Chronic ectopic pregnancy complicated by septicemic shock and disseminated intravascular coagulation

Disseminated intravascular coagulation is a life threatening complication of ectopic pregnancy. It results from washing out of all important procoagulants. This is basically a state of increased propensity for clot formation triggered by a variety of stimuli related to such diverse disorders as sepsis ,endothelial cell damage (heat stroke and shock), obstetrical complication (abruptio placenta, amniotic fluid embolism, severe preeclampsia and retained intrauterine dead foetus). A case of disseminated intravascular coagulation with septicemic shock following laprotomy for ectopic pregnancy is reported. She was treated by vasopressors, broad spectrum antibiotic and aggressive blood and blood component therapy.

Pregnancy Outcomes in Takayasu Arteritis Patients

BackgroundsTakayasu Arteritis (TAK) is a chronic inflammatory autoimmune disease with a high prevalence in women of child-bearing age. We aim to investigate the maternal complications and pregnancy outcomes in patients with TAK and identify the related factors.MethodsA total of 110 pregnancies in 80 TAK patients in a Chinese TAK patient cohort and 440 matched pregnancies in healthy women between 2000 to 2020 were included. The maternal complications and pregnancy outcomes between TAK patients and matched controls were compared by chi-square test. The logistic regression analysis was used to identify the risk factors of maternal complications and adverse pregnancy outcomes in patients with TAK.ResultsMaternal complications and adverse pregnancy outcomes were more frequent in pregnancies with TAK than that in healthy women (P<0.001). In pregnancies with TAK, the most common maternal complication was new-onset or worsening of hypertension (18.2% [20/110]) and the most prevalent obstetrical complication was spontaneous abortion (32.7% [36/110]). Hypertension (OR 5.01, 95% CI 1.61 to 16.01), heart disease (OR 15.83, 95% CI 1.99 to 125.99), and active TAK (OR 7.54, 95% CI 1.85 to 30.72) before pregnancy were independently associated with increased maternal complications. The disease duration (OR 1.12, 95% CI 1.02 to 1.23) and active disease during pregnancy (OR 14.59, 95% CI 1.81 to 117.49) were correlated with adverse pregnancy outcomes. ConclusionTAK disease itself is a risk factor for adverse pregnancy outcomes. Treating the disease to a stable state before and after pregnancy, and close collaboration between rheumatologists and obstetricians are important measures to reduce maternal complications and reach favorable pregnancy outcomes.

Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare

Aim: Incarcerated gravid uterus is a rare obstetrical complication that leads to adverse outcomes, especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery. However, there is no consensus regarding the optimal management of this complication because of its rarity. In this study, we aimed to elucidate the incidence of incarcerated gravid uterus, as well as its natural courses and perinatal outcomes. Methods: We retrospectively reviewed medical records of patients who had incarcerated gravid uterus and managed at Osaka City University Hospital between April 2011 and March 2021. Incarcerated gravid uterus was defined as a retroverted or retroflexed uterus after 16 weeks of gestation. Results: There were 14 incarcerated cases among 6958 pregnant women, and 13 of them had some kind of gynecological complication and/or history. Spontaneous resolution of incarcerated gravid uterus after 16 gestational weeks was observed in six cases before the late second trimester and five cases at the late second trimester to early third trimester. Three cases remained incarcerated at term or near-term. One case with adenomyosis had severe abdominal pain, although it was difficult to ascertain whether the cause of pain was triggered by adenomyosis and/or incarceration. One case was misdiagnosed as placenta previa, and the uterine cervix was subsequently injured during cesarean delivery, resulting in massive hemorrhaging. Conclusions: Approximately 1 in 2300 pregnancies continued to be in an incarcerated condition at term or near-term, and 78.5% of cases showed a spontaneous resolution after 16 weeks of gestation. Expectant management with careful attention to the incarcerated gravid uterus may be one option in situations where there are no severe symptoms related to the incarceration itself.

Postpartum lumbosacral radiculopathy: a neuraxial anaesthesia complication or an intrinsic obstetric palsy?

Postpartum peripheral nerve disorders are an uncommon obstetrical complication, with most cases resulting from intrinsic obstetric palsies. We present the case of a full-term nulliparous pregnant 33-year-old woman with a vacuum-assisted vaginal delivery due to a prolonged second stage of labour and occipitoposterior position of the fetal head. For analgesia, a combined spinal–epidural technique was used. Four hours after delivery, the patient experienced a painless asymmetric motor deficit and hypoesthesia in the lower limbs, followed by sphincter disturbance. Emergent MRI was unremarkable. Electromyography showed signs of a bilateral lumbosacral radiculopathy. The patient experienced a gradual recovery over the following 2 months. Although a definitive aetiological diagnosis could not be confirmed, a lumbosacral polyradiculopathy due to intrinsic obstetric complication was considered. The patient presented several risk factors known to be associated with intrinsic obstetric palsies. Obstetricians and anaesthesiologists have an important role in preventing and diagnosing postpartum peripheral nerve disorders.

Maternal outcome of selective feticide due to fetal anomaly in late trimester: a retrospective 10 years’ experience in Taiwan

Background With advanced diagnostic techniques, early identification of fetal anomaly becomes more accurate. However, certain diseases could only be diagnosed in late gestation. Feticide was suggested to avoid delivering children with abnormalities. Recently, twin pregnancies have increased gradually, and so have their complications. Selective feticide was considered to achieve good outcome of pregnancy. This study aimed to evaluate the performance of feticide in twin pregnancy with fetal anomaly. Methods This was a retrospective study enrolled from 2009 to 2018. A total of 68 pregnancies complicated with fetal anomalies received feticide were recorded. Potassium Chloride (KCl) was injected into left ventricle to induce fetal asystole. Monochorionic twin pregnancies were excluded, maternal and fetal characteristics of 16 dichorionic twins were documented to compare the effectiveness of feticide performed before and after 24th gestational week. Results All the pregnant women received feticide smoothly without any maternal complication. The reasons for choosing feticide were divided into four groups, including morphologic defect (61.8%), genetic-chromosomal abnormality (30.9%), obstetrical complication (5.9%) and maternal request (1.5%). Mean gestational age at delivery was significantly higher in dichorionic twins underwent selective feticide before and after 24th gestational week (36.7 vs 33.4, [p < .05]). No fetal loss in twin pregnancy demonstrated a high successful rate of selective feticide. Conclusion Intra-cardiac injection of KCl was effective for feticide and safe for mothers and fetuses. Selective feticide was beneficial to late gestation of dichorionic twin pregnancy. With sufficient discussion with patients, selective feticide served as an alternative approach for twin pregnancy with fetal anomaly.

A Rare Case Report of a Consecutive Rib Fractures as an Isolated Obstetrical Complication

AIM: The aim of the following paper is to present the case of a term neonate with consecutive posterior rib fractures as an isolated finding after birth. METHODS: In the medical literature, there have been reported some sporadic cases indicating rib fractures in neonates. We present literature review and report a rare case of consecutive posterior rib fractures in neonate born following an uneventful pregnancy and uncomplicated labor. MAIN FINDING: The most common factors that can lead to rib fractures are birth trauma, cardiopulmonary resuscitation, and underlying disorders influencing bone development. In the presented case, there were no signs of other bone fractures or systems involved. CONCLUSION: Isolated form of consecutive posterior rib fracture after birth is a rare obstetrical complication. It is most likely caused by birth trauma but should be interpreted as a clinical sign of the potential syndrome. A decision whether to perform an X-ray depends on a physical examination of the newborn within the 1st h of life.

Post-Delivery Brachial Plexus Injury in Neonates: A Case Series

Brachial plexus injury in neonates is a rare obstetrical complication, but it can cause huge anxiety to parents if occurring and sometimes leading to legal disputes in obstetrical practice. Trauma during birth delivery is mainly due to the over-stretch of fetal neck which is the main cause of brachial plexus injury in infants. However, those injuries are self-limited and most of them will self-recover. We conducted a retrospective analysis on ten cases diagnosed of post-delivery brachial plexus injury under monitoring at Tu Du Hospital from January to November 2018. Such factors as maternal obstetrical history, labor characteristics, mode of delivery, clinical symptoms and treatment approach of those cases were collected and analyzed. The risk factors of brachial plexus injury in our study included large fetus, interventional delivery, prolonged second stage of labor and shoulder dystocia. All the cases were treated with physiotherapy and recovered after 3 – 6 months. Family counseling and infants’ recovery played an important role in the management of those cases.

A study to evaluate the causes of stillbirths according to the ReCoDe classification

Background: Foetal death or stillbirth is a major obstetrical complication and a devastating experience for the pregnant patients and relatives. Worldwide an estimate of at least 3.2 million stillbirths occurs each year. There are intensified demands on medical, political and epidemiological ground for proper determination and classification of causes of perinatal death. The aim of this study was to test a new classification system- Re. Co. De. Classification (Relevant Condition at Death) for stillbirths to improve our understanding of the main causes and conditions associated with foetal deaths.Methods: This study was a hospital based Prospective study conducted in department of obstetrics and Gynaecology, SZH, Bhopal. The study included 463 women who were admitted with Intra Uterine Foetal Demise. All cases were evaluated and after delivery the stillborn baby, the placenta and cord were examined. The causes were classified according to Re. Co. De. System.Results: The analysis of the new classification system Re. Co. De. Allowed attributable causes to about 90.72% of causes of still births explained where 9.28% were unexplained. The commonest cause was found to be class F4-Toxaemia of pregnancy (13.17%) followed by class A7- IUGR (10.58%), class C1-Abruptio placentae (10.36%), class E3-Obstructed labour (9.8%) and class A1- Lethal congenital malformations (8.42%).Conclusions: The Re. Co. De. Classification system gives us a better understanding of antecedents of stillbirths and the clinical practices, which need to be addressed to reduce perinatal mortality and have a better obstetric result in the next pregnancy.

Spontaneous cord hematoma: report of two cases

Spontaneous hematoma of the umbilical cord due to rupture of an umbilical cord vessel is a rare obstetrical complication which represents a severe cause of fetal distress with a 50% of reported fetal demise. Although several risk factors have been suggested, the cause of this disorder remains unknown. Herein we describe two cases of term deliveries with spontaneous umbilical cord hematomas which resulted in live births. In both cases the diagnosis was made intrapartum and was confirmed by a histopathologic examination.