Emergency delivery and perimortem C-section

The emergency department is a suboptimal location for delivery, and the greater prevalence of complicated presentations and emergency deliveries results in higher morbidity and mortality. Any woman greater than 20 weeks' gestation in labor is considered medically unstable and should be triaged quickly. Fetal viability occurs after 24 to 26 weeks' gestation. Placenta previa and abruption should be considered in a woman in labor with ongoing bleeding, and ultrasound evaluation should be performed emergently. Continuous fetal monitoring is the best method to assess for heart rate variations, accelerations, or decelerations. After the fetus crowns, a finger sweep can exclude the presence of a cord prolapse or nuchal cord. Set up a safety net by notifying appropriate specialists when a complicated delivery is suspected. In shoulder dystocia, generous episiotomy, drainage of the bladder, McRobert's maneuver, and suprapubic pressure may all help disengage the anterior shoulder. With a cord prolapse, the mother is instructed not to push, and the presenting part is elevated off of the cord. Perimortum cesarean delivery is performed with gestational age greater than 24 to 26 weeks. The supine position can lead to aortocaval compression. Perimortum cesarean delivery should be performed within 4 minutes of maternal cardiopulmonary arrest.     

Cardiac arrest secondary to indomethacin-induced renal failure: a case report

Acute renal failure secondary to nonsteroidal anti-inflammatory agents is an uncommon occurrence, but may have serious or even lethal consequences. We present one such reaction resulting in cardiac arrest in a 59-year-old diabetic treated with indomethacin. Since presenting symptoms may be vague and unimpressive, one must consider this potential complication to make an early diagnosis and intervene appropriately. In addition when prescribing anti-inflammatory drugs such as indomethacin, one should be cautious in patients who are predisposed to the development of acute renal failure. Risk factors that should be considered are preexistent hepatorenal dysfunction, extracellular fluid volume contraction, and concomitant use of nephrotoxic drugs.     

Diabetes in pregnancy and cesarean delivery.

OBJECTIVE: To evaluate the effect of diabetes during pregnancy on cesarean delivery and to determine whether the association between diabetes during pregnancy and cesarean delivery is mediated by birth weight. RESEARCH DESIGN AND METHODS: South Carolina 1993 birth certificates were matched through a unique identifier with infant and maternal hospital discharge records for the same year, yielding a total study population of 42,071 singleton births. Adjusted odds ratios (ORs) and 95% CIs were determined for the association between diabetes in pregnancy and cesarean delivery through multiple logistic regression, controlling for maternal age, race, education, number of prenatal care visits, length of gestation, birth weight, and a number of medical indications. RESULTS: Of the study population, 0.7% were pregnancies complicated by preexisting diabetes, 2.9% were pregnancies complicated by gestational diabetes, and 23.4% were cesarean deliveries. After controlling for confounders, including birth weight, cesarean delivery was strongly associated with both preexisting diabetes (OR [95% CI] 6.20 [4.47-8.61]) and gestational diabetes (1.71 [1.41-2.07]). The estimates remained essentially unchanged without birth weight in the model, and were substantially higher in analyses restricted to deliveries without common medical indications for cesarean delivery. CONCLUSIONS: Both preexisting and gestational diabetes increase the risk for cesarean delivery, independent of the effect of birth weight. The association is markedly greater among women without other medical indications for cesarean delivery. The increased risk of cesarean delivery for women with diabetes is mediated through other factors, which may include practice patterns and physician referrals to high-risk care.     

超声诊断子宫切口处妊娠1例

患者女,37岁,因不规则阴道出血于外院接受清宫术,术中大出血急转我院.既往有剖宫产手术史,尿HCG(+).超声:子宫切面形态正常,大小78 mm×36 mm×43 mm,内膜居中,于子宫前壁切口处见一大小42 mm×36 mm混合回声区(图1),边界清,类圆形,内可见大小21 mm×16 mm不规则无回声区;该混合回声区与前壁子宫肌层菲薄;双侧附件区未见异常回声;     

