Phlegmasia Cerulea Dolens and May-Thurner Syndrome in the first trimester of Pregnancy.

Background Venous thromboembolism in pregnancy remains one of the leading causes of morbidity and mortality. Case A young, gravid patient presented with a cyanotic, edematous left lower extremity with no distal pulses palpable. She was emergently taken to the operating room and was found to have extensive iliofemoral thrombosis requiring femoral angioplasty and embolectomy with 43.7-rad intraoperative radiation exposure. Phlegmasia cerulea dolens and May-Thurner syndrome were diagnosed. Conclusion Timely diagnosis and prompt surgical management are necessary due to the limb-threatening nature of this condition. Despite maternal radiation exposure, the nature and extent of fetal effects depends upon radiation dose and gestational age.

Discordance of first-trimester crown-rump length is a predictor of adverse outcomes in structurally normal euploid dichorionic twins.

OBJECTIVE: The purpose of this study was to determine the association between discordant crown-rump length (CRL) measurements in structurally normal euploid dichorionic twins and adverse pregnancy outcomes. METHODS: This retrospective cohort study included women with dichorionic twins who underwent chorionic villus sampling and delivered in our facility from January 2000 to September 2007. Only pregnancies with viable twin fetuses and normal karyotypes were included. The association between CRL discordance, defined as a CRL discrepancy of 9% or greater, and adverse pregnancy outcomes was evaluated. RESULTS: Seventy-eight women met inclusion criteria and included 24 discordant twins (group 1) and 54 concordant twins (group 2). Maternal ages were similar: mean ± SD, 38.2 ± 3.1 years in group 1 versus 39.2 ± 3.9 years in group 2 (P = not significant). The median gestational ages at delivery were 35.6 ± 3.1 weeks in group 1 and 37.3 ± 2.0 weeks in group 2 (P < .01). At least 1 major complication occurred in 19 women (79%) in group 1 and 25 (46%) in group 2 (P = .01). Group 1 had significantly more major complications overall (P = .0008). Preterm premature rupture of membranes occurred in 10 women (42%) in group 1 and 6 (11%) in group 2 (P = .005). Delivery before 37 weeks' gestation occurred in 19 of 24 women (79%) in group 1 and 24 of 54 (44%) in group 2 (P = .006). There was a significant difference for younger gestational age at delivery in the discordant group (P < .01). CONCLUSIONS: Our data suggest that there is an increased risk of adverse pregnancy outcomes in chromosomally normal dichorionic twins with first-trimester discordant CRL measurements. These results may be clinically useful for counseling, management, and antenatal surveillance.

Subgaleal hemorrhage after the use of a vacuum extractor during elective cesarean delivery: a case report.

BACKGROUND: Subgaleal hemorrhage (SGH) is a rare but possibly fatal condition in the neonate. Vacuum extractors are effective options for operative vaginal delivery. However, their use can increase the risk of intracranial hemorrhage in the neonate. CASE: A male infant delivered by cesarean section with assistance of a vacuum extractor had SGH attributed to the vacuum. CONCLUSION: The application of a vacuum extractor can increase the risk of trauma, including SGH. Good communication between health care providers and the use of the same precautions as with a vaginal delivery are advised.