1/19. Gastric adenocarcinoma presenting with persistent, mild gastrointestinal symptoms in pregnancy. A case report.BACKGROUND: Mild gastrointestinal symptoms are common during pregnancy but can also be the only symptoms in stomach cancer until the late stage. Clinicians' reluctance to pursue diagnostic studies appears to be a major contributing factor to delayed diagnosis and poor outcome. We report a case of maternal death to alert clinicians to this rare possibility. CASE: A 36-year-old woman had persistent, mild epigastric discomfort, nausea, vomiting and frequent episodes of dark stools since the second trimester of pregnancy. These were attributed to peptic ulcer and an iron supplement given, without investigation. gastroscopy was performed only at 32 weeks of gestation, when the patient had heavy hematemesis. biopsy confirmed the diagnosis of poorly differentiated adenocarcinoma of the stomach. cesarean section was performed after steroid therapy. Advanced stomach cancer with stomach perforation was found. Curative surgery was not possible. The patient died four weeks after delivery. CONCLUSION: stomach cancer is a rare complication of pregnancy. Delay in diagnosis is commonly due to clinicians' reluctance to request diagnostic studies and the nonspecific symptoms of the disease. Early recognition and diagnosis are the only possibilities for a better outcome. Clinicians must be alert to this possibility and include this in the differential diagnosis of minor gastrointestinal discomfort during pregnancy.- - - - - - - - - - ranking = 1keywords = pregnancy, gestation (Clic here for more details about this article) |
2/19. Managing women with nausea and vomiting of pregnancy. Canadian consensus.QUESTION: I have a 30-year-old pregnant patient who is asthmatic and is taking prednisone. Whenever she decreases her prednisone dose, her nausea increases tremendously even though she is taking two tablets of doxylamine and pyridoxine combination (Diclectin) daily. She is already at 26 weeks' gestation, and I really do not want her to continue the prednisone beyond what is needed for her asthma, but two attempts to taper prednisone off failed because of unbearable nausea. ANSWER: Several controlled trials show the efficacy of prednisone for nausea and vomiting of pregnancy (NVP), but your case is fascinating in proving the point by challenge-rechallenge. You should try to decrease the prednisone while increasing doxylamine and pyridoxine to its recommended dose of two tablets before sleep, one in the morning, and on in the afternoon.- - - - - - - - - - ranking = 0.63422154420069keywords = pregnancy, gestation (Clic here for more details about this article) |
3/19. midwifery co-management of hyperemesis gravidarum.hyperemesis gravidarum is an infrequent, yet significant, maternal complication of pregnancy. Beginning with the frequently experienced nausea and vomiting of pregnancy, symptoms can progress to hyperemesis, a debilitating condition affecting maternal and fetal well-being. A basic understanding of the pathophysiology of the disease process and an awareness of the therapeutic interventions that are available will facilitate midwifery planning for either the collaborative care or the potential referral to medical management, both of which may be required with this clinical entity. The diagnosis and initial management of hyperemesis is within the purview of midwifery care. As certain critical features of duration and severity evolve, medical collaboration and ultimate hospitalization may be required. For those few individuals requiring the most intense level of care, the critical support and encouragement afforded by midwifery participation will contribute to timely resolution of this debilitating condition. This article discusses the continuum from differential diagnosis to ultimate care of the woman who has excessive nausea and vomiting of pregnancy. Collaboration among health care providers will allow all to exercise their respective skills in achieving the optimum in safe therapy and support for their patients.- - - - - - - - - - ranking = 0.36577845579931keywords = pregnancy (Clic here for more details about this article) |
4/19. Cerebellar hemangioblastoma in pregnancy. A case report.BACKGROUND: The incidence of symptomatic hemangioblastoma of the posterior fossa during pregnancy is extremely low. Previous reports have noted that pregnancy seems to aggravate the clinical course of intracranial tumors, but little is known about the possible reasons. Various theories have been proposed to explain the rapid neurologic deterioration of hemangioblastoma patients during pregnancy; however, the pathophysiologic behavior and histogenesis of this vascular tumor are still not well understood. CASE: A case of cerebellar hemangioblastoma was diagnosed during pregnancy. Urgent surgery was required due to rapid development of obstructive hydrocephalus and brainstem compression. CONCLUSION: Obstetricians and neurosurgeons should be aware of the rare clinic entity of hemangioblastoma during pregnancy. Surgery might be indicated as soon as the tumor becomes symptomatic.- - - - - - - - - - ranking = 1.0973353673979keywords = pregnancy (Clic here for more details about this article) |
