scholarly journals Aortic complications in pregnancy: the less remembered chapter—a narrative review

2021 ◽  
Author(s):  
Preetha Rajasekaran ◽  
Praveena Gandhi ◽  
Mohammed Idhrees ◽  
Bashi V. Velayudhan
Keyword(s):  
Aortic Rupture ◽  
Ascending Aorta ◽  
Fetal Mortality ◽  
Hormonal Changes ◽  
Connective Tissue Disorders ◽  
Hemodynamic Changes ◽  
Vascular Events ◽  
Life Threatening ◽  
Complete History ◽  
In Pregnancy

Pregnancy increases the risk of common vascular events and also the rarer events like aortic dissection (AD)/aortic rupture and this is even more pronounced in patients with predisposing aortopathies. AD was found to occur in 0.0004% of all pregnancies, and it is more pronounced in patients with underlying connective tissue disorders. The normal hemodynamic changes on a weak aorta will lead to AD and/or rupture, more so with increase in the period of gestation. Hence the haemodynamic and hormonal changes during pregnancy make pregnancy itself a risk factor for AD. It is advised that women with Marfan syndrome who are planning pregnancy should go through prophylactic aortic repair if the diameter of the ascending aorta exceeds 4 cm. Pre-pregnancy counselling is very important in these patients and must include complete history taking, including family history, physical examination and advanced aortic imaging. There is a general consensus among various authors advising against surgery during pregnancy in stable patients due to increased maternal and fetal morbidity but it is justified if the condition is refractory to medical management or in life threatening stage like acute AD. Though the incidence of aortopathy in pregnancy is rare, there is a high maternal and fetal mortality associated with this condition.

scholarly journals A life-threatening spontaneous ascending aortic rupture due to a small penetrating aortic ulcer

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110377
Author(s):  
Yasuhito Nakamura ◽  
Kiyoshi Doi ◽  
Syojiro Yamaguchi ◽  
Etsuji Umeda ◽  
Osamu Sakai ◽  
...  
Keyword(s):  
Rare Case ◽  
Aortic Wall ◽  
Aortic Rupture ◽  
Ascending Aorta ◽  
Bleeding Site ◽  
Penetrating Aortic Ulcer ◽  
Postoperative Course ◽  
Life Threatening ◽  
Aortic Dissections

We reported a rare case of spontaneous frank rupture of a small (4 mm) penetrating aortic ulcer in the ascending aorta resulted in catastrophic bleeding. The ulcer only created a pinhole wound in the adventitia without saccular aneurysms, intramural hematomas, or aortic dissections. Notably, the wound could be directly closed because the aortic wall was intact only 5 mm away from the bleeding site. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day. After 8 months, follow-up computed tomography showed no abnormality of the aortic wall at the repair site.

scholarly journals Aortic Dissection in a Pregnant Patient without Other Risk Factors

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Priya V. Patel ◽  
Raanan Alter ◽  
Recia Frenn ◽  
Thaddeus P. Waters
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Aortic Rupture ◽  
Treatment Options ◽  
Pregnant Patient ◽  
Physical Exam ◽  
Vascular Events ◽  
Increased Risk ◽  
Threatening Condition ◽  
Life Threatening

Background. An aortic dissection is a life-threatening condition in which the intima of the artery tears causing separation of the intima and media. Pregnancy places women at a significantly increased risk of common vascular events including venous thromboembolism, myocardial infarction, and stroke, while also increasing the risk of rarer vascular events such as aortic dissection and aortic rupture. Case. A 30-year-old previously healthy multiparous woman presenting at 36 weeks of pregnancy with a Type A aortic dissection. She underwent a combined emergent cesarean delivery followed by repair of her aortic root. Conclusions. Aortic dissection should be high on the differential for pregnant patients presenting with the characteristic complaints and physical exam findings given the high mortality rate associated with this vascular event. Teaching Points. (1) This report reviews the characteristic presentation, risk factors, and physical exam findings in a patient with an aortic dissection. (2) The report includes treatment options for pregnant patients based on the classification of the dissection.

scholarly journals Pheochromocytoma during pregnancy - a rare diagnose with a complex multidisciplinary approach

2021 ◽  
Vol 10 (9) ◽  
pp. 3587
Author(s):  
Rita Silva ◽  
Catarina R. Carvalho ◽  
Madalena Andrade Tavares ◽  
Celia Pedroso ◽  
Paula Tapadinhas
Keyword(s):  
Multidisciplinary Approach ◽  
Gestational Hypertension ◽  
Cardiovascular Complications ◽  
Fetal Mortality ◽  
Common Causes ◽  
Threatening Condition ◽  
Fetal Complications ◽  
Life Threatening ◽  
The Common ◽  
In Pregnancy

