scholarly journals Conservative Treatment of Huge Retroperitoneal Hematoma Postpartum: Case Report

Author(s):  
Sedigheh Ghasemian Dizajmehr ◽  
Farzaneh Rashidi Fakari ◽  
Mohsen Ghasemian

Introduction: Retroperitoneal hematoma are an important factor for hospitalization in patients with trauma and proper treatment is still under discussion and Controversial. We describe a successful case of conservative treatment of huge hematoma after cesarean section. Case presentation: An Iranian 34-year-old multigravida(G4L3) woman with three previous cesarean sections from Urmia province presented to our hospital with amniotic fluid leak. She had full-term pregnancy. Caesarean section was done. One day after caesarean section, she became dyspnea and had chest pain in left side. Embolism is suspected and enoxaparin was administered. According, hemoglobin decreased (HB:6.2) after administered the second dose of enoxaparin and a clear dullness percussion led tosuspected to hemorrhage and retroperitoneal hematoma was discontinued enoxaparin. After the patient is stable, the patient was discharged and retroperitoneal hematoma was followed up by ultrasonography and conservative treatment. Conclusion: Conservative treatment of retroperitoneal hematoma postpartum with good clinical evolution, depends on status of the patient, cause of injury and its evolution.

Author(s):  
Arrigo Fruscalzo ◽  
Marwa Elgendi ◽  
Marcus Gantert

Abstract Background Natural childbirth could represent a deeply rooted need for many women, even in exceptional situations such as after 3 previous caesarean sections. Case presentation The first patient, a 28-year-old 6th gravida and 3rd para, first presented in the 40+3 week of pregnancy desiring a vaginal birth, after all the other hospitals in the area had refused her request. A detailed explanation of potential risks was given and, when 2 days later contractions started, she gave birth to a newborn of 4450 g spontaneously, without complications. A month later, a second woman, 42 years old, 5th gravida, 3rd para, read about the above-mentioned case on social media and decided to attempt a natural delivery after 3 caesarean sections at our hospital as well. She presented herself for the first time in the 41+1 week of pregnancy in our delivery room with an onset of labor after rupture of the membranes and gave birth on the same day, spontaneously without complications, to a 4150 g heavy healthy newborn. Conclusions The wish to attempt a spontaneous birth after 3 previous caesarean sections can be deeply anchored and should be professionally approached by obstetricians, even if counseling and management can be challenging.


2000 ◽  
Vol 49 (1) ◽  
pp. 88-94
Author(s):  
V. I. Krasnopolsky ◽  
L. S. Logutova

In the article, the summary on the 20-years experience on labor management in high- risk pregnant is given. The prospective for the alternative labor management in diabetes mellitus, fetoplacental insufficiency, elder nullipara, uterine scar after previous cesarean sections, breach or pelvic presentation are covered.


Author(s):  
Sonali S. Somani ◽  
Sunita Sudhir ◽  
Shashikant G. Somani ◽  
. Bushra

Background: Caesarean section (CS) is one of the most common obstetric procedures worldwide and an increased rate of caesarean section has been observed in recent studies. Maternal morbidities and mortality associated with repeat caesarean section is an important health problem. The present study aims at knowing the various intraoperative complications encountered during repeat caesarean sections. Objective was to study the incidence and type of surgical difficulties encountered in repeat cesarean sectionsMethods: It was a prospective observational study of 118 cases of repeat cesarean sections. Intra-operative findings of all cases were analyzed to know the difficulties encountered because of previous cesarean section.Results: In present study, out of total 118 cases of previous cesarean sections, 71 (60.17%) cases were of previous one caesarean section and 47(39.83%) were of previous two cesarean sections. Following intraoperative morbidities were encountered – adhesions (1 caesarean section vs 2 caesarean section – 40.85 vs 65.96% respectively) , thin lower uterine segment (1 caesarean section vs 2 caesarean section – 21.13 vs 36.17% respectively), advanced bladder(1 caesarean section vs 2 caesarean section – 15.49 vs 36.17 % respectively) , extension of uterine incision(1 caesarean section vs 2 caesarean section – 9.86 vs 19.15% respectively) , scar dehiscence(1 caesarean section vs 2 caesarean section –7.04 vs 31.91% respectively), excess blood loss (1 caesarean section vs 2 caesarean section –7.04 vs 19.15% respectively), 1 case of placenta accrete was found in previous 2 caesarean section 2.13%) which needed caesarean hysterectomy. uterine rupture and bladder injury seen in one patients of previous 2caesarean section. Time taken for surgery was more in repeat CS group Delivery.Conclusions: An increasing number of CS is accompanied by increased maternal morbidity. Intraoperative complication which increase the risk of morbidity are adhesion, placenta accreta. It is prudent to involve a senior experienced obstetrician in repeat cesarean section. The best way to reduce this is by reducing primary caesarean section rates. Patients with previous caesarean section should be considered as high risk and should be counseled for regular antenatal check-up and they should be given option of vaginal birth after CS whenever possible.


Author(s):  
M.A. Esetov , A.M. Esetov , I.V. Ramazanova

Seven cases of ultrasound diagnosis of velamentous insertion (VCI) of the umbilical cord at singleton pregnancies on 21–34 weeks of gestation are presented. The ultrasound picture two of the VIC types is presented: fixed in 5 cases and free in 2 cases. In one case the VCI was in the lower third of the uterus and the wound has been diagnosed the vasa previa. In other cases, the VCI was in middle third of the uterus. In all cases delivery was at 37–39.1 weeks of gestation. In 4 cases Cesarean sections were performed. In two of the VCI cases elective Ce sarean sections were performed for the following indications: previous Cesarean section and vasa previa. VCI can reliably be detected prenatally by gray-scale and color Doppler ultrasound. For fixed VCI located in the middle-upper of the uterus, no change in standard obstetrical management seems to be required.


