RESUMO
INTRODUCTION: Nexplanon is a 4âcm rod-shaped barium sulphate coated contraceptive implant with a usual subdermal insertion in the inner non-dominant upper arm. Complications proper to subdermal contraceptive implants are unusual and principally localized and minor, comprising infection at the site of implantation, hematoma, abnormal scar development, or local nerve and blood vessel injuries. Infrequently, contraceptive implant migration can happen, though habitually not far from the site of insertion. Pulmonary embolization of the device is remarkably rare and can present with symptoms such as chest pain or dyspnea. PATIENT CONCERNS AND DIAGNOSIS: We report one of the rare cases of asymptomatic Nexplanon pulmonary embolism in a 26-year-old female. INTERVENTIONS AND OUTCOMES: An endovascular intervention successfully retrieved the device from the lateral segment right middle lobe pulmonary artery without any complications. CONCLUSION: Several cases of contraceptive implant migration into the pulmonary artery have been reported to this day. Preventing this life-threatening complication is challenging, and yet, no clear guidelines have been established.
Assuntos
Contraceptivos Hormonais/administração & dosagem , Desogestrel/administração & dosagem , Implantes de Medicamento/efeitos adversos , Migração de Corpo Estranho/cirurgia , Artéria Pulmonar/diagnóstico por imagem , Adulto , Angiografia por Tomografia Computadorizada/métodos , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Humanos , UltrassonografiaRESUMO
BACKGROUND: Clinical fetal weight estimation is a common practice in obstetrics. This study aims to evaluate the accuracy of fetal weight estimation by midwives, and to identify factors that may lead to overestimation or underestimation of fetal weight. METHODS: A cohort prospective study in a Lebanese university hospital, included weight estimation of singleton pregnancies above 35 weeks. Multiple pregnancies, unclear dating, growth retardation, malformations and stillbirths cases are excluded. The estimated fetal weight is recorded by midwives in a sealed envelope and compared to true weight later. The effects of BMI, weight gain, parity, diabetes, hypertension, neonate's sex and weight, uterine contractions, rupture of membranes and daytime or nighttime shift on these estimations were assessed. RESULTS: One hundred and sixty-six patients were included. Mean birth weight was 3246 ± 362 g. Mean absolute percentage error of weight estimation was 8.5 ± 6.7% (0-30.9%). Estimation was within the correct range of ±10% in 63% of cases. Maternal and fetal factors did not significantly change weight estimation. Fetuses with birth weights more than 4000 tended to be underestimated by midwives. Estimation improved over time (nonsignificant). CONCLUSIONS: Maternal and fetal factors, except for macrosomia, have limited impact on estimation of fetal birth weight. Macrosomia is challenging because of a consistent tendency of underestimation by midwives.
Assuntos
Competência Clínica/estatística & dados numéricos , Peso Fetal , Tocologia/métodos , Obstetrícia/métodos , Estatística como Assunto/métodos , Adulto , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Estudos ProspectivosRESUMO
OBJECTIVE: The current study tested the hypothesis that collagen content in the pregnant cervix decreases with labor, using morphologically preserved specimens, avoiding limitations of earlier studies. Collagen abundance remote from pregnancy was also evaluated. MATERIALS AND METHODS: Histologic sections of postpartum cervix obtained from 22 cases of total hysterectomy performed immediately after delivery: 13 cases performed after delivery with no labor and 9 cases in which labor had ensued before delivery. Cervices from 10 nonpregnant uteri served as additional controls. Sections were stained, and quantitative histomorphometric assessment of relative collagen abundance was performed using computer-assisted image analysis. Data were assessed for differences using rank sum tests. Relationships between cervical collagen abundance and age, parity, ethnicity, or mode of delivery were also assessed. RESULTS: Quantitative assessment of collagen abundance in trichrome-stained cervical sections revealed significantly decreased cervical collagen expression in sections from pregnant uteri. Mean percent collagen was 73.5% ± 3.5% (±SEM) in cervices from nonpregnant uteri (n = 10) and 21.5% ± 2.2% in cervices from pregnant uteri (n = 22, p < .0001). Cervical collagen content was significantly lower (p = .04) in cervices from cases in which labor had ensued before delivery (mean percent collagen = 16.1% ± 3.4%, n = 9) than in those in which delivery occurred with no labor (25.3% ± 2.3%, n = 13). No relationships between collagen expression and age, parity, ethnicity, or mode of delivery were observed. CONCLUSIONS: Collagen expression seems to be reduced in the postpartum cervix, particularly after labor has ensued.
