Current Issue : April - June Volume : 2021 Issue Number : 2 Articles : 6 Articles
We report a case of acquired factor XI deficiency with lupus anticoagulant (LA) in a 28-year-old primigravida who presented with finger pain and eruptions on her palms and fingers during the 3rd trimester of pregnancy. The patient complained of pain and reddening of the fingers at 30 weeks of gestation. She was referred to our tertiary center with a diagnosis of preeclampsia and suspected collagen disease at 35 weeks of gestation. Erythema was seen on the fingers and palms, and she presented with pain and cryesthesia on the fingers. Laboratory investigations revealed an activated partial thromboplastin time of 51 s (normal, 23–40 s), although it was normal during the 30th and 34th gestational weeks, LA with an anticardiolipin-beta2-glycoprotein I complex antibody, and low level of clotting XI activity (25 U/mL). On week 37 day 0 of gestation, the patient presented with severe hypertension. An urgent Cesarean section was performed after transfusion of two units of fresh frozen plasma. There was no excessive bleeding during the surgery or the postpartum period. The symptoms on her fingers and palms gradually improved after surgery. Our case indicates that dermatoses of pregnancy may become a starting point for the diagnosis of autoimmune diseases and coagulation abnormalities. When a patient presents with an atypical symptom, as in our case, the possibility of various diseases should be considered....
Dengue fever is a major public health problem in tropical and subtropical areas. There are not many studies concerning the complications of dengue fever in pregnancy. We present four serial cases of dengue fever in pregnancy. Case illustration: Three of four cases were delivered by caesarean section; two of them died during post-caesarean care. All cases had the lowest platelet level below 50,000/μL and were given platelet transfusion during and after delivery; they also showed abnormal liver function tests. For foetal outcome, none tested positive for dengue. Discussion: Complication of dengue infection depends on a combination of host and viral virulence. Regardless of prophylactic platelet transfusion, some studies revealed clinical bleeding in patients with dengue infection due to an intricate effect on the haemostatic system. The adverse foetal outcome may contribute because of placental circulation caused by endothelial damage with increased vascular permeability leading to plasma leakage. There is no national guideline for dengue fever in pregnancy. Conclusions: The management of dengue fever in pregnancy at the tertiary hospital is still suboptimal. Dengue fever around peripartum presents a higher risk of morbidity and mortality for the mother and therefore needs a multidiscipline team approach....
Uterine tumors detected after pelvic radiation therapy are rare. We report a case in which an endometrial tumor developed after pelvic radiation therapy for cervical cancer. The patient was a 70-year-old female with a history of pelvic radiotherapy for locally advanced cervical cancer. After 12 months of radiation therapy, magnetic resonance imaging showed tumors in the uterine cavity, and positron emission tomography-computed tomography showed no tumors, except uterine tumors. Since radiation therapy-induced cervical stenosis was conducted, endometrial examination could not be performed without anesthesia. As these tumors were detected after radiation therapy for uterine cancer, malignancy was considered. A laparoscopic-assisted transcervical hysteroscopic resection was performed for the diagnosis and treatment of uterine tumors after radiation therapy. This operative method was useful and enabled us to perform complete resection, observe the abdominal cavity, prepare for the possibility of secondary hysterectomy, and improve safety....
Introduction. Nonpuerperal uterine inversion is an extremely rare clinical condition. As such, some cases will have to be managed without prior experience. Clinicians must have a high index of suspicion to make the diagnosis and a clear understanding of the principles of recommended surgical techniques. Here, we report a case of nonpuerperal uterine inversion managed using a combined vaginal and abdominal approach. Case Presentation. A 70-year-old postmenopausal woman presented with profuse vaginal bleeding and protruding mass per vagina. Examination showed a solitary globular mass attached to an inverted uterus. A clinical diagnosis of nonpuerperal uterine inversion was made. A vaginal approach was used to first remove the mass followed by an abdominal approach to reposition the uterus using the Haultain procedure. Subsequently, total abdominal hysterectomy with bilateral salpingo-oophorectomy was done without complication. Histologic examination showed myoma with adenomyosis. Conclusion. Advanced imaging techniques such as 3D power Doppler and MRI have signature signs to confirm the clinical diagnosis of uterine inversion. Short of these diagnostic modalities, however, carefully conducted clinical examination including examination under anesthesia, and pelvic ultrasonography can be valuable tools to reach at a diagnosis. A combined vaginal and abdominal surgical approach can facilitate repositioning and/or hysterectomy when there is a large protruding vaginal mass....