2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Masayuki Kojima ◽  
Masanori Inoue ◽  
Seiichiro Yamamoto ◽  
Toshio Kanai ◽  
Seishi Nakatsuka ◽  
...  

Abstract Background Conventional lymphangiography cannot detect leakage sites of hepatic lymphatic vessels. Percutaneous transhepatic lymphangiography can be used to visualize leakage sites, and once the leakage site has been confirmed, effective sclerotherapy can be performed. Case presentation A rare case of intractable hepatic lymphorrhea due to injury of the hepatoduodenal ligament following pancreaticoduodenectomy is reported. Drainage of massive ascites from the drainage tube continued after surgery. Percutaneous transhepatic lymphangiography visualized the intrahepatic lymphatic vessels and the leakage site at the hepatic hilum. An 8-Fr drainage catheter was inserted adjacent to the leakage point under fluoroscopic computed tomography guidance. Repeated sclerotherapy using intraperitoneal administration of OK-432 (picibanil) through the catheter was performed, which exposed the leakage site, and control of the ascites was finally achieved. Conclusions To the best of our knowledge, this is the first successful case of detection of a leakage site using intrahepatic lymphangiography, followed by sclerotherapy using OK-432.


2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Margarita Alvarez de la Rosa ◽  
Olga Rosales Aedo ◽  
Ricardo Darias Garzón ◽  
Ana Isabel Padilla Pérez ◽  
Juan Mario Troyano Luque

AbstractObjectivesWe aim to report a case of a fetal goiter with postpartum spontaneous resolution. Fetal goiter can be secondary to maternal treatment and range from clinically asymptomatic or cause alterations in the fetus, from impaired swallowing to difficulty in vaginal delivery and even perinatal asphyxia due to the mass effect. The need for intrauterine treatment remains controversial.Case presentationWe present a case of fetal goiter with postpartum resolution. A 34-year-old multigravida presented to the emergency department with hiperemesis gravidarum at 10 weeks’ gestation. During evaluation for severe vomiting, Graves disease was diagnosed and treated with propylthiouracil. A routine ultrasound scan at 28 weeks gestation revealed a fetal anterior neck mass suggesting a fetal goiter. Cordocentesis showed fetal iatrogenic hypothyroidism. Conservative treatment was decided. Pregnancy concluded uneventful and the mass resolved spontaneously in the newborn.ConclusionsThe fetal thyroid gland is a structure that usually goes unnoticed during the process of prenatal diagnosis. In cases of maternal Graves diseases, fetal thyroid needs monitoring during pregnancy and conservative treatment is an option. Fetal goiter should be searched for secondary to thyroid alterations of the gravida, and in selected cases it can be managed without intrauterine treatment.


The Lancet ◽  
1899 ◽  
Vol 154 (3970) ◽  
pp. 887-888
Author(s):  
J.P. Walker

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Takeshi Ueda ◽  
Tetsuya Tanaka ◽  
Takashi Yokoyama ◽  
Tomomi Sadamitsu ◽  
Suzuka Harada ◽  
...  

Abstract Background Pneumoperitoneum commonly occurs as a result of a viscus perforation and usually presents with peritoneal signs requiring emergent laparotomy. Spontaneous pneumoperitoneum is a rare condition characterized by intraperitoneal gas with no clear etiology. Case presentation We herein report a case in which conservative treatment was achieved for an 83-year-old male patient with spontaneous pneumoperitoneum that probably occurred due to duodenal diverticulosis. He had stable vital signs and slight epigastric discomfort without any other signs of peritonitis. A chest radiograph and computed tomography showed that a large amount of free gas extended into the upper abdominal cavity. Esophagogastroduodenoscopy showed duodenal diverticulosis but no perforation of the upper gastrointestinal tract. He was diagnosed with spontaneous pneumoperitoneum, and conservative treatment was selected. His medical course was uneventful, and pneumoperitoneum disappeared after 6 months. Conclusion In the management of spontaneous pneumoperitoneum, recognition of this rare condition and an accurate diagnosis based on symptoms and clinical imaging might contribute to reducing the performance of unnecessary laparotomy. However, in uncertain cases with peritoneal signs, spontaneous pneumoperitoneum is difficult to differentiate from free air resulting from gastrointestinal perforation and emergency exploratory laparotomy should be considered for these patients.


2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Chunyan Zeng ◽  
Feng Yang ◽  
Chunhua Wu ◽  
Junlin Zhu ◽  
Xiaoming Guan ◽  
...  

Uterine prolapse complicating pregnancy is rare. Two cases are presented here: one patient had uterine prolapse at both her second and third pregnancy, and the other developed only once prolapse during pregnancy. This report will analyze etiology, clinical characteristics, complication, and treatment of uterine prolapse in pregnancy. Routine gynecologic examination should be carried out during pregnancy. If uterine prolapse occurred, conservative treatment could be used to prolong the gestational period as far as possible. Vaginal delivery is possible, but caesarean section seems a better alternative when prolapsed uterus cannot resolve during childbirth.


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