11/47. Adnexal torsion during pregnancy -- management and literature overview.We present a patient in the 30th week of gestation with adnexal torsion, which was treated by laparotomy with oophorectomy. After 2 days, we had to perform a cesarean section because of bowel obstruction. We discuss the diagnosis and treatment of adnexal torsion in pregnancy and compare laparoscopic management with laparotomy. By reviewing the literature, we evaluate the conservative therapy by detorsion employing Doppler sonography.- - - - - - - - - - ranking = 1keywords = pregnancy, gestation (Clic here for more details about this article) |
12/47. Hepatic infarctions during pregnancy are associated with the antiphospholipid syndrome and in addition with complete or incomplete hellp syndrome.Antiphospholipid antibody syndrome (APS) is associated with adverse pregnancy outcomes and maternal complications including thrombotic events and early pre-eclampsia. hellp syndrome (hemolysis, Elevated liver enzymes, Low Platelets) represents a unique form in the spectrum of pre-eclampsia. This report describes four patients with pregnancy-associated hepatic infarctions. All four had APS and hellp syndrome, which was complete in one patient and incomplete in three patients, with elevated liver enzymes in all, and either thrombocytopenia or hemolysis in two. In the literature, we found descriptions of an additional 24 patients who had 26 pregnancies with concomitant hepatic infarction. Of the total 28 patients, anticardiolipin antibodies (aCL) and/or lupus anticoagulant (LAC) were assessed in 16 patients, out of whom 15 were found to be positive. Hepatic infartction during pregnancy was associated almost always with APS, with HELLP (2/3 complete, 1/3 incomplete), and only in one-third of the pregnancies with pre-eclampsia (PE).- - - - - - - - - - ranking = 1.3132027279463keywords = pregnancy (Clic here for more details about this article) |
13/47. Maternal floor infarction: relationship to X cells, major basic protein, and adverse perinatal outcome.OBJECTIVE: Maternal floor infarction of the placenta is characterized by gross placental abnormalities and histologic evidence of X-cell proliferation. Previously, pregnancy-associated major basic protein has been localized to the placental X cell and identified at elevated levels in serum and amniotic fluid in all normal pregnancies. Here we test the hypothesis that pregnancy-associated major basic protein is localized to the X cells in maternal floor infarction and that it contributes to the pathophysiologic features of pregnancies complicated by maternal floor infarction. STUDY DESIGN: Seven patients with eight pregnancies complicated by maternal floor infarction were evaluated. We analyzed placental tissue, serum, amniotic fluid, and placental cyst fluid for pregnancy-associated major basic protein. RESULTS: Placental tissue from pregnancies complicated by maternal floor infarction had increased numbers of X cells and fibrinoid material that occupied or surrounded degenerating villi and that stained intensely for pregnancy-associated major basic protein. serum pregnancy-associated major basic protein levels were variable and likely cannot be used to predict the occurrence of maternal floor infarction. CONCLUSION: pregnancy-associated major basic protein, a potent cytotoxin, is localized to X cells and is deposited in close proximity to chorionic villi in maternal floor infarction and may contribute to the pathophysiology of this disorder.- - - - - - - - - - ranking = 0.9380019485331keywords = pregnancy (Clic here for more details about this article) |
14/47. Discordancy for maternal floor infarction in dizygotic twin placentas.Maternal floor infarction (also known as massive perivillous fibrin/fibrinoid deposition) is a rare and devastating pregnancy disorder associated with prematurity, fetal growth restriction, spontaneous abortion, and long-term neurologic impairment. recurrence in multiple pregnancies is common. Little is known regarding either the pathophysiology or the management and treatment of patients at risk for recurrence in subsequent pregnancies. Most authors have emphasized maternal risk factors believed to act in a dominant fashion irrespective of fetal genotype. We report on dizygotic twins discordant for the development of placental maternal floor infarction and fetal growth restriction. The mother was a poorly controlled class C diabetic, and the onset of disease was coincident with the clinical onset of preeclampsia. This case demonstrates that fetal genotype, or some other factor specific to an individual fetoplacental unit, can lead to the differential expression of maternal floor infarction in dizygotic twins gestating in the same intrauterine environment.- - - - - - - - - - ranking = 0.18760038970662keywords = pregnancy (Clic here for more details about this article) |
15/47. Successful pregnancy in a young woman with essential thrombocythemia treated with platelet apheresis.We report a 27-year-old woman with essential thrombocythemia who had delivered a healthy baby after Caesarian section. The patient was treated with two courses of platelet apheresis at the beginning of the gestation. Subsequent to this procedure, the platelet count decreased progressively and remained at about 500,000/microl of blood until delivery without any further treatment. Caesarian section was performed at the 37th week when the placenta presented grade III lesions on ultrasound examination. histology of the placenta revealed multiple infarcts. platelet count in the newborn was normal. We concluded that essential thrombocythemia is not a risk factor for pregnancy, and that platelet count may decrease during pregnancy. In addition, an emergent reduction of platelets may easily be obtained by platelet apheresis.- - - - - - - - - - ranking = 1.1876003897066keywords = pregnancy, gestation (Clic here for more details about this article) |
