1/5. A hypothesis to explain the occurence of inner myometrial laceration causing massive postpartum hemorrhage.BACKGROUND: Inner myometrial lacerations were found in three patients who developed uncontrollable postpartum massive bleeding despite the usual treatment for uterine atony. Because all the patients suffered from hemorrhage shock and their medical status deteriorated, their uteri were surgically removed to stop bleeding. After removal, one of them died. postpartum hemorrhage was caused by inner myometrial laceration. We hypothesized a cause of inner myometrial laceration, using the three resected uteri, an assumed model of the uterine body, and 34 women. methods: The subjects were 37 women, of whom three were patients with inner myometrial laceration, 23 were women without inner myometrial laceration who underwent cesarean section, and 11 were women in the first stage of labor. The three resected uteri were examined both macroscopically and microscopically. We measured the thickness of the wall of the uterine muscle at the widest point of the uterine corpus and the thickness of the myometrial wall at a transverse section of the uterine cervix, as well as the radius of the inner lumen at the widest point of the uterus in 23 women during cesarean section. We also measured the thickness of the myometrial wall at the widest point of the uterine corpus in 11 women at the end of the first stage of labor during ultrasonic examination. The data were then used to estimate the stress on the uterine muscle. RESULTS: The stress on the uterine cervix was stronger than that on the uterine corpus during labor. When the stress on the uterine muscle is stronger than a specific value, inner myometrial lacerations develop on the right and/or left side of the uterine cervix. These lacerations may involve large vessels. CONCLUSIONS: We have discovered another cause of postpartum hemorrhage which we have named inner myometrial laceration. These lacerations appeared to result from a strong stress on the uterine cervix caused by an abnormal rise in intrauterine pressure during labor.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/5. Severe vasovagal attack: an unusual cause of abruptio placentae.CASE REPORT: abruptio placentae occurred in a 29 years old woman following a vasovagal episode. Her medical history was free from all the commonly accepted risk factors for abruption. DISCUSSION: We speculate that the restoration of placental blood flow caused a sudden increase in uteroplacental blood pressure, and induces rupture of some vessels, causing a progressively growing retroplacental hematoma and placental detachment.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/5. DIC and acute renal failure as a complication of abruptio placentae.Disseminated intravascular coagulopathy (DIC) is not a new concept. Almost 90 years ago De Lee reported a case of fetal coagulation disorder with abruptio placentae and described it as "temporary hemophilia." Disseminated intravascular clotting is the result of a widespread exposure of the circulating blood to procoagulant activity capable of activating fibrinolytic enzyme system converting fibrinogen into the fibrin. Fibrin may in turn cause small blood vessel occlusion resulting in tissue necrosis, and as the phenomenon occurs more often in the glomerular capillaries acute renal failure may ensue.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/5. Ocular complications of disseminated intravascular coagulation (DIC) in abruptio placentae.A 30 year old white woman presented at term with vaginal bleeding, dizziness and blurred vision due to bilateral serous retinal detachments. Extensive areas of choroidal occlusion with focal leakage of dye from the posterior retinal pigment epithelium and choroid were demonstrated by fluorescein angiography. With the diagnosis of abruptio placentae, a dead fetus and disseminated intravascular coagulation (DIC) the patient underwent removal of the uterine contents by cesarean section. DIC and retinal detachments resolved with improvement of vision, DIC, frequently observed in obstetric complications, has a tendency to occlude the posterior choroidal vessels, which often results in serous retinal detachments. In the setting of pregnancy, especially complicated late pregnancy, the occurrence of serous retinal detachments may be an early ocular sign of DIC.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/5. Spontaneous rectus sheath hematoma during pregnancy mimicking abruptio placenta.Sudden disruption of a deep epigastric vessel may result in an abdominal wall hematoma, which, depending upon its location and size, can produce symptoms and clinical findings compatible with a variety of acute intra-abdominal conditions. The literature has noted a predominance of pregnant patients among those affected with this malady. Such hematomas are infrequently encountered and early accurate diagnosis could prevent surgical intervention. Unfortunately, the clinical manifestations of rectus muscle hematoma are sometimes so dramatic that laparotomy is performed under the belief that intra-abdominal pathology is present. We present a case of a suspected abruptio placenta misdiagnosed by clinical and ultrasound examination that was subsequently discovered to be a rectus sheath hematoma at the time of surgery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |