A case of postpartum cerebellar infarction with hemolysis,elevated liver enzymes,low platelets (HELLP) syndrome

Cerebellar infarction has been described rarely during pregnancy, and there has been no case report of cerebellar infarction with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. A 39-year-old Japanese primipara had postpartum HELLP syndrome soon after cesarean section at term. Several hours later, she developed cerebellar infarction which was fatal. HELLP syndrome may have contributed to the development of cerebellar infarction in the case.     

Cervico-isthmic pregnancy developing within the scar of a previous cesarean section: a case report

The cervico-isthmic pregnancy is a rare event occurring during pregnancy. In this current report, we describe a case of a woman with pregnancy developed within a previous cesarean section scar and successfully treated with conservative management.     

Pregnancy after myocardial infarction and a coronary artery bypass graft

The authors report a pregnancy in a 34 year old patient who previously experienced a myocardial infarction. The pregnancy ended at 39 weeks in the birth of a healthy girl weigthing 3040 g, by cesarean section under epidural anesthesia. A review of the literature revealed 33 similar cases, 16 of which were adequately documented. Received: 23 January 1997 / Accepted: 20 March 1997     

Myomectomy during cesarean section and outside pregnancy. Different outcomes of scars

BACKGROUND: The purpose of this study is the comparison between the scar of myomectomy performed during cesarean section and out of the pregnancy. METHODS: Eighteen pregnant patients were submitted to cesarean section between 37 and 39 weeks of gestation for previous myomectomy. The previous myomectomy has been performed in 8 patients during a cesarean section, in 10 patients out of pregnancy; in all patients only one subserous-intramural myoma of uterine fundus or body with a maximum diameter of 4-5 cm has been excised. RESULTS: In myomectomies performed during cesarean section the scar appeared more linear, with good well defined limits, less wide and with modest introflection in comparison to surrounding myometrium. The myometrial thickness did not present variations and was well contracted. CONCLUSIONS: Our results show substantial differences: in fact, according to personal opinion, the different evolution of the healing process is due to variations occurring in pregnancy and particularly for local immunology system which in pregnancy is hyperactive. The presence and increased synthesis of immunological substances support a better healing with an optimal functional recovery.     

The study of maternal and fetal plasma catecholamines levels during pregnancy and delivery.

BACKGROUND: To study maternal and fetal plasma levels of catecholamines (CA) during pregnancy and delivery, especially changes in CA levels during fetal distress and conditions of different modes of delivery. METHODS: Maternal and fetal plasma NE, E and DA levels were determined by high performance liquid chromatography (HPLC) for 16 non-pregnant women, 19 cases of early pregnancy, 17 cases of mid pregnancy, late pregnancy, spontaneous vaginal delivery and 53 cases of cesarean section. RESULTS: Plasma NE and DA levels decreased gradually with the advance of gestational weeks, and levels of plasma NE were significantly lower than those of non-pregnant women (P < 0.05). The levels of plasma CA in patients who had elective cesarean section were significantly lower than those who had vaginal delivery and emergency cesarean section (P < 0.01). However, CA levels of the cord artery in the vaginal delivery group were significantly higher than those in the cesarean section group (P < 0.01). CONCLUSION: Vaginal delivery is better than cesarean section for the newborn. If cesarean section is necessary, it is best for the newborn after onset of labor.     

Desmoid tumor arising in a cesarean section scar during pregnancy: monitoring and management.

Desmoid tumors (DTs) are frequently associated with either surgical trauma, like scars, or physiologic trauma, like pregnancy. A DT arising in a cesarean scar during pregnancy shows both correlations. A case of DT that grew gradually in a cesarean scar during the first trimester of a subsequent pregnancy is presented. After initial MR imaging, the lesion was biopsied and carefully monitored; immediate surgical removal was considered at any time if indicated by the follow-up results. No increase in the tumor size was observed during the following 6 months of gestation, and the lesion was extirpated with mesh replacement of the abdominal defect at the time of cesarean section.     

Ovarian carcinoma as an incidental finding during cesarean section in a preeclamptic woman: case report

Gynecologic malignancies are rarely associated with pregnancy and ovarian tumors diagnosed during cesarean section are very uncommon. A 38-year-old grandmultipara with no prenatal care was hospitalized at an estimated 28 weeks of gestation for high blood pressure and increased proteinuria but no other symptoms of preeclampsia. We present a rare case of advanced ovarian carcinoma diagnosed during cesarean section.     