超声诊断子宫切口妊娠1例

患者,28岁,G2P1。因停经47天,不规则少量阴道流血7天,尿HCG(+)就诊。3年前有剖宫产史。平素月经规律。妇科检查示:宫颈外观无明显异常,子宫孕6周大小,双附件区无明显增厚、触痛等。超声检查示子宫57mm×55mm×46mm,内膜厚16mm。子宫前壁峡部稍隆起,局部见孕囊回声28mm×14mm×14mm,其内侧与宫腔相通,外侧距浆膜面2mm,孕囊内见胚芽10mm及原始心管搏动。左卵巢45mm×40mm×42mm,内无回声大小为30mm×28mm×34mm,形态规则边界清,后方回声增强。宫颈长30mm,宫颈内口闭(图1)。彩色多普勒超声可见孕囊着床部位及胚芽内胎心搏动的闪烁血流信号(图2)。孕囊着床部位高速低阻的血流来自子宫前壁峡部宫颈一侧,PI=0.95,RI=0.60。提示:①子宫前壁峡部原剖宫产切口部位妊娠;②左卵巢增大,内囊性结构(黄体囊肿可能)。讨论子宫切口部位妊娠过去较罕见,近年随着剖宫产率的增加发病率有所上升。目前子宫下段已成为剖宫产常规子宫切口,子宫切口部位妊娠可能与各种原因引起受精卵游走过快导致受精卵偏离正常位置而着床于子宫下段,或当受精卵到达子宫腔时尚未发育到能着床的阶段而继续下降至...     

Neurologically normal survival after fibrinolysis during prolonged cardiac arrest: case report and discussion

Cardiac arrest secondary to pulmonary embolism is a devastating condition with a high mortality rate. It is currently unclear whether fibrinolysis (thrombolysis) is beneficial in this setting. We report the case of a 28-year-old woman with a pulmonary embolism who developed return of pulses following the administration of tissue plasminogen activator after 38 minutes of pulseless electrical activity cardiac arrest. She went on to make a full neurologic and cardiopulmonary recovery. This case is discussed with reference to the current literature on the subject.     

Ruptured arteriovenous malformation and subarachnoid hemorrhage during emergent cesarean delivery: a case report

Cerebral arteriovenous malformations (AVMs) are formed from a vascular plexus of direct arterial-venous connections that progressively dilate, making them prone to rupture. They are frequently asymptomatic and often remain undiagnosed until they present with associated symptoms of headaches, seizures, neurological deficits, or hemorrhages. Occurrence of headache during pregnancy and labor is associated with several diverse etiologies, making definitive diagnosis extremely difficult. This case report describes the anesthetic management of a 31-year-old laboring patient who first complained of headache, then suffered an acute subarachnoid hemorrhage secondary to rupture of a previously undiagnosed AVM during emergent cesarean delivery.     

Combined cesarean delivery and repair of acute aortic dissection at 34 weeks of pregnancy during COVID-19 outbreak: A case report

BACKGROUNDSince the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, the exclusion of a patient from COVID-19 should be performed before surgery. However, patients with type A acute aortic dissection (AAD) during pregnancy can seriously endanger the health of either the mother or fetus that requires emergency surgical treatment without the test for COVID-19. CASE SUMMARYA 38-year-old woman without Marfan syndrome was admitted to the hospital because of chest pain in the 34^th week of gestation. She has diagnosed as having a Stanford type-A AAD involving an aortic arch and descending aorta via aortic computed tomographic angiography. The patient was transferred to the isolated negative pressure operating room in one hour and underwent cesarean delivery and ascending aorta replacement. All medical staff adopted third-level medical protection measures throughout the patient transfer and surgical procedure. After surgery, the patient was transferred to the isolated negative pressure intensive care unit ward. The nucleic acid test and anti-COVID-19 immunoglobulin (Ig) G and IgM were performed and were negative. The patient and infant were discharged without complication nine days later and recovered uneventfully. CONCLUSIONThe results indicated that the procedure that we used is feasible in patients with a combined cesarean delivery and surgery for Stanford type-A AAD during the COVID-19 outbreak, which was mainly attributed to rapid multidisciplinary consultation, collaboration, and quick decision-making.     

