scholarly journals Anesthesia Management at Postpartum et causa Atonic Uteri Bleeding in P3A0H3 Post SCTP Outside Dr. Moewardi Hospital

2021 ◽  
Vol 1 (1) ◽  
pp. 34
Author(s):  
RTh Supraptomo ◽  
Muhammad Ridho Aditya
Keyword(s):  
General Anesthesia ◽  
Postpartum Hemorrhage ◽  
Hypovolemic Shock ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Emergency Laparotomy ◽  
Excessive Bleeding ◽  
Mortality And Morbidity ◽  
Anesthesia Management ◽  
Intraoperative Management

<p>Postpartum hemorrhage remains the leading cause of maternal mortality and morbidity worldwide, happens more in developing countries with an estimated mortality rate of 140,000 per year or one maternal death every four minutes</p><p>To understand anesthesia management at postpartum et causa atonic uteri bleeding outside Dr. Moewardi hospital</p><p>In this case reported 25 years old patient was admitted to the emergency room at Dr. Moewardi Hospital Surakarta, on the 28/11/2019 at 15.30 WIB, sent by Waras Hospital Wiris Boyolali. On examination found the patient in a state of weakness, apathy awareness and blood pressure 90/60, heart rate 130, respiration rate 22, conjunctival anemic and palpable contractions of soft uterine contractions. The patient's condition is in accordance with the manifestation of grade III blood loss. The anesthesiology diagnosis is a 25-year-old woman with Postpartum hemorrhage et causa Atonic Bleeding of Uterine on P3A0H3 post SCTP Outside Dr. Moewardi Hospital + Hypovolemic Shock pro Emergency Laparotomy until Total Abdominal Hysterectomy with Physical Status ASA IVE Plan with RSI general anesthesia Control.</p><p>Intraoperative Management of anesthesia uses RSI's general anesthesia technique to control hemodynamics and uses anesthesia drugs that do not worsen the patient's condition. At the time of surgery, we did the transfusion because there was a significant amount of bleeding during the procedure and was categorized as Class IV bleeding.</p><p>Anesthesia care of patients with postpartum hemorrhage extends from the antenatal period to the postpartum period. Optimal postpartum hemorrhage management occurs when nurses, obstetricians and anesthesiologists recognize early the potential for excessive bleeding and trigger a 'major obstetric hemorrhage protocol' that describes specific tasks for each team player and the algorithm that must be followed according to etiology, circumstances and time during labor.</p>

scholarly journals Uterus-sparing myomectomy for idiopathic uterine pyomyoma in a young woman: A case report

2020 ◽  
Vol 2 (2) ◽  
pp. 19-22
Author(s):  
Ugur Sen ◽  
Tuğba Karadeniz ◽  
Emrah Beyan
Keyword(s):  
Risk Factor ◽  
Uterine Fibroids ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Proper Treatment ◽  
Imaging Findings ◽  
Cervical Stenosis ◽  
Mortality And Morbidity ◽  
Risk Of Mortality ◽  
History Of

Pyomyoma, or suppurative leiomyoma, is a rare but serious complication of uterine fibroids. The mechanism of pyomyoma is an infection caused by microorganisms coming from ascending or hematogenously on the ground of necrosis following ischemia and infarction. It can be seen during the course of pregnancy or after abortion and birth. It can also develop after uterine instrumentation or due to cervical stenosis. Patients often present with pain and fever. It should be considered in cases had no other etiology of fever and had a history of uterine fibroids. Diagnosis and treatment are often delayed due to non-specific presentation and imaging findings. This delay increases the risk of mortality and morbidity such as fertility loss. In the vast majority of these cases, total abdominal hysterectomy is required. The case we presented is a premenopausal and sexually inactive woman without any history of pregnancy or uterine instrumentation or immunocompromised. This patient is the 5th case of pyomyoma without risk factor and the 3rd case that was successfully treated with myomectomy. Knowing the proper treatment of pyomyoma will be beneficial to prevent potential mortality and morbidity.

scholarly journals Glucose, C-peptide and Cortisol Response To Surgery Under General Anesthesia In Diabetic Subjects with Treatment Variability

2009 ◽  
Vol 20 (1) ◽  
pp. 3-8
Author(s):  
K Sardar ◽  
UHS Khatun ◽  
L Ali ◽  
NN Chowdhury ◽  
KM Iqbal
Keyword(s):  
Blood Glucose ◽  
General Anesthesia ◽  
Plasma Glucose ◽  
Plasma Glucose Level ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Cortisol Response ◽  
C Peptide ◽  
Type 2 Diabetic

