J Gynecol Obst Bio R
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J Gynecol Obst Bio R · Jan 1993
Review Case Reports[A difficult diagnosis: pelvic-abdominal actinomycosis abscess].
A laparotomy for hysterectomy was performed in a 46-year-old nulliparous woman who had worn an intra-uterine sterilization device for 8 years. The patient was in poor general health and had had abdominal pain and repeated episodes of fever over the preceding 3 months. An abscess of the abdominal muscle was found peroperatively. ⋯ The frequency increases with the duration of insertion and the pathogenicity appears when the immune responses are deficient and/or when a cofactor is involved. Treatment relies on surgical exeresis and prolonged antibiotics (penicillin G or macrolides). Hyperbar treatment is sometimes used.
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J Gynecol Obst Bio R · Jan 1993
Review[Delivery after 2 previous cesarean sections. A series of 41 uterine trials].
It has been possible to consider how delivery should be carried out in view of the progress that has been made handling scarred uteruses. Over 21 months 41 tests of uterine function have been authorized in our department out of 67 cases where there were two scars in the uterus (67%). 26 patients delivered vaginally (63.4%) and 5 had Caesarean sections because of failure of the test of the scar. When the relationship between the fetus and the pelvis was satisfactory, the fact that the cervix was not ripe and the presenting part was not engaged, did not prevent carrying out a trial of scar in 78% of cases. ⋯ Epidural anaesthesia was used in 90.2% of cases. A full obstetric team must be present throughout the whole labour so that the conduct of the labour can be observed, and if necessary corrected quickly if anything in its progress is becoming abnormal. It has become reasonable to carry out tests of uterine scars even after two scars have been made in the uterus because of the absence of any maternal or fetal complications in this series or in the literature.
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J Gynecol Obst Bio R · Jan 1992
Case Reports[A complication of epidural anesthesia: cerebral pneumatocele. A case report].
Having had a case themselves the authors report a rare complication of epidural anaesthetic, namely pneumocephaly. When it occurs it is usually after a difficult puncture; and usually thought of if headaches are unusually severe of there is a picture of intracranial rise in pressure. Then a tomodensitometry will lead to the diagnosis. Literature shows that it can be a serious condition, sometimes fatal, which means that the case has to be followed up very carefully and tomodensitometry has to be repeated until complete cure has been obtained.
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J Gynecol Obst Bio R · Jan 1992
Review Case Reports[Sub-capsular hematoma of the liver during pregnancy: a case report].
A sub-capsular haematoma of the liver is a rare but very serious complication of pregnancy. We report a case of a primipara whose pregnancy was first complicated by hypertension, then by a haematoma of the liver at the 28th week of amenorrhoea. It was diagnosed because of the clinical symptoms associated with the hypertension and a pain in the right hypochondrium and nausea. ⋯ Regular X-ray follow-ups showed that the lesion had regressed in six months. MRI investigation of the parenchyma of the liver showed no cause of the lesions. If there is even the slightest suspicion of a haematoma of the liver in pregnancy, ultrasound nowadays should be carried out because it is indispensable to make the diagnosis.
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J Gynecol Obst Bio R · Jan 1991
[Functioning of implantable catheters of intraperitoneal chemotherapy].
Intraperitoneal chemotherapy with a totally implantable catheter was performed in 42 patients with advanced ovarian cancer who received 178 courses of chemotherapy administered in 2 l of solution. Major complication was inflow obstruction due to fibrosis around the catheter observed in 10 patients, 23.8% of the cases. ⋯ Outflow obstruction which occurred in 23 patients (54.8%), did not create discomfort and could not be considered as a complication. Despite the problems, intraperitoneal chemotherapy with a totally implantable catheter appeared feasible in at least 80% of the patients.