Retroplacental Hematoma Research Articles

Determinants of retroplacental hematoma at the Maradi mother and child health center, Niger: a case‒control study.

Retroplacental hematoma is a paroxysmal accident that threatens maternal and fetal prognosis. It is a major emergency in obstetric pathology. The objective of this study was to identify the factors associated with retroplacental hematomas at the Maradi Mother and Child Health Center in 2022. This was a case‒control cross-sectional analytical study that used patient records for the year 2022 from September 20 to October 20, 2023. The presence of a retropl placental hematoma was the outcome variable and was measured by a case (yes) or control (no) response. The exposure variables included sociodemographic characteristics, obstetric characteristics, care, progression of patients and neonatal characteristics. Pearson's chi-square tests at the 5% significance level were used to analyze differences between categorical variables. All variables that had a bilateral p value < 0.05 in the bivariate analysis were introduced into the binary logistic regression model to identify factors associated with retroplacental hematoma. A total of 246 cases of retroplacental hematoma were recorded out of 4731 deliveries recorded during the study period, for an estimated frequency of 5.20%. The mean age of the patients was 29.41 ± 6.94 years. Factors associated with retroplacental hematoma included multiple parity [adjusted odds ratio (ORA): 0.38, 95% confidence interval (CI) (0.24-0.61)], fewer than 4 antenatal visits [AOR: 10.70, 95% CI (1.14-99.74)], blood transfusion [AOR: 2.01, 95% CI (1.11-3.60)], a newborn birth weight less than 2500g [AOR: 1.92, 95% CI (1.53-2.42)] and fetal mortality in utero [AOR: 13.20, 95% CI (1.86-93.70)]. This study identified the factors associated with retroplacental hematoma. Prevention requires regular, high-quality prenatal care. Early diagnosis and cesarean section improve maternal-fetal prognosis. Not applicable.

Contribution of Ultrasound in the Management of Haemorrhages in the Third Trimester of Pregnancy at the Kalabancoro Reference Health Center, Mali 2023

Introduction: Haemorrhages in the third trimester of pregnancy are nowadays a frequent situation that can jeopardize the maternal-fetal prognosis. Given its scale and degree of seriousness, this work was initiated to assess the contribution of ultrasound in its management. Material and Methods: This was a descriptive cross-sectional study with retrospective data collection which took place at the Kalabancoro Reference Health Center from May 1, 2022 to October 31, 2022. Its objective was to study the contribution of ultrasound in the management of haemorrhage in the third trimester of pregnancy. Results: During the study, 154 cases of haemorrhage in the third part of pregnancy out of 2,546 pregnancies were recorded, representing a frequency of 3.4%. The average age of the patients was 27 ± 3.5 years with extremes of 16 and 38 years. Married women were the most represented with 84.4%. Out-of-school women were the most represented, accounting for 63.6% of cases. Multiparous women were the most represented with 39.6% cases. Arterial hypertension was the most common medical history, i.e. 66.6%. Bleeding during pregnancy was the most frequent reason for consultation with 87.6%. Retroplacental hematoma was the predominant etiology, i.e. 67.5%. In utero fetal death was found in 54.5% of cases. Conclusion: The contribution of ultrasound was very important in the therapeutic decision-making. Emergency caesarean section was performed in 66.7% of cases.

Uterine layers hypervascularization in atypical placentation: the comparison of magnetic resonance imaging with vascular pathomorphology

