Subject(s)
Infertility, Female/etiology , Leiomyoma/complications , Uterine Neoplasms/complications , Abortion, Spontaneous/etiology , Female , Humans , Infertility, Female/diagnosis , Infertility, Female/therapy , Leiomyoma/diagnosis , Leiomyoma/physiopathology , Leiomyoma/therapy , Pregnancy , Pregnancy Complications, Neoplastic , Treatment Outcome , Uterine Neoplasms/diagnosis , Uterine Neoplasms/physiopathology , Uterine Neoplasms/therapyABSTRACT
A 27-year-old woman, gravida 3, para 2002, underwent repeat cesarean section and inadvertent cystotomy, with subsequent development of a vesicouterine fistula. The fistula did not resolve with prolonged bladder catheterization and required total abdominal hysterectomy with resection of the fistula tract and primary closure for definitive treatment.
Subject(s)
Cesarean Section/adverse effects , Fistula/etiology , Urinary Bladder Fistula/etiology , Uterine Diseases/etiology , Adult , Female , Fistula/therapy , Humans , Hysterectomy , Pregnancy , Urinary Bladder Fistula/therapy , Urinary Catheterization , Uterine Diseases/therapyABSTRACT
Prescribing a contraceptive method for women with intercurrent disease poses a difficult clinical management problem for physicians. The contraceptive chosen may adversely affect the underlying disease of the patient. Conversely, failure of contraception could result in pregnancy, which could also adversely affect the patient's underlying disease. These factors must be taken into consideration in selecting appropriate and effective contraceptive agents to avoid complications and undesired pharmacologic interactions.
PIP: The selection of a contraceptive method for women with intercurrent disease necessitates complex balancing of the medical risks inherent in pregnancy and effects of the method on the underlying disease process. Presented in this review are contraceptive options for women with psychiatric, coagulation, cardiovascular, endocrine, and neurologic disorders as well as sickle cell disease and acquired immunodeficiency syndrome (AIDS). In women who are taking antidepressants or anti-anxiety medications, drug interactions can lower the efficacy of estrogen. Those with cardiovascular disorders face the potential adverse effects of exogenous steroids contained in oral contraceptives (OCs); at the same time, the need for effective methods is great given the increased cardiovascular demands of pregnancy. Current OC preparations can be safely prescribed to women with chronic nonvascular headaches, while the relationship between OC use and migraine remains inconclusive. In all cases, thorough counseling is essential to ensure informed consent and compliance.
Subject(s)
Blood Coagulation Disorders , Cardiovascular Diseases , Contraception , Mental Disorders , Blood Coagulation Disorders/complications , Blood Coagulation Disorders/drug therapy , Cardiovascular Diseases/complications , Contraceptives, Oral/adverse effects , Drug Interactions , Female , Humans , Mental Disorders/complications , Mental Disorders/drug therapyABSTRACT
Unusual complications of warfarin therapy include cutaneous necrosis and the "purple toe syndrome." The latter is more common in men and is not associated with vascular compromise; it usually occurs 3 to 8 weeks after warfarin therapy is begun and may persist for many months after the medication is discontinued. The following is a case of a 63-year-old woman who received warfarin therapy in conjunction with heparin for treatment of a left leg deep vein thrombosis. Approximately 8 hours after receiving her first dose of warfarin (15 mg), she developed acute pain, edema, and discoloration of the entire left leg to the mid-thigh, most prominent in the left great toe. After discontinuation of warfarin therapy, her symptoms completely resolved within 48 hours. This may be a report of a new cutaneous lesion associated with anticoagulant therapy.