Cardiac arrest under anesthesia in a pediatric patient with Williams syndrome: a case report

Serial cardiac arrests occurred during the induction of a 3-year-old boy for elective 1-sided orchiopexy surgery and evaluation under anesthesia of previously placed ear tympanoplasty tubes. The child's history included Williams syndrome along with hypercalcemia and mild supravalvular aortic stenosis. The initial arrests included significant ST wave changes along with profound brodycardia, hypotension, and pulseless electrical activity requiring full resuscitation twice. The patient was transferred on an emergency basis to the intensive care unit (the surgery was cancelled), and a heart catheterization was scheduled for the following morning. The patient experienced several cardiac arrests during the cardiac catheterization procedure, necessitating emergency extracorporeal membrane oxygenation cannulation and immediate transfer to the operating room for emergency cardiac surgery. A thorough preoperative cardiac workup, including cardiac catheterization, electrocardiogram, and echocardiogram, may decrease mortality and morbidity in patients with Williams syndrome. However, cardiac catheterization has been associated with increased risk in this patient population.     

Cardiac arrest due to massive aspiration from a broncho-esophageal fistula: A case report

BACKGROUNDTracheo and broncho esophageal fistulas and their potential complications in adults are seldom encountered in clinical practice but carries a significant morbidity and mortality.CASE SUMMARYWe present a case of a 39-year-old otherwise healthy man who presented to our hospital after ingestion of drain cleaner substance during a suicidal attempt. He unexpectedly suffered from cardiac arrest during his stay in the intensive care unit. The patient had developed extensive segmental trachea-broncho-esophageal fistulous tracks that led to a sudden and significant aspiration event of gastric and duodenal contents with subsequent cardiopulmonary arrest. Endoscopic evaluation of extension of fistulous track proved a slow and delayed progression of disease despite initial management with esophageal stenting for his caustic injury.CONCLUSIONThe aim of this case presentation is to share with the reader the dire natural history of trachea-broncho-esophageal fistulas and its delayed progression. We aim to illustrate pitfalls in the endoscopic examination and provide further awareness on critical care monitoring and management strategies to reduce its morbidity and mortality.     

Emergency delivery: prehospital care, emergency department delivery, perimortem salvage

The incidence of high-risk conditions complicating pregnancy is greater than one would suspect. Many times a pregnancy does not become high risk until labor starts. Prehospital and Emergency Department protocol should be directed at getting the mother to the labor and delivery suite as soon as possible. Most complications resulting in maternal-fetal morbidity and mortality are handled best in that setting. Prehospital and Emergency Department personnel should, however, be prepared to handle imminent delivery because it cannot be avoided when it occurs. Emergency Department personnel also should be familiar with the technique of perimortem cesarean delivery and use this technique when indicated for fetal-maternal salvage.     

双胎妊娠第2胎延迟分娩的护理

报告1例双胎妊娠合并妊娠期糖尿病产妇第2胎延迟分娩20d的护理.产前护理要点为:加强基础护理和心理护理,注意预防感染、抑制宫缩、监测血糖及胎儿宫内安危.产时密切监测产程进展及做好抢救新生儿的准备.产后注意预防产后出血、感染及进行健康教育.本例产妇经过围产期的精心护理,产后7d出院;延迟分娩的第2个新生儿娩出后59d健康出院.     

剖宫产瘢痕妊娠吸宫不全超声造影表现一例

正患者女性,38岁,孕3产1,人工流产2次,6年前足月妊娠剖宫产1次。平素月经规律,末次月经2017年3月14日。因闭经7周伴少许阴道出血于2017年5月4日就诊。超声初诊检查提示宫内早孕,妊娠囊着床位置低(图1,2),查血人绒毛膜促性腺激素(human chorionic gonadotrophin,h CG)检测23 500 m IU/ml。妇科检查:宫     

Cardiac arrest during surgery and ventilation in the prone position: a case report and systematic review.

We present a case report of successful resuscitation following cardiac arrest in a patient undergoing surgery in the prone position. A systematic review of the literature identified 22 further cases. Risk factors for intra-operative cardiac arrest in patients in the prone position include: cardiac abnormalities in patients undergoing major spinal surgery, hypovolaemia, air embolism, wound irrigation with hydrogen peroxide, poor positioning and occluded venous return. Cardiac arrest is also a risk in the increasing number of patients with acute respiratory distress syndrome ventilated in the prone position. Management of prone cardiac arrest may be improved by identification of high-risk patients, careful patient positioning, use of invasive monitoring and placement of self-adhesive defibrillator paddles. Suitable techniques for cardiopulmonary resuscitation including methods for chest compression, defibrillation and the management of air embolism are discussed.