1/11. Minimally invasive endoscopy in the treatment of preterm premature rupture of membranes by application of fibrin sealant.We report only the 3rd case of closure of amniorrhexis following genetic amniocentesis. Our technique is the first to use endoscopic visualization of the rupture site and apply maternal platelets and fibrinogen/thrombin (Hemaseel Haemacure Corp Sarasota F1). The patient underwent repair at 20.6 weeks, 26 days after spontaneous rupture of membranes post-amniocentesis. At the time of the procedure the amniotic fluid index was 1 cm. Patient was delivered at 32.3 weeks secondary to complications of diabetes and severe preeclampsia. The neonate had APGARS of 7 at 1 min and 8 at 5 min and was discharged home on Day 21 of life.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/11. Prolonged-interval delivery between the first and second twin. A case report.BACKGROUND: Prolonged-interval delivery between twins can improve neonatal outcome and, under careful monitoring, poses minimal maternal risk. CASE: A 27-year-old, nulliparous woman conceived after in vitro fertilization and was found to have diamniotic-dichorionic twins. At 17 weeks she presented with premature preterm rupture of the membranes of twin A. She was offered delivery or expectant management. She chose expectant management and was discharged. At 18 weeks she delivered twin A and decided to expectantly manage the second twin. amniocentesis was performed to evaluate for intraamniotic infections. There was no evidence of them, and a McDonald cerclage was placed. At 32 weeks, spontaneous rupture of the membranes occurred for twin B. The patient delivered vaginally a male infant (2,070 g) who did not need mechanical ventilation and was discharged from neonatal intensive care on the 7th day of life, with no complications. CONCLUSION: Expectant management of a second twin after delivery of the first in selected patients can improve neonatal outcome.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
3/11. Failure of methotrexate and internal iliac balloon catheterization to manage placenta percreta.BACKGROUND: placenta percreta is a rare but potentially lethal condition. Previously described conservative measures to avoid life-threatening hemorrhage and preserve fertility include use of methotrexate and uterine artery embolization. CASE: A woman with suspected placenta percreta diagnosed on ultrasound in the second trimester was delivered by classic, fundal cesarean at 30 weeks' gestation for bleeding and premature rupture of membranes. The placenta was left in situ, and she was treated with methotrexate. Postpartum bleeding 1 week later was managed by internal iliac balloon catheterization and manual transcervical removal of the placenta, which resulted in hysterectomy and required massive blood transfusion. CONCLUSION: placenta percreta managed conservatively with methotrexate and internal iliac balloon catheterization resulted in serious morbidity.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
4/11. Early onset neonatal sepsis due to morganella morganii.Two neonates, both 32-weekers, developed morganella morganii sepsis on the first day of life. They presented within a day of each other, primarily with respiratory signs. In both cases there was a history of spontaneous premature rupture of membranes, exposure to a single dose of ampicillin ante-partum, and similar antibiograms. No common source could be identified.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
5/11. Premature rupture of membranes at 20 weeks: report of a successful outcome after transcervical application of fibrin glue.A 30-year-old primigravida was admitted to hospital at 20 weeks of gestation because of premature rupture of membranes and oligohydramnios. The patient was maintained in bed rest and given intravenous ampicillin. Forty-eight hours later, after documenting the absence of infection and maintenance of the oligohydramnios, fibrin glue was applied transcervically under ultrasound control. There was subjective improvement in amniotic fluid volume after treatment, but always within the criteria of oligohydramnios. Fibrin glue application was repeated twice due to reported increase in fluid loss and diminished amniotic fluid volume on ultrasound. amoxicillin per os was started at 23 weeks, and clavulanic acid was added at 26 weeks due to the isolation of an escherichia coli on cervical-vaginal cultures. No signs of infection ensued until 34 weeks, when an axillary temperature of 39.5 degrees C was detected together with a non-reassuring cardiotocographic pattern, the latter leading to the performance of an urgent cesarean section. The newborn had an apgar score of 9/10/10, umbilical artery pH of 7.32, and no external deformities. He showed no signs of lung hypoplasia and required no oxygen supplementation. Oropharyngeal and blood cultures revealed an E. coli infection and antibiotic treatment was started. No further complications occurred and he was discharged home on the 8th day of life. At 12 months, the child reveals a normal development. The mother had a mild and short-lasting wound infection and was discharged on the 8th postoperative day.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