Growth hormone secretion during termination of pregnancy. Further evidence of a placental variant

Serum profiles of growth hormone (GH), hPL and hCG were recorded in 5 pregnant women during termination of pregnancy at cesarean section and legal abortion. Two monoclonal antibodies directed against different epitopes on the GH molecule were used to distinguish the pituitary 22K-GH from the placental GH variant. After placental removal at cesarean section, a rapid fall in GH as well as in hPL and hCG concentrations was recorded. On the other hand GH levels were unaffected when early pregnancy was terminated by legal abortion. The importance of an intact placental function for the maintenance of high GH levels lends further support to the concept that a placental GH variant is produced during late pregnancy.     

Borderline micropapillary serous tumor of the ovary detected during a cesarean section due to a transabdominal cervico-isthmic cerclage in a patient with congenital cervical hypoplasia: a rare case

A young woman with polycystic ovary syndrome and congenital cervical hypoplasia conceived with clomifen citrate treatment after placement of a transabdominal cervico-isthmic cerclage. Her pregnancy successfully reached term and cesarean section was performed to preserve the cerclage for the next pregnancy; when the ovaries were explored an irregular structure was detected on the left ovary. A wedge biopsy was done and the pathological assessment of the specimen was borderline micropapillary serous tumor of the ovary. The patient wanted to preserve her fertility, therefore a fertility-sparing staging surgery was performed six months after the cesarean section. There was no residual tumor in the left ovary, but there was a borderline tumor in the right ovarian biopsy specimen (frozen section was negative). Two months after staging surgery the patient conceived with IVF and delivered twins at the 33rd week of pregnancy with cesarean section. At her second cesarean section the right ovary and abdomen appeared normal on inspection, but the cerclage tape was in the endocervical canal and was thus removed. To our knowledge this is the second reported case of transabdominal cerclage tape migration into the endocervical canal. The patient is clinically disease-free 18 months after her second cesarean section. The clinical findings, treatment modalities, management and prognosis are discussed together with a literature review of a patient with a serous borderline ovarian tumor and congenital cervical hypoplasia.     

Successful term pregnancy after B-Lynch compression suture in a previous pregnancy on account of massive primary postpartum hemorrhage

A case is presented of a successful term pregnancy in a 28-year-old secundipara after previous Misgav-Ladach cesarean section and B-Lynch compression suture on account of massive postpartal hemorrhage caused by uterine atony. On account of dystocia and relative cephalopelvic disproportion, secondary repeated cesarean section was performed; she gave birth to a live child 3,900 g/52 cm, Apgar score 9/10, with a regular neonatal course. During the repeated cesarean section, thin laces of connective tissue were found along the sutures placed on the uterus during the previous B-Lynch operation. Pelvic and intrauterine adhesions were not found.     

A twin pregnancy in a bicornuate uterus]

A case of twin pregnancy in bicornuate uterus with a fetus in each horn is presented. During the second trimester, the rudimentary horn ruptured. This horn was extirpated and two non viable fetus were delivered by cesarean section. Later on, the patient had another pregnancy in the unicornuate uterus. She was delivered at 36th week of pregnancy by cesarean section. The baby was in good condition.     

Multiple-dose methotrexate for pregnancy in a cesarean section scar. A case report

BACKGROUND: Pregnancy developing in a cesarean section scar is a very rare but possibly life-threatening condition because of the risk of rupture and excessive hemorrhage. CASE: A woman with previous cesarean section had transvaginal sonography performed at 7 weeks of gestation that showed a gestational sac implanted in the anterior isthmus wall of the uterus with 3 mm of myometrium between the sac and bladder wall. A diagnosis of pregnancy in the cesarean section scar was made. The patient was asymptomatic, and her hemodynamic condition was stable. Two courses of multiple-dose systemic methotrexate-folinic acid (1 mg/kg methotrexate intramuscularly on days 1, 3, 5 and 7 with 0.1 mg/kg folinic acid intramuscularly on days 2, 4, 6 and 8) were given. The patient tolerated it and remained stable during treatment. The serum hCG dropped to < 5 IU/L on day 56. CONCLUSION: Treatment with methotrexate is a non-surgical option that can improve preservation of the uterus in patients who desire fertility. A multiple-dose regimen causes rapid interruption of the pregnancy. This is very important because the risk of rupture and hemorrhage directly correlates with the duration of the pregnancy.     

