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Other Neurologic Diseases in Pregnancy
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Loralei L. Thornburg, Meredith L. Birsner
Autonomic dysreflexia: ADR is the most serious complication impacting obstetric management, affecting about 85% of patients with lesions at or above the level of T6 (above sympathetic outflow and above the upper level of greater splanchnic flow) [9, 32]. It is potentially fatal. It is attributed to loss of hypothalamic control over sympathetic spinal reflexes of somatic or visceral sensory impulses still active distal to the level of the lesion [33]. The most common sign of ADR is systemic hypertension (vasoconstriction), which is which is variable in severity but can be severe. Clinical manifestations include hyperthermia, piloerection, diaphoresis, increased extremity spasticity, pupil dilation, nasal congestion, respiratory distress, bradycardia (most common) or tachycardia or cardiac arrhythmia, extreme fear and anxiety, headache, loss of consciousness, intracranial bleed, convulsions, and even death. Symptoms are typically synchronous with uterine contractions. BP rises with contractions, then normalizes in between.
Prelabor Rupture Of Membranes At Or Near Term
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Initial evaluation of PROM involves confirmation of the diagnosis. Digital examination can increase the risk of infection and as a result should be avoided [14]. The cervix can be visually assessed for dilation and effacement [15]. Fetal presentation should be confirmed by ultrasound. Fetal well-being and the presence of uterine contractions should be assessed by external monitoring.
Primary Postpartum Haemorrhage
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
Fundal massage, which is the first step in managing uterine atony, should be applied with circular movements of the left hand on the fundus of the uterus. Only gentle rubbing is needed to initiate uterine contractions. Vigorous rubbing is unnecessary and could possibly even be counterproductive. Blood clots within the lower uterine segment, the cervical canal and in the vagina should be simultaneously removed with the index and middle fingers of the right hand in the vagina (Figure 14.1). If these blood clots are not removed, then the uterus would not be able to contract adequately, in spite of high and repeated doses of uterotonics. It is important to identify the uterine fundus carefully in obese women because a roll of abdominal fat may be mistaken for the uterus. A two-handed technique of applying fundal massage is also described.
Impact of prolonged use of adjuvant tocolytics after cervical cerclage on late abortion and premature delivery
Published in Journal of Obstetrics and Gynaecology, 2023
Li-Rong Zhao, Shu-Jing Lu, Qing Liu, Ying-Chun Yu, Li Xiao
A crucial reason for treatment failure is that uterine contraction was not effectively inhibited. Although most patients had no apparent uterine contractions before the surgery, patients had different degrees of uterine contractions after the surgery and required uterine contraction inhibitor administration accordingly because of the stimulation of the cervix and uterus. In this study, the gestational age was prolonged by 16.42 ± 7.84 weeks. The average delivery gestational age was 35.91 ± 5.16 weeks. The duration of the gestational age was positively correlated with the gestational age at delivery, p < .01. Tocolytics can delay delivery (Jørgensen et al. 2014). It is necessary to treat uterine contraction in order to prolong the pregnancy, achieve a higher birth weight, and reduce the associated morbidity and mortality (Carvajal et al. 2017). Additionally, it takes 4–7 days to produce lung surfactant after initial corticosteroid administration (Ballard et al. 1997). So, it is obviously important to restrain uterine contraction.
Acute spontaneous non-hemorrhagic adrenal infarction in pregnancy: case-report and literature review
Published in Gynecological Endocrinology, 2023
Sara Ornaghi, Federica Fernicola, Elisabetta Marelli, Mario Perotti, Filiberto Di Gennaro, Irene Cameroni, Eloisa M. Mariani, Angela I. Pincelli, Elisabetta Colciago, Irene Cetin, Patrizia Vergani
Unilateral AI can present with acute-onset, severe, upper right or left abdominal quadrant and/or flank pain non-responsive to analgesics and usually associated with emesis. This is what we observed in our case. However, the clinical presentation of unilateral AI may vary from patient to patient. This further increases the difficulty in correctly diagnosing unilateral AI by pointing to other more common non-obstetric causes of acute pain, including biliary or renal colic, cholecystitis, pyelonephritis, appendicitis, pneumonia, or pleuritis. Placental abruption, uterine rupture, pulmonary embolism, acute pancreatitis, gonadic vein thrombosis, and ovarian torsion should also be included in the differential diagnosis. In some cases, uterine contractions can be present, thus deceitfully suggesting threatened preterm labor [5]. It is unclear whether the threatened preterm labor diagnosed in our patient was a prodromal sign of the unilateral NHAI or a separate event.
Comparative evaluation of normal saline, 1/3-2/3, and ringer's lactate infusion on labour outcome, PH, bilirubin, and glucose level of the umbilical cord blood in nulliparous women with labour induction: a randomised clinical trial
Published in Journal of Obstetrics and Gynaecology, 2022
Ladan Haghighi, Fatemeh Jahanshahi, Mojgan Mokhtari, Zahra Rampisheh, Mina Momeni
During the labour process, uterine contractions with adequate strength and frequency are essential for a successful labour progression. In addition to the genetic and individual characteristics of the mother, which are very important in this process, given that muscles utilise glucose as the source of energy, sufficient glucose can affect the adequacy of contractions. Therefore, it can be expected that the supply of glucose can cause better contractions, and as a result, improve the progression of labour, reduce its duration, and lower the rate of caesarean section. A systematic review and meta-analysis conducted by Melissa Riegel and colleagues compared the length of labour in the two IVF groups with or without receiving 5% of dextrose. The results of 16 trials with a total number of participants of 2503 showed no significant difference in the duration of labour and the third stage between the two groups. However, the first stage, the longest part of labour, was significantly shorter in the dextrose group. In general, no significant differences were reported in the incidence of labour longer than 12 hours, chorioamnionitis, vaginal delivery, and OVD between the two groups (Riegel et al. 2018).