CASE REPORTUterine inversion is a rare but potentially life-threatening obstetric emergency of unknown aetiology, which is often associated with inadvertent traction on the umbilical cord before separation of the placenta. Here we report a case of a 26-year-old woman who presented with a day's history of uterine inversion after an attempt to remove a retained placenta following a second-trimester miscarriage. Reduction was attempted in casualty without success and she was taken to theatre for surgical reduction under anaesthesia. Reduction was eventually achieved using the Haultain method. Uterine inversion is defined as the 'turning inside out of the fundus into the uterine cavity' and the incidence is about 1 in 3 737. S Afr J Obstet Gynaecol[1]Active management of the third stage of labour resulted in a 4.4-fold decline in the incidence of uterine inversion.[1] The main causes of uterine inversion are thought to be mismanagement of the third stage of labour, such as premature traction of the umbilical cord with or without fundal pressure and manual placental removal after delivery before complete placental separation. Other associated factors include nulliparity, a morbidly adherent fundal placenta, short umbilical cord and rare connective tissue disorders. Spontaneous inversion has been reported in about 50% of the cases. [2,3] Case reportA 26-year-old patient, who had had two previous normal vaginal deliveries and one miscarriage presented with a day's history of a vaginal mass after an attempted removal of a retained placenta following a miscarriage that was managed at a local hospital. The mass was associated with vaginal bleeding and lower abdominal pain. She also reported having passed a fetus. She was unaware of the current pregnancy because of lactational amenorrhoea and gestation was estimated at a possible 18 weeks based on recent perception of fetal movements. She was using progesterone-only pills for contraception. An attempt to remove the placenta by cord traction at the local hospital resulted in the inversion. She was subsequently referred to Harare Central hospital. On examination she was ill-looking, markedly pale and had a tachycardia of 128 beats per minute. Her blood pressure was 115/55 mmHg and she had a normal urine output of 40 mL/h. Her haemoglobin level was 4.2 g/dL.Her abdomen was soft and non-tender without masses and the uterine fundus was not palpable abdominally. Vaginal examination revealed a globular and firm mass in the vagina; the cervix could not be visualised and the fornices were drawn upwards. A diagnosis of subacute uterine inversion was made and resuscitation was performed using ringer's lactate fluid and 4 units of packed red blood cells. She was commenced on intravenous antibiotics. A manoeuvre to correct the inversion by placing a cupped hand into the vagina and applying upward pressure, also known as Johnson's manoeuvre, was attempted in casualty to no avail. [2,3] She was taken to theatre and the procedure was attempted again under anaesthesia without success. We p...
Background Acute Fatty Liver of Pregnancy (AFLP) is a rare, catastrophic disease affecting women in the third trimester of pregnancy or in the post-partum period. It is usually a diagnosis of exclusion and requires a strong index of suspicion for a timely diagnosis and prompt intervention. Case presentation We report a case of AM, an 18 year patient, in her first pregnancy at 35 weeks gestation who presented with nausea, vomiting and jaundice. She had a vaginal delivery following spontaneous preterm labour. A clinical diagnosis of acute fatty liver of pregnancy was made on the 3rd day post-delivery. The post-delivery course was complicated by a deterioration of clinical symptoms with worsening hepatorenal function and development of encephalopathy. The patient died 3 days after admission and the diagnosis was confirmed on post-mortem and histology. Conclusion Delay in the diagnosis is associated with morbid complications with high mortality and this case highlights the importance of a high index of suspicion of the condition in women presenting with jaundice in pregnancy.
The TRAP sequence, also known as acardiac twinning is a rare complication that is unique to monochorioinic multiple pregnancies affecting 1% of monochorioinic pregnancies and about 1 in 35000 of all pregnancies. In TRAP, blood flows from the umbilical artery of the pump twin to the umbilical artery of the perfused twin through artery to artery (AA) anastomosis. The perfused twin has poor development of the upper extremities and the normal or pump twin is at risk of a poor perinatal outcome. This is a report of a patient with TRAP sequence diagnosed in the second trimester who was managed conservatively and had a good outcome for the normal twin.
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