Rationale: One in five women worldwide delivers through cesarean section, which is associated to a high rate of placenta previa and abnormal placenta attachment to the uterine wall. The grade of placenta accreta spectrum (PAS) correlates with blood loss volume, which could be related to vascularization characteristics. Up to now, there have been no studies on the diagnostic value of magnetic resonance criteria for hypervascularization of the uterine wall and their correlation with an assumed grade of PAS according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Also, abnormal vessels location and their wall structure have not been studied with state-of-the-art pathomorphological methods. Aim: To develop a classification for various types of the uterine wall hypervascularization depending on the depth of placental invasion assessed by magnetic resonance imaging (MRI). Methods: We retrospectively analyzed medical files of 66 patients aged 18 to 45 years, who were assumed to have PAS based on their sonography results. To clarify the extent and localization of the placental invasion, all patients had MRI performed at 24 to 32 weeks of gestation. In all patients, the PAS grade was verified pathologically; in 30 of them (45,5%), a detailed pathological examination was additionally performed. The PAS grades were classified according to Morbidly Adherent Placenta Imaging Reporting and Data System (MAPI-RADS). The MRI data were correlated with the PAS (FIGO) grade estimated from intraoperative data and with intraoperative blood loss. At the final study step, the MRI data was correlated with abnormal pathomorphology, with the assessment of the degree of vascularization and the visual picture of abnormal uteroplacental vasculature. Results: We have proposed a classification of MRI signs of hypervascularization in the lower uterine segment correlating with the depth of placenta accreta. Type 1. Single small vessels in the myometrium, medium caliber arteries in the projection of the uterine serosa (normal variation for the 3rd trimester of gestation). Type 2. Numerous small confluent vessels, mainly in the uteroplacental region, and retroplacental hematomas (typical for placenta accreta, or FIGO PAS 1). Type 3. Intrauterine hypervascularization with a deficient myometrium thickness, predominantly vessels of the middle layer (typical for placenta increta, or FIGO PAS 2). Type 4. Thinning of the lower uterine segment due to significant bulging of the placenta in the presence of curved anastomosing vessels of vast caliber over 4 mm (typical for placenta increta – FIGO PAS 2, as well as placenta percreta – FIGO PAS 3a). Type 5. Hypervascularization outside the uterus, over its surface and in the parametrial tissues: at the border with the bladder, uterine isthmus, including signs of fibrosis and growing into the posterior bladder wall (typical for various grades of placenta percreta – FIGO PAS 3b, 3c). Conclusion: The proposed classification of uterine wall hypervascularization in accordance with the grades of placenta accreta spectrum (FIGO PAS) could be useful for its practical implementation by radiologists.

Cesarean Delivery in Case of Retroplacental Hematoma in a Reference Health Center in Bamako, Mali

Introduction: Retroplacental hematoma is a significant cause of maternal death in developing countries. The objective of this study was to study the retroplacental hematoma at the reference health center (CSRef) of commune V of the district of Bamako. Patients and Method: This was a cross-sectional study conducted at the gynaecological and obstetrics department of the CSRéf of commune V in the district of Bamako. It involved 117 cases of retroplacental hematoma. Data entry and analysis were carried out on the Epi info software version 6.2. Results: Our study found that the frequency of retroplacental hematoma was 1.44%. The preferred age was 20 to 34 years (76.3%). Large multiparous women were the most affected (38.1%) and 6.2% of patients had a history of HRP. Caesarean section was the most commonly used route of delivery (82.9%) and the fetal prognosis was very poor (64% of fresh stillbirths). Postoperative complications were dominated by anaemia (81.4%). Conclusion: Retroplacental hematoma is a worrying pathology because of its maternal and perinatal morbidity and mortality.

Influence of Seasonality on the Frequency and Prognosis of Retroplacentary Hematoma at the Gabriel Touré University Hospital in Bamako (Mali)

This was a cross-sectional, retrospective study on the influence of seasonality on the frequency and prognosis of HRP at the Gabriel Touré University Hospital from January 1, 2020 to December 31, 2022, i.e. a duration of 3 years. This study allowed us to identify over a period of 3 years, 595 cases of HRP out of a total of 9447 deliveries, i.e. a frequency of 6.2%, with an increase in cases of HRP during the rainy season to 43.02%. The main reason for admission was metrorrhagia/pregnancy 83.03%. We found at the end of our study that the rainy season is a risk factor for the occurrence of HRP with a frequency of 43.02% during the rainy season, followed by the hot season at 30.25% and the cold season at 26.72%. Sher's HRP grade IIIA was the most diagnosed type at 76.63% and especially during the rainy season, with more complications of anemia and hemorrhagic shock at 73.61% and 14.96%. Caesarean section was performed in 80.2% of cases. We recorded 42 HRP-related maternal deaths or 7.05%, with a higher number during the rainy season at 59.52%. The fetal prognosis was poor with 89.06% fetal mortality. Retroplacental hematoma is a relatively common obstetric pathology. The rainy season would have an impact on its occurrence, but also on the maternal and fetal prognosis in our context.

UTERINE RUPTURE IN A HEALTHY UTERUS ASSOCIATED WITH A RETROPLACENTAL HEMATOMA, REPORT OF A CASE AND REVIEW OF THE LITERATURE

Uterine rupture is a complication of childbirth, its relatively rare but its actual frequency is relative to degree of development of the health system of the country where it occurs. The vital prognosis of the mother and that of the fetus are most often at stake, as well as the subsequent fertility of the patient. Its frequency is increased for scarred uteri and increasingly rare for healthy uterus. Through this work, we present an atypical case of uterine rupture occurring in a non-scarred uterus in a context of eclampsia complicating severe preeclampsia in a 31-year-old patient diagnosed intraoperatively. We discuss through this case and the review of literature, the interest of keeping in mind that this complication can threaten any childbirth even when the diagnosis of other complication seems more conclusive the case of a retroplacental hematoma in our case. The clinical warning signs, the risk factors, the diagnostic methodology are crucial to the therapeutic management of this entity.

Assessment of an AI-based tool for population-wide collection of placental morphological data

ObjectivesAutomated placental assessment could allow accurate and timely morphological/pathological measurements at scale. We undertook a pilot study using an artificial intelligence-based assessment system (AI-PLAX) to ascertain the potential of a state-wide rollout as part of Generation Victoria, assessing the impact of time post-delivery, user, and technology used for image capture, on a range of derived placental data. Study designTen placentas were imaged by three different users and imaging technologies (iPad, iPhone, Samsung) at (0 h), 24 h, and 48 h post-delivery. Using AI-PLAX, disc size (short and long length, perimeter, area), shape (normal, abnormal), cord insertion type (central, eccentric), cord coiling, abruption (retroplacental hematoma), and meconium staining were determined. ResultsWhen analysing the maternal surface of the placenta, time in cold storage post-delivery had modest effects on placental dimensions, with decreases in the short length (24–48 h: −3.7 %), disc area (0–24 h: 4.7 % and 0–48 h: −7.4 %), and perimeter (0–48 h: −3.8 %) observed. There was marginal impact on placental dimensions when the placenta was imaged by different users, including long length (+1.9 %), disc area (+2.9 %), and perimeter (+2.0 %). Measures of placental size were not impacted by the type of technology used to capture the images. When analysing the fetal surface of the placenta, more variance in placental size measures were observed between users. Abruption detection was not affected by any parameter. Time between delivery and imaging impacted apparent meconium staining – likely reflecting changes in fetal surface colour over time. Meconium staining was not affected by technology or user. ConclusionsThis study supports the feasibility of the collection of placenta images for later morphological analysis by AI-PLAX, with measures obtained minimally influenced by time in cold storage, user imaging the placenta, or technology to capture the images.

Renal Cortical Necrosis Complicating Postpartum Hemorrhage. Use of Tranexamic Acid: Solution or Problem? Case Report

Renal cortical necrosis associated with postpartum hemorrhage is a rare obstetric complication that can lead to end-stage renal disease. We report a case of a 37-year-old woman, admitted for preeclampsia complicated by in utero fetal death, having presented postpartum hemorrhage complicated by a retroplacental hematoma (RPH). She was treated with tranexamic acid to control bleeding. She subsequently presented a severe acute kidney injury (AKI) requiring hemodialysis with, on computed tomography (CT), the presence of bilateral renal cortical necrosis. A renal biopsy showed cortical necrosis lesions associated with glomerular and vascular thrombotic microangiopathy. There was no recovery of renal function, requiring long-term hemodialysis. Renal cortical necrosis, although rare, can occur in some cases of postpartum hemorrhage. Tranexamic acid would be involved and its use should be done with suspicion. The CT scan is an important diagnostic tool. Renal prognosis is poor.

Retro Placental Hematoma: Maternal and Fetal Prognosis at the Maternity of the University Hospital of Bouake

Retro Placental Hematoma: Maternal and Fetal Prognosis at the Maternity of the University Hospital of Bouake

Role of Blood Transfusion in the Management of Obstetric Emergencies in the Gynaecology-Obstetrics Department of Gao Hospital (Mali)

The aim was to evaluate the role of blood transfusion in the management of obstetric emergencies in the gynaecology and obstetrics department at Gao Hospital. Materials and methods: This was a prospective, descriptive, cross-sectional, analytical study from January 01 to June 30, 2020, i.e. a period of six (06) months in the gynecology-obstetrics department at Gao Hospital. Results: We recorded 536 cases of obstetric emergencies, of which 120 cases required emergency blood transfusion, i.e. 22.39%. The 20-29 age group was the most affected with an average age of 26.5 years. The extremes were 15 and 49 years old. About 95.8% of the transfused women were housewives. During our study, 99.2% of transfused patients were married. During our study, the majority of transfused patients were non-literate, i.e. 90% of cases. Referral/Evacuation was the most common mode of admission at 63.3%. The majority of women transfused had a haemoglobin level between 4 and 6 g/dl, or 55.8%. Whole blood was the only blood product for blood transfusion, accounting for 100% of cases. In 39.2% of the cases, we asked for 4 units of blood. 37.5% of patients had received at least 2 units of blood. During our study, 341 bags were prescribed, an average of 2.85 per patient. Of the 341 bags requested, 237 were served, which represents 69.5% of needs covered. The rate of unmet needs was 30.5% or 104 bags of blood. Retroplacental hematoma was the main indication for blood transfusion with 21.7% of cases. In 7.5% of patients experienced transfusion-related complications (malaria). 70.0% of patients had a haemoglobin level between 8 and 9 g/dl after transfusion. The majority of transfused patients were discharged from hospital (cured), i.e. 93.3%. Conclusion: The rate of unmet obstetric needs is high. This high rate can have a negative impact on obstetric prognosis.

ULTRASOUND IN THE ETIOLOGICAL ASSESSMENT OF HEMORRHAGES DURING THE 3RD TRIMESTER OF PREGNANCY AT THE FERTILIA MEDICAL CLINIC IN BAMAKO

Background: Haemorrhage in the third trimester of pregnancy is a major public health problem because it can jeopardize the vital prognosis of the mother and the fetus. The objective of our study was to study the sonographic etiologies of hemorrhages in the 3rd trimester of pregnancy. Subjects and Methods: This was a 5-year cross-sectional and prospective study, between JUNE 2017 and MAY 2022, which involved 82 pregnant women who were between 28 and 40 weeks of amenorrhea (SA) and who presented with hemorrhage regardless of its volume. The data collected was obtained on the ultrasound reports and a series of questions asked either of the patient or her companions. Data were entered and analyzed on SPSS version 26.0. Results: In our study, we performed 12,900 obstetrical ultrasounds, of which 82 women had hemorrhage, i.e. a frequency of 0.63%. The average age was 29 years with extremes ranging from 17 to 43 years. 39 patients or 47.5% were between 20 and 30 years old. 42 patients or 51% were multi gestures. 51 patients or 62% were multiparous. The clinical information prompting an ultrasound was abdominal pain + metrorrhagia in 58.5% of cases. 70.7% were between 37 SA and 42 SA. The sonographic etiologies were retroplacental hematoma (HRP) with 56% placenta previa (33%), placenta previa+HRP (2.2%) and uterine rupture (1.8%). Conclusion : Faced with the occurrence of metrorrhagia in the 3rd trimester of pregnancy, it is always necessary to think of the most serious etiologies, which are ultimately not so rare and can jeopardize the vital prognosis of the mother and the child. A targeted questioning and a concise clinical examination make it possible to quickly orient towards an etiology. Ultrasound is an invaluable diagnostic and prognostic aid. The speed of emergency care can sometimes save the child, most often the mother.

