Downer cow syndrome causing rhabdomyolysis and acute renal failure in a 17-month-old Guzerá heifer

ABSTRACT: The downer cow syndrome (DCS) is characterized by an alert cow showing inability or reluctance to stand for 12 hours or more. This paper reported clinical, laboratory, and pathological findings in a Guzerá heifer with rhabdomyolysis, pigmenturia and acute renal failure following DCS. A 17-month-old Guzerá heifer was transported via a 350-km ride in a truck and showed sternal recumbency and severe difficulty in standing and walking. Neurological examination was unremarkable, and the heifer presented normal response to cranial nerves and spinal cord tests. Rectal palpation revealed a 5-month gravid uterus. No other abnormalities were noted in the pelvis or around the coxofemoral joints. Biochemical abnormalities included extremely high muscular enzyme activities (creatine phosphokinase and aspartate aminotransferase) and high creatinine levels. Urinalysis revealed blackish and cloudy urine, proteinuria, and a positive occult blood test. Spinal cord ultrasonography showed no abnormalities. This report highlighted an uncommon clinical presentation (myoglobinuria) and pathological findings in a heifer with DCS as a consequence of severe compressive muscle damage. Practitioners and producers must be aware of the risk of careless road transportation for long distances of cattle, especially obese cows, avoiding unnecessary suffering and expenses due to DCS.

Reply to Orsi, M.; Somigliana, E. Incarceration of the Gravid Uterus: Proposal for a Shared Definition. Comment on “Tachibana et al. Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare. Diagnostics 2021, 11, 1544”

We appreciate the interest in our paper, and we are grateful for the comment by Orsi et al. [...]

Incarceration of the Gravid Uterus: Proposal for a Shared Definition. Comment on Tachibana et al. Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare. Diagnostics 2021, 11, 1544

We read with great interest the paper entitled “Incarcerated gravid uterus: spontaneous resolution is not rare” by Tachibana et al. [...]

Scar Tissue after a Cesarean Section—The Management of Different Complications in Pregnant Women

The definition of a cesarean scar pregnancy (CSP) is the localization of the gestational sac (GS) in the cicatrix tissue, which is created in the front wall of the uterus after a previous cesarean section (CS). The worldwide prevalence of CSP has been growing rapidly. However, there are no general recommendations regarding prophylaxis and treatment of the abnormalities of the anterior wall of the uterus discovered in a non-pregnant myometrium, or how to deal with existing cases of CSP. We present the latest knowledge, a holistic approach to the biology, histology, imaging, and management concerning post-CS scars based on our cases, which were treated in the Department of Pregnancy and Pathology of Pregnancy in the Medical University of Lublin, Poland. In our study, we present images of tissue samples of areas with a cicatrix in the uterus, and ultrasound and MRI images of CSP. We discuss the advances in the biology of the post-CS scar tissue, the prevention techniques used to repair the scar defect (niche) before the pregnancy, and the treatment of different complications of CSP, such as the rupture of the gravid uterus or the dehiscence of the myometrium.

Spontaneous Rupture of the Non Gravid Uterus: A Case Report

Uterine rupture can cause serious morbidity and mortality to the women. A complete uterine rupture is a diagnosis made when all three layers of the uterus are separated, while uterine dehiscence is a similar condition in which there is incomplete division of the uterus that does not penetrate all three layers of the uterus. Uterine dehiscence is most often an occult finding in asymptomatic patients. Mostly the uterine rupture is seen in gravid females however it has been reported in non gravid patients as well. Spontaneous uterine rupture is extremely rare to be seen in non gravid patients, but should be included in the differential diagnosis of acute abdomen and shock in a non pregnant woman of any age due to its catastrophic consequences. In non gravid uterus the most common cause of the uterine rupture is pelvic trauma, uterine myomas, infection or uterine carcinoma. We hereby report a case of 44 years old female with previous 4 caesarean sections who came on12th day of her cycle with heavy bleeding, lower abdominal pain and anaemia. She was found to have small fibroids which were blamed for the menorrhagia and she was admitted for the conservative management. She collapsed on day 2 of admission suddenly and after stabilization of the patient her exploratory laparotomy was done and uterine rupture was detected on the right side of the previous scar. The uterus was repaired as the patient refused for hysterectomy. Her post op recovery was uneventful. Her first periods after the surgery was normal with average amount of blood loss. Key words: Uterine rupture, haemorrhage, non -gravid, caesarean, hysterectomy, laparotomy.

