[Rupture of splenic artery aneurysm--life-threatening condition for women during pregnancy and after birth (with report of one case)].

Spontaneous rupture of a splenic artery aneurysm is an uncommon and usually catastrophic event during pregnancy and puerperium. The mortality rate among pregnant women is very high at 75% with a fetus mortality rate of 95%. This report describes the clinical course of a 25-year-old woman with hemorrhagic shock four hours after elective Cesarean Section. Symptoms like hypotension, tachycardia, dyspnoe were initially suggestive of pulmonary embolism. Ultrasound demonstrated a nonechogenic mass in the abdomen suggestive of a fluid collection. Ruptured splenic artery aneurysm was recognized during the second emergency laparotomy for hemoperitoneum. Splenectomy was performed. The outcome for the patient was good. We underline that the only way to avoid a fatal event is to know and to think about this rare but very important complication in any woman with unexplained abdominal pain or with clear signs of haemorrhage during pregnancy or shortly after delivery.

[Caesarean section by vertical incision of lower uterine segment].

OBJECTIVES: The aim of the study is to analyze the use of vertical incision of the lower uterine segment when performing Caesarean section (CS). MATERIAL AND METHODS: The study includes 89 pregnant women who delivered by CS. The main group includes 40 cases with vertical incision in lower uterine segment (preliminary intention, but final decision made during surgery) and controls--49 cases with transversal incision of lower uterus segment with difficulties/complications of fetus extraction (30 with uterine lacerations and 19 with T-form incision). The mean gestational age in the main group is 32 g.w. (range 26-39) vs. 31 in control group (27-39). RESULTS. Vertical incision of the uterus is performed in 57.5% due to prematurity and lack of enough space for transversal incision (lower uterine segment not yet formed), in 25 % the cause is situs transverses of the foetus and the rest of the cases are related with technical difficulties in isthmicotransversal approach (myoma praevia, anomalies of the uterus, adhesions of the omentum). C.S. is performed for mean 66 min. in the main group vs. 74 min. with controls (p < 0.05). Time to extraction of the foetus is less than a minute in main group vs more than a minute with controls. No lacerations are found with vertical incision of uterus. Blood loss in main group is 664 ml, vs. 884 ml in control group (p < 0.05). Mean values of pH from umbilical artery of the newborn is 7.257 in main group vs. 7.19 in controls (p < 0.05), resp. Apgar scores atb 5-th min. is 7 vs 6. CONCLUSIONS. Vertical incision of lower uterine segment before the formation of the latter, with situs transversus of the foetus and difficult approach renders the option for less lacerations intra operationem, less birth trauma with better final outcome for the newborn.