Placenta percreta after Strassman metroplasty of complete bicornuate uterus: a case report

Abstract Background A bicornuate uterus often results in infertility. While reconstructive procedures may facilitate pregnancy, spontaneous abortion or serious pregnancy complications may occur. We present a case of a bicornuate uterus with spontaneous conception after Strassman metroplasty; however, life-threatening complications during pregnancy occurred. Case presentation : A 38-year-old woman with a history of infertility presented for prenatal care at 6 weeks of gestation. She had conceived spontaneously after four failed in vitro fertilization and embryo transfer (IVF-ET) procedures, Strassman metroplasty for a complete bicornuate uterus, and two postoperative IVF-ET pregnancies that ended in embryo arrest. This pregnancy was uneventful until the patient presented with massive vaginal bleeding at 28 weeks of gestation and was diagnosed with placenta previa and placenta percreta. Bleeding was controlled after emergency Caesarean section and delivery of a healthy neonate. However, severe adhesions were noted as well as a rupture along the metroplasty scar. Two days later, on removal of the intrauterine gauze packing, severe hemorrhage resumed, and the uterus did not respond to oxytocin, hemabate, or carbetocin. Emergency hysterectomy was required. Conclusions Reconstructive surgical procedures for complete bicornuate uterus may allow patients to achieve spontaneous pregnancies. However, potential intrapartum complications include placenta implantation and postpartum hemorrhage, and the latter may be exacerbated as the uterus does not contract or respond to oxytocin or prostaglandin drugs. Patients should be counseled on the risks associated with pregnancy after Strassman metroplasty, and clinicians must be aware of potential severe complications.

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Latex Hypersensitivity in Children: Clinical Presentation and Detection of Latex-Specific Immunoglobulin E

PEDIATRICS ◽

10.1542/peds.95.5.693 ◽

1995 ◽

Vol 95 (5) ◽

pp. 693-699

Author(s):

Pamela L. Kwittken ◽

Sharon K. Sweinberg ◽

Donald E. Campbell ◽

Nicholas A. Pawlowski

Keyword(s):

High Risk ◽

Immunoglobulin E ◽

High Risk Patient ◽

Latex Allergy ◽

Patient Profile ◽

Specific Immunoglobulin E ◽

Specific Immunoglobulin ◽

Life Threatening ◽

History Of

Objective. To better understand the clinical characteristics, diagnosis, and possible prevention of immediate hypersensitivity reactions to latex in a hospitalized, pediatric patient population. Methods. We performed a retrospective case analysis of the first 35 patients with latex allergy evaluated by our service over a 2-year period at our institution. Characteristics of patients and clinical reactions were analyzed and the presence of latex-specific immunoglobulin E was assessed using in vitro methods. In a limited group of Objective. To better understand the clinical premedication with steroids and antihistamines was evaluated for the prevention of latex allergic reactions. Results. The majority of our patients had life-threatening reactions. In previous reports, most pediatric patients underwent reactions in the perioperative period and belonged to two well-recognized "high-risk" patient groups (spina bifida and genitourinary malformations). In our series, 21 patients (60%) had reactions outside of the operating room setting, and 14 patients (40%) had primary diagnoses outside of the previously recognized "high-risk" groups. Many patients had a history of multiple surgical procedures, and a history of a surgical procedure in the first year of life was very common. A pre-existing clinical history of latex allergy was present in only 18 of the 35 patients, and a severe or life-threatening allergic reaction was the presenting feature of latex allergy in 11 of the 35 patients. Using in vitro assays, we were able to detect latex-specific immunoglobulin E in the sera of all but two of our patients. Latex gloves and latex-containing intravenous sets were common triggers for reactions. When exposure to latex occurs systemically, as through an intravenous line, premedication with steroids and antihistamines may fail to protect against anaphylaxis. Conclusions. Our experience indicates that the incidence of latex hypersensitivity in children is increasing, that the circumstances (patient profile, hospital location, route of exposure) in which life-threatening reactions may occur are more broad than previously reported, and that a better understanding of both environmental sources of latex antigens and host responses to latex exposure are needed for improved prevention of serious reactions.

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Acute retroperitoneal hemorrhage after oocyte retrieval: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjab066 ◽

2021 ◽

Vol 2021 (3) ◽

Author(s):

Yangying Xu ◽

Cuifang Hao ◽

Xiaoqiang Liu ◽

Zongzhi Yang ◽

Xianhua Sun

Keyword(s):

Case Report ◽

Diagnostic Laparoscopy ◽

Oocyte Retrieval ◽

Von Willebrand Disease ◽

Retroperitoneal Hemorrhage ◽

Vitro Fertilization ◽

History Of ◽

Von Willebrand ◽

Ivf Et

Abstract A 29-year-old woman with a 5-year history of primary infertility underwent in vitro fertilization-embryo transfer (IVF-ET) treatment. Hemorrhagic shock caused by retroperitoneal hematoma after oocyte retrieval was treated promptly by the evaluation of diagnostic laparoscopy and angiography. The patient was recovered and discharged from the hospital 7 days later without any complications. She was later diagnosed with Von Willebrand disease by a hematologist.

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Spontaneous Haemoperitoneum in Pregnancy (SHiP) with Placenta Percreta in Bicornuate Uterus with Successful Pregnancy Outcome

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.5.2021.102 ◽

2021 ◽

Author(s):

Jayasree Santhosh ◽

Latha V. Kharka ◽

Atheel Kamona ◽

Sumaiya S. Al Amri

Keyword(s):

Abdominal Pain ◽

Caesarean Section ◽

Iliac Fossa ◽

Rare Condition ◽

Placenta Percreta ◽

Bicornuate Uterus ◽

Lower Segment Caesarean Section ◽

History Of ◽

Intraperitoneal Bleeding ◽

In Pregnancy

Intraperitoneal haemorrhage during pregnancy or postpartum without any history of trauma is termed Spontaneous Haemoperitoneum in Pregnancy (SHiP). This is a rare condition, causing significant morbidity and mortality for the mother and the neonate. We report a case of SHiP in a patient who presented to us at 31 weeks of gestation with right iliac fossa pain, pallor and tachycardia. Radiological investigations revealed intraperitoneal bleeding and a right adnexal haematoma. She was managed conservatively with blood transfusion and supportive care. At 36 weeks of gestation, lower segment caesarean section (LSCS) was done and a live baby with good Apgar score was delivered. Per-operatively, she was found to have a bicornuate uterus, placenta percreta at the junction of the horns and a right adnexal haematoma. This case highlights the significance of thorough evaluation of acute abdominal pain in pregnancy in avoiding unnecessary surgical intervention and iatrogenic prematurity. Keywords: Abdominal pain; Caesarean Section; Hemoperitoneum; Placenta accreta; Pregnancy.

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Caution with bilateral salpingectomy and consideration of tubal stump ectopic in IVF

BMJ Case Reports ◽

10.1136/bcr-2020-235893 ◽

2020 ◽

Vol 13 (11) ◽

pp. e235893

Author(s):

Swee Lin Yip ◽

Shahul Hameed Mohamed Siraj ◽

Jerry Kok Yen Chan

Keyword(s):

Ectopic Pregnancy ◽

Cystic Mass ◽

In Vitro Fertilisation ◽

Beta Human Chorionic Gonadotropin ◽

Life Threatening ◽

History Of ◽

Bilateral Salpingectomy ◽

Ectopic Pregnancies ◽

The Right

We report a 35-year-old female patient with a history of bilateral salpingectomy from ectopic pregnancies presenting with a positive serum beta-human chorionic gonadotropin (bhCG) result following in vitro fertilisation (IVF) treatment. Apart from per vaginal spotting, she remained asymptomatic. Initial ultrasound showed an empty uterus with a cystic mass on the right side of the uterus. Serum beta-hCG was trended. A follow-up pelvic ultrasound 1 week later showed a live pregnancy in the right adnexa. A diagnostic laparoscopy was performed, which revealed an unruptured right stump ectopic pregnancy that was successfully removed. As a stump ectopic pregnancy can be a potentially life-threatening occurrence, we emphasise caution with salpingectomy and the consideration of tubal stump ectopic pregnancies following IVF treatment.

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Development of Meningitis During Therapy with Cefamandole

PEDIATRICS ◽

10.1542/peds.67.5.727 ◽

1981 ◽

Vol 67 (5) ◽

pp. 727-728

Author(s):

S. C. Aronoff ◽

W. Thomford ◽

J. S. Bertino ◽

W. T. Speck

Keyword(s):

Bacterial Infections ◽

Antimicrobial Agents ◽

Pediatric Patients ◽

Potential Hazard ◽

Procaine Penicillin ◽

Source Of Infection ◽

Local Physician ◽

Life Threatening ◽

History Of

Cefamandole nafate is a relatively new cephalosporin approved for use in pediatric patients. This compound offers certain advantages over previously approved cephalosporins including its in vitro antimicrobial activity against β-lactamase-producing Haemophilus influenzae. The purpose of this report is to describe a potential hazard associated with the use of this and closely related antimicrobial agents in life-threatening bacterial infections. CASE REPORT This was the first Rainbow Babies and Childrens Hospital admission for this 7-month-old boy with a ten-day history of fever and irritability. Seven days prior to admission he was seen by a local physician for fever. No source of infection was noted and the infant was treated with 300,000 units of intramuscular procaine penicillin.

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Prevalence and Risk Factors of Severe Postpartum Hemorrhage: a Retrospective Cohort Study

10.21203/rs.3.rs-61698/v1 ◽

2020 ◽

Author(s):

Chenning Liu ◽

Fubing Yu ◽

Yunzhe Xu ◽

Jinsheng Li ◽

Zhihong Guan ◽

...

Keyword(s):

Risk Factors ◽

Postpartum Hemorrhage ◽

Retrospective Cohort ◽

Southern China ◽

Placenta Previa ◽

Obstetric Care ◽

Vitro Fertilization ◽

Quality Of Obstetric Care ◽

History Of

Abstract Background: Although maternal deaths are rare in developed regions, the morbidity associated with severe postpartum hemorrhage remains a major problem. To provide new insight into severe postpartum hemorrhage, we analyzed data of women giving birth in Guangzhou Medical Centre for Critical Pregnant Women, which receiveda large quantity of critically ill obstetric patients from other hospitals of Southern China. Methods: In this study, we conducted a retrospective cohort by using the criteria of severe maternal morbidities, which was defined by estimation of blood loss volume and use of blood transfusion≥4 units, to determine the prevalence, risk factors and short-term complications of severe postpartum hemorrhage. Results: Severe postpartum hemorrhage was observed in 532 mothers (1.56%) among the total population of 34 178 mothers. Placental related cause (55.83%) was the major identified cause of severe postpartum hemorrhage, while uterine atony without associated retention of placental tissues accounted for 38.91%. The risk factors for severe postpartum hemorrhage were maternal age<18 years, previous cesarean section, history of postpartum hemorrhage, conception through in vitro fertilization, pre-delivery anemia, stillbirth, prolonged labor, placenta previa, placental abruption, placenta accrete spectrum and macrosomia. The prevalence rates of admission to ICU, hysterectomy, acute renal failure and sepsis were significantly higher in women with severe postpartum hemorrhage. Conclusion:The results of this study suggested that severe postpartum hemorrhagecould be adopted as an indicator to assess the quality of obstetric care because of its severity and potential lethality. Extra vigilance during the antenatal and peripartum periods is needed to identify women who have risk factors and enable early intervention to prevent severe postpartum hemorrhage. It’s important to remember that we have to prepare for all mothers giving birth, as some get severe postpartum hemorrhagewithout any known risk factors.

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Management of placenta percreta. A case report

10.36811/ojgor.2020.110012 ◽

2020 ◽

pp. 01-04

Author(s):

DIOUF A ◽

Thiam O ◽

Ndour K ◽

Gueye M ◽

Ndiaye MD ◽

...

Keyword(s):

Placenta Accreta ◽

Placenta Previa ◽

Multiple Organ ◽

Placenta Percreta ◽

High Parity ◽

Surgical Wounds ◽

History Of ◽

Uterine Curettage ◽

High Risk Situation ◽

Previous Cesarean

The placenta accreta designates an abnormality of the placental insertion characterized, on the anatomopathological level, by an absence of deciduous deciduous between the placenta and the myometrium. This insertion anomaly may interest all or only part of the placenta. We distinguish within this terminology the terms of - placenta accreta when the placenta is simply attached to the Myometrium. - placenta increta when the placenta invades the myometrium. - placenta percreta when the placenta enters the serosa uterine, or even the neighboring organs (bladder, peritoneum, etc.) [1]. Placentas accretas are a high-risk situation for severe postpartum hemorrhage and its inherent complications such as disseminated intravascular coagulation, hemostasis hysterectomy, surgical wounds to the ureters, bladder, multiple organ failure, or even maternal death, particularly in the case of placenta percreta [2,3]. Risk factors for placenta percreta include a history of cesarean, uterine curettage or manual removal of placenta, presence of placenta previa, endometriosis, high parity and advanced maternal age [4]. We report the case of a 30-year-old woman, IIGIIP, who had a previous cesarean section during her first pregnancy and who had a placenta percreta and who underwent hysterectomy without cystectomy and without ligation of the hypogastric arteries.

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Risk factors and pregnancy outcomes of heterotopic pregnancy secondary to in vitro fertilization-embryo transfer: A case series study

10.21203/rs.3.rs-40273/v1 ◽

2020 ◽

Author(s):

Shaomi Zhu ◽

Qinxiu Zhang ◽

Linjiang Song

Keyword(s):

Embryo Transfer ◽

Pregnancy Outcomes ◽

Case Series ◽

Tubal Infertility ◽

Vitro Fertilization ◽

Operative Duration ◽

History Of ◽

Ectopic Pregnancies ◽

Ivf Et

Abstract Background: The early diagnosis and treatment of heterotopic pregnancy (HP) remain one of the biggest challenges in the field of gynecology. A coexisting intrauterine gestation makes the ectopic pregnancy in HP more difficult to diagnose. This case series analysis is designed to explore factors affecting the incidence of HP secondary to in vitro fertilization-embryo transfer (IVF-ET) and that affecting pregnancy outcomes after surgical treatment of HP.Methods: From the IVF registry system, the clinical data of 29 patients with HP and 92 with an intrauterine-only pregnancy (IUP) following embryo transfer from January 2009 to December 2017 were retrospectively analyzed.Results HP had a higher proportion of previous ectopic pregnancies, multiple abortion history ( ≧ 2 times) and tubal indication for IVF than IUP. In patients with HP, 31.03% had spontaneous abortion, 25.00% had preterm delivery and 58.62% resulted in a live birth. According to the results from logistic regression, history of multiple abortions (odds ratio (OR) 3.031, 95% confidence intervals (CI) 1.087-8.453; P=0.034), tubal infertility (OR 3.844, 95% CI 1.268-11.656; P=0.017), previous ectopic pregnancies (OR 2.303, 95% CI 0.625-8.490; P=0.021) and multiple embryo transfer ( OR 0.300, 95% CI 0.092-0.983; P=0.037) resulted in an elevated proportion of HP in IVF cycles. Incidence of HP was comparable between patients transferred with blastocyst and cleavage embryos. Shorter operative duration, smaller size of the ectopic mass and location in the ampulla of the fallopian tube were associated with higher chance of survival in the coexistent intrauterine pregnancy after surgical treatment with HP.Conclusions:The early diagnosis of HP remains a challenge. Previous history of ectopic pregnancy, multiple abortions, tubal infertility and multiple embryo transfer may be considered as meaningful risk factors of subsequent HP following IVF-ET. In patients with HP treated by surgery, shorter operative duration, smaller size of the ectopic mass and location in the ampulla of the fallopian tube means better reproductive prognosis.

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Fibrinogen ""New York"--an abnormal fibrinogen associated with thromboembolism: functional evaluation

Blood ◽

10.1182/blood.v45.5.607.607 ◽

1975 ◽

Vol 45 (5) ◽

pp. 607-619 ◽

Cited By ~ 41

Author(s):

H Al-Mondhiry ◽

SB Bilezikian ◽

HL Nossel

Keyword(s):

New York ◽

Fibrinogen Concentration ◽

Functional Evaluation ◽

Fibrinopeptide A ◽

Life Threatening ◽

History Of ◽

And Control ◽

Kinetics Of ◽

Control Plasma

Abstract A 54-yr-old woman presented with a 23-yr history of repeated life- threatening thromboembolism. The presence of a qualitatively abnormal fibrinogen was suggested by the demonstration of delayed and incomplete coagulation of plasma or partially purified fibrinogen by thrombin or Reptilase. Two brothers showed a similar in vitro defect but were clinically not affected. The plasma fibrinogen concentration was 0.50- 1.64 mg/ml when estimated by heat turbidity, clottability, or immunologic techniques. The serum contained 80–820 mug/ml of unclottable fibrinogen-related materials even after 24 hr exposure to thrombin. The fibrinogen-related material in the serum showed faster anodal mobility an immunoelectrophoresis than that of normal plasma. Immunodiffusion studies with rabbit antihuman fibrinogen antiserum showed lines of identity between control plasma and the patient's plasma and serum. Studies of the kinetics of thrombin action on fibrinogen demonstrated impaired release of fibrinopeptide A and B and defective polymerization of preformed fibrin monomers. The maximum amount of fibrinopeptide A released by exhaustive treatment with thrombin was similar (per milligram protein) for both the patient's and control fibrinogen. This abnormal fibrinogen varient is tentatively designated fibrinogen “New York”; its possible identity with one of the previously described abnormal fibrinogens has not been excluded.

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Vasa previa: a case report

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204329 ◽

2020 ◽

Vol 9 (10) ◽

pp. 4301

Author(s):

Ipsita Mohapatra ◽

Subha R. Samantaray ◽

V. Naga Sindhuja

Keyword(s):

Neonatal Outcome ◽

Placenta Previa ◽

Placental Tissue ◽

Multiple Pregnancies ◽

Lower Segment ◽

Vitro Fertilization ◽

Vasa Previa ◽

History Of ◽

Fetal Vessels

Vasa previa is defined as a condition where fetal vessels traverse the membranes in the lower segment below the presenting part unsupported by placental tissue or umbilical cord. Rupture of the membranes leads to fetal exsanguinations and even neonatal death. The etiology is uncertain, but risk factors include bilobed or succenturiate lobed placenta, velamentous insertion of cord, placenta previa, pregnancies resulting from In vitro fertilization (IVF) and multiple pregnancies. We report here a case of 24 year old woman, G3A2 at 34 weeks of gestation and history of 2 previous spontaneous abortions with vasa previa which was successfully managed. Prenatal sonographic diagnosis has the potential to improve or prevent the poor obstetric and neonatal outcome associated with it.

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