Acute appendicitis in pregnancy; maternal and foetal outcome

To determine the maternal and foetal outcome among the cases of acute appendicitis during pregnancy. Prospective Study. Aga Khan Hospital for Women, Kutyana Memon Hospital and Hamdard University Hospital, where authors work. Period: From June 2004 to May 2008. A total of 21 pregnant females who presented with right sided abdominal pain with clinical diagnosis of acute appendicitis were managed during this study period. All patients were admitted and managed by both surgeon and obstetrician. Detailed 'clinical history and physical examination was performed and all patients were investigated by complete blood picture, urine analysis and ultrasonography of abdomen and pelvis. Appendicectomy was performed through Grid Iron incision. Macroscopic appearance of appendices and other operative findings were recorded and all specimens were sent for histopathology. All the patients were followed up till the out come of pregnancy. Twenty one patients were managed during this study period and out of these 21,13 patients were primigravida and 8 were multigravida. At presentation most of the patients were in their second trimester of pregnancy. Acute appendicitis was confirmed by histopathologically in 16 out of 17 patients with inflamed looking appendices [negative appendicectomy rate was 23.80%]. Foetal loss occurred in 2 patients [9.52%] and both were in their second trimester of pregnancy. One patient gave birth to a baby who had low birth weight [4.76%] and one patient who was operated in third trimester had premature labour [4.76%] three weeks prior to expected date. Remaining 17 patients delivered at term without any consequences. Two patients developed wound infection which responded to wound care and antibiotics. Acute appendicitis is the commonest cause of acute abdomen during pregnancy. A timely decision and a professional liaison among obstetrician and surgeon are key factors for a better outcome

Emergency Laparoscopic cholecystectomy for acute empyema of the gallbladder in pregnancy

This report describes a pregnant patient on whom emergency laparoscopic cholecystectomy was performed for empyema gallbladder. The patient was in her second trimester of pregnancy. The distended gallbladder was decompressed before dissection was commenced. There was no mortality, morbidity or conversion. There were no complications for either mother or child related to general anesthesia

Hidatidosis y embarazo / Hydatidosis and pregnancy

La hidatidosis constituye una zoonosis endémica en la IX Región de Chile.Esto, trae como consecuencia que se produzcan hechos considerados como rarezas dentro de la práctica clínica como la asociación de hidatidosis y embarazo. Se presentan 3 pacientes embarazadas portadoras de hidatidosis abdominal, intervenidas quirúrgicamente en nuestro servicio durante el período abril-diciembre de 1996. El diagnóstico fue confirmado mediante ecotomografía abdominal y determinación de inmunoglobulinas específicas. Se les sometió a cirugía a las 26, 38 y 14 semanas respectivamente. Todas las pacientes presentaban quistes fértiles. La evolución postoperatoria fue satisfactoria. En los dos primeros casos la interrupción del embarazo fue electiva mediante operación cesárea, con recién nacidos de término sin complicaciones. Ambas pacientes recibieron quimioterapia complementaria. El último caso, con una evolución postoperatoria correcta, cursa su embarazo en forma fisiológica. Las placentas sometidas a estudio histopatológico no demostraron evidencias de infestación con equinoccocus granulosus. Se presenta una serie de casos consecutivos de embarazadas con EH tratadas en forma agresiva. Creemos que esta conducta es plenamente justificada, dado los graves riesgos implícitos para el binomio madre-hijo

Carbon dioxide laser vaporization for genital wart.

The purpose of this study was to evaluate the effectiveness of carbon dioxide laser vaporization in the treatment of coalescent condyloma acuminata of the female lower genital tract. Between July 1990 and September 1992, 24 cases were enrolled in the study. There were 13 pregnant patients and 11 nonpregnant patients. We performed the procedure under colposcopic guidance on an out-patient basis. Carbon dioxide laser vaporization was carried out in continuity to an appropriate tissue depth with carbon dioxide brushing 1 cm around the lesion. Of these 24 cases, biopsy proven 2 residual lesions and 1 recurrence were documented at the 2nd week and the 2nd month postoperative, respectively. We found low rate of intraoperative and postoperative morbidity or complication, with mild to moderate vulvar pain in the patients and no gross scarring. It is concluded that carbon dioxide laser is effective for eradicating extensive condylomata in the female lower genital tract with low intraoperative and postoperative morbidity on an out-patient basis.