Diabetic patients are considered to be at increased risk of perioperative morbidity and mortality because of the involvement of their vital organs and the autonomic nervous system in the natural course of the disease. Various aspects of anesthesia and surgery cause stress induced hemodynamic, endocrine and metabolic changes in type 2 diabetic subjects. The present study was designed to investigate the surgical stress response difference between the patients groups those who are treated with only insulin and with insulin-oral hypoglycaemic drugs combination before surgery. Stress response was measured with the changes of blood glucose, C-peptide and cortisol. A total number of 30 subjects who were admitted in BIRDEM hospital in fit physical condition (ASA Class I & II) were selected for the present study. Among them 15 patients were treated with only insulin and 15 patients were treated with insulin- OHA combination before surgery. All of the subjects were received total abdominal hysterectomy under general anesthesia. Three samples were collected from each subject. The first sample (control, PT0) was collected just before anesthesia; second sample (PT1) collected 10 minutes after incision and third sample (PT2) collected 10 minutes after extubation. Plasma glucose was measured by glucose oxidase method, serum C-peptide and cortisol by chemiluminescent based ELISA technique. The mean±SD age and BMI were 44±6 years and 24.4±3.0 kg/m2 respectively. In insulin treated group, the plasma glucose level was significantly higher in PT2 and it was about 147% whereas in insulin-OHA group, the plasma glucose level was significantly higher in both PT1 (111%) and PT2 (196%). The serum C-peptide values were decreasing tendency but not significant in both groups. The serum cortisol level was increased gradually and significantly higher in PT2 in both groups. The data suggest that a) insulin treatment alone is more effective than insulin-OHA combination to control blood glucose in type 2 diabetic subjects undergoing surgery under general anesthesia, b) lower abdominal surgery under general anesthesia in well controlled type 2 diabetic subjects is accompanied by a hyperglycemic response which results from rise of insulin antagonists like cortisol rather than fall of insulin secretion, but the two treatment modalities lead to similar cortisol response. Key words: General anesthesia, Serum glucose, cortisol, Total abdominal hysterectomy Journal of BSA, Vol. 20, No. 1, January 2007 p.3-8

scholarly journals Subacute uterine inversion following an induced abortion in a teenage girl: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Asiphas Owaraganise ◽  
Leevan Tibaijuka ◽  
Joseph Ngonzi
Keyword(s):  
Rare Complication ◽  
Hypovolemic Shock ◽  
Lower Abdominal Pain ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Unsafe Abortion ◽  
Axillary Temperature ◽  
Uterine Inversion ◽  
History Of ◽  
Failed Surgery

Abstract Background Subacute uterine inversion is a very rare complication of mid-trimester termination of pregnancy that should be considered in a situation where unsafe abortion occurs. Case presentation We present a case of subacute uterine inversion complicated by hypovolemic shock following an unsafe abortion in a 17-year-old nulliparous unmarried girl. She presented with a history of collapse, mass protruding per vagina that followed Valsalva, and persistent lower abdominal pain but not vaginal bleeding. This followed her second attempt to secretly induce an abortion at 18 weeks amenorrhea. On examination, she was agitated, severely pale, cold on palpation, with an axillary temperature of 35.8 °C, a tachycardia of 143 beats per minute and unrecordable low blood pressure. The abdomen was soft and non-tender with no palpable masses; the uterine fundus was absent at its expected periumbilical position and cupping was felt instead. A fleshy mass with gangrenous patches protruding in the introitus was palpated with no cervical lip felt around it. We made a clinical diagnosis of subacute uterine inversion complicated with hypovolemic shock and initiated urgent resuscitation with crystalloid and blood transfusion. Non-operative reversal of the inversion failed. Surgery was done to correct the inversion followed by total abdominal hysterectomy due to uterine gangrene. Conclusion Our case highlights an unusual presentation of subacute uterine inversion following unsafe abortion. This case was managed successfully but resulted in significant and permanent morbidity.

scholarly journals Uterine Rupture with Massive Late Postpartum Hemorrhage due to Placenta Percreta Left Partially In Situ

