The acute abdomen in pregnancy and postpartum of a teenager woman. Case report.

The acute abdomen with its many clinical aspects is not a condition that eludes pregnancy; acute appendicitis being the most frequently incriminated, but when it comes to its complication - peritonitis and the pregnant is a teenager, the cases cited in the literature are quite rare. We present the case of a 15-year-old teenager pregnant within 24 weeks admitted from the emergency department with the diagnosis of acute abdomen and operated for generalized peritonitis due to a perforated appendicitis. The microscopic analysis of the specimen indicated the presence of ulceration and extensive and deep and necrosis of the appendicle wall, the residual structures being dissected by a predominantly polymorphonuclear leukocytes inflammatory infiltrate associated with eosinophilic fibrinous deposits. Gangrenous extended necrosis of appendicle tissues, on the background of inflammatory thrombosis of appendicle vessels and mesothelium, sustained the diagnosis of acute gangrenous appendicitis. After a rather difficult evolution, she gave birth to a healthy fetus through a segmental-transverse Caesarean section at 35 gestational weeks. One week after the birth, the patient was operated for bowel obstruction by means of bridles and adherents. Both the appendicitis and the intestinal obstruction syndrome have been resolved by classic surgery. The fetal and maternal, vital and functional prognosis was good.

Placental abruption: etiopathogenic aspects, diagnostic and therapeutic implications.

The severe form of retroplacental hematoma is a serious accident in the second stage of pregnancy and at birth with frightening for the mother and fetus that often lead to death. The pathological mechanism presumes conditions for a "special ground" capital for the "efficiency" of the acute intradecidual vascular accident with the rupture of the uterus-placental arterioles. The complete clinical picture of this severe form of retroplacental hematoma - the placental abruption, observed and mentioned by the classics (vascular drama of Couvelaire) consists of five syndromes, 18 signs and symptoms, four paradoxes, phenomena not fully met in the other forms of retroplacental hematoma (minor and intermediate). The rate of incidence of retroplacental hematoma is in between 0.13-1.38% and depends on the environment, on the socio-economic and medical conditions, on the "obstetric education" and associated pathology. Our study aims at re-evaluating the clinico-paraclinical phenomenon imposed by the dramatism of the phenomenon of in utero placental apoplexy, the impact on neonatal mortality and on the functional prognosis from the point of view of surgical climax.

Uteroplacental apoplexy associated with invasive cervical neoplasm.

The cervical cancer is the worldwide second neoplasia in women, after the breast cancer. The incidence of invasive carcinoma in pregnancy is 1÷2000 to 1÷10 000 pregnancies. In most of the studies, almost all the patients had microinvasive carcinoma or limited cervical carcinoma at the cervix level. In the uteroplacental apoplexy, pathologically, retroplacental hematoma is formed while the fetus is still in the uterus. When speaking about the uteroplacental apoplexy, the fetal mortality is 100% and the maternal mortality can reach 5%. The particularity of the presented case is the association of the invasive cervical neoplasm, pathology unknown to the patient, with uteroplacental apoplexy, diagnosis for which she was hospitalized as an emergency. After the extraction of the dead fetus by segmental-transversal cesarean section, we continued to perform the total hysterectomy with adnexectomy. The fetus, the placenta, the uterus and the ovaries were sent for histopathological examination. Subsequently, the histopathological bulletin revealed cervical lesions in the neck of type cervical intraepithelial neoplasia (CIN) I, CIN II, CIN III, metaplastic squamous epithelium and moderately differentiated squamous cell carcinoma.