ABSTRACT
BACKGROUND: Avitaminosis can result from the acute malnutrition associated with prolonged pregnancy-related hyperemesis. Serious complications may arise from thiamine deficiency under these circumstances. CASE: We review the relevant literature and describe a case with central nervous system involvement presenting with typical manifestations of Wernicke's encephalopathy, apparently precipitated by a combination of hyperemesis gravidarum, diabetic ketoacidosis, and intravenous glucose administration. CONCLUSION: While this life-threatening complication is rare, it is important for all who care for obstetric patients to be aware of it and alert to its development. Early recognition is critical given the need to treat affected women expeditiously to help avoid potentially fatal adverse consequences. Prophylactic thiamine supplementation should be considered in the care of gravidas with hyperemesis.
Subject(s)
Diabetes, Gestational , Diabetic Ketoacidosis/complications , Hyperemesis Gravidarum , Pregnancy Complications/etiology , Wernicke Encephalopathy/etiology , Adult , Female , Humans , PregnancyABSTRACT
BACKGROUND: Hemorrhage is a serious threat with placenta accreta, often requiring aggressive operative intervention by hysterectomy and resuscitative measures with large-volume blood replacement to ensure survival. Refusal to accept transfusion makes management especially difficult. CASE: We report a Jehovah's Witness patient who had 9 previous cesarean deliveries and presented with anemia and placenta previa percreta invading the bladder wall. Management objectives were to enhance the patient's status, using erythropoietin and autologous transfusion, and to minimize the chance of hemorrhage by prophylactic uterine artery embolization. The placenta was left in situ after the delivery with no untoward consequences. Methotrexate was held in readiness, but was not required as adjuvant therapy. CONCLUSION: Effective care of such patients requires close collaborative team effort and advanced planning to ensure a good outcome.
Subject(s)
Blood Transfusion/methods , Embolization, Therapeutic/methods , Erythropoietin/therapeutic use , Jehovah's Witnesses , Placenta Previa/therapy , Adult , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Placenta Previa/diagnosis , Pregnancy , Pregnancy Trimester, Second , Risk Assessment , Transplantation, Autologous , Treatment Outcome , Uterine Hemorrhage/etiology , Uterine Hemorrhage/therapyABSTRACT
OBJECTIVE: To determine if manual vs. spontaneous delivery of the placenta at cesarean section affects the rate of postoperative endometritis and amount of blood loss. STUDY DESIGN: A prospective, randomized study was carried out on patients who had cesarean delivery assigned either to spontaneous delivery of the placenta (group 1) or manual removal (group 2). We excluded patients undergoing emergency cesareans and those with possible placenta accreta or evidence of preexisting infection. Outcome measures (frequency of endometritis and quantitative decrease in hemoglobin) were compared for the two groups. RESULTS: Study criteria were met for 375 subjects: 177 in group 1 and 198 in group 2. Endometritis was diagnosed in 1.7% of the former and 2.5% of the latter. The change in hemoglobin, reflecting operative blood loss, was similar in both groups (-1.81 and -1.72 g/dL, respectively). CONCLUSION: We found no significant difference in either postoperative endometritis or blood loss regardless of the means used to effect delivery of the placenta. The frequency of febrile morbidity in our study cases was considerably lower than heretofore reported.