Retroplacental Hematoma with Non-Term Live Fetus; a Relevant Indication for Vaginal Caesarean Section

The objective is to report a clinical case of vaginal caesarean performed to save a fetus in distress by retroplacental hematoma. For this indication, the vaginal caesarean can be an alternative to the classic caesarean because of its short duration and the preservation of the possibility of future childbirth by natural means. However, this surgical technique described since the 19th century is still unknown to many practitioners and few publications exist on the subject throughout the world. Considered obsolete by some practitioners, it retains all its advantages in the practice of modern obstetrics. We report this case of fetal rescue performed by vaginal caesarean section at the Reference Health Center of the Sanitary District (District Hospital) of Bla in Mali in a 34-year-old patient, admitted for retroplacental hematoma with live fetal on a non-term pregnancy in latency phase of labor.

Placental Pathology and Maternal Risk Factors for Stillbirth: A Case-Control Study.

Background Fetal death is the delivery of a fetus with no sign of life, as indicated by the absence of breathing, heartbeat, pulsation of the umbilical cord, or definite movement of voluntary muscles. Nearly 2.6 million stillbirths are estimated to occur worldwide every year. Almost all of these (98%) stillbirths occur in low- and middle-income countries. About one-sixth of the stillbirths globally were recorded in India in 2019, making it the most burdened country in the world. In light of this, we conducted a study to identify the placental pathologies and maternal factors associated with stillbirth. Methodology A case-control study was conducted at the Department of Obstetrics & Gynecology, Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), from June 2022 to May 2023. Cases included pregnant women with a gestational age of 28 weeks or more who delivered a stillbirth infant at VIMSAR, and controls included gestational age-matched deliveries with live birth. Consent to participate in the study was obtained before enrolment. The final sample size was 79 cases and controls. The chi-square test was performed for bivariate analysis, and logistic regression was used for multivariate analysis. Results In our study, we found a significant association between maternal age of more than 30 years (odds ratio (OR) = 3.01, 95% confidence interval (CI) = 1.91-4.22, p = 0.012), maternal education (with up to the primary level or less: OR = 6.19, 95% CI = 2.92-7.87, p = 0.012), history of addiction (tobacco chewing: OR = 5.58, 95% CI = 3.71-7.11, p = 0.03), and the number of antenatal visits (no visit: OR = 6.87, 95% CI = 2.91-7.79, p = 0.019) with an increased risk of stillbirth. Among the obstetrical complications, pre-eclampsia/eclampsia (OR = 3.87, 95% CI = 1.98-5.11, p = 0.001), premature rupture of membranes (PROM)/preterm premature rupture of the membranes (PPROM) (OR = 2.49, 95% CI = 1.31-3.91, p = 0.03) and antepartum hemorrhage (APH) (OR = 2.66, 95% CI = 1.65-3.58, p = 0.02) were found to be significantly related with stillbirth. Among placental pathologies, uteroplacental vascular pathology (OR = 7.39, 95% CI = 3.01-8.97), acute chorioamnionitis (OR = 3.35, 95% CI = 2.11-5.21), chronic inflammation (OR = 2.33, 95% CI = 1.91 4.17), calcific changes (OR = 4.46, 95% CI = 2.56-6.01), and retroplacental clots (OR = 9.95, 95% CI = 4.39-11.71) were associated with stillbirth. Conclusions In our study, advanced maternal age, absence of antenatal visits, low level of education, tobacco addiction, pre-eclampsia/eclampsia, APH, and PROM in pregnancy were the major risk factors associated with stillbirth. Uteroplacental vascular pathology, chorioamnionitis, chronic inflammation, retroplacental hematoma, and calcific changes were the most significant placental lesions associated with stillbirth.

