Obstetrics and gynecology
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Obstetrics and gynecology · Aug 1977
Case ReportsPregnancy in cirrhotic and noncirrhotic portal hypertension.
The course of pregnancy in 1 patient with chronic active hepatitis (CAH) and cirrhosis, and another with extrahepatic portal vein obstruction (EHPVO) is described. The management of pregnancy in these diseases associated with portal hypertension is discussed and risks of pregnancy are compared. The patient with CAH presented with anovulatory cycles, and ovulation occurred following immunosuppressive therapy. ⋯ Review of literature demonstrated that variceal bleeding occurred in 43% of women with EHPVO compared to 23% of those with CAH and cirrhosis. Additional complications including hepatocellular failure (24%) occurred in patients with CAH but not in EHPVO. The management of pregnancy in portal hypertension and advice for contraception or sterilization are discussed.
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In the past 17 years, Cuba has established a system of governmental medical care, and undergraduate and graduate medical education have also been revised and expanded. Special attention has been directed to maternal and pediatric care, but no description of this has been published outside Cuba. ⋯ New laws providing benefits for working women encourage prenatal care, rest, and breastfeeding. In 1974 the maternal mortality rate was 55.6 per 100,000 live births, and perinatal mortality was 28.5 per 1000 live births.
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The course of a pregnant patient with von Willebrand's disease, who underwent a successful cesarean section without supportive Factor VIII therapy is described. She had no postoperative bleeding despite a persistently prolonged bleeding time. The significance of the bleeding time, Factor VIII activity, and Factor VIII-related antigen in relation to bleeding tendency and therapeutic management is discussed.
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Acute renal failure of obstetric origin is common among North Indian patients and comprised 72 (22.1%) of 325 patients undergoing dialysis over an 11-year period. Of these, 46 gravidas had developed renal failure following abortion, and 29 cases were due to complications of late pregnancy. The most striking feature of this study was a high incidence of irreversible renal lesions of bilateral diffuse cortical necrosis in early (18.6%) as well as late pregnancy (37.8%). ⋯ Pathogenetic factors which contributed to the development of renal failure, either singly or in combination, were loss of blood failure, either singly or in combination, were loss of blood (79.1%), septicemia (31.9%), hypotension due th hemorrhagic and septicemic shock (51.4%), eclamptic toxemia (11.1%), and disseminated intravascular coagulation in 12.5% patients. Infrequent occurrence of disseminated intravascular coagulation in the septic anc eclamptic patients who developed diffuse cortical necrosis was an interesting finding, as was the fact that coagulopathy was more frequently observed in acute tubular necrosis. Late referral, frequent sepsis, and high incidence of bilateral diffuse cortical necrosis contributed significantly to a high mortality (55.3%).