Effects of transfusing older red blood cells and platelets on obstetric patient outcomes: A retrospective cohort study.

OBJECTIVE: To investigate associations between transfusion of blood products close to the end of shelf-life and clinical outcomes in obstetric inpatients. METHODS: Mortality and morbidity were compared in patients transfused exclusively with red blood cells (RBC) stored for less than 21 days (fresh) versus RBC stored for 35 days or longer (old), and platelets (PLT) stored for 3 days or fewer (fresh) versus 4 days or longer (old) in Queensland, Australia from 2007 to 2013. Multivariable models were used to examine associations between these groups of blood products and clinical end points. RESULTS: There were 3371 patients who received RBC and 280 patients who received PLT of the eligible storage durations. Patients transfused with old RBC received fewer transfusions (2.7 ± 1.8 vs. 2.3 ± 1.0 units; P < 0.001). However, a higher rate of single-unit transfusions was also seen in those patients who exclusively received old RBC (252 [9.3%] vs. 92 [13.7%]; P = 0.003). Comparison of fresh vs. old blood products revealed no differences in the quantities of transfused RBC (9.5 ± 5.9 vs. 9.1 ± 5.2 units; P = 0.680) or PLT (1.5 ± 0.8 vs. 1.4 ± 1.1 units; P = 0.301) as well as the length of hospital stay for RBC (3 [2-5] vs. 3 [2-5] days; P = 0.124) or PLT (5 [4-8] vs. 6 [4-9] days; P = 0.120). CONCLUSION: Transfusing exclusively older RBC or PLT was not associated with increased morbidity or mortality.

Spontaneous renal fornix rupture in pregnancy and the post partum period: a systematic review of outcomes and management.

BACKGROUND: Spontaneous renal fornix rupture (SRFR) causing urinoma is an uncommon but serious condition in pregnancy. Limited information is available to describe the natural history and outcomes to guide appropriate treatment. The aim of this study was to determine the natural history and outcomes of SRFR to determine appropriate management recommendations. METHODS: A systematic review of literature databases was performed, using the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) checklist from 1950 - April 2020. Inclusion criteria included any urinary extravasation from the kidney or ureter during pregnancy, or in the 8 weeks following delivery, confirmed via imaging or surgery. Haematomas and non-confirmed cases were excluded. RESULTS: A total of 1579 records were originally identified, of which 39 case reports were appropriate for inclusion. SRFR was most commonly reported during the first pregnancy (72%), 19/30 during the third trimester and 9 in the post-natal period. All patients presented with pain, with haematuria positive on urine dipstick in only 36% of 26 reported cases. Ultrasound was the most frequently used imaging modality, resulting in a diagnosis in 42% of cases. All cases reported on treatment procedures including ureteric stents (46%), percutaneous drain (15%), conservative management (15%), nephrostomy (13%) and ureteral catherization (10%). Long term urological outcomes were positive, however women suffering SRFR were significantly more likely to undergo pre-term labour. CONCLUSION: While selected cases may be successfully managed conservatively, urinary diversion, through ureteric stents, should be considered the management of choice in these individuals. Clinicians should be mindful of an increased risk of premature delivery and its' associated negative fetal outcomes.

A systematic review of ectopic pregnancy after hysterectomy.

BACKGROUND: An ectopic pregnancy after hysterectomy is a rare but potentially life-threatening event. Women with this condition might not be appropriately investigated, resulting in delays in diagnosis and treatment. OBJECTIVES: To characterize cases of ectopic pregnancy occurring after hysterectomy. SEARCH STRATEGY: PubMed, Embase, Scopus, and Web of Science were searched using the terms "pregnancy, abdominal" or "pregnancy, tubal" or "pregnancy, ectopic" and "hysterectomy" or "post-hysterectomy" or "post hysterectomy." SELECTION CRITERIA: Case reports or case series published in English up to October 10, 2016, were included. Patients were included if the diagnosis was confirmed by definitive tests such as serum or urine ß-human chorionic gonadotropin (ß-hCG) testing, ultrasonography evidence of pregnancy, or histology. DATA COLLECTION AND ANALYSIS: Patient characteristics were extracted via a standard spreadsheet. MAIN RESULTS: A total of 57 patients were included in the analysis. Abdominal pain was the predominant symptom. Implantation in a remaining fallopian tube was common. Most patients were managed surgically. CONCLUSIONS: A high index of suspicion and a low threshold for performing a ß-hCG pregnancy test is recommended in all women presenting with clinical symptoms of ectopic pregnancy, regardless of the hysterectomy status. This could lead to earlier diagnosis and fewer complications.

Beware of a multi-fibroid uterus: The importance of ultrasound reporting in the early detection of uterine sarcomas.

Primary uterine malignancy masquerading as a benign leiomyoma is a rare yet devastating condition if missed on ultrasound. Although there are no current guidelines to aide in early ultrasound identification of these high-risk patients prior to histological analysis, certain imaging characteristics may heighten the suspicion of malignancy. Unfortunately, these atypical features are often not included in ultrasonographic reports resulting in delayed treatment and catastrophic consequences. We present a case of a uterine Ewing's sarcoma (ES), which was diagnosed as a multi-fibroid uterus on initial ultrasound. The lack of clinical suspicion resulted in a delay to definitive diagnosis and a sub-optimal surgical resection. We compare this to a standard case of a multi-fibroid uterus in order to highlight the differences in ultrasonographic appearance. This case delineates the importance of accurate identification and open reporting of suspicious features in order to assist ultrasonographers and specialist gynaecologists in creating a differential diagnosis of an otherwise common condition. A high index of suspicion of atypical lesions may lead to early life-saving interventions and careful tissue control during surgery, resulting in improved patient outcomes.