1/4. pregnancy in asymmetric blind hemicavity of Robert's uterus--a previously unreported phenomenon.An 18-year-old primigravida presented following recurrent failed attempts at pregnancy termination for intra-uterine fetal death. Clinical examination aroused suspicion of non-communicating uterine horn with bicornuate uterus. Examination under anaesthesia and laparotomy revealed a partial vaginal septum, complete septate uterus with septum deviated to one side and fetus lying in the non-communicating right blind hemicavity (Robert's uterus). hysterotomy and ipsilateral tubal ligation were performed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/4. Undiagnosed phaeochromocytoma mimicking severe preeclampsia in a pregnant woman at term.We report an unusual case of phaeochromocytoma in pregnancy. The patient presented with severe hypertension, visual disturbances, proteinuria, glycosuria and pulmonary oedema at 38 weeks' gestation. The initial diagnosis was severe preeclampsia, but rapid deterioration of the fetus necessitated an emergency caesarean section under general anaesthesia, following which the maternal condition deteriorated rapidly. Differential diagnoses included pulmonary embolus, cardiomyopathy, amniotic fluid embolus and ischaemic/embolic cerebrovascular accident. Despite aggressive maximal treatment, mother and baby died 36 h later. Post mortem examination of the mother revealed a 5.5-cm tumour of the right adrenal gland confirmed histologically as a phaeochromocytoma. We examine the diagnostic dilemmas of this case and consider the treatment and management options when faced with a critically ill mother and the need to deliver her fetus by emergency caesarean section. We also question the clinical priorities during management of a sudden deterioration in both maternal and fetal health.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/4. maternal death following epidural anaesthesia for caesarean section delivery in a patient with unsuspected sepsis.sepsis in the parturient may be difficult to recognize in light of the physiological changes associated with pregnancy. The purposes of this report are to highlight the signs and symptoms which indicate an underlying septic process and the management of these patients in the peripartum period. This 32-yr-old GII PI woman with twin gestation presented at 36 wk in labour. Her temperature was 35.3 degrees C, she was normotensive and had a normal white blood cell count. After epidural anaesthesia was administered for Caesarean section, she became apnoeic, pulseless and unresponsive. Despite aggressive cardiopulmonary resuscitation, neither she nor her twin babies survived. Post mortem blood work revealed a considerable left shift of her white blood count (> 60% bands) and an anion gap acidosis. autopsy revealed evidence of widespread Group A beta-haemolytic streptococcal sepsis. diagnosis of sepsis in the parturient involves assessment of the patient's temperature, WBC and differential and acid-base status. Evaluation of the intravascular volume must precede anaesthetic intervention. Epidural anaesthesia may be considered in the labouring and Caesarean section patient who has been fluid-resuscitated. Emergency operative delivery may result in cardiovascular compromise in the patient with severe sepsis.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |
4/4. General anaesthesia for caesarean section in a parturient with Noonan's syndrome.We describe the anaesthetic management of a parturient with Noonan's syndrome. Her problems included severe cardiac disease, facial abnormalities and extreme phobia to needles. After intrauterine death at 30 weeks gestation, induction of labour was attempted and extradural analgesia initiated using low-dose bupivacaine. She failed to progress and underwent Caesarean section under general anaesthesia using awake oral fibreoptic intubation.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |