scholarly journals Surgery for Severe Ulcerative Colitis during Pregnancy: Report of Two Cases

2015 ◽  
Vol 9 (1) ◽  
pp. 74-80 ◽  
Author(s):  
Motoi Uchino ◽  
Hiroki Ikeuchi ◽  
Hiroki Matsuoka ◽  
Toshihiro Bando ◽  
Kei Hirose ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Cesarean Section ◽  
Disease Severity ◽  
Gestational Age ◽  
Surgical Procedure ◽  
Conservative Therapy ◽  
Toxic Megacolon ◽  
Maternal Complications ◽  
Severe Ulcerative Colitis ◽  
History Of

Refractory ulcerative colitis (UC) that does not respond to medical therapy often requires surgery even during pregnancy. Although surgical cases of UC during pregnancy were reported previously, the standard surgical strategy for both colitis and pregnancy was unclear. Herein, fetal and maternal safety as well as the strategy for this unusual surgical procedure during pregnancy in patients with UC are considered. A 28-year-old woman was diagnosed with left-sided moderate UC at 12 weeks of pregnancy; toxic megacolon was suspected, and surgery was required. Although the baby's gestational age was 23 weeks and 3 days, a cesarean section was performed before the colectomy. In a next case, a 28-year-old woman had a 2-year history of left-sided UC. Her colitis flared up at 11 weeks of pregnancy. Colectomy was performed because her colitis was unresponsive to conservative therapy, and the pregnancy was continued, with a transvaginal delivery at 36 weeks. In patients with UC, the need for surgery should be determined promptly based on disease severity, whether or not the patient is pregnant. The need for surgery should not be affected by pregnancy. The pregnancy should be continued for as long as possible when there are no fetal and maternal complications. Both cesarean section and colectomy should be performed independently if necessary.

scholarly journals Management of Severe Attacks of Ulcerative Colitis with New Technologies

1990 ◽  
Vol 4 (7) ◽  
pp. 347-349
Author(s):  
M Campieri ◽  
P Gionchetti ◽  
A Belluzzi ◽  
M Tampieri ◽  
C Brignola ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Transverse Colon ◽  
Bowel Wall ◽  
New Technologies ◽  
Toxic Megacolon ◽  
Abdominal Ultrasound ◽  
Histological Evaluation ◽  
Excellent Correlation ◽  
Severe Ulcerative Colitis ◽  
Descending Colon

Barium enema and colonoscopy are contraindicated in severe attacks of ulcerative colitis because of the possibility of toxic megacolon and perforation. The authors have assessed abdominal ultrasound in 38 patients with severe ulcerative colitis. Ultrasound revealed bowel wall thicknesses ranging from 3.9 to 9.2 mm (mean 7.7) extending the whole length of the colon, to the transverse colon, and to the descending colon, respectively, in 18, 10 and eight patients. The degree of bowel thickening was related to the severity of inflammation based on clinical, sigmoidoscopic and histological evaluation. In two patients, ultrasound showed a thin bowel wall distended without motility, suggesting the diagnosis of toxic megacolon (confirmed radiologically). An excellent correlation (95%) was found between ultrasound and technetium-99 scanning. Ultrasound might be a reasonable first investigation in the assessment of patients with severe ulcerative colitis.

scholarly journals Predicting therapeutic outcome in severe ulcerative colitis by measuring in vitro steroid sensitivity of proliferating peripheral blood lymphocytes

Gut ◽  
1999 ◽  
Vol 45 (3) ◽  
pp. 382-388 ◽  
Author(s):  
S D Hearing ◽  
M Norman ◽  
C S J Probert ◽  
N Haslam ◽  
C M Dayan
Keyword(s):  
Ulcerative Colitis ◽  
T Lymphocytes ◽  
Disease Severity ◽  
T Lymphocyte ◽  
Peripheral Blood ◽  
Steroid Treatment ◽  
Steroid Resistance ◽  
Severe Ulcerative Colitis ◽  
Steroid Sensitivity

