Rupture of rudimentary horn pregnancy.

A rare case of rupture of an noncommunicating rudimentary horn pregnancy is reported. The pregnancy proceeded to 25 gestational weeks, when the rudimentary horn ruptured. The patient had signs and symptoms of massive hemoperitoneum. An emergency exploratory laparotomy revealed rupture of the gravid rudimentary horn and the fetus was lying free in the peritoneal cavity, was delivered breech and died 2 hours later. This reproductive complication was treated successfully by prompt exploratory laparotomy. Some of the factors associated with pregnancy in a rudimentary horn are discussed.     

An unusual cause of urinary retention in early pregnancy

Urinary retention is a rare complication of early pregnancy with few serious sequelae. A Medline search found no association between urinary symptoms and cervical pregnancy. This case describes urinary retention resulting from a cervical pregnancy and describes a proposed mechanism to explain the presenting symptoms. Cervical pregnancy should be considered as a rare cause of acute retention of urine in early pregnancy, especially in the presence of vaginal bleeding.     

Unilateral pleural effusion as the main presentation of "early onset" severe ovarian hyperstimulation syndrome

OBJECTIVE: To report a case of severe early onset ovarian hyperstimulation syndrome with unilateral pleural effusion and little ascites as the main presenting clinical signs. DESIGN: Case report. SETTING: University affiliated teaching hospital and in vitro fertilization (IVF) clinic. PATIENT(S): A 33-year-old woman known to have bilateral polycystic ovaries underwent IVF and became pregnant. INTERVENTION(S): Pleuracentesis. MAIN OUTCOME MEASURE(S): Resolution of symptoms, pregnancy outcome. RESULT(S): A total of 4,200 mL of pleural fluid was drained from the right hemithorax. Complete resolution of symptoms did not occur until 16 weeks' gestation. The pregnancy progressed normally until 27 weeks when spontaneous preterm labor resulted in a vaginal delivery of a live female infant weighing 880 grams. CONCLUSION(S): This case described is unusual in that the patient presented with significant right-sided pleural effusions on day 2 after embryo transfer and continued to be symptomatic until 16 weeks' gestation. This is much earlier than any previously described case report of isolated unilateral pleural effusion associated with ovarian hyperstimulation syndrome.     

Gestación heterotópica triple: gestación gemelar intrauterina

Heterotopic pregnancy is increasingly common in Spain mainly due to the greater use of in vitro fertilization techniques. We report a case of heterotopic pregnancy after artificial insemination in a patient who consulted for mild metrorrhagia. Ultrasound examination showed a diamniotic dichorionic twin pregnancy and a singleton intrauterine gestation in the right tube. The case was resolved by laparoscopic unilateral salpingectomy. The symptoms of these rare pregnancies are nonspecific. Moreover, they are usually underdiagnosed, because the adnexa are not usually examined when an intrauterine gestational sac is found. Due to the severity of maternal and fetal compications, early diagnosis is essential.     

A multicentre study of advanced abdominal pregnancy: a review of six cases in low resource settings

Abdominal pregnancy has remained a big challenge worldwide especially in developing countries where there are limitations in diagnostic resources. The most important approach is to be vigilant for the unexpected as most patients present with no specific symptoms or clinical signs. It also poses great challenges in diagnosis and management, and is associated with a lot of morbidity and mortality. This series of six cases, each presenting in a peculiar way, typically illustrates these issues. The cases were managed in three different hospitals in the last 15 years. These series is aimed at highlighting the atypical presenting features of advanced abdominal pregnancy and the need for vigilance when there is suspicion of a case. It is also aimed at showing the difficulty of diagnosis and management of advanced abdominal pregnancy in low resource environment.     

An arteriovenous malformation in pregnancy: a case report and review of the literature

A case is described of a young woman with progression of a macrofistulous arteriovenous malformation during pregnancy. This resulted in severe symptoms necessitating cesarean section, following which there was a dramatic postpartum recovery. The arteriovenous malformation was confirmed by angiography. The literature related to arteriovenous malformations in pregnancy is reviewed.     

Common symptoms and signs during pregnancy

During pregnancy, a woman may notice the development of a number of new symptoms. Many of these are widely accepted as a normal part of uncomplicated pregnancy but others may be of more concern. The anatomical and physiological changes that accompany normal pregnancy are profound, and it is therefore not surprising that as the various systems adapt, which can result in changes that overlap with those seen in disease. Additionally, sub-clinical disease can be unmasked during pregnancy, when the physiological adaptation to pregnancy provides an additional stress test.Common symptoms may include palpitations, dyspnoea, peripheral oedema, nausea, vomiting and pruritus. Underlying alterations in major organs can explain a large number of symptoms and signs, which are benign. It is prudent that clinicians are aware of those symptoms and signs that warrant further investigation and that may be associated with disease. Furthermore, biochemical and haematological variables may also be altered in pregnancy, and this should be taken into account when interpreting blood results.     

