1/38. Postpartum cerebral angiopathy associated with the administration of sumatriptan and dihydroergotamine--a case report.Cerebral angiopathy of the postpartum period is a rare entity, sometimes promoted by vasoconstrictives drug prescription. Its clinical presentation includes headaches, seizures and focal neurological deficits, which develop shortly after a normal pregnancy. The diagnosis is based on clinical findings and angiography, showing multiple narrowing of the intracranial cerebral arteries. This neurological feature is reversible and the clinical outcome is good. We report a case of benign cerebral angiopathy in a 20-year-old woman in the postpartum period, occurring after administration of sumatriptan and ergot derivates.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
2/38. impetigo herpetiformis during the puerperium.We report on a 29-year-old primigravida who developed impetigo herpetiformis 1 day after delivery. To our knowledge, this patient is the second reported case of impetigo herpetiformis presenting during the puerperium. The patient responded quickly to systemic administration of methotrexate and prednisolone.- - - - - - - - - - ranking = 0.2keywords = administration (Clic here for more details about this article) |
3/38. Effective administration of recombinant tissue plasminogen activator (rt-PA) during resuscitation of a post partum patient with massive pulmonary embolism.Severe pulmonary embolism with cardiac arrest occurred half an hour after the 5th spontaneous delivery in a 34-year-old multipara. Standard resuscitation for 30 minutes remained ineffective. Only after Actilyse rt-PA infusion the patient's state improved. She regained consciousness on the third day. After 32 days of hospital treatment the patient was discharged in a generally good condition. Today, 5 years after the described event her state of health is very good.- - - - - - - - - - ranking = 0.8keywords = administration (Clic here for more details about this article) |
4/38. Severe postpartum hypertension and reversible cerebral angiopathy associated with ergot derivative (methergoline) administration.A 36-year-old woman (gravida 2, para 2) delivered a healthy child by cesarean section at the 37th week of an unremarkable gestation. blood pressure remained within normal range throughout the pregnancy, surgery, and for the 9 following days. On day 10, about 36 hours after the initiation of oral methergoline to suppress lactation, the patient complained of severe posterior headache, flashing scotomata, hypertension, tonico-clonic seizures and then homonymous left hemianopsia and hemiparesis. blood pressure monitoring confirmed intermittent and severe hypertension. angiography demonstrated diffuse narrowing of the small and medium cerebral arteries. Transcranial Doppler ultrasound examination disclosed a bilateral increase in mean flow velocity. Progressive normalization of blood pressure, obtained with labetalol and oral clonidine, was accompanied by amelioration of the neurological deficits until a complete recovery and normalization of transcranial Doppler flow velocity occurred. This case provides further evidences that hypertension might play a major pathogenetic role in reversible cerebral angiopathy. Some ergot derivatives (including methergoline) might trigger the initial rise in blood pressure.- - - - - - - - - - ranking = 0.8keywords = administration (Clic here for more details about this article) |
5/38. The role of hypertension in bromocriptine-related puerperal intracranial hemorrhage.The spate of medicolegal inquiries following the disqualification of Parlodel (bromocriptine mesylate) by the food and Drug Administration for postpartum ablactation, uncovered previously unreported side effects associated with its postpartum administration. In 1994, bromocriptine mesylate was withdrawn from the market as a milk suppressant. Since this time, over a dozen cases of postpartum intracranial hemorrhages associated with its use have been reported. We describe three additional cases of postpartum intracranial hemorrhage related to bromocriptine usage. One patient, previously normotensive, developed hypertension and a headache; initial CT was normal, but CT 24 h later demonstrated intracranial hemorrhage. This suggests that the blood-pressure elevation was drug-induced and was the cause, rather than the consequence, of bromocriptine-related intracranial hemorrhage.- - - - - - - - - - ranking = 0.2keywords = administration (Clic here for more details about this article) |
