Live Female Baby Research Articles

Psoriasis in Pregnancy

We report a thirty-five-year-old pregnant Bahraini patient with a flare-up preexisting psoriasis during the second half of pregnancy. At 33 weeks, intra uterine growth retardation was discovered. At 38 weeks, after failed induction, a cesarean section was performed; a healthy live female baby was delivered.

Twin Reverse Arterial Perfusion (TRAP): Case Report

The twin reversed arterial perfusion (TRAP) sequence is an anomaly unique to monochorionic multiple pregnancies. It is a rare complication. We present a case of acardius anephus, which was mistaken for a live anomalous singleton fetus. A 21-year-old unbooked Primigravida was seen in labour ward with a ten hours history of labour pains. Urgent transabdominal ultrasound revealed a singleton live fetus at 30 weeks gestation with gross cystic mass lesion at the level of the abdomen and polyhydramnious. Caesarean section confirms a twin gestation with monoamniotic monochorionic single placenta. The umbilical cord of the acardiac twin was short—First twin was a live female baby, weighing 1000 g. TRAP is a rare event an early referral to feto maternal unit will improve perinatal outcome.

Case report on septate uterus: An incidental finding in a multiparous woman who had an emergency cesarean section

Background: Septate uterus is caused by incomplete resorption of the Mullerian duct during embryogenesis which may alter the reproductive outcome of the patients. It is the commonest form of structural uterine anomaly and has the highest reproductive failure rate. Case Report: A 21-year-old booked G4P2 +1 woman with two living male children admitted into the Antenatal ward through the Accident and Emergency ward at 33 weeks gestation for conservative management of preterm premature rupture of membrane. She had a previous history of miscarriage, preterm delivery, and elective caesarean section due to breech presentation in her first, second, and third pregnancies in 2007, 2008, and 2009, respectively. She, however, had an emergency caesarean section due to fetal distress at 33 weeks plus 4 days with the delivery of a live female baby that weighed 2.0 kg with APGAR scores of 7 and 8 in the 1st and 5th minutes, respectively. There was intraoperative finding of septate uterus with dimple at the fundus. The other abdominal viscera were normal. Conclusion : congenital uterine anomalies especially septate uterus, though rare, should be suspected in women with positive history of miscarriage, preterm delivery and malpresentation. Keywords : Asia, fetal distress, multiparous, preterm, septate, uterus

English

Fetus acardia is a rare and serious complication of monozygotic twin gestation which usually presents as a placental mass. We encountered a case of acardia fetus as a skin covered placental mass which was incidentally detected during delivery of a live female baby. Grossly central area of the mass was bony hard and showed vertebral organization. Periphery was firm with a myxoid appearance. Histology of the mass revealed flattened epidermis, below which is a

Anesthetic management of a patient with narcolepsy for emergency caesarean section

Narcolepsy is defined as a neurological disorder and is characterized by excessive daytime somnolence, sleep paralysis and cataplexy [1]. The cause of this disorder is thought to be a loss of function of the neurones in the hypothalamus producing hypocretin/orexin peptides, which play an important role in the control of the human sleep-wake cycle [2]. Herein we present an emergency caesarean surgery of a narcoleptic patient under general anesthesia who was not receiving any treatment. A 35-year-old primigravida (weight: 82 kg, height: 165 cm) with a 13-year history of narcolepsy at 39 weeks gestation received emergency caesarean delivery due to failure of labor progression. She first experienced symptoms of excessive sleepiness when she was 22 years old, but she had been diagnosed by her neurologist at age 25 with narcolepsy. She was treated well with modafinil 200 mg and imipramine 10 mg. She stopped her medication of her own account 1.5 years ago. Bedside ultrasound, revealed fetal distress, and the patient was taken to the operating room for an emergency caesarean section. In the operating room, routine monitors (electrocardiogram, pulse oximeter, arterial blood pressure) were attached. Her blood pressure was 144/92 mmHg, heart rate was 88 beats/min, and pulse oximeter oxygen saturation was 97% at room air. Bispectral index (BIS) values of the patient were recorded using a BIS sensor applied to her left forehead. General anesthesia was induced with propofol 2 mg/kg, and rocuronium 0.6 mg/kg IV was administered to facilitate tracheal intubation. BIS values of the patient were above 95 before induction of anesthesia. Her trachea was intubated with a 7.5 mm-sized endotracheal tube in one attempt without difficulty. A live female baby weighing 3160 g was delivered (APGAR scores; at one minute: 9, and at five minutes: 10). Anesthesia was maintained with sevoflurane in 1 : 1 of oxygen and nitrous oxide mixture, with end tidal sevoflurane concentrations between 0.8-1.4%. BIS values ranged between 46 and 60. Hemodynamic parameters of the patient were stable during the surgery. The surgery lasted 50 minutes. Postoperative analgesia was provided with intramuscular diclofenac sodium. Neuromuscular blockade was antagonized with 100 mg sugammadex. When she responded to verbal commands with sufficient respiration and neuromuscular function, she was extubated successfully. Her BIS value was above 94 after extubation. She did not experience any complications such as cataplexy, apnea, or prolonged emergence associated with narcolepsy in the postanesthesia care unit. She was discharged home on the third postoperative day. There's no specific treatment for narcolepsy. While excessive daytime sleepiness is treated using central nervous system stimulants, cataplexy is treated with various tricyclic antidepressants or with fluoxetine. All of these drugs used to treat narcolepsy are metabolized in the liver by the cytocrome P 450 system as propofol and fentanyl. For this reason, the anesthesist should be aware of potential drug interactions [3]. Additionally, use of amphetamines may cause a depletion of catecholamines and reduce patients' ability to generate a sympathetic response to hypotension. Direct acting agents such as phenylephrine and/or epinephrine should be used to treat refractory hypotension instead of indirect acting agents such as ephedrine [4]. It has been reported that central nervous system stimulants like modafinil can be used safely during the preoperative period. However, limited information is available about the safety of modafinil in pregnancy. Embryo toxicity has been shown in rats, and the manufacturer recommends avoidance during pregnancy and while breastfeeding [5]. Our patient had been using modafinil 200 mg and imipramine 10 mg once daily before her current pregnancy, but she stopped taking her medication. In the present case report, we used sevoflurane in a 50% oxygen and 50% nitrous oxide mixture without complication. We used a BIS monitor for titrating sevoflurane concentrations. We did not use narcotics and long-acting agents. Our patient was extubated without any complication at the end of the operation. In conclusion, we found sevoflurane anesthesia safe to use for the management of an uncontrolled narcoleptic patient with BIS monitoring for emergence caesarean section.

Delayed visual recovery in pregnancy-associated thrombotic thrombocytopenic purpura with bilateral serous retinal detachment

To present a pregnancy-associated thrombotic thrombocytopenic purpura (TTP) patient with bilateral serous retinal detachment (SRD). Case report. A 28-year-old nulliparous woman with 31 weeks gestation was presented to the local hospital with preeclampsia, hemolytic anemia, thrombocytopenia and bilateral blurry vision. Funduscopic examination showed bilateral macular SRD. Within the first month after delivery of a live female baby via cesarean section (at 32 weeks gestation), the patient experienced a recurrent course of hemolytic anemia and thrombocytopenia, and was then transferred to our hospital. On admission, her best corrected visual acuity (BCVA) was 0.1 OU; optical coherence tomography (OCT) confirmed the presence of bilateral macular SRD; electroretinography (ERG) examination showed diminished rod responses with reduced a and b waves in cone and mixed rod-cone responses. She was ultimately diagnosed with TTP and was treated systemically with fresh frozen plasma, rituximab, prednisone and cyclophosphamide. Despite persistent visual disturbances, she was discharged 1 month after admission with stabilization of systemic manifestations. At her first follow-up visit 6 months after discharge, surprisingly, her BCVA had improved to 1.0 OU; fundus examination and OCT confirmed the complete resolution of bilateral macular SRD and ERG revealed subnormal (right) and normal (left) electrophysiological responses. We believe that in this case, the clinical context (pregnancy) in which TTP developed, the unreported ERG characteristics and the unexpected delayed visual recovery are worth reporting. TTP should be considered as a potential differential diagnosis in patients with pregnancy-associated SRD. Appropriate systemic treatment might be mandatory for visual recovery.

Live Birth Following Resection of Multiple Submucous Myomas: A Unique Case Report

