Hemoperitoneum in a Peritoneal Dialysis Patient: Ruptured Ectopic Pregnancy.

Hemoperitoneum is a well-recognized complication in female peritoneal dialysis (PD) patients of childbearing age. Bloody effluent is commonly of minor nature, presenting during menstruation or midcycle, resolving after a few rapid exchanges without a need for further intervention. One must remain vigilant, however, and consider a broader differential diagnosis when hemoperitoneum is persistent or severe, as it indicates a serious and potentially life-threatening etiology. We report 2 episodes of hemoperitoneum in a PD patient occurring more than 1.5 years apart, with different underlying etiologies. The more dramatic second episode was due to a ruptured ectopic pregnancy, a condition which had not been reported as a cause of hemoperitoneum in dialysis patients to date and requires a high index of suspicion and prompt surgical intervention.

Urinary and anal incontinence in African American teenaged gravidas during pregnancy and the puerperium.

STUDY OBJECTIVE: To determine the prevalence of urinary and anal incontinence during pregnancy and immediately postpartum in a convenience sample of African American teenaged women in an urban setting and to assess for an association between this incontinence and obstetrical risk factors. METHODS: 74 African American adolescents, ages 14-19, participated in the study. During third trimester prenatal visits and at 6 weeks postpartum, participants completed the Wexner Continence Grading Scale and Urogenital Distress Inventory Short Form (UDI-6). Chart abstraction was conducted for other relevant history. RESULTS: Seventy-eight percent (58/74) of the adolescents were followed for the duration of the study; 22% were lost to follow-up. Incontinence was defined by a positive response on either questionnaire, irrespective of severity. In the third trimester, 44% of patients complained of urinary urge incontinence and 43% of stress incontinence; 12% complained of fecal and 41% of flatal incontinence. At six weeks postpartum, only 9% complained of urge incontinence and 5% of stress symptoms. Similarly, fecal incontinence decreased to 4% and flatal incontinence to 9%. Postpartum, the rate of flatal incontinence in the women who underwent instrumental deliveries was significantly increased when compared to those who had a spontaneous vaginal delivery or cesarean section (OR 12, P = 0.04). CONCLUSION: Urinary and anal incontinence is present in this convenience sample of pregnant African American teenagers and should be addressed during pregnancy and the puerperium. Instrumental delivery significantly increased the risk of flatal incontinence postpartum in this population.