APPENDICITIS IN PREGNANCY

2012 ◽  
Vol 23 (3-4) ◽  
pp. 276-295 ◽  
Author(s):  
CATHERINE M WINDRIM ◽  
MARIE J CZIKK
Keyword(s):  
Surgical Intervention ◽  
Fetal Loss ◽  
Lower Abdominal Pain ◽  
Normal Pregnancy ◽  
Gravid Uterus ◽  
Diagnostic Dilemma ◽  
Presenting Symptoms ◽  
Symptom Pattern ◽  
Time Required ◽  
In Pregnancy

Acute appendicitis is the most common non-obstetric indication for surgical intervention in pregnancy, complicating 1/500 to 1/2000 deliveries. Due to the anatomical and physiological changes associated with pregnancy, appendicitis may present a diagnostic dilemma, leading to management delays and thus increasing the risk of appendiceal perforation. Many of the common presenting symptoms of appendicitis are common features of normal pregnancy including lower abdominal pain, nausea, vomiting and leukocytosis. Furthermore, the enlarging gravid uterus may displace the appendix to varying degrees thus altering the classic symptom pattern of appendicitis. The often nonspecific presentation in pregnancy may necessitate the utilization of diagnostic imaging to aid in accurate diagnosis. However, the perforated appendix is the most common surgical cause of fetal loss and the time required for any diagnostic aid must be weighed against the increasing risk of perforation caused by delay in surgical intervention.

scholarly journals IBD in pregnancy: recent advances, practical management

2020 ◽  
pp. flgastro-2019-101371 ◽  
Author(s):  
Christian P Selinger ◽  
Catherine Nelson-Piercy ◽  
Aileen Fraser ◽  
Veronica Hall ◽  
Jimmy Limdi ◽  
...  
Keyword(s):  
Quality Care ◽  
Fetal Loss ◽  
Normal Pregnancy ◽  
Current Evidence ◽  
Voluntarily Childless ◽  
Increased Risk ◽  
Relative Indication ◽  
Inflammatory Bowel ◽  
Maintenance Of Remission ◽  
In Pregnancy

Inflammatory bowel disease (IBD) poses complex issues in pregnancy, but with high-quality care excellent pregnancy outcomes are achievable. In this article, we review the current evidence and recommendations for pregnant women with IBD and aim to provide guidance for clinicians involved in their care. Many women with IBD have poor knowledge about pregnancy-related issues and a substantial minority remains voluntarily childless. Active IBD is associated with an increased risk of preterm birth, low for gestation weight and fetal loss. With the exception of methotrexate and tofacitinib the risk of a flare outweighs the risk of IBD medication and maintenance of remission from IBD should be the main of care. Most women with IBD will experience a normal pregnancy and can have a vaginal delivery. Active perianal Crohn’s disease is an absolute and ileal pouch surgery a relative indication for a caesarean section. Breast feeding is beneficial to the infant and the risk from most IBD medications is negligible.

scholarly journals Acute abdomen in a term pregnancy due to isolated tubal torsion

2020 ◽  
Vol 28 (3) ◽  
pp. 217-220
Author(s):  
Güneş Topçu ◽  
Yağmur Şimşek ◽  
Şenay Çetin ◽  
Murat Muhçu ◽  
Ayşegül Özel
Keyword(s):  
Acute Abdomen ◽  
Surgical Intervention ◽  
Lower Abdominal Pain ◽  
Rare Condition ◽  
Exploratory Laparotomy ◽  
Mri Findings ◽  
Obstetric Morbidity ◽  
Magnetic Resonance Imaging Mri ◽  
Early Surgical Intervention ◽  
In Pregnancy

Objective: Isolated tubal torsion in pregnancy is a rare condition we want to present this case. Case(s): In our study, we present a 23-year-old woman primigravida at 37 weeks of gestation with acute right lower abdominal pain. The clinical and Magnetic resonance imaging (MRI) findings led to diagnosis of acute appendicitis. Emergency exploratory laparotomy and cesarean section were performed. A twisted right Fallopian tube and Morgagni’s cyst was noted and right salpingectomy was performed. Conclusion: Although isolated tubal torsion during pregnancy is very rare, it should be included in the differential diagnosis of acute abdomen in pregnancy. Early surgical intervention will decrease obstetric morbidity.

