Diagnosis pitfall of interstitial pregnancy: a case report of a term pregnancy with abnormal placentation

Abstract Background Interstitial Pregnancy (IP) is a lethal condition due to high risk of sudden onset massive hemorrhage. Such conditions are managed as soon as diagnosed almost in the first trimester. There are a few case reports of IP conditions terminated after the second trimester. Herein, we introduce a term interstitial pregnancy complicated by abnormal placentation. Case presentation In this case report, we introduce a 32-year-old lady, primigravida, with an undiagnosed IP that was in her 38 weeks of gestational with placenta increta. She developed with perforated IP presenting with acute abdomen and internal bleeding at 26 weeks of gestational age. However, with a misdiagnosis impression, she got stable in operation room. Then, the pregnancy continued till 36 weeks of gestational age that was misdiagnosed with cervical cancer in prenatal work-ups. Finally, during elective cesarean section at 38 weeks, an IP with placenta increta (placenta evading from the serosa to the myometrium of the uterus) was observed. The baby was healthy with no obvious anomaly or morbidity. Conclusions Physicians should be aware to detect IP in all trimesters and pay attention to the coexisting complications such as placenta accreta to manage them more accurately.

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Acute Promyelocytic Leukemia during Pregnancy: A Systematic Review of the Literature

Cancers ◽

10.3390/cancers12040968 ◽

2020 ◽

Vol 12 (4) ◽

pp. 968 ◽

Cited By ~ 2

Author(s):

Andrea Santolaria ◽

Alfredo Perales ◽

Pau Montesinos ◽

Miguel A. Sanz

Keyword(s):

Acute Promyelocytic Leukemia ◽

Gestational Age ◽

Remission Rate ◽

Single Case ◽

Case Reports ◽

Pulmonary Hemorrhage ◽

First Trimester ◽

Promyelocytic Leukemia ◽

Eligibility Criteria ◽

Challenging Situation

The management of pregnant women with acute promyelocytic leukemia (APL) is a challenging situation where limited evidence-based information is available. We performed a systematic literature review to analyze the outcomes reported for both mother and fetus when APL is diagnosed during pregnancy. PubMed, Scopus and Web of Science databases were systematically searched to identify studies reporting cases of APL during pregnancy. Sixty-six articles met the eligibility criteria (53 single case reports). Ninety-two patients were eligible for induction therapy, with most them being treated with all-trans retinoic acid alone (32%) or combined with chemotherapy (43%), while the remaining patients received chemotherapy alone. Three patients were treated with arsenic-based regimens after delivery. Overall complete remission rate was 89%, with no statistically significant differences according to the type of induction and gestational age. During the first trimester, women were more likely to experience spontaneous and induced abortion compared to those during the second trimester (88% vs. 30%) (p < 0.0001), while only one patient diagnosed during the third trimester terminated in stillbirth. Twelve of 16 infants with neonatal complications had respiratory distress syndrome. Except two early deaths (Potter’s syndrome and pulmonary hemorrhage), all neonates evolved favorably. This study confirms that gestational age does not affect the results in the mother, but is closely related to fetal viability. Our results may be useful for the process of decision making that requires the involvement of the patient, hematologist, obstetrician and neonatologist.

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P50.09: Placenta increta in the first trimester: a case report

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.5055 ◽

2007 ◽

Vol 30 (4) ◽

pp. 646-646

Author(s):

H. S. Wong ◽

P. Carryer ◽

L. Strand ◽

J. Zuccollo ◽

S. Parker ◽

...

Keyword(s):

Case Report ◽

First Trimester ◽

Placenta Increta

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Chronic Tubal Ectopic Pregnancy with Diagnostic Conundrum: A Case Report

International Journal of Science and Healthcare Research ◽

10.52403/ijshr.20210435 ◽

2021 ◽

Vol 6 (2) ◽

pp. 192-194

Author(s):

Vishal Sharma ◽

Ravi Dutt Wadhwa

Keyword(s):

Case Report ◽

Ectopic Pregnancy ◽

Gestational Age ◽

First Trimester ◽

Present Case Report ◽

Tubal Ectopic Pregnancy ◽

Threatening Condition ◽

Life Threatening ◽

First Trimester Of Pregnancy ◽

Ectopic Pregnancies

Ectopic pregnancy is a life threatening condition and mostly ectopic pregnancies occurs in fallopian tube. The most common site of ectopic tubal pregnancy is ampulla. Ectopic pregnancy is a complication of pregnancy and usually easy to diagnose by ultrasonography during the first trimester of pregnancy. Due to limited healthcare resources in developing countries, women do not undergo for ultrasound examination during pregnancy which leads to late diagnosis. In most of cases women with ectopic pregnancy are asymptomatic, unless ruptured. The mean gestational age for clinical presentation of ectopic pregnancy is 7.2 weeks after the last normal menstrual period. In rural population, late presentations of ectopic pregnancies are more commonly seen because of lack of modern diagnostic ability. Present case report is a rare case of non-viable, unruptured, tubal ampullary chronic ectopic pregnancy of 12 weeks gestational age. Keywords: Ectopic pregnancy, Unruptured, gestational age, ultrasonography.

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Intravenous Acetaminophen Overdose in an Infant With Toxicokinetic Data

Journal of Pharmacy Practice ◽

10.1177/08971900211021286 ◽

2021 ◽

pp. 089719002110212

Author(s):

Joshua Trebach ◽

Sarah G. Mahonski ◽

Kristina Melchert ◽

Mary Ann Howland ◽

William K. Chiang

Keyword(s):

Case Report ◽

Gestational Age ◽

Half Life ◽

Case Reports ◽

Adverse Outcomes ◽

Acetaminophen Overdose ◽

Apap Overdose ◽

Intravenous Acetaminophen ◽

Toxicokinetic Data ◽

Colostomy Reversal

The toxicokinetics of pediatric intravenous (IV) acetaminophen (APAP) in overdose is not well described and few case reports with serial APAP concentrations allowing for calculations of half-life exist. Here, we report toxicokinetic data from a case of an unintentional IV APAP overdose in a 12-month-old male who was treated with NAC. Case Report: A 12-month-old (former 24 week gestational age), 8.7 kg male was hospitalized after an uneventful colostomy reversal. In the postoperative unit, the patient unintentionally received 1000 mg IV (114.9 mg/kg) acetaminophen instead of the intended 100 mg IV. Serial acetaminophen concentrations were drawn. The patient received IV Nacetylcysteine and ultimately had no adverse outcomes. Discussion: This case report adds to the existing literature regarding toxicokinetics of IV APAP in infants. Our patient had a calculated ke of 0.263 h-1, correlating with a half-life of 2.63 hours. Based on current available data, the half-life of IV APAP in infants varies (2.6 to 4.9 hours). The reason for this variation is unknown and further research is needed in this area.

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Interstitial Pregnancy Managed with Single-dose Systemic Methotrexate: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.6595 ◽

2021 ◽

Vol 59 (241) ◽

pp. 932-934

Author(s):

Tulasa Basnet ◽

Punita Yadav ◽

Manoj Kumar Sah ◽

Jyotsna Yadav

Keyword(s):

Single Dose ◽

Case Report ◽

High Risk ◽

Mortality Rate ◽

Early Diagnosis ◽

Diagnostic Imaging ◽

Massive Hemorrhage ◽

Rare Type ◽

Interstitial Pregnancy ◽

Life Threatening

Interstitial pregnancy is a rare type of ectopic pregnancy with a high risk of massive hemorrhage on rupture as compared to ectopic on other sites. The mortality rate for the ruptured interstitial pregnancy is high. Therefore, early diagnosis of such pregnancy before the rupture occurs facilitates appropriate management and avoids life-threatening complications. With the advancement in diagnostic imaging modalities, early diagnosis and more conservative management for interstitial pregnancy have become possible. Here, we report a case of primigravida diagnosed with interstitial pregnancy with ultrasonography and successfully managed with a single dose of methotrexate.

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Cryptococcal meningitis in HIV negative pregnant women: case report and review of literature

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652009000500010 ◽

2009 ◽

Vol 51 (5) ◽

pp. 289-294 ◽

Cited By ~ 19

Author(s):

Maria Laura Botelho Costa ◽

João Paulo Dias de Souza ◽

Antônio Francisco de Oliveira Neto ◽

João Luiz Pinto e Silva

Keyword(s):

Case Report ◽

Pregnant Women ◽

Amphotericin B ◽

Mental Status ◽

Cryptococcal Meningitis ◽

Opportunistic Infections ◽

Case Reports ◽

Post Partum ◽

First Trimester ◽

Altered Mental Status

INTRODUCTION: Cryptococcosis has become an important entity due to the epidemic of AIDS and therefore it is a significant opportunistic infection. However, there are case reports of cryptococcal meningitis in immune competent pregnant women. Since pregnancy is considered a period of relative immunosuppression, which likely prevents fetal rejection, this could explain the occurrence of opportunistic infections. OBJECTIVE: To report a case of cryptococcosis, and review all cases involving pregnancy and neurocryptococcal infection in immune competent pregnant patients. METHODS: Case report and systematic review of the literature using the MEDLINE and SciELO databases. DISCUSSION: A total of 27 patients were analyzed from 19 studies. The mean age at diagnosis was 26.4 years. There were six patients in their first trimester of pregnancy, 10 in the second, eight in the third and three post-partum. The most prevalent symptoms were headache (85.2%), altered vision (44.4%), altered mental status (44.4%), nausea (40.7%) and fever (33.3%). There were nine deaths (33.3%). Most of the patients received intravenous amphotericin B as treatment (77.8%). The majority (66.6%) of the patients accomplished a term delivery with healthy infants. CONCLUSION: Cryptococcal meningitis should be considered during pregnancy in cases of unexplained headache, altered vision, altered mental status, nausea and fever. Patients with a confirmed diagnosis should be admitted and treated with amphotericin B.

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Mild Fetal Tricuspid Regurgitation in the First Trimester as a Predictor of Perinatal Outcomes

Medicina ◽

10.3390/medicina57060637 ◽

2021 ◽

Vol 57 (6) ◽

pp. 637

Author(s):

Ji-Eun Park ◽

Hyen-Chul Jo ◽

Seon-Mi Lee ◽

Jong-Chul Baek ◽

In-Ae Cho ◽

...

Keyword(s):

Gestational Diabetes ◽

Amniotic Fluid ◽

Gestational Age ◽

Tricuspid Regurgitation ◽

Perinatal Outcomes ◽

First Trimester ◽

Abnormal Placentation ◽

Amniotic Fluid Index ◽

Beta Coefficient ◽

Age And Sex

Background and Objectives: This study aimed to investigate whether mild fetal tricuspid regurgitation (TR) at 11+ 0 to 13+ 6 weeks of gestation affects perinatal outcomes. Since fetal right ventricular load is associated with placental resistance, we hypothesized that fetal mild TR would be associated with perinatal outcomes as a consequence of abnormal placentation. Materials and Methods: We retrospectively evaluated 435 women with first-trimester scan data. Blood flow across the tricuspid valve was examined in singleton pregnancies between 11+ 0 and 13+ 6 weeks of gestation. Women were categorized according to the presence or absence of fetal mild TR, and the maternal and pregnancy characteristics and perinatal outcomes were compared. Multiple linear and logistic regression analyses were conducted to identify independent predictors of perinatal outcome. Results: In the group with mild TR, there were more cases of borderline amniotic fluid index, including oligohydramnios (p = 0.031), and gestational age- and sex-specific birth weights were lower (p = 0.012). There were no significant differences in other perinatal outcomes, including preeclampsia, gestational hypertension and small for gestational age. Gestational diabetes (adjusted odds ratio (OR) 0.514, 95% confidence interval (CI) 0.312–0.947) and fetal mild TR (adjusted OR 1.602, 95% CI 1.080–2.384) were identified as factors associated with below borderline amniotic fluid index before birth. The factors that affected gestational age and sex-specific birth weight were also gestational diabetes (adjusted beta coefficient 9.673, p = 0.008) and the presence of fetal mild TR (adjusted beta coefficient −6.593, p = 0.007). Conclusions: Mild fetal TR observed in the first trimester is negatively associated with fetal growth and the amniotic fluid index at term but not with other adverse pregnancy or perinatal outcomes due to abnormal placentation.

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