摘要:

Background: The antenatal diagnosis of fetal arrhythmias helps direct medical management, which may include intra-uterine therapy. Ectopic atrial tachycardia is an unusual arrhythmia in children, and we know of no previous reports of antenatal diagnosis of this particular arrhythmia.Case: The diagnosis of fetal ectopic atrial tachycardia was suggested by the monitor tracing during labor and was subsequently confirmed by the postpartum behavior of the arrhythmia and its electrocardiographs characteristics.Conclusion: Ectopic atrial tachycardia, although uncommon, should be considered in the differential diagnosis of fetal tachycardias. The fetal monitor tracing may be useful in making this diagnosis antenatally, which may help to direct management both before and after birth.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: Monoamniotic twin pregnancies are frequently associated with cord entanglement, but such entanglement rarely involves the co-twin's trunk, extremities, or neck.Case: We report a set of monoamniotic twins in which color Doppler imaging revealed that the cord of twin B was wrapped around the neck of its dead co-twin. This knowledge allowed us to avoid clamping and dividing twin A's nuchal cord during vaginal delivery, preventing asphyxia of twin B. This is the fifth reported incidence of this particular monoamniotic complication and the first to be diagnosed prenatally.Conclusion: Color Doppler imaging facilitates the diagnosis of rare cord complications in monoamniotic twin pregnancies.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: Intrauterine cytomegalovirus infection is usually unrecognized during pregnancy. However, in some cases, ultrasound abnormalities can be observed in association with cytomegalovirus infection.Case: The prenatal diagnosis of cytomegalovirus infection in a fetus with transient hydrops is reported. Fetal ascites was first recognized by routine ultrasound examination at 20 weeks' gestation. Hydrops fetalis was obvious at 23 weeks and completely resolved 1 week later. Cytomegalovirus was detected from amniotic fluid samples by centrifugal culture and direct immunofluorescent examination. The diagnosis of maternal primary infection could be established retrospectively by demonstrating immunoglobulin (Ig) G and IgM seroconversion on sequential sera. The pregnancy was electively terminated. Autopsy findings were consistent with fetal disseminated infection.Conclusion: Transient hydrops fetalis in association with intrauterine cytomegalovirus infection is infrequent. The resolution of hydrops fetalis could be explained by hepatic dysfunction of limited duration. Amniotic fluid culture is a reliable approach for diagnosing intrauterine cytomegalovirus infection, but does not predict the severity of the disease or the outcome of the pregnancy. The long-term clinical significance of intrauterine cytomegalovirus infection has to be established.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: Primary sclerosing cholangitis is a rare form of progressive biliary inflammation and fibrosis of unknown etiology that ultimately destroys the liver, leading to cirrhosis, liver failure, and death. Only one prior case has been reported in pregnancy.Case: Our patient had the diagnosis of primary sclerosing cholangitis made 2 years before conception. Her course was remarkable for retroplacental hemorrhage at 14–16 weeks and preplacental hemorrhage at 28–34 weeks, with fetal growth retardation, spontaneous premature rupture of the membranes, meconium-stained amniotic fluid, fetal bradycardia, and peripartal exacerbations of her disease. Most uniquely, however, in our case the fetal compromise was associated with an extreme elevation of the bile acid level to greater than 2000 mg/dL in the fetal circulation.Conclusion: The extreme elevation of fetal bile acidemia at levels greater than 40 times normal in our case may well represent the pathophysiologic link between aberrations of maternal bile acid metabolism during pregnancy and fetal compromise.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: Laparoscopic surgery has become an important tool in the treatment of tubal pregnancy. Skillful operative technique should prevent tissue spread and thus avoid persistence of ectopic trophoblastic cells.Case: A laparotomy with complete salpingectomy was performed in a patient with rising serum hCG levels after a previous laparoscopic partial salpingectomy for ampullary tubal pregnancy. The only residual trophoblastic tissue found was an implant in the abdominal wall at the site of auxiliary puncture.Conclusion: Extra-abdominal dispersion of active trophoblastic cells may lead to increasing hCG levels, mimicking persistent tubal pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: Ovarian torsion, although a rare gynecologic emergency, is