ABSTRACT
BACKGROUND: The management of an abnormally invaded placenta presents a challenging obstetric problem. Recent reports have suggested that a conservative approach to the treatment of this condition is appropriate in selected cases. We present the courses of two women with suspected placenta percreta who were managed conservatively and the complications that ensued. CASES: Two multiparous women underwent elective repeat cesarean deliveries and were found to have clinical evidence of placenta percreta with bladder invasion. In both cases, the placenta was left in situ and medical management was attempted with methotrexate. Both women developed significant delayed complications requiring reoperation and hysterectomy, and both required multiple transfusions. CONCLUSION: Conservative management of the abnormally invaded placenta should be undertaken with caution, and complications should be anticipated.
Subject(s)
Placenta Accreta/therapy , Female , Humans , Hysterectomy , Methotrexate/therapeutic use , Nucleic Acid Synthesis Inhibitors/therapeutic use , Pregnancy , Urinary Bladder Diseases/etiology , Urinary Bladder Diseases/therapyABSTRACT
A bottlenose dolphin was tested on its ability to echoically discriminate horizontal angular differences between arrays of vertically oriented air-filled PVC rods. The blindfolded dolphin was required to station in a submerged hoop 2 radial m from the stimuli and indicate if an array with two rods (S+) was to the right or the left of a single rod (S-). The angular separation between the two rods (thetaw) was held constant within each experiment while the angle between the S+ and the S-stimuli (thetab) varied to produce angular differences (deltatheta= thetab-thetaw) ranging from 0.25 to 4 degrees. In experiment I, thetaw was maintained at 2 degrees and in experiment II, thetaw was maintained at 4 degrees. Resulting 75% correct thresholds (method of constant stimuli) were 1.5 and 0.7 degrees, respectively. The two main findings of this study are: (1) decreasing the number of targets does not aid in localization, and (2) increasing the space between the rods enhances localization. Taken as a whole, the experiments suggest dolphins have a well-developed ability to resolve spatial information through sonar.