Complete hydatidiform mole with a surviving coexistent twin in a woman with sickle cell disease: a case report

BACKGROUND: Twin pregnancy with an apparently healthy fetus and complete hydatidiform mole (CHMTF) is a rare condition. We present the first reported case in a woman with sickle cell disease. CASE: An 18-year-old woman, para 1, gravida 0, with sickle cell disease was diagnosed at 19 weeks as having a complete molar pregnancy with a coexistent live fetus. The patient presented with abdominal pain, nausea, headaches, body aches, joint pain and chest pain on 2 different occasions. She denied having vaginal bleeding. Whether the patient was having a sickle cell crisis or molar pregnancy symptoms (i.e., thyrotoxicosis) was not clear. She was given intravenous hydration and pain management. All her symptoms resolved, confirming sickle cell crisis as the final diagnosis. The pregnancy was uneventful until 35 weeks, when oligohydramnios prompted induction of labor. Suction curettage was performed after delivery for removal of the molar pregnancy. The patient did not show any evidence of persistent trophoblastic disease 2 months after delivery. CONCLUSION: CHMTF in sickle cell disease patients is challenging. Adequate intravenous hydration and pain management should be started when one suspects a crisis. If the symptoms resolved, thyrotoxicosis due to the molar pregnancy is unlikely. In addition to proper medical management, proper counseling of the patient and close monitoring of both fetus and mother should be undertaken.     

Peripartum Cardiomyopathy

Peripartum cardiomyopathy is a rare and devastating disease of unknown etiology that manifests between the last trimester of pregnancy and five postpartum months. This disease often is confused with many other illnesses, and even with hemodynamic changes in normal pregnancy. Pathophysiology, signs, and symptoms of this unique cardiomyopathy are presented and case studies offered. Since outcome of this disease is directly related to duration of the illness, nurses must be aware of the symptoms and investigate them immediately. The nurse must support the patient and involve the family and social services in the patient's recovery.     

Delayed presentation of eclampsia: lessons from a case diagnosed at Day 11

We report a case of late postpartum eclampsia at Day 11 in a 40-year-old woman after normal pregnancy and delivery. The delayed eclamptic episode is defined by seizures between two days and four weeks after delivery. About 40% of late eclampsia has no premonitory symptoms. This case highlights the possible diagnosis of late eclampsia even after normal pregnancy and delivery. Active and prompt management, brain imaging are mandating in cases of persistent headaches in postpartum.     

Common symptoms and signs during pregnancy

The anatomical and physiological changes that accompany normal pregnancy are profound. It is therefore not surprising that, as the various systems adapt, changes result that overlap with those seen in disease. Additionally, sub-clinical disease can be unmasked during pregnancy, when the physiological adaptation to pregnancy provides an additional stress test. Common symptoms may include palpitations, dyspnoea, peripheral oedema, nausea, vomiting and pruritus. Underlying alterations in major organs can explain a large number of benign symptoms and signs. It is prudent that clinicians are aware of symptoms and signs that warrant further investigation and that may be associated with disease. Furthermore, biochemical and haematological variables may also be altered in pregnancy, and this should be taken into account when interpreting blood results.     

Pregnancy 5 Years After Onset of Amyotrophic Lateral Sclerosis Symptoms: A Case Report and Review of the Literature

BackgroundPregnancy in patients with amyotrophic lateral sclerosis (ALS) is extremely rare and often results in delivery of a healthy baby when patients are in the early stages of the disease.CaseThis report describes the case of a successful pregnancy 5 years after ALS onset. Significant worsening of weakness, unsteady balance, and dysphagia were noticed around the third trimester. A healthy child was delivered at term by planned Caesarean section. After delivery the patient developed remarkable weakness, dysphagia, and dysarthria.ConclusionA literature search found 22 cases through PubMed and Ovid, with key words “amyotrophic lateral sclerosis” and “pregnancy.” Both slow progression and rapid progression of ALS during pregnancy have been reported. Worsening of symptoms seems to be common, but little is still known about the influence of pregnancy on ALS onset and progression.     

Pre-existing mental health disorders and pregnancy

Mental health disorders are independent risk factors for adverse perinatal and neonatal outcomes. It is estimated that 20% of women may experience symptoms of mental health disorders during or following pregnancy. It is important that obstetricians recognize the presentation of these symptoms and follow pathways for managing these conditions. This article utilizes case vignettes to describe the epidemiology, role of the multi-disciplinary team, clinical presentation, and management of common perinatal mental health disorders both from the obstetric and psychiatric view point. Indications and duration of psychotropic medications including side effects are also discussed as well as safety in pregnancy and lactation.     

