ABSTRACT
La hemorragia de origen obstétrico constituye la primera causa de morbilidad y mortalidad maternas en la región de las Américas y el mundo, con el sangrado posparto como su forma de presentación más común. La presente revisión ha perseguido actualizar la información disponible sobre prevención, diagnóstico precoz e intervención temprana en lo que respecta al tratamiento médico o quirúrgico del riesgoso proceso, a fin de que apoye a la comunidad científica de esta disciplina en la toma de decisiones, contribuya a lograr un mejor control de esa contingencia negativa en las féminas y disminuya el número de madres fallecidas por complicaciones del embarazo, parto o puerperio, como la mencionada al inicio de esta síntesis.
Hemorrhage of obstetric origin constitutes the first maternal morbidity and mortality cause in the region of the Americas and of the world, with the postpartum bleeding as its most common form of presentation. The present review has been aimed at updating the available information on prevention, early diagnosis and intervention concerning medical or surgical treatment of the risky event, so that it supports the scientific community of this discipline in the decision making process, contributes to achieve a better control of this negative disorder in the females and diminishes the number of dead mothers due to complications of pregnancy, delivery or puerperium, as the one mentioned at the beginning of this synthesis.
ABSTRACT
Placenta accreta is a rare complication of pregnancy with high rates of maternal morbidity and mortality.It is usually discovered when removal of the placenta after delivery is difficult or there is substantial postpartum bleeding.Placenta accreta can be complicated by disseminated intravascular coagulation (DIC) and this increases maternal morbidity and mortality.DIC is characterized by the widespread activation of coagulation, which results in the intravascular formation of fibrin and ultimately thrombotic occlusion of small and midsize vessel.We report a 24-year-old woman with DIC, who developed severe pre- and intraoperative bleeding and massive transfusion during emergent cesarean section.
Subject(s)
Female , Humans , Pregnancy , Young Adult , Dacarbazine , Disseminated Intravascular Coagulation , Fibrin , Hemorrhage , Placenta , Placenta Accreta , Postpartum PeriodABSTRACT
Placenta accreta is a rare complication of pregnancy with high rates of maternal morbidity and mortality.It is usually discovered when removal of the placenta after delivery is difficult or there is substantial postpartum bleeding.Placenta accreta can be complicated by disseminated intravascular coagulation (DIC) and this increases maternal morbidity and mortality.DIC is characterized by the widespread activation of coagulation, which results in the intravascular formation of fibrin and ultimately thrombotic occlusion of small and midsize vessel.We report a 24-year-old woman with DIC, who developed severe pre- and intraoperative bleeding and massive transfusion during emergent cesarean section.
Subject(s)
Female , Humans , Pregnancy , Young Adult , Dacarbazine , Disseminated Intravascular Coagulation , Fibrin , Hemorrhage , Placenta , Placenta Accreta , Postpartum PeriodABSTRACT
We report two cases of acute Sheehan's syndrome with a brief review of literature: A 28-year-old woman who had been performed cesarean section delivery complicated by hemorrhage due to uterine atony. And a 29-year-old woman who had vaginal birth after cesarean section (VBAC) complicated by hemorrhage due to birth canal laceration. On 8th day after delivery, both patient visited emergency room in critical condition with nausea, vomiting and general weakness. Although clinically significant Sheehan's syndrome is an uncommon consequence of obstetric hemorrhage, Sheehan's syndrome should be considered in the differential diagnosis of hyponatremia and suggestive hypoglycemia in early postpartum period women with history of massive obstetric hemorrhage.
Subject(s)
Adult , Female , Humans , Pregnancy , Cesarean Section , Diagnosis, Differential , Emergencies , Hemorrhage , Hypoglycemia , Hyponatremia , Hypopituitarism , Lacerations , Nausea , Parturition , Postpartum Period , Uterine Inertia , Vaginal Birth after Cesarean , VomitingABSTRACT
OBJECTIVE: To evaluate the efficacy of clinical use of a intrauterine Sengstaken-Blakemore tube (S-B tube) in postpartum hemorrhage not controlled with medication and conservative treatment. METHODS: Retrospective review was done in 18 women with insertion of S-B tube into intrauterine cavity who did not controlled with medication and conservative treatment for postpartum hemorrhage. After third stage of labor, women were treated with prophylactic intramuscular Methylergonovine 0.2 mg and intravenous infusions of oxytocin routinely. If the postpartum bleeding continued, Misoprostol 800 microgram (per rectal) and intravenous infusions of Dinoprost 2 mg mixed with 5% D/S 500 cc were employed. And then women were examined for retained placenta and laceration of birth canal. Where necessary, retained placenta was removed and lacerations were sutured. If the postpartum bleeding did not controlled despite all of procedures, we decided use of intrauterine S-B tube. RESULTS: The mean age of the patients was 30.9+/-4.4 (27-39) years, their mean body weights and parities were 67.8+/-8.2 (56.2-85.7) kg, 1.8+/-0.8 (1-4) and mean gestational age was 38.5+/-2.9 (37-42) weeks respectively. The mean time from delivery to insertion of S-B tube was 107.6+/-94.0 (24-360) minutes. The mean filled normal saline amount was 190.5+/-35.2 (120-230) cc. Of 18 who was inserted of S B tube, 15 cases needed not additional surgical therapy. So success rate was 83.3%. CONCLUSION: Insertion of intrauterine S-B tube appears as a simple and effective means of treating postpartum hemorrhage not controlled with medication and conservative treatment.
