1/152. Laparoscopic hernias: two case reports and a review of the literature.Laparoscopic operations are becoming more common and replacing more traditional surgical procedures. As a result, radiologists should be aware of some of the unique complications that may occur from these types of procedures. We report two cases of incarcerated bowel hernias in lateral trocar sites.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
2/152. Ultrasound evaluation of a near-term abdominal ectopic pregnancy.Ultrasound confirmation of an abdominal ectopic pregnancy was established by the demonstration of an enlarged but empty uterus and the delineation of the fetal head within the abdominal cavity. Other portions of the fetus could not be demonstrated. The margins and attachments of the placenta could not be accurately delineated prospectively.- - - - - - - - - - ranking = 2keywords = rate (Clic here for more details about this article) |
3/152. Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience.OBJECTIVE: Obstetric hemorrhage is a significant cause of maternal morbidity and death. postpartum hemorrhage that cannot be controlled by local measures has traditionally been managed by bilateral uterine artery or hypogastric artery ligation. These techniques have a high failure rate, often resulting in hysterectomy. In contrast, endovascular embolization techniques have a success rate of >90%. An additional benefit of the latter procedure is that fertility is maintained. We report our experience at Stanford University Medical Center in which this technique was used in 6 cases within the past 5 years. STUDY DESIGN: Six women between the ages of 18 and 41 years underwent placement of arterial catheters for emergency (n = 3) or prophylactic (n = 3) control of postpartum bleeding. Specific diagnoses included cervical pregnancy (n = 1), uterine atony (n = 3), and placenta previa and accreta (n = 2). RESULTS: Control of severe or anticipated postpartum hemorrhage was obtained with transcatheter embolization in 4 patients. A fifth patient had balloon occlusion of the uterine artery performed prophylactically, but embolization was not necessary. In a sixth case, bleeding could not be controlled in time, and hysterectomy was performed. The only complication observed with this technique was postpartum fever in 1 patient, which was treated with antibiotics and resolved within 7 days. CONCLUSIONS: uterine artery embolization is a superior first-line alternative to surgery for control of obstetric hemorrhage. Use of transcatheter occlusion balloons before embolization allows timely control of bleeding and permits complete embolization of the uterine arteries and hemostasis. Given the improved ultrasonography techniques, diagnosis of some potential high-risk conditions for postpartum hemorrhage, such as placenta previa or accreta, can be made prenatally. The patient can then be prepared with prophylactic placement of arterial catheters, and rapid occlusion of these vessels can be achieved if necessary.- - - - - - - - - - ranking = 2.4968880529129keywords = rate, death (Clic here for more details about this article) |
4/152. Extrauterine pregnancy resulting from early uterine rupture.BACKGROUND: Cesarean scar rupture of a gravid uterus in early gestation is rare. CASE: A 38-year-old woman, gravida 4, para 2-0-1-1, presented at 13 weeks' gestation with cramping and spotting. She had a history of two cesareans. Ultrasound and magnetic resonance imaging indicated probable uterine dehiscence and a viable extrauterine pregnancy. After embolization of the uterine arteries with subsequent fetal death, the subject had a hysterectomy. Intraoperatively, she had complete rupture of the lower uterine segment, but the pregnancy was enclosed within scar tissue between the uterus and bladder. Placenta percreta was found by histologic examination. CONCLUSION: women with histories of cesareans might be at risk of early uterine rupture.- - - - - - - - - - ranking = 0.49688805291294keywords = death (Clic here for more details about this article) |
5/152. Treatment of heterotopic cervical and intrauterine pregnancy.OBJECTIVE: To find a suitable technique to selectively terminate a cervically implanted embryo while maintaining viability of a concomitant intrauterine pregnancy. methods: A 34-year-old patient achieved a twin pregnancy after 4 IVF attempts. Ultrasound revealed a viable intrauterine and cervical pregnancy. Given our experience with KCl injection for fetal reduction, we offered the patient an attempt to reduce the cervical pregnancy. RESULTS: Best visualization in this case was obtained by transabdominal scanning. A 6-inch 20-gauge spinal needle was inserted transcervically and maneuvered into the thorax of the embryo. fetal heart rate ceased even before KCl could be injected. Then 3 cm(3) of saline were injected to provide better visualization of the cervical fetus, and to confirm absence of heart beat. The patient had minor vaginal bleeding for several days. The intrauterine pregnancy progressed uneventfully through 36(1)/(2) weeks with delivery of a healthy, 2, 700-gram newborn. CONCLUSION: Cervical pregnancy is usually considered a life-threatening event. Other factors such as concomitant intrauterine pregnancy and the patient's infertility history generally would be secondary concerns. In this case, we were able to selectively terminate the cervical pregnancy, while preserving the intrauterine one, allowing this couple to have a healthy newborn. Further cases will be necessary to appropriately define risk rates for such an approach.- - - - - - - - - - ranking = 2keywords = rate (Clic here for more details about this article) |
