Successfully conservative management of the uterus in acute pulmonary embolism during cesarean section for placenta previa: a case report from Tu Du Hospital, Vietnam and literature review.

BACKGROUND: Cardiopulmonary collapse is a catastrophic event in cesarean section, which leads to adverse outcomes for both the mother and the fetus. Pulmonary embolism is one of the rare etiologies of this entity. We herein reported the successful management of acute embolism pulmonary associated with cesarean delivery on a healthy pregnant woman at our tertiary referral hospital. CASE PRESENTATION: A full-term pregnant woman hospitalized for planned cesarean delivery due to placenta previa without cardiorespiratory diseases. She was scheduled uneventfully for a planned cesarean section. After placental delivery, the patient spontaneously fell into cardiopulmonary collapse and her vital signs deteriorated rapidly. The obstetricians promptly completed the cesarean section and performed all procedures to prevent the PPH and preserve the uterus. At the same time, the anesthesiologists continued to carry out advanced heart-lung resuscitation in order to control her vital signs. After surgery, the multidisciplinary team assessed the patient and found a thrombus in her pulmonary circulation. Therefore, the patient was managed with therapeutic anticoagulation. The patient recovered in good clinical condition and was discharged after 2 weeks without any complications. CONCLUSIONS: The diagnosis of acute pulmonary embolism is extremely difficult due to uncommon occurrence, sudden onset, and non-specific presentation. Awareness of this life-threatening pathology during cesarean delivery should be raised. Interdisciplinary assessment must be essentially established in this life-threatening condition. After the whole conventional management, uterine conservation may be acceptable where applicable. Further data is required to encourage this finding.

Modified one-step conservative uterine surgery (MOSCUS) versus cesarean hysterectomy in the management of placenta accreta spectrum: A single-center retrospective analysis based on 619 Vietnamese pregnant women.

OBJECTIVES: To compare maternal outcome measures in surgical management of placenta accreta spectrum (PAS)-the modified one-step conservative uterine surgery (MOSCUS), a new approach at Tu Du Hospital in Vietnam, versus cesarean hysterectomy, and to identify factors that appear to contribute to the successful outcome of the MOSCUS. METHODS: This retrospective study was conducted at Tu Du Hospital in southern Vietnam between January 2019 and December 2020. The study enrolled all pregnant women at more than 28 weeks of pregnancy with a diagnosis of PAS who underwent either a cesarean hysterectomy or a uterus-preserving approach using the MOSCUS method. RESULTS: The prevalence of PAS at our single tertiary referral hospital was 0.4% (619 PAS cases/132 518 births) in 2 years. Among 296 patients, the surgical time duration, estimated blood loss, and red blood cell transfusion in the MOSCUS group (n = 217) were all significantly less than in the cesarean hysterectomy group (n = 79) (152.72 ± 42.23 vs 185.13 ± 58.22 min, 1000 vs 1500 mL, and 500 vs 710 mL, respectively). Intraoperatively, the rate of visceral injuries in the hysterectomy group was higher than that in the MOSCUS group (P < 0.001). However, the rate of postoperative infection was higher in the MOSCUS group than in the cesarean hysterectomy group (P = 0.012). Of a total of 217 cases managed using the MOSCUS management, 24 required a secondary hysterectomy; the success rate was 88.9% (95% confidence interval [CI] 84.3%-93.1%). Some of the primary factors associated with the success of MOSCUS included maternal age less than 35 years, planned surgery, severity of PAS, and estimated blood loss during surgery (odds ratio [OR] 5.16, 95% CI 1.96-13.59; OR 3.05, 95% CI 1.08-8.62; OR 3.62, 95% CI 1.19-10.98; and OR 49.66, 95% CI 11.16-221.02, respectively; P < 0.05). CONCLUSION: MOSCUS is an acceptable alternative to cesarean hysterectomy in many patients diagnosed with PAS. This new surgical management of PAS resulted in the preservation of the uterus, and a favorable outcome in nearly 9 out of 10 pregnant women. We believe that MOSCUS can be safely offered for the management of PAS in referral hospital settings.

Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review.

BACKGROUND: Spontaneous hemoperitoneum in pregnancy (SHiP) refers to fluid collection in the abdominal cavity with a vague presentation of clinical symptoms. Particularly, SHiP causes a life-threatening condition with the coexistence of intrauterine pregnancy, since this dangerous complication significantly increases the maternal and fetal mortality. Herein, we present two cases of nontraumatic SHiP in the second and third trimester of pregnancy, respectively. CASE PRESENTATION: The pregnant woman in case 1 was admitted to our hospital owing to severe paroxysmal shoulder pain along with abdominal pain. Her medical history was remarkably recorded with endometriosis and adenomyosis. At the emergency room, an ultrasound scan revealed a live fetus corresponding to 21 weeks and 3 days and free fluid in the abdominal cavity. She was subsequently diagnosed with SHiP and underwent immediate laparotomy for hemostatic procedures. During the postpartum course, the patient was uneventfully monitored. Unfortunately, the patient delivered on the 4th postoperative day in spite of the initial administration of tocolytic agents and close monitoring. The primigravid woman in case 2 complained of lower abdominal pain and vaginal bleeding. The patient's history was noted with ovarian tumor removal. At admission, the sonography scan revealed free fluid in the abdominal cavity, a fetus at 34 weeks and 3 days gestational age with bradycardia of 70 bpm, and a laboratory test showed a low hemoglobin level. Thus, exploratory laparotomy and hysterotomy were performed at the same time due to fetal distress. The postpartum course was uneventful. The patient was discharged 5 days later. CONCLUSIONS: In pregnant women with a history of endometriosis, adenomyosis, or ovarian tumor removal, acute abdominal pain combined with the presence of free fluid collection in the intraperitoneal cavity, and a decreased hemoglobin levels should be first assessed as SHiP originating from the spontaneous rupture of abnormal vascular proliferation. Proper management is strongly indicated for an emergent laparotomy to control the active bleeding point, thus increasing the survival rate for both mother and neonate.

