11/274. Multi-system cytomegalovirus fetopathy by recurrent infection in a pregnant woman with hepatitis B.A pregnant woman with acute hepatitis b virus (HBV) infection had her second pregnancy terminated at 25 weeks' gestation because of fetal ascites and ventriculitis. meconium peritonitis was also found at autopsy. No HBV dna but cytomegalovirus (CMV) dna was detected in the fetal liver and ascitic fluid. Recurrent maternal CMV infection was demonstrated by pre-existing CMV IgG antibodies, high IgG avidity and low IgM levels. After abortion, the patient developed chronic active hepatitis. Nevertheless, having become pregnant again with a new partner, she had an uneventful third pregnancy and gave birth to a healthy boy.- - - - - - - - - - ranking = 1keywords = pregnancy, gestation (Clic here for more details about this article) |
12/274. Acute jaundice in pregnancy: acute fatty liver or acute viral hepatitis?In this case, the difficulty in differential diagnosis between acute viral hepatitis and acute fatty liver of pregnancy was analyzed. These 2 conditions often raise controversal question regarding the decision making on emergency anesthesia for cesarean section to avert complications and optimize management. The dilemma in which an anesthesiologist is put is whether to promise the anesthesia straightaway in the face of a demonstrable acute jaundice in pregnancy to advise a postponement of surgery until a turn for the better. In this embarrassing situation, the authors suggest that a postpronement of surgery is rational to observe the development during which both the mother and the fetus should be closely monitored. Once the necessity of a cesarean section outweighs the benefit of transitional conservative treatment, it should be performed immediately.- - - - - - - - - - ranking = 2.8148074375273keywords = pregnancy (Clic here for more details about this article) |
13/274. Obstetric triage: management of acute nonobstetric abdominal pain in pregnancy.Acute, nonobstetric abdominal pain is a common complaint during pregnancy. Both anatomic and physiologic variations in pregnancy cloud the clinical picture when attempts at clinical decision-making and triage are made. Abdominal disorders such as appendicitis, gallbladder disease, pancreatitis, bowel obstruction, liver disease, pyelonephritis, and inflammatory bowel disease are explored from an obstetric triage perspective. Key triage points are noted to augment clinical assessment by the practitioner.- - - - - - - - - - ranking = 2.8148074375273keywords = pregnancy (Clic here for more details about this article) |
14/274. Gestational thyrotoxicosis with acute wernicke encephalopathy: a case report.A 35-year-old hyperthyroid woman who developed nausea, vomiting, tachycardia, nystagmus and mental disturbance, was referred to our hospital with a suspected diagnosis of thyroid storm. However, the thyroid gland was only slightly palpable, bruits were not audible, and exophthalmos was not present. serum levels of thyroid hormone were increased, but TSH receptor antibodies were negative. Echography and color flow doppler ultrasonography revealed a slightly enlarged thyroid gland and a slightly increased blood flow, both of which were much less milder than those expected for severe hyperthyroid Graves' disease. Under the diagnosis of hyperthyroidism due to gestational thyrotoxicosis associated with wernicke encephalopathy, vitamin B1 was administered on the first day of admission. Her consciousness became nearly normal on the second day except for slight amnesia. Her right abducent nerve palsy rapidly improved, but horizontal and vertical nystagmus, diminished deep tendon reflexes and gait ataxia improved only gradually. MRI findings of the brain were compatible with acute wernicke encephalopathy. We concluded that history taking and physical findings are important to make a differential diagnosis of gestational thyrotoxicosis with acute wernicke encephalopathy from Graves' thyroid storm, and that wernicke encephalopathy should be treated as soon as possible to improve the prognosis.- - - - - - - - - - ranking = 0.12346170831511keywords = gestation (Clic here for more details about this article) |
15/274. prenatal diagnosis of tracheal obstruction: possible association with maternal pertussis infection.A fetus with the sonographic appearance of echogenic and enlarged lungs and dilated trachea and bronchi, indicating laryngotracheal obstruction, is reported. Additionally, the fetus had ascites and subcutaneous edema and the amniotic fluid volume was reduced. Doppler flow investigation of the systemic venous circulation revealed signs of heart failure, and color Doppler visualized possible increased pulmonary flow. Following termination of pregnancy, autopsy confirmed the sonographic observations and revealed a hypoplastic thymus. During the present pregnancy the mother suffered from sustained cough, and serological tests revealed acute pertussis infection. polymerase chain reaction investigation for bordetella pertussis in the amniotic fluid was negative. The possibilities of pertussis toxins as noxious factors and of an atypical presentation of DiGeorge anomaly are discussed.- - - - - - - - - - ranking = 0.93826914584245keywords = pregnancy (Clic here for more details about this article) |
