RESUMO
Many headaches following epidural analgesia are a consequence of a dural tap having occurred. However, this is not always the case and careful evaluation is required. A case of postpartum headache caused by an intracerebral haemorrhage is presented.
Assuntos
Analgesia Epidural , Analgesia Obstétrica , Hemorragia Cerebral/complicações , Cefaleia/etiologia , Hematoma/complicações , Adulto , Feminino , Cefaleia/fisiopatologia , Humanos , Período Pós-Parto , GravidezRESUMO
A 3-year retrospective survey of patients presenting with an antepartum haemorrhage (APH) to The Royal Women's Hospital, Melbourne, was undertaken. Cases of placenta praevia were excluded from the series. The overall perinatal mortality (PNM) was 14.5%. There were 98 patients with accidental haemorrhage (PNM 23.4%) and 101 patients with an APH of unknown aetiology (PNM 6%). Generalized uterine tenderness and tenseness were the most consistent features associated with imminent fetal compromise and it is in this group that an early resort to Caesarean section may be beneficial. The routine use of a clotting profile was found to be of little value, especially in patients with a mild haemorrhage.
Assuntos
Complicações Cardiovasculares na Gravidez/terapia , Hemorragia Uterina/terapia , Cesárea , Feminino , Monitorização Fetal , Humanos , Mortalidade Infantil , Recém-Nascido , Masculino , Gravidez , Estudos RetrospectivosRESUMO
A case of excessive fetal bleeding following scalp blood sampling is reported. The literature is reviewed and recommendations are made to reduce the incidence of this potentially fatal complication.
Assuntos
Sangue Fetal/análise , Doenças Fetais/etiologia , Hemorragia/etiologia , Punções/efeitos adversos , Couro Cabeludo , Adulto , Feminino , Hemorragia/diagnóstico , Humanos , Recém-Nascido , GravidezRESUMO
Thirty patients have been treated with heparin during pregnancy or in the immediate postpartum period. Twenty had severe preclamptic toxemia. Five presented before 30 weeks and in addition had low estriol levels and high blood ureas. The chance of a successful pregnancy in such patients is very low indeed; however 3 of these 5 patients had living babies. Even in patients presenting after 30 weeks of gestation, if severe preeclampsia is accompanied by low estriol levels and high blood urea levels, the anticipated fetal survival is poor. However, all 5 patients in this group were treated with heparin and had living babies. In the small group of patients with glomerulonephritis, there was a suggestion that heparin treatment may have been of value. Biopsy studies suggested that heparin may help to prevent lesions in arteries and arterioles which have been noted to develop in association with preeclamptic toxemia. In four patients treated in the postpartum period, there was possible benefit in terms of renal function, intravascular coagulation, vessel lesions, and subsequent successful pregnancies.
