Uterus couvelaire after caesarean section: A challenging case report

HIGHLIGHTS1. Uterus couvelaire, also known as uteroplacental apoplexy, is one of the causative post-partum haemorrhage and peripartum hysterectomy.2. The pathophysiology of uterus couvelaire are bleeding in the layer between the decidua-placenta, which then develops and infiltrates into the uterine wall.3. The uterine couvelaire is associated with placental abruption, placenta previa, coagulopathy, pre-eclampsia, uterine rupture, and amniotic fluid embolism.4. This case report shows the unknown of causative during delivery which can lead to maternal morbidity even mortality if there is no proper maternal monitoring during delivery.ABSTRACTObjectives: To discuss the discovery of uterine couvelaire events after the cesarean section without accompanying placental abruption.Case Report: Uterus Couvelaire is a rare occurrence. The incidence of this case is difficult to ascertain and its estimated incidence is as much as 20% and others’ estimatation is as low as 5%. It occurs mainly due to complications from placental abruption. When a vascular injury occurs in the placenta, it causes bleeding that infiltrates the wall of the uterus. This case is usually diagnosed accidentally because it is diagnosed only by direct visualization or biopsy. In this case, uterine couvelaire was found in a woman after a cesarean section that had been performed previously. Uterine couvelaire events are usually seen due to complications from placental abruption, but in this case, there was none.Conclusion: It was not known for sure what caused the emergence of the uterine couvelaire in this case. Hysterectomy was performed in this case due to the patient's unstable hemodynamic state.

Efficacy of oral nifedipine as a tocolytic agent

Background: Preterm birth is defined as birth at less than 37 weeks period of gestation, is the most important single determinant of adverse infant outcome in terms of both survival and quality of life. The need for tocolysis in terms of safety and efficacy is necessary to decrease perinatal mortality and morbidity in preterm labour. This study was aimed to evaluate the effectiveness of nifedipine as a tocolytic for inhibiting uterine contraction in threatened preterm labour.Methods: It was a prospective, nonblinded, single centred, randomized control trial. This study included 100 cases of preterm labour admitted in department of obstetrics and gynaecology, KIMSH, Bangalore, who satisfied the inclusion and exclusion criteria and were administered with nifedipine tocolysis.Results: 100 cases of preterm were evaluated for the prolongation of pregnancy for more than 48 hours. Prolongation of pregnancy till term was observed in 88% of the cases administered with nifedipine tocolysis. The mean gestational age in each group was 32.58±1.95 weeks. Nifedipine had very few side effects, namely tachycardia and headache and no changes in fetal heart rate.Conclusions: In this study oral nifedipine was found to be efficacious in prolongation of pregnancy for more than 48 hours with the ease of oral administration and with minimal dose tocolytic effect was achieved. It had minimal maternal and neonatal side effects and eliminate the need for intensive maternal monitoring.

Neighborhood, Peer, and Parental Influences on Minor and Major Substance Use of Latino and Black Adolescents

Self-report survey data were collected from 797 adolescents (47.2% Latino, 52.8% Black) in North Carolina. Path analyses were conducted to examine relationships between youth perceptions of maternal and paternal monitoring, neighborhood crime/drugs, friends’ delinquency, peer victimization, minor substance use, and major substance use. After establishing a good fitting model, multigroup models were conducted for Blacks vs. Latinos. The results indicated perceived maternal monitoring (and paternal monitoring for Latinos) was directly related to decreased exposure to neighborhood crime/drugs and friends’ delinquency. For Latinos and Blacks, maternal and paternal monitoring were directly related to gateway substance use, and indirectly related to major substance use through gateway substance use. Additionally, friends’ delinquency and peer victimization were directly related to gateway and major substance use for Blacks and Latinos. Thus, exposure to neighborhood crime/drugs was indirectly related to substance use through friends’ delinquency and peer victimization.