BACKGROUNDUp to 29% of patients with severe ulcerative colitis (UC) fail to respond to steroid treatment and require surgery. Previous studies have failed to show a clear correlation between failure of steroid treatment in severe UC and measures of disease severity. The reasons for treatment failure therefore remain unknown.AIMTo investigate the hypothesis that patients with severe UC who fail to respond to steroid treatment have steroid resistant T lymphocytes.METHODSEighteen patients with severe UC were studied. After seven days’ treatment with high dose intravenous steroids they were classified as complete responders (CR), incomplete responders (IR), or treatment failures (TF). Within 48 hours of admission blood was taken and the antiproliferative effect of dexamethasone on phytohaemagglutinin stimulated peripheral blood T lymphocytes was measured. Maximum dexamethasone induced inhibition of proliferation (Imax) was measured.RESULTSIn vitro T lymphocyte steroid sensitivity of TF and IR patients was significantly less than that of CR patients. Both TF and 3/5 IR patients had an Imax of less than 60%; all CR patients had an Imax of greater than 60%. No significant correlation was seen between response to treatment and disease severity on admission. When in vitro T lymphocyte steroid sensitivity was remeasured three months later, there was no difference between the groups.CONCLUSIONSResults suggest that T lymphocyte steroid resistance is an important factor in determining response to steroid treatment in patients with severe UC and may be more predictive of outcome than disease severity.

CLINICAL AND SUBCLINICAL CHARACTERICTIS AND PREGNANCY OUTCOME OF FETAL MACROSOMIA AT OBSTETRIC DEPARTMENT AT HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

2020 ◽  
pp. 78-84
Author(s):  
Giang Truong Thi Linh ◽  
Quang Mai Van
Keyword(s):  
Birth Weight ◽  
Caesarean Section ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Vaginal Birth ◽  
Fetal Macrosomia ◽  
Major Influence ◽  
Maternal Complications ◽  
Perineal Tear ◽  
History Of

Background: Fetal macrosomia has a major influence on maternal, neonatal and pregnancy outcomes.Objective: To describe the clinical and subclinical features and the management of fetal macrosomia on pregnancy outcomes. Subjects and methods: Study subjects including pregnant women and babies born ≥ 3500 g with nulliparous and over 4000 grams with primiparous or multiparous at Departement of Obstetrics and Gynecology in Hue University of Medicine and Pharmacy Hospital. The time of choosing subjects to enter the research group is that after birth, the weight is above 3500/4000 grams, then follow up the pregnancy result and retrospect the clinical and subclinical characteristics. Results: From May 2019 to April 2020, there were 223 pregnant women with the birth weight ≥ 3500 g in this study. The mean neonatal weight for macrosomia was 3869.96 ± 315.72 (g). The birth weight ≥ 4000 g, the rate of cesarean section was 91.5%, vaginal birth was 8.5%. The birth weight 3500 - under 4000 g, the rate of cesarean section was 76%, vaginal birth was 24%. 1.1% maternal complications was perineal tear. Conclusion:Factors related to fetal macrosomia: Maternal age, gender of fetus, parity, a history of fetal macrosomia, maternal height, pregnancy weight gain. Caesarean section is the majority. Key words: Fetal macrosomia, gestational diabetes mellitus, normal labor, caesarean section.

scholarly journals Factors Influencing Maternal Mortality from Severe Preeclampsia and Eclampsia

2016 ◽  
Author(s):  
Denny Khusen
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Maternal Mortality ◽  
Maternal Death ◽  
Gestational Age ◽  
Post Partum ◽  
Severe Preeclampsia ◽  
Maternal Complications ◽  
History Of ◽  
Post Partum Bleeding

Objective: To analyze risk factor, both clinical and laboratory findings, associated with maternal mortality from severe preeclampsia and eclampsia in Atma Jaya Hospital. Methods: This was a retrospective case control study. All medical records of maternal death associated with severe preeclampsia and eclampsia between 1st January 2009 and 31st December 2011 were obtained and then information about risk factors were collected and tabulated. Risk factor analyzed were maternal age, gestational age, parity, coexisting medical illness (hypertension), antenatal examination status, maternal complications, systolic and diastolic blood pressure at admission, and admission laboratory data. Results: There were 19 maternal deaths associated with severe preeclampsia and eclampsia during period of study (Consisted of 6 cases of eclampsia and 13 cases of severe preeclampsia). Maternal mortality rate for severe preeclampsia and eclampsia were 16.7% and 33.3% respectively. Multivariate analysis identified the following risk factors associated with maternal death: gestation age <32 week, history of hypertension, thrombocyte count < 100.0000/μl, post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. Conclusion: In this study, we found that gestational age, history of hypertension, and platelet count are the cause of maternal mortality. Maternal complications associated with maternal mortality are post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. [Indones J Obstet Gynecol 2012; 36-2: 90-4] Keywords: eclampsia, maternal mortality, preeclampsia

scholarly journals Pregnancy with previous caesarean section: an overview of adverse fetomaternal sequelae