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Mehmet Coskun Salman ◽  
Pinar Calis ◽  
Ozgur Deren
Keyword(s):  
Uterine Rupture ◽  
Bladder Wall ◽  
Placental Tissue ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Uterine Wall ◽  
Placenta Percreta ◽  
Emergency Laparotomy ◽  
Life Threatening

Placental adhesive disorders involve the growth of placental tissue into or through the uterine wall. Among these disorders, placenta percreta is the rarest one. However, it may cause significant complications. This report aimed to report a neglected patient with placenta percreta who developed uterine rupture with life-threatening late postpartum intra-abdominal hemorrhage. On admission, the patient had acute abdomen with moderate abdominal distention and was subjected to emergency laparotomy. A full-thickness defect of the anterior uterine wall involving the hysterotomy site was seen. Placental tissues occupied both sides of the incision and posterior bladder wall was also invaded by placenta. Total abdominal hysterectomy with partial resection of the posterior bladder wall was performed.

scholarly journals A Rare Case of Choriocarcinoma following a Normal Pregnancy and Delivery

2017 ◽  
Vol 03 (01) ◽  
pp. 064-066
Author(s):  
C Hariharan ◽  
Shubhada Jajoo ◽  
Anuradha Khemka
Keyword(s):  
Postpartum Hemorrhage ◽  
Histological Study ◽  
Distant Metastases ◽  
Total Abdominal Hysterectomy ◽  
Normal Pregnancy ◽  
Abdominal Hysterectomy ◽  
Subsequent Treatment ◽  
Time Interval ◽  
Vaginal Deliveries ◽  
Secondary Postpartum Hemorrhage

Abstract Introduction: Choriocarcinoma is one of the rarest entities encountered in routine obstetric practice. It is usually diagnosed when patient is symptomatic, presenting with either abnormal bleeding per vaginum or symptoms of distant metastases. The presentation of choriocarcinoma as secondary postpartum hemorrhage is a least common scenario. Choriocarcinoma is mostly seen following an abnormal pregnancy, either a partial or complete mole. Case report: A 25-year-old para 3 live 3 patient presented with secondary postpartum hemorrhage on 4th week postpartum. She had two normal full-term vaginal deliveries that were uncomplicated with normal antenatal period. As she presented with secondary postpartum hemorrhage with the thought of retained products of conception, an emergency diagnostic dilatation and curettage was done. Histopathology was suggestive of gestational choriocarcinoma. Patient was given single regimen of methotrexate and subsequently decision of total abdominal hysterectomy was taken and patient was kept in close follow-up. Presently, beta-human chorionic gonadotropin (hCG) is below 2 mIU/mL. Conclusion: The concern is the time interval or delay between the onset of symptoms and diagnosis with subsequent treatment. Although there are a number of reasons of postpartum hemorrhage, simple curettage for histological study and titer serum beta-hCG may lead to early diagnosis and initiation of treatment. Obstetricians and pathologists should have increased awareness regarding the consequences of choriocarcinoma.

scholarly journals CAESAREAN SCAR PREGNANCY;

2013 ◽  
Vol 20 (05) ◽  
pp. 849-851
Author(s):  
RAZIA SULTANA ◽  
SAIF-UL- ISLAM ◽  
NURJAHAN -
Keyword(s):  
Uterine Rupture ◽  
Operative Procedure ◽  
Fibrous Tissue ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Massive Hemorrhage ◽  
Emergency Laparotomy ◽  
Caesarean Scar ◽  
Caesarean Scar Pregnancy ◽  
Profuse Hemorrhage

Caesarean Scar pregnancy (CSP) is a rare form of Ectopic pregnancy where the gestation sac is surrounded bymyometrium and the fibrous tissue of the scar from the previous caesarean section. It is often misdiagnosed as Molar pregnancy orInevitable Abortion and can be associated with massive hemorrhage and pervaginal bleeding leading to uterine rupture. Here we reporteda case of Caesarean scar pregnancy who presented with history of cesarean section and pervaginal bleeding. Dilatation and curettagewas planned but during the operative procedure there was profuse hemorrhage leading to hypovolumic shock which was managed byBlood and venesection then emergency laparotomy followed by Total Abdominal Hysterectomy done as life saving procedure,th postoperative period was uneventful and the patient was discharged on 10 postoperative day. Diagnosis is important as caesarean scarpregnancy is associated with life threatening complications such as uterine rupture, massive hemorrhage and the need for Hysterectomywith subsequent loss of fertility.

