Safe management of cesarean section in a patient of Eisenmenger syndrome.

We report our experience of a 29-year-old female with a complete atrio-ventricular septal defect leading to a single ventricle physiology and Eisenmenger syndrome. The patient successfully underwent spinal anesthesia for cesarean section in the 31 st week of pregnancy. A multidisciplinary approach involving cardiologist, cardiac surgeon, obstetrician, and anesthesiologist was utilized to achieve a safe pregnancy and cesarean for the delivery of the baby. A close clinical assessment is required, especially during the third trimester when the risk of acute right ventricular dysfunction increases. The use of extracorporeal membrane oxygenation (ECMO) (as a bridge to recovery or bridge to salvage) was planned to support oxygenation and circulation in case of acute biventricular dysfunction. The delivery/cesarean section was performed in a cardiac surgery operating room, and to reduce the time-frame for ECMO institution the femoral vessels were exposed surgically before the cesarean section.

Pregnancy associated breast cancer [PARC]

Pregnancy associated breast carcinoma is an entity which is diagnosed during pregnancy or within one year postpartum. [1] To understand the pathogenesis of pregnancy associated breast carcinoma. [2] To be able to manage this problem most effectively in the interest of fetus and mother. [3] To be able to avoid preventable complications of treatment. The pregnancy associated breast carcinoma can be managed effectively with various treatment modalities during various stages of pregnancy and lactation. It is not worse than the stage wise carcinoma breast in non pregnant women of the same age

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

Cesarienne elective : indications; techniques et pronostic maternel. A propos de 358 cas colliges au Centre Hospitalier et Universitaire (CHU) de Cocody de 2000 a 2001

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