5/19. Non-aneurysmal primary subarachnoid hemorrhage in pregnancy-induced hypertension and eclampsia.Clinical as well as neuroimaging studies of women with eclampsia or pregnancy-induced hypertension (PIH) have described a variety of neurologic manifestations, including intraparenchymal brain hemorrhage. autopsy studies have described pia-arachnoid hemorrhage in women who died of eclampsia, but radiographic studies have found only intraparenchymal hemorrhage. The author describes clinical and radiographic features in three women with subarachnoid hemorrhage associated with PIH.- - - - - - - - - - ranking = 0.60963075966551keywords = pregnancy (Clic here for more details about this article) |
6/19. Acute pancreatitis occurring in the early postpartum period: a case report.We report a case of acute pancreatitis, which occurred after delivery in a woman who had an uneventful course of pregnancy and parturition. A 17-year-old Japanese woman was referred to our department because of nausea and vomiting two hours after delivery, followed by severe abdominal and back pain. On admission, in addition to elevated serum and urine amylase, plain computed tomography demonstrated a swollen pancreas and high density in the peripancreatic lesion with a large amount of ascites, suggesting the presence of an inflammation of the pancreas as well as peripancreatic lesion. Accompanied by subsiding abdominal and back pain, serum amylase concentration gradually decreased and returned to a normal level on the 11th postpartum day. Acute pancreatitis must be kept in mind when evaluating patients presenting with abdominal pain after delivery.- - - - - - - - - - ranking = 0.1219261519331keywords = pregnancy (Clic here for more details about this article) |
7/19. Acute hernia of Bochdalek during pregnancy. Hyperemesis for the first time in a third pregnancy?A rare case of a patient with right-sided diaphragmatic hernia during pregnancy is described. knowledge of this disorder offers the possibility of early diagnosis on clinical, ultrasound, and radiographic criteria before serious complications develop. Operative correction must be performed, with timing dependent on clinical presentation and period of gestation.- - - - - - - - - - ranking = 1.1219261519331keywords = pregnancy, gestation (Clic here for more details about this article) |
8/19. Qualitative beta-hCG urine assays may be misleading in the presence of molar pregnancy: a case report.molar pregnancy is a rare complication of pregnancy and the diagnosis is usually confirmed with a markedly elevated beta-hCG and a "snowstorm" appearance on pelvic ultrasound. patients frequently present with a positive pregnancy test, vaginal bleeding, nausea and vomiting. A 23-year-old woman presented to our Emergency Department with a history of 7 weeks of intermittent vaginal bleeding and 1 h of peri-umbilical abdominal pain. She reported that 7 weeks before this visit she was diagnosed with a miscarriage. The bedside qualitative urine human chorionic gonadotropin (hCG) test that we performed was negative, but the quantitative serum hCG was markedly elevated. Ultrasound and operative findings confirmed the diagnosis of molar pregnancy. We conclude that rapid urine qualitative hCG assays may not be reliable in the presence of markedly elevated hCG levels found in molar pregnancy.- - - - - - - - - - ranking = 1.0973353673979keywords = pregnancy (Clic here for more details about this article) |
9/19. Isolated torsion of the fallopian tube: a case report and review of the literature.INTRODUCTION: Isolated torsion of the fallopian tube is a very rare condition. It occurs without ipsilateral ovarian involvement associated with pregnancy, haemosalpinx, hydrosalpinx, ovarian or paraovarian cysts and other adnexal alterations or even with an otherwise normal fallopian tube. We document a case of isolated torsion of the right fallopian tube associated with hydrosalpinx. CASE: The patient was a 39-year-old female, para 2, gravida 4, who was presented with acute pelvic pain, nausea and vomiting. Her medical history included an appendectomy and right hydrosalpinx diagnosed five months before admission by hysterosalpingography because of investigation for secondary infertility. The urinary pregnancy test was negative. Pelvic ultrasonography showed a dilated folded right tubular structure measuring 7.8 x 2.7 cm with thickened echogenic walls and mucosal folds protruding into the lumen; the ovaries and uterus were unremarkable. No free fluid in the cul-de-sac was noted. Preoperatively, a diagnosis of twisted right fallopian tube was suspected and an exploratory laparotomy confirmed the diagnosis of isolated torsion of the oviduct. The ipsilateral ovary appeared normal, but the fallopian tube was gangrenous and right salpingectomy was performed. The patient became pregnant three months after surgery. CONCLUSION: Isolated torsion of the fallopian tube should be considered in the differential diagnosis of patients with acute abdomen and previous medical history of hydrosalpinx.- - - - - - - - - - ranking = 0.2438523038662keywords = pregnancy (Clic here for more details about this article) |
10/19. Failure to diagnose: ectopic pregnancy.Case histories are based on actual medical negligence claims, however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. Medical negligence claims alleging 'failure to diagnose' are a common cause of claims and complaints against general practitioners. This article outlines strategies to minimise the possibility of an adverse patient outcome arising out of a delay in diagnosis of ectopic pregnancy.- - - - - - - - - - ranking = 0.60963075966551keywords = pregnancy (Clic here for more details about this article) |
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