摘要:

In 1983, a 24-year-old woman presented with a clear-cell vaginal adenocarcinoma. She had been exposedin uteroto maternally ingested diethylstilbestrol, taken from the 9th to the 16th week of pregnancy for threatened miscarriage. Treatment consisted of removal of the vagi-naand the vaginal portion of the cervix, together with the adjacent segment of the bladder and urethral wall. The pouch of Douglas was opened so that the supravaginal cervix could be divided above the vaginal fornices. This perineal procedure was accompanied by bilateral extra-peritoneal pelvic lymphadenectomy. One week later, reconstruction of the vagina was performed with a split-skin graft taken from the thigh (Mclndoe-Jayes technique). The apex of the graft was fenestrated for opposition to the supravaginal cervix.Following surgery, the patient was kept under regular surveillance, without evidence of recurrence of the malignancy. Some contraction of the neovagina occurred, and the donor site was afflicted with a “flare-up” of preexisting psoriasis. It was extremely difficult to identify the site of the “cervix,” but regular menstruation occurred, and it was possible to locate a pinpoint aperture communicating with the uterus.A period of primary infertility, to which a male factor contributed, ensued. Diagnostic curettage was carried out at a later stage. It was eventually decided that the couple might be suitable for gamate intrafallopian transfer. Conception, however, occurred without further intervention in 1986.Pregnancy proceeded uneventfully until the 36th week of gestation. Elective cesarean section had been chosen as the method of delivery, and consideration was given to prophylactic measures against midtrimester miscarriage. It was recognized that the uterine abnormalities associated with maternal diethylstilbestrol ingestion might, if present, predispose to early pregnancy loss. The complete absence of the vaginal portion of the cervix precluded cerclage except by the abdominal route, and a decision was made, by agreement with the patient, to await events. Spontaneous premature labor began at 36 weeks, and a female infant was born by emergency cesarean section. The baby thrived.

ISSN:0029-7828    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

It has been found that half of the direct maternal deaths are due to acute causes. For this reason, resuscitation techniques must remain an essential part of staff training for those who care for pregnant women. In the third trimester, resuscitation is complicated by compression of the aorta and vena cava by the uterus. The present authors describe a case in which cesarean section was performed as part of the resuscitation of the mother, resulting in the survival of mother and infant.A 27-year-old woman (gravida 2, para 1) was admitted at 38 weeks of gestation, having collapsed at home about 10 minutes earlier. Her antenatal course had been uneventful, and there was no history of uterine contractions or ruptured membranes. Upon admission, the patient was deeply cyanosed and apneic and had fixed, dilated pupils, and no pulse. Cardiopulmonary resuscitation was started, with intubation and the insertion of a right internal jugular line. An electrocardiogram of the patient showed asystole. She was tilted to the left lateral position, but resuscitation in that position proved difficult. Examination showed that the size of the uterus was compatible with the patient's dates. The single fetus presented cephalically, and the fetal heart was not heard.Five minutes after admission, a lower-segment cesarean section was performed while the patient was on the casualty trolley. The amniotic liquor was stained with blood, but there was no evidence of placental abruption. A male infant was delivered within 1 minute. The uterus was atonic, and there was no bleeding during the operation. Cardiopulmonary resuscitation was continued throughout the procedure. Immediately after delivery, the mother developed ventricular fibrillation, which was successfully treated with defibrillation. She was transferred to the intensive therapy unit 15 minutes after arrival.Results of tests on a blood sample taken upon admission were consistent with disseminated intravascular coagulation and showed amniotic squamous cells consistent with amniotic fluid embolism. Heavy vaginal bleeding occurred, and there was oozing from the abdominal wound. The disseminated intravascular coagulation was corrected with an infusion of packed cells, cryoprecipitate, platelets, and fresh frozen plasma.Twenty hours after the operation, the patient developed severe bilateral edema. Total support was continued until extubation on day 14, when a tracheostomy was performed. This was removed on day 39. A neurologist stated that her prognosis for survival was excellent, but that her intellectual function was likely to be poor. At 16 months postpartum, there was with minimal weakness on the right side. She was continent, but her mental state remained severely impaired, her speech was poor, and she needed constant attendance by her family.

ISSN:0029-7828    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1989

数据来源: OVID