Obstetrical complications in hereditary fibrinogen disorders: the Fibrinogest study

BackgroundWomen with hereditary fibrinogen disorders (HFDs) seem to be at an increased risk of adverse obstetrical outcomes, but epidemiologic data are limited. ObjectivesWe aimed to determine the prevalence of pregnancy complications; the modalities and management of delivery; and the postpartum events in women with hypofibrinogenemia, dysfibrinogenemia, and hypodysfibrinogenemia. MethodsWe conducted a retrospective and prospective multicentric international study. ResultsA total of 425 pregnancies were investigated from 159 women (49, 95, and 15 cases of hypofibrinogenemia, dysfibrinogenemia, and hypodysfibrinogenemia, respectively). Overall, only 55 (12.9%) pregnancies resulted in an early miscarriage, 3 (0.7%) resulted in a late miscarriage, and 4 (0.9%) resulted in an intrauterine fetal death. The prevalence of live birth was similar among the types of HFDs (P = .31). Obstetrical complications were observed in 54 (17.3%) live birth pregnancies, including vaginal bleeding (14, 4.4%), retroplacental hematoma (13, 4.1%), and thrombosis (4, 1.3%). Most deliveries were spontaneous (218, 74.1%) with a vaginal noninstrumental delivery (195, 63.3%). A neuraxial anesthesia was performed in 116 (40.4%) pregnancies, whereas general or no anesthesia was performed in 71 (16.6%) and 129 (44.9%) pregnancies, respectively. A fibrinogen infusion was administered in 28 (8.9%) deliveries. Postpartum hemorrhages were observed in 62 (19.9%) pregnancies. Postpartum venous thrombotic events occurred in 5 (1.6%) pregnancies. Women with hypofibrinogenemia were at an increased risk of bleeding during the pregnancy (P = .04). ConclusionCompared with European epidemiologic data, we did not observe a greater frequency of miscarriage, while retroplacental hematoma, postpartum hemorrhage, and thrombosis were more frequent. Delivery was often performed without locoregional anesthesia. Our findings highlight the urgent need for guidance on the management of pregnancy in HFDs.

Bilateral Central Serous Chorioretinopathy (CRSC) in Pregnancy Complicated with Retroplacental Hematoma: About A Case

Introduction: Central serous chorioretinopathy (CSCR) is associated with serous sensorineural retinal detachment in the macular region. The condition that affects the male gender more than their female counterpart results from focal leakage disturbance of retinal pigment epithelial cells and choroidal abnormalities. The corticosteroid is highlighted as one of the major factors that promote the occurrence of CSCR. Stress and pregnancy, especially in the third trimester, have also been reported by some authors. Central serous chorioretinopathy associated with pregnancy complicated by retroplacental hematoma is a rare event. Observation: We report the case of a pregnant woman at approximately 34 weeks of amenorrhea who presented a sudden and severe drop in visual acuity on a pregnancy complicated by retroplacental hematoma and delivered by cesarean section. The diagnosis was based on clinical arguments associated with photos of the retina made by the MII Ret Cam device (Made In India, Retinoscope Camera) highlighting the lifting of the macular region. Ophthalmological monitoring without medical or physical treatment was instituted. At two months of progression without treatment, bilateral visual acuity was 10/10. Conclusion: Central serous chorioretinopathy and pregnancy is not unusual; however, its bilateral and brutal form in a context of pregnancy complicated by retroplacental hematoma is rare. Despite this favorable evolution, monitoring remains necessary in order to prevent recurrences and complications.

