1/46. Fetal methotrexate and misoprostol exposure: the past revisited. BACKGROUND: Fetal aminopterin/methotrexate syndrome was described nearly 50 years ago when these agents were first used as abortifacients. physicians essentially stopped using these agents when the associated anomalies were recognized. Over the last several years the use of methotrexate with or without misoprostol for management of ectopic pregnancy and medical terminations of pregnancy has increased. methods: A 23-year-old female sought a termination at eight weeks gestation. She was given methotrexate followed by misoprostol. RESULTS: The medical termination was unsuccessful. The patient elected to continue the pregnancy secondary to financial considerations. She presented at 39 weeks without intervening prenatal care. She was diagnosed with severe preeclampsia. At delivery the infant was hypotonic and growth restricted with multiple anomalies. CONCLUSIONS: physicians are increasingly using methotrexate with or without misoprostol for treatment of ectopic pregnancies and medical terminations. Clinicians need to be aware of the characteristic teratologic effects of these two agents. ( info) |
2/46. Postabortal and postpartum tetanus. A review of 19 cases. The occurrence of postabortal and postpartum tetanus over a 7 1/2-year period at Groote Schuur Hospital, Cape Town, is reviewed. Of all the women between the ages of 15 years and 50 years who were admitted with tetanus, 34,7% were admitted after abortions. The mortality rate was 15,8%, which appears to be the lowest thus far reported. Possible methods of preventing postabortal tetanus are discussed. ( info) |
3/46. Novel treatment of a patient with secondary infertility due to retained fetal bone. OBJECTIVE: To describe a simple and previously unreported treatment for retained fetal bone fragments as a cause of secondary infertility. SETTING: Fertility center at a Canadian teaching hospital. DESIGN: Case report. PATIENT(S): A 36-year-old woman with a 15-year history of secondary infertility. INTERVENTION(S): A second dilation and curettage (D C) performed under abdominal ultrasound guidance was performed where the curette could be directed for the removal of echogenic endometrial foci. MAIN OUTCOME MEASURE(S): Resolution of long-term infertility. RESULT(S): Spontaneous pregnancy 4 months after ultrasound-guided D C and subsequent term delivery. CONCLUSION(S): If an echogenic area is discovered in the endometrium, it is now standard to look at the uterine cavity by hysteroscopy. However, if the hysteroscopy is normal, we suggest that a D C with intraoperative abdominal ultrasound assistance be done to ensure that all the abnormal tissue is removed. ( info) |
4/46. Uterine intramural bone after mid-trimester termination of pregnancy may not affect fertility: a case report. We present a case of a 27-year-old asymptomatic woman, gravida 2 para 0 abortus 2, diagnosed with uterine intramural fetal bone 30 days after a mid-trimester termination of pregnancy (TOP) by dilatation and evacuation (D&E). On ultrasound part of a fetal spine was seen within the right lateral isthmocervical area, adjacent to the descending branch of the uterine artery. Within 4 months after TOP the patient conceived again. This case illustrates the risk of myometrial penetration during mid-trimester TOP by D&E. Removal of intramural bony fragments may not be needed in an asymptomatic patient, as their presence does not seem to compromise fertility. ( info) |
5/46. Massive haematochezia after uterine evacuation: an uncommon cause of lower gastrointestinal bleeding. We report a case of a 30-year-old Para 2 1 who presented with massive haematochezia 7 days after uterine evacuation for an incomplete abortion. Difficulty in pre-operative diagnosis in this type of presentation and treatment is highlighted and the literature reviewed. ( info) |
| cytomegalovirus (CMV) is the most common cause of congenital infection worldwide. We report on a fatal fetal manifestation of primary maternal CMV infection including cerebellar hemorrhage and hydrops. The diagnosis was established by maternal serological tests, culture and polymerase chain reaction testing of amniotic fluid and fetal blood. The pregnancy was terminated. Postmortem examination confirmed the diagnosis. ( info) |
7/46. Fetal bones retained in the uterine cavity as a rare cause of chronic pelvic pain: a case report. BACKGROUND: Intrauterine retention of fetal bones is a rare complication of abortion. Abnormal uterine bleeding, dysmenorrhea and secondary infertility are the usual complaints. In this case the prolonged retention of fetal bones caused chronic pelvic pain. Hysteroscopic removal of the bones resulted in resolution of the chronic pelvic pain. CASE: A 20-year-old woman with a history of multiple terminations of pregnancies, was seen in the clinic with a complaint of chronic pelvic pain. Ultrasound and sonohysterogram revealed the presence of a foreign body in the uterine cavity. Hysteroscopic removal of fetal bones was performed, and the patient's pelvic pain was resolved. CONCLUSION: Intrauterine retention of fetal bones may result in chronic pelvic pain. In patients with history of abortion, the presence of fetal bones may cause chronic pelvic pain. ( info) |
8/46. Anomalies associated with failed methotrexate and misoprostol termination. BACKGROUND: methotrexate and misoprostol are frequently used in combination for medical termination of pregnancy. Despite their frequent use, published information about low-dose exposures to these known teratogens is sparse and neonatal follow-up data are limited. We present neonatal outcomes in three infants from two different women who had failed medical terminations with methotrexate and misoprostol. CASES: A young gravida 1, para 0, presented with intrauterine pregnancy complicated by first-trimester exposure to oral methotrexate and vaginal misoprostol. ultrasonography determined that the fetus had intrauterine growth restriction and ventriculomegaly. The infant had growth and developmental delays. A young gravida 4, para 3-0-0-3, also presented after first trimester exposure to methotrexate and misoprostol, and was found to have a twin gestation. The infants were noted to have multiple congenital anomalies, growth restriction, and developmental delay. CONCLUSION: Even single doses of methotrexate and misoprostol used in medical termination of pregnancy can be associated with multiple congenital anomalies. ( info) |
9/46. The incidence of retained fetal bone revealed in 2000 diagnostic hysteroscopies. Three of 2000 diagnostic hysteroscopies revealed residual fetal bony fragments in women with abnormal uterine bleeding. Removal of bony fragments by hysteroscopy is associated with therapeutic success. ( info) |
10/46. Pelvic actinomycosis: a case report. BACKGROUND: Pelvic actinomycosis is rare but can manifest with multiple presentations. CASE: A 28-year-old woman, gravida 4, para 2, conceived with a Paraguard intrauterine device (IUD) (FEI Products LLC, North Tonawanda, new york) in place. The IUD had been present for 2 years. The patient presented with an incomplete abortion at 6 weeks' gestation, and the IUD was removed. Two and one-half months later the patient presented with signs and symptoms of pelvic inflammatory disease and underwent hospitalization and exploratory laparotomy. The pathology specimen revealed diffuse actinomycosis involving the tube and ovary, appendix, and bowel mucosa. A Pap smear 3 months earlier had revealed actinomyces. CONCLUSION: actinomyces has been associated with IUD use and may present even after removal of the IUD. Pelvic actinomycosis is rare, and removal of the IUD may not be adequate treatment. If a patient presents with symptoms of infection, early diagnosis and aggressive antibiotics may prevent further complications. ( info) |