Extrauterine pregnancy resulting from late spontaneous rupture of an unscarred gravid uterus: case report.

PURPOSE: Rupture of the unscarred grand uterus is a rare obstetric event associated with major perinatal mortality and a high incidence of maternal mortality and morbidity, particularly peripartum hysterectomy. METHODS & RESULTS: We present the case of a primigravida woman who was admitted at 38 weeks of gestation complaining of intermittent abdominal pain and vaginal bleeding. Although initial evaluation suggested that both mother and fetus were doing well, continuous assessment resulted in cesarean section due to variable decelerations and increasing abdominal pain. An unexpected abdominal pregnancy was discovered resulting from a complete uterine rupture. A healthy infant was delivered and hysterectomy was performed. CONCLUSION: Although extrauterine advanced abdominal pregnancy resulting from late uterine rupture is associated with high maternal and perinatal mortality, a high index of suspicion, close surveillance and ultrasonography can achieve good outcome for both mother and infant. We strongly believe, that this case report contributes to the insight and further knowledge of this rare pregnancy complication.

Transdermal estradiol plus oral medroxyprogesterone acetate replacement therapy in primary amenorrheic adolescents. Clinical, hormonal and metabolic aspects.

Twelve primary amenorrheic adolescents were treated with transdermal estradiol 100 micrograms (Estraderm TTS-100 (R)) twice weekly for 3 weeks, plus MPA 10 mg per os daily (Provera) for the last 11 days, following an interval of 1 week. A basic examination and a re-examination at 6- and 12-month intervals were carried out for clinical evaluation, hormonal assays, lipid, carbohydrate and bone metabolism. No significant changes were recorded on the FSH, LH, 17 beta-estradiol and PRL serum levels. A significant decrease of TC values and atheromatic indices 1 (TC/HDL) and 2 (LDL/HDL) was seen (P < 0.05) at the end of treatment. On the other hand a significant increase in apolipoproteins A1 was found. A beneficial effect was also recorded on the bone mass. Finally, no significant side-effects were reported. It is concluded that this kind of hormone replacement therapy is efficient and safe for the treatment of amenorrheic adolescents due to gonadal dysgenesis.

Teenage pregnancy: comparison with two groups of older pregnant women.

To evaluate the risk of adolescent pregnancies, we examined three groups of primigravidae in a prospective study from 1987 to 1988. A special protocol for the evaluation and follow-up of adolescent pregnancies was made. The rate of adolescent pregnancies was found to be two times higher between the years 1985 and 1987-1988. The pregnancy complications seen in the adolescent patients were equal to or lower than those found in older women. The cesarean section rate was also found to be lower in adolescent pregnancies. We conclude that sexual education programs are necessary for the reduction of teenage pregnancies and adequate medical prenatal care, as well as psychologic and social support, must be given to avoid both medical and psychologic problems for the sensitive young mother.