Management of Deliveries at the University Gynecology-Obstetrics Department of the institute of social hygiene hospital of Dakar

Objectives: Describe the epidemiological profile of patients, specify the characteristics of the delivery and evaluate the maternal and perinatal prognosis at the Maternity Hospital Institute of Social Hygiene in Dakar. Materials and Methods: This was a retrospective and descriptive study conducted over a period of six months from January 1 to June 30, 2019, involving all women who gave birth in the Gynecology-Obstetrics Department of the Institut d&#39;Hygiène Sociale Hospital in Dakar. Results: During the study period, we collected 689 delivery records, i.e., 8.2% of the department&#39;s overall activities and 69% of emergency activities. The epidemiological profile of the patients was that of a woman with an average age of 27 years, married (96%), with an average parity of 2, and residing outside the Southern Health District of Dakar (58%). More than half of the patients (58.1%) had received at least 4 prenatal consultations. The majority of parturients had a single pregnancy (97%) at term (72%). Uterine height measurement and fetal heart rate assessment were normal in 59% and 95.5% of the sample respectively. The vaginal touch revealed ruptured membranes in 34.5% of the patients with amniotic fluid that was mostly clear (68.1%) and a vertex presentation (96%). Clinical pelvimetry allowed the diagnosis of 19% of moderately narrowed pelvises and 2% of surgical pelvises. Slightly more than half of the parturients (56.6%) were in the latent phase of labor. We recorded 130 labor events (18.9%), 67 uterine events (9.7%), 76 directions of labor (11%), and 45 labor inductions (6.5%). In our series, 55.4% of the patients had benefited from labor monitoring by cardiotocograph and complications were found in 25.5% of the patients. These were mainly cases of non-reassuring fetal status (71.8%). More than half of the parturients (55.3%) had given birth by vaginal delivery. Caesarean sections and instrumental extractions represented 44.6% and 0.1% of deliveries respectively. Complications recorded (6.8%) were dominated by retroplacental hematoma (4%) and eclampsia (1.1%). We recorded 98% live births. Most newborns (87.4%) had an Apgar score of 7 or more at the first minute. We recorded 82% eutrophic, 13.3% hypotrophic, and 4.7% macrosomic newborns. Among the newborns transferred to neonatology (9.8%), 17.4% died during hospitalization. Stillbirth was estimated at 20‰ live births. Conclusion: Childbirth constitutes the main emergency activity at the Maternity Hospital of the Institute of Social Hygiene of Dakar with low maternal and perinatal morbidity and mortality.

Couvelaire uterus in the setting of hemolysis syndrome, hepatic dysfunction, and thrombocytopenia. Presentation of a case

Couvelaire's uterus, or uteroplacental apoplexy, an exceptional clinical condition in modern obstetrics consisting of hematic infiltration of the uterine myometrium due to the formation of a massive retroplacental hematoma that cannot find its way out into the vaginal cavity and constitutes one of the most Severe cases of placental abruption, defined as partial or complete separation of a normally inserted placenta prior to the onset of labor. It occurs in 0.5-2% of all births, and of these, 50% of cases are accompanied by hypertensive disorders of pregnancy, associated with high perinatal maternal morbidity and mortality. There are different risk factors associated with placental abruption, among which the following stand out: hypertensive disorders of pregnancy, which continue to be an important cause of maternal morbidity and mortality, mainly secondary to cerebral hemorrhages, perinatal mortality due to prematurity, growth restriction intrauterine (IUGR), and abruptio placentae. The etiology is not defined, and its diagnosis is fundamentally based on clinical manifestations. A case of a pregnant woman with a Couvelaire uterus in the context of a HELLP syndrome is presented, at the Teófilo Dávila hospital in the city of Machala, which presented with alterations in the laboratory tests, and was successfully treated in the hospital. aforementioned health home.