6/152. Medical management of interstitial pregnancy with a retained IUD. A case report.BACKGROUND: Systemic methotrexate therapy for interstitial pregnancy has an increased failure rate as compared to other ectopic locations. No case of interstitial pregnancy with a retained intrauterine device (IUD) has been reported on before. CASE: An asymptomatic, 21-year-old woman presented with a positive pregnancy test and a retained IUD. Vaginal ultrasound revealed a left interstitial pregnancy. Diagnostic laparoscopy was followed by a single dose of methotrexate (50 mg/m2). Five days later, a marked increase in the human chorionic gonadotropin level was followed by a second course (four doses) of methotrexate, 1 mg/kg, alternating with 0.1 mg/kg of leucovorin. Concomitant chlamydia was treated with azithromycin, and the IUD was expelled spontaneously. CONCLUSION: Medical management of interstitial pregnancy may prevent surgery that limits future fertility, but the evidence suggests that more than one dose of methotrexate may be required.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
7/152. Laparoscopic therapy of an intact primary ovarian pregnancy with ovarian hyperstimulation syndrome: case report.A case of an intact primary ovarian pregnancy with ultrasonographic demonstration of heart motion following ovarian stimulation is presented. After preoperative ultrasonographic confirmation of an extrauterine pregnancy, proof of the ovarian localization was achieved by intra-operative ultrasonographic visualization during a diagnostic laparoscopy on post-menstrual day 48. A moderate ovarian hyperstimulation syndrome with a concomitant increase in size, vulnerability and vascularity of the ovaries presented an additional challenge for the surgical approach. However, thanks to the early diagnosis of the ectopic pregnancy localization, a laparoscopic organ-preserving removal of the intact ovarian pregnancy was successfully performed. In this way, the fertility of the patient, who had previously undergone contralateral ovariectomy, was preserved. To our knowledge, this represents the first such treatment to be reported in the medical literature. Improvements in diagnosis and therapy of ovarian pregnancy are reviewed.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
8/152. Expectant management of intramural ectopic pregnancy.BACKGROUND: Intramural ectopic pregnancy is unusual, difficult to diagnose, and associated with a high rate of uterine rupture. CASE: A 35-year-old, gravida 3, para 0-0-2-0 was diagnosed with intramural ectopic pregnancy by ultrasound showing a gestational sac surrounded completely by myometrium. It was confirmed by laparoscopy. With expectant management, the gestation resolved spontaneously. CONCLUSION: early diagnosis by ultrasound of intramural ectopic pregnancy permits expectant management which, if successful, would aid in maintaining fertility.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
9/152. Transvaginal sonographic diagnosis of live monochorionic twin ectopic pregnancy.Ectopic pregnancy is a leading cause of pregnancy-related deaths; its incidence has progressively increased in recent years. Spontaneous twin ectopic pregnancy, however, is extremely rare. Among more than 100 reported cases of twin tubal pregnancies, only 5 cases in which fetal cardiac motion has been visualized in both embryos have been reported. We describe an additional case of a live monochorionic twin ectopic pregnancy in a patient with no predisposing factor. With transabdominal sonography, we initially diagnosed a single ectopic pregnancy, visualized as an ill-defined mass in the left adnexa. However, with transvaginal sonography, we determined the left adnexal mass to contain a single monochorionic gestational sac with 2 embryos, each with cardiac motion. These findings were confirmed with color Doppler sonography and at laparotomy. The introduction of high-resolution transvaginal sonography has resulted in the earlier diagnosis of ectopic pregnancy and has contributed to a recent decrease in the maternal mortality and morbidity associated with this condition.- - - - - - - - - - ranking = 14.749084557845keywords = mortality, death (Clic here for more details about this article) |
10/152. Ultrasound diagnosis of interstitial pregnancy: findings and pitfalls.The diagnosis of an unruptured interstitial gestation can be made by means of ultrasound examination. The most specific finding is an incomplete myometrial mantle around the sac. An eccentrically placed sac and failure to demonstrate the sac within the uterine cavity, i.e., near the internal os on the longitudinal scans, may be helpful ancillary findings. The differential diagnosis must take into consideration a pregnancy within one horn of a bicornuate uterus and a pregnancy within a myomatous uterus. Although this is a rare condition, it carries significant mortality if it ruptures. Diagnosis prior to rupture will reduce mortality and offer the possibility of preserving reproductive capabilities.- - - - - - - - - - ranking = 29.504393009864keywords = mortality, rate (Clic here for more details about this article) |
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