Subject(s)
Female , Humans , Body Weight , Dinoprost , Gestational Age , Hemorrhage , Infusions, Intravenous , Lacerations , Methylergonovine , Misoprostol , Oxytocin , Parturition , Placenta, Retained , Postpartum Hemorrhage , Postpartum Period , Retrospective StudiesABSTRACT
Hypertensive encephalpathy is defined as severe hypertension in association with headache, nausea and vomiting, visual disturbances, confusion, stupor and coma. The pathophysiological mechanism is incompletely understood and causing as a result of failure of the upper limit of cerebral vascular autoregulation. Magnetic resonance imaging shows a characteristics posterior leukoencephalopathy, predominantly affects the white matter of the parietal and occipital lobes. Hypertensive encephalopathy are potentially reversible with timely and appropriate treatment. We experienced a case of hypertensive encephalopathy after normal vaginal delivery and report this case with a brief review of the literatures.
Subject(s)
Coma , Headache , Hemorrhage , Homeostasis , Hypertension , Hypertensive Encephalopathy , Leukoencephalopathies , Magnetic Resonance Imaging , Nausea , Occipital Lobe , Postpartum Period , Rabeprazole , Stupor , VomitingABSTRACT
Gestational trophoblastic tumor is one of the curable disease, but metastatic trophoblastic tumor still shows high mortality rate because of resistance to the chemotherapy. Choriocarcinoma may occur after an any type of human pregnancy. The incidence of choriocarcinoma following term pregnancy is very uncommon, and such tumor appears to follow a more aggressive course with more extensive metastatic spread and is less responsive to chemotherapy resulting in a poorer prognosis. Choriocarcinoma presenting as postpartum hemorrhage, and spontaneous tumor perforation with intra-abdominal hemorrhage is even rarer, requiring emergency laparotomy. We had experienced one case of metastatic choriocarcinoma following term pregnancy that required emergency total abdominal hysterectomy due to uterine perforation and hemorrhage. So, we report this case with brief review of literatures.
Subject(s)
Female , Humans , Pregnancy , Pregnancy , Choriocarcinoma , Drug Therapy , Emergencies , Hemorrhage , Hysterectomy , Incidence , Laparotomy , Mortality , Postpartum Hemorrhage , Prognosis , Trophoblastic Neoplasms , Uterine PerforationABSTRACT
OBJECTIVE: We analyzed the clinical features of amniotic fluid embolism confirmed by autopsy or clinical dicision for making a plan of rapid diagnosis and intensive emergency care. STUDY DESIGN: We experienced 2 clincal cases in Ewha Mokdong Hospital and Severance Hospital at 1995, and reviewed the medical record & autopsy report of 15 cases in National Institute of Scientific Investigation from Jan, 1991 to Dec, 1995. RESULTS: The mean maternal age was 31+/-3 years. The mean gestational age was 40+/-1 weeks. The number of delivery were 1.4+/-0.8. The number of abortion history. were 2.6+/-2. The sexuality of fetus were six males (35 %), five females (29%), and unknown six cases (35 %) and the fetal mortality rate was 29 % (5 cases). The initial clinical symptoms and signs were hypotension (12 patients, 71%), vaginal bleeding(ll patients, 65%), cardiac arrest (6 patients, 35 %), dyspnea (5 patients, 29 %), and seizure (2 patients, 12%). In the case of normal spontaneous vaginal delivary (NSVD), the symptoms occurred during induction in 3 (18%), during delivery in 1 (6%), and after delivery in 9 (53%). In the case of Cesarean section, the symptoms occurred during section in 2 (12%), and after section in 1 (6%). There are one case whose symptoms occurred during 3rd gestational period. CONCLUSIONS: We should alert for the amniotic fluid embolism in the clinical findings of acute collapse and vaginal bleeding, respiratory symptoms, and seizure at any peripartum. With eary suspicion of this disease and aggressive intensive care we can reduce amniotic fluid embolism mortality rate and it's legal problem.