6/38. Breast milk activity during early lactation following maternal 99Tcm macroaggregated albumin lung perfusion scan.A breast feeding infant may receive a radiation dose from ingestion of breast milk following the administration of a radiopharmaceutical to the mother. The Administration of Radioactive Substances Advisory Committee recommendation to interrupt breast feeding may not necessarily apply in the period of early lactation when colostrum is being produced. Following a lung scan using 99Tcm macroaggregated albumin (MAA) on a patient approximately 15 h post partum, radioactivity within breast milk was measured. milk was expressed approximately every 4 h during the day and samples were counted. The sample radioactivity concentration peaked at 15 h and decayed monoexponentially (half clearance time was approximately 4.8 h). The estimated effective dose to the infant from ingestion alone, had breast feeding not been interrupted, was approximately 0.02 mSv. These data suggest that interruption to breast feeding may not be necessary following administration of up to the diagnostic reference level of 99Tcm MAA during early lactation.- - - - - - - - - - ranking = 0.4keywords = administration (Clic here for more details about this article) |
7/38. plasma exchange in severe postpartum hellp syndrome.We present a case of extremely severe postpartum HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, associated with activation of coagulation, massive recurrent intra-abdominal bleeding requiring two laparotomies, renal failure, and central nervous system symptoms. This case underlines the complexity of pregnancy-related thrombotic microangiopathies regarding their differential diagnosis, multiple organ dysfunction, as well as management. Systemic endothelial cell injury plays a central role in the pathogenesis of thrombotic microangiopathies. Treatment of hellp syndrome usually consists of administration of antihypertensive therapy and magnesium sulfate. No consensus exists regarding the use of plasma exchange or corticosteroids. plasma exchange was a major part of the treatment regime in our patient. Early plasma exchange may be considered as an adjuvant therapy in severe and progressive postpartum hellp syndrome.- - - - - - - - - - ranking = 0.2keywords = administration (Clic here for more details about this article) |
8/38. Recurrent post-partum seizures after epidural blood patch.There are many causes for headaches after childbirth. Even though postdural puncture headache (PDPH) has to be considered in a woman with a history of difficult epidural anaesthesia, pre-eclampsia should always be excluded as an important differential diagnosis. We report a case with signs of late-onset pre-eclampsia where administration of an epidural blood patch (EBP) was associated with eclampsia. A hypothetical causal relationship between the EBP and seizures was discarded on the basis of evidence presented in this report.- - - - - - - - - - ranking = 0.2keywords = administration (Clic here for more details about this article) |
9/38. Postpartum acute myocardial infarction induced by ergonovine administration.We report a primigravida woman with acute myocardial infarction caused by coronary artery spasm induced by intravenous administration of methyl ergometrine maleate just after delivery. Despite the frequent usage of ergot derivatives to promote uterine contractions, cardiac complications related to this drug are rare. myocardial infarction may be overlooked in young women in the early postpartum period. Careful monitoring and prompt evaluation should be performed when this drug is administered for obstetrical purposes.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
10/38. A rare case of central post-gravid diabetes insipidus.Central diabetes insipidus (CDI) arising in the puerperal period has been attributed mainly to Sheehan's syndrome or to lymphocytic infundibulo-neurohypophysitis. We report the case of a 24-year-old woman who came to our observation for the appearance, 3 weeks after a normal delivery, of a polyuric-polydipsic syndrome. Measurements of urinary volumes, plasma osmolality and urinary osmolality, in conditions of free water intake, water deprivation and a water deprivation-vasopressin administration test, demonstrated CDI. brain magnetic resonance imaging showed a normal morphology of the adenohypophysis and total absence of the neurohypophysis. Assays of the pituitary hormones were found to be within normal limits. These results, incompatible with a diagnosis of Sheehan's syndrome and lymphocytic infundibulo-neurohypophysis, excluded all the other known causes of acquired CDI. Our diagnosis was therefore of post-gravid idiopathic CDI. Thus, it is possible that in the puerperal period other diseases of the posterior hypophysis may develop, of unknown etiopathogenesis but equally responsible for CDI.- - - - - - - - - - ranking = 0.2keywords = administration (Clic here for more details about this article) |
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