Uterine leiomyomas are by far the most common benign uterine tumours present in almost 25 % women of reproductive age. However fibroids are an infrequent cause of infertility being the sole cause in less than 3 % of infertile couples [1]. Uterine fibroids especially submucous leiomyomas may be associated with infertility as well as with subfertilty and pregnancy losses. Some researchers have speculated that the location of fibroids within the endometrial cavity may interfere with sperm transport and/or implantation [2]. One study has calculated a 10 % rate of pregnancy complications in women with fibroids [3]. Though being an infrequent cause of infertility and pregnancy complications, it is still extremely rare to have a pregnancy, that too uneventful in patients with extreme distortion of uterine cavity due to multiple intramural and submucosal fibroids. We would like to report such a case. Patient first presented in 1998 at 28 years of age with secondary infertility and failure to conceive for 1 year. She was married for 4 years and had undergone medical termination of pregnancy 2 years earlier. On investigations, she had regular ovulatory cycles; hysterosalpingogram confirmed bilateral tubal patency and the semen parameters were normal. Pelvic ultrasound showed a uterus with numerous intramural and submucous fibroids of variable size, the largest being 3 × 3 cm. There were no other factors contributing to infertility. She was subjected to six-cycles of COH with IUI, using Clomiphene for 3 cycles urinary gonadotrophins for other 3 cycles. These were unsuccessful. Pelvic ultrasound revealed increasing size and number of myomas. In view of above finding and inability to conceive, she was taken up for operative laparoscopic and hysteroscopic resection of myomas, wherein eight submucosal myomas were resected, the largest on the right lateral wall measuring 3 × 3 × 3 cm. Diagnostic laparoscopy revealed multiple subserous and intramural myomas on the posterior wall and right cornua. Both the tubes were patent. Three more cycles of controlled ovarian hyperstimulation with intrauterine insemination were attempted to no avail. Pelvic ultrasound again revealed a number of submucous myomas. Two injections of depot GnRh-agonist were administered at four weekly intervals and hysteroscopic loop resection of fourteen submucous myomas was done (Fig. 1). Due to suboptimal preovulatory endometrium, IVF was delayed till endometrium was 7 mm and carried out 8 months later. However, at the time of embryo transfer the endometrium was only 5.4 mm triple layered. She failed to conceive and discontinued any further management. She next came to us 10 months later at 35 years of age with a naturally conceived pregnancy. Despite our apprehensions and USG again confirming an extremely unhealthy milieu interior for the conceptus she continued her pregnancy uneventfully except for mild PIH. She was taken up for an elective LSCS at 37 weeks of gestation and a live female baby was delivered. The placenta was however partially adherent and removed piecemeal because the entire uterine cavity was riddled with fibroids from 0.3 to 4 cm in size, a few of which presented themselves in the surgeon’s hands. This case brings a ray of hope to those managing seemingly hopeless cases of leiomyomas. Fig. 1 View of submucous myomas at time of second hysteroscopic resection S submucous myoma, U uterine cavity

Anaesthesia for a patient with Eisenmenger′s syndrome undergoing caesarean section

Eisenmenger's syndrome is a cyanotic congenital heart disease that includes pulmonary hypertension with reversed or bidirectional shunt associated with septal defects or patent ductus arteriosus. The decreased systemic vascular resistance associated with pregnancy increases the degree of right to left shunting, thereby carrying substantial risk to both the mother and the foetus. The maternal mortality rate of pregnancy in the presence of Eisenmenger's syndrome is reported to be as high as 30–70%. We present a case of a 22-year-old primigravida with Eisenmenger's syndrome who gave birth at 37 weeks of gestation via caesarean section to a live female baby under general anaesthesia. On the third post-operative day, the patient developed tachycardia, tachypnoea, hypotension and decrease in oxygen saturation despite supplemental oxygen, clinically suspected pulmonary thromboembolism. We describe the anaesthetic management for caesarean section and its complications in a patient with Eisenmenger's syndrome. Although pregnancy should be discouraged in women with Eisenmenger's syndrome, it can be successful.

Spontaneous Heterotrophic Pregnancy with Tubal Rupture and Delivery of a Live Baby at Term: a Case Report

Heterotopic pregnancy is the coexistence of intrauterine and extrauterine gestations. It is associated with significant maternal morbidity and mortality particularly in low resource settings. Spontaneous heterotopic pregnancy is very rarely seen with documented incidence of 1 in 30,000 pregnancies. We present the first case of heterotopic pregnancy managed in our center with the delivery a live female baby at term. The case of a 25 year nulliparous lady who presented in our center with lower abdominal pains, amenorrhoea and an ultrasound report confirming an intrauterine, pregnancy is presented. Examination revealed mild right iliac fossa tenderness, cervical motion tenderness and a bulky uterus. A trans-vaginal ultrasound scan confirmed a right fimbrial ectopic gestation. A right salpingectomy was performed. The patient subsequently had an uneventful antenatal period and spontaneous vaginal delivery of a live female baby at term. We also review literatures on heterotopic pregnancy and its management. Spontaneous heterotopic pregnancy a potentially fatal condition though rare can occur in our environment. Clinicians should maintain a high index of suspicion in all patients presenting with amenorrhoea and abdominal pains even if an intrauterine pregnancy has been confirmed and a thorough evaluation of the adnexae using a trans-vaginal ultrasound scan should be routinely performed in such cases.

A case of tuberculosis causing extensive surgical maternal morbidity and poor neonatal outcome

The incidence of tuberculosis in pregnancy in UK is increasing among ethnic minority women.A 25 year old Indian woman with a BMI of 17 was booked in her first pregnancy.Her...