6/11. extracorporeal membrane oxygenation in pregnancy.BACKGROUND: safety and efficacy of extracorporeal membrane oxygenation (ECMO) in pregnancy is unknown. CASE: A 33-year-old pregnant woman at 23 weeks of gestation presented with acute respiratory distress syndrome unresponsive to conventional mechanical ventilation. Early initiation of ECMO therapy along with protective mechanical ventilation strategy resulted in an excellent maternal and fetal outcome. CONCLUSION: extracorporeal membrane oxygenation can be life saving when initiated early in pregnant patients with severe acute respiratory insufficiency unresponsive to conventional mechanical ventilation.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
7/11. Fetal hemorrhage from umbilical cord hemangioma.Hemangiomas of the umbilical cord are rare. In this case, an acute, massive fetal hemorrhage from a ruptured umbilical hemangioma occurred after spontaneous rupture of membranes. Ectopic small intestinal mucosa covered the proximal surface of the umbilical cord. Fetal anomalies included a patent vitellointestinal duct remnant and distal ileal atresia. Fetal hemorrhage appears to be another previously unreported and potentially life-threatening complication of umbilical hemangiomas.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
8/11. The pathologic findings of the fetal membranes in very prolonged amniotic fluid leakage.We examined the fetal membranes in five patients with prolonged amniotic fluid leakage. Four patients had a clinical history of fluid leakage of at least six weeks' duration, while, in the fifth patient, prolonged leakage was only an inferred diagnosis. Four of the infants died within the first two days of life, while one infant survived. The pathologic findings were varied. Two cases showed, to our knowledge, a previously unreported subchorionic accumulation of squames, which were presumably from cells that were shed into amniotic fluid. One other case showed a subchorionic foreign-body reaction. The two remaining cases showed only necrosis and hemorrhage.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
9/11. Vascular tufts in retrolental fibroplasia.Three cases of retrolental fibroplasia with vascular tufts at different locations are described. They probably represent mesenchymal proliferation in response to severe hypoxia. The tufts are reddish-pink in color and angiographically do not leak fluorescein. When present posterior to the equator they suggest an immature retinal circulation and the visual prognosis is poor.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
10/11. New interpretation and management of dry lung syndrome: a case report.A premature female infant with life-threatening respiratory distress which was diagnosed as 'dry lung syndrome' is reported. The mother had 4 weeks of large volume leakage of the amniotic fluid due to premature rupture of the fetal membranes (PROM) at 23 weeks' gestation. The infant was born after 27 weeks' gestation (birthweight, 1016 g) and was suffering severe respiratory distress. Although a chest radiogram and gastric juice microbubble test did not improve the possibility of respiratory distress syndrome (RDS), very high ventilator settings did not improve her respiratory disorders. Considering the infant's deteriorating respiratory status and the prolonged leakage of the amniotic fluid, we suspected the presence of pulmonary hypoplasia. Although an attempt at high frequency oscillation (HFO) to rescue this infant had no effect, intratracheal instillation of epinephrine (EP) showed dramatic improvement of her respiratory status. This clinical course showed that the patient did not have pulmonary hypoplasia but might have severe airway obstruction and this airway obstruction may be the major cause of 'dry lung syndrome'. We postulate that when a newborn with suspected pulmonary hypoplasia is unresponsive to respiratory support. HFO should be administered. If HFO is ineffective in relieving the respiratory distress, one should suspect the presence of airway collapse and administer a bronchodilator such as EP. If the infant improves, a diagnosis of 'dry lung syndrome' may be assumed.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
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