A Rare Case of Acute Myocardial Infarction in Pregnancy: Successful Treatment Strategies.

BACKGROUND Acute myocardial infarction during pregnancy is rare, but is associated with a high mortality rate, particularly during labor and delivery. This article concerns a 23-year-old woman with a history of insulin-treated gestational diabetes and hypothyroidism treated with levothyroxine presenting at 32 weeks of pregnancy with acute chest pain and coronary artery occlusion requiring angioplasty followed by cesarean delivery. The aim of this report is to outline the diagnostic difficulties of acute coronary syndromes during pregnancy and to present their treatment. CASE REPORT A 23-year-old female patient at 32 weeks' gestation treated for insulin-dependent diabetes mellitus and hypothyroidism was admitted to the hospital due to acute chest pain. The ECG showed ST-segment elevation in leads I, aVL, and V4-V6 and elevated troponin T. Based on this, the patient was diagnosed with myocardial infarction and given low-molecular heparin, followed by primary coronary angioplasty with revascularization. After the procedure, she received dual antiplatelet therapy (DAPT) with acetylsalicylic acid and clopidogrel. The pregnancy was terminated at 38 weeks by cesarean section, delivering a healthy baby. CONCLUSIONS This report shows the importance of rapid and accurate diagnosis and management of acute myocardial infarction during pregnancy, and delivery by cesarean section, to ensure survival of the mother and the child.

Hemoglobin Levels and Platelet Counts after Hysteroscopy Due to Abnormal Uterine Bleeding.

Abnormal uterine bleeding (AUB) is a condition defined as all uterine bleeding that differs from physiological menstruation. The etiology of AUB has been classified by the International Federation of Gynecology and Obstetrics (FIGO). It includes structural categories, such as endometrial polyps, adenomyosis, leiomyomas, hyperplasia, and malignant neoplasms, and non-structural categories, i.e., hemorrhages due to congenital and acquired coagulopathies, ovarian dysfunction, disorders of the local endometrial hemostasis mechanism with normal organ structure, iatrogenic causes, and due to other poorly defined causes. This is a retrospective study based on the medical data of a group of 543 women aged 21−88 years (52.81 ± 11.79) (p < 0.01) hospitalized at the Gynecology and Obstetrics Department in Biala Podlaska, Poland. These patients underwent an hysteroscopy procedure due to excessive uterine bleeding of varied, FIGO-divided etiology. The results show the dependence of postoperative hemoglobin and platelet count on the etiology of bleeding and the age of the women. The majority of patients had normal hemoglobin and platelet counts after the procedure, while moderate anemia was the most common disorder. It occurred most frequently in patients undergoing hysteroscopy due to heavy menstrual bleeding.

Heterotopic pregnancy - case report.

OBJECTIVE: Heterotopic pregnancy is the simultaneous occurrence of intrauterine and ectopic pregnancy. This situation is very rare (1:30 000 pregnancies), while recently, with the development of assisted reproductive techniques, the incidence has increased to 1:100 - 1:500 pregnancies. The aim of the study is to present the situation of coexistence of intrauterine pregnancy and ruptured tubal pregnancy. PATIENTS AND METHODS: The case concerns a 32-year-old patient in the 12th week of the second pregnancy in whom the only risk factor was the state after Caesarean section and thus possible intraperitoneal adhesions. The ultrasound revealed normal intrauterine pregnancy and a very large amount of free fluid in the smaller pelvis. After immediate surgical intervention, a ruptured right tubal pregnancy was found. Right fallopian tube was removed. After the operation, the patient with the preserved intrauterine pregnancy was discharged from the ward. Further intrauterine pregnancy was normal. Delivery by Caesarean section. CONCLUSION: Conclusions: The described case indicates that the existence of intrauterine pregnancy does not exclude the existence of ectopic pregnancy and emphasizes the great importance of correctly and accurately carried out ultrasound examination in the first trimester of pregnancy along with appendicitis assessment. Early diagnosis of heterotopic pregnancy reduces the risk of complications.