Hypertension is a common problem in pregnancy that can result in significant maternal and fetal morbidity and mortality. The common causes include pre-eclampsia, gestational hypertension and essential hypertension. Although pheochromocytoma is a rare of hypertension in pregnancy, it can lead to potentially life-threatening cardiovascular complications for the mother and increased fetal mortality if left undiagnosed and untreated. Early diagnosis and timely, appropriate management reduce possible maternal and fetal complications. We report a case of a 32-week pregnant woman diagnosed with hypertension secondary to pheochromocytoma. An elective caesarian section was performed at 37 weeks of gestational age and underwent a laparoscopic left adrenalectomy with success. A multidisciplinary approach is of utmost importance and essential during the management of this life-threatening condition during pregnancy.

scholarly journals Midgut Volvulus: A Rare but Fatal Cause of Abdominal Pain in Pregnancy—How Can We Diagnose and Prevent Mortality?

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Eelyn Chong ◽  
David S Liu ◽  
Neil Strugnell ◽  
Vishnupriya Rajagopal ◽  
Krinal K Mori
Keyword(s):  
Abdominal Pain ◽  
Rare Condition ◽  
Definitive Treatment ◽  
Fetal Mortality ◽  
Midgut Volvulus ◽  
Loss Of Life ◽  
Delay In Diagnosis ◽  
Life Threatening ◽  
Low Incidence ◽  
In Pregnancy

Midgut volvulus in pregnancy is rare but life-threatening, resulting in high maternal and fetal mortality. This surgical emergency commonly masquerades as symptoms of pregnancy, which together with its low incidence often leads to delay in diagnosis and definitive treatment. Here, we review the last three decades of the literature, discuss the challenges in managing this rare condition, and raise awareness among clinicians to minimise loss of life.

scholarly journals Spontaneous rupture of splenic artery aneurysm in pregnancy: an autopsy-based case report

2021 ◽  
Vol 10 (4) ◽  
pp. 1739
Author(s):  
Aditya Anand ◽  
Mohit Gupta ◽  
Manish Kumath ◽  
Sanjay Kumar
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Splenic Artery ◽  
Artery Aneurysm ◽  
Mortality Rates ◽  
Splenic Artery Aneurysm ◽  
Fetal Mortality ◽  
Intraperitoneal Hemorrhage ◽  
Life Threatening ◽  
In Pregnancy

Splenic artery aneurysm (SAA) is an infrequent form of vascular disease that has a significant potential for rupture, resulting in life-threatening intraperitoneal hemorrhage commonly during pregnancy. The incidence of splenic artery aneurysms has been estimated between 0.01% and 0.98%. We describe a case of sudden death of a 36 years old full term, primigravida female. During autopsy we found ruptured splenic artery aneurysm about 2.0 cm in diameter near hilum with intraperitoneal hemorrhage. It is important to be alert about the possibility of SAA in pregnant women for its early diagnosis, as the chance of it getting ruptured during pregnancy is high with high maternal and fetal mortality rates.

scholarly journals Treatment and therapeutic strategies for pituitary apoplexy in pregnancy: a case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuya Kato ◽  
Yoshikazu Ogawa ◽  
Teiji Tominaga
Keyword(s):  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Case Series ◽  
Optimal Timing ◽  
Presenting Symptoms ◽  
Pathological Evaluation ◽  
Mother And Child ◽  
Life Threatening ◽  
In Pregnancy

Abstract Background Pregnancy is a known risk factor for pituitary apoplexy, which is life threatening for both mother and child. However, very few clinical interventions have been proposed for managing pituitary apoplexy in pregnancy. Case presentation We describe the management of three cases of pituitary apoplexy during pregnancy and review available literature. Presenting symptoms in our case series were headache and/or visual disturbances, and the etiology in all cases was hemorrhage. Conservative therapy was followed until 34 weeks of gestation, after which babies were delivered by cesarean section with prophylactic bolus hydrocortisone supplementation. Tumor removal was only electively performed after delivery using the transsphenoidal approach. All three patients and their babies had a good clinical course, and postoperative pathological evaluation revealed that all tumors were functional and that they secreted prolactin. Conclusions Although the mechanism of pituitary apoplexy occurrence remains unknown, the most important treatment strategy for pituitary apoplexy in pregnancy remains adequate hydrocortisone supplementation and frequent hormonal investigation. Radiological follow-up should be performed only if clinical symptoms deteriorate, and optimal timing for surgical resection should be discussed by a multidisciplinary team that includes obstetricians and neonatologists.

scholarly journals Thyroid storm in the second stage of labour: a case report

2021 ◽  
Vol 14 (7) ◽  
pp. e243159
Author(s):  
Yudianto Budi Saroyo ◽  
Achmad Kemal Harzif ◽  
Beryliana Maya Anisa ◽  
Fistyanisa Elya Charilda
Keyword(s):  
Treatment Guidelines ◽  
Thyroid Storm ◽  
Lung Oedema ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Failure Treatment ◽  
Life Threatening ◽  
Thyroid Hormone Levels ◽  
Peripartum Period ◽  
In Pregnancy