16/274. Acute heart failure in the parturient--do not forget phaeochromocytoma.Phaeochromocytoma is a rare condition and extremely rare in pregnancy. Diagnosis is notoriously difficult, as phaeochromocytoma may present a broad spectrum of clinical manifestations. The key to a successful outcome is a high index of suspicion of its existence and its early diagnosis.- - - - - - - - - - ranking = 0.46913457292122keywords = pregnancy (Clic here for more details about this article) |
17/274. extracorporeal membrane oxygenation in pregnancy.We describe the use of extracorporeal membrane oxygenation in pregnancy. There were no major complications, and the outcome was successful for mother and baby.- - - - - - - - - - ranking = 2.3456728646061keywords = pregnancy (Clic here for more details about this article) |
18/274. Acute fatty liver in the second trimester.BACKGROUND: Acute fatty liver of pregnancy is a rare, potentially fatal disease that occurs in the late third trimester or early postpartum period. The case of a woman with acute fatty liver in the second trimester is presented. CASE: A 35-year-old woman, gravida 5, para 4, presented at 22 weeks' gestation with nausea, vomiting, malaise, weight loss, and moderately elevated liver transaminase levels. The differential diagnoses included viral gastroenteritis and cholelithiasis. During the next 12 days, her transaminase levels increased, jaundice developed, her sensorium changed, and coagulopathy appeared. After the patient was transferred to a tertiary care hospital, acute fatty liver of pregnancy was diagnosed. The woman rapidly improved after delivery. CONCLUSION: Although acute fatty liver of pregnancy usually occurs in the late third trimester or early postpartum period, it can occur in the second trimester.- - - - - - - - - - ranking = 1.4691345729212keywords = pregnancy, gestation (Clic here for more details about this article) |
19/274. Coronary artery plaque disruption as cause of acute myocardial infarction during cesarean section with spinal anesthesia.A 31-year-old parturient delivered twins at 35 weeks' gestation by cesarean section with spinal anesthesia. Following anesthesia induction, hypotension and bradycardia occurred, and were immediately treated with theodrenaline plus cafedrin (Akrinor) and atropine. blood pressure and heart rate increased to 180/100 mmHg and 140 beats per minute, respectively. Several minutes later, the patient developed a myocardial infarction (MI) that she survived after intensive care treatment without sequelae. Although the coronary angiography showed normal coronary vessels, an intravascular ultrasound study demonstrated an atheroma in the left main coronary artery with ruptured fibrous cap. Laboratory screening for risk factors of coronary artery disease (CAD) showed hypercholesterinemia, increased factor vii activity, and hyperfibrogenemia. Angiographically normal coronary vessels are frequently found in pregnant patients who suffered MI. In these patients, coronary spasms have been discussed as the major mechanism of disease. Our case demonstrates that a significant CAD may be present despite angiographically normal findings. Plaque rupture was triggered by hypertension and led to MI as the first symptom of disease. On the basis of these findings, we believe that MI during pregnancy is more often caused by plaque rupture than may be expected, according to the current literature.- - - - - - - - - - ranking = 0.53086542707878keywords = pregnancy, gestation (Clic here for more details about this article) |
20/274. Acute bowel perforation in a fetus with gastroschisis.gastroschisis is a congenital anomaly with a reported incidence of 1 in 10,000 live births. Although prenatal diagnosis is more common with the widespread use of biochemical markers and obstetric ultrasound, the role of ultrasound in the identification of the fetus that might need early intervention has not been established. Acute bowel perforation was diagnosed by ultrasound at 34 weeks gestation in a fetus with gastroschisis. An immediate cesarean section was performed, followed by repair with primary closure. The neonatal outcome was favorable. The post-partum findings, including bowel pathology, confirmed the antenatal diagnosis. Acute bowel perforation can be diagnosed antenatally. Immediate intervention, before further bowel injury occurs, might enhance the ability of the surgeon to perform primary closure and obtain a favorable outcome.- - - - - - - - - - ranking = 0.061730854157553keywords = gestation (Clic here for more details about this article) |
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