RESUMO
BACKGROUND: Rupture of a pseudoaneurysm after vaginal delivery is a rare cause of postpartum hemorrhage. CASE: A 29-year-old primigravida delivered a healthy boy by vacuum extraction at 38 weeks of gestation. The patient underwent repair of a right mediolateral episiotomy and left vaginal wall laceration. On the third postpartum day she experienced massive vaginal bleeding with vaginal wall laceration, and the vaginal bleeding progressively increased. A selective angiogram of the left internal iliac artery showed a pseudoaneurysm with extravasation originating from the left internal pudendal artery. Complete occlusion of the pseudoaneurysm was achieved by embolization of the left internal pudendal artery. The postprocedural course was uneventful. CONCLUSION: A pseudoaneurysm should be considered in unclear cases of postpartum hemorrhage.
Assuntos
Falso Aneurisma/cirurgia , Parto Obstétrico/efeitos adversos , Hemorragia Pós-Parto/cirurgia , Embolização da Artéria Uterina/métodos , Adulto , Falso Aneurisma/diagnóstico , Falso Aneurisma/diagnóstico por imagem , Angiografia/métodos , Episiotomia/efeitos adversos , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/diagnóstico por imagem , Hemorragia Pós-Parto/etiologia , Gravidez , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Resultado do Tratamento , Vagina/irrigação sanguínea , Vagina/lesõesRESUMO
Warfarin-associated fetal hemorrhage is a fatal event. We report the case of a 39-year-old woman who had been taking warfarin for 23 years since undergoing mitral valve replacement. Thereafter, when she was found to be pregnant, the medication was switched to heparin from 6 to 21 weeks of gestation. Following this, she was prescribed oral warfarin again (3.5 mg per day), with a strict control of prothrombin time/international normalized ratio (PT/INR). At 23 weeks of gestation, fetal intracranial hemorrhage occurred because of maternal exposure to warfarin. Maternal PT/INR does not correlate well with the activity of warfarin in the fetus and currently, there is no direct way to prevent fetal intracranial hemorrhage. Hence, further research on the optimal coagulation therapy in pregnant women with valve replacement should be encouraged.
Assuntos
Anticoagulantes/efeitos adversos , Doenças Fetais/induzido quimicamente , Implante de Prótese de Valva Cardíaca , Hemorragias Intracranianas/induzido quimicamente , Complicações Hematológicas na Gravidez/prevenção & controle , Varfarina/efeitos adversos , Adulto , Anticoagulantes/administração & dosagem , Feminino , Morte Fetal/etiologia , Heparina/administração & dosagem , Humanos , Coeficiente Internacional Normatizado , Gravidez , Complicações Hematológicas na Gravidez/sangue , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Varfarina/administração & dosagemRESUMO
BACKGROUND: We describe a case that developed a delayed pneumothorax after laparoscopic surgery. CASE: A 40-year-old woman (BMI: 19.1) underwent a laparoscopic ovarian cystectomy. On the first postoperative day, she developed a pneumothorax. The subcutaneous CO2 tracked up through the fascial planes, and ruptured into the pleural space, where delayed pneumothorax developed. CONCLUSION: Gynecologists should be aware of pneumothorax after laparoscopic surgery and should also keep in mind its possible delayed development.