Placenta accreta spectrum on an unscarred uterus in the third-trimester pregnancy: two rare cases at Tu Du Hospital in Vietnam.

INTRODUCTION AND IMPORTANCE: Placenta accreta spectrum disorders (PASD) refer to an uncommon obstetrical conditions leading to significant life-threatening obstetrical issue for mothers and foetus during pregnancy. Rarely, this pathology can occur in the uterus without a history of uterine surgery, localize at unusual site of the uterus, and result in the spontaneous uterine rupture. We herein reported two unusual cases managed successfully in the third trimester of pregnancy at our tertiary referral hospital. CASE PRESENTATION: Two pregnant women were hospitalized at our maternity hospital for a dilemma diagnosis of PASD without history of previous caesarean scar. Following the suspected images of PASD on ultrasound combined with a hematoma anterior to the body of the uterus, especially a sudden onset of abdominal pain and intraperitoneal fluid without a clear etiology, we made the suspected diagnosis of uterine rupture associated with PASD. Moreover, a gradual reduction of hemoglobin concentration also supported this diagnosis. Both cases underwent immediately caesarean hysterectomy for saving the life of the mother and baby following suspicion. CLINICAL DISCUSSION: PASD associated with an unscarred uterus is an uncommon placentation during pregnancy. Although an extremely rare cases, PASD may be present without association with placenta praevia. Timely management by caesarean hysterectomy can avoid adverse maternal-foetal outcomes. CONCLUSION: PASD can be appeared on the uterus without a previous uterine scar, thus leading to unexpected complications during pregnancy. Closely strict monitoring helps avoiding the materno-foetal mortality. Further data is needed to summarize this rarely uncommon entity.

Synthesis of Benzoxazoles, Benzimidazoles, and Benzothiazoles Using a Brønsted Acidic Ionic Liquid Gel as an Efficient Heterogeneous Catalyst under a Solvent-Free Condition.

Herein, we introduce a reusable Brønsted acidic ionic liquid gel (BAIL gel) obtained by treating 1-methyl-3-(4-sulfobutyl)-1H-imidazolium hydrogen sulfate with tetraethyl orthosilicate (TEOS). The grafting of the Brønsted acidic ionic liquid to the surface of TEOS has increased the catalytic activity of the material and also simplified catalyst recovery from the reaction mixture. This reaction has a wide substrate scope, and the BAIL gel represents a new catalyst for the synthesis of benzoxazoles, benzimidazoles, and benzothiazoles. The method shows attractive characteristics such as high yields, recyclable catalyst, and work-up simplicity. More importantly, no additional additives or volatile organic solvent and inert atmosphere are required for the reaction, and the BAIL gel has shown a great promise for industrial applications. To the best of our knowledge, the synthesis of benzoxazoles, benzimidazoles, and benzothiazoles using a recyclable heterogeneous ionic liquid gel was not previously reported in the literature.

Porous metal oxides derived from Cu-Al layered double hydroxide as an efficient heterogeneous catalyst for the Friedel-Crafts alkylation of indoles with benzaldehydes under microwave irradiation.

Four Cu-Mg-Al mixed metal oxides (MMO) were synthesized through the calcination of layered double hydroxides (LDHs). These catalysts were fully characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), thermogravimetric analysis (TGA), Brunauer-Emmett-Teller surface area (BET), and inductively coupled plasma optical emission spectrometer (ICP-OES). The catalytic efficiency of porous metal oxides derived from LDHs has been tested successfully for the synthesis of bis(indolyl)methanes via the Friedel-Crafts alkylation of indoles with aromatic aldehydes under solvent-free microwave irradiation. The Cu-Al MMO showed the best catalytic activity to produce the expected products up to 98% yield and 100% selectivity for only 20 min under solvent-free microwave irradiation. Moreover, the catalyst can be recovered quickly from the reaction mixture by filtration and reused several times without significant loss of the reactivity.

Synthesis of benzo[4,5]imidazo[1,2-a]pyrimidines and 2,3-dihydroquinazolin-4(1H)-ones under metal-free and solvent-free conditions for minimizing waste generation.

Brønsted acidic ionic liquid was found to be an efficient and recyclable catalyst for the synthesis of benzo[4,5]imidazo[1,2-a]pyrimidines and 2,3-dihydroquinazolin-4(1H)-ones. The reactions proceeded smoothly with a broad scope of substrates providing the expected products in good to excellent yields under an atom-economical pathway. The low-cost recyclable catalyst, metal- and solvent-free conditions, and the ease of product isolation are the highlighted advantages in solving the issue of trace metal contamination in synthesized pharmaceuticals.