Postpartum splenic rupture.

BACKGROUND: Spontaneous splenic rupture in pregnancy is rare and occurs most commonly in the third trimester or puerperium. CASES: In the first case, an eclamptic woman had postpartum uterine atony that necessitated hysterectomy. She was reexplored for increasing abdominal girth and evidence of hemoperitoneum on computed tomography scan. An actively bleeding defect was noted in the spleen, necessitating splenectomy. In the second case, a patient with cholestasis of pregnancy developed persistent bleeding after manual removal of the placenta, requiring a suction curettage followed by hysterectomy. Reexploration because of a dropping hematocrit revealed a capsular defect on the spleen, for which splenectomy was performed. CONCLUSION: A high index of suspicion of postpartum splenic rupture is imperative because delay in the diagnosis can lead to catastrophic consequences. Thus, it is vital to evaluate the entire abdomen in posthysterectomy hemoperitoneum.

Neonatal outcome of growth discordant twin gestations.

The aim of the study was to compare a variety of neonatal outcome variables of growth concordant twin gestations (CT) to that of growth discordant twins (DT). Maternal and neonatal charts of live, non-anomalous twins > 25 weeks' gestation from 1984-2000 with no evidence of twin-twin transfusion syndrome were reviewed for several variables. DT occurred in (N = 81) 11.9% of all twin pregnancies. In 61.7% of DT, twin B was the smaller of the twins. There was no difference in maternal age, admission indications, or antepartum complications between both groups. DT had a significantly higher incidence of growth restriction compared to CT (88.9% vs 43.5%, p < 0.001). More mothers of DT required oxytocin (37.0% vs 26.3%, p = 0.024); however, cesarean delivery rate and indications were similar in both groups. A similar percentage of infants had AS < 4 at 1 min and AS < 7 at 5 min in both groups. There was no difference between the 2 groups in neonatal complications including: trauma, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, pneumonia, seizures, or neonatal mortality. However, DT had a significantly higher incidence of hyperbilirubinemia, need for mechanical ventilation and a longer nursery stay. The neonatal outcome of growth discordant twins is worse than that of concordant twins even in pregnancies uncomplicated by twin-twin transfusion syndrome or congenital anomalies.

Measuring gynecological morbidity: evaluating two different data sources from Beirut.

The lack of consensus over the most appropriate source to use in assessing reproductive morbidity could, in part, explain the inadequacy of available information on the subject. To outline this situation, gynecological morbidity data collected from two different sources in Beirut, Lebanon, namely, population-based health interviews (779 ever-married women aged between 15 and 49) and private gynecologists' clinics (867 women with similar characteristics), are described. Although neither source is likely to represent the true prevalence of gynecological conditions, both agree sufficiently to shed light on the importance of some conditions such as menstrual disturbances (15% in both samples), infections/inflammations (17% in the households sample), and infertility-related concerns (12% in the clinics sample). Interestingly, despite the demographic differences, the most common conditions that the women complained about and the most common diagnoses that the gynecologists offered were similar for both samples. Therefore, given that the logistics in the gynecologists' clinic survey were easier, we recommend the use of health service data in settings where a representative sample of providers can be identified and service use is high.