RESUMO
The authors present a case of splenic artery aneurysm rupture, which neatly illustrates some of the problems of modern medical practice and the potential detriment of blind adherence to protocol driven care, without adequate reflection on the whole clinical picture and possible alternative diagnoses.
Assuntos
Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Aneurisma/diagnóstico por imagem , Oclusão com Balão/métodos , Embolia Pulmonar/diagnóstico , Artéria Esplênica , Adulto , Angiografia/métodos , Diagnóstico Diferencial , Feminino , Seguimentos , Idade Gestacional , Humanos , Trabalho de Parto , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/cirurgia , Período Pós-Parto , Gravidez , Embolia Pulmonar/terapia , Radiografia Intervencionista/métodos , Doenças Raras , Medição de Risco , Resultado do TratamentoAssuntos
Corioamnionite/diagnóstico , Cisto Dermoide/diagnóstico , Ruptura Prematura de Membranas Fetais/diagnóstico , Neoplasias Ovarianas/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Dor Abdominal/etiologia , Adulto , Cisto Dermoide/complicações , Feminino , Humanos , Neoplasias Ovarianas/complicações , Gravidez , Recidiva , Ruptura EspontâneaRESUMO
Fetal bradycardia is a recognized response to maternal hypothermia but has not previously been reported in conjunction with diabetes. A 30-year-old insulin-dependent diabetic was admitted at 35 weeks gestation for control of her diabetes. She developed maternal hypothermia and hypoglycemia and the fetal heart rate fell to 100 beats per minute (b.p.m.). However, the fetal heart rate gradually returned to normal after rewarming the patient.
Assuntos
Diabetes Mellitus Tipo 1/complicações , Frequência Cardíaca Fetal , Hipoglicemia/complicações , Hipotermia/complicações , Gravidez em Diabéticas/complicações , Adulto , Bradicardia/etiologia , Feminino , Doenças Fetais/etiologia , Humanos , Gravidez , Terceiro Trimestre da GravidezRESUMO
OBJECTIVE: To assess the relation between the indication for fetal blood sampling and pregnancy loss following the procedure. DESIGN: Retrospective study. SETTING: The tertiary referral Fetal Medicine Units at Guy's and University College Hospitals, London. SUBJECTS: Women undergoing diagnostic fetal blood sampling in four groups: (1) 94 having prenatal diagnosis with normal ultrasound findings; (2) 94 with a structural fetal abnormality; (3) 30 having fetal assessment and (4) 35 with non-immune hydrops. INTERVENTIONS: Freehand ultrasound guided fetal blood sampling from umbilical cord, intrahepatic vein or fetal heart. MAIN OUTCOME MEASURES: Pregnancy losses were divided into those within 2 weeks and those 2 weeks after the procedure, obstetric accidents and neonatal deaths. RESULTS: The 253 patients had fetal blood sampled on 268 occasions. Fifty-one pregnancies were terminated. Overall, 51 of the remaining 202 desired continuing pregnancies were lost, of which 19 (9%) were lost within 2 weeks of the procedure. After exclusion of the pregnancies that were terminated, the procedure-related losses within 2 weeks of sampling were 1 in 76 (1%), 5 in 76 (7%), 4 in 29 (14%) and 9 in 36 (25%) in groups 1, 2, 3 and 4 respectively. CONCLUSIONS: The risk of fetal blood sampling is increased in abnormal pregnancies, reflecting the underlying pathology and this must be taken into account when counselling patients before the procedure.
Assuntos
Aborto Espontâneo/etiologia , Coleta de Amostras Sanguíneas/métodos , Sangue Fetal/química , Diagnóstico Pré-Natal/métodos , Anormalidades Congênitas , Feminino , Doenças Fetais/diagnóstico , Humanos , Hidropisia Fetal/diagnóstico , Gravidez , Estudos Retrospectivos , Risco , Fatores de TempoRESUMO
We report five cases of enlarged, hyperechogenic kidneys detected prenatally where the liquor volume was normal or increased. The etiology was different in all cases and included infantile and adult polycystic kidney disease, Perlman syndrome, trisomy 13 and cystic dysplasia. The differential diagnosis of such findings is discussed and other cases reported in the literature are reviewed.
