16.2 ± 2.8 ) U/L and (24.3 ±3.1) U/L in control group (P=0.035 and P =0.031).At 12 months after surgery,LH in study group of (24.1 ±3.0) U/L was significantly higher than (22.5 ± 1.8) U/L in control group (P =0.017).E2 in control group of (97 ±22) pmol/L was significantly lower than ( 109 ± 17) pmol/L in control group at 24 months after surgery ( P =0.028) ; FSH in study group was lower than that in control group at 48 months after surgery [ (34.9 ± 6.7 ) U/L vs.(38.0 ± 4.8 ) U/L,P =0.043 ].There were no significant differences of FSH,LH,and E2 between two groups at the other time points (P ＞ 0.05 ).(3) At 6 months after surgery,the rate of perimenopausl systems of 21.8％ (76/348) in study group was significantly higher than 15.9％ (81/511 ) in control group ( P =0.026).However,at 24 months after surgery,the rate of perimenopausal symptoms of 54.4％ (278/511) in control group was significantly higher than 47.1％ (164/348) in study group (P =0.036).ConclusionSimultaneous hysterectomy and bilateral salpingectomy could decrease the occurrence of pelvic pseudocyst,and had similar effects on ovarian function and peri-menopausal symptoms compared with only hysterectomy in patients with benign uterine diseases.