Assuntos
Colo do Útero/fisiologia , Colágeno/metabolismo , Trabalho de Parto/metabolismo , Adulto , Colo do Útero/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Período Pós-Parto , GravidezRESUMO
BACKGROUND: Pregnancy has been associated with aplastic anemia, but a causal relationship has been questioned. CASE: A case of aplastic anemia was diagnosed during pregnancy and initially mimicked immune-mediated thrombocytopenic purpura. CONCLUSION: Pregnant women with aplastic anemia are at high risk. The severity of the disease and choice of the patient have to be considered before treatment.
Assuntos
Anemia Aplástica/diagnóstico , Anemia Aplástica/etiologia , Medula Óssea/patologia , Complicações Hematológicas na Gravidez/diagnóstico , Púrpura Trombocitopênica Idiopática/diagnóstico , Adulto , Exame de Medula Óssea , Diagnóstico Diferencial , Feminino , Humanos , Contagem de Plaquetas , Transfusão de Plaquetas , Gravidez , Complicações Hematológicas na Gravidez/sangueRESUMO
BACKGROUND: Cervical incompetence can lead to the inability to sustain an intrauterine pregnancy and may account for a substantial portion of second-trimester losses. Placement of a transvaginal cerclage has been shown to decrease morbidity in a substantial number of such cases. In patients lacking sufficient cervical tissue, a cerclage may be placed by a transabdominal approach. This procedure carries risks of significant morbidity to the maternal-fetal unit if done by laparotomy. CASE: A 22-year-old gravida at 13 weeks' gestation with a past history significant for cervical incompetence and absence of cervical tissue underwent placement of an abdominal cerclage. We utilized laparoscopic operative techniques and employed hydrodissection to decrease manipulation and bleeding around the gravid uterus. CONCLUSION: A laparoscopic approach to cerclage in patients diagnosed with cervical incompetence can be performed with minimal risks to the gravid uterus.
Assuntos
Cerclagem Cervical/métodos , Diagnóstico Pré-Natal , Incompetência do Colo do Útero/diagnóstico , Incompetência do Colo do Útero/cirurgia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Incompetência do Colo do Útero/patologiaRESUMO
Uterine anomalies are rare entities, vary from 0.1 to 4%, and are related to an increase risk of obstetrical complications. We report a case of a uterine anomaly, diagnosed during the management of a patient who presented with a missed abortion.
Assuntos
Aborto Retido/cirurgia , Útero/anormalidades , Adulto , Dilatação e Curetagem , Feminino , Humanos , Gravidez , Ultrassonografia , Útero/diagnóstico por imagemRESUMO
The transobturator sling procedure is a relatively new technique as compared to the retropubic version. The functional differences between these two procedures are largely unknown. Two cases of failed transobturator slings are reported. In both cases, the procedure was done under local anesthesia and a cough stress test was performed to adjust the tape. The transobturator slings were unable to stop the leakage and we replaced them with the retropubic versions, which were successful. Even when pulled very tightly, some transobturator slings will fail to stop stress incontinence that is amenable to cure from a typically placed "tension-free" retropubic sling. The cough stress test can identify such cases.
Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Acute leukemia is a rare malignancy of pregnancy. When it develops, there are many complications to consider and management becomes exceedingly difficult. We report a case of acute myelogenous leukemia presenting as preeclampsia and fetal demise at 36 weeks of gestation. A 30-year-old multigravida presented with intrauterine fetal demise at 36 weeks' gestation, hypertension, and thrombocytopenia. The patient received platelet and packed red blood cell transfusion, with concurrent prophylactic magnesium sulfate and dexamethasone treatment. Following labor induction, the patient delivered a nonviable female fetus and suffered a stroke postpartum. Peripheral smear and flow cytometry revealed the patient had acute myeloid leukemia with prominent monocytic differentiation. The patient expired on postpartum day six. Acute leukemia during the pregnancy is associated with an unfavorable outcome.
Assuntos
Leucemia Monocítica Aguda/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Diagnóstico Pré-Natal , Trombocitopenia/etiologia , Adulto , Diagnóstico Diferencial , Evolução Fatal , Feminino , Morte Fetal , Hemólise , Humanos , Leucemia Monocítica Aguda/sangue , Leucemia Monocítica Aguda/complicações , Leucemia Monocítica Aguda/patologia , Fígado/enzimologia , Transfusão de Plaquetas , Gravidez , Complicações Neoplásicas na Gravidez/sangue , Complicações Neoplásicas na Gravidez/patologia , Terceiro Trimestre da Gravidez , Trombocitopenia/sangueRESUMO
Follicular dendritic cell (FDC) sarcoma is a rare tumor. Most cases that have been described involve lymph nodes in young adults, but have not been reported in pregnancy. We describe the case of a 20-year-old woman with a FDC sarcoma diagnosed during pregnancy that initially presented as a painful mass in the right axilla. The patient underwent a tumor excision and chemotherapy. The intrapartum course was uncomplicated and she delivered a live female child at 34 weeks. During her postpartum course, she received radiation therapy and chemotherapy.
Assuntos
Células Dendríticas Foliculares/patologia , Complicações Neoplásicas na Gravidez/diagnóstico , Sarcoma/diagnóstico , Adulto , Axila , Feminino , Humanos , Gravidez , Complicações Neoplásicas na Gravidez/terapia , Sarcoma/terapiaRESUMO
The purpose of this study was to determine whether testing for cystic fibrosis (CF) and cytomegalovirus (CMV) infection is necessary in African-American and Hispanic gravidas in whom the fetus had an echogenic bowel. This retrospective study consisted of only African American and Hispanic patients in whom the fetus had an echogenic bowel, referred to the Maternal and Fetal Medicine unit at New Jersey Medical School for a specialized ultrasound, between June 30, 2004, and March 31, 2005. Sixty-five patients met the inclusion criteria for our study. Maternal serum testing for CF was done in 32 patients and all newborns were screened for the disease. There were no positive results for CF. CMV serology was tested in 38 patients and there were no cases of acute congenital CMV infection. In our population of 65 patients, there was one intrauterine growth restricted (IUGR) fetus and five intrauterine fetal demise (IUFD). Although all patients who were tested for CMV infection tested negative, the true incidence in our selected population may be underestimated because some of our patients were not tested. There were no cases of congenital CMV infection and all newborn screening tests for CF were negative. Prenatal diagnosis of fetal echogenic bowel was associated with a 7.6% incidence of IUFD and 1.6% incidence of IUGR.
Assuntos
Negro ou Afro-Americano , Fibrose Cística/etnologia , Infecções por Citomegalovirus/etnologia , Hispânico ou Latino , Intestinos/diagnóstico por imagem , Complicações na Gravidez/etnologia , Ultrassonografia Pré-Natal , Adulto , Amniocentese , Fibrose Cística/diagnóstico , Fibrose Cística/genética , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Infecções por Citomegalovirus/diagnóstico , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/etnologia , Triagem de Portadores Genéticos , Humanos , Recém-Nascido , Mutação , Polimorfismo Genético , Gravidez , Complicações na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/etnologia , Fatores de RiscoRESUMO
Septic pelvic thrombophlebitis (SPT) was initially diagnosed and described in the late 1800's. The entity had a high incidence and mortality during this period of time, and a surgical therapeutic approach was the treatment of choice. Since then, the diagnosis, incidence, and management of the entity evolved. This evolution followed the development of newer diagnostic tools such as computed tomography (CT), magnetic resonance imaging (MRI), and a better understanding of the pathophysiology of the disease. The treatment of SPT has had significant changes as well, from a surgical approach at the end of the 19th century to a medical approach after the 1960's. By using an adequate broad-spectrum antibiotic therapy, mortality has decreased. However, controversy in the management of this entity remains even till today.
Assuntos
Pelve , Sepse , Tromboflebite , Adulto , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Feminino , Humanos , Imageamento por Ressonância Magnética , Pelve/irrigação sanguínea , Pelve/diagnóstico por imagem , Sepse/diagnóstico , Sepse/diagnóstico por imagem , Sepse/tratamento farmacológico , Sepse/microbiologia , Tromboflebite/diagnóstico , Tromboflebite/diagnóstico por imagem , Tromboflebite/tratamento farmacológico , Tromboflebite/terapia , Tomografia Computadorizada por Raios XRESUMO
Multiple gestations have a significantly increased incidence of preterm labor and preterm rupture of membranes. In this case, a 32-year-old woman had a car accident with preterm labor at 19 weeks' gestation. A vaginal delivery of the presenting triplet followed. After conservative management, the second and third triplets were delivered by cesarean section after a 70-day delay. A review of the literature was done.