Endocardite infecciosa relacionada à gravidez / Infective Endocarditis in Pregnancy

PURPOSE--To report the intra-hospitalar and late follow-up of patients with infective endocarditis (IE) acquired in the pregnancy or puerperium. METHODS--Eleven patients, between 1984-1992 according to the beginning of the IE episode (fever and other signals) were studied. Patients were divided in two groups: IE of pregnancy (7 cases), and puerperal IE (4 cases). RESULTS--In the pregnancy IE group, mitral valve was affected in 6 (85), and aortic valve in 1 (15). During the course of the treatment, two patients had to be operated on, respectively, in the 24th and 28th week of the pregnancy. The 1st one had a successfully mitral valve replacement by a biological prosthesis but 48 h later she aborted, and the 2nd presented neurological complication (intracerebral hemorrhage) in the immediate post-operative period of a successfully mitral valve replacement by biological prosthesis. She was undergone to a cesarean but the fetus remained alive for 24 h only. If we look at the newborns (fetus), only 4 of them survived. Out of 3 fetal deaths, 2 had close association with mother cardiac surgeries. In the pregnant period acquired IE, 3 (47) mothers died. In the puerperium group, 2 mitral valves and 2 aortic valves had IE. Two of them had to be operated on due to an important aortic regurgitation and cardiac failure. There were no deaths in this group. CONCLUSION--During pregnancy, IE showed a high morbi-mortality for mother and concept. The mother's neurological complications played a major role in the poor outcome during the pregnancy period.

Apendicite aguda na gestaçäo: diagnóstico e conduta / Acute appendicitis in the pregnancy: diagnosis and treatment

Realizou-se a análise de sete casos de apendicite aguda na gravidez, ocorridos no Serviço de Cirurgia do Hospital Regional de Säo José (SC) entre 1987 e 1992, com a existência de um caso para cada 3.333 partos realizados. A idade gestacional das pacientes variou de 8 a 32 semanas, havendo predomínio da incidência no 2o. trimestre. A história clínica apresentada pelas pacientes foi semelhante, exceto em relaçäo à localizaçäo da dor, que foi descrita como em flanco direito em 2 casos e difusa em 1 caso. Nas pacientes que apresentaram tempo de evoluçäo da doença prolongado houve necrose e perfuraçäo apendicular. Näo houve mortes maternas. Como complicaçöes, ocorreram um caso de abscesso de parede no 7o. pós-operatóruio e um caso de trabalho de parto prematuro, no qual a inibiçäo näo foi possível, havendo nascimento de feto morto. As demais pacientes deram à luz fetos vivos, a termo, sem anormalidades

Gravidez e mal de Pott: relato de 2 casos / Pregnancy and Pott's disease: report of 2 cases

Säo apresentados dois casos de gestantes que apresentaram lesäo nervosa, por compressäo medular, conseqüente à destruiçäo vertebral por tuberculose (mal de Pott). Os casos apresentaram evoluçöes distintas, sendo que o diagnóstico tardio resultou em paraplegia definitiva, enquanto o tratamento precoce permitiu recuperaçäo da lesäo nervosa medular.

Sepse em obstetricia / Sepsis in obstetrics

O autor aborda a sepse como uma situacao ameacadora a vida da paciente, sendo a gravidez um fator predisponente. Destaca o abortamento septico, a pielonefrite, corioamnionite, as endonefrites e suas complicacoes, como situacoes de risco de choque septico. Descreve o manejo das principais situacoes clinicas e as formas de tratamento