ABSTRACT
BACKGROUND: Diabetic ketoacidosis (DKA) can have an atypical presentation during pregnancy. In the case of euglycemic DKA, relatively normal blood glucose levels can hinder a quick diagnosis. CASE DESCRIPTION: A 34-year-old DM1 patient, 31 weeks pregnant, was admitted because of reduced fetal movements and nausea. She had reduced the amount of insulin that her insulin pump administered and had a severe euglycemic DKA. The CTG was abnormal and there was a threat of preterm birth. She was treated with insulin, glucose and bicarbonate. A month later the patient underwent an emergency cesarean section because of an abnormal CTG. A daughter was born that weighed 4820 grams, the Apgar score was 5/8/8, and the pH was 7.14. The girl required intravenous glucose for a week. CONCLUSION: Euglycemic DKA during pregnancy requires swift recognition and treatment but this remains challenging.
Subject(s)
Diabetic Ketoacidosis , Premature Birth , Adult , Blood Glucose , Cesarean Section , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/drug therapy , Female , Humans , Infant, Newborn , Insulin , PregnancyABSTRACT
BACKGROUND: Acute fatty liver of pregnancy (AFLP) is a rare complication of pregnancy which is potentially fatal to mother and child. CASE DESCRIPTION: A primigravida at term with gestational diabetes presented at hospital complaining mainly of nausea and vomiting. Test results were consistent with acute fatty liver of pregnancy (AFLP). Due to the seriousness and rapid progression of the disease, we strove for a rapid delivery. The patient was admitted to the intensive care unit, but was eventually able to leave hospital in a good condition with a healthy child. CONCLUSION: AFLP is a rare and potentially dangerous condition of pregnancy and requires multidisciplinary collaboration. Knowledge of clinical symptoms, early diagnosis, treatment and anticipation of expected complications is essential to prevent the death of mother and child. Diabetes gravidarum can complicate the making of the diagnosis. More research into potential early diagnostics or screening instruments and the long-term outcomes for mother and child is necessary.
Subject(s)
Fatty Liver/diagnosis , Lipid Metabolism , Liver/metabolism , Nausea/diagnosis , Pregnancy Complications/diagnosis , Vomiting/diagnosis , Acute Disease , Adult , Diabetes, Gestational , Early Diagnosis , Female , Humans , Mass Screening , Nausea/etiology , Pregnancy , Pregnancy Outcome , Vomiting/etiologyABSTRACT
OBJECTIVE: To compare two methods for second trimester termination of pregnancy: mifepristone and misoprostol versus Dilapan and sulprostone. METHODS: This was a randomized study involving 16 patients with a singleton live fetus with congenital malformations or genetic disorders. Eight patients were treated with 200 mg mifepristone orally followed by 200 microg misoprostol vaginally 3 hourly and eight patients received a sulprostone infusion after cervical dilatation with Dilapan. RESULTS: Mifepristone and misoprostol had a mean induction interval of 17.8 hours and sulprostone and Dilapan 20.9 hours. The mean induction interval did not differ significantly. Mean hospital stay was shorter in the patients treated with misoprostol: 2.1 vs. 3.3 days (p = 0.02) with a 95% confidence interval of -2.1 to 0.3. CONCLUSION: Mifepristone and misoprostol did not reduce the induction interval significantly compared to the sulprostone and Dilapan treatment for second trimester pregnancy termination. Hospital admission was significantly shorter in patients treated with mifepristone and misoprostol.
Subject(s)
Abortifacient Agents/administration & dosage , Abortion, Induced/methods , Dinoprostone/analogs & derivatives , Mifepristone/administration & dosage , Misoprostol/administration & dosage , Polymers/administration & dosage , Adult , Dinoprostone/administration & dosage , Drug Therapy, Combination , Female , Humans , Length of Stay , Pregnancy , Pregnancy Trimester, Second , Prospective StudiesABSTRACT
Endometrial ablation is used extensively to treat dysfunctional bleeding. Since the introduction of Essure tubal sterilization, this permanent contraception method has been widely used. Both endometrial ablation and Essure sterilization are procedures reported to have only a few complications. We describe a serious infectious complication shortly after an endometrial ablation in a patient with Essure microinserts in situ. To our knowledge, this complication has not been reported before in patients with Essure microinserts in situ. We suggest administering prophylactic antibiotics before endometrial ablation in women with Essure microinserts in situ.