Disrupted redox balance in utero-placenteal junction may be the main culprit in the occurrence of abruptio placenta.

To determine the oxidant/antioxidant balance and proinflammatory status in amniotic fluids collected during cesarean section of patients diagnosed with abruptio placenta. Twenty-five patients diagnosed with ablatio placenta with intact membranes who went to emergency cesarean section were included in the study. A diagnosis of AP was made in those who had at least one of the following criteria or, in suspicious cases, two findings. (i) Antepartum hemorrhage starting after 20 weeks of gestation, (ii) presence of retroplacental hematoma on ultrasonography, (iii) severe fetal distress or death, (iv) localized or diffuse uterine tenderness or pain. The control group consisted of 25 patients who presented for delivery, who were not diagnosed with AP, and whose membranes were intact. NF-κB, total oxidant capacity (TOC), total antioxidant capacity (TAC), and oxidative stress index (TOC/TAC=OSI) levels were measured in amniotic fluids collected during cesarean section from both groups. Amniotic fluid TAS values of the AP group were significantly lower than the healthy controls (1.14±0.33 vs. 9.05.±3.40, p<0.01). Amniotic fluid TOS values were significantly increased in the AP group (36.1±8.10 vs. 11.4±2.77, p<0.02). OSI values were significantly higher in the AP group (31.6±9.03 vs. 1.26±0.02, p<0.01). Amniotic fluid NF-κB expression of the AP group was approximately 5 times higher than the control group (10.4±2.56 ng/mL vs. 1.86±0.30 ng/mL, p<0.01). High blood pressure and smoking history were significantly higher in the AP group. Gestational age and fetal birth weight of the AP group were lower than the control group. Since the increase in amniotic fluid oxidant capacity and proinflammatory cytokine synthesis cannot be neutralized by the antioxidant system, hypoxic cell damage may lead to premature separation of the placenta.

Bilateral Adnexal Torsion during the Third Trimester of Pregnancy

Acute pelvic pain during pregnancy can pose a problem for differential diagnosis. We report a case of bilateral adnexal torsion in the third trimester of pregnancy. Indeed, this diagnosis may go unnoticed in front of pelvic pain associated with a pregnancy and only an early management can avoid irreversible lesions due to ischemia, which may jeopardize the subsequent prognosis of fertility. Our patient is 28 years old, primiparous, with polycystic ovary syndrome, followed for a pregnancy stimulated by clomiphene citrate. She developed preeclampsia with intrauterine growth retardation during the follow-up of her pregnancy. She presented to the maternity emergency room with sustained uterine contractions at 36 weeks' gestation. The patient had a code red cesarean section for suspected retroplacental hematoma. Intraoperatively, no retroplacental hematoma was found but bilateral torsion of the adnexa with huge polycystic ovaries. Conservative treatment was recommended and the postoperative follow-up of the cesarean section was simple. Adnexal torsion is an emergency that should not be ignored in the presence of any acute pelvic pain in a pregnant woman.

Couvelaire uterus after external cephalic version

A 30-years-old primiparous woman with 37 weeks of amenorrhoea was admitted to the Obstetric ward with symptoms of ruptured membranes and abdominal pain. The day before she was subjected to an unsuccessful external cephalic version. Transabdominal ultrasonography revealed a breech presentation. The placenta appeared normal. The Cardiotocograph (CTG) showed a nonreassuring pattern with deep variable decelerations. An emergency cesarean section was performed. Intraoperatively, the uterus showed a large intramyometrial hematoma coinciding with the operator`s side of the external cephalic version the previous day. A retroplacental hematoma was evidenced after hysterotomy. The diagnosis of placental abruption and Couvelaire`s uterus was established. The newborn`s 1-minute and 5-minute Apgar scores were 8 and 9, respectively. The postoperative period was good and mother and son are progressing favourably.