[Severe maternal hepatopathies in the peripartum period--a case series with review of the literature focusing on pathogenesis and differential diagnosis]. / Lebensbedrohliche, maternale Leberaffektionen in der späten Schwangerschaft und im Wochenbett--eine Fallserie mit Überblick über Pathogenese und differenzialdiagnostische Abgrenzung.

BACKGROUND: A severe hepatopathy constitutes a serious threat during pregnancy and poses considerable challenges to the treating physicians. A broad spectrum of pregnancy-dependent or independent diseases like HELLP-syndrome, liver infection or acute fatty liver of pregnancy (AFLP) is characterized by these affections of the liver. In this study, we present a series of 3 cases with life-threatening hepatopathies and discuss the current state of the literature. A special focus is placed on pathogenesis and differential diagnosis. METHODOLOGY: Pathological, radiological and gynaecological/surgical procedures were performed according to the current German guidelines. Laboratory tests were conducted in the clinics' routine diagnostics section. The existing literature was reviewed via the US National Library of Medicine database "PubMed.gov". RESULTS: The first patient had been afflicted by a fulminant HELLP syndrome causing delivery after 32 weeks of pregnancy. Consecutively, she suffered a sub-total liver infarction followed by a severe coagulopathy and septic peritonitis. The second patient was diagnosed with HELLP syndrome at 36 weeks of pregnancy. The initially mild syndrome exacerbated after delivery leading to haemorrhagic shock and acute renal failure. In the third case, a woman with asymptomatic hepatitis B delivered in the 36th week of pregnancy. Post partum, her pre-existing condition worsened fulminantly resulting in sub-acute liver dystrophy and massive coagulopathy. DISCUSSION AND CONCLUSION: Whenever a hepatopathy occurs during pregnancy, several divergent diagnoses with severe implications and different aetiopathologies have to be considered. Diagnostic and therapeutic strategies have to be weighed quickly to enable a fast, interdisciplinary cooperation in order to prevent fatal outcomes.

[Influence of socio-economic status on the utilization of epidural analgesia during labor]. / Einfluss von Faktoren des sozioökonomischen Status auf die Anwendung der Periduralanästhesie subpartal.

OBJECTIVE: Evaluation of the influence of socio-economic status on the utilization of epidural analgesia during labor. MATERIAL AND METHODS: Modes of delivery, insurance, marital status and maternal occupation were retrospectively reviewed between 2000 and 2003 according to the birth documentation of all deliveries at the department of obstetrics and gynaecology, university of Wuerzburg, Germany. Using the maternal occupation groups were formed according to the minimum degree of education required for its practise. Women with epidural analgesia during labor were compared to those without it. RESULTS: 30 % of all deliveries during the evaluated four years were aided by employing epidural analgesics. For both collectives there were no changes of percentages concerning insurance, marital status or maternal occupation during this time. With 12-24 %, epidural analgesia was more often performed in patients undergoing operative transvaginal deliveries in comparison to women without epidural analgesics (2-5 %). There are no differences between the two groups concerning maternal occupation, insurance or marital status. However, looking at the collective of women with epidural analgesia during labor, epidural analgesia is more often used among women with private insurance. Concerning the degree of education there is also a marginal significant difference in the utilization of epidural analgesia in favour for women with a higher educational degree. CONCLUSION: The use of intrapartum epidural analgesia is associated with insurance and maternal occupation/educational degree.

[Placenta praevia percreta--a serious complication after previous cesarean section]. / Plazenta praevia percreta--eine schwere Komplikation nach vorausgegangener Sectio caesarea.

A 36-year-old G4P1 presented at 20 weeks gestation with vaginal bleeding. Her obstetrical history was significant for two first-trimester spontaneous abortions requiring curettage and a cesarean section. On admission placenta praevia was suspected by ultrasound. A placenta percreta was suspected by ultrasound follow-up at 30 weeks. At 33 weeks she underwent cesarean section because of serious vaginal bleeding. The profound blood loss with consecutive coagulopathy required an emergency hysterectomy and multiple blood transfusions. Placenta percreta is a rare but dramatic complication after previous cesarean section. This should be kept in mind as the rate of elective cesarean sections is rising continuously.