2018 ◽  
Vol 7 (5) ◽  
pp. 1817 ◽  
Author(s):  
Joyita Bhowmik ◽  
Amit Kyal ◽  
Indrani Das ◽  
Vidhika Berwal ◽  
Pijush Kanti Das ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Previous History ◽  
Successful Outcome ◽  
Maternal Complications ◽  
Cross Sectional ◽  
Medical College ◽  
Increased Risk ◽  
Fetal Complications ◽  
History Of

Background: The Caesarean section epidemic is a reason for immediate concern and deserves serious international attention. The purpose of this study was to evaluate adverse maternal and fetal complications associated with pregnancies with history of previous caesarean section.Methods: A cross-sectional, observational study carried out over a period of 1 year from 1st June 2016 to 31st July 2017 in Medical College Kolkata. 200 antenatal patients with previous history of 1 or more caesarean sections were included. In all cases thorough history, complete physical and obstetrical examination, routine and case specific investigations were carried out and patients were followed till delivery and for 7 days thereafter. All adverse maternal and fetal complications were noted.Results: Out of 200 women, 30 candidates were tried for VBAC, of them 20 (66.66%) had successful outcome. Most common antenatal complication was APH (5.5%) due to placenta praevia followed by scar dehiscence. There were 12 cases (6.66%) of PPH and 6 cases (3.33%) of scar dehiscence in the study group. 3 cases required urgent hysterectomy due to placenta accreta. 42 out of 196 babies required management in SNCU immediately or later after birth.Conclusions: Women with a prior cesarean are at increased risk for repeat cesarean section. Vigilance with respect to indication at primary cesarean delivery, proper counselling for trial of labor and proper antepartum and intrapartum monitoring of patients are key to reducing the cesarean section rates and maternal complications.

scholarly journals Feto-maternal Outcomes in Cesarean Section Compared to Vaginal Delivery in Eclamptic Patients in a Tertiary Level Hospital

2013 ◽  
Vol 3 (2) ◽  
pp. 77-83
Author(s):  
Sheuly Begum ◽  
Ferdousi Islam ◽  
Arifa Akter Jahan
Keyword(s):  
Cesarean Section ◽  
Maternal Mortality ◽  
Vaginal Delivery ◽  
Gestational Age ◽  
Birth Asphyxia ◽  
Maternal Outcome ◽  
Maternal Complications ◽  
Medical College ◽  
Group I ◽  
Significant Difference

Background: Over  half-a-million women die each year  from pregnancy-related  causes, and  99 percent of these occur in developing countries. In Bangladesh though maternal mortality  rate (MMR) declined  significantly  around 40% in  the  past  decade,  still  eclampsia  accounts  for 20% of maternal deaths. Eclampsia is uniquely a disease of pregnancy, and the only cure  is  delivery  regardless  of  gestational  age.  A  rational  therapy  for  general  management  of  hypertension and convulsion has been established in Bangladesh by the Eclampsia Working  Group.  But  controversy  still  exists  regarding  obstetric  management. Objective: To  evaluate  the  feto-maternal  outcome  in  cesarean  section  compared  to  vaginal  delivery  in  eclamptic  patients. Materials  and  Methods: This  prospective  cohort  study  was  conducted  in  the  department of Obstretics & Gynecology, Dhaka Medical College & Hospital (DMCH), from  January to December 2011. A total 100 eclamptic women with term pregnancy and live foetus  were purposively included in the study (Group I, 50 patients with vaginal delivery and Group  II, 50 with cesarean section). Results: Out  of these 100 patients 56% were aged <20 years,  71%  were  primigravida  and  77%  were  from  low  socioeconomic  status.  Sixteen  percent  patients from vaginal delivery group and 18% from cesarean section group had no antenatal  care. The mean gestational age was about 38 weeks in two groups. No significant difference  was found between the two groups regarding blood pressure, proteinuria, consciousness level  and convulsion. Recurrence of convulsion occurred in 30% patients of vaginal delivery group  compared  to  6%  in  cesarean  section  group.  Maternal  complications  such  as  postpartum  hemorrhage,  cerebrovascular  accident,  renal  failure,  obstetric  shock  and  abruptio  placenta  were  higher  among  vaginal  delivery  group  patients  (46%)  than  cesarean  section  patients  (16%).  Maternal  mortality  was 6% in  the  vaginal  delivery  group  and  none  in  the  cesarean  section  group.  Regarding  fetal  outcome,  stillbirth  was  20%  after  vaginal  delivery  and  6%  after cesarean section,  the result was statistically  significant.  Birth asphyxia was less  in  the  cesarean  section  group  (23.4%)  than  in  vaginal  delivery  group  (60%)  and  this  was  statistically  significant. Conclusions:  The  result  of  the  present  study  shows  a  better  feto- maternal outcome in the cesarean section group than in the vaginal delivery group. Journal of Enam Medical College; Vol 3 No 2 July 2013; Page 77-83 DOI: http://dx.doi.org/10.3329/jemc.v3i2.16128

