Accidental electric shock in pregnancy and antenatal occurrence of maternal deep vein thrombosis. A case report

BACKGROUND: Even low-voltage electric shock can initiate late vascular thromboses. We present the first reported case of antenatal deep vein thrombosis (DVT) in a pregnant woman that could be attributed to the electric shock she accidentally received several weeks prior to the DVT. CASE: A 19-year-old primigravida presented to the office at 29 weeks of gestation with signs and symptoms of DVT. A magnetic resonance imaging revealed an occluding thrombus involving the entire left common iliac and external iliac vein. She tested negative for all the biochemical abnormalities that could lead to a hypercoagulable state. Her prior pregnancy course had been unremarkable with the exception of an electric shock she had had secondary to touching exposed electric wires at home at 22 weeks of gestation. CONCLUSION: Pregnant women exposed to electric shock should be carefully monitored for such complications as DVT during the weeks following the exposure.     

A rare gynecologic contraindication to the use of prostaglandins and oxytocin to induce abortion. A case report

Premature rupture of the membranes was diagnosed in a 27-year-old nullipara at 24 weeks' gestation. Medical induction of abortion (because of sepsis) was attempted and failed. The products of conception were removed surgically per vagina; that procedure was followed by an intractable hemorrhage. Subtotal hysterectomy and repair of the left common iliac artery and vein were performed to stop the bleeding. In retrospect the case was diagnosed as a left ligamentary ectopic pregnancy with uterine rupture and erosion of the left common iliac vessels.     

Fetal curarization for prenatal magnetic resonance imaging

Fetal magnetic resonance (MR) imaging was performed at 33 weeks of gestation for investigation of a posterior fossa abnormality found at ultrasound screening. Fetal movements were abolished by vecuronium injected under ultrasound guidance into the umbilical vein. MR images showed atrophy of the left cerebellar lobe with cisternal dilatation. These were confirmed postnatally by CT scan.     

Acute iliac vein thrombosis in pregnancy treated successfully by streptokinase lysis: a case report

BACKGROUND: Postthrombotic syndrome is an important late complication after deep vein thrombosis in pregnancy. Thrombolytic agents are more efficient in preventing this condition but are rarely used in pregnant women. CASE: A 22-year-old woman at 29 weeks of gestation presented with acute iliac vein thrombosis. After application of a heparin bolus, systemic streptokinase lysis was performed. Low-dose heparin therapy was continued for the remainder of the, otherwise unremarkable, pregnancy. Spontaneous delivery of a healthy girl was without complications and thromboprophylaxis with low-molecular heparin was continued. CONCLUSION: Thrombolysis in pregnancy is possible and may help to prevent severe long-term sequelae of thrombosis in young women. Bleeding is a major risk, which must be considered and therapy should only be administered under close observation.     

Serial colour flow duplex scanning of the veins of the lower limb throughout pregnancy

Objective To examine changes in diameter and reflux in normal veins of the lower limb throughout pregnancy.
Methods Fifty-seven women were recruited into the study and 43 completed the full assessment to six weeks postpartum. Thirteen had pre-existing venous disease and are reported elsewhere. The veins were assessed in both lower limbs using colour flow duplex scanning. This was performed at a 75° tilt measuring vein diameter and the presence or absence of reflux. Measurements were made at 12, 20, 26, 34, 38 weeks of gestation and 6 weeks postpartum.
Results No new reflux developed in any of the veins studied. In the superficial system the maximum change was seen in the long saphenous vein at 34 weeks, on the left side the vein diameter failed to return to baseline size. Significant change also occurred in the superficial femoral vein. Dilatation of the deep veins of the calf was observed being greater in the left posterior tibia1 and the left peroneal at the mid-calf point.
Conclusion Colour flow duplex scanning is an acceptable method of assessing the lower limb veins in pregnancy. Maximum diameter changes were seen in the long saphenous vein and in the deep veins at mid-calf. No new reflux developed during the gestation period in veins which were previously normal.     

Serial colour flow duplex scanning of the veins of the lower limb throughout pregnancy.

