Perforation of the Pregnant Uterus during Laparoscopy for Suspected Internal Herniation after Gastric Bypass.

We report perforations of a pregnant uterus during laparoscopy for suspected internal herniation after gastric bypass at 24 weeks of gestation. Abdominal access and gas insufflation were achieved by the use of a 12 mm optic trocar. An additional 5 mm trocar was positioned. The perforations were handled by suturing following laparotomy and mobilisation of the high located uterus. The uterine fundus was located in the subcostal area. Internal herniation was not verified. A cesarean section was made 6 weeks later due to acute low abdominal pain. During delivery the uterus was found normal. At 5 months of age the child has developed normal and seems healthy. Optical trocars should be used with caution for abdominal access during laparoscopy in pregnancy. Open access should probably be preferred in most cases. Accidental perforations of the uterine cavity may be handled in selected cases with simple closure even following the use of large trocars under close postoperative surveillance throughout the pregnancy.

Acute atherosis in decidual tissue: not associated with systemic oxidative stress in preeclampsia.

The aim of this study was to explore a possible association between the presence of decidual acute atherosis, maternal hyperlipidaemia and oxidative stress in the maternal circulation in preeclamptic and uneventful pregnancies. Decidual tissue was harvested by a vacuum suction technique following delivery of the baby and placenta in 102 caesarean deliveries. Maternal plasma lipid profile and concentration of 8-isoprostane, a marker of oxidative stress, was analysed. Acute atherosis was present in 42% of the preeclamptic patients with identified spiral arteries. CD68 positive foam cells were found in the spiral artery walls in 14% of the normal pregnancies. We have previously demonstrated an elevated plasma level of 8-isoprostane in the preeclampsia group, as compared to the uneventful pregnancy group (218 vs. 354 pg/mL, p=0.02). Presence of acute atherosis was, however, not associated with an elevated level of oxidative stress in the maternal circulation, measured as 8-isoprostane. In conclusion, the presence of decidual vascular changes in the form of acute atherosis is not necessarily paralleled by hyperlipidaemia or augmented oxidative stress in the maternal systemic circulation. This study adds to the notion of preeclampsia being a multifactorial disease with a variety of clinical forms.