scholarly journals Longitudinal ultrasonic dimensions and parametric solid models of the gravid uterus and cervix

2020 ◽  
Author(s):  
Erin Louwagie ◽  
Lindsey Carlson ◽  
Veronica Over ◽  
Lu Mao ◽  
Shuyang Fang ◽  
...  
Keyword(s):  
Solid Modeling ◽  
Normal Pregnancy ◽  
Gravid Uterus ◽  
Dual Function ◽  
Ultrasound Images ◽  
3 Dimensional ◽  
Solid Models ◽  
Magnetic Resonance Frequency ◽  
Computational Calculations ◽  
In Pregnancy

AbstractTissue mechanics is central to pregnancy, during which maternal anatomic structures undergo continuous remodeling to serve a dual function to first protect the fetus in utero while it develops and then facilitate its passage out. In this study of normal pregnancy using biomechanical solid modeling, we used standard clinical ultrasound images to obtain measurements of structural dimensions of the gravid uterus and cervix throughout gestation. 2-dimensional ultrasound images were acquired from the uterus and cervix in 30 pregnant subjects in supine and standing positions at four time points during pregnancy (8-14, 14-16, 22-24, and 32-34 weeks). Offline, three observers independently measured from the images of multiple anatomic regions. Statistical analysis was performed to evaluate inter-observer variance, as well as effect of gestational age, gravity, and parity on maternal geometry. A parametric solid model developed in the Solidworks computer aided design (CAD) software was used to convert ultrasonic measurements to a 3-dimensional solid computer model, from which estimates of uterine and cervical volumes were made. This parametric model was compared against previous 3-dimensional solid models derived from magnetic resonance frequency images in pregnancy. In brief, we found several anatomic measurements easily derived from standard clinical imaging are reproducible and reliable, and provide sufficient information to allow biomechanical solid modeling. This structural dataset is the first, to our knowledge, to provide key variables to enable future computational calculations of tissue stress and stretch in pregnancy, making it possible to characterize the biomechanical milieu of normal pregnancy. This vital dataset will be the foundation to understand how the uterus and cervix malfunction in pregnancy leading to adverse perinatal outcomes.

scholarly journals Longitudinal ultrasonic dimensions and parametric solid models of the gravid uterus and cervix

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0242118
Author(s):  
Erin Marie Louwagie ◽  
Lindsey Carlson ◽  
Veronica Over ◽  
Lu Mao ◽  
Shuyang Fang ◽  
...  
Keyword(s):  
Solid Modeling ◽  
Normal Pregnancy ◽  
Gravid Uterus ◽  
Dual Function ◽  
Ultrasound Images ◽  
3 Dimensional ◽  
Solid Models ◽  
Magnetic Resonance Frequency ◽  
Computational Calculations ◽  
In Pregnancy

Tissue mechanics is central to pregnancy, during which maternal anatomic structures undergo continuous remodeling to serve a dual function to first protect the fetus in utero while it develops and then facilitate its passage out. In this study of normal pregnancy using biomechanical solid modeling, we used standard clinical ultrasound images to obtain measurements of structural dimensions of the gravid uterus and cervix throughout gestation. 2-dimensional ultrasound images were acquired from the uterus and cervix in 30 pregnant subjects in supine and standing positions at four time points during pregnancy (8-14, 14-16, 22-24, and 32-34 weeks). Offline, three observers independently measured from the images of multiple anatomic regions. Statistical analysis was performed to evaluate inter-observer variance, as well as effect of gestational age, gravity, and parity on maternal geometry. A parametric solid model developed in the Solidworks computer aided design (CAD) software was used to convert ultrasonic measurements to a 3-dimensional solid computer model, from which estimates of uterine and cervical volumes were made. This parametric model was compared against previous 3-dimensional solid models derived from magnetic resonance frequency images in pregnancy. In brief, we found several anatomic measurements easily derived from standard clinical imaging are reproducible and reliable, and provide sufficient information to allow biomechanical solid modeling. This structural dataset is the first, to our knowledge, to provide key variables to enable future computational calculations of tissue stress and stretch in pregnancy, making it possible to characterize the biomechanical milieu of normal pregnancy. This vital dataset will be the foundation to understand how the uterus and cervix malfunction in pregnancy leading to adverse perinatal outcomes.

