A Case of Spontaneous Renal Subcapsular Hematoma and Acute Renal Failure Developed after Cesarean Section with Severe Preeclampsia / 대한산부인과학회잡지

Spontaneous renal subcapsular hematoma is a rare, life-threatening condition that is usually caused by benign and malignant renal tumors, vascular diseases, inflammatory disorders, blood dyscrasias, and seldom suspected clinically. The characteristic clinical features are abdominal pain, a mass in the flank and signs of internal bleeding. Severe preeclampsia is also a major contributing factor of the renal hematoma. Because renal function is decreased in spontaneous renal subcapsular hematoma, physicians should be aware of the clinical symptoms and signs, appropriate investigation and management may be life-saving. This case of spontaneous renal subcapsular hematoma and acute renal failure complicated by severe preeclampsia, which occurred after delivery and was treated conservatively.

Antepartum Expectant Management of Placenta Previa, Inpatient Versus Outpatient / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to determine the outcome of inpatient and outpatient management of placenta previa. METHODS: Sixty women with the initial diagnosis of placenta previa at 30 to 37 weeks' gestation who required hospitalization for no or minimal vaginal bleeding were stabilized and then randomized to receive either inpatient or outpatient expectant management. Thirty inpatients were treated at bed rest with minimal ambulation, received corticosteroids until 33 weeks of gestation and underwent ultrasonographic examination at 2 week intervals to assess fetal growth and placental location. Thirty outpatients were discharged after 2 or 3 days of hospitalization, and also received corticosteroids every week until 33 weeks of gestation and underwent ultrasonographic examination at 2 weeks intervals. All subjects who reached 37 weeks' gestation with persistent placenta previa underwent cesarean section electively. RESULTS: There were no differences between inpatients and outpatients for mean age, parity, gestational age at diagnosis, gestational age at first bleeding, and number of prior cesarean sections. There were no significant differences in the maternal and neonatal outcome measures as measured by time pregnancy prolonged, transfusions, cesarean hysterectomy, gestational age at delivery, birth weight, and neonatal morbidity. Significant difference observed only in maternal total hospital stay (p<0.01) as inpatient is 29.5+/-21.4 days and outpatient is 10.1+/-7.5 days. CONCLUSION: In selected patients, outpatient management of placenta previa can be reduced maternal total hospital stay. There were no apparent differences in the maternal and neonatal outcome of the two groups.