Rupture of pregnant noncommunicating rudimentary uterine horn with fetal salvage: a case report

A rare case of noncommunicating rudimentary uterine horn pregnancy is described. The pregnancy proceeded to twenty-six gestational weeks when the rudimentary uterine horn ruptured as the patient had signs and symptoms of massive hemoperitoneum. An emergency exploratory laparotomy revealed incomplete rupture of the gravid rudimentary horn. A viable female infant with a birth weight of 633 g was delivered. The rudimentary horn had no direct communication to the uterine cavity of the unicornate right uterus. Immunohistochemical examination showed that the excised uterine horn was filled with placental tissue without an intervening layer of decidua basalis.     

Ruptured subcapsular haematoma of the liver in pregnancy; a case report

A case of ruptured subcapsular haematoma of the liver, a rare and potentially lethal complication of pre-eclampsia, is presented. The lack of characteristic signs and symptoms is highlighted. This case serves to remind clinicians of the high maternal and perinatal mortality rates associated with complications of hypertension in pregnancy.     

Uncommon clinical presentation of a gestational choriocarcinoma

Gestational choriocarcinoma is a rare malignant tumour with a strong metastatic potential. We report a case of a 31-year-old patient with a gestational trophoblastic tumor revealed by renal and pulmonary metastases, one year after a normal pregnancy. The diagnosis was established by the pathologist on the radical nephrectomy specimen. The evolution was quickly favorable after adequate treatment using multiagent chemotherapy. This case highlights the polymorphic aspects of the gestational choriocarcinoma and stresses the importance of a betaHCG assessment anytime abnormal symptoms occur in the outcome of a pregnancy.     

Pitfalls in the diagnosis of infection following medical termination of pregnancy

The psychological reaction to medical termination of pregnancy may produce symptoms indicating infection where none is present, as is shown from a case report. The patient was admitted to the Postpartum Ward of University Hospital, Banaras Hindu University, on 7 April 1977, complaining of symptoms indicating peritonitis. Although a blood test and urine examinations did not point to an infective state, and an abdomen X-ray excluded uterine perforation, the patient's pulse, respiration, and temperature remained high and caused concern. Anti-inflammatory treatment was started but progress was unsatisfactory. The patient was referred for psychiatric examination, which disproved the clinical diagnosis of pelvic infection. Thus, laboratory tests and psychiatric examination can be of immense value in managing cases of functional disorders. But 2 possibilities must always be considered when dealing with an apparent case of infection following medical termination of pregnancy. The first is that incomplete abortion may give rise to most of the symptoms of infection without the presence of important signs and symptoms of incomplete evacuation such as bleeding episodes, bulky uterus and patulous cervix. The second is that the presence of a small adherent degenerating blood clot inside the uterus may give rise to most of the symptoms of infection. If these 2 conditions can be excluded, and if the role of functional disorders can be proved or disproved, the diagnosis becomes easier.     

von Recklinghausen's disease and pregnancy

Neurofibrosis or the Von Recklinghausen disease constitutes a genetically transmitted disease that appears in many parts of the body as well as many symptoms. It is inherited from the autosomatic dominant type (gene NFI on chromosome 17) and is characterized by brownish blemishes of the skin (cafe au lait), multiple neurofibromas (small dermal or subcutaneous lumps), symptoms of the peripheral and central nervous systems as well as disorders of the eyes, skeletal system, gastric system and vascular system (aneurysms of the aorta, carotid and renal arteries). We describe the case study of a 25 year old female, second pregnancy with known history of the above mentioned disease. She delivered on the 39th week of pregnancy (male neonate weighing 3000 gr.), with no problems. On the 22nd week of her pregnancy she presented with a large distension of the anterior surface of the neck in the area of the thyroid that gradually increased in size. Differential Diagnosis includes nodular goiter and neurofibroma. One month postpartum the morphoma was surgically. Neurofibrosis during pregnancy can cause many complications such as IUGR, hypertensive disease, spontaneous abortions, oligohydraminios and neurofibroma development. This case study is being discussed in international bibliography.     

Sneddon's syndrome and pregnancy; a case report

The diagnostic and therapeutic problems posed by Sneddon's syndrome are discussed with reference to the case of a 31-year-old pregnant woman. This patient developed episodes of cerebral ischemia with multiple neurological deficits in the 24th week of pregnancy. The symptoms were associated with the dermatological signs of livedo racemosa. Delivery by Cesarean section in the 36th week of pregnancy resulted in marked improvement of the neurological signs and symptoms.     

Primary omental pregnancy presenting with hemorrhagic shock. A case report

Abdominal pregnancy is a very rare and serious type of extrauterine gestation that accounts for approximately 0.003% of all ectopic pregnancies. Omental pregnancy, an extremely rare form of abdominal pregnancy, can be primary or secondary to a tubal pregnancy that aborts out of the fimbria and reimplants in the peritoneal cavity. We present an additional case of primary omental pregnancy at 12 gestational weeks presenting with symptoms of hemoperitoneum and acute abdomen.