剖宫产术后再次足月妊娠172例分娩方式的探讨

目的:探讨剖宫产术后再次妊娠的分娩方式。方法;对1999年12月至2008年12月我院172例剖宫产术后再次足月妊娠孕妇的分娩方式进行回顾性分析。结果:172例中76例进行阴道试产,54例试产成功,成功率71.05%。选择性剖宫产96例,其中有手术指征的仅49例。结论:剖宫产史不是再次剖宫产的指征,应结合前次剖宫产的指征、手术方式、术后情况,本次妊娠情况及B超监测伤口情况综合考虑,符合试产条件者,严密监护下可阴道试产。     

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.     

Embarazo heterotópico diagnosticado en una cesárea a término

The incidence of heterotopic pregnancy is increasing as a result of the greater use of assisted reproduction techniques. Early diagnosis is important because a ruptured ectopic pregnancy can be life threatening. We present an atypical case of extrauterine pregnancy diagnosed during the course of an elective cesarean section at term.     

Breast cancer in pregnant women

The problem of breast cancer during pregnancy was touched. Usually in pregnant women with breast cancer the prognosis is bad. Authors described 3 cases of pregnant patients with breast cancer. All those pregnancies were pre-term finished by cesarean section: 2 after induction of fetal lungs maturation with Mucosolvan (2 newborns in a good state) and 1 case in 19th week of pregnancy. In 2 cases during the cesarean section ovariectomy was performed. In all cases very dynamical progress of illness was described what is consistent with other reports. In one case we observed an inflammatory form of breast cancer. We suggest three breast examinations during pregnancy should be performed.     

Cervical varix complicating marginal placenta previa: a unique coexistence

Uterine cervical varix (CV) is a very rare condition during pregnancy and may cause moderate to severe hemorrhage. We present the third reported case of huge CV coexisting with placenta previa in the English literature. A 40-year-old chronic hypertensive patient with marginal placenta previa also had cervical varix causing hemorrhage. At the 38th gestational week emergent cesarean section was performed because of placental abruption. Placenta previa is a risk factor for CV and patients with placenta previa who have moderate bleeding should be examined for this coexistence. The choice of management is close follow-up and cesarean section close to term.     

妊娠期子宫破裂8例报告及文献复习

目的:探讨妊娠期子宫破裂的可能原因、临床表现及预防措施。方法:回顾2013—2016年首都医科大学附属北京安贞医院妇产科收治的8例子宫破裂患者的临床特点、治疗情况及预后,并结合相关文献进行分析。结果:8例妊娠期子宫破裂患者中有7例是瘢痕子宫破裂,1例是非瘢痕子宫破裂,临床表现多样。妊娠期瘢痕子宫发生破裂的概率较非瘢痕子宫高,而剖宫产术是造成瘢痕子宫及再次妊娠子宫破裂的高危因素。结论:剖宫产术后再次妊娠的时机及分娩方式的选择对预防妊娠期子宫破裂的发生至关重要。     

Pregnancy outcomes and deliveries following laparoscopic transsection of uterine vessels: a pilot study

OBJECTIVE: To assess pregnancy outcomes and deliveries after laparoscopic uterine artery transsection (LTUV) in symptomatic women with fibroids. SETTING: Department of Obstetrics and Gynecology, Endoscopic Training Center, Baby Friendly Hospital, Kladno, Czech Republic. DESIGN: One hundred and fifty three patients underwent laparoscopic transsection of uterine vessels during a 4-year period. RESULTS: Nine of the 21 women desiring pregnancy conceived spontaneously and one after anovulation treatment. The average age of the women was 32.4 years, and the range was 26-39 years. Two women had vaginal delivery at term and one delivered vaginally at 31 weeks secondary to premature preterm rupture of membrane (PROM). Four others delivered at term by cesarean section. One woman with placenta previa was delivered by cesarean section 3 weeks before term. Mean birth weight was 3199 g (range 1710-3910 g). One spontaneous abortion was reported in the first trimester of pregnancy. One case of undesired pregnancy occurred. An extrauterine pregnancy was reported in this woman. CONCLUSION: LTUV is a minimally invasive operative procedure, that preserves the uterus and ovarian blood supply and allows for the achievement of pregnancy in women with symptomatic fibroids. Fetal growth and umbilical Doppler findings remained normal in all cases. An increased risk for preterm delivery and cesarean section was found in this small series.