A thyroid storm (or thyroid crisis) is an emergency in endocrinology. It is a form of complication of hyperthyroidism that can be life-threatening. Inadequate control of hyperthyroidism in pregnancy could develop into thyroid storm, especially in the peripartum period. We present a woman came in the second stage of labour, with thyroid storm, superimposed pre-eclampsia, acute lung oedema and impending respiratory failure. Treatment for thyroid storm, pre-eclampsia protocol and corticosteroid was delivered. The baby was born uneventfully, while the mother was discharged after 5 days of hospitalisation. Delivery is an important precipitant in the development of thyroid storm in uncontrolled hyperthyroidism in pregnancy. Although very rare, it can cause severe consequences. Diagnosis and treatment guidelines for thyroid storm were available and should be done aggressively and immediately. Uncontrolled hyperthyroidism should be prevented by adequate control in thyroid hormone levels, especially before the peripartum period.

Odontogenic deep neck space infection as life-threatening condition in pregnancy

2014 ◽  
Vol 59 (3) ◽  
pp. 375-378 ◽  
Author(s):  
D Dalla Torre ◽  
D Burtscher ◽  
D Höfer ◽  
FR Kloss
Keyword(s):  
Space Infection ◽  
Threatening Condition ◽  
Life Threatening ◽  
Deep Neck Space Infection ◽  
In Pregnancy

scholarly journals Profound Hypokalaemia Resulting in Maternal Cardiac Arrest: A Catastrophic Complication of Hyperemesis Gravidarum?

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Anna Walch ◽  
Madeline Duke ◽  
Travis Auty ◽  
Audris Wong
Keyword(s):  
Cardiac Arrest ◽  
Hyperemesis Gravidarum ◽  
Extracellular Fluid ◽  
Nutritional Deficiencies ◽  
Normal Limits ◽  
Life Threatening ◽  
Total Body ◽  
Anuric Renal Failure ◽  
Hospital Cardiac Arrest ◽  
In Pregnancy

We present a case of a 39-year-old G8P6 Pacific Islander woman who at 15+5 weeks’ gestation had an out-of-hospital cardiac arrest secondary to profound hypokalaemia which was associated with severe hyperemesis gravidarum (HG). Her clinical course after arrest was complicated by a second 5-minute cardiac arrest in the Intensive Care Unit (ICU) (pre-arrest potassium 1.8), anuric renal failure requiring dialysis, ischaemic hepatitis, and encephalopathy and unfortunately fetal demise and a spontaneous miscarriage on day 2 of admission. Despite these complications, she was discharged home 4 weeks later with a full recovery. Following a plethora of inpatient and outpatient investigations, the cause of her cardiac arrest was determined to be profound hypokalaemia. The hypokalaemia was presumed second to a perfect storm of HG with subsequent nutritional deficiencies causing electrolyte wasting, extracellular fluid (ECF) volume reduction, and activation of the renin-angiotensin-aldosterone axis (RAAS). This combined with the physiological changes that promote potassium wasting in pregnancy including volume expansion, increased renal blood flow, increased glomerular filtration rate, and increase in cortisol contributed to the patient having a profoundly low total body potassium level. This diagnosis is further strengthened by the fact that her pre- and post-pregnancy potassium levels were within normal limits in the absence of supplementary potassium. This case highlights the potentially life-threatening electrolyte imbalances that can occur with HG and the importance of recognising the disease, comprehensive electrolyte monitoring, and aggressive management in pregnancy.

Diaphragmatic Hernia

1983 ◽  
Vol 4 (8) ◽  
pp. 244-266
Keyword(s):  
Intensive Care ◽  
Pulmonary Arterial Hypertension ◽  
Diaphragmatic Hernia ◽  
Neonatal Intensive Care ◽  
Pulmonary Hypoplasia ◽  
Thoracic Cavity ◽  
Hemodynamic Changes ◽  
Life Threatening ◽  
Pulmonary Arterial ◽  
Immediate Surgery

In spite of the availability of almost immediate surgery and neonatal intensive care, congenital diaphragmatic hernia is a life-threatening anomaly in the newborn. It is the result of early embryologic malformation or failure of fusion of the components of the diaphragm allowing for the displacement of the abdominal contents into the thoracic cavity. There is consequent compression of the lung which may result in pulmonary hypoplasia or compression of the cardiovascular structures resulting in deleterious hemodynamic changes. Hypoxia and acidosis result in the presentation of respiratory distress and cyanosis. This is frequently associated with pulmonary arterial hypertension with right to left shunting through fetal circuits.

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