a threat to women of all ages. Traditionally, ultrasonography and laparoscopy facilitated early diagnosis and treatment of this condition. This case report highlights the usefulness of color Doppler ultrasonography in the diagnosis of ovarian torsion.Case: A 25-year-old patient who conceived after ovulation induction was treated conservatively for mild ovarian hyperstimulation and threatened abortion. She subsequently underwent selective first-trimester multifetal reduction and was admitted and treated for suspected pelvic infection. On the 17th post-procedure morning, ovarian torsion was diagnosed using color Doppler ultrasonography.Conclusion: Because gynecologists face serious management dilemmas when confronted with ovarian torsion, this technique of using color Doppler ultrasonography should provide a highly specific finding in complete ovarian torsion, aiding the clinician in prompt diagnosis and treatment.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: Müllerian anomalies are associated with several gynecologic complications including endometriosis, infertility, and pelvic pain.Case: A woman with duplicate cervix and a non-communicating longitudinal vaginal septum, but no other uterine anomalies, presented with pelvic pain, secondary infertility, and a long history of endometriosis. She was treated with operative laparoscopy and excision of the vaginal septum.Conclusion: A thorough evaluation, including history, physical examination, and appropriate imaging techniques (hysterosalpingography and magnetic resonance imaging) facilitates accurate diagnosis of anatomical defects and any associated disease in cases of unusual mullerian anomalies. An accurate preoperative diagnosis allows a planned, efficient surgical approach.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: The role of cervical cerclage in the prevention of fetal wastage due to cervical incompetence is well established. The transvaginal approach and, failing that, the transabdominal approach, provide sufficient treatment in most cases. However, the traditional techniques require adequate cervical length for placement and maintenance of the suture.Case: We report a new technique used for a patient with a markedly foreshortened cervix and a history of multiple second-trimester pregnancy losses despite placement of McDonald cerclages. To improve the performance of the cervix, we included the lower portion of the uterus in a 3-cm-wide Prolene mesh cerclage. During the patient's subsequent pregnancy, the mesh band funneled the lower uterine segment, creating a functionally longer cervix. The patient successfully carried the pregnancy to term and was delivered by cesarean.Conclusion'. This variation on the transabdominal approach is useful in the management of patients with cervical incompetence who demonstrate a foreshortened cervix incapable of maintaining a traditional cervical suture.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: Appendicitis in a pelvic appendix can be difficult to diagnose. Transvaginal sonography may help to visualize an inflamed pelvic appendix.Case: A 31-year-old woman presented to the hospital with symptoms suggestive of pelvic inflammatory disease. Transabdominal ultrasound, useful in the diagnosis of appendicitis, showed a mass between the uterus and the right ovary. Transvaginal ultrasound clarified the finding as a bulbous fluid-filled structure extending into the cul-de-sac. The structure was diagnosed as an inflamed appendix. Laparoscopic appendectomy was performed, and the patient had an uneventful recovery.Conclusion: To our knowledge, this is the first case of appendicitis diagnosed with transvaginal sonography. Transvaginal sonography can delineate the features of an inflamed pelvic appendix and help to narrow the diagnostic possibilities in symptomatic women of childbearing age.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: Hemangiomas of the uterus are rare. Involvement of the uterus with hereditary hemorrhagic telangiectasia causing menorrhagia is also rare. To our knowledge, only one case of combined uterine hemangioma and hereditary hemorrhagic telangiectasia has ever been reported.Case: A 34-year-old woman was to undergo hysterectomy for menorrhagia unresponsive to treatment. Before surgery, she was found to have typical telangiectases associated with hereditary hemorrhagic telangiectasia. The fundus of the uterus contained a hemangioma extending from the serosa to the endometrium.Conclusion: Vascular malformations have been found in various organs in individuals with hereditary hemorrhagic telangiectasia. Although involvement of the uterus in hereditary hemorrhagic telangiectasia is uncommon, telangiectasia should be considered in any patient with menorrhagia resistant to treatment.

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID