Spontaneous rupture of a splenic artery aneurysm in pregnancy: report of two cases.

The spontaneous rupture of a splenic artery aneurysm during pregnancy is a rare but catastrophic event. Two cases are reported, both involving fetal death and one maternal death as well. A review of the literature covering this condition shows that mortality amongst pregnant women remains high at 75% with 95% fetal loss, which compares with a 25% mortality rate amongst non-pregnant women. Clinical presentation is often non-specific, with good haemodynamic compensation, followed by a rapid deterioration. The best investigation appears to be a diagnostic laparotomy. The discussion stresses the importance of early diagnosis faced with this serious condition, as well as the potential benefits of a prompt lower mid-line incision in terms of statistical survival for both mother and fetus.

Labour analgesia in a patient with carnitine palmityl transferase deficiency and idiopathic thrombocytopenic purpura.

We report a case of a woman with carnitine palmityl deficiency (CPT) and idiopathic thrombocytopenic purpura, presenting in active labour at 38 weeks gestation. We discuss different anaesthetic factors involved with both diseases, and we propose an optimal management of such cases. Neuraxial analgesia with minimal motor blockade is indicated in early labour because it is necessary to alleviate stress in order to avoid rhabdomyolisis associated with CPT deficiency. Neuraxial analgesia is also needed because the theoretical risk of performing a caesarean section is higher than in a normal population, first because labour must be kept as short as possible and secondly because the possible thrombocytopenic in the baby precludes the use of instrumental delivery.

Complete hydatidiform mole and coexisting normal fetuses. A report of two cases with contrasting outcomes.

BACKGROUND: Multiple pregnancies consisting of a complete hydatidiform mole and coexisting fetuses are relatively rare but may become more common due to the increasing use of ovulation-induction agents. CASES: We report on a twin and a triplet pregnancy, conceived using clomiphene citrate, with contrasting outcomes. The twin pregnancy resulted in a term delivery of a healthy singleton and the triplet pregnancy in a termination at 17 weeks followed by the development of choriocarcinoma. CONCLUSION: The few cases available suggest that a subgroup of complete moles follows a more benign course and can be managed conservatively, allowing the pregnancy to go to term with appropriate follow-up, whereas other cases follow a more aggressive course. Larger case series are needed to develop definitive protocols.