Embolie amniotique : à propos de l’issue favorable d’un cas avec arrêt cardiaque inaugural et CIVD précoce compliquée d’un hémopéritoine d’origine iatrogène et d’un saignement sur un adénome hépatique

Amniotic fluid embolism is a relatively rare clinical entity and with difficult medical recognition. However, it is the second leading cause of maternal mortality. We report here the case of a 32-year-old patient who underwent elective caesarean section complicated by an amniotic fluid embolism with cardiac arrest. The presence of a major disseminated intravascular coagulation favored the occurrence of a retroperitoneal hematoma of iatrogenic origin on attempt of femoral venous catheterization and that of hemoperitoneum on bleeding of an hepatic adenoma. The diagnostic of amniotic fluid embolism was confirmed by the presence of amniotic cells in the bronchoalveolar lavage. The patient survived without sequelae.     

Polymyosite révélant un syndrome de Gougerot-Sjögren

Introduction

Near 10 to 20% of patients with myositis have another systemic, sometimes inaugural, disease.

Case report

A 48-year-old woman was admitted with progressive hypoesthesia in V2 and V3 areas on both sides, difficulties to chew and swallow and then, proximal and axial muscular deficiency, with weight loss. Brain MRI showed gadolinium-enhanced trigeminal nerves and biological tests revealed anti-SSA and anti-Pm/Scl antibodies and a grade IV in Chisholm scoring system on the labial salivary gland biopsy. Neurophysiological studies revealed a myogenic pattern on tibialis anterior muscles and a muscle biopsy confirmed the diagnosis of polymyositis.

Conclusion

The diagnosis of primitive Sjogren's syndrome was suspected because of the association of bilateral trigeminal neuropathy and anti-SSA and anti-Pm/Scl antibodies.     

Uterine torsion in twin pregnancy

A case of uterine torsion in a 37-years-old woman during twin pregnancy is described. Diagnosis was made during caesarean section and the torsion successfully reduced through a standing laparotomy. Detorsion was accomplished by rotating the uterus to the left. A severe post-partum haemorrhage occurred and hysterectomy was required. The patient recovered and was discharged home with her baby. Uterine torsion at term is a rare obstetric event that occurs mainly in the third trimester with adverse maternal and neonatal consequences and raises several critical management considerations. We review possible diagnostic signs and management of this rare complication from literature.     

Twin dystocia: about one case of compaction

We report a case of twin dystocia during the evacuation of full-term fetus both in cephalic presentation. A low-outlet forceps for second-phase arrest was performed for the first twin but the head remained stuck to maternal perineum, mimicking a shoulder dystocia. Digital examination found a twin compaction, that is the presence of the second twin's fetal head at the level of the first twin's chest. The discrepancy between fetal weights and the use of forceps could favor this rare complication. Various maneuvers were described previously attempted to solve the problem. Forcing back the second head may help to achieve delivery of the first twin.