Cranial imaging spectrum in hypertensive disease of pregnancy.

OBJECTIVE: To determine cranial imaging findings in patients with severe preeclampsia, eclampsia and HELLP syndrome and the correlation between these findings and neurological symptoms. MATERIALS AND METHODS: CT or MRI findings of 120 patients diagnosed with severe preeclampsia, eclampsia and/or HELLP syndrome between January 1998 and December 2005 are presented. RESULTS: Pathological imaging findings were observed in 28.1% (n = 32) of the severe preeclampsia group, in 43.3% (n = 30) of the HELLP group, in 51.35% (n = 27) of the eclampsia group and in 61.9% (n = 21) of the eclampsia + HELLP group and in 45% of all patients. Thirty-five patients had specific pathology defined as ischemic lesions, edema, and perivascular microhemorrhage. Infarcts were found in seven, intracranial hemorrhage in seven, hydrocephaly in two, dural sinus thrombosis in two and a pineal cyst in one patient. Specific lesions were generally located in the posterior parietal and occipital lobes. Five patients died due to intracranial hemorrhage and one patient due to septic shock. CONCLUSION: A wide imaging spectrum from the ischemic lesion to severe intracranial hemorrhage can be detected in complicated cases of hypertensive diseases of pregnancy. It is essential to perform cranial imaging in patients with symptoms and neurological deficits.

Acute severe reversible oligohydramnios induced by indomethacin in a patient with rheumatoid arthritis: a case report and review of the literature.

Although the association between oligohydramnios and indomethacin use for premature labor has been well known for many years, there have been few cases published about it. We present a case of indomethacin-induced oligohydramnios due to use in a patient for rheumatoid arthritis. A 27-year-old G2P1 woman was referred to our prenatal unit with oligohydramnios at 33 weeks of pregnancy. Ultrasonography revealed severe oligohydramnios with an amniotic fluid index of 0.9 cm. She gave a history of daily 150 mg indomethacin use for newly diagnosed rheumatoid arthritis. All possible reasons for oligohydramnios were excluded and indomethacin was discontinued. In four days the amniotic fluid was observed as normal. We concluded that the oligohydramnios caused by indomethacin occurs quickly, is dose-related and reversible. Amniotic fluid volume should be monitored while using indomethacin.

Chronic uterine inversion: preservation of the uterus--case report.

Uterine inversion is a rare and dangerous complication of labor. Although it can be reconstructed successfully with prompt intervention in acute stages, surgical interventions are usually mandatory in sub-acute or chronic phases. In this report we present a case of chronic uterine inversion, that was successfully treated with abdominal surgery.

The outcome of pregnancy among patients receiving hemodialysis treatment.

Pregnancy among women receiving hemodialysis as a renal replacement therapy is rare and the chance of a successful delivery is relatively low. In this article, we present 3 cases of women conceiving either before or after the initiation of hemodialysis. The various risks of each pregnancy and the outcome are discussed as well as the latest management guidelines for pregnant dialysis patients.

Uterine artery embolization in a 10-week cervical pregnancy with coexisting fibroids.

A 36-year-old woman, gravid 3, para 1, abortus 1, was admitted to our department at 10 weeks and 4 days of gestation with the diagnosis of cervical pregnancy and multiple uterine fibroids. After admission she underwent angiographic embolization of bilateral uterine arteries followed by intraamniotic 70-mg methotrexate injection. Despite being given a second dose of methotrexate injection 1 week later, the gestational sac did not resolve spontaneously, thus vacuum evacuation and curettage of the cervical canal was required on the 15th day of embolization. The patient was discharged in good condition. She had no complaints by post-operative at month 11, except amenorrhea. Her uterine fibroids markedly decreased in size after the procedure. As a result, embolization of uterine arteries provided surgical evacuation of cervical pregnancy with minimal hemorrhage, and the patient's potential fertility was preserved, but a long-term amenorrhea was observed.

A 22-week cervical pregnancy.

We report on a cervical pregnancy at advanced gestational age. Misdiagnosis allowed pregnancy to proceed until the 22nd week of gestation and made its management more complicated. An abdominal hysterectomy with preservation of the adnexa was performed.

Plasma nitric oxide metabolites and lipid peroxide levels in preeclamptic pregnant women before and after delivery.

It has been suggested that oxidative stress may cause endothelial dysfunction and that endothelial dysfunction may lead to hypertension by reduced release of vasodilating agents such as nitric oxide (NO). In this study, we investigated the relationship between serum NO and lipid peroxides in preeclamptic and normal pregnant women before and after delivery. Plasma from women with preeclampsia had significantly lower nitrate/nitrite concentrations and significantly higher lipid peroxide levels than normal pregnant women before the delivery. Lipid peroxide levels were significantly elevated in preeclamptic placenta. After delivery in the preeclamptic group the plasma concentration of nitrate/nitrite was increased and plasma thiobarbituric acid reactive substance levels decreased, while these parameters remained unchanged in the normal pregnants women. These results indicate that high levels of lipid peroxides in the circulation may be the cause of lowered NO synthesis and hypertension observed in preeclamptic women.

Imbalance between lipid peroxidation and antioxidant status in preeclampsia.

Lipid peroxidation and the antioxidant system were investigated in the plasma and placenta of normal and preeclamptic pregnant women. A significant increase in thiobarbituric acid reactive substance (TBARS), significant decreases in total thiol (t-SH) content and superoxide dismutase (SOD) activity, and unchanged vitamin C levels and glutathione peroxidase (GPx) activity were observed in the plasma of preeclamptic women compared to women with normal pregnancies. In placentas from preeclamptic women TBARS levels were significantly elevated, while glutathione and vitamin C levels and GPx, glutathione S-transferase and SOD activities were decreased. After delivery, the elevated TBARS values decreased significantly and the reduced SOD activity and t-SH contents increased significantly. We concluded that preeclampsia is associated with an imbalance between lipid peroxides and the antioxidant system.