16/47. Use of aspirin and low-molecular-weight heparin to prevent recurrence of maternal floor infarction in women without evidence of antiphospholipid antibody syndrome.During pregnancy, maternal floor infarction (MFI) and massive perivillous fibrin deposition (MFD) often cause fetal growth restriction and death, both being markedly increased by occlusion of the maternal intravenous circulation. Incident rates have been reported to be in the range of 0.09-0.5% and recurrent MFI/MFD might be more frequent in early-onset cases. Thus, prevention measures are necessary for high-risk women who have had MFI/MFD as complications in a previous pregnancy. In this report, the use of oral low-dose aspirin at the early trimester and low-molecular-weight heparin drip infusion from the mid-second trimester was examined for this purpose.- - - - - - - - - - ranking = 0.37520077941324keywords = pregnancy (Clic here for more details about this article) |
17/47. Massive hepatic infarction in preeclampsia: successful treatment with continuous hemodiafiltration and corticosteroid therapy.Massive hepatic infarction associated with pregnancy is extremely rare, but is potentially fatal. A 35-year-old primigravida with mild preeclampsia developed acute right upper quadrant pain and marked elevation of liver enzymes at 26 weeks' gestation. After emergent cesarean section, her condition was complicated by oliguric renal failure and pulmonary edema with further deterioration of hepatic function (aspartate transaminase 4339 IU/L; alanine transaminase 3489 IU/L; lactate dehydrogenase 10780 IU/L). The contrast-enhanced computed tomography revealed non-enhancing low attenuation throughout the right lobe of liver, compatible with infarction. Continuous hemodiafiltration was initiated as renal support on postpartum day one. However, excessive fluid accumulation persisted, and she developed severe edema formation in both lung and systemic body surface. To ameliorate microvascular endothelial injury, corticosteroid therapy was begun on postpartum day five. Following treatment initiation, her renal and hepatic function showed steady improvement, accompanied by drastic resolution of edema formation. She was discharged five weeks postpartum with no additional treatment, and is without sequelae six months later. Massive hepatic infarction should be considered in preeclamptic patients who present acute abdominal pain and severe hepatic dysfunction, and continuous hemodiafiltration with corticosteroid therapy may improve the maternal outcome.- - - - - - - - - - ranking = 0.24959844117352keywords = pregnancy, gestation (Clic here for more details about this article) |
18/47. Thrombotic microangiopathy with liver, gut, and bone infarction (catastrophic antiphospholipid syndrome) associated with hellp syndrome.hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome is a thrombotic microangiopathy complicating pregnancy and shares many clinical and biological features with thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). Thrombotic microangiopathy is also a pathological feature of catastrophic antiphospholipid syndrome (CAPS). An association between refractory hellp syndrome and antiphospholipid syndrome (APS) has been reported in a few cases. We describe a 19-year-old woman with APS and multiorgan failure conforming to a diagnosis of CAPS who developed refractory hellp syndrome.- - - - - - - - - - ranking = 0.18760038970662keywords = pregnancy (Clic here for more details about this article) |
19/47. association of fetal heart block and massive placental infarction due to maternal autoantibodies.Two different effects of maternal autoantibodies presented in a third-trimester pregnancy. The first was complete fetal heart block, demonstrated ultrasonographically, which correlated with the presence of anti-Ro and anti-La antibodies in the maternal serum. The second effect was decidual vasculopathy and thrombosis, a morphologic finding in the placenta that caused massive placental infarction and intrauterine death. The placental pathology correlated with the presence of anticardiolipin antibodies in the maternal serum at the time of stillbirth.- - - - - - - - - - ranking = 0.18760038970662keywords = pregnancy (Clic here for more details about this article) |
20/47. diagnosis of liver infarction postpartum.BACKGROUND: patients with antiphospholipid syndrome (APS) have increased risks of developing thromboembolism, and the risk maybe amplified by the hypercoagulable state associated with pregnancy. CASE: A patient presented with severe chest pain, mild pyrexia associated with elevated serum transaminases, and marked neutrophilia after vaginal delivery. liver infarction was diagnosed by spiral computer tomography and treated successfully with anticoagulation. CONCLUSION: liver infarction is a possible diagnosis in a patient with antiphospholipid syndrome who presents with chest or abdominal pain in the postpartum period.- - - - - - - - - - ranking = 0.18760038970662keywords = pregnancy (Clic here for more details about this article) |
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