Introduction. Pregnancy at an advanced maternal age is defined as pregnancy at 35 years or older. Today, women postpone pregnancy due to different socioeconomic and personal reasons. However, there was limited evidence on fetal adverse outcomes’ association with pregnancy at an advanced maternal age in Ethiopia and particularly in the study area. This study was aimed at assessing the effect of pregnancy at an advanced age on selected neonatal adverse pregnancy outcomes in Debre Markos Referral Hospital, Ethiopia, 2019. Methods. Institution-based retrospective cohort study was conducted on 303 exposed (35 years and older) and 604 nonexposed (20–34 years old) immediate postpartum women who delivered at Debre Markos Referral Hospital after 28 weeks of gestation. All exposed women who fulfilled the inclusion criteria were sampled, and systematic random sampling was employed for those in the nonexposed group. The data were collected from 1st of July to 30th of December, 2019, by face-to-face interview and extraction from maternal chart using a structured questionnaire and data extraction checklist, respectively. Binary logistic regression (bivariate and multivariable) model was fitted, and wealth index was analyzed by principal component analysis. Adjusted relative risk with respect to 95% confidence interval was employed for the strength and directions of association between advanced maternal age and selected adverse pregnancy outcomes, respectively. P-value of <0.05 was used to declare statistical significance. Results. The incidence of adverse neonatal outcomes including stillbirth, preterm birth, and low birth weight in the advanced maternal age group was 13.2%, 19.8%, and 16.5%, respectively. The incidence of stillbirth, preterm birth, and low birth weight in the nonexposed group was 3.1%, 8.4%, and 12.4%, respectively. The advanced maternal age group had three times the risk of stillbirth compared with the nonexposed group (ARR = 3.14 95% CI (1.30–7.00)). The advanced maternal age group had 2.66 times the risk of delivering preterm fetus (ARR = 2.66 95% CI (1.81–3.77)) compared with the younger counterparts. Low birth weight was not significantly associated with pregnancy at an advanced maternal age. Conclusion. Fetal adverse outcomes including stillbirth and preterm birth were significantly associated with pregnancy at an advanced maternal age....
Background: Conventional ultrasound dating is not very accurate after 34 weeks of gestation and has standard deviation of about 2 weeks. Objective: Verify whether fetal colon diameter can be used as a tool for estimating gestational age (GA) of fetuses between 34 to 40 weeks. Materials and Methods: This was a prospective cross-sectional study conducted at Obstetrics and Gynecology University Hospital, Damascus, Syria, during the period from September 2019-September 2020. The study enrolled 395 women with uncomplicated singleton pregnancies at 34 - 40 weeks of gestation. Fetal bi-parietal diameter, head circumference, abdominal circumference, and femoral lengths were assessed by ultrasound. In addition, descending colon diameter was assessed at the level of colonic haustra. The correlation between GA and colon diameter was assessed by the Pearson correlation test. Results: Significant correlation between fetal colon diameter and gestational age was observed P < 0.0001 (r = 0.852). In addition, a highly significant correlation between colon diameter and bi-parietal diameter, femoral length, head circumference and abdominal circumference were found with P values < 0.0001. The correlation between gestational age at 3rd trimester and colon diameter was significantly stronger than the correlation between gestational age and bi-parietal diameter, head circumference, and abdominal circumference. Whereas, no significant difference was found when comparing colon diameter and femoral lengths (P = 0.089). Conclusion: The present study suggested that colon diameter can be used for predicting third trimester gestational age....
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