Women with an antenatal diagnosis of placenta accreta should be managed in a tertiary facility with multidisciplinary input. To determine optimum management strategies, it is imperative that larger studies are carried out in the future. It is essential that the continual monitoring and containment of rising caesarean section rates becomes a priority to prevent a further increase in the incidence of placenta accreta.
Summary: Portal vein thrombosis (PVT) is a rare complication of pancreatitis and can cause portal hypertension and oesophageal varices. Variceal rupture carries a high mortality. We report a case of successful pregnancy complicated by two episodes of massive variceal bleeding in a woman with PVT, and discuss how this might have been prevented.
Women with pre-existing diabetes in pregnancy are at increased risk of fetal loss, fetal congenital anomaly and abnormal fetal growth. Obstetric complications are more likely and good peripartum care is essential. This article also considers preconceptual counselling which may minimize these risks.
Women of reproductive age with abdominal pain represent a diagnostic challenge, especially in primary care where the decision whether to refer to hospital needs to be taken. The diagnosis of an ectopic pregnancy hinges on a combination of clinical findings and a positive urinary pregnancy test (UPT). We investigated whether non-pregnant patients with abdominal pain were being referred inappropriately to hospital to exclude ectopic pregnancy because a UPT had not been performed or had been interpreted incorrectly. In this study, of the 81 patients referred by their general practitioners (GPs) on suspicion of ectopic, 38 were not pregnant on admission and only 46% of the UPT results in hospital agreed with those reported to the GP by the patient prior to referral. Given the high sensitivity and specificity of correctly interpreted UPTs, our findings suggest that pregnancy should be confirmed before hospital referral.
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