1/9. Primary repair of cornual rupture occurring at 21 weeks gestation and successful pregnancy outcome.The successful delivery in a 31 year old woman at 33 weeks gestation is reported, after repair to a cornual rupture which occurred at 21 weeks gestation. The patient exhibited acute abdominal pain and pending shock. Emergency laparotomy showed a cornual rupture and an intrauterine vital fetus having intact amnion membrane. On the patient's family's insistence, primary repair for a cornual rupture was performed and preservation of the fetus attempted. Postoperatively, tocolytic agent with ritodrine hydrochloride was administered and close follow-up of the patient was uneventful. The patient had a smooth obstetric course until 33 weeks gestation when premature rupture of the membranes occurred, soon followed by the onset of labour. She underwent an elective Caesarean section and delivered a normal male fetus weighing 2140 g with Apgar scores at 1, 5 and 10 min of 6, 8, and 9 respectively. Because of this successful outcome, we suggest that primary repair for such an unusual patient should be accepted.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
2/9. Spontaneous rupture of hepatocellular carcinoma during pregnancy.BACKGROUND: Hepatocellular carcinoma associated with pregnancy is unusual. CASE: A 33-year-old woman presented at 25 weeks' gestation with sudden, severe epigastric pain for 6 hours. Abdominal ultrasonography and magnetic resonance imaging showed multiple liver tumors with a small amount of ascites. Exploratory laparotomy revealed an unresectable ruptured liver tumor that was treated by packing. Although a biopsy was nondiagnostic, ultrasound-guided needle biopsy 6 days after cesarean delivery at 41 weeks' gestation showed hepatocellular carcinoma, which was treated with transarterial embolization. At 3.5 years posttherapy, both mother and infant are well. CONCLUSION: Ruptured hepatocellular carcinoma during pregnancy is rare but should be included in the differential diagnosis of sudden, severe epigastric pain.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
3/9. Diagnostic challenge of abdominal pain in late pregnancy--a case of adnexal torsion.Clinical evaluation of pregnant patients with abdominal pain can be confusing, because the examination is usually hampered by the anatomical displacement of abdominal organs by the gravid uterus, and difficulty in localisation of pain. Delayed surgical intervention could result in increased maternal morbidity and poor fetal outcome. We report on a case of recurring acute abdominal pain in pregnancy, which led to diagnostic difficulties and resulted in a diagnostic laparotomy and caesarean delivery.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
4/9. Acute gastric ulcer perforation in a 35 weeks' nulliparous patient with gastric banding.We present a case of a primiparous patient at 35 weeks' gestation who had had laparoscopic gastric banding, and who presented to labor and delivery with protracted vomiting followed by an acute abdomen and fetal distress. An emergency surgery revealed acute gastric ulcer perforation. This complication, although rare, should be considered.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
5/9. Term abdominal pregnancy misdiagnosed as abruptio placenta.A 37 year old multiparous woman at 37th week gestation presented with an undiagnosed abdominal pregnancy and acute abdomen following forceful reduction of an associated utero-vaginal prolapse. She had an urgent laparotomy with delivery of a live female baby lying in the left broad ligament. The baby weighed 2.6kg with Apgar scores of 2 and 6 at first and fifth minutes respectively. The partially detached placenta was easily delivered complete with membranes. Haemostasis was secured by ligation and excision of the left adnexum (broad ligament with the pregnancy sac and uterine appendages). She was transfused with two units of whole blood. This case highlights the importance of excluding pregnancy in any woman of reproductive age with undiagnosed abdominal mass and utero-vaginal prolapse before any manipulation. It also underscores the importance of ultrasound scan in early pregnancy by a competent sonologist.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
6/9. Acute intermittent porphyria complicated by pregnancy.The case of a woman with acute intermittent porphyria complicated by two pregnancies is described. Both pregnancies gave an exacerbation of the disease. Premature delivery were necessary for both children due to intrauterine growth retardation. The first child died from respiratory distress syndrome, but the second child was healthy apart from transient abstinence symptoms due to pethidine given to the mother during pregnancy. The effect of pregnancy on acute intermittent porphyria is discussed.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
7/9. Spontaneous rupture of the cystic duct during pregnancy.A patient with an acute abdomen during pregnancy is reported. It was due to perforation of the cystic duct by a cholesterol gallstone. A cholecystectomy and T-tube drainage resulted in recovery and normal delivery twelve weeks after operation. The presence of gallstones, their location at the weakest point of the cystic duct, and the possible hemodynamic changes (as there is a higher pressure in the vena cava) occurring during pregnancy, are discussed as possible causes of this acute abdominal condition.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
8/9. Abrupt onset of severe pain at term. A case report.This case report involves an adolescent primigravida at term who was admitted with urinary complaints to the labor and delivery unit of a medical center. Within an hour, she suddenly began screaming and complaining of severe pain running from her anterior pelvis through her vagina and up her spine. Three days of very challenging co-management of the patient, with several recurrences of acute pain, followed. Differential diagnoses that could explain this patient's symptoms are reviewed and discussed. Difficult management issues, including the stress of clinical management in the face of unidentified disease processes, are addressed. Lacking a certain diagnosis even retrospectively, the authors request comments from readers.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
9/9. Late complication of laparoscopic salpingoophorectomy: retained foreign body presenting as an acute abdomen.BACKGROUND: laparoscopy is widely used as a tool in many clinical situations allowing for diagnosis and/or surgical management in a minimally invasive fashion. Most laparoscopic cases are ambulatory and allow patients to recover quickly. Nonetheless, attention to surgical technique is paramount to avoid both short and long term complications. CASE: A 32-year-old woman had a laparoscopy and a reported left salpingoophorectomy for benign disease of the ovary in September, 1994. Shortly thereafter, in January, 1995, she was diagnosed with an intrauterine pregnancy and delivered in October of 1995 by spontaneous vaginal delivery. The pregnancy and delivery were both uncomplicated. The patient presented four weeks postpartum with clinical suspicion of appendicitis. However, at the time of laparotomy, the patient was found to have a retained foreign body from her prior laparoscopy in the right lower quadrant with a pelvic abscess and evidence of prior right salpingoophorectomy. The appendix appeared grossly normal. CONCLUSION: laparoscopy is a safe, effective modality for various surgical and gynecologic conditions. Although laparoscopy is usually done on an outpatient basis, complications can manifest several weeks or months later. This case illustrates and reminds us of the importance of adherence to surgical laparoscopic principles. These include direct visualization when removing equipment and a complete count of surgical instrumentation to confirm the integrity of such at the end of each procedure.- - - - - - - - - - ranking = 2keywords = delivery (Clic here for more details about this article) |