EP.FRI.159 Crohn’s terminal ileal perforation peri partum; a case report and review of the literature

Introduction Surgical care of complicated Crohn’s disease (CD) during pregnancy is often a clinicodiagnostic conundrum. We present a case of a 26 year old with active CD and subsequent terminal ileal (TI) perforation diagnosed post-partum. Case A 26 year old with known CD presented with abdominal pain at 24 weeks pregnant to Obstetrics. Surgical opinion was sought due to increasing abdominal pain; MRI was performed and found active TI CD but no free gas. Within 24 hours the patient prematurely delivered. Immediately post-partum the patient reported worsening pain with notable peritonism on examination. Urgent CT abdomen was arranged demonstrating free aim secondary to TI perforation. The patient underwent laparotomy. Intraoperatively there was 4 quadrant peritonitis, confined TI loops behind the gravid uterus and TI perforations. Following drainage of the intrabdominal sepsis, a ileo-caecal resection was performed with end ileostomy and colonic mucous fistula formation. Post-operative recovery was uneventful and the patient was discharged 5 days later. Discussion There is a paucity of evidence describing manifestations of CD during pregnancy. Meta-analysis has shown a correlation of active CD and adverse perinatal outcome. The specific complication of TI perforation is a rare sequelae of CD; documented in less than 5% of cases. TI perforation during pregnancy has been described in only a handful of case reports. Conclusion This case report illustrates diagnostic challenges faced in the investigation and management of active CD in pregnant patients. It also highlights the importance of dynamic reassessment and the collaborative efforts of the multidisciplinary team.

Multiple gestation and perinatal outcome in the Federal Medical Centre, Yenagoa, South-South, Nigeria: A 5-year review

Background: Multiple gestation occurs when the gravid uterus harbours more than one foetus. It is a high-risk pregnancy, because of the associated adverse pregnancy outcomes culminating in some cases, in a high rate of maternal and perinatal morbidity and mortality. Objective: To determine the incidence of multiple gestation, and maternal and perinatal outcomes associated with it at the Federal Medical Centre, Yenagoa, South-South, Nigeria, over a five-year period. Materials and Methods: This retrospective study was carried out between 1st January, 2016 and 31st December, 2020. Data were retrieved and entered into a pre-designed proforma, and analysed using IBM SPSS version 25.0. Results were presented in frequencies and percentages for categorical variables, and mean and standard deviation for continuous variables. Results: One hundred and sixty-three women had multiple gestation in the period under review, out of a total of 4,571 pregnancies, which represented a case incidence rate of 35.6 multiple gestations per 1,000 deliveries in the Centre. Incidence rates for twins and triplets were 32.5 and 3.5 per 1,000 deliveries, respectively. About 51.5% were unbooked for antenatal care in the index pregnancy. The most common (47.2%) complication was preterm delivery. There were 342 neonates from 163 multiple gestations. There was death of 20 (5.8%) babies. Conclusion: The significant maternal and perinatal morbidity and mortality associated with multiple gestation can be reduced by early diagnosis, specialized antenatal care, skilled intrapartum, postpartum and neonatal care in centres with a full complement of skilled obstetricians, anaesthetists and neonatologists.

A rare case report on double J stenting in a rare case antepartum patient with right sided hydronephrosis and hydroureter

Gestational hydronephrosis (GH) is caused due to dilatation effect of the progesterone as well as physical pressure of the gravid uterus. In pregnancy, its management is challenging as routine radiological investigations and surgical treatments cannot be performed due to the potential harm to the foetus. Women who fail to respond to conservative methods require intervention. Acute hydronephrosis and renal colic are common aetiologies for loin pain, and can lead to severe form of urinary tract infection affecting perinatal outcome. Double J (DJ) stenting during pregnancy is safe, requiring no intra-operative imaging, and inserted under local anaesthesia. It provides good symptom relief, low complication rate, efficient and safe modality for women with refractory symptoms. Multidisciplinary approach to this procedure is advised.

Covid-19 in Gravid Uterus – The Challenge in Antenatal Care and Its Outcome – A Tertiary Level Cross Sectional Analysis from Chennai, India

BACKGROUND With the emerging pandemic of corona virus disease 19 (Covid-19) infection around the world, the need to identify the course of this disease in pregnant women becomes the need of the hour. Its effect on pregnancy and the neonatal outcome is not well known because of lack of any reliable data. We wanted to evaluate the clinical features, laboratory manifestations and obstetric outcome of Covid-19 in the term of antenatal mothers who were either admitted in labour, induction of labour or elective caesarean section and rule out vertical transmission by doing a routine neonatal screening for Covid-19. METHODS A descriptive cross-sectional study conducted at Sri Ramachandra Medical College & Research Institute, Chennai from March 2020 to September 2020 includes all antenatal women who were tested positive for severe acute respiratory syndrome (SARS- Cov2) reverse transcription - polymerase chain reaction (RT-PCR). 43 Covid positive patients were included in the study. RESULTS Incidence of Covid positive antenatal women was found to be 1.7 %. Only 3 % were symptomatic with mild disease. Gestational diabetes mellitus accounted for (27 %), Class II obesity (7 %), hypertensive disorders of pregnancy (13 %) of the screen positive mothers. 20 % of the labouring women had meconium-stained liquor. Lymphopenia was seen in 73 % of cases. Elevated d-dimer in 13 %, requiring thromboprophylaxis. Negative RT-PCR for SARS-CoV-2 in the neonates ruled out vertical transmission. CONCLUSIONS Covid-19 in pregnancy is more common in those with gestational diabetes, obesity, with development of complications like hypertension and meconium-stained liquor. The impact of Covid-19 is not as disabling as it is in the non-pregnant population. KEY WORDS Universal Screening, In/Near Labour, Lymphopenia, Thromboprophylaxis, Meconium- Stained Amniotic Fluid.