scholarly journals Uterine torsion in non-gravid women: A case report and review of cases reported in the last 20 years

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110666
Author(s):  
Harunobu Matsumoto ◽  
Yoko Aoyagi ◽  
Taisuke Morita ◽  
Kaei Nasu
Keyword(s):  
Surgical Intervention ◽  
Lower Abdominal Pain ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Uterine Leiomyomas ◽  
Emergency Laparotomy ◽  
Resonance Imaging ◽  
Uterine Torsion ◽  
Life Threatening ◽  
Tomography Scan

Uterine torsion is defined as a rotation of >45° around the long axis of the uterus. Uterine torsion is an uncommon event but is even rarer in non-gravid women, with only 25 cases reported in the last 20 years. Here, we report a case of uterine torsion associated with multiple pedunculated subserosal uterine leiomyomas in an 83-year-old woman. She presented at the hospital with lower abdominal pain, and a computed tomography scan revealed multiple uterine leiomyomas with calcifications. Subsequent magnetic resonance imaging raised suspicion for torsion of pedunculated subserosal uterine leiomyomas. Emergency laparotomy was performed, and the patient was diagnosed with uterine torsion with multiple pedunculated subserosal uterine leiomyomas. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. The patient’s postoperative course was uneventful. Although difficult to diagnose due to its rarity, uterine torsion can be life-threatening and may cause infertility. Therefore, early diagnosis with imaging and surgical intervention are crucial to avoid serious complications.

scholarly journals Anesthesia management of patient with achondroplasia for abdominal hysterectomy

2015 ◽  
Vol 1 (6) ◽  
pp. 264 ◽  
Author(s):  
Asmita P. Karnalkar ◽  
Ashok Deshpande
Keyword(s):  
Laryngeal Mask Airway ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Preoperative Assessment ◽  
Abdominal Hysterectomy ◽  
Regional Analgesia ◽  
Anesthesia Management ◽  
Controlled Ventilation ◽  
Anesthetic Considerations ◽  
Spinal Abnormality

<p class="abstract">Achondroplasia is the commonest form of dwarfism. These patients present several problems for both general and regional anesthesia. There are reports describing regional anesthesia in such patients but there are scarce reports of general anesthesia. The aim of this report is to discuss anesthetic considerations in such patients and to emphasize the difficulties encountered. A 34 year old patient with achondroplasia underwent abdominal hysterectomy under general anesthesia supplemented with regional analgesia. Since preoperative assessment suggested difficult airway, regional anesthesia was planned which was not successful due to spinal abnormality. Subsequently general anesthesia was established with Laryngeal Mask Airway (LMA) with controlled ventilation without any complication.</p>

scholarly journals Anesthetic management of an achondroplastic dwarf with difficult airway and kyphoscoliosis for total abdominal hysterectomy

2021 ◽  
Vol 8 (3) ◽  
pp. 475-478
Author(s):  
Tejaswini L Phalke ◽  
Jyoti P Deshpande ◽  
Jyoti H Kale ◽  
Madhavi R Godbole
Keyword(s):  
General Anesthesia ◽  
Difficult Airway ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Neurological Injury ◽  
Fiberoptic Intubation ◽  
Short Neck ◽  
Neck Movement ◽  
Neck Extension ◽  
Awake Fiberoptic Intubation

Achondroplasia is a common form of dwarfism and possesses multiple anesthetic challenges including securing of intravenous line, monitoring and calculating drug dosage, spine abnormality, difficulty in mask ventilation and endotracheal intubation, obesity, cardiopulmonary and neurological system abnormality. There is multiple systems involvement, therefore thorough preanesthetic check ups, investigations and planning for anesthesia is important. Here we came across 36 years old female patient, achondroplasic dwarf (height- 100cm) with thoracolumbar kyphoscoliosis, fused cervical spine, short neck and restricted neck movement with mild pulmonary restrictive disease for total abdominal hysterectomy. Patient also had complained of generalized weakness and fatigue. She had a limited neck extension and short neck possesses anticipated difficult intubation, therefore we planned awake fiberoptic intubation with smaller size endotracheal tube for airway management and general anesthesia in a patient with difficult airway and spine for total abdominal hysterectomy. As the spread of the drug in regional anesthesia is unpredicted, we planned general anesthesia with awake fiberoptic intubation to avoid the risk of neurological injury while extending the neck during laryngoscopy for tracheal intubation due to restricted neck movement.

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