Placenta percreta in a booked multiparous woman with minimal risk factors and challenges of management in a low resource setting.

Retained placenta membranes and tissue are responsible for 5% to 10% of postpartum hemorrhage. Placenta accreta occurs in approximately 1 in 2500 pregnancies of which placenta percreta constitutes about 5% of placenta accreta. This portends the rarity of placenta percreta especially in a 32 year old woman with minimal risk factors. Our patient was a G4P3(+0) woman with 2 living male children who presented at 39 weeks plus 2 days gestation in latent phase of labour and transverse lie. She had emergency caesarean hysterectomy due to primary postpartum haemorrhage secondary to placenta percreta. There should be a high index of suspicion of placenta percreta in women with the risk factors and whoever does caesarean section should have the skills for hysterectomy in case of any encounter with placenta percreta not amenable to conservative management.

Chronic thromboembolic pulmonary hypertension with pulmonary infarction occuring in a hypertensive.

We present a 72-year-old man and a known hypertensive with poor drug compliance seen here on 22-03-06, with a 4-year history of progressive dyspnoea, associated with cough and a wheeze. On examination he was chronically ill looking with altered state of consciousness, pale, centrally cyanosed, febrile (T-38 degrees C), in respiratory distress (RR-33 pm). Significant chest radiological findings include marked aortic unfolding and cardiomegaly, with biventricular involvement. Numerous nodular opacities in both lung fields especially the Right side with right apical opacification/thickening. Treatment as appropriate was instituted but unfortunately the patient succumbed after thirty days on admission and an autopsy carried out revealed multiple pulmonary infarcts with pulmonary thrombo-embolism.

Chronic thromboembolic pulmonary hypertension with pulmonary infarction occuring in a hypertensive.

We present a 72-year-old man and a known hypertensive with poor drug compliance seen here on 22-03-06,with a 4-year history of progressive dyspnoea, associated with cough and a wheeze. On examination he was chronically ill looking with altered state of consciousness, pale, centrally cyanosed, febrile (T-38 degrees C), in respiratory distress (RR-33pm). Significant chest radiological findings include marked aortic unfolding and cardiomegaly, with biventricular involvement. Numerous nodular opacities in both lung fields especially the Right side with right apical opacification/thickening. Treatment as appropriate was instituted but unfortunately the patient succumbed after thirty days on admission and an autopsy carried out revealed multiple pulmonary infarcts with pulmonary thrombo-embolism.