RESUMO
Chronic non-puerperal uterine inversions are rare but the occasional case has to be managed without previous experience. Of the 77 cases reported, 75 (97.4%) were tumour produced and 20% of these tumours were malignant. The importance of taking biopsies from tumours before definitive surgery is highlighted. Adequate surgical management requires experience in vaginal surgery.
Assuntos
Leiomiossarcoma/complicações , Tumor Mulleriano Misto/complicações , Inversão Uterina/etiologia , Neoplasias Uterinas/complicações , Adulto , Idoso , Biópsia , Feminino , Humanos , Histerectomia , Leiomiossarcoma/patologia , Leiomiossarcoma/cirurgia , Tumor Mulleriano Misto/patologia , Tumor Mulleriano Misto/cirurgia , África do Sul , Inversão Uterina/classificação , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgiaRESUMO
OBJECTIVES: To study the epidemiology of eclampsia and the maternal and fetal outcome of the disease. DESIGN: Observational study. SETTING: Ga-Rankuwa Hospital, a tertiary institution. SUBJECTS: Patients admitted with the diagnosis of eclampsia from 1 January 1994 to 31 December 1995. OUTCOME MEASURES: Age, parity, booking status, fits, blood pressure, gestational age, mode of delivery, fetal outcome, maternal complications and outcome. RESULTS: Out of 18145 women delivered, 66 had eclampsia (3.6/1000). Of the 36 maternal deaths in the same period, 14 (38.9%) were caused by eclampsia. The case fatality rate was 21.2%. Maternal mortality was significantly higher in the unbooked population, women aged 30 years and above, and those with multiple fits. The mean (SD) maternal age was 22.3 (6.8) years and fits occurred in the presence of high diastolic blood pressure (mean 113.7 +/- 15.6 mmHg). The majority of fits (90.1%) occurred at home and in 70.3% of patients, this happened before 37 weeks (mean gestational age 33.2 (3.9) weeks). In 77.3%, eclampsia was antepartum while it occurred postpartum in 4.5% of cases. The caesarean section rate of 66.7% is justified. The perinatal mortality rate was 47.7% and maternal complications were varied and severe. It is disturbing that health care providers failed to act on warning signs in 14 (46.7%) of the 30 booked patients that were evident long before they developed fits. CONCLUSION: Eclampsia is a problem and is responsible for a significant proportion of maternal deaths. The epidemiological factors responsible are identified and some recommendations are made. Patient and physician education, together with improved socio-economic conditions, are likely to improve the situation.