OBJECTIVE: To examine changes in diameter and reflux in normal veins of the lower limb throughout pregnancy. METHODS: Fifty-seven women were recruited into the study and 43 completed the full assessment to six weeks postpartum. Thirteen had pre-existing venous disease and are reported elsewhere. The veins were assessed in both lower limbs using colour flow duplex scanning. This was performed at a 75 degree tilt measuring vein diameter and the presence or absence of reflux. Measurements were made at 12, 20, 26, 34, 38 weeks of gestation and 6 weeks postpartum. RESULTS: No new reflux developed in any of the veins studied. In the superficial system the maximum change was seen in the long saphenous vein at 34 weeks, on the left side the vein diameter failed to return to baseline size. Significant change also occurred in the superficial femoral vein. Dilatation of the deep veins of the calf was observed being greater in the left posterior tibial and the left peroneal at the mid-calf point. CONCLUSION: Colour flow duplex scanning is an acceptable method of assessing the lower limb veins in pregnancy. Maximum diameter changes were seen in the long saphenous vein and in the deep veins at mid-calf. No new reflux developed during the gestation period in veins which were previously normal.     

Cushing syndrome and pregnancy: a propos of a malignant adrenocortical carcinoma

Cushing's syndrome is a rare condition in the general population (1/1000000) and is even less common during pregnancy. We report the case of a patient cared at 27 weeks of gestation (wg) for hypertension and electolyte disturbances. Cushing's syndrome was confirmed by salivary cortisol and ACTH assessment. RMN revealed a 9 cm left adrenal tumor. Severe hypertension and electolyte disturbances on the one hand, and diagnostic uncertainty on the other hand, imposed adrenalectomy at 29 wg. Twelve days later, fetal distress led to a caesarian section and birth of a well being male baby.     

A fetal lung lesion consisting of bronchogenic cyst, bronchopulmonary sequestration, and congenital cystic adenomatoid malformation: the missing link?

A fetus was found to have a large left thoracic cyst on routine prenatal ultrasound at 23 weeks of gestation. This lesion caused compression of the normal left lung tissue and contralateral mediastinal shift. At 23 weeks of gestation the cyst was percutaneously aspirated without subsequent reaccumulation of fluid. Serial ultrasounds showed decrease in the size of the cyst. The clinical diagnosis of congenital cystic adenomatoid malformation was made. At birth, the child had no respiratory distress, and a CT scan confirmed the finding of a fluid-filled cyst in the left chest. At the time of resection, a nonaerated extralobar bronchopulmonary sequestration (with a systemic arterial blood supply and separate pleural investment) was found. The dominant cyst had ciliated respiratory epithelium with cartilage, indicative of a bronchogenic cyst, and the remainder of the specimen had the histologic hallmarks of a congenital cystic adenomatoid malformation. The coexistence of three separate anomalies in one lesion suggests a common embryological link for these malformations.     

The relationship of the umbilicus to the aortic bifurcation: implications for laparoscopic technique.

OBJECTIVE: We evaluated the location of the umbilicus relative to the aortic bifurcation and the left common iliac vein where it crosses the midline. METHODS: Abdominal computed tomography images from 35 reproductive-age women were retrospectively reviewed to determine the location of the umbilicus. The results were correlated with body mass index using Pearson correlation coefficient and a two-tailed paired t test. RESULTS: The location of the umbilicus, but not the aortic bifurcation, was more caudal in heavier women and negatively correlated with body mass index. In nonobese women, the mean location of the umbilicus was 0.4 cm caudal to the aortic bifurcation, and was at or cephalad to the bifurcation in eight of 15 (53%). In overweight women, the mean umbilical location was 2.4 cm caudal to the bifurcation, and in obese women, 2.9 cm caudal to the bifurcation. In the last two groups of subjects, the umbilicus was located at the level of the bifurcation in six of 20 (30%). In every case, the umbilicus was located cephalad to where the common iliac vein crossed the midline. CONCLUSIONS: The umbilicus is often located at or cephalad to the aortic bifurcation, and consistently located cephalad to where the left common iliac vein crosses the midline. The laparoscopic approach should take these relationships into account to minimize injuries to major retroperitoneal vessels.     

Temporary balloon occlusion of the common iliac artery: new approach to bleeding control during cesarean hysterectomy for placenta percreta

A case of placenta percreta was referred at 31 weeks' gestation. We performed a cesarean hysterectomy preceded by placement of occlusive balloon catheters at bilateral common iliac arteries at 34 weeks' gestation. This simple and safe technique provides satisfactory efficacy for control of profuse bleeding during operation, with blood loss estimated at 800 mL.     