A rare case of term viable secondary abdominal pregnancy following rupture of a rudimentary horn: a case report

IntroductionAbdominal pregnancy is a rare event, but one that represents a grave risk to the health of the pregnant woman. An abdominal pregnancy is defined as an ectopic pregnancy that implants in the peritoneal cavity. Early abdominal pregnancy is self-limited by hemorrhage from trophoblastic invasion with complete abortion of the gestational sac that leaves a discrete crater. Advanced abdominal pregnancy is a rare event, with high fetal and maternal morbidity and mortality.Case presentationThis is a case report of a 22-year-old primigravida with an abdominal pregnancy from a ruptured rudimentary horn. She was diagnosed as a case of term pregnancy with placenta previa with a transverse fetal lie and cervical fibroid and was prepared for an elective cesarean section. Intra-operatively, a live term female baby was extracted from the peritoneal cavity and it turned out to be an abdominal pregnancy from a ruptured rudimentary horn of a unicornuate uterus, which is a very rare condition. Mother and baby were in good condition after such a catastrophic event.ConclusionThis case illustrates a rare obstetric condition which can be a severe catastrophic condition leading to maternal mortality and morbidity. It is imperative for every obstetrician to have in mind the possibility of abdominal pregnancy, although rare, especially in pregnant patients with persistent abdominal pain and painful fetal movements.

Disseminated Intravascular Coagulation Following Induction of Labour with Misoprostol:

Disseminated Intravascular coagulopathy (DIC) has been reported following use of Misoprostol which is an old drug with new indications in Obstetrics and Gynecology. Its effectiveness, low cost, stability in tropical conditions and ease of administration as well as side effects like gastrointestinal effect, uterine rupture and post partum haemorrhage (PPH) have been documented. This is to report a case of disseminated intravascular coagulopathy (DIC) associated with use of misoprostol for induction of labour and to call for extra vigilance in its use. This was a case of 22-year old gravida 2 para 1 at 42 weeks gestation that was induced with 100 microg of misoprostol and delivered a live female baby with good Apgar score. She subsequently developed PPH and epistaxis simultaneously, then conjunctival haemorrhage 30 minutes later. She was managed with fresh whole blood and had a satisfactory recovery. Life threatening complication could result from use of Misoprostol. More research and high index of suspicion are needed to establish the association of prostaglandins with DIC.

Ruptured uterus in a primigravida, secondary to abdominal manipulation by a traditional birth attendant: a case report

Rupture of the gravid uterus is a life threatening obstetric complication which is a rare event in the primigravida. We present a case of uterine rupture in a 34 year-old unbooked primigravida. She presented in labour post-term to a traditional birth attendant who carried out an abdominal manipulation to correct a suspected oblique lie. Soon afterward she developed severe epigastric pain and breathlessness and was referred to our center. Findings at operation included a live female baby weighing 2.9kg and 6 cm transverse posterio-fundal rupture. Repair of the uterine rupture was done without bilateral tubal ligation. Keywords : uterus, rupture, TBA, manipulation Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 83-84

Anesthetic management of Cesarean delivery in a patient with hypoplastic anemia and severe pre-eclampsia

To describe the anesthetic management of Cesarean delivery in a patient with hypoplastic anemia and severe pre-eclampsia. A 28-yr-old parturient with a history of thrombocytopenia was admitted with signs of pre-eclampsia (blood pressure of 140/90 mmHg, heavy proteinuria and moderate bilateral ankle edema) at 25 weeks of gestation. Laboratory studies revealed pancy-topenia (hemoglobin 6.4 g.dL(-1), white cell count 3.43 x 10(9).L(-1), platelet count 20 x 10(9).L(-1)) and bone marrow biopsy showed hypoplastic anemia. As pre-eclampsia worsened, a Cesarean delivery was performed at 27 weeks with prophylactic platelet transfusion and meticulous blood pressure control. The procedure was uneventful, conducted under general anesthesia with an estimated blood loss of around 600 mL and a live female baby was delivered. Postoperatively her blood pressure and neurological symptoms improved but thrombocytopenia remained at discharge. Hypoplastic anemia is rare in pregnancy but it poses an increased risk for both mother and fetus. The mother is at risk of life-threatening episodes of bleeding and infection and a multidisciplinary team approach (obstetrician, anesthesiologist, hematologist and pediatrician) is essential. An accurate assessment of the hematological condition should be made and abnormalities corrected before surgery. Regional anesthesia may not be possible in this circumstance.

A Term Abdominal Pregnancy

SummaryA 36 year old infertile primigravid lady had a laparotomy at 39 weeks and was found to have an abdominal term pregnancy. A live female baby was delivered safely. The placenta was left in situ. The mother was followed up for 3 months after delivery and observations were made on her clotting function, and on the fate of the placenta, by serial plasma steroid estimations and by serial ultrasonic scans.

Pheochromocytoma Associated with Pregnancy: A Case Report

Pheochromocytoma Associated with Pregnancy: A Case Report