RESUMO
Background: Perinatal Palliative Care provides comprehensive and holistic care for expectant and new parents, who receive a diagnosis of life-limiting fetal condition and opt to continue pregnancy and care for their newborn infant. Aim: To develop a service providing individually tailored holistic care during pregnancy, birth, postnatal and bereavement period. Methods: Following a baseline survey of neonatologists and discussions with key stakeholders we launched the Perinatal Palliative service at the KK Women's and Children's hospital, Singapore in January 2017. The multidisciplinary team, led by a Palliative care specialist comprised of Obstetricians, Neonatologists, nurses and medical social workers. The Birth defect clinic referred parents with antenatally diagnosed 'Lethal' fetal conditions. The team checked the understanding and the decision making process of parents and initiated and finalized advance care plans. The service also embraced deserving postnatal referrals upon request. Results: A total of 41 cases were seen from January 2017 to December 2019. Of these, 26/41(63%) were referred antenatally and had completed advance care plans. 18/41 (44%) died during or shortly after birth and 10/41(24%) continue to survive and are supported by the community palliative team. During this time a workflow was formulated and modified based on parent and team feedback. Conclusion: Awareness of the service has increased over the years and a clear workflow has been formulated. Advance care plans are prepared and documented before birth so as to enable service teams on board to provide well timed pertinent care. Feedbacks from parents about this service were positive.
Assuntos
Luto , Doenças Fetais , Criança , Feminino , Humanos , Recém-Nascido , Cuidados Paliativos , Pais , Assistência Perinatal , Gravidez , Encaminhamento e ConsultaAssuntos
Artrogripose/genética , Pé Torto Equinovaro/genética , Anormalidades do Olho/genética , Cardiopatias Congênitas/genética , Malformações do Sistema Nervoso/genética , Proteínas/genética , Anormalidades Múltiplas , Agenesia do Corpo Caloso/diagnóstico por imagem , Agenesia do Corpo Caloso/genética , Artrogripose/diagnóstico por imagem , Tronco Encefálico/anormalidades , Tronco Encefálico/diagnóstico por imagem , Cerebelo/anormalidades , Cerebelo/diagnóstico por imagem , Pé Torto Equinovaro/diagnóstico por imagem , Deficiências do Desenvolvimento/diagnóstico por imagem , Deficiências do Desenvolvimento/genética , Anormalidades do Olho/diagnóstico por imagem , Feminino , Mutação da Fase de Leitura , Idade Gestacional , Cardiopatias Congênitas/diagnóstico por imagem , Heterozigoto , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/genética , Recém-Nascido , Lisencefalia/diagnóstico por imagem , Lisencefalia/genética , Imageamento por Ressonância Magnética , Masculino , Mutação de Sentido Incorreto , Malformações do Sistema Nervoso/diagnóstico por imagem , Medição da Translucência Nucal , Gravidez , Síndrome , Ultrassonografia Pré-NatalRESUMO
Ectopic pregnancy in the interstitial part of the fallopian tube is a rare event, associated with a high rate of complications due to delayed diagnosis. Rupture of such pregnancy often results in catastrophic hemorrhage. Several reports highlighted the role of magnetic resonance imaging in establishing the diagnosis of interstitial pregnancy, but magnetic resonance imaging findings of a ruptured advanced interstitial ectopic pregnancy have not been published before. The authors therefore present characteristic findings on magnetic resonance imaging of a ruptured interstitial ectopic pregnancy which had reached 18 weeks, in a 25-year-old woman who presented with acute abdominal pain.
Assuntos
Doenças das Tubas Uterinas/diagnóstico , Gravidez Ectópica/diagnóstico , Diagnóstico Pré-Natal/métodos , Dor Abdominal/etiologia , Adulto , Doenças das Tubas Uterinas/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Gravidez , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/cirurgia , Ultrassonografia Pré-Natal/métodosRESUMO
INTRODUCTION: Pathologically adherent placentas occur when there is a defect of the decidua basalis, typically arising from previous caesarean section, resulting in abnormally invasive implantation of the placenta. The depth of placental invasion varies from the superficial (accreta), to transmural and possibly beyond (percreta). CLINICAL PICTURE: We report on 2 cases, one treated "conservatively", the other with a caesarean hysterectomy, both of which led to a safe outcome for both mother and baby. CONCLUSIONS: Management relies on accurate early diagnosis with appropriate perioperative multidisciplinary planning to anticipate and avoid massive obstetric haemorrhage at delivery.