Delayed Diagnosis of Iliac Vein Thrombus in a Sexually-Active Adolescent with Klippel-Trénaunay Syndrome

BackgroundAlthough iliac vein thrombus is uncommon in adolescents, it can present with pelvic inflammatory disease (PID) symptoms.CaseA 19-year-old sexually active female with Klippel-Trénaunay syndrome (KTS) presented with fever, abdominal and lower extremity pain. Physical findings included cervical motion tenderness and left lower extremity swelling and erythema. The patient was admitted for PID and cellulitis. Despite antimicrobial treatment her pain continued. Neisseriae gonorrhea and Chlamydia trachomatis cultures were negative. Abdominal and pelvic computed tomography scans revealed a left internal iliac vein thrombus. Anticoagulation therapy was initiated; her pain improved. On hospital day 7 she developed pulmonary emboli.Summary and ConclusionIn sexually active adolescents with known risk factors for thromboembolism such as KTS, symptoms and signs considered characteristic for PID can be present in association with an iliac vein thrombus.     

Prediction of HELLP syndrome with assessment of maternal dual hepatic blood supply by using Doppler ultrasound

Objective: Early structural and functional changes in the systemic vasculature have been proposed to play a major pathogenetic role in HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Our objective was to assess whether the evaluation of maternal hepatic blood supply is instructive to the prediction of onset of HELLP syndrome. Design: Prospective observation study. Population: Fifty-eight women with severe preeclampsia and 60 healthy pregnant controls at 25–36 weeks gestation. Methods: Angle-corrected time-averaged flow velocity and the cross-sectional area of common hepatic artery and portal vein were measured by using Doppler ultrasonography in 58 women with severe preeclampsia and in 60 healthy pregnant controls at 25–36 weeks gestation. Intravascular flow volumes were calculated from the product of the time-averaged velocity and the cross-sectional area. The total liver blood flow was taken as the sum of flow volumes in the hepatic artery and portal vein. Results: The total liver blood flow decreased significantly to about 40% of control in 9 women with severe preeclampsia who developed HELLP syndrome within 4 days after the examination, but not in 49 women with severe preeclampsia without HELLP syndrome. Conclusion: The results indicated that the decrease in dual hepatic blood supply preceded the onset of HELLP syndrome.     

Functional aortic stenosis diagnosed in fetal period

We report a case of fetal congenital heart disease prenatally diagnosed as critical aortic valve stenosis at 25 weeks of gestation. Fetal echocardiography demonstrated severe mitral regurgitation, aortic valve stenosis, hypocontractility of the left ventricle, and showed retrograde flow in the aortic arch like HLHS (hypoplastic left heart syndrome). However, soon after delivery, improvement in the baby's hemodynamics and myocardial contractility were recognized without any treatment.     

Luteotropic effect of human chorionic gonadotropin on human corpus luteum in early gestation (author's transl)

To study the luteotropic effect of human chorionic gonadotropin (hCG) on human corpus luteum in early gestation, serum pregnenolone, 17 alpha OH-pregnenolone, dehydroepiandrosterone, progesterone, 17 alpha OH-progesterone, androstenedione, 20 alpha-dihydroprogesterone and estradiol levels in both ovarian and peripheral venous blood measured by RIA before and after administration of hCG. Seven patients selected for this experiment were 6 to 16 weeks of gestation complicated with fibromyoma. On hysterectomy, 1,000 or 2,000 I.U. of hCG was directly injected into the ovary with corpus luteum to the patients of 6, 12 and 16 weeks of gestation, or 100,000 I.U. of hCG was infused intravenously to the patients of 9 and 14 weeks of gestation. Before 12 weeks of gestation, all free steroid levels except for conjugated steroids in ovarian vein increased promptly 1.8 to 8.9 fold as compared with control levels and stayed high levels for 25 to 60 minutes after administration of hCG. However no marked alteration of these steroids was observed in peripheral vein. In cases studied after 14 weeks of gestation, no marked change of steroid levels in ovarian vein was noticed, while a moderate increase of hCG was observed. These results demonstrated that hCG stimulates the steroidogenesis of corpus luteum in early pregnancy. It was demonstrated that extremely high doses of hCG was required to stimulate steroidogenesis corpus in luteum gravidarum of early gestation.     

Changes in the size of maternal inferior vena cava during pregnancy

AIMS: To investigate the changes in the size of maternal inferior vena cava (IVC) during normal pregnancy. METHODS: The diameter and the area of IVC were measured in 32 non-pregnant and 214 pregnant women by ultrasonography. They were measured not only in the supine but also in the complete left lateral position when gestation was over 16 weeks. RESULTS: IVC in the 4-7 weeks pregnant group was larger than that in the non-pregnant group, and it decreased as gestation progressed during an early stage of pregnancy. After 16 weeks gestation, it demonstrated no change, at least for depending on the periods when the mother was in the supine position. On the contrary, they increased with the gestational progress as for the maternal left lateral position. CONCLUSIONS: The size of IVC at an early stage of pregnancy is enlarged, suggesting an underfilling state of arterial circulation. In the second and third trimesters, it is stationary when the mother is supine. In the left lateral position, it increases as the gestation progresses, reflecting blood volume expansion during pregnancy.     

Primary Retroperitoneal Müllerian Adenocarcinoma: Report of Two Cases Treated With Radical Surgery

BackgroundPrimary retroperitoneal Müllerian adenocarcinoma (PRMA) is a very rare type of primary retroperitoneal tumour.Case 1A 45-year-old woman presented with left lower extremity swelling and pain. Imaging revealed that the tumour had invaded the left common iliac vein and artery, internal and external iliac arteries, sciatic and obturator nerves, and pelvic wall.Case 2A 37-year-old was admitted with pelvic pain. Imaging showed the tumor at the left iliac bifurcation infiltrating the internal iliac artery and left sciatic, obturator, and femoral nerves.Both of these patients were treated with radical surgery that achieved no visible tumour at the end of the operation.ConclusionThere is no guideline for the diagnosis and management of this entity due to its rarity. These cases should be managed at highly specialized centres with expertise in radical surgery.     

基于磁共振成像在体盆腔及骶前区血管三维重建模型构建方法探讨

目的 探讨应用盆腔磁共振成像（MRI）原始数据重建在体女性骶前血管三维模型的方法及意义。方法 对2012年2-5月广州医科大学附属第一医院25例因盆腔良性肿瘤患者手术前行盆腔MRI检查,以e-THRIVE序列获取所有MRI原始数据,应用Minics10.0软件重建骶前血管三维图像。结果 骶前区血管三维重建均可清晰地显示腹主动脉、下腔静脉、双侧髂总、髂外及髂内动、静脉;25例患者中18例显示骶正中动脉,6例显示骶正中静脉及部分横干静脉。18例骶正中动脉均从腹主动脉分叉,平均直径为2.3(1.2～3.6) mm;6例骶正中静脉均汇入左侧髂总静脉,平均直径为3(1.7～4.6) mm。结论 利用e-THRIVE序列MRI扫描盆腔血管,可构建盆腔血管三维重建模型,且骶前区的骶正中动脉显影率高,部分病例可显影骶正中静脉及横干静脉。     

Evolution of left ventricular diseasein the fetus. Case report

A fetal case is described that showed a rapid progression from the features of initial left ventricular fibroelastosis at 20 weeks of gestation to a more marked dilation at 22 weeks and finally to a hypoplastic left ventricle with aortic stenosis at 24 weeks of gestation. This case confirms the evolutive character of left ventricular disease during fetal life.     

Common iliac artery flow velocity waveforms in fetuses with a single umbilical artery: a longitudinal study

Objective In fetuses with a single umbilical artery the entire blood flow to the placenta is transported through the common and internal iliac arteries from the side of the single artery, whereas the pelvic vessels from the side of the missing artery do not participate in the fetoplacental circulation. The aim of this study was to investigate the effect of gestational age on pelvic arterial blood flow in fetuses with single umbilical artery.
Design In 15 fetuses with a single umbilical artery (SUA), common iliac artery flow velocity waveforms were studied longitudinally using high resolution colour Doppler ultrasonography at three gestational ages: 18 to 20 weeks, 28 to 30 weeks, and 35 to 37 weeks. The pulsatility index was measured in each common iliac artery and mixed model analysis of variance was used to examine the effect of gestational age and side.
Results There was a highly significant difference in pulsatility index between common iliac arteries at all gestational ages, the values always being higher on the side that did not participate in the fetoplacental circulation (   P < 0.001  ). For increasing gestation, the pulsatility index fell significantly in the SUA side but remained high in the non-SUA side (   P < 0.001  ).
Conclusions This study shows that the asymmetry in the pelvic arterial blood flow in fetuses with SUA increases as pregnancy progresses, consistent with decreasing vascular resistance in the placenta and increasing resistance in the lower extremities.     

In utero diagnosis of an aneurysm of the vein of Galen causing hydrocephalus and heart failure

A prenatally diagnosed aneurysm of the vein of Galen was presented in the fetus of a patient referred to our hospital at 31 weeks of gestation. Ultrasonography demonstrated polyhydramnios, cardiomegaly, dilatation of the right atrium and superior vena cava, tricuspid valve regurgitation, hydrocephalus, and a large hypoechoic mass with blood flow in the suboccipital region. Skin edema was shown thereafter. A 3262-g male was delivered by cesarean at 35 weeks of gestation. Computed tomography imaging demonstrated a large mass in the suboccipital region, after which thrombocytopenia appeared and the neonate died at 18 days of age.