Investigation of Methods to Extract Fetal Electrocardiogram from the Mother’s Abdominal Signal in Practical Scenarios

Monitoring of fetal electrocardiogram (fECG) would provide useful information about fetal wellbeing as well as any abnormal development during pregnancy. Recent advances in flexible electronics and wearable technologies have enabled compact devices to acquire personal physiological signals in the home setting, including those of expectant mothers. However, the high noise level in the daily life renders long-entrenched challenges to extract fECG from the combined fetal/maternal ECG signal recorded in the abdominal area of the mother. Thus, an efficient fECG extraction scheme is a dire need. In this work, we intensively explored various extraction algorithms, including template subtraction (TS), independent component analysis (ICA), and extended Kalman filter (EKF) using the data from the PhysioNet 2013 Challenge. Furthermore, the modified data with Gaussian and motion noise added, mimicking a practical scenario, were utilized to examine the performance of algorithms. Finally, we combined different algorithms together, yielding promising results, with the best performance in the F1 score of 92.61% achieved by an algorithm combining ICA and TS. With the data modified by adding different types of noise, the combination of ICA–TS–ICA showed the highest F1 score of 85.4%. It should be noted that these combined approaches required higher computational complexity, including execution time and allocated memory compared with other methods. Owing to comprehensive examination through various evaluation metrics in different extraction algorithms, this study provides insights into the implementation and operation of state-of-the-art fetal and maternal monitoring systems in the era of mobile health.

Adolescents’ Food Purchasing Patterns in The School Food Environment: Examining the Role of Perceived Relationship Support and Maternal Monitoring

The school food environment plays a role in adolescents’ dietary behaviors. In this study, adolescents’ food purchasing patterns in and around school and its potential relationship with perceived maternal relationship support and maternal monitoring were examined. Data were collected in The Netherlands in 2017. A total of 726 adolescents (45.8% boys; Mage = 13.78 ± 0.49) and 713 mothers (Mage = 45.05 ± 4.45) participated. Adolescents’ frequency of bringing and purchasing foods was assessed via a Food Frequency Questionnaire (FFQ). Relationship support and monitoring were measured via self-report questionnaires. Structural Equation Modelling (SEM) was conducted to examine associations between adolescents’ food purchasing patterns, relationship support, and monitoring. Results indicated that adolescents brought food and drinks mostly from home, and infrequently purchased these products in and around school. Yet, differences exist between subgroups of adolescents. Relationship support was positively associated with bringing fruit, vegetables and salad and negatively associated with purchasing sweet snacks. No associations were found for monitoring. These findings indicate that family-home determinants of healthy and unhealthy eating are important factors to consider when examining the impact of the school food environment on adolescents’ food purchasing patterns. This has implications for policy makers who aim to develop and implement measures to improve adolescents’ eating in and around school.

A rare case of fetus papyraceous presenting in monozygotic biamniotic twins

Fetus papyraceous or compresses is characteristic of compressed mummified, parchment like remains of dead twin retained in utero after intrauterine death in the second trimester. It is an uncommon finding and we report in a G2P1L1 with 22 weeks with Monozygoticbiamniotic twins with fetus papyraceous stuck to left upper segment followed up to 36 weeks. The mother was advised regular antenatal visits and frequent feto-maternal monitoring was done. Patient delivered a single live baby and a placenta with mummified fetus within it. The incidence of fetus papyraceous is about 1 in 17000 to 1 in 20000 pregnancies. Early diagnosis of this condition helps in monitoring the surviving fetus.

Maternal monitoring and safety considerations during antiarrhythmic treatment for fetal supraventricular tachycardia

Fetal tachycardia is a rare complication during pregnancy. After exclusion of maternal and fetal conditions that can result in a secondary fetal tachycardia, supraventricular tachycardia is the most common cause of a primary sustained fetal tachyarrhythmia. In cases of sustained fetal supraventricular tachycardia, maternal administration of digoxin, flecainide, sotalol, and more rarely amiodarone, is considered. As these medications have the potential to cause significant adverse effects, we sought to examine maternal safety during transplacental treatment of fetal supraventricular tachycardia. In this narrative review we summarize the literature addressing pharmacologic properties, monitoring, and adverse reactions associated with medications most commonly prescribed for transplacental therapy of fetal supraventricular tachycardia. We also describe maternal monitoring practices and adverse events currently reported in the literature. In light of our findings, we provide clinicians with a suggested maternal monitoring protocol aimed at optimizing safety.