The benefits of non-invasive, correctly-directed instrumentation coupled with an ability to predict complete evacuation of the uterus can make intraoperative ultrasound an important addition in the continued and improved care of women with a perforated uterus and retained products of conception. Two such cases are reported.
Case reportA 36 year old woman had previously had a caesarean section after a failed Kielland's forceps delivery. In her second pregnancy she had an amniocentesis at 15 weeks of gestation which revealed a normal female fetal karyotype. The gestational age had been confirmed by an earlydating, ultrasound examination Her blood group was 0 Rhesus positive, and routine antenatal blood tests were normal; an ultrasound scan for fetal morphology at 18 weeks was also unremarkable. The pregnancy progressed normally until, at 26 weeks of gestation, she perceived a decrease in fetal movements. She presented to the nearest hospital and had a cardiotocograph (CTG), which was thought to be normal, and she was discharged. She felt no further movements over the next 12 h, again presented to the same hospital, and was re-admitted. A repeat CTG showed a fetal heart rate of 130 beats/min with decreased variability. An ultrasound examination the following day showed a morphologically normal fetus with normal amniotic fluid volume and normal umbilical artery Doppler studies. The only abnormal features were absent fetal movements during the 1 h examination and a large placental venous lake measuring 2.7 x 2 1 x 2.5 cm in the anterior placenta. The consultant obstetrician was unable to explain the findings and referred the woman to a tertiary centre for further investigation.Further CTG on arrival that night and the next morning showed reduced variability. An amniocentesis, performed to locate evidence of intrauterine infection, showed that the amniotic fluid was clear, and both Gram stain and culture were negative. However, a Kleihauer-Betke test on maternal blood, taken prior to the amniocentesis, was positive for 50ml of fetal blood, and a diagnosis of fetomaternal haemorrhage was made. Fetal blood sampling, performed via the umbilical vein, showed a haemoglobin concentration of 2.7 g/dl. A transfusion of 35 ml(80 % Hct) of group 0 Rh negative blood was given via the umbilical vein later the same day. The posttransfusion haemoglobin level was 8.3 g/dl. Fetal movements returned within 1 h and variability returned to the CTG over a period of 2 h.In an attempt to distinguish between a single acute episode of bleeding and persistent bleeding, fetal blood sampling was repeated four days later. The haemoglobin level was 8.4 g/dl, suggesting that no further significant fetomaternal haemorrhage had occurred. The woman was discharged the next day, but the pregnancy was monitored by daily outpatient CTG and maternal perception of fetal movements. The pregnancy progressed well until 30 weeks when a further decrease in fetal movements was perceived and a reduction in variability of the CTG over the preceding week was noted. A repeat Kleihauer-Betke test demonstrated a rise in the fetal blood (59 ml) in the maternal circulation and repeat fetal blood sampling showed the haemoglobin level was 3.7 g/dl. A second transfusion was performed that day, giving 50 ml of blood via the umbilical vein. The post-transfusion haemoglobin level was 11-3 g/dl, a...
At the Nepean Hospital transabdominal ultrasound has been used to assist the hysteroscopic surgeon when performing complicated transcervical operations. The 2 main areas of use appear to be either to direct the surgeon within the uterus to the site of pathology or to prevent inadvertent perforation of the uterine wall. The cases vary from haematometra following endometrial ablation to Asherman syndrome and subseptate uteri.
EDITORIAL COMMENT: We accepted this paper for publication because it explains the basic facts of life concerning computerization of obstetric antenatal histories. The editorial committee is convinced that such a system should now be introduced into all obstetric hospitals at least for the purposes of prompt production of a discharge summary and letter to the referring practitioner. This system is easily adapted to the coding requirements for clinical audit and Diagnostic Related Group (DRG) coding now required for funding of Public Hospitals in Victoria. We encourage all readers to seek more information about these systems and to Rquest that the administrators in the hospitals where they work at least introduce them for generation of discharge summaries and letters. The rest will follow.Summary: Computers have existed for over 40 years. Their evolution has transformed them from being merely big calculators into versatile user-friendly machines with the possibility to interact with the operator.Within their clinical capacity one of their main benefits is within the area of quality assurance. When applied in an appropriate way in obstetrics, they can actually lead to improved antenatal care This can be achieved through obtaining a more standardized and comprehensive patient history and the use of management suggestions, made by the computer, in response to specific items in the patient history. These suggestions are titled 'action prompts'. Other quality assurance advantages exist within the areas of legibility and availability of individual patient files, while within a general setting they lend themselves easily to research and education.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.