scholarly journals P782 Natural history of acute severe ulcerative colitis in elderly: A population-based study

2018 ◽  
Vol 12 (supplement_1) ◽  
pp. S506-S506 ◽  
Author(s):  
L Bril ◽  
A Leroyer ◽  
M Fumery ◽  
C Charpentier ◽  
B Pariente ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Natural History ◽  
Population Based ◽  
Population Based Study ◽  
Severe Ulcerative Colitis ◽  
History Of

P103 FULMINANT CLOSTRIDIUM DIFFICILE ENTERITIS IN A PATIENT WITH ULCERATIVE COLITIS FOLLOWING TOTAL COLECTOMY RELIEVED BY ILEAL DECOMPRESSION

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S20-S20
Author(s):  
Matthew Rolfsen ◽  
Erin Forster ◽  
Virgilio George ◽  
Scott Curry
Keyword(s):  
Ulcerative Colitis ◽  
Clostridium Difficile ◽  
Toxic Megacolon ◽  
Total Colectomy ◽  
Colonic Surgery ◽  
Rectal Tube ◽  
Toxin A ◽  
Toxin B ◽  
Common Cause ◽  
History Of

Abstract A 20 year old female with a history of Ulcerative colitis status post total colectomy and end ileostomy was admitted to the intensive care unit with septic shock. She had initially been diagnosed with fulminant ulcerative pancolitis three months prior, and after failing to respond to dual therapy with high dose infliximab and azathioprine, she underwent total colectomy and end ileostomy as the first part of a staged ileal pouch-anal anastomosis procedure. Upon presentation to the emergency department, she endorsed fevers, chills, abdominal pain, and decreased stomal output. Diagnostic workup was notable for polymerase chain reaction (PCR) positive for Clostridium difficile toxin A and toxin B. She began treatment with oral vancomycin and IV flagyl, but remained critically ill with persistent fevers, vasopressor requirement and imaging showing 4.1 cm dilation of her distal ileum. As such the decision was made to attempt decompression via placement of a rectal tube into her ileostomy, after which her ostomy output improved from &lt;20cc/day to 7L in the ensuing 48 hours. During this time she defervesced, was taken off of vasopressors, and was able to be discharged from the hospital one week later. Infectious agents are the most common cause of diarrhea worldwide. Amongst implicated culprits, C. difficile is both the most common nosocomial infection and the most common cause of death due to gastrointestinal infections. Mechanisms of infectious diarrhea include formation of various toxins as well as cellular adherence and invasion (1). In the case of C. difficile, the gram positive anaerobe produces both an enterotoxin (toxin A) and a cytotoxin (toxin B). In patients found to have C. difficile infections (CDI), the vast majority are affected by colitis. There is a small prevalence of extracolonic CDI, including extraintestinal in a small subgroup (0.17%)(2). According to literature, extracolonic CDI carries a 20% mortality rate. Out of those cases of extracolonic CDI, the majority (4/7 in a small case series), had a history of a previous colonic surgery (3). It has been postulated that the reason for increased prevalence amongst patients with previous colonic surgery is the adaptation of ileal flora to resemble fecal flora following ileostomy (3). Although not considered to be standard of care, colonic decompression has been described for patients with toxic megacolon refractory to medical therapy. In a seven patient series which looked at decompressive colonoscopy with intracolonic perfusion of vancomycin in patients with toxic megacolon, 57% had complete resolution (5). In a patient who has undergone ileostomy and who had a significant amount of dilation on her imaging, we felt that her clinical scenario was analogous to megacolon, and that an escalation in therapy was warranted. Image 1. CT Abdomen showing diffuse ileal dilation

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