scholarly journals Treatment and therapeutic strategies for pituitary apoplexy in pregnancy: a case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuya Kato ◽  
Yoshikazu Ogawa ◽  
Teiji Tominaga
Keyword(s):  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Case Series ◽  
Optimal Timing ◽  
Presenting Symptoms ◽  
Pathological Evaluation ◽  
Mother And Child ◽  
Life Threatening ◽  
In Pregnancy

Abstract Background Pregnancy is a known risk factor for pituitary apoplexy, which is life threatening for both mother and child. However, very few clinical interventions have been proposed for managing pituitary apoplexy in pregnancy. Case presentation We describe the management of three cases of pituitary apoplexy during pregnancy and review available literature. Presenting symptoms in our case series were headache and/or visual disturbances, and the etiology in all cases was hemorrhage. Conservative therapy was followed until 34 weeks of gestation, after which babies were delivered by cesarean section with prophylactic bolus hydrocortisone supplementation. Tumor removal was only electively performed after delivery using the transsphenoidal approach. All three patients and their babies had a good clinical course, and postoperative pathological evaluation revealed that all tumors were functional and that they secreted prolactin. Conclusions Although the mechanism of pituitary apoplexy occurrence remains unknown, the most important treatment strategy for pituitary apoplexy in pregnancy remains adequate hydrocortisone supplementation and frequent hormonal investigation. Radiological follow-up should be performed only if clinical symptoms deteriorate, and optimal timing for surgical resection should be discussed by a multidisciplinary team that includes obstetricians and neonatologists.

Comparison of pregnancy outcomes after second trimester amniocentesis between procedures performed by experts and non-experts

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Tanapak Wisetmongkolchai ◽  
Fuanglada Tongprasert ◽  
Kasemsri Srisupundit ◽  
Suchaya Luewan ◽  
Kuntharee Traisrisilp ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Loss Rate ◽  
Fetal Loss ◽  
Adverse Pregnancy Outcomes ◽  
Expert Group ◽  
Second Trimester ◽  
Single Institution ◽  
Adverse Pregnancy ◽  
In Pregnancy ◽  
Singleton Pregnancies

AbstractObjectivesTo compare the rate of fetal loss in pregnancy after second trimester amniocentesis between procedures performed by experts and non-experts and to assess other pregnancy complications as secondary outcomes.MethodsA retrospective cohort study was performed on singleton pregnancies that underwent mid-trimester amniocenteses in a single institution. The fetal loss rates of procedures performed by experts and non-experts were collected and analyzed. Other adverse pregnancy outcomes were also examined.ResultsIn total, 14,450 amniocenteses were performed during the study period. These included 11,357 (78.6%) procedures in the group expert operators and 3,093 (21.4%) procedures in the group non-expert operators. In the non-expert group, the fetal loss rate was slightly increased but not significantly (p=0.24).In addition, the higher number of spontaneous abortions was associated with blood-stained amniotic fluid sample (p<0.001; RR=9.28). Multiple needle insertions also increased in the non-expert group significantly. However, no difference in pregnancy outcomes was found between in single and multiple needle insertions.ConclusionsThe amniocentesis procedures performed by the non-experts was not increase the fetal loss rate. However, the other adverse pregnancy outcomes, including preterm birth, low birth weight and fetal growth restriction were significantly increased in the non-expert group.

Successful Treatment of Graves Disease in Pregnancy with Lugol's Iodine

2000 ◽  
Vol 45 (1) ◽  
pp. 20-21 ◽  
Author(s):  
A. Jamieson ◽  
C.G. Semple
Keyword(s):  
Drug Therapy ◽  
Successful Treatment ◽  
Surgical Intervention ◽  
Antithyroid Drug ◽  
Primary Treatment ◽  
Graves Disease ◽  
Lugol’S Iodine ◽  
Organic Iodine ◽  
Antithyroid Drug Therapy ◽  
In Pregnancy

We report a case of Grave's disease in pregnancy complicated by intolerance of standard antithyroid drug therapy. We describe the success of prolonged use of organic iodine as a primary treatment prior to surgical intervention.

Iron and folic acid tablets in pregnancy

1964 ◽  
Vol 2 (4) ◽  
pp. 13-14
Keyword(s):  
Folic Acid ◽  
Normal Pregnancy ◽  
Megaloblastic Anaemia ◽  
Combined Administration ◽  
Mild Deficiency ◽  
Iron And Folic Acid ◽  
In Pregnancy

Mild deficiency of folic acid is common in the later months of normal pregnancy, due apparently to increased demand and in some cases to impaired absorption1. Megaloblastic anaemia from this cause is not rare, but more frequently a lesser degree of deficiency complicates lack of iron, and in such cases the anaemia responds only to the combined administration of both substances. Deficiency of folic acid has been found in patients with accidental haemorrhage and may be found in anaemia in the puerperium.

Metformin Combined LMWH Intervention in 25 Pregnant Women with History of Hyperlipidemia Pancreatitis in Pregnancy

2021 ◽  
Author(s):  
Mei Peng ◽  
Ya-Li Deng ◽  
Ling Yu ◽  
Yan-Ting Nie ◽  
Ting Luo ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Cohort Analysis ◽  
Intervention Group ◽  
Fetal Loss ◽  
Preventive Treatment ◽  
Full Term ◽  
Lipid Lowering ◽  
Neonatal Asphyxia ◽  
In Pregnancy

Objective: To explore the early preventive treatment of hypertriglyceridemia-induced acute pancreatitis (HTGP) in pregnancy. Methods: A retrospective cohort analysis was performed to examine the drug intervention on recurrent HTGP and related pregnancy outcomes among women who had HTGP in their past pregnancy and developed hyperlipidemia during the second pregnancy. Participants were identified through inpatient case records under a single physician at the clinic and divided into two groups. The intervention group was given metformin lipid-lowering combined with low-molecular-weight heparin to prevent thrombosis when hypertriglyceridemia was developed during the pregnancy. In contrast, the non-intervention group includes those who did not receive active drug treatment until they developed recurrent HTGP. Metabolic markers were also examined by comparing them with their respective past pregnancies. Results: All participants experienced elevated triglycerides during their two consecutive pregnancies. No pregnant women developed HTGP in the intervention group (n=12), while 10 of 13 (76.9%) women developed HTGP in the non-intervention group. Thus, the outcome seemed to be markedly different. In the intervention group, 11 women were gestated to term, and one was premature; one of 12 (8.3%) births was neonatal asphyxia; there was no low-weight birth, and the prognosis of mother and baby was favorable. Of 10 women who developed recurrent HTGP in the non-intervention group, four suffered from fetal loss, four had premature, and two had full-term delivery; among the three pregnant women without HTGP, one had a premature and two had full-term births; five of thirteen (38.5%) births were neonatal asphyxia. Conclusion: Pregnant women with HTGP history, if not treated, are likely to develop the condition recurrently during pregnancy, but timely intervention on hypertriglyceridemia with lipid-lowering and thrombosis-preventing seemed complete to reduce the recurrent HTGP and improve the pregnancy outcomes.

scholarly journals Pneumatosis Intestinalis: A Case Report and Approach to Management

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Sean Donovan ◽  
Joseph Cernigliaro ◽  
Nancy Dawson
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Bowel Wall ◽  
Surgical Intervention ◽  
Wide Spectrum ◽  
Pneumatosis Intestinalis ◽  
Rapid Evaluation ◽  
Thought Process ◽  
Diagnostic Dilemma ◽  
Clinical Scenarios

Pneumatosis intestinalis (PI), defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007), Morris et al. (2008), and Peter et al. (2003)). Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios.

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