PATHOLOGICAL ADHERENCE OF PLACENTA - CASE REPORTS.

Major obstetric hemorrhage is the leading cause of maternal morbidity and mortality. In rare cases, life-threatening hemorrhage in pregnant women may result from abnormal adherence of placenta. Three grades of abnormal placental attachment are defined according to the depth of invasion: placenta accreta, placenta increta, and placenta percreta. An important risk factor for placenta abnormal adherence of placenta is placenta previa in the presence of a uterine scar. The increased prevalence of cesarean section, uterine surgery, and increasing parturient age and parity have led to an increased incidence of abnormal placentation, from one in 2,500 a quarter century ago, to one in 533 deliveries currently. Placenta percreta significantly increases risk for both maternal and fetal morbidity and mortality. Placental invasion of the bladder carries a maternal morbidity of 9.5% and perinatal mortality of 24%. Prevention of the maternal death in the condition when the patients have uterine scarring or a history of other invasive procedures may be improved by the adequate preoperative diagnostics of these conditions. When it involves the urinary bladder, a multidisciplinary approach utilizing a team of physicians and surgeons representing urology, radiology, and obstetrics-gynecology is the key to successful management.

Pheochromocytoma and pregnancy: complications and solutions (case report).

Hypertension is the most common medical complication of pregnancy. Pheochromocytoma in pregnancy is rare, and if unrecognized, can cause serious perinatal morbidity and mortality. A patient with paroxysmal hypertension, postpartum intraabdominal bleeding, and a recognized pheochromocytoma is described. A 36-yr-old previously practical healthy woman (gravida 4, para 3) presented to our tertiary care centre at at 26 weeks four days gestation with a history of labile blood pressure and severe hypertension. A two week prior to admission she began having episodes of severe headache, sweating, nausea and dizziness. On an obstetric visit she was noted to be severely hypertensive with a blood pressure of 220/120 mmHg. Ultrasound imaging demonstrated a 11,6 cm x 9,2 cm right adrenal mass, biochemical investigations confirmed the diagnosis of pheochromocytoma. The patient was invasively monitored in the intensive care unit and treated with alpha-blockers and doxazosin. A multidisciplinary conference was organized involving endocrinology, anesthesiology, general surgery and obstetrics to determine the most appropriate management of the patient. Childbirth was performed by elective Cesarean Section with simultaneous laparatomic right-sided adrenalectomy. Postoperative period was complicated with intraabdominal bleeding consequently treated during relaparatomy. The primary goals in the management of pheochromocytoma in pregnancy are early diagnosis, usage of alpha-blockers, and avoidance of a hypertensive crises during delivery and definitive surgical treatment. Timing of surgical resection will depend on the gestational age at which diagnosis is made. Cesarean section is the preferred mode of delivery when the tumor is still present. Complications such is bleeding from adrenalectomy site should be considered. This case illustrates that with antenatal diagnosis, advanced methods of tumor localization, adequate preoperative adrenergic blockade and team planning, pheochromocytoma in pregnancy can be treated successfully even in complicated cases.

Effect of magnesium and furosemide on bronchial asthma.

In recent years along with the conventional bronchodilatators the data of so called "extraordinary bronchodilatators" have appeared, among which there are furosemide and magnesium sulphate. However these data concern their bronchoprotection properties (those often are contradictory), and about bronchodilatative properties of these medications nothing is known. Proceeding from above stated the purpose of our study was the investigation of bronchodilative effectiveness of magnesium and furosemide delivered through an inhalation route in treatment of mild and severe course of bronchial asthma. The study was performed on patients with bronchial asthma in age of 20-70 (39 persons), who were in-patients of Allergology and Clinical Immunology Center of TMSU. For the study the double-blind placebo-controlled trial with crossover design and parallel study methods were used. As primary variables following data were assumed: the forced expiratory rate, respiratory rate and heart rate. The analysis of obtained results by t-statistics methods has shown that the effectiveness of magnesium comparatively to placebo has been insignificant in quantitative improvement (though statistically reliable), and the furosemide has